China, as a whole, is about to meet the Millennium Development Goals for reducing the maternal mortality ratio (MMR) and infant mortality rate (IMR), but the disparities between rural area and urban area still exists....China, as a whole, is about to meet the Millennium Development Goals for reducing the maternal mortality ratio (MMR) and infant mortality rate (IMR), but the disparities between rural area and urban area still exists. This study estimated the potential effectiveness of expanding coverage with high impact interventions using the Lives Saved Tool (LiST). It was found that gestational hypertension, antepartum and postpartum hemorrhage, preterm birth, neonatal asphyxia, and neonatal childhood pneumonia and diarrhea are still the major killers of mothers and children in rural area in China. It was estimated that 30% of deaths among 0-59 month old children and 25% of maternal deaths in 2008 could be prevented in 2015 if primary health care intervention coverage expanded to a feasible level. The LiST death cause framework, compared to data from the Maternal and Child Mortality Surveillance System, represents 60%-80% of neonatal deaths, 40%-50% of deaths in 1-59 month old children and 40%-60% of maternal deaths in rural areas of western China.展开更多
County-based IMR and U5MR in Anhui and Henan provinces in China were estimated and analyzed by using the 1990 Census Data. Census was conducted on July 1,1990, the number of deaths only occurred in the first half year...County-based IMR and U5MR in Anhui and Henan provinces in China were estimated and analyzed by using the 1990 Census Data. Census was conducted on July 1,1990, the number of deaths only occurred in the first half year of 1990 was collected. In order to obtain the total population and total number of deaths in the same year, the total number of deaths in each eqersex group for the whole 1990 was then estimated by taking the death number in the first half of 1990 as the base and multiplying a coefficient, which varied in different age-sex-region groups. Two major adjustments for some possible underreporting cases in female birth and infant death were made. If the sex ratio at age 0 in some counties was beyond 1. 2, then it was taken as 1. 15 for rural counties and 1.10 for urban cities, which were the estimates of sex ratios for the children at ape 5 in the national 1% Population Sampling Survey in 1995. The adjustment for IMR were made by comparing the segment of the county lift table from age 15 through 59 with that from the same age groups in the international and Chinese Model Life Tables. The IMR in the county life table would be substituted by the one in the closest Model Life Talbe, if it was less than in the latter.The findings of the analysis may be summarized as fol1ows: (i) Total county-based IMR and U5MR were 33. 4 Per 1000 and 41. 4 per 1000 respectively, with great variations between urban cities (25. 4 per 1000 for IMR and 31. 4 per 1 000 for U5MR) and rural counties (35. 1 Per 1000 for IMR and 43. 6 per 1000 for U5MR). There were also sighficant differences in child mortality between nationally identified Poor counties and other counties in rural areas. In the opr counties the total IMR was 40. 7 per 1 000 living births in average while in non-opr counties it was only 33. 2 per 1000 in average (P < 0.05). The U5MR in opr counties was 25 percent higher than in non-opr counties (51. 5 vs 40. 9 Per 1 000 living births).(ii) Statistically significant correlation between child mortality and socio-economic variables was revealed from the data set, among which gross social economic products per capita was found to have the strongest relationship with child mortality. The neqative correlation was found between child mortality and a set of socalled' rich' variables including the gross social products, gr-oss agricultural products, gna industrial products and the proportions of high-educated population at county level, whereas the poSitive correlation was found between child mortality and a set of'poor' variables, such as proportions Of residents with lower 1evel of education and illiteracy rate.(iii) thfferences in child mortality between these two provinces were found, which were identical to the trends of differences in socio-economic indicators between them.tower child mortality proved to be associated with better socio-economic conditions(higher per capita products, higher proPortions of residents with higher level of education, lower proportion of less educated people and illiteracy) in province Henan.展开更多
