Kipp Aaron M, Blevins Meridith, Haley Connie A, Mwinga Kasonde, Habimana Phanuel, Shepherd Bryan E, Aliyu Muktar H, Ketsela Tigest, Vermund Sten H
Vanderbilt Institute for Global Health, Nashville, Tennessee, USA Department of Medicine, Vanderbilt University School of Medicine, Nashville, Tennessee, USA.
Vanderbilt Institute for Global Health, Nashville, Tennessee, USA Department of Biostatistics, Vanderbilt University School of Medicine, Nashville, Tennessee, USA.
BMJ Open. 2016 Jan 8;6(1):e007675. doi: 10.1136/bmjopen-2015-007675.
Inadequate overall progress has been made towards the 4th Millennium Development Goal of reducing under-five mortality rates by two-thirds between 1990 and 2015. Progress has been variable across African countries. We examined health, economic and social factors potentially associated with reductions in under-five mortality (U5M) from 2000 to 2013.
Ecological analysis using publicly available data from the 46 nations within the WHO African Region.
We assessed the annual rate of change (ARC) of 70 different factors and their association with the annual rate of reduction (ARR) of U5M rates using robust linear regression models.
Most factors improved over the study period for most countries, with the largest increases seen for economic or technological development and external financing factors. The median (IQR) U5M ARR was 3.6% (2.8 to 5.1%). Only 4 of 70 factors demonstrated a strong and significant association with U5M ARRs, adjusting for potential confounders. Higher ARRs were associated with more rapidly increasing coverage of seeking treatment for acute respiratory infection (β=0.22 (ie, a 1% increase in the ARC was associated with a 0.22% increase in ARR); 90% CI 0.09 to 0.35; p=0.01), increasing health expenditure relative to gross domestic product (β=0.26; 95% CI 0.11 to 0.41; p=0.02), increasing fertility rate (β=0.54; 95% CI 0.07 to 1.02; p=0.07) and decreasing maternal mortality ratio (β=-0.47; 95% CI -0.69 to -0.24; p<0.01). The majority of factors showed no association or raised validity concerns due to missing data from a large number of countries.
Improvements in sociodemographic, maternal health and governance and financing factors were more likely associated with U5M ARR. These underscore the essential role of contextual factors facilitating child health interventions and services. Surveillance of these factors could help monitor which countries need additional support in reducing U5M.
在实现第四个千年发展目标（即到2015年将五岁以下儿童死亡率降低三分之二）方面，总体进展不足。非洲各国的进展情况各不相同。我们研究了2000年至2013年期间可能与五岁以下儿童死亡率（U5M）降低相关的健康、经济和社会因素。
利用世界卫生组织非洲区域46个国家的公开数据进行生态分析。
我们使用稳健线性回归模型评估了70个不同因素的年变化率（ARC）及其与五岁以下儿童死亡率年降低率（ARR）的关联。
在研究期间，大多数国家的大多数因素都有所改善，经济或技术发展以及外部融资因素的增幅最大。五岁以下儿童死亡率年降低率的中位数（IQR）为3.6%（2.8%至5.1%）。在调整潜在混杂因素后，70个因素中只有4个与五岁以下儿童死亡率年降低率表现出强烈且显著的关联。较高的年降低率与急性呼吸道感染治疗寻求覆盖率的更快提高相关（β=0.22，即年变化率每增加1%，年降低率增加0.22%；90%CI为0.09至0.35；p=0.01），卫生支出相对于国内生产总值的增加（β=0.26；95%CI为0.11至0.41；p=0.02），生育率的增加（β=0.54；95%CI为0.07至1.02；p=0.07）以及孕产妇死亡率的降低（β=-0.47；95%CI为-0.69至-0.24；p<0.01）。由于大量国家数据缺失，大多数因素未显示出关联或引发了有效性担忧。
社会人口、孕产妇健康以及治理和融资因素的改善更有可能与五岁以下儿童死亡率年降低率相关。这些强调了背景因素在促进儿童健康干预和服务方面的重要作用。对这些因素的监测有助于监测哪些国家在降低五岁以下儿童死亡率方面需要额外支持。
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