School of International Development and Global Studies, University of Ottawa, Ottawa, Canada.
The George Institute for Global Health, The University of Oxford, Oxford, UK.
Fam Pract. 2020 Nov 28;37(6):785-792. doi: 10.1093/fampra/cmaa083.
Inequalities in neonatal mortality rates (NMRs) in low- and middle-income countries show key disparities at the detriment of disadvantaged population subgroups. There is a lack of scholarly evidence on the extent and reasons for the inequalities in NMRs in Angola.
The aim of this study was to assess the socio-economic, place of residence, region and gender inequalities in the NMRs in Angola.
The World Health Organization Health Equity Assessment Toolkit software was used to analyse data from the 2015 Angola Demographic and Health Survey. Five equity stratifiers: subnational regions, education, wealth, residence and sex were used to disaggregate NMR inequality. Absolute and relative inequality measures, namely, difference, population attributable fraction (PAF), population attributable risk (PAR) and ratio, were calculated to provide a broader understanding of the inequalities in NMR. Statistical significance was calculated at corresponding 95% uncertainty intervals.
We found significant wealth-driven [PAR = -14.16, 95% corresponding interval (CI): -15.12, -13.19], education-related (PAF = -22.5%, 95% CI: -25.93, -19.23), urban-rural (PAF = -14.5%, 95% CI: -16.38, -12.74), sex-based (PAR = -5.6%, 95% CI: -6.17, -5.10) and subnational regional (PAF = -82.2%, 95% CI: -90.14, -74.41) disparities in NMRs, with higher burden among deprived population subgroups.
High NMRs were found among male neonates and those born to mothers with no formal education, poor mothers and those living in rural areas and the Benguela region. Interventions aimed at reducing NMRs, should be designed with specific focus on disadvantaged subpopulations.
在中低收入国家，新生儿死亡率（NMR）的不平等现象严重，弱势群体的死亡率明显更高。安哥拉 NMR 不平等的程度和原因缺乏学术证据。
本研究旨在评估安哥拉 NMR 中的社会经济、居住地、地区和性别不平等。
使用世界卫生组织健康公平评估工具包软件分析了 2015 年安哥拉人口与健康调查的数据。使用了五个公平分层因素：次国家地区、教育、财富、居住地和性别，对 NMR 不平等进行细分。计算了绝对和相对不平等指标，即差异、人群归因分数（PAF）、人群归因风险（PAR）和比值，以更全面地了解 NMR 中的不平等。在相应的 95%置信区间计算了统计显著性。
我们发现财富驱动的（PAR = -14.16，95%置信区间（CI）：-15.12，-13.19）、与教育相关的（PAF = -22.5%，95% CI：-25.93，-19.23）、城乡差异（PAF = -14.5%，95% CI：-16.38，-12.74）、性别差异（PAR = -5.6%，95% CI：-6.17，-5.10）和次国家地区差异（PAF = -82.2%，95% CI：-90.14，-74.41）在 NMR 中存在显著差异，处于劣势的人群负担更重。
男性新生儿和未受过正规教育的母亲所生的新生儿、贫困母亲和农村地区以及本格拉地区的新生儿死亡率较高。旨在降低 NMR 的干预措施应特别关注弱势亚人群。