Background: To reduce infant and child mortality in Benin, a package of high-impact interventions per healthcare level was implemented in 2009. This study aimed to assess the quality of community-based health interven...Background: To reduce infant and child mortality in Benin, a package of high-impact interventions per healthcare level was implemented in 2009. This study aimed to assess the quality of community-based health interventions in reducing infant and child mortality within the municipality of Pobè in southeastern Benin. Methods: This was a cross-sectional evaluative study carried out in November 2021 focused on children aged 0 - 59 months, their mothers, health workers, community facilitators, community health workers and the Town Hall health focal point. Mothers and their children were targeted by cluster sampling, and exhaustive selection was used to recruit all other participants. Predetermined scores based on rating criteria were used to assess the quality of community health interventions using the “input, process and outcome” of Donabedian approach. Results: Over 300 mother-child couples, 46 community health workers, 7 health agents, 1 community facilitator and 1 health focal point from Pobè town hall were surveyed. Intervention quality was judged as “average”, with a score of 73.80%. The “inputs” and “outcomes” components were the weakest links. Conclusion: Improving access to the inputs needed by community health workers can enhance the quality of PIHI interventions.展开更多
During the 2012–2016 drought in La Guajira,Colombia,child mortality rates rose to 23.4 out of 1000.Most of these children belonged to the Wayuu indigenous community,the largest and one of the most vulnerable in Colom...During the 2012–2016 drought in La Guajira,Colombia,child mortality rates rose to 23.4 out of 1000.Most of these children belonged to the Wayuu indigenous community,the largest and one of the most vulnerable in Colombia.At the municipal level,this study found a significant positive correlation between the average child mortality rate and households with a monthly income of less than USD 100,the number of people without access to health insurance,being part of the indigenous population,being illiterate,lacking sewage systems,living in rural areas,and large households with members younger than5 years old and older than 65 years old.No correlation was found with households without access to a water source.The stepwise regression analysis showed that households with a monthly income of less than USD 100,no members older than 65 years old,but several children younger than5 years old,account for 90.4%of the child mortality rate.This study concludes that,if inhabitants had had better incomes or assets,as well as an adequate infrastructure,they could have faced the drought without the observed increase in child mortality.展开更多
Background Closing the gap between child mortality in low-and middle-income countries(LMICs)and high-income countries is a priority set by the WHO in sustainable development goals(SDGs).We aimed to examine poor nutrit...Background Closing the gap between child mortality in low-and middle-income countries(LMICs)and high-income countries is a priority set by the WHO in sustainable development goals(SDGs).We aimed to examine poor nutrition and prenatal and postnatal care that could increase the risk of child mortality in LMICs.Methods The Demographic and Health Survey(DHS)was used to examine data from 26 countries to compare prenatal,postnatal,nutritional,and demographic factors across LMICs.Outcome of child death was classified into death before one month of age,between 1 to 11 months,between one to two years,between three to five years,and overall death before five years.Chi-square analyses identified differences in prenatal care,postnatal care,nutrition,and demographic factors between children who died and those who survived.Logistic regression identified factors that increased child mortality risk.Results The majority of deaths occurred before the ages of one month and one year.Considerably poorer quality of prenatal care,postnatal care,and nutrition were found in low-income and low-middle-income countries in the contemporary 2020s.High child mortality and poor quality of prenatal and postnatal care coincide with low income.Children in LMICs were exposed to less vitamin A-rich foods than children in higher-middle-income countries.The use of intestinal parasite drugs and the absence of postpartum maternal vitamin A supplementation significantly increased child mortality risk.Significant socio-demographic risk factors were associated with an increased mortality rate in children,including lack of education,maternal marital status,family wealth index,living rurally,and financial problems hindering access to healthcare.Conclusions Poor nutrition remains a vital factor across all LMICs,with numerous children being exposed to foods low in iron and vitamin A.Significantly,most deaths occur in neonates and infants,indicating an urgent need to address risk factors associated with early child death.展开更多
