孟加拉国卫生保健设施的可及性和准备情况及其对五岁以下儿童死亡率的影响：关联数据分析。
Availability and readiness of health care facilities and their effects on under-five mortality in Bangladesh: Analysis of linked data.
出版信息
J Glob Health. 2022 Sep 17;12:04081. doi: 10.7189/jogh.12.04081.
BACKGROUND
Under-five mortality is unacceptably high in Bangladesh instead of governmental level efforts to reduce its prevalence over the years. Increased availability and accessibility to the health care facility and its services can play a significant role to reduce its occurrence. We explored the associations of several forms of child mortality with health facility level factors.
METHODS
The 2017-18 Bangladesh Demographic and Health Survey (BDHS) data and 2017 Bangladesh Health Facility Survey (BHFS) data were linked and analysed. The outcome variables were neonatal mortality, infant mortality, and under-five mortality. Health facility level factors were considered as major explanatory variables. They were the basic management and administrative system of the nearest health care facility where child health care services are available, degree of availability of the child health care services at the nearest health care facility, degree of readiness of the nearest health care facility (where child health care services are available) to provide child health care services and average distance of the nearest health care facility from mothers' homes where child health care services are available. The associations between the outcome variables and explanatory variables were determined using the multilevel mixed-effect logistic regression model.
RESULTS
Reported under-five, infant and neonatal mortality were 40, 27, and 22 per 10 000 live births, respectively. The likelihood of neonatal mortality was found to be declined by 15% for every unit increase in the score of the basic management and administrative system of the mothers' homes nearest health care facility where child health care services are available. Similarly, degree of availability and readiness of the mothers' homes nearest health care facilities to provide child health care services were found to be linked with 18%-24% reduction in neonatal and infant mortality. On contrary, for every kilometre increased distance between mothers' homes and its nearest health care facility was found to be associated with a 15%-20% increase in the likelihoods of neonatal, infant and under-five mortality.
CONCLUSIONS
The availability of health facilities providing child health care services close to mothers' residence and its readiness to provide child health care services play a significant role in reducing under-five mortality in Bangladesh. Policies and programs should be taken to increase the availability and accessibility of health facilities that provide child health care services.
背景
孟加拉国五岁以下儿童死亡率居高不下，尽管多年来政府一直努力降低这一比例。增加医疗保健设施的可及性和可获得性可以在降低死亡率方面发挥重要作用。我们探讨了几种形式的儿童死亡率与医疗设施水平因素之间的关联。
方法
将 2017-18 年孟加拉国人口与健康调查（BDHS）数据和 2017 年孟加拉国卫生设施调查（BHFS）数据进行关联和分析。结果变量是新生儿死亡率、婴儿死亡率和五岁以下儿童死亡率。医疗设施水平因素被视为主要解释变量。这些因素包括提供儿童保健服务的最近保健设施的基本管理和行政系统、最近保健设施提供儿童保健服务的程度、最近保健设施（提供儿童保健服务）提供儿童保健服务的准备程度以及提供儿童保健服务的最近保健设施与母亲家之间的平均距离。使用多水平混合效应逻辑回归模型确定结果变量与解释变量之间的关联。
结果
报告的五岁以下、婴儿和新生儿死亡率分别为每 10000 例活产 40 例、27 例和 22 例。研究发现，母亲家最近提供儿童保健服务的保健设施基本管理和行政系统评分每增加一个单位，新生儿死亡率就会降低 15%。同样，母亲家最近提供儿童保健服务的保健设施的可用性和准备程度与新生儿和婴儿死亡率降低 18%-24%有关。相反，母亲家和最近的保健设施之间每增加一公里的距离，新生儿、婴儿和五岁以下儿童死亡率的可能性就会增加 15%-20%。
结论
在孟加拉国，提供儿童保健服务的保健设施的可及性以及提供儿童保健服务的准备情况在降低五岁以下儿童死亡率方面发挥了重要作用。应采取政策和方案来增加提供儿童保健服务的保健设施的可及性。
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