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White Johansson, Emily
Publications (10 of 21) Show all publications
Ohuma, E. O., Moller, A.-B., Bradley, E., Chakwera, S., Hussain-Alkhateeb, L., Lewin, A., . . . Moran, A. C. (2023). National, regional, and global estimates of preterm birth in 2020, with trends from 2010: a systematic analysis. The Lancet, 402(10409), 1261-1271
Open this publication in new window or tab >>National, regional, and global estimates of preterm birth in 2020, with trends from 2010: a systematic analysis
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2023 (English)In: The Lancet, ISSN 0140-6736, E-ISSN 1474-547X, Vol. 402, no 10409, p. 1261-1271Article in journal (Refereed) Published
Abstract [en]

Background

Preterm birth is the leading cause of neonatal mortality and is associated with long-term physical, neurodevelopmental, and socioeconomic effects. This study updated national preterm birth rates and trends, plus novel estimates by gestational age subgroups, to inform progress towards global health goals and targets, and aimed to update country, regional, and global estimates of preterm birth for 2020 in addition to trends between 2010 and 2020.

Methods

We systematically searched population-based, nationally representative data on preterm birth from Jan 1, 2010, to Dec 31, 2020 and study data (26 March–14 April, 2021) for countries and areas with no national-level data. The analysis included 679 data points (86% nationally representative administrative data [582 of 679 data points]) from 103 countries and areas (62% of countries and areas having nationally representative administrative data [64 of 103 data points]). A Bayesian hierarchical regression was used for estimating country-level preterm rates, which incoporated country-specific intercepts, low birthweight as a covariate, non-linear time trends, and bias adjustments based on a data quality categorisation, and other indicators such as method of gestational age estimation.

Findings

An estimated 13·4 million (95% credible interval [CrI] 12·3–15·2 million) newborn babies were born preterm (<37 weeks) in 2020 (9·9% of all births [95% CrI 9·1–11·2]) compared with 13·8 million (12·7–15·5 million) in 2010 (9·8% of all births [9·0–11·0]) worldwide. The global annual rate of reduction was estimated at –0·14% from 2010 to 2020. In total, 55·6% of total livebirths are in southern Asia (26·8% [36 099 000 of 134 767 000]) and sub-Saharan Africa (28·7% [38 819 300 of 134 767 000]), yet these two regions accounted for approximately 65% (8 692 000 of 13 376 200) of all preterm births globally in 2020. Of the 33 countries and areas in the highest data quality category, none were in southern Asia or sub-Saharan Africa compared with 94% (30 of 32 countries) in high-income countries and areas. Worldwide from 2010 to 2020, approximately 15% of all preterm births occurred at less than 32 weeks of gestation, requiring more neonatal care (<28 weeks: 4·2%, 95% CI 3·1–5·0, 567 800 [410 200–663 200 newborn babies]); 28–32 weeks: 10·4% [9·5–10·6], 1 392 500 [1 274 800–1 422 600 newborn babies]).

Interpretation

There has been no measurable change in preterm birth rates over the last decade at global level. Despite increasing facility birth rates and substantial focus on routine health data systems, there remain many missed opportunities to improve preterm birth data. Gaps in national routine data for preterm birth are most marked in regions of southern Asia and sub-Saharan Africa, which also have the highest estimated burden of preterm births. Countries need to prioritise programmatic investments to prevent preterm birth and to ensure evidence-based quality care when preterm birth occurs. Investments in improving data quality are crucial so that preterm birth data can be improved and used for action and accountability processes.

