Papers by Talata Sawadogo-Lewis
Food and Nutrition Bulletin
Background:The global nutrition community has called for a multisectoral approach to improve nutr... more Background:The global nutrition community has called for a multisectoral approach to improve nutritional outcomes. While most essential nutrition interventions are delivered through the health system, nutrition-sensitive interventions from other sectors are critical.Objective:We modeled the potential impact that Scaling Up Nutrition (SUN) interventions delivered by the health system would have on reaching World Health Assembly (WHA) stunting targets. We also included results for targets 2, 3, and 5.Methods:Using all available countries enrolled in the SUN movement, we identified nutrition interventions that are delivered by the health system available in the Lives Saved Tool. We then scaled these interventions linearly from 2012 up to nearly universal coverage (90%) in 2025 and estimated the potential impact that this increase would have with regard to the WHA targets.Results:Our results show that only 16 countries out of 56 would reach the 40% reduction in the number of stunted chi...
Journal of Global Health Reports
Background The health sector is essential in delivering high-quality nutrition interventions to w... more Background The health sector is essential in delivering high-quality nutrition interventions to women and children in low and middle-income countries, and Mozambique is no exception. Still, the quality and readiness of health services to deliver nutritional services have yet to be comprehensively mapped across the country. We assessed the accessibility and readiness of health facilities to deliver maternal and child nutrition services in Mozambique. Methods Using multiple data sources within a geographic information system (GIS) environment, we calculated facility readiness to deliver nutritional services, population access to health facilities, and health facilities ready to deliver nutrition services. Data from Mozambique’s 2018 Service Availability and Readiness Assessment (SARA) was used to calculate readiness scores for each facility in the country. We used geospatial data from the ´WorldPop´ initiative to estimate the proportion of people in Mozambique within 10 kilometers of ...
AIJR Abstracts, Jul 24, 2021
Background Gender is a crucial consideration of human rights that impacts many priority maternal ... more Background Gender is a crucial consideration of human rights that impacts many priority maternal health outcomes. However, gender is often only reported in relation to sex-disaggregated data in health coverage surveys. Few coverage surveys to date have integrated a more expansive set of gender-related questions and indicators, especially in low- to middle-income countries that have high levels of reported gender inequality. Using various gender-sensitive indicators, we investigated the role of gender power relations within households on women’s health outcomes in Simiyu region, Tanzania. Methods We assessed 34 questions around gender dynamics reported by men and women against 18 women’s health outcomes. We created directed acyclic graphs (DAGs) to theorize the relationship between indicators, outcomes, and sociodemographic covariates. We grouped gender variables into four categories using an established gender framework: (1) women’s decision-making, (2) household labor-sharing, (3) women’s resource access, and (4) norms/beliefs. Gender indicators that were most proximate to the health outcomes in the DAG were tested using multivariate logistic regression, adjusting for sociodemographic factors. Results The overall percent agreement of gender-related indicators within couples was 68.6%. The lowest couple concordance was a woman’s autonomy to decide to see family/friends without permission from her husband/partner (40.1%). A number of relationships between gender-related indicators and health outcomes emerged: questions from the decision-making domain were found to play a large role in women’s health outcomes, and condoms and contraceptive outcomes had the most robust relationship with gender indicators. Women who reported being able to make their own health decisions were 1.57 times (95% CI: 1.12, 2.20) more likely to use condoms. Women who reported that they decide how many children they had also reported high contraception use (OR: 1.79, 95% CI: 1.34, 2.39). Seeking care at the health facility was also associated with women’s autonomy for making major household purchases (OR: 1.35, 95% CI: 1.13, 1.62). Conclusions The association between decision-making and other gender domains with women’s health outcomes highlights the need for heightened attention to gender dimensions of intervention coverage in maternal health. Future studies should integrate and analyze gender-sensitive questions within coverage surveys.
