PDF(Pubmed)
Abstract：
Child death rates are often regarded as reliable indicators for overall welfare of a country since they give insight of health accessibility and development. For planning and controlling purposes, it is important to understand which ages are at higher risks of experiencing child death as well as determinants thereof.
We used the Sierra Leone DHS 2019 data which was collected using two stage sampling methods. Data collection involved interviewing women aged from 15-49 to obtain information about children they had in the past up to 2019. Age at death of child was modelled using discrete-time survival analysis with a logit link at the same time applying survey weights. The analysis also sought to estimate the determinants of child death (under-five mortality). The baseline hazard was modelled with a polynomial function.
Results showed that children from rural areas had significantly lower odds of dying compared with those from urban areas (odds ratio (OR) = 0.861, p-value = 0.0003). Children of mothers who were currently using contraceptives, and those whose mothers had been using since their last birth were at higher odds of child death compared to children whose mothers had never used contraceptives before (currently using: OR = 1.118, p-value = < .0001; used since last birth: OR = 1.372, p-value = < .0001). Children with no health insurance had significantly higher odds of death than those with health insurance (OR = 1.036, p-value = < .0001). Children of women who were married, and of women who were formerly married were at significantly higher odds of experiencing child death than children of women who had never been in union (married: OR = 1.207, p-value = 0.0003; formerly married: OR = 1.308, p-value = 0.0009 compared to those that have never been married). Increase in the age group of mothers increases the odds of their children experiencing child death compared to mothers in their teenage years (20-29: OR = 1.943, p-value = < .0001, 30-39: OR = 2.397, p-value = < .0001 and > = 40: OR = 2.895, p-value = < .0001 compared to mothers in their 15-19 years).
The study provides evidence that residing in urban areas, marital union of the mother, children having no health insurance, use of contraceptives by mother, older ages of the mother and no health insurance significantly increase the odds of child death. This points out to a possible need for improved health infrastructure to be made available to citizens in all places of delivery and more awareness on pregnancy related complications.
We used the Sierra Leone DHS 2019 data which was collected using two stage sampling methods. Data collection involved interviewing women aged from 15-49 to obtain information about children they had in the past up to 2019. Age at death of child was modelled using discrete-time survival analysis with a logit link at the same time applying survey weights. The analysis also sought to estimate the determinants of child death (under-five mortality). The baseline hazard was modelled with a polynomial function.
Results showed that children from rural areas had significantly lower odds of dying compared with those from urban areas (odds ratio (OR) = 0.861, p-value = 0.0003). Children of mothers who were currently using contraceptives, and those whose mothers had been using since their last birth were at higher odds of child death compared to children whose mothers had never used contraceptives before (currently using: OR = 1.118, p-value = < .0001; used since last birth: OR = 1.372, p-value = < .0001). Children with no health insurance had significantly higher odds of death than those with health insurance (OR = 1.036, p-value = < .0001). Children of women who were married, and of women who were formerly married were at significantly higher odds of experiencing child death than children of women who had never been in union (married: OR = 1.207, p-value = 0.0003; formerly married: OR = 1.308, p-value = 0.0009 compared to those that have never been married). Increase in the age group of mothers increases the odds of their children experiencing child death compared to mothers in their teenage years (20-29: OR = 1.943, p-value = < .0001, 30-39: OR = 2.397, p-value = < .0001 and > = 40: OR = 2.895, p-value = < .0001 compared to mothers in their 15-19 years).
The study provides evidence that residing in urban areas, marital union of the mother, children having no health insurance, use of contraceptives by mother, older ages of the mother and no health insurance significantly increase the odds of child death. This points out to a possible need for improved health infrastructure to be made available to citizens in all places of delivery and more awareness on pregnancy related complications.
摘要：
背景：儿童死亡率通常被视为一个国家整体福利的可靠指标，因为它们提供了健康可及性和发展的洞察力。出于计划和控制目的，重要的是要了解哪些年龄的儿童死亡风险较高，以及其决定因素。
方法：我们使用了塞拉利昂DHS2019年数据，该数据采用两阶段抽样方法收集。数据收集涉及采访15-49岁的女性，以获取他们在过去到2019年之前生育的孩子的信息。使用离散时间生存分析对儿童死亡年龄进行建模，并同时应用调查权重进行logit链接。该分析还试图估计儿童死亡(五岁以下儿童死亡率)的决定因素。基线危险用多项式函数建模。
结果：结果显示，与城市地区相比，农村地区儿童的死亡几率明显较低（优势比（OR）=0.861，p值=0.0003）。目前正在使用避孕药具的母亲的孩子，与母亲从未使用过避孕药的儿童相比，母亲自上次出生以来一直使用避孕药的儿童死亡几率更高（目前使用：OR=1.118，p值=<.0001；自上次出生以来使用：OR=1.372，p值=<.0001）。没有健康保险的儿童死亡几率明显高于有健康保险的儿童（OR=1.036，p值=<0.0001）。已婚妇女的子女，与从未结过婚的女性相比,以前结过婚的女性发生儿童死亡的几率显著更高(已婚:OR=1.207,p值=0.0003;与从未结过婚的女性相比,以前结过婚的女性:OR=1.308,p值=0.0009).与十几岁的母亲相比，母亲年龄组的增加增加了孩子死亡的可能性（与15-19岁的母亲相比，20-29：OR=1.943，p值=<.0001，30-39：OR=2.397，p值=<.0001和>=40：OR=2.895，p值=<.0001）。
结论：该研究提供的证据表明，居住在城市地区，母亲的婚姻结合，没有健康保险的孩子，母亲使用避孕药具，母亲年龄较大且没有健康保险会显著增加儿童死亡的几率。这表明可能需要改善所有分娩地点的公民的卫生基础设施，并提高对妊娠相关并发症的认识。
方法：我们使用了塞拉利昂DHS2019年数据，该数据采用两阶段抽样方法收集。数据收集涉及采访15-49岁的女性，以获取他们在过去到2019年之前生育的孩子的信息。使用离散时间生存分析对儿童死亡年龄进行建模，并同时应用调查权重进行logit链接。该分析还试图估计儿童死亡(五岁以下儿童死亡率)的决定因素。基线危险用多项式函数建模。
结果：结果显示，与城市地区相比，农村地区儿童的死亡几率明显较低（优势比（OR）=0.861，p值=0.0003）。目前正在使用避孕药具的母亲的孩子，与母亲从未使用过避孕药的儿童相比，母亲自上次出生以来一直使用避孕药的儿童死亡几率更高（目前使用：OR=1.118，p值=<.0001；自上次出生以来使用：OR=1.372，p值=<.0001）。没有健康保险的儿童死亡几率明显高于有健康保险的儿童（OR=1.036，p值=<0.0001）。已婚妇女的子女，与从未结过婚的女性相比,以前结过婚的女性发生儿童死亡的几率显著更高(已婚:OR=1.207,p值=0.0003;与从未结过婚的女性相比,以前结过婚的女性:OR=1.308,p值=0.0009).与十几岁的母亲相比，母亲年龄组的增加增加了孩子死亡的可能性（与15-19岁的母亲相比，20-29：OR=1.943，p值=<.0001，30-39：OR=2.397，p值=<.0001和>=40：OR=2.895，p值=<.0001）。
结论：该研究提供的证据表明，居住在城市地区，母亲的婚姻结合，没有健康保险的孩子，母亲使用避孕药具，母亲年龄较大且没有健康保险会显著增加儿童死亡的几率。这表明可能需要改善所有分娩地点的公民的卫生基础设施，并提高对妊娠相关并发症的认识。