Background and objective:To provide good health and well-being as established by the Sustainable Development Goal(SDG)3,access to digital technologies can act as conduits to achieve such progress in a population.As gu...Background and objective:To provide good health and well-being as established by the Sustainable Development Goal(SDG)3,access to digital technologies can act as conduits to achieve such progress in a population.As guided by the World Health Organization,antenatal care(ANC)attendance is one of the measures promoted to curtail the global health burden of maternal and infant mortality.ANC services are seldom utilized to their full potential in Zimbabwe.This study explores if any of the women's digital technology characteristics were associated with antenatal care visits.Methods:The study analyzed population-based cross-sectional data with a subsample of 1932 women aged 15-49 years from the 2019 Zimbabwe Multiple Indicator Cluster Survey.Test of associations with chi-square test,bivariate,and multivariate multinomial logistic regression analyses were used to examine the predictors of adequate(4-7)and optimal(≥8)ANC visits relative to undesirable(1-3)antenatal care visits among women who had given births 2 years before the survey.Results:The results indicate that 64.5%(1246/1932)of the women attained adequate ANC while about 9.8%(189/1932)attained optimal ANC.Reading a newspaper/magazine at least once a week(odds ratio[OR] 1.73,β'=0.551,t=2.030,P=0.043)and watching television at least once a week(OR 1.72,β=0.545,t=2.454,P=0.015),listening to the radio less than once a week(OR 1.28,β'=0.247,t=1.750,P=0.080),and owning a mobile phone(OR 1.48,β'=0.394,t=3.020,P=0.003)were positively associated with adequate ANC.Optimal ANC was significantly associated with women being able to read a newspaper at least once a week(OR 2.93,β'=1.074,t=3.120,P=0.002),listen to the radio less than 0nce a week(OR 2.07,p'=0.73,t=2.700,P=0.007)and have ownership of a mobile phone(OR 1.88,β'=0.631,t=2.620,P=0.009).Conclusion:Access to a newspaper,radio,television,and mobile phone were important predictors of a woman's ability to achieve her ANC attendance.Policies to improve the knowledge of ANC packages can be facilitated using digital technology to achieve adequate and preferably optimal ANC in Zimbabwe.It is important to improve digital infrastructure to support digital technologies in providing ANC services.展开更多
Background:Mass drug administration(MDA)of medications to entire at-risk communities or populations has shown promise in the control and elimination of global infectious diseases.MDA of the broad-spectrum antibiotic a...Background:Mass drug administration(MDA)of medications to entire at-risk communities or populations has shown promise in the control and elimination of global infectious diseases.MDA of the broad-spectrum antibiotic azithromycin has demonstrated the potential to reduce childhood mortality in children at risk of premature death in some global settings.However,MDA of antibiotics raises complex ethical challenges,including weighing near-term benefts against longer-term risks—particularly the development of antimicrobial resistance that could diminish antibiotic efectiveness for current or future generations.The aim of this study was to understand how key actors involved in MDA perceive the ethical challenges of MDA.Methods:We conducted 35 semi-structured interviews from December 2020–February 2022 with investigators,funders,bioethicists,research ethics committee members,industry representatives,and others from both highincome countries(HICs)and low-and middle-income countries(LMICs).Interview participants were identifed via one of seven MDA studies purposively chosen to represent diversity in terms of use of the antibiotic azithromycin;use of a primary mortality endpoint;and whether the study occurred in a high child mortality country.Data were analyzed using constructivist grounded theory methodology.Results:The most frequently discussed ethical challenges related to meaningful community engagement,how to weigh risks and benefts,and the need to target MDA We developed a concept map of how participants considered ethical issues in MDA for child mortality;it emphasizes MDA’s place alongside