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首页> 外文期刊>BMC Public Health >Do improvements in outreach, clinical, and family and community-based services predict improvements in child survival? An analysis of serial cross-sectional national surveys
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Do improvements in outreach, clinical, and family and community-based services predict improvements in child survival? An analysis of serial cross-sectional national surveys

机译：外展，临床以及家庭和社区服务的改善是否预示着儿童生存的改善？连续横截面国家调查分析

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Background There are three main service delivery channels: clinical services, outreach, and family and community. To determine which delivery channels are associated with the greatest reductions in under-5 mortality rates (U5MR), we used data from sequential population-based surveys to examine the correlation between changes in coverage of clinical, outreach, and family and community services and in U5MR for 27 high-burden countries. Methods Household survey data were abstracted from serial surveys in 27 countries. Average annual changes (AAC) between the most recent and penultimate survey were calculated for under-five mortality rates and for 22 variables in the domains of clinical, outreach, and family- and community-based services. For all 27 countries and a subset of 19 African countries, we conducted principal component analysis to reduce the variables into a few components in each domain and applied linear regression to assess the correlation between changes in the principal components and changes in under-five mortality rates after controlling for multiple potential confounding factors. Results AAC in under 5-mortality varied from 6.6% in Nepal to -0.9% in Kenya, with six of the 19 African countries all experiencing less than a 1% decline in mortality. The strongest correlation with reductions in U5MR was observed for access to clinical services (all countries: p = 0.02, r2 = 0.58; 19 African countries p 2 = 0.67). For outreach activities, AAC U5MR was significantly correlated with antenatal care and family planning services, while AAC in immunization services showed no association. In the family- and community services domain, improvements in breastfeeding were associated with significant changes in mortality in the 30 countries but not in the African subset; while in the African countries, nutritional status improvements were associated with a significant decline in mortality. Conclusions Our findings support the importance of increasing access to clinical services, certain outreach services and breastfeeding and, in Africa, of improving nutritional status. Integrated programs that emphasize these services may lead to substantial mortality declines.
机译：背景技术主要提供三种服务渠道：临床服务，外展以及家庭和社区。为了确定哪些分娩渠道与5岁以下死亡率的下降幅度最大相关（U5MR），我们使用了基于人群的连续调查数据，以检查临床，外展，家庭和社区服务范围以及适用于27个高负担国家的U5MR。方法家庭调查数据摘自27个国家的系列调查。最近的调查和倒数第二次调查之间的平均年变化（AAC）是针对5岁以下的死亡率以及临床，外展以及基于家庭和社区的服务领域中的22个变量进行计算的。对于所有27个国家和19个非洲国家的子集，我们进行了主成分分析，以将变量减少到每个域中的几个成分中，并应用线性回归来评估主要成分变化与5岁以下死亡率变化之间的相关性在控制了多个潜在的混杂因素之后。结果5岁以下儿童的AAC从尼泊尔的6.6％到肯尼亚的-0.9％不等，在19个非洲国家中，有6个国家的死亡率下降均不到1％。观察到获得临床服务与U5MR降低最密切相关（所有国家：p = 0.02，r 2 = 0.58; 19个非洲国家p 2 = 0.67）。对于外展活动，AAC U5MR与产前保健和计划生育服务显着相关，而免疫服务中的AAC没有关联。在家庭和社区服务领域，母乳喂养的改善与30个国家死亡率的显着变化有关，而非洲部分国家则没有。而在非洲国家，营养状况的改善与死亡率的大幅下降有关。结论我们的研究结果支持增加获得临床服务，某些外展服务和母乳喂养以及在非洲改善营养状况的重要性。强调这些服务的综合方案可能导致死亡率大幅下降。

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