Women's Hospital, Hamad Medical Corporation, Doha, Qatar.
Int J Womens Health. 2010 Sep 17;2:311-8. doi: 10.2147/IJWH.S12426.
This retrospective study analyzed the temporal association between socioeconomic development indices and improved maternal, neonatal, and perinatal survival in the State of Qatar over a period of 35 years (1974-2008). We explored the association between reduction in poverty, improvement in maternal education, and perinatal health care on the one hand, and increased maternal, neonatal, and perinatal survival on the other hand. Yearly mortality data was ascertained from the perinatal and neonatal mortality registers of the Women's Hospital and the national database in the Department of Preventive Medicine at Hamad Medical Corporation in Doha. A total of 323,014 births were recorded during the study period. During these 35 years, there was a remarkable decline (P < 0.001) in Qatar's neonatal mortality rate from 26.27/1000 in 1974 to 4.4/1000 in 2008 and in the perinatal mortality rate from 44.4/1000 in 1974 to 10.58/1000 in 2008. Qatar's maternal mortality rate remained zero during 1993, 1995, and then in 1998-2000. The maternal mortality rate was 11.6/100,000 in 2008. For the rest of the years it has been approximately 10/100,000. Across the study period, the reduction in poverty, increase in maternal education, and improved perinatal health care were temporally associated with a significant improvement in maternal, neonatal, and perinatal survival. The total annual births increased five-fold during the study period, with no negative impact on survival rates. Neonatal mortality rates in Qatar have reached a plateau since 2005. We also conducted a substudy to assess the association between improvements in survival rates in relation to health care investment. For this purpose, we divided the study period into two eras, ie, era A (1974-1993) during which major health care investment was in community-based, low-cost interventions, and era B (1994-2008) during which the major health care investment was in high-technology institutional interventions. Although from 1974-1993 (era A) the per capita health expenditure increased by only 19% as compared with a 137% increase in 1994-2008 (era B). The decline in neonatal and perinatal mortality rates was three times steeper during era A than in era B. The decline in neonatal and perinatal mortality rates was also significant (P < 0.001) when analyzed separately for era A and era B. We concluded that across the 35-year period covered by our study, the reduction in poverty, increased maternal education, and improved perinatal health care were temporally associated with improved maternal, neonatal, and perinatal survival in the State of Qatar. From the subanalysis of era A and era B, we concluded that low-cost, community-based interventions, on the background of socioeconomic development, have a stronger impact on maternal, neonatal, and perinatal survival as compared with high-cost institutional interventions.
本回顾性研究分析了 35 年来（1974 年至 2008 年）卡塔尔社会经济发展指数与孕产妇、新生儿和围产儿生存改善之间的时间关联。我们探讨了贫困减少、孕产妇教育改善和围产保健之间的关联，以及它们与孕产妇、新生儿和围产儿生存改善之间的关联。每年的死亡率数据来自多哈哈马德医疗公司预防医学系妇女医院和国家数据库中的围产儿和新生儿死亡率登记册。在研究期间共记录了 323014 例分娩。在这 35 年中，卡塔尔的新生儿死亡率从 1974 年的 26.27/1000 显著下降到 2008 年的 4.4/1000，围产儿死亡率从 1974 年的 44.4/1000 下降到 2008 年的 10.58/1000（P<0.001）。1993 年、1995 年和 1998-2000 年期间，卡塔尔的孕产妇死亡率一直为零。2008 年的孕产妇死亡率为 11.6/100000。在其余年份，大约为 10/100000。在整个研究期间，贫困减少、孕产妇教育增加和围产保健改善与孕产妇、新生儿和围产儿生存的显著改善有关。在研究期间，每年的总出生人数增加了五倍，但生存率没有受到负面影响。自 2005 年以来，卡塔尔的新生儿死亡率已达到稳定水平。我们还进行了一项子研究，以评估与医疗保健投资相关的生存率改善之间的关联。为此，我们将研究期间分为两个时代，即时代 A（1974-1993 年），在此期间，主要的医疗保健投资是基于社区的低成本干预，以及时代 B（1994-2008 年），在此期间，主要的医疗保健投资是基于高科技机构干预。尽管从 1974 年至 1993 年（时代 A），人均医疗支出仅增长了 19%，而 1994 年至 2008 年（时代 B）增长了 137%。在时代 A 期间，新生儿和围产儿死亡率的下降速度比时代 B 快三倍。在时代 A 和时代 B 分别进行分析时，新生儿和围产儿死亡率的下降均具有显著意义（P<0.001）。我们得出结论，在我们研究涵盖的 35 年期间，贫困减少、孕产妇教育提高和围产保健改善与卡塔尔孕产妇、新生儿和围产儿生存的改善有关。从时代 A 和时代 B 的子分析中，我们得出结论，在社会经济发展的背景下，低成本、基于社区的干预措施对孕产妇、新生儿和围产儿生存的影响比高成本的机构干预措施更大。