other public health interventions,empowerment,and equity.Concerns over an ethical double standard in weighing risks and benefts emerged as a unifying theme,albeit one that participants interpreted in radically diferent ways.Some thought MDA for reducing child mortality was ethically obligatory;others suggested it was impermissible.Conclusions:Ethical challenges raised by MDA of antibiotics for childhood mortality-which span socio-cultural issues,the environment,and efects on future generations-require consideration beyond traditional clinical trial review.The appropriate role of MDA also requires attention to concerns over ethical double standards and power dynamics in global health that afect how we view antibiotic use in HICs versus LMICs.Our fndings suggest the need to develop additional,comprehensive guidance on managing ethical challenges in MDA.展开更多
Background: Mass drug administration(MDA)is a strategy to improve health at the population level through widespread delivery of medicine in a community.We surveyed the literature to summarize the benefits and potentia...Background: Mass drug administration(MDA)is a strategy to improve health at the population level through widespread delivery of medicine in a community.We surveyed the literature to summarize the benefits and potential risks associated with MDA of antibacterials,focusing predominantly on azithromycin as it has the greatest evidence base.Main body: High-quality evidence from randomized controlled trials(RCTs)indicate that MDA-azithromycin is effective in reducing the prevalence of infection due to yaws and trachoma.In addition,RCTs suggest that MDA-azithromycin reduces under-five mortality in certain low-resource settings that have high childhood mortality rates at baseline.This reduction in mortality appears to be sustained over time with twice-yearly MDA-azithromycin,with the greatest effect observed in children<1 year of age.In addition,observational data suggest that infections such as skin and soft tissue infections,rheumatic heart disease,acute respiratory illness,diarrheal illness,and malaria may all be treated by azithromycin and thus incidentally impacted by MDA-azithromycin.However,the mechanism by which MDA-azithromycin reduces childhood mortality remains unclear.Verbal autopsies performed in MDA-azithromycin childhood mortality studies have produced conflicting data and are underpowered to answer this question.In addition to benefits,there are several important risks associated with MDA-azithromycin.Direct adverse effects potentially resulting from MDA-azithromycin include gastrointestinal side effects,idiopathic hypertrophic pyloric stenosis,cardiovascular side effects,and increase in chronic diseases such as asthma and obesity.Antibacterial resistance is also a risk associated with MDA-azithromycin and has been reported for both gram-positive and enteric organisms.Further,there is the risk for cross-resistance with other antibacterial agents,especially clindamycin.Conclusions: Evidence shows that MDA-azithromycin programs may be beneficial for reducing trachoma,yaws,and mortality in children<5 years of age in certain under-resourced settings.However,there are significant potential risks that need to be considered when deciding how,when,and where to implement these programs.Robust systems to monitor benefits as well as adverse effects and antibacterial resistance are warranted in communities where MDA-azithromycin programs are implemented.展开更多
基金supported jointly by WHO(CHN-12-MCN-005007)UNICEF(YH702H&N)Chinese Post-doctoral Foundation(2012M510295)
文摘China, as a whole, is about to meet the Millennium Development Goals for reducing the maternal mortality ratio (MMR) and infant mortality rate (IMR), but the disparities between rural area and urban area still exists. This study estimated the potential effectiveness of expanding coverage with high impact interventions using the Lives Saved Tool (LiST). It was found that gestational hypertension, antepartum and postpartum hemorrhage, preterm birth, neonatal asphyxia, and neonatal childhood pneumonia and diarrhea are still the major killers of mothers and children in rural area in China. It was estimated that 30% of deaths among 0-59 month old children and 25% of maternal deaths in 2008 could be prevented in 2015 if primary health care intervention coverage expanded to a feasible level. The LiST death cause framework, compared to data from the Maternal and Child Mortality Surveillance System, represents 60%-80% of neonatal deaths, 40%-50% of deaths in 1-59 month old children and 40%-60% of maternal deaths in rural areas of western China.
