Findings from a comprehensive diarrhoea prevention and treatment programme in Lusaka, Zambia.
Findings from a comprehensive diarrhoea prevention and treatment programme in Lusaka, Zambia.
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DOI：
10.1186/s12889-016-3089-7
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发表时间：
2016-06-06
影响因子：
4.5
通讯作者：
Chilengi R
中科院分区：
文献类型：
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作者：
Bosomprah S;Beach LB;Beres LK;Newman J;Kapasa K;Rudd C;Njobvu L;Guffey B;Hubbard S;Foo K;Bolton-Moore C;Stringer J;Chilengi R
提高认识和消除腹泻方案是一项综合腹泻预防和控制试点方案，旨在将卢萨卡省新生儿后全因五岁以下儿童死亡率降低15%。干预措施包括采用轮状病毒疫苗，改善腹泻的临床病例管理，以及开展全面的社区预防和宣传运动，宣传用肥皂洗手、纯母乳喂养至6个月，以及使用补液补液和锌。本研究旨在评估PAED对5岁以下儿童死亡率的影响。本研究采用前后评价设计。在卢萨卡省，采用人口与健康调查式的基于人口的两阶段方法收集干预开始时和开始实施干预后3年的数据。主要研究结果是全因新生儿后5岁以下儿童死亡率，其定义为1-59个月儿童在28天后和5岁生日之前死亡的概率。Kaplan-Meier事件时间分析法用于估计死亡概率；将这一概率乘以1000得到新生儿后期死亡率。采用生存时间逆概率加权模型估计平均治疗效果（ATE）。调查前最后两周发生腹泻的5岁以下儿童比例从2012年的15.8% （95% CI: 15.2%, 16.4%）下降到2015年的12.7% （95% CI: 12.3%, 13.2%）。在同一时期，5岁以下新生儿后期儿童的死亡率下降了34%，从每1000例活产死亡29人（95%置信区间：每1000例活产死亡26,32人）的估计比率降至每1000例活产死亡19人（95%置信区间：每1000例活产死亡16,21人）。当1-59月龄儿童群体中的每个儿童都接受干预时，估计平均死亡时间比没有儿童接受干预时多约8个月（ATE = 7.9; 95% CI: 4.4,11.5; P < 0.001）。在诊所和社区一级提供包装良好的腹泻预防和治疗干预措施，可能会降低1-59个月儿童的死亡率。
The Programme for the Awareness and Elimination of Diarrhoea (PAED) was a pilot comprehensive diarrhoea prevention and control programme aimed to reduce post-neonatal, all-cause under-five mortality by 15 % in Lusaka Province. Interventions included introduction of the rotavirus vaccine, improved clinical case management of diarrhoea, and a comprehensive community prevention and advocacy campaign on hand washing with soap, exclusive breastfeeding up to 6 months of age, and the use of ORS and Zinc. This study aimed to assess the impact of PAED on under-5 mortality. The study was a pre-post evaluation design. The Demographic and Health Survey style population-based two-stage approach was used to collect data at the beginning of the intervention and 3 years following the start of intervention implementation in Lusaka province. The primary outcome of interest was an all-cause, post-neonatal under-five mortality rate defined as the probability of dying after the 28th day and before the fifth birthday among children aged 1–59 months. The Kaplan-Meier time to event analysis was used to estimate the probability of death; multiplying this probability by 1000 to yield the post-neonatal mortality rate. Survival-time inverse probability weighting model was used to estimate Average Treatment Effect (ATE). The percentage of children under age 5 who had diarrhoea in the last 2 weeks preceding the survey declined from 15.8 % (95 % CI: 15.2 %, 16.4 %) in 2012 to 12.7 % (95 % CI: 12.3 %, 13.2 %) in 2015. Over the same period, mortality in post-neonatal children under 5 years of age declined by 34 %, from an estimated rate of 29 deaths per 1000 live births (95 % CI: (26, 32) death per 1000 live births) to 19 deaths per 1000 live births (95 % CI: (16, 21) death per 1000 live births). When every child in the population of children aged 1–59 months is exposed to the intervention, the average time-to-death was estimated to be about 8 months more than when no child is exposed (ATE = 7.9; 95 % CI: 4.4,11.5; P < 0.001). Well-packaged diarrhoea preventive and treatment interventions delivered at the clinic and community-level could potentially reduce probability of death among children aged 1–59 months.