Department of Reproductive, Family and Population Health, School of Public Health, Addis Ababa University, Addis Ababa, Ethiopia.
PLoS One. 2020 Oct 22;15(10):e0241049. doi: 10.1371/journal.pone.0241049. eCollection 2020.
Within country inequality in infant mortality poses a big challenge for countries moving towards the internationally agreed upon targets on child mortality by 2030. There is a lack of high-quality evidence on infant mortality measured through different dimensions of social inequality in Angola. Thus, this paper was carried out to address the knowledge gap by conducting in-depth examination of infant mortality rate (IMR) inequality among population subgroups to provide more nuanced evidence to help end IMR disparity in the country.
The World Health Organization's (WHO) Health Equity Assessment Toolkit (HEAT) was used to analyze IMR inequality. HEAT is a software application that facilitates examination of disparities in reproductive, maternal, neonatal and child health indicators using the WHO Health Equity Monitor (HEM) database. Inequality of IMR was analyzed through disaggregation by five equity stratifiers: education, wealth, gender, subnational region and residence. These were analyzed through three inequality measures: Population Attributable Risk, Ratio and Slope Index of Inequality. A 95% confidence Interval (CI) was built around point estimates to determine statistical significance.
A notable disadvantage was found for children born to poor (Population Attributable Risk (PAR): -27.0; -28.4, -26.0) and uneducated (PAR: -17.0; -17.9, -16.0), women who live in rural areas (PAR: -7.3;-7.8, -6.7) and those residing in certain regions of the country (PAR: -43.0; 45.3, -4). Male infants had a higher risk of death than female infants (PAR: -6.8;-7.5, -6.2). The subnational regional variation of IMR had been the most evident when compared with the disparities in the other equity stratifers.
Policymakers and planners need to address the disproportionately higher clustering of IMR among infants born to disadvantaged subpopulations through interventions that benefit such subgroups.
在国内，婴儿死亡率方面的不平等对各国实现到 2030 年国际商定的儿童死亡率目标构成了重大挑战。安哥拉在通过不同社会不平等维度衡量婴儿死亡率方面缺乏高质量证据。因此，本文通过深入研究人口亚组的婴儿死亡率（IMR）不平等，旨在填补这一知识空白，提供更细致入微的证据，以帮助该国消除 IMR 差异。
本研究使用世界卫生组织（WHO）的卫生公平评估工具包（HEAT）分析 IMR 不平等。HEAT 是一种软件应用程序，通过世卫组织卫生公平监测器（HEM）数据库，促进对生殖、孕产妇、新生儿和儿童健康指标差异的检查。通过五个公平分层因素（教育、财富、性别、次国家区域和居住地）对 IMR 不平等进行分解分析。使用人口归因风险、比值和不平等斜率指数三种不平等衡量标准进行分析。置信区间（CI）围绕点估计构建，以确定统计显著性。
研究发现，贫穷（人口归因风险（PAR）：-27.0；-28.4，-26.0）和未受教育（PAR：-17.0；-17.9，-16.0）的儿童、居住在农村地区（PAR：-7.3；-7.8，-6.7）和居住在该国某些地区（PAR：-43.0；45.3，-4）的妇女所生的儿童处于明显劣势。男婴的死亡风险高于女婴（PAR：-6.8；-7.5，-6.2）。与其他公平分层因素相比，IMR 的国家间区域差异最为明显。
决策者和规划者需要通过有利于弱势群体的干预措施，解决处于劣势的亚人群中婴儿死亡率不成比例地更高聚集的问题。
