Zeng Meng, Niu Lu
Department of Social Medicine and Health Management, Xiangya School of Public Health, Central South University, Changsha, China.
Front Public Health. 2023 Sep 13;11:1193319. doi: 10.3389/fpubh.2023.1193319. eCollection 2023.
West African countries experienced the highest under-5 mortality rate (U5MR), the lowest life expectancy, and the poorest economic development. This study aimed to explore the spatiotemporal trend of U5MR and spatial spillover effects of health resources and services to provide a basis for establishing health policies and international cooperative mechanisms in West Africa.
We retrieved data from the World Health Organization's Global Health Observatory, the United Nations Human Development Report, and the Global Burden of Disease Study 2019. Joinpoint regression analysis and Moran's method were used to examine the temporal trend and spatial dependence of U5MR, respectively. Spatial regression analysis was used to examine the spatial spillover effects.
The long-term downward trends in U5MR were divided into multiple segments by two or three change points in 2013, 2014, or 2015, and the annual percentage change after 2015 was higher than before 2015. Global Moran's was positive, significantly indicating positive spatial autocorrelation, which increased from 0.2850 ( = 0.0210) to 0.3597 ( = 0.0080). Based on spatial regression analysis, human development index (HDI), physicians density, nurses and midwives density, health center density, percentage of infants lacking immunization for diphtheria and measles, and coverage rate of at least one antenatal visit had negative spatial spillover effects on U5MR. HDI had the strongest negative correlation ( = -0.0187 to -0.1054, < 0.0001). Current health expenditure (CHE) had positive spatial spillover effects on U5MR.
This study revealed the spatiotemporal trend of U5MR in West African countries and spatial spillover effects of health resources and services. Promoting economic development, increasing health human resources, health expenditure, vaccination rate, antenatal care coverage, and the proportion of health professionals attending births not only reduced the local U5MR but also exerted spatial spillover effects on adjacent countries. The West African Health Organization may consider regional spillover mechanisms to develop regional health policy and intervention cooperation mechanisms, which will contribute to achieving the sustainable development goal on U5MR, Africa Agenda 2063, and universal health coverage.
西非国家的五岁以下儿童死亡率（U5MR）最高，预期寿命最低，经济发展最落后。本研究旨在探讨U5MR的时空趋势以及卫生资源与服务的空间溢出效应，为西非制定卫生政策和国际合作机制提供依据。
我们从世界卫生组织全球卫生观测站、联合国人类发展报告以及《2019年全球疾病负担研究》中检索数据。分别采用Joinpoint回归分析和莫兰氏I方法来检验U5MR的时间趋势和空间依赖性。采用空间回归分析来检验空间溢出效应。
U5MR的长期下降趋势在2013年、2014年或2015年被两到三个变化点划分为多个阶段，2015年之后的年百分比变化高于2015年之前。全局莫兰氏I为正，显著表明存在正空间自相关，其值从0.2850（P = 0.0210）增至0.3597（P = 0.0080）。基于空间回归分析，人类发展指数（HDI）、医生密度、护士和助产士密度、卫生中心密度、白喉和麻疹疫苗接种不足的婴儿比例以及至少进行一次产前检查的覆盖率对U5MR具有负空间溢出效应。HDI的负相关性最强（β = -0.0187至-0.1）