Place, publisher, year, edition, pages
Elsevier, 2023
National Category
Public Health, Global Health, Social Medicine and Epidemiology
Identifiers
urn:nbn:se:uu:diva-516361 (URN)10.1016/S0140-6736(23)00878-4 (DOI)001092457800001 ()37805217 (PubMedID)
Available from: 2023-11-21 Created: 2023-11-21 Last updated: 2023-11-21Bibliographically approved
Allwell-Brown, G., Namugambe, J., Ssanyu, J., White Johansson, E., Hussain-Alkhateeb, L., Strömdahl, S., . . . Kitutu, F. (2022). Patterns and contextual determinants of antibiotic prescribing for febrile under-five outpatients at primary and secondary healthcare facilities in Bugisu, Eastern Uganda. JAC-Antimicrobial Resistance, 4(5)
Open this publication in new window or tab >>Patterns and contextual determinants of antibiotic prescribing for febrile under-five outpatients at primary and secondary healthcare facilities in Bugisu, Eastern Uganda
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2022 (English)In: JAC-Antimicrobial Resistance, Vol. 4, no 5Article in journal (Refereed) Published
Abstract [en]

Objectives: To describe patterns and contextual determinants of antibiotic prescribing for febrile under-five outpatients at primary and secondary healthcare facilities across Bugisu, Eastern Uganda.

Methods: We surveyed 37 public and private-not-for-profit healthcare facilities and conducted a retrospective review of antimicrobial prescribing patterns among febrile under-five outpatients (with a focus on antibiotics) in 2019–20, based on outpatient registers. Multilevel logistic regression analysis was used to identify determinants of antibiotic prescribing at patient- and healthcare facility-levels.

Results: Antibiotics were prescribed for 62.2% of 3471 febrile under-five outpatients. There were a total of 2478 antibiotic prescriptions of 22 antibiotic types: amoxicillin (52.2%), co-trimoxazole (14.7%), metronidazole (6.9%), gentamicin (5.7%), ceftriaxone (5.3%), ampicillin/cloxacillin (3.6%), penicillin (3.1%), and others (8.6%). Acute upper respiratory tract infection (AURTI) was the commonest single indication for antibiotic prescribing, with 76.3% of children having AURTI as their only documented diagnosis receiving antibiotic prescriptions. Only 9.2% of children aged 2–59 months with non-severe pneumonia received antibiotic prescriptions in line with national guidelines. Higher health centre levels, and private-not-for-profit ownership (adjusted OR, 4.30; 95% CI, 1.91–9.72) were significant contextual determinants of antibiotic prescribing.

Conclusions: We demonstrated a high antibiotic prescribing prevalence among febrile under-five outpatients in Bugisu, Eastern Uganda, including prescriptions for co-trimoxazole and ampicillin/cloxacillin (which are not indicated in the management of the common causes of under-five febrile illness in Uganda). Study findings may be linked to limited diagnostic capacity and inadequate antibiotic availability, which require prioritization in interventions aimed at improving rational antibiotic prescribing among febrile under-five outpatients.

Place, publisher, year, edition, pages
Oxford University Press (OUP), 2022
National Category
General Practice
Identifiers
urn:nbn:se:uu:diva-470901 (URN)10.1093/jacamr/dlac091 (DOI)000850292800001 ()36072304 (PubMedID)
Available from: 2022-03-30 Created: 2022-03-30 Last updated: 2022-09-19Bibliographically approved
Allwell-Brown, G., Hussain-Alkhateeb, L., Sewe, M. O., Kitutu, F. E., Strömdahl, S., Mårtensson, A. & White Johansson, E. (2021). Determinants of trends in reported antibiotic use among sick children under five years of age across low-income and middle-income countries in 2005-17: A systematic analysis of user characteristics based on 132 national surveys from 73 countries. International Journal of Infectious Diseases, 108, 473-482
Open this publication in new window or tab >>Determinants of trends in reported antibiotic use among sick children under five years of age across low-income and middle-income countries in 2005-17: A systematic analysis of user characteristics based on 132 national surveys from 73 countries
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2021 (English)In: International Journal of Infectious Diseases, ISSN 1201-9712, E-ISSN 1878-3511, Vol. 108, p. 473-482Article in journal (Refereed) Published
Abstract [en]

