南非农村的家庭环境与儿童死亡率：生育间隔、共同死亡率、家庭构成及社会经济地位的影响
Household context and child mortality in rural South Africa: the effects of birth spacing, shared mortality, household composition and socio-economic status.
作者信息
Houle Brian, Stein Alan, Kahn Kathleen, Madhavan Sangeetha, Collinson Mark, Tollman Stephen M, Clark Samuel J
机构信息
Institute of Behavioral Science (IBS), University of Colorado at Boulder, Boulder, CO, USA, MRC/Wits Rural Public Health and Health Transitions Research Unit (Agincourt), School of Public Health, Faculty of Health Sciences, University of the Witwatersrand, Johannesburg, South Africa, Section of Child and Adolescent Psychiatry, Department of Psychiatry, University of Oxford, Oxford, UK, Centre for Global Health Research, Umeå University, Umeå, Sweden, INDEPTH Network, Accra, Ghana, Department of African-American Studies, University of Maryland-College Park, College Park, MD, USA and Department of Sociology, University of Washington, Seattle, WA, USA.
出版信息
Int J Epidemiol. 2013 Oct;42(5):1444-54. doi: 10.1093/ije/dyt149. Epub 2013 Aug 2.
BACKGROUND
Household characteristics are important influences on the risk of child death. However, little is known about this influence in HIV-endemic areas. We describe the effects of household characteristics on children's risk of dying in rural South Africa.
METHODS
We use data describing the mortality of children younger than 5 years living in the Agincourt health and socio-demographic surveillance system study population in rural northeast South Africa during the period 1994-2008. Using discrete time event history analysis we estimate children's probability of dying by child characteristics and household composition (other children and adults other than parents) (N=924,818 child-months), and household socio-economic status (N=501,732 child-months).
RESULTS
Children under 24 months of age whose subsequent sibling was born within 11 months experience increased odds of dying (OR 2.5; 95% CI 1.1-5.7). Children also experience increased odds of dying in the period 6 months (OR 2.1; 95% CI 1.2-3.6), 3-5 months (OR 3.0; 95% CI 1.5-5.9), and 2 months (OR 11.8; 95% CI 7.6-18.3) before another household child dies. The odds of dying remain high at the time of another child's death (OR 11.7; 95% CI 6.3-21.7) and for the 2 months following (OR 4.0; 95% CI 1.9-8.6). Having a related but non-parent adult aged 20-59 years in the household reduces the odds (OR 0.6; 95% CI 0.5-0.8). There is an inverse relationship between a child's odds of dying and household socio-economic status.
CONCLUSIONS
This detailed household profile from a poor rural setting where HIV infection is endemic indicates that children are at high risk of dying when another child is very ill or has recently died. Short birth intervals and additional children in the household are further risk factors. Presence of a related adult is protective, as is higher socio-economic status. Such evidence can inform primary health care practice and facilitate targeting of community health worker efforts, especially when covering defined catchment areas.
背景
家庭特征对儿童死亡风险有重要影响。然而，在艾滋病流行地区，人们对这种影响知之甚少。我们描述了南非农村地区家庭特征对儿童死亡风险的影响。
方法
我们使用了描述1994年至2008年期间生活在南非东北部农村阿金库尔健康与社会人口监测系统研究人群中5岁以下儿童死亡率的数据。通过离散时间事件史分析，我们根据儿童特征、家庭构成（其他儿童和非父母的成年人）（N = 924,818儿童月）以及家庭社会经济地位（N = 501,732儿童月）来估计儿童的死亡概率。
结果
24个月以下儿童，如果其随后出生的兄弟姐妹在11个月内出生，其死亡几率会增加（比值比2.5；95%置信区间1.1 - 5.7）。在家庭中另一个孩子死亡前6个月（比值比2.1；95%置信区间1.2 - 3.6）、3 - 5个月（比值比3.0；95%置信区间1.5 - 5.9）和2个月（比值比11.8；95%置信区间7.6 - 18.3），儿童的死亡几率也会增加。在另一个孩子死亡时（比值比11.7；95%置信区间6.3 - 21.7）以及之后的2个月内（比值比4.0；95%置信区间1.9 - 8.6），死亡几率仍然很高。家庭中有一位20至59岁的亲属但非父母的成年人会降低死亡几率（比值比0.6；95%置信区间0.5 - 0.8）。儿童的死亡几率与家庭社会经济地位呈负相关。
结论
来自艾滋病流行的贫困农村地区的这一详细家庭情况表明，当另一个孩子病得很重或最近死亡时，儿童面临着很高的死亡风险。生育间隔短和家庭中有更多孩子是进一步的风险因素。有亲属成年人存在具有保护作用，较高的社会经济地位也是如此。这些证据可为初级卫生保健实践提供参考，并有助于确定社区卫生工作者的工作重点，特别是在覆盖特定集水区时。
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