撒哈拉以南非洲地区新生儿死亡率的个体和社区层面决定因素：基于近期人口与健康调查数据的研究结果

Individual and community level determinants of neonatal mortality in sub saharan Africa: findings from recent demographic and health survey data.

作者信息

Enyew Engidaw Fentahun, Getnet Mihret, Gebiru Ashebir Mamay, Dessie Gashaw

机构信息

Department of Anatomy, School of Medicine, College of Medicine and Health Science, University of Gondar, Gondar, Ethiopia.

Department of Reproductive Health, Institute of Public Health, College of Medicine and Health Science, University of Gondar, Gondar, Ethiopia.

出版信息

Ital J Pediatr. 2025 May 19;51(1):144. doi: 10.1186/s13052-025-01997-7.

DOI:10.1186/s13052-025-01997-7

PMID:40390123

原文链接:https://pmc.ncbi.nlm.nih.gov/articles/PMC12090633/

Abstract

BACKGROUND

A major cause of deaths among children under five is neonatal mortality, a worldwide problem. However, the problem in sub-Saharan Africa is not well documented. Understanding the prevalence of neonatal death and its related causes is crucial for creating efforts and policies that could help address the problem. This study set out to determine the prevalence of neonatal death and its determinants in sub-Saharan Africa.

METHODS

Using secondary data analysis of demographic and health surveys conducted between 2014 and 2024 in sub-Saharan Africa. Total weighted samples of 133,448 live births in all during the period in 31 Sub- Saharan Africa. The determinants of neonatal mortality were identified using a multilevel mixed-effects logistic regression model. A multilevel binary logistic regression was fitted to identify the significant determinants of neonatal mortality. The Intra-class Correlation Coefficient, Median Odds Ratio, Proportional Change in Variance was used for assessing the clustering effect, and deviance for model comparison. Variables with a p-value < 0.2 in the Bivariable analysis were considered in the multivariable analysis. In the multivariable multilevel binary logistic regression analysis, Adjusted Odds Ratio with 95% CI was reported to declare statistically significant determinants of neonatal mortality.

RESULTS

The neonatal mortality in sub-Saharan Africa was 32 per 1000 live births (95% CI: 30, 34). maternal occupation (AOR = 1.26, 95% CI: 1.16, 1.37), home delivery (AOR = 1.29; 95% CI: 1.21, 1.39), caesarean section (AOR = 1.58; 95%CI: 1.36, 1.83), twin births(AOR = 2.48, 95% CI: 2.05, 2.54), birth order of 2-4 (AOR = 1.30, 95% CI: 1.18, 1.44), birth order of ≥ 5 (AOR = 1.43, 95% CI: 1.31, 1.59) and smaller size than average (AOR = 1.49, 95% CI: 1.36, 1.63)were significantly associated with higher odds of neonatal mortality.

CONCLUSION

According to this study, in sub-Saharan Africa neonatal mortality rate was high. The following factors should be taken into account while developing policies and measures to reduce newborn mortality in sub-Saharan Africa: the mother's education, wealth index, occupation, place of delivery, mode of delivery, twin birth, neonatal sex, birth order, and size at birth.

摘要

背景

五岁以下儿童死亡的一个主要原因是新生儿死亡率，这是一个全球性问题。然而，撒哈拉以南非洲地区的这一问题记录并不完善。了解新生儿死亡的患病率及其相关原因对于制定有助于解决该问题的措施和政策至关重要。本研究旨在确定撒哈拉以南非洲地区新生儿死亡的患病率及其决定因素。

方法

对2014年至2024年期间在撒哈拉以南非洲地区进行的人口与健康调查进行二次数据分析。在撒哈拉以南非洲地区的31个国家，该时期内共有133448例活产的总加权样本。使用多级混合效应逻辑回归模型确定新生儿死亡率的决定因素。拟合多级二元逻辑回归以确定新生儿死亡率的显著决定因素。组内相关系数、中位数优势比、方差比例变化用于评估聚类效应，偏差用于模型比较。在多变量分析中考虑双变量分析中p值<0.2的变量。在多变量多级二元逻辑回归分析中，报告调整优势比及95%置信区间以宣布新生儿死亡率的统计学显著决定因素。

结果

撒哈拉以南非洲地区的新生儿死亡率为每1000例活产中有32例（95%置信区间：30, 34）。母亲职业（调整优势比=1.26，95%置信区间：1.16, 1.37）、在家分娩（调整优势比=1.29；95%置信区间：1.21, 1.39）、剖宫产（调整优势比=1.58；95%置信区间：1.36, 1.83）、双胞胎出生（调整优势比=2.48，95%置信区间：2.05, 2.54）、出生顺序为2 - 4（调整优势比=1.30，95%置信区间：1.18, 1.44）、出生顺序≥5（调整优势比=1.43，95%置信区间：1.31, 1.59）以及体型小于平均水平（调整优势比=1.49，95%置信区间：1.36, 1.63）与新生儿死亡几率较高显著相关。