Survived infancy but still vulnerable: spatial-temporal trends and risk factors for child mortality in rural South Africa (Agincourt), 1992-2007
Survived infancy but still vulnerable: spatial-temporal trends and risk factors for child mortality in rural South Africa (Agincourt), 1992-2007
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DOI：
10.4081/gh.2011.181
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发表时间：
2011-05-01
影响因子：
1.7
通讯作者：
Tollman, Stephen M.
中科院分区：
文献类型：
--
作者：
Sartorius, Benn;Kahn, Kathleen;Tollman, Stephen M.
针对死亡风险最高的贫困儿童采取保健干预措施是加强公平的有希望的办法。已经出现了准确量化过度风险和识别时空差异的方法。这为指导政策提供了有用和详细的信息。进行了时空分析，以确定与儿童（1-4岁）死亡率在阿金库尔分区，南非，以评估在1992年和2007年之间的研究地点内的儿童死亡率模式的时间变化的风险因素，并制作全因和特定原因的死亡率地图，以确定高风险地区。人口统计学、母亲、父亲和生育相关因素、家庭死亡率经验、到卫生保健设施的距离和社会经济地位是研究的风险因素。分析进行了拟合贝叶斯离散时间伯努利生存地质统计模型，使用马尔可夫链蒙特卡罗模拟。贝叶斯克里金法被用来制作死亡风险图。由于艾滋病毒的流行，儿童死亡率暂时大幅上升。观察到一个独特的空间风险模式，高风险地区集中在研究区东部较贫穷的定居点，主要居住着前莫桑比克难民。经多变量调整后，儿童死亡率的主要风险因素是母亲死亡（特别是由于艾滋病毒和结核病）、5岁以下儿童生活在同一家庭中的人数较多和冬季。这项研究表明，使用贝叶斯地质统计模型准确量化的风险因素，并在健康和人口监测系统的儿童死亡率风险的地图。根据时空分析，该场地的东南部和中上部区域似乎具有最高的死亡风险。研究结果为解决阿金库尔分区健康不平等问题和改善获得保健服务的政策提供了信息。需要作出有针对性的努力，防止艾滋病毒在特定环境中的垂直传播，并确保母亲和父亲在童年时期的生存。
Targeting of health interventions to poor children at highest risk of mortality are promising approaches for enhancing equity. Methods have emerged to accurately quantify excess risk and identify space-time disparities. This provides useful and detailed information for guiding policy. A spatio-temporal analysis was performed to identify risk factors associated with child (1-4 years) mortality in the Agincourt sub-district, South Africa, to assess temporal changes in child mortality patterns within the study site between 1992 and 2007, and to produce all-cause and cause-specific mortality maps to identify high risk areas. Demographic, maternal, paternal and fertility-related factors, household mortality experience, distance to health care facility and socio-economic status were among the examined risk factors. The analysis was carried out by fitting a Bayesian discrete time Bernoulli survival geostatistical model using Markov chain Monte Carlo simulation. Bayesian kriging was used to produce mortality risk maps. Significant temporal increase in child mortality was observed due to the HIV epidemic. A distinct spatial risk pattern was observed with higher risk areas being concentrated in poorer settlements on the eastern part of the study area, largely inhabited by former Mozambican refugees. The major risk factors for childhood mortality, following multivariate adjustment, were mother's death (especially when due to HIV and tuberculosis), greater number of children under 5 years living in the same household and winter season. This study demonstrates the use of Bayesian geostatistical models for accurately quantifying risk factors and producing maps of child mortality risk in a health and demographic surveillance system. According to the space-time analysis, the southeast and upper central regions of the site appear to have the highest mortality risk. The results inform policies to address health inequalities in the Agincourt sub-district and to improve access to health services. Targeted efforts to prevent vertical transmission of HIV in specific settings need to be undertaken as well as ensuring the survival of the mother and father in childhood.