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Okpani AI, Umar L, Karim ME. Traditional birth attendant-assisted versus unassisted births: a comparison of neonatal deaths in Nigeria, 2008-2018. Ann Epidemiol 2022; 75:1-8. [PMID: 36028147 DOI: 10.1016/j.annepidem.2022.08.042] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/23/2022] [Revised: 07/16/2022] [Accepted: 08/17/2022] [Indexed: 11/01/2022]
Abstract
PURPOSE to directly compare the risk of neonatal death between traditional birth attendant (TBA)-assisted and unassisted deliveries in Nigeria. METHODS Using data on live births from the 2008, 2013, and 2018 Nigeria Demographic and Health Surveys, this cross-sectional study compared risk of neonatal death for TBA-assisted versus unassisted births. We used survey-featured logistic regression to estimate the odds of neonatal death. Survey year-stratified and propensity score-matched (PSM) estimates were obtained. Multivariate imputation by chained equation (MICE) for missing data was conducted. RESULTS A total of 28, 922 births were included. Regression and PSM analysis of pooled data showed that unassisted births had lower odds of neonatal death compared to TBA-assisted births, (aOR 0.81, 95% CI: 0.65,1.00) and (aOR 0.80, 95% CI: 0.64,1.00), respectively. Regression analysis by survey year yielded non-significant higher odds of neonatal death for TBA-assisted births. Pooled estimates from MICE showed non-significant higher odds of death for TBA-assisted births. CONCLUSIONS These findings indicate that birth care by TBAs do not necessarily lead to better neonatal survival. Jurisdictions seeking to allow continued operation of TBAs need to consider measures such as training, supervision, and regulation to ensure the safety of newborns.
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Affiliation(s)
- Arnold Ikedichi Okpani
- School of Population and Public Health, Faculty of Medicine, The University of British Columbia, Vancouver, BC, Canada; National Emergency Maternal and Child Health Intervention Centre, National Primary Health Care Development Agency, Abuja, FCT, Nigeria.
| | - Laila Umar
- National Emergency Maternal and Child Health Intervention Centre, National Primary Health Care Development Agency, Abuja, FCT, Nigeria
| | - Mohammad Ehsanul Karim
- School of Population and Public Health, Faculty of Medicine, The University of British Columbia, Vancouver, BC, Canada; Centre for Health Evaluation and Outcome Sciences, St. Paul's Hospital, Vancouver, BC, Canada
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Marinonio ASS, Costa-Nobre DT, Miyoshi MH, Balda RDCX, Areco KCN, Konstantyner T, Kawakami MD, Sanudo A, Bandiera-Paiva P, de Freitas RMV, Morais LCC, La Porte Teixeira M, Waldvogel BC, de Almeida MFB, Guinsburg R, Kiffer CRV. Clusters of preterm live births and respiratory distress syndrome-associated neonatal deaths: spatial distribution and cooccurrence patterns. BMC Public Health 2022; 22:1226. [PMID: 35725459 PMCID: PMC9210662 DOI: 10.1186/s12889-022-13629-4] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/24/2021] [Accepted: 06/09/2022] [Indexed: 11/23/2022] Open
Abstract
Background Prematurity and respiratory distress syndrome (RDS) are strongly associated. RDS continues to be an important contributor to neonatal mortality in low- and middle-income countries. This study aimed to identify clusters of preterm live births and RDS-associated neonatal deaths, and their cooccurrence pattern in São Paulo State, Brazil, between 2004 and 2015. Methods Population-based study of all live births with gestational age ≥ 22 weeks, birthweight ≥ 400 g, without congenital anomalies from mothers living in São Paulo State, Brazil, during 2004–2015. RDS-associated neonatal mortality was defined as deaths < 28 days with ICD-10 codes P22.0 or P28.0. RDS-associated neonatal mortality and preterm live births rates per municipality were submitted to first- and second-order spatial analysis before and after smoothing using local Bayes estimates. Spearman test was applied to identify the correlation pattern between both rates. Results Six hundred forty-five thousand two hundred seventy-six preterm live births and 11,078 RDS-associated neonatal deaths in São Paulo State, Brazil, during the study period were analyzed. After smoothing, a non-random spatial distribution of preterm live births rate (I = 0.78; p = 0.001) and RDS-associated neonatal mortality rate (I = 0.73; p = 0.001) was identified. LISA maps confirmed clusters for both, with a negative correlation (r = -0.24; p = 0.0000). Clusters of high RDS-associated neonatal mortality rates overlapping with clusters of low preterm live births rates were detected. Conclusions Asymmetric cluster distribution of preterm live births and RDS-associated neonatal deaths may be helpful to indicate areas for perinatal healthcare improvement. Supplementary Information The online version contains supplementary material available at 10.1186/s12889-022-13629-4.
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Affiliation(s)
- Ana Sílvia Scavacini Marinonio
- Departamento de Pediatria, Escola Paulista de Medicina - Universidade Federal de São Paulo (UNIFESP), Rua Marselhesa 630, São Paulo, Vila Clementino, 04020-060, Brazil.
| | - Daniela Testoni Costa-Nobre
- Departamento de Pediatria, Escola Paulista de Medicina - Universidade Federal de São Paulo (UNIFESP), Rua Marselhesa 630, São Paulo, Vila Clementino, 04020-060, Brazil
| | - Milton Harumi Miyoshi
- Departamento de Pediatria, Escola Paulista de Medicina - Universidade Federal de São Paulo (UNIFESP), Rua Marselhesa 630, São Paulo, Vila Clementino, 04020-060, Brazil
| | - Rita de Cassia Xavier Balda
- Departamento de Pediatria, Escola Paulista de Medicina - Universidade Federal de São Paulo (UNIFESP), Rua Marselhesa 630, São Paulo, Vila Clementino, 04020-060, Brazil
| | - Kelsy Catherina Nema Areco
- Departamento de Pediatria, Escola Paulista de Medicina - Universidade Federal de São Paulo (UNIFESP), Rua Marselhesa 630, São Paulo, Vila Clementino, 04020-060, Brazil
| | - Tulio Konstantyner
- Departamento de Pediatria, Escola Paulista de Medicina - Universidade Federal de São Paulo (UNIFESP), Rua Marselhesa 630, São Paulo, Vila Clementino, 04020-060, Brazil
| | - Mandira Daripa Kawakami
- Departamento de Pediatria, Escola Paulista de Medicina - Universidade Federal de São Paulo (UNIFESP), Rua Marselhesa 630, São Paulo, Vila Clementino, 04020-060, Brazil
| | - Adriana Sanudo
- Departamento de Pediatria, Escola Paulista de Medicina - Universidade Federal de São Paulo (UNIFESP), Rua Marselhesa 630, São Paulo, Vila Clementino, 04020-060, Brazil
| | - Paulo Bandiera-Paiva
- Departamento de Pediatria, Escola Paulista de Medicina - Universidade Federal de São Paulo (UNIFESP), Rua Marselhesa 630, São Paulo, Vila Clementino, 04020-060, Brazil
| | - Rosa Maria Vieira de Freitas
- Fundação Sistema Estadual de Análise de Dados (SEADE Foundation), Avenida Professor Lineu Prestes, 913 - Cidade Universitária, São Paulo, 05508-000, Brazil
| | - Lilian Cristina Correia Morais
- Fundação Sistema Estadual de Análise de Dados (SEADE Foundation), Avenida Professor Lineu Prestes, 913 - Cidade Universitária, São Paulo, 05508-000, Brazil
| | - Mônica La Porte Teixeira
- Fundação Sistema Estadual de Análise de Dados (SEADE Foundation), Avenida Professor Lineu Prestes, 913 - Cidade Universitária, São Paulo, 05508-000, Brazil
| | - Bernadette Cunha Waldvogel
- Fundação Sistema Estadual de Análise de Dados (SEADE Foundation), Avenida Professor Lineu Prestes, 913 - Cidade Universitária, São Paulo, 05508-000, Brazil
| | - Maria Fernanda Branco de Almeida
- Departamento de Pediatria, Escola Paulista de Medicina - Universidade Federal de São Paulo (UNIFESP), Rua Marselhesa 630, São Paulo, Vila Clementino, 04020-060, Brazil
| | - Ruth Guinsburg
- Departamento de Pediatria, Escola Paulista de Medicina - Universidade Federal de São Paulo (UNIFESP), Rua Marselhesa 630, São Paulo, Vila Clementino, 04020-060, Brazil
| | - Carlos Roberto Veiga Kiffer
- Departamento de Pediatria, Escola Paulista de Medicina - Universidade Federal de São Paulo (UNIFESP), Rua Marselhesa 630, São Paulo, Vila Clementino, 04020-060, Brazil
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Abstract
BACKGROUND Globally, there has been a marked decline in neonatal mortality and overall child mortality indicators from 1990 to date. In Kenya, neonatal deaths remain unacceptably high, contributing to 40% of under-five mortality rates (U5MR) making it an important health priority. The objective of this study was to identify the determinants of neonatal mortality in Kenya. An understanding of the determinants of neonatal mortality will provide evidence for better interventions to reduce these deaths. METHODS Neonatal deaths from singleton live-born infants were extracted from women's dataset collected for the 5-year period preceding the study published in the Kenya Demographic and Health Survey (KDHS), 2014. Data were obtained from 18,951 births. There were 356 neonatal deaths recorded. Data were weighted using an individual weighting factor to adjust for the study design and reduce sample variability. Data were analyzed using SPSS version 20.0. Logistic regression was conducted to adjust for confounding factors. RESULTS Neonatal mortality rate was established at 19/1000 (95% CI: 16.8-20.7). Mothers with no education had higher odds of experiencing deaths of neonates with adjusted Odds Ratio (aOR)=2.201, 95% CI: 1.43-4.15,p=0.049) compared to mothers with higher education. Low Birth Weight (LBW) neonates were 3.2 times likely to die in the first 28 days (aOR=3.206, 95% CI: 1.85-12.08, p=0.006) compared to neonates with >3.5 kilograms at birth. Mothers who did not attend ANC during pregnancy and those who attended between 1-3 ANC visits had higher odds of losing their infants (aOR=3.348, 95% CI: 1.616-8.53, p=0.041, and aOR=2.316, 95% CI: 1.10-4.88, p=0.027) respectively, compared to mothers who attended >4 ANC visits. CONCLUSION AND GLOBAL HEALTH IMPLICATIONS Improving maternal health and nutrition during pregnancy should be enhanced to ensure adequate weight gain and reduce instances of low birth weight. Community referrals and follow-up for expectant women to take up the requisite 4 ANC visits should be encouraged. Girls' education should be emphasized to reduce the proportion of illiterate mothers.