文摘County-based IMR and U5MR in Anhui and Henan provinces in China were estimated and analyzed by using the 1990 Census Data. Census was conducted on July 1,1990, the number of deaths only occurred in the first half year of 1990 was collected. In order to obtain the total population and total number of deaths in the same year, the total number of deaths in each eqersex group for the whole 1990 was then estimated by taking the death number in the first half of 1990 as the base and multiplying a coefficient, which varied in different age-sex-region groups. Two major adjustments for some possible underreporting cases in female birth and infant death were made. If the sex ratio at age 0 in some counties was beyond 1. 2, then it was taken as 1. 15 for rural counties and 1.10 for urban cities, which were the estimates of sex ratios for the children at ape 5 in the national 1% Population Sampling Survey in 1995. The adjustment for IMR were made by comparing the segment of the county lift table from age 15 through 59 with that from the same age groups in the international and Chinese Model Life Tables. The IMR in the county life table would be substituted by the one in the closest Model Life Talbe, if it was less than in the latter.The findings of the analysis may be summarized as fol1ows: (i) Total county-based IMR and U5MR were 33. 4 Per 1000 and 41. 4 per 1000 respectively, with great variations between urban cities (25. 4 per 1000 for IMR and 31. 4 per 1 000 for U5MR) and rural counties (35. 1 Per 1000 for IMR and 43. 6 per 1000 for U5MR). There were also sighficant differences in child mortality between nationally identified Poor counties and other counties in rural areas. In the opr counties the total IMR was 40. 7 per 1 000 living births in average while in non-opr counties it was only 33. 2 per 1000 in average (P < 0.05). The U5MR in opr counties was 25 percent higher than in non-opr counties (51. 5 vs 40. 9 Per 1 000 living births).(ii) Statistically significant correlation between child mortality and socio-economic variables was revealed from the data set, among which gross social economic products per capita was found to have the strongest relationship with child mortality. The neqative correlation was found between child mortality and a set of socalled' rich' variables including the gross social products, gr-oss agricultural products, gna industrial products and the proportions of high-educated population at county level, whereas the poSitive correlation was found between child mortality and a set of'poor' variables, such as proportions Of residents with lower 1evel of education and illiteracy rate.(iii) thfferences in child mortality between these two provinces were found, which were identical to the trends of differences in socio-economic indicators between them.tower child mortality proved to be associated with better socio-economic conditions(higher per capita products, higher proPortions of residents with higher level of education, lower proportion of less educated people and illiteracy) in province Henan.
文摘Background: To reduce infant and child mortality in Benin, a package of high-impact interventions per healthcare level was implemented in 2009. This study aimed to assess the quality of community-based health interventions in reducing infant and child mortality within the municipality of Pobè in southeastern Benin. Methods: This was a cross-sectional evaluative study carried out in November 2021 focused on children aged 0 - 59 months, their mothers, health workers, community facilitators, community health workers and the Town Hall health focal point. Mothers and their children were targeted by cluster sampling, and exhaustive selection was used to recruit all other participants. Predetermined scores based on rating criteria were used to assess the quality of community health interventions using the “input, process and outcome” of Donabedian approach. Results: Over 300 mother-child couples, 46 community health workers, 7 health agents, 1 community facilitator and 1 health focal point from Pobè town hall were surveyed. Intervention quality was judged as “average”, with a score of 73.80%. The “inputs” and “outcomes” components were the weakest links. Conclusion: Improving access to the inputs needed by community health workers can enhance the quality of PIHI interventions.
基金the framework of the Resilience Academy(RA 2013-2014)“Exploring Livelihood Resilience”the project“Social Vulnerability to Natural Hazards and dependence to Urban Critical Infrastructure:Spatial Model for Drinking Water and Healthcare Systems”sponsored by CONICYT/FONDAP/15,110,017,Research Center for Integrated Disaster Risk Management(CIGIDEN)+2 种基金the Munich Re Foundation for the sponsorship of the RA and Capstone Conference(2017)the United Nations University-Institute for Environment and Human Security(UNU-EHS)the International Centre for Climate Change and Development(ICCCAD)for co-organizing this event.
文摘During the 2012–2016 drought in La Guajira,Colombia,child mortality rates rose to 23.4 out of 1000.Most of these children belonged to the Wayuu indigenous community,the largest and one of the most vulnerable in Colombia.At the municipal level,this study found a significant positive correlation between the average child mortality rate and households with a monthly income of less than USD 100,the number of people without access to health insurance,being part of the indigenous population,being illiterate,lacking sewage systems,living in rural areas,and large households with members younger than5 years old and older than 65 years old.No correlation was found with households without access to a water source.The stepwise regression analysis showed that households with a monthly income of less than USD 100,no members older than 65 years old,but several children younger than5 years old,account for 90.4%of the child mortality rate.This study concludes that,if inhabitants had had better incomes or assets,as well as an adequate infrastructure,they could have faced the drought without the observed increase in child mortality.
