Health Services Research, Epidemiology and International Health, Institute for Maternal and Child Health IRCCS Burlo Garofolo, Via dell'Istria 65/1, Trieste, Italy.
Health Res Policy Syst. 2010 Feb 12;8(1):5. doi: 10.1186/1478-4505-8-5.
Data on under five mortality in the twelve countries of the Commonwealth of Independent States show important fluctuations over time due to variations in quality of data, definitions of neonatal deaths and methods of mortality estimation. Despite the uncertainties regarding mortality trends, the analysis of health and social information from different sources offers clues to identify priority areas and key strategic directions for accelerating the achievement of the 4th Millennium Development Goal. Neonatal deaths represent from 40% to over 50% of under five deaths in all these countries. Maternal mortality was above 50 per 100,000 in 2005, despite the good coverage with antenatal care and births assisted by skilled birth attendants. The scanty information on quality of perinatal care indicates widespread substandard care at all levels. Stunting in children under five is above 10% in ten out of twelve countries and coexists with emerging overweight. Exclusivity and duration of breastfeeding fall short of what is recommended. There are important inequalities in child and maternal mortality, malnutrition and access and use of health services within countries. Taken as a whole, the available information clearly indicates that priority should be given to improvement of the health of women in reproductive age and of the quality of perinatal care, including the establishment of reliable data collection systems. To achieve this, action will need to focus on strengthening the capacity of the health system to improve the technical content of service provision, and on improving access and appropriate use of services by the most disadvantaged groups. The involvement of other sectors will be necessary to improve reproductive health and nutrition at community level and to tackle inequity. Comparisons between countries with similar socioeconomic background but different health policies seem to indicate that gradual progression towards universal coverage with essential health care through a national health insurance system is associated with larger reduction of child mortality than troubled transition towards a privatized and unregulated health system.
独联体十二国五岁以下儿童死亡率的数据表明，由于数据质量、新生儿死亡定义和死亡率估计方法的差异，死亡率随时间呈现出重要波动。尽管死亡率趋势存在不确定性，但对来自不同来源的健康和社会信息进行分析，为确定优先领域和加速实现第四个千年发展目标的关键战略方向提供了线索。在所有这些国家，新生儿死亡占五岁以下儿童死亡的 40%至 50%以上。尽管有很好的产前保健覆盖率和熟练助产士协助分娩，但 2005 年的孕产妇死亡率仍超过每 10 万人 50 人。围产期保健质量的信息很少，表明各级保健服务普遍达不到标准。十二国中十个国家的五岁以下儿童发育迟缓率超过 10%，同时还出现了超重现象。母乳喂养的专一性和持续时间都没有达到建议的标准。儿童和产妇死亡率、营养不良以及在国家内部获得和使用卫生服务方面存在着严重的不平等。总的来说，现有信息清楚地表明，应优先重视改善育龄妇女的健康和围产期保健质量，包括建立可靠的数据收集系统。要做到这一点，就需要采取行动，重点加强卫生系统的能力，提高服务提供的技术含量，并改善最弱势群体获得和适当利用服务的情况。需要其他部门的参与，以改善社区一级的生殖健康和营养，并解决不平等问题。在社会经济背景相似但卫生政策不同的国家之间进行比较，似乎表明，通过国家健康保险制度逐步实现基本医疗保健全覆盖，与向私有化和不受监管的卫生系统艰难过渡相比，更有利于降低儿童死亡率。