Objectives: This study aimed to analyze any reported antibiotic use for children aged <5 years with fever, diarrhea or cough with fast or difficult breathing (outcome) from low-income and middle-income countries (LMICs) during 2005-2017 by user characteristics: rural/urban residence, maternal education, household wealth, and healthcare source visited. Methods: Based on 132 demographic and health surveys and multiple indicator cluster surveys from 73 LMICs, the outcome by user characteristics for all country-years was estimated using a hierarchical Bayesian linear regression model. Results: Across LMICs during 2005-2017, the greatest relative increases in the outcome occurred in rural areas, poorest quintiles and least educated populations, particularly in low-income countries and South-East Asia. In low-income countries, rural areas had a 72% relative increase from 17.8% (Uncertainty Interval (UI): 5.2%-44.9%) in 2005 to 30.6% (11.7%-62.1%) in 2017, compared to a 29% relative increase in urban areas from 27.1% (8.7%- 58.2%) in 2005 to 34.9% (13.3%-67.3%) in 2017. Despite these increases, the outcome was consistently highest in urban areas, wealthiest quintiles, and populations with the highest maternal education. Conclusion: These estimates suggest that the increasing reported antibiotic use for sick children aged <5 years in LMICs during 2005-2017 was driven by gains among groups often underserved by formal health services.

Place, publisher, year, edition, pages
ElsevierELSEVIER SCI LTD, 2021
Keywords
Antibiotic use, Antibiotic consumption, Determinants, Children, Low-and middle-income countries, Global trends
National Category
Public Health, Global Health, Social Medicine and Epidemiology Infectious Medicine
Identifiers
urn:nbn:se:uu:diva-455783 (URN)10.1016/j.ijid.2021.05.058 (DOI)000677647400031 ()34058373 (PubMedID)
Available from: 2021-10-14 Created: 2021-10-14 Last updated: 2024-01-15Bibliographically approved
Guthold, R., White Johansson, E., Mathers, C. D. & Ross, D. A. (2021). Global and regional levels and trends of child and adolescent morbidity from 2000 to 2016: an analysis of years lost due to disability (YLDs). BMJ Global Health, 6(3), Article ID e004996.
Open this publication in new window or tab >>Global and regional levels and trends of child and adolescent morbidity from 2000 to 2016: an analysis of years lost due to disability (YLDs)
2021 (English)In: BMJ Global Health, E-ISSN 2059-7908, Vol. 6, no 3, article id e004996Article in journal (Refereed) Published
Abstract [en]

Introduction Non-fatal health loss makes a substantial contribution to the total disease burden among children and adolescents. An analysis of these morbidity patterns is essential to plan interventions that improve the health and well-being of children and adolescents. Our objective was to describe current levels and trends in the non-fatal disease burden from 2000 to 2016 among children and adolescents aged 0-19 years. Methods We used years lost due to disability (YLD) estimates in WHO's Global Health Estimates to describe the non-fatal disease burden from 2000 to 2016 for the age groups 0-27 days, 28 days-11 months, 1-4 years, 5-9 years, 10-14 years and 15-19 years globally and by modified WHO region. To describe causes of YLDs, we used 18 broad cause groups and 54 specific cause categories. Results In 2016, the total number of YLDs globally among those aged 0-19 years was about 130 million, or 51 per 1000 population, ranging from 30 among neonates aged 0-27 days to 67 among older adolescents aged 15-19 years. Global progress since 2000 in reducing the non-fatal disease burden has been limited (53 per 1000 in 2000 for children and adolescents aged 0-19 years). The most important causes of YLDs included iron-deficiency anaemia and skin diseases for both sexes, across age groups and regions. For young children under 5 years of age, congenital anomalies, protein-energy malnutrition and diarrhoeal diseases were important causes of YLDs, while childhood behavioural disorders, asthma, anxiety disorders and depressive disorders were important causes for older children and adolescents. We found important variations between sexes and between regions, particularly among adolescents, that need to be addressed context-specifically. Conclusion The disappointingly slow progress in reducing the global non-fatal disease burden among children and adolescents contrasts starkly with the major reductions in mortality over the first 17 years of this century. More effective action is needed to reduce the non-fatal disease burden among children and adolescents, with interventions tailored for each age group, sex and world region.

