Centre for Global Child Health, Hospital for Sick Children, Toronto, Canada.
UNICEF Kyrgyzstan, Bishkek, Kyrgyzstan.
Lancet Glob Health. 2021 Mar;9(3):e352-e360. doi: 10.1016/S2214-109X(20)30460-5. Epub 2020 Dec 10.
Kyrgyzstan has made considerable progress in reducing child mortality compared with other countries in the region, despite a comparatively low economic standing. However, maternal mortality is still high. Given the availability of an established birth registration system, we aimed to comprehensively assess the trends and determinants of reproductive, maternal, newborn, and child health in Kyrgyzstan.
For this Countdown to 2030 country case study, we used publicly available data repositories and the national birth registry of Kyrgyzstan to examine trends and inequalities of reproductive, maternal, and newborn health and mortality between 1990 and 2018, at a national and subnational level. Coverage of newborn and maternal health interventions was assessed and disaggregated by equity dimensions. We did Oaxaca-Blinder decomposition to determine the contextual factors associated with the observed decline in newborn mortality rates. We also undertook a comprehensive review of national policies and programmes, as well as a prospective Lives Saved Tool analysis, to highlight interventions that have the potential to avert the most maternal, neonatal, and child deaths.
Over the past two decades, Kyrgyzstan reduced newborn mortality rates by 46% and mortality rates of children younger than 5 years by 69%, whereas maternal mortality rates were reduced by 7% and stillbirth rates by 29%. The leading causes of neonatal deaths were prematurity and asphyxia or hypoxia, and preterm small-for-gestational-age infants were more than 80 times more likely to die in their first month of life compared with those born appropriate-for-gestational age at term. Except for contraceptive use, coverage of essential interventions has increased and is generally high, with limited sociodemographic inequities. With scale-up of a few essential neonatal and maternal interventions, 39% of neonatal deaths, 11% of stillbirths, and 19% of maternal deaths could be prevented by 2030.
Kyrgyzstan has reduced newborn mortality rates considerably, with the potential for further reduction. To achieve and exceed the Sustainable Development Goal 3 targets for newborn survival and reducing stillbirths, Kyrgyzstan needs to scale up packages of interventions for the care of small and sick babies, assure quality of care in all health-care facilities with regionalised perinatal care, and create a linked national registry for mothers and neonates with rapid feedback and accountability.
US Fund for UNICEF under the Countdown to 2015, UNICEF Kyrgyzstan Office.
与该地区其他国家相比，吉尔吉斯斯坦在降低儿童死亡率方面取得了相当大的进展，尽管其经济地位相对较低。然而，产妇死亡率仍然很高。鉴于已经建立了出生登记制度，我们旨在全面评估吉尔吉斯斯坦的生殖、孕产妇、新生儿和儿童健康的趋势和决定因素。
在这项“倒计时 2030”国家案例研究中，我们使用了公开的数据库和吉尔吉斯斯坦国家出生登记处，在国家和次国家层面上，考察了 1990 年至 2018 年期间生殖、孕产妇和新生儿健康和死亡率的趋势和不平等现象。我们评估并按公平维度细分了新生儿和孕产妇健康干预措施的覆盖情况。我们采用 Oaxaca-Blinder 分解法确定与新生儿死亡率下降相关的背景因素。我们还对国家政策和方案进行了全面审查，并进行了前瞻性的“生命拯救工具”分析，以突出有可能避免孕产妇、新生儿和儿童死亡的干预措施。
在过去的二十年中，吉尔吉斯斯坦将新生儿死亡率降低了 46%，将 5 岁以下儿童死亡率降低了 69%，而产妇死亡率降低了 7%，死产率降低了 29%。新生儿死亡的主要原因是早产和窒息或缺氧，与那些足月出生、大小与胎龄相符的婴儿相比，早产儿在出生后的第一个月内死亡的可能性高出 80 倍以上。除了避孕措施外，基本干预措施的覆盖率有所增加，并且普遍较高，社会人口不公平现象有限。随着少数基本新生儿和孕产妇干预措施的推广，到 2030 年，39%的新生儿死亡、11%的死产和 19%的孕产妇死亡可以得到预防。
吉尔吉斯斯坦已经大大降低了新生儿死亡率，还有进一步降低的潜力。为了实现和超过可持续发展目标 3 中关于新生儿生存和减少死产的目标，吉尔吉斯斯坦需要扩大对小而患病婴儿的护理措施，确保所有卫生保健设施的护理质量，实现区域围产期护理，并创建一个母婴快速反馈和问责制的全国登记册。
美国儿基会在“倒计时 2015”下为联合国儿童基金会提供的资金，联合国儿童基金会吉尔吉斯斯坦办事处。
