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Community development actions to achieve the Millennium Development Goals: An analysis based on a surveillance site in Cuatro Santos, 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).
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).
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).
The Centre for Research and Interventions in Health (CIS), León, Nicaragua.
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(English)Manuscript (preprint) (Other academic)
Abstract [en]

Background

According to preliminary data, the remote rural area of Cuatro Santos, Nicaragua has shown improvements in almost all Millennium Development Goals (MDG), while a set of interventions have been running in the area. This study describes the progress toward a set of MDG, as well as the geographical disparities encountered in reaching MDG1.

Methods

We investigated selected MDG prospectively and retrospectively in 2004 and 2009, and prepared a descriptive analysis of MDG and community interventions by proportions, rates, and ratios.  In order to determine any geographical disparities in progress toward MDG1 among the households receiving interventions, we used a spatial scan test (SaTScan®) to identify unique non-random spatial clusters of poverty and interventions, and a retrospective model to identify multiple clusters in a defined geographic area. Multinomial logistic regression analyses were also performed to examine the participation of single interventions on the poverty clusters that were identified by the spatial cluster analysis technique.

Results

Descriptive analysis indicated that poverty and under-five mortality declined in Cuatro Santos. Education showed no wide inequality by gender. Access to drinking water and sanitation has risen, but is not universal. Spatial analyses identified a sizeable cluster of poor households located in the northeast part of Cuatro Santos with a high probability of receiving one or more intervention. However, none reached this area. More detailed analyses of the relations between the single interventions and the poverty clusters showed that almost all interventions were positively related to the low poverty clusters (OR > 1), and negatively connected to the high-poverty clusters (OR > 1).

Conclusions

The Cuatro Santos area of Nicaragua has reached several millennium targets, and scaling up of community actions has accelerated the trend towards fulfilling MDG without increasing inequality. However, a geographical analysis reveals that areas of high poverty barely reached by interventions remain. Therefore, continuous surveillance is important to prioritize segments of the population with more social needs.

Keyword [en]
Millennium Development Goals, interventions, inequality, rural, spatial model, Nicaragua
National Category
Social Sciences
Identifiers
URN: urn:nbn:se:uu:diva-183133OAI: oai:DiVA.org:uu-183133DiVA: diva2:563938
Available from: 2012-10-31 Created: 2012-10-22 Last updated: 2013-02-11
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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