利用来自埃塞俄比亚人口与健康调查（2005、2011 和 2016 年）的数据研究埃塞俄比亚哺乳期母亲贫血的时空模式。
Spatiotemporal patterns of anemia among lactating mothers in Ethiopia using data from Ethiopian Demographic and Health Surveys (2005, 2011 and 2016).
机构信息
Department of Epidemiology and Biostatistics, Institute of Public Health, College of Medicine and Health Sciences and Comprehensive Specialized Hospital, University of Gondar, Gondar, Ethiopia.
School of Nursing, College of Medicine and Health Sciences and Comprehensive Specialized Hospital, University of Gondar, Gondar, Ethiopia.
出版信息
PLoS One. 2020 Aug 6;15(8):e0237147. doi: 10.1371/journal.pone.0237147. eCollection 2020.
INTRODUCTION
Maternal anemia is a worldwide public health problem especially in developing countries including Ethiopia. The burden of anemia among lactating mothers in Ethiopia was higher than those who were neither pregnant nor breastfeeding. To date, there is limited evidence on spatiotemporal patterns of anemia among lactating mothers in the country. Exploring the spatial patterns of maternal anemia is vital to design and monitor effective intervention programs. Therefore this study aimed to explore spatiotemporal patterns of anemia among lactating mothers in Ethiopia over the past one and half-decades.
METHODS
A total of 11,989 lactating mothers were included from the three consecutive Ethiopian Demographic and Health Surveys(2005, 2011, and 2016). The trend of anemia over the three surveys was showed. Furthermore, spatial autocorrelation analysis, cluster and outlier analysis, hotspot analysis, spatial interpolation, and spatial scan statistics were carried out to identify geographically risk areas of anemia among lactating mothers in Ethiopia. Finally, the most anemia risk areas were detected consistently by different spatial analytic methods in each survey.
RESULTS
Anemia during lactation had an increasing trend from 2011 to 2016 in all regions of Ethiopia. It was also spatially clustered over three survey periods (Moran's I: 0.102-0.256, P<0.01).The hotspot areas were detected in Afar, Somali, Gambela, Dire Dawa, and Oromia regions during the last fifteen years. In 2005 and 2011, a total of 100 most likely clusters (Loglikelihood Ratio(LLR) = 8.8, P<0.05, and LLR = 45.94, P<0.001, respectively) were identified in the Afar region. However, in the 2016 survey period, primary clusters were shifted to the Somali region where 57 clusters (LLR = 72.73, P<0.001) were detected in the entire region. Besides, the risk prediction map showed that the eastern part of the country was at a higher risk of anemia during lactation.
CONCLUSION
Anemia during lactation was spatially clustered in Ethiopia. High-risk areas were detected in the eastern part of Ethiopia prominently in the Afar and Somali regions. Therefore, public health intervention activities designed in a targeted approach to impact high-risk populations in those hot spot areas wound be helpful to reduce anemia in Ethiopia.
简介
孕产妇贫血是一个全球性的公共卫生问题，尤其是在发展中国家，包括埃塞俄比亚。在埃塞俄比亚，哺乳期母亲的贫血负担高于非妊娠和非哺乳期妇女。迄今为止，关于该国哺乳期妇女贫血的时空模式的证据有限。探索孕产妇贫血的空间模式对于设计和监测有效的干预计划至关重要。因此，本研究旨在探讨过去十五年埃塞俄比亚哺乳期妇女贫血的时空模式。
方法
本研究共纳入了来自三次连续的埃塞俄比亚人口与健康调查（2005 年、2011 年和 2016 年）的 11989 名哺乳期母亲。结果表明，在过去的三次调查中，贫血的趋势呈上升趋势。此外，进行了空间自相关分析、聚类和异常值分析、热点分析、空间插值和空间扫描统计分析，以确定埃塞俄比亚哺乳期妇女贫血的地理风险区域。最后，在每个调查中，不同的空间分析方法都检测到了最贫血的风险区域。
结果
在埃塞俄比亚所有地区，哺乳期贫血的患病率从 2011 年到 2016 年呈上升趋势。在过去的十五年中，该疾病在三个调查期间都存在空间聚集现象（Moran's I：0.102-0.256，P<0.01）。在 2005 年和 2011 年，在阿法尔地区总共发现了 100 个最可能的集群（对数似然比（LLR）=8.8，P<0.05，和 LLR=45.94，P<0.001）。然而，在 2016 年的调查期间，主要集群转移到了索马里地区，在整个地区共检测到 57 个集群（LLR=72.73，P<0.001）。此外，风险预测图显示，该国东部地区处于哺乳期贫血的高风险之中。
结论
埃塞俄比亚哺乳期贫血呈空间聚集性。高危地区主要集中在埃塞俄比亚的东部，特别是在阿法尔和索马里地区。因此，针对这些热点地区的高危人群进行有针对性的公共卫生干预活动，将有助于减少埃塞俄比亚的贫血。
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