Supplemental Material, sj-xlsx-1-fnb-10.1177_0379572121998127 for The Potential Contribution of t... more Supplemental Material, sj-xlsx-1-fnb-10.1177_0379572121998127 for The Potential Contribution of the Health System to Reducing Stunting in SUN Countries by Talata Sawadogo-Lewis, Shannon E. King, Tricia Aung and Timothy Roberton in Food and Nutrition Bulletin
Additional file 3. Completed ANC4 Visits by Month 2012–2019, Nationally. National monthly average... more Additional file 3. Completed ANC4 Visits by Month 2012–2019, Nationally. National monthly average of 4 completed ANC visits for each year of data (PDF 59 KB)
Additional file 1. Precipitation Data, Nationally. Average monthly rainfall by year (PDF 65 KB)
Additional file 5. ANC Trends by Province (2012–2019). Average monthly rainfall and 4 completed A... more Additional file 5. ANC Trends by Province (2012–2019). Average monthly rainfall and 4 completed ANC visits by province (PDF 44 KB)
Additional file 2. Institutional Deliveries by Month 2012–2019, Nationally. National monthly aver... more Additional file 2. Institutional Deliveries by Month 2012–2019, Nationally. National monthly average of institutional deliveries for each year of data (PDF 60 KB)
Maternal & Child Nutrition, 2021
In low‐ and middle‐income countries (LMICs), access to water, sanitation and hygiene (WASH) is as... more In low‐ and middle‐income countries (LMICs), access to water, sanitation and hygiene (WASH) is associated with nutritional status including stunting, which affects 144 million children under 5 globally. Despite the consistent epidemiological association between WASH indicators and nutritional status, the provision of WASH interventions alone has not been found to improve child growth in recent randomized control trials. We conducted a literature review to develop a new conceptual framework that highlights what is known about the WASH to nutrition pathways, the limitations of certain interventions and how future WASH could be leveraged to benefit nutritional status in populations. This new conceptual framework will provide policy makers, program implementors and researchers with a visual tool to bring into perspective multiple levels of WASH and how it may effectively influence nutrition while identifying existing gaps in implementation and research.
Additional file 1:. Interview guide used to guide the individual in-depth interviews with partici... more Additional file 1:. Interview guide used to guide the individual in-depth interviews with participants in the study. (DOCX 23 kb)
*Denotes equal authorship. All analysis code for <em>Can we use routine data for decision-m... more *Denotes equal authorship. All analysis code for <em>Can we use routine data for decision-making? A time trend comparison between survey and routine data at regional and national level in Mali</em> have been made available for replication or extension. GetData.R saves the raw DHS and HMIS data, GetTables.R calculates survey-weighted indicators and produces the tables in the paper, and GetFigures.R reproduces figures from the paper. Users can run GetFigures.R without accessing the raw data. We cannot directly provide the HMIS routine data which was provided to us by the Ministry of Health, nor can we provide the DHS household data, which require access permission. However, we encourage all who are interested in obtaining DHS data to register for accounts with dhsprogram.com. We used these DHS files in this analysis: MLIR41FL.DTA MLIR52FL.DTA MLIR6HFL.DTA MLBR41FL.DTA MLBR52FL.DTA MLBR6HFL.DTA GetData: loads raw data and saves as .RData file (runtime = 7mins) GetTables: loads saved .RData and produces results for tables 3-6 (runtime = 4mins) GetFigures: loads output from GetTables and makes figures 1-4 (runtime = 2mins) We recommend maintaining the naming convention of the DHS, and routine data, files. If you put these files in the "Data" subfolder, and access the .R scripts by first opening the MaliTrends.Rproj file, you won't have to edit data file names or directories. Scripts were written in R 3.5.1. R packages required are listed at the top of each script. Users can install the most recent versions of these packages by running this code: install.packages(c(' readstata13', 'haven', 'readr', 'survey', 'dplyr', 'data.table', 'ggplot2', 'tidyverse', 'gridExtra', 'grid', 'cowplot'), dependencies = T)
Global Health: Science and Practice, 2021
Journal of Global Health, 2021
The Lancet Global Health, 2020
Background While the COVID-19 pandemic will increase mortality due to the virus, it is also likel... more Background While the COVID-19 pandemic will increase mortality due to the virus, it is also likely to increase mortality indirectly. In this study, we estimate the additional maternal and under-5 child deaths resulting from the potential disruption of health systems and decreased access to food. Methods We modelled three scenarios in which the coverage of essential maternal and child health interventions is reduced by 9•8-51•9% and the prevalence of wasting is increased by 10-50%. Although our scenarios are hypothetical, we sought to reflect real-world possibilities, given emerging reports of the supply-side and demand-side effects of the pandemic. We used the Lives Saved Tool to estimate the additional maternal and under-5 