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O'Quigley J. Suspected serial killers and unsuspected statistical blunders. MEDICINE, SCIENCE, AND THE LAW 2024:258024241242549. [PMID: 38557203 DOI: 10.1177/00258024241242549] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 04/04/2024]
Abstract
A whole branch of theoretical statistics devotes itself to the analysis of clusters, the aim being to distinguish an apparent cluster arising randomly from one that is more likely to have been produced as a result of some systematic influence. There are many examples in medicine and some that involve both medicine and the legal field; criminal law in particular. Observed clusters or a series of cases in a given setting can set off alarm bells, the recent conviction of Lucy Letby in England being an example. It was an observed cluster, a series of deaths among neonates, that prompted the investigation of Letby. There have been other similar cases in the past and there will be similar cases in the future. Our purpose is not to reconsider any particular trial but, rather, to work with similar, indeed more extreme numbers of cases as a way to underline the statistical mistakes that can be made when attempting to make sense of the data. These notions are illustrated via a made-up case of 10 incidents where the anticipated count was only 2. The most common statistical analysis would associate a probability of less than 0.00005 with this outcome: A very rare event. However, a more careful analysis that avoids common pitfalls results in a probability close to 0.5, indicating that, given the circumstances, we were as likely to see 10 or more as we were to see less than 10.
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Affiliation(s)
- John O'Quigley
- Department of Statistical Science, University College London, UK
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Putri AWS, Harahap H, Harnani Y, Rany N, Syafrani S. The Risk Factors of Neonatal Mortality in Pekanbaru City, Indonesia. Open Access Maced J Med Sci 2022. [DOI: 10.3889/oamjms.2022.7997] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/05/2022] Open
Abstract
BACKGROUND: Neonatal mortality is death during the first 28 days of life, expressed per 1000 live births. In 2020, there was an increase in the number of neonatal mortality from 50 infant to 115 infant in Pekanbaru City, Indonesia.
AIM: The study objective was to analyze factors associated with neonatal mortality in the Pekanbaru City, Indonesia.
METHODS: The sample was 220, consisting of 110 case and 110 control samples. The total sampling technique was used for case and systematic sampling for control samples. The variables analyzed were mother’s age, mother’s education, parity, birth spacing, gestational age, birth weight, and antenatal care. Data were analyzed by multiple logistic regressions.
RESULTS: The results showed that the risk factors for neonatal mortality were antenatal care < 4 times (OR = 8.2; 95% CI = 4.0−17.1), gestational age < 35 weeks (OR = 5.5; 95% CI = 2.2–14.0), mother’s < 20 years or > 35 years (OR = 3.1; 95% CI = 1.3−7.1), and birth spacing < 2 years (OR = 2.6; 95% CI = 1.2−5.7).
CONCLUSION: The antenatal care, gestational age, mother’s age, and birth spacing are preventable or possibly preventable risk factors. As a recommendation, the Health Office of Pekanbaru and Community Health Service should increase promotion of antenatal care for pregnant women and family planning to preserve birth spacing for women of childbearing age.
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Influência da idade gestacional no termo sobre o peso: estudo de coorte. ACTA PAUL ENFERM 2021. [DOI: 10.37689/acta-ape/2021ao03002] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/17/2022] Open
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Eyeberu A, Shore H, Getachew T, Atnafe G, Dheresa M. Neonatal mortality among neonates admitted to NICU of Hiwot Fana specialized university hospital, eastern Ethiopia, 2020: a cross-sectional study design. BMC Pediatr 2021; 21:125. [PMID: 33722200 PMCID: PMC7962329 DOI: 10.1186/s12887-021-02598-z] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 11/09/2020] [Accepted: 03/04/2021] [Indexed: 11/24/2022] Open
Abstract
Background In Ethiopia, neonatal mortality is unacceptably high. Despite many efforts made by the government and other partners to reduce neonatal mortality; it has been increasing since 2014. Factors associated with neonatal mortality were explained by different researchers indifferently. There is no clear evidence to identify the magnitude of neonatal mortality and associated factors in the study area. The study aimed to assess the magnitude and factors associated with neonatal mortality. Methods Facility-based cross-sectional study was conducted among 834 randomly selected neonates. The study was conducted from February 20 to March 21, 2020. Data were extracted from medical records using a checklist adapted from the World Health Organization, and neonatal registration book. The data were inserted into Epi-data version 3.1 and then exported into SPSS window version 20 for analysis. Bivariate and multivariate analyses were employed to identify the association between independent variables and the outcome variable. Results Magnitude of neonatal mortality was 14.4% (95% CI:11.9,16.7). Being neonates of mothers whose pregnancy was complicated with antepartum hemorrhage [AOR = 4.13, 95%CI: (1.92,8.85)], born from mothers with current pregnancy complicated with pregnancy-induced hypertension [AOR = 4.41, 95%CI: (1.97,9.86)], neonates of mothers with multiple pregnancy [AOR = 2.87, 95% CI (1.08,7.61)], neonates delivered at the health center [AOR = 5.05, 95%CI: (1.72,14.79)], low birth weight [AOR = 4.01, 95%CI (1.30,12.33)], having perinatal asphyxia [AOR =3.85, 95%CI: (1.83,8.10)], and having early-onset neonatal sepsis [AOR = 3.93, 95%CI: (1.84,8.41)] were factors significantly associated with neonatal mortality. Conclusion The proportion of neonatal mortality was relatively in line with other studies but still needs attention. Antepartum hemorrhage, Pregnancy-induced hypertension, place of delivery, low birth weight, having perinatal asphyxia, and having neonatal sepsis were independent factors. The hospital, and health care workers should give attention to neonates admitted to intensive care units by strengthening the quality of care given at neonatal intensive care unit like infection prevention and strengthening early detection and treatment of health problems during Antenatal care visit.
