Equity and Geography The Case of Child Mortality in Papua New Guinea 英文参考文献.docVIP

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Equity and Geography The Case of Child Mortality in Papua New Guinea 英文参考文献.doc

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Equity and Geography The Case of Child Mortality in Papua New Guinea 英文参考文献

EquityandGeography:TheCaseofChildMortalityin PapuaNewGuinea AnnaE.Bauze1,LindaN.Tran2,Kim-HuongNguyen2,SonjaFirth2,ElianaJimenez-Soto2,LauraDwyer- Lindgren3,AndrewHodge2*,AlanD.Lopez2 1Burnet Institute, Melbourne, Victoria, Australia, 2School of Population Health, The University of Queensland, Brisbane, Queensland, Australia, 3Institute for Health MetricsandEvaluation,UniversityofWashington,Seattle,Washington,UnitedStatesofAmerica Abstract Background: Recent assessments show continued decline in child mortality in Papua New Guinea (PNG), yet complete subnationalanalysesremainrare.Thisstudyaimstoestimateunder-fivemortalityinPNGatnationalandsubnationallevels to examine the importance of geographical inequities in health outcomes and track progress towards Millennium DevelopmentGoal(MDG)4. Methodology:WeperformedretrospectivedatavalidationoftheDemographicandHealthSurvey(DHS)2006using2000 Censusdata,thenappliedadvancedindirectmethodstoestimateunder-fivemortalityratesbetween1976and2000. Findings:TheDHS2006wasfoundtobeunreliable.Henceweusedthe2000Censustoestimateunder-fivemortalityrates atnationalandsubnationallevels.Duringtheperiodunderstudy,PNGexperiencedaslowreductioninnationalunder-five mortality fromapproximately 103to78 deathsper 1,000 livebirths. Subnational analyses revealedsignificantdisparities betweenruralandurbanpopulationsaswellasinter-andintra-regionalvariations.Someoftheprovincesthatperformed thebest(worst)intermsofunder-fivemortalityincludedthedistrictsthatperformedworst(best),withdistrict-levelunder- fivemortalityratescorrelatingstronglywithpovertylevelsandaccesstoservices. Conclusions:TheevidencefromPNGdemonstratessubstantialwithin-provinceheterogeneity,suggestingthatunder-five mortalityneedstobeaddressedatsubnationallevels.Thisisespeciallyrelevantincountries,likePNG,whereresponsibility forhealthservicesisdevolvedtoprovincesanddistricts.Thisstudypresentsthefirstcomprehensiveestimatesofunder-five mortalityatthedistrictlevelforPNG.Theresultsdemonstratet