Birth spacing and child mortality: an analysis of prospective data from the Nairobi urban health and demographic surveillance system.
Birth spacing and child mortality: an analysis of prospective data from the Nairobi urban health and demographic surveillance system.
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DOI：
10.1017/s0021932012000570
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发表时间：
2013-11
影响因子：
1.5
通讯作者：
Elungata P
中科院分区：
文献类型：
--
作者：
Fotso JC;Cleland J;Mberu B;Mutua M;Elungata P
大多数关于生育间隔与儿童生存关系的研究依赖于回顾性数据，这些数据容易受到可能导致结果偏差的错误的影响。研究人员利用2003年至2009年间在内罗毕两个贫民窟出生的13502名儿童的前瞻性数据，对这种关系进行了重新评估。近48%是头胎。在其余的人中，早产间隔很短是很常见的：20%的第二胎和更高的胎是在哥哥姐姐出生后的24个月内分娩的，其中9%的早产间隔很短，不到18个月。在对潜在混杂因素进行调整后，产前间隔时间的长短是婴儿和幼儿死亡率的主要决定因素。在婴儿期，产前间隔时间少于18个月与死亡风险增加两倍相关（与间隔时间延长至36个月或更长相比），而间隔时间为18 - 23个月与死亡风险增加18%相关。在幼儿期，与年长兄弟姐妹相隔18个月以内出生的儿童的死亡率是与年长兄弟姐妹相隔36个月或更长时间出生的儿童的两倍以上。只有592名儿童在20个月内有了弟弟妹妹；他们第二年的死亡率大约是其他孩子的两倍。这些结果支持了基于回顾性数据的研究结果。
The majority of studies of the birth spacing–child survival relationship rely on retrospective data, which are vulnerable to errors that might bias results. The relationship is re-assessed using prospective data on 13,502 children born in two Nairobi slums between 2003 and 2009. Nearly 48% were first births. Among the remainder, short preceding intervals are common: 20% of second and higher order births were delivered within 24 months of an elder sibling, including 9% with a very short preceding interval of less than 18 months. After adjustment for potential confounders, the length of the preceding birth interval is a major determinant of infant and early childhood mortality. In infancy, a preceding birth interval of less than 18 months is associated with a two-fold increase in mortality risks (compared with lengthened intervals of 36 months or longer), while an interval of 18–23 months is associated with an increase of 18%. During the early childhood period, children born within 18 months of an elder sibling are more than twice as likely to die as those born after an interval of 36 months or more. Only 592 children experienced the birth of a younger sibling within 20 months; their second-year mortality was about twice as high as that of other children. These results support the findings based on retrospective data.