mdgs 4 and 5: what can hdss sites contribute? don de savigny indepth scientific advisory committee
TRANSCRIPT
![Page 1: MDGs 4 and 5: What Can HDSS sites contribute? Don de Savigny INDEPTH Scientific Advisory Committee](https://reader035.vdocument.in/reader035/viewer/2022070413/5697bff51a28abf838cbd88e/html5/thumbnails/1.jpg)
MDGs 4 and 5: What Can HDSS sites contribute?
Don de Savigny
INDEPTH Scientific Advisory Committee
![Page 2: MDGs 4 and 5: What Can HDSS sites contribute? Don de Savigny INDEPTH Scientific Advisory Committee](https://reader035.vdocument.in/reader035/viewer/2022070413/5697bff51a28abf838cbd88e/html5/thumbnails/2.jpg)
Millennium Development
Goals
“Obstacles - are those frightful things you see when you take
your eyes off your goal”
Henry Ford
![Page 3: MDGs 4 and 5: What Can HDSS sites contribute? Don de Savigny INDEPTH Scientific Advisory Committee](https://reader035.vdocument.in/reader035/viewer/2022070413/5697bff51a28abf838cbd88e/html5/thumbnails/3.jpg)
MDG 4Reduce 1990 under-five mortality by 66%
by 2015
MDG 5Reduce 1990 maternal mortality by 75%
by 2015
![Page 4: MDGs 4 and 5: What Can HDSS sites contribute? Don de Savigny INDEPTH Scientific Advisory Committee](https://reader035.vdocument.in/reader035/viewer/2022070413/5697bff51a28abf838cbd88e/html5/thumbnails/4.jpg)
MDG 4How are we doing?
In countries with INDEPTH Sites
![Page 5: MDGs 4 and 5: What Can HDSS sites contribute? Don de Savigny INDEPTH Scientific Advisory Committee](https://reader035.vdocument.in/reader035/viewer/2022070413/5697bff51a28abf838cbd88e/html5/thumbnails/5.jpg)
Under-five mortality decline progress
Rajaratnam et al. Lancet 375: 1988-2008 (2010)
Countries need 4.4% annual declines to achieve MDG4
![Page 6: MDGs 4 and 5: What Can HDSS sites contribute? Don de Savigny INDEPTH Scientific Advisory Committee](https://reader035.vdocument.in/reader035/viewer/2022070413/5697bff51a28abf838cbd88e/html5/thumbnails/6.jpg)
CountryProbability of
acheiving MDG 4Vietnam 84.00%Indonesia 50.00%Bangladesh 43.00%Malawi 19.00%Ethiopia 5.00%Mozambique 4.00%Burkina Faso 0.00%Chad 0.00%Cote d'Ivoire 0.00%Ghana 0.00%Guinea Bissau 0.00%India 0.00%Kenya 0.00%Nigeria 0.00%Papua New Guinea 0.00%Senegal 0.00%South Africa 0.00%Tanzania 0.00%Uganda 0.00%Zambia 0.00%
"Prediction is very difficult,
especially about the future"
Niels Bohr
![Page 7: MDGs 4 and 5: What Can HDSS sites contribute? Don de Savigny INDEPTH Scientific Advisory Committee](https://reader035.vdocument.in/reader035/viewer/2022070413/5697bff51a28abf838cbd88e/html5/thumbnails/7.jpg)
MDG 4 Progress in Asia
Data source: Calculated from UN Inter-agency Group on Child Mortality Estimation Sept 16, 2010
![Page 8: MDGs 4 and 5: What Can HDSS sites contribute? Don de Savigny INDEPTH Scientific Advisory Committee](https://reader035.vdocument.in/reader035/viewer/2022070413/5697bff51a28abf838cbd88e/html5/thumbnails/8.jpg)
MDG 4 Progress in Western & Central Africa
Data source: Calculated from UN Inter-agency Group on Child Mortality Estimation Sept 16, 2010
![Page 9: MDGs 4 and 5: What Can HDSS sites contribute? Don de Savigny INDEPTH Scientific Advisory Committee](https://reader035.vdocument.in/reader035/viewer/2022070413/5697bff51a28abf838cbd88e/html5/thumbnails/9.jpg)
MDG 4 Progress in East & Southern Africa
Data source: Calculated from UN Inter-agency Group on Child Mortality Estimation Sept 16, 2010
![Page 10: MDGs 4 and 5: What Can HDSS sites contribute? Don de Savigny INDEPTH Scientific Advisory Committee](https://reader035.vdocument.in/reader035/viewer/2022070413/5697bff51a28abf838cbd88e/html5/thumbnails/10.jpg)
What does this mean for a typical high mortality INDEPTH country?
