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运用挽救生命工具(LiST)对拉丁美洲和加勒比地区27个国家的28项预防死产及孕产妇、新生儿和儿童死亡干预措施的三个扩大覆盖水平进行分析。

An analysis of three levels of scaled-up coverage for 28 interventions to avert stillbirths and maternal, newborn and child mortality in 27 countries in Latin America and the Caribbean with the Lives Saved Tool (LiST).

作者信息

Arnesen Lauren, O'Connell Thomas, Brumana Luisa, Durán Pablo

机构信息

Pan American Health Organization, Centro Latinoamericano de Perinatología, Salud de la Mujer y Reproductiva, Montevideo, Uruguay.

UNICEF, New York Headquarters, New York, USA.

出版信息

BMC Public Health. 2016 Jul 22;16:613. doi: 10.1186/s12889-016-3238-z.

Abstract

BACKGROUND

Action to avert maternal and child mortality was propelled by the Millennium Development Goals (MDGs) in 2000. The Latin American and Caribbean (LAC) region has shown promise in achieving the MDGs in many countries, but preventable maternal, neonatal and child mortality persist. Furthermore, preventable stillbirths are occurring in large numbers in the region. While an effective set of maternal, newborn and child health (MNCH) interventions have been identified, they have not been brought to scale across LAC.

METHODS

Baseline data for select MNCH interventions for 27 LAC countries that are included in the Lives Saved Tool (LiST) were verified and updated with survey data. Three LiST projections were built for each country: baseline, MDG-focused, and All Included, each scaling up a progressively larger set of interventions for 2015 - 2030. Impact was assessed for 2015 - 2035, comparing annual and total lives saved, as projected by LiST.

RESULTS

Across the 27 countries 235,532 stillbirths, and 752,588 neonatal, 959,393 under-five, and 60,858 maternal deaths would be averted between 2015 and 2035 by implementing the All-Included intervention package, representing 67 %, 616 %, 807 % and 101 % more lives saved, respectively, than with the MDG-focused interventions. 25 % neonatal deaths averted with the All-Included intervention package would be due to asphyxia, 42 % from prematurity and 24 % from sepsis.

CONCLUSIONS

Our modelling suggests a 337 % increase in the number of lives saved, which would have enormous impacts on population health. Further research could help clarify the impacts of a comprehensive scale-up of the full range of essential MNCH interventions we have modelled.

摘要

背景

2000年的千年发展目标推动了预防母婴死亡的行动。拉丁美洲和加勒比地区在许多国家实现千年发展目标方面展现出了希望,但可预防的孕产妇、新生儿和儿童死亡仍然存在。此外,该地区仍有大量可预防的死产发生。虽然已经确定了一套有效的孕产妇、新生儿和儿童健康(MNCH)干预措施,但它们尚未在拉丁美洲和加勒比地区全面推广。

方法

利用调查数据对纳入“挽救生命工具”(LiST)的27个拉丁美洲和加勒比国家的特定MNCH干预措施的基线数据进行核实和更新。为每个国家建立了三个LiST预测模型:基线模型、聚焦千年发展目标模型和全部纳入模型,每个模型在2015 - 2030年期间逐步扩大一系列干预措施的规模。评估了2015 - 2035年的影响,比较了LiST预测的每年挽救的生命数和总共挽救的生命数。

结果

通过实施全部纳入的干预措施包,在2015年至2035年期间,27个国家将避免235,532例死产、752,588例新生儿死亡、959,393例五岁以下儿童死亡和60,858例孕产妇死亡,与聚焦千年发展目标的干预措施相比,分别多挽救67%、616%、807%和101%的生命。全部纳入的干预措施包避免的25%新生儿死亡将归因于窒息,42%归因于早产,24%归因于败血症。

结论

我们的模型显示挽救的生命数增加了337%,这将对人口健康产生巨大影响。进一步的研究有助于阐明全面扩大我们所建模的全套基本MNCH干预措施的影响。

https://cdn.ncbi.nlm.nih.gov/pmc/blobs/4541/4957379/92c5e013fafb/12889_2016_3238_Fig1_HTML.jpg

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