Discovering Subgroups of Children With High Mortality in Urban Guinea-Bissau: Exploratory and Validation Cohort Study
BackgroundThe decline in global child mortality is an important public health achievement, yet child mortality remains disproportionally high in many low-income countries like Guinea-Bissau. The persisting high mortality rates necessitate targeted research to identify vulnera...
| Main Authors: | , , , , , , , , , , , , , |
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| Format: | Article |
| Language: | English |
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JMIR Publications
2024-04-01
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| Series: | JMIR Public Health and Surveillance |
| Online Access: | https://publichealth.jmir.org/2024/1/e48060 |
| _version_ | 1797216331278319616 |
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| author | Andreas Rieckmann Sebastian Nielsen Piotr Dworzynski Heresh Amini Søren Wengel Mogensen Isaquel Bartolomeu Silva Angela Y Chang Onyebuchi A Arah Wojciech Samek Naja Hulvej Rod Claus Thorn Ekstrøm Christine Stabell Benn Peter Aaby Ane Bærent Fisker |
| author_facet | Andreas Rieckmann Sebastian Nielsen Piotr Dworzynski Heresh Amini Søren Wengel Mogensen Isaquel Bartolomeu Silva Angela Y Chang Onyebuchi A Arah Wojciech Samek Naja Hulvej Rod Claus Thorn Ekstrøm Christine Stabell Benn Peter Aaby Ane Bærent Fisker |
| author_sort | Andreas Rieckmann |
| collection | DOAJ |
| description |
BackgroundThe decline in global child mortality is an important public health achievement, yet child mortality remains disproportionally high in many low-income countries like Guinea-Bissau. The persisting high mortality rates necessitate targeted research to identify vulnerable subgroups of children and formulate effective interventions.
ObjectiveThis study aimed to discover subgroups of children at an elevated risk of mortality in the urban setting of Bissau, Guinea-Bissau, West Africa. By identifying these groups, we intend to provide a foundation for developing targeted health interventions and inform public health policy.
MethodsWe used data from the health and demographic surveillance site, Bandim Health Project, covering 2003 to 2019. We identified baseline variables recorded before children reached the age of 6 weeks. The focus was on determining factors consistently linked with increased mortality up to the age of 3 years. Our multifaceted methodological approach incorporated spatial analysis for visualizing geographical variations in mortality risk, causally adjusted regression analysis to single out specific risk factors, and machine learning techniques for identifying clusters of multifactorial risk factors. To ensure robustness and validity, we divided the data set temporally, assessing the persistence of identified subgroups over different periods. The reassessment of mortality risk used the targeted maximum likelihood estimation (TMLE) method to achieve more robust causal modeling.
ResultsWe analyzed data from 21,005 children. The mortality risk (6 weeks to 3 years of age) was 5.2% (95% CI 4.8%-5.6%) for children born between 2003 and 2011, and 2.9% (95% CI 2.5%-3.3%) for children born between 2012 and 2016. Our findings revealed 3 distinct high-risk subgroups with notably higher mortality rates, children residing in a specific urban area (adjusted mortality risk difference of 3.4%, 95% CI 0.3%-6.5%), children born to mothers with no prenatal consultations (adjusted mortality risk difference of 5.8%, 95% CI 2.6%-8.9%), and children from polygamous families born during the dry season (adjusted mortality risk difference of 1.7%, 95% CI 0.4%-2.9%). These subgroups, though small, showed a consistent pattern of higher mortality risk over time. Common social and economic factors were linked to a larger share of the total child deaths.
