Quantifying within-city inequalities in child mortality across neighbourhoods in Accra, Ghana: a Bayesian spatial analysis.
Quantifying within-city inequalities in child mortality across neighbourhoods in Accra, Ghana: a Bayesian spatial analysis.
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DOI：
10.1136/bmjopen-2021-054030
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发表时间：
2022-01-13
期刊：
影响因子：
2.9
通讯作者：
Baumgartner J
中科院分区：
文献类型：
--
作者：
Bixby H;Bennett JE;Bawah AA;Arku RE;Annim SK;Anum JD;Mintah SE;Schmidt AM;Agyei-Asabere C;Robinson BE;Cavanaugh A;Agyei-Mensah S;Owusu G;Ezzati M;Baumgartner J
撒哈拉以南非洲国家的儿童死亡率是全世界最高的。城市地区的死亡率往往低于农村地区，但这些比较可能掩盖了城市内部的巨大不平等。我们的目的是估算加纳大阿克拉都市区 (GAMA) 社区层面的五岁以下儿童死亡率 (U5M)，并衡量城市内不平等的程度。我们使用加纳最近的人口普查（2010 年）获取了居住在 GAMA 的超过 700 名 25-49 岁女性的数据。我们按五岁年龄组的妇女和邻居 (n=406) 总结了儿童出生和死亡的计数，并应用间接人口统计方法将摘要转换为五岁之前的每年死亡概率。我们对邻里 U5M 概率进行了贝叶斯时空模型拟合，以获得 2010 年的估计值，并检验了它们与邻里生活和社会经济条件指标的相关性。 2010 年，GAMA 各社区的 U5M 变化几乎五倍，从每 1000 名活产婴儿 28 例（95% 可信区间 (CrI) 8 至 63）到 138 例（95% CrI 111 至 167）例死亡不等。 U5M 在市中心和工业区的社区中最高，这些社区中每 1000 名活产婴儿平均有 95 人死亡。平均而言，城郊社区的表现较好，但与中心城区的社区相比，各个社区的比率差异更大。 U5M 与城郊社区生活和社会经济条件改善的多项指标呈负相关。在城市社区中，与这些因素的相关性较弱，或者在某些情况下甚至相反，包括与家庭消费中位数和女性受教育程度的相关性。 GAMA 居住着相当大一部分城市人口，应优先降低高负担城市社区的儿童死亡率，作为持续努力的一部分，以实现可持续发展目标每 1000 名活产儿死亡人数低于 25 人的国家目标。
Countries in sub-Saharan Africa suffer the highest rates of child mortality worldwide. Urban areas tend to have lower mortality than rural areas, but these comparisons likely mask large within-city inequalities. We aimed to estimate rates of under-five mortality (U5M) at the neighbourhood level for Ghana’s Greater Accra Metropolitan Area (GAMA) and measure the extent of intraurban inequalities. We accessed data on >700 000 women aged 25–49 years living in GAMA using the most recent Ghana census (2010). We summarised counts of child births and deaths by five-year age group of women and neighbourhood (n=406) and applied indirect demographic methods to convert the summaries to yearly probabilities of death before age five years. We fitted a Bayesian spatiotemporal model to the neighbourhood U5M probabilities to obtain estimates for the year 2010 and examined their correlations with indicators of neighbourhood living and socioeconomic conditions. U5M varied almost five-fold across neighbourhoods in GAMA in 2010, ranging from 28 (95% credible interval (CrI) 8 to 63) to 138 (95% CrI 111 to 167) deaths per 1000 live births. U5M was highest in neighbourhoods of the central urban core and industrial areas, with an average of 95 deaths per 1000 live births across these neighbourhoods. Peri-urban neighbourhoods performed better, on average, but rates varied more across neighbourhoods compared with neighbourhoods in the central urban areas. U5M was negatively correlated with multiple indicators of improved living and socioeconomic conditions among peri-urban neighbourhoods. Among urban neighbourhoods, correlations with these factors were weaker or, in some cases, reversed, including with median household consumption and women’s schooling. Reducing child mortality in high-burden urban neighbourhoods in GAMA, where a substantial portion of the urban population resides, should be prioritised as part of continued efforts to meet the Sustainable Development Goal national target of less than 25 deaths per 1000 live births.
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影响因子：
168.9
作者：
Bhutta, Zulfiqar A.;Das, Jai K.;Black, Robert E.
通讯作者：
Black, Robert E.
影响因子：
15.8
作者：
Arku RE;Bennett JE;Castro MC;Agyeman-Duah K;Mintah SE;Ware JH;Nyarko P;Spengler JD;Agyei-Mensah S;Ezzati M
通讯作者：
Ezzati M
DOI：
10.1073/pnas.2003719117
发表时间：
2020-07-28
影响因子：
11.1
作者：
Boing, Antonio Fernando;Boing, Alexandra Crispim;Subramanian, S. V.
通讯作者：
Subramanian, S. V.
影响因子：
56.9
作者：
Guiteras, Raymond;Levinsohn, James;Mobarak, Ahmed Mushfiq
通讯作者：
Mobarak, Ahmed Mushfiq
影响因子：
2.4
作者：
Agyei-Mensah, Samuel;Owusu, George
通讯作者：
Owusu, George