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Rebouças P, Paixão ES, Ramos D, Pescarini J, Pinto-Junior EP, Falcão IR, Ichihara MY, Sena S, Veiga R, Ribeiro R, Rodrigues LC, Barreto ML, Goes EF. Ethno-racial inequalities on adverse birth and neonatal outcomes: a nationwide, retrospective cohort study of 21 million Brazilian newborns. LANCET REGIONAL HEALTH. AMERICAS 2024; 37:100833. [PMID: 39070074 PMCID: PMC11269955 DOI: 10.1016/j.lana.2024.100833] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 11/07/2023] [Revised: 04/30/2024] [Accepted: 06/18/2024] [Indexed: 07/30/2024]
Abstract
Background Ethno-racial inequalities are critical determinants of health outcomes. We quantified ethnic-racial inequalities on adverse birth outcomes and early neonatal mortality in Brazil. Methods We conducted a cohort study in Brazil using administrative linked data between 2012 and 2019. Estimated the attributable fractions for the entire population (PAF) and specific groups (AF), as the proportion of each adverse outcome that would have been avoided if all women had the same baseline conditions as White women, both unadjusted and adjusted for socioeconomics and maternal risk factors. AF was also calculated by comparing women from each maternal race/skin colour group in different groups of mothers' schooling, with White women with 8 or more years of education as the reference group and by year. Findings 21,261,936 newborns were studied. If all women experienced the same rate as White women, 1.7% of preterm births, 7.2% of low birth weight (LBW), 10.8% of small for gestational age (SGA) and 11.8% of early neonatal deaths would have been prevented. Percentages preventable were higher among Indigenous (22.2% of preterm births, 17.9% of LBW, 20.5% of SGA and 19.6% of early neonatal deaths) and Black women (6% of preterm births, 21.4% of LBW, 22.8% of SGA births and 20.1% of early neonatal deaths). AF was higher in groups with fewer years of education among Indigenous, Black and Parda for all outcomes. AF increased over time, especially among Indigenous populations. Interpretation A considerable portion of adverse birth outcomes and neonatal deaths could be avoided if ethnic-racial inequalities were non-existent in Brazil. Acting on the causes of these inequalities must be central in maternal and child health policies. Funding Bill & Melinda Gates Foundation and Wellcome Trust.
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Affiliation(s)
- Poliana Rebouças
- Center for Data and Knowledge Integration for Health (CIDACS), Gonçalo Moniz Institute, Oswaldo Cruz Foundation, Salvador, Bahia, Brazil
| | - Enny S. Paixão
- Center for Data and Knowledge Integration for Health (CIDACS), Gonçalo Moniz Institute, Oswaldo Cruz Foundation, Salvador, Bahia, Brazil
- Maternal, Adolescent, Reproductive & Child Health (MARCH) Centre, London School of Hygiene & Tropical Medicine, London, UK
| | - Dandara Ramos
- Center for Data and Knowledge Integration for Health (CIDACS), Gonçalo Moniz Institute, Oswaldo Cruz Foundation, Salvador, Bahia, Brazil
- Instituto de Saúde Coletiva, Federal University of Bahia, Salvador, Bahia, Brazil
| | - Julia Pescarini
- Center for Data and Knowledge Integration for Health (CIDACS), Gonçalo Moniz Institute, Oswaldo Cruz Foundation, Salvador, Bahia, Brazil
| | - Elzo Pereira Pinto-Junior
- Center for Data and Knowledge Integration for Health (CIDACS), Gonçalo Moniz Institute, Oswaldo Cruz Foundation, Salvador, Bahia, Brazil
| | - Ila R. Falcão
- Center for Data and Knowledge Integration for Health (CIDACS), Gonçalo Moniz Institute, Oswaldo Cruz Foundation, Salvador, Bahia, Brazil
| | - Maria Yury Ichihara
- Center for Data and Knowledge Integration for Health (CIDACS), Gonçalo Moniz Institute, Oswaldo Cruz Foundation, Salvador, Bahia, Brazil
| | - Samila Sena
- Center for Data and Knowledge Integration for Health (CIDACS), Gonçalo Moniz Institute, Oswaldo Cruz Foundation, Salvador, Bahia, Brazil
| | - Rafael Veiga
- Center for Data and Knowledge Integration for Health (CIDACS), Gonçalo Moniz Institute, Oswaldo Cruz Foundation, Salvador, Bahia, Brazil
| | - Rita Ribeiro
- Center for Data and Knowledge Integration for Health (CIDACS), Gonçalo Moniz Institute, Oswaldo Cruz Foundation, Salvador, Bahia, Brazil
- Faculdade de Nutrição, Federal University of Bahia, Salvador, Bahia, Brazil
| | - Laura C. Rodrigues
- Faculty of Epidemiology and Population Health, London School of Hygiene & Tropical Medicine, London, UK
| | - Maurício L. Barreto
- Center for Data and Knowledge Integration for Health (CIDACS), Gonçalo Moniz Institute, Oswaldo Cruz Foundation, Salvador, Bahia, Brazil
- Instituto de Saúde Coletiva, Federal University of Bahia, Salvador, Bahia, Brazil
| | - Emanuelle F. Goes
- Center for Data and Knowledge Integration for Health (CIDACS), Gonçalo Moniz Institute, Oswaldo Cruz Foundation, Salvador, Bahia, Brazil
- Instituto de Saúde Coletiva, Federal University of Bahia, Salvador, Bahia, Brazil
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2
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Falcão IR, Ribeiro-Silva RDC, Fiaccone RL, Alves FJO, Rocha ADS, Ortelan N, Silva NJ, Rebouças P, Pinto Júnior EP, de Almeida MF, Paixao ES, Pescarini JM, Rodrigues LC, Ichihara MY, Barreto ML. Participation in Conditional Cash Transfer Program During Pregnancy and Birth Weight-Related Outcomes. JAMA Netw Open 2023; 6:e2344691. [PMID: 38015506 PMCID: PMC10685879 DOI: 10.1001/jamanetworkopen.2023.44691] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 07/26/2023] [Accepted: 10/10/2023] [Indexed: 11/29/2023] Open
Abstract
Importance There is limited evidence of the association of conditional cash transfers, an important strategy to reduce poverty, with prevention of adverse birth-related outcomes. Objective To investigate the association between receiving benefits from the Bolsa Família Program (BFP) and birth weight indicators. Design, Setting, and Participants This cohort study used a linked data resource, the Centro de Integracao de Dados e Conhecimentos Para Saude (CIDACS) birth cohort. All live-born singleton infants born to mothers registered in the cohort between January 2012 and December 2015 were included. Each analysis was conducted for the overall population and separately by level of education, self-reported maternal race, and number of prenatal appointments. Data were analyzed from January 3 to April 24, 2023. Exposure Live births of mothers who had received BFP until delivery (for a minimum of 9 months) were classified as exposed and compared with live births from mothers who did not receive the benefit prior to delivery. Main Outcomes and Measures Low birth weight (LBW), birth weight in grams, and small for gestational age (SGA) were evaluated. Analytical methods used included propensity score estimation, kernel matching, and weighted logistic and linear regressions. Race categories included Parda, which translates from Portuguese as "brown" and is used to denote individuals whose racial background is predominantly Black and those with multiracial or multiethnic ancestry, including European, African, and Indigenous origins. Results A total of 4 277 523 live births (2 085 737 females [48.8%]; 15 207 among Asian [0.4%], 334 225 among Black [7.8%], 29 115 among Indigenous [0.7%], 2 588 363 among Parda [60.5%], and 1 310 613 among White [30.6%] mothers) were assessed. BFP was associated with an increase of 17.76 g (95% CI, 16.52-19.01 g) in birth weight. Beneficiaries had an 11% lower chance of LBW (odds ratio [OR], 0.89; 95% CI, 0.88-0.90). BFP was associated with a greater decrease in odds of LBW among subgroups of mothers who attended fewer than 7 appointments (OR, 0.85; 95% CI, 0.84-0.87), were Indigenous (OR, 0.73; 95% CI, 0.61-0.88), and had 3 or less years of education (OR, 0.76; 95% CI, 0.72-0.81). There was no association between BFP and SGA, except among less educated mothers, who had a reduced risk of SGA (OR, 0.83; 95% CI, 0.79-0.88). Conclusions and Relevance This study found that BFP was associated with increased birth weight and reduced odds of LBW, with a greater decrease in odds of LBW among higher-risk groups. These findings suggest the importance of maintaining financial support for mothers at increased risk of birth weight-related outcomes.
