Magnani R J, Rice J C, Mock N B, Abdoh A A, Mercer D M, Tankari K
Tulane University Medical Center, School of Public Health and Tropical Medicine, Department of International Health and Development, 1440 Canal Street, Suite 2220-12, PO Box 13, New Orleans, LA 70112-2737, USA.
Int J Epidemiol. 1996 Jun;25(3):568-77. doi: 10.1093/ije/25.3.568.
Despite large investments in basic primary health care in sub-Saharan Africa over the past two decades, quantifying the contribution of national programme efforts to the reduction of infant/child mortality in the region has proven difficult. This study takes advantage of the phased implementation of the national Rural Health Improvement Program in Niger and conveniently timed survey data to reassess programme impact on under-five mortality during the 1980-1985 period.
Health service use and under-five mortality rates for children born in the 5 years prior to the 1985 survey are compared for three groups of villages: villages served by a dispensary, villages served by village health teams (VHT), and villages without access to modern primary care services. Multi-level regression analyses using both household- and community-level variables are undertaken in estimating the magnitude of effects.
Children residing in villages proximate to health dispensaries were approximately 32% less likely to have died during the study period than children without access to modern health services. Village health teams were not, however, associated with significantly lower mortality probabilities. Formal test for endogeneity indicated that these effects were not the result of non-uniform/non-random allocation of resources.
The findings are largely supportive of the key premise underlying selective primary health care interventions - that packages of basic services can be effectively mounted nationally in poor countries and have a significant impact over a short time period. In Niger, less than optimal implementation of VHT appears to have reduced the magnitude of the impact achieved.
尽管在过去二十年里，撒哈拉以南非洲地区在基础初级卫生保健方面投入巨大，但要量化国家项目努力对该地区婴儿/儿童死亡率降低的贡献却颇具难度。本研究利用了尼日尔国家农村健康改善项目的分阶段实施情况以及适时的调查数据，重新评估了1980 - 1985年期间该项目对五岁以下儿童死亡率的影响。
将1985年调查前5年出生的儿童的卫生服务利用情况和五岁以下儿童死亡率，在三组村庄之间进行比较：设有诊疗所的村庄、由村级卫生团队（VHT）服务的村庄以及无法获得现代初级保健服务的村庄。在估计影响程度时，使用家庭层面和社区层面变量进行多层次回归分析。
在研究期间，居住在靠近卫生诊疗所村庄的儿童死亡可能性比无法获得现代卫生服务的儿童低约32%。然而，村级卫生团队与死亡率显著降低并无关联。内生性的正式检验表明，这些影响并非资源分配不均/非随机分配的结果。
这些发现很大程度上支持了选择性初级卫生保健干预措施背后的关键前提——即基本服务包可以在贫穷国家有效推广，并在短时间内产生重大影响。在尼日尔，村级卫生团队实施效果欠佳似乎降低了所取得的影响程度。
