Global infant mortality trends and attributable determinants – an ecological study using data from 192 countries for the period 1990-2011

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Study Justification:
– Infant mortality rate (IMR) is an important indicator of population health.
– There are significant variations in IMR rates across different regions and countries.
– Identifying spatial disparities in IMR and quantifying risk factors is crucial for policymakers to develop targeted interventions.
– The study aims to provide insights into the determinants of IMR and their attributability.
Highlights:
– Significant reductions in IMR were observed in all World Health Organization regions except sub-Saharan Africa (SSA) due to HIV.
– High-risk clustering of IMR was found in SSA countries and parts of Asia.
– Maternal mortality, lack of water and sanitation, and female education were identified as prominent risk factors for IMR.
– The attributability of these factors varied over time and across regions and countries.
– The study suggests underestimation of IMR in regions with poorer data quality.
Recommendations:
– Policymakers should prioritize interventions targeting maternal mortality, access to sanitation and water, and female education to reduce IMR.
– Tailored interventions should be developed based on regional and country-specific factors.
– Improving data quality in regions with underestimation of IMR is essential for accurate monitoring and intervention planning.
Key Role Players:
– Policymakers and government officials responsible for healthcare and public health policies.
– Health organizations and NGOs involved in maternal and child health programs.
– Researchers and epidemiologists specializing in infant mortality and population health.
Cost Items for Planning Recommendations:
– Funding for maternal and child health programs and interventions.
– Investments in improving access to sanitation and water.
– Resources for promoting female education and empowerment.
– Research and data collection to improve data quality in regions with underestimation of IMR.

Background: Infant mortality rate (IMR) is regarded as an important indicator of population health. IMR rates vary substantially with the highest found in sub-Saharan Africa (SSA) compared to the lowest in Europe. Identifying spatial disparities in IMR and quantifying attributable risk factors is essential for policymakers when tailoring time-appropriate interventions at a global, regional, and country level. Methods: Data for 192 countries were extracted from the World Bank Development Indicator database for the period 1990-2011. Spatial clustering was used to identify significant higher-risk IMR countries. A robust ecological generalized linear negative binomial regression model was used to quantify risk factors and associated decomposition values (Shapley). Results: Significant reductions were observed in IMR for all of the World Health Organization regions for the period 1990-2011 except for SSA, which indicated a reversal of this trend in the 1990s due to HIV. Significant high-risk clustering of IMR is also indicated in SSA countries and parts of Asia. Maternal mortality (survival), lack of water and sanitation and female education were confirmed as prominent and high attributable risk factors for IMR. Distinct temporal changes in the attributability of these factors were observed, as well as significant heterogeneity with regards to the most attributable factor by region and country. Conclusions: Our study suggests that maternal mortality is the most prominent attributable risk factor for infant mortality, followed by lack of access to sanitation, lack of access to water, and lower female education. Variation exists across regions and countries with regards to the most attributable factor. Our study also suggests significant underestimation of IMR in regions known for poorer data quality. The results will aid policymakers in re-tailoring time-appropriate interventions to more effectively reduce IMR in line with Millennium Development Goal 4.

Based on the information provided in the publication, a recommendation to improve access to maternal health and reduce infant mortality rates could be to focus on the following areas:

1. Strengthening maternal healthcare services: Enhance the availability and quality of maternal healthcare services, including prenatal care, skilled birth attendance, and postnatal care. This could involve increasing the number of healthcare facilities, improving their infrastructure and equipment, and ensuring the presence of trained healthcare professionals.

2. Addressing maternal mortality: Implement strategies to reduce maternal mortality rates, as it is identified as the most prominent attributable risk factor for infant mortality. This could involve improving access to emergency obstetric care, promoting safe delivery practices, and providing comprehensive reproductive healthcare services.

3. Improving access to sanitation and clean water: Lack of access to sanitation and clean water is identified as a significant risk factor for infant mortality. Therefore, efforts should be made to improve access to clean water sources and sanitation facilities, particularly in regions and countries where these factors contribute significantly to infant mortality rates.

