Grady Sue C, Frake April N, Zhang Qiong, Bene Matlhogonolo, Jordan Demetrice R, Vertalka Joshua, Dossantos Thania C, Kadhim Ameen, Namanya Judith, Pierre Lisa-Marie, Fan Yi, Zhou Peiling, Barry Fatoumata B, Kutch Libbey
Department of Geography, Environment and Spatial Sciences, Michigan State University, East Lansing, MI; Global Health and Medical Geography Lab, Department of Geography, Environment and Spatial Sciences, Michigan State University, Lansing, MI.
Geospat Health. 2017 May 26;12(1):501. doi: 10.4081/gh.2017.501.
Under-five child mortality declined 47% since 2000 following the implementation of the United Nation's (UN) Millennium Development Goals. To further reduce under-five child mortality, the UN's Sustainable Development Goals (SDGs) will focus on interventions to address neonatal mortality, a major contributor of under-five mortality. The African region has the highest neonatal mortality rate (28.0 per 1000 live births), followed by that of the Eastern Mediterranean (26.6) and South-East Asia (24.3). This study used the Demographic and Health Survey Birth Recode data (http://dhsprogram.com/data/File-Types-and-Names.cfm) to identify high-risk districts and countries for neonatal mortality in two sub-regions of Africa - East Africa and West Africa. Geographically weighted Poisson regression models were estimated to capture the spatially varying relationships between neonatal mortality and dimensions of potential need i) care around the time of delivery, ii) maternal education, and iii) women's empowerment. In East Africa, neonatal mortality was significantly associated with home births, mothers without an education and mothers whose husbands decided on contraceptive practices, controlling for rural residency. In West Africa, neonatal mortality was also significantly associated with home births, mothers with a primary education and mothers who did not want or plan their last child. Importantly, neonatal mortality associated with home deliveries were explained by maternal exposure to unprotected water sources in East Africa and older maternal age and female sex of infants in West Africa. Future SDG-interventions may target these dimensions of need in priority high-risk districts and countries, to further reduce the burden of neonatal mortality in Africa.
自联合国千年发展目标实施以来，五岁以下儿童死亡率自2000年起下降了47%。为进一步降低五岁以下儿童死亡率，联合国可持续发展目标将专注于采取干预措施来解决新生儿死亡率问题，因为新生儿死亡率是五岁以下儿童死亡率的主要促成因素。非洲区域的新生儿死亡率最高（每1000例活产中有28.0例），其次是东地中海区域（26.6例）和东南亚区域（24.3例）。本研究使用了人口与健康调查出生记录数据（http://dhsprogram.com/data/File-Types-and-Names.cfm）来确定非洲两个次区域——东非和西非——新生儿死亡率高风险的地区和国家。估计了地理加权泊松回归模型，以捕捉新生儿死亡率与潜在需求维度之间的空间变化关系：i）分娩时的护理，ii）母亲教育程度，以及iii）妇女赋权。在东非，在控制农村居住情况的条件下，新生儿死亡率与在家分娩、未受过教育的母亲以及丈夫决定避孕措施的母亲显著相关。在西非，新生儿死亡率也与在家分娩、接受过小学教育的母亲以及不想要或未计划生育最后一个孩子的母亲显著相关。重要的是，东非与在家分娩相关的新生儿死亡率可由母亲接触未受保护水源来解释，而西非则可由母亲年龄较大和婴儿为女性来解释。未来的可持续发展目标干预措施可能会针对高风险优先地区和国家的这些需求维度，以进一步减轻非洲新生儿死亡率的负担。
