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Effect of health systems context on infant and child mortality in sub-Saharan Africa from 1995 to 2015, a longitudinal cohort analysis.

Publication ,  Journal Article
Simmons, RA; Anthopolos, R; O'Meara, WP
Published in: Sci Rep
August 11, 2021

Each year, > 3 million children die in sub-Saharan Africa before their fifth birthday. Most deaths are preventable or avoidable through interventions delivered in the primary healthcare system. However, evidence regarding the impact of health system characteristics on child survival is sparse. We assembled a retrospective cohort of > 250,000 children in seven countries in sub-Saharan Africa. We described their health service context at the subnational level using standardized surveys and employed parametric survival models to estimate the effect of three major domains of health services-quality, access, and cost-on infant and child survival, after adjusting for child, maternal, and household characteristics. Between 1995 and 2015 we observed 13,629 deaths in infants and 5149 in children. In fully-adjusted models, the largest effect sizes were related to fees for services. Immunization fees were correlated with poor child survival (HR = 1.20, 95% CI 1.12-1.28) while delivery fees were correlated with poor infant survival (HR = 1.11, 95% CI 1.01-1.21). Accessibility of facilities and greater concentrations of private facilities were associated with improved infant and child survival. The proportion of facilities with a doctor was correlated with increased risk of death in children and infants. We quantify the impact of health service environment on survival up to five years of age. Reducing health care costs and improving the accessibility of health facilities should remain a priority for improving infant and child survival. In the absence of these fundamental investments, more specialized interventions may not achieve their desired impact.

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Published In

Sci Rep

DOI

EISSN

2045-2322

Publication Date

August 11, 2021

Volume

11

Issue

1

Start / End Page

16263

Location

England

Related Subject Headings

  • Time Factors
  • Survival Rate
  • Retrospective Studies
  • Quality of Health Care
  • Primary Health Care
  • Male
  • Longitudinal Studies
  • Infant, Newborn
  • Infant Mortality
  • Infant
 

Citation

APA
Chicago
ICMJE
MLA
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Simmons, R. A., Anthopolos, R., & O’Meara, W. P. (2021). Effect of health systems context on infant and child mortality in sub-Saharan Africa from 1995 to 2015, a longitudinal cohort analysis. Sci Rep, 11(1), 16263. https://doi.org/10.1038/s41598-021-95886-8
Simmons, Ryan A., Rebecca Anthopolos, and Wendy Prudhomme O’Meara. “Effect of health systems context on infant and child mortality in sub-Saharan Africa from 1995 to 2015, a longitudinal cohort analysis.Sci Rep 11, no. 1 (August 11, 2021): 16263. https://doi.org/10.1038/s41598-021-95886-8.
Simmons, Ryan A., et al. “Effect of health systems context on infant and child mortality in sub-Saharan Africa from 1995 to 2015, a longitudinal cohort analysis.Sci Rep, vol. 11, no. 1, Aug. 2021, p. 16263. Pubmed, doi:10.1038/s41598-021-95886-8.

Published In

Sci Rep

DOI

EISSN

2045-2322

Publication Date

August 11, 2021

Volume

11

Issue

1

Start / End Page

16263

Location

England

Related Subject Headings

  • Time Factors
  • Survival Rate
  • Retrospective Studies
  • Quality of Health Care
  • Primary Health Care
  • Male
  • Longitudinal Studies
  • Infant, Newborn
  • Infant Mortality
  • Infant