Place, publisher, year, edition, pages
BMJ Publishing Group LtdBMJ, 2021
Keywords
child health, indices of health and disease and standardisation of rates, health policy
National Category
Public Health, Global Health, Social Medicine and Epidemiology Pediatrics
Identifiers
urn:nbn:se:uu:diva-441451 (URN)10.1136/bmjgh-2021-004996 (DOI)000631522000001 ()33731441 (PubMedID)
Available from: 2021-05-19 Created: 2021-05-19 Last updated: 2024-01-15Bibliographically approved
Oliphant, N. P., Manda, S., Daniels, K., Odendaal, W. A., Besada, D., Kinney, M., . . . Doherty, T. (2021). Integrated community case management of childhood illness in low- and middle-income countries. Cochrane Database of Systematic Reviews (2), Article ID CD012882.
Open this publication in new window or tab >>Integrated community case management of childhood illness in low- and middle-income countries
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2021 (English)In: Cochrane Database of Systematic Reviews, ISSN 1469-493X, E-ISSN 1469-493X, no 2, article id CD012882Article, review/survey (Refereed) Published
Abstract [en]

Background The leading causes of mortality globally in children younger than five years of age (under-fives), and particularly in the regions of sub-Saharan Africa (SSA) and Southern Asia, in 2018 were infectious diseases, including pneumonia (15%), diarrhoea (8%), malaria (5%) and newborn sepsis (7%) (UNICEF 2019). Nutrition-related factors contributed to 45% of under-five deaths (UNICEF 2019). World Health Organization (WHO) and United Nations Children's Fund (UNICEF), in collaboration with other development partners, have developed an approach - now known as integrated community case management (iCCM) - to bring treatment services for children 'closer to home'. The iCCM approach provides integrated case management services for two or more illnesses - including diarrhoea, pneumonia, malaria, severe acute malnutrition or neonatal sepsis - among under-fives at community level (i.e. outside of healthcare facilities) by lay health workers where there is limited access to health facility-based case management services (WHO/UNICEF 2012).

Objectives To assess the effects of the integrated community case management (iCCM) strategy on coverage of appropriate treatment for childhood illness by an appropriate provider, quality of care, case load or severity of illness at health facilities, mortality, adverse events and coverage of careseeking for children younger than five years of age in low- and middle-income countries.

Search methods We searched CENTRAL, MEDLINE, Embase and CINAHL on 7 November 2019, Virtual Health Library on 8 November 2019, and Popline on 5 December 2018, three other databases on 22 March 2019 and two trial registers on 8 November 2019. We performed reference checking, and citation searching, and contacted study authors to identify additional studies.

Selection criteria Randomized controlled trials (RCTs), cluster-RCTs, controlled before-after studies (CBAs), interrupted time series (ITS) studies and repeated measures studies comparing generic WHO/UNICEF iCCM (or local adaptation thereof) for at least two iCCM diseases with usual facility services (facility treatment services) with or without single disease community case management (CCM). We included studies reporting on coverage of appropriate treatment for childhood illness by an appropriate provider, quality of care, case load or severity of illness at health facilities, mortality, adverse events and coverage of careseeking for under-fives in low- and middle-income countries.

Data collection and analysis At least two review authors independently screened abstracts, screened full texts and extracted data using a standardised data collection form adapted from the EPOC Good Practice Data Collection Form. We resolved any disagreements through discussion or, if required, we consulted a third review author not involved in the original screening. We contacted study authors for clarification or additional details when necessary. We reported risk ratios (RR) for dichotomous outcomes and hazard ratios (HR) for time to event outcomes, with 95% confidence intervals (CI), adjusted for clustering, where possible. We used estimates of effect from the primary analysis reported by the investigators, where possible. We analysed the effects of randomized trials and other study types separately. We used the GRADE approach to assess the certainty of evidence.

