利用来自 65 个中低收入国家的 191 次 DHS 数据估计麻疹疫苗接种对儿童生长的影响。

Estimating the effect of measles vaccination on child growth using 191 DHS from 65 low- and middle-income countries.

机构信息

University of Göttingen, Germany.

出版信息

Vaccine. 2019 Aug 14;37(35):5073-5088. doi: 10.1016/j.vaccine.2019.06.054. Epub 2019 Jul 9.

DOI:10.1016/j.vaccine.2019.06.054

PMID:31300290

Abstract

BACKGROUND

Childhood vaccinations reduce morbidity and mortality and are highly cost-effective. They may also protect children from malnutrition and lead to improved child growth. Stunting, wasting and underweight are targets used to monitor progress towards the achievement of the sustainable development goals (SDGs).

METHODS

We use data from Demographic and Health Surveys (DHS) covering the period from 1990 to 2017 to estimate the effect of measles vaccination at 12 months of age on stunting, wasting, and underweight. For causal estimation, we use household- and mother-fixed effects, which allows us to compare outcomes across siblings while controlling for all observed and unobserved confounders that are shared by the siblings, such as household social characteristics and home location. In addition, we control for a wide range of sibling-varying confounders, including sex, age, birth order and mother's age at birth, as well as vaccination with diphtheria-tetanus-polio (DPT), as a broad indicator of general likelihood to receive vaccinations.

RESULTS

Our samples include 347,808 individuals in 132 surveys from 59 countries (for stunting), 430,963 individuals in 190 surveys from 65 countries (for wasting), and 353,520 individuals in 130 surveys from 59 countries (for underweight). Measles vaccination is associated with significantly reduced odds of stunting (odds ratio 0.90 [95% CI 0.86-0.94], p < 0.001) and underweight (odds ratio 0.90 [95% CI 0.86-0.95], p < 0.001). The association with wasting is weaker and not statistically significant (odds ratio 0.95 [95% CI 0.89-1.02], p = 0.143). Our results remain robust across several alternative specifications of our regression models.

CONCLUSIONS

Measles vaccination substantially reduces stunting and underweight among children in low- and middle-income countries. Increasing measles coverage from the current low to near-universal levels would provide a large boost to child growth and the attainment of the SDGs.

摘要

背景

儿童疫苗接种可降低发病率和死亡率，具有很高的成本效益。它们还可以保护儿童免受营养不良的影响，并促进儿童的生长发育。发育迟缓、消瘦和体重不足是用于监测实现可持续发展目标（SDGs）进展的指标。

方法

我们使用了涵盖 1990 年至 2017 年期间的人口与健康调查（DHS）的数据，来估计 12 个月龄时接种麻疹疫苗对发育迟缓、消瘦和体重不足的影响。为了进行因果估计，我们使用了家庭和母亲固定效应，这使我们能够在控制所有由兄弟姐妹共享的可观察和不可观察的混杂因素（如家庭社会特征和家庭所在地）的同时，比较兄弟姐妹之间的结果。此外，我们还控制了一系列广泛的兄弟姐妹间混杂因素，包括性别、年龄、出生顺序和母亲的出生年龄，以及接种白喉、破伤风、百日咳（DPT）疫苗，作为广泛接受疫苗接种可能性的指标。

结果

我们的样本包括来自 59 个国家的 132 项调查中的 347808 人（用于发育迟缓）、来自 65 个国家的 190 项调查中的 430963 人（用于消瘦）和来自 59 个国家的 130 项调查中的 353520 人（用于体重不足）。麻疹疫苗接种与发育迟缓（优势比 0.90 [95%CI 0.86-0.94]，p<0.001）和体重不足（优势比 0.90 [95%CI 0.86-0.95]，p<0.001）的几率显著降低相关。与消瘦的相关性较弱，且无统计学意义（优势比 0.95 [95%CI 0.89-1.02]，p=0.143）。我们的结果在回归模型的几种替代规范下仍然稳健。