child deaths under each scenario, in 118 low-income and middle-income countries. We estimated additional deaths for a single month and extrapolated for 3 months, 6 months, and 12 months. Findings Our least severe scenario (coverage reductions of 9•8-18•5% and wasting increase of 10%) over 6 months would result in 253 500 additional child deaths and 12 200 additional maternal deaths. Our most severe scenario (coverage reductions of 39•3-51•9% and wasting increase of 50%) over 6 months would result in 1 157 000 additional child deaths and 56 700 additional maternal deaths. These additional deaths would represent an increase of 9•8-44•7% in under-5 child deaths per month, and an 8•3-38•6% increase in maternal deaths per month, across the 118 countries. Across our three scenarios, the reduced coverage of four childbirth interventions (parenteral administration of uterotonics, antibiotics, and anticonvulsants, and clean birth environments) would account for approximately 60% of additional maternal deaths. The increase in wasting prevalence would account for 18-23% of additional child deaths and reduced coverage of antibiotics for pneumonia and neonatal sepsis and of oral rehydration solution for diarrhoea would together account for around 41% of additional child deaths. Interpretation Our estimates are based on tentative assumptions and represent a wide range of outcomes. Nonetheless, they show that, if routine health care is disrupted and access to food is decreased (as a result of unavoidable shocks, health system collapse, or intentional choices made in responding to the pandemic), the increase in child and maternal deaths will be devastating. We hope these numbers add context as policy makers establish guidelines and allocate resources in the days and months to come. Funding Bill & Melinda Gates Foundation, Global Affairs Canada.
BMC Health Services Research, 2020
Background Climatic conditions and seasonal trends can affect population health, but typically, w... more Background Climatic conditions and seasonal trends can affect population health, but typically, we consider the effect of climate on the epidemiology of communicable diseases. However, climate can also have an effect on access to care, particularly in remote rural areas of low- and middle-income countries. In this study, we investigate associations between the rainy season and the utilization of maternal health services in Mozambique. Methods We examined patterns in the number of women receiving antenatal care (ANC) and delivering at a health facility for 2012–2019, using data from Mozambique’s Health Management Information Systems. We investigated the association between seasonality (rainfall) and maternal health service utilization (ANC and institutional delivery) at national and provincial level. We fit a negative binomial regression model for institutional delivery and used it to estimate the yearly reduction in institutional deliveries due to the rainy season, with other factor...
Background: Gender is a crucial consideration of human rights that impacts many priority maternal... more Background: Gender is a crucial consideration of human rights that impacts many priority maternal health outcomes. However, gender is often only reported in relation to sex-disaggregated data in health coverage surveys. Few coverage surveys to date have integrated a more expansive set of gender-related questions and indicators, especially in low- to middle-income countries that have high levels of reported gender inequality. Objective: Using various gender-sensitive indicators, we investigated the role of gender power relations within households on women’s health outcomes in Simiyu region, Tanzania. Methods: We assessed 34 questions around gender dynamics reported by men and women against 18 women’s health outcomes. We created directed acyclic graphs (DAGs) to theorize the relationship between indicators, outcomes, and sociodemographic covariates. We grouped gender variables into four categories using an established gender framework: (1) women’s decision-making, (2) household labor-...
BMC Health Services Research, 2020
Background The need for evidence-based decision-making in the health sector is well understood in... more Background The need for evidence-based decision-making in the health sector is well understood in the global health community. Yet, gaps persist between the availability of evidence and the use of that evidence. Most research on evidence-based decision-making has been carried out in higher-income countries, and most studies look at policy-making rather than decision-making more broadly. We conducted this study to address these gaps and to identify challenges and facilitators to evidence-based decision-making in Maternal, Newborn and Child Health and Nutrition (MNCH&N) at the municipality, district, and national levels in Mozambique. Methods We used a case study design to capture the experiences of decision-makers and analysts (n = 24) who participated in evidence-based decision-making processes related to health policies and interventions to improve MNCH&N in diverse decision-making contexts (district, municipality, and national levels) in 2014–2017, in Mozambique. We examined six c...
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Papers by Talata Sawadogo-Lewis