文摘Background Closing the gap between child mortality in low-and middle-income countries(LMICs)and high-income countries is a priority set by the WHO in sustainable development goals(SDGs).We aimed to examine poor nutrition and prenatal and postnatal care that could increase the risk of child mortality in LMICs.Methods The Demographic and Health Survey(DHS)was used to examine data from 26 countries to compare prenatal,postnatal,nutritional,and demographic factors across LMICs.Outcome of child death was classified into death before one month of age,between 1 to 11 months,between one to two years,between three to five years,and overall death before five years.Chi-square analyses identified differences in prenatal care,postnatal care,nutrition,and demographic factors between children who died and those who survived.Logistic regression identified factors that increased child mortality risk.Results The majority of deaths occurred before the ages of one month and one year.Considerably poorer quality of prenatal care,postnatal care,and nutrition were found in low-income and low-middle-income countries in the contemporary 2020s.High child mortality and poor quality of prenatal and postnatal care coincide with low income.Children in LMICs were exposed to less vitamin A-rich foods than children in higher-middle-income countries.The use of intestinal parasite drugs and the absence of postpartum maternal vitamin A supplementation significantly increased child mortality risk.Significant socio-demographic risk factors were associated with an increased mortality rate in children,including lack of education,maternal marital status,family wealth index,living rurally,and financial problems hindering access to healthcare.Conclusions Poor nutrition remains a vital factor across all LMICs,with numerous children being exposed to foods low in iron and vitamin A.Significantly,most deaths occur in neonates and infants,indicating an urgent need to address risk factors associated with early child death.
文摘Background and objective:To provide good health and well-being as established by the Sustainable Development Goal(SDG)3,access to digital technologies can act as conduits to achieve such progress in a population.As guided by the World Health Organization,antenatal care(ANC)attendance is one of the measures promoted to curtail the global health burden of maternal and infant mortality.ANC services are seldom utilized to their full potential in Zimbabwe.This study explores if any of the women's digital technology characteristics were associated with antenatal care visits.Methods:The study analyzed population-based cross-sectional data with a subsample of 1932 women aged 15-49 years from the 2019 Zimbabwe Multiple Indicator Cluster Survey.Test of associations with chi-square test,bivariate,and multivariate multinomial logistic regression analyses were used to examine the predictors of adequate(4-7)and optimal(≥8)ANC visits relative to undesirable(1-3)antenatal care visits among women who had given births 2 years before the survey.Results:The results indicate that 64.5%(1246/1932)of the women attained adequate ANC while about 9.8%(189/1932)attained optimal ANC.Reading a newspaper/magazine at least once a week(odds ratio[OR] 1.73,β'=0.551,t=2.030,P=0.043)and watching television at least once a week(OR 1.72,β=0.545,t=2.454,P=0.015),listening to the radio less than once a week(OR 1.28,β'=0.247,t=1.750,P=0.080),and owning a mobile phone(OR 1.48,β'=0.394,t=3.020,P=0.003)were positively associated with adequate ANC.Optimal ANC was significantly associated with women being able to read a newspaper at least once a week(OR 2.93,β'=1.074,t=3.120,P=0.002),listen to the radio less than 0nce a week(OR 2.07,p'=0.73,t=2.700,P=0.007)and have ownership of a mobile phone(OR 1.88,β'=0.631,t=2.620,P=0.009).Conclusion:Access to a newspaper,radio,television,and mobile phone were important predictors of a woman's ability to achieve her ANC attendance.Policies to improve the knowledge of ANC packages can be facilitated using digital technology to achieve adequate and preferably optimal ANC in Zimbabwe.It is important to improve digital infrastructure to support digital technologies in providing ANC services.