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Affiliation(s)
- Akinyi E. Imbo
- Egerton University, Njoro Campus, Njoro Mau Narok Road P.O Box 536, Nakuru, Kenya
| | - Elizabeth K. Mbuthia
- Egerton University, Njoro Campus, Njoro Mau Narok Road P.O Box 536, Nakuru, Kenya
| | - Douglas N. Ngotho
- Egerton University, Njoro Campus, Njoro Mau Narok Road P.O Box 536, Nakuru, Kenya
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Yang M, Ahn SY, Jo HS, Sung SI, Chang YS, Park WS. Mortality and Morbidities according to Time of Birth in Extremely Low Birth Weight Infants. J Korean Med Sci 2021; 36:e86. [PMID: 33821593 PMCID: PMC8021978 DOI: 10.3346/jkms.2021.36.e86] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 10/10/2020] [Accepted: 01/14/2021] [Indexed: 11/20/2022] Open
Abstract
BACKGROUND Although the overall quality of high-risk neonatal care has improved recently, there is still concern about a difference in the quality of care when comparing off-hour births and regular-hour births. Moreover, there are no data in Korea regarding the impact of time of birth on mortality and morbidities in preterm infants. METHODS A total of 3,220 infants weighing < 1,000 g and born at 23-34 weeks in 2013-2017 were analyzed based on the Korean Neonatal Network data. Mortality and major morbidities were analyzed using logistic regression according to time of birth during off-hours (nighttime, weekend, and holiday) and regular hours. The institutes were sub-grouped into hospital group I and hospital group II based on the neonatal intensive care unit (NICU) care level defined by the mortality rates of < 50% and ≥ 50%, respectively, in infants born at 23-24 weeks' gestation. RESULTS The number of births during regular hours and off-hours was similar. In the total population and hospital group I, off-hour births were not associated with increased neonatal mortality and morbidities. However, in hospital group II, increased early mortality was found in the off-hour births when compared to regular-hour births. CONCLUSION Efforts to improve the overall quality of NICU are required to lower the early mortality rate in off-hour births. Also, other sensitive indexes for the evaluation of quality of NICU care should be further studied.
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MESH Headings
- After-Hours Care
- Cerebral Intraventricular Hemorrhage/epidemiology
- Cerebral Intraventricular Hemorrhage/mortality
- Databases, Factual
- Enterocolitis, Necrotizing/epidemiology
- Enterocolitis, Necrotizing/mortality
- Female
- Gestational Age
- Humans
- Infant
- Infant Mortality
- Infant, Extremely Low Birth Weight
- Infant, Newborn
- Infant, Premature, Diseases/epidemiology
- Infant, Premature, Diseases/mortality
- Intensive Care Units, Neonatal
- Logistic Models
- Male
- Morbidity
- Odds Ratio
- Quality of Health Care
- Republic of Korea
- Time Factors
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Affiliation(s)
- Misun Yang
- Department of Pediatrics, Samsung Medical Center, Sungkyunkwan University School of Medicine, Seoul, Korea
| | - So Yoon Ahn
- Department of Pediatrics, Samsung Medical Center, Sungkyunkwan University School of Medicine, Seoul, Korea
- Stem Cell and Regenerative Medicine Institute, Samsung Medical Center, Seoul, Korea
| | - Heui Seung Jo
- Department of Pediatrics, Samsung Medical Center, Sungkyunkwan University School of Medicine, Seoul, Korea
| | - Se In Sung
- Department of Pediatrics, Samsung Medical Center, Sungkyunkwan University School of Medicine, Seoul, Korea
| | - Yun Sil Chang
- Department of Pediatrics, Samsung Medical Center, Sungkyunkwan University School of Medicine, Seoul, Korea
- Stem Cell and Regenerative Medicine Institute, Samsung Medical Center, Seoul, Korea
- Department of Health Sciences and Technology, SAIHST, Sungkyunkwan University, Seoul, Korea.
| | - Won Soon Park
- Department of Pediatrics, Samsung Medical Center, Sungkyunkwan University School of Medicine, Seoul, Korea
- Stem Cell and Regenerative Medicine Institute, Samsung Medical Center, Seoul, Korea
- Department of Health Sciences and Technology, SAIHST, Sungkyunkwan University, Seoul, Korea
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Chauhan BG, Verma RK, Alagarajan M, Chauhan SK. Effect of Maternal Healthcare Utilization on Early Neonatal, Neonatal and Post- Neonatal Mortality in India. Int Q Community Health Educ 2021; 43:31-43. [PMID: 33745398 DOI: 10.1177/0272684x211004925] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 11/17/2022]
Abstract
This paper examines the effect of maternal healthcare utilization on early neonatal, neonatal and post-neonatal mortality in India using the recent round of National Family Health Survey (NFHS-4) data. At the national level, for the last live birth of women during the five year preceding the survey, the early neonatal mortality rate was about 16, neonatal mortality rate was 19 and post-neonatal mortality was 7 per thousand live births. Also, only one-fifth of women who had a birth in the past five years received full antenatal care (ANC), 83 percent women received safe delivery and 65 percent women received post-natal care. Findings of the study indicate that full ANC and postnatal care were significantly associated with early neonatal and neonatal mortality. However, no significant association between safe delivery and newborn mortality were found after adjusting the socio-economic and demographic characteristics. Therefore, for a policy point of view, there is a dire need to strengthen supply dependent factors regarding public awareness, accessibility, and affordability of maternal and child healthcare services. It is also necessary to focus on increasing utilization along with continuum of care of maternal and child healthcare services to sustain the reduction in mortality during infancy.
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Affiliation(s)
- Bal Govind Chauhan
- Population Research Centre, Gokhale Institute of Politics and Economics, Pune, India
| | | | - Manoj Alagarajan
- Department of Development Studies, International Institute for Population Sciences, Mumbai, India
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Gurusamy PSR, Janagaraj PD. A Success Story: The Burden of Maternal, Neonatal and Childhood Mortality in Rwanda - Critical Appraisal of Interventions and Recommendations for the Future. Afr J Reprod Health 2019; 22:9-16. [PMID: 30052329 DOI: 10.29063/ajrh2018/v22i2.1] [Citation(s) in RCA: 6] [Impact Index Per Article: 1.2] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/21/2022]
Abstract
Globally, the burden of maternal, neonatal and childhood mortality is disproportionately shared between the least developed nations and the developed nations. While the global maternal mortality has been almost halved since 1990, 99% of maternal deaths occur in developing regions. This invariably highlights the impact of poverty and, to combat poverty in its different elements, the United Nations (UN) established eight Millennium Development Goals (MDGs), including improving maternal health (MDG 5) and reducing child mortality (MDG 4). Rwanda is one of the few countries that have met both MDGs 4 and 5 ahead of time. In 2015, the UN established 17 Sustainable Development Goals (SDGs), a renewed version of targets to be achieved by 2030, including Good Health and Well-being (SDG 3). SDG 3 aims to achieve a global maternal mortality rate (MMR) of 70 or less by 2030, requiring an annual reduction in MMR by 7.5%. Rwanda is on track to achieving its SDG targets with the support of local government, donors, and international and local agencies. The multipronged approach initiated by the Rwandan government, backed by international organizations, is to be credited for this success. Studying these proven strategies and interventions will allow us to identify gaps, further develop and eventually transfer them to the rest of the world, with suitable contextualization.
