Amenable mortality in children under 5: an indicator for identifying inequalities in healthcare delivery: a review

Universal health coverage has been proposed as a strategy to improve health in low- and middle-income countries, but this depends on a good provision of health services. Under-5 mortality (U5M) reflects the quality of health services, and its reduction has been a milestone in modern society, reducin...

Full description

Autores:
Navarro-Jimenez, Eduardo
Saturno-Hernández, Pedro
Jaramillo-Mejía, Marta
Clemente-Suárez, Vicente Javier
Tipo de recurso:
Article of investigation
Fecha de publicación:
2024
Institución:
Corporación Universidad de la Costa
Repositorio:
REDICUC - Repositorio CUC
Idioma:
OAI Identifier:
oai:repositorio.cuc.edu.co:11323/13396
Acceso en línea:
https://hdl.handle.net/11323/13396
https://repositorio.cuc.edu.co/
Palabra clave:
Amenable (treatable) mortality
Under-5 mortality
Timely medical care
Healthcare service quality
Universal health coverage
Respiratory disease
Perinatal period
Rights
openAccess
License
Atribución 4.0 Internacional (CC BY 4.0)
id RCUC2_30bcdd2861727f047b906d41e491bf2b
oai_identifier_str oai:repositorio.cuc.edu.co:11323/13396
network_acronym_str RCUC2
network_name_str REDICUC - Repositorio CUC
repository_id_str
dc.title.eng.fl_str_mv Amenable mortality in children under 5: an indicator for identifying inequalities in healthcare delivery: a review
title Amenable mortality in children under 5: an indicator for identifying inequalities in healthcare delivery: a review
spellingShingle Amenable mortality in children under 5: an indicator for identifying inequalities in healthcare delivery: a review
Amenable (treatable) mortality
Under-5 mortality
Timely medical care
Healthcare service quality
Universal health coverage
Respiratory disease
Perinatal period
title_short Amenable mortality in children under 5: an indicator for identifying inequalities in healthcare delivery: a review
title_full Amenable mortality in children under 5: an indicator for identifying inequalities in healthcare delivery: a review
title_fullStr Amenable mortality in children under 5: an indicator for identifying inequalities in healthcare delivery: a review
title_full_unstemmed Amenable mortality in children under 5: an indicator for identifying inequalities in healthcare delivery: a review
title_sort Amenable mortality in children under 5: an indicator for identifying inequalities in healthcare delivery: a review
dc.creator.fl_str_mv Navarro-Jimenez, Eduardo
Saturno-Hernández, Pedro
Jaramillo-Mejía, Marta
Clemente-Suárez, Vicente Javier
dc.contributor.author.none.fl_str_mv Navarro-Jimenez, Eduardo
Saturno-Hernández, Pedro
Jaramillo-Mejía, Marta
Clemente-Suárez, Vicente Javier
dc.subject.proposal.none.fl_str_mv Amenable (treatable) mortality
topic Amenable (treatable) mortality
Under-5 mortality
Timely medical care
Healthcare service quality
Universal health coverage
Respiratory disease
Perinatal period
dc.subject.proposal.eng.fl_str_mv Under-5 mortality
Timely medical care
Healthcare service quality
Universal health coverage
Respiratory disease
Perinatal period
description Universal health coverage has been proposed as a strategy to improve health in low- and middle-income countries, but this depends on a good provision of health services. Under-5 mortality (U5M) reflects the quality of health services, and its reduction has been a milestone in modern society, reducing global mortality rates by more than two-thirds between 1990 and 2020. However, despite these impressive achievements, they are still insufficient, and most deaths in children under 5 can be prevented with the provision of timely and high-quality health services. The aim of this paper is to conduct a literature review on amenable (treatable) mortality in children under 5. This indicator is based on the concept that deaths from certain causes should not occur in the presence of timely and effective medical care. A systematic and exhaustive review of available literature on amenable mortality in children under 5 was conducted using MEDLINE/PubMed, Cochrane CENTRAL, OVID medline, Scielo, Epistemonikos, ScienceDirect, and Google Scholar in both English and Spanish. Both primary sources, such as scientific articles, and secondary sources, such as bibliographic indices, websites, and databases, were used. Results: The main cause of amenable mortality in children under 5 was respiratory disease, and the highest proportion of deaths occurred in the perinatal period. Approximately 65% of avoidable deaths in children under 5 were due to amenable mortality, that is, due to insufficient quality in the provision of health services. Most deaths in all countries and around the world are preventable, primarily through effective and timely access to healthcare (amenable mortality) and the management of public health programs focused on mothers and children (preventable mortality).
publishDate 2024
dc.date.accessioned.none.fl_str_mv 2024-09-26T21:38:04Z
dc.date.available.none.fl_str_mv 2024-09-26T21:38:04Z
dc.date.issued.none.fl_str_mv 2024-06-24
dc.type.none.fl_str_mv Artículo de revista
dc.type.coar.none.fl_str_mv http://purl.org/coar/resource_type/c_2df8fbb1
dc.type.content.none.fl_str_mv Text
dc.type.driver.none.fl_str_mv info:eu-repo/semantics/article
dc.type.redcol.none.fl_str_mv http://purl.org/redcol/resource_type/ART
dc.type.version.none.fl_str_mv info:eu-repo/semantics/publishedVersion
dc.type.coarversion.none.fl_str_mv http://purl.org/coar/version/c_970fb48d4fbd8a85
format http://purl.org/coar/resource_type/c_2df8fbb1
status_str publishedVersion
dc.identifier.citation.none.fl_str_mv Navarro-Jimenez, E.; Saturno-Hernández, P.; Jaramillo-Mejía, M.; Clemente-Suárez, V.J. Amenable Mortality in Children under 5: An Indicator for Identifying Inequalities in Healthcare Delivery: A Review. Children 2024, 11, 764. https://doi.org/10.3390/children11070764
dc.identifier.uri.none.fl_str_mv https://hdl.handle.net/11323/13396
dc.identifier.doi.none.fl_str_mv 10.3390/children11070764
dc.identifier.eissn.none.fl_str_mv 2227-9067
dc.identifier.instname.none.fl_str_mv Corporación Universidad de la Costa
dc.identifier.reponame.none.fl_str_mv REDICUC - Repositorio CUC
dc.identifier.repourl.none.fl_str_mv https://repositorio.cuc.edu.co/
identifier_str_mv Navarro-Jimenez, E.; Saturno-Hernández, P.; Jaramillo-Mejía, M.; Clemente-Suárez, V.J. Amenable Mortality in Children under 5: An Indicator for Identifying Inequalities in Healthcare Delivery: A Review. Children 2024, 11, 764. https://doi.org/10.3390/children11070764
10.3390/children11070764
2227-9067
Corporación Universidad de la Costa
REDICUC - Repositorio CUC
url https://hdl.handle.net/11323/13396
https://repositorio.cuc.edu.co/
dc.relation.references.none.fl_str_mv 1. The World Bank. Universal Health Coverage as a Sustainable Development Goal. 2023. Available online: https://datatopics. worldbank.org/world-development-indicators/stories/universal-health-coverage-as-a-sustainable-development-goal.html (accessed on 15 April 2023).
2. Barredo, L.; Agyepong, I.; Liu, G.; Reddy, S. Objetivo 3—Los Objetivos de Desarrollo Sostenible y un 2030 Más Saludable. Available online: https://www.un.org/es/chronicle/article/objetivo-3-los-objetivos-de-desarrollo-sostenible-y-un-2030-mas-saludable (accessed on 15 April 2023).
