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Sample records for prevent infant mortality

  1. Infant Mortality

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    ... After hours (404) 639-2888 Contact Media Infant Mortality Recommend on Facebook Tweet Share Compartir On This ... differences in rates among population groups. About Infant Mortality Infant mortality is the death of an infant ...

  2. Reducing infant mortality.

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    Johnson, T R

    1994-01-01

    Public health and social policies at the population level (e.g., oral rehydration therapy and immunization) are responsible for the major reduction in infant mortality worldwide. The gap in infant mortality rates between developing and developed regions is much less than that in maternal mortality rates. This indicates that maternal and child health (MCH) programs and women's health care should be combined. Since 1950, 66% of infant deaths occur in the 1st 28 days, indicating adverse prenatal and intrapartum events (e.g., congenital malformation and birth injuries). Infection, especially pneumonia and diarrhea, and low birth weight are the major causes of infant mortality worldwide. An estimated US$25 billion are needed to secure the resources to control major childhood diseases, reduce malnutrition 50%, reduce child deaths by 4 million/year, provide potable water and sanitation to all communities, provide basic education, and make family planning available to all. This cost for saving children's lives is lower than current expenditures for cigarettes (US$50 billion in Europe/year). Vitamin A supplementation, breast feeding, and prenatal diagnosis of congenital malformations are low-cost strategies that can significantly affect infant well-being and reduce child mortality in many developing countries. The US has a higher infant mortality rate than have other developed countries. The American College of Obstetricians and Gynecologists and the US National Institutes of Health are focusing on prematurity, low birth weight, multiple pregnancy, violence, alcohol abuse, and poverty to reduce infant mortality. Obstetricians should be important members of MCH teams, which also include traditional birth attendants, community health workers, nurses, midwives, and medical officers. We have the financial resources to allocate resources to improve MCH care and to reduce infant mortality.

  3. Infant Mortality in Novo Hamburgo: Associated Factors and Cardiovascular Causes

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    Camila de Andrade Brum

    2015-04-01

    Full Text Available Background: Infant mortality has decreased in Brazil, but remains high as compared to that of other developing countries. In 2010, the Rio Grande do Sul state had the lowest infant mortality rate in Brazil. However, the municipality of Novo Hamburgo had the highest infant mortality rate in the Porto Alegre metropolitan region. Objective: To describe the causes of infant mortality in the municipality of Novo Hamburgo from 2007 to 2010, identifying which causes were related to heart diseases and if they were diagnosed in the prenatal period, and to assess the access to healthcare services. Methods: This study assessed infants of the municipality of Novo Hamburgo, who died, and whose data were collected from the infant death investigation records. Results: Of the 157 deaths in that period, 35.3% were reducible through diagnosis and early treatment, 25% were reducible through partnership with other sectors, 19.2% were non-preventable, 11.5% were reducible by means of appropriate pregnancy monitoring, 5.1% were reducible through appropriate delivery care, and 3.8% were ill defined. The major cause of death related to heart disease (13.4%, which was significantly associated with the variables ‘age at death’, ‘gestational age’ and ‘birth weight’. Regarding access to healthcare services, 60.9% of the pregnant women had a maximum of six prenatal visits. Conclusion: It is mandatory to enhance prenatal care and newborn care at hospitals and basic healthcare units to prevent infant mortality.

  4. Infant Mortality in Novo Hamburgo: Associated Factors and Cardiovascular Causes

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    Brum, Camila de Andrade [Instituto de Cardiologia/Fundação Universitária de Cardiologia (IC/FUC), Porto Alegre, RS (Brazil); Stein, Airton Tetelbom [Universidade Federal de Ciências da Saúde de Porto Alegre (UFCSPA), Porto Alegre, RS (Brazil); Grupo Hospitalar Conceição (GHC), Porto Alegre, RS (Brazil); Universidade Luterana do Brasil (ULBRA), Porto Alegre, RS (Brazil); Pellanda, Lucia Campos, E-mail: luciapell.pesquisa@cardiologia.org.br [Instituto de Cardiologia/Fundação Universitária de Cardiologia (IC/FUC), Porto Alegre, RS (Brazil); Universidade Federal de Ciências da Saúde de Porto Alegre (UFCSPA), Porto Alegre, RS (Brazil)

    2015-04-15

    Infant mortality has decreased in Brazil, but remains high as compared to that of other developing countries. In 2010, the Rio Grande do Sul state had the lowest infant mortality rate in Brazil. However, the municipality of Novo Hamburgo had the highest infant mortality rate in the Porto Alegre metropolitan region. To describe the causes of infant mortality in the municipality of Novo Hamburgo from 2007 to 2010, identifying which causes were related to heart diseases and if they were diagnosed in the prenatal period, and to assess the access to healthcare services. This study assessed infants of the municipality of Novo Hamburgo, who died, and whose data were collected from the infant death investigation records. Of the 157 deaths in that period, 35.3% were reducible through diagnosis and early treatment, 25% were reducible through partnership with other sectors, 19.2% were non-preventable, 11.5% were reducible by means of appropriate pregnancy monitoring, 5.1% were reducible through appropriate delivery care, and 3.8% were ill defined. The major cause of death related to heart disease (13.4%), which was significantly associated with the variables ‘age at death’, ‘gestational age’ and ‘birth weight’. Regarding access to healthcare services, 60.9% of the pregnant women had a maximum of six prenatal visits. It is mandatory to enhance prenatal care and newborn care at hospitals and basic healthcare units to prevent infant mortality.

  5. Infant Mortality in Novo Hamburgo: Associated Factors and Cardiovascular Causes

    International Nuclear Information System (INIS)

    Brum, Camila de Andrade; Stein, Airton Tetelbom; Pellanda, Lucia Campos

    2015-01-01

    Infant mortality has decreased in Brazil, but remains high as compared to that of other developing countries. In 2010, the Rio Grande do Sul state had the lowest infant mortality rate in Brazil. However, the municipality of Novo Hamburgo had the highest infant mortality rate in the Porto Alegre metropolitan region. To describe the causes of infant mortality in the municipality of Novo Hamburgo from 2007 to 2010, identifying which causes were related to heart diseases and if they were diagnosed in the prenatal period, and to assess the access to healthcare services. This study assessed infants of the municipality of Novo Hamburgo, who died, and whose data were collected from the infant death investigation records. Of the 157 deaths in that period, 35.3% were reducible through diagnosis and early treatment, 25% were reducible through partnership with other sectors, 19.2% were non-preventable, 11.5% were reducible by means of appropriate pregnancy monitoring, 5.1% were reducible through appropriate delivery care, and 3.8% were ill defined. The major cause of death related to heart disease (13.4%), which was significantly associated with the variables ‘age at death’, ‘gestational age’ and ‘birth weight’. Regarding access to healthcare services, 60.9% of the pregnant women had a maximum of six prenatal visits. It is mandatory to enhance prenatal care and newborn care at hospitals and basic healthcare units to prevent infant mortality

  6. Infant Mortality and Native Hawaiians/Pacific Islanders

    Science.gov (United States)

    ... Hawaiian/Other Pacific Islander > Infant Health & Mortality Infant Mortality and Native Hawaiians/Pacific Islanders While the overall ... data for this ethnic group is limited. Infant Mortality Rate Infant mortality rate per 1,000 live ...

  7. Infant Mortality and American Indians/Alaska Natives

    Science.gov (United States)

    ... American Indian/Alaska Native > Infant Health & Mortality Infant Mortality and American Indians/Alaska Natives American Indian/Alaska ... as compared to non-Hispanic white mothers. Infant Mortality Rate: Infant mortality rate per 1,000 live ...

  8. Infant Mortality and Hispanic Americans

    Science.gov (United States)

    ... Infant Mortality Statistics from the 2013 Period Linked Birth/Infant Death Data Set. National Vital Statistics Reports . Table 5. http://www.cdc.gov/nchs/data/nvsr/nvsr64/nvsr64_09.pdf [PDF | 994KB] Infant deaths and mortality rates for the top 4 leading cause of death ...

  9. [Impact of immunization measures by the Family Health Program on infant mortality from preventable diseases in Olinda, Pernambuco State, Brazil].

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    Guimarães, Tânia Maria Rocha; Alves, João Guilherme Bezerra; Tavares, Márcia Maia Ferreira

    2009-04-01

    This article analyzes the impact of the Family Health Program (FHP) on infant health in Olinda, Pernambuco State, Brazil, evaluating immunization and infant mortality from vaccine-preventable diseases. A time-series study was conducted with data from the principal health information systems, analyzing indicators before and after implementation of the FHP in 1995. The independent variable was year of birth, related to degree of population coverage by the FHP. Three periods were analyzed: 1990-1994 (prior), 1995-1996 (implementation phase: 0 to 30% coverage), and 1997-2002 (intervention: coverage of 38.6% to 54%). Trends in the indicators were analyzed by simple linear regression, testing significance with the t test. During the implementation period there was an increase in all the vaccination coverage rates (176% BCG, 223% polio, 52% DPT, 61% measures) and a decrease in infant mortality from preventable diseases (12.7 deaths/year), even without a decrease in absolute poverty in the municipality or an increase in either coverage by the public health care system or the sewage system. Improvement in the indicators demonstrates the effectiveness of FHP actions in the municipality.