Main results We included seven studies, of which three were cluster RCTs and four were CBAs. Six of the seven studies were in SSA and one study was in Southern Asia. The iCCM components and inputs were fairly consistent across the seven studies with notable variation for the training and deployment component (e.g. on payment of iCCM providers) and the system component (e.g. on improving information systems). When compared to usual facility services, we are uncertain of the effect of iCCM on coverage of appropriate treatment from an appropriate provider for any iCCM illness (RR 0.96, 95% CI 0.77 to 1.19; 2 CBA studies, 5898 children; very low-certainty evidence). iCCM may have little to no effect on neonatal mortality (HR 1.01, 95% 0.73 to 1.28; 2 trials, 65,209 children; low-certainty evidence). We are uncertain of the effect of iCCM on infant mortality (HR 1.02, 95% CI 0.83 to 1.26; 2 trials, 60,480 children; very low-certainty evidence) and under-five mortality (HR 1.18, 95% CI 1.01 to 1.37; 1 trial, 4729 children; very low-certainty evidence). iCCM probably increases coverage of careseeking to an appropriate provider for any iCCM illness by 68% (RR 1.68, 95% CI 1.24 to 2.27; 2 trials, 9853 children; moderate-certainty evidence). None of the studies reported quality of care, severity of illness or adverse events for this comparison. When compared to usual facility services plus CCM for malaria, we are uncertain of the effect of iCCM on coverage of appropriate treatment from an appropriate provider for any iCCM illness (very low-certainty evidence) and iCCM may have little or no effect on careseeking to an appropriate provider for any iCCM illness (RR 1.06, 95% CI 0.97 to 1.17; 1 trial, 811 children; low-certainty evidence). None of the studies reported quality of care, case load or severity of illness at health facilities, mortality or adverse events for this comparison.

Authors' conclusions iCCM probably increases coverage of careseeking to an appropriate provider for any iCCM illness. However, the evidence presented here underscores the importance of moving beyond training and deployment to valuing iCCM providers, strengthening health systems and engaging community systems.

Place, publisher, year, edition, pages
John Wiley & SonsWiley, 2021
National Category
Public Health, Global Health, Social Medicine and Epidemiology
Identifiers
urn:nbn:se:uu:diva-442575 (URN)10.1002/14651858.CD012882.pub2 (DOI)000624575100023 ()33565123 (PubMedID)
Available from: 2021-05-19 Created: 2021-05-19 Last updated: 2024-01-15Bibliographically approved
Strong, K. L., Pedersen, J., White Johansson, E., Cao, B., Diaz, T., Guthold, R., . . . Liu, L. (2021). Patterns and trends in causes of child and adolescent mortality 2000-2016: setting the scene for child health redesign. BMJ Global Health, 6(3), Article ID e004760.
Open this publication in new window or tab >>Patterns and trends in causes of child and adolescent mortality 2000-2016: setting the scene for child health redesign
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2021 (English)In: BMJ Global Health, E-ISSN 2059-7908, Vol. 6, no 3, article id e004760Article in journal (Refereed) Published
Abstract [en]

The under-5 mortality rate has declined from 93 deaths per 1000 live births in 1990 to 39 per 1000 live births in 2018. This improvement in child survival warrants an examination of age-specific trends and causes of death over time and across regions and an extension of the survival focus to older children and adolescents. We examine patterns and trends in mortality for neonates, postneonatal infants, young children, older children, young adolescents and older adolescents from 2000 to 2016. Levels and trends in causes of death for children and adolescents under 20 years of age are based on United Nations Inter-agency Group for Child Mortality Estimation for all-cause mortality, the Maternal and Child Epidemiology Estimation group for cause of death among children under-5 and WHO Global Health Estimates for 5-19 year-olds. From 2000 to 2016, the proportion of deaths in young children aged 1-4 years declined in most regions while neonatal deaths became over 25% of all deaths under 20 years in all regions and over 50% of all under-5 deaths in all regions except for sub-Saharan Africa which remains the region with the highest under-5 mortality in the world. Although these estimates have great variability at the country level, the overall regional patterns show that mortality in children under the age of 5 is increasingly concentrated in the neonatal period and in some regions, in older adolescents. The leading causes of disease for children under-5 remain preterm birth and infectious diseases, pneumonia, diarrhoea and malaria. For older children and adolescents, injuries become important causes of death as do interpersonal violence and self-harm. Causes of death vary by region.

