Factors Contributing to Maternal and Child Mortality Reductions in 146 Low- and Middle-Income Countries between 1990 and 2010.
Factors Contributing to Maternal and Child Mortality Reductions in 146 Low- and Middle-Income Countries between 1990 and 2010.
复制标题
DOI：
10.1371/journal.pone.0144908
复制
发表时间：
2016
期刊：
影响因子：
3.7
通讯作者：
Schweitzer J
中科院分区：
文献类型：
--
作者：
Bishai DM;Cohen R;Alfonso YN;Adam T;Kuruvilla S;Schweitzer J
从1990年到2010年，全球儿童死亡率下降了43%，孕产妇死亡率下降了40%。本文比较了两种进展来源：健康决定因素的社会覆盖面的改善与技术变革导致的健康决定因素影响的改善。本文将146个低收入和中等收入国家在降低儿童和孕产妇死亡率方面取得的进展分解为一个组成部分，即由于识字率，收入和健康覆盖率等健康决定因素的改善，以及由于这些健康决定因素影响的变化而产生的第二个组成部分。健康决定因素选自八个不同的健康影响部门。健康决定因素选自八个不同的健康影响部门。回归模型被用来估计1990年和2010年的影响规模。使用二手数据衡量健康决定因素水平的变化。该模型显示，自1990年以来，孕产妇和儿童死亡率分别下降了100%和89%，这是由于健康决定因素在全国范围内的覆盖率提高。任何单一决定因素在总体改善中所占的相对份额因国家和模型规格而异。然而，总体而言，约50%的死亡率下降是由于卫生部门的改善，另外50%的死亡率下降是由于卫生部门以外的进步。总体而言，从1990年到2010年，各国主要通过改善一系列广泛的卫生系统的社会覆盖面以及儿童健康的社会、经济和环境决定因素，改善了孕产妇和儿童健康。这些调查结果证明，国际社会为实现这些改善所作的努力是正确的，并与2015年后发展议程保持一致，该议程借鉴了千年发展目标的经验教训，并强调必须以更综合的方式跨部门促进卫生和可持续发展。
From 1990–2010, worldwide child mortality declined by 43%, and maternal mortality declined by 40%. This paper compares two sources of progress: improvements in societal coverage of health determinants versus improvements in the impact of health determinants as a result of technical change. This paper decomposes the progress made by 146 low- and middle-income countries (LMICs) in lowering childhood and maternal mortality into one component due to better health determinants like literacy, income, and health coverage and a second component due to changes in the impact of these health determinants. Health determinants were selected from eight distinct health-impacting sectors. Health determinants were selected from eight distinct health-impacting sectors. Regression models are used to estimate impact size in 1990 and again in 2010. Changes in the levels of health determinants were measured using secondary data. The model shows that respectively 100% and 89% of the reductions in maternal and child mortality since 1990 were due to improvements in nationwide coverage of health determinants. The relative share of overall improvement attributable to any single determinant varies by country and by model specification. However, in aggregate, approximately 50% of the mortality reductions were due to improvements in the health sector, and the other 50% of the mortality reductions were due to gains outside the health sector. Overall, countries improved maternal and child health (MCH) from 1990 to 2010 mainly through improvements in the societal coverage of a broad array of health system, social, economic and environmental determinants of child health. These findings vindicate efforts by the global community to obtain such improvements, and align with the post-2015 development agenda that builds on the lessons from the MDGs and highlights the importance of promoting health and sustainable development in a more integrated manner across sectors.