Childhood mortality among former Mozambican refugees and their hosts in rural South Africa
Childhood mortality among former Mozambican refugees and their hosts in rural South Africa
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DOI：
10.1093/ije/dyh257
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发表时间：
2004-12-01
影响因子：
7.7
通讯作者：
Tollman, SM
中科院分区：
文献类型：
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作者：
Hargreaves, JR;Collinson, MA;Tollman, SM
重要的是监测不同人群之间的健康差异，以了解这些差异是如何产生的。国际流离失所者是一个潜在的弱势群体。我们调查了南非东北部一个农村街道前莫桑比克难民家庭和南非收容家庭儿童死亡率的差异。方法1992年1月1日至2000年10月31日在南非林波波省对30276名儿童进行开放性前瞻性队列研究，随访80 462人年。暴露和结果数据来自阿金库尔健康和人口监测系统（DSS）。结果来自前莫桑比克难民家庭的儿童和来自南非家庭的儿童的婴儿死亡率没有差异（调整后的比率[RR] = 1.02, 95% CI: 0.79, 1.32），但在接下来的4年里，前莫桑比克难民儿童的死亡率水平更高（调整后的RR = 1.91, 95% CI: 1.50, 2.42）。家庭人口较多和母亲去世的儿童死亡率也有所上升，而年龄在40岁至40岁之间或受过高等教育的母亲所生的儿童死亡率较低。测量的产妇、家庭和卫生服务利用特征无法解释前莫桑比克难民和南非家庭儿童死亡率的差异。居住在难民定居点的前莫桑比克难民儿童的死亡率高于居住在较成熟村庄的儿童。本研究表明，前莫桑比克难民家庭的儿童死亡率高于南非农村南非收容家庭的儿童死亡率，而不是婴儿死亡率。许多前莫桑比克难民缺乏法律地位和较低的财富可能部分解释了这种差异。
Background It is important to monitor health differentials between population groups to understand how they are generated. Internationally displaced people represent one potentially disadvantaged group. We investigated differentials in mortality between children from former Mozambican refugee and host South African households in a rural sub-district in the north-east of South Africa.Methods Open prospective cohort of 30 276 children (80 462 person years of follow-up) followed from 1 January 1992 to 31 October 2000 in Limpopo Province, South Africa. Exposure and outcomes data came from the Agincourt Health and Demographic Surveillance System (DSS).Results There was no difference in infant mortality between children from former Mozambican refugee households and those from South African homes (adjusted rate ratio [RR] = 1.02, 95% CI: 0.79, 1.32), but mortality levels were higher among former Mozambican refugee children during the next 4 years (adjusted RR = 1.91, 95% CI: 1.50, 2.42). Increased mortality levels were also seen among children from larger households and whose mother died, while children born to mothers aged >40 years or with higher education were at lower risk. Measured maternal, household, and health service utilization characteristics could not explain the difference in mortality between children from former Mozambican refugee and South African households. Former Mozambican refugee children residing in refugee settlements had higher mortality rates than those residing in more established villages.Conclusions This study demonstrates higher childhood, but not infant, mortality rates among children from former Mozambican refugee households compared with those from host South African households in rural South Africa. The lack of legal status and lower wealth of many former Mozambican refugees may partly explain this disparity.