Changes in the contributions of risk factors to under-five mortality in low- and lower-middle-income countries (1997-2022): an analysis of Demographic and Health Survey data.
Bereket Kefale, Jonine Jancey, Amanuel T Gebremedhin, Gavin Pereira, Gizachew A Tessema
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引用次数: 0
Abstract
Background: Under-five mortality (U5M) is a critical public health challenge in low- and lower-middle-income countries (LLMICs), where over 90% of global deaths occur. Despite progress, the changing contributions of risk factors to U5M in LLMICs remains unexplored.
Methods: We analysed Demographic and Health Survey (DHS) data from 24 LLMICs across two periods: 1997-2005 and 2016-2022. We included 139,890 live births in 1997-2005 and 319,034 in 2016-2022. A mixed-effects robust Poisson regression model with a log link function was employed to identify risk factors of U5M in each period. Population-attributable fractions (PAFs) were calculated and compared to investigate changes in the contributions of risk factors over time.
Results: U5M attributable to never having been breastfed increased by 15.5 percentage points (95% CI 8.6, 22.9), early maternal age at birth (< 20 years) by 5.4 percentage points (95% CI 3.1, 5.7), and plural births by 1.2 percentage points (95% CI 0.4, 1.8). U5M reductions attributable to maternal secondary education were increased by 5.5 percentage points (95% CI 0.4, 11.0) and tertiary education increased by 2.6 percentage points (95% CI 1.6, 4.2). However, U5M reductions associated with 1-3 antenatal care (ANC) visits decreased by 7.2 percentage points (95% CI 2.4, 11.7).
Conclusions: The main contributors of U5M in LLMICs were never breastfeeding, short birth intervals (<33 months), ANC uptake, higher maternal education (secondary and tertiary), advanced maternal age at birth (≥35 years), early maternal age at birth (<20 years), very small infants at birth, male sex, plurality, and single motherhood. The contributions of risk factors to U5M have changed over time. Interventions need to prioritize promoting breastfeeding, enhancing maternal education and increasing ANC uptake, and addressing other significant contributors to U5M.
背景：五岁以下儿童死亡率（U5M）是低收入和中低收入国家（LLMICs）面临的一项重大公共卫生挑战，全球90%以上的死亡发生在这些国家。尽管取得了进展，但风险因素对低收入中低收入国家u500万的影响仍未得到探索。方法：我们分析了来自24个低收入中等收入国家1997-2005年和2016-2022年两个时期的人口与健康调查（DHS）数据。我们纳入了1997-2005年的139,890例活产婴儿和2016-2022年的319,034例活产婴儿。采用带对数链接函数的混合效应稳健泊松回归模型识别各时期U5M的危险因素。计算并比较人口归因分数（paf），以调查危险因素随时间的变化。结果：未母乳喂养导致的U5M增加了15.5个百分点（95% CI 8.6, 22.9），产妇出生年龄早(结论：The低生育mics中U5M的主要原因是未母乳喂养，出生间隔短(
期刊介绍：
The World Journal of Pediatrics, a monthly publication, is dedicated to disseminating peer-reviewed original papers, reviews, and special reports focusing on clinical practice and research in pediatrics.
We welcome contributions from pediatricians worldwide on new developments across all areas of pediatrics, including pediatric surgery, preventive healthcare, pharmacology, stomatology, and biomedicine. The journal also covers basic sciences and experimental work, serving as a comprehensive academic platform for the international exchange of medical findings.
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