Time trends and inequalities of under-five mortality in Nepal: a secondary data analysis of four demographic and health surveys between 1996 and 2011.
Time trends and inequalities of under-five mortality in Nepal: a secondary data analysis of four demographic and health surveys between 1996 and 2011.
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尼泊尔五岁以下死亡率的时间趋势和不平等：在1996年至2011年之间对四个人口和健康调查的二级数据分析。
DOI：
10.1371/journal.pone.0079818
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发表时间：
2013
期刊：
影响因子：
3.7
通讯作者：
Sathian B
中科院分区：
文献类型：
--
作者：
Sreeramareddy CT;Harsha Kumar HN;Sathian B
在实现千年发展目标四(MDG-4)方面的进展不平等反映了获得儿童保健服务的机会不平等。审查尼泊尔五岁以下儿童死亡率(U5MR)的时间趋势、社会经济和地区不平等。我们分析了1996年、2001年、2006年和2011年进行的四次尼泊尔人口与健康调查(NDHS)的完整生育史数据。对于每个活产，我们计算从出生到五岁生日或调查日期的存活期。采用直接法，即通过构建寿命表，计算了1991-2010年的年度U5MR。对2011年至2015年进行了预测。根据儿童性别、母亲受教育程度、家庭财富指数、城乡居住地、开发地区和生态区等因素，计算每个NDHS的U5MR。不平等被计算为比率差异、比率比率、人群归因风险和危险比率。每年U5MR(每千名活产儿)从1991年的157.3(95%CI 178.0-138.9)下降到2010年的43.2%(95%CI 59.1-31.5)，即绝对风险降低了114.1。预计2015年的U5MR为54.33。U5MR在所有分组中的绝对值都有所下降，但只有性别和城乡居民的相对不平等现象有所减少。财富和教育方面存在着广泛的不平等，并在1996年至2011年期间加剧。对于最低财富五分位数(与最高五分位数相比)，危险比(HR)从1.37(95%CI 1.27，1.49)增加到2.54(95%CI 2.25，2.86)，对于没有受过教育(与高等教育相比)的母亲，HR从2.55(95%CI 1.95，3.33)增加到3.75(95%CI 3.17，4.44)。区域不平等的变化是微乎其微和不规律的。尼泊尔最有可能实现千年发展目标4，但教育和财富不平等可能进一步扩大。国家卫生政策应致力于通过“包容性政策”减少U5MR的不平等。
Inequalities in progress towards achievement of Millennium Development Goal four (MDG-4) reflect unequal access to child health services. To examine the time trends, socio-economic and regional inequalities of under-five mortality rate (U5MR) in Nepal. We analyzed the data from complete birth histories of four Nepal Demographic and Health Surveys (NDHS) done in the years 1996, 2001, 2006 and 2011. For each livebirth, we computed survival period from birth until either fifth birthday or the survey date. Using direct methods i.e. by constructing life tables, we calculated yearly U5MRs from 1991 to 2010. Projections were made for the years 2011 to 2015. For each NDHS, U5MRs were calculated according to child's sex, mother’s education, household wealth index, rural/urban residence, development regions and ecological zones. Inequalities were calculated as rate difference, rate ratio, population attributable risk and hazard ratio. Yearly U5MR (per 1000 live births) had decreased from 157.3 (95% CIs 178.0-138.9) in 1991 to 43.2 (95% CIs 59.1-31.5) in 2010 i.e. 114.1 reduction in absolute risk. Projected U5MR for the year 2015 was 54.33. U5MRs had decreased in absolute terms in all sub groups but relative inequalities had reduced for gender and rural/urban residence only. Wide inequalities existed by wealth and education and increased between 1996 and 2011. For lowest wealth quintile (as compared to highest quintile) hazard ratio (HR) increased from 1.37 (95% CIs 1.27, 1.49) to 2.54 ( 95% CIs 2.25, 2.86) and for mothers having no education (as compared to higher education) HR increased from 2.55 (95% CIs 1.95, 3.33) to 3.75 (95% CIs 3.17, 4.44). Changes in regional inequities were marginal and irregular. Nepal is most likely to achieve MDG-4 but eductional and wealth inequalities may widen further. National health policies should address to reduce inequalities in U5MR through ‘inclusive policies'.
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