Example: Tanzania
![Page 11: MDGs 4 and 5: What Can HDSS sites contribute? Don de Savigny INDEPTH Scientific Advisory Committee](https://reader035.vdocument.in/reader035/viewer/2022070413/5697bff51a28abf838cbd88e/html5/thumbnails/11.jpg)
Tanzania national MDG 4 Progress?
Needed trajectory4.4% annual decline
![Page 12: MDGs 4 and 5: What Can HDSS sites contribute? Don de Savigny INDEPTH Scientific Advisory Committee](https://reader035.vdocument.in/reader035/viewer/2022070413/5697bff51a28abf838cbd88e/html5/thumbnails/12.jpg)
Tanzania national MDG 4 Progress?DHS data 1992 to 1999
Source data: Tanzania DHS 1992, 1996, 1999, Tanzania National Bureau of Statistics & ORC Macro.
Lost decade of the ’90’s
![Page 13: MDGs 4 and 5: What Can HDSS sites contribute? Don de Savigny INDEPTH Scientific Advisory Committee](https://reader035.vdocument.in/reader035/viewer/2022070413/5697bff51a28abf838cbd88e/html5/thumbnails/13.jpg)
Tanzania national MDG 4 Progress?Four DHS surveys 1992 to 2004
Source data: Tanzania DHS 1992, 1996, 1999, 2004, Tanzania National Bureau of Statistics & Macro International.
Significant drop before
GFATM, PEPFAR, PMI.
But still “off track”
![Page 14: MDGs 4 and 5: What Can HDSS sites contribute? Don de Savigny INDEPTH Scientific Advisory Committee](https://reader035.vdocument.in/reader035/viewer/2022070413/5697bff51a28abf838cbd88e/html5/thumbnails/14.jpg)
Tanzania national MDG 4 Progress?Six DHS Surveys 1992 to 2010
Source data: Tanzania DHS All Surveys, Tanzania National Bureau of Statistics & Macro International.
Still dropping,But still
“off track”
![Page 15: MDGs 4 and 5: What Can HDSS sites contribute? Don de Savigny INDEPTH Scientific Advisory Committee](https://reader035.vdocument.in/reader035/viewer/2022070413/5697bff51a28abf838cbd88e/html5/thumbnails/15.jpg)
TZ Under five mortality 1990-2010Three things not normally considered
Source data: Tanzania DHS All Surveys, Tanzania National Bureau of Statistics & Macro International.
1. These are not points but 5 year averages
3. What is hidden in these averages?
2. Estimates should be lagged 2.5 years
![Page 16: MDGs 4 and 5: What Can HDSS sites contribute? Don de Savigny INDEPTH Scientific Advisory Committee](https://reader035.vdocument.in/reader035/viewer/2022070413/5697bff51a28abf838cbd88e/html5/thumbnails/16.jpg)
Under five mortality 1990-2010Accelerating & back on track
Source data: Tanzania DHS 2004, Tanzania MIS 2008, Tanzania National Bureau of Statistics & Macro International.
