Department of Sociology and Political Science, Centre for Global Health Inequalities Research (CHAIN), Norwegian University of Science and Technology (NTNU), Trondheim, Norway.
Population Health Sciences Institute, Newcastle University, Newcastle upon Tyne, United Kingdom.
PLoS One. 2021 Jun 10;16(6):e0251905. doi: 10.1371/journal.pone.0251905. eCollection 2021.
Despite significant progress in the last few decades, infectious diseases remain a major threat to child health in low- and middle-income countries (LMICs)-particularly amongst more disadvantaged groups. It is imperative to understand the best available evidence concerning which public health interventions reduce morbidity, mortality and health inequalities in children aged under five years. To address this gap, we carried out an umbrella review (a systematic reviews of reviews) to identify evidence on the effects of public health interventions (promotion, protection, prevention) on morbidity, mortality and/or health inequalities due to infectious diseases amongst children in LMICs. Ten databases were searched for records published between 2014-2021 alongside a manual search of gray literature. Articles were quality-assessed using the Assessment of Multiple Systematic Reviews tool (AMSTAR 2). A narrative synthesis was conducted. We identified 60 systematic reviews synthesizing 453 individual primary studies. A majority of the reviews reported on preventive interventions (n = 48), with a minority on promotion (n = 17) and almost no reviews covering health protection interventions (n = 2). Effective interventions for improving child health across the whole population, as well as the most disadvantaged included communication, education and social mobilization for specific preventive services or tools, such as immunization or bed nets. For all other interventions, the effects were either unclear, unknown or detrimental, either at the overall population level or regarding health inequalities. We found few reviews reporting health inequalities information and the quality of the evidence base was generally low. Our umbrella review identified some prevention interventions that might be useful in reducing under five mortality from infectious diseases in LMICs, particularly amongst the most disadvantaged groups.
尽管在过去几十年中取得了重大进展，但传染病仍然是低收入和中等收入国家（LMICs）儿童健康的主要威胁 - 尤其是在较弱势群体中。了解有关公共卫生干预措施可降低五岁以下儿童发病率、死亡率和健康不平等的最佳现有证据至关重要。为了解决这一差距，我们进行了伞式审查（系统评价的系统评价），以确定有关公共卫生干预措施（促进、保护、预防）对 LMICs 中儿童传染病发病率、死亡率和/或健康不平等影响的证据。在 2014 年至 2021 年期间，我们在 10 个数据库中搜索了记录，并对灰色文献进行了手动搜索。使用评估多项系统评价工具（AMSTAR 2）对文章进行了质量评估。进行了叙述性综合。我们确定了 60 项综合 453 项独立初级研究的系统评价。大多数评论报告了预防干预措施（n = 48），少数评论报告了促进干预措施（n = 17），几乎没有评论涵盖健康保护干预措施（n = 2）。在整个人口中改善儿童健康的有效干预措施，以及最弱势群体包括针对特定预防服务或工具（如免疫接种或蚊帐）的沟通、教育和社会动员。对于所有其他干预措施，其效果要么不清楚，要么未知，要么对整个人口水平或健康不平等都有害。我们发现很少有评论报告健康不平等信息，证据基础的质量普遍较低。我们的伞式审查确定了一些预防干预措施，这些措施可能有助于降低 LMICs 五岁以下儿童因传染病导致的死亡率，尤其是在最弱势群体中。
