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Background
A recent national survey in Tanzania reported that mortality in children
younger than 5 years dropped by 24% over the 5 years between 2000 and 2004.
We aimed to investigate yearly changes to identify what might have
contributed to this reduction and to investigate the prospects for meeting
the Millennium Development Goal for child survival (MDG 4).
Methods
We analysed data from the four demographic and health surveys done in
Tanzania since 1990 to generate estimates of mortality in children younger
than 5 years for every 1-year period before each survey back to 1990. We
estimated trends in mortality between 1990 and 2004 by fitting Lowess
regression, and forecasted trends in mortality in 2005 to 2015. We aimed to
investigate contextual factors, whether part of Tanzania's health system or
not, that could have affected child mortality.
Findings
Disaggregated estimates of mortality showed a sharp acceleration in the
reduction in mortality in children younger than 5 years in Tanzania between
2000 and 2004. In 1990, the point estimate of mortality was 141·5 (95% CI
141·5–141·5) deaths per 1000 livebirths. This was reduced by 40%, to reach
a point estimate of 83·2 (95% CI 70·1–96·3) deaths per 1000 livebirths in
2004. The change in absolute risk was 58·4 (95% CI 32·7–83·8; p<0·0001).
Between 1999 and 2004 we noted important improvements in Tanzania's health
system, including doubled public expenditure on health; decentralisation
and sector-wide basket funding; and increased coverage of key
child-survival interventions, such as integrated management of childhood
illness, insecticide-treated nets, vitamin A supplementation, immunisation,
and exclusive breastfeeding. Other determinants of child survival that are
not related to the health system did not change between 1999 and 2004,
except for a slow increase in the HIV/AIDS burden.
Interpretation
Tanzania could attain MDG 4 if this trend of improved child survival were
to be sustained. Investment in health systems and scaling up interventions
can produce rapid gains in child survival.
2) QUERY TO READERS
I should be grateful to see any high quality reports, published or
unpublished, assessing the impact on owner malaria bednet utilization of
social mobilization. What works?
3) READER FEEDBACK ON HIB VACCINATION
Bob,
In addition to these important results and update you might also reference
the work done by colleagues in Malawi, one of the first countries in
Subsaharan Africa, together with Gambia and RSA, to document the impact of
Hib vaccination (importantly, fig 3 of the paper includes SPn cases
so authors were confident this was not an artifact of laboratory
procedures, etc.).
As noted in the Discussion:
'This work demonstrates that Hib conjugate vaccine delivered through a
National Expanded Program on Immunization (EPI) is highly effective in
reducing Hib meningitis cases, even in a country with extremely limited
health care resources and a high HIV burden.'
Paul Daza, Richard Banda, Keystoxe Misoya, Agnes Katsulukuta, Bradford
D. Gessner, Reggis Katsande, Bekithemba R. Mhlanga, Judith E. Mueller,
Christopher B. Nelson, Amos Phiri, et al. The impact of routine infant
immunization with Haemophilus influenzae type b conjugate vaccine in
Malawi, a country with high human immunodeficiency virus prevalence.
(2006) Vaccine. 24(37-39): 6232-6239
With positive results accumulating in East and Southern Africa, it will
be exciting to see results from West and Southern African countries as
they adopt pentavalent vaccine.
Chris Nelson
CSU 21/2008: CHILD SURVIVAL IN TANZANIA/QUERY TO READERS/READER FEEDBACK
| Friday, 16th of May 2008 |
 |
 |
CSU 21/2008: CHILD SURVIVAL IN TANZANIA/QUERY TO READERS/READER FEEDBACK
Dear All,
CHILD SURVIVAL UPDATE 21/2008: CHILD SURVIVAL IN TANZANIA/QUERY TO
READERS/READER FEEDBACK
1) CHILD SURVIVAL IN TANZANIA
Masania and colleagues review Tanzania's progress towards MDG 4 in this
update from The Lancet, also available at
http://www.thelancet.com/journals/lancet/article/PIIS0140673608605620/fulltext
Though Tanzania can make some further progress in "quick return"
interventions like vaccination and bednet distribution and use, much of the
remaining child mortality lies in neonatal mortality, for which multiple
interventions, both curative and preventive, will be necessary.
Once more we see another discussion of rising HIV seroprevalence with no
discussion of male circumcision, universally practiced in Zanzibar, but by
only 2/3 of mainland Tanzanians.
Background
A recent national survey in Tanzania reported that mortality in children
younger than 5 years dropped by 24% over the 5 years between 2000 and 2004.
We aimed to investigate yearly changes to identify what might have
contributed to this reduction and to investigate the prospects for meeting
the Millennium Development Goal for child survival (MDG 4).
Methods
We analysed data from the four demographic and health surveys done in
Tanzania since 1990 to generate estimates of mortality in children younger
than 5 years for every 1-year period before each survey back to 1990. We
estimated trends in mortality between 1990 and 2004 by fitting Lowess
regression, and forecasted trends in mortality in 2005 to 2015. We aimed to
investigate contextual factors, whether part of Tanzania's health system or
not, that could have affected child mortality.
Findings
Disaggregated estimates of mortality showed a sharp acceleration in the
reduction in mortality in children younger than 5 years in Tanzania between
2000 and 2004. In 1990, the point estimate of mortality was 141·5 (95% CI
141·5–141·5) deaths per 1000 livebirths. This was reduced by 40%, to reach
a point estimate of 83·2 (95% CI 70·1–96·3) deaths per 1000 livebirths in
2004. The change in absolute risk was 58·4 (95% CI 32·7–83·8; p<0·0001).
Between 1999 and 2004 we noted important improvements in Tanzania's health
system, including doubled public expenditure on health; decentralisation
and sector-wide basket funding; and increased coverage of key
child-survival interventions, such as integrated management of childhood
illness, insecticide-treated nets, vitamin A supplementation, immunisation,
and exclusive breastfeeding. Other determinants of child survival that are
not related to the health system did not change between 1999 and 2004,
except for a slow increase in the HIV/AIDS burden.
Interpretation
Tanzania could attain MDG 4 if this trend of improved child survival were
to be sustained. Investment in health systems and scaling up interventions
can produce rapid gains in child survival.
2) QUERY TO READERS
I should be grateful to see any high quality reports, published or
unpublished, assessing the impact on owner malaria bednet utilization of
social mobilization. What works?
3) READER FEEDBACK ON HIB VACCINATION
Bob,
In addition to these important results and update you might also reference
the work done by colleagues in Malawi, one of the first countries in
Subsaharan Africa, together with Gambia and RSA, to document the impact of
Hib vaccination (importantly, fig 3 of the paper includes SPn cases
so authors were confident this was not an artifact of laboratory
procedures, etc.).
As noted in the Discussion:
'This work demonstrates that Hib conjugate vaccine delivered through a
National Expanded Program on Immunization (EPI) is highly effective in
reducing Hib meningitis cases, even in a country with extremely limited
health care resources and a high HIV burden.'
Paul Daza, Richard Banda, Keystoxe Misoya, Agnes Katsulukuta, Bradford
D. Gessner, Reggis Katsande, Bekithemba R. Mhlanga, Judith E. Mueller,
Christopher B. Nelson, Amos Phiri, et al. The impact of routine infant
immunization with Haemophilus influenzae type b conjugate vaccine in
Malawi, a country with high human immunodeficiency virus prevalence.
(2006) Vaccine. 24(37-39): 6232-6239
With positive results accumulating in East and Southern Africa, it will
be exciting to see results from West and Southern African countries as
they adopt pentavalent vaccine.
Chris Nelson
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