3. The Global Heatlh Observatory. Child Mortality and Causes of Death. 2023. Available online: https://www.who.int/data/ gho/data/themes/topics/topic-details/GHO/child-mortality-and-causes-of-death#:~:text=Since1990,theglobalunder,to2.3 millionin2021 (accessed on 15 April 2023).
4. Wang, H.; Abajobir, A.A.; Abate, K.H.; Abbafati, C.; Abbas, K.M.; Abd-Allah, F.; Abera, S.F.; Abraha, H.N.; Abu-Raddad, L.J.; Abu-Rmeileh, N.M.E.; et al. Global, regional, and national under-5 mortality, adult mortality, age-specific mortality, and life expectancy, 1970–2016: A systematic analysis for the Global Burden of Disease Study 2016. Lancet 2017, 390, 1084–1150.
5. Petrou, S.; Fraser, J.; Sidebotham, P. Child death in high-income countries. Lancet 2014, 384, 831–833.
6. World Health Organization. Children: Improving Survival and Well-Being. 2020. Available online: https://www.who.int/es/ news-room/fact-sheets/detail/children-reducing-mortality (accessed on 26 January 2021).
7. Rojas-Botero, M.; Fernández, J.A.; Borrero-Martinez, Y. Trends of inequalities of avoidable mortality among children in Colombia: A group-based trajectory analysis. Res. Sq. 2022.
8. Houweling, T.A.J.; Kunst, A.E. Socio-economic inequalities in childhood mortality in low- and middle-income countries: A review of the international evidence. Br. Med. Bull. 2010, 93, 7–26.
9. Rutstein, D.D.; Berenberg, W.; Chalmers, T.C.; Child, C.G.; Fishman, A.P.; Perrin, E.B.; Feldman, J.J.; Leaverton, P.E.; Lane, J.M.; Sencer, D.J.; et al. Measuring the Quality of Medical Care. N. Engl. J. Med. 1976, 294, 582–588.
10. Cardona, M.; Millward, J.; Gemmill, A.; Jison Yoo, K.; Bishai, D.M. Estimated impact of the 2020 economic downturn on under-5 mortality for 129 countries. PLoS ONE 2022, 17, e0263245.
11. Lozano, R.; Fullman, N.; Mumford, J.E.; Knight, M.; Barthelemy, C.M.; Abbafati; Abbastabar, H.; Abd-Allah, F.; Abdollahi, M.; Abedi, A.; et al. Measuring universal health coverage based on an index of effective coverage of health services in 204 countries and territories, 1990–2019: A systematic analysis for the Global Burden of Disease Study 2019. Lancet 2020, 396, 1250–1284.
12. Tobias, M.; Yeh, L.-C. How much does health care contribute to health gain and to health inequality? Trends in amenable mortality in New Zealand 1981–2004. Aust. N. Z. J. Public Health 2009, 33, 70–78.
13. OECD. Avoidable Mortality: OECD/Eurostat Lists of Preventable and Treatable Causes of Death (October 2021 Version). 2021. Available online: https://www.oecd.org/health/health-systems/Avoidable-mortality-2019-Joint-OECD-Eurostat-Listpreventable-treatable-causes-of-death.pdf (accessed on 30 March 2024).
14. Paho. Potentially Avoidable Premature Mortality: What Is It and Why Is It Relevant? 2021. Available online: https://hia.paho. org/en/potentially-avoidable-premature-mortality-what-it-and-why-it-relevant (accessed on 15 April 2023).
15. Kossarova, L.; Holland, W.; Nolte, E.; McKee, M. Measuring ‘Avoidable’ Mortality: Methodological Note. 2009. Available online: http://eprints.lse.ac.uk/46390/ (accessed on 30 March 2024).
16. Rojas-Botero, M.L.; Borrero-Ramírez, Y.E.; Cáceres-Manrique, F.d.M. Lista de causas de muerte potencialmente evitables en la niñez: Una propuesta para Colombia. Cad. Saude Publica 2020, 36, e00086519.
17. Organización Mundial de la Salud. Mortalidad Prematura Potencialmente Evitable: ¿Qué es y por qué es relevante? 2021. Available online: https://hia.paho.org/es/mppe-por-que-relevante (accessed on 30 March 2024).
18. Kruk, M.E.; Gage, A.D.; Joseph, N.T.; Danaei, G.; García-Saisó, S.; Salomon, J.A. Mortality due to low-quality health systems in the universal health coverage era: A systematic analysis of amenable deaths in 137 countries. Lancet 2018, 392, 2203–2212.
19. Yirgu, R.; Molla, M.; Sibley, L. Determinants of neonatal mortality in rural Northern Ethiopia: A population based nested case control study. PLoS ONE 2017, 12, e0172875.
20. El-Sayed, A.M.; Finkton, D.W.; Paczkowski, M.; Keyes, K.M.; Galea, S. Socioeconomic position, health behaviors, and racial disparities in cause-specific infant mortality in Michigan, USA. Prev. Med. 2015, 76, 8–13.
21. Bayley, O.; Chapota, H.; Kainja, E.; Phiri, T.; Gondwe, C.; King, C.; Nambiar, B.; Mwansambo, C.; Kazembe, P.; Costello, A.; et al. Community-linked maternal death review (CLMDR) to measure and prevent maternal mortality: A pilot study in rural Malawi. BMJ Open 2015, 5, e007753.
22. Bahk, J.; Jung-Choi, K. The Contribution of Avoidable Mortality to the Life Expectancy Gains in Korea between 1998 and 2017. Int. J. Environ. Res. Public Health 2020, 17, 6499.
23. Truche, P.; Botelho, F.; Bowder, A.N.; Levis, A.W.; Greenberg, S.L.M.; Smith, E.; Corlew, S.; Bickler, S.; Rice, H.E.; Ameh, E.A.; et al. Potentially Avertable Child Mortality Associated with Surgical Workforce Scale-up in Low- and Middle-Income Countries: A Global Study. World J. Surg. 2021, 45, 2643–2652.
24. Alvarez, J.-A.; Aburto, J.M.; Canudas-Romo, V. Latin American convergence and divergence towards the mortality profiles of developed countries. Popul. Stud. 2020, 74, 75–92.
25. Aburto, J.M.; Riffe, T.; Canudas-Romo, V. Trends in avoidable mortality over the life course in Mexico, 1990–2015: A cross-sectional demographic analysis. BMJ Open 2018, 8, e022350.
26. Hone, T.; Rasella, D.; Barreto, M.; Atun, R.; Majeed, A.; Millett, C. Large Reductions In Amenable Mortality Associated with Brazil’s Primary Care Expansion And Strong Health Governance. Health Aff. 2017, 36, 149–158.
27. Aquino, R.; de Oliveira, N.F.; Barreto, M.L. Impact of the Family Health Program on Infant Mortality in Brazilian Municipalities. Am. J. Public Health 2009, 99, 87–93.
28. Rasella, D.; Aquino, R.; Barreto, M.L. Impact of the Family Health Program on the quality of vital information and reduction of child unattended deaths in Brazil: An ecological longitudinal study. BMC Public Health 2010, 10, 380.
29. Hone, T.; Rasella, D.; Barreto, M.L.; Majeed, A.; Millett, C. Association between expansion of primary healthcare and racial inequalities in mortality amenable to primary care in Brazil: A national longitudinal analysis. PLoS Med. 2017, 14, e1002306.
30. Pitchon, R.R.; Alvim, C.G.; de Andrade, C.R.; Lasmar, L.M.d.L.B.F.; Cruz, Á.A.; dos Reis, A.P. Asthma mortality in children and adolescents of Brazil over a 20-year period. J. Pediatr. 2020, 96, 432–438.
