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Da Silva AM, De Lavôr JR, Freitas VS, Vieira AR. Risk of orofacial clefts in relation to maternal body mass index, diabetes and hypertension. J Neonatal Perinatal Med 2024; 17:41-48. [PMID: 38277306 DOI: 10.3233/npm-230118] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/28/2024]
Abstract
BACKGROUND To investigate if maternal body mass index, diabetes and hypertension are associated with orofacial clefts. METHODS Case-control study. Information from 53,188 live births with and without orofacial cleft registered at USA Vital Statistics Natality Birth Data between 2017 and 2021. Case group consisted of all affected live births diagnosed with orofacial clefts (13,297 cases). Comparison group consisted of 39,891 live births without clefts or any other congenital malformation. Information about orofacial cleft cases were compared with the comparison group. The unadjusted and adjusted Odds Ratios were estimated to evaluate the strength of association between mother's pre-pregnancy body mass index, maternal diabetes and hypertension and orofacial cleft occurrence, assuming a p value < 0.05 and 95% confidence intervals (95% C.I.) for statistically significant differences. RESULTS Mother's pre-pregnancy body mass index, maternal diabetes and maternal hypertension are conditions associated with an increased risk of orofacial cleft development in the child (OR = 1.08, p = 0.004, 95% C.I. = 1.024-1.149; OR = 1.32, 95%, p = 0.000, 95% C.I. = 1.202-1.444; and OR = 1.35, p = 0.000, 95% C.I. = 1.239-1.484; respectively). Maternal ethnicity, sex of infant, and cigarette smoking pregnancy remained as covariates after adjustments in all logistic regression models. CONCLUSION Due to the increased prevalence of obesity, diabetes, and hypertension, and also to their association with congenital malformations, such as clefts, it is recommended that mothers planning to become pregnant to follow healthy habits, maintain healthy weight, and be screened for possible diabetes or hypertension prior to conception and early in pregnancy.
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Affiliation(s)
- A M Da Silva
- Public Health PhD Graduate Program, State University of Feira de Santana, Feira de Santana, BA, Brazil
- Department of Oral and Craniofacial Sciences, University of Pittsburgh, Pittsburgh, PA, USA
| | - J R De Lavôr
- Pediatric Dentistry PhD Graduate Program, State University of Pernambuco, Recife, PE, Brazil
- Department of Oral and Craniofacial Sciences, University of Pittsburgh, Pittsburgh, PA, USA
| | - V S Freitas
- Department of Health, State University of Feira de Santana, Feira de Santana, BA, Brazil
| | - A R Vieira
- Department of Oral and Craniofacial Sciences, University of Pittsburgh, Pittsburgh, PA, USA
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Liliane Odette MO. Measuring the effects of prenatal care on child birth weight in Cameroon. Health Policy Plan 2021; 36:1625-1632. [PMID: 34553210 DOI: 10.1093/heapol/czab117] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/24/2021] [Revised: 08/26/2021] [Accepted: 09/22/2021] [Indexed: 11/13/2022] Open
Abstract
Low birth weight continues to be a significant public health problem worldwide with a range of short- and long-term consequences. However, the analysis of its determinants remains a less addressed issue in sub-Saharan African countries despite the poor child health indicators observed there. The objective of this study is to examine the effects of prenatal care on child birth weight in Cameroon, using data from the fifth Demographic and Health Survey. For this purpose, we use a system of simultaneous equations that takes into account potential endogeneity and sample selection bias. Two measures of prenatal care are used in this study, namely, adequacy and quality. Estimation of the birth weight production function using the instrumental variable two-stage least square approach reveals that adequate prenatal care increases the child's birth weight by 882.84 g. Also an increase in the quality of prenatal care by one unit improves the child's birth weight by 147.79 g. Thus, despite the fact that prenatal care in Cameroon suffers from some shortcomings as regards to the standards recommended by the World Health Organization, it remains a key factor for the improvement of neonatal health outcomes in this country.
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Shibre G, Zegeye B, Ahinkorah BO, Idriss-Wheeler D, Keetile M, Yaya S. Sub-regional disparities in the use of antenatal care service in Mauritania: findings from nationally representative demographic and health surveys (2011-2015). BMC Public Health 2021; 21:1818. [PMID: 34627186 PMCID: PMC8501590 DOI: 10.1186/s12889-021-11836-z] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/10/2020] [Accepted: 09/22/2021] [Indexed: 11/10/2022] Open
Abstract
Background Skilled antenatal care (ANC) has been identified as a proven intervention to reducing maternal deaths. Despite improvements in maternal health outcomes globally, some countries are signaling increased disparities in ANC services among disadvantaged sub-groups. Mauritania is one of sub-Saharan countries in Africa with a high maternal mortality ratio. Little is known about the inequalities in the country’s antenatal care services. This study examined both the magnitude and change from 2011 to 2015 in socioeconomic and geographic-related disparities in the utilization of at least four antenatal care visits in Mauritania. Methods Using the World Health Organization’s Health Equity Assessment Toolkit (HEAT) software, data from the 2011 and 2015 Mauritania Multiple Indicator Cluster Surveys (MICS) were analyzed. The inequality analysis consisted of disaggregated rates of antenatal care utilization using four equity stratifiers (economic status, education, residence, and region) and four summary measures (Difference, Population attributable risk, Ratio and Population attributable fraction). A 95% Uncertainty Interval was constructed around point estimates to measure statistical significance. Results Substantial absolute and relative socioeconomic and geographic related disparities in attending four or more ANC visits (ANC4+ utilization) were observed favoring women who were richest/rich (PAR = 19.5, 95% UI; 16.53, 22.43), educated (PAF = 7.3 95% UI; 3.34, 11.26), urban residents (D = 19, 95% UI; 14.50, 23.51) and those living in regions such as Nouakchott (R = 2.1, 95% UI; 1.59, 2.56). While education-related disparities decreased, wealth-driven and regional disparities remained constant over the 4 years of the study period. Urban-rural inequalities were constant except with the PAR measure, which showed an increasing pattern. Conclusion A disproportionately lower ANC4+ utilization was observed among women who were poor, uneducated, living in rural areas and regions such as Guidimagha. As a result, policymakers need to design interventions that will enable disadvantaged subpopulations to benefit from ANC4+ utilization to meet the Sustainable Development Goal (SDG) of reducing the maternal mortality ratio (MMR) to 140/100, 000 live births by 2030.
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Affiliation(s)
- Gebretsadik Shibre
- Department of Reproductive Health and Health Services Management, School of Public Health, Addis Ababa University, Addis Ababa, Ethiopia
| | - Betregiorgis Zegeye
- HaSET Maternal and Child Health Research Program, Shewarobit Field Office, Shewarobit, Ethiopia
| | - Bright Opoku Ahinkorah
- School of Public Health, Faculty of Health, University of Technology Sydney, Ultimo, Australia
| | | | - Mpho Keetile
- Population Studies and Demography, University of Botswana, Gaborone, Botswana
| | - Sanni Yaya
- School of International Development and Global Studies, Faculty of Social Sciences, University of Ottawa, 120 University Private, Ottawa, ON, K1N 6N5, Canada. .,The George Institute for Global Health, Imperial College London, London, UK.