1990 -1999 1% annual decline
2000 – 2007 10% annual decline
![Page 17: MDGs 4 and 5: What Can HDSS sites contribute? Don de Savigny INDEPTH Scientific Advisory Committee](https://reader035.vdocument.in/reader035/viewer/2022070413/5697bff51a28abf838cbd88e/html5/thumbnails/17.jpg)
TZ under five mortalityUnpacking the 2004 & 2008 DHS by year
Source data: Tanzania DHS 2004, Tanzania AIDS & Malaria Indicator Survey 2008, Tanzania DHS 2010, Tanzania National Bureau of Statistics & Macro International.
Point rate in 2004 is 83 (CI 70.1 - 96.3)A 40% reduction
112
91 8
1
50?
MDG achieved in 2010 ?
Point rate in 2007 is 59(CI 47.1 – 71.1)A 58% reduction
![Page 18: MDGs 4 and 5: What Can HDSS sites contribute? Don de Savigny INDEPTH Scientific Advisory Committee](https://reader035.vdocument.in/reader035/viewer/2022070413/5697bff51a28abf838cbd88e/html5/thumbnails/18.jpg)
NationalMDG 4
Possible
Latest point is within the forecast
![Page 19: MDGs 4 and 5: What Can HDSS sites contribute? Don de Savigny INDEPTH Scientific Advisory Committee](https://reader035.vdocument.in/reader035/viewer/2022070413/5697bff51a28abf838cbd88e/html5/thumbnails/19.jpg)
Under-five mortality Navrongo HDSS
MDG 4 progress and achievement seen first
in the HDSS
67% Reduction: District MDG achieved in 2009
![Page 20: MDGs 4 and 5: What Can HDSS sites contribute? Don de Savigny INDEPTH Scientific Advisory Committee](https://reader035.vdocument.in/reader035/viewer/2022070413/5697bff51a28abf838cbd88e/html5/thumbnails/20.jpg)
“There is compelling evidence that several low-income countries in sub-Saharan Africa are experiencing an accelerated decline in child mortality.
Our descriptive analysis does not explain this. "
![Page 21: MDGs 4 and 5: What Can HDSS sites contribute? Don de Savigny INDEPTH Scientific Advisory Committee](https://reader035.vdocument.in/reader035/viewer/2022070413/5697bff51a28abf838cbd88e/html5/thumbnails/21.jpg)
What a remote rural DSS shows
![Page 22: MDGs 4 and 5: What Can HDSS sites contribute? Don de Savigny INDEPTH Scientific Advisory Committee](https://reader035.vdocument.in/reader035/viewer/2022070413/5697bff51a28abf838cbd88e/html5/thumbnails/22.jpg)
MDG 5 Maternal Mortality 2010
Hogan et al. Lancet 375: 1609-1623 (2010)
![Page 23: MDGs 4 and 5: What Can HDSS sites contribute? Don de Savigny INDEPTH Scientific Advisory Committee](https://reader035.vdocument.in/reader035/viewer/2022070413/5697bff51a28abf838cbd88e/html5/thumbnails/23.jpg)
Maternal mortality:A huge measurement challenge
All of MDG 4
Part of MDG 5
![Page 24: MDGs 4 and 5: What Can HDSS sites contribute? Don de Savigny INDEPTH Scientific Advisory Committee](https://reader035.vdocument.in/reader035/viewer/2022070413/5697bff51a28abf838cbd88e/html5/thumbnails/24.jpg)
HDSS tracking of District MDG 5
MDG 5 progress and achievement seen first
in the HDSS
Key to political and technical inspiration of what works and what
does not
![Page 25: MDGs 4 and 5: What Can HDSS sites contribute? Don de Savigny INDEPTH Scientific Advisory Committee](https://reader035.vdocument.in/reader035/viewer/2022070413/5697bff51a28abf838cbd88e/html5/thumbnails/25.jpg)
MDG 5 & maternal mortality• Patchy and uncertain / unknown progress• HDSS (and DHS) under-powered to detect
annual trends in maternal mortality, but can show plausible trends within five year periods
• HDSS could do a better job now of:– registering pregnancies, documenting obstetric care,
and – explaining determinants of each maternal death --
steering: • health system change• population behaviour change
![Page 26: MDGs 4 and 5: What Can HDSS sites contribute? Don de Savigny INDEPTH Scientific Advisory Committee](https://reader035.vdocument.in/reader035/viewer/2022070413/5697bff51a28abf838cbd88e/html5/thumbnails/26.jpg)
"The trouble with our times is that the future is not what it used to be."
