撒哈拉以南非洲国家死胎的总体流行率和多层次决定因素:对实现可持续发展目标的影响。

IF 4 2区 医学 Q1 PUBLIC, ENVIRONMENTAL & OCCUPATIONAL HEALTH
Bewuketu Terefe, Mahlet Moges Jembere, Nega Nigussie Abrha, Dejen Kahsay Asgedom, Solomon Keflie Assefa, Nega Tezera Assimamaw
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引用次数: 0

摘要

背景:尽管已被纳入千年发展目标(MDGs)和现在的可持续发展目标(SDGs),但死产仍然被忽视,区域研究有限,突出表明在解决这一问题方面存在持续差距。然而,每年仍有惊人的200万死产,相当于每16秒就有一个。此外,大约98%的死产发生在发展中国家,特别是撒哈拉以南非洲(SSA)。鉴于这些统计数据以及解决数据缺乏、方法方法和人口差距的需要,本研究旨在评估2016年至2023年SSA死产的患病率和决定因素,与可持续发展目标保持一致。方法:本研究使用SSA人口与健康调查(DHS)的数据。该分析包括2016年至2023年期间收集的212,194例妊娠期至少28周的加权样本,使用R-4.4.0软件。描述性数据,如频率,被执行。使用森林图可视化死产发生率。考虑个体水平因素和社区水平因素,采用多层次模型分析。多层模型用于解释国家内部的聚类,并允许检查影响死产的固定效应和随机效应。对于多变量分析,考虑双变量分析中p值≤0.2的变量。校正优势比(AOR)有95%可信区间(CI)和p值结果:死产的合并患病率为1.54% / 100 [95% CI 1.19-2.01]。与SSA死产呈正相关的因素包括产妇年龄(25-34岁、35-49岁)、婚姻状况(已婚、离婚或丧偶)、产前检查、第一胎年龄(20岁之前)、生育间隔短、生育间隔长、生育顺序(第二或第三)、农村地区居住、国家收入水平(中低收入)和识字率低。与死产死亡率负相关的因素包括产妇教育(初等教育、中等教育或高等教育)、财富指数(较高的经济地位)、获得大众媒体、获得改善的饮用水、到保健设施的距离和国家收入水平(中高收入)。结论:在撒哈拉以南非洲,死产率明显低于到2030年实现每个新生儿行动计划的目标。对影响死产死亡率的因素的分析揭示了重要的联系。必须改善孕产妇教育、经济状况和保健基础设施,以降低该地区的死胎率并改善母婴的健康状况。为有效应对这些风险,应集中努力增加获得产前保健的机会、提高认识和改善社会经济条件。通过改善获得保健和教育的机会,这些差距可能会导致该地区死产率的下降。
本文章由计算机程序翻译,如有差异,请以英文原文为准。
Pooled prevalence and multilevel determinants of stillbirths in sub-Saharan African countries: implications for achieving sustainable development goal.

Background: Despite being included in the Millennium Development Goals (MDGs) and now the Sustainable Development Goals (SDGs), stillbirths remain overlooked with limited regional research, highlighting an ongoing gap in addressing this issue. However, a staggering 2 million stillbirths occur each year, equivalent to one every 16 s. Furthermore, approximately 98% of these stillbirths take place in developing countries, particularly in sub-Saharan Africa (SSA). In light of these statistics and the need to address the lack of data, methodological approaches, and population gaps, this study aims to assess the prevalence and determinants of stillbirths in SSA from 2016 to 2023, aligning with the SDGs.

Methods: This study used data from the Demographic and Health Survey (DHS) conducted in SSA. The analysis included a weighted sample of 212,194 pregnancies of at least 28 weeks' gestation collected from 2016 to 2023, using R-4.4.0 software. Descriptive data, such as frequencies, were performed. Stillbirth prevalence was visualized using a forest plot. A multilevel modeling analysis was used by considering individual-level factors and community level factors. The multilevel model was employed to account for clustering within countries and allow for the examination of both fixed and random effects that influence stillbirths. For the multivariable analysis, variables with a p value ≤ 0.2 in the bivariate analysis were considered. The Adjusted Odds Ratio (AOR) with a 95% Confidence Interval (CI) and a p value < 0.05 were reported to indicate the statistical significance and the degree of association in the final model.

Results: The pooled prevalence of stillbirths was found to be 1.54% per 100 [95% CI 1.19-2.01]. Factors positively associated with stillbirths in SSA included maternal age (25-34 years, 35-49 years), marital status (married, divorced or widowed), antenatal care visits, age at first birth (before age 20), short birth intervals, long birth intervals, birth order (second or third), residence in rural areas, country income level (lower middle income), and low literacy rate. Factors negatively associated with stillbirth mortality included maternal education (primary education, secondary or higher education), wealth index (higher economic status), access to mass media, access to improved drinking water, distance to health facilities, and country income level (upper middle income).

Conclusions: Stillbirth rates fall significantly short of achieving Every Newborn Action Plan target by 2030 in SSA. The analysis of factors that affect stillbirth mortality reveals important connections. It is essential to improve maternal education, economic status, and healthcare infrastructure to decrease stillbirth rates and enhance the health outcomes of mothers and children in the region. To effectively address these risks, efforts should concentrate on increasing access to antenatal care, raising awareness, and improving socio-economic conditions. By improving access to healthcare and education, these disparities could potentially lead to a decrease in stillbirth rates in the region.

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来源期刊
Global Health Research and Policy
Global Health Research and Policy Social Sciences-Health (social science)
CiteScore
12.00
自引率
1.10%
发文量
43
审稿时长
5 weeks
期刊介绍: Global Health Research and Policy, an open-access, multidisciplinary journal, publishes research on various aspects of global health, addressing topics like health equity, health systems and policy, social determinants of health, disease burden, population health, and other urgent global health issues. It serves as a forum for high-quality research focused on regional and global health improvement, emphasizing solutions for health equity.
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