Chadoka-Mutanda Nyasha, Odimegwu Clifford O
Demography and Population Studies Programme,Schools of Public Health and Social Sciences,University of the Witwatersrand,Johannesburg,South Africa.
J Biosoc Sci. 2017 May;49(3):408-421. doi: 10.1017/S0021932016000298. Epub 2016 Jun 21.
Under-five mortality remains a major public health challenge in sub-Saharan Africa. Zimbabwe is one of the countries in the region that failed to achieve Millennium Developmental Goal 4 in 2015. The objective of this study was to examine the extent to which maternal health-seeking behaviour prior to and during pregnancy and post-delivery influences the likelihood of under-five mortality among Zimbabwean children. The study was cross-sectional and data were extracted from the 2010/11 Zimbabwe Demographic and Health Survey (ZDHS). The study sample comprised 5155 children who were born five years preceding the 2010/11 ZDHS to a sample of 4128 women of reproductive age (15-49 years). Cox Proportional Hazard regression modelling was used to examine the relationship between maternal health-seeking behaviour and under-five mortality. The results showed that maternal health-seeking behaviour factors are associated with the risk of dying during childhood. Children born to mothers who had ever used contraceptives (HR: 0.38, CI 0.28-0.51) had a lower risk of dying during childhood compared with children born to mothers who had never used any contraceptive method. The risk of under-five mortality among children who had a postnatal check-up within two months after birth (HR: 0.36, CI 0.23-0.56) was lower than that of children who did not receive postnatal care. Small birth size (HR: 1.70, CI 1.20-2.41) and higher birth order (2+) increased the risk of under-five mortality. Good maternal health-seeking behaviour practices at the three critical stages around childbirth have the potential to reduce under-five mortality. Therefore, public health programmes should focus on influencing health-seeking behaviour among women and removing obstacles to effective maternal health-seeking behaviour in Zimbabwe.
五岁以下儿童死亡率仍然是撒哈拉以南非洲地区面临的一项重大公共卫生挑战。津巴布韦是该地区未能在2015年实现千年发展目标4的国家之一。本研究的目的是考察孕期及分娩前后孕产妇寻求医疗保健行为对津巴布韦儿童五岁前死亡可能性的影响程度。该研究为横断面研究，数据取自2010/11年津巴布韦人口与健康调查（ZDHS）。研究样本包括在2010/11年ZDHS之前五年出生的5155名儿童，其母亲为4128名育龄妇女（15 - 49岁）。采用Cox比例风险回归模型来考察孕产妇寻求医疗保健行为与五岁以下儿童死亡率之间的关系。结果显示，孕产妇寻求医疗保健行为因素与儿童期死亡风险相关。与从未使用过任何避孕方法的母亲所生子女相比，曾使用过避孕药具的母亲所生子女在儿童期死亡风险较低（风险比：0.38，置信区间0.28 - 0.51）。出生后两个月内进行过产后检查的儿童，其五岁以下死亡风险（风险比：0.36，置信区间0.23 - 0.56）低于未接受产后护理的儿童。低出生体重（风险比：1.70，置信区间1.20 - 2.41）和较高胎次（二胎及以上）会增加五岁以下儿童死亡风险。在分娩前后三个关键阶段采取良好的孕产妇寻求医疗保健行为措施，有可能降低五岁以下儿童死亡率。因此，公共卫生项目应着重影响女性的就医行为，并消除津巴布韦有效孕产妇就医行为的障碍。
