An ecological quantification of the relationships between water, sanitation and infant, child, and maternal mortality.
An ecological quantification of the relationships between water, sanitation and infant, child, and maternal mortality.
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DOI：
10.1186/1476-069x-11-4
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发表时间：
2012-01-27
期刊：
影响因子：
--
通讯作者：
Mente A
中科院分区：
文献类型：
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作者：
Cheng JJ;Schuster-Wallace CJ;Watt S;Newbold BK;Mente A
水和卫生设施的获得与新生儿、儿童和产妇的健康有关。我们的研究试图使用国家层面的数据在全球范围内量化这些关系：改善水和卫生设施的获取对婴儿、儿童和孕产妇死亡率的影响有多大？193个国家的数据取自全球数据库（世界银行、世卫组织和儿童基金会）。对5岁以下儿童死亡率和婴儿死亡率的结果进行线性回归。这些结果表示为每1000例活产的事件。有序逻辑回归用于计算孕产妇死亡率（MMR）结局的比值比。校正混杂因素后，人口用水量每增加四分位数，五岁以下儿童死亡率降低1.17（95%CI 1.08-1.26）/1000，p < 0.001。卫生设施可及性的四分位数增加与5岁以下儿童死亡率之间存在类似的关系，每1000人中死亡人数减少了1.66人（95%CI 1.11-1.32），p < 0.001。改善供水也与婴儿死亡率有关，随着获得改善水源的四分位数的增加，婴儿死亡率降低了1.14（95%CI 1.05-1.23）/1000，p < 0.001。这种关系的显著性随着卫生设施获得的四分位数的改善而保持，其中婴儿死亡率下降为每1000人死亡1.66人（95%CI 1.11-1.32），p < 0.001。获得水的四分位数增加与MMR四分位数增加显著相关的估计比值比为0.58（95%CI 0.39-0.86），p = 0.008。卫生条件的相应比值比为0.52（95%CI 0.32-0.85），p = 0.009，这两项均表明更好的水和卫生条件与MMR降低相关。我们的分析表明，获得水和卫生设施是导致儿童和孕产妇死亡率结果的独立因素。如果全世界要认真实现降低儿童和孕产妇死亡率的千年发展目标，那么改善水和卫生设施是关键战略。
Water and sanitation access are known to be related to newborn, child, and maternal health. Our study attempts to quantify these relationships globally using country-level data: How much does improving access to water and sanitation influence infant, child, and maternal mortality? Data for 193 countries were abstracted from global databases (World Bank, WHO, and UNICEF). Linear regression was used for the outcomes of under-five mortality rate and infant mortality rate (IMR). These results are presented as events per 1000 live births. Ordinal logistic regression was used to compute odds ratios for the outcome of maternal mortality ratio (MMR). Under-five mortality rate decreased by 1.17 (95%CI 1.08-1.26) deaths per 1000, p < 0.001, for every quartile increase in population water access after adjustments for confounders. There was a similar relationship between quartile increase of sanitation access and under-five mortality rate, with a decrease of 1.66 (95%CI 1.11-1.32) deaths per 1000, p < 0.001. Improved water access was also related to IMR, with the IMR decreasing by 1.14 (95%CI 1.05-1.23) deaths per 1000, p < 0.001, with increasing quartile of access to improved water source. The significance of this relationship was retained with quartile improvement in sanitation access, where the decrease in IMR was 1.66 (95%CI 1.11-1.32) deaths per 1000, p < 0.001. The estimated odds ratio that increased quartile of water access was significantly associated with increased quartile of MMR was 0.58 (95%CI 0.39-0.86), p = 0.008. The corresponding odds ratio for sanitation was 0.52 (95%CI 0.32-0.85), p = 0.009, both suggesting that better water and sanitation were associated with decreased MMR. Our analyses suggest that access to water and sanitation independently contribute to child and maternal mortality outcomes. If the world is to seriously address the Millennium Development Goals of reducing child and maternal mortality, then improved water and sanitation accesses are key strategies.