Measuring and correcting biased child mortality statistics in countries with generalized epidemics of HIV infection
Measuring and correcting biased child mortality statistics in countries with generalized epidemics of HIV infection
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DOI：
10.2471/blt.09.071779
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发表时间：
2010-10-01
期刊：
影响因子：
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通讯作者：
Nyamukapa, Constance A
中科院分区：
文献类型：
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作者：
Hallett, Timothy B;Gregson, Simon;Nyamukapa, Constance A
目标 千年发展目标 4 要求各国在 1990 年至 2015 年间将儿童死亡率降低三分之二。在人体免疫机能丧失病毒 (HIV) 感染普遍流行的国家，由于获得性免疫机能丧失综合症导致的母亲死亡和儿童早期死亡之间的相关性，基于生育史的标准统计数据可能会误报实现这一目标的进展情况。方法是通过 1998 年至 2005 年期间对津巴布韦东部的前瞻性家庭调查收集的。然后使用数学模型来研究偏差的决定因素和时间动态，首先在津巴布韦，然后在具有不同背景死亡率和艾滋病毒相关流行病概况的其他国家。结果根据经验数据，标准横断面调查统计数据分别低估了婴儿和 5 岁以下儿童的真实死亡率 6.7% 和 9.8%。这些估计与模型的输出一致，其中偏差根据艾滋病毒感染流行的程度和阶段以及背景死亡率而变化。调查前和疫情后期的时间越长，偏差就越大。偏差可能会严重扭曲降低非艾滋病毒相关死亡率的干预措施和预防母婴传播计划的测量效果，特别是当趋势基于单项调查的数据时。 结论 母亲及其子女与艾滋病毒相关的死亡之间的相关性可能会使调查对早期儿童死亡率的估计产生偏差。在衡量艾滋病毒感染普遍流行的国家实现千年发展目标 4 的进展情况时，可以使用具有用户友好界面的数学模型来纠正这种偏差
Objective Under Millennium Development Goal 4, countries are required to reduce child mortality by two-thirds between 1990 and 2015. In countries with generalized epidemics of human immunodeficiency virus (HIV) infection, standard statistics based on fertility history may misrepresent progress towards this target owing to the correlation between deaths among mothers and early childhood deaths from acquired immunodeficiency syndrome.Methods To empirically estimate this bias, child mortality data and fertility history, including births to deceased women, were collected through prospective household surveys in eastern Zimbabwe during 1998-2005. A mathematical model was then used to investigate the determinants and temporal dynamics of the bias, first in Zimbabwe and then in other countries With different background mortality rates and HIV-related epidemic profiles.Findings According to the empirical data, standard cross-sectional survey statistics underestimated true infant and under-5 mortality by 6.7% and 9.8%, respectively. These estimates-were in agreement with the output from the model, in which the bias varied according to the magnitude and stage of the epidemic of HIV infection and background mortality rates. The bias was greater the longer the period elapsed before the survey and in later stages of the epidemic. Bias could substantially distort the measured effect of interventions to reduce non-HIV-related mortality and of programmes to-prevent mother-to-child transmission, especially when trends are based on data from a single survey.Conclusion The correlation between the HIV-related deaths of mothers and their children can bias survey estimates of early child mortality. A mathematical model with a user-friendly interface is available to correct for this bias when measuring progress towards Millennium Development Goal 4 in countries With generalized epidemics of HIV infection