Moore David, Castillo Eliana, Richardson Chris, Reid Robert J
Department of Health Care and Epidemiology, University of British Columbia, Vancouver, Canada V6T 1Z3.
Int J Health Plann Manage. 2003 Oct-Dec;18(4):279-92. doi: 10.1002/hpm.731.
Primary health care (PHC) services have been advocated as a means by which less developed countries may improve the health of their populations even in the face of poverty, low levels of literacy, poor nutrition and other factors that negatively influence health status. Using aggregated data from the World Bank and UNICEF this study examined which factors, both within the health care system and outside of it, are associated with under-5 mortality rates in 22 countries of Latin America and the Caribbean during the 1990s. In a multivariate analysis using generalized estimating equations for repeated measures, five factors were found to be independent predictors of lower under-5 mortality rates (U5MRs). These were vaccination levels, female literacy, the use of oral rehydration therapy, access to safe water and GNP per capita. When the magnitude of these associations were assessed, higher levels of GNP per capita was found to be very weakly associated with lower U5MRs, compared with female literacy and vaccination rates. These findings suggest that government policies which focus only on promoting economic growth, while not making important investments in PHC services, female education and access to safe water are unlikely to see large improvements in health status.
初级卫生保健（PHC）服务被倡导为一种手段，通过它，欠发达国家即使面对贫困、低识字率、营养不良以及其他对健康状况产生负面影响的因素，也能够改善其民众的健康。本研究利用世界银行和联合国儿童基金会的汇总数据，考察了在20世纪90年代拉丁美洲和加勒比地区的22个国家中，卫生保健系统内部及外部的哪些因素与5岁以下儿童死亡率相关。在一项使用广义估计方程进行重复测量的多变量分析中，发现有五个因素是5岁以下儿童死亡率（U5MRs）降低的独立预测因素。这些因素是疫苗接种水平、女性识字率、口服补液疗法的使用、安全饮用水的可及性以及人均国民生产总值。在评估这些关联的程度时，发现与女性识字率和疫苗接种率相比，人均国民生产总值水平较高与较低的U5MRs之间的关联非常微弱。这些发现表明，仅专注于促进经济增长，而不在初级卫生保健服务、女性教育和安全饮用水可及性方面进行重要投资的政府政策，不太可能使健康状况有大幅改善。