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Ali N, Elbarazi I, Alabboud S, Al-Maskari F, Loney T, Ahmed LA. Antenatal Care Initiation Among Pregnant Women in the United Arab Emirates: The Mutaba'ah Study. Front Public Health 2020; 8:211. [PMID: 32596198 PMCID: PMC7300181 DOI: 10.3389/fpubh.2020.00211] [Citation(s) in RCA: 13] [Impact Index Per Article: 3.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/03/2019] [Accepted: 05/07/2020] [Indexed: 11/13/2022] Open
Abstract
Introduction: Antenatal care (ANC) provides monitoring and regular follow-up of maternal and fetal health during pregnancy. Women with appropriate ANC tend to have better delivery and birth outcomes. This study describes the patterns of ANC utilization and factors associated with appropriate ANC initiation in the United Arab Emirates (UAE) for the first time. Methods: Baseline cross-sectional data from pregnant women who participated in the Mutaba'ah-Mother and Child Health Study between May 2017 and January 2019 was analyzed. Participants were recruited during ANC visits and completed a self-administered questionnaire that collected socio-demographic and pregnancy-related information and assessed whether it was their first ANC appointment. Regression models assessed the relationship between socio-demographic and pregnancy-related variables and "appropriate" (≤ 4 months' gestation) vs. "late" ANC initiation (>4 months' gestation). Results: At recruitment, 841 participants reported that it was their first ANC visit and half (50.2%) of these women were late initiating their ANC. Mothers who were more educated, had previous infertility treatment or previous miscarriages were all more likely to achieve appropriate ANC initiation [adjusted odds ratio (aOR): 1.66, 95% confidence interval (CI): 1.05-2.62; aOR: 3.68, 95% CI: 1.50-9.04; aOR: 1.80, 95% CI: 1.16-2.79, respectively]. Women worrying about childbirth were less likely to achieve appropriate ANC initiation (aOR: 0.54, 95% CI: 0.34-0.85). Conclusion: Half of pregnant women in this study did not achieve the global consensus guidelines on appropriate ANC initiation. Interventions among less educated women and those with previous pregnancy complications and childbirth anxiety are recommended to ensure appropriate ANC initiation.
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Affiliation(s)
- Nasloon Ali
- Institute of Public Health, College of Medicine and Health Sciences, United Arab Emirates University, Al Ain, United Arab Emirates
| | - Iffat Elbarazi
- Institute of Public Health, College of Medicine and Health Sciences, United Arab Emirates University, Al Ain, United Arab Emirates.,College of Health Sciences, Abu Dhabi University, Abu Dhabi, United Arab Emirates
| | - Souha Alabboud
- Institute of Public Health, College of Medicine and Health Sciences, United Arab Emirates University, Al Ain, United Arab Emirates
| | - Fatima Al-Maskari
- Institute of Public Health, College of Medicine and Health Sciences, United Arab Emirates University, Al Ain, United Arab Emirates.,Zayed Center for Health Sciences, United Arab Emirates University, Al Ain, United Arab Emirates
| | - Tom Loney
- College of Medicine, Mohammed Bin Rashid University of Medicine and Health Sciences, Dubai, United Arab Emirates
| | - Luai A Ahmed
- Institute of Public Health, College of Medicine and Health Sciences, United Arab Emirates University, Al Ain, United Arab Emirates
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Akombi BJ, Agho KE, Renzaho AM, Hall JJ, Merom DR. Trends in socioeconomic inequalities in child undernutrition: Evidence from Nigeria Demographic and Health Survey (2003 - 2013). PLoS One 2019; 14:e0211883. [PMID: 30730946 PMCID: PMC6366715 DOI: 10.1371/journal.pone.0211883] [Citation(s) in RCA: 37] [Impact Index Per Article: 7.4] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/16/2018] [Accepted: 01/23/2019] [Indexed: 11/26/2022] Open
Abstract
OBJECTIVE The aim of this study was to examine the trend in socioeconomic inequalities in child undernutrition in Nigeria. METHODS The study analysed cross-sectional data from the Nigeria Demographic and Health Survey (NDHS) 2003 to 2013. The outcome variables were stunting, wasting and underweight among children under-five years. The magnitude of child undernutrition in Nigeria was estimated via a concentration index, and the socioeconomic factors contributing to child undernutrition over time were determined using the decomposition method. RESULTS The concentration index showed an increase in childhood wasting and underweight in Nigeria over time. The socioeconomic factors contributing to the increase in child undernutrition were: child's age (0-23 months), maternal education (no education), household wealth index (poorest household), type of residence (rural) and geopolitical zone (North East, North West). CONCLUSIONS To address child undernutrition, there is a need to improve maternal education and adopt effective social protection policies especially in rural communities in Nigeria.
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Affiliation(s)
- Blessing J. Akombi
- School of Social Sciences and Psychology, Western Sydney University, Penrith, New South Wales, Australia
| | - Kingsley E. Agho
- School of Science and Health, Western Sydney University, Penrith, New South Wales, Australia
| | - Andre M. Renzaho
- School of Social Sciences and Psychology, Western Sydney University, Penrith, New South Wales, Australia
| | - John J. Hall
- School of Public Health and Community Medicine, University of New South Wales, Sydney, New South Wales, Australia
| | - Dafna R. Merom
- School of Science and Health, Western Sydney University, Penrith, New South Wales, Australia
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Ataguba JEO. A reassessment of global antenatal care coverage for improving maternal health using sub-Saharan Africa as a case study. PLoS One 2018; 13:e0204822. [PMID: 30289886 PMCID: PMC6173396 DOI: 10.1371/journal.pone.0204822] [Citation(s) in RCA: 35] [Impact Index Per Article: 5.8] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/30/2018] [Accepted: 09/15/2018] [Indexed: 11/18/2022] Open
Abstract
BACKGROUND Antenatal period is an opportunity for reaching pregnant women with vital interventions. In fact, antenatal care (ANC) coverage was an indicator for assessing progress towards the Millennium Development Goals. This paper applies a novel index of service coverage using ANC, which accounts for every ANC visit. An index of service coverage gap is also proposed. These indices are additively decomposable by population groups and they are sensitive to the receipt of more ANC visits below a defined threshold. These indices have also been generalised to account for the quality of services. METHODS Data from recent rounds of the Demographic and Health Survey (DHS) are used to reassess ANC service coverage in 35 sub-Saharan African countries. An index of ANC coverage was estimated. These countries were ranked, and their ranks are compared with those based on attaining at least four ANC visits (ANC4+). FINDINGS The index of ANC coverage reflected the level of service coverage in countries. Further, disparities exist in country ranking as some countries, e.g. Cameroon, Benin Republic and Nigeria are ranked better using the ANC4+ indicator but poorly using the proposed index. Also, Rwanda and Malawi are ranked better using the proposed index. CONCLUSION The proposed ANC index allows for the assessment of progressive realisation, rooted in the move towards universal health coverage. In fact, the index reflects progress that countries make in increasing service coverage. This is because every ANC visit counts. Beyond ANC coverage, the proposed index is applicable to assessing service coverage generally including quality education.
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Affiliation(s)
- John Ele-Ojo Ataguba
- Health Economics Unit, School of Public Health and Family Medicine, Health Sciences Faculty, University of Cape Town, Cape Town, South Africa
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Makate M, Makate C. The impact of prenatal care quality on neonatal, infant and child mortality in Zimbabwe: evidence from the demographic and health surveys. Health Policy Plan 2017; 32:395-404. [PMID: 27993962 DOI: 10.1093/heapol/czw154] [Citation(s) in RCA: 12] [Impact Index Per Article: 1.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 10/19/2016] [Indexed: 11/13/2022] Open
Abstract
The impact of the quality of prenatal care on child mortality outcomes has received less attention in sub-Saharan Africa. This study endeavoured to explore the effect of the quality of prenatal care and its individual components on neonatal, infant and under-five mortality. The empirical analysis uses data from the three most recent waves of the nationally representative Demographic and Health Survey for Zimbabwe conducted in 1999, 2005/06 and 2010/11. The results indicate that a one-unit increase in the quality of prenatal care lowers the prospect of neonatal, infant and under-five mortality by approximately 42.33, 30.86 and 28.65%, respectively. These findings remained roughly the same even after adjusting for potential mediating factors. Examining the effect of individual prenatal care components on child mortality revealed that women who receive information on possible complications arising during pregnancy are less liable to experience a neonatal death. Similarly, women who had blood pressure checks and tetanus immunizations were less likely to experience an infant or under-five death. We did not find any statistically meaningful impact on child mortality outcomes of blood and urine sample checks, iron tablet consumption, and the receipt of malarial tablets. Overall, our results suggest the need for public health policymakers to focus on ensuring high-quality prenatal care to enhance the survival prospects of Zimbabwe's infants.