文摘Background:Mass drug administration(MDA)of medications to entire at-risk communities or populations has shown promise in the control and elimination of global infectious diseases.MDA of the broad-spectrum antibiotic azithromycin has demonstrated the potential to reduce childhood mortality in children at risk of premature death in some global settings.However,MDA of antibiotics raises complex ethical challenges,including weighing near-term benefts against longer-term risks—particularly the development of antimicrobial resistance that could diminish antibiotic efectiveness for current or future generations.The aim of this study was to understand how key actors involved in MDA perceive the ethical challenges of MDA.Methods:We conducted 35 semi-structured interviews from December 2020–February 2022 with investigators,funders,bioethicists,research ethics committee members,industry representatives,and others from both highincome countries(HICs)and low-and middle-income countries(LMICs).Interview participants were identifed via one of seven MDA studies purposively chosen to represent diversity in terms of use of the antibiotic azithromycin;use of a primary mortality endpoint;and whether the study occurred in a high child mortality country.Data were analyzed using constructivist grounded theory methodology.Results:The most frequently discussed ethical challenges related to meaningful community engagement,how to weigh risks and benefts,and the need to target MDA We developed a concept map of how participants considered ethical issues in MDA for child mortality;it emphasizes MDA’s place alongside other public health interventions,empowerment,and equity.Concerns over an ethical double standard in weighing risks and benefts emerged as a unifying theme,albeit one that participants interpreted in radically diferent ways.Some thought MDA for reducing child mortality was ethically obligatory;others suggested it was impermissible.Conclusions:Ethical challenges raised by MDA of antibiotics for childhood mortality-which span socio-cultural issues,the environment,and efects on future generations-require consideration beyond traditional clinical trial review.The appropriate role of MDA also requires attention to concerns over ethical double standards and power dynamics in global health that afect how we view antibiotic use in HICs versus LMICs.Our fndings suggest the need to develop additional,comprehensive guidance on managing ethical challenges in MDA.
文摘Background: Mass drug administration(MDA)is a strategy to improve health at the population level through widespread delivery of medicine in a community.We surveyed the literature to summarize the benefits and potential risks associated with MDA of antibacterials,focusing predominantly on azithromycin as it has the greatest evidence base.Main body: High-quality evidence from randomized controlled trials(RCTs)indicate that MDA-azithromycin is effective in reducing the prevalence of infection due to yaws and trachoma.In addition,RCTs suggest that MDA-azithromycin reduces under-five mortality in certain low-resource settings that have high childhood mortality rates at baseline.This reduction in mortality appears to be sustained over time with twice-yearly MDA-azithromycin,with the greatest effect observed in children<1 year of age.In addition,observational data suggest that infections such as skin and soft tissue infections,rheumatic heart disease,acute respiratory illness,diarrheal illness,and malaria may all be treated by azithromycin and thus incidentally impacted by MDA-azithromycin.However,the mechanism by which MDA-azithromycin reduces childhood mortality remains unclear.Verbal autopsies performed in MDA-azithromycin childhood mortality studies have produced conflicting data and are underpowered to answer this question.In addition to benefits,there are several important risks associated with MDA-azithromycin.Direct adverse effects potentially resulting from MDA-azithromycin include gastrointestinal side effects,idiopathic hypertrophic pyloric stenosis,cardiovascular side effects,and increase in chronic diseases such as asthma and obesity.Antibacterial resistance is also a risk associated with MDA-azithromycin and has been reported for both gram-positive and enteric organisms.Further,there is the risk for cross-resistance with other antibacterial agents,especially clindamycin.Conclusions: Evidence shows that MDA-azithromycin programs may be beneficial for reducing trachoma,yaws,and mortality in children<5 years of age in certain under-resourced settings.However,there are significant potential risks that need to be considered when deciding how,when,and where to implement these programs.Robust systems to monitor benefits as well as adverse effects and antibacterial resistance are warranted in communities where MDA-azithromycin programs are implemented.
