School of International Development and Global Studies, Faculty of Social Sciences, University of Ottawa, Ottawa, Canada.
Warwick Centre for Applied Health Research and Delivery (WCAHRD), Division of Health Sciences, Warwick Medical School, University of Warwick, Coventry, United Kingdom.
J Matern Fetal Neonatal Med. 2020 Oct;33(20):3501-3508. doi: 10.1080/14767058.2019.1576623. Epub 2019 Feb 10.
Interpregnancy intervals (IPI) are independently associated with maternal, perinatal, infant and child outcomes. Birth spacing is a recommended tool to reduce adverse health outcomes especially among children. This study aims to determine the prevalence of adverse child health outcomes in sub-Saharan Africa (SSA) countries and to examine the association between the length of preceding birth interval child health outcomes. Secondary data from Demographic and Health Survey (DHS) in 34 SSA countries with 299 065 births was used in this study. The outcome variables were infant mortality, low birth weight, stunting, underweight, wasting, overweight and anemia. Percentage was used in univariate analysis. Cox proportional hazard regression was used to examine association between the adjusted model of preceding birth interval and infant mortality. Multinomial and binary logistic regression models were used to examine the association between under-five children adverse health outcomes and interpregnancy birth interval. Infant mortality was lowest in Gambia (3.4%) and highest in Sierra Leone (9.3%). Comoros (16.8%) accounted for the highest percentage of low birth weight (<2.5 kg). Child stunting was as high as 54.6% in Burundi. IPIs of <24 months, 24-36 months, 37-59 months and ≤60 months accounted for 19.3, 37.8, 29.5 and 13.4% respectively. Median IPI was 34 months. Results from Cox proportional hazard regression showed that children with preceding birth interval <24 months had 57% higher risk of infant mortality, compared to children with IPI of 24-36 months (Hazard ratio (HR) = 1.57; 95%CI: 1.45, 1.69). However, there were 19% and 10% reduction in the risk of infant mortality at IPIs of 37-59 months and ≥60 months, compared to 24-36 months IPI (37-59 months: HR = 0.81; 95%CI: 0.75, 0.87; ≥60 months: HR = 0.90; 95%CI: 0.81, 0.99). The findings of this study suggest the need for urgent intervention to promote the recommended interpregnancy interval of 24-36 months to reduce adverse child health outcomes. These data also bring into limelight the importance of exclusive breastfeeding to enhance proper nutritional approach and to prolong lactational amenorrhea. Health care system stakeholders would find this study interesting as a base for policy formulation and implementation.
孕间隔（IPI）与母婴、围生期、婴儿和儿童结局独立相关。生育间隔是减少不良健康结局的一种推荐工具，尤其是在儿童中。本研究旨在确定撒哈拉以南非洲（SSA）国家中儿童不良健康结局的流行情况，并研究前次生育间隔与儿童健康结局之间的关联。本研究使用了 34 个 SSA 国家的人口与健康调查（DHS）中的二次数据，共有 299065 例分娩。结局变量为婴儿死亡率、低出生体重、发育迟缓、体重不足、消瘦、超重和贫血。单变量分析中使用了百分比。使用 Cox 比例风险回归检验了前次生育间隔调整模型与婴儿死亡率之间的关联。多分类和二分类逻辑回归模型用于检验 5 岁以下儿童不良健康结局与孕间隔的关联。婴儿死亡率在冈比亚最低（3.4%），在塞拉利昂最高（9.3%）。科摩罗（16.8%）的低出生体重（<2.5kg）占比最高。布隆迪的儿童发育迟缓率高达 54.6%。<24 个月、24-36 个月、37-59 个月和≤60 个月的 IPI 分别占 19.3%、37.8%、29.5%和 13.4%。中位 IPI 为 34 个月。Cox 比例风险回归的结果显示，与 IPI 为 24-36 个月的儿童相比，前次生育间隔<24 个月的儿童婴儿死亡率风险高 57%（风险比（HR）=1.57；95%CI：1.45，1.69）。然而，与 IPI 为 24-36 个月相比，IPI 为 37-59 个月和≥60 个月的婴儿死亡率风险分别降低了 19%和 10%（37-59 个月：HR=0.81；95%CI：0.75，0.87；≥60 个月：HR=0.90；95%CI：0.81，0.99）。本研究结果表明，迫切需要采取干预措施，促进推荐的 24-36 个月的孕间隔，以降低儿童不良健康结局。这些数据还凸显了纯母乳喂养的重要性，以增强适当的营养方法和延长哺乳期闭经。卫生保健系统利益相关者会发现本研究很有趣，因为它是制定和实施政策的基础。