31. Victora, C.G.; Barros, F.C. Infant mortality due to perinatal causes in Brazil: Trends, regional patterns and possible interventions. Sao Paulo Med. J. 2001, 119, 33–42.
32. de Assis, H.M.; Machado, C.J.; Rodrigues, R.N. Perfis de mortalidade neonatal precoce: Um estudo para uma Maternidade Pública de Belo Horizonte (MG), 2001–2006. Rev. Bras. Epidemiol. 2008, 11, 675–686. Available online: http://www.scielosp.org/ scielo.php?script=sci_arttext&pid=S1415-790X2008000400014&lang=es (accessed on 30 March 2024).
33. Mason, L.; Dellicour, S.; Ter Kuile, F.; Ouma, P.; Phillips-Howard, P.; Were, F.; Laserson, K.; Desai, M. Barriers and facilitators to antenatal and delivery care in western Kenya: A qualitative study. BMC Pregnancy Childbirth 2015, 15, 26.
34. Carshon-Marsh, R.; Aimone, A.; Ansumana, R.; IB, S.; Assalif, A.; Musa, A.; Meh, C.; Smart, F.; Fu, S.H.; Newcombe, L.; et al. Child, maternal, and adult mortality in Sierra Leone: Nationally representative mortality survey 2018–2020. Lancet Glob. Health 2021, 10, e114–e123.
35. Njuma Libwea, J.; Bebey Kingue, S.R.; Taku Ashukem, N.; Kobela, M.; Boula, A.; Sinata, K.-S.; Koki Ndombo, P. Assessing the causes of under-five mortality and proportion associated with pneumococcal diseases in Cameroon. A case-finding retrospective observational study: 2006–2012. PLoS ONE 2019, 14, e0212939.
36. Deribew, A.; Tessema, F.; Girma, B. Determinants of under-five mortality in Gilgel Gibe Field Research Center, Southwest Ethiopia. Ethiop. J. Health Dev. 2007, 21. Available online: https://ejhd.org/index.php/ejhd/article/view/539/400 (accessed on 30 March 2024).
37. Cavallin, F.; Bonasia, T.; Yimer, D.A.; Manenti, F.; Putoto, G.; Trevisanuto, D. Risk factors for mortality among neonates admitted to a special care unit in a low-resource setting. BMC Pregnancy Childbirth 2020, 20, 722.
38. Abd salam El Vilaly, M.; Jones, M.A.; Stankey, M.C.; Seyi-Olajide, J.; Onajin-Obembe, B.; Dasogot, A.; Klug, S.J.; Meara, J.G.; Ameh, E.A.; Osagie, O.O.; et al. Access to paediatric surgery: The geography of inequality in Nigeria. BMJ Glob. Health 2021, 6, e006025.
39. Ahn, B.; Mupere, E.; Irarrázaval, B.; RO, O.; Aanyu-Tukamuhebwa, H.; CB, B.; Gingo, D.; NW, G. Qualitative needs assessment for paediatric emergency care in Kampala, Uganda. Afr. J. Emerg. Med. Rev. Afr. Med. d’urgence 2021, 11, 277–282.
40. Bado, A.R.; Appunni, S.S. Decomposing wealth-based inequalities in under-five mortality in West Africa. Iran. J. Public Health 2015, 44, 920.
41. Sayinzoga, F.; Hirschhorn, L.R.; Ntawukuriryayo, J.T.; Beyer, C.; Donahoe, K.B.; Binagwaho, A. Understanding rapid implementation from discovery to scale: Rwanda’s implementation of rotavirus vaccines and PMTCT in the quest to reduce under-5 mortality. BMC Pediatr. 2024, 23, 649.
42. Dube, L.; Taha, M.; Asefa, H. Determinants of infant mortality in community of Gilgel Gibe Field Research Center, Southwest Ethiopia: A matched case control study. BMC Public Health 2013, 13, 401.
43. Boettiger, D.C.; Treleaven, E.; Kayentao, K.; Guindo, M.; Coumare, M.; Johnson, A.D.; Whidden, C.; Kone, N.; Cisse, A.B.; Padian, N.; et al. Household factors and under-five mortality in Bankass, Mali: Results from a cross-sectional survey. BMC Public Health 2021, 21, 244.
44. Neethling, I.; Groenewald, P.; Schneider, H.; Bradshaw, D. Trends and inequities in amenable mortality between 1997 and 2012 in South Africa. SAMJ South African Med. J. 2019, 109, 597–604.
45. García, P.J.; Williams, A.L.; Carcamo, M.H.; VanderZanden, A.; Binagwaho, A. Lessons from Peru to reduce under-5 mortality: Understanding program implementation and context. BMC Pediatr. 2024, 23, 646.
46. Surenjav, E.; Sovd, T.; Yoshida, Y.; Yamamoto, E.; Reyer, J.A.; Hamajima, N. Trends in amenable mortality rate in the Mongolian population, 2007–2014. Nagoya J. Med. Sci. 2016, 78, 55–68.
47. Varma, G.R.; Kusuma, Y.S.; Babu, B. V Antenatal care service utilization in tribal and rural areas in a South Indian district: An evaluation through mixed methods approach. J. Egypt. Public Health Assoc. 2011, 86, 11–15.
48. Nuruddin, R.; Hadden, W.C.; Petersen, M.R.; Lim, M.K. Does child gender determine household decision for health care in rural Thatta, Pakistan? J. Public Health 2009, 31, 389–397.
49. Habib, O.S.; Warid, S.A. Mortality among children in Basrah. Med. J. Basrah Univ. 2015, 33, 93–99.
50. The World Bank. Life Expectancy at Birth, Total (Years)—Korea, Rep. 2023. Available online: https://data.worldbank.org/ indicator/SP.DYN.LE00.IN?locations=KR (accessed on 21 April 2024).
51. Yang, S.; Khang, Y.-H.; Harper, S.; Davey Smith, G.; Leon, D.A.; Lynch, J. Understanding the Rapid Increase in Life Expectancy in South Korea. Am. J. Public Health 2010, 100, 896–903.
52. Eun, S.J. Avoidable, amenable, and preventable mortalities in South Korea, 2000–2017: Age-period-cohort trends and impact on life expectancy at birth. Soc. Sci. Med. 2019, 237, 112482.
53. Zylbersztejn, A.; Gilbert, R.; Hjern, A.; Hardelid, P. Origins of disparities in preventable child mortality in England and Sweden: A birth cohort study. Arch. Dis. Child. 2020, 105, 53–61.
54. Wall-Wieler, E.; Vinnerljung, B.; Liu, C.; Roos, L.L.; Hjern, A. Avoidable mortality among parents whose children were placed in care in Sweden: A population-based study. J. Epidemiol. Community Health 2018, 72, 1091–1098.
55. Zylbersztejn, A.; Gilbert, R.; Hjern, A.; Hardelid, P. A comparison of child mortality from potentially preventable causes in England and Sweden using birth cohorts from linked administrative datasets. Int. J. Popul. Data Sci. 2018, 3.
56. Rhoades, E.R.; Brenneman, G.; Lyle, J.; Handler, A. Mortality of American Indian and Alaska native infants. Annu. Rev. Public Health 1992, 13, 269–285.
57. Rzo´nca, E.; Swie ´ zewski, S.P.; Gał ˛azkowski, R.; Bie´n, A.; Kosowski, A.; Leszczy´nski, P.; Rzo´nca, P. Neonatal Transport in the ˙ Practice of the Crews of the Polish Medical Air Rescue: A Retrospective Analysis. Int. J. Environ. Res. Public Health 2020, 17, 705.
