Equity dimensions of the decline in under-five mortality in Ghana: a joinpoint regression analysis
Equity dimensions of the decline in under-five mortality in Ghana: a joinpoint regression analysis
复制标题
DOI：
10.1111/tmi.13391
复制
发表时间：
2020-04-16
影响因子：
3.3
通讯作者：
Olakunde, Babayemi O.
中科院分区：
文献类型：
--
作者：
Alhassan, Jacob Albin Korem;Adeyinka, Daniel A.;Olakunde, Babayemi O.
背景全球对降低五岁以下儿童死亡率的关注和努力有所增加，特别是在低收入和中等收入国家。加纳在改善这一结果取得了一定的进展，但是，这种进步的程度和公平的影响仍然understudied.Methods本研究采用了联合点回归分析，以评估在加纳的五岁以下儿童死亡率的趋势变化的意义之间的1988年和2017年使用的数据从七轮加纳人口与健康调查。估计了年度百分比变化（APC）。通过重合检验比较不同公平维度（居住地，行政区域，母亲教育和财富五分位数）的APC-通过10 000个Monte Carlo Resistance.Results确定joinpoint回归函数的相似性加纳在1988年至2017年期间在降低5岁以下儿童死亡率方面取得了进展，年百分比变化为-3.49%。趋势分类显示，上东地区五岁以下儿童死亡率改善最快（APC = -5.0%）。在研究所涉期间，该国五岁以下儿童死亡率公平差距的缩小情况参差不齐。农村和城市之间的差距缩小得最快，其次是地区差距（在上东和阿散蒂地区之间），而最持久的差距仍然存在于孕产妇教育和财富五分位数。结论研究结果表明，方案干预措施在减少地理分布方面更为成功，在加纳，五岁以下儿童死亡率的不平等（城乡和按行政区域）高于非地理（孕产妇教育和财富五分位数）的不平等。为了加速降低五岁以下儿童死亡率并消除这方面的不平等现象，加纳可能需要推行更多旨在重新分配的社会政策。
Background There has been a global rise in interest and efforts to improve under-five mortality rates, especially in low- and middle-income countries. Ghana has made some progress in improving this outcome; however, the extent of such progress and its equity implications remains understudied.Methods This study used a joinpoint regression analysis to assess the significance of changes in trends of under-five mortality rates in Ghana between 1988 and 2017 using data from seven rounds of the Ghana Demographic and Health Survey. Annual percentage change (APC) was estimated. The APCs of different dimensions of equity (residence, administrative region, maternal education and wealth quintile) were compared by coincidence test - to determine similarity in joinpoint regression functions via 10 000 Monte Carlo resampling.Results There has been progress in reduction of under-five mortality in Ghana between 1988 and 2017 with an annual percentage change of -3.49%. Disaggregation of the trends showed that the most rapid improvement in under-five mortality rates occurred in the Upper East Region (APC = -5.0%). The closing of under-five mortality equity gaps in the study period has been uneven in the country. The gap between rural and urban rates has closed the most, followed by regional gaps (between Upper East and Ashanti Region), while the most persistent gaps remain in maternal education and wealth quintile.Conclusion The findings suggest that programmatic interventions have been more successful in reducing geographic (rural-urban and by administrative region) than non-geographic (maternal education and wealth quintile) inequities in under-five mortality in Ghana. To accelerate reduction and bridge the inequities in under-five mortality, Ghana may need to pursue more social policies aimed at redistribution.