Instituto Nacional de Saúde, Ministry of Health, Maputo, Mozambique.
Direcçăo Nacional de Saúde Pública, Ministry of Health, Maputo, Mozambique.
J Glob Health. 2018 Dec;8(2):021202. doi: 10.7189/jogh.08.021201.
As one of several countries that pledged to achieve the Millennium Development Goals (MDGs), Mozambique sought to reduce child, neonatal, and maternal mortality by two thirds by 2015. This study examines the impact of Mozambique's efforts between 1997 and 2015, highlighting the increases in intervention coverage that contributed to saving the most lives.
A retrospective analysis of available household survey data was conducted using the Lives Saved Tool (LiST). Baseline mortality rates, cause-of-death distributions, and coverage of child, neonatal, and maternal interventions were entered as inputs. Changes in mortality rates, causes of death, and additional lives saved were calculated as results. Due to limited coverage data for the year 2015, we reported most results for the period 1997-2011. For 2011-2015 we reported additional lives saved for a subset of interventions. All analyses were performed at national and provincial level.
Our modelled estimates show that increases in intervention coverage from 1997 to 2011 saved an additional 422 282 child lives (0-59 months), 85 450 neonatal lives (0-1 month), and 6528 maternal lives beyond those already being saved at baseline coverage levels in 1997. Malaria remained the leading cause of child mortality from 1997 to 2011; prematurity, asphyxia, and sepsis remained the leading causes of neonatal mortality; and hemorrhage remained the leading cause of maternal mortality. Interventions to reduce acute malnutrition and promote artemisinin-based combination therapy (ACT) for malaria were responsible for the largest number of additional child lives saved in the 1997-2011 period. Increases in coverage of delivery management were responsible for most additional newborn and maternal lives saved in both periods in Mozambique.
Mozambique has made impressive gains in reducing child mortality since 1997. Additional effort is needed to further reduce maternal and neonatal mortality in all provinces. More lives can be saved by continuing to increase coverage of existing health interventions and exploring new ways to reach underserved populations.
作为承诺实现千年发展目标(MDGs)的几个国家之一,莫桑比克力求在 2015 年之前将儿童、新生儿和产妇死亡率降低三分之二。本研究审视了莫桑比克 1997 年至 2015 年期间的努力情况,重点介绍了增加干预措施覆盖范围以拯救更多生命的情况。
使用生存工具(LiST)对现有的家庭调查数据进行了回顾性分析。将基线死亡率、死因分布以及儿童、新生儿和产妇干预措施的覆盖率作为投入输入。计算了死亡率、死因变化和额外拯救的生命数。由于 2015 年的覆盖范围数据有限,我们报告了大部分结果来自 1997 年至 2011 年。对于 2011 年至 2015 年,我们报告了部分干预措施的额外拯救生命数。所有分析均在国家和省级层面进行。
我们的模型估计表明,1997 年至 2011 年干预措施覆盖率的增加使儿童(0-59 个月)额外多拯救了 422282 条生命,新生儿(0-1 个月)额外多拯救了 85450 条生命,并且使 1997 年基线覆盖率水平下本应拯救的产妇生命数增加了 6528 人。1997 年至 2011 年,疟疾仍是导致儿童死亡的主要原因;早产、窒息和败血症仍是导致新生儿死亡的主要原因;出血仍然是产妇死亡的主要原因。减少急性营养不良和推广青蒿素联合疗法(ACT)治疗疟疾的干预措施是在 1997 年至 2011 年期间拯救儿童生命最多的干预措施。在两个时期,莫桑比克提高分娩管理覆盖率都为拯救更多新生儿和产妇生命做出了主要贡献。
自 1997 年以来,莫桑比克在降低儿童死亡率方面取得了令人瞩目的进展。所有省份都需要进一步努力,以进一步降低产妇和新生儿死亡率。通过继续提高现有卫生干预措施的覆盖率并探索新途径为服务不足的人群提供服务,可以拯救更多生命。