58. Gianino, M.M.; Lenzi, J.; Bonaudo, M.; Fantini, M.P.; Siliquini, R.; Ricciardi, W.; Damiani, G. Patterns of amenable child mortality over time in 34 member countries of the Organisation for Economic Co-operation and Development (OECD): Evidence from a 15-year time trend analysis (2001–2015). BMJ Open 2019, 9, e027909.
59. Viner, R.M.; Hargreaves, D.S.; Coffey, C.; Patton, G.C.; Wolfe, I. Deaths in young people aged 0–24 years in the UK compared with the EU15+ countries, 1970–2008: Analysis of the WHO Mortality Database. Lancet 2014, 384, 880–892.
60. Ward, J.L.; Wolfe, I.; Viner, R.M. Cause-specific child and adolescent mortality in the UK and EU15+ countries. Arch. Dis. Child. 2020, 105, 1055–1060.
61. Bundey, S.; Alam, H.; Kaur, A.; Mir, S.; Lancashire, R. Why do UK-born Pakistani babies have high perinatal and neonatal mortality rates? Paediatr. Perinat. Epidemiol. 1991, 5, 101–114.
62. Nasi, T.; Vince, J.D.; Mokela, D. Mortality in children admitted to Port Moresby General Hospital: How can we improve our hospital outcomes? P. N. G. Med. J. 2003, 46, 113–124. Available online: http://www.ncbi.nlm.nih.gov/pubmed/16454393 (accessed on 30 March 2024).
63. Korda, R.J.; Butler, J.R.G. Effect of healthcare on mortality: Trends in avoidable mortality in Australia and comparisons with Western Europe. Public Health 2006, 120, 95–105.
64. Delavar, A.; Barnes, J.M.; Wang, X.; Johnson, K.J. Associations Between Race/Ethnicity and US Childhood and Adolescent Cancer Survival by Treatment Amenability. JAMA Pediatr. 2020, 174, 428.
65. Knaul, F.M.; Arreola-Ornelas, H.; Rodriguez, N.M.; Méndez-Carniado, O.; Kwete, X.J.; Puentes-Rosas, E.; Bhadelia, A. Avoidable Mortality: The Core of the Global Cancer Divide. J. Glob. Oncol. 2018, 4, 1–12.
66. Smith, G.S.; Fleming, M.; Kinnear, D.; Henderson, A.; Pell, J.P.; Melville, C.; Cooper, S.-A. Rates and causes of mortality among children and young people with and without intellectual disabilities in Scotland: A record linkage cohort study of 796 190 school children. BMJ Open 2020, 10, e034077.
67. Hiam, L.; Steele, S.; McKee, M. Creating a ‘hostile environment for migrants’: The British government’s use of health service data to restrict immigration is a very bad idea. Health Econ. Policy Law 2018, 13, 107–117.
68. Silwal, P.; Lopez, M.I.; Pledger, M.; Cumming, J.; Jeffreys, M. Association between enrolment with a Primary Health Care provider and amenable mortality: A national population-based analysis in Aotearoa New Zealand. PLoS ONE 2023, 18, e0281163.
69. Verstraeten, S.P.A.; van Oers, H.A.M.; Mackenbach, J.P. Contribution of amenable mortality to life expectancy differences between the Dutch Caribbean islands of Aruba and Curaçao and the Netherlands. Rev. Panam. Salud Pública 2020, 44, e38.
70. Roberton, T.; Carter, E.D.; Chou, V.B.; Stegmuller, A.R.; Jackson, B.D.; Tam, Y.; Sawadogo-Lewis, T.; Walker, N. Early estimates of the indirect effects of the COVID-19 pandemic on maternal and child mortality in low-income and middle-income countries: A modelling study. Lancet Glob. Health 2020, 8, e901–e908.
71. Rojas-Botero, M.L.; Borrero Ramírez, Y.E.; Cáceres-Manrique, F. de M. Muertes evitables en la niñez: Un análisis por departamento y municipio en Colombia (2000–2018). Rev. Panam. Salud Pública 2021, 46, 1
72. Castelli, A.; Nizalova, O. Avoidable Mortality: What It Means and How It Is Measured. York. 2011. Available online: https: //ideas.repec.org/p/chy/respap/63cherp.html (accessed on 30 March 2024).
73. Nolte, E.; Mckee, M. Does Health Care Save Lives? Avoidable Mortality Revisited. Nuffield Trust: London, UK, 2004.
74. Basera, T.J.; Schmitz, K.; Price, J.; Willcox, M.; Bosire, E.N.; Ajuwon, A.; Mbule, M.; Ronan, A.; Burtt, F.; Scheepers, E.; et al. Community surveillance and response to maternal and child deaths in low- and middle-income countries: A scoping review. PLoS ONE 2021, 16, e0248143.
75. Kazembe, L.; Clarke, A.; Kandala, N.-B. Childhood mortality in sub-Saharan Africa: Cross-sectional insight into small-scale geographical inequalities from Census data. BMJ Open 2012, 2, e001421.
76. Quentin, W.; Abosede, O.; Aka, J.; Akweongo, P.; Dinard, K.; Ezeh, A.; Hamed, R.; Kayembe, P.K.; Mitike, G.; Mtei, G.; et al. Inequalities in child mortality in ten major African cities. BMC Med. 2014, 12, 95.
77. Rajan, S.; Ricciardi, W.; McKee, M.; McKee, M. The SDGs and health systems: The last step on the long and unfinished journey to universal health care? Eur. J. Public Health 2020, 30, I28–I31.
78. Clemente-Suárez, V.J.; Rodriguez-Besteiro, S.; Cabello-Eras, J.J.; Bustamante-Sanchez, A.; Navarro-Jiménez, E.; Donoso-Gonzalez, M.; Beltrán-Velasco, A.I.; Tornero-Aguilera, J.F. Sustainable Development Goals in the COVID-19 Pandemic: A Narrative Review. Sustainability 2022, 14, 7726.
79. Martín-Rodríguez, A.; Tornero-Aguilera, J.F.; López-Pérez, P.J.; Clemente-Suárez, V.J. Dietary patterns of adolescent students during the COVID-19 pandemic lockdown. Physiol. Behav. 2022, 249, 113764.
80. Clemente-Suárez, V.J.; Beltrán-Velasco, A.I.; Ramos-Campo, D.J.; Mielgo-Ayuso, J.; Nikolaidis, P.A.; Belando, N.; Tornero-Aguilera, J.F. Physical activity and COVID-19. The basis for an efficient intervention in times of COVID-19 pandemic. Physiol. Behav. 2022, 244, 113667.
81. Martín-Rodríguez, A.; Bustamante-Sánchez, Á.; Martínez-Guardado, I.; Navarro-Jiménez, E.; Plata-SanJuan, E.; Tornero-Aguilera, J.F.; Clemente-Suárez, V.J. Infancy Dietary Patterns, Development, and Health: An Extensive Narrative Review. Children 2022, 9, 1072.
82. Martín-Rodríguez, A.; Tornero-Aguilera, J.F.; López-Pérez, P.J.; Clemente-Suárez, V.J. Gender Differences in Nutritional, Odontological and Psychological Patterns of Adolescent Students during COVID-19 Pandemic. Appl. Sci. 2021, 11, 8499.
83. Bajekal, M.; Scholes, S.; Love, H.; Hawkins, N.; O’flaherty, M.; Raine, R.; Capewell, S. Analysing Recent Socioeconomic Trends in Coronary Heart Disease Mortality in England, 2000–2007: A Population Modelling Study. PLoS Med. 2012, 9, e1001237.