  10. Infant mortality in the Marshall Islands.

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    Levy, S J; Booth, H

    1988-12-01

    Levy and Booth present previously unpublished infant mortality rates for the Marshall Islands. They use an indirect method to estimate infant mortality from the 1973 and 1980 censuses, then apply indirect and direct methods of estimation to data from the Marshall Islands Women's Health Survey of 1985. Comparing the results with estimates of infant mortality obtained from vital registration data enables them to estimate the extent of underregistration of infant deaths. The authors conclude that 1973 census appears to be the most valid information source. Direct estimates from the Women's Health Survey data suggest that infant mortality has increased since 1970-1974, whereas the indirect estimates indicate a decreasing trend in infant mortality rates, converging with the direct estimates in more recent years. In view of increased efforts to improve maternal and child health in the mid-1970s, the decreasing trend is plausible. It is impossible to estimate accurately infant mortality in the Marshall Islands during 1980-1984 from the available data. Estimates based on registration data for 1975-1979 are at least 40% too low. The authors speculate that the estimate of 33 deaths per 1000 live births obtained from registration data for 1984 is 40-50% too low. In round figures, a value of 60 deaths per 1000 may be taken as the final estimate for 1980-1984.

  11. The Prevention of Prematurity: A Strategy to Reduce Infant Mortality in the District of Columbia.

    Science.gov (United States)

    Maxwell, Joan

    The infant mortality rate in the District of Columbia is higher than that for any other state. This high rate stems from the great number of infants born seriously underweight and reflects the area's high percentage of births to impoverished black women. Efforts to reduce the mortality rate have centered around the medical treatment approach,…

  12. Infant Mortality Statistics From the 2013 Period Linked Birth/Infant Death Data Set.

    Science.gov (United States)

    Matthews, T J; MacDorman, Marian F; Thoma, Marie E

    2015-08-06

    This report presents 2013 period infant mortality statistics from the linked birth/infant death data set (linked file) by maternal and infant characteristics. The linked file differs from the mortality file, which is based entirely on death certificate data. Descriptive tabulations of data are presented and interpreted. The U.S. infant mortality rate was 5.96 infant deaths per 1,000 live births in 2013, similar to the rate of 5.98 in 2012. The number of infant deaths was 23,446 in 2013, a decline of 208 infant deaths from 2012. From 2012 to 2013, infant mortality rates were stable for most race and Hispanic origin groups; declines were reported for two Hispanic subgroups: Cuban and Puerto Rican. Since 2005, the most recent high, the U.S. infant mortality rate has declined 13% (from 6.86), with declines in both neonatal and postneonatal mortality overall and for most groups. In 2013, infants born at 37–38 weeks of gestation (early term) had mortality rates that were 63% higher than for full-term (39–40 week) infants. For multiple births, the infant mortality rate was 25.84, 5 times the rate of 5.25 for singleton births. In 2013, 36% of infant deaths were due to preterm-related causes of death, and an additional 15% were due to causes grouped into the sudden unexpected infant death category. All material appearing in this report is in the public domain and may be reproduced or copied without permission; citation as to source, however, is appreciated.

  13. Temperature extremes and infant mortality in Bangladesh: Hotter months, lower mortality.

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    Babalola, Olufemi; Razzaque, Abdur; Bishai, David

    2018-01-01

    Our study aims to obtain estimates of the size effects of temperature extremes on infant mortality in Bangladesh using monthly time series data. Data on temperature, child and infant mortality were obtained for Matlab district of rural Bangladesh for January 1982 to December 2008 encompassing 49,426 infant deaths. To investigate the relationship between mortality and temperature, we adopted a regression with Autoregressive Integrated Moving Average (ARIMA) errors model of seasonally adjusted temperature and mortality data. The relationship between monthly mean and maximum temperature on infant mortality was tested at 0 and 1 month lags respectively. Furthermore, our analysis was stratified to determine if the results differed by gender (boys versus girls) and by age (neonates (≤ 30 days) versus post neonates (>30days and Bangladesh. Each degree Celsius increase in mean monthly temperature reduced monthly mortality by 3.672 (SE 1.544, pBangladesh. This may reflect a more heightened sensitivity of infants to hypothermia than hyperthermia in this environment.

  14. Evaluating the impact a proposed family planning model would have on maternal and infant mortality in Afghanistan.

    Science.gov (United States)

    Rahmani, Ahmad Masoud; Wade, Benjamin; Riley, William

    2015-01-01

    This study aimed to assess the potential impact a proposed family planning model would have on reducing maternal and infant mortality in Afghanistan. Afghanistan has a high total fertility rate, high infant mortality rate, and high maternal mortality rate. Afghanistan also has tremendous socio-cultural barriers to and misconceptions about family planning services. We applied predictive statistical models to a proposed family planning model for Afghanistan to better understand the impact increased family planning can have on Afghanistan's maternal mortality rate and infant mortality rate. We further developed a sensitivity analysis that illustrates the number of maternal and infant deaths that can be averted over 5 years according to different increases in contraceptive prevalence rates. Incrementally increasing contraceptive prevalence rates in Afghanistan from 10% to 60% over the course of 5 years could prevent 11,653 maternal deaths and 317,084 infant deaths, a total of 328,737 maternal and infant deaths averted. Achieving goals in reducing maternal and infant mortality rates in Afghanistan requires a culturally relevant approach to family planning that will be supported by the population. The family planning model for Afghanistan presents such a solution and holds the potential to prevent hundreds of thousands of deaths. Copyright © 2013 John Wiley & Sons, Ltd.

  15. INFANT MORTALITY MAR URAL POPULATION OF MEERUT

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    C Prakash

    1994-06-01

    Full Text Available A cross sectional study was conducted in eight selected villages of Meerut District [UJP.} to find out infant mortality rate alongwith other various health care delivery practices associated with this. An infant mortality rate of 106.7/1000 LB was found in the study population. Infant mortality was higher in female infants, infants of mothers not availed antenatal care, not received tetanus toxoid, delivered by untrained personnel and where cow-dung was applied to cord stump. Among the causes of infant deaths prematurity or low birth weight was the commonest cause followed by respiratory infections, diarrhoeal diseases and tetanus neonatorum

  16. Infant Mortality and Asians and Pacific Islanders

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    ... infant mortality rates than the overall population, however statistics for Asian American subgroups are very limited for ... 1 0.4 Source: CDC 2015. Infant Mortality Statistics from the 2013 Period Linked Birth/Infant Death ...

  17. Poverty Mapping Project: Global Subnational Infant Mortality Rates

    Data.gov (United States)

    National Aeronautics and Space Administration — The Global Subnational Infant Mortality Rates consists of estimates of infant mortality rates for the year 2000. The infant mortality rate for a region or country is...

  18. VSRR - Quarterly provisional estimates for infant mortality

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    U.S. Department of Health & Human Services — Provisional estimates of infant mortality (deaths of infants under 1 year per 1,000 live births), neonatal mortality (deaths of infants aged 0-27 days per 1,000 live...

  19. Are infant mortality rate declines exponential? The general pattern of 20th century infant mortality rate decline

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    Opuni Marjorie

    2009-08-01

    Full Text Available Abstract Background Time trends in infant mortality for the 20th century show a curvilinear pattern that most demographers have assumed to be approximately exponential. Virtually all cross-country comparisons and time series analyses of infant mortality have studied the logarithm of infant mortality to account for the curvilinear time trend. However, there is no evidence that the log transform is the best fit for infant mortality time trends. Methods We use maximum likelihood methods to determine the best transformation to fit time trends in infant mortality reduction in the 20th century and to assess the importance of the proper transformation in identifying the relationship between infant mortality and gross domestic product (GDP per capita. We apply the Box Cox transform to infant mortality rate (IMR time series from 18 countries to identify the best fitting value of lambda for each country and for the pooled sample. For each country, we test the value of λ against the null that λ = 0 (logarithmic model and against the null that λ = 1 (linear model. We then demonstrate the importance of selecting the proper transformation by comparing regressions of ln(IMR on same year GDP per capita against Box Cox transformed models. Results Based on chi-squared test statistics, infant mortality decline is best described as an exponential decline only for the United States. For the remaining 17 countries we study, IMR decline is neither best modelled as logarithmic nor as a linear process. Imposing a logarithmic transform on IMR can lead to bias in fitting the relationship between IMR and GDP per capita. Conclusion The assumption that IMR declines are exponential is enshrined in the Preston curve and in nearly all cross-country as well as time series analyses of IMR data since Preston's 1975 paper, but this assumption is seldom correct. Statistical analyses of IMR trends should assess the robustness of findings to transformations other than the log

  20. Developing a statewide public health initiative to reduce infant mortality in Oklahoma.

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    Dooley, Suzanna; Patrick, Paul; Lincoln, Alicia; Cline, Janette

    2014-01-01

    The Preparing for a Lifetime, It's Everyone's Responsibility initiative was developed to improve the health and well- being of Oklahoma's mothers and infants. The development phase included systematic data collection, extensive data analysis, and multi-disciplinary partnership development. In total, seven issues (preconception/interconception health, tobacco use, postpartum depression, breastfeeding, infant safe sleep, preterm birth, and infant injury prevention) were identified as crucial to addressing infant mortality in Oklahoma. Workgroups were created to focus on each issue. Data and media communications workgroups were added to further partner commitment and support for policy and programmatic changes across multiple agencies and programs. Leadership support, partnership, evaluation, and celebrating small successes were important factors that lead to large scale adoption and support for the state-wide initiative to reduce infant mortality.

