Under Five Mortality

NRHM is a crucial health initiative taken by the government to improve the health of the rural masses with the special attention to the disadvantaged groups including women and children. In this developing country with illiteracy, poverty, disparity, malnutrition etc., among the rural population, the mission aimed to have dramatic changes in the health status by providing affordable, accessible and available healthcare facility. Assam was embraced by the umbrella of the mission as one of the special focus states. Various initiatives and schemes have been undertaken under the mission to positively affect the health status of the state. An attempt is made in this paper to analyze the performance and effectiveness of the role played by the mission to meet its goals and to change the health scenario of the state. Relying on the available secondary data, the paper shows the improved health indicators and the health system during the period of NRHM. Also, an attempt is made to focus on the existing lacuna of the mission or its performance.

Background: More than two thirds of the total population of Ethiopia is estimated to be at risk of malaria. Malaria is the leading public health problem in Ethiopia.
Objective: To investigate the determinants of a positive malaria Rapid Diagnosis Test (RDT) result, use of mosquito nets and use of indoor residual spray, as well as the associations between these and other factors.
Methods: Data obtained from a baseline household cluster malaria survey, conducted from December 2006 to January 2007, were analysed. In the survey, a total of 224 clusters, comprising around 25 households each, were selected from the Amhara, Oromiya and Southern Nation Nationalities and People (SNNP) regions of Ethiopia. A multivariate generalized mixed random effects approach was used to jointly analyse the data.
Results: The probability of a positive malaria RDT result decreased with use of mosquito nets and use of indoor residual spray. Overall, associations between a positive malaria RDT result and use of mosquito nets, and a positive malaria RDT result and use of indoor residual spray, were negative, i.e. households with more nets and those using indoor residual spray had fewer positive malaria RDT results. In addition, individuals in households with toilet facilities, clean drinking water and more living space had lower chances of testing positive for malaria.
Conclusion: Increasing the use of bed nets in Ethiopia and spraying indoor residual spray can reduce the risk of malaria, as can having toilet facilities, clean drinking water and more living space.

Child mortality is a factor that is associated with the well-being of a population and it is taken as an indicator of health development and socioeconomic status. According to the 2011 UN report during the last 10 years, the death rate for children under five has decreased by 35% worldwide. UNICEF in 2008 reported that Ethiopia has reduced under-five mortality by 40 percent over the past 15 years. From the EDHS 2011 report child mortality rate in Ethiopia was reduced from 50/1000 deaths in 2005 to 31/1000 deaths in 2011. The Ethiopian Demographic and Health Survey data are used for the study. In this paper we have attempted to find out the impact of socioeconomic, demographic and environmental factors in the context of under five mortality. In this attempt we first analyzed our data using Kaplan-Meier nonparametric method of estimation of survival function and also using lifetable. We have also used Log-Rank test to compare different survival functions and found that sex, type of birth, religion, mothers' education, birth order, maternity age, source of drinking water and region have statistically significant difference in the under five survival time. We have also used Cox proportional hazard model to identify the covariates which influence the under five mortality. But we found that our data do not fulfill the proportionality assumption of Cox proportional model in case of infant and child mortality. Then we applied stratified Cox proportional model to our data to find out the potential covariates which influence under five mortality and found birth order, mothers' education level, sex, type of birth and the interaction of birth order and sex as vital factors for the deaths occurring under the age of five. The Cox proportional hazard models which were used separately for each stratum also identified mothers' educational level, sex, type of birth, and the interaction of sex and water supply as the risk factors for the death of infants. Whereas for child stratum; type of birth, mothers' education, sex and the interaction of water supply and sex were the risk factors associated with the death of children.

Bangladesh wants to achieve the millennium development goals which is related to infant and under-five mortality by the year 2015. To achieve the goals it is needed to reduce the child mortality and to reduce mortality in Bangladesh it is needed to determine the determinants of mortality. Thus the main purpose of this study is to find the determinants of under-five mortality in Bangladesh. The objective of this study is to determine the impact of parental, socioeconomic, demographic, environmental, and nutritional and health seeking variables on under-five mortality. This study used the data extracted from Bangladesh demographic and health survey (BDHS). Chi-square test for dependency checking and multivariate proportional hazard analysis techniques are used to investigate the effects of those variables on under-five mortality. The study results show that several socioeconomic, demographic, nutritional, environmental and health related variables affect on under-five mortality. Multivariate hazards analysis results show that father's education, region of residence, preceding birth interval, number of children under-five years of age, mother's age, contraceptive use and breastfeeding have significant effect on under-five mortality. In this study it has revealed that the environmental, demographic, nutritional and health seeking variables have highly significant impact on under-five mortality than the socioeconomic variables. So we should give attention to these influencing variables to reduce the rate of under-five mortality in Bangladesh.