84. Nolte, E. Measuring the health of nations: Analysis of mortality amenable to health care. BMJ 2003, 327, 1129.
dc.relation.citationendpage.none.fl_str_mv 30
dc.relation.citationstartpage.none.fl_str_mv 1
dc.relation.citationissue.none.fl_str_mv 7
dc.relation.citationvolume.none.fl_str_mv 11
dc.rights.none.fl_str_mv © 2024 by the authors. Licensee MDPI, Basel, Switzerland.
dc.rights.license.none.fl_str_mv Atribución 4.0 Internacional (CC BY 4.0)
dc.rights.uri.none.fl_str_mv https://creativecommons.org/licenses/by/4.0/
dc.rights.accessrights.none.fl_str_mv info:eu-repo/semantics/openAccess
dc.rights.coar.none.fl_str_mv http://purl.org/coar/access_right/c_abf2
rights_invalid_str_mv Atribución 4.0 Internacional (CC BY 4.0)
© 2024 by the authors. Licensee MDPI, Basel, Switzerland.
https://creativecommons.org/licenses/by/4.0/
http://purl.org/coar/access_right/c_abf2
eu_rights_str_mv openAccess
dc.format.extent.none.fl_str_mv 30 páginas
dc.format.mimetype.none.fl_str_mv application/pdf
dc.publisher.none.fl_str_mv Multidisciplinary Digital Publishing Institute (MDPI)
dc.publisher.place.none.fl_str_mv Switzerland
publisher.none.fl_str_mv Multidisciplinary Digital Publishing Institute (MDPI)
dc.source.none.fl_str_mv https://www.mdpi.com/2227-9067/11/7/764
institution Corporación Universidad de la Costa
bitstream.url.fl_str_mv https://repositorio.cuc.edu.co/bitstreams/c394e75d-09ec-4097-adf2-6ac062c9b6c5/download
https://repositorio.cuc.edu.co/bitstreams/fc80483b-657a-4985-a2d2-fde202360fe4/download
https://repositorio.cuc.edu.co/bitstreams/90fe70b9-1834-48d5-ab66-bb2a49dd9dc2/download
https://repositorio.cuc.edu.co/bitstreams/310cb853-9cb8-4e87-a8f5-272ea2c1312c/download
bitstream.checksum.fl_str_mv e9e3b8994ae57fb0abd2ba002edde8b3
73a5432e0b76442b22b026844140d683
a4c2591d976fe77cce7f03f324d64f07
b58fdf3098007b2d99bd2dcc91e3c3c4
bitstream.checksumAlgorithm.fl_str_mv MD5
MD5
MD5
MD5
repository.name.fl_str_mv Repositorio de la Universidad de la Costa CUC
repository.mail.fl_str_mv repdigital@cuc.edu.co
_version_ 1828166841520881664
spelling Atribución 4.0 Internacional (CC BY 4.0)© 2024 by the authors. Licensee MDPI, Basel, Switzerland.https://creativecommons.org/licenses/by/4.0/info:eu-repo/semantics/openAccesshttp://purl.org/coar/access_right/c_abf2Navarro-Jimenez, EduardoSaturno-Hernández, PedroJaramillo-Mejía, MartaClemente-Suárez, Vicente Javier2024-09-26T21:38:04Z2024-09-26T21:38:04Z2024-06-24Navarro-Jimenez, E.; Saturno-Hernández, P.; Jaramillo-Mejía, M.; Clemente-Suárez, V.J. Amenable Mortality in Children under 5: An Indicator for Identifying Inequalities in Healthcare Delivery: A Review. Children 2024, 11, 764. https://doi.org/10.3390/children11070764https://hdl.handle.net/11323/1339610.3390/children110707642227-9067Corporación Universidad de la CostaREDICUC - Repositorio CUChttps://repositorio.cuc.edu.co/Universal health coverage has been proposed as a strategy to improve health in low- and middle-income countries, but this depends on a good provision of health services. Under-5 mortality (U5M) reflects the quality of health services, and its reduction has been a milestone in modern society, reducing global mortality rates by more than two-thirds between 1990 and 2020. However, despite these impressive achievements, they are still insufficient, and most deaths in children under 5 can be prevented with the provision of timely and high-quality health services. The aim of this paper is to conduct a literature review on amenable (treatable) mortality in children under 5. This indicator is based on the concept that deaths from certain causes should not occur in the presence of timely and effective medical care. A systematic and exhaustive review of available literature on amenable mortality in children under 5 was conducted using MEDLINE/PubMed, Cochrane CENTRAL, OVID medline, Scielo, Epistemonikos, ScienceDirect, and Google Scholar in both English and Spanish. Both primary sources, such as scientific articles, and secondary sources, such as bibliographic indices, websites, and databases, were used. Results: The main cause of amenable mortality in children under 5 was respiratory disease, and the highest proportion of deaths occurred in the perinatal period. Approximately 65% of avoidable deaths in children under 5 were due to amenable mortality, that is, due to insufficient quality in the provision of health services. Most deaths in all countries and around the world are preventable, primarily through effective and timely access to healthcare (amenable mortality) and the management of public health programs focused on mothers and children (preventable mortality).30 páginasapplication/pdfMultidisciplinary Digital Publishing Institute (MDPI)Switzerlandhttps://www.mdpi.com/2227-9067/11/7/764Amenable mortality in children under 5: an indicator for identifying inequalities in healthcare delivery: a reviewArtículo de revistahttp://purl.org/coar/resource_type/c_2df8fbb1Textinfo:eu-repo/semantics/articlehttp://purl.org/redcol/resource_type/ARTinfo:eu-repo/semantics/publishedVersionhttp://purl.org/coar/version/c_970fb48d4fbd8a851. The World Bank. Universal Health Coverage as a Sustainable Development Goal. 2023. Available online: https://datatopics. worldbank.org/world-development-indicators/stories/universal-health-coverage-as-a-sustainable-development-goal.html (accessed on 15 April 2023).2. Barredo, L.; Agyepong, I.; Liu, G.; Reddy, S. Objetivo 3—Los Objetivos de Desarrollo Sostenible y un 2030 Más Saludable. Available online: https://www.un.org/es/chronicle/article/objetivo-3-los-objetivos-de-desarrollo-sostenible-y-un-2030-mas-saludable (accessed on 15 April 2023).3. The Global Heatlh Observatory. Child Mortality and Causes of Death. 2023. Available online: https://www.who.int/data/ gho/data/themes/topics/topic-details/GHO/child-mortality-and-causes-of-death#:~:text=Since1990,theglobalunder,to2.3 millionin2021 (accessed on 15 April 2023).4. Wang, H.; Abajobir, A.A.; Abate, K.H.; Abbafati, C.; Abbas, K.M.; Abd-Allah, F.; Abera, S.F.; Abraha, H.N.; Abu-Raddad, L.J.; Abu-Rmeileh, N.M.E.; et al. Global, regional, and national under-5 mortality, adult mortality, age-specific mortality, and life expectancy, 1970–2016: A systematic analysis for the Global Burden of Disease Study 2016. Lancet 2017, 390, 1084–1150.5. Petrou, S.; Fraser, J.; Sidebotham, P. Child death in high-income countries. Lancet 2014, 384, 831–833.6. World Health Organization. Children: Improving Survival and Well-Being. 