Skip to main content

Advertisement

SpringerLink
Log in

Inequalities in cause-specific mortality in children and adolescents in the Moramanga health survey, Madagascar

  • Original article
  • Published:
International Journal of Public Health

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.

This is a preview of subscription content, log in via an institution to check access.

Access this article

Log in via an institution

Price excludes VAT (USA)
Tax calculation will be finalised during checkout.

Instant access to the full article PDF.

Institutional subscriptions

Fig. 1

Similar content being viewed by others

References

  • Bado AR, Sathiya Susuman A (2016) Women's education and health inequalities in under-five mortality in selected Sub-Saharan African countries, 1990–2015. PLoS ONE 11(7):e0159186

    Article  Google Scholar 

  • Bocquier P, Madise NJ, Zulu EM (1990s) Is there an urban advantage in child survival in sub-saharan Africa? Evidence from 18 countries in the 1990s. Demography 48(2):531–558

    Article  Google Scholar 

  • Caldwell JC (1979) Education as a factor in mortality decline: an examination of Nigerian data. Popul Studies 33(3):395–413

    Article  Google Scholar 

  • Calu Costa J, Wehrmeister FC, Barros AJ, Victora CG (2017) Gender bias in careseeking practices in 57 low- and middle-income countries. J Glob Health 7(1):010418

    Article  Google Scholar 

  • Chiang CL (1984) The life table and its application. Krieger Press, Malabar

    Google Scholar 

  • Clouston S, Kidman R, Palermo T (2014) Social inequalities in vaccination uptake among children aged 0–59 months living in Madagascar: an analysis of demographic and health survey data from 2008 to 2009. Vaccine 32(28):3533–3539

    Article  CAS  Google Scholar 

  • Fuchs R, Pamuk E, Lutz W (2010) Education or wealth: which matters for reducing child mortality in developping countries? Vienna Yearb Popul Res 8:175–199

    Article  Google Scholar 

  • Garchitorena A, Miller AC, Cordier LF et al (2018) Early changes in intervention coverage and mortality rates following the implementation of an integrated health system intervention in Madagascar. BMJ Glob Health 3(3):e000762

    Article  Google Scholar 

  • Gunther I, Harttgen K (2012) Deadly cities? Spatial inequalities in mortality in Sub-Saharan Africa. Popul Develop Rev 38(3):469–486

    Article  Google Scholar 

  • Hlavac M (2018) Stargazer: well-formatted regression and summary statistics tables. R package version 5.2.2

  • United Nations Inter-agency Group for Child Mortality Estimation (2015) Levels and Trends in Child Mortality. Report 2015. UNICEF, UNICEF, WHO, World Bank Group and United Nations

  • United Nations Inter-agency Group for Child Mortality Estimation (2019) Levels and Trends in Child Mortality. Report 2019, UNICEF, WHO, World Bank Group and United Nations

  • Institut National de la Statistique and ICF Macro (2010) Enquête démographique et de Santé de Madagascar 2008–2009. INSTAT et ICF Macro, Antananarivo

    Google Scholar 

  • Institut National des Statistiques (2013) Enquête nationale pour le suivi des objectifs du millénaire pour le développement à Madagascar, INSTAT

  • Jha P (2012) Counting the dead is one of the world's best investments to reduce premature mortality. Hypothesis 10(1):e3

    Article  Google Scholar 

  • Karlsson O, De Neve J-W, Subramanian SV (2018) Weakening association of parental education: analysis of child health outcomes in 43 low- and middle-income countries. Int J Epidemiol 48(1):83–97

    Article  Google Scholar 

  • Lang E, Saint-Firmin P, Olivetti A, Rakotomalala M, Dutta A (2018) Analyse du système de financement de la santé à Madagascar pour guider de futures réformes, notamment la CSU. Palladium, Washington, DC, p 97

    Google Scholar 

  • Lu SSM, Stewart Williams J, Sommar JN (2019) Inequalities in early childhood mortality in Myanmar—Association between parents’ socioeconomic status and early childhood mortality. Global Health Action 12(1):1603516

    Article  Google Scholar 

  • Manus MB, Bloomfield GS, Leonard AS, Guidera LN, Samson DR, Nunn CL (2018) High prevalence of hypertension in an agricultural village in Madagascar. PLoS ONE 13(8):e0201616

