Fikree F F, Gray R H
Department of Community Health Sciences, The Aga Khan University, Karachi, Pakistan.
Paediatr Perinat Epidemiol. 1996 Jan;10(1):86-96. doi: 10.1111/j.1365-3016.1996.tb00029.x.
A demographic survey was used to estimate the level and determinants of perinatal mortality in eight lower socio-economic squatter settlements of Karachi, Pakistan. The perinatal mortality rate was 54.1 per 1000 births, with a stillbirth to early neonatal mortality ratio of 1:1. About 65% of neonatal deaths occurred in the early neonatal period, and early neonatal mortality contributed 32% of all infant deaths. Risk factor assessment was conducted on 375 perinatal deaths and 6070 current survivors. Poorer socio-economic status variables such as maternal and paternal illiteracy, maternal work outside the home and fewer household assets were significantly associated with perinatal mortality as were biological factors of higher parental age, short birth intervals and poor obstetric history. Multivariable logistic analysis indicated that some socio-economic factors retained their significance after adjusting for the more proximate biological factors. Population attributable risk estimates suggest that public health measures for screening of high-risk women and use of family planning to space births will not improve perinatal mortality substantially without improvement of socio-economic conditions, particularly maternal education. The results of this study indicate that an evaluation of perinatal mortality can be conducted using pregnancy histories derived from demographic surveys.
在巴基斯坦卡拉奇的八个社会经济地位较低的棚户区，开展了一项人口统计学调查，以评估围产期死亡率水平及其决定因素。围产期死亡率为每1000例出生54.1例，死产与早期新生儿死亡率之比为1:1。约65%的新生儿死亡发生在早期新生儿期，早期新生儿死亡率占所有婴儿死亡的32%。对375例围产期死亡病例和6070名现存活者进行了危险因素评估。社会经济地位较差的变量，如母亲和父亲的文盲、母亲外出工作以及家庭资产较少，与围产期死亡率显著相关，父母年龄较大、生育间隔短和产科病史不良等生物学因素也是如此。多变量逻辑分析表明，在对更直接的生物学因素进行调整后，一些社会经济因素仍具有显著性。人群归因风险估计表明，如果不改善社会经济状况，特别是母亲教育水平，筛查高危妇女和使用计划生育来间隔生育的公共卫生措施不会大幅改善围产期死亡率。本研究结果表明，可利用人口统计学调查得出的妊娠史对围产期死亡率进行评估。