2020. Available online: https://www.who.int/es/ news-room/fact-sheets/detail/children-reducing-mortality (accessed on 26 January 2021).7. Rojas-Botero, M.; Fernández, J.A.; Borrero-Martinez, Y. Trends of inequalities of avoidable mortality among children in Colombia: A group-based trajectory analysis. Res. Sq. 2022.8. Houweling, T.A.J.; Kunst, A.E. Socio-economic inequalities in childhood mortality in low- and middle-income countries: A review of the international evidence. Br. Med. Bull. 2010, 93, 7–26.9. Rutstein, D.D.; Berenberg, W.; Chalmers, T.C.; Child, C.G.; Fishman, A.P.; Perrin, E.B.; Feldman, J.J.; Leaverton, P.E.; Lane, J.M.; Sencer, D.J.; et al. Measuring the Quality of Medical Care. N. Engl. J. Med. 1976, 294, 582–588.10. Cardona, M.; Millward, J.; Gemmill, A.; Jison Yoo, K.; Bishai, D.M. Estimated impact of the 2020 economic downturn on under-5 mortality for 129 countries. PLoS ONE 2022, 17, e0263245.11. Lozano, R.; Fullman, N.; Mumford, J.E.; Knight, M.; Barthelemy, C.M.; Abbafati; Abbastabar, H.; Abd-Allah, F.; Abdollahi, M.; Abedi, A.; et al. Measuring universal health coverage based on an index of effective coverage of health services in 204 countries and territories, 1990–2019: A systematic analysis for the Global Burden of Disease Study 2019. Lancet 2020, 396, 1250–1284.12. Tobias, M.; Yeh, L.-C. How much does health care contribute to health gain and to health inequality? Trends in amenable mortality in New Zealand 1981–2004. Aust. N. Z. J. Public Health 2009, 33, 70–78.13. OECD. Avoidable Mortality: OECD/Eurostat Lists of Preventable and Treatable Causes of Death (October 2021 Version). 2021. Available online: https://www.oecd.org/health/health-systems/Avoidable-mortality-2019-Joint-OECD-Eurostat-Listpreventable-treatable-causes-of-death.pdf (accessed on 30 March 2024).14. Paho. Potentially Avoidable Premature Mortality: What Is It and Why Is It Relevant? 2021. Available online: https://hia.paho. org/en/potentially-avoidable-premature-mortality-what-it-and-why-it-relevant (accessed on 15 April 2023).15. Kossarova, L.; Holland, W.; Nolte, E.; McKee, M. Measuring ‘Avoidable’ Mortality: Methodological Note. 2009. Available online: http://eprints.lse.ac.uk/46390/ (accessed on 30 March 2024).16. Rojas-Botero, M.L.; Borrero-Ramírez, Y.E.; Cáceres-Manrique, F.d.M. Lista de causas de muerte potencialmente evitables en la niñez: Una propuesta para Colombia. Cad. Saude Publica 2020, 36, e00086519.17. Organización Mundial de la Salud. Mortalidad Prematura Potencialmente Evitable: ¿Qué es y por qué es relevante? 2021. Available online: https://hia.paho.org/es/mppe-por-que-relevante (accessed on 30 March 2024).18. Kruk, M.E.; Gage, A.D.; Joseph, N.T.; Danaei, G.; García-Saisó, S.; Salomon, J.A. Mortality due to low-quality health systems in the universal health coverage era: A systematic analysis of amenable deaths in 137 countries. Lancet 2018, 392, 2203–2212.19. Yirgu, R.; Molla, M.; Sibley, L. Determinants of neonatal mortality in rural Northern Ethiopia: A population based nested case control study. PLoS ONE 2017, 12, e0172875.20. El-Sayed, A.M.; Finkton, D.W.; Paczkowski, M.; Keyes, K.M.; Galea, S. Socioeconomic position, health behaviors, and racial disparities in cause-specific infant mortality in Michigan, USA. Prev. Med. 2015, 76, 8–13.21. Bayley, O.; Chapota, H.; Kainja, E.; Phiri, T.; Gondwe, C.; King, C.; Nambiar, B.; Mwansambo, C.; Kazembe, P.; Costello, A.; et al. Community-linked maternal death review (CLMDR) to measure and prevent maternal mortality: A pilot study in rural Malawi. BMJ Open 2015, 5, e007753.22. Bahk, J.; Jung-Choi, K. The Contribution of Avoidable Mortality to the Life Expectancy Gains in Korea between 1998 and 2017. Int. J. Environ. Res. Public Health 2020, 17, 6499.23. Truche, P.; Botelho, F.; Bowder, A.N.; Levis, A.W.; Greenberg, S.L.M.; Smith, E.; Corlew, S.; Bickler, S.; Rice, H.E.; Ameh, E.A.; et al. Potentially Avertable Child Mortality Associated with Surgical Workforce Scale-up in Low- and Middle-Income Countries: A Global Study. World J. Surg. 2021, 45, 2643–2652.24. Alvarez, J.-A.; Aburto, J.M.; Canudas-Romo, V. Latin American convergence and divergence towards the mortality profiles of developed countries. Popul. Stud. 2020, 74, 75–92.25. Aburto, J.M.; Riffe, T.; Canudas-Romo, V. Trends in avoidable mortality over the life course in Mexico, 1990–2015: A cross-sectional demographic analysis. BMJ Open 2018, 8, e022350.26. Hone, T.; Rasella, D.; Barreto, M.; Atun, R.; Majeed, A.; Millett, C. Large Reductions In Amenable Mortality Associated with Brazil’s Primary Care Expansion And Strong Health Governance. Health Aff. 2017, 36, 149–158.27. Aquino, R.; de Oliveira, N.F.; Barreto, M.L. Impact of the Family Health Program on Infant Mortality in Brazilian Municipalities. Am. J. Public Health 2009, 99, 87–93.28. Rasella, D.; Aquino, R.; Barreto, M.L. Impact of the Family Health Program on the quality of vital information and reduction of child unattended deaths in Brazil: An ecological longitudinal study. BMC Public Health 2010, 10, 380.29. Hone, T.; Rasella, D.; Barreto, M.L.; Majeed, A.; Millett, C. Association between expansion of primary healthcare and racial inequalities in mortality amenable to primary care in Brazil: A national longitudinal analysis. PLoS Med. 2017, 14, e1002306.30. Pitchon, R.R.; Alvim, C.G.; de Andrade, C.R.; Lasmar, L.M.d.L.B.F.; Cruz, Á.A.; dos Reis, A.P. Asthma mortality in children and adolescents of Brazil over a 20-year period. J. Pediatr. 2020, 96, 432–438.31. Victora, C.G.; Barros, F.C. Infant mortality due to perinatal causes in Brazil: Trends, regional patterns and possible interventions. Sao Paulo Med. J. 2001, 119, 33–42.32. de Assis, H.M.; Machado, C.J.; Rodrigues, R.N. Perfis de mortalidade neonatal precoce: Um estudo para uma Maternidade Pública de Belo Horizonte (MG), 2001–2006. Rev. Bras. Epidemiol. 2008, 11, 675–686. Available online: http://www.scielosp.org/ scielo.php?script=sci_arttext&pid=S1415-790X2008000400014&lang=es (accessed on 30 March 2024).33. Mason, L.; Dellicour, S.; Ter Kuile, F.; Ouma, P.; Phillips-Howard, P.; Were, F.; Laserson, K.; Desai, M. Barriers and facilitators to antenatal and delivery care in western Kenya: A qualitative study. BMC Pregnancy Childbirth 2015, 15, 26.34. Carshon-Marsh, R.; Aimone, A.; Ansumana, R.; IB, S.; Assalif, A.; Musa, A.; Meh, C.; Smart, F.; Fu, S.H.; Newcombe, L.; et al. Child, maternal, and adult mortality in Sierra Leone: Nationally representative mortality survey 2018–2020. Lancet Glob. Health 2021, 10, e114–e123.35. Njuma Libwea, J.; Bebey Kingue, S.R.; Taku Ashukem, N.; Kobela, M.; Boula, A.; Sinata, K.