  1. Stillbirth and Infant Mortality

    DEFF Research Database (Denmark)

    Nøhr, Ellen Aagaard

    2012-01-01

    mechanisms behind these associations remain largely unknown. Although maternal obesity is associated with a wide range of complications in the mother and neonate that may impair fetal and infant survival, the increased risk of stillbirth and infant mortality is virtually unchanged when accounting...

  2. Infant mortality in a rural population of Meerut

    Directory of Open Access Journals (Sweden)

    C Prakash

    1994-06-01

    Full Text Available A cross sectional study was conducted in eight selected villages of Meerut District [UJP.} to find out infant mortality rate alongwith other various health care delivery practices associated with this. An infant mortality rate of 106.7/1000 LB was found in the study population. Infant mortality was higher in female infants, infants of mothers not availed antenatal care, not received tetanus toxoid, delivered by untrained personnel and where cow-dung was applied to cord stump. Among the causes of infant deaths prematurity or low birth weight was the commonest cause followed by respiratory infections, diarrhoeal diseases and tetanus neonatorum Infant mortality in a rural population of meerut

  3. Disparities in Infant Mortality by Race Among Hispanic and Non-Hispanic Infants.

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    Rice, Whitney S; Goldfarb, Samantha S; Brisendine, Anne E; Burrows, Stevie; Wingate, Martha S

    2017-07-01

    U.S.-born Hispanic infants have a well-documented health advantage relative to other minority groups. However, little published research has examined racial heterogeneity within the Hispanic population, in relation to health outcomes. The current study aims to explore possible implications of racial identification for the health of U.S. born Hispanic compared to non-Hispanic infants. Methods Data were drawn from 2007 to 2008 NCHS Cohort Linked Live Birth-Infant Death Files, restricted to deliveries of Hispanic black, Hispanic white, non-Hispanic black (NHB) and non-Hispanic white mothers (NHW) (n = 7,901,858). Adjusted odds ratios for first week mortality, neonatal, postneonatal, and overall infant mortality were calculated for each group, using NHW as the reference group. A distinct health gradient was observed in which NHB infants (n = 1,250,222) had the highest risk of first week (aOR 2.29, CI 2.21-2.37), neonatal (aOR 2.23, CI 2.17-2.30), postneonatal (aOR 1.74, CI 1.68-1.81), and infant mortality (aOR 2.05, CI 2.00-2.10) compared to NHW infants (n = 4,578,150). Hispanic black infants (n = 84,377) also experienced higher risk of first-week (aOR 1.28 (1.12-1.47), neonatal (aOR .27, CI 1.13-1.44), postneonatal (aOR 1.34, CI 1.15-1.56), and infant mortality (aOR 1.30, CI 1.18-1.43) compared to both NHW and Hispanic white infants (n = 1,989,109). Conclusions for Practice: Risk of infant mortality varies among Hispanic infants by race, with poorer outcomes experienced by Hispanic black infants. Compared to non-Hispanic infants of the same race, Hispanic black infants experience a smaller health disadvantage and Hispanic white infants have better or similar infant health outcomes. Our findings suggest implications of racial heterogeneity on infant health outcomes, and provide insight into the role of race as a social construct.

  4. Optimal breastfeeding durations for HIV-exposed infants: the impact of maternal ART use, infant mortality and replacement feeding risk.

    Science.gov (United States)

    Mallampati, Divya; MacLean, Rachel L; Shapiro, Roger; Dabis, Francois; Engelsmann, Barbara; Freedberg, Kenneth A; Leroy, Valeriane; Lockman, Shahin; Walensky, Rochelle; Rollins, Nigel; Ciaranello, Andrea

    2018-04-01

    In 2010, the WHO recommended women living with HIV breastfeed for 12 months while taking antiretroviral therapy (ART) to balance breastfeeding benefits against HIV transmission risks. To inform the 2016 WHO guidelines, we updated prior research on the impact of breastfeeding duration on HIV-free infant survival (HFS) by incorporating maternal ART duration, infant/child mortality and mother-to-child transmission data. Using the Cost-Effectiveness of Preventing AIDS Complications (CEPAC)-Infant model, we simulated the impact of breastfeeding duration on 24-month HFS among HIV-exposed, uninfected infants. We defined "optimal" breastfeeding durations as those maximizing 24-month HFS. We varied maternal ART duration, mortality rates among breastfed infants/children, and relative risk of mortality associated with replacement feeding ("RRRF"), modelled as a multiplier on all-cause mortality for replacement-fed infants/children (range: 1 [no additional risk] to 6). The base-case simulated RRRF = 3, median infant mortality, and 24-month maternal ART duration. In the base-case, HFS ranged from 83.1% (no breastfeeding) to 90.2% (12-months breastfeeding). Optimal breastfeeding durations increased with higher RRRF values and longer maternal ART durations, but did not change substantially with variation in infant mortality rates. Optimal breastfeeding durations often exceeded the previous WHO recommendation of 12 months. In settings with high RRRF and long maternal ART durations, HFS is maximized when mothers breastfeed longer than the previously-recommended 12 months. In settings with low RRRF or short maternal ART durations, shorter breastfeeding durations optimize HFS. If mothers are supported to use ART for longer periods of time, it is possible to reduce transmission risks and gain the benefits of longer breastfeeding durations. © 2018 The Authors. Journal of the International AIDS Society published by John Wiley & sons Ltd on behalf of the International AIDS Society.

  5. Ethnicity and infant mortality in Malaysia.

    Science.gov (United States)

    Dixon, G

    1993-06-01

    Malaysian infant mortality differentials are a worthwhile subject for study, because socioeconomic development has very clearly had a differential impact by ethnic group. The Chinese rates of infant mortality are significantly lower than the Malay or Indian rates. Instead of examining the obvious access to care issues, this study considered factors related to the culture of infant care. Practices include the Chinese confinement of the mother in the first month after childbirth ("pe'i yue") and Pillsbury's 12 normative rules for Malaysian Chinese care. Malay practices vary widely by region and history. Indian mothers are restricted by diet. Data-recording flaws do not permit analysis of Sarawak or Sabah. The general assumption that Western medicine favors better health for mothers and infants is substantiated among peninsular communities, however, there are also negative impacts which affect infant mortality. The complex interaction of factors impacting on infant mortality reported in seven previous studies is discussed. A review of these studies reveals that immediate causes are infections, injuries, and dehydration. Indirect causes are birth weight or social and behavioral factors such as household income or maternal education. Indirect factors, which are amenable to planned change and influence the biological proximate determinants of infant mortality, are identified as birth weight, maternal age at birth, short pregnancy intervals or prior reproductive loss, sex of the child, birth order, duration of breast feeding and conditions of supplementation, types of household water and sanitation, year of child's birth, maternal education, household income and composition, institution of birth, ethnicity, and rural residence. Nine factors are identified empirically as not significant: maternal hours of work in the child's first year, maternal occupation, distance from home to workplace, presence of other children or servants, incidence of epidemics in the child's first

  6. Causes of Infant Mortality in Kalaleh City During 2004-2012

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    Abed Nouri

    2013-10-01

    Full Text Available Background and objectives: Almost 130 million infants are born each year, more than 8 million of whomdie before their first year of life. In the developing countries, two thirds of these deaths occur in the first monthof their life. Reduced infant mortality is among the Millennium Development indicators, and this rate is highin Kalaleh city. This study aimed to identify the most common causes of infant death, so that the avoidabledeaths be prevented by offering intervention plans.Methods: information was collected with the designed form. The data were, then, coded and entered into the SPSS 17software, and analyzed using independent statistical chi-square test.In this study, all causes of infant death in Kalaleh city during 2003-2013 were investigated. TheResults: prematurity (47.42%, congenital abnormalities (22.42%, and disasters and accidents (9.79%. 82.73%of the infants weighed below 2500 g. 60% of the prematurity deaths occurred to primigravid women. There388 infant deaths accounted for 83% of under-5 mortality. The most common causes of death includewas a statistically significant relationship between primigravity and prematurity infant death with a 95% confidence(P=0.003. 74.74% of the infant deaths occurred in the first week, and 58.96% in the first 24 hours.Conclusion: As 38.4% of the infant deaths occurred in the first pregnancy, and 60% of prematurity deathshappened to primigravid women, and there was a relationship between primigravity and prematurity infantdeaths, the importance of the particular care of these mothers comes into sight. Planning for teaching the imof caring the primigravid mothers and making their families more sensitive about the significance ofportancecaring these mothers can be effective in reducing premature infant mortality.

