EFFECT OF THE GULF-WAR ON INFANT AND CHILD-MORTALITY IN IRAQ
EFFECT OF THE GULF-WAR ON INFANT AND CHILD-MORTALITY IN IRAQ
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DOI：
10.1056/nejm199209243271306
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发表时间：
1992-09-24
影响因子：
158.5
通讯作者：
ZAIDI, S
中科院分区：
文献类型：
--
作者：
ASCHERIO, A;CHASE, R;ZAIDI, S
背景：几个实况调查团报告称，波斯湾战争爆发后，伊拉克儿童营养不良和发病率有所增加。然而，战争和经济禁运对儿童死亡率影响的程度仍不确定。
方法：我们对271个群组进行了调查，每个群组包含25到30户家庭，这些家庭是作为伊拉克人口的代表性样本选取的。家庭的选取以及访谈是由一个独立于伊拉克当局的国际公共卫生专业人员团队进行的。在每个家庭中，对所有15到49岁的女性进行了访谈，并记录了1985年1月1日及以后出生的所有儿童的出生日期和死亡日期。
结果：研究人群包括16076名儿童，其中768名在调查期间（1985年1月1日至1991年8月31日）死亡。与战前时期相比，战后时期年龄调整后的相对死亡率为3.2（95%置信区间，2.8到3.7）。在对居住地区、母亲教育程度和母亲年龄进行调整后，未观察到相对风险有实质性变化。战争爆发后，1至不到12个月大的儿童（相对风险，4.1；95%置信区间，3.3到5.2）以及12至不到60个月大的儿童（相对风险，3.8；95%置信区间，2.6到5.4）死亡率的增加高于不到1个月大的儿童（相对风险，1.8；95%置信区间，1.4到2.4）。战争与死亡率之间的关联在伊拉克北部（相对风险，5.3）和南部（相对风险，3.4）比在中部地区（相对风险，1.9）或巴格达（相对风险，1.7）更强。
结论：这些结果提供了有力证据，表明海湾战争和贸易制裁导致伊拉克五岁以下儿童死亡率增加了两倍。我们估计，1991年1月至8月期间，有超过46900名儿童额外死亡。
Background. Increased malnutrition and morbidity among Iraqi children after the onset of the Persian Gulf war have been reported by several fact-finding missions. The magnitude of the effect of the war and the economic embargo on child mortality remains uncertain, however.Methods. We conducted a survey of 271 clusters of 25 to 30 households each, chosen as a representative sample of the Iraqi population. The households were selected and the interviews conducted by an international team of public health professionals independent of Iraqi authorities. In each household all women 15 to 49 years of age were interviewed, and the dates of birth and death of all children born on or after January 1, 1985, were recorded.Results. The study population included 16,076 children, 768 of whom died during the period surveyed (January 1, 1985, to August 31, 1991). The age-adjusted relative mortality for the period after the war began, as compared with the period before the war, was 3.2 (95 percent confidence interval, 2.8 to 3.7). No material change in the relative risk was observed after adjustment for region of residence, maternal education, and maternal age. The increase in mortality after the onset of the war was higher among children 1 to less than 12 months old (relative risk, 4.1; 95 percent confidence interval, 3.3 to 5.2) and among those 12 to less than 60 months old (relative risk, 3.8; 95 percent confidence interval, 2.6 to 5.4) than among those less than 1 month old (relative risk, 1.8; 95 percent confidence interval, 1.4 to 2.4). The association between the war and mortality was stronger in northern Iraq (relative risk, 5.3) and southern Iraq (relative risk, 3.4) than in the central areas (relative risk, 1.9) or in Baghdad (relative risk, 1.7).Conclusions. These results provide strong evidence that the Gulf war and trade sanctions caused a threefold increase in mortality among Iraqi children under five years of age. We estimate that an excess of more than 46,900 children died between January and August 1991.