Place, publisher, year, edition, pages
BMJ Publishing Group LtdBMJ, 2021
Keywords
child health, epidemiology, public health
National Category
Public Health, Global Health, Social Medicine and Epidemiology Pediatrics
Identifiers
urn:nbn:se:uu:diva-441452 (URN)10.1136/bmjgh-2020-004760 (DOI)000631522000002 ()33731440 (PubMedID)
Available from: 2021-05-19 Created: 2021-05-19 Last updated: 2024-01-15Bibliographically approved
De Costa, A., Moller, A.-B., Blencowe, H., White Johansson, E., Hussain-Alkhateeb, L., Ohuma, E. O., . . . Moran, A. C. (2021). Study protocol for WHO and UNICEF estimates of global, regional, and national preterm birth rates for 2010 to 2019. PLOS ONE, 16(10), Article ID e0258751.
Open this publication in new window or tab >>Study protocol for WHO and UNICEF estimates of global, regional, and national preterm birth rates for 2010 to 2019
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2021 (English)In: PLOS ONE, E-ISSN 1932-6203, Vol. 16, no 10, article id e0258751Article in journal (Refereed) Published
Abstract [en]

Background

Preterm birth is a leading cause of death among children under five years. Previous estimates indicated global preterm birth rate of 10.6% (14.8 million neonates) in 2014. We aim to update preterm birth estimates at global, regional, and national levels for the period 2010 to 2019.

Methods

Preterm birth is defined as a live birth occurring before 37 completed gestational weeks, or <259 days since a woman's last menstrual period. National administrative data sources for WHO Member States with facility birth rates of >= 80% in the most recent year for which data is available will be searched. Administrative data identified for these countries will be considered if >= 80% of UN estimated live births include gestational age information to define preterm birth. For countries without eligible administrative data, a systematic review of studies will be conducted. Research studies will be eligible if the reported outcome is derived from an observational or intervention study conducted at national or sub-national level in population- or facility-based settings. Risk of bias assessments will focus on gestational age measurement method and coverage, and inclusion of special subgroups in published estimates. Covariates for inclusion will be selected a priori based on a conceptual framework of plausible associations with preterm birth, data availability, and quality of covariate data across many countries and years. Global, regional and national preterm birth rates will be estimated using a Bayesian multilevel-mixed regression model.

Discussion

Accurate measurement of preterm birth is challenging in many countries given incomplete or unavailable data from national administrative sources, compounded by limited gestational age assessment during pregnancy to define preterm birth. Up-to-date modelled estimates will be an important resource to measure the global burden of preterm birth and to inform policies and programs especially in settings with a high burden of neonatal mortality.

Place, publisher, year, edition, pages
Public Library of Science (PLoS)Public Library of Science (PLoS), 2021
National Category
Public Health, Global Health, Social Medicine and Epidemiology
Identifiers
urn:nbn:se:uu:diva-468405 (URN)10.1371/journal.pone.0258751 (DOI)000746969100038 ()34669749 (PubMedID)
Available from: 2022-03-02 Created: 2022-03-02 Last updated: 2024-01-15Bibliographically approved
White Johansson, E., Lindsjö, C., Weiss, D. J., Nsona, H., Ekholm Selling, K., Lufesi, N. & Hildenwall, H. (2020). Accessibility of basic paediatric emergency care in Malawi: analysis of a national facility census. BMC Public Health, 20(1), Article ID 992.
Open this publication in new window or tab >>Accessibility of basic paediatric emergency care in Malawi: analysis of a national facility census
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2020 (English)In: BMC Public Health, E-ISSN 1471-2458, Vol. 20, no 1, article id 992Article in journal (Refereed) Published
Abstract [en]

Background

Emergency care is among the weakest parts of health systems in low-income countries with both quality and accessibility constraints. Previous studies estimated accessibility to surgical or emergency care based on population travel times to nearest hospital with no assessment of hospital readiness to provide such care. We analysed a Malawi national facility census with comprehensive inventory audits and geocoded facility locations to identify hospitals equipped to provide basic paediatric emergency care with estimated travel times to these hospitals from non-equipped facilities and in relation to Malawi's population distribution.

