Rila Ratovoson1,2, Bruno Masquelier3,4, Todisoa Andriatahina5, Reziky Mangahasimbola6, Zo Andrianirina7, Gilles Pison3,8, Laurence Baril6,9. 1. Epidemiology and Clinical Research Unit, Institut Pasteur de Madagascar, Ambatofotsikely Avaradoha, Po Box 1274, 101, Antananarivo, Madagascar. rilaratov@gmail.com. 2. UR 15 DEMOSUD, Institut national d'études démographiques, Paris, France. rilaratov@gmail.com. 3. UR 15 DEMOSUD, Institut national d'études démographiques, Paris, France. 4. Centre de Recherche en Démographie, Université Catholique de Louvain, Louvain-la-Neuve, Belgium. 5. Pediatric Unit, District Hospital, Moramanga, Madagascar. 6. Epidemiology and Clinical Research Unit, Institut Pasteur de Madagascar, Ambatofotsikely Avaradoha, Po Box 1274, 101, Antananarivo, Madagascar. 7. Pediatric and Neonatal Unit, Soavinandriana Hospital, Antananarivo, Madagascar. 8. Eco-Anthropology Research Unit, National Museum of Natural History, Paris, France. 9. Institut Pasteur of Cambodia, Phnom Penh, Cambodia.
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.
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.
Authors: Emma Hahesy; Ligia Maria Cruz-Espinoza; Gabriel Nyirenda; Birkneh Tilahun Tadesse; Jerome H Kim; Florian Marks; Raphael Rakotozandrindrainy; Wibke Wetzker; Andrea Haselbeck Journal: Front Public Health Date: 2022-09-16