Regional inequalities in under-5 mortality in Nigeria: a population-based analysis of individual- and community-level determinants
Regional inequalities in under-5 mortality in Nigeria: a population-based analysis of individual- and community-level determinants
复制标题
DOI：
10.1186/1478-7954-9-6
复制
发表时间：
2011-03-09
影响因子：
3.3
通讯作者：
Antai, Diddy
中科院分区：
文献类型：
--
作者：
Antai, Diddy
背景：地理生态和社会经济环境不同的地区可能有不同的疾病暴露和儿童健康结果。这项研究评估了尼日利亚各地区5岁以下儿童死亡风险的差异，并确定了个人和社区层面的特征，这些特征解释了各地区之间可能存在的差异。方法：对2003年尼日利亚人口与健康调查的365个社区中2,735名年龄在15-49岁的母亲的6,029名儿童进行了多水平Cox比例风险分析。采用95%可信区间（CI）的风险比（HR）来表达特征之间的关联度量。方差划分系数和Wald统计量表示变异测度。结果：5岁以下儿童在家庭和社区内的死亡聚集模式。居住在南南（尼日尔三角洲）地区的母亲所生儿童的5岁以下死亡风险要高得多（风险比：1.30；95%可信区间：1.76-2.20），居住在接受医生产前护理的母亲比例较低的社区的母亲所生儿童的风险要高得多（风险比：1.36；95%可信区间：1.15-1.86）。此外，母亲受教育程度与医生社区产前护理之间的跨水平交互作用与死亡风险增加40%以上相关（HR: 1.41; 95% CI: 1.21-1.78）。结论：研究结果表明，需要区别对待社区层面的干预措施，以提高妇幼保健的利用率，改善母亲的社会经济地位，特别是在南南（尼日尔三角洲）等弱势地区。需要进一步研究5岁以下儿童死亡率的社区决定因素。
Background: Regions with geographically diverse ecology and socioeconomic circumstances may have different disease exposures and child health outcomes. This study assessed variations in the risks of death in children under age 5 across regions of Nigeria and determined characteristics at the individual and community levels that explain possible variations among regions.Methods: Multilevel Cox proportional hazards analysis was performed using a nationally representative sample of 6,029 children from 2,735 mothers aged 15-49 years and nested within 365 communities from the 2003 Nigeria Demographic and Health Survey. Hazard ratios (HR) with 95% confidence intervals (CI) were used to express measures of association among the characteristics. Variance partition coefficients and Wald statistic were used to express measures of variation.Results: Patterns of under-5 mortality cluster within families and communities. The risks of under-5 deaths were significantly higher for children of mothers residing in the South South (Niger Delta) region (HR: 1.30; 95% CI: 1.76-2.20) and children of mothers residing in communities with a low proportion of mothers attending prenatal care by a doctor (HR: 1.36; 95% CI: 1.15-1.86). In addition, the cross-level interaction between mothers' education and community prenatal care by a doctor was associated with a more than 40% higher risk of dying (HR: 1.41; 95% CI: 1.21-1.78).Conclusion: The findings suggest the need to differentially focus on community-level interventions aimed at increasing maternal and child health care utilization and improving the socioeconomic position of mothers, especially in disadvantaged regions such as the South South (Niger Delta) region. Further studies on community-levels determinants of under-5 mortality are needed.