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Affiliation(s)
- Marshall Makate
- Department of Economics, State University of New York at Albany, Albany, NY, USA and
| | - Clifton Makate
- UNEP Tongji Institute of Environment for Sustainable Development, Tongji University, Shanghai, People's Republic of China
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Liu X, Behrman JR, Stein AD, Adair LS, Bhargava SK, Borja JB, da Silveira MF, Horta BL, Martorell R, Norris SA, Richter LM, Sachdev HS. Prenatal care and child growth and schooling in four low- and medium-income countries. PLoS One 2017; 12:e0171299. [PMID: 28158229 PMCID: PMC5291430 DOI: 10.1371/journal.pone.0171299] [Citation(s) in RCA: 13] [Impact Index Per Article: 1.9] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/06/2016] [Accepted: 01/19/2017] [Indexed: 11/18/2022] Open
Abstract
BACKGROUND The effectiveness of prenatal care for improving birth and subsequent child outcomes in low-income countries remains controversial, with much of the evidence to date coming from high-income countries and focused on early-life outcomes. We examined associations between prenatal care visits and birth weight, height-for-age at 24 months and attained schooling in four low- and middle-income countries. METHODS We pooled data from prospective birth-cohort studies from Brazil, Guatemala, Philippines and South Africa. We created a prenatal care utilization index based on the number and timing of prenatal visits. Associations were examined between this index and birth weight, height-for-age at 24 months, and highest attained schooling grade until adulthood. RESULTS Among 7203 individuals in the analysis, 68.9% (Philippines) to 96.7% (South Africa) had at least one prenatal care visit, with most having at least four visits. Over 40% of Brazilians and Guatemalans had their first prenatal visit in the first trimester, but fewer Filipinos (13.9%) and South Africans (19.8%) did so. Prenatal care utilization was not significantly associated with birth weight (p>0.05 in pooled data). Each unit increase in the prenatal care utilization index was associated with 0.09 (95% CI 0.04 to 0.15) higher height-for-age z-score at 24 months and with 0.26 (95% CI 0.17 to 0.35) higher schooling grades attained. Although there was some heterogeneity and greater imprecision across sites, the results were qualitatively similar among the four different populations. CONCLUSIONS While not related to birth weight, prenatal care utilization was associated with important outcomes later in life, specifically higher height-for-age at 24 months and higher attained school grades. These results suggest the relevance of prenatal care visits for human capital outcomes important over the lifecycle.
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Affiliation(s)
- Xiaoying Liu
- Population Studies Center, University of Pennsylvania, Philadelphia, Pennsylvania, United States of America
| | - Jere R. Behrman
- Population Studies Center, University of Pennsylvania, Philadelphia, Pennsylvania, United States of America
| | - Aryeh D. Stein
- Hubert Department of Global Health, Rollins School of Public Health, Emory University, Atlanta, Georgia, United States of America
- University of the Witwatersrand / Medical Research Council Developmental Pathways to Health Research Unit, University of the Witwatersrand, Johannesburg, South Africa
| | - Linda S. Adair
- Department of Nutrition, University of North Carolina at Chapel Hill, United States of America
| | | | - Judith B. Borja
- USC-Office of Population Studies Foundation, Inc., and Department of Nutrition and Dietetics, University of San Carlos, Cebu City, Philippines
| | | | - Bernardo L. Horta
- Post-Graduation Program in Epidemiology, Faculty of Medicine, Federal University of Pelotas, Brazil
| | - Reynaldo Martorell
- Hubert Department of Global Health, Rollins School of Public Health, Emory University, Atlanta, Georgia, United States of America
| | - Shane A. Norris
- University of the Witwatersrand / Medical Research Council Developmental Pathways to Health Research Unit, University of the Witwatersrand, Johannesburg, South Africa
| | - Linda M. Richter
- University of the Witwatersrand / Medical Research Council Developmental Pathways to Health Research Unit, University of the Witwatersrand, Johannesburg, South Africa
- University of the Witwatersrand, DST-NRF Centre of Excellence in Human Development, Johannesburg, South Africa
| | - Harshpal S. Sachdev
- Department of Pediatrics and Clinical Epidemiology, Sitaram Bhartia Institute of Science and Research, New Delhi, India
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Wehby GL, Pawluk M, Nyarko KA, López-Camelo JS. Explaining ethnic disparities in preterm birth in Argentina and Ecuador. Glob Public Health 2016; 13:1126-1143. [PMID: 27875924 DOI: 10.1080/17441692.2016.1251603] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/20/2022]
Abstract
Little is understood about racial/ethnic disparities in infant health in South America. We quantified the extent to which the disparity in preterm birth (PTB; <37 gestational weeks) rate between infants of Native only ancestry and those of European only ancestry in Argentina and Ecuador are explained by household socio-economic, demographic, healthcare use, and geographic location indicators. The samples included 5199 infants born between 2000 and 2011 from Argentina and 1579 infants born between 2001 and 2011 from Ecuador. An Oaxaca-Blinder type decomposition model adapted to binary outcomes was estimated to explain the disparity in PTB risk across groups of variables and specific variables. Maternal use of prenatal care services significantly explained the PTB disparity, by nearly 57% and 30% in Argentina and Ecuador, respectively. Household socio-economic status explained an additional 26% of the PTB disparity in Argentina. Differences in maternal use of prenatal care may partly explain ethnic disparities in PTB in Argentina and Ecuador. Improving access to prenatal care may reduce ethnic disparities in PTB risk in these countries.
