For Personal Use. Only Reproduce with Permission from the Lancet Identifying Effective Child Survival Interventions Child Survival Ii
For Personal Use. Only Reproduce with Permission from the Lancet Identifying Effective Child Survival Interventions Child Survival Ii
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G. Jones;R. Steketee;G. Jones;R. Steketee;R. Black;Z. Bhutta;S. Morris;Bellagio Child;Survival Study Group
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G. Jones;R. Steketee;G. Jones;R. Steketee;R. Black;Z. Bhutta;S. Morris;Bellagio Child;Survival Study Group
这一系列关于儿童生存问题的第一份文件描绘了一幅令人无法接受的画面：每年有1 000多万儿童死亡，几乎都在低收入国家或中等收入国家的贫困地区。1这些死亡中有90%发生在42个国家，2大多数是由下列原因造成的：腹泻、肺炎、麻疹、疟疾、艾滋病毒/艾滋病，以及5岁以下儿童死亡的根本原因营养不良，新生儿死亡的根本原因是窒息、早产、败血症和破伤风。1按死因分列的死亡评估为评估现有儿童生存干预措施提供了一个有益的起点。在本文中，我们回顾了干预措施的证据状态，以降低5岁以下儿童（5岁以下死亡）的主要直接和根本死亡原因的儿童死亡率。干预一词在此仅限于指旨在降低发病率或死亡率的生物制剂或行动。向儿童和母亲提供所需干预措施的方法被称为交付战略。我们利用现有的研究报告和系统评价来记录每种干预措施在降低5岁以下儿童死亡率方面的有效性或有效性，总结这些干预措施的当前覆盖范围，并估计如果向所有需要的儿童和母亲提供经过验证的干预措施，可以预防多少儿童死亡。交付战略将在本系列的下一篇论文中讨论。因此，我们的目标是评估将目前有关儿童生存干预措施的知识转化为有效行动的潜在影响。鉴于2001年制定并由联合国成员国通过的千年发展目标，这些问题变得更加紧迫。4这八个目标之一是在1990年至2015年期间将儿童死亡率降低三分之二。4我们在这一时期刚刚走过了一半，除非有实质性的改变，否则很快就会无法实现这一目标。儿童死亡率是由许多层面的复杂决定因素造成的。5虽然我们认识到贫困和物质环境特征等远距离决定因素所发挥的重要作用，但我们在此侧重于针对儿童死亡率更近距离决定因素的干预措施，以及主要可通过卫生部门提供的干预措施。干预措施，以解决更多的.
The first paper in this series on child survival presented an unacceptable picture: more than 10 million children dying every year, almost all in low-income countries or poor areas of middle-income countries. 1 90% of these deaths occurred in just 42 countries, 2 most from one of a short list of causes: diarrhoea, pneumonia, measles, malaria, HIV/AIDS, and the underlying cause of undernutrition for deaths among children younger than 5 years, and asphyxia, preterm delivery, sepsis, and tetanus for deaths among neonates. 1 The assessment of deaths by cause provides a useful starting point for a stocktaking of available child survival interventions. In this paper we review the state of the evidence for interventions to reduce child mortality for each of the major direct and underlying causes of death in children younger than 5 years (under-5 deaths). The term intervention is used here in a limited sense to refer to a biological agent or action intended to reduce morbidity or mortality. Approaches used to reach children and mothers with the interventions they need are referred to as delivery strategies. We draw on existing research reports and systematic reviews to document the efficacy or effectiveness of each intervention in reducing mortality among children younger than 5 years, to summarise current coverage with these interventions, and to estimate how many child deaths could be prevented if proven interventions were delivered to all the children and mothers who need them. Delivery strategies are addressed in the next paper in the series. Our aim, then, is to assess the potential effect of translating current knowledge about child survival interventions into effective action. These questions take on added urgency in view of the millennium development goals, which were set in 2001 and adopted by the member states of the UN. 4 One of these eight goals is to reduce child mortality by two-thirds between 1990 and 2015. 4 We have just passed the halfway mark in this period, and unless there is substantial change, very soon, the target will be out of reach. Child mortality is the result of a complex web of determinants at many levels. 5 Although we recognise the important role played by distal determinants such as poverty and characteristics of the physical environment, we focus here on interventions addressing the more proximal determinants of child mortality and those that can be delivered mainly through the health sector. Interventions that addressed more …