  7. CDC WONDER: Mortality - Infant Deaths

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    U.S. Department of Health & Human Services — The Mortality - Infant Deaths (from Linked Birth / Infant Death Records) online databases on CDC WONDER provide counts and rates for deaths of children under 1 year...

  8. Gender Differentials and Disease-Specific Cause of Infant Mortality ...

    African Journals Online (AJOL)

    AJRH Managing Editor

    causes of infant mortality in an urban hospital in Ghana and gender differences in the burden of infant mortality. Births and deaths data at the hospital .... intended to assess the picture of infant mortality in Ghana as presented in the WHO and ..... Central Intelligence Agency: World Fact Book-Ghana. (2008): Rank order-Infant ...

  9. Total prevention of folic acid-preventable spina bifida and anencephaly would reduce child mortality in India: Implications in achieving Target 3.2 of the Sustainable Development Goals.

    Science.gov (United States)

    Kancherla, Vijaya; Oakley, Godfrey P

    2018-03-15

    The potential to reduce child mortality by preventing folic acid-preventable spina bifida and anencephaly (FAP SBA) is inadequately appreciated. To quantify possible reduction in FAP SBA-associated child mortality in low- and middle-income countries, we conducted an analysis to demonstrate in India, a country with more than 25 million births and 1.2 million under-five deaths each year, the decrease in neonatal, infant, and under-five mortality that would occur through total prevention of FAP SBA. We estimated the percent reductions in neonatal, infant, and under-five mortality that would have occurred in India in 2015 had all of FAP SBA been prevented. We also estimated the contributions of these reductions toward India's Sustainable Development Goals on child mortality indicators. We considered the overall prevalence of spina bifida and anencephaly in India as 5 per 1,000 live births, of which 90% were preventable with effective folic acid intervention. In the year 2015, folic acid interventions would have prevented about 116,070 cases of FAP SBA and 101,565 under-five deaths associated with FAP SBA. Prevention of FAP SBA would have reduced annually, neonatal, infant, and under-five mortality by 10.2%, 8.9%, and 8.3%, respectively. These reductions would have contributed 18.5% and 17.2% to the reductions in neonatal and under-five mortality, respectively, needed by India to achieve its 2030 Sustainable Developmental Goal Target 3.2 addressing preventable child mortality. Total prevention of FAP SBA clearly has a significant potential for immediate reductions in neonatal, infant, and under-five mortality in India, and similarly other countries. © 2017 Wiley Periodicals, Inc.

  10. Reproductive justice & preventable deaths: State funding, family planning, abortion, and infant mortality, US 1980–2010

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    Nancy Krieger

    2016-12-01

    Full Text Available Introduction: Little current research examines associations between infant mortality and US states’ funding for family planning services and for abortion, despite growing efforts to restrict reproductive rights and services and documented associations between unintended pregnancy and infant mortality. Material and methods: We obtained publicly available data on state-only public funding for family planning and abortion services (years available: 1980, 1987, 1994, 2001, 2006, and 2010 and corresponding annual data on US county infant death rates. We modeled the funding as both fraction of state expenditures and per capita spending (per woman, age 15–44. State-level covariates comprised: Title X and Medicaid per capita funding, fertility rate, and percent of counties with no abortion services; county-level covariates were: median family income, and percent: black infants, adults without a high school education, urban, and female labor force participation. We used Possion log-linear models for: (1 repeat cross-sectional analyses, with random state and county effects; and (2 panel analysis, with fixed state effects. Results: Four findings were robust to analytic approach. First, since 2000, the rate ratio for infant death comparing states in the top funding quartile vs. no funding for abortion services ranged (in models including all covariates between 0.94 and 0.98 (95% confidence intervals excluding 1, except for the 2001 cross-sectional analysis, whose upper bound equaled 1, yielding an average 15% reduction in risk (range: 8–22%. Second, a similar risk reduction for state per capita funding for family planning services occurred in 1994. Third, the excess risk associated with lower county income increased over time, and fourth, remained persistently high for counties with a high percent of black infants. Conclusions: Insofar as reducing infant mortality is a government priority, our data underscore the need, despite heightened contention

  11. Ethamsylate for the prevention of morbidity and mortality in preterm or very low birth weight infants.

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    Hunt, Rod; Hey, Edmund

    2010-01-20

    Ethamsylate decreases blood loss in certain clinical situations such as menorrhagia and following some surgical procedures. This potential to reduce bleeding has led to the hypothesis that it may have a role to play in reducing intraventricular haemorrhage in preterm infants. To determine if ethamsylate, when compared to placebo or no treatment, reduces morbidity and/or mortality in preterm infants. We searched the Cochrane Neonatal Group Trials Register (24 August 2009), the Cochrane Central Register of Controlled Trials (CENTRAL, The Cochrane Library 2009, Issue 2), MEDLINE and EMBASE (January 1966 to July 2009) and the Oxford Database of Perinatal Trials. Randomised controlled trials or quasi-randomised trials comparing ethamsylate with placebo or no treatment. The initial search for trials enrolling infants born less than 32 weeks gestation was subsequently expanded to include trials enrolling preterm infants ethamsylate and controls. Infants treated with ethamsylate had significantly less intraventricular haemorrhage than controls at ethamsylate identified from this systematic review. Preterm infants treated with ethamsylate showed no reductions in mortality or neurodevelopmental impairment despite the reduction in any grade of intraventricular haemorrhage seen in infants < 35 weeks gestation.

  12. Deciphering infant mortality

    Science.gov (United States)

    Berrut, Sylvie; Pouillard, Violette; Richmond, Peter; Roehner, Bertrand M.

    2016-12-01

    This paper is about infant mortality. In line with reliability theory, "infant" refers to the time interval following birth during which the mortality (or failure) rate decreases. This definition provides a systems science perspective in which birth constitutes a sudden transition falling within the field of application of the Transient Shock (TS) conjecture put forward in Richmond and Roehner (2016c). This conjecture provides predictions about the timing and shape of the death rate peak. It says that there will be a death rate spike whenever external conditions change abruptly and drastically and also predicts that after a steep rise there will be a much longer hyperbolic relaxation process. These predictions can be tested by considering living organisms for which the transient shock occurs several days after birth. Thus, for fish there are three stages: egg, yolk-sac and young adult phases. The TS conjecture predicts a mortality spike at the end of the yolk-sac phase and this timing is indeed confirmed by observation. Secondly, the hyperbolic nature of the relaxation process can be tested using very accurate Swiss statistics for postnatal death rates spanning the period from one hour immediately after birth through to age 10 years. It turns out that since the 19th century despite a significant and large reduction in infant mortality, the shape of the age-specific death rate has remained basically unchanged. Moreover the hyperbolic pattern observed for humans is also found for small primates as recorded in the archives of zoological gardens. Our overall objective is to identify a series of cases which start from simple systems and move step by step to more complex organisms. The cases discussed here we believe represent initial landmarks in this quest.

  13. Infant mortality due to perinatal causes in Brazil: trends, regional patterns and possible interventions

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    Cesar Gomes Victora

    2001-01-01

    Full Text Available CONTEXT: Brazilian infant and child mortality levels are not compatible with the country's economic potential. In this paper, we provide a description of levels and trends in infant mortality due to perinatal causes and malformations and assess the likely impact of changing intermediate-level determinants, many of which are amenable to direct interventions through the health or related sectors. TYPE OF STUDY: Review paper. METHODS: Two main sources of mortality data were used: indirect mortality estimates based on censuses and surveys, and rates based on registered deaths. The latter were corrected for under-registration. Combination of the two sources of data allowed the estimation of cause-specific mortality rates. Data on current coverage of preventive and curative interventions were mostly obtained from the 1996 Demographic and Health Survey. Other national household surveys and Ministry of Health Statistics were also used. A thorough review of the Brazilian literature on levels, trends and determinants of infant mortality led to the identification of a large number of papers and books. These provided the background for the analyses of risk factors and potential interventions. RESULTS: The indirect infant mortality rate estimate for 1995-97 is of 37.5 deaths per thousand live births, about six times higher than in the lowest mortality countries in the world. Perinatal causes account for 57% of all infant deaths, and congenital malformations are responsible for 11.2% of these deaths. Mortality levels are highest in the Northeast and North, and lowest in the South and Southeast; the Center-West falls in between. Since surveys of the North region do not cover rural areas, mortality for this region may be underestimated. CONCLUSIONS: A first priority for the further reduction in infant mortality in Brazil is to improve equality among regions, since the North and Northeast, and particularly rural areas, still show very high death rates. Further

  14. Infant Mortality: An American Tragedy.

    Science.gov (United States)

    Hale, Christiane B.