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Affiliation(s)
- George L Wehby
- a Departments of Health Management and Policy, Economics, and Preventive & Community Dentistry, and Public Policy Center , University of Iowa , Iowa City , IA , USA.,b National Bureau of Economic Research , Cambridge , MA , USA
| | - Mariela Pawluk
- c Center of Medical Education and Clinical Investigation/Centro de Educación Médica e Investigación Clínica (CEMIC) , Buenos Aires , Argentina
| | - Kwame A Nyarko
- d Department of Health Management and Policy , University of Iowa , Iowa City , IA, USA
| | - Jorge S López-Camelo
- c Center of Medical Education and Clinical Investigation/Centro de Educación Médica e Investigación Clínica (CEMIC) , Buenos Aires , Argentina.,e Latin American Collaborative Study of Congenital Anomalies/Estudio Colaborativo Latinoamericano de Malformaciones Congénitas (ECLAMC) , Buenos Aires , Argentina
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Deguen S, Kihal W, Jeanjean M, Padilla C, Zmirou-Navier D. Neighborhood Deprivation and Risk of Congenital Heart Defects, Neural Tube Defects and Orofacial Clefts: A Systematic Review and Meta-Analysis. PLoS One 2016; 11:e0159039. [PMID: 27783616 PMCID: PMC5082651 DOI: 10.1371/journal.pone.0159039] [Citation(s) in RCA: 17] [Impact Index Per Article: 2.1] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/02/2015] [Accepted: 06/27/2016] [Indexed: 11/22/2022] Open
Abstract
Background We conducted this systematic review and meta-analysis to address the open question of a possible association between the socioeconomic level of the neighborhoods in which pregnant women live and the risk of Congenital Heart Defects (CHDs), Neural Tube Defects (NTDs) and OroFacial Clefts (OFCs). Methods We searched MEDLINE from its inception to December 20th, 2015 for case-control, cohort and ecological studies assessing the association between neighborhood socioeconomic level and the risk of CHDs, NTDs and the specific phenotypes Cleft Lip with or without Cleft Palate (CLP) and Cleft Palate (CP). Study-specific risk estimates were pooled according to random-effect and fixed-effect models. Results Out of 245 references, a total of seven case-control studies, two cohort studies and two ecological studies were assessed in the systematic review; all studies were enrolled in the meta-analysis with the exception of the two cohort studies. No significant association has been revealed between CHDs or NTDs and neighborhood deprivation index. For CLP phenotype subgroups, we found a significantly higher rate in deprived neighborhoods (Odds Ratios (OR) = 1.22, 95% CI: 1.10, 1.36) whereas this was not significant for CP phenotype subgroups (OR = 1.20, 95%CI: 0.89, 1.61). Conclusion In spite of the small number of epidemiological studies included in the present literature review, our findings suggest that neighborhood socioeconomic level where mothers live is associated only with an increased risk of CLP phenotype subgroups. This finding has methodological limitations that impede the formulation of firm conclusions, and further investigations should confirm this association.
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Affiliation(s)
- Séverine Deguen
- EHESP School of Public Health, Department of Environmental and Occupational Health, Rennes, Cedex 35043, France
- INSERM U1085 (IRSET), Department of Environmental and Occupational Health, Rennes, Cedex 35043, France
- * E-mail:
| | - Wahida Kihal
- EHESP School of Public Health, Department of Environmental and Occupational Health, Rennes, Cedex 35043, France
| | - Maxime Jeanjean
- EHESP School of Public Health, Department of Environmental and Occupational Health, Rennes, Cedex 35043, France
- INSERM U1085 (IRSET), Department of Environmental and Occupational Health, Rennes, Cedex 35043, France
| | - Cindy Padilla
- EHESP School of Public Health, Department of Environmental and Occupational Health, Rennes, Cedex 35043, France
| | - Denis Zmirou-Navier
- EHESP School of Public Health, Department of Environmental and Occupational Health, Rennes, Cedex 35043, France
- INSERM U1085 (IRSET), Department of Environmental and Occupational Health, Rennes, Cedex 35043, France
- Lorraine University Medical School, Nancy, Cedex 54052, France
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11
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The impact of unemployment cycles on child and maternal health in Argentina. Int J Public Health 2016; 62:197-207. [PMID: 27572492 DOI: 10.1007/s00038-016-0857-1] [Citation(s) in RCA: 7] [Impact Index Per Article: 0.9] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/12/2016] [Revised: 06/21/2016] [Accepted: 07/08/2016] [Indexed: 10/21/2022] Open
Abstract
OBJECTIVES The purpose of this study is to examine the effects of economic cycles in Argentina on infant and maternal health between 1994 and 2006, a period that spans the major economic crisis in 1999-2002. METHODS We evaluate the effects of province-level unemployment rates on several infant health outcomes, including birth weight, gestational age, fetal growth rate, and hospital discharge status after birth in a sample of 15,000 infants born in 13 provinces. Maternal health and healthcare outcomes include acute and chronic illnesses, infectious diseases, and use of prenatal visits and technology. Regression models control for hospital and year fixed effects and province-specific time trends. RESULTS Unemployment rise reduces fetal growth rate particularly among high educated parents. Also, maternal poverty-related infectious diseases increase, although reporting of acute illnesses declines (an effect more pronounced among low educated parents). There is also some evidence for reduced access to prenatal care and technology among less educated parents with higher unemployment. CONCLUSIONS Unemployment rise in Argentina has adversely affected certain infant and maternal health outcomes, but several measures show no evidence of significant change.
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Devkota S, Panda B. Childhood Immunization and Access to Health Care: Evidence From Nepal. Asia Pac J Public Health 2016; 28:167-77. [PMID: 26809971 DOI: 10.1177/1010539515626268] [Citation(s) in RCA: 15] [Impact Index Per Article: 1.9] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/16/2022]
Abstract
This article examines the effect of access to health care center, in terms of travel time, on childhood immunization in Nepal using the 2004 and 2011 waves of the Nepal Living Standards Measurement Surveys. We employ probit and instrumental variable probit estimation methods to estimate the causal effect of travel time on the probability of immunization. Results indicate that travel time to the nearest health center displays a significant negative association with the probability of immunization (coefficient = -0.015,P< .05). Furthermore, the effect of travel time tends to be stronger in rural and distant areas of Nepal's mountain and hill regions. The results suggest that policy interventions should increase the number of mobile clinics in rural villages and provide conditional cash transfer to incentivize immunization coverage at the household level. In addition, household income, parental education, ethnicity, and household location emerge as important determinants of immunization in Nepal.
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Affiliation(s)
- Satis Devkota
- Discipline of Economics and Management, Division of Social Science, University of Minnesota-Morris, Morris, MN, USA
| | - Bibhudutta Panda
- Discipline of Economics and Management, Division of Social Science, University of Minnesota-Morris, Morris, MN, USA
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Nyarko KA, Lopez-Camelo J, Castilla EE, Wehby GL. Explaining racial disparities in infant health in Brazil. Am J Public Health 2015; 105 Suppl 4:S575-84, S563-74. [PMID: 26313046 DOI: 10.2105/ajph.2012.301021r] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/04/2022]
Abstract
OBJECTIVES We sought to quantify how socioeconomic, health care, demographic, and geographic effects explain racial disparities in low birth weight (LBW) and preterm birth (PTB) rates in Brazil. METHODS We employed a sample of 8949 infants born between 1995 and 2009 in 15 cities and 7 provinces in Brazil. We focused on disparities in LBW (< 2500 g) and PTB (< 37 gestational weeks) prevalence between infants of African ancestry alone or African mixed with other ancestries, and European ancestry alone. We used a decomposition model to quantify the contributions of conceptually relevant factors to these disparities. RESULTS The model explained 45% to 94% of LBW and 64% to 94% of PTB disparities between the African ancestry groups and European ancestry. Differences in prenatal care use and geographic location were the most important contributors, followed by socioeconomic differences. The model explained the majority of the disparities for mixed African ancestry and part of the disparity for African ancestry alone. CONCLUSIONS Public policies to improve children's health should target prenatal care and geographic location differences to reduce health disparities between infants of African and European ancestries in Brazil.