    Article  Google Scholar 

  • Masquelier B, Hug L, Sharrow D et al (2018) Global, regional, and national mortality trends in older children and young adolescents (5–14 years) from 1990 to 2016: an analysis of empirical data. Lancet Glob Health 6(10):e1087–e1099

    Article  Google Scholar 

  • Masquelier B, Pison G, Rakotonirina J, Rasoanomenjanahary A (2019) Estimating cause-specific mortality in Madagascar: an evaluation of death notification data from the capital city. Popul Health Metr 17(1):8

    Article  Google Scholar 

  • Ministère de la Santé Publique (2011) Annuaire statistique de la santé. MinSanP, Antananarivo

    Google Scholar 

  • Nichols EK, Byass P, Chandramohan D et al (2018) The WHO 2016 verbal autopsy instrument: an international standard suitable for automated analysis by InterVA, InSiliconVA, and Tariff 2.0. PLoS Med 15(1):e1002486

    Article  Google Scholar 

  • Patton GC, Sawyer SM, Santelli JS et al (2016) Our future: a Lancet commission on adolescent health and wellbeing. Lancet 387(10036):2423–2478

    Article  Google Scholar 

  • R Core Team (2018) R: a language and environment for statistical computing. Vienna, Austria. R Found Stat Comput

  • Randremanana RV, Randrianirina F, Sabatier P (2014) Campylobacter infection in a cohort of rural children in Moramanga, Madagascar. BMC Infect Dis 14:372

    Article  Google Scholar 

  • Ratovoson R, Randremanana R, Rakotomanana F et al (1755i) Cohort profile: Moramanga health survey in urban and rural areas in Madagascar (MHURAM project). Int J Epidemiol 48(6):1754–1755i

    PubMed  Google Scholar 

  • Ratovoson R, Rasetarinera OR, Andrianantenaina I (2015) Hypertension, a neglected disease in rural and urban areas in Moramanga, Madagascar. PLoS ONE 10(9):e0137408

    Article  Google Scholar 

  • Ratsimbasoa A, Ravony H, Vonimpaisomihanta JA et al (2012) Compliance, safety, and effectiveness of fixed-dose artesunate-amodiaquine for presumptive treatment of non-severe malaria in the context of home management of malaria in Madagascar. Am J Trop Med Hyg 86(2):203–210

    Article  CAS  Google Scholar 

  • Remonja CR, Rakotoarison R, Rakotonirainy NH (2017) The importance of public health, poverty reduction programs and women's empowerment in the reduction of child stunting in rural areas of Moramanga and Morondava, Madagascar. PLoS ONE 12(10):e0186493

    Article  Google Scholar 

  • Setel PW, Macfarlane SB, Szreter S (2007) A scandal of invisibility: making everyone count by counting everyone. Lancet 370(9598):1569–1577

    Article  Google Scholar 

  • Swanson D, Siegel JS, Shyrock HS (2004) The methods and materials of demography. Emeral Group Publishing, San Diego

    Google Scholar 

  • Tyler MD, Richards DB, Reske-Nielsen C (2017) The epidemiology of drowning in low- and middle-income countries: a systematic review. BMC Public Health 17(1):413

    Article  Google Scholar 

  • UN Habitat (2012). Madagascar: profil urbain de Moramanga, Nations Unies

  • World Bank (2019) World bank data. 2019, from https://databank.worldbank.org/data/home.aspx

  • World Health Organization (2018) MCEE-WHO methods and data sources for child causes of death 2000–2017. Global health estimates technical paper WHO/HMM/IER/GHE/2018.4, from https://www.who.int/healthinfo/global_burden_disease/estimates/en/index2.html

  • World Health Organization and UNICEF (2019) Madagascar: WHO and UNICEF estimates of immunization coverage: 2018 revision. 2019, from https://www.who.int/immunization/monitoring_surveillance/data/mdg.pdf

Download references

Acknowledgements

We express our gratitude to the Moramanga population, the district health authorities, the mayors, traditional leaders, and chiefs of villages for their continuous cooperation, support and participation in the MHURAM cohort. We acknowledge the support of Geraldine Duthé, Daouda Kassie and Andres Garchitorena. We are also grateful to the following researchers: Rindra Randremanana, Soa Fy Andriamandimby and Fanjasoa Rakotomanana. The authors would like to thank Vincent Richard (project initiator), Patrice Piola (former head of Epidemiology Unit), Christophe Rogier, and André Spiegel, former and current General Directors of the IPM, for their continuous support to the MHURAM cohort. The authors are also grateful for the contributions of the field staff for their important role in maintaining the quality of the collected data as well as a good rapport with the Moramanga population. 