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Affiliation(s)
- Ila R. Falcão
- Centre for Data and Knowledge Integration for Health, Oswaldo Cruz Foundation, Salvador, Brazil
| | - Rita de Cássia Ribeiro-Silva
- Centre for Data and Knowledge Integration for Health, Oswaldo Cruz Foundation, Salvador, Brazil
- School of Nutrition, Federal University of Bahia, Salvador, Brazil
| | - Rosemeire L. Fiaccone
- Centre for Data and Knowledge Integration for Health, Oswaldo Cruz Foundation, Salvador, Brazil
- Department of Statistics, Federal University of Bahia, Salvador, Brazil
| | | | - Aline dos Santos Rocha
- Centre for Data and Knowledge Integration for Health, Oswaldo Cruz Foundation, Salvador, Brazil
- School of Nutrition, Federal University of Bahia, Salvador, Brazil
| | - Naiá Ortelan
- Centre for Data and Knowledge Integration for Health, Oswaldo Cruz Foundation, Salvador, Brazil
| | - Natanael J. Silva
- Centre for Data and Knowledge Integration for Health, Oswaldo Cruz Foundation, Salvador, Brazil
- Barcelona Institute for Global Health, Hospital Clinic, Barcelona, Spain
| | - Poliana Rebouças
- Centre for Data and Knowledge Integration for Health, Oswaldo Cruz Foundation, Salvador, Brazil
| | | | | | - Enny S. Paixao
- Centre for Data and Knowledge Integration for Health, Oswaldo Cruz Foundation, Salvador, Brazil
- Epidemiology and Population Health, London School of Hygiene and Tropical Medicine, London, United Kingdom
| | - Júlia M. Pescarini
- Centre for Data and Knowledge Integration for Health, Oswaldo Cruz Foundation, Salvador, Brazil
- Epidemiology and Population Health, London School of Hygiene and Tropical Medicine, London, United Kingdom
| | - Laura C. Rodrigues
- Centre for Data and Knowledge Integration for Health, Oswaldo Cruz Foundation, Salvador, Brazil
- Epidemiology and Population Health, London School of Hygiene and Tropical Medicine, London, United Kingdom
| | - Maria Yury Ichihara
- Centre for Data and Knowledge Integration for Health, Oswaldo Cruz Foundation, Salvador, Brazil
- Institute of Collective Health, Federal University of Bahia, Salvador, Bahia, Brazil
| | - Mauricio L. Barreto
- Centre for Data and Knowledge Integration for Health, Oswaldo Cruz Foundation, Salvador, Brazil
- Institute of Collective Health, Federal University of Bahia, Salvador, Bahia, Brazil
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Guarnizo-Herreño CC, Buitrago G, Wehby GL. Changes in birth outcomes and utilization of prenatal care during the COVID-19 pandemic in 2020: a secondary analysis of vital statistics in Colombia. BMC Pediatr 2023; 23:234. [PMID: 37173676 PMCID: PMC10175897 DOI: 10.1186/s12887-023-04027-9] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 07/26/2022] [Accepted: 04/22/2023] [Indexed: 05/15/2023] Open
Abstract
BACKGROUND Birth outcomes could have been affected by the COVID-19 pandemic through changes in access to prenatal services and other pathways. The aim of this study was to examine the effects of the COVID-19 pandemic on fetal death, birth weight, gestational age, number of prenatal visits, and caesarean delivery in 2020 in Colombia. METHODS We conducted a secondary analysis of data on 3,140,010 pregnancies and 2,993,534 live births from population-based birth certificate and fetal death certificate records in Colombia between 2016 and 2020. Outcomes were compared separately for each month during 2020 with the same month in 2019 and pre-pandemic trends were examined in regression models controlling for maternal age, educational level, marital status, type of health insurance, place of residence (urban/rural), municipality of birth, and the number of pregnancies the mother has had before last pregnancy. RESULTS We found some evidence for a decline in miscarriage risk in some months after the pandemic start, while there was an apparent lagging increase in stillbirth risk, although not statistically significant after correction for multiple comparisons. Birth weight increased during the onset of the pandemic, a change that does not appear to be driven by pre-pandemic trends. Specifically, mean birth weight was higher in 2020 than 2019 for births in April through December by about 12 to 21 g (p < 0.01). There was also a lower risk of gestational age at/below 37 weeks in 2020 for two months following the pandemic (April, June), but a higher risk in October. Finally, there was a decline in prenatal visits in 2020 especially in June-October, but no evidence of a change in C-section delivery. CONCLUSIONS The study findings suggest mixed early effects of the pandemic on perinatal outcomes and prenatal care utilization in Colombia. While there was a significant decline in prenatal visits, other factors may have had counter effects on perinatal health including an increase in birth weight on average.
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Affiliation(s)
| | - Giancarlo Buitrago
- Facultad de Medicina, Universidad Nacional de Colombia, Bogotá, Colombia
- Hospital Universitario Nacional de Colombia, Bogotá, Colombia
| | - George L Wehby
- Department of Health Management and Policy, College of Public Health, University of Iowa, Iowa, USA
- National Bureau of Economic Research, Cambridge, MA, USA
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Falcão IR, Ribeiro-Silva RDC, Alves FJO, Ortelan N, Silva NJ, Fiaccone RL, de Almeida MF, Pescarini JM, Lisboa CS, Júnior EPP, Paixao ES, Ferreira AJF, Teixeira CSS, Rocha ADS, Katikireddi SV, Ali MS, Dundas R, Leyland A, Rodrigues LC, Ichihara MY, Barreto ML. Evaluating the effect of Bolsa Familia, Brazil's conditional cash transfer programme, on maternal and child health: A study protocol. PLoS One 2022; 17:e0268500. [PMID: 35604890 PMCID: PMC9126365 DOI: 10.1371/journal.pone.0268500] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/17/2021] [Accepted: 05/01/2022] [Indexed: 11/19/2022] Open
Abstract
BACKGROUND Conditional Cash Transfer Programs have been developed in Latin America in response to poverty and marked social inequalities on the continent. In Brazil, the Bolsa Familia Program (BFP) was implemented to alleviate poverty and improve living conditions, health, and education for socioeconomically vulnerable populations. However, the effect of this intervention on maternal and child health is not well understood. METHODS We will evaluate the effect of BFP on maternal and child outcomes: 1. Birth weight; 2. Preterm birth; 3. Maternal mortality; and 4. Child growth. Dynamic retrospective cohort data from the 100 Million Brazilian Cohort (2001 to 2015) will be linked to three different databases: Live Birth Information System (2004 to 2015); Mortality Information System (2011 to 2015); and Food and Nutritional Surveillance System (2008 to 2017). The definition of exposure to the BFP varies according to the outcome studied. Those who never received the benefit until the outcome or until the end of the follow-up will be defined as not exposed. The effects of BFP on maternal and child outcomes will be estimated by a combination of propensity score-based methods and weighted logistic regressions. The analyses will be further stratified to reflect changes in the benefit entitlement before and after 2012. DISCUSSION Harnessing a large linked administrative cohort allows us to assess the effect of the BFP on maternal and child health, while considering a wide range of explanatory and confounding variables.
