背景:在发展中国家,与发达国家相比,儿童和母亲的死亡概率更大;这些健康结果的不平等是不公平的。本研究包括对巴基斯坦母婴死亡率的空间分析。该研究旨在估计地区死亡率指数(MDI),测量不等式比率和斜率,并确定众多因素对巴基斯坦各地区STI分数的空间影响。
方法:本研究使用来自多指标聚类调查(MICS)的微观水平家庭数据集来估计MI。为了找出QI分数有多不同,使用不等式比率和斜率。这项研究进一步利用空间自相关测试来确定具有高死亡率和低死亡率的集群的空间依赖性的大小和位置。地理加权回归(GWR)模型也被用来检验社会经济的空间影响,环境,健康,和dmi上的住房属性。
结果:MI的不平等比率表明,上十分位数地区的死亡率是下十分位数地区的16倍,Bal路支省的地区在MI方面描述了极端的空间异质性。地方空间关联指标(LISA)和Moran\的检验结果证实了巴基斯坦各地区所有死亡率的空间同质性。H-H孕产妇死亡率和MI集中在俾路支省,在旁遮普邦看到了儿童死亡率的H-H集群。GWR的结果表明,财富指数五分位数对STI有显著的空间影响;然而,改善卫生条件,洗手的做法,和产前护理对MI评分产生不利影响。
结论:研究结果揭示了巴基斯坦地区所有死亡率之间的MI和空间关系的显着差异。此外,社会经济,环境,健康,住房变量对DMA有影响。值得注意的是,有死亡风险的个体之间的空间接近性发生在死亡率升高的地区.政策制定者可以通过关注脆弱地区和实施提高公众意识等措施来减轻这些死亡率,加强医疗服务,改善获得清洁饮用水和卫生设施的机会。
BACKGROUND: In developing countries, the death probability of a child and mother is more significant than in developed countries; these inequalities in health outcomes are unfair. The present study encompasses a spatial analysis of maternal and child mortalities in Pakistan. The study aims to estimate the District Mortality Index (DMI), measure the inequality ratio and slope, and ascertain the spatial impact of numerous factors on DMI scores across Pakistani districts.
METHODS: This study used micro-level household datasets from multiple indicator cluster surveys (MICS) to estimate the DMI. To find out how different the DMI scores were, the inequality ratio and slope were used. This study further utilized spatial autocorrelation tests to determine the magnitude and location of the spatial dependence of the clusters with high and low mortality rates. The Geographically Weighted Regression (GWR) model was also applied to examine the spatial impact of socioeconomic, environmental, health, and housing attributes on DMI.
RESULTS: The inequality ratio for DMI showed that the upper decile districts are 16 times more prone to mortalities than districts in the lower decile, and the districts of Baluchistan depicted extreme spatial heterogeneity in terms of DMI. The findings of the Local Indicator of Spatial Association (LISA) and Moran\'s test confirmed spatial homogeneity in all mortalities among the districts in Pakistan. The H-H clusters of maternal mortality and DMI were in Baluchistan, and the H-H clusters of child mortality were seen in Punjab. The results of GWR showed that the wealth index quintile has a significant spatial impact on DMI; however, improved sanitation, handwashing practices, and antenatal care adversely influenced DMI scores.
CONCLUSIONS: The findings reveal a significant disparity in DMI and spatial relationships among all mortalities in Pakistan\'s districts. Additionally, socioeconomic, environmental, health, and housing variables have an impact on DMI. Notably, spatial proximity among individuals who are at risk of death occurs in areas with elevated mortality rates. Policymakers may mitigate these mortalities by focusing on vulnerable zones and implementing measures such as raising public awareness, enhancing healthcare services, and improving access to clean drinking water and sanitation facilities.