Minnery Mark, Jimenez-Soto Eliana, Firth Sonja, Nguyen Kim-Huong, Hodge Andrew
School of Population Health, Public Health Building, The University of Queensland, Herston Road, Herston, Brisbane, Queensland 4006, Australia.
BMC Public Health. 2013 Aug 27;13:779. doi: 10.1186/1471-2458-13-779.
India has the world's highest total number of under-five deaths of any nation. While progress towards Millennium Development Goal 4 has been documented at the state level, little information is available for greater disaggregation of child health markers within states. In 2000, new states were created within the country as a partial response to political pressures. State-level information on child health trends in the new states of Chhattisgarh and Jharkhand is scarce. To fill this gap, this article examines under-five and neonatal mortality across various equity markers within these two new states, pre-and post-split.
Both direct and indirect estimation using pooled data from five available sources were undertaken. Inter-population disparities were evaluated by mortality data stratification of rural-urban location, ethnicity, wealth and districts.
Both states experienced an overall reduction in under-five and neonatal mortality, however, this has stagnated post-2001 and various disparities persist. In cases where disparities have declined, such as between urban-rural populations and low- and high-income groups, this has been driven by modest declines within the disadvantaged groups (i.e. low-income rural households) and stagnation or worsening of outcomes within the advantaged groups. Indeed, rising trends in mortality are most prevalent in urban middle-income households.
The results suggest that rural health improvements may have come at the expense of urban areas, where poor performance may be attributed to factors such as lack of access to quality private health facilities. In addition, the disparities may in part be associated with geographical access, traditional practices and district-level health resource allocation.
印度是世界上五岁以下儿童死亡总数最多的国家。虽然在邦一级已记录了在实现千年发展目标4方面取得的进展，但关于邦内儿童健康指标更详细分类的信息却很少。2000年，该国为部分应对政治压力设立了新的邦。关于恰蒂斯加尔邦和贾坎德邦这两个新邦儿童健康趋势的邦级信息匮乏。为填补这一空白，本文研究了这两个新邦在分邦前后各公平指标下的五岁以下儿童和新生儿死亡率。
采用了来自五个现有来源的汇总数据进行直接和间接估计。通过按城乡地点、种族、财富和地区对死亡率数据进行分层来评估人群间的差异。
两个邦的五岁以下儿童和新生儿死亡率总体都有所下降，然而，2001年后这种下降停滞了，各种差异仍然存在。在一些差异有所下降的情况中，比如城乡人口之间以及低收入和高收入群体之间，这是由弱势群体（即低收入农村家庭）的适度下降以及优势群体中结果的停滞或恶化所推动的。事实上，死亡率上升趋势在城市中等收入家庭中最为普遍。
结果表明，农村地区健康状况的改善可能是以城市地区为代价的，城市地区表现不佳可能归因于缺乏获得优质私立医疗设施等因素。此外，这些差异可能部分与地理可达性、传统习俗和地区层面的卫生资源分配有关。
