Kazembe Lawrence N, Appleton Christopher C, Kleinschmidt Immo
Applied Statistics and Epidemiology Research Unit, Mathematical Sciences Department, Chancellor College, University of Malawi, Zomba, Malawi.
Geospat Health. 2007 Nov;2(1):41-50. doi: 10.4081/gh.2007.253.
Spatial differences in mortality have been reported in Africa amongst children under-five years of age. Risk factors contributing to this geographical variation include bio-demographic and socio-economic factors, the prevalence of infectious diseases and the variability in the quality of child health care. This paper is concerned with investigating the link between early childhood mortality and malaria risk. We used data from the Mapping Malaria Risk in Africa (MARA) and Demographic and Health Survey (DHS) databases to explore this relationship. The DHS survey included questions on bio-demographic and socio-economic status, complete birth histories and survival time of each child within the five years preceding the survey. Survival times were computed in months until death or until the survey was done. The malaria risk was based on prevalence data estimated at the precise DHS sampling location. A spatial Cox regression model was applied to analyze child survival, assessing the influence of both individual-specific factors, malaria endemicity and group-specific environmental factors, approximated by geographical location. Geographical location was considered at subdistrict level. Our analysis shows that although malaria endemicity is not associated with the risk of infant mortality, it is an important risk factor for child mortality. The results confirm the effects of bio-demographic and socio-economic variables (maternal education, maternal age, birth order and place of residence) on infant and child mortality. The subdistrict-specific variation of infant and child mortality shows a rural-urban distinction with a relatively lower risk of mortality in main urban areas.
非洲已报告了五岁以下儿童死亡率的空间差异。造成这种地理差异的风险因素包括生物人口学和社会经济因素、传染病的流行情况以及儿童医疗保健质量的差异。本文关注的是调查幼儿死亡率与疟疾风险之间的联系。我们使用了非洲疟疾风险地图绘制（MARA）和人口与健康调查（DHS）数据库的数据来探究这种关系。DHS调查包括有关生物人口学和社会经济状况、完整的出生史以及调查前五年内每个儿童的存活时间的问题。存活时间以月为单位计算，直至死亡或直至调查结束。疟疾风险基于在DHS精确抽样地点估计的流行数据。应用空间Cox回归模型来分析儿童存活率，评估个体特定因素、疟疾流行程度以及由地理位置近似表示的群体特定环境因素的影响。地理位置在分区层面进行考虑。我们的分析表明，虽然疟疾流行程度与婴儿死亡率风险无关，但它是儿童死亡率的一个重要风险因素。结果证实了生物人口学和社会经济变量（母亲教育程度、母亲年龄、出生顺序和居住地点）对婴儿和儿童死亡率的影响。婴儿和儿童死亡率在分区层面的差异显示出城乡区别，主要城市地区的死亡率风险相对较低。
