2000年から2019年までの世界,地域,国の推定値と死産の傾向:体系的な評価
Lucia Hug1, Danzhen You1, Hannah Blencowe2
1Division of Data, Analytics, Planning and Monitoring, UNICEF, New York, NY, USA.
Lancet (London, England)
|August 29, 2021
まとめ
2019年に世界中で200万人の赤ん坊が死産しました. 特にサハラ以南のアフリカでは 死産率を減らすための進歩が遅いため,公衆衛生への投資と意識の向上が必要である.
科学分野:
- 公衆衛生
- 流行病学について
- 母親と子供の健康
背景:
- 死産は世界的な公衆衛生問題であり,母親と新生児の医療の質の重要な指標です.
- 国連の"女性・児童・青少年保健に関する世界戦略"や"すべての新生児のための行動計画"など 国際的な戦略は,予防可能な死産の撲滅の必要性を強調しています.
- 死亡率の標準化測定は 効果的な予防活動に不可欠です
研究 の 目的:
- 2000年から2019年の間に195か国における死産率とその傾向を推定する.
- 死亡率の削減における 20 年間のグローバルと地域の進歩を評価する.
- 死亡率の減少傾向と他の幼児死亡率指標を比較する.
主な方法:
- 171カ国の1531のデータポイントを利用した体系的な評価は,ベイジアン階層的な時間的稀少回帰モデルを使用した.
- このモデルは,データ品質,代替定義,非サンプリングエラーを含む2000年から2019年の国別死産率 (妊娠28週以上) を推定した.
- 推定値は,高品質のデータがあり,データ不足の期間の共変数で,5歳未満の死亡率の推定値と比較した.
主要な成果:
- 2019年には,推定200万人の死産が世界中で発生し,1000人当たり13.9人の割合で発生しました. 割合は地域によって大きく異なり,西アフリカと中央アフリカで最高 (22.8/1000),西ヨーロッパで最低 (2.9/1000) であった.
- 2000年から2019年にかけての全世界の死産減少率 (2.3%) は,新生児死亡率 (2.9%) と1~59ヶ月の幼児死亡率 (4.3%) の減少に遅れていました.
- 死亡率の減少は114カ国でみられ,減少は81カ国でみられ,その多くはサハラ以南のアフリカです.
結論:
- 死亡率の減少の進展は他の幼児死亡率の指標よりも遅いため,改善を加速する必要が迫っています.
- 死産率が最も高い地域,特にサハラ以南のアフリカでは,予防の取り組みを強化する必要があります.
- 将来の死産予防には,公衆の意識向上,強力なデータ収集,進捗状況の評価,地域の健康優先事項の理解への投資が必要です.
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