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Affiliation(s)
- Ila Rocha Falcão
- School of Nutrition, Federal University of Bahia, Salvador, Brazil
- Centre for Data and Knowledge Integration for Health (CIDACS), Oswaldo Cruz Foundation, Salvador, Brazil
| | - Rita de Cássia Ribeiro-Silva
- School of Nutrition, Federal University of Bahia, Salvador, Brazil
- Centre for Data and Knowledge Integration for Health (CIDACS), Oswaldo Cruz Foundation, Salvador, Brazil
| | - Flávia Jôse Oliveira Alves
- Centre for Data and Knowledge Integration for Health (CIDACS), Oswaldo Cruz Foundation, Salvador, Brazil
- Institute of Collective Health, Federal University of Bahia, Salvador, Brazil
| | - Naiá Ortelan
- Centre for Data and Knowledge Integration for Health (CIDACS), Oswaldo Cruz Foundation, Salvador, Brazil
| | - Natanael J. Silva
- Centre for Data and Knowledge Integration for Health (CIDACS), Oswaldo Cruz Foundation, Salvador, Brazil
| | - Rosemeire L. Fiaccone
- Centre for Data and Knowledge Integration for Health (CIDACS), Oswaldo Cruz Foundation, Salvador, Brazil
- Department of Statistics, Federal University of Bahia, Salvador, Brazil
| | | | - Júlia M. Pescarini
- Centre for Data and Knowledge Integration for Health (CIDACS), Oswaldo Cruz Foundation, Salvador, Brazil
- Epidemiology and Population Health, London School of Hygiene and Tropical Medicine, London, United Kingdom
| | - Cinthia Soares Lisboa
- Centre for Data and Knowledge Integration for Health (CIDACS), Oswaldo Cruz Foundation, Salvador, Brazil
- Feira de Santana State University, Feira de Santana, Brazil
| | - Elzo Pereira Pinto Júnior
- Centre for Data and Knowledge Integration for Health (CIDACS), Oswaldo Cruz Foundation, Salvador, Brazil
| | - Enny S. Paixao
- Centre for Data and Knowledge Integration for Health (CIDACS), Oswaldo Cruz Foundation, Salvador, Brazil
- Epidemiology and Population Health, London School of Hygiene and Tropical Medicine, London, United Kingdom
| | - Andrea J. F. Ferreira
- Centre for Data and Knowledge Integration for Health (CIDACS), Oswaldo Cruz Foundation, Salvador, Brazil
- Institute of Collective Health, Federal University of Bahia, Salvador, Brazil
| | - Camila Silveira Silva Teixeira
- Centre for Data and Knowledge Integration for Health (CIDACS), Oswaldo Cruz Foundation, Salvador, Brazil
- Institute of Collective Health, Federal University of Bahia, Salvador, Brazil
| | - Aline dos Santos Rocha
- School of Nutrition, Federal University of Bahia, Salvador, Brazil
- Centre for Data and Knowledge Integration for Health (CIDACS), Oswaldo Cruz Foundation, Salvador, Brazil
| | | | - M. Sanni Ali
- Epidemiology and Population Health, London School of Hygiene and Tropical Medicine, London, United Kingdom
| | - Ruth Dundas
- MRC/CSO Social and Public Health Sciences Unit, University of Glasgow, Glasgow, Scotland
| | - Alastair Leyland
- MRC/CSO Social and Public Health Sciences Unit, University of Glasgow, Glasgow, Scotland
| | - Laura C. Rodrigues
- Centre for Data and Knowledge Integration for Health (CIDACS), Oswaldo Cruz Foundation, Salvador, Brazil
- Epidemiology and Population Health, London School of Hygiene and Tropical Medicine, London, United Kingdom
| | - Maria Yury Ichihara
- Centre for Data and Knowledge Integration for Health (CIDACS), Oswaldo Cruz Foundation, Salvador, Brazil
- Institute of Collective Health, Federal University of Bahia, Salvador, Brazil
| | - Mauricio L. Barreto
- Centre for Data and Knowledge Integration for Health (CIDACS), Oswaldo Cruz Foundation, Salvador, Brazil
- Institute of Collective Health, Federal University of Bahia, Salvador, Brazil
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Blanco E, Marcela M, Nuñez L, Retamal E, Ossa X, Woolley KE, Oludotun T, Bartington SE, Delgado-Saborit JM, Harrison RM, Ruiz-Rudolph P, Quinteros ME. Adverse pregnancy and perinatal outcomes in Latin America and the Caribbean: systematic review and meta-analysis. Rev Panam Salud Publica 2022; 46:e21. [PMID: 35509645 PMCID: PMC9060182 DOI: 10.26633/rpsp.2022.21] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/21/2021] [Accepted: 02/15/2022] [Indexed: 12/04/2022] Open
Abstract
Objective. To estimate the point prevalence and likely ranges of pregnancy-induced hypertension, pre-eclampsia, gestational diabetes, low birth weight and preterm delivery in Latin America and the Caribbean, and evaluate the heterogeneity of the estimates. Methods. We conducted a systematic review and meta-analysis of observational studies reporting the prevalence of maternal and perinatal adverse outcomes in populations in Latin American and the Caribbean published between 2000 and 2019 in English, Spanish, or Portuguese. We searched PubMed, Embase, and LILACS. We estimated the point prevalence and evaluated overall heterogeneity and, in sub-group analyses, heterogeneity by study design and level of bias. Results. Of 1087 records retrieved, 50 articles were included in the review: two on hypertensive disorders of pregnancy, 14 on pre-eclampsia, six on gestational diabetes, nine on low birth weight and 19 on preterm birth. No meta-analysis for hypertensive disorders of pregnancy could be done because of the small number of studies. Point prevalence estimates and 95% confidence intervals (CIs) for pre-eclampsia, gestational diabetes, low birth weight, and preterm birth were: 6.6% (95% CI: 4.9%, 8.6%), 8.5% (95% CI: 3.9%, 14.7%), 8.5% (95% CI: 7.2%, 9.8%), and 10.0% (95% CI: 8.0%, 12.0%), respectively. We observed substantial heterogeneity overall and by study design. No major differences in estimates were observed by level of bias. Conclusions. The results of this study provide updated estimates of some of the most prevalent adverse pregnancy and perinatal outcomes in Latin America and the Caribbean. They highlight that important heterogeneity exists in prevalence estimates, which may reflect the diversity of populations in the region.
