Singh Abhishek, Pallikadavath Saseendran, Ram Faujdar, Alagarajan Manoj
Department of Public Health & Mortality Studies, International Institute for Population Sciences, Mumbai 400 088, India, Global Health and Social Care Unit, School of Health Sciences & Social Work, University of Portsmouth, Portsmouth PO1 2FR, UK, Director & Senior Professor, International Institute for Population Sciences, Mumbai 400 088, India and Department of Development Studies, International Institute for Population Sciences, Mumbai 400 088, India
Department of Public Health & Mortality Studies, International Institute for Population Sciences, Mumbai 400 088, India, Global Health and Social Care Unit, School of Health Sciences & Social Work, University of Portsmouth, Portsmouth PO1 2FR, UK, Director & Senior Professor, International Institute for Population Sciences, Mumbai 400 088, India and Department of Development Studies, International Institute for Population Sciences, Mumbai 400 088, India.
Health Policy Plan. 2014 Oct;29(7):842-8. doi: 10.1093/heapol/czt066. Epub 2013 Sep 13.
Although antenatal care (ANC) interventions have been in place for a long time, there is hardly any systematic evidence on the association between ANC interventions and neonatal mortality in India. The present study attempts to investigate the association between ANC interventions and neonatal mortality in India using data from the District Level Household Survey conducted in India during 2007-8. The ANC interventions included in the analysis are at least four antenatal visits, consumption of 90 or more iron-folic acid (IFA) tablets, and uptake of two or more tetanus toxoid (TT) injections. We have used discrete-time logistic regression models to investigate the association between ANC interventions and neonatal mortality. Risk of neonatal mortality was significantly lower for infants of mothers who availed four or more antenatal visits [odds ratio (OR): 0.69; 95% confidence interval (CI): 0.60-0.81], consumed 90 or more IFA tablets (OR: 0.85; 95% CI: 0.73-0.99), received two or more TT injections (OR: 0.73; 95% CI: 0.63-0.83). When we analysed different combinations of antenatal visits, IFA supplementation and TT injections, TT injections provided the main protective effect-the risk of neonatal mortality was significantly lower in newborns of women who received two or more TT injections but did not consume 90 or more IFA tablets (OR: 0.69; 95% CI: 0.60-0.78), or who received two or more TT injections but did not avail four or more antenatal visits (OR: 0.75; 95% CI: 0.66-0.86). In the statistical model, 6% (95% CI: 4-8%) of the neonatal deaths in India could be attributed to a lack of at least two TT injections during pregnancy. Indian public health programmes must ensure that every pregnant woman receives two or more TT injections during antenatal visits.
尽管产前保健（ANC）干预措施已经实施了很长时间，但在印度，几乎没有任何关于ANC干预措施与新生儿死亡率之间关联的系统性证据。本研究试图利用2007 - 2008年在印度进行的地区级家庭调查数据，调查印度ANC干预措施与新生儿死亡率之间的关联。分析中纳入的ANC干预措施包括至少四次产前检查、服用90片或更多的铁叶酸（IFA）片以及接受两次或更多次破伤风类毒素（TT）注射。我们使用离散时间逻辑回归模型来研究ANC干预措施与新生儿死亡率之间的关联。母亲进行四次或更多次产前检查的婴儿，其新生儿死亡风险显著降低[比值比（OR）：0.69；95%置信区间（CI）：0.60 - 0.81]；服用90片或更多IFA片的婴儿（OR：0.85；95% CI：0.73 - 0.99）；接受两次或更多次TT注射的婴儿（OR：0.73；95% CI：0.63 - 0.83）。当我们分析产前检查、IFA补充剂和TT注射的不同组合时，TT注射提供了主要的保护作用——接受两次或更多次TT注射但未服用90片或更多IFA片的妇女所生新生儿的新生儿死亡风险显著降低（OR：0.69；95% CI：0.60 - 0.78），或者接受两次或更多次TT注射但未进行四次或更多次产前检查的妇女所生新生儿的新生儿死亡风险显著降低（OR：0.75；95% CI：0.66 - 0.86）。在统计模型中，印度6%（95% CI：4 - 8%）的新生儿死亡可归因于孕期缺乏至少两次TT注射。印度公共卫生项目必须确保每位孕妇在产前检查期间接受两次或更多次TT注射。
