Malaria Infection, Poor Nutrition and Indoor Air Pollution Mediate Socioeconomic Differences in Adverse Pregnancy Outcomes in Cape Coast, Ghana
Malaria Infection, Poor Nutrition and Indoor Air Pollution Mediate Socioeconomic Differences in Adverse Pregnancy Outcomes in Cape Coast, Ghana
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DOI：
10.1371/journal.pone.0069181
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发表时间：
2013-07-22
期刊：
影响因子：
3.7
通讯作者：
Jaakkola, Jouni J. K.
中科院分区：
文献类型：
--
作者：
Amegah, Adeladza K.;Damptey, Obed K.;Jaakkola, Jouni J. K.
背景：将社会经济剥夺与不良妊娠结局联系起来的流行病学证据一直相互矛盾，主要是由于社会经济地位（SES）测量不善。研究也未能评估社会经济劣势对妊娠结局影响的合理途径。我们调查了城市地区母亲社会经济地位作为出生体重和妊娠持续时间决定因素的重要性，并评估了社会经济地位影响的主要因果路径。方法：对 2011 年在加纳海岸角四个主要卫生机构接受产后服务的 559 名母亲进行了一项基于人群的横断面研究。通过结构化问卷收集了母亲社会经济特征的信息。结果：在调整母亲年龄的多元线性回归中，新生儿的胎次和性别，低 SES 导致出生体重减少 292 克（95% CI：440-145）。与社会经济地位相关的重要决定因素是邻里贫困（221克；95%置信区间：355-87）、教育程度低（187克；95%置信区间：355-20）、怀孕期间的学生身份（291克；95%置信区间：506-76）和低收入（147克；95%置信区间：277-17）。在因果路径分析中，疟疾感染（6-20%）、营养不良（2-51%）和室内空气污染（10-62%）介导了观察到的社会经济剥夺对出生体重影响的很大一部分。调整混杂因素后的广义线性模型表明，低收入母亲中 LBW 风险增加 218%（RR：3.18；95% CI：1.41-7.21），PTB 风险增加 83%（RR：1.83；95% CI：1.31-2.56）。低SES和中SES分别与LBW风险增加357%（RR：4.57；95% CI：1.67-12.49）和278%（RR：3.78；95% CI：1.39-10.27）相关。疟疾感染、营养不良和室内空气污染分别介导了观察到的社会经济劣势对低出生体重风险影响的 10-21%、16-44% 和 31-52%。结论：我们提供了证据，证明社会经济剥夺对发展中国家妊娠结局的影响，而这主要是由疟疾感染、营养不良和室内空气污染介导的。
Background: The epidemiological evidence linking socioeconomic deprivation with adverse pregnancy outcomes has been conflicting mainly due to poor measurement of socioeconomic status (SES). Studies have also failed to evaluate the plausible pathways through which socioeconomic disadvantage impacts on pregnancy outcomes. We investigated the importance of maternal SES as determinant of birth weight and gestational duration in an urban area and evaluated main causal pathways for the influence of SES.Methods: A population-based cross-sectional study was conducted among 559 mothers accessing postnatal services at the four main health facilities in Cape Coast, Ghana in 2011. Information on socioeconomic characteristics of the mothers was collected in a structured questionnaire.Results: In multivariate linear regression adjusting for maternal age, parity and gender of newborn, low SES resulted in 292 g (95% CI: 440-145) reduction in birth weight. Important SES-related determinants were neighborhood poverty (221 g; 95% CI: 355-87), low education (187 g; 95% CI: 355-20), studentship during pregnancy (291 g; 95% CI: 506-76) and low income (147 g; 95% CI: 277-17). In causal pathway analysis, malaria infection (6-20%), poor nutrition (2-51%) and indoor air pollution (10-62%) mediated substantial proportions of the observed effects of socioeconomic deprivation on birth weight. Generalized linear models adjusting for confounders indicated a 218% (RR: 3.18; 95% CI: 1.41-7.21) risk increase of LBW and 83% (RR: 1.83; 95% CI: 1.31-2.56) of PTB among low income mothers. Low and middle SES was associated with 357% (RR: 4.57; 95% CI: 1.67-12.49) and 278% (RR: 3.78; 95% CI: 1.39-10.27) increased risk of LBW respectively. Malaria infection, poor nutrition and indoor air pollution respectively mediated 10-21%, 16-44% and 31-52% of the observed effects of socioeconomic disadvantage on LBW risk.Conclusion: We provide evidence of the effects of socioeconomic deprivation, substantially mediated by malaria infection, poor nutrition and indoor air pollution, on pregnancy outcomes in a developing country setting.