4. Promoting female education: Lower female education is identified as a prominent risk factor for infant mortality. Therefore, initiatives should be implemented to promote and improve access to education for girls and women. This could involve providing scholarships, addressing barriers to education, and promoting gender equality in education.

5. Tailoring interventions to regional and country-specific needs: Recognize the heterogeneity in risk factors and attributability across regions and countries. Policymakers should tailor interventions based on the specific needs and challenges of each region or country, taking into account the local context, resources, and cultural factors.

By focusing on these recommendations, it is expected that access to maternal health will be improved, leading to a reduction in infant mortality rates globally.
AI Innovations Description
Based on the information provided in the publication, a recommendation to improve access to maternal health and reduce infant mortality rates could be to focus on the following areas:

1. Strengthening maternal healthcare services: Enhance the availability and quality of maternal healthcare services, including prenatal care, skilled birth attendance, and postnatal care. This could involve increasing the number of healthcare facilities, improving their infrastructure and equipment, and ensuring the presence of trained healthcare professionals.

2. Addressing maternal mortality: Implement strategies to reduce maternal mortality rates, as it is identified as the most prominent attributable risk factor for infant mortality. This could involve improving access to emergency obstetric care, promoting safe delivery practices, and providing comprehensive reproductive healthcare services.

3. Improving access to sanitation and clean water: Lack of access to sanitation and clean water is identified as a significant risk factor for infant mortality. Therefore, efforts should be made to improve access to clean water sources and sanitation facilities, particularly in regions and countries where these factors contribute significantly to infant mortality rates.

4. Promoting female education: Lower female education is identified as a prominent risk factor for infant mortality. Therefore, initiatives should be implemented to promote and improve access to education for girls and women. This could involve providing scholarships, addressing barriers to education, and promoting gender equality in education.

5. Tailoring interventions to regional and country-specific needs: Recognize the heterogeneity in risk factors and attributability across regions and countries. Policymakers should tailor interventions based on the specific needs and challenges of each region or country, taking into account the local context, resources, and cultural factors.

By focusing on these recommendations, it is expected that access to maternal health will be improved, leading to a reduction in infant mortality rates globally.
AI Innovations Methodology
To simulate the impact of the main recommendations on improving access to maternal health, a methodology could involve the following steps:

1. Data collection: Gather data on the current status of maternal health and infant mortality rates in the target regions or countries. This could include information on healthcare facilities, healthcare professionals, prenatal care coverage, skilled birth attendance, postnatal care, access to clean water and sanitation, and female education rates.

2. Baseline assessment: Analyze the collected data to establish a baseline for maternal health and infant mortality rates. This will provide a starting point for comparison after implementing the recommendations.

3. Intervention implementation: Implement the recommended interventions in the target regions or countries. This could involve increasing the number of healthcare facilities, improving infrastructure and equipment, training healthcare professionals, promoting safe delivery practices, improving access to emergency obstetric care, providing comprehensive reproductive healthcare services, improving access to clean water sources and sanitation facilities, and promoting female education.

4. Monitoring and evaluation: Continuously monitor and evaluate the impact of the interventions on maternal health and infant mortality rates. This could involve collecting data on key indicators such as the number of healthcare facilities, healthcare professionals, prenatal care coverage, skilled birth attendance, postnatal care, access to clean water and sanitation, and female education rates.

5. Analysis: Analyze the collected data to assess the changes in maternal health and infant mortality rates after implementing the interventions. Compare the post-intervention data with the baseline data to determine the impact of the recommendations.

6. Adjustments and improvements: Based on the analysis, identify any areas where the interventions may not have had the desired impact or where further improvements can be made. Adjust the interventions accordingly to optimize their effectiveness.

7. Reporting and dissemination: Prepare a report summarizing the findings of the simulation and the impact of the recommendations on improving access to maternal health. Disseminate the findings to policymakers, healthcare professionals, and other relevant stakeholders to inform future decision-making and interventions.

By following this methodology, policymakers can gain insights into the potential impact of the recommendations and make informed decisions to improve access to maternal health and reduce infant mortality rates.

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