Health transitions in sub-Saharan Africa: overview of mortality trends in children under 5 years old (1950-2000)
Health transitions in sub-Saharan Africa: overview of mortality trends in children under 5 years old (1950-2000)
复制标题
DOI：
10.2471/blt.05.029231
复制
发表时间：
2006-06-01
期刊：
影响因子：
--
通讯作者：
Gakusi, Enéas
中科院分区：
文献类型：
--
作者：
Garenne, Michel;Gakusi, Enéas
目的重建和分析1950 ~ 2000年撒哈拉以南非洲5岁以下儿童死亡率的变化趋势。方法选取32个非洲国家的66份人口与健康调查和世界生育率调查资料进行分析。每次调查的死亡率按年度计算。如果对同一个国家进行了几次调查，则将重叠的年份合并。对具体国家的时间序列进行了分析，以确定单调趋势的时期，无论是下降、稳定还是上升。我们测试的趋势变化，使用线性logistic model.Findings四分之一的国家研究单调下降的死亡率趋势：即平稳的健康过渡。另一个季度长期下降，短期内略有上升。有八个国家由于政治或经济危机而出现死亡率大幅上升的时期，有七个国家的死亡率数年来停止下降。在另外八个国家，由于儿童艾滋病，死亡率近年来有所上升。重建的水平和趋势进行了比较，由国际组织作出的其他估计，通常是根据间接的方法。结论总体而言，在撒哈拉以南非洲地区的儿童生存取得了重大进展，在第二个世纪后半叶。然而，转型比预期的要慢，平均每年下降1.8%。此外，许多国家的过渡混乱不堪。死亡率上升的主要原因是政治不稳定、严重的经济衰退和新出现的疾病。
Objective To reconstruct and analyse mortality trends in children younger than 5 years in sub-Saharan Africa between 1950 and 2000.Methods We selected 66 Demographic and Health Surveys and World Fertility Surveys from 32 African countries for analysis. Death rates were calculated by yearly periods for each survey. When several surveys were available for the same country, overlapping years were combined. Country-specific time series were analysed to identify periods of monotonic trends, whether declining, steady or increasing. We tested changes in trends using a linear logistic model.Findings A quarter of the countries studied had monotonic declining mortality trends: i.e. a smooth health transition. Another quarter had long-term declines with some minor rises over short periods of time. Eight countries had periods of major increases in mortality due to political or economic crises, and in seven countries mortality stopped declining for several years. In eight other countries mortality has risen in recent years as a result of paediatric AIDS. Reconstructed levels and trends were compared with other estimates made by international organizations, usually based on indirect methods.Conclusion Overall, major progress in child survival was achieved in sub-Saharan Africa during the second half of the twentieth century. However, transition has occurred more slowly than expected, with an average decline of 1.8% per year. Additionally, transition was chaotic in many countries. The main causes of mortality increase were political instability, serious economic downturns, and emerging diseases.