Countdown to 2015 for maternal, newborn, and child survival: the 2008 report on tracking coverage of interventions
Countdown to 2015 for maternal, newborn, and child survival: the 2008 report on tracking coverage of interventions
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DOI：
10.1016/s0140-6736(08)60559-0
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发表时间：
2008-04-12
期刊：
影响因子：
168.9
通讯作者：
Wardlaw, Tessa
中科院分区：
文献类型：
--
作者：
Bryce, Jennifer;Daelmans, Bernadette;Wardlaw, Tessa
背景孕产妇、新生儿和儿童生存倒计时倡议监测优先干预措施的覆盖面，以实现降低孕产妇和儿童死亡率的千年发展目标。我们的目标是报告全球孕产妇和儿童死亡97%的68个国家，以及已被证明可以改善孕产妇、新生儿和儿童存活率的22项干预措施。方法我们选择孕产妇和儿童死亡率较高的国家，以及最有潜力避免此类死亡的干预措施。我们分析了针对具体国家的孕产妇和儿童死亡率数据以及选定干预措施的覆盖面。我们还跟踪了死因概况；营养状况指标；支持性政策的实施情况；孕产妇、新生儿和儿童健康的资金流；以及干预措施覆盖面的公平性。在68个优先国家中，有16个国家正在实现千年发展目标4。其中，7个国家在2005年启动倒计时倡议时已经步入正轨，3个国家(包括中国)在2008年进入正轨类别，6个国家在2008年首次纳入倒计时进程。没有显示在实现千年发展目标5方面取得进展的产妇死亡率趋势，但在大多数国家(68个国家中的56个)，产妇死亡率很高或很高。不同干预措施的覆盖范围在国家之间和国家内部都有很大差异。可以常规安排的干预措施，如免疫接种和产前护理，其覆盖率远远高于那些依靠正常运作的卫生系统和24小时临床服务的干预措施，如出生时的熟练或紧急护理和患病新生儿和儿童的护理。几乎所有68个国家的产后护理数据要么无法获得，要么显示覆盖率很低。免疫覆盖率增长最快的是免疫接种，在此期间也获得了大量投资。口译快速进步是可能的，但可以而且必须做得更多。将需要集中努力提高覆盖率，特别是在避孕服务、分娩护理、产后护理和新生儿和儿童疾病临床病例管理等优先事项方面。
Background The Countdown to 2015 for Maternal, Newborn, and Child Survival initiative monitors coverage of priority interventions to achieve the Millennium Development Goals (MDG) for reduction of maternal and child mortality. We aimed to report on 68 countries which have 97% of maternal and child deaths worldwide, and on 22 interventions that have been proven to improve maternal, newborn, and child survival.Methods We selected countries with high rates of maternal and child deaths, and interventions with the most potential to avert such deaths. We analysed country-specific data for maternal and child mortality and coverage of selected interventions. We also tracked cause-of-death profiles; indicators of nutritional status; the presence of supportive policies; financial flows to maternal, newborn, and child health; and equity in coverage of interventions.Findings Of the 68 priority countries, 16 were on track to meet MDG 4. Of these, seven had been on track in 2005 when the Countdown initiative was launched, three (including China) moved into the on-track category in 2008, and six were included in the Countdown process for the first time in 2008. Trends in maternal mortality that would indicate progress towards MDG 5 were not available, but in most (56 of 68) countries, maternal mortality was high or very high. Coverage of different interventions varied widely both between and within countries.Interventions that can be routinely scheduled, such as immunisation and antenatal care, had much higher coverage than those that rely on functional health systems and 24-hour availability of clinical services, such as skilled or emergency care at birth and care of ill newborn babies and children. Data for postnatal care were either unavailable or showed poor coverage in almost all 68 countries. The most rapid increases in coverage were seen for immunisation, which also received significant investment during this period. Interpretation Rapid progress is possible, but much more can and must be done. Focused efforts will be needed to improve coverage, especially for priorities such as contraceptive services, care in childbirth, postnatal care, and clinical case management of illnesses in newborn babies and children.