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Affiliation(s)
- Addis Eyeberu
- Department of Midwifery, School of Nursing and Midwifery, College of Health and Medical Sciences, Haramaya University, P.O. BOX 138, Dire Dawa, Harar, Ethiopia.
| | - Hirpo Shore
- Department of Epidemiology, School of Public Health, College of Health and Medical Sciences, Haramaya University, Harar, Ethiopia
| | - Tamirat Getachew
- Department of Midwifery, School of Nursing and Midwifery, College of Health and Medical Sciences, Haramaya University, P.O. BOX 138, Dire Dawa, Harar, Ethiopia
| | - Genanaw Atnafe
- Department of Pediatrics, School of Nursing and Midwifery, College of Health and Medical Sciences, Haramaya University, Harar, Ethiopia
| | - Merga Dheresa
- School of Nursing and Midwifery, College of Health and Medical Sciences, Haramaya University, Harar, Ethiopia
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França KEXD, Vilela MBR, Frias PGD, Sarinho SW. EARLY NEONATAL NEAR MISS IN A UNIVERSITY HOSPITAL: COMPARATIVE CROSS-SECTIONAL STUDY. ACTA ACUST UNITED AC 2020; 39:e2019317. [PMID: 32996995 PMCID: PMC7518722 DOI: 10.1590/1984-0462/2021/39/2019317] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/10/2019] [Accepted: 12/05/2019] [Indexed: 11/22/2022]
Abstract
OBJECTIVE To compare 2012 and 2016 data on early neonatal near miss indicators from Health Information Systems at a university hospital. METHODS This is a cross-sectional study conducted in 2012 and 2016. We considered early neonatal near misses the live births that presented one of the following risk conditions at birth: gestational age <33 weeks, birth weight <1,750g or 5-minute Apgar score <7, or Neonatal Intensive Care Unit (NICU) admission, and were alive until the 7th day of life. Data were collected from the Live Birth Information System, Hospital Information System, and Mortality Information System. We calculated the early neonatal mortality rate, neonatal near miss rate, severe neonatal outcome rate, early neonatal survival index, and early neonatal mortality index, compared by year of birth. RESULTS In 2012, 304 early neonatal near misses were registered, with a higher proportion of cases with very low birth weight and mothers who had zero to three prenatal visits. In 2016, the number of cases was 243, with a predominance of more NICU admissions. The incidence of early neonatal deaths and early neonatal near misses was higher in 2012 than in 2016. CONCLUSIONS Neonatal near miss indicators identified difference between years. The cases were more severe in 2012 and there were more NICU admissions in 2016.
