Disparities in interventions for child and maternal mortality.
Disparities in interventions for child and maternal mortality.
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DOI：
10.1016/s0140-6736(12)60474-7
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发表时间：
2012-03-31
期刊：
影响因子：
168.9
通讯作者：
McClure, Elizabeth M.
中科院分区：
文献类型：
--
作者：
Goldenberg, Robert L.;McClure, Elizabeth M.
最低收入国家的孕产妇死亡率、死产率和新生儿死亡率明显高于最高收入国家; 98%或更多的这些不良后果发生在低收入国家。1，2为了强调这些差异并确定针对具体国家的改进目标，联合国会员国通过了千年发展目标（MDG）。3这些目标包括千年发展目标4，即在1990年至2015年期间将5岁以下儿童死亡率降低三分之二，以及千年发展目标5，即在1990年至2015年期间将孕产妇死亡率降低四分之三。2对世界上75个最贫穷国家这一进程的监测被称为2015年倒计时。4可能降低孕产妇、胎儿、新生儿和儿童死亡率的干预措施已详细描述。5-7利用人口健康调查和多指标类集调查等全国性调查的数据，可以估计这些干预措施在国家一级或在特定亚人口中的使用情况。例如，可以确定接受四次产前检查或在分娩时有熟练助产士在场的孕妇比例，还可以确定腹泻儿童接受口服补液治疗或接种各种传染病疫苗的比例。8经常讨论子人群（这些人群以不同的方式定义）之间妊娠结局的差异。4，9最富有和最贫穷国家之间不良出生结果比率的差异，特别是产妇死亡率的巨大差异，是有记录以来最大的差异。此外，各国内部的健康结果可能存在很大差异。4，9，10在美国，黑人的孕产妇和婴儿死亡率高于白色人群，这是健康结果中种族差异的一个例子; 10然而，孕产妇和儿童健康结果的国内差异不仅仅是种族的原因。低收入妇女和儿童的结局一般比高收入妇女和儿童差，生活在农村地区的妇女和儿童的结局一般比城市地区的妇女和儿童差。3造成差异的原因往往不明确，但部分原因与获得保健和具体干预措施方面的差异有关。
Rates of maternal mortality, stillbirth, and neonatal mortality are substantially higher in the lowest than in the highest income countries; 98% or more of these adverse outcomes occur in low-income countries. 1, 2 To emphasise these differences and define countryspecific goals for improvement, UN member states have adopted the Millennium Development Goals (MDG). 3 These goals include MDG 4, to reduce the mortality rate by two-thirds in children younger than 5 years between 1990 and 2015, and MDG 5, to reduce maternal mortality by three-quarters between 1990 and 2015. 2 Monitoring of this process in the world’s 75 poorest countries is known as the Countdown to 2015. 4 Interventions likely to reduce maternal, fetal, and neonatal and childhood mortality have been described in detail. 5–7 With use of data from countrywide surveys, such as the Demographic Health Surveys and Multiple Indicator Cluster Surveys, use of these interventions at country level or for specific subpopulations can be estimated. For example, the proportion of pregnant women who received four prenatal visits or for whom a skilled birth attendant were present during labour can be identified, as can the proportion of children with diarrhoea treated by oral rehydration treatment, or who were vaccinated for various infectious diseases. 8 Disparities in pregnancy outcomes between sub populations (with these populations defined in different ways) are often discussed. 4, 9 Dissimilarities in rates of adverse birth outcomes between the richest and poorest countries—especially the substantial differences in maternal mortality ratios—are among the greatest disparities ever recorded. Furthermore, large differences might occur in health outcomes within countries. 4, 9, 10 The higher maternal and infant mortality in black than in white populations in the USA is an example of racial disparity in a health outcome; 10 however, within-country differences in maternal and child health outcomes can be attributed to more than race alone. Low-income women and children generally have worse outcomes than do high-income women and children, and those living in rural areas generally have worse outcomes than do those in urban areas. 3 Reasons for disparities are often obscure, but partly relate to differences in access to health care and specific interventions.