ConclusionsThe study’s results underscore the need for targeted interventions to address the specific risks faced by these identified high-risk subgroups. These interventions should be designed to work to complement broader public health strategies, creating a comprehensive approach to reducing child mortality. We suggest future research that focuses on developing, testing, and comparing targeted intervention strategies unraveling the proposed hypotheses found in this study. The ultimate aim is to optimize health outcomes for all children in high-mortality settings, leveraging a strategic mix of targeted and general health interventions to address the varied needs of different child subgroups. |
| first_indexed | 2024-04-24T11:44:16Z |
| format | Article |
| id | doaj.art-dd0b1dd474624265bdcb4da2c74f7b57 |
| institution | Directory Open Access Journal |
| issn | 2369-2960 |
| language | English |
| last_indexed | 2024-04-24T11:44:16Z |
| publishDate | 2024-04-01 |
| publisher | JMIR Publications |
| record_format | Article |
| series | JMIR Public Health and Surveillance |
| spelling | doaj.art-dd0b1dd474624265bdcb4da2c74f7b572024-04-09T14:30:38ZengJMIR PublicationsJMIR Public Health and Surveillance2369-29602024-04-0110e4806010.2196/48060Discovering Subgroups of Children With High Mortality in Urban Guinea-Bissau: Exploratory and Validation Cohort StudyAndreas Rieckmannhttps://orcid.org/0000-0001-8695-2376Sebastian Nielsenhttps://orcid.org/0000-0003-3384-7489Piotr Dworzynskihttps://orcid.org/0000-0002-6717-8052Heresh Aminihttps://orcid.org/0000-0002-4825-1322Søren Wengel Mogensenhttps://orcid.org/0000-0002-6652-155XIsaquel Bartolomeu Silvahttps://orcid.org/0000-0001-9371-4253Angela Y Changhttps://orcid.org/0000-0003-3947-3588Onyebuchi A Arahhttps://orcid.org/0000-0002-9067-1697Wojciech Samekhttps://orcid.org/0000-0002-6283-3265Naja Hulvej Rodhttps://orcid.org/0000-0002-6400-5105Claus Thorn Ekstrømhttps://orcid.org/0000-0003-1191-373XChristine Stabell Bennhttps://orcid.org/0000-0001-6102-3810Peter Aabyhttps://orcid.org/0000-0001-8331-1389Ane Bærent Fiskerhttps://orcid.org/0000-0002-8521-0992 BackgroundThe decline in global child mortality is an important public health achievement, yet child mortality remains disproportionally high in many low-income countries like Guinea-Bissau. The persisting high mortality rates necessitate targeted research to identify vulnerable subgroups of children and formulate effective interventions. ObjectiveThis study aimed to discover subgroups of children at an elevated risk of mortality in the urban setting of Bissau, Guinea-Bissau, West Africa. By identifying these groups, we intend to provide a foundation for developing targeted health interventions and inform public health policy. MethodsWe used data from the health and demographic surveillance site, Bandim Health Project, covering 2003 to 2019. We identified baseline variables recorded before children reached the age of 6 weeks. The focus was on determining factors consistently linked with increased mortality up to the age of 3 years. Our multifaceted methodological approach incorporated spatial analysis for visualizing geographical variations in mortality risk, causally adjusted regression analysis to single out specific risk factors, and machine learning techniques for identifying clusters of multifactorial risk factors. To ensure robustness and validity, we divided the data set temporally, assessing the persistence of identified subgroups over different periods. The reassessment of mortality risk used the targeted maximum likelihood estimation (TMLE) method to achieve more robust causal modeling. ResultsWe analyzed data from 21,005 children. The mortality risk (6 weeks to 3 years of age) was 5.2% (95% CI 4.8%-5.6%) for children born between 2003 and 2011, and 2.9% (95% CI 2.5%-3.3%) for children born between 2012 and 2016. Our findings revealed 3 distinct high-risk subgroups with notably higher mortality rates, children residing in a specific urban area (adjusted mortality risk difference of 3.4%, 95% CI 0.3%-6.5%), children born to mothers with no prenatal consultations (adjusted mortality risk difference of 5.8%, 95% CI 2.6%-8.9%), and children from polygamous families born during the dry season (adjusted mortality risk difference of 1.7%, 95% CI 0.4%-2.9%). These subgroups, though small, showed a consistent pattern of higher mortality risk over time. Common social and economic factors were linked to a larger share of the total child deaths. ConclusionsThe study’s results underscore the need for targeted interventions to address the specific risks faced by these identified high-risk subgroups. These interventions should be designed to work to complement broader public health strategies, creating a comprehensive approach to reducing child mortality. We suggest future research that focuses on developing, testing, and comparing targeted intervention strategies unraveling the proposed hypotheses found in this study. The ultimate aim is to optimize health outcomes for all children in high-mortality settings, leveraging a strategic mix of targeted and general health interventions to address the varied needs of different child subgroups.https://publichealth.jmir.org/2024/1/e48060 |
| spellingShingle | Andreas Rieckmann Sebastian Nielsen Piotr Dworzynski Heresh Amini Søren Wengel Mogensen Isaquel Bartolomeu Silva Angela Y Chang Onyebuchi A Arah Wojciech Samek Naja Hulvej Rod Claus Thorn Ekstrøm Christine Stabell Benn Peter Aaby Ane Bærent Fisker Discovering Subgroups of Children With High Mortality in Urban Guinea-Bissau: Exploratory and Validation Cohort Study JMIR Public Health and Surveillance |
| title | Discovering Subgroups of Children With High Mortality in Urban Guinea-Bissau: Exploratory and Validation Cohort Study |
| title_full | Discovering Subgroups of Children With High Mortality in Urban Guinea-Bissau: Exploratory and Validation Cohort Study |
| title_fullStr | Discovering Subgroups of Children With High Mortality in Urban Guinea-Bissau: Exploratory and Validation Cohort Study |
| title_full_unstemmed | Discovering Subgroups of Children With High Mortality in Urban Guinea-Bissau: Exploratory and Validation Cohort Study |
| title_short | Discovering Subgroups of Children With High Mortality in Urban Guinea-Bissau: Exploratory and Validation Cohort Study |
| title_sort | discovering subgroups of children with high mortality in urban guinea bissau exploratory and validation cohort study |
| url | https://publichealth.jmir.org/2024/1/e48060 |
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