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Abstract
Neonatal mortality has been recognized as a global public health challenge and Nigeria has the highest prevalence in Africa. Malaria during pregnancy jeopardizes neonatal survival through placental parasitaemia, maternal anaemia, and low birth weight. This study investigated association between the malaria prevention in pregnancy and neonatal survival using a nationally representative data - Nigeria Demographic Health Survey 2013. Child recode data was used and the outcome variable was neonatal death. The main independent variables were the use of at least 2 doses of intermittent preventive treatment in pregnancy with sulfadoxine-pyrimethamine (IPT-SP) and proportion of pregnant women who reported Insecticide Treated Net (ITN) use the night before the survey. Data were analyzed using Pearson Chi-square (x 2 ) test of association and survival analysis techniques. Total neonatal mortality rate was 38 per1000 live births. Cox proportional hazard model showed that low birth weight (HR 1.49, 95% CI (1.15 - 1.93 p=0.003) and adequate number of ANC visits (≥ 4 visits) (HR 0.68, 95% CI (0.53 - 0.93) were associated with neonatal survival. The use of at least 2 doses of IPT-SP was not an independent factor for neonatal survival (HR 0.72, 95% CI (0.53 - 1.15). Malaria prevention in pregnancy is crucial for neonatal survival through the prevention of low birth weight.
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Affiliation(s)
- Ikeola A Adeoye
- Department of Epidemiology and Medical Statistics, Faculty of Public Health, College of Medicine, University of Ibadan, Ibadan, Nigeria
| | - Adeniyi F Fagbamigbe
- Department of Epidemiology and Medical Statistics, Faculty of Public Health, College of Medicine, University of Ibadan, Ibadan, Nigeria
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Bills CB, Newberry JA, Darmstadt G, Pirrotta EA, Rao GVR, Mahadevan SV, Strehlow MC. Reducing early infant mortality in India: results of a prospective cohort of pregnant women using emergency medical services. BMJ Open 2018; 8:e019937. [PMID: 29654018 PMCID: PMC5905760 DOI: 10.1136/bmjopen-2017-019937] [Citation(s) in RCA: 12] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/06/2022] Open
Abstract
OBJECTIVES To describe the demographic characteristics and clinical outcomes of neonates born within 7 days of public ambulance transport to hospitals across five states in India. DESIGN Prospective observational study. SETTING Five Indian states using a centralised emergency medical services (EMS) agency that transported 3.1 million pregnant women in 2014. PARTICIPANTS Over 6 weeks in 2014, this study followed a convenience sample of 1431 neonates born to women using a public-private ambulance service for a 'pregnancy-related' problem. Initial calls were deemed 'pregnancy related' if categorised by EMS dispatchers as 'pregnancy', 'childbirth', 'miscarriage' or 'labour pains'. Interfacility transfers, patients absent on ambulance arrival, refusal of care and neonates born to women beyond 7 days of using the service were excluded. MAIN OUTCOME MEASURES death at 2, 7 and 42 days after delivery. RESULTS Among 1684 women, 1411 gave birth to 1431 newborns within 7 days of initial ambulance transport. Median maternal age at delivery was 23 years (IQR 21-25). Most mothers were from rural/tribal areas (92.5%) and lower social (79.9%) and economic status (69.9%). Follow-up rates at 2, 7 and 42 days were 99.8%, 99.3% and 94.1%, respectively. Cumulative mortality rates at 2, 7 and 42 days follow-up were 43, 53 and 62 per 1000 births, respectively. The perinatal mortality rate (PMR) was 53 per 1000. Preterm birth (OR 2.89, 95% CI 1.67 to 5.00), twin deliveries (OR 2.80, 95% CI 1.10 to 7.15) and caesarean section (OR 2.21, 95% CI 1.15 to 4.23) were the strongest predictors of mortality. CONCLUSIONS The perinatal mortality rate associated with this cohort of patients with high-acuity conditions of pregnancy was nearly two times the most recent rate for India as a whole (28 per 1000 births). EMS data have the potential to provide more robust estimates of PMR, reduce inequities in timely access to healthcare and increase facility-based care through service of marginalised populations.
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Affiliation(s)
- Corey B Bills
- Department of Emergency Medicine, University of California, San Francisco, California, USA
| | - Jennifer A Newberry
- Department of Emergency Medicine, Stanford University, Stanford, California, USA
| | - Gary Darmstadt
- Department of Pediatrics, Stanford University, Stanford, California, USA
| | - Elizabeth A Pirrotta
- Department of Emergency Medicine, Stanford University, Stanford, California, USA
| | - G V Ramana Rao
- GVK Emergency Management and Research Institute, Secunderabad, Telangana, India
| | - S V Mahadevan
- Department of Emergency Medicine, Stanford University, Stanford, California, USA
| | - Matthew C Strehlow
- Department of Emergency Medicine, Stanford University, Stanford, California, USA
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Malak JS, Safdari R, Zeraati H, Nayeri FS, Mohammadzadeh N, Farajollah SSS. An agent based architecture for high-risk neonate management at neonatal intensive care unit. Electron Physician 2018; 10:6193-6200. [PMID: 29588819 PMCID: PMC5853993 DOI: 10.19082/6193] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/28/2017] [Accepted: 12/14/2017] [Indexed: 01/15/2023] Open
Abstract
Background In recent years, the use of new tools and technologies has decreased the neonatal mortality rate. Despite the positive effect of using these technologies, the decisions are complex and uncertain in critical conditions when the neonate is preterm or has a low birth weight or malformations. There is a need to automate the high-risk neonate management process by creating real-time and more precise decision support tools. Objective To create a collaborative and real-time environment to manage neonates with critical conditions at the NICU (Neonatal Intensive Care Unit) and to overcome high-risk neonate management weaknesses by applying a multi agent based analysis and design methodology as a new solution for NICU management. Methods This study was a basic research for medical informatics method development that was carried out in 2017. The requirement analysis was done by reviewing articles on NICU Decision Support Systems. PubMed, Science Direct, and IEEE databases were searched. Only English articles published after 1990 were included; also, a needs assessment was done by reviewing the extracted features and current processes at the NICU environment where the research was conducted. We analyzed the requirements and identified the main system roles (agents) and interactions by a comparative study of existing NICU decision support systems. The Universal Multi Agent Platform (UMAP) was applied to implement a prototype of our multi agent based high-risk neonate management architecture. Results Local environment agents interacted inside a container and each container interacted with external resources, including other NICU systems and consultation centers. In the NICU container, the main identified agents were reception, monitoring, NICU registry, and outcome prediction, which interacted with human agents including nurses and physicians. Conclusion Managing patients at the NICU units requires online data collection, real-time collaboration, and management of many components. Multi agent systems are applied as a well-known solution for management, coordination, modeling, and control of NICU processes. We are currently working on an outcome prediction module using artificial intelligence techniques for neonatal mortality risk prediction. The full implementation of the proposed architecture and evaluation is considered the future work.
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Affiliation(s)
- Jaleh Shoshtarian Malak
- Ph.D. Candidate of Medical Informatics, Department of Medical Information Management, Faculty of Allied Sciences, Tehran University of Medical Science, Tehran, Iran
| | - Reza Safdari
- Ph.D. of Health Information Management, Professor, Department of Medical Information Management, Faculty of Allied Sciences, Tehran University of Medical Science, Tehran, Iran
| | - Hojjat Zeraati
- Ph.D. of Biostatistics, Professor, Department of Epidemiology and Biostatistics, School of Public Health, Tehran University of Medical Science, Tehran, Iran
| | - Fatemeh Sadat Nayeri
- Ph.D. of Neonatology, Professor, Maternal-Fetal & Neonatal Research Center, Tehran University of Medical Science, Tehran, Iran
| | - Niloofar Mohammadzadeh
- Ph.D. of Health Information Management, Assistant Professor, Department of Medical Information Management, Faculty of Allied Sciences, Tehran University of Medical Science, Tehran, Iran
| | - Seide Sedighe Seied Farajollah
- Ph.D. Candidate of Health Information Management, Department of Medical Information Management, Faculty of Allied Sciences, Tehran University of Medical Science, Tehran, Iran
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Slinkard SA, Pharr JR, Bruno T, Patel D, Ogidi A, Obiefune M, Ezeanolue EE. Determinants of Infant Mortality in Southeast Nigeria: Results from the Healthy Beginning Initiative, 2013-2014. Int J MCH AIDS 2018; 7:1-8. [PMID: 30305984 PMCID: PMC6168798 DOI: 10.21106/ijma.229] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/16/2022] Open
Abstract
BACKGROUND Neonatal mortality due to preventable factors occurs at high rates throughout sub-Saharan Africa. Community-based interventions increase opportunities for prenatal screening and access to antenatal care services (ANC) services. The Healthy Beginning Initiative (HBI) provided congregation-based prenatal screening and health counseling for 3,047 women in Enugu State. The purpose of this study was to identify determinants for infant mortality among this cohort. METHODS This was a prospective cohort study of post-delivery outcomes at 40 churches in Enugu State, Nigeria between 2013 and 2014. Risk factors for infant mortality were assessed using chi square, odds ratios, and multiple logistic regression. RESULTS There were 2,436 live births from the 2,379 women who delivered (55 sets of twins and one set of triplets), and 99 cases of neonatal/early postneonatal mortality. The neonatal mortality rate was 40.6 per 1,000 live births. Risk factors associated with neonatal mortality were lack of access to ANC services [OR= 8.81], maternal mortality [OR= 15.28], caesarian section [OR= 2.47], syphilis infection [OR= 6.46], HIV-positive status [OR= 3.87], and preterm birth [OR= 14.14]. CONCLUSIONS AND GLOBAL HEALTH IMPLICATIONS These results signify that culturally-acceptable community-based interventions targeted to increase access to ANC services, post-delivery services for preterm births, and HIV and syphilis screening for expectant mothers are needed to reduce infant mortality in resource-limited settings.
