Department of Paediatrics and Child Health, Division of Women and Child Health, Aga Khan University, Karachi, Pakistan.
Lancet. 2013 Jun 22;381(9884):2207-18. doi: 10.1016/S0140-6736(12)61999-0. Epub 2013 May 17.
Globally, Pakistan has the third highest burden of maternal, fetal, and child mortality. It has made slow progress in achieving the Millennium Development Goals (MDGs) 4 and 5 and in addressing common social determinants of health. The country also has huge challenges of political fragility, complex security issues, and natural disasters. We undertook an in-depth analysis of Pakistan's progress towards MDGs 4 and 5 and the principal determinants of health in relation to reproductive, maternal, newborn, and child health and nutrition. We reviewed progress in relation to new and existing public sector programmes and the challenges posed by devolution in Pakistan. Notwithstanding the urgent need to tackle social determinants such as girls' education, empowerment, and nutrition in Pakistan, we assessed the effect of systematically increasing coverage of various evidence-based interventions on populations at risk (by residence or poverty indices). We specifically focused on scaling up interventions using delivery platforms to reach poor and rural populations through community-based strategies. Our model indicates that with successful implementation of these strategies, 58% of an estimated 367,900 deaths (15,900 maternal, 169,000 newborn, 183,000 child deaths) and 49% of an estimated 180,000 stillbirths could be prevented in 2015.
在全球范围内，巴基斯坦的孕产妇、胎儿和儿童死亡率居世界第三位。在实现千年发展目标 4 和 5 以及解决常见的健康决定因素方面，该国进展缓慢。此外，巴基斯坦还面临政治脆弱、复杂的安全问题和自然灾害等巨大挑战。我们对巴基斯坦在实现千年发展目标 4 和 5 方面的进展以及与生殖、孕产妇、新生儿和儿童健康和营养有关的主要健康决定因素进行了深入分析。我们审查了新的和现有的公共部门方案所取得的进展，以及巴基斯坦权力下放带来的挑战。尽管巴基斯坦迫切需要解决女童教育、赋权和营养等社会决定因素，但我们评估了通过按居住或贫困指数对风险人群系统地增加各种基于证据的干预措施的覆盖范围的效果。我们特别关注通过以社区为基础的战略，利用各种交付平台来扩大干预措施，以覆盖贫困和农村人口。我们的模型表明，如果成功实施这些战略，预计到 2015 年，可预防 367900 例死亡人数（15900 例孕产妇死亡、169000 例新生儿死亡、183000 例儿童死亡）中的 58%和 180000 例死产中的 49%。
