早期出産の予防: 39カ国で非常に高い人間開発指数を持つ介入による傾向と潜在的減少の分析
Hannah H Chang1, Jim Larson, Hannah Blencowe
1Boston Consulting Group, Boston, MA, USA.
Lancet (London, England)
|November 20, 2012
まとめ
証拠に基づいた介入の実施は,早産を5%削減し,毎年58,000人の幼児死亡を防ぐことができます. 主要な戦略は,禁煙と非医学的に示された帝王切開の削減です.
科学分野:
- 産婦人科と産婦人科を担当しています.
- 新生児の健康について
- 公衆衛生は公衆衛生である.
背景:
- 早期出産は,毎年世界中で1500万人の赤ちゃんに影響を及ぼし,生存者の間で増加率と重大な障害を伴う.
- 早期出産の原因と効果的な予防介入の理解は依然として限られている.
- この研究は,極めて高い人間開発指数 (VHHDI) を有する国々に焦点を当てて,早産率の減少の可能性を評価しています.
研究 の 目的:
- VHHDI諸国における早産率の動向を調査する.
- 証拠に基づいた介入の広範な実施を通じて,早産の減少の可能性を推定する.
- "Born Too Soon"イニシアチブのレート削減目標に情報を提供するためです.
主な方法:
- 39のVHHDI国の早産発生率データ (2000-2010年) とトレンド予測の分析.
- アメリカ合衆国における早産率の上昇 (1989-2004) の要因の調査.
- 5つの主要な介入 (禁煙,複数の胚移植の減少,子宮頸筋結束,プロゲステロン補充,非医学的に示された出産誘導/帝王切開の減少) のモデリング.
主要な成果:
- 最高のパフォーマンスを発揮した国であっても,VHHDI国は2015年までに早産の相対的な減少が5%未満になると予測されています.
- 米国では,早産の増加の半分は説明がつかないもので,出産誘導,帝王切開,助産生殖技術が大きく貢献しています.
- モデリングは,5つの介入の高いカバーで,早産率の5%の相対的な減少 (9.59%から9.07%) を予測し,約58,000人の出産を回避し,年間約30億ドルを節約しました.
結論:
- 2015年までに早産率を5%減少させるという保守的な目標が推奨されています.
- 早期出産のメカニズムに関する緊急の研究と革新的な介入が必要である.
- 原因と解決策 (例えば,出産間隔,感染症治療) が異なるため,低所得環境に焦点を当てることが重要です.
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