Gabriel Incoom

Objective Despite the huge financial investment in the free maternal healthcare policy (FMHCP) by the Governments of Ghana and Burkina Faso, no study has quantified the impact of FMHCP on the relative reduction in neonatal and infant mortality rates using a more rigorous matching procedure with the difference in differences (DID) analysis. This study used several rounds of publicly available population-based complex survey data to determine the impact of FMHCP on neonatal and infant mortality rates in these two countries. Design A quasi-experimental study to evaluate the FMHCP implemented in Burkina Faso and Ghana between 2007 and 2014. Setting Demographic and health surveys and maternal health surveys conducted between 2000 and 2014 in Ghana, Burkina Faso, Nigeria and Zambia. Participants Children born 5 years preceding the survey in Ghana, Burkina Faso, Nigeria and Zambia. Primary outcome measures Neonatal and infant mortality rates. Results The Propensity Score Kernel Matching coupled with DID analysis with modified Poisson showed that the FMHCP was associated with a 45% reduction in the risk of neonatal mortality rate in Ghana and Burkina Faso compared with Nigeria and Zambia (adjusted relative risk (aRR)=0.55, 95% CI: 0.40 to 0.76, pConclusion The FMHCP had a significant impact and still remains relevant in achieving Sustainable Development Goal 3 and could provide lessons for other sub-Saharan countries in the design and implementation of a similar policy.

Background The diagnosis and treatment of Depressive Disorders (DD) remain a challenge in low and middle-income countries (LMICs). Identifying the most important correlate of DD would serve as a guide in the design and implementation of targeted intervention in resource-constrained LMICs. This study determined whether there is/are common risk factor(s) of DD across the six LMICs and whether there is a risk factor that can be ranked consistently as the most important predictor of DD in all the six LMICs. We further estimated the impact of DD on the quality of life (QoL).Methods We used data from the World Health Organization Study on Global Ageing and Adult Health. Weighted dominance analysis was performed to determine the most important risk factor of DD. We applied inverse probability weighting Poisson regression adjustment to estimate the impact of DD on QoL for each country and further estimated the overall effect of DD on QoL in the six countries by computing a weighted average of the country-specific estimate using the technique of meta-analysis.Results Among the 58 risk factors investigated, Asthma was the most common and the most important predictor of DD across all six LMICs. DD contributed to a 12% increase in the poor QoL in China, (prevalence difference (PD)=0.12; 95% CI: 0.07-0.18, p<0.001). In India (PD=0.08; 95% CI: 0.04-0.13, p<0.01) and Russian Federation (PD=0.08; 95% CI: 0.01-0.15, p<0.01). Although there was some increase in poor QoL in Mexico, Ghana, and South Africa due to DD, the increase was not statistically significant.Conclusions Asthma is a major contributing factor to the high prevalence of DD among older adults and could have a direct or indirect effect on QoL. We recommend integrated intervention for Asthma patients that incorporates the diagnosis and treatment of DD. Access to quality mental healthcare should be a major government priority in LMICs.

Introduction Despite the decline in infant and under-five mortality rates since the last decade, Ghana did not meet the millennium development goal (MDG) 4 target. To implement effective interventions that could fast-track progress towards achieving the sustainable development goal 3 in 2030, factors contributing to the decline in child mortality throughout the MDG period and which factor(s) has/have been consistent in affecting child survival in the last decade need to be understood. Methods This study used Demographic and Health Surveys (DHS) from 2003, 2008 and 2014 and data from World Bank Development Indicators (2000–2018). We employed modified Poisson with robust SE and multivariate decomposition approach to assess risk factors of child mortality using DHS data from 2003, 2008 and 2014. Penalised regression was used assess the effect of 25 country-level contextual factors on child survival. Results The risk of infant mortality is approximately five times higher among mothers who had multiple births compared with mothers who had single birth over the last decade (adjusted relative risk 4.6, 95% CI 3.2 to 6.6, pConclusions This study found that multiple births and shorter birth spacing are associated with increased risk of infant and under-five deaths over the last decade. Increased in FLFP, and the proportion of children sleeping under bed-net are associated with reduced risk of both infants and under-five deaths.