五岁以下儿童和婴儿死亡的风险因素：系统评价和荟萃分析的伞状综述。
Risk factors of under-five and infant mortality: An umbrella review of systematic reviews and meta-analyses.
机构信息
Curtin School of Population Health, Curtin University, Perth, Western Australia, Australia.
Department of Reproductive Health, School of Public Health, Wollo University, Dessie, Ethiopia.
出版信息
J Glob Health. 2024 Nov 29;14:04260. doi: 10.7189/jogh.14.04260.
BACKGROUND
Ensuring child survival is a critical global challenge, requiring a robust and comprehensive understanding of the risk factors contributing to under-five mortality (U5M). We aimed to synthesise and summarise the current available evidence on risk factors of U5M and infant mortality worldwide to inform global child health programmes.
METHODS
We searched six major databases (Embase, Medline, Scopus, CINAHL, Web of Science, and Global Health) and repositories of systematic reviews, as well as grey literature sources to identify systematic reviews and meta-analyses that examined the associations between risk factors of U5M and infant mortality between 1 January 1990 and 4 March 2024. The quality of reviews was assessed using A Measurement Tool to Assess Systematic Reviews, Version 2 (AMSTAR 2). The strength of evidence and direction of associations was graded.
RESULTS
Of 5684 records, we included 32 reviews (including five systematic reviews without meta-analysis) which comprised 1042 primary studies. We synthesised 28 and 29 unique risk factors associated with U5M and infant mortality, respectively. Although there was no convincing evidence for the risk factors, we found probable evidence of association between exclusive breastfeeding (consistent negative association), and maternal death (consistent positive association) with U5M. There was also probable evidence for the association of short (<18 months) interpregnancy intervals (less consistent negative association), pre-pregnancy maternal obesity (consistent positive association), and maternal HIV infection (consistent positive association) with infant mortality.
CONCLUSIONS
While the review identified a broad range of risk factors, the overall evidence for most factors associated with under-five and infant mortality was 'limited-suggestive' or 'limited and no conclusive'. Thus, further high-quality studies are required to strengthen the evidence on these risk factors.
REGISTRATION
PROSPERO CRD42023455542.
背景
确保儿童生存是一项全球性的重大挑战，需要对导致五岁以下儿童死亡率（U5M）的风险因素有一个强有力且全面的理解。我们旨在综合和总结全球范围内 U5M 和婴儿死亡率的风险因素的现有证据，为全球儿童健康计划提供信息。
方法
我们检索了六个主要数据库（Embase、Medline、Scopus、CINAHL、Web of Science 和 Global Health）和系统评价库以及灰色文献来源，以确定 1990 年 1 月 1 日至 2024 年 3 月 4 日期间审查 U5M 和婴儿死亡率之间关联的系统评价和荟萃分析。使用评估系统评价的测量工具，版本 2（AMSTAR 2）评估评价的质量。对证据的强度和关联的方向进行分级。
结果
在 5684 条记录中，我们纳入了 32 篇综述（包括 5 篇没有荟萃分析的系统综述），其中包括 1042 项原始研究。我们分别综合了 28 个和 29 个与 U5M 和婴儿死亡率相关的独特风险因素。虽然没有令人信服的证据表明这些风险因素的存在，但我们发现纯母乳喂养（一致的负相关）和孕产妇死亡（一致的正相关）与 U5M 之间可能存在关联。妊娠间隔较短（<18 个月）（不太一致的负相关）、妊娠前母亲肥胖（一致的正相关）和母亲 HIV 感染（一致的正相关）与婴儿死亡率之间也可能存在关联。
结论
虽然该综述确定了广泛的风险因素，但与五岁以下儿童和婴儿死亡率相关的大多数因素的总体证据是“有限提示性”或“有限且无定论”。因此，需要进一步进行高质量的研究来加强这些风险因素的证据。
注册
PROSPERO CRD42023455542。
Zotero 插件