Equity and Geography: The Case of Child Mortality in Papua New Guinea
Equity and Geography: The Case of Child Mortality in Papua New Guinea
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DOI：
10.1371/journal.pone.0037861
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发表时间：
2012-05-25
期刊：
影响因子：
3.7
通讯作者：
Lopez, Alan D.
中科院分区：
文献类型：
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作者：
Bauze, Anna E.;Tran, Linda N.;Lopez, Alan D.
背景：最近的评估显示，巴布亚新几内亚的儿童死亡率继续下降，但完整的国家以下分析仍然很少见。这项研究的目的是在国家和国家以下各级估计巴布亚新几内亚的五岁以下儿童死亡率，以检查地理不平等在卫生结果中的重要性，并跟踪实现千年发展目标(MDG)的进展情况。方法：我们使用2000年人口普查数据对2006年人口与健康调查(DHS)进行了回顾数据验证，然后应用先进的间接方法估计1976至2000年间五岁以下儿童的死亡率。因此，我们利用2000年人口普查估算了国家和国家以下各级的五岁以下儿童死亡率。在本报告所述期间，巴布亚新几内亚的全国五岁以下儿童死亡率缓慢下降，从每1000名活产中约103人死亡降至78人。国家以下各级的分析显示，农村人口和城市人口之间以及区域间和区域内的差异很大。在五岁以下儿童死亡率方面表现最好(最差)的一些省份包括表现最差(最好)的地区，地区一级的五岁以下儿童死亡率与贫困程度和获得服务的机会密切相关。结论：来自巴布亚新几内亚的证据表明，五岁以下儿童死亡率在省内存在很大的异质性，这表明需要在国家以下各级解决五岁以下儿童死亡率问题。这在像巴布亚新几内亚这样的国家尤其重要，在这些国家，卫生服务的责任被移交给省和地区。这项研究首次对巴新地区一级的五岁以下儿童死亡率进行了全面估计。结果表明，对于依赖很少数据来源的国家来说，必须更加重视未来人口调查的质量以及探索出生和死亡监测的替代选择。
Background: Recent assessments show continued decline in child mortality in Papua New Guinea (PNG), yet complete subnational analyses remain rare. This study aims to estimate under-five mortality in PNG at national and subnational levels to examine the importance of geographical inequities in health outcomes and track progress towards Millennium Development Goal (MDG) 4.Methodology: We performed retrospective data validation of the Demographic and Health Survey (DHS) 2006 using 2000 Census data, then applied advanced indirect methods to estimate under-five mortality rates between 1976 and 2000.Findings: The DHS 2006 was found to be unreliable. Hence we used the 2000 Census to estimate under-five mortality rates at national and subnational levels. During the period under study, PNG experienced a slow reduction in national under-five mortality from approximately 103 to 78 deaths per 1,000 live births. Subnational analyses revealed significant disparities between rural and urban populations as well as inter-and intra-regional variations. Some of the provinces that performed the best (worst) in terms of under-five mortality included the districts that performed worst (best), with district-level under-five mortality rates correlating strongly with poverty levels and access to services.Conclusions: The evidence from PNG demonstrates substantial within-province heterogeneity, suggesting that under-five mortality needs to be addressed at subnational levels. This is especially relevant in countries, like PNG, where responsibility for health services is devolved to provinces and districts. This study presents the first comprehensive estimates of under-five mortality at the district level for PNG. The results demonstrate that for countries that rely on few data sources even greater importance must be given to the quality of future population surveys and to the exploration of alternative options of birth and death surveillance.