Next wave of interventions to reduce under-five mortality in Rwanda: a cross-sectional analysis of demographic and health survey data
Next wave of interventions to reduce under-five mortality in Rwanda: a cross-sectional analysis of demographic and health survey data
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DOI：
10.1186/s12887-018-0997-y
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发表时间：
2018-02-05
期刊：
影响因子：
2.4
通讯作者：
Ngabo, Fidele
中科院分区：
文献类型：
--
作者：
Amoroso, Cheryl L.;Nisingizwe, Marie Paul;Ngabo, Fidele
背景：对卢旺达卫生系统的持续投资使五岁以下儿童死亡率历史性地降低。根据全国人口普查，虽然卢旺达在2002年至2012年期间实现了全国5岁以下儿童死亡率估计下降68%，但仍有5.8%的儿童未满5岁，这需要开展下一波儿童死亡率预防战略。方法：这是一项横断面研究，对2010年卢旺达人口与健康调查中9002名15-49岁妇女的6328名分娩进行研究。我们检验了29个协变量与U5死亡率之间的双变量关联，保留了比值比p < 0.1的协变量来建立模型。我们使用手动反向逐步逻辑回归来确定所有U5、0-11个月和12-59个月儿童U5死亡率的相关因素。分析在Stata v12中进行，调整复杂的样本设计。结果:14与反是U5死亡率在双变量分析,以下仍与U5死亡率多元相关分析:家庭是最穷的穷人(或= 1.98),孩子是双胞胎(或= 2.40),母亲有3 - 4出生在过去五年里(或= 3.97)相比,1 - 2出生,母亲是HIV阳性(或= 2.27),和母亲不使用避孕措施(或= 1.37)使用现代避孕方法相比(p < 0.05)。母亲在过去12个月内遭受身体暴力或性暴力与1-4岁儿童U5死亡率相关（or = 1.48, p < 0.05）。与9-24个月相比，U5存活率与出生间隔25-50个月（OR = 0.67）以及是否有蚊帐（OR = 0.46）相关（两者均p < 0.05）。结论：在过去十年中，卢旺达推行了儿童疾病综合管理、儿童疫苗接种几乎全民覆盖、国家社区卫生工作者计划和全民健康保险计划。确定继续与儿童死亡率有关的因素有助于确定应加强哪些干预措施以进一步降低儿童死亡率。这项研究表明，卢旺达下一波降低5岁以下儿童死亡率的工作应着眼于改善新生儿结局、减少贫困、计划生育、艾滋病毒服务、疟疾预防和亲密伴侣暴力预防等项目。
Background: Sustained investments in Rwanda's health system have led to historic reductions in under five (U5) mortality. Although Rwanda achieved an estimated 68% decrease in the national under U5 mortality rate between 2002 and 2012, according to the national census, 5.8% of children still do not reach their fifth birthday, requiring the next wave of child mortality prevention strategies.Methods: This is a cross-sectional study of 9002 births to 6328 women age 15-49 in the 2010 Rwanda Demographic and Health Survey. We tested bivariate associations between 29 covariates and U5 mortality, retaining covariates with an odds ratio p < 0.1 for model building. We used manual backward stepwise logistic regression to identify correlates of U5 mortality in all children U5, 0-11 months, and 12-59 months. Analyses were performed in Stata v12, adjusting for complex sample design.Results: Of 14 covariates associated with U5 mortality in bivariate analysis, the following remained associated with U5 mortality in multivariate analysis: household being among the poorest of the poor (OR = 1.98), child being a twin (OR = 2.40), mother having 3-4 births in the past 5 years (OR = 3.97) compared to 1-2 births, mother being HIV positive (OR = 2.27), and mother not using contraceptives (OR = 1.37) compared to using a modern method (p < 0.05 for all). Mother experiencing physical or sexual violence in the last 12 months was associated with U5 mortality in children ages 1-4 years (OR = 1.48, p < 0.05). U5 survival was associated with a preceding birth interval 25-50 months (OR = 0.67) compared to 9-24 months, and having a mosquito net (OR = 0.46) (p < 0.05 for both).Conclusions: In the past decade, Rwanda rolled out integrated management of childhood illness, near universal coverage of childhood vaccinations, a national community health worker program, and a universal health insurance scheme. Identifying factors that continue to be associated with childhood mortality supports determination of which interventions to strengthen to reduce it further. This study suggests that Rwanda's next wave of U5 mortality reduction should target programs in improving neonatal outcomes, poverty reduction, family planning, HIV services, malaria prevention, and prevention of intimate partner violence.