Institute of Tropical Medicine Antwerp
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Niger's child survival success, contributing factors and challenges to sustainability: a retrospective analysis

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dc.contributor.author Besada, D.
dc.contributor.author Kerber, K.
dc.contributor.author Leon, N.
dc.contributor.author Sanders, D.
dc.contributor.author Daviaud, E.
dc.contributor.author Rohde, S.
dc.contributor.author Rohde, J.
dc.contributor.author Van Damme, W.
dc.contributor.author Kinney, M.
dc.contributor.author Manda, S.
dc.contributor.author Oliphant, N. P.
dc.contributor.author Hachimou, F.
dc.contributor.author Ouedraogo, A.
dc.contributor.author Yaroh Ghali, A.
dc.contributor.author Doherty, T.
dc.date.accessioned 2016-05-18T13:39:39Z
dc.date.available 2016-05-18T13:39:39Z
dc.date.issued 2016
dc.identifier.issn 1932-6203
dc.identifier.doi http://dx.doi.org/10.1371/journal.pone.0146945
dc.identifier.other ITG-H8A
dc.identifier.other DPH
dc.identifier.other U-HPOL
dc.identifier.other JIF
dc.identifier.other DOI
dc.identifier.other FTA
dc.identifier.other OAJ
dc.identifier.other Abstract
dc.identifier.other UPD61
dc.identifier.uri http://hdl.handle.net/10390/8812
dc.description.abstract BACKGROUND: Household surveys undertaken in Niger since 1998 have revealed steady declines in under-5 mortality which have placed the country 'on track' to reach the fourth Millennium Development goal (MDG). This paper explores Niger's mortality and health coverage data for children under-5 years of age up to 2012 to describe trends in high impact interventions and the resulting impact on childhood deaths averted. The sustainability of these trends are also considered. METHODS AND FINDINGS: Estimates of child mortality using the 2012 Demographic and Health Survey were developed and maternal and child health coverage indicators were calculated over four time periods. Child survival policies and programmes were documented through a review of documents and key informant interviews. The Lives Saved Tool (LiST) was used to estimate the number of child lives saved and identify which interventions had the largest impact on deaths averted. The national mortality rate in children under-5 decreased from 286 child deaths per 1000 live births (95% confidence interval 177 to 394) in the period 1989-1990 to 128 child deaths per 1000 live births in the period 2011-2012 (101 to 155), corresponding to an annual rate of decline of 3.6%, with significant declines taking place after 1998. Improvements in the coverage of maternal and child health interventions between 2006 and 2012 include one and four or more antenatal visits, maternal Fansidar and tetanus toxoid vaccination, measles and DPT3 vaccinations, early and exclusive breastfeeding, oral rehydration salts (ORS) and proportion of children sleeping under an insecticide-treated bed net (ITN). Approximately 26,000 deaths of children under-5 were averted in 2012 due to decreases in stunting rates (27%), increases in ORS (14%), the Hib vaccine (14%), and breastfeeding (11%). Increases in wasting and decreases in vitamin A supplementation negated some of those gains. Care seeking at the community level was responsible for an estimated 7,800 additional deaths averted in 2012. A major policy change occurred in 2006 enabling free health care provision for women and children, and in 2008 the establishment of a community health worker programme. CONCLUSION: Increases in access and coverage of care for mothers and children have averted a considerable number of childhood deaths. The 2006 free health care policy and health post expansion were paramount in reducing barriers to care. However the sustainability of this policy and health service provision is precarious in light of persistently high fertility rates, unpredictable GDP growth, a high dependence on donor support and increasing pressures on government funding. en_US
dc.language English en_US
dc.subject Public health en_US
dc.subject Child health en_US
dc.subject Survival en_US
dc.subject Epidemiology en_US
dc.subject Children en_US
dc.subject Trends en_US
dc.subject Mortality rates en_US
dc.subject Health projects en_US
dc.subject Health policy en_US
dc.subject Sustainability en_US
dc.subject Niger en_US
dc.subject Europe, West en_US
dc.title Niger's child survival success, contributing factors and challenges to sustainability: a retrospective analysis en_US
dc.type Article-E en_US
dc.citation.issue 1 en_US
dc.citation.jtitle PLoS ONE en_US
dc.citation.volume 11 en_US
dc.citation.pages e0146945 en_US
dc.identifier.pmid http://www.ncbi.nlm.nih.gov/pubmed/26784993
dc.citation.jabbreviation PLoS ONE en_US


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