撒哈拉以南非洲地区 5 岁以下儿童死亡率差异的来源：一项空间分析。

Sources of variation in under-5 mortality across sub-Saharan Africa: a spatial analysis.

机构信息

Department of Earth System Science, Stanford University, Stanford, CA, USA; Center on Food Security and the Environment, Stanford University, Stanford, CA, USA; National Bureau of Economic Research, Cambridge, MA, USA.

Department of Earth System Science, Stanford University, Stanford, CA, USA.

出版信息

Lancet Glob Health. 2016 Dec;4(12):e936-e945. doi: 10.1016/S2214-109X(16)30212-1. Epub 2016 Oct 25.

DOI:10.1016/S2214-109X(16)30212-1

PMID:27793587

Abstract

BACKGROUND

Detailed spatial understanding of levels and trends in under-5 mortality is needed to improve the targeting of interventions to the areas of highest need, and to understand the sources of variation in mortality. To improve this understanding, we analysed local-level information on child mortality across sub-Saharan Africa between 1980-2010.

METHODS

We used data from 82 Demographic and Health Surveys in 28 sub-Saharan African countries, including the location and timing of 3·24 million childbirths and 393 685 deaths, to develop high-resolution spatial maps of under-5 mortality in the 1980s, 1990s, and 2000s. These estimates were at a resolution of 0·1 degree latitude by 0·1 degree longitude (roughly 10 km × 10 km). We then analysed this spatial information to distinguish within-country versus between-country sources of variation in mortality, to examine the extent to which declines in mortality have been accompanied by convergence in the distribution of mortality, and to study localised drivers of mortality differences, including temperature, malaria burden, and conflict.

FINDINGS

In our sample of sub-Saharan African countries from the 1980s to the 2000s, within-country differences in under-5 mortality accounted for 74-78% of overall variation in under-5 mortality across space and over time. Mortality differed significantly across only 8-15% of country borders, supporting the role of local, rather than national, factors in driving mortality patterns. We found that by the end of the study period, 23% of the eligible children in the study countries continue to live in mortality hotspots-areas where, if current trends continue, the Sustainable Developent Goals mortality targets will not be met. In multivariate analysis, within-country mortality levels at each pixel were significantly related to local temperature, malaria burden, and recent history of conflict.

INTERPRETATION

Our findings suggest that sub-national determinants explain a greater portion of under-5 mortality than do country-level characteristics. Sub-national measures of child mortality could provide a more accurate, and potentially more actionable, portrayal of where and why children are still dying than can national statistics.

FUNDING

The Stanford Woods Institute for the Environment.

摘要

背景

为了改善干预措施的针对性，满足高需求地区的需要，并了解死亡率变化的来源，需要详细了解五岁以下儿童死亡率的水平和趋势的空间分布情况。为了更好地了解这一点，我们分析了 1980 年至 2010 年期间撒哈拉以南非洲地区的地方一级儿童死亡率信息。

方法

我们利用来自撒哈拉以南非洲 28 个国家的 82 项人口与健康调查的数据，包括 324 万例分娩和 393685 例死亡的地点和时间，绘制了 20 世纪 80 年代、90 年代和 21 世纪的五岁以下儿童死亡率高分辨率空间图。这些估计的分辨率为 0.1 度纬度乘以 0.1 度经度（大约 10 公里×10 公里）。然后，我们分析了这些空间信息，以区分死亡率的国内和国际差异来源，检验死亡率下降是否伴随着死亡率分布的趋同，以及研究死亡率差异的局部驱动因素，包括温度、疟疾负担和冲突。

发现

在我们的样本中，20 世纪 80 年代至 2000 年代期间，撒哈拉以南非洲国家的国内死亡率差异占整个空间和时间内五岁以下儿童死亡率变化的 74-78%。只有 8-15%的国家边界存在明显的死亡率差异，这支持了地方因素而非国家因素在推动死亡率模式方面的作用。我们发现，在研究期间结束时，研究国家中 23%的合格儿童仍生活在死亡率热点地区——如果目前的趋势继续下去，这些地区将无法实现可持续发展目标的死亡率目标。在多元分析中，每个像素的国内死亡率水平与当地温度、疟疾负担和近期冲突历史显著相关。