Risk factors of under-five and infant mortality: An umbrella review of systematic reviews and meta-analyses.

IF 4.5 3区 医学 Q1 PUBLIC, ENVIRONMENTAL & OCCUPATIONAL HEALTH
Bereket Kefale, Jonine Jancey, Amanuel T Gebremedhin, Sylvester Dodzi Nyadanu, Daniel G Belay, Gavin Pereira, Gizachew A Tessema
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引用次数: 0

Abstract

Background: Ensuring child survival is a critical global challenge, requiring a robust and comprehensive understanding of the risk factors contributing to under-five mortality (U5M). We aimed to synthesise and summarise the current available evidence on risk factors of U5M and infant mortality worldwide to inform global child health programmes.

Methods: We searched six major databases (Embase, Medline, Scopus, CINAHL, Web of Science, and Global Health) and repositories of systematic reviews, as well as grey literature sources to identify systematic reviews and meta-analyses that examined the associations between risk factors of U5M and infant mortality between 1 January 1990 and 4 March 2024. The quality of reviews was assessed using A Measurement Tool to Assess Systematic Reviews, Version 2 (AMSTAR 2). The strength of evidence and direction of associations was graded.

Results: Of 5684 records, we included 32 reviews (including five systematic reviews without meta-analysis) which comprised 1042 primary studies. We synthesised 28 and 29 unique risk factors associated with U5M and infant mortality, respectively. Although there was no convincing evidence for the risk factors, we found probable evidence of association between exclusive breastfeeding (consistent negative association), and maternal death (consistent positive association) with U5M. There was also probable evidence for the association of short (<18 months) interpregnancy intervals (less consistent negative association), pre-pregnancy maternal obesity (consistent positive association), and maternal HIV infection (consistent positive association) with infant mortality.

Conclusions: While the review identified a broad range of risk factors, the overall evidence for most factors associated with under-five and infant mortality was 'limited-suggestive' or 'limited and no conclusive'. Thus, further high-quality studies are required to strengthen the evidence on these risk factors.

Registration: PROSPERO CRD42023455542.

五岁以下儿童和婴儿死亡率的危险因素:系统评价和荟萃分析的综合综述。
背景:确保儿童生存是一项重大的全球挑战,需要对导致五岁以下儿童死亡的风险因素有全面有力的了解。我们的目的是综合和总结目前可获得的关于世界范围内儿童死亡率和婴儿死亡率风险因素的证据,以便为全球儿童保健方案提供信息。方法:我们检索了六个主要数据库(Embase、Medline、Scopus、CINAHL、Web of Science和Global Health)和系统综述库,以及灰色文献来源,以确定1990年1月1日至2024年3月4日期间U5M危险因素与婴儿死亡率之间关系的系统综述和荟萃分析。使用评估系统评价的测量工具,版本2 (AMSTAR 2)来评估评价的质量。证据的强度和关联的方向被分级。结果:在5684份记录中,我们纳入了32篇综述(包括5篇没有荟萃分析的系统综述),其中包括1042项主要研究。我们分别综合了28和29个与U5M和婴儿死亡率相关的独特危险因素。虽然没有令人信服的危险因素证据,但我们发现纯母乳喂养(一致的负相关)和孕产妇死亡(一致的正相关)与U5M之间可能存在关联的证据。结论:虽然审查确定了广泛的风险因素,但大多数与五岁以下儿童和婴儿死亡率相关的因素的总体证据是“有限的暗示”或“有限且无结论性”。因此,需要进一步的高质量研究来加强这些风险因素的证据。注册:普洛斯彼罗CRD42023455542。
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来源期刊
Journal of Global Health
Journal of Global Health PUBLIC, ENVIRONMENTAL & OCCUPATIONAL HEALTH -
CiteScore
6.10
自引率
2.80%
发文量
240
审稿时长
6 weeks
期刊介绍: Journal of Global Health is a peer-reviewed journal published by the Edinburgh University Global Health Society, a not-for-profit organization registered in the UK. We publish editorials, news, viewpoints, original research and review articles in two issues per year.
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