马拉维农村地区婴儿死亡率的产前和围产期预测因素
Antenatal and perinatal predictors of infant mortality in rural Malawi.
作者信息
Vaahtera M, Kulmala T, Ndekha M, Koivisto A M, Cullinan T, Salin M L, Ashorn P
机构信息
Medical School, University of Tampere, PO Box 607, FIN-33101 Tampere, Finland.
出版信息
Arch Dis Child Fetal Neonatal Ed. 2000 May;82(3):F200-4. doi: 10.1136/fn.82.3.f200.
BACKGROUND
The slow pace in the reduction of infant mortality in sub-Saharan Africa has partially been attributed to the epidemic of human immunodeficiency virus (HIV) infection. To facilitate early interventions, antenatal and perinatal predictors of 1st year mortality were identified in a rural community in southern Malawi.
METHODS
A cohort of 733 live born infants was studied prospectively from approximately 24 gestation weeks onwards. Univariate analysis was used to determine relative risks for infant mortality after selected antenatal and perinatal exposures. Multivariate modelling was used to control for potential confounders.
FINDINGS
The infant mortality rate was 136 deaths/1000 live births. Among singleton newborns, the strongest antenatal and perinatal predictors of mortality were birth between May and July, maternal primiparity, birth before 38th gestation week, and maternal HIV infection. Theoretically, exposure to these variables accounted for 22%, 22%, 17%, and 15% of the population attributable risk for infant mortality, respectively.
INTERPRETATION
The HIV epidemic was an important but not the main determinant of infant mortality. Interventions targetting the offspring of primiparous women or infants born between May and July or prevention of prematurity would all have considerable impact on infant survival.
背景
撒哈拉以南非洲地区婴儿死亡率下降缓慢，部分原因可归咎于人类免疫缺陷病毒（HIV）感染的流行。为促进早期干预，在马拉维南部的一个农村社区确定了1岁死亡率的产前和围产期预测因素。
方法
对733名活产婴儿组成的队列进行前瞻性研究，从大约妊娠24周起开始。采用单因素分析确定选定的产前和围产期暴露后婴儿死亡的相对风险。采用多变量建模来控制潜在的混杂因素。
研究结果
婴儿死亡率为136例/1000例活产。在单胎新生儿中，死亡率最强的产前和围产期预测因素为5月至7月出生、母亲初产、妊娠38周前出生以及母亲感染HIV。理论上，暴露于这些变量分别占婴儿死亡率人群归因风险的22%、22%、17%和15%。
解读
HIV流行是婴儿死亡率的一个重要但非主要决定因素。针对初产妇的后代或5月至7月出生的婴儿进行干预或预防早产，都将对婴儿存活产生重大影响。
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