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Affiliation(s)
- Samantha A Slinkard
- University of Nevada, Las Vegas, School of Community Health Sciences. 4505 S. Maryland Pkwy, Las Vegas, NV 89154, USA
| | - Jennifer R Pharr
- University of Nevada, Las Vegas, School of Community Health Sciences. 4505 S. Maryland Pkwy, Las Vegas, NV 89154, USA
| | - Tamara Bruno
- University of Nevada, Las Vegas, School of Community Health Sciences. 4505 S. Maryland Pkwy, Las Vegas, NV 89154, USA
| | - Dina Patel
- University of Nevada, Las Vegas, School of Community Health Sciences. 4505 S. Maryland Pkwy, Las Vegas, NV 89154, USA
| | - Amaka Ogidi
- Research Resource Centre, University of Nigeria, Enugu, College of Medicine. University Road, 410001, Nsukka, Enugu State, NIGERIA
| | - Michael Obiefune
- Institute of Human Virology, University of Maryland School of Medicine. 655 W. Balitimore St, Balitimore, MD 21201, USA
| | - Echezona E Ezeanolue
- University of Nevada, Las Vegas, School of Community Health Sciences. 4505 S. Maryland Pkwy, Las Vegas, NV 89154, USA
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Amini Rarani M, Rashidian A, Khosravi A, Arab M, Abbasian E, Khedmati Morasae E. Changes in Socio-Economic Inequality in Neonatal Mortality in Iran Between 1995-2000 and 2005-2010: An Oaxaca Decomposition Analysis. Int J Health Policy Manag 2017; 6:219-218. [PMID: 28812805 PMCID: PMC5384984 DOI: 10.15171/ijhpm.2016.127] [Citation(s) in RCA: 16] [Impact Index Per Article: 2.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/14/2016] [Accepted: 09/17/2016] [Indexed: 11/22/2022] Open
Abstract
BACKGROUND Exploring changes in health inequality and its determinants over time is of policy interest. Accordingly, this study aimed to decompose inequality in neonatal mortality into its contributing factors and then explore changes from 1995-2000 to 2005-2010 in Iran. METHODS Required data were drawn from two Iran's demographic and health survey (DHS) conducted in 2000 and 2010. Normalized concentration index (CI) was used to measure the magnitude of inequality in neonatal mortality. The contribution of various determinants to inequality was estimated by decomposing concentration indices in 1995-2000 and 2005-2010. Finally, changes in inequality were investigated using Oaxaca-type decomposition technique. RESULTS Pro-rich inequality in neonatal mortality was declined by 16%, ie, the normalized CI dropped from -0.1490 in 1995-2000 to -0.1254 in 2005-2010. The largest contribution to inequality was attributable to mother's education (32%) and household's economic status (49%) in 1995-2000 and 2005-2010, respectively. Changes in mother's educational level (121%), use of skilled birth attendants (79%), mother's age at the delivery time (25-34 years old) (54%) and using modern contraceptive (29%) were mainly accountable for the decrease in inequality in neonatal mortality. CONCLUSION Policy actions on improving households' economic status and maternal education, especially in rural areas, may have led to the reduction in neonatal mortality inequality in Iran.
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Affiliation(s)
- Mostafa Amini Rarani
- Department of Health Management and Economics, School of Public Health, Tehran University of Medical Sciences, Tehran, Iran
- Health Management and Economics Research Center, Isfahan University of Medical Sciences, Isfahan, Iran
| | - Arash Rashidian
- Department of Health Management and Economics, School of Public Health, Tehran University of Medical Sciences, Tehran, Iran
| | - Ardeshir Khosravi
- Deputy of Public Health, Ministry of Health and Medical Education, Tehran, Iran
| | - Mohammad Arab
- Department of Health Management and Economics, School of Public Health, Tehran University of Medical Sciences, Tehran, Iran
| | | | - Esmaeil Khedmati Morasae
- Department of Public Health, Qom University of Medical Sciences, Qom, Iran
- Centre for System Studies (CSS), Hull University Business School (HUBS), Hull York Medical School (HYMS), University of Hull, Hull, UK
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Soofi S, Ariff S, Sadiq K, Habib A, Bhatti Z, Ahmad I, Hussain M, Ali N, Cousens S, Bhutta ZA. Evaluation of the uptake and impact of neonatal vitamin A supplementation delivered through the Lady Health Worker programme on neonatal and infant morbidity and mortality in rural Pakistan: an effectiveness trial. Arch Dis Child 2017; 102:216-223. [PMID: 27471856 DOI: 10.1136/archdischild-2016-310542] [Citation(s) in RCA: 13] [Impact Index Per Article: 1.9] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 01/27/2016] [Revised: 05/31/2016] [Accepted: 06/04/2016] [Indexed: 11/04/2022]
Abstract
BACKGROUND Despite evidence for the benefits of vitamin A supplementation (VAS) among children 6 to 59 months of age, the feasibility of introduction and potential benefit of VAS in the neonatal period in public health programmes is uncertain. OBJECTIVE The primary objective was to evaluate the feasibility and effectiveness of early neonatal VAS (single dose of 50 000 international units within 48-72 hours after birth) delivered through the public sector Lady Health Worker (LHW) programme in rural Pakistan and to document its association with a reduction in mortality at 6 months of age. METHODS A community-based, cluster randomised, placebo-controlled trial was undertaken in two districts of rural Pakistan. LHWs dispensed vitamin A/placebo in identical capsules to newborn infants within 48-72 hours of birth. Follow-up visits were undertaken at 1 week of age and every 4 weeks thereafter until 6 months of age. RESULTS Of a total of 15 433 consecutive pregnancies among eligible women of reproductive age, 13 225 pregnancies were registered, 12 218 live births identified and 11 028 newborn infants reached by LHWs. Of these, 5380 (49%) received neonatal VAS and 5648 (51%) placebo. The LHWs successfully delivered the capsules to 79% of newborns within 72 hours of birth with no significant adverse effects. Although the proportion of days observed with symptoms of fever, diarrhoea or rapid breathing were lower with neonatal VAS, these differences were not statistically significant. Mortality rates in the two groups were comparable at 6 months of age. CONCLUSIONS While our study demonstrated that neonatal VAS was safe and could be feasibly delivered by LHWs in Pakistan as part of their early postnatal visits, the overall lack of benefit on neonatal and 6-month morbidity and mortality in our population suggests the need for further evaluation of this intervention in populations at risk. TRIAL REGISTRATION NUMBER ClinicalTrials.gov NCT00674089.
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Affiliation(s)
- Sajid Soofi
- Women & Child Health Division, The Aga Khan University, Karachi, Pakistan
| | - Shabina Ariff
- Women & Child Health Division, The Aga Khan University, Karachi, Pakistan
| | - Kamran Sadiq
- Women & Child Health Division, The Aga Khan University, Karachi, Pakistan
| | - Atif Habib
- Women & Child Health Division, The Aga Khan University, Karachi, Pakistan
| | - Zaid Bhatti
- Women & Child Health Division, The Aga Khan University, Karachi, Pakistan
| | - Imran Ahmad
- Women & Child Health Division, The Aga Khan University, Karachi, Pakistan
| | - Masawar Hussain
- Women & Child Health Division, The Aga Khan University, Karachi, Pakistan
| | - Nabeela Ali
- John Snow International Research Institute, Islamabad, Pakistan
| | - Simon Cousens
- London School of Hygiene and Tropical Medicine, London, UK
| | - Zulfiqar A Bhutta
- Women & Child Health Division, The Aga Khan University, Karachi, Pakistan.,London School of Hygiene and Tropical Medicine, London, UK.,Centre for Global Child Health, The Hospital for Sick Children, Toronto, UK
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Khurmi MS, Sayinzoga F, Berhe A, Bucyana T, Mwali AK, Manzi E, Muthu M. Newborn Survival Case Study in Rwanda - Bottleneck Analysis and Projections in Key Maternal and Child Mortality Rates Using Lives Saved Tool (LiST). Int J MCH AIDS 2017; 6:93-108. [PMID: 29367886 PMCID: PMC5777390 DOI: 10.21106/ijma.214] [Citation(s) in RCA: 8] [Impact Index Per Article: 1.1] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/23/2022] Open
Abstract
BACKGROUND AND OBJECTIVE The Newborn Survival Case study in Rwanda provides an analysis of the newborn health and survival situation in the country. It reviews evidence-based interventions and coverage levels already implemented in the country; identifies key issues and bottlenecks in service delivery and uptake of services by community/beneficiaries, and provides key recommendations aimed at faster reduction in newborn mortality rate. METHODS This study utilized mixed method research including qualitative and quantitative analyses of various maternal and newborn health programs implemented in the country. This included interviewing key stakeholders at each level, field visits and also interviewing beneficiaries for assessment of uptake of services. Monitoring systems such as Health Management Information Systems (HMIS), maternal and newborn death audits were reviewed and data analyzed to aid these analyses. RESULTS Policies, protocols, various guidelines and tools for monitoring are already in place however, implementation of these remains a challenge e.g. infection control practices to reduce deaths due to sepsis. Although existing staff are quite knowledgeable and are highly motivated, however, shortage of health personnel especially doctors in an issue. New facilities are being operationalized e.g. at Gisenyi, however, the existing facilities needs expansion. CONCLUSION AND GLOBAL HEALTH IMPLICATIONS It is essential to implement high impact evidence based interventions but coverage levels need to be significantly high in order to achieve higher reduction in newborn mortality rate. Equity approach should be considered in planning so that the services are better implemented and the poor and needy can get the benefits of public health programs.
