Child survival gains Tanzania: analysis of data from demographic and health surveys
Child survival gains Tanzania: analysis of data from demographic and health surveys
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DOI：
10.1016/s0140-6736(08)60562-0
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发表时间：
2008-04-12
期刊：
影响因子：
168.9
通讯作者：
Mshinda, Hassan
中科院分区：
文献类型：
--
作者：
Masanja, Honorati;de Savigny, Don;Mshinda, Hassan
坦桑尼亚最近的一项全国性调查报告说，5岁以下儿童的死亡率在2000年至2004年的5年间下降了24%。我们的目的是调查每年的变化，以确定什么可能有助于这种减少，并探讨实现千年发展目标的儿童生存（千年发展目标4）的前景。方法我们分析了自1990年以来在坦桑尼亚进行的四次人口和健康调查的数据，以产生估计的死亡率在5岁以下的儿童每1年期间，每次调查前回到1990年。我们通过拟合Lowess回归估计了1990年至2004年的死亡率趋势，并预测了2005年至2015年的死亡率趋势。我们的目的是调查上下文的因素，无论是坦桑尼亚的卫生系统的一部分或没有，可能会影响儿童mortality.Findings死亡率的分类估计显示，在坦桑尼亚的儿童死亡率在2000年和2004年之间的下降急剧加速。1990年，死亡率的点估计值为141. 5（95% CI 141. 5 -141. 5）。5)每1 000名活产婴儿的死亡率。2004年，这一数字下降了40%，达到每1 000例活产83.2例死亡（95%可信区间70.1-96-3）的点估计值。绝对风险的变化为58. 4（95% CI 32 . 4）。7-83 . 8; p< 0 . 0001）。1999年至2004年期间，我们注意到坦桑尼亚卫生系统有了重大改进，包括卫生方面的公共支出增加了一倍;权力下放和全部门一揽子供资;以及扩大了关键儿童生存干预措施的覆盖面，如儿童疾病综合管理、驱虫蚊帐、维生素A补充剂、免疫接种和纯母乳喂养。1999年至2004年期间，与卫生系统无关的其他儿童生存决定因素没有变化，只是艾滋病毒/艾滋病负担缓慢增加。对卫生系统的投资和扩大干预措施可以迅速提高儿童生存率。
Background A recent national survey in Tanzania reported that mortality in children younger than 5 years dropped by 24% over the 5 years between 2000 and 2004. We aimed to investigate yearly changes to identify what might have contributed to this reduction and to investigate the prospects for meeting the Millennium Development Goal for child survival (MDG 4).Methods We analysed data from the four demographic and health surveys done in Tanzania since 1990 to generate estimates of mortality in children younger than 5 years for every 1-year period before each survey back to 1990. We estimated trends in mortality between 1990 and 2004 by fitting Lowess regression, and forecasted trends in mortality in 2005 to 2015. We aimed to investigate contextual factors, whether part of Tanzania's health system or not, that could have affected child mortality.Findings Disaggregated estimates of mortality showed a sharp acceleration in the reduction in mortality in children younger than 5 years in Tanzania between 2000 and 2004. In 1990, the point estimate of mortality was 141.5 (95% CI 141.5-141. 5) deaths per 1000 livebirths. This was reduced by 40%, to reach a point estimate of 83.2 (95% CI 70.1-96-3) deaths per 1000 livebirths in 2004. The change in absolute risk was 58.4 (95% CI 32 . 7-83 . 8; p< 0 . 0001). Between 1999 and 2004 we noted important improvements in Tanzania's health system, including doubled public expenditure on health; decentralisation and sector-wide basket funding; and increased coverage of key child-survival interventions, such as integrated management of childhood illness, insecticide-treated nets, vitamin A supplementation, immunisation, and exclusive breastfeeding. Other determinants of child survival that are not related to the health system did not change between 1999 and 2004, except for a slow increase in the HIV/AIDS burden.Interpretation Tanzania could attain MDG 4 if this trend of improved child survival were to be sustained. Investment in health systems and scaling up interventions can produce rapid gains in child survival.Funding Government of Norway.