-S.; Koki Ndombo, P. Assessing the causes of under-five mortality and proportion associated with pneumococcal diseases in Cameroon. A case-finding retrospective observational study: 2006–2012. PLoS ONE 2019, 14, e0212939.36. Deribew, A.; Tessema, F.; Girma, B. Determinants of under-five mortality in Gilgel Gibe Field Research Center, Southwest Ethiopia. Ethiop. J. Health Dev. 2007, 21. Available online: https://ejhd.org/index.php/ejhd/article/view/539/400 (accessed on 30 March 2024).37. Cavallin, F.; Bonasia, T.; Yimer, D.A.; Manenti, F.; Putoto, G.; Trevisanuto, D. Risk factors for mortality among neonates admitted to a special care unit in a low-resource setting. BMC Pregnancy Childbirth 2020, 20, 722.38. Abd salam El Vilaly, M.; Jones, M.A.; Stankey, M.C.; Seyi-Olajide, J.; Onajin-Obembe, B.; Dasogot, A.; Klug, S.J.; Meara, J.G.; Ameh, E.A.; Osagie, O.O.; et al. Access to paediatric surgery: The geography of inequality in Nigeria. BMJ Glob. Health 2021, 6, e006025.39. Ahn, B.; Mupere, E.; Irarrázaval, B.; RO, O.; Aanyu-Tukamuhebwa, H.; CB, B.; Gingo, D.; NW, G. Qualitative needs assessment for paediatric emergency care in Kampala, Uganda. Afr. J. Emerg. Med. Rev. Afr. Med. d’urgence 2021, 11, 277–282.40. Bado, A.R.; Appunni, S.S. Decomposing wealth-based inequalities in under-five mortality in West Africa. Iran. J. Public Health 2015, 44, 920.41. Sayinzoga, F.; Hirschhorn, L.R.; Ntawukuriryayo, J.T.; Beyer, C.; Donahoe, K.B.; Binagwaho, A. Understanding rapid implementation from discovery to scale: Rwanda’s implementation of rotavirus vaccines and PMTCT in the quest to reduce under-5 mortality. BMC Pediatr. 2024, 23, 649.42. Dube, L.; Taha, M.; Asefa, H. Determinants of infant mortality in community of Gilgel Gibe Field Research Center, Southwest Ethiopia: A matched case control study. BMC Public Health 2013, 13, 401.43. Boettiger, D.C.; Treleaven, E.; Kayentao, K.; Guindo, M.; Coumare, M.; Johnson, A.D.; Whidden, C.; Kone, N.; Cisse, A.B.; Padian, N.; et al. Household factors and under-five mortality in Bankass, Mali: Results from a cross-sectional survey. BMC Public Health 2021, 21, 244.44. Neethling, I.; Groenewald, P.; Schneider, H.; Bradshaw, D. Trends and inequities in amenable mortality between 1997 and 2012 in South Africa. SAMJ South African Med. J. 2019, 109, 597–604.45. García, P.J.; Williams, A.L.; Carcamo, M.H.; VanderZanden, A.; Binagwaho, A. Lessons from Peru to reduce under-5 mortality: Understanding program implementation and context. BMC Pediatr. 2024, 23, 646.46. Surenjav, E.; Sovd, T.; Yoshida, Y.; Yamamoto, E.; Reyer, J.A.; Hamajima, N. Trends in amenable mortality rate in the Mongolian population, 2007–2014. Nagoya J. Med. Sci. 2016, 78, 55–68.47. Varma, G.R.; Kusuma, Y.S.; Babu, B. V Antenatal care service utilization in tribal and rural areas in a South Indian district: An evaluation through mixed methods approach. J. Egypt. Public Health Assoc. 2011, 86, 11–15.48. Nuruddin, R.; Hadden, W.C.; Petersen, M.R.; Lim, M.K. Does child gender determine household decision for health care in rural Thatta, Pakistan? J. Public Health 2009, 31, 389–397.49. Habib, O.S.; Warid, S.A. Mortality among children in Basrah. Med. J. Basrah Univ. 2015, 33, 93–99.50. The World Bank. Life Expectancy at Birth, Total (Years)—Korea, Rep. 2023. Available online: https://data.worldbank.org/ indicator/SP.DYN.LE00.IN?locations=KR (accessed on 21 April 2024).51. Yang, S.; Khang, Y.-H.; Harper, S.; Davey Smith, G.; Leon, D.A.; Lynch, J. Understanding the Rapid Increase in Life Expectancy in South Korea. Am. J. Public Health 2010, 100, 896–903.52. Eun, S.J. Avoidable, amenable, and preventable mortalities in South Korea, 2000–2017: Age-period-cohort trends and impact on life expectancy at birth. Soc. Sci. Med. 2019, 237, 112482.53. Zylbersztejn, A.; Gilbert, R.; Hjern, A.; Hardelid, P. Origins of disparities in preventable child mortality in England and Sweden: A birth cohort study. Arch. Dis. Child. 2020, 105, 53–61.54. Wall-Wieler, E.; Vinnerljung, B.; Liu, C.; Roos, L.L.; Hjern, A. Avoidable mortality among parents whose children were placed in care in Sweden: A population-based study. J. Epidemiol. Community Health 2018, 72, 1091–1098.55. Zylbersztejn, A.; Gilbert, R.; Hjern, A.; Hardelid, P. A comparison of child mortality from potentially preventable causes in England and Sweden using birth cohorts from linked administrative datasets. Int. J. Popul. Data Sci. 2018, 3.56. Rhoades, E.R.; Brenneman, G.; Lyle, J.; Handler, A. Mortality of American Indian and Alaska native infants. Annu. Rev. Public Health 1992, 13, 269–285.57. Rzo´nca, E.; Swie ´ zewski, S.P.; Gał ˛azkowski, R.; Bie´n, A.; Kosowski, A.; Leszczy´nski, P.; Rzo´nca, P. Neonatal Transport in the ˙ Practice of the Crews of the Polish Medical Air Rescue: A Retrospective Analysis. Int. J. Environ. Res. Public Health 2020, 17, 705.58. Gianino, M.M.; Lenzi, J.; Bonaudo, M.; Fantini, M.P.; Siliquini, R.; Ricciardi, W.; Damiani, G. Patterns of amenable child mortality over time in 34 member countries of the Organisation for Economic Co-operation and Development (OECD): Evidence from a 15-year time trend analysis (2001–2015). BMJ Open 2019, 9, e027909.59. Viner, R.M.; Hargreaves, D.S.; Coffey, C.; Patton, G.C.; Wolfe, I. Deaths in young people aged 0–24 years in the UK compared with the EU15+ countries, 1970–2008: Analysis of the WHO Mortality Database. Lancet 2014, 384, 880–892.60. Ward, J.L.; Wolfe, I.; Viner, R.M. Cause-specific child and adolescent mortality in the UK and EU15+ countries. Arch. Dis. Child. 2020, 105, 1055–1060.61. Bundey, S.; Alam, H.; Kaur, A.; Mir, S.; Lancashire, R. Why do UK-born Pakistani babies have high perinatal and neonatal mortality rates? Paediatr. Perinat. Epidemiol. 