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Tracking progress towards equitable child survival in a Nicaraguan community: neonatal mortality challenges to meet the MDG 4
Uppsala University, Disciplinary Domain of Medicine and Pharmacy, Faculty of Medicine, Department of Women's and Children's Health, International Maternal and Child Health (IMCH). (Internationell barnhälsa och nutrition/Persson)
Health and Demographic Research Centre, CIDS, National Autonomous University, León; Nicaragua.
Uppsala University, Disciplinary Domain of Medicine and Pharmacy, Faculty of Medicine, Department of Women's and Children's Health, International Maternal and Child Health (IMCH). (Internationell barnhälsa och nutrition/Persson)
Uppsala University, Disciplinary Domain of Medicine and Pharmacy, Faculty of Medicine, Department of Women's and Children's Health, International Maternal and Child Health (IMCH). (Internationell barnhälsa och nutrition/Persson)
2011 (English)In: BMC Public Health, ISSN 1471-2458, E-ISSN 1471-2458, Vol. 11, 455- p.Article in journal (Refereed) Published
Abstract [en]

Background:

Nicaragua has made progress in the reduction of the under-five mortality since 1980s. Data for the national trends indicate that this poor Central American country is on track to reach the Millennium Development Goal-4 by 2015. Despite this progress, neonatal mortality has not showed same progress. The aim of this study is to analyse trends and social differentials in neonatal and under-five mortality in a Nicaraguan community from 1970 to 2005.

Methods:

Two linked community-based reproductive surveys in 1993 and 2002 followed by a health and demographic surveillance system providing information on all births and child deaths in urban and rural areas of Leon municipality, Nicaragua. A total of 49 972 live births were registered.

Results:

A rapid reduction in under-five mortality was observed during the late 1970s (from 103 deaths/1000 live births) and the 1980s, followed by a gradual decline to the level of 23 deaths/1000 live births in 2005. This community is on track for the Millennium Development Goal 4 for improved child survival. However, neonatal mortality increased lately in spite of a good coverage of skilled assistance at delivery. After some years in the 1990s with a very small gap in neonatal survival between children of mothers of different educational levels this divide is increasing.

Conclusions:

After the reduction of high under-five mortality that coincided with improved equity in survival in this Nicaraguan community, the current challenge is the neonatal mortality where questions of an equitable perinatal care of good quality must be addressed.

Place, publisher, year, edition, pages
2011. Vol. 11, 455- p.
National Category
Medical and Health Sciences
Identifiers
URN: urn:nbn:se:uu:diva-156489DOI: 10.1186/1471-2458-11-455ISI: 000292502000002OAI: oai:DiVA.org:uu-156489DiVA: diva2:431788
Available from: 2011-07-25 Created: 2011-07-25 Last updated: 2017-12-08Bibliographically approved
In thesis
1. Millennium Development Goals in Nicaragua: Analysing progress, social inequalities, and community actions
Open this publication in new window or tab >>Millennium Development Goals in Nicaragua: Analysing progress, social inequalities, and community actions
2012 (English)Doctoral thesis, comprehensive summary (Other academic)
Abstract [en]

The world has made important efforts to meet the Millennium Development Goals (MDG) by 2015. However, it is still insufficient and inequalities prevail in the poorest settings. We tracked selected MDG, barriers for their achievement, and community actions that help to accelerate the pace of their accomplishment in two Nicaraguan communities (León and Cuatro Santos).

In the first two studies we track the progress of MDG4 (reduce child mortality) using the under-five mortality rate. Inequalities in mortality were mainly assessed by means of maternal education, but other social stratifications were performed on rural-urban residence and sub-regional comparisons between both communities. The last two studies describe community interventions in Cuatro Santos and their association with progress toward MDG1 (poverty reduction). Participation in interventions and poverty were visualized geographically in this remote rural community between 2004 and 2009. Other selected MDG targets were also tracked.

These communities will possibly meet MDG4 even before 2015. In León, MDG progress has been accompanied by a decline in child mortality. Despite social inequalities with regard to mortality persisting in education and places of residence, these have decreased. However, it is crucial to reduce neonatal mortality if MDG4 is to be achieved. For example, in León the percentage of under-five deaths in the neonatal period has doubled from 1970 to 2005. In the remote rural area of Cuatro Santos, progress has been accelerated and no child mortality differences were observed despite the level of a mother’s education.

Cuatro Santos has also progressed in the reduction of poverty and extreme poverty. The participation of the population in such community interventions as microcredit, home gardening, technical training, safe drinking water, and latrines has increased. Microcredit was an intervention that was unequally distributed in this rural area, where participation was lower in poor and extremely poor households than in non-poor households. In those households that transitioned from poor to non-poor status, microcredit, home gardening, and technical training were associated with this transition. Furthermore spatial analysis revealed that clusters of low participation in interventions overlapped with clusters of high poverty households.

Place, publisher, year, edition, pages
Uppsala: Acta Universitatis Upsaliensis, 2012. 62 p.
Series
Digital Comprehensive Summaries of Uppsala Dissertations from the Faculty of Medicine, ISSN 1651-6206 ; 839
Keyword
Millennium Development Goals, child survival, poverty, inequality, interventions, spatial model, Nicaragua
National Category
Public Health, Global Health, Social Medicine and Epidemiology
Identifiers
urn:nbn:se:uu:diva-183273 (URN)978-91-554-8532-0 (ISBN)
Public defence
2012-12-14, Rosénsalen, Akademiska sjukhuset, Entrance 95/96 nbv, Uppsala, 13:00 (English)
Opponent
Supervisors
Available from: 2012-11-23 Created: 2012-10-23 Last updated: 2013-02-11Bibliographically approved

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Pérez, WiltonPersson, Lars-ÅkeKällestål, Carina

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