Geographical Inequalities and Social and Environmental Risk Factors for Under-Five Mortality in Ghana in 2000 and 2010: Bayesian Spatial Analysis of Census Data.
Geographical Inequalities and Social and Environmental Risk Factors for Under-Five Mortality in Ghana in 2000 and 2010: Bayesian Spatial Analysis of Census Data.
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DOI：
10.1371/journal.pmed.1002038
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发表时间：
2016-06
期刊：
影响因子：
15.8
通讯作者：
Ezzati M
中科院分区：
文献类型：
--
作者：
Arku RE;Bennett JE;Castro MC;Agyeman-Duah K;Mintah SE;Ware JH;Nyarko P;Spengler JD;Agyei-Mensah S;Ezzati M
在加纳和许多其他国家，五岁以下儿童的死亡率正在下降。很少有研究以精细的空间分辨率衡量五岁以下儿童的死亡率--及其社会和环境风险因素--这与政策目的有关。我们的目标是估计加纳地区一级的五岁以下儿童死亡率及其社会和环境风险因素。我们使用了加纳2000年和2010年全国人口和住房普查中10%的随机样本。我们应用间接人口学方法和贝叶斯空间模型来估计加纳110个区中每个区的5岁以下儿童死亡率(5岁前死亡的概率，5q0)。我们还利用人口普查数据估计了每个地区的家庭或个人在做饭、卫生设施、饮用水来源和父母教育所用燃料方面的分布。5q0区的中位数从2000年的每1000名活产儿中有99人死亡下降到2010年的70人。降幅从2000年5q0较高的一些北部地区的5%到2000年较低的南部地区的40%不等，加剧了现有的不平等。男子和妇女的初级教育有所增加，更多的家庭能够获得更好的水和卫生设施以及更清洁的烹饪燃料。在多因素分析中，较多使用液化石油气做饭与较低的5q0相关。加纳所有地区的五岁以下儿童死亡率都有所下降，但跨地区的死亡率不平等现象有所加剧。需要更多的数据，包括关于医疗保健的数据，以及更多的环境和社会经济测量数据，以了解死亡率水平和趋势变化的原因。在一项基于人口普查的研究中，Majid Ezzati和他的同事使用人口模型来估计加纳五岁以下儿童死亡率在地区一级的变化。在过去的几十年里，全球五岁以下儿童的死亡率一直在下降。撒哈拉以南非洲地区的儿童死亡率虽然也在下降，但仍高于其他地区。加纳在减少儿童死亡方面比大多数其他撒哈拉以南非洲国家做得更好，但我们缺乏关于加纳不同地区儿童死亡率差异有多大的信息。此外，不知道母亲受教育程度低或没有干净的水或改善的厕所设施等增加儿童患病和死亡风险的因素在加纳不同地区有何不同。我们研究的目的是提供关于2000年至2010年加纳所有110个区的儿童死亡率变化情况以及与此相关的社会和环境因素的资料。2000年和2010年的两次全国人口普查的资料和复杂的统计模型被用来估计每个地区在2000年和2010年的儿童死亡率以及这两年之间的变化。加纳北部儿童在五岁之前死亡的风险高于该国南部。2000至2010年间，加纳各区的儿童死亡率都有所下降，但加纳北部的进展慢于该国南部。2010年，该国完成小学教育的男女人数超过了2000年，更多的家庭获得了干净的水，改善了厕所设施，并使用了液化石油气等更清洁的烹饪燃料。使用液化石油气做饭可能会降低加纳儿童死亡的风险。应该制定战略，帮助幼儿死亡风险相对较高的地区，主要是加纳北部的地区，赶上儿童死亡率较低的地区。一些需要采取的行动可能与教育、清洁卫生和烹饪燃料等社会和环境因素有关。但这很可能是医疗保健的一个重要作用，这一点在本研究中没有进行调查。加纳和其他撒哈拉以南非洲国家必须在社区一级改进对儿童死亡率及其社会、环境和医疗保健风险因素的衡量和监测。
Under-five mortality is declining in Ghana and many other countries. Very few studies have measured under-five mortality—and its social and environmental risk factors—at fine spatial resolutions, which is relevant for policy purposes. Our aim was to estimate under-five mortality and its social and environmental risk factors at the district level in Ghana. We used 10% random samples of Ghana’s 2000 and 2010 National Population and Housing Censuses. We applied indirect demographic methods and a Bayesian spatial model to the information on total number of children ever born and children surviving to estimate under-five mortality (probability of dying by 5 y of age, 5q0) for each of Ghana’s 110 districts. We also used the census data to estimate the distributions of households or persons in each district in terms of fuel used for cooking, sanitation facility, drinking water source, and parental education. Median district 5q0 declined from 99 deaths per 1,000 live births in 2000 to 70 in 2010. The decline ranged from <5% in some northern districts, where 5q0 had been higher in 2000, to >40% in southern districts, where it had been lower in 2000, exacerbating existing inequalities. Primary education increased in men and women, and more households had access to improved water and sanitation and cleaner cooking fuels. Higher use of liquefied petroleum gas for cooking was associated with lower 5q0 in multivariate analysis. Under-five mortality has declined in all of Ghana’s districts, but the cross-district inequality in mortality has increased. There is a need for additional data, including on healthcare, and additional environmental and socioeconomic measurements, to understand the reasons for the variations in mortality levels and trends. In a census-based study, Majid Ezzati and colleagues use demographic modeling to estimate district-level variation in under-five mortality across Ghana. Deaths among children younger than five years old have been declining worldwide for the past few decades. Children’s death rates in sub-Saharan Africa, although also declining, remain higher than in other regions. Ghana has performed better than most other sub-Saharan African countries in terms of reducing child deaths, but we lack information on how much child mortality varies in different parts of Ghana. Also, it is not known how factors such as low education of mothers or not having clean water or improved toilet facilities that increase the risk of illness and death among children vary in different parts of Ghana. The purpose of our study was to provide information on changes in the child death rate, and the social and environmental factors associated with it, for all of Ghana’s 110 districts between the years 2000 and 2010. Information from two national censuses in 2000 and 2010 and sophisticated statistical models were used to make estimates of the child death rate in each district for the years 2000 and 2010 and for change between these two years. The risk of children dying before they reach age five was higher in northern Ghana than it was in the southern part of the country. Child death rates went down in every district in Ghana between 2000 and 2010, but progress was slower in northern Ghana than in the southern part of the country. More women and men in the country had completed primary school education in 2010 than in 2000, and more homes had access to clean water and improved toilet facilities and cleaner cooking fuels like liquefied petroleum gas. Use of liquefied petroleum gas for cooking may reduce the risk of child death in Ghana. There should be strategies to help districts where young children are at a relatively higher risk of dying, largely those in northern Ghana, to catch up with those districts with lower child mortality. Some of the actions needed may be related to social and environmental factors like education, clean sanitation, and cooking fuels. But it is likely that there is an important role for healthcare, which was not investigated in this study. It is important for Ghana and other sub-Saharan African countries to improve the measurement and monitoring of child mortality and its social, environmental, and healthcare risk factors at the community level.