PDF(Pubmed)
Abstract：
BACKGROUND: Under-five mortality remains a global public health concern, particularly in East African countries. Short birth interval is highly associated with under-five mortality, and birth spacing has a significant effect on a child\'s likelihood of survival. The association between short birth intervals and under-five mortality was demonstrated by numerous observational studies. However, the effect of short birth intervals on under-five mortality has not been investigated yet. Therefore, this study aimed to investigate the impact of short birth intervals on under-five mortality in East Africa using Propensity Matched Analysis.
METHODS: A secondary data analysis was conducted based on the most recent Demographic and Health Survey (DHS) data of 12 East African countries. A total weighted sample of 105,662 live births was considered for this study. A PSM analysis was carried out to evaluate the effect of short birth intervals on under-five mortality. Under-five mortality was the outcome variable, while the short birth interval was considered a treatment variable. To determine the Average Treatment Effect on the population (ATE), Average Treatment Effect on the treated (ATT), and Average Treatment Effect on the untreated (ATU), we performed PSM analysis with a logit-based model using the psmatch2 ate STATA function. The quality of matching was assessed statistically and graphically. The common support assumption was checked and fulfilled. We have employed Mantel-Haenszel bounds to examine whether the result would be free from hidden bias or not.
RESULTS: The prevalence of short birth intervals in East Africa was 44%. The under-five mortality rate among mothers who had optimal birth intervals was 39.9 (95% CI: 38.3, 41.5) per 1000 live births while it was 60.6 (95% CI: 58.5, 62.8) per 1000 live births among mothers who had a short birth intervals. Propensity score matching split births from mothers into treatment and control groups based on the preceding birth interval. In the PSM analysis, the ATT values in the treated and control groups were 6.09% and 3.97%, respectively, showed under-five mortality among births to mothers with short birth intervals was 2.17% higher than births to mothers who had an optimal birth interval. The ATU values in the intervention and control groups were 3.90% and 6.06%, respectively, indicating that for births from women who had an optimal birth interval, the chance of dying within five years would increase by 2.17% if they were born to mother with short birth interval. The final ATE estimate was 2.14% among the population. After matching, there was no significant difference in baseline characteristics between the treated and control groups (p-value > 0.05), which indicates the quality of matching was good.
CONCLUSIONS: We conclude that enhancing mothers to have optimal birth spacing is likely to be an effective approach to reducing the incidence of under-five mortality. Our findings suggest that births to mothers with short birth intervals have an increased risk of death in the first five years of life than births to mothers who had an optimal birth interval. Therefore, public health programs should enhance interventions targeting improving birth spacing to reduce the incidence of under-five mortality in low-and middle-income countries like East African countries. Moreover, to achieve a significant reduction in the under-five mortality rate, interventions that encourage birth spacing should be considered. This will improve child survival and help in attaining Sustainable Development Goal targets in East African countries.
METHODS: A secondary data analysis was conducted based on the most recent Demographic and Health Survey (DHS) data of 12 East African countries. A total weighted sample of 105,662 live births was considered for this study. A PSM analysis was carried out to evaluate the effect of short birth intervals on under-five mortality. Under-five mortality was the outcome variable, while the short birth interval was considered a treatment variable. To determine the Average Treatment Effect on the population (ATE), Average Treatment Effect on the treated (ATT), and Average Treatment Effect on the untreated (ATU), we performed PSM analysis with a logit-based model using the psmatch2 ate STATA function. The quality of matching was assessed statistically and graphically. The common support assumption was checked and fulfilled. We have employed Mantel-Haenszel bounds to examine whether the result would be free from hidden bias or not.
RESULTS: The prevalence of short birth intervals in East Africa was 44%. The under-five mortality rate among mothers who had optimal birth intervals was 39.9 (95% CI: 38.3, 41.5) per 1000 live births while it was 60.6 (95% CI: 58.5, 62.8) per 1000 live births among mothers who had a short birth intervals. Propensity score matching split births from mothers into treatment and control groups based on the preceding birth interval. In the PSM analysis, the ATT values in the treated and control groups were 6.09% and 3.97%, respectively, showed under-five mortality among births to mothers with short birth intervals was 2.17% higher than births to mothers who had an optimal birth interval. The ATU values in the intervention and control groups were 3.90% and 6.06%, respectively, indicating that for births from women who had an optimal birth interval, the chance of dying within five years would increase by 2.17% if they were born to mother with short birth interval. The final ATE estimate was 2.14% among the population. After matching, there was no significant difference in baseline characteristics between the treated and control groups (p-value > 0.05), which indicates the quality of matching was good.
CONCLUSIONS: We conclude that enhancing mothers to have optimal birth spacing is likely to be an effective approach to reducing the incidence of under-five mortality. Our findings suggest that births to mothers with short birth intervals have an increased risk of death in the first five years of life than births to mothers who had an optimal birth interval. Therefore, public health programs should enhance interventions targeting improving birth spacing to reduce the incidence of under-five mortality in low-and middle-income countries like East African countries. Moreover, to achieve a significant reduction in the under-five mortality rate, interventions that encourage birth spacing should be considered. This will improve child survival and help in attaining Sustainable Development Goal targets in East African countries.