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Affiliation(s)
| | - Felix Sayinzoga
- Rwanda Ministry of Health/Rwanda Biomedical Centre, Kigali, Rwanda
| | | | - Tatien Bucyana
- Rwanda Ministry of Health/Rwanda Biomedical Centre, Kigali, Rwanda
| | - Assumpta Kayinamura Mwali
- Maternal and Child Survival Program, USAID Grantee, USAID Maternal and Child Survival Program Rwanda
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Chiabi A, Takou V, Mah E, Nguefack S, Siyou H, Takou V, Tchokoteu PF, Mbonda E. Risk factors for neonatal mortality at the yaounde gynaeco-obstetric and pediatric hospital, cameroon. Iran J Pediatr 2014; 24:393-400. [PMID: 25755860 PMCID: PMC4339562] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Download PDF] [Subscribe] [Scholar Register] [Received: 09/18/2013] [Accepted: 03/25/2014] [Indexed: 11/18/2022]
Abstract
OBJECTIVE Neonatal mortality is a major health problem in sub-Saharan Africa and the risk factors are not well established. The objective of this study was to determine the risk factors for neonatal mortality at the Yaounde Gynaeco-Obstetric and Pediatric Hospital. METHODS We conducted a retrospective and analytic case-control study from the medical records of newborns admitted at the neonatal unit of this hospital between 1(st) March 2003 and 31(st) December 2012. 850 subjects were enrolled; that is 425 cases and 425 controls. Findings : The intra-hospital neonatal mortality rate was 9.83%. The main causes of neonatal mortality were in descending order: neonatal sepsis (60.2%), complications from prematurity (42.6%), birth asphyxia (37.4%), and congenital malformations (11.8%).The most prominent risk factors for neonatal mortality after multivariate analysis with logistic regression were: prolonged membrane rupture (OR: 3.8719, 95% CI: 2.3619-6.3471; P=0.0000), low birth weight (OR: 1.6240, 95% CI: 1.0108-2.6091; P=0.0450), Apgar score less than 7 at the 5th minute (OR: 6.8979, 95% CI: 4.0709-11.6883; P=0.0000), and congenital malformations (OR: 4.3307, 95% CI: 1.6120-11.6347; P=0.0037). Delivery by cesarean section (OR: 0.2644, 95% CI: 0.1478-0.4732; P=0.0000) and being born in this hospital (OR: 0.4409;95% CI: 0.2566-0.7576; P=0.0030) were protective. CONCLUSION Neonatal mortality was influenced by both maternal and neonatal factors. This could be reduced through sensitization of pregnant women on the need of good quality antenatal visits, and capacitating the health personnel on the adequate management of high risk neonates.
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Affiliation(s)
- Andreas Chiabi
- Yaounde Gynaeco-Obstetric and Pediatric Hospital, Faculty of Medicine and Biomedical Sciences, University of Yaounde I, Cameroon
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Afjeh SA, Sabzehei MK, Fallahi M, Esmaili F. Outcome of very low birth weight infants over 3 years report from an Iranian center. Iran J Pediatr 2013; 23:579-87. [PMID: 24800021 PMCID: PMC4006510] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Download PDF] [Subscribe] [Scholar Register] [Received: 12/17/2012] [Accepted: 07/10/2013] [Indexed: 10/25/2022]
Abstract
OBJECTIVE Very low birth weight (VLBW) infants are at high risk for morbidity and mortality. This article determines the frequency of disease, rate od survival, complications and risk factors for morbidity and mortality in VLBW neonates admitted to a level III neonatal intensive care unit (NICU) at Mahdieh Hospital in Tehran. METHODS This cross-sectional retrospective study was performed from April 2007 to March 2010 on all hospitalized VLBW neonates. Relevant pre- and peri-natal data up to the time of discharge from the hospital or death, including complications during the course of hospitalization, were collected from the case notes, documented on a pre-designed questionnaire and analyzed. FINDINGS Out of 13197 neonates, 564 (4.3%) were VLBW with 51.4% males. Mean gestational age was 29.6±2.5 weeks; mean birth weight 1179±257 grams. Mean birth weight, gestational age and Apgar scores were significantly higher in babies who survived than in those who died, (1275±189 vs. 944±253 grams; 30.5±2.2 vs. 27.5±2 weeks and 6.9±1.7 vs. 5±2.1 respectively, P<0.001 in all instances). Overall survival was 70.9%; in extremely low birth weight (ELBW) newborns this figure was 33.3% rising to 84.1% in infants weighing between 1001-1500 grams. Respiratory failure resulting from RDS in ELBW babies was the major factor leading to death. Need for mechanical ventilation, pulmonary hemorrhage and gastro-intestinal bleeding were also significant predictive factors for mortality. CONCLUSION Birth weight and mechanical ventilation are the major factors predicting VLBW survival.
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Affiliation(s)
- Seyyed-Abolfazl Afjeh
- Mahdieh Medical Center, Shahid Beheshti University of Medical Sciences, Tehran, Iran,Corresponding Author:Address: Newborn Service, Mahdieh Medical Center, Shoosh Square, Shahrezad Street, Tehran, Iran. E-mail:
| | | | - Minoo Fallahi
- Mahdieh Medical Center, Shahid Beheshti University of Medical Sciences, Tehran, Iran
| | - Fatemeh Esmaili
- Mahdieh Medical Center, Shahid Beheshti University of Medical Sciences, Tehran, Iran
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Mukherjee S, Roy P, Mitra S, Samanta M, Chatterjee S. Measuring new born foot length to identify small babies in need of extra care: a cross-sectional hospital based study. Iran J Pediatr 2013; 23:508-12. [PMID: 24800008 PMCID: PMC4006497] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 07/27/2012] [Accepted: 02/24/2013] [Indexed: 11/28/2022]
Abstract
OBJECTIVE The neonatal mortality rate (NMR) continues to remain quite high, one important cause being preterm deliveries. The main obstacle in the pathway towards decreasing NMR is identification of babies in need of extra care. To analyze the utility of newborn foot length as a proxy measure for birth weight and gestational age. METHODS A cross-sectional study done in a hospital of eastern India with 351 babies during 4 months. Right foot length of each recorded using a plastic, stiff ruler. FINDINGS 48.1% babies were preterm, 51.8% low birth weight (LBW) and 33.3% very low birth weight (VLBW). Foot length less than 7.75 cm has 92.3% sensitivity and 86.3% specificity for identification of preterm neonates. For identification of LBW babies (<2500 gm) a foot length less than 7.85cm has 100% sensitivity and 95.3% specificity. Foot length less than 6.85 cm has 100% sensitivity and 94.9% specifity for identification of VLBW babies (<1500 gm). CONCLUSION Foot length may be used in the identification of LBW and preterm babies who are in need of extra care.
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Affiliation(s)
- Satarupa Mukherjee
- Corresponding Author:Address: 517, Brahmapur, Badamtolla, Kolkata-700096, West Bengal, India. E-mail:
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Abstract
After the passing of the 1902 Midwives Act, a growing proportion of women were delivered by trained and supervised midwives. Standards of midwifery should therefore have improved over the first three decades of the twentieth century, yet nationally this was not reflected in the main outcome measures (stillbirths, early neonatal mortality and maternal death). This paper shows that there was a difference in the risks associated with delivery by the different attendants, with qualified midwives having the best outcome, then bona-fide (untrained) midwives and lastly doctors, even when account is taken of the fact that doctors were called in cases of medical need and may have been booked where a problematic delivery was expected. The paper argues that the lack of improvement in outcome measures could be consistent with improving standards of care among both trained and bona-fide midwives, because increased attention to the rules stipulating when midwives called for medical help meant that a doctor was called into an increasing number of deliveries (including less complicated ones), raising the chance of unnecessary and dangerous interventions.
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Affiliation(s)
- Alice Reid
- The Cambridge Group for the History of Population and Social Structure, Department of Geography, Downing Place, Cambridge CB2 3EN, UK.