    1990-01-01

    Assesses the complex problem of infant deaths in America and reviews the policy options before the nation. High infant mortality rates have been attributed to population heterogeneity, poverty, or differences in the way health services are organized. Links health policy issues to the larger issue of social and economic equity. (AF)

  15. Low infant mortality among Palestine refugees despite the odds

    Science.gov (United States)

    Khader, Ali; Sabatinelli, Guido

    2011-01-01

    Abstract Objective To present data from a 2008 infant mortality survey conducted in Jordan, Lebanon, the Syrian Arab Republic, the Gaza Strip and the West Bank and analyse infant mortality trends among Palestine refugees in 1995–2005. Methods Following the preceding birth technique, mothers who were registering a new birth were asked if the preceding child was alive or dead, the day the child was born and the date of birth of the neonate whose birth was being registered. From this information, neonatal, infant and early child mortality rates were estimated. The age at death for early child mortality was determined by the mean interval between successive births and the mean age of neonates at registration. Findings In 2005–2006, infant mortality among Palestine refugees ranged from 28 deaths per 100 000 live births in the Syrian Arab Republic to 19 in Lebanon. Thus, infant mortality in Palestine refugees is among the lowest in the Near East. However, infant mortality has stopped decreasing in recent years, although it remains at a level compatible with the attainment of Millennium Development Goal 4. Conclusion Largely owing to the primary health care provided by the United Nations Relief and Works Agency (UNRWA) for Palestine Refugees in the Near East and other entities, infant mortality among Palestine refugees had consistently decreased. However, it is no longer dropping. Measures to address the most likely reasons – early marriage and childbearing, poor socioeconomic conditions and limited access to good perinatal care – are needed. PMID:21479095

  16. Geographical trends in infant mortality: England and Wales, 1970-2006.

    Science.gov (United States)

    Norman, Paul; Gregory, Ian; Dorling, Danny; Baker, Allan

    2008-01-01

    At national level in England and Wales, infant mortality rates fell rapidly from the early 1970s and into the 1980s. Subnational areas have also experienced a reduction in levels of infant mortality. While rates continued to fall to 2006, the rate of reduction has slowed. Although the Government Office Regions Yorkshire and The Humber, the North West and the West Midlands and the Office for National Statistics local authority types Cities and Services and London Cosmopolitan have experienced relatively large absolute reductions in infant mortality, their rates remained high compared with the national average. Within all regions and local authority types, a strong relationship was found between ward level deprivation and infant mortality rates. Nevertheless, levels of infant mortality declined over time even in the most deprived areas with a narrowing of absolute differences in rates between areas. Areas in which the level of deprivation eased have experienced greater than average reductions in levels of infant mortality.

  17. An Overview of Infant Mortality Trends in Qatar from 2004 to 2014.

    Science.gov (United States)

    Al-Thani, Mohammed; Al-Thani, Al-Anoud; Toumi, Amine; Khalifa, Shams Eldin; Akram, Hammad

    2017-09-09

    Background Infant mortality is an important health indicator that estimates population well-being. Infant mortality has declined globally but is still a major public health challenge. This article provides the characteristics, causes, burden, and trends of infant mortality in Qatar. Methods Frequencies, percentages, and rates were calculated using data from birth-death registries over 2004-2014 to describe infant mortality by nationality, gender, and age group. We calculated the relative risks of the top causes of infant mortality among subgroups according to the 10 th Revision of the International Statistical Classification of Diseases and Related Health Problems (ICD-10, Version 2016). Results During 2004-2014, 204,224 live births and 1,505 infant deaths were recorded. The infant mortality rate (IMR) averaged 7.4/1000 live births (males 8.1, females 6.6, non-Qataris 7.7, and Qataris 6.8). IMR declined 20% from 2004 to 2014. The decline in IMR was significant for the overall population of infants (p=0.006), male infants (p=0.04), females (p=0.006), and for non-Qatari males (p=0.007) and non-Qatari females (p=0.007). The leading causes of infant mortality were congenital malformations (all types) (34.5%), low birth weight (LBW) (27%), and respiratory distress of newborns (2.8%). Male infants had a higher risk of mortality than female infants due to a congenital malformation of lungs (p=0.02), other congenital malformations, not elsewhere classified (p=0.01), and cardiovascular disorders (p=0.05). Conclusion The study shows that infant mortality among male infants is high due to the top infant mortality-related disorders, and male infants have a higher risk of mortality than female infants.

  18. Maternal socioeconomic status and infant mortality with low birth weight as a mediator: an inter-country comparison between Scotland and Denmark using administrative data

    Directory of Open Access Journals (Sweden)

    Yongfu Yu

    2017-04-01

    Our result suggests that SES has similar effects on infant mortality in Denmark and Scotland but more of the effect of SES on infant mortality is mediated through low birth weight in Denmark. Public health preventive strategies for infant mortality in both countries need to address prenatal risk factors for low birth weight. The substantial direct effects of SES on infant mortality seen in Scotland, which were not mediated through low birth weight, may be explained by other birth characteristics or could reflect persisting SES disparities in the care of infants after birth.

  19. Narrowing inequalities in infant mortality in Southern Brazil

    Directory of Open Access Journals (Sweden)

    Goldani Marcelo Zubaran

    2002-01-01

    Full Text Available OBJECTIVE: To determine the trends of infant mortality from 1995 to 1999 according to a geographic area-based measure of maternal education in Porto Alegre, Brazil. METHODS: A registry-based study was carried out and a municipal database created in 1994 was used. All live births (n=119,170 and infant deaths (n=1,934 were considered. Five different geographic areas were defined according to quintiles of the percentage of low maternal educational level (<6 years of schooling: high, medium high, medium, medium low, and low. The chi-square test for trend was used to compare rates between years. Incidence rate ratio was calculated using Poisson regression to identify excess infant mortality in poorer areas compared to higher schooling areas. RESULTS: The infant mortality rate (IMR decreased steadily from 18.38 deaths per 1,000 live births in 1995 to 12.21 in 1999 (chi-square for trend p<0.001. Both neonatal and post-neonatal mortality rates decreased although the drop seemed to be steeper for the post-neonatal component. The higher decline was seen in poorer areas. CONCLUSION: Inequalities in IMR seem to have decreased due to a steeper reduction in both neonatal and post-neonatal components of infant mortality in lower maternal schooling area.

  20. Transient cultural influences on infant mortality: Fire-Horse daughters in Japan.

    Science.gov (United States)

    Bruckner, Tim A; Subbaraman, Meenakshi; Catalano, Ralph A

    2011-01-01

    Parental investment theory suggests that the quality and quantity of parental care depends, in part, on assessments of whether offspring will survive and yield grandchildren. Consistent with this theory, we hypothesize that parental perception that a birth cohort will have low reproductive success coincides with higher than expected infant mortality in the cohort. We test this hypothesis in industrialized Japan in 1966 when cultural aversion to females born in the astrological year of the Fire-Horse may have jeopardized the life of female infants. We applied time-series methods to cohort infant mortality data for Japan, from 1947 to 1976, to test whether female infant mortality in 1966 rose above levels expected from history, male infant mortality, and fertility. Methods control for the secular decline in infant mortality as well as other temporal patterns that could induce spurious associations. Findings support the hypothesis in that female infant mortality rises by 1.1 deaths per 1,000 live births above expected levels (coefficient = 0.0011; standard error = 0.0005; P = 0.03). The result indicates an excess of 721 female infant deaths statistically attributable to the Fire-Horse year. Findings remain robust to control for male infant mortality and the secular decline in mortality over the test period. The discovery of a predictable, acute increase in female infant mortality during the Fire-Horse year supports the relevance of parental investment theory to developed countries. Results should encourage further research on the health sequelae of abrupt, population-level shifts in culture. Copyright © 2011 Wiley-Liss, Inc.

  1. Separate and unequal: Structural racism and infant mortality in the US.

    Science.gov (United States)

    Wallace, Maeve; Crear-Perry, Joia; Richardson, Lisa; Tarver, Meshawn; Theall, Katherine

    2017-05-01

    We examined associations between state-level measures of structural racism and infant mortality among black and white populations across the US. Overall and race-specific infant mortality rates in each state were calculated from national linked birth and infant death records from 2010 to 2013. Structural racism in each state was characterized by racial inequity (ratio of black to white population estimates) in educational attainment, median household income, employment, imprisonment, and juvenile custody. Poisson regression with robust standard errors estimated infant mortality rate ratios (RR) and 95% confidence intervals (CI) associated with an IQR increase in indicators of structural racism overall and separately within black and white populations. Across all states, increasing racial inequity in unemployment was associated with a 5% increase in black infant mortality (RR=1.05, 95% CI=1.01, 1.10). Decreasing racial inequity in education was associated with an almost 10% reduction in the black infant mortality rate (RR=0.92, 95% CI=0.85, 0.99). None of the structural racism measures were significantly associated with infant mortality among whites. Structural racism may contribute to the persisting racial inequity in infant mortality. Copyright © 2017 Elsevier Ltd. All rights reserved.

