Tottrup C, Tersbol B P, Lindeboom W, Meyrowitsch D
Geographic Resource Analysis and Science Ltd, c/o University of Copenhagen, Copenhagen, Denmark.
Trop Med Int Health. 2009 Jun;14(6):653-62. doi: 10.1111/j.1365-3156.2009.02275.x. Epub 2009 Jun 9.
To map and analyse geographical (spatial) variations of child mortality trends in mainland Tanzania.
We used a geographic information system to integrate data on child mortality and associated risk factors. We then applied spatial statistics to quantify the spatial component of child mortality trends, and employed multivariate analysis to break mortality down into a spatial and a local component.
The results support our hypothesis that child mortality trends have a spatial component that can be attributed to broad-scale environmental and social-economic factors. However, the multivariate analysis showed that the spatial component only explained one-third of the variation in child mortality trends. The results thus point towards the presence of local (non-spatial) causative factors, including variations in the access to and quality of child health care.
The method we used is a cost-effective way to systematically assess geographical variations in health outcomes. It can thus provide researchers and practitioners with a good first-line tool in understanding local contributions to differences in mortality and other indicators, and give authorities at all levels a better foundation for addressing health inequities.
绘制并分析坦桑尼亚大陆儿童死亡率趋势的地理（空间）变化情况。
我们使用地理信息系统整合儿童死亡率及相关风险因素的数据。然后应用空间统计方法量化儿童死亡率趋势的空间成分，并采用多变量分析将死亡率分解为空间成分和局部成分。
结果支持了我们的假设，即儿童死亡率趋势存在一个可归因于广泛环境和社会经济因素的空间成分。然而，多变量分析表明，空间成分仅解释了儿童死亡率趋势变化的三分之一。因此，结果表明存在局部（非空间）致病因素，包括儿童医疗保健可及性和质量的差异。
我们使用的方法是系统评估健康结果地理差异的一种经济有效的方式。因此，它可以为研究人员和从业者提供一个很好的一线工具，以了解局部因素对死亡率和其他指标差异的影响，并为各级当局解决健康不平等问题提供更好的基础。
