Waxler N E, Morrison B M, Sirisena W M, Pinnaduwage S
Soc Sci Med. 1985;20(4):381-92. doi: 10.1016/0277-9536(85)90013-9.
The infant mortality rate in Sri Lanka has fallen precipitiously since World War II, to 44 per 1000 births, a rate that is similar to a number of Western Countries. Yet the aggregated country rate masks wide variations across districts, from a low 21 per 1000 in Jaffna District to a high of 100 per 1000 in Nuwara Eliya District. Such regional variations in infant mortality rates have been shown to be related to a number of social, demographic and intitutional characteristics of each area. To specify such linkages we move, in this paper, from the aggregate level of analysis to the level of individual households in order to look for social, economic and other characteristics associated with infant deaths. Data are derived from a systematic interview of 480 household heads in 12 villages of Sri Lanka, collected in 1980. The most proximate factors, public health or medical variables, that predict infant death in particular households include quality of family nutrition, supervised childbirth, immunization of children and, most significant, whether the family has a sanitary latrine. Yet these medical variables are strongly associated with educational and economic characteristics of the family which, in turn, are predictive of infant mortality. Poor families and poorly educated mothers are less likely to go to hospital for childbirth, have a latrine, etc., and more likely to have had an infant die. Underlying the variations in education and economic status are variations in ethnic group; families with poor sanitation, least education and few economic resources are most likely to be members of the minority communities, Ceylon or Indian Tamils and Muslims. Minority group membership is significantly associated with infant mortality as well. When a set of medical, educational, economic and cultural variables are examined simultaneously within a path model we show that the best causal explanation of infant death in Sri Lankan households says, "Minority group status results in poverty which prevents families from having safe sanitary facilities which causes infant death". Infant mortality in Sri Lanka is thus not simply a medical problem to be dealt with by public health programs, nor is it solely an economic problem that can be solved with creation of jobs, but it is better seen as a problem of the structure of the whole society.
自第二次世界大战以来，斯里兰卡的婴儿死亡率急剧下降，降至每1000例出生中有44例，这一比率与一些西方国家相近。然而，全国的总比率掩盖了各地区之间的巨大差异，从贾夫纳地区每1000例中的低比率21例到努沃勒埃利耶地区每1000例中的高比率100例。婴儿死亡率的这种地区差异已被证明与每个地区的一些社会、人口和制度特征有关。为了明确这种联系，在本文中，我们从总体分析层面转向个体家庭层面，以寻找与婴儿死亡相关的社会、经济和其他特征。数据来自1980年对斯里兰卡12个村庄的480户户主进行的系统访谈。预测特定家庭中婴儿死亡的最直接因素，即公共卫生或医疗变量，包括家庭营养质量、助产、儿童免疫，以及最重要的，家庭是否有卫生厕所。然而，这些医疗变量与家庭的教育和经济特征密切相关，而这些特征反过来又可以预测婴儿死亡率。贫困家庭和受教育程度低的母亲去医院分娩、拥有厕所等的可能性较小，婴儿死亡的可能性更大。教育和经济状况差异的背后是种族群体的差异；卫生条件差、教育程度最低且经济资源匮乏的家庭最有可能是少数群体，即锡兰或印度泰米尔人和穆斯林。少数群体身份也与婴儿死亡率显著相关。当在路径模型中同时考察一组医疗、教育、经济和文化变量时，我们表明，对斯里兰卡家庭中婴儿死亡的最佳因果解释是：“少数群体身份导致贫困，贫困使家庭无法拥有安全的卫生设施，从而导致婴儿死亡”。因此，斯里兰卡的婴儿死亡率不仅仅是一个可由公共卫生项目处理的医疗问题，也不仅仅是一个可通过创造就业机会解决的经济问题，而更应被视为一个整个社会结构的问题。