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18
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Singh GK, Kposowa AJ. A comparative analysis of infant mortality in major Ohio cities: significance of socio-biological factors. Appl Behav Sci Rev 2002; 2:77-94. [PMID: 12346273 DOI: 10.1016/1068-8595(94)90022-1] [Citation(s) in RCA: 16] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [What about the content of this article? (0)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 10/26/2022]
Abstract
"Using linked birth and infant death records for Ohio for the 1984-87 birth cohorts, this paper examines differentials in neonatal, postneonatal, and infant mortality rates in four major Ohio cities....It was found that, compared to Toledo, Cleveland had 51% higher risk of infant death, Cincinnati had 45% higher risk, [and] Columbus had 13% higher risk of infant death. Although in each of these cities, black infants had significantly higher risk of death than white infants, controlling for race alone reduced but did not eliminate the infant mortality differentials among the cities. The results of the hazards analyses reveal that maternal education, marital status, maternal age, birth order, prenatal care, gestational age, and birth weight had a profound net impact on the risk of infant death and that, even after controlling for these and other maternal and infant characteristics, significant city differentials persisted in infant mortality."
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Ekwempu CC. The influence of antenatal care on pregnancy outcome. Trop J Obstet Gynaecol 2002; 1:67-71. [PMID: 12179287] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Key Words] [MESH Headings] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 02/26/2023] Open
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Rehan NE, Tafida DS. Low birthweight in Hausa infants. Niger J Paediatr 2002; 8:35-9. [PMID: 12338583] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Key Words] [MESH Headings] [Subscribe] [Scholar Register] [Indexed: 02/26/2023]
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Lagazio C, Pagani L. [The application of event history analysis to historical demographic studies]. Boll Demogr Stor 2002:97-112. [PMID: 12348621] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Key Words] [MESH Headings] [Subscribe] [Scholar Register] [Indexed: 02/26/2023]
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Akadli B, Tuncbilek E. An evaluation on the relation between birth spacing and infant mortality in Turkey. Nufusbil Derg 2002; 9:27-38. [PMID: 12159438] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Key Words] [MESH Headings] [Subscribe] [Scholar Register] [Indexed: 02/26/2023]
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Ozcebe H, Enunlu T, Bertan M. [Some health indicators in Etimesgut health training and research area (Ankara, Turkey, 1967-1988)]. Nufusbil Derg 2002; 12:101-13. [PMID: 12159420] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Key Words] [MESH Headings] [Subscribe] [Scholar Register] [Indexed: 02/26/2023]
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Urass EJ, Kilewo C, Mtavangu R, Mhalu FS, Mbena E, Biberfeld G. The role of HIV infection in pregnancy wastage in Dar es Salaam, Tanzania. J Obstet Gynaecol East Cent Africa 2002; 10:70-2. [PMID: 12319036] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Key Words] [MESH Headings] [Subscribe] [Scholar Register] [Indexed: 02/26/2023]
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Okonofua FE, Makinde ON, Ayangade SO. Yearly trends in caesarean section and cesarean mortality at Ile-Ife, Nigeria. Trop J Obstet Gynaecol 2002; 1:31-5. [PMID: 12179273] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Key Words] [MESH Headings] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 02/26/2023] Open
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Kartoglu HU. [Neonatal tetanus mortality: using the survey technique as a different approach to the selection of a survey region for Turkey]. Nufusbil Derg 2002; 10:63-72. [PMID: 12159418] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Key Words] [MESH Headings] [Subscribe] [Scholar Register] [Indexed: 02/26/2023]
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Ruzkova J, Ales M. [Population development in the Czech Republic in 1993]. Demografie 2002; 36:225-37. [PMID: 12319421] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Abstract] [Key Words] [MESH Headings] [Subscribe] [Scholar Register] [Indexed: 02/26/2023]
Abstract
The "Czech Republic's demographic development in 1993 was characterized particularly by conspicuous abatement of nuptiality, continuance of natality decline, marked reduction of induced abortions...,continued decrease of infant and neonatal mortality rates and by considerable shrinkage of population increase due to migration. [A] steep fall of nuptiality became the most pronounced feature of population development in 1993.... The number of children born in 1993 in the Czech Republic was the [lowest] since 1918 and the crude birth rate...was the lowest...since 1785.... Marked diminution of abortions signifies another outstanding phenomenon of population development in the Czech Republic. There has [been a]...decline of deaths, [a] decrease of crude death rate and [a] medium life span extension." (SUMMARY IN ENG AND RUS)
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Zahid GM. Mother's health-seeking behaviour and childhood mortality in Pakistan. Pak Dev Rev 2002; 35:719-31. [PMID: 12146446] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Abstract] [Key Words] [MESH Headings] [Subscribe] [Scholar Register] [Indexed: 02/26/2023]
Abstract
"The paper examines the mother's health-seeking behaviour and childhood mortality in Pakistan. This is based on the 1990-91 Pakistan Demographic and Health Survey (PDHS).... It was found that neonatal, infant, and child mortality rate is the highest among children of mothers aged less than 20 years. Infant and child mortality rate is likewise higher among first and higher order births than among births of second or third order. It was further found that mortality declines as the length of the birth interval increases. The results reveal that the education of mother has significant effect on the neonatal, infant and child survival.... Health care factors such as antenatal care, place of delivery, assistance at delivery and immunisation also influenced neonatal, infant and child mortality."
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Onyemeh AU, Twomey D. The consecutive management of uterine rupture. Trop J Obstet Gynaecol 2002; 1:80-1. [PMID: 12179278] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Key Words] [MESH Headings] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 02/26/2023] Open
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Campos TP, Carvalho MS, Barcellos CC. [Infant mortality in Rio de Janeiro, Brazil: risk areas and distance traveled by patients to get to health care facilities]. Rev Panam Salud Publica 2000; 8:164-71. [PMID: 11036426 DOI: 10.1590/s1020-49892000000800003] [Citation(s) in RCA: 23] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/22/2022] Open
Abstract
The infant mortality rate has been considered a summary of the quality of life and level of development of a given population. However, this indicator is very sensitive to such simple measures as oral rehydration therapy, vaccination, and continuation of breast-feeding. Given that such health activities have become more widespread, an infant mortality rate may no longer reflect a particular development model. With the aim of broadening the discussion regarding infant mortality, this study analyzed the 153 neighborhoods of the city of Rio de Janeiro, Brazil. Our objective was to identify areas with more risk, and the priority groups for interventions to decrease infant mortality. We analyzed neonatal and postneonatal mortality in each neighborhood. We also identified the children's home neighborhood and the location of their deaths and related these results to the socioeconomic classification of the corresponding neighborhoods. In relation to the average infant mortality rate for the city, we could not make statistically significant comparisons for some neighborhoods due to their small number of births. One-third of the infant deaths could have been prevented with early diagnosis and treatment. Only 15% of the deaths were considered unavoidable. Both neonatal mortality and postneonatal mortality were geographically dispersed, with no direct association with the socioeconomic profile of the neighborhoods. An analysis of the children's place of residence and the location of their deaths showed flows of patients from poor areas to more affluent city areas with better health services. This pattern highlights the effect of access to quality medical care on infant mortality.
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Affiliation(s)
- T P Campos
- Fundação Oswaldo Cruz, Escola Nacional de Saúde Pública, Departamento de Epidemiologia e Métodos Quantitativos em Saúde, Rio de Janeiro, Brasil
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Abstract
BACKGROUND Neonatal care is not available to most neonates in developing countries because hospitals are inaccessible and costly. We developed a package of home-based neonatal care, including management of sepsis (septicaemia, meningitis, pneumonia), and tested it in the field, with the hypothesis that it would reduce the neonatal mortality rate by at least 25% in 3 years. METHODS We chose 39 intervention and 47 control villages in the Gadchiroli district in India, collected baseline data for 2 years (1993-95), and then introduced neonatal care in the intervention villages (1995-98). Village health workers trained in neonatal care made home visits and managed birth asphyxia, premature birth or low birthweight, hypothermia, and breast-feeding problems. They diagnosed and treated neonatal sepsis. Assistance by trained traditional birth attendants, health education, and fortnightly supervisory visits were also provided. Other workers recorded all births and deaths in the intervention and the control area (1993-98) to estimate mortality rates. FINDINGS Population characteristics in the intervention and control areas, and the baseline mortality rates (1993-95) were similar. Baseline (1993-95) neonatal mortality rate in the intervention and the control areas was 62 and 58 per 1000 live births, respectively. In the third year of intervention 93% of neonates received home-based care. Neonatal, infant, and perinatal mortality rates in the intervention area (net percentage reduction) compared with the control area, were 25.5 (62.2%), 38.8 (45.7%), and 47.8 (71.0%), respectively (p<0.001). Case fatality in neonatal sepsis declined from 16.6% (163 cases) before treatment, to 2.8% (71 cases) after treatment by village health workers (p<0.01). Home-based neonatal care cost US$5.3 per neonate, and in 1997-98 such care averted one death (fetal or neonatal) per 18 neonates cared for. INTERPRETATION Home-based neonatal care, including management of sepsis, is acceptable, feasible, and reduced neonatal and infant mortality by nearly 50% among our malnourished, illiterate, rural study population. Our approach could reduce neonatal mortality substantially in developing countries.
