Countdown researchers published 31 peer-reviewed articles in 2022, advancing knowledge around measurement of reproductive, maternal, newborn, child and adolescent health, including:

• how the COVID-19 pandemic impacted use of health services in Africa;
• global trends in child survival and thriving;
• the relationships between gender, ethnicity and health;
• factors related to coverage of vaccines, family planning, and breastfeeding;
• methodological advances for geospatial and equity analysis

“If there is one theme I had to select from the rich and diverse set of publications of the Countdown collaboration in 2022 I would pick equity,” said to Dr. Cheikh Faye, current director of Countdown to 2030. “Many studies examined inequalities in creative ways with existing data and show how the gaps in achieving the ‘no one left behind’ Sustainable Development Goal agenda.”

COVID-19 Pandemic

Amouzou et al published the results from health facility data in 12 African countries which concluded that the pandemic had negatively impacted inpatient, antenatal and immunization services utilization in 2020; learn more about this study.

Lancet Series: Optimising Child and Adolescent Development

Countdown researchers contributed to a Lancet series which took a look back at child survival over the past 20 years and proposed a future research agenda. Black et al analyzed global trends in child survival, flourishing, and human capital. After analyzing survey data from 105 LMICs plus data from six long-running cohort studies, Victora et al concluded that of early-life poverty has lasting effects on health and human capital in children and adolescents. Based on evidence from the past 20 years, Vavaida et al identified scalable interventions and crucial data gaps for child and adolescent health and development.   Kruk et al reviewed the evidence around health and social systems essential to child health. A commentary by Bhutta et al expressed the need for revitalized global effort around child and adolescent health.  Learn more about this series.

 Sex of “Head of Household”, Women’s Empowerment

Several studies examined the complex relationship between gender roles and health behaviors. Descriptively analyzing survey data from 103 low and middle income countries (LMICs), Saad et al reported that the typology of female-headed households is complex, varying substantially within and between countries. Wendt et al found that in 93 countries the relationship between the sex of the head of household and the coverage of birth registration differed by country, with no association for data pooled across countries. Coll et al found that in most (but not all) of 12 African countries, women who reported higher measures of empowerment were less likely to report approving of female genital mutilation/cutting and less likely to report having a daughter who had undergone this practice.  Across 52 countries, Johns et al  found that the Survey-based Women’s empowerment (SWPER) index showed a positive association with children receiving three doses diptheria-tetanus-pertussis (DPT) vaccine coverage. Similarly, Wendt el at reported that higher empowerment (using a different measurement) was associated with lower levels being unvaccinated.

Vaccines

In addition to the two studies described above, five other studies examined factors associated with childhood vaccine uptake. Utazi et al used geospatial datasets to describe community-level factors associated with vaccine coverage in 9 LMICs, with remote communities being most at risk. Utazi and co-authors also analyzed vaccine coverage at the district level in Nigeria. Providing further context for vaccine coverage, Wendt et al found that children who did not receive DPT immunization were also more likely to be exposed to other markers of deprivation, such as lack of maternal education and lack of improved water and sanitation. Santos et al examined the association between religious affiliation and immunization coverage in 66 LMIS; while important differences existed between countries, pooled data found lower coverage among Muslim children. Cata-Preta et al found that 35 of 64 LMIcs had significant ethnic disparities in childhood immunization coverage.

Breastfeeding

Neves et al explored the wealth-based disparities in early initiation of breast eeding and prelacteal feeding in 76 LMICs and showed wealthier families were more likely to give any prelacteal feeds, especially milk-based ones.  Singh et al found 3.6% prevalence of tobacco use and 2.6% for smokeless tobacco during breastfeeding across 78 LMICs.

Ethnicity and health behaviors

In addition to the study by Cata-Preta described above, three other studies examined the relationship between ethnicity and health. Across 10 Latin American and Caribbean countries, Costa et al found lower health coverage and outcomes among Afrodescedant people for most countries and indicators. Rios-Quituizaca and co-authors found relatively poor coverage of reproductive, maternal, newborn and child health indicators among indigenous women in Ecuador. Likewise, Mexican women living in municipalities with higher indigenous populations had lower coverage of five key women’s health interventions, concluded Armenta-Paulino et al.

Reproductive and maternal health

Five articles explored aspects of reproductive and maternal health. Hellwig et al described the contribution of permanent contraception in meeting the demand for family planning across 105 LMICs.  Hellwig and Barros analyzed policy and social changes associated with universal access to family planning across six countries. Using combined survey and geospatial data from Ghana, Dotse-Gborgbortsi et al  found that long travel times remain a barrier to accessing skilled birth attendance. Based on data from 50 LMICs, Li et al found that women with short height, low socioeconomic status, previous stillbirth, low education, or very short interpregnancy interval were at increased risk of having a stillbirth.   Kinney et al found that good health governance, specific skill development, embedded activities, and valuing social processes contributed to the sustainability of maternal and perinatal death surveillance and response in South Africa.

Methodology for equity and geospatial analyses

Four articles discussed potential solutions to persistent measurement challenges. Tatem et al discussed how advances in the use of computing power, satellite imagery and new forms of digital data can be used to estimate small area population distributions, even when up-to-date population data are unavailable. Dotse-Gborgbortsi et al used routine health data and geospatial data to define natural catchment areas for health facilities, and these estimates seemed more valid than administratively defined areas. Using data from Peru, Ferreira et al demonstrated how model-based geospatial methods could be used to obtain more granular estimates of the composite coverage index that would typically be available from household survey data.  Dirksen et al developed a new survey-based measure of socioeconomic deprivation.