School of Public Health, Faculty of Health Sciences, Curtin University, Perth, WA, 6102, Australia.
Population Wellbeing and Environment Research Lab (PowerLab), School of Health and Society, Faculty of Social Sciences, University of Wollongong, Wollongong, NSW, 2522, Australia.
BMC Public Health. 2018 Dec 17;18(1):1375. doi: 10.1186/s12889-018-6308-6.
As an important marker for health equity and access, under-five mortality (UFM) is a primary measure for socioeconomic development. The importance of reducing UFM has been further emphasized in an ambitious target under Sustainable Development Goals. The factors influencing UFM are not adequately understood in Bhutan.
The most recent dataset of the Bhutan National Health Survey (BNHS) 2012 was used in this study. Multiple logistic regression analysis using a backwards elimination approach was performed to identify significant factors influencing UFM. All statistical analyses were adjusted for the complex study design due to the multistage stratified cluster sampling used in BNHS.
Bhutan's UFM rate was 37 per 1000 live births. The weighted mean age of the children was 7.3 years (SD: 1.53; range: 3-12). Mother's age, household size, access to electricity and sanitation, residential region, and parity were the key factors associated with UFM. The UFM risk was significantly lower in children born to mothers aged 36-40 years, 41-45 years, and > 45 years when compared to that in children born to mothers aged < 26 years. The likelihood of mortality was 66% lower (95% CI: 0.21-0.55) among children born in households with > 5 members. Children born in households without electricity and safe sanitation had a significantly higher risk of death, by 81 and 49% respectively. Relative to those born in the west, children born in the central and eastern regions were 1.72 (95% CI: 1.07-2.77) and 2.09 (95% CI: 1.46-2.99) times more likely to die, respectively. Children born to mothers who gave birth to > 2 children were significantly more likely to die than their counterparts.
These findings suggest that younger mother's age, the higher number of births and being born in the central and eastern regions are associated with a higher UFM risk, whereas a larger household size and access to electricity and safe sanitation are key factors associated with lower UFM risk in Bhutan. Women empowerment, health education and strategies promoting maternal and child health in rural areas need to be scaled-up. Additionally, socioeconomic development programs should seek to reduce regional disparities.
作为健康公平和可及性的重要指标，五岁以下儿童死亡率（UFM）是衡量社会经济发展的主要指标。可持续发展目标中提出了一个雄心勃勃的目标，进一步强调了降低 UFM 的重要性。然而，不丹对影响 UFM 的因素了解不足。
本研究使用了不丹最近的国家健康调查（BNHS）2012 数据集。采用向后消除法的多因素逻辑回归分析，确定影响 UFM 的显著因素。由于 BNHS 采用多阶段分层聚类抽样，所有统计分析均针对复杂的研究设计进行了调整。
不丹的 UFM 率为每 1000 例活产 37 例。儿童的加权平均年龄为 7.3 岁（SD：1.53；范围：3-12）。母亲年龄、家庭规模、用电和卫生设施的可及性、居住地区和生育子女数是与 UFM 相关的关键因素。与 26 岁以下母亲所生的儿童相比，36-40 岁、41-45 岁和>45 岁母亲所生的儿童的 UFM 风险显著降低。在家庭人口>5 人的儿童中，死亡的可能性降低了 66%（95%CI：0.21-0.55）。与有电和安全卫生设施的家庭相比，没有电和安全卫生设施的家庭出生的儿童死亡风险分别高 81%和 49%。与出生在西部地区的儿童相比，出生在中部和东部地区的儿童的死亡风险分别高 1.72 倍（95%CI：1.07-2.77）和 2.09 倍（95%CI：1.46-2.99）。与生育 2 个及以下子女的母亲所生的儿童相比，生育 3 个及以上子女的母亲所生的儿童死亡的可能性明显更高。
这些发现表明，年轻母亲的年龄、较高的生育次数和出生在中部和东部地区与较高的 UFM 风险相关，而较大的家庭规模以及获得电和安全卫生设施是与不丹较低的 UFM 风险相关的关键因素。需要扩大妇女赋权、健康教育以及促进农村地区母婴健康的战略。此外，社会经济发展计划应努力减少地区差异。
