Braintree Global Health, Cambridge, MA, USA.
Department of Global Health and Population, Harvard TH Chan School of Public Health, Boston, MA, USA.
Lancet Glob Health. 2017 Nov;5(11):e1142-e1151. doi: 10.1016/S2214-109X(17)30331-5.
3 years before the 2015 deadline, Ethiopia achieved Millennium Development Goal 4. The under-5 mortality decreased 69%, from 205 deaths per 1000 livebirths in 1990 to 64 deaths per 1000 livebirths in 2013. To understand the underlying factors that contributed to the success in achieving MDG4, Ethiopia was selected as a Countdown to 2015 case study.
We used a set of complementary methods to analyse progress in child health in Ethiopia between 1990 and 2014. We used Demographic Health Surveys to analyse trends in coverage and equity of key reproductive, maternal health, and child health indicators. Standardised tools developed by the Countdown Health Systems and Policies working group were used to understand the timing and content of health and non-health policies. We assessed longitudinal trends in health-system investment through a financial analysis of National Health Accounts, and we used the Lives Saved Tool (LiST) to assess the contribution of interventions towards reducing under-5 mortality.
The annual rate of reduction in under-5 mortality increased from 3·3% in 1990-2005 to 7·8% in 2005-13. The prevalence of stunting decreased from 60% in 2000 to 40% in 2014. Overall levels of coverage of reproductive, maternal health, and child health indicators remained low, with disparities between the lowest and highest wealth quintiles despite improvement in coverage for essential health interventions. Coverage of child immunisation increased the most (21% of children in 2000 vs 80% of children in 2014), followed by coverage of satisfied demand for family planning by women of reproductive age (19% vs 63%). Provision of antenatal care increased from 10% of women in 2000 to 32% of women in 2014, but only 15% of women delivered with a skilled birth attendant by 2014. A large upturn occurred after 2005, bolstered by a rapid increase in health funding that facilitated the accelerated expansion of health infrastructure and workforce through an innovative community-based delivery system. The LiST model could explain almost 50% of the observed reduction in child mortality between 2000 and 2011; and changes in nutritional status were responsible for about 50% of the 469 000 lives saved between 2000 and 2011. These developments occurred within a multisectoral policy platform, integrating child survival and stunting goals within macro-level policies and programmes for reducing poverty and improving agricultural productivity, food security, water supply, and sanitation.
The reduction of under-5 mortality in Ethiopia was the result of combined activities in health, nutrition, and non-health sectors. However, Ethiopia still has high neonatal and maternal morbidity and mortality from preventable causes and an unfinished agenda in reducing inequalities, improving coverage of effective interventions, and strengthening multisectoral partnerships for further progress.
Bill & Melinda Gates Foundation and Government of Canada.
在 2015 年最后期限前 3 年，埃塞俄比亚实现了千年发展目标 4。5 岁以下儿童死亡率降低了 69%，从 1990 年每 1000 例活产 205 例死亡降至 2013 年的 64 例死亡。为了了解促成实现千年发展目标 4 的潜在因素，埃塞俄比亚被选为 2015 年倒计时案例研究。
我们使用一系列互补的方法来分析 1990 年至 2014 年期间埃塞俄比亚儿童健康方面的进展。我们使用人口健康调查来分析关键生殖、孕产妇健康和儿童健康指标的覆盖范围和公平性趋势。倒计时卫生系统和政策工作组制定的标准化工具用于了解卫生和非卫生政策的时间安排和内容。我们通过对国家卫生账户进行财务分析来评估卫生系统投资的纵向趋势，并使用挽救生命工具（LiST）评估干预措施对降低 5 岁以下儿童死亡率的贡献。
5 岁以下儿童死亡率的年降低率从 1990-2005 年的 3.3%增加到 2005-2013 年的 7.8%。发育迟缓的流行率从 2000 年的 60%下降到 2014 年的 40%。生殖、孕产妇健康和儿童健康指标的整体覆盖率仍然较低，尽管基本卫生干预措施的覆盖率有所提高，但在最贫穷和最富有五分之一之间仍存在差距。儿童免疫接种的覆盖率增长最多（2000 年有 21%的儿童，2014 年有 80%的儿童），其次是满足育龄妇女计划生育需求的满意度（19%对 63%）。产前保健的提供从 2000 年的 10%增加到 2014 年的 32%，但到 2014 年，只有 15%的妇女由熟练的接生员接生。2005 年后出现了大幅上升，这得益于卫生资金的快速增加，通过创新的基于社区的交付系统，加速扩大了卫生基础设施和劳动力。LiST 模型可以解释 2000 年至 2011 年期间儿童死亡率观察到的近 50%的下降；营养状况的变化占 2000 年至 2011 年期间挽救的 469000 人生命的 50%左右。这些发展发生在一个多部门政策平台内，将儿童生存和发育迟缓目标纳入减贫和提高农业生产力、粮食安全、供水和卫生等宏观一级政策和方案。
埃塞俄比亚 5 岁以下儿童死亡率的降低是卫生、营养和非卫生部门综合活动的结果。然而，埃塞俄比亚仍然存在高新生儿和孕产妇发病率和死亡率，以及预防原因，减少不平等、提高有效干预措施的覆盖率以及加强多部门伙伴关系以进一步取得进展方面仍有未完成的议程。
比尔和梅琳达盖茨基金会和加拿大政府。