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Affiliation(s)
- Estela Blanco
- Facultad de Medicina, Pontifica Universidad Católica, Santiago, Chile
| | - Marin Marcela
- Facultad de Ciencias de la Salud, Universidad de Talca, Talca, Chile
| | - Loreto Nuñez
- Facultad de Ciencias de la Salud, Universidad de Talca, Talca, Chile
| | - Erika Retamal
- Facultad de Ciencias de la Salud, Universidad de Talca, Talca, Chile
| | - Ximena Ossa
- Departamento de Salud Pública y Centro de Excelencia CIGES, Universidad de la Frontera, Temuco, Chile
| | - Katherine E. Woolley
- Institute of Applied Health Research, University of Birmingham, Birmingham, United Kingdom of Great Britain and Northern Ireland
| | - Tosin Oludotun
- Institute of Applied Health Research, University of Birmingham, Birmingham, United Kingdom of Great Britain and Northern Ireland
| | - Suzanne E. Bartington
- Institute of Applied Health Research, University of Birmingham, Birmingham, United Kingdom of Great Britain and Northern Ireland
| | | | - Roy M. Harrison
- School of Geography, Earth & Environmental Sciences, University of Birmingham, Birmingham, United Kingdom
| | - Pablo Ruiz-Rudolph
- Instituto de Salud Poblacional, Facultad de Medicina, Universidad de Chile, Santiago, Chile
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Di Giacomo M, Piacenza M, Siciliani L, Turati G. The effect of co-payments on the take-up of prenatal tests. JOURNAL OF HEALTH ECONOMICS 2022; 81:102553. [PMID: 34808492 DOI: 10.1016/j.jhealeco.2021.102553] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 01/13/2021] [Revised: 10/29/2021] [Accepted: 11/01/2021] [Indexed: 06/13/2023]
Abstract
Noninvasive prenatal screening tests help identify genetic disorders in a fetus, but their take-up remains low in several countries. Using a regression discontinuity design, we test the causal effect of a policy that eliminated co-payments for noninvasive screening tests in Italy. We identify the treatment effects by a discontinuity in women's eligibility for a free test based on their conception date. We find that the policy increases the probability of women's undergoing noninvasive screening tests by 5.5 percentage points, and the effect varies by socioeconomic status. We do not find evidence of substitution effects with more expensive and riskier invasive diagnostic tests. In addition, the increase in take-up does not affect pregnancy termination or newborn health. We find some evidence of positive effects on mothers' health behaviors during pregnancy as measured by reductions in mothers' weight gain and hospital admissions during pregnancy, but these are statistically significant only at the 10 percent level.
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Affiliation(s)
- Marina Di Giacomo
- University of Torino, Department of Economics, Social Sciences, Applied Mathematics and Statistics (ESOMAS).
| | - Massimiliano Piacenza
- University of Piemonte Orientale, Department of Economics and Business (DISEI), Novara, Italy.
| | - Luigi Siciliani
- University of York, Department of Economics and Related Studies, York, United Kingdom.
| | - Gilberto Turati
- Università Cattolica del Sacro Cuore, Department of Economics and Finance, Rome, Italy.
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7
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Falcão IR, Ribeiro-Silva RDC, de Almeida MF, Fiaccone RL, Silva NJ, Paixao ES, Ichihara MY, Rodrigues LC, Barreto ML. Factors associated with small- and large-for-gestational-age in socioeconomically vulnerable individuals in the 100 Million Brazilian Cohort. Am J Clin Nutr 2021; 114:109-116. [PMID: 33826704 PMCID: PMC8246620 DOI: 10.1093/ajcn/nqab033] [Citation(s) in RCA: 14] [Impact Index Per Article: 4.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/04/2020] [Accepted: 01/29/2021] [Indexed: 02/05/2023] Open
Abstract
BACKGROUND Evidence points to diverse risk factors associated with small- (SGA) and large-for-gestational-age (LGA) births. A more comprehensive understanding of these factors is imperative, especially in vulnerable populations. OBJECTIVES To estimate the occurrence of and sociodemographic factors associated with SGA and LGA births in poor and extremely poor populations of Brazil. METHODS The study population consisted of women of reproductive age (14-49 y), whose last child was born between 2012 and 2015. INTERGROWTH 21st consortium criteria were used to classify weight for gestational age according to sex. Multinomial logistic regression modeling was performed to investigate associations of interest. RESULTS Of 5,521,517 live births analyzed, SGA and LGA corresponded to 7.8% and 17.1%, respectively. Multivariate analysis revealed greater odds of SGA in children born to women who self-reported as black (OR: 1.21; 95% CI: 1.19, 1.22), mixed-race (parda) (OR: 1.08; 95% CI: 1.07, 1.09), or indigenous (OR: 1.11; 95% CI: 1.06, 1.15), were unmarried (OR: 1.08; 95% CI: 1.07, 1.08), illiterate (OR: 1.47; 95% CI: 1.42, 1.52), did not receive prenatal care (OR: 1.57; 95% CI: 1.53, 1.60), or were aged 14-20 y (OR: 1.21; 95% CI: 1.20, 1.22) or 35-49 y (OR: 1.12; 95% CI: 1.10, 1.13). Considering LGA children, higher odds were found in infants born to women living in households with ≥3 inadequate housing conditions (OR: 1.11; 95% CI: 1.10, 1.12), in indigenous women (OR: 1.22; 95% CI: 1.19, 1.25), those who had 1-3 y of schooling (OR: 1.18; 95% CI: 1.17, 1.19), 1-3 prenatal visits (OR: 1.16; CI 95%: 1.14, 1.17), or were older (OR: 1.26; 95% CI: 1.25, 1.27). CONCLUSIONS In poorer Brazilian populations, socioeconomic, racial, and maternal characteristics are consistently associated with the occurrence of SGA births, but remain less clearly linked to the occurrence of LGA births.
