Association between Proximity to a Health Center and Early Childhood Mortality in Madagascar 英文参考文献.docVIP

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Association between Proximity to a Health Center and Early Childhood Mortality in Madagascar 英文参考文献.doc

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Association between Proximity to a Health Center and Early Childhood Mortality in Madagascar 英文参考文献

AssociationbetweenProximitytoaHealthCenterand EarlyChildhoodMortalityinMadagascar SaoriKashima1,2*,EtsujiSuzuki2,ToshiharuOkayasu3,RazafimahatratraJeanLouis4,AkiraEboshida1, S.V.Subramanian5 1Department of Public Health and Health Policy, Hiroshima University Graduate School of Biomedical Sciences, Hiroshima, Japan, 2Department of Epidemiology, OkayamaUniversityGraduateSchoolofMedicine,DentistryandPharmaceuticalSciences,Okayama,Japan,3HIVPreventionStrengtheningProject/JapanInternational Cooperation Agency Madagascar, Antananarivo, Madagascar, 4Ministry of Health in Service of Statistic Health, Antananarivo, Madagascar, 5Department of Society, HumanDevelopment,andHealth,HarvardSchoolofPublicHealth,Boston,Massachusetts,UnitedStatesofAmerica Abstract Objective:ToevaluatetheassociationbetweenproximitytoahealthcenterandearlychildhoodmortalityinMadagascar, andtoassesstheinfluenceofhouseholdwealth,maternaleducationalattainment,andmaternalhealthontheeffectsof distance. Methods:FrombirthrecordsofsubjectsintheDemographicandHealthSurvey,weidentified12565singletonbirthsfrom January2004toAugust2009.Afterexcluding220birthsthatlackedglobalpositioningsysteminformationforexposure assessment, odds ratios (ORs) and their 95% confidence intervals (CIs) for neonatal mortality and infant mortality were estimatedusingmultilevellogisticregressionmodels,with12345subjects(level1),nestedwithin584villagelocations(level 2),andinturnnestedwithin22regions(level3).Weadditionallystratifiedthesubjectsbythebirthorder.Weestimated predicted probabilities of each outcome by a three-level model including cross-level interactions between proximity to ahealthcenterandhouseholdwealth,maternaleducationalattainment,andmaternalanemia. Results: Compared with those who lived .1.5–3.0km from a health center, the risks for neonatal mortality and infant mortalitytendedtoincreaseamongthosewholivedfurtherthan5.0kmfromahealthcenter;theadjustedORsforneonatal mortalityandinfantmortalityforthosewholived.5.0–10.0kmawayf