Fantahun Mesganaw, Berhane Yemane, Wall Stig, Byass Peter, Högberg Ulf
Department of Community Health, Addis Ababa University, PO Box 24762, Code 1000 Addis Ababa University, Addis Ababa, Ethiopia.
Acta Paediatr. 2007 Apr;96(4):582-9. doi: 10.1111/j.1651-2227.2007.00147.x. Epub 2007 Feb 14.
To assess the influence of household decision making, social capital, socio-economic factors and health service use on under-five mortality.
Butajira Demographic Surveillance Site, Ethiopia.
A prospective case-referent design with a total of 209 under-five year old deaths occurring in an 18-month period, together with 627 referents matched for age, sex and community of residence were included. Questionnaires were administered to mothers or caretakers. Matched case control analysis investigated the effect of risk factors on mortality and the presence of avoidable factors was assessed for each death.
Lack of immunization was strongly associated with mortality (adjusted OR=9.8, 95% CI 5.9, 16.1). Low decision making capacity of women (adjusted OR=3.2 95% CI 2.0, 5.0) and low social capital scores (adjusted OR=1.9 95% CI 1.1, 3.5) were also related to high under-five mortality in multivariate analyses. Potentially avoidable household and health facility factors were identified, respectively in 71% and 40% of the deaths.
Combined efforts to improve women's involvement in household decision making, social capital and immunization may decrease the high child mortality in this setting where the level of poverty is high and no appreciable trend in child mortality decline has been noted over the years.
评估家庭决策、社会资本、社会经济因素及卫生服务利用对五岁以下儿童死亡率的影响。
埃塞俄比亚布塔吉拉人口监测点。
采用前瞻性病例对照设计，纳入18个月内共209例五岁以下儿童死亡病例，以及627例按年龄、性别和居住社区匹配的对照。对母亲或照料者进行问卷调查。配对病例对照分析调查危险因素对死亡率的影响，并评估每例死亡中可避免因素的存在情况。
未接种疫苗与死亡率密切相关（校正比值比=9.8，95%置信区间5.9, 16.1）。在多变量分析中，女性决策能力低（校正比值比=3.2，95%置信区间2.0, 5.0）和社会资本得分低（校正比值比=1.9，95%置信区间1.1, 3.5）也与五岁以下儿童高死亡率相关。分别在71%和40%的死亡病例中发现了潜在可避免的家庭和卫生设施因素。
在贫困程度高且多年来儿童死亡率未出现明显下降趋势的环境中，共同努力提高女性在家庭决策中的参与度、社会资本水平和疫苗接种率，可能会降低儿童高死亡率。
