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2000-2017年中低收入国家儿童腹泻发病率和死亡率的地理不平等
作者:小柯机器人 发布时间:2020/5/8 14:27:01

美国华盛顿大学Robert C Reiner Jr研究组分析了2000-2017年中低收入国家儿童腹泻发病率和死亡率的地理不平等。该成果发表在2020年5月6日出版的《柳叶刀》杂志上。

在中低收入国家(LMIC)中,五岁以下儿童中十分之一的死亡因腹泻引起。不同国家间腹泻发生率和死亡率的巨大差异可归因于保护儿童、预防感染和治疗疾病的干预措施。查明负担最重的国家地区以及相关的危险因素,有助于减少可预防的儿童腹泻。

研究组使用基于贝叶斯模型的地质统计学方法,以及在94个中低收入国家的466项调查中收集的15072746名5岁以下儿童的地理定位数据集,并结合2017年全球疾病、伤害和风险因素研究(GBD)的发现,来估算2000-2017年腹泻患病率、发病率和死亡率的后验分布。

腹泻死亡率下降最大的地区是南亚、东南亚和南美,分别有54.0%、17.4%和59.5%的研究点腹泻死亡率下降幅度超过10%。尽管非洲大部分地区的儿童仍然面临腹泻致死的高风险,但死亡人数最多的地区在非洲以外。

通过共同分析腹泻负担及其主要危险因素的地理空间趋势,研究组评估了降低国家以下各级死亡率的候选驱动因素。通过使用关键危险因素对剩余疾病负担进行反事实分析,研究组确定了针对弱势人群的潜在干预策略。鉴于中低收入国家资源有限,准确量化腹泻负担及其驱动因素对于精准的公共卫生非常重要。

附:英文原文

Title: Mapping geographical inequalities in childhood diarrhoeal morbidity and mortality in low-income and middle-income countries, 2000–17: analysis for the Global Burden of Disease Study 2017

Author: Robert C Reiner, Simon I Hay, Robert C Reiner, Kirsten E Wiens, Aniruddha Deshpande, Mathew M Baumann, Paulina A Lindstedt, Brigette F Blacker, Christopher E Troeger, Lucas Earl, Sandra B Munro, Degu Abate, Hedayat Abbastabar, Foad Abd-Allah, Ahmed Abdelalim, Ibrahim Abdollahpour, Rizwan Suliankatchi Abdulkader, Getaneh Abebe, Kedir Hussein Abegaz, Lucas Guimares Abreu, Michael R M Abrigo, Manfred Mario Kokou Accrombessi, Dilaram Acharya, Maryam Adabi, Oladimeji M Adebayo, Rufus Adesoji Adedoyin, Victor Adekanmbi, Olatunji O Adetokunboh, Beyene Meressa Adhena, Mohsen Afarideh, Keivan Ahmadi, Mehdi Ahmadi, Anwar E Ahmed, Muktar Beshir Ahmed, Rushdia Ahmed, Olufemi Ajumobi, Chalachew Genet Akal, Temesgen Yihunie Akalu, Ali S Akanda, Genet Melak Alamene, Turki M Alanzi, James R Albright, Jacqueline Elizabeth Alcalde Rabanal, Birhan Tamene Alemnew, Zewdie Aderaw Alemu, Beriwan Abdulqadir Ali, Muhammad Ali, Mehran Alijanzadeh, Vahid Alipour, Syed Mohamed Aljunid, Ali Almasi, Amir Almasi-Hashiani, Hesham M Al-Mekhlafi, Khalid Altirkawi, Nelson Alvis-Guzman, Nelson J Alvis-Zakzuk, Azmeraw T Amare, Saeed Amini, Arianna Maever Loreche Amit, Catalina Liliana Andrei, Masresha Tessema Anegago, Mina Anjomshoa, Fereshteh Ansari, Carl Abelardo T Antonio, Ernoiz Antriyandarti, Seth Christopher Yaw Appiah, Jalal Arabloo, Olatunde Aremu, Bahram Armoon, Krishna K Aryal, Afsaneh Arzani, Mohsen Asadi-Lari, Alebachew Fasil Ashagre, Hagos Tasew Atalay, Suleman Atique, Sachin R Atre, Marcel Ausloos, Leticia Avila-Burgos, Ashish Awasthi, Nefsu Awoke, Beatriz Paulina Ayala Quintanilla, Getinet Ayano, Martin Amogre Ayanore, Asnakew Achaw Ayele, Yared A Asmare Aynalem, Samad Azari, Ebrahim Babaee, Alaa Badawi, Shankar M Bakkannavar, Senthilkumar Balakrishnan, Ayele Geleto Bali, Maciej Banach, Aleksandra Barac, Till Winfried Brnighausen, Huda Basaleem, Quique Bassat, Mohsen Bayati, Neeraj Bedi, Masoud Behzadifar, Meysam Behzadifar, Yibeltal Alemu Bekele, Michelle L Bell, Derrick A Bennett, Dessalegn Ajema Berbada, Tina Beyranvand, Anusha Ganapati Bhat, Krittika Bhattacharyya, Suraj Bhattarai, Soumyadeep Bhaumik, Ali Bijani, Boris Bikbov, Raaj Kishore Biswas, Kassawmar Angaw Bogale, Somayeh Bohlouli, Oliver J Brady, Nicola Luigi Bragazzi, Nikolay Ivanovich Briko, Andrey Nikolaevich Briko, Sharath Burugina Nagaraja, Zahid A Butt, Ismael R Campos-Nonato, Julio Cesar Campuzano Rincon, Rosario Cárdenas, Félix Carvalho, Franz Castro, Collins Chansa, Pranab Chatterjee, Vijay Kumar Chattu, Bal Govind Chauhan, Ken Lee Chin, Devasahayam J Christopher, Dinh-Toi Chu, Rafael M Claro, Natalie M Cormier, Vera M Costa, Giovanni Damiani, Farah Daoud, Lalit Dandona, Rakhi Dandona, Amira Hamed Darwish, Ahmad Daryani, Jai K Das, Rajat Das Gupta, Tamirat Tesfaye Dasa, Claudio Alberto Davila, Nicole Davis Weaver, Dragos Virgil Davitoiu, Jan-Walter De Neve, Feleke Mekonnen Demeke