Methods

We analysed a Malawi national facility census in 2013-2014 to identify hospitals equipped to manage critically ill children according to an extended version of WHO Emergency Triage, Assessment and Treatment (ETAT) guidelines. These guidelines include 25 components including staff, transport, equipment, diagnostics, medications, fluids, feeds and consumables that defined an emergency-equipped hospital in our study. We estimated travel times to emergency-equipped hospitals from non-equipped facilities and relative to population distributions using geocoded facility locations and an established accessibility mapping approach using global road network datasets from OpenStreetMap and Google.

Results

Four (3.5, 95% CI: 1.3-8.9) of 116 Malawi hospitals were emergency-equipped. Least available items were nasogastric tubes in 34.5% of hospitals (95% CI: 26.4-43.6), blood typing services (40.4, 95% CI: 31.9-49.6), micro nebulizers (50.9, 95% CI: 41.9-60.0), and radiology (54.2, 95% CI: 45.1-63.0). Nationally, the median travel time from non-equipped facilities to the nearest emergency-equipped hospital was 73 min (95% CI: 67-77) ranging 1-507 min. Approximately one-quarter (27%) of Malawians lived over 120 min from an emergency-equipped hospital with significantly better accessibility in Central than North and South regions (16% vs. 38 and 35%,p < 0.001).

Conclusions

There are unacceptable deficiencies in accessibility of basic paediatric emergency care in Malawi. Reliable supply chains for essential drugs and commodities are needed, particularly nasogastric tubes, asthma drugs and blood, along with improved capacity for time-sensitive referral. Further child mortality reductions will require substantial investments to expand basic paediatric emergency care into all Malawi hospitals for better managing critically ill children at highest mortality risk.

Keywords
Malawi, Emergency care, Paediatrics, Health systems
National Category
Public Health, Global Health, Social Medicine and Epidemiology Health Care Service and Management, Health Policy and Services and Health Economy
Identifiers
urn:nbn:se:uu:diva-420110 (URN)10.1186/s12889-020-09043-3 (DOI)000544970300001 ()32580762 (PubMedID)
Funder
Swedish Research Council, 348-20142791Stockholm County Council, ALF project 20150545
Available from: 2020-09-23 Created: 2020-09-23 Last updated: 2023-08-28Bibliographically approved
Allwell-Brown, G., Hussain-Alkhateeb, L., Kitutu, F., Strömdahl, S., Mårtensson, A. & Johansson, E. W. (2020). Trends in reported antibiotic use among children under 5 years of age with fever, diarrhoea, or cough with fast or difficult breathing across low-income and middle-income countries in 2005-17: a systematic analysis of 132 national surveys from 73 countries. The Lancet Global Health, 8(6), E799-E807
Open this publication in new window or tab >>Trends in reported antibiotic use among children under 5 years of age with fever, diarrhoea, or cough with fast or difficult breathing across low-income and middle-income countries in 2005-17: a systematic analysis of 132 national surveys from 73 countries
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2020 (English)In: The Lancet Global Health, E-ISSN 2214-109X, Vol. 8, no 6, p. E799-E807Article in journal (Refereed) Published
Abstract [en]

Background: Global assessments of antibiotic consumption have relied on pharmaceutical sales data that do not measure individual-level use, and are often unreliable or unavailable for low-income and middle-income countries (LMICs). To help fill this evidence gap, we compiled data from national surveys in LMICs in 2005-17 reporting antibiotic use for sick children under the age of 5 years.

Methods: Based on 132 Demographic and Health Surveys and Multiple Indicator Cluster Surveys from 73 LMICs, we analysed trends in reported antibiotic use among children under 5 years of age with fever, diarrhoea, or cough with fast or difficult breathing by WHO region, World Bank income classification, and symptom complaint. A logit transformation was used to estimate the outcome using a linear Bayesian regression model. The model included country-level socioeconomic, disease incidence, and health system covariates to generate estimates for country-years with missing values.

Findings: Across LMICs, reported antibiotic use among sick children under 5 years of age increased from 36.8% (uncertainty interval [UI] 28.8-44.7) in 2005 to 43.1% (33.2-50.5) in 2017. Low-income countries had the greatest relative increase; in these countries, reported antibiotic use for sick children under 5 years of age rose 34% during the study period, from 29.6% (21.2-41.1) in 2005 to 39.5% (32.9-47.6) in 2017, although it remained the lowest of any income group throughout the study period.

