Factors Contributing to Maternal and Child Mortality Reductions in 146 Low- and Middle-Income Countries between 1990 and 2010

被引:237
作者
Bishai, David M. [1 ]
Cohen, Robert [1 ]
Alfonso, Y. Natalia [1 ]
Adam, Taghreed [2 ]
Kuruvilla, Shyama [3 ]
Schweitzer, Julian [4 ]
机构
[1] Johns Hopkins Bloomberg Sch Publ Hlth, Dept Populat Family & Reprod Hlth, Baltimore, MD USA
[2] WHO, Hlth Syst & Innovat, CH-1211 Geneva, Switzerland
[3] WHO, Family Womens & Childrens Hlth, CH-1211 Geneva, Switzerland
[4] Results Dev, Washington, DC USA
关键词
HEALTH EXPENDITURES; UNDER-5; MORTALITY; COUNTDOWN; NEWBORN; PROGRESS; OUTCOMES;
D O I
10.1371/journal.pone.0144908
中图分类号
O [数理科学和化学]; P [天文学、地球科学]; Q [生物科学]; N [自然科学总论];
学科分类号
07 ; 0710 ; 09 ;
摘要
Introduction From 1990-2010, worldwide child mortality declined by 43%, and maternal mortality declined by 40%. This paper compares two sources of progress: improvements in societal coverage of health determinants versus improvements in the impact of health determinants as a result of technical change. Methods This paper decomposes the progress made by 146 low-and middle-income countries (LMICs) in lowering childhood and maternal mortality into one component due to better health determinants like literacy, income, and health coverage and a second component due to changes in the impact of these health determinants. Health determinants were selected from eight distinct health-impacting sectors. Health determinants were selected from eight distinct health-impacting sectors. Regression models are used to estimate impact size in 1990 and again in 2010. Changes in the levels of health determinants were measured using secondary data. Findings The model shows that respectively 100% and 89% of the reductions in maternal and child mortality since 1990 were due to improvements in nationwide coverage of health determinants. The relative share of overall improvement attributable to any single determinant varies by country and by model specification. However, in aggregate, approximately 50% of the mortality reductions were due to improvements in the health sector, and the other 50% of the mortality reductions were due to gains outside the health sector. Conclusions Overall, countries improved maternal and child health (MCH) from 1990 to 2010 mainly through improvements in the societal coverage of a broad array of health system, social, economic and environmental determinants of child health. These findings vindicate efforts by the global community to obtain such improvements, and align with the post-2015 development agenda that builds on the lessons from the MDGs and highlights the importance of promoting health and sustainable development in a more integrated manner across sectors.
引用
收藏
页数:13
相关论文
共 23 条
[1]  
[Anonymous], LEV TRENDS CHILD MOR
[2]  
[Anonymous], J HUMAN RESOURCES
[3]   Health Expenditures and Health Outcomes in Africa [J].
Anyanwu, John C. ;
Erhijakpor, Andrew E. O. .
AFRICAN DEVELOPMENT REVIEW-REVUE AFRICAINE DE DEVELOPPEMENT, 2009, 21 (02) :400-433
[4]   Countdown to 2015 decade report (2000-10): taking stock of maternal, newborn, and child survival [J].
Bhutta, Zulfiqar A. ;
Chopra, Mickey ;
Axelson, Henrik ;
Berman, Peter ;
Boerma, Ties ;
Bryce, Jennifer ;
Bustreo, Flavia ;
Cavagnero, Eleonora ;
Cometto, Giorgio ;
Daelmans, Bernadette ;
de Francisco, Andres ;
Fogstad, Helga ;
Gupta, Neeru ;
Laski, Laura ;
Lawn, Joy ;
Maliqi, Blerta ;
Mason, Elizabeth ;
Pitt, Catherine ;
Requejo, Jennifer ;
Starrs, Ann ;
Victora, Cesar G. ;
Wardlaw, Tessa .
LANCET, 2010, 375 (9730) :2032-2044
[5]   Government health expenditures and health outcomes [J].
Bokhari, Farasat A. S. ;
Gai, Yunwei ;
Gottret, Pablo .
HEALTH ECONOMICS, 2007, 16 (03) :257-273
[6]   Equitable child health interventions [J].
Burström, B ;
Macassa, G ;
Öberg, L ;
Bernhardt, E ;
Smedman, L .
AMERICAN JOURNAL OF PUBLIC HEALTH, 2005, 95 (02) :208-216
[7]  
Chadwick E., 1842, REPORT SANITARY COND, V1965
[8]   Health expenditures, health outcomes and the role of good governance [J].
Farag, Marwa ;
Nandakumar, A. K. ;
Wallack, Stanley ;
Hodgkin, Dominic ;
Gaumer, Gary ;
Erbil, Can .
INTERNATIONAL JOURNAL OF HEALTH CARE FINANCE & ECONOMICS, 2013, 13 (01) :33-52
[9]  
Fenton PM, 2008, LANCET, V372, P369, DOI 10.1016/S0140-6736(08)61148-4
[10]   Increased educational attainment and its effect on child mortality in 175 countries between 1970 and 2009: a systematic analysis [J].
Gakidou, Emmanuela ;
Cowling, Krycia ;
Lozano, Rafael ;
Murray, Christopher J. L. .
LANCET, 2010, 376 (9745) :959-974