2015 signifies the deadline for the Millennium Development Goals (MDGs) which include reduction of the under-five mortality rate by two-thirds, reduction of the maternal mortality ratio by three quarters (both relative to the 1990 figures), and universal access to reproductive health. This issue of the SACEMA Quarterly focuses on various aspects of maternal and child health, and the role of statistical and mathematical modelling techniques in this area of research.
While in the past antiretroviral treatment (ART) for children aged 2-5 years was started only when the CD4 count or CD4% fell below a critical threshold, or a clinically severe event occurred, the new WHO 2013 guidelines recommend immediate treatment initiation regardless of the child’s immune status. Scientific evidence which can guide policies is sparse and conducting trials on the optimal timing of ART initiation is lengthy, costly, and ethically difficult. Instead, routinely captured observational data can be used to answer this question if the statistical analysis makes use of methods which allow a causal interpretation. One of these methods which allows causal interpretations is called “g-computation”.
King James VI of Scotland, I of England, (1567−1625) commissioned the most influential book ever to be written in English. While the language of the King James Bible has done much to define modern English, it can be argued that the Bible also developed, for the first time, the notion of peer-review which is at the very heart of modern science. And one may argue further that the way in which he organized the writing of the new Bible holds lessons for how we should organize our scientific lives today.
To examine the geographic distribution of the prevalence of modern contraceptive use across the provinces of the Democratic Republic of Congo a study was conducted using data from the Demographic Health Survey 2007. In addition we investigated the association between modern contraceptive use, birth intervals and associated risk factors among Congolese women in general and young women in particular. The results show that the use of modern contraceptives is dependent on the province of residence, location of residence, household economic status, level of education and age. The study found that there is evidence for distinct geographic patterns in the use of modern contraceptive in young women and the whole sample of women in the DRC.
Worldwide there are over 2 million third-trimester stillbirths. The lack of attention given to stillbirths may be attributed to the view that stillbirths are not preventable. There is, however, reason to believe that initiating antenatal care (ANC) early may help to prevent stillbirths in term pregnancies by preventing labour complications through early referral to skilled birth attendants, and/or by detecting and managing maternal chronic conditions and infectious diseases. The primary objective of this study was therefore to determine if the timing of the first ANC visit influences the risk of having a stillbirth in a full-term, singleton pregnancy for a population of South African women.
The majority of infant deaths in Kenya are due to poor perinatal outcomes, including early neonatal deaths and stillborn deliveries. This study was conducted to determine whether selected health service delivery indicators differ between primary care facilities which reported adverse maternal and perinatal outcomes in the national health management information system compared to those that did not.
In many developing countries, fertility rates remain high due to lack of access to reproductive health and family planning (FP) services. FP use remains a central intervention in addressing maternal/child morbidity and mortality. Timely monitoring and evaluation (M&E) of FP indicators is therefore critical in addressing maternal and child mortality. Performance Monitoring and Accountability PMA2020 introduces an innovative approach for program M&E. Using this approach a study was conducted to estimate demand/use, supply and access of modern contraception in Kenya.
SACEMA has been involved in the development of a modelling framework for ‘HIV Affected Children’ (children who are not infected themselves, but who have family members, in particular parents, that are infected). The article describes the process, benefits, and challenges of developing this framework that could be used to estimate the magnitude of negative consequences of adult HIV infection for the health and well-being of children.
Currently we are faced with two major threats from viral diseases: Over the last 30 years HIV has spread across the world and continues to plague us. Over the last 3 months the hemorrhagic fever caused by the Ebola virus has spread across West Africa killing thousands of people. If we are to contain HIV in the long-run and Ebola, hopefully, in a much shorter time, this will depend on our ability to understand the nature of the threat and the strategies of the disease causing organisms.
Epidemiological models for describing how a disease spreads through a population have been extremely useful to reduce the number of individuals who get sick or even die from illness. Developing meaningful and useful models is not easy however. In this paper, we first motivate the use of agent-based modelling and secondly, we present common challenges associated with agent-based modelling (of HIV) and our approaches to dealing with them.