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Affiliation(s)
| | - Rita de Cássia Ribeiro-Silva
- The School of Nutrition, Federal University of Bahia, Salvador, Brazil,Centre for Data and Knowledge Integration for Health (CIDACS), Oswaldo Cruz Foundation, Salvador, Brazil
| | | | - Rosemeire L Fiaccone
- Centre for Data and Knowledge Integration for Health (CIDACS), Oswaldo Cruz Foundation, Salvador, Brazil,Department of Statistics, Federal University of Bahia, Salvador, Brazil
| | - Natanael J Silva
- Centre for Data and Knowledge Integration for Health (CIDACS), Oswaldo Cruz Foundation, Salvador, Brazil
| | - Enny S Paixao
- Centre for Data and Knowledge Integration for Health (CIDACS), Oswaldo Cruz Foundation, Salvador, Brazil,Epidemiology and Population Health, London School of Hygiene and Tropical Medicine, London, United Kingdom
| | - Maria Yury Ichihara
- Centre for Data and Knowledge Integration for Health (CIDACS), Oswaldo Cruz Foundation, Salvador, Brazil,Institute of Collective Health, Federal University of Bahia, Salvador, Bahia, Brazil
| | - Laura C Rodrigues
- Centre for Data and Knowledge Integration for Health (CIDACS), Oswaldo Cruz Foundation, Salvador, Brazil,Epidemiology and Population Health, London School of Hygiene and Tropical Medicine, London, United Kingdom
| | - Mauricio L Barreto
- Centre for Data and Knowledge Integration for Health (CIDACS), Oswaldo Cruz Foundation, Salvador, Brazil,Institute of Collective Health, Federal University of Bahia, Salvador, Bahia, Brazil
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8
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Falcão IR, Ribeiro-Silva RDC, de Almeida MF, Fiaccone RL, Dos S Rocha A, Ortelan N, Silva NJ, Paixao ES, Ichihara MY, Rodrigues LC, Barreto ML. Factors associated with low birth weight at term: a population-based linkage study of the 100 million Brazilian cohort. BMC Pregnancy Childbirth 2020; 20:536. [PMID: 32928144 PMCID: PMC7491100 DOI: 10.1186/s12884-020-03226-x] [Citation(s) in RCA: 16] [Impact Index Per Article: 4.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/27/2020] [Accepted: 09/01/2020] [Indexed: 12/18/2022] Open
Abstract
BACKGROUND Factors associated with low birth weight at term (TLBW), a proxy for intrauterine growth restriction (IUGR), are not well-elucidated in socioeconomically vulnerable populations. This study aimed to identify the factors associated with TLBW in impoverished Brazilian women. METHODS Records in the 100 Million Brazilian Cohort database were linked to those in the National System of Information on Live Births (SINASC) to obtain obstetric, maternal, birth and socioeconomic data between 2001 and 2015. Multivariate logistic regression was performed to investigate associations between variables of exposure and TLBW. RESULTS Of 8,768,930 term live births analyzed, 3.7% presented TLBW. The highest odds of TLBW were associated with female newborns (OR: 1.49; 95% CI: 1.47-1.50), whose mothers were black (OR: 1.20; 95% CI: 1.18-1.22), had a low educational level (OR: 1.57; 95% CI: 1.53-1.62), were aged ≥35 years (OR: 1.44; 95% CI: 1.43-1.46), had a low number of prenatal care visits (OR: 2.48; 95% CI: 2.42-2.54) and were primiparous (OR: 1.62; 95% CI: 1.60-1.64). Lower odds of TLBW were found among infants whose mothers lived in the North, Northeast and Center-West regions of Brazil compared to those in the South. CONCLUSION Multiple aspects were associated with TLBW, highlighting the need to comprehensively examine the mechanisms underlying these factors, especially in more vulnerable Brazilian populations, in order to contribute to the elaboration of health policies and promote better conditions of life for poor and extremely poor mothers and children.
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Affiliation(s)
- Ila R Falcão
- School of Nutrition, Federal University of Bahia, Salvador, Brazil.
- Center for Data and Knowledge Integration for Health (CIDACS), Oswaldo Cruz Foundation, Salvador, Brazil.
| | - Rita de Cássia Ribeiro-Silva
- School of Nutrition, Federal University of Bahia, Salvador, Brazil
- Center for Data and Knowledge Integration for Health (CIDACS), Oswaldo Cruz Foundation, Salvador, Brazil
| | | | - Rosemeire L Fiaccone
- Center for Data and Knowledge Integration for Health (CIDACS), Oswaldo Cruz Foundation, Salvador, Brazil
- Department of Statistics, Institute of Mathematics, Federal University of Bahia, Salvador, Brazil
| | - Aline Dos S Rocha
- School of Nutrition, Federal University of Bahia, Salvador, Brazil
- Center for Data and Knowledge Integration for Health (CIDACS), Oswaldo Cruz Foundation, Salvador, Brazil
| | - Naiá Ortelan
- Center for Data and Knowledge Integration for Health (CIDACS), Oswaldo Cruz Foundation, Salvador, Brazil
| | - Natanael J Silva
- Center for Data and Knowledge Integration for Health (CIDACS), Oswaldo Cruz Foundation, Salvador, Brazil
| | - Enny S Paixao
- Center for Data and Knowledge Integration for Health (CIDACS), Oswaldo Cruz Foundation, Salvador, Brazil
- Epidemiology and Population Health, London School of Hygiene and Tropical Medicine, London, UK
| | - Maria Yury Ichihara
- Center for Data and Knowledge Integration for Health (CIDACS), Oswaldo Cruz Foundation, Salvador, Brazil
- Institute of Collective Health, Federal University of Bahia, Salvador, Brazil
| | - Laura C Rodrigues
- Center for Data and Knowledge Integration for Health (CIDACS), Oswaldo Cruz Foundation, Salvador, Brazil
- Epidemiology and Population Health, London School of Hygiene and Tropical Medicine, London, UK
| | - Mauricio L Barreto
- Center for Data and Knowledge Integration for Health (CIDACS), Oswaldo Cruz Foundation, Salvador, Brazil
- Institute of Collective Health, Federal University of Bahia, Salvador, Brazil
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9
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Baldewsingh GK, Wickliffe JK, van Eer ED, Shankar A, Hindori-Mohangoo AD, Harville EW, Covert HH, Shi L, Lichtveld MY, Zijlmans WC. Prenatal Mercury Exposure in Pregnant Women from Suriname's Interior and Its Effects on Birth Outcomes. INTERNATIONAL JOURNAL OF ENVIRONMENTAL RESEARCH AND PUBLIC HEALTH 2020; 17:ijerph17114032. [PMID: 32517037 PMCID: PMC7312160 DOI: 10.3390/ijerph17114032] [Citation(s) in RCA: 8] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 05/01/2020] [Revised: 06/03/2020] [Accepted: 06/03/2020] [Indexed: 12/26/2022]
Abstract
Prenatal mercury (Hg) exposure was determined in a sub-cohort of the Caribbean Consortium for Environmental and Occupational Health’s environmental epidemiologic prospective cohort study of pregnant women living in Suriname’s interior. The associations between Hg exposure, low birth weight (LBW, <2500 g) and preterm birth (PTB, <37 weeks) were explored. Correlation analysis, Fisher’s exact test and logistic regression analyses were conducted to evaluate the associations between maternal hair Hg levels and birth weight, LBW and PTB, and between potential confounders, LBW and PTB, respectively. Among 204 singleton births were 198 live births, five stillbirths and one miscarriage. The mean participant age was 26 years; 15.7% of participants had PTBs and 8.1% delivered a child with a LBW. The median hair Hg level was 3.48 μg/g hair. Low hair Hg exposure, based on lowest tertile < 2.34 μg/g, was associated with LBW (OR = 7.2; 95% CI 1.5–35.6; p = 0.015); this association was independent of maternal age, ethnic background, household income and village location, and no correlation was found between hair Hg and PTB. Young maternal age was associated with PTB (RR = 5.09, 95% CI: 1.92–13.85; p = 0.0004) while maternal age was not associated with hair Hg or LBW. The impact of prenatal Hg exposure on pediatric neurodevelopment is currently being evaluated in the infant sub-cohort.
