Maternal, neonatal, and child health in southeast Asia: towards greater regional collaboration.
Although maternal and child mortality are on the decline in southeast Asia, there are still major disparities, and greater equity is key to achieve the Millennium Development Goals. We used comparable cross-national data sources to document mortality trends from 1990 to 2008 and to assess major causes of maternal and child deaths. We present inequalities in intervention coverage by two common measures of wealth quintiles and rural or urban status. Case studies of reduction in mortality in Thailand and Indonesia indicate the varying extents of success and point to some factors that accelerate progress. We developed a Lives Saved Tool analysis for the region and for country subgroups to estimate deaths averted by cause and intervention. We identified three major patterns of maternal and child mortality reduction: early, rapid downward trends (Brunei, Singapore, Malaysia, and Thailand); initially high declines (sustained by Vietnam but faltering in the Philippines and Indonesia); and high initial rates with a downward trend (Laos, Cambodia, and Myanmar). Economic development seems to provide an important context that should be coupled with broader health-system interventions. Increasing coverage and consideration of the health-system context is needed, and regional support from the Association of Southeast Asian Nations can provide increased policy support to achieve maternal, neonatal, and child health goals.
Institute of Clinical Epidemiology, University of the Philippines, National Institutes of Health, Ermita, Manila, Philippines. cesacuin@gmail.com
Cecilia S
CS
Acuin
Geok Lin
GL
Khor
Tippawan
T
Liabsuetrakul
Endang L
EL
Achadi
Thein Thein
TT
Htay
Rebecca
R
Firestone
Zulfiqar A
ZA
Bhutta
D001210:Asia, Southeastern; D002648:Child; D002662:Child Health Services; D046688:Child Mortality / Q000639:trends; D002669:Child Welfare; D005260:Female; D006282:Health Personnel / Q000193:education; D006291:Health Policy; D006280:Health Workforce; D054625:Healthcare Disparities; D006801:Humans; D007231:Infant, Newborn; D008427:Maternal Health Services; D008428:Maternal Mortality / Q000639:trends; D008429:Maternal Welfare; D011203:Poverty; D019035:Rural Health Services; D019472:Universal Health Insurance; D019037:Urban Health Services; D014611:Vaccination
Lancet. 2005 Mar 5-11;365(9462):891-900
15752534
Lancet. 2010 Jun 5;375(9730):1988-2008
20546887
Lancet. 2006 Oct 7;368(9543):1284-99
17027735
Lancet. 2011 Feb 12;377(9765):599-609
21269678
Lancet. 2009 Sep 5;374(9692):835-46
19709729
PLoS Med. 2010 Jun 21;7(6):e1000295
20574515
BMC Pregnancy Childbirth. 2010 Feb 23;10 Suppl 1:S4
20233385
Lancet. 2010 May 8;375(9726):1609-23
20382417
Lancet. 2011 Mar 5;377(9768):863-73
21269682
Lancet. 2005 Mar 12-18;365(9463):977-88
15767001
Lancet. 2006 Apr 1;367(9516):1066-1074
16581405
Lancet. 2008 Feb 2;371(9610):417-40
18206226
Niger J Clin Pract. 2007 Dec;10(4):272-82
18293634
Lancet. 2008 Sep 13;372(9642):950-61
18790318
Lancet. 2010 Jun 5;375(9730):1969-87
20466419
Lancet. 2007 Oct 13;370(9595):1358-69
17933651
Int J Epidemiol. 2010 Apr;39 Suppl 1:i1-2
20348111
Lancet. 2003 Jul 5;362(9377):65-71
12853204
Int J Epidemiol. 2010 Apr;39 Suppl 1:i7-10
20348129
Int J Epidemiol. 2010 Apr;39 Suppl 1:i40-7
20348125
Bull World Health Organ. 2010 Jun;88(6):420-7
20539855
Bull World Health Organ. 1999;77(2):190-3
10083722
Lancet. 2008 Sep 13;372(9642):972-89
18790320
Int J Epidemiol. 2010 Apr;39 Suppl 1:i21-31
20348122
Int J Epidemiol. 2010 Apr;39 Suppl 1:i32-9
20348124
Int J Epidemiol. 2010 Apr;39 Suppl 1:i3-6
20348123
Lancet. 2010 Sep 18;376(9745):959-74
20851260
Lancet. 2011 Jan 29;377(9763):429-37
21269685
Lancet. 2008 Apr 12;371(9620):1259-67
18406860