Hong Rathavuth
Department of Global Health, School of Public Health and Health Services, George Washington University, Washington, DC, USA.
J Paediatr Child Health. 2006 Oct;42(10):630-5. doi: 10.1111/j.1440-1754.2006.00940.x.
Levels of infant and child mortality in many developing countries remain unacceptably high, and they are disproportionably higher among high-risk groups such as newborn and infant of multiple births, particularly in countries where advanced medical cares are available only at regional referral levels with limited access by the poor rural women and children. This study examined the relationship between high-risk infant of multiple birth and infant mortality in Bangladesh.
The analysis uses information on 7001 childbirths in 5 years preceding the 2004 Bangladesh Demographic and Health Survey to examine the relationship between multiple birth and infant mortality using multivariate analysis, controlling for child's sex, birth order, prenatal care, delivery assistance; mother's age at child birth, nutritional status, education level; household living conditions and several other risk factors.
Results indicate that children born multiple birth were more than six-times as likely to die during infancy as those born singletons (hazard ratio = 6.51; 95% confidence interval: 4.10, 10.36). Controlling for all other risk factors does not change the strength and direction of the relationship (hazard ratio = 6.18; 95% confidence interval: 3.65, 10.46). Receiving prenatal care and access to safe drinking water are associated with lower risk.
Multiple births are strongly negatively associated with infant survival in Bangladesh independent of other risk factors. This evidence suggests that improving maternal and child health at the community level, screening for high-risk pregnancies and making referral services for these conditions more accessible to the rural women and children will be key to improving child survival in Bangladesh.
许多发展中国家的婴幼儿死亡率仍然高得令人无法接受，在多胞胎新生儿和婴儿等高风险群体中，死亡率尤其高，特别是在那些只有区域转诊机构才能提供先进医疗服务、贫困农村妇女和儿童难以获得此类服务的国家。本研究调查了孟加拉国多胞胎高危婴儿与婴儿死亡率之间的关系。
分析采用了2004年孟加拉国人口与健康调查前5年7001例分娩的相关信息，通过多变量分析来研究多胞胎与婴儿死亡率之间的关系，同时控制孩子的性别、出生顺序、产前护理、分娩协助；母亲生育时的年龄、营养状况、教育水平；家庭生活条件以及其他几个风险因素。
结果表明，多胞胎出生的孩子在婴儿期死亡的可能性是单胞胎出生孩子的六倍多（风险比=6.51；95%置信区间：4.10, 10.36）。控制所有其他风险因素并不会改变这种关系的强度和方向（风险比=6.18；95%置信区间：3.65, 10.46）。接受产前护理和获得安全饮用水与较低风险相关。
在孟加拉国，多胞胎与婴儿存活率呈强烈负相关，且独立于其他风险因素。这一证据表明，在社区层面改善母婴健康、筛查高危妊娠并使农村妇女和儿童更易获得针对这些情况的转诊服务，将是提高孟加拉国儿童存活率的关键。