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Alemu AY, Belay GM, Berhanu M, Minuye B. Determinants of neonatal mortality at neonatal intensive care unit in Northeast Ethiopia: unmatched case-control study. Trop Med Health 2020; 48:40. [PMID: 32514229 PMCID: PMC7268585 DOI: 10.1186/s41182-020-00232-9] [Citation(s) in RCA: 8] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/23/2020] [Accepted: 05/25/2020] [Indexed: 11/14/2022] Open
Abstract
Background Globally, in 2016, about 38% and 3% of all neonatal death were recorded in sub-Saharan Africa and Ethiopia, respectively. In the same year, 47 neonates out of 1000 live births were not surviving in the first 28 days of age in the Amhara region, Ethiopia. Despite the highest burden of neonatal death in the region, specific or the proximate determinants of neonatal death in the neonatal intensive care unit were not well identified. Objective This study aimed to identify the determinants of neonatal mortality at neonatal intensive care unit in Dessie Referral Hospital, Northeast Ethiopia. Methods An institution-based unmatched case-control study was conducted on neonates admitted to the neonatal intensive care unit of Dessie Referral Hospital, from January 1, 2016, to December 30, 2017. A total of 390 charts (130 cases and 260 controls) were selected by simple random sampling technique. The data were abstracted from the facility-based data abstraction form. A binary logistic regression analysis was fitted to identify the determinants of neonatal mortality. Results Pregnancy-induced hypertension (AOR = 4.57; 95% CI 1.45–14.43), prolonged rupture of membrane (AOR = 2.04; 95% CI 1.13–3.68), very low birth weight (AOR = 7.00; 95% CI 2.10–23.35), and low birth weight (AOR = 2.12; 95% CI 1.10–4.20) were identified factors. Moreover, respiratory distress syndrome (AOR = 3.61; 95% CI 1.10–12.04), perinatal asphyxia (AOR = 2.27; 95% CI 1.18–4.39), meconium aspiration syndrome (AOR = 2.35; 95% CI 1.12–4.97), and infection (AOR = 2.26; 95% CI 1.34–3.82) were also significantly associated with neonatal death. Conclusions Pregnancy-induced hypertension, prolonged rupture of membrane, low birth weight, respiratory distress syndrome, perinatal asphyxia, meconium aspiration syndrome, and infections were the major determinants of neonatal mortality. Therefore, special attention will be given to small and sick babies. Moreover, early anticipation of complications and management of mothers who had pregnancy-induced hypertension and prolonged rupture of the membrane would save neonates.
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Affiliation(s)
- Abebaw Yeshambel Alemu
- Department of Nursing, College of Health Science, Debre Tabor University, Debre Tabor, Ethiopia
| | - Getaneh Mulualem Belay
- Department of Pediatric and Child Health Nursing, School of Nursing, College of Medicine and Health Sciences, University of Gondar, P.O.Box:196, Gondar, Ethiopia
| | - Mengistu Berhanu
- Department of Pediatric and Child Health Nursing, School of Nursing, College of Medicine and Health Sciences, University of Gondar, P.O.Box:196, Gondar, Ethiopia
| | - Biniam Minuye
- Department of Nursing, College of Health Science, Debre Tabor University, Debre Tabor, Ethiopia
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Garcia LP, Fernandes CM, Traebert J. Risk factors for neonatal death in the capital city with the lowest infant mortality rate in Brazil. J Pediatr (Rio J) 2019; 95:194-200. [PMID: 29444451 DOI: 10.1016/j.jped.2017.12.007] [Citation(s) in RCA: 19] [Impact Index Per Article: 3.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 08/05/2017] [Revised: 12/15/2017] [Accepted: 12/06/2017] [Indexed: 11/25/2022] Open
Abstract
OBJECTIVES To analyze the risk factors for neonatal death in Florianópolis, the Brazilian city capital with the lowest infant mortality rate. METHOD Data were extracted from a historical cohort with 15,879 live births. A model was used that included socioeconomic, behavioral, and health service use risk factors, as well as the Apgar score and biological factors. Risk factors were analyzed by hierarchical logistic regression. RESULTS Based on the multivariate analysis, socioeconomic factors showed no association with death. Insufficient prenatal consultations showed an OR of 3.25 (95% CI: 1.70-6.48) for death. Low birth weight (OR 8.42; 95% CI: 3.45-21.93); prematurity (OR 5.40; 95% CI: 2.22-13.88); malformations (OR 4.42; 95% CI: 1.37-12.43); and low Apgar score at the first (OR 6.65; 95% CI: 3.36-12.94) and at the fifth (OR 19.78; 95% CI: 9.12-44.50) minutes, were associated with death. CONCLUSION Differing from other studies, socioeconomic conditions were not associated with neonatal death. Insufficient prenatal consultations, low Apgar score, prematurity, low birth weight, and malformations showed an association, reinforcing the importance of prenatal access universalization and its integration with medium and high-complexity neonatal care services.
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Affiliation(s)
- Leandro Pereira Garcia
- Universidade do Sul de Santa Catarina (UNISUL), Departamento de Ciências da Saúde, Palhoça, SC, Brazil.
| | - Camila Mariano Fernandes
- Universidade Federal de Santa Catarina (UFSC), Departamento de Saúde Pública, Florianópolis, SC, Brazil
| | - Jefferson Traebert
- Universidade do Sul de Santa Catarina (UNISUL), Departamento de Ciências da Saúde, Palhoça, SC, Brazil
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Garcia LP, Fernandes CM, Traebert J. Risk factors for neonatal death in the capital city with the lowest infant mortality rate in Brazil. JORNAL DE PEDIATRIA (VERSÃO EM PORTUGUÊS) 2019. [DOI: 10.1016/j.jpedp.2018.03.004] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/27/2022] Open
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