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Affiliation(s)
- A T Bang
- Society for Education, Action, and Research in Community Health, Gadchiroli, Maharashtra, India
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Ameh EA. Incarcerated and strangulated inguinal hernias in children in Zaria, Nigeria. East Afr Med J 1999; 76:499-501. [PMID: 10685318] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Subscribe] [Scholar Register] [Indexed: 02/15/2023]
Abstract
OBJECTIVE To reappraise the problem of incarcerated and strangulated inguinal hernias in children in Zaria, Nigeria. DESIGN A retrospective study. SETTING Ahmadu Bello University Teaching Hospital, Zaria, Nigeria. PATIENTS Eighteen children aged below two years with incarcerated and strangulated inguinal hernias managed over a 10 year period. MAIN OUTCOME MEASURES Incarceration and strangulation rate, resection rate, testicular infarction, wound infection. RESULTS The overall incarceration and strangulation rate was 4.8%. The rate in neonates was 80%, 33% in those less than six months and 21% in those below one year. There was no incarceration or strangulations after two years of age. The intestinal resection rate for gangrene was 11% (two neonates) and ipsilateral orchidectomy was necessary for testicular infarction in two neonates (11%). Wound infection occurred in three patients (17%) and there were no deaths. Overall, there has been an improvement in the incarceration and strangulation rate, resection rate and wound infection rate over earlier years (5.7%, 28% and 50% respectively for earlier years) due largely to early presentation. Testicular infarction, however, remains a major risk particularly in neonates. CONCLUSION The policy of early repair of inguinal hernias in children especially below two years and particularly in neonates should be continuously emphasised to avoid morbidity.
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Affiliation(s)
- E A Ameh
- Department of Surgery, Ahmadu Bello University Teaching Hospital, Zaria, Nigeria
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Abstract
Analysis of vital statistics for the Czech Republic between 1986 and 1993, including 3,254 infant deaths from 350,978 first births to married and single women who conceived at ages 18-29 years, revealed a neonatal survival advantage for low-weight infants born to disadvantaged (single, less educated) women, particularly for deaths from congenital anomalies. This advantage largely disappeared after the neonatal period. The same patterns have been observed for low-weight infants born to black women in the United States. Since the Czech Republic had an ethnically homogenous population, virtually universal prenatal care, and uniform institutional conditions for delivery, Czech results must be attributed to social rather than to biologic or medical circumstances. This strengthens the contention that in the United States, the black neonatal survival paradox may be due as much to race-related social stigmatization and consequent disadvantage as to any hypothesized hereditary influences on birth-weight-specific survival.
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Affiliation(s)
- E Carlson
- Department of Sociology, University of South Carolina, Columbia, USA
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36
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Abstract
The objective of this study was to validate retrospective caregiver interviews for diagnosing major causes of severe neonatal illness and death. A convenience sample of 149 infants aged < 28 days with one or more suspected diagnoses of interest (low birthweight/severe malnutrition, preterm birth, birth asphyxia, birth trauma, neonatal tetanus, pneumonia, meningitis, septicaemia, diarrhoea, congenital malformation or injury) was taken from patients admitted to two hospitals in Dhaka, Bangladesh. Study paediatricians performed a standardised history and physical examination and ordered laboratory and radiographic tests according to study criteria. With a median interval of 64.5 days after death or hospital discharge, caregivers of 118 (79%) infants were interviewed about their child's illness. Using reference diagnoses based on predefined clinical and laboratory criteria, the sensitivity and specificity of particular combinations of signs (algorithms) reported by the caregivers were ascertained. Sufficient numbers of children with five reference standard diagnoses were studied to validate caregiver reports. Algorithms with sensitivity and specificity > 80% were identified for neonatal tetanus, low birthweight/severe malnutrition and preterm delivery. Algorithms with specificities > 80% for birth asphyxia and pneumonia had sensitivities < 70%, or alternatively had high sensitivity with lower specificity. In settings with limited access to medical care, retrospective caregiver interviews provide a valid means of diagnosing several of the most common causes of severe neonatal illness and death.
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Affiliation(s)
- H D Kalter
- Department of International Health, Johns Hopkins School of Hygiene and Public Health, Baltimore, MD 21205, USA
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Wang PD, Lin RS. Perinatal mortality in Taiwan. Public Health 1999; 113:27-33. [PMID: 10823745] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 02/16/2023]
Abstract
Information on perinatal deaths was obtained from 310 women by collecting detailed obstetric histories dating from marriage to the start of the survey. These histories were compared to those of 688 age matched controls. Potential risk factors, levels and time trends of perinatal mortality in Taiwan were examined and factors underlying stillbirths and early neonatal deaths were also compared using conditional logistic regression analyses. A nearly 56% decline of the perinatal mortality rate during the 35 y, approximately, prior to the survey was observed. Risk of stillbirths was increased among those who had abused illegal drugs during pregnancy, those who reported that the pregnancy was unwanted and those with Thalassemia trait. Body mass index was log-linearly related with stillbirths, with higher body mass associated with higher risk. For early neonatal deaths, those mothers aged 19 y or less, those giving birth to either their first children or to their fifth or later child, those who had their first prenatal care visit after the first three months of pregnancy were associated with increased risk in the logistic model. Those with a birth interval of less than two years and those with less education were associated with increased risk in both perinatal death groups. While some of these factors have already been associated with perinatal deaths, others have not; the new associations provide clues to mechanisms by which the risk of death increases before or after delivery.
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Affiliation(s)
- P D Wang
- Taipei Wanhwa District Health Center, Taiwan
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38
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Fazili F, Mattoo GM. Epidemiology of perinatal mortality: a hospital baed study. JK Pract 1999; 6:41-5. [PMID: 12295050] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Key Words] [MESH Headings] [Subscribe] [Scholar Register] [Indexed: 04/19/2023]
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39
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Abstract
Although Hong Kong's infant mortality is among the lowest in the world, there may still be subgroups in the population with unusually high and possibly avoidable mortality rates. We conducted an ecological study on the relationship between socioeconomic deprivation and infant mortality in Hong Kong by using government data from three periods: 1979-83, 1984-88 and 1989-93. The study population comprised all infant births in 65 modified districts in Hong Kong in the period 1979-93. Infant, neonatal and post-neonatal mortality rates (IMRs, NMRs and PNMRs) were used as the health indicators. An F score was derived from highly correlated socioeconomic variables by factor analysis and used as a summary index of socioeconomic status. In 1979-83, socioeconomic deprivation was found to be significantly associated with high IMRs and high NMRs in both sexes, while in 1984-88 this association was observed only in baby girls. None of the observed associations were significant in 1989-93. Overall, the territory's infant mortality rates fell from 10.2 per thousand live births in 1979-83 to 5.6 per thousand live births in 1989-93. Individual-based studies are needed to ascertain whether this apparent disappearance of the socioeconomic relationship with infant and neonatal mortality is real.
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Affiliation(s)
- T W Wong
- Department of Community and Family Medicine, Chinese University of Hong Kong, Hong Kong
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40
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Abstract
Close consanguineous unions continue to be extremely common in much of West Asia, including Pakistan. However, the impact of inbreeding on offspring mortality, particularly perinatal mortality, remains poorly documented. This paper attempts to measure the mortality risks associated with consanguinity and inbreeding while controlling for the effects of other potential confounders. The study sample comprises a multi-ethnic population residing in selected squatter settlements of Karachi. The adjusted odds ratio for perinatal mortality in the offspring of women married to their first cousins was 2.0 [95% CI 1.5, 2.6]. When parental inbreeding was also taken into account, the adjusted odds ratio for perinatal mortality increased further. Analysis of a subsample of data limited to pregnancies to women aged 35 years or above (at the time of the survey) showed that, despite adjustment for important biological and socio-demographic factors, both consanguinity and inbreeding remained important predictors of perinatal mortality in the offspring. Implications of the present study for further research are highlighted.
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Affiliation(s)
- R Hussain
- Australian National University, Canberra, Australia
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Koupilova I, Mckee M, Holcik J. Neonatal mortality in the Czech Republic during the transition. Health Policy 1998; 46:43-52. [PMID: 12349027] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Abstract] [Key Words] [MESH Headings] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 02/26/2023]
Abstract
"This paper examines how neonatal mortality has changed in the Czech Republic during the [1990s], examining trends in the distribution of birth weights and in birth weight specific neonatal mortality. It examines how these have varied in different parts of the country and, to ascertain the scope for further improvement, it compares them with corresponding values from Sweden, a country with one of the lowest neonatal mortality rates in Europe."