1991, 5, 101–114.62. Nasi, T.; Vince, J.D.; Mokela, D. Mortality in children admitted to Port Moresby General Hospital: How can we improve our hospital outcomes? P. N. G. Med. J. 2003, 46, 113–124. Available online: http://www.ncbi.nlm.nih.gov/pubmed/16454393 (accessed on 30 March 2024).63. Korda, R.J.; Butler, J.R.G. Effect of healthcare on mortality: Trends in avoidable mortality in Australia and comparisons with Western Europe. Public Health 2006, 120, 95–105.64. Delavar, A.; Barnes, J.M.; Wang, X.; Johnson, K.J. Associations Between Race/Ethnicity and US Childhood and Adolescent Cancer Survival by Treatment Amenability. JAMA Pediatr. 2020, 174, 428.65. Knaul, F.M.; Arreola-Ornelas, H.; Rodriguez, N.M.; Méndez-Carniado, O.; Kwete, X.J.; Puentes-Rosas, E.; Bhadelia, A. Avoidable Mortality: The Core of the Global Cancer Divide. J. Glob. Oncol. 2018, 4, 1–12.66. Smith, G.S.; Fleming, M.; Kinnear, D.; Henderson, A.; Pell, J.P.; Melville, C.; Cooper, S.-A. Rates and causes of mortality among children and young people with and without intellectual disabilities in Scotland: A record linkage cohort study of 796 190 school children. BMJ Open 2020, 10, e034077.67. Hiam, L.; Steele, S.; McKee, M. Creating a ‘hostile environment for migrants’: The British government’s use of health service data to restrict immigration is a very bad idea. Health Econ. Policy Law 2018, 13, 107–117.68. Silwal, P.; Lopez, M.I.; Pledger, M.; Cumming, J.; Jeffreys, M. Association between enrolment with a Primary Health Care provider and amenable mortality: A national population-based analysis in Aotearoa New Zealand. PLoS ONE 2023, 18, e0281163.69. Verstraeten, S.P.A.; van Oers, H.A.M.; Mackenbach, J.P. Contribution of amenable mortality to life expectancy differences between the Dutch Caribbean islands of Aruba and Curaçao and the Netherlands. Rev. Panam. Salud Pública 2020, 44, e38.70. Roberton, T.; Carter, E.D.; Chou, V.B.; Stegmuller, A.R.; Jackson, B.D.; Tam, Y.; Sawadogo-Lewis, T.; Walker, N. Early estimates of the indirect effects of the COVID-19 pandemic on maternal and child mortality in low-income and middle-income countries: A modelling study. Lancet Glob. Health 2020, 8, e901–e908.71. Rojas-Botero, M.L.; Borrero Ramírez, Y.E.; Cáceres-Manrique, F. de M. Muertes evitables en la niñez: Un análisis por departamento y municipio en Colombia (2000–2018). Rev. Panam. Salud Pública 2021, 46, 172. Castelli, A.; Nizalova, O. Avoidable Mortality: What It Means and How It Is Measured. York. 2011. Available online: https: //ideas.repec.org/p/chy/respap/63cherp.html (accessed on 30 March 2024).73. Nolte, E.; Mckee, M. Does Health Care Save Lives? Avoidable Mortality Revisited. Nuffield Trust: London, UK, 2004.74. Basera, T.J.; Schmitz, K.; Price, J.; Willcox, M.; Bosire, E.N.; Ajuwon, A.; Mbule, M.; Ronan, A.; Burtt, F.; Scheepers, E.; et al. Community surveillance and response to maternal and child deaths in low- and middle-income countries: A scoping review. PLoS ONE 2021, 16, e0248143.75. Kazembe, L.; Clarke, A.; Kandala, N.-B. Childhood mortality in sub-Saharan Africa: Cross-sectional insight into small-scale geographical inequalities from Census data. BMJ Open 2012, 2, e001421.76. Quentin, W.; Abosede, O.; Aka, J.; Akweongo, P.; Dinard, K.; Ezeh, A.; Hamed, R.; Kayembe, P.K.; Mitike, G.; Mtei, G.; et al. Inequalities in child mortality in ten major African cities. BMC Med. 2014, 12, 95.77. Rajan, S.; Ricciardi, W.; McKee, M.; McKee, M. The SDGs and health systems: The last step on the long and unfinished journey to universal health care? Eur. J. Public Health 2020, 30, I28–I31.78. Clemente-Suárez, V.J.; Rodriguez-Besteiro, S.; Cabello-Eras, J.J.; Bustamante-Sanchez, A.; Navarro-Jiménez, E.; Donoso-Gonzalez, M.; Beltrán-Velasco, A.I.; Tornero-Aguilera, J.F. Sustainable Development Goals in the COVID-19 Pandemic: A Narrative Review. Sustainability 2022, 14, 7726.79. Martín-Rodríguez, A.; Tornero-Aguilera, J.F.; López-Pérez, P.J.; Clemente-Suárez, V.J. Dietary patterns of adolescent students during the COVID-19 pandemic lockdown. Physiol. Behav. 2022, 249, 113764.80. Clemente-Suárez, V.J.; Beltrán-Velasco, A.I.; Ramos-Campo, D.J.; Mielgo-Ayuso, J.; Nikolaidis, P.A.; Belando, N.; Tornero-Aguilera, J.F. Physical activity and COVID-19. The basis for an efficient intervention in times of COVID-19 pandemic. Physiol. Behav. 2022, 244, 113667.81. Martín-Rodríguez, A.; Bustamante-Sánchez, Á.; Martínez-Guardado, I.; Navarro-Jiménez, E.; Plata-SanJuan, E.; Tornero-Aguilera, J.F.; Clemente-Suárez, V.J. Infancy Dietary Patterns, Development, and Health: An Extensive Narrative Review. Children 2022, 9, 1072.82. Martín-Rodríguez, A.; Tornero-Aguilera, J.F.; López-Pérez, P.J.; Clemente-Suárez, V.J. Gender Differences in Nutritional, Odontological and Psychological Patterns of Adolescent Students during COVID-19 Pandemic. Appl. Sci. 2021, 11, 8499.83. Bajekal, M.; Scholes, S.; Love, H.; Hawkins, N.; O’flaherty, M.; Raine, R.; Capewell, S. Analysing Recent Socioeconomic Trends in Coronary Heart Disease Mortality in England, 2000–2007: A Population Modelling Study. PLoS Med. 2012, 9, e1001237.84. Nolte, E. Measuring the health of nations: Analysis of mortality amenable to health care. BMJ 2003, 327, 1129.301711Amenable (treatable) mortalityUnder-5 mortalityTimely medical careHealthcare service qualityUniversal health coverageRespiratory diseasePerinatal periodPublicationORIGINALAmenable Mortality in Children under 5.pdfAmenable Mortality in Children under 5.pdfapplication/pdf690324https://repositorio.cuc.edu.co/bitstreams/c394e75d-09ec-4097-adf2-6ac062c9b6c5/downloade9e3b8994ae57fb0abd2ba002edde8b3MD51LICENSElicense.txtlicense.txttext/plain; charset=utf-815543https://repositorio.cuc.edu.co/bitstreams/fc80483b-657a-4985-a2d2-fde202360fe4/download73a5432e0b76442b22b026844140d683MD52TEXTAmenable Mortality in Children under 5.pdf.txtAmenable Mortality in Children under 5.pdf.txtExtracted texttext/plain100310https://repositorio.cuc.edu.co/bitstreams/90fe70b9-1834-48d5-ab66-bb2a49dd9dc2/downloada4c2591d976fe77cce7f03f324d64f07MD53THUMBNAILAmenable Mortality in Children under 5.pdf.jpgAmenable Mortality in Children under 5.pdf.jpgGenerated Thumbnailimage/jpeg15141https://repositorio.cuc.edu.co/bitstreams/310cb853-9cb8-4e87-a8f5-272ea2c1312c/downloadb58fdf3098007b2d99bd2dcc91e3c3c4MD5411323/13396oai:repositorio.cuc.edu.co:11323/133962024-09-27 03:02:01.757https://creativecommons.org/licenses/by/4.0/© 2024 by the authors. Licensee MDPI, Basel, Switzerland.open.accesshttps://repositorio.cuc.edu.coRepositorio de la Universidad de la Costa CUCrepdigital@cuc.edu.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