  2. THE CAUSAL RELATIONSHIP BETWEEN CONSANGUINEOUS MARRIAGES AND INFANT MORTALITY IN TURKEY.

    Science.gov (United States)

    Koç, İsmet; Eryurt, Mehmet Alİ

    2017-07-01

    Turkey has high levels of infant mortality and consanguineous marriages. It has had a high level of infant mortality for its economic level for many years. Over recent decades, although adult mortality rates have not been very different from those of other countries with similar socioeconomic structures, its life expectancy at birth has remained low due to its high infant mortality rate. This has been called the Turkish Puzzle. According to the Turkey Family Structure and Population Issues Survey, 27% of women had a consanguineous marriage in 1968. Subsequent Turkish Demographic and Health Surveys (TDHSs) found the rate of consanguineous marriages to be stagnated at 22-24%, with a resistance to reduction. According to the TDHS-2008, 24% of women had a consanguineous marriage. Numerous studies in various countries of the world have indicated that consanguineous marriages, particularly of first-degree, have the effect of increasing infant mortality. The main aim of this study was to assess the causal impact of consanguineous, particularly first-degree consanguineous, marriages on infant mortality, controlling for individual, cultural, bio-demographic and environmental factors. Data were merged from four Turkish DHS data sets (1993, 1998, 2003 and 2008). Multivariate analysis revealed that first-degree consanguineous marriages have increased infant mortality by 45% in Turkey: 57% in urban areas and 39% in rural areas. The results indicate that there is a causal relationship between consanguineous marriages and infant mortality. This finding should be taken into account when planning policies to reduce infant mortality in Turkey, and in other countries with high rates of consanguineous marriage and infant mortality.

  3. A population-based study of effect of multiple birth on infant mortality in Nigeria

    Directory of Open Access Journals (Sweden)

    Uthman Mubashir B

    2008-09-01

    Full Text Available Abstract Background Multi-foetal pregnancies and multiple births including twins and higher order multiples births such as triplets and quadruplets are high-risk pregnancy and birth. These high-risk groups contribute to the higher rate of childhood mortality especially during early period of life. Methods We examined the relationship between multiple births and infant mortality using univariable and multivariable survival regression procedure with Weibull hazard function, controlling for child's sex, birth order, prenatal care, delivery assistance; mother's age at child birth, nutritional status, education level; household living conditions and several other risk factors. Results Children born multiple births were more than twice as likely to die during infancy as infants born singleton (hazard ratio = 2.19; 95% confidence interval: 1.50, 3.19 holding other factors constant. Maternal education and household asset index were associated with lower risk of infant mortality. Conclusion Multiple births are strongly negatively associated with infant survival in Nigeria independent of other risk factors. Mother's education played a protective role against infant death. This evidence suggests that improving maternal education may be key to improving child survival in Nigeria. A well-educated mother has a better chance of satisfying important factors that can improve infant survival: the quality of infant feeding, general care, household sanitation, and adequate use of preventive and curative health services.

  4. Differences in perinatal and infant mortality in high-income countries

    DEFF Research Database (Denmark)

    Deb-Rinker, Paromita; León, Juan Andrés; Gilbert, Nicolas L.

    2015-01-01

    BACKGROUND: Variation in birth registration criteria may compromise international comparisons of fetal and infant mortality. We examined the effect of birth registration practices on fetal and infant mortality rates to determine whether observed differences in perinatal and infant mortality rates...... by gestational age and birth weight; gestational age-and birth weight-specific stillbirth rates; neonatal, post-neonatal, and cause-specific infant mortality. RESULTS: Proportion of live births ....02%), Canada (0.07%) and United States (0.08%). At 22-23 weeks, neonatal mortality rates were highest in Canada (892.2 per 1000 live births), Denmark (879.3) and Iceland (1000.0), moderately high in the United States (724.1), Finland (794.3) and Norway (739.0) and low in Sweden (561.2). Stillbirth:live birth...

  5. [Social determinants of infant mortality in socioeconomic deprived rural areas in Mexico].

    Science.gov (United States)

    Duarte-Gómez, María Beatriz; Núñez-Urquiza, Rosa María; Restrepo-Restrepo, José Alonso; Richardson-López-Collada, Vesta Louise

    The aim of this study was to identify determinants of infant mortality in rural areas in Mexico and recommend strategies for its decrease. A study was conducted in a sample of 16 municipalities among those with the lowest index of human development. Infant deaths were identified through official data, records and through interviews with civil authorities, health workers and community leaders. Mothers of children who died were also interviewed. In most cases, deaths were related with intermediate social determinants (living conditions and health services converged). The most important critical factors were the prevention programs and delays in receiving healthcare. Deficiencies in intersectorial policies to guarantee effective access to health services were found. To decrease infant mortality in rural areas of Mexico, geographic access has to be improved as well as investment in resources and training health personnel in intercultural competence and primary health care skills. Copyright © 2015. Publicado por Masson Doyma México S.A.

  6. Young and vulnerable: Spatial-temporal trends and risk factors for infant mortality in rural South Africa (Agincourt, 1992-2007

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    Vounatsou Penelope

    2010-10-01

    Full Text Available Abstract Background Infant mortality is an important indicator of population health in a country. It is associated with several health determinants, such as maternal health, access to high-quality health care, socioeconomic conditions, and public health policy and practices. Methods A spatial-temporal analysis was performed to assess changes in infant mortality patterns between 1992-2007 and to identify factors associated with infant mortality risk in the Agincourt sub-district, rural northeast South Africa. Period, sex, refugee status, maternal and fertility-related factors, household mortality experience, distance to nearest primary health care facility, and socio-economic status were examined as possible risk factors. All-cause and cause-specific mortality maps were developed to identify high risk areas within the study site. The analysis was carried out by fitting Bayesian hierarchical geostatistical negative binomial autoregressive models using Markov chain Monte Carlo simulation. Simulation-based Bayesian kriging was used to produce maps of all-cause and cause-specific mortality risk. Results Infant mortality increased significantly over the study period, largely due to the impact of the HIV epidemic. There was a high burden of neonatal mortality (especially perinatal with several hot spots observed in close proximity to health facilities. Significant risk factors for all-cause infant mortality were mother's death in first year (most commonly due to HIV, death of previous sibling and increasing number of household deaths. Being born to a Mozambican mother posed a significant risk for infectious and parasitic deaths, particularly acute diarrhoea and malnutrition. Conclusions This study demonstrates the use of Bayesian geostatistical models in assessing risk factors and producing smooth maps of infant mortality risk in a health and socio-demographic surveillance system. Results showed marked geographical differences in mortality risk across

  7. Maternal obesity and infant mortality: a meta-analysis.

    Science.gov (United States)

    Meehan, Sean; Beck, Charles R; Mair-Jenkins, John; Leonardi-Bee, Jo; Puleston, Richard

    2014-05-01

    Despite numerous studies reporting an elevated risk of infant mortality among women who are obese, the magnitude of the association is unclear. A systematic review and meta-analysis was undertaken to assess the association between maternal overweight or obesity and infant mortality. Four health care databases and gray literature sources were searched and screened against the protocol eligibility criteria. Observational studies reporting on the relationship between maternal overweight and obesity and infant mortality were included. Data extraction and risk of bias assessments were performed. Twenty-four records were included from 783 screened. Obese mothers (BMI ≥30) had greater odds of having an infant death (odds ratio 1.42; 95% confidence interval, 1.24-1.63; P obese (BMI >35) (odds ratio 2.03; 95% confidence interval, 1.61-2.56; P obese mothers and that this risk may increase with greater maternal BMI or weight; however, residual confounding may explain these findings. Given the rising prevalence of maternal obesity, additional high-quality epidemiologic studies to elucidate the actual influence of elevated maternal mass or weight on infant mortality are needed. If a causal link is determined and the biological basis explained, public health strategies to address the issue of maternal obesity will be needed. Copyright © 2014 by the American Academy of Pediatrics.

  8. High Rates of All-cause and Gastroenteritis-related Hospitalization Morbidity and Mortality among HIV-exposed Indian Infants

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    Tripathy Srikanth

    2011-07-01

    Full Text Available Abstract Background HIV-infected and HIV-exposed, uninfected infants experience a high burden of infectious morbidity and mortality. Hospitalization is an important metric for morbidity and is associated with high mortality, yet, little is known about rates and causes of hospitalization among these infants in the first 12 months of life. Methods Using data from a prevention of mother-to-child transmission (PMTCT trial (India SWEN, where HIV-exposed breastfed infants were given extended nevirapine, we measured 12-month infant all-cause and cause-specific hospitalization rates and hospitalization risk factors. Results Among 737 HIV-exposed Indian infants, 93 (13% were HIV-infected, 15 (16% were on HAART, and 260 (35% were hospitalized 381 times by 12 months of life. Fifty-six percent of the hospitalizations were attributed to infections; gastroenteritis was most common accounting for 31% of infectious hospitalizations. Gastrointestinal-related hospitalizations steadily increased over time, peaking around 9 months. The 12-month all-cause hospitalization, gastroenteritis-related hospitalization, and in-hospital mortality rates were 906/1000 PY, 229/1000 PY, and 35/1000 PY respectively among HIV-infected infants and 497/1000 PY, 107/1000 PY, and 3/1000 PY respectively among HIV-exposed, uninfected infants. Advanced maternal age, infant HIV infection, gestational age, and male sex were associated with higher all-cause hospitalization risk while shorter duration of breastfeeding and abrupt weaning were associated with gastroenteritis-related hospitalization. Conclusions HIV-exposed Indian infants experience high rates of all-cause and infectious hospitalization (particularly gastroenteritis and in-hospital mortality. HIV-infected infants are nearly 2-fold more likely to experience hospitalization and 10-fold more likely to die compared to HIV-exposed, uninfected infants. The combination of scaling up HIV PMTCT programs and implementing proven health

  9. Maternal stress and infant mortality: The importance of the preconception period

    Science.gov (United States)

    Class, Quetzal A.; Khashan, Ali S.; Lichtenstein, Paul; Långström, Niklas; D’Onofrio, Brian M.

