Associations of women's empowerment with neonatal, infant and under-5 mortality in low- and /middle-income countries: meta-analysis of individual participant data from 59 countries
Associations of women's empowerment with neonatal, infant and under-5 mortality in low- and /middle-income countries: meta-analysis of individual participant data from 59 countries
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DOI：
10.1136/bmjgh-2019-001558
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发表时间：
2020-01-01
影响因子：
8.1
通讯作者：
Neupane, Subas
中科院分区：
文献类型：
--
作者：
Doku, David T.;Bhutta, Zulfiqar A.;Neupane, Subas
儿童生存和增强妇女权能是全球关注的公共卫生问题，也是重要的可持续发展目标。低收入和中等收入国家（LMICs）对这两种现象的负担最大。本研究的目的是调查59个低收入中低收入国家在个人和人口层面赋予妇女权力的措施及其与国家和区域层面新生儿、婴儿和5岁以下儿童死亡率的潜在关联。方法采用标准化方案，从2000年至2015年对59个低收入国家（n=6 12 529）进行了基于人群的汇总横断面调查。我们为低收入国家构建了个体水平的妇女赋权指数（ILWEI）和群体水平的妇女赋权指数（PLWEI），并使用两阶段随机效应个体参与者数据（IPD）荟萃分析调查了这些指标与新生儿、婴儿和5岁以下儿童死亡率的潜在关联。结果新生儿总死亡率为24 / 1000活产。婴儿和5岁以下儿童死亡率分别为43 /1000和55/1000活产。在汇总样本中，分别有61.6%和19.9%的妇女在医疗保健和家庭决策方面拥有自主权，而56.0%的妇女以任何理由拒绝对妇女实施家庭暴力。IPD荟萃分析显示，与ILWEI高的儿童相比，低ILWEI妇女的儿童有更高的新生儿（OR: 1.18, 95% CI 1.14至1.22）、婴儿（OR: 1.12, 95% CI 1.08至1.17）和5岁以下儿童（OR: 1.12, 95% CI 1.07至1.18）死亡风险。在大多数地区以及PLWEI与所有三种结果之间都发现了类似的关系。结论妇女在个人和群体层面的赋权与中低收入国家的新生儿、婴儿和5岁以下儿童死亡率有关。我们的研究强调了妇女赋权对于加快实现中低收入国家儿童生存的可持续发展目标的重要性。为了消除这些国家可预防的儿童死亡率，需要多部门和协调一致的努力。
BackgroundChild survival and women's empowerment are global public health concerns and important sustainable development goals (SDGs). Low- and middle-income countries (LMICs) have the largest burden of both phenomena. The aim of this study is to investigate a measure of women's empowerment at individual and population levels and its potential associations with neonatal, infant and under-5 mortality at national and regional levels in 59 LMICs.MethodsWe used pooled population-based cross-sectional surveys from 59 LMICs (n=6 12 529) conducted from 2000 to 2015 using standardised protocols. We constructed individual-level women's empowerment index (ILWEI) and population-level women's empowerment index (PLWEI) for LMICs and investigated the potential associations of these measures with neonatal, infant and under-5 mortality using two-stage random-effect individual participant data (IPD) meta-analysis.ResultsThe pooled neonatal mortality rate was 24 per 1000 live births. Infant and under-5 mortality rates were 43 and 55/1000 live births, respectively. In the pooled sample, 61.6% and 19.9% of women had autonomy regarding their healthcare and household decision-making, respectively, whereas 56.0% rejected domestic violence against women for any reason. IPD meta-analysis showed that children of women with low ILWEI had a higher risk of neonatal (OR: 1.18, 95% CI 1.14 to 1.22), infant (OR: 1.12, 95% CI 1.08 to 1.17) and under-5 (OR: 1.12, 95% CI 1.07 to 1.18) mortality compared with children of high ILWEI. Similar relationships were found across most of the regions as well as between PLWEI and all the three outcomes.ConclusionsWomen's empowerment at individual and population levels is associated with neonatal, infant and under-5 mortality in LMICs. Our study underscores the importance of women's empowerment in accelerating progress towards the attainment of the SDG targets for child survival in LMICs. Multi-sectoral and concerted efforts are necessary to eliminate preventable child mortality in these countries.