Amoroso Cheryl L, Nisingizwe Marie Paul, Rouleau Dominique, Thomson Dana R, Kagabo Daniel M, Bucyana Tatien, Drobac Peter, Ngabo Fidele
Inshuti Mu Buzima/Partners in Health-Rwanda, Rwinkwavu, Rwanda.
USAID Global Health Fellows II, Public Health Institute, Washington DC, USA.
BMC Pediatr. 2018 Feb 5;18(1):27. doi: 10.1186/s12887-018-0997-y.
Sustained investments in Rwanda's health system have led to historic reductions in under five (U5) mortality. Although Rwanda achieved an estimated 68% decrease in the national under U5 mortality rate between 2002 and 2012, according to the national census, 5.8% of children still do not reach their fifth birthday, requiring the next wave of child mortality prevention strategies.
This is a cross-sectional study of 9002 births to 6328 women age 15-49 in the 2010 Rwanda Demographic and Health Survey. We tested bivariate associations between 29 covariates and U5 mortality, retaining covariates with an odds ratio p < 0.1 for model building. We used manual backward stepwise logistic regression to identify correlates of U5 mortality in all children U5, 0-11 months, and 12-59 months. Analyses were performed in Stata v12, adjusting for complex sample design.
Of 14 covariates associated with U5 mortality in bivariate analysis, the following remained associated with U5 mortality in multivariate analysis: household being among the poorest of the poor (OR = 1.98), child being a twin (OR = 2.40), mother having 3-4 births in the past 5 years (OR = 3.97) compared to 1-2 births, mother being HIV positive (OR = 2.27), and mother not using contraceptives (OR = 1.37) compared to using a modern method (p < 0.05 for all). Mother experiencing physical or sexual violence in the last 12 months was associated with U5 mortality in children ages 1-4 years (OR = 1.48, p < 0.05). U5 survival was associated with a preceding birth interval 25-50 months (OR = 0.67) compared to 9-24 months, and having a mosquito net (OR = 0.46) (p < 0.05 for both).
In the past decade, Rwanda rolled out integrated management of childhood illness, near universal coverage of childhood vaccinations, a national community health worker program, and a universal health insurance scheme. Identifying factors that continue to be associated with childhood mortality supports determination of which interventions to strengthen to reduce it further. This study suggests that Rwanda's next wave of U5 mortality reduction should target programs in improving neonatal outcomes, poverty reduction, family planning, HIV services, malaria prevention, and prevention of intimate partner violence.
对卢旺达卫生系统的持续投资已使五岁以下儿童死亡率历史性下降。尽管根据全国人口普查，卢旺达在2002年至2012年间全国五岁以下儿童死亡率估计下降了68%，但仍有5.8%的儿童活不到五岁生日，这就需要下一波儿童死亡率预防策略。
这是一项对2010年卢旺达人口与健康调查中6328名15至49岁妇女所生的9002例婴儿进行的横断面研究。我们测试了29个协变量与五岁以下儿童死亡率之间的双变量关联，保留比值比p<0.1的协变量用于模型构建。我们使用手动向后逐步逻辑回归来确定所有五岁以下儿童、0至11个月儿童以及12至59个月儿童中五岁以下儿童死亡率的相关因素。分析在Stata v12中进行，并针对复杂样本设计进行了调整。
在双变量分析中与五岁以下儿童死亡率相关的14个协变量中，以下因素在多变量分析中仍与五岁以下儿童死亡率相关：家庭属于最贫困中的贫困家庭（比值比=1.98）、孩子为双胞胎（比值比=2.40）、母亲在过去五年内生育3至4次（比值比=3.97），而生育1至2次的母亲与之相比、母亲为艾滋病毒阳性（比值比=2.27），以及母亲未使用避孕药具（比值比=1.37），而使用现代避孕方法的母亲与之相比（所有p<0.05）。在过去12个月内遭受身体或性暴力的母亲与1至4岁儿童的五岁以下儿童死亡率相关（比值比=1.48，p<0.05）。与9至24个月的生育间隔相比，前次生育间隔为25至50个月与五岁以下儿童存活相关（比值比=0.67），拥有蚊帐也与之相关（比值比=0.46）（两者p<0.05）。
在过去十年中，卢旺达推出了儿童疾病综合管理、儿童疫苗接种近乎普及、全国社区卫生工作者计划以及全民健康保险计划。确定继续与儿童死亡率相关的因素有助于确定加强哪些干预措施以进一步降低死亡率。本研究表明，卢旺达下一波降低五岁以下儿童死亡率的行动应针对改善新生儿结局、减贫、计划生育、艾滋病毒服务、疟疾预防以及预防亲密伴侣暴力等项目。
