Co-coverage of preventive interventions and implications for child-survival strategies: evidence from national surveys
Co-coverage of preventive interventions and implications for child-survival strategies: evidence from national surveys
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DOI：
10.1016/s0140-6736(05)67599-x
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发表时间：
2005-10-22
期刊：
影响因子：
168.9
通讯作者：
Kirkwood, BR
中科院分区：
文献类型：
--
作者：
Victora, CG;Fenn, B;Kirkwood, BR
在大多数低收入国家，正在实施若干儿童生存干预措施。我们评估了这些干预措施是如何聚集在单个child.Methods的水平，我们分析了来自孟加拉国，贝宁，巴西，柬埔寨，厄立特里亚，海地，马拉维，尼泊尔和尼加拉瓜的数据。通过将每个儿童接受的干预措施（包括卡介苗、白喉-百日咳-破伤风和麻疹疫苗）、母亲破伤风类毒素、维生素A补充剂、产前护理、熟练分娩和安全用水的数量相加，获得共同覆盖率得分。社会经济地位进行了评估，通过家庭资产的主成分分析，并集中指数calculated.Findings谁没有收到一个单一的干预儿童的百分比范围从0. 3%（14/5495）在尼加拉瓜到18. 8%（1154/6144）在柬埔寨。接受所有现有干预措施的比例从柬埔寨的0.8%（48/6144）到尼加拉瓜的13.3%（733/5495）不等。所有国家内部都存在着严重的不平等现象。在最贫穷的五分之一人口中，31%的柬埔寨儿童没有得到任何干预，17%的儿童只得到一次干预;在海地，这两个数字分别为15%和17%。不平等与覆盖率成反比。覆盖率较高的国家往往表现出底部的不平等模式，最贫穷的落后于所有其他群体，而低覆盖率的国家表现出顶部的不平等，富人大大高于其余的。通过一项单一的交付战略将几项干预措施组合在一起，虽然具有经济意义，但可能会加剧不平等，除非人口覆盖率非常高。对儿童健康调查的共同覆盖分析提供了评估这些问题的方法。
Background In most low-income countries, several child-survival interventions are being implemented. We assessed how these interventions are clustered at the level of the individual child.Methods We analysed data from Bangladesh, Benin, Brazil, Cambodia, Eritrea, Haiti, Malawi, Nepal, and Nicaragua. A co-coverage score was obtained by adding the number of interventions received by each child (including BCG, diphtheria-pertussis-tetanus, and measles vaccines), tetanus toxoid for the mother, vitamin A supplementation, antenatal care, skilled delivery, and safe water. Socioeconomic status was assessed through principal components analysis of household assets, and concentration indices were calculated.Findings The percentage of children who did not receive a single intervention ranged from 0.3% (14/5495) in Nicaragua to 18.8% (1154/6144) in Cambodia. The proportions receiving all available interventions varied from 0.8% (48/6144) in Cambodia to 13.3% (733/5495) in Nicaragua. There were substantial inequities within all countries. In the poorest wealth quintile, 31% of Cambodian children received no interventions and 17% only one intervention; in Haiti, these figures were 15% and 17%, respectively. Inequities were inversely related to coverage levels. Countries with higher coverage rates tended to show bottom inequity patterns, with the poorest lagging behind all other groups, whereas low-coverage countries showed top inequities with the rich substantially above the rest.Interpretation The inequitable clustering of interventions at the level of the child raises the possibility that the introduction of new technologies might primarily benefit children who are already covered by existing interventions. Packaging several interventions through a single delivery strategy, while making economic sense, could contribute to increased inequities unless population coverage is very high. Co-coverage analyses of child-health surveys provide a way to assess these issues.