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Affiliation(s)
- Gaitree K. Baldewsingh
- Medical Mission Primary Health Care Suriname, Paramaribo, Suriname;
- Faculty of Medical Sciences, Anton de Kom University of Suriname, Paramaribo, Suriname;
- Correspondence:
| | - Jeffrey K. Wickliffe
- School of Public Health and Tropical Medicine, Tulane University, New Orleans, LA 70112, USA; (J.K.W.); (A.S.); (A.D.H.-M.); (E.W.H.); (H.H.C.); (L.S.); (M.Y.L.)
| | | | - Arti Shankar
- School of Public Health and Tropical Medicine, Tulane University, New Orleans, LA 70112, USA; (J.K.W.); (A.S.); (A.D.H.-M.); (E.W.H.); (H.H.C.); (L.S.); (M.Y.L.)
| | - Ashna D. Hindori-Mohangoo
- School of Public Health and Tropical Medicine, Tulane University, New Orleans, LA 70112, USA; (J.K.W.); (A.S.); (A.D.H.-M.); (E.W.H.); (H.H.C.); (L.S.); (M.Y.L.)
- Foundation for Perinatal Interventions and Research in Suriname (Perisur), Paramaribo, Suriname
| | - Emily W. Harville
- School of Public Health and Tropical Medicine, Tulane University, New Orleans, LA 70112, USA; (J.K.W.); (A.S.); (A.D.H.-M.); (E.W.H.); (H.H.C.); (L.S.); (M.Y.L.)
| | - Hannah H. Covert
- School of Public Health and Tropical Medicine, Tulane University, New Orleans, LA 70112, USA; (J.K.W.); (A.S.); (A.D.H.-M.); (E.W.H.); (H.H.C.); (L.S.); (M.Y.L.)
| | - Lizheng Shi
- School of Public Health and Tropical Medicine, Tulane University, New Orleans, LA 70112, USA; (J.K.W.); (A.S.); (A.D.H.-M.); (E.W.H.); (H.H.C.); (L.S.); (M.Y.L.)
| | - Maureen Y. Lichtveld
- School of Public Health and Tropical Medicine, Tulane University, New Orleans, LA 70112, USA; (J.K.W.); (A.S.); (A.D.H.-M.); (E.W.H.); (H.H.C.); (L.S.); (M.Y.L.)
- Scientific Research Center Suriname/Academic Hospital Paramaribo, Paramaribo, Suriname
| | - Wilco C.W.R. Zijlmans
- Faculty of Medical Sciences, Anton de Kom University of Suriname, Paramaribo, Suriname;
- School of Public Health and Tropical Medicine, Tulane University, New Orleans, LA 70112, USA; (J.K.W.); (A.S.); (A.D.H.-M.); (E.W.H.); (H.H.C.); (L.S.); (M.Y.L.)
- Scientific Research Center Suriname/Academic Hospital Paramaribo, Paramaribo, Suriname
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10
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Zarante I, Hurtado-Villa P, Walani SR, Kancherla V, López Camelo J, Giugliani R, Groisman B, Howson CP, Durán P. A consensus statement on birth defects surveillance, prevention, and care in Latin America and the Caribbean. Rev Panam Salud Publica 2019; 43:e2. [PMID: 31093226 PMCID: PMC6419921 DOI: 10.26633/rpsp.2019.2] [Citation(s) in RCA: 8] [Impact Index Per Article: 1.6] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/12/2018] [Accepted: 10/11/2018] [Indexed: 11/24/2022] Open
Abstract
Birth defects contribute up to 21% of the mortality in those under 5 years of age in Latin America and the Caribbean (LAC), and that burden has been compounded by the Zika virus epidemic. In 2001, the March of Dimes launched a series of biennial assemblies called the International Conference on Birth Defects and Disabilities in the Developing World (ICBD). The latest ICBD, in 2017, convened in Bogotá, Colombia, and was attended by over 300 professionals, policymakers, and donors. The conference attendees, a majority of whom were from LAC, supported a call to action in the form of a consensus statement. The consensus statement lists key actions for maximizing birth defects surveillance, prevention, and care in LAC: 1) improving surveillance; 2) reducing risks for birth defects; 3) fortifying staple foods; 4) preventing and treating infections associated with birth defects; 5) implementing newborn screening; 6) providing care and services for people with birth defects and disabilities; 7) involving governments, civil society, and international agencies; and 8) advancing research for birth defects. Implementation and scale-up of evidence-based interventions using multisectoral and multidisciplinary collaborative approaches were endorsed. LAC countries can leverage technology and social media to advance and advocate for approaches identified in the consensus statement. The consensus statement can be used as a guide by both governments and nongovernmental agencies to take immediate steps for improving the quality of life of those living with birth defects and associated disabilities in the LAC countries.
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Affiliation(s)
- Ignacio Zarante
- Pontificia Universidad Javeriana Pontificia Universidad Javeriana School of Medicine Human Genetics Institute Bogotá Colombia Human Genetics Institute, School of Medicine, Pontificia Universidad Javeriana, Bogotá, Colombia
| | - Paula Hurtado-Villa
- Pontificia Universidad Javeriana Pontificia Universidad Javeriana Faculty of Health Sciences Basic Health Sciences Department Cali Colombia Basic Health Sciences Department, Faculty of Health Sciences, Pontificia Universidad Javeriana, Cali, Colombia
| | - Salimah R Walani
- March of Dimes March of Dimes ArlingtonVirginia United States of America March of Dimes, Arlington, Virginia, United States of America
| | - Vijaya Kancherla
- Emory University Rollins School of Public Health Department of Epidemiology Center for Spina Bifida Prevention AtlantaGeorgia United States of America Center for Spina Bifida Prevention, Department of Epidemiology, Rollins School of Public Health, Emory University, Atlanta, Georgia, United States of America
| | - Jorge López Camelo
- Center for Medical Education and Clinical Research (CEMIC-CONICET) Center for Medical Education and Clinical Research (CEMIC-CONICET) Latin American Collaborative Study of Congenital Malformations (ECLAMC) Buenos Aires Argentina Latin American Collaborative Study of Congenital Malformations (ECLAMC), Center for Medical Education and Clinical Research (CEMIC-CONICET), Buenos Aires, Argentina
| | - Roberto Giugliani
- Hospital de Clinicas de Porto Alegre Federal University of Rio Grande do Sul Medical Genetics Service Department of Genetics Porto Alegre Brasil Department of Genetics, Federal University of Rio Grande do Sul, Medical Genetics Service, Hospital de Clinicas de Porto Alegre, Porto Alegre, Brazil
| | - Boris Groisman
- National Administration of Laboratories and Health Institutes National Administration of Laboratories and Health Institutes National Center of Medical Genetics National Network of Congenital Anomalies of Argentina Buenos Aires Argentina National Network of Congenital Anomalies of Argentina, National Center of Medical Genetics, National Administration of Laboratories and Health Institutes, Buenos Aires, Argentina
| | - Christopher P Howson
- Howson & Partners for Global Health Howson & Partners for Global Health Santa FeNew Mexico United States of America Howson & Partners for Global Health, Santa Fe, New Mexico, United States of America
| | - Pablo Durán
- Pan American Health Organization/World Health Organization Pan American Health Organization/World Health Organization Women's and Reproductive Health Latin American Center for Perinatology Montevideo Uruguay Latin American Center for Perinatology, Women's and Reproductive Health, Pan American Health Organization/World Health Organization, Montevideo, Uruguay
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11
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Wehby GL, López-Camelo JS. Maternal Education Gradients in Infant Health in Four South American Countries. Matern Child Health J 2018; 21:2122-2131. [PMID: 28699095 DOI: 10.1007/s10995-017-2327-7] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/19/2022]
Abstract
Objective We investigate gradients (i.e. differences) in infant health outcomes by maternal education in Argentina, Brazil, Chile, and Venezuela and explore channels related to father's education, household labor outcomes, and maternal health, fertility, and use of prenatal services and technology. Methods We employ secondary interview and birth record data similarly collected across a network of birth hospitals from the early 1980s through 2011 within the Latin American Collaborative Study of Congenital Anomalies (ECLAMC). Focusing on children without birth defects, we estimate gradients in several infant health outcomes including birth weight, gestational age, and hospital discharge status by maternal education using ordinary least squares regression models adjusting for several demographic factors. To explore channels, we add as covariates father's education, parental occupational activity, maternal health and fertility history, and use of prenatal services and technology and evaluate changes in the coefficient of maternal education. We use the same models for each country sample. Results We find important differences in gradients across countries. We find evidence for educational gradients in preterm birth in three countries but weaker evidence for gradients in fetal growth. The extent to which observed household and maternal factors explain these gradients based on changes in the regression coefficient of maternal education when controlling for these factors as covariates also varies between countries. In contrast, we generally find evidence across all countries that higher maternal education is associated with increased use of prenatal care services and technology. Conclusions Our findings suggest that differences in infant health by maternal education and their underlying mechanisms vary and are not necessarily generalizable across countries. However, the positive association between maternal education and use of prenatal services and technology is more consistent across examined countries.