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Affiliation(s)
- Kwame A Nyarko
- Kwame A. Nyarko and George L. Wehby are with the Department of Health Management and Policy, University of Iowa, Iowa City. Jorge Lopez-Camelo and Eduardo E. Castilla are with Estudio Colaborativo Latino Americano de Malformaciones Congenitas (ECLAMC), Centro de Educación Médica e Investigación Clínica, Buenos Aires, Argentina, and ECLAMC, Laboratório de Epidemiologia de Malformações Congênitas, Instituto Oswaldo Cruz, Fundação Oswaldo Cruz, Rio de Janeiro, Brazil
| | - Jorge Lopez-Camelo
- Kwame A. Nyarko and George L. Wehby are with the Department of Health Management and Policy, University of Iowa, Iowa City. Jorge Lopez-Camelo and Eduardo E. Castilla are with Estudio Colaborativo Latino Americano de Malformaciones Congenitas (ECLAMC), Centro de Educación Médica e Investigación Clínica, Buenos Aires, Argentina, and ECLAMC, Laboratório de Epidemiologia de Malformações Congênitas, Instituto Oswaldo Cruz, Fundação Oswaldo Cruz, Rio de Janeiro, Brazil
| | - Eduardo E Castilla
- Kwame A. Nyarko and George L. Wehby are with the Department of Health Management and Policy, University of Iowa, Iowa City. Jorge Lopez-Camelo and Eduardo E. Castilla are with Estudio Colaborativo Latino Americano de Malformaciones Congenitas (ECLAMC), Centro de Educación Médica e Investigación Clínica, Buenos Aires, Argentina, and ECLAMC, Laboratório de Epidemiologia de Malformações Congênitas, Instituto Oswaldo Cruz, Fundação Oswaldo Cruz, Rio de Janeiro, Brazil
| | - George L Wehby
- Kwame A. Nyarko and George L. Wehby are with the Department of Health Management and Policy, University of Iowa, Iowa City. Jorge Lopez-Camelo and Eduardo E. Castilla are with Estudio Colaborativo Latino Americano de Malformaciones Congenitas (ECLAMC), Centro de Educación Médica e Investigación Clínica, Buenos Aires, Argentina, and ECLAMC, Laboratório de Epidemiologia de Malformações Congênitas, Instituto Oswaldo Cruz, Fundação Oswaldo Cruz, Rio de Janeiro, Brazil
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Nyarko KA, López-Camelo J, Castilla EE, Wehby GL. Explicación de las disparidades raciales en la salud neonatal en Brasil. Am J Public Health 2015. [DOI: 10.2105/ajph.2012.301021s] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/04/2022]
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Woodhouse C, Lopez Camelo J, Wehby GL. A comparative analysis of prenatal care and fetal growth in eight South American countries. PLoS One 2014; 9:e91292. [PMID: 24625630 PMCID: PMC3953331 DOI: 10.1371/journal.pone.0091292] [Citation(s) in RCA: 60] [Impact Index Per Article: 6.0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/05/2013] [Accepted: 02/12/2014] [Indexed: 11/25/2022] Open
Abstract
There has been little work that comprehensively compared the relationship between prenatal care and infant health across multiple countries using similar data sources and analytical models. Such comparative analyses are useful for understanding the background of differences in infant health between populations. We evaluated the association between prenatal care visits and fetal growth measured by birth weight (BW) in grams or low birth weight (<2500 grams; LBW) adjusted for gestational age in eight South American countries using similarly collected data across countries and the same analytical models. OLS and logistic regressions were estimated adjusting for a large set of relevant infant, maternal, and household characteristics and birth year and hospital fixed effects. Birth data were acquired from 140 hospitals that are part of the Latin American Collaborative Study of Congenital Malformations (ECLAMC) network. The analytical sample included 56,014 live-born infants (∼69% of total sample) with complete data born without congenital anomalies in the years 1996–2011 in Brazil, Argentina, Chile, Venezuela, Ecuador, Colombia, Bolivia, and Uruguay. Prenatal care visits were significantly (at p<.05) and positively associated with BW and negatively associated with LBW for all countries. The OLS coefficients ranged from 9 grams per visit in Bolivia to 36 grams in Uruguay. The association with LBW was strongest for Chile (OR = 0.87 per visit) and lowest for Argentina and Venezuela (OR = 0.95). The association decreased in the recent decade compared to earlier years. Our findings suggest that estimates of association between prenatal care and fetal growth are population-specific and may not be generalizable to other populations. Furthermore, as one of the indicators for a country’s healthcare system for maternal and child health, prenatal care is a highly variable indicator between countries in South America.
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Affiliation(s)
- Cristina Woodhouse
- College of Medicine, University of Iowa, Iowa City, Iowa, United States of America
| | - Jorge Lopez Camelo
- Centro de Educación Médica e Investigación Clínica (CEMIC); Consejo Nacional de Investigaciones, Científicas y Tecnológicas (CONICET), Buenos Aires, Argentina
| | - George L. Wehby
- Associate Professor, University of Iowa, Research Associate, National Bureau of Economic Research, Dept. of Health Management and Policy, College of Public Health, University of Iowa, Iowa City, Iowa, United States of America
- * E-mail:
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Educated mothers, healthy infants. The impact of a school reform on the birth weight of Norwegian infants 1967–2005. Soc Sci Med 2014; 105:84-92. [DOI: 10.1016/j.socscimed.2014.01.008] [Citation(s) in RCA: 24] [Impact Index Per Article: 2.4] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/16/2013] [Revised: 01/07/2014] [Accepted: 01/11/2014] [Indexed: 11/23/2022]
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Abstract
A huge literature shows that teen mothers face a variety of detriments across the life course, including truncated educational attainment. To what extent is this association causal? The estimated effects of teen motherhood on schooling vary widely, ranging from no discernible difference to 2.6 fewer years among teen mothers. The magnitude of educational consequences is therefore uncertain, despite voluminous policy and prevention efforts that rest on the assumption of a negative and presumably causal effect. This study adjudicates between two potential sources of inconsistency in the literature—methodological differences or cohort differences—by using a single, high-quality data source: namely, The National Longitudinal Study of Adolescent Health. We replicate analyses across four different statistical strategies: ordinary least squares regression; propensity score matching; and parametric and semiparametric maximum likelihood estimation. Results demonstrate educational consequences of teen childbearing, with estimated effects between 0.7 and 1.9 fewer years of schooling among teen mothers. We select our preferred estimate (0.7), derived from semiparametric maximum likelihood estimation, on the basis of weighing the strengths and limitations of each approach. Based on the range of estimated effects observed in our study, we speculate that variable statistical methods are the likely source of inconsistency in the past. We conclude by discussing implications for future research and policy, and recommend that future studies employ a similar multimethod approach to evaluate findings.
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Affiliation(s)
- Jennifer B. Kane
- Carolina Population Center, University of North Carolina at Chapel Hill, 123 W. Franklin Street, Chapel Hill, NC 27516
| | - S. Philip Morgan
- Department of Sociology and Carolina Population Center, University of North Carolina at Chapel Hill
| | - Kathleen Mullan Harris
- Department of Sociology and Carolina Population Center, University of North Carolina at Chapel Hill
| | - David K. Guilkey
- Department of Economics and Carolina Population Center, University of North Carolina at Chapel Hill
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Wehby GL, Wilcox A, Lie RT. The Impact of Cigarette Quitting during Pregnancy on Other Prenatal Health Behaviors. REVIEW OF ECONOMICS OF THE HOUSEHOLD 2013; 11:211-233. [PMID: 23807871 PMCID: PMC3690665 DOI: 10.1007/s11150-012-9163-8] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 06/02/2023]
Abstract
Several economic studies have evaluated the effects of cigarette smoking and quitting on other health behaviors such as alcohol use and weight gain. However, there is little research that evaluates the effects of cigarette quitting during pregnancy on other health behaviors such as caloric intake, alcohol consumption, multivitamin use, and caffeine intake. In this paper, we evaluate these effects and employ a genetic variant that predicts cigarette quitting to aid in identification. We find some evidence that cigarette quitting during pregnancy may increase multivitamin use and caloric intake and reduce caffeine consumption.