    2013-01-01

    Although preconception and prenatal maternal stress are associated with adverse birth and childhood outcomes, the relation to infant mortality remains uncertain. We used logistic regression to study infant mortality risk following maternal stress within a population-based sample of offspring born in Sweden from 1973 to 2008 (N= 3,055,361). Preconception (6-0 months before conception) and prenatal (conception to birth) stress was defined as death of a first-degree relative of the mother. A total of 20,651 offspring were exposed to preconception stress, 26,731 to prenatal stress, and 8,398 cases of infant mortality were identified. Preconception stress increased the risk of infant mortality independent of measured covariates (adjusted OR=1.53; 95% CI=1.25–1.88) and the association was timing-specific and robust across low-risk groups. Prenatal stress did not increase risk of infant mortality (adjusted OR=1.05; 95% CI=0.84–1.30). The period immediately before conception may be a sensitive developmental period influencing risk for infant mortality. PMID:23653129

  10. Urban poverty and infant mortality rate disparities.

    Science.gov (United States)

    Sims, Mario; Sims, Tammy L; Bruce, Marino A

    2007-04-01

    This study examined whether the relationship between high poverty and infant mortality rates (IMRs) varied across race- and ethnic-specific populations in large urban areas. Data were drawn from 1990 Census and 1992-1994 Vital Statistics for selected U.S. metropolitan areas. High-poverty areas were defined as neighborhoods in which > or = 40% of the families had incomes below the federal poverty threshold. Bivariate models showed that high poverty was a significant predictor of IMR for each group; however, multivariate analyses demonstrate that maternal health and regional factors explained most of the variance in the group-specific models of IMR. Additional analysis revealed that high poverty was significantly associated with minority-white IMR disparities, and country of origin is an important consideration for ethnic birth outcomes. Findings from this study provide a glimpse into the complexity associated with infant mortality in metropolitan areas because they suggest that the factors associated with infant mortality in urban areas vary by race and ethnicity.

  11. State infant mortality: an ecologic study to determine modifiable risks and adjusted infant mortality rates.

    Science.gov (United States)

    Paul, David A; Mackley, Amy; Locke, Robert G; Stefano, John L; Kroelinger, Charlan

    2009-05-01

    To determine factors contributing to state infant mortality rates (IMR) and develop an adjusted IMR in the United States for 2001 and 2002. Ecologic study of factors contributing to state IMR. State IMR for 2001 and 2002 were obtained from the United States linked death and birth certificate data from the National Center for Health Statistics. Factors investigated using multivariable linear regression included state racial demographics, ethnicity, state population, median income, education, teen birth rate, proportion of obesity, smoking during pregnancy, diabetes, hypertension, cesarean delivery, prenatal care, health insurance, self-report of mental illness, and number of in-vitro fertilization procedures. Final risk adjusted IMR's were standardized and states were compared with the United States adjusted rates. Models for IMR in individual states in 2001 (r2 = 0.66, P < 0.01) and 2002 (r2 = 0.81, P < 0.01) were tested. African-American race, teen birth rate, and smoking during pregnancy remained independently associated with state infant mortality rates for 2001 and 2002. Ninety five percent confidence intervals (CI) were calculated around the regression lines to model the expected IMR. After adjustment, some states maintained a consistent IMR; for instance, Vermont and New Hampshire remained low, while Delaware and Louisiana remained high. However, other states such as Mississippi, which have traditionally high infant mortality rates, remained within the expected 95% CI for IMR after adjustment indicating confounding affected the initial unadjusted rates. Non-modifiable demographic variables, including the percentage of non-Hispanic African-American and Hispanic populations of the state are major factors contributing to individual variation in state IMR. Race and ethnicity may confound or modify the IMR in states that shifted inside or outside the 95% CI following adjustment. Other factors including smoking during pregnancy and teen birth rate, which are

  12. Effects of employment and education on preterm and full-term infant mortality in Korea.

    Science.gov (United States)

    Ko, Y-J; Shin, S-H; Park, S M; Kim, H-S; Lee, J-Y; Kim, K H; Cho, B

    2014-03-01

    The infant mortality rate is a sensitive and commonly used indicator of the socio-economic status of a population. Generally, studies investigating the relationship between infant mortality and socio-economic status have focused on full-term infants in Western populations. This study examined the effects of education level and employment status on full-term and preterm infant mortality in Korea. Data were collected from the National Birth Registration Database and merged with data from the National Death Certification Database. Prospective cohort study. In total, 1,316,184 singleton births registered in Korea's National Birth Registration Database between January 2004 and December 2006 were included in the study. Multivariate logistic regression analysis was performed. Paternal and maternal education levels were inversely related to infant mortality in preterm and full-term infants following multivariate adjusted logistic models. Parental employment status was not associated with infant mortality in full-term infants, but was associated with infant mortality in preterm infants, after adjusting for place of birth, gender, marital status, paternal age, maternal age and parity. Low paternal and maternal education levels were found to be associated with infant mortality in both full-term and preterm infants. Low parental employment status was found to be associated with infant mortality in preterm infants but not in full-term infants. In order to reduce inequalities in infant mortality, public health interventions should focus on providing equal access to education. Copyright © 2013 The Royal Society for Public Health. Published by Elsevier Ltd. All rights reserved.

  13. Effect of Determinants of Infant and Child Mortality In Nigeria ...

    African Journals Online (AJOL)

    Prof. Osuagwwu

    Nigeria: Hazard And Odds Ratio Models ... Infant and child mortality is a major public health problem; however, quantifying its burden ... Also, there is an increased risk of infant and child mortality ... health risks into traditional hazards related.

  14. Infant mortality trends in a region of Belarus, 1980–2000

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    Lawvere Silvana

    2004-02-01

    Full Text Available Abstract Background The Chernobyl disaster in 1986 and the breakup of the former Soviet Union (FSU in 1991 challenged the public health infrastructure in the former Soviet republic of Belarus. Because infant mortality is regarded as a sensitive measure of the overall health of a population, patterns of neonatal and postneonatal deaths were examined within the Mogilev region of Belarus between 1980 and 2000. Methods Employing administrative death files, this study utilized a regional cohort design that included all infant deaths occurring among persons residing within the Mogilev oblast of Belarus between 1980 and 2000. Patterns of death and death rates were examined across 3 intervals: 1980–1985 (pre-Chernobyl, 1986–1991 (post-Chernobyl & pre-FSU breakup, and 1992–2000 (post-Chernobyl & post-FSU breakup. Results Annual infant mortality rates declined during the 1980s, increased during the early 1990s, and have remained stable thereafter. While infant mortality rates in Mogilev have decreased since the period 1980–1985 among both males and females, this decrement appears due to decreases in postneonatal mortality. Rates of postneonatal mortality in Mogilev have decreased since the period 1980–1985 among both males and females. Analyses of trends for infant mortality and neonatal mortality demonstrated continuous decreases between 1990, followed by a bell-shaped excess in the 1990's. Compared to rates of infant mortality for other countries, rates in the Mogilev region are generally higher than rates for the United States, but lower than rates in Russia. During the 1990s, rates for both neonatal and postneonatal mortality in Mogilev were two times the comparable rates for East and West Germany. Conclusions While neonatal mortality rates in Mogilev have remained stable, rates for postneonatal mortality have decreased among both males and females during the period examined. Infant mortality rates in the Mogilev region of Belarus remain

  15. Determinants of infant and child mortality in Zimbabwe: Results of multivariate hazard analysis

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    Joshua Kembo

    2009-10-01

    Full Text Available This study addresses important issues in infant and child mortality in Zimbabwe. The objective of the paper is to determine the impact of maternal, socioeconomic and sanitation variables on infant and child mortality. Results show that births of order 6+ with a short preceding interval had the highest risk of infant mortality. The infant mortality risk associated with multiple births was 2.08 times higher relative to singleton births (p<0.001. Socioeconomic variables did not have a distinct impact on infant mortality. Determinants of child mortality were different in relative importance from those of infant mortality. This study supports health policy initiatives to stimulate use of family planning methods to increase birth spacing. These and other results are expected to assist policy makers and programme managers in the child health sector to formulate appropriate strategies to improve the situation of children under 5 in Zimbabwe.

  16. Ecological context of infant mortality in high-focus states of India

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    Laishram Ladusingh

    2016-03-01

    Full Text Available OBJECTIVES: This goal of this study was to shed light on the ecological context as a potential determinant of the infant mortality rate in nine high-focus states in India. METHODS: Data from the Annual Health Survey (2010-2011, the Census of India (2011, and the District Level Household and Facility Survey 3 (2007-08 were used in this study. In multiple regression analysis explanatory variable such as underdevelopment is measured by the non-working population, and income inequality, quantified as the proportion of households in the bottom wealth quintile. While, the trickle-down effect of education is measured by female literacy, and investment in health, as reflected by neonatal care facilities in primary health centres. RESULTS: A high spatial autocorrelation of district infant mortality rates was observed, and ecological factors were found to have a significant impact on district infant mortality rates. The result also revealed that non-working population and income inequality were found to have a negative effect on the district infant mortality rate. Additionally, female literacy and new-born care facilities were found to have an inverse association with the infant mortality rate. CONCLUSIONS: Interventions at the community level can reduce district infant mortality rates.