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Affiliation(s)
- George L Wehby
- Departments of Health Management and Policy, Economics, and Preventive & Community Dentistry, and Public Policy Center, University of Iowa, 145 N. Riverside Dr., 100 College of Public Health Bldg., Room N250, Iowa City, IA, 52242-2007, USA. .,National Bureau of Economic Research, Cambridge, MA, USA.
| | - Jorge S López-Camelo
- Center of Medical Education and Clinical Investigation/Centro de Educación Médica e Investigación Clínica (CEMIC), Buenos Aires, Argentina
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12
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Pawluk MS, Campaña H, Rittler M, Poletta FA, Cosentino VR, Gili JA, Gimenez LG, López Camelo JS. Individual deprivation, regional deprivation, and risk for oral clefts in Argentina. Rev Panam Salud Publica 2018; 41:e110. [PMID: 29466515 PMCID: PMC6645331] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/28/2016] [Accepted: 11/17/2016] [Indexed: 10/14/2023] Open
Abstract
OBJECTIVE The aim of this study was to analyze the effects of individual low socioeconomic status (SES) and deprived geographical area (GA) on the occurrence of isolated cleft lip with or without cleft palate (CL±P) in Argentina. METHODS This case-control study included 577 newborns with isolated CL±P and 13 344 healthy controls, born between 1992 and 2001, from a total population of 546 129 births in 39 hospitals in Argentina. Census data on unsatisfied basic needs were used to establish the degree of geographical area deprivation. An SES index for each individual was established, using maternal age, gravidity, low paternal and maternal education, and low-level paternal occupation. Logistic regression was used to assess the effects of low SES and of deprived GA on CL±P. RESULTS A slightly increased risk of CL±P was observed in mothers with a low SES, while a deprived GA showed no effect. Native ancestry, acute maternal illnesses, and poor prenatal care were significant risk factors for CL±P for the mothers with low SES, after using propensity scores to adjust for the demographic characteristics in cases and controls. CONCLUSIONS Low individual SES slightly increased the risk for CL±P, but a deprived GA did not have that effect. There was no interaction between individual SES and deprived GA. Factors related to low individual SES-including poor prenatal care, low parental education, lack of information, and lifestyle factors-should be primarily targeted as risk factors for CL±P rather than factors related to a deprived place of residence.
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Affiliation(s)
- Mariela Soledad Pawluk
- Estudio Colaborativo Latinoamericano de Malformaciones Congénitas (ECLAMC), Laboratorio de Epidemiología Genética, Centro de Educación Médica e Investigaciones Clínicas (CEMIC-CONICET), Buenos Aires, Argentina. Send correspondence to Mariela Soledad Pawluk, at
| | - Hebe Campaña
- Estudio Colaborativo Latinoamericano de Malformaciones Congénitas (ECLAMC), Laboratorio de Epidemiología Genética, Centro de Educación Médica e Investigaciones Clínicas (CEMIC-CONICET), Buenos Aires, Argentina. Send correspondence to Mariela Soledad Pawluk, at
| | - Monica Rittler
- Estudio Colaborativo Latinoamericano de Malformaciones Congénitas (ECLAMC), Hospital Materno Infantil Ramón Sarda, Buenos Aires, Argentina
| | - Fernando Adrián Poletta
- Estudio Colaborativo Latinoamericano de Malformaciones Congénitas (ECLAMC), Laboratorio de Epidemiología Genética, Centro de Educación Médica e Investigaciones Clínicas (CEMIC-CONICET), Buenos Aires, Argentina. Send correspondence to Mariela Soledad Pawluk, at
| | - Viviana R Cosentino
- Estudio Colaborativo Latinoamericano de Malformaciones Congénitas (ECLAMC), Laboratorio de Epidemiología Genética, Centro de Educación Médica e Investigaciones Clínicas (CEMIC-CONICET), Buenos Aires, Argentina. Send correspondence to Mariela Soledad Pawluk, at
| | - Juan Antonio Gili
- Estudio Colaborativo Latinoamericano de Malformaciones Congénitas (ECLAMC), Laboratorio de Epidemiología Genética, Centro de Educación Médica e Investigaciones Clínicas (CEMIC-CONICET), Buenos Aires, Argentina. Send correspondence to Mariela Soledad Pawluk, at
| | - Lucas Gabriel Gimenez
- Estudio Colaborativo Latinoamericano de Malformaciones Congénitas (ECLAMC), Laboratorio de Epidemiología Genética, Centro de Educación Médica e Investigaciones Clínicas (CEMIC-CONICET), Buenos Aires, Argentina. Send correspondence to Mariela Soledad Pawluk, at
| | - Jorge Santiago López Camelo
- Estudio Colaborativo Latinoamericano de Malformaciones Congénitas (ECLAMC), Laboratorio de Epidemiología Genética, Centro de Educación Médica e Investigaciones Clínicas (CEMIC-CONICET), Buenos Aires, Argentina. Send correspondence to Mariela Soledad Pawluk, at
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13
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Pawluk MS, Campaña H, Rittler M, Poletta FA, Cosentino VR, Gili JA, Gimenez LG, López Camelo JS. Individual deprivation, regional deprivation, and risk for oral clefts in Argentina. Rev Panam Salud Publica 2017. [PMID: 29466515 PMCID: PMC6645331 DOI: 10.26633/rpsp.2017.110] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/24/2022] Open
Abstract
Objective. The aim of this study was to analyze the effects of individual low socioeconomic status (SES) and deprived geographical area (GA) on the occurrence of isolated cleft lip with or without cleft palate (CL±P) in Argentina.