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Affiliation(s)
- George L. Wehby
- Associate Professor of Health Economics, Dept. of Health Management and Policy, College of Public Health, University of Iowa, 105 River Street, N248 CPHB, Iowa City, IA 52242, Phone: 319-384-3814, Fax: 319-384-4371
| | - Allen Wilcox
- National Institute of Environmental Health Sciences, Research Triangle Park, North Carolina, USA
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Nyarko KA, Lopez-Camelo J, Castilla EE, Wehby GL. Explaining racial disparities in infant health in Brazil. Am J Public Health 2013; 103:1675-84. [PMID: 23409894 DOI: 10.2105/ajph.2012.301021] [Citation(s) in RCA: 24] [Impact Index Per Article: 2.2] [Reference Citation Analysis] [Abstract] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/04/2022]
Abstract
OBJECTIVES We sought to quantify how socioeconomic, health care, demographic, and geographic effects explain racial disparities in low birth weight (LBW) and preterm birth (PTB) rates in Brazil. METHODS We employed a sample of 8949 infants born between 1995 and 2009 in 15 cities and 7 provinces in Brazil. We focused on disparities in LBW (< 2500 g) and PTB (< 37 gestational weeks) prevalence between infants of African ancestry alone or African mixed with other ancestries, and European ancestry alone. We used a decomposition model to quantify the contributions of conceptually relevant factors to these disparities. RESULTS The model explained 45% to 94% of LBW and 64% to 94% of PTB disparities between the African ancestry groups and European ancestry. Differences in prenatal care use and geographic location were the most important contributors, followed by socioeconomic differences. The model explained the majority of the disparities for mixed African ancestry and part of the disparity for African ancestry alone. CONCLUSIONS Public policies to improve children's health should target prenatal care and geographic location differences to reduce health disparities between infants of African and European ancestries in Brazil.
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Affiliation(s)
- Kwame A Nyarko
- Department of Health Management and Policy, University of Iowa, Iowa City, IA 52242, USA
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Noonan K, Corman H, Schwartz-Soicher O, Reichman NE. Effects of prenatal care on child health at age 5. Matern Child Health J 2013; 17:189-99. [PMID: 22374319 PMCID: PMC3391357 DOI: 10.1007/s10995-012-0966-2] [Citation(s) in RCA: 20] [Impact Index Per Article: 1.8] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/01/2022]
Abstract
The broad goal of contemporary prenatal care is to promote the health of the mother, child, and family through the pregnancy, delivery, and the child's development. Although the vast majority of mothers giving birth in developed countries receive prenatal care, past research has not found compelling evidence that early or adequate prenatal care has favorable effects on birth outcomes. It is possible that prenatal care confers health benefits to the child that do not become apparent until after the perinatal period. Using data from a national urban birth cohort study in the US, we estimate the effects of prenatal care on four markers of child health at age 5-maternal-reported health status, asthma diagnosis, overweight, and height. Prenatal care, defined a number of different ways, does not appear to have any effect on the outcomes examined. The findings are robust and suggest that routine health care encounters during the prenatal period could potentially be used more effectively to enhance children's health trajectories. However, future research is needed to explore the effects of prenatal care on additional child health and developmental outcomes as well as the effects of preconceptional and maternal lifetime healthcare on child health.
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Affiliation(s)
- Kelly Noonan
- Department of Economics, Rider University and National Bureau of Economic Research, 2083 Lawrenceville Rd., Lawrenceville, NJ 08648, Phone: 609-895-5539, Fax: 609-609-896-5387
| | - Hope Corman
- Department of Economics, Rider University and National Bureau of Economic Research, 2083 Lawrenceville Rd., Lawrenceville, NJ 08648, Phone: 609-895-5559, Fax: 609-609-896-5387
| | | | - Nancy E. Reichman
- Department of Pediatrics, Robert Wood Johnson Medical School, University of Medicine and Dentistry of New Jersey, 97 Paterson St., Room 435, New Brunswick, NJ 08903, Phone: 732-235-7977, Fax: 732-235-7088
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Nyarko KA, Lopez-Camelo J, Castilla EE, Wehby GL. Does the relationship between prenatal care and birth weight vary by oral clefts? evidence using South American and United States samples. J Pediatr 2013; 162:42-9.e1. [PMID: 22835882 PMCID: PMC3485451 DOI: 10.1016/j.jpeds.2012.06.040] [Citation(s) in RCA: 11] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 10/13/2011] [Revised: 05/23/2012] [Accepted: 06/20/2012] [Indexed: 11/18/2022]
Abstract
OBJECTIVE To evaluate if the association between prenatal care use and birth weight (BW) varies for infants with cleft lip and/or cleft palate (CL/P), classified into isolated and non-isolated forms, compared with unaffected infants. STUDY DESIGN The study employed 2 datasets. The first included a multi-country sample of 2405 infants with CL/P and 24046 infants without CL/P born in 1996-2007 in South America. The second was a sample of 2122 infants with CL/P and 297415 without CL/P from the United States 2004 natality dataset. Separate analyses were performed for the South American and United States samples. The association between prenatal care and BW was evaluated separately for isolated CL/P, non-isolated CL/P, and unaffected infants using regression models adjusting for several background characteristics. RESULTS Prenatal care was associated with improved BW for all infant groups, with greater BW increases for infants with CL/P particularly non-isolated forms. In the South American sample, BW increased by 108, 69, and 40 g on average per prenatal visit for infants with non-isolated CL/P, infants with isolated CL/P, and unaffected infants, respectively. In the United States sample, BW increased by 51, 21, and 16 g on average per prenatal visit for these infant groups, respectively. CONCLUSIONS Prenatal care was associated with larger BW increases for pregnancies complicated with CL/P, particularly non-isolated forms, compared with unaffected pregnancies. Given that reduced BW is a well-recognized comorbidity of CL/P, the findings highlight the importance of prenatal care for at-risk pregnancies as a tertiary-prevention intervention to reduce the health burden of CL/P.
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Affiliation(s)
- Kwame A. Nyarko
- Doctoral Candidate, Department of Health Management and Policy, University of Iowa
| | - Jorge Lopez-Camelo
- CEMIC: Centro de Educación Médica e Investigación Clínica; INAGEMP (Instituto Nacional de Genética Médica Populacional) and ECLAMC (Estudio Colaborativo Latino Americano de Malformaciones Congénitas), at Laboratório de Epidemiologia de Malformações Congênitas, Instituto Multidisciplinario de Biologia Celular – IMBICE-CICPBA-CONICET
| | - Eduardo E Castilla
- INAGEMP (Instituto Nacional de Genética Médica Populacional) and ECLAMC (Estudio Colaborativo Latino Americano de Malformaciones Congénitas), at Laboratório de Epidemiologia de Malformações Congênitas, Instituto Oswaldo Cruz, Fundação Oswaldo Cruz, Rio de Janeiro, Brazil, and CEMIC: Centro de Educación Médica e Investigación Clínica
| | - George L. Wehby
- Associate Professor, Department of Health Management and Policy, College of Public Health, University of Iowa, 105 River Street, N248 CPHB, Iowa City, IA 52242, 319 384 3814 phone, 319 384 4371 fax,
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Delajara M, Wendelspiess Chávez Juárez F. Birthweight outcomes in Bolivia: the role of maternal height, ethnicity, and behavior. ECONOMICS AND HUMAN BIOLOGY 2013; 11:56-68. [PMID: 22560303 DOI: 10.1016/j.ehb.2012.03.004] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 04/27/2011] [Revised: 03/22/2012] [Accepted: 03/22/2012] [Indexed: 05/31/2023]
Abstract
We identify maternal behavioral factors associated with birthweight in Bolivia using data from the Demographic and Health Survey (DHS) of 2003. We estimate birthweight as a function of maternal behavior and the child's sex and gestational age. We control for maternal height, ethnicity, education, and wealth, and for differences observed across Bolivian regions in educational and health outcomes, demographic indicators, and altitude. We find that maternal age, fertility record, and birth spacing behavior are the main observable behavioral factors associated with birthweight, and that maternal height is associated with gestational age, a main determinant of birthweight. We also find that after controlling for gestational age, both ethnicity and altitude have an insignificant effect on birthweight.