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42
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Tsao PN, Teng RJ, Wu TJ, Tang JR, Yau KI. Early outcome of extremely low birth weight infants in Taiwan. J Formos Med Assoc 1998; 97:471-6. [PMID: 9700244] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 02/08/2023] Open
Abstract
We retrospectively evaluated the outcome and the risk factors for mortality among extremely low birth weight (ELBW) infants born at National Taiwan University Hospital. The records of all live-born infants with body birth weight of less than 1,000 g from January 1, 1993, to December 31, 1996, were evaluated. Infants with major anomalies or whose parents refused resuscitation were excluded from the analysis. There were 81 ELBW infants (0.59%) among a total of 13,835 live births during the study period, and 73 cases were enrolled for study. The mean gestational age (GA) was 27.2 (range, 24-34) weeks. Sixty-six percent of the ELBW infants were born by cesarean delivery. Respiratory distress syndrome occurred in 64% of infants and exogenous surfactant therapy was given to 47%, while intermittent mandatory ventilation was given to 85%. Symptomatic patent ductus arteriosus occurred in 34% of infants, septicemia in 30%, chronic lung disease in 48%, grade III to IV intraventricular hemorrhage in 27%, stage III to V retinopathy of prematurity in 33%, and necrotizing enterocolitis in 8%. Neonatal survival was 74%, survival to discharge was 60%, and intact survival was 50%. The survival rate was 40% for infants with a birth body of weight less than or equal to 750 g, and 68% for those with a birth body weight of greater than 750 g. While survival was 27% for infants with a GA of less than 26 weeks, it was 75% for those with a GA of greater than or equal to 26 weeks. The survival rate improved year by year for those with a GA less than 28 weeks. Cox regression analysis of survival showed that Apgar score at 1 minute (p = 0.0063), pulmonary hypertension (p = 0.012), and severe intraventricular hemorrhage (p = 0.0031) were the most important factors associated with mortality. Though the outcome of ELBW infants in our institute seems poorer than in some more developed countries, it is improving. The prognosis for ELBW infants of 24 to 25 weeks' GA remains guarded under our present care.
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Affiliation(s)
- P N Tsao
- Department of Pediatrics, National Taiwan University, Medical College, Taipei, Taiwan
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43
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Rajna PN, Mishra AK, Krishnamoorthy S. Impact of maternal education and health services on child mortality in Uttar Pradesh, India. Asia Pac Popul J 1998; 13:27-38. [PMID: 12321739] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Abstract] [Key Words] [MESH Headings] [Subscribe] [Scholar Register] [Indexed: 02/26/2023]
Abstract
"This article, which examines the effect of maternal education on child mortality [in India], shows that education has direct as well as indirect effects through antenatal care and family formation patterns on neonatal mortality. Maternal education also has a substantial effect on later childhood mortality. While improving maternal education is a means of reducing childhood mortality, an immediate reduction in childhood mortality is feasible even under existing social conditions by enhancing accessibility to maternal and child health services and safe drinking water."
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Abstract
OBJECTIVES This study identified factors contributing to the rapid decline in infant mortality in New York City from 1989 to 1992. METHODS Changes in birthweight distributions and in birthweight/age-, cause-, and birthweight/age/cause-specific mortality rates from 1988/89 (before the mortality reduction) to 1990/91 were identified from New York City vital statistics data. RESULTS Infant, neonatal, and postneonatal mortality of very-low-birthweight (< 1500 g) and normal-birthweight infants decreased significantly. The declines were almost entirely due to decreases in birthweight-specific mortality rates, rather than increased birthweights. All races experienced most of these reductions. Mortality decreased significantly for 6 causes of death. These decreases were consistent with the birthweight/age groups experiencing mortality declines. CONCLUSIONS Widespread, multiple perinatal and postnatal factors contributed to the decline in infant mortality.
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Affiliation(s)
- H D Kalter
- Bureau of Maternity Services and Family Planning, New York City Department of Health, NY, USA.
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45
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Bittar Z. Rates of perinatal mortality and low birth weight among 3367 consecutive births in south of Beirut. J Med Liban 1998; 46:126-30. [PMID: 10095842] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Subscribe] [Scholar Register] [Indexed: 02/11/2023]
Abstract
3367 consecutive births were reviewed prospectively. Population belongs mainly to a community with relatively underprivileged living conditions. Perinatal mortality was found at a rate of 22.4/1000 B. Early neonatal mortality formed 6.66/1000 B and stillbirth formed 15.83/1000 B. Low birth weight rate was 5.43% of live birth. Analysis of our findings suggests the need to improve follow-up during gestation to avoid complications resulting in macerated stillbirths, and to review the routine of follow-up and care in the immediate period before delivery, during delivery, in the immediate post partum period including resuscitation procedures, and care in the ICN. The aim is to prevent and appropriately treat intrauterine asphyxia, fetal distress, obstetric complications, and in the post partum period to appropriately resuscitate the newborn and improve ICN procedures. These measures are expected to reduce fresh stillbirth and early neonatal mortality and consequently infant mortality. Lowering rate of low birth weight is of less urgent nature in this population as it is relatively not high, but because a larger portion of early neonatal mortality is among low birth weight infants, with weights below 2000 gms, improving ICN care provided to these neonates is expected to sharply reduce neonatal mortality. In Lebanon we have a growing number of ICN units with wide variability of the quality of medical supervision and facilities. Insufficient number of neonatologists and nurses who are specialized in neonatal intensive care is leaving the chance for sick neonates to be attended by general pediatricians and insufficiently trained nurses. Our medical schools are called to encourage pediatricians to specialize in neonatal intensive care and to create more opportunities for this specialty to meet the national requirement. It is suggested, too, to subject ICN units in Lebanon to standardized requirements concerning attendance and facilities before obtaining official recognition. Centralization of care given to severely sick neonates and to women with high risk pregnancy in optimal conditions is most needed.
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Affiliation(s)
- Z Bittar
- Pediatric Department, Lebanese University Medical School, Beirut
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46
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Aleman J, Brännström I, Liljestrand J, Peña R, Persson LA, Steidinger J. Saving more neonates in hospital: an intervention towards a sustainable reduction in neonatal mortality in a Nicaraguan hospital. Trop Doct 1998; 28:88-92. [PMID: 9594676 DOI: 10.1177/004947559802800211] [Citation(s) in RCA: 9] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/15/2022]
Abstract
A process of change was initiated in a Nicaraguan regional hospital in order to achieve a sustainable reduction of early neonatal mortality. A series of organizational, educational and hygienic measures was introduced, involving all staff in antenatal care, delivery care and neonatal care. Neonatal mortality decreased from 56/1000 live births in 1985 to 11/1000 in 1993. A commission of maternal and child health, a weekly perinatal audit, the active involvement of all staff and dedicated work of key individuals, as well as national policy decisions, are considered important determinants of the process. Keeping neonatal mortality in focus through continuous analysis of care routines, and through external exchange of ideas is important in order to sustain improvements and to decrease further the mortality.
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Affiliation(s)
- J Aleman
- Department of Paediatrics, HEODRA, León, Nicaragua
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47
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Luther NY. Mother's tetanus immunisation is associated not only with lower neonatal mortality but also with lower early-childhood mortality. Natl Fam Health Surv Bull 1998:1-4. [PMID: 12295450] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Key Words] [MESH Headings] [Subscribe] [Scholar Register] [Indexed: 04/19/2023]
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48
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Bird ST, Bauman KE. State-level infant, neonatal, and post neonatal mortality: the contribution of selected structural socioeconomic variables. Int J Health Serv 1998; 28:13-27. [PMID: 9493751 DOI: 10.2190/7ufv-cb1w-m5kd-qd9p] [Citation(s) in RCA: 9] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 02/06/2023]
Abstract
Reducing infant mortality in the United States is a national priority. States' infant mortality rates vary substantially. Public health researchers, practitioners, and leaders have long argued that social and other structural factors must be addressed if health outcomes are to be improved. A knowledge of which structural variables are most strongly related to state-level infant mortality is needed to guide the development of policies and programs to reduce this mortality. The authors examine the importance of several structural (social, economic, and political) variables for state-level infant, neonatal, and postneonatal mortality. With the state as the unit of analysis, data for all 50 states were analyzed using multiple regression. Together, the structural variables accounted for two-thirds of the variance in infant and neonatal mortality rates and over half of the variance in postneonatal mortality rates. States with proportionately larger black populations had higher infant, neonatal, and postneonatal mortality rates. States with greater percentages of high school graduates had lower neonatal mortality rates but higher postneonatal mortality rates. The findings suggest that a better understanding of the relationship between states' social structure and infant health outcomes is needed if state-level infant mortality is to be reduced.
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Affiliation(s)
- S T Bird
- Center for the Study of Women in Society, University of Oregon, Eugene 97403-1201, USA
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49
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Gao M, He Y, Li Y, Liu X, Li Y. An analysis of the result of life observation of children under the age of five in Dongcheng district, Beijing, between 1991 and 1994. Chin J Popul Sci 1998; 10:101-5. [PMID: 12294556] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Key Words] [MESH Headings] [Subscribe] [Scholar Register] [Indexed: 04/19/2023]
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50
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Koschin F. [What is the height of the force of mortality on the beginning of human life?]. Demografie 1998; 40:103-12. [PMID: 12293851] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Key Words] [MESH Headings] [Subscribe] [Scholar Register] [Indexed: 04/19/2023]
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