Morakinyo Oyewale Mayowa, Fagbamigbe Adeniyi Francis, Adebowale Ayo Stephen
Department of Environmental Health Sciences, Faculty of Public Health, College of Medicine, University of Ibadan, Ibadan, Nigeria.
Department of Epidemiology and Medical Statistics, Faculty of Public Health, College of Medicine, University of Ibadan, Ibadan, Nigeria.
Arch Public Health. 2022 Jan 4;80(1):13. doi: 10.1186/s13690-021-00768-0.
Low-and Medium-Income Countries (LMIC) continue to record a high burden of under-five deaths (U5D). There is a gap in knowledge of the factors contributing to housing materials inequalities in U5D. This study examined the contributions of the individual- and neighbourhood-level factors to housing materials inequalities in influencing U5D in LMIC.
We pooled data from the most recent Demographic and Health Surveys for 56 LMIC conducted between 2010 and 2018. In all, we analysed the data of 798,796 children living in 59,791 neighbourhoods. The outcome variable was U5D among live births within 0 to 59 months of birth. The main determinate variable was housing material types, categorised as unimproved housing materials (UHM) and improved housing materials (IHM) while the individual-level and neighbourhood-level factors are the independent variables. Data were analysed using the Fairlie decomposition analysis at α = 0.05.
The overall U5D rate was 53 per 1000 children, 61 among children from houses built with UHM, and 41 among children from houses built with IHM (p < 0.001). This rate was higher among children from houses that were built with UHM in all countries except Malawi, Zambia, Lesotho, Gambia, Liberia, Sierra Leone, Indonesia, Maldives, Jordan, and Albania. None of these countries had significant pro-IHM inequality. The factors explaining housing inequalities in U5D include household wealth status, residence location, source of drinking water, media access, paternal employment, birth interval, and toilet type.
There are variations in individual- and neighbourhood-level factors driving housing materials inequalities as it influences U5D in LMIC. Interventions focusing on reducing the burden of U5D in households built with UHM are urgently needed.
低收入和中等收入国家（LMIC）五岁以下儿童死亡（U5D）负担仍然很高。在导致五岁以下儿童死亡中住房材料不平等的因素方面，存在知识差距。本研究调查了个人层面和社区层面因素对低收入和中等收入国家五岁以下儿童死亡中住房材料不平等的影响。
我们汇总了2010年至2018年期间对56个低收入和中等收入国家进行的最新人口与健康调查数据。总共，我们分析了居住在59,791个社区的798,796名儿童的数据。结果变量是出生后0至59个月内活产儿中的五岁以下儿童死亡情况。主要决定变量是住房材料类型，分为未改善的住房材料（UHM）和改善的住房材料（IHM），而个人层面和社区层面因素是自变量。使用Fairlie分解分析在α = 0.05的水平上对数据进行分析。
总体五岁以下儿童死亡率为每1000名儿童中有53例，居住在用未改善住房材料建造房屋中的儿童死亡率为61例，居住在用改善住房材料建造房屋中的儿童死亡率为41例（p < 0.001）。除马拉维、赞比亚、莱索托、冈比亚、利比里亚、塞拉利昂、印度尼西亚、马尔代夫、约旦和阿尔巴尼亚外，在所有国家中，居住在用未改善住房材料建造房屋中的儿童死亡率更高。这些国家中没有一个存在显著的有利于改善住房材料的不平等情况。解释五岁以下儿童死亡中住房不平等的因素包括家庭财富状况、居住地点、饮用水来源、媒体接触情况、父亲的就业情况、生育间隔和厕所类型。
在低收入和中等收入国家，个人层面和社区层面因素在推动住房材料不平等从而影响五岁以下儿童死亡方面存在差异。迫切需要采取干预措施，以减轻居住在用未改善住房材料建造房屋中的家庭的五岁以下儿童死亡负担。