Issue&Volume: 2020-05-06

Abstract: Background

Across low-income and middle-income countries (LMICs), one in ten deaths in children younger than 5 years is attributable to diarrhoea. The substantial between-country variation in both diarrhoea incidence and mortality is attributable to interventions that protect children, prevent infection, and treat disease. Identifying subnational regions with the highest burden and mapping associated risk factors can aid in reducing preventable childhood diarrhoea.

Methods

We used Bayesian model-based geostatistics and a geolocated dataset comprising 15072746 children younger than 5 years from 466 surveys in 94 LMICs, in combination with findings of the Global Burden of Diseases, Injuries, and Risk Factors Study (GBD) 2017, to estimate posterior distributions of diarrhoea prevalence, incidence, and mortality from 2000 to 2017. From these data, we estimated the burden of diarrhoea at varying subnational levels (termed units) by spatially aggregating draws, and we investigated the drivers of subnational patterns by creating aggregated risk factor estimates.

Findings

The greatest declines in diarrhoeal mortality were seen in south and southeast Asia and South America, where 54·0% (95% uncertainty interval [UI] 38·1–65·8), 17·4% (7·7–28·4), and 59·5% (34·2–86·9) of units, respectively, recorded decreases in deaths from diarrhoea greater than 10%. Although children in much of Africa remain at high risk of death due to diarrhoea, regions with the most deaths were outside Africa, with the highest mortality units located in Pakistan. Indonesia showed the greatest within-country geographical inequality; some regions had mortality rates nearly four times the average country rate. Reductions in mortality were correlated to improvements in water, sanitation, and hygiene (WASH) or reductions in child growth failure (CGF). Similarly, most high-risk areas had poor WASH, high CGF, or low oral rehydration therapy coverage.

Interpretation

By co-analysing geospatial trends in diarrhoeal burden and its key risk factors, we could assess candidate drivers of subnational death reduction. Further, by doing a counterfactual analysis of the remaining disease burden using key risk factors, we identified potential intervention strategies for vulnerable populations. In view of the demands for limited resources in LMICs, accurately quantifying the burden of diarrhoea and its drivers is important for precision public health.

DOI: 10.1016/S0140-6736(20)30114-8

Source: https://www.thelancet.com/journals/lancet/article/PIIS0140-6736(20)30114-8/fulltext

 

期刊信息

LANCET:《柳叶刀》,创刊于1823年。隶属于爱思唯尔出版社,最新IF:59.102
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