Abir Tanvir, Ogbo Felix Akpojene, Stevens Garry John, Page Andrew Nicolas, Milton Abul Hasnat, Agho Kingsley Emwinyore
School of Science and Health, Western Sydney University, Penrith, New South Wales, Australia.
Translational Health Research Institute (THRI), School of Medicine, Western Sydney University, Penrith, New South Wales, Australia.
PLoS One. 2017 Nov 1;12(11):e0187090. doi: 10.1371/journal.pone.0187090. eCollection 2017.
Appropriate antenatal care (ANC) is an important preventive public health intervention to ensure women's and newborn health outcomes. The study aimed to investigate the impact of ANC, iron-folic acid (IFA) supplementation and tetanus toxoid (TT) vaccination during pregnancy on child mortality in Bangladesh.
A cross-sectional study of three datasets from the Bangladesh Demographic and Health Surveys for the years 2004, 2007 and 2011 were pooled and used for the analyses. A total weighted sample of 16,721 maternal responses (5,364 for 2004; 4,872 for 2007 and 6,485 for 2011) was used. Multivariate logistic models that adjusted for cluster and sampling weights were used to examine the impact of ANC, IFA supplementation and TT vaccination during pregnancy on the death of a child aged 0-28 days (neonatal), 1-11 months (post-neonatal) and 12-59 months (child).
Multivariable analyses revealed that the odds of postnatal and under-5 mortality was lower in mothers who had ANC [Odds Ratio (OR) = 0.60, 95% confidence interval (95% CI): 0.43-0.85], IFA supplementation [OR = 0.66, 95% CI: (0.45-0.98)] and ≥2 TT vaccinations (OR = 0.43, 95% CI: 0.49-0.78) for post-natal mortality; and for under-5 mortality, any form of ANC (OR = 0.69, 95% CI: 0.51-0.93), IFA supplementation (OR = 0.67, 95% CI: 0.48-0.94) and ≥2 TT vaccinations (OR = 0.50, 95% CI: 0.36-0.69). When combined, TT vaccination with IFA supplementation, and TT vaccination without IFA supplementation were protective across all groups.
The study found that ANC, IFA supplementation, and TT vaccination during pregnancy reduced the likelihood of child mortality in Bangladesh. The findings suggest that considerable gains in improving child survival could be achieved through ensuring universal coverage of ANC, promoting TT vaccination during pregnancy and IFA supplementation among pregnant women in Bangladesh.
适当的产前护理是一项重要的预防性公共卫生干预措施，以确保妇女和新生儿的健康结局。该研究旨在调查孟加拉国孕期的产前护理、铁叶酸（IFA）补充剂和破伤风类毒素（TT）疫苗接种对儿童死亡率的影响。
对来自2004年、2007年和2011年孟加拉国人口与健康调查的三个数据集进行横断面研究，并将其合并用于分析。使用了总共16721份母亲回复的加权样本（2004年为5364份；2007年为4872份；2011年为6485份）。采用调整了聚类和抽样权重的多变量逻辑模型，来研究孕期的产前护理、IFA补充剂和TT疫苗接种对0至28天（新生儿）、1至11个月（新生儿后期）和12至59个月（儿童）儿童死亡的影响。
多变量分析显示，接受产前护理的母亲产后和5岁以下儿童死亡率的几率较低[比值比（OR）=0.60，95%置信区间（95%CI）：0.43-0.85]，补充IFA的母亲[OR=0.66，95%CI：（0.45-0.98）]，以及接种≥2剂TT疫苗的母亲产后死亡率较低（OR=0.43，95%CI：0.49-0.78）；对于5岁以下儿童死亡率，任何形式的产前护理（OR=0.69，95%CI：0.51-0.93）、补充IFA（OR=0.67，95%CI：0.48-0.94）和接种≥2剂TT疫苗（OR=0.50，95%CI：0.36-0.69）。综合来看，接种TT疫苗并补充IFA以及接种TT疫苗但未补充IFA在所有组中都具有保护作用。
该研究发现，孟加拉国孕期的产前护理、IFA补充剂和TT疫苗接种降低了儿童死亡的可能性。研究结果表明，通过确保普遍提供产前护理、促进孕期TT疫苗接种以及为孟加拉国孕妇补充IFA，可以在改善儿童生存方面取得显著成效。