摘要：
背景：五岁以下儿童死亡率仍然是一个全球公共卫生问题，特别是在东非国家。出生间隔短与五岁以下儿童死亡率高度相关，出生间隔对儿童的生存可能性有显著影响。许多观察性研究证明了短出生间隔与五岁以下儿童死亡率之间的关联。然而,短出生间隔对5岁以下儿童死亡率的影响尚未得到研究.因此,本研究旨在利用倾向匹配分析研究出生间隔短对东非地区5岁以下儿童死亡率的影响.
方法：根据12个东非国家的最新人口与健康调查（DHS）数据进行了二次数据分析。这项研究考虑了105,662例活产的总加权样本。进行了PSM分析，以评估短出生间隔对五岁以下儿童死亡率的影响。五岁以下儿童死亡率是结果变量，而短出生间隔被认为是治疗变量。为了确定对人群的平均治疗效果（ATE），对被治疗者的平均治疗效果(ATT)，和对未处理(ATU)的平均处理效果，我们使用基于logit的模型使用psmatch2ateSTATA函数进行了PSM分析.对匹配的质量进行统计和图形评估。检查并实现了共同支持假设。我们采用了Mantel-Haenszel边界来检查结果是否没有隐藏的偏见。
结果：在东非，短出生间隔的患病率为44%。具有最佳出生间隔的母亲中五岁以下儿童的死亡率为每1000例活产39.9（95％CI：38.3，41.5），而母亲中每1000例活产60.6（95％CI：58.5，62.8）出生间隔短。根据先前的出生间隔，倾向评分匹配将母亲的出生分为治疗组和对照组。在PSM分析中，治疗组和对照组的ATT值分别为6.09%和3.97%,分别,显示，出生间隔短的母亲的婴儿中五岁以下儿童的死亡率比出生间隔最佳的母亲的婴儿高2.17％。干预组和对照组的ATU值分别为3.90%和6.06%,分别,这表明对于有最佳生育间隔的女性来说，如果母亲出生间隔短，五年内死亡的机会将增加2.17%。最终的ATE估计为人口中的2.14％。匹配后,治疗组和对照组之间的基线特征没有显着差异（p值>0.05），这表明匹配的质量是好的。
结论：我们得出结论，增加母亲的最佳生育间隔可能是降低5岁以下儿童死亡率的有效方法。我们的研究结果表明，出生间隔短的母亲在出生后的头五年内的死亡风险比出生间隔最佳的母亲的死亡风险增加。因此,在东非国家等中低收入国家，公共卫生计划应加强针对改善生育间隔的干预措施，以降低五岁以下儿童死亡率。此外，为了显着降低五岁以下儿童的死亡率，应考虑鼓励生育间隔的干预措施。这将提高儿童的生存率，并有助于实现东非国家的可持续发展目标。
方法：根据12个东非国家的最新人口与健康调查（DHS）数据进行了二次数据分析。这项研究考虑了105,662例活产的总加权样本。进行了PSM分析，以评估短出生间隔对五岁以下儿童死亡率的影响。五岁以下儿童死亡率是结果变量，而短出生间隔被认为是治疗变量。为了确定对人群的平均治疗效果（ATE），对被治疗者的平均治疗效果(ATT)，和对未处理(ATU)的平均处理效果，我们使用基于logit的模型使用psmatch2ateSTATA函数进行了PSM分析.对匹配的质量进行统计和图形评估。检查并实现了共同支持假设。我们采用了Mantel-Haenszel边界来检查结果是否没有隐藏的偏见。
结果：在东非，短出生间隔的患病率为44%。具有最佳出生间隔的母亲中五岁以下儿童的死亡率为每1000例活产39.9（95％CI：38.3，41.5），而母亲中每1000例活产60.6（95％CI：58.5，62.8）出生间隔短。根据先前的出生间隔，倾向评分匹配将母亲的出生分为治疗组和对照组。在PSM分析中，治疗组和对照组的ATT值分别为6.09%和3.97%,分别,显示，出生间隔短的母亲的婴儿中五岁以下儿童的死亡率比出生间隔最佳的母亲的婴儿高2.17％。干预组和对照组的ATU值分别为3.90%和6.06%,分别,这表明对于有最佳生育间隔的女性来说，如果母亲出生间隔短，五年内死亡的机会将增加2.17%。最终的ATE估计为人口中的2.14％。匹配后,治疗组和对照组之间的基线特征没有显着差异（p值>0.05），这表明匹配的质量是好的。
结论：我们得出结论，增加母亲的最佳生育间隔可能是降低5岁以下儿童死亡率的有效方法。我们的研究结果表明，出生间隔短的母亲在出生后的头五年内的死亡风险比出生间隔最佳的母亲的死亡风险增加。因此,在东非国家等中低收入国家，公共卫生计划应加强针对改善生育间隔的干预措施，以降低五岁以下儿童死亡率。此外，为了显着降低五岁以下儿童的死亡率，应考虑鼓励生育间隔的干预措施。这将提高儿童的生存率，并有助于实现东非国家的可持续发展目标。
