克服儿童死亡率水平与分布的停滞状况:以菲律宾为例。
Overcoming Stagnation in the Levels and Distribution of Child Mortality: The Case of the Philippines.
作者信息
Bermejo Raoul, Firth Sonja, Hodge Andrew, Jimenez-Soto Eliana, Zeck Willibald
机构信息
UNICEF Philippines, Makati City, Philippines; Institute of Tropical Medicine, Antwerp, Belgium.
School of Public Health, The University of Queensland, Brisbane, Queensland, Australia.
出版信息
PLoS One. 2015 Oct 2;10(10):e0139458. doi: 10.1371/journal.pone.0139458. eCollection 2015.
BACKGROUND
Health-related within-country inequalities continue to be a matter of great interest and concern to both policy makers and researchers. This study aims to assess the level and the distribution of child mortality outcomes in the Philippines across geographical and socioeconomic indicators.
METHODOLOGY
Data on 159,130 children ever borne were analysed from five waves of the Philippine Demographic and Health Survey. Direct estimation was used to construct under-five and neonatal mortality rates for the period 1980-2013. Rate differences and ratios, and where possible, slope and relative indices of inequality were calculated to measure disparities on absolute and relative scales. Stratification was undertaken by levels of rural/urban location, island groups and household wealth.
FINDINGS
National under-five and neonatal mortality rates have shown considerable albeit differential reductions since 1980. Recently released data suggests that neonatal mortality has declined following a period of stagnation. Declines in under-five mortality have been accompanied by decreases in wealth and geography-related absolute inequalities. However, relative inequalities for the same markers have remained stable over time. For neonates, mixed evidence suggests that absolute and relative inequalities have remained stable or may have risen.
CONCLUSION
In addition to continued reductions in under-five mortality, new data suggests that the Philippines have achieved success in addressing the commonly observed stagnated trend in neonatal mortality. This success has been driven by economic improvement since 2006 as well as efforts to implement a nationwide universal health care campaign. Yet, such patterns, nonetheless, accorded with persistent inequalities, particularly on a relative scale. A continued focus on addressing universal coverage, the influence of decentralisation and armed conflict, and issues along the continuum of care is advocated.
背景
国内与健康相关的不平等现象仍然是政策制定者和研究人员极为关注的问题。本研究旨在评估菲律宾儿童死亡率在地理和社会经济指标方面的水平及分布情况。
方法
分析了来自菲律宾人口与健康调查五轮数据中的159,130名曾生育儿童的数据。采用直接估计法构建1980 - 2013年期间的五岁以下儿童和新生儿死亡率。计算率差和率比,并在可能的情况下计算不平等斜率和相对指数,以衡量绝对和相对尺度上的差异。按农村/城市地区、岛屿组和家庭财富水平进行分层。
结果
自1980年以来,全国五岁以下儿童和新生儿死亡率虽有不同程度但都有显著下降。最近发布的数据表明,新生儿死亡率在经历一段时间的停滞之后有所下降。五岁以下儿童死亡率的下降伴随着与财富和地理相关的绝对不平等现象的减少。然而,相同指标的相对不平等现象长期以来一直保持稳定。对于新生儿,综合证据表明绝对和相对不平等现象保持稳定或可能有所上升。
结论
除了五岁以下儿童死亡率持续下降外,新数据表明菲律宾在解决新生儿死亡率普遍停滞不前这一常见趋势方面取得了成功。这一成功得益于2006年以来的经济改善以及实施全国范围全民医疗保健运动的努力。然而,这种模式仍然伴随着持续存在的不平等现象,特别是在相对尺度上。提倡继续关注实现全民覆盖、分权和武装冲突的影响以及连续护理过程中的问题。
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