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Factors associated with short birth interval in low- and middle-income countries: a systematic review
BMC Pregnancy and Childbirth ( IF 3.1 ) Pub Date : 2020-03-12 , DOI: 10.1186/s12884-020-2852-z
Juan Pimentel , Umaira Ansari , Khalid Omer , Yagana Gidado , Muhd Chadi Baba , Neil Andersson , Anne Cockcroft

There is ample evidence of associations between short birth interval and adverse maternal and child health outcomes, including infant and maternal mortality. Short birth interval is more common among women in low- and middle-income countries. Identifying actionable aspects of short birth interval is necessary to address the problem. To our knowledge, this is the first systematic review to systematize evidence on risk factors for short birth interval in low- and middle-income countries. A systematic mixed studies review searched PubMed, Embase, LILACS, and Popline databases for empirical studies on the topic. We included documents in English, Spanish, French, Italian, and Portuguese, without date restriction. Two independent reviewers screened the articles and extracted the data. We used the Mixed Methods Appraisal Tool to conduct a quality appraisal of the included studies. To accommodate variable definition of factors and outcomes, we present only a narrative synthesis of the findings. Forty-three of an initial 2802 documents met inclusion criteria, 30 of them observational studies and 14 published after 2010. Twenty-one studies came from Africa, 18 from Asia, and four from Latin America. Thirty-two reported quantitative studies (16 studies reported odds ratio or relative risk, 16 studies reported hazard ratio), 10 qualitative studies, and one a mixed-methods study. Studies most commonly explored education and age of the mother, previous pregnancy outcome, breastfeeding, contraception, socioeconomic level, parity, and sex of the preceding child. For most factors, studies reported both positive and negative associations with short birth interval. Shorter breastfeeding and female sex of the previous child were the only factors consistently associated with short birth interval. The quantitative and qualitative studies reported largely non-overlapping results. Promotion of breastfeeding could help to reduce short birth interval and has many other benefits. Addressing the preference for a male child is complex and a longer-term challenge. Future quantitative research could examine associations between birth interval and factors reported in qualitative studies, use longitudinal and experimental designs, ensure consistency in outcome and exposure definitions, and include Latin American countries. Prospectively registered on PROSPERO (International Prospective Register for Systematic Reviews) under registration number CRD42018117654.

中文翻译:

中低收入国家出生间隔短的相关因素:系统评价

有充分的证据表明出生间隔短与不良的母婴健康结局(包括婴儿和产妇死亡率)之间存在关联。在中低收入国家,生育间隔短的妇女更为普遍。确定缩短出生间隔的可行方面对于解决该问题是必要的。据我们所知,这是第一次系统化审查低收入和中等收入国家出生间隔短的危险因素的证据。一项系统的混合研究综述在PubMed,Embase,LILACS和Popline数据库中进行了针对该主题的实证研究。我们收录了英文,西班牙文,法文,意大利文和葡萄牙文的文档,没有日期限制。两名独立的审阅者筛选了文章并提取了数据。我们使用混合方法评估工具对纳入研究进行了质量评估。为了适应因素和结果的可变定义,我们仅对结果进行叙述性综合。最初的2802篇文献中有43篇符合入选标准,其中30篇是观察性研究,而2010年之后发表了14篇。21项研究来自非洲,18项来自亚洲,4项来自拉丁美洲。报告了32项定量研究(16项研究报告了优势比或相对风险,16项研究报告了危险比),10项定性研究和一项混合方法研究。研究最常探讨的是母亲的教育程度和年龄,以前的妊娠结局,母乳喂养,避孕,社会经济水平,均等和先前孩子的性别。对于大多数因素,研究报告了出生间隔短的正面和负面关联。以前的孩子较短的母乳喂养时间和女性性别是与生育间隔短持续相关的唯一因素。定量和定性研究报告的结果基本不重叠。促进母乳喂养可以帮助缩短出生间隔,并具有许多其他好处。解决对男孩的偏爱是一个复杂且长期的挑战。未来的定量研究可以检查定性研究中报告的出生间隔和因素之间的关联,使用纵向和实验设计,确保结果和暴露定义的一致性,并包括拉丁美洲国家。
更新日期:2020-03-12
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