  17. The Effect of Oral Polio Vaccine at Birth on Infant Mortality

    DEFF Research Database (Denmark)

    Lund, Najaaraq; Andersen, Andreas; Hansen, Anna Sofie K

    2015-01-01

    BACKGROUND: Routine vaccines may have nonspecific effects on mortality. An observational study found that OPV given at birth (OPV0) was associated with increased male infant mortality. We investigated the effect of OPV0 on infant mortality in a randomized trial in Guinea-Bissau. METHODS: A total ...

  18. [Association between types of need, human development index, and infant mortality in Mexico, 2008].

    Science.gov (United States)

    Medina-Gómez, Oswaldo Sinoe; López-Arellano, Oliva

    2011-08-01

    The aim of this study was to assess the association between different types of economic and social deprivation and infant mortality rates reported in 2008 in Mexico. We conducted an ecological study analyzing the correlation and relative risk between the human development index and levels of social and economic differences in State and national infant mortality rates. There was a strong correlation between higher human development and lower infant mortality. Low schooling and poor housing and crowding were associated with higher infant mortality. Although infant mortality has declined dramatically in Mexico over the last 28 years, the decrease has not been homogeneous, and there are persistent inequalities that determine mortality rates in relation to different poverty levels. Programs with a multidisciplinary approach are needed to decrease infant mortality rates through comprehensive individual and family development.

  19. Social inequality in infant mortality: what explains variation across low and middle income countries?

    Science.gov (United States)

    Hajizadeh, Mohammad; Nandi, Arijit; Heymann, Jody

    2014-01-01

    Growing work demonstrates social gradients in infant mortality within countries. However, few studies have compared the magnitude of these inequalities cross-nationally. Even fewer have assessed the determinants of social inequalities in infant mortality across countries. This study provides a comprehensive and comparative analysis of social inequalities in infant mortality in 53 low-and-middle-income countries (LMICs). We used the most recent nationally representative household samples (n = 874,207) collected through the Demographic Health Surveys (DHS) to calculate rates of infant mortality. The relative and absolute concentration indices were used to quantify social inequalities in infant mortality. Additionally, we used meta-regression analyses to examine whether levels of inequality in proximate determinants of infant mortality were associated with social inequalities in infant mortality across countries. Estimates of both the relative and the absolute concentration indices showed a substantial variation in social inequalities in infant mortality among LMICs. Meta-regression analyses showed that, across countries, the relative concentration of teenage pregnancy among poorer households was positively associated with the relative concentration of infant mortality among these groups (beta = 0.333, 95% CI = 0.115 0.551). Our results demonstrate that the concentration of infant deaths among socioeconomically disadvantaged households in the majority of LMICs remains an important health and social policy concern. The findings suggest that policies designed to reduce the concentration of teenage pregnancy among mothers in lower socioeconomic groups may mitigate social inequalities in infant mortality. Copyright © 2013 Elsevier Ltd. All rights reserved.

  20. infant mortality and the Kimberley Board of Health, 1898-1977

    African Journals Online (AJOL)

    Leonard B. Lerer. Annual reports of the Kimberley Board of Health, established in 1883. provide rich insight into public hearth discourse on infant mortality. Commentaries on the determinants of infant mortality, especially prior to 1950, largely focus on poverty and interracial disparities, issues relevant to current heatth policy.

  1. Polygynous contexts, family structure, and infant mortality in sub-saharan Africa.

    Science.gov (United States)

    Smith-Greenaway, Emily; Trinitapoli, Jenny

    2014-04-01

    Contextual characteristics influence infant mortality above and beyond family-level factors. The widespread practice of polygyny is one feature of many sub-Saharan African contexts that may be relevant to understanding patterns of infant mortality. Building on evidence that the prevalence of polygyny reflects broader economic, social, and cultural features and that it has implications for how families engage in the practice, we investigate whether and how the prevalence of polygyny (1) spills over to elevate infant mortality for all families, and (2) conditions the survival disadvantage for children living in polygynous families (i.e., compared with monogamous families). We use data from Demographic and Health Surveys to estimate multilevel hazard models that identify associations between infant mortality and region-level prevalence of polygyny for 236,336 children in 260 subnational regions across 29 sub-Saharan African countries. We find little evidence that the prevalence of polygyny influences mortality for infants in nonpolygynous households net of region-level socioeconomic factors and gender inequality. However, the prevalence of polygyny significantly amplifies the survival disadvantage for infants in polygynous families. Our findings demonstrate that considering the broader marital context reveals important insights into the relationship between family structure and child well-being.

  2. Mortality in infants discharged from neonatal intensive care units in Georgia.

    Science.gov (United States)

    Allen, D M; Buehler, J W; Samuels, B N; Brann, A W

    Although neonatal intensive care units (NICUs) have contributed to advances in neonatal survival, little is known about the epidemiology of deaths that occur after NICU discharge. To determine mortality rates following NICU discharge, we used linked birth, death, and NICU records for infants born to Georgia residents from 1980 through 1982 and who were admitted to NICUs participating in the state's perinatal care network. Infants who died after discharge (n = 120) had a median duration of NICU hospitalization of 20 days (range, 1 to 148 days) and a median birth weight of 1983 g (range, 793 to 5159 g). The postdischarge mortality rate was 22.7 per 1000 NICU discharges. This rate is more than five times the overall postneonatal mortality rate for Georgia from 1980 to 1982. The most common causes of death were congenital heart disease (23%), sudden infant death syndrome (21%), and infection (13%). Demographic characteristics commonly associated with infant mortality were not strongly associated with the mortality following NICU discharge.

  3. Socioeconomic inequality and its determinants regarding infant mortality in iran.

    Science.gov (United States)

    Damghanian, Maryam; Shariati, Mohammad; Mirzaiinajmabadi, Khadigeh; Yunesian, Masud; Emamian, Mohammad Hassan

    2014-06-01

    Infant mortality rate is a useful indicator of health conditions in the society, the racial and socioeconomic inequality of which is from the most important measures of social inequality. The aim of this study was to determine the socioeconomic inequality and its determinants regarding infant mortality in an Iranian population. This cross-sectional study was performed on 3794 children born during 2010-2011 in Shahroud, Iran. Based on children's addresses and phone numbers, 3412 were available and finally 3297 participated in the study. A data collection form was filled out through interviewing the mothers as well as using health records. Using principal component analysis, the study population was divided to high and low socioeconomic groups based on the case's home asset, education and job of the household's head, marital status, and composition of the household members. Inequality between the groups with regard to infant mortality was investigated by Blinder-Oaxaca decomposition method. The mortality rate was 15.1 per 1000 live births in the high socioeconomic group and 42.3 per 1000 in the low socioeconomic group. Mother's education, consanguinity of parents, and infant's nutrition type and birth weight constituted 44% of the gap contributing factors. Child's gender, high-risk pregnancy, and living area had no impact on the gap. There was considerable socioeconomic inequality regarding infant mortality in Shahroud. Mother's education was the most contributing factor in this inequality.

  4. Illness Human - MDC_InfantMortality2006

    Data.gov (United States)

    NSGIC Local Govt | GIS Inventory — Polygon feature class based on Zip Code boundaries showing the rate of infant mortality per 1000 births in Miami-Dade County, 2006. Rate does not include out of...

  5. Mortality among infants with congenital malformations, New York State, 1983 to 1988.

    Science.gov (United States)

    Druschel, C; Hughes, J P; Olsen, C

    1996-01-01

    OBJECTIVE. The authors examined first-year mortality and risk factors for mortality among infants with major congenital malformations. METHODS. Infants with major congenital malformations born from 1983 to 1988 were identified from a statewide population-based congenital malformations registry. Variables analyzed included year of birth, birth weight, gestational age, infant sex, number of malformations, number of organ systems involved, level of care of the birth hospital, maternal age, maternal education, and maternal ethnicity. RESULTS. Infants with major malformations had a risk of death 6.3 times higher than the general population of live births. The risk declined from 6.5 in 1983 to 5.9 in 1988. Birth weight and number of malformations were the strongest risk factors. The likelihood of survival was similar for white and black infants. CONCLUSIONS. Being born with a malformation outweighs most of the other risks for infant mortality. Children with congenital malformations had higher cause-specific mortality for all causes except injury. PMID:8711105

  6. Effects of maternal education on infant mortality and stillbirths in Denmark

    DEFF Research Database (Denmark)

    Olsen, O; Madsen, Mette

    1999-01-01

    and has increased in the lowest educational group. In conclusion, social inequality in infant mortality in Denmark is pronounced and cannot be explained by differences in smoking habits. The social gap between different educational groups has widened during the last decade, but may partly be explained......,814 births. When adjusted for mother's age, parity, and smoking, the stillbirth rate was independent of mother's educational level, but a clear social gradient