Interpretation: We found a limited but steady increase in reported antibiotic use for sick children under 5 years of age across LMICs in 2005-17, although overlapping UIs complicate interpretation. The increase was largely driven by gains in low-income countries. Our study expands the evidence base from LMICs, where strengthening antibiotic consumption and resistance surveillance is a global health priority.

Place, publisher, year, edition, pages
ELSEVIER SCI LTD, 2020
National Category
Public Health, Global Health, Social Medicine and Epidemiology
Identifiers
urn:nbn:se:uu:diva-413913 (URN)10.1016/S2214-109X(20)30079-6 (DOI)000536463500027 ()32446345 (PubMedID)
Available from: 2020-06-24 Created: 2020-06-24 Last updated: 2022-03-30Bibliographically approved
White Johansson, E., Nsona, H., Carvajal-Aguirre, L., Amouzou, A. & Hildenwall, H. (2017). Determinants of Integrated Management of Childhood Illness (IMCI) non-severe pneumonia classification and care in Malawi health facilities: Analysis of a national facility census. Journal of Global Health, 7(2), Article ID 020408.
Open this publication in new window or tab >>Determinants of Integrated Management of Childhood Illness (IMCI) non-severe pneumonia classification and care in Malawi health facilities: Analysis of a national facility census
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2017 (English)In: Journal of Global Health, ISSN 2047-2978, E-ISSN 2047-2986, Vol. 7, no 2, article id 020408Article in journal (Refereed) Published
Abstract [en]

Background

Research shows inadequate Integrated Management of Childhood Illness (IMCI)-pneumonia care in various low-income settings but evidence is largely from small-scale studies with limited evidence of patient-, provider-and facility-levels determinants of IMCI non-severe pneumonia classification and its management.

Methods

The Malawi Service Provision Assessment 2013-2014 included 3149 outpatients aged 2-59 months with completed observations, interviews and re-examinations. Mixed-effects logistic regression models quantified the influence of patient-, provider and facility-level determinants on having IMCI non-severe pneumonia and its management in observed consultations.

Findings

Among 3149 eligible outpatients, 590 (18.7%) had IMCI non-severe pneumonia classification in re-examination. 228 (38.7%) classified cases received first-line antibiotics and 159 (26.9%) received no antibiotics. 18.6% with cough or difficult breathing had 60-second respiratory rates counted during consultations, and conducting this assessment was significantly associated with IMCI training ever received (odds ratio (OR) = 2.37, 95% confidence interval (CI): 1.29-4.31) and negative rapid diagnostic test results (OR = 3.21, 95% CI: 1.45-7.13). Older children had lower odds of assessments than infants (OR = 48-59 months: 0.35, 95% CI: 0.16-0.75). Children presenting with any of the following complaints also had reduced odds of assessment: fever, diarrhea, skin problem or any danger sign. First-line antibiotic treatment for classified cases was significantly associated with high temperatures (OR = 3.26, 95% CI: 1.24-8.55) while older children had reduced odds of first-line treatment compared to infants (OR = 48-59 months: 0.29, 95% CI: 0.10-0.83). RDT-confirmed malaria was a significant predictor of no antibiotic receipt for IMCI non-severe pneumonia (OR = 10.65, 95% CI: 2.39-47.36).

Conclusions

IMCI non-severe pneumonia care was sub-optimal in Malawi health facilities in 2013-2014 with inadequate assessments and prescribing practices that must be addressed to reduce this leading cause of mortality. Child's symptoms and age, malaria diagnosis and provider training were primary influences on assessment and treatment practices. Current evidence could be used to better target IMCI training and support to improve pneumonia care for sick children in Malawi facilities.

National Category
Public Health, Global Health, Social Medicine and Epidemiology
Identifiers
urn:nbn:se:uu:diva-340321 (URN)10.7189/jogh.07.020408 (DOI)000418869800017 ()
Available from: 2018-02-09 Created: 2018-02-09 Last updated: 2018-02-09Bibliographically approved
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