Equitable Child Health Interventions

Burström, Bo; Macassa, Glória; Öberg, Lisa; Bernhardt, Eva; Smedman, Lars

doi:10.2105/ajph.2003.034900

Cited by 50 publications

(11 citation statements)

References 18 publications

(18 reference statements)

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“…The direct relationship from maternal and child health (MCH) improvements to the alleviation of poverty has long been recognized [ 12 ]. Other key social determinants of health include better schooling [ 11 ], good governance [ 9 ], clean water [ 13 ], and less social inequality [ 14 ].…”

Section: Introductionmentioning

confidence: 99%

Factors Contributing to Maternal and Child Mortality Reductions in 146 Low- and Middle-Income Countries between 1990 and 2010

et al. 2016

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IntroductionFrom 1990–2010, worldwide child mortality declined by 43%, and maternal mortality declined by 40%. This paper compares two sources of progress: improvements in societal coverage of health determinants versus improvements in the impact of health determinants as a result of technical change.MethodsThis paper decomposes the progress made by 146 low- and middle-income countries (LMICs) in lowering childhood and maternal mortality into one component due to better health determinants like literacy, income, and health coverage and a second component due to changes in the impact of these health determinants. Health determinants were selected from eight distinct health-impacting sectors. Health determinants were selected from eight distinct health-impacting sectors. Regression models are used to estimate impact size in 1990 and again in 2010. Changes in the levels of health determinants were measured using secondary data.FindingsThe model shows that respectively 100% and 89% of the reductions in maternal and child mortality since 1990 were due to improvements in nationwide coverage of health determinants. The relative share of overall improvement attributable to any single determinant varies by country and by model specification. However, in aggregate, approximately 50% of the mortality reductions were due to improvements in the health sector, and the other 50% of the mortality reductions were due to gains outside the health sector.ConclusionsOverall, countries improved maternal and child health (MCH) from 1990 to 2010 mainly through improvements in the societal coverage of a broad array of health system, social, economic and environmental determinants of child health. These findings vindicate efforts by the global community to obtain such improvements, and align with the post-2015 development agenda that builds on the lessons from the MDGs and highlights the importance of promoting health and sustainable development in a more integrated manner across sectors.

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Section: Introductionmentioning

confidence: 99%

Factors Contributing to Maternal and Child Mortality Reductions in 146 Low- and Middle-Income Countries between 1990 and 2010

et al. 2016

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“…However, very few studies have looked at how scaling up such interventions differentially impacts different socio-economic groups. A study of the impact of improved water and sanitation in Stockholm from 1878 to 1925 showed a decline in overall mortality and of diarrhea mortality and a leveling out of socioeconomic differences in child mortality due to diarrheal diseases [ 15 ]. Another paper used comparative risk assessment modeling to estimate the reduction in child mortality as a result of improving child nutrition and providing clean water, sanitation, and fuels [ 16 ].…”

Section: Introductionmentioning

confidence: 99%

Estimating the child health equity potential of improved sanitation in Nepal

Acharya

Liu

et al. 2013

BMC Public Health

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Background Access to improved sanitation plays an important role in child health through its impact on diarrheal mortality and malnutrition. Inequities in sanitation coverage translate into health inequities across socio-economic groups. This paper presents the differential impact on child mortality and diarrheal incidence of expanding sanitation coverage across wealth quintiles in Nepal. Methods We modeled three scale up coverage scenarios at the national level and at each of the 5 wealth quintiles for improved sanitation in Nepal in the Lives Saved Tool (LiST): equal for all quintiles, realistically pro-poor and ambitiously pro-poor. Results The results show that equal improvement in sanitation coverage can save a total of 226 lives (10.7% of expected diarrhea deaths), while a realistically pro-poor program can save 451 child lives (20.5%) and the ambitiously pro-poor program can save 542 lives (24.6%). Conclusions Pro-poor policies for expanding sanitation coverage have the ability to reduce population level health inequalities which can translate into reduced child diarrheal mortality.

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“…For all relevant peer-reviewed articles, we abstracted data for the following: (1) information on the intervention being evaluated, including type of structural intervention, target populations, and start and end date of the intervention; (2) components of the theory of change (TOC) or causal pathway framework including predictor variables, intermediate variables, and outcomes of interest; (3) components of the evaluation, including type of evaluation (outcome or impact), type of data collected and timeline for data collection, and statistical methods used to analyze evaluation data; (4) study limitations in conducting the evaluation; and (5) reported generalizability of the findings and scalability of the intervention.…”

Section: Methodsmentioning

confidence: 99%

“…Structural interventions refer to public health interventions that alter the social, economic, legal, political, and built environment that shapes health processes and outcomes (1, 2). While they have a long history of implementation and have been considered successful in sectors such as water and sanitation (e.g., water purification and latrine construction) (3, 4), structural interventions have only recently drawn attention in the HIV-prevention field. The World Health Organization’s Global Health Sector Strategy for HIV/AIDS 2011–2015 included for the first time the removal of structural barriers as one of its four strategic directions to achieve universal access to HIV prevention, diagnosis, treatment, and care services (5).…”

Section: Introductionmentioning

confidence: 99%

Evaluations of Structural Interventions for HIV Prevention: A Review of Approaches and Methods

Lebov

Hart

et al. 2017

AIDS Behav

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Structural interventions alter the social, economic, legal, political, and built environments that underlie processes affecting population health. We conducted a systematic review of evaluations of structural interventions for HIV prevention in low- and middle-income countries (LMICs) to better understand methodological and other challenges and identify effective evaluation strategies. We included 27 peer-reviewed articles on interventions related to economic empowerment, education, and substance abuse in LMICs. Twenty-one evaluations included clearly articulated theories of change (TOCs); 14 of these assessed the TOC by measuring intermediary variables in the causal pathway between the intervention and HIV outcomes. Although structural interventions address complex interactions, no evaluation included methods designed to evaluate complex systems. To strengthen evaluations of structural interventions, we recommend clearly articulating a TOC and measuring intermediate variables between the predictor and outcome. We additionally recommend adapting study designs and analytic methods outside traditional epidemiology to better capture complex results, influences external to the intervention, and unintended consequences.

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Equitable Child Health Interventions

Cited by 50 publications

References 18 publications

Factors Contributing to Maternal and Child Mortality Reductions in 146 Low- and Middle-Income Countries between 1990 and 2010

Factors Contributing to Maternal and Child Mortality Reductions in 146 Low- and Middle-Income Countries between 1990 and 2010

Estimating the child health equity potential of improved sanitation in Nepal

Evaluations of Structural Interventions for HIV Prevention: A Review of Approaches and Methods

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