Inequalities in cause-specific mortality in children and adolescents in the Moramanga health survey, Madagascar
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ORIGINAL ARTICLE
Inequalities in cause-specific mortality in children and adolescents in the Moramanga health survey, Madagascar Rila Ratovoson1,2 • Bruno Masquelier2,3 • Todisoa Andriatahina4 • Reziky Mangahasimbola1 Zo Andrianirina5 • Gilles Pison2,6 • Laurence Baril1,7
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Received: 27 December 2019 / Revised: 4 June 2020 / Accepted: 9 June 2020 Swiss School of Public Health (SSPH+) 2020
Abstract Objectives One child or young adolescent dies every 10 min in Madagascar and large disparities in survival persist. We estimated cause-specific mortality in a cohort of children aged 0–14 in the Moramanga district and explored how causes of death shape these inequalities. Methods Children were followed prospectively between 2012 and 2017. Causes of death were established based on verbal autopsies. Incidence rate ratios were estimated in Poisson regression models. Results The risk of dying before age 15 was 68.1 per thousand live births. Risks of dying were highest in the first year of life (31.2%) and lowest in children aged 10–14 (6.4%). The male-to-female sex ratios of mortality increased with age and reached 2.3 among adolescents aged 10–14. Communicable, nutritional and neonatal causes accounted for 79.5% of deaths below age 5 and 47.0% above age 5. Mortality was positively associated with household poverty, lack of education of the household head, and rural residence. Conclusions Interventions should be designed with an equity lens to reduce large disparities in survival and be tailored to the needs of each age-group. Keywords Madagascar Low-income countries Child mortality Verbal autopsy Rural area Urban area
Introduction Remarkable progress in preventing child mortality has been made in Madagascar, in a context characterized by political instability, limited economic growth, and high
Gilles Pison and Laurence Baril authors are joint senior authors on this work.
Electronic supplementary material The online version of this article (https://doi.org/10.1007/s00038-020-01409-z) contains supplementary material, which is available to authorized users. & Rila Ratovoson [email protected]
rates of chronic undernutrition (World Bank 2019). Madagascar was among the 62 countries that met the target set in the Millennium Development Goals (MGDs) to reduce the under-five mortality rate (U5MR) by two-thirds between 1990 and 2015 (IGME 2015). In the Sustainable Development Goals (SDGs) agenda, the new target is to reduce U5MR to less than 25 deaths before age 5 per 1,000 live births. In Madagascar, U5MR had already declined to 54% in 2018 (IGME 2019). Immunization could have contributed to this reduction, despite important gaps in the immunization coverage. According to WHO and UNICEF estimates, the immunization coverage was still below 80% Zo Andrianirina [email protected]
Bruno Masquelier [email protected]
Gilles Pison [email protected]
Todisoa Andriatahina [email protected]
Laurence Baril [email protected]
Reziky Mangahasimbola mreziky@pasteu
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