Methods. This case-control study included 577 newborns with isolated CL±P and 13 344 healthy controls, born between 1992 and 2001, from a total population of 546 129 births in 39 hospitals in Argentina. Census data on unsatisfied basic needs were used to establish the degree of geographical area deprivation. An SES index for each individual was established, using maternal age, gravidity, low paternal and maternal education, and low-level paternal occupation. Logistic regression was used to assess the effects of low SES and of deprived GA on CL±P.
Results. A slightly increased risk of CL±P was observed in mothers with a low SES, while a deprived GA showed no effect. Native ancestry, acute maternal illnesses, and poor prenatal care were significant risk factors for CL±P for the mothers with low SES, after using propensity scores to adjust for the demographic characteristics in cases and controls.
Conclusions. Low individual SES slightly increased the risk for CL±P, but a deprived GA did not have that effect. There was no interaction between individual SES and deprived GA. Factors related to low individual SES—including poor prenatal care, low parental education, lack of information, and lifestyle factors—should be primarily targeted as risk factors for CL±P rather than factors related to a deprived place of residence.
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Affiliation(s)
- Mariela Soledad Pawluk
- Estudio Colaborativo Latinoamericano de Malformaciones Congénitas (ECLAMC), Laboratorio de Epidemiología Genética, Centro de Educación Médica e Investigaciones Clínicas (CEMIC-CONICET), Buenos Aires, Argentina
| | | | - Monica Rittler
- Estudio Colaborativo Latinoamericano de Malformaciones Congénitas (ECLAMC), Hospital Materno Infantil Ramón Sarda, Buenos Aires, Argentina
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14
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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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15
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Differences in early cognitive and receptive-expressive neurodevelopment by ancestry and underlying pathways in Brazil and Argentina. Infant Behav Dev 2017; 46:100-114. [PMID: 28068525 DOI: 10.1016/j.infbeh.2016.12.001] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/21/2016] [Revised: 11/22/2016] [Accepted: 12/03/2016] [Indexed: 12/21/2022]
Abstract
We examine disparities in early child cognitive and receptive-expressive skills by ethnic ancestry among infants aged 3-24 months from Brazil and Argentina. We employ unique data on the neurodevelopment of children who were seeking routine well-child care at a set of pediatric clinics in these countries. The sample included children who had normal birth outcomes and no major health complications, allowing us to focus on variation in neurodevelopment among children without major physical health limitations. The physicians attending the pediatric clinics were trained in administering the Bayley Infant Neurodevelopmental Screener, a standardized instrument used to screen an infant's risk of neurodevelopmental problems on various domains of abilities. We evaluate disparities in overall neurodevelopmental scores and risk for neurodevelopmental problems as well as in cognitive functioning and receptive-expressive neurodevelopment. We also examine the extent to which household demographic and socioeconomic characteristics and geographic location explain these disparities. We find large gaps in both cognitive and receptive-expressive neurodevelopment by ancestry. In Brazil, children of African ancestry have lower scores on both cognitive and receptive-expressive domains and on overall neurodevelopment than children of European ancestry. In Argentina, children of Native ancestry have lower scores on these outcomes than children of European ancestry. These gaps however are largely explained by differences in geographic location and household characteristics, highlighting the importance of policies that reduce socioeconomic and geographic disparities in social capital and economic development for eliminating ethnic disparities in infant neurodevelopment.
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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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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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Fonseca SC, Kale PL, Silva KSD. Pré-natal em mulheres usuárias do Sistema Único de Saúde em duas maternidades no Estado do Rio de Janeiro, Brasil: a cor importa? REVISTA BRASILEIRA DE SAÚDE MATERNO INFANTIL 2015. [DOI: 10.1590/s1519-38292015000200007] [Citation(s) in RCA: 10] [Impact Index Per Article: 1.1] [Reference Citation Analysis] [Abstract] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 01/12/2023]
Abstract
Resumo Objetivos: identificar fatores associados ao pré-natal inadequado, com destaque para cor da pele, em usuárias do SUS do Estado do Rio de Janeiro (RJ), no último trimestre de 2011. Métodos: estudo de corte seccional em duas maternidades públicas no RJ. Foram entrevistadas 1790 parturientes, arroladas sequencialmente. Número de consultas e início do acompanhamento foram coletados dos cartões de pré-natal. O desfecho foi adequação do pré-natal, classificada pelo Índice de Adequação de Utilização do Pré-natal. A exposição principal foi cor da pele, além de covariáveis sociodemográficas e reprodutivas. A regressão logística multivariada usou níveis hierárquicos: variáveis predisponentes e capacitantes da utilização do pré-natal no primeiro e segundo nível, respectivamente. Resultados: a cor da pele preta manteve-se associada ao pré-natal inadequado, mesmo após ajuste para covariáveis (OR=1,37; IC95%:1,02-1,83). Gravidez adolescente (OR=1,85; IC95%:1,43-2,41); ausência de companheiro (OR=1,75; IC95%:1,38- 2,20) e multiparidade (OR=2,40; IC95%:1,49-3,85) também se associaram positivamente ao desfecho. O atendimento ao pré-natal em serviços públicos (OR=0,67; IC95%: 0,49-0,91) e primiparidade (OR=0,41; IC95%: 0,32 e 0,52) tiveram efeito protetor. Conclusões: gestantes de cor preta tiveram maior chance de realizar pré-natal inadequado no RJ. São necessárias políticas para reduzir iniquidades de raça/cor na assistência pré-natal desta população.
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Wehby GL, Gili JA, Pawluk M, Castilla EE, López-Camelo JS. Disparities in birth weight and gestational age by ethnic ancestry in South American countries. Int J Public Health 2015; 60:343-51. [PMID: 25542227 PMCID: PMC4699418 DOI: 10.1007/s00038-014-0639-6] [Citation(s) in RCA: 17] [Impact Index Per Article: 1.9] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/28/2014] [Revised: 11/24/2014] [Accepted: 12/13/2014] [Indexed: 11/30/2022] Open
Abstract
OBJECTIVES We examine disparities in birth weight and gestational age by ethnic ancestry in 2000-2011 in eight South American countries. METHODS The sample included 60,480 singleton live births. Regression models were estimated to evaluate differences in birth outcomes by ethnic ancestry controlling for time trends. RESULTS Significant disparities were found in seven countries. In four countries-Brazil, Ecuador, Uruguay, and Venezuela-we found significant disparities in both low birth weight and preterm birth. Disparities in preterm birth alone were observed in Argentina, Bolivia, and Colombia. Several differences in continuous birth weight, gestational age, and fetal growth rate were also observed. There were no systematic patterns of disparities between the evaluated ethnic ancestry groups across the study countries, in that no racial/ethnic group consistently had the best or worst outcomes in all countries. CONCLUSIONS Racial/ethnic disparities in infant health are common in several South American countries. Differences across countries suggest that racial/ethnic disparities are driven by social and economic mechanisms. Researchers and policymakers should acknowledge these disparities and develop research and policy programs to effectively target them.
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Affiliation(s)
- George L Wehby
- Department of Health Management and Policy, College of Public Health, University of Iowa, 145N. Riverside Dr., 100 College of Public Health Bldg., Room N248, Iowa City, IA, 52242-2007, USA,
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