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Affiliation(s)
- Marcelo Delajara
- Banco de México, Av 5 de Mayo 18, Col. Centro, 06059 Mexico City, Mexico.
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Wehby GL, von Hinke Kessler Scholder S. Genetic instrumental variable studies of effects of prenatal risk factors. BIODEMOGRAPHY AND SOCIAL BIOLOGY 2013; 59:4-36. [PMID: 23701534 PMCID: PMC3690512 DOI: 10.1080/19485565.2013.774615] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 05/09/2023]
Abstract
Identifying the effects of maternal risk factors during pregnancy on infant and child health is an area of tremendous research interest. However, policymakers are primarily interested in unraveling the causal effects of prenatal risk factors, not their associations with child health, which may be confounded by several unobserved factors. In this article, we evaluate the utility of genetic variants in three genes that have unequivocal evidence of being related to three major risk factors-CHRNA3 for smoking, ADH1B for alcohol use, and FTO for obesity-as instrumental variables for identifying the causal effects of such factors during pregnancy. Using two independent datasets, we find that these variants are overall predictive of the risk factors and are not systematically related to observed confounders, suggesting that they may be useful instruments. We also find some suggestive evidence that genetic effects are stronger during than before pregnancy. We provide an empirical example illustrating the use of these genetic variants as instruments to evaluate the effects of risk factors on birth weight. Finally, we offer suggestions for researchers contemplating the use of these variants as instruments.
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Affiliation(s)
- George L. Wehby
- Assistant Professor, Department of Health Management and Policy, College of Public Health, University of Iowa, 200 Hawkins Drive, E205 GH, Iowa City, IA 52242, Phone: 1-319-384-5133, Fax: 1-319-384-5125,
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Wehby GL, Lopez-Camelo J, Castilla EE. Hospital volume and mortality of very low-birthweight infants in South America. Health Serv Res 2012; 47:1502-21. [PMID: 22352946 PMCID: PMC3360993 DOI: 10.1111/j.1475-6773.2012.01383.x] [Citation(s) in RCA: 8] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/29/2022] Open
Abstract
OBJECTIVE To assess the effects of hospital volume of very low-birthweight (VLBW) infants on in-hospital mortality of VLBW and very preterm birth (VPB) infants in South America. DATA SOURCES/STUDY SETTING Birth-registry data for infants born in 1982-2008 at VLBW or very preterm in 66 hospitals in Argentina, Brazil, and Chile. DESIGN Regression analyses that adjust for several individual-level demographic, socioeconomic, and health factors; hospital-level characteristics; and country-fixed effects are employed. DATA COLLECTION/EXTRACTION METHODS Physicians interviewed mothers before hospital discharge and abstracted hospital medical records using similar methods at all hospitals. PRINCIPAL FINDINGS Volume has significant nonlinear beneficial effects on VLBW and VPB in-hospital survival. The largest survival benefits--more than 80 percent decrease in mortality rates--are with volume increases from low to medium or medium-high levels (from ≤ 25 to 72 infants annually) with significantly lower incremental benefits thereafter. The cumulative volume effects are maximized at the 121-144 annual VLBW infant range--about 90 percent decrease in mortality rates compared to <25 VLBW infants annually. CONCLUSIONS Increasing the access of pregnancies at-risk of VLBW and VPB to medium- or high-volume hospitals up to 144 VLBW infants per year may substantially improve in-hospital infant survival in the study countries.
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Affiliation(s)
- George L Wehby
- Department of Health Management and Policy, University of Iowa, E205 GH, 200 Hawkins Drive, Iowa City, IA 52242, USA.
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The Impact of Household Investments on Early Child Neurodevelopment and on Racial and Socioeconomic Developmental Gaps - Evidence from South America. Forum Health Econ Policy 2011; 14. [PMID: 22639558 DOI: 10.2202/1558-9544.1237] [Citation(s) in RCA: 13] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/29/2022]
Abstract
Abstract
This paper assesses the effects of household investments through child educating activities on child neurodevelopment between the ages of 3 and 24 months, and evaluates whether investments explain racial and socioeconomic developmental gaps in South America. Quantile regression is used to evaluate the heterogeneity in investment effects by unobserved developmental endowments. The study finds large positive investment effects on early child neurodevelopment, with generally larger effects among children with low developmental endowments (children at the left margin of the development distribution). Investments explain part of the observed racial gaps and the whole socioeconomic developmental gap. Investments may compensate for low endowments and policy interventions to increase investments may reduce early development gaps and result in high social and economic returns.
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Wehby G, Jugessur A, Murray JC, Moreno L, Wilcox A, Lie RT. GENES AS INSTRUMENTS FOR STUDYING RISK BEHAVIOR EFFECTS: AN APPLICATION TO MATERNAL SMOKING AND OROFACIAL CLEFTS. HEALTH SERVICES AND OUTCOMES RESEARCH METHODOLOGY 2011; 11:54-78. [PMID: 22102793 DOI: 10.1007/s10742-011-0071-9] [Citation(s) in RCA: 35] [Impact Index Per Article: 2.7] [Reference Citation Analysis] [Abstract] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/25/2022]
Abstract
This study uses instrumental variable (IV) models with genetic instruments to assess the effects of maternal smoking on the child's risk of orofacial clefts (OFC), a common birth defect. The study uses genotypic variants in neurotransmitter and detoxification genes relateded to smoking as instruments for cigarette smoking before and during pregnancy. Conditional maximum likelihood and two-stage IV probit models are used to estimate the IV model. The data are from a population-level sample of affected and unaffected children in Norway. The selected genetic instruments generally fit the IV assumptions but may be considered "weak" in predicting cigarette smoking. We find that smoking before and during pregnancy increases OFC risk substantially under the IV model (by about 4-5 times at the sample average smoking rate). This effect is greater than that found with classical analytic models. This may be because the usual models are not able to consider self-selection into smoking based on unobserved confounders, or it may to some degree reflect limitations of the instruments. Inference based on weak-instrument robust confidence bounds is consistent with standard inference. Genetic instruments may provide a valuable approach to estimate the "causal" effects of risk behaviors with genetic-predisposing factors (such as smoking) on health and socioeconomic outcomes.
