Reducing child mortality: can public health deliver?
Reducing child mortality: can public health deliver?
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DOI：
10.1016/s0140-6736(03)13870-6
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发表时间：
2003-07-12
期刊：
影响因子：
168.9
通讯作者：
Habicht, JP
中科院分区：
文献类型：
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作者：
Bryce, J;el Arifeen, S;Habicht, JP
这是儿童生存系列的第三篇论文。上周发表的该系列的第二篇论文得出的结论是，2000 年，在 42 个国家中，全球儿童死亡人数占 90%，其中 63% 的死亡可以通过全面实施一些已知的有效干预措施来避免。在大多数低收入和中等收入国家，这些干预措施的覆盖率仍然低得令人无法接受。更糟糕的是，在一些最贫穷的国家，免疫接种和助产等一些干预措施的覆盖率停滞不前，甚至失败。本文强调了将生物或行为干预措施与实施这些干预措施所需的交付系统分开的重要性，以及根据卫生系统发展阶段调整交付策略的必要性。我们回顾了儿童健康方面的最新举措，并讨论了交付系统的重要方面，包括： 需要地方一级的数据来支持卫生规划；定期监测卫生服务的提供和使用情况以及干预措施的覆盖范围；以及通过选定的干预措施实现高且公平的覆盖率的必要性。基于社区的举措可以在难以获得卫生服务的地区扩大干预措施的实施范围，但加强国家卫生系统应该是长期目标。儿童生存的千年发展目标是可以实现的，但前提是分娩干预策略得到极大改进和扩大。
This is the third paper in the series on child survival. The second paper in the series, published last week, concluded that in the 42 countries with 90% of child deaths worldwide in 2000, 63% of these deaths could have been prevented through full implementation of a few known and effective interventions. Levels of coverage with these interventions are still unacceptably low in most low-income and middle-income countries. Worse still, coverage for some interventions, such as immunisations and attended delivery, are stagnant or even failing in several of the poorest countries. This paper highlights the importance of separating biological or behavioural interventions from the delivery systems required to put them in place, and the need to tailor delivery strategies to the stage of health-system development. We review recent initiatives in child health and discuss essential aspects of delivery systems, including: need for data at the subnational level to support health planning; regular monitoring of provision and use of health services, and of intervention coverage; and the need to achieve high and equitable coverage with selected interventions. Community-based initiatives can extend the delivery of interventions in areas where health services are hard to access, but strengthening national health systems should be the long-term aim. The millennium development goal for child survival can be achieved, but only if strategies for delivery interventions are greatly improved and scaled-up.