Paul Valery
Telling the future by looking at the past (DHS) assumes that conditions remain constant. This is like driving a car
by looking in the rearview mirror.
With prospective surveillance in HDSS we can do better.
What about SRS with VA?
![Page 27: MDGs 4 and 5: What Can HDSS sites contribute? Don de Savigny INDEPTH Scientific Advisory Committee](https://reader035.vdocument.in/reader035/viewer/2022070413/5697bff51a28abf838cbd88e/html5/thumbnails/27.jpg)
What can INDEPTH HDSS sites do for MDGs?
![Page 28: MDGs 4 and 5: What Can HDSS sites contribute? Don de Savigny INDEPTH Scientific Advisory Committee](https://reader035.vdocument.in/reader035/viewer/2022070413/5697bff51a28abf838cbd88e/html5/thumbnails/28.jpg)
INDEPTH well placed for MDG4But needs expansion in
Central Africa
"The future is here. It's just not widely distributed yet.”
William Gibson
![Page 29: MDGs 4 and 5: What Can HDSS sites contribute? Don de Savigny INDEPTH Scientific Advisory Committee](https://reader035.vdocument.in/reader035/viewer/2022070413/5697bff51a28abf838cbd88e/html5/thumbnails/29.jpg)
The current INDEPTH publication galaxy
Measles
Respiratory
Child mortality
Socioeconomic factors
Maternal health
ITNs
Methods and Surveillance
Tuberculosis
Socioeconomic factors
Maternal health
Malaria
HIV
1,288 Publications
![Page 30: MDGs 4 and 5: What Can HDSS sites contribute? Don de Savigny INDEPTH Scientific Advisory Committee](https://reader035.vdocument.in/reader035/viewer/2022070413/5697bff51a28abf838cbd88e/html5/thumbnails/30.jpg)
0
50
100
150
200
250
300
HIV/AIDS (MDG 6)
Tuberculosis (MDG 6)
Malaria (MDG 6)Maternal Mortality (MDG 5)
Child Mortality (MDG 4)
n = 622 references
INDEPTH HDSS Publications 1990-2009Millennium Development Goals
![Page 31: MDGs 4 and 5: What Can HDSS sites contribute? Don de Savigny INDEPTH Scientific Advisory Committee](https://reader035.vdocument.in/reader035/viewer/2022070413/5697bff51a28abf838cbd88e/html5/thumbnails/31.jpg)
For the MDGs, what INDEPTH HDSSs have now ….
• Research infrastructure in high mortality settings• Pregnancy, birth, mortality, & cause of death surveillance• Ability to evaluate health interventions• Equity disaggregation (MDGs for the poorest?)
Six things INDEPTH can and needs to do better ….
1. Report mortality in real-time over next five years
2. Add district health system observatory function
3. Measure system-level interventions and monitor system change
4. Monitor mortality contextual dynamics
5. Expand in Central Africa
6. Explain reasons for acceleration (or stagnation) in MDGs 4 & 5
![Page 32: MDGs 4 and 5: What Can HDSS sites contribute? Don de Savigny INDEPTH Scientific Advisory Committee](https://reader035.vdocument.in/reader035/viewer/2022070413/5697bff51a28abf838cbd88e/html5/thumbnails/32.jpg)
Don de SavignyINDEPTH Scientific Advisory Committee
&Health Systems Unit
Department of Epidemiology and Public HealthSwiss Tropical and Public Health Institute
University of BaselBasel, Switzerland
Thank you