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Affiliation(s)
- George Wehby
- Assistant Professor, Dept. of Health Management and Policy, College of Public Health, University of Iowa, 200 Hawkins Drive, E205 GH, Iowa City, IA 52242 USA,
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Beigi M, Javanmardi Z, Khani B, Safdari F. The effect of using maternal care log book on pregnancy outcome in clients referred to private gynecologists and midwives offices. IRANIAN JOURNAL OF NURSING AND MIDWIFERY RESEARCH 2011; 16:222-6. [PMID: 22224111 PMCID: PMC3249803] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 01/20/2011] [Accepted: 03/11/2011] [Indexed: 11/24/2022]
Abstract
BACKGROUND One of the important health indicators in every society is maternal and neonatal health status. Provision of the best prenatal care can reduce mortality rate in these two susceptible groups. This study focused on the effect of maternal care log book on pregnancy outcome. METHODS This was a clinical trial and 180 samples were randomly selected from the mothers referred to private offices of gynecologists and midwives and were divided into two groups of case and control. The outcome of pregnancy was determined by prenatal care log books in the case group and with pregnancy card in the control group. The data were collected using quality of life questionnaire and a pregnancy complications questionnaire. Descriptive and analytical statistical methods (Fisher's exact test, independent t-test and chi-square test) were used to analyze the data. RESULTS The results demonstrated a significant difference between case and control groups concerning normal vaginal delivery (p = 0.01), preterm labor (p = 0.015) and postpartum infection (p = 0.012). The result of quality of life in physical and mental domains and especially in mental domains was better in the case group than in the control group (p = 0.026 in physical and mental dimensions and (p = 0.02 in mental dimensions). This difference was lower in physical dimensions alone (p = 0.049). However, there was no significant difference between the case and control groups in terms of preeclampsia, intrauterine growth retardation and intrauterine fetal death. CONCLUSIONS As found out by the results, using maternal log book of mothers cares due to its comprehensive care items was more effective than simple maternal cards used by gynecologists and midwives. This can bring about better prenatal care and detected pregnancy complications.
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Affiliation(s)
- Marjan Beigi
- Instructor, Department of Midwifery, School of Nursing and Midwifery, Isfahan University of Medical Sciences, Isfahan, Iran.,
Correspondence to: Marjan Beigi, MSc. Research Article of Isfahan university of Medical Sciences, No: 1852223
| | - Zahra Javanmardi
- Department of Midwifery, Treatment Adjutancy of Isfahan University of Medical Scienses, Isfahan, Iran
| | - Behnaz Khani
- Assistant Professor, Gynecologist, Faculty Member, School of Medicine, Isfahan University of Medical Sciences, Isfahan, Iran
| | - Faranak Safdari
- Instructor, Department of Midwifery, School of Nursing and Midwifery, Shahr-e-Kord University of Medical Sciences, Shahr-e-Kord, Iran
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Habibov NN, Fan L. Does prenatal healthcare improve child birthweight outcomes in Azerbaijan? Results of the national Demographic and Health Survey. ECONOMICS AND HUMAN BIOLOGY 2011; 9:56-65. [PMID: 20851064 DOI: 10.1016/j.ehb.2010.08.003] [Citation(s) in RCA: 17] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 05/27/2009] [Revised: 08/24/2010] [Accepted: 08/24/2010] [Indexed: 05/29/2023]
Abstract
This paper evaluates the effectiveness of prenatal healthcare in Azerbaijan on improving child birthweight using the 2006 Azerbaijan Demographic and Health Survey, a nationally representative survey of reproductive aged women. Two measures of prenatal health utilization are used to measure healthcare input-the number of prenatal visits and the quality index of health care. Endogeneity in prenatal healthcare utilization is controlled by 2SLS regression. Selection bias of probability of child being weighed is controlled by a binomial probit regression. We found that prenatal healthcare does improve child birthweight. The results of the 2SLS suggest that an additional prenatal visit increases birthweight by about 26g, or approximately 0.8% of the raw mean of birthweight in the country. Likewise, a unit increase in quality of prenatal healthcare increases birthweight by 21g or by approximately 1.3% of the birthweight. In general, the magnitude of prenatal care impact in Azerbaijan is comparable with that in other countries.
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Affiliation(s)
- Nazim N Habibov
- School of Social Work, University of Windsor, 401 Sunset Avenue, Windsor, Ontario, N9B 3P4, Canada.
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Wehby GL, Prater K, McCarthy AM, Castilla EE, Murray JC. The Impact of Maternal Smoking during Pregnancy on Early Child Neurodevelopment. JOURNAL OF HUMAN CAPITAL 2011; 5:207-254. [PMID: 22272363 PMCID: PMC3262676 DOI: 10.1086/660885] [Citation(s) in RCA: 65] [Impact Index Per Article: 5.0] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 05/02/2023]
Abstract
Early child neurodevelopment has major impacts on future human capital and health. However, not much is known about the impacts of prenatal risk factors on child neurodevelopment. This study evaluates the effects of maternal smoking during pregnancy on child neurodevelopment between 3 and 24 months of age and interactions with socioeconomic status (SES). Data from a unique sample of children from South America are employed. Smoking has large adverse effects on neurodevelopment, with larger effects in the low SES sample. The study results highlight the importance of early interventions beginning before and during pregnancy for enhancing child development and future human capital attainment.
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Affiliation(s)
- George L. Wehby
- Dept. of Health Management and Policy, College of Public Health, University of Iowa, 200 Hawkins Drive, E205 GH, Iowa City, IA 52242, Phone: 319- 384-5133, Fax: 319-384-5125
| | - Kaitlin Prater
- Dept. of Health Management and Policy, College of Public Health, University of Iowa, 200 Newton Road, 5231, WL, Iowa City, IA 52246
| | - Ann Marie McCarthy
- Parent, Child & Family Nursing, College of Nursing, NB 344, The University of Iowa, Iowa City, IA 52245
| | - Eduardo E. Castilla
- INAGEMP (Instituto Nacional de Genética Médica Populacional) and ECLAMC (Estudio Colaborativo Latino Americano de Malformaciones Congénitas), at Laboratório de Epidemiologia de Malformações Congênitas, Instituto Oswaldo Cruz, Fundação Oswaldo Cruz, Rio de Janeiro, Brazil, and CEMIC: Centro de Educación Médica e Investigación Clinica, Buenos Aires, Argentina., Av. Brazil 4365, Pav. 26, sala 617. 21045-900, Rio de Janeiro. Brazil
| | - Jeffrey C. Murray
- Department of Pediatrics, College of Medicine, University of Iowa, Iowa City, IA, 52242
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Wehby GL, Castilla EE, Lopez-Camelo J. The impact of altitude on infant health in South America. ECONOMICS AND HUMAN BIOLOGY 2010; 8:197-211. [PMID: 20594925 PMCID: PMC2914839 DOI: 10.1016/j.ehb.2010.04.002] [Citation(s) in RCA: 32] [Impact Index Per Article: 2.3] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Subscribe] [Scholar Register] [Received: 08/12/2009] [Revised: 02/21/2010] [Accepted: 04/30/2010] [Indexed: 05/12/2023]
Abstract
Several studies report that altitude reduces birth weight. However, much remains unknown about effects in various altitude ranges and about the heterogeneity in altitude effects by fetal health endowments. This study estimates the effects of altitude in South America on the means and quantiles of birth weight and gestational age separately for two large samples born at altitude ranges of 5 to 1,280 m and 1,854 to 3,600 m. The study finds significant negative altitude effects on birth weight and gestational age in the low-altitude sample and on birth weight in the high-altitude sample. Altitude effects are larger for infants with very low fetal health endowments. The study finds differences in the effects of several inputs such as socioeconomic status and maternal fertility history and health between the two altitude samples. The study highlights the importance of adverse altitude effects on infant health when evaluating the costs and returns of policies that change the number of individuals who reside at higher altitude in both low and high altitude ranges.
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Affiliation(s)
- George L. Wehby
- Department of Health Management and Policy, University of
Iowa, E204 GH, Iowa City, IA, 52242, USA
| | - Eduardo E. Castilla
- INAGEMP and ECLAMC (Latin American Collaborative Study of
Congenital Malformations) at CEMIC (Center for Medical Education and Clinical
Investigations), Buenos Aires, Argentina and ECLAMC at Instituto Oswaldo Cruz, Rio
de Janeiro, Brazil. ECLAMC/FIOCRUZ. Av. Brazil 4365, Pav. 26, sala 617. 21045-900
Rio de Janeiro. Brazil.
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