Funding

As of today, the MHURAM cohort has no core funding. It is supported through ongoing specific projects from the Institut Pasteur de Madagascar. The following institutions have provided financial support through various projects: Total Foundation, France Expertise International (Mission n°12INI109), the United States Agency for International Development (Grant AID-687-G-13-00003), the European Commission (EDCTP project: ALERRT (RIA: 2016E-1612) and MTBVAC (RIA: 2016 V-1637)) consortia and the French Institute for Demographic Studies (Institut national d’études démographiques). In addition, the author Rila Ratovoson benefited from the European Union Horizon 2020 Research and Innovation Programme under the Marie Sklodowska-Curie Grant Agreement N°690984 of the DEMOSTAF project.

Author information

Authors and Affiliations

  1. Epidemiology and Clinical Research Unit, Institut Pasteur de Madagascar, Ambatofotsikely Avaradoha, Po Box 1274, 101, Antananarivo, Madagascar

    Rila Ratovoson, Reziky Mangahasimbola & Laurence Baril

  2. UR 15 DEMOSUD, Institut national d’études démographiques, Paris, France

    Rila Ratovoson, Bruno Masquelier & Gilles Pison

  3. Centre de Recherche en Démographie, Université Catholique de Louvain, Louvain-la-Neuve, Belgium

    Bruno Masquelier

  4. Pediatric Unit, District Hospital, Moramanga, Madagascar

    Todisoa Andriatahina

  5. Pediatric and Neonatal Unit, Soavinandriana Hospital, Antananarivo, Madagascar

    Zo Andrianirina

  6. Eco-Anthropology Research Unit, National Museum of Natural History, Paris, France

    Gilles Pison

  7. Institut Pasteur of Cambodia, Phnom Penh, Cambodia

    Laurence Baril

Authors
  1. Rila Ratovoson
    View author publications

    You can also search for this author in PubMed Google Scholar

  2. Bruno Masquelier
    View author publications

    You can also search for this author in PubMed Google Scholar

  3. Todisoa Andriatahina
    View author publications

    You can also search for this author in PubMed Google Scholar

  4. Reziky Mangahasimbola
    View author publications

    You can also search for this author in PubMed Google Scholar

  5. Zo Andrianirina
    View author publications

    You can also search for this author in PubMed Google Scholar

  6. Gilles Pison
    View author publications

    You can also search for this author in PubMed Google Scholar

  7. Laurence Baril
    View author publications

    You can also search for this author in PubMed Google Scholar

Contributions

RR, BM, GP and LB conceived this study. RR and BM analyzed data. TA and ZA determined the causes of death. RM coordinated the data management. RR, BM and LB wrote the first draft of the manuscript. All authors reviewed the manuscript and approved its submission.

Corresponding author

Correspondence to Rila Ratovoson.

Ethics declarations

Conflict of interest

The authors declare that they have no conflict of interest.

Data Availability and materials

The specific customized data used in this study can be made available upon request to interested researchers.

Ethical approval

All procedures performed in studies involving human participants were in accordance with the ethical standards of the national research committee (Comité d’Ethique de la Recherche Biomédicale auprès du Ministère de la Santé Publique) (Approval N°52-CE/MINSAN 02 November 2009 and amendment N°60/MSANP/CE 26 May 2016) and with the 1964 Helsinki declaration and its later amendments or comparable ethical standards.

Informed consent

Informed consent was obtained from the head of the household participants included in the study.

Additional information

Publisher's Note

Springer Nature remains neutral with regard to jurisdictional claims in published maps and institutional affiliations.

Gilles Pison and Laurence Baril authors are joint senior authors on this work.

Electronic supplementary material

Below is the link to the electronic supplementary material.

Supplementary file1 (DOCX 59 kb)

Rights and permissions

Reprints and permissions

About this article

Check for updates. Verify currency and authenticity via CrossMark

Cite this article

Ratovoson, R., Masquelier, B., Andriatahina, T. et al. Inequalities in cause-specific mortality in children and adolescents in the Moramanga health survey, Madagascar. Int J Public Health 65, 781–790 (2020). https://doi.org/10.1007/s00038-020-01409-z

Download citation

  • Received:

  • Revised:

  • Accepted:

  • Published:

  • Issue Date:

  • DOI: https://doi.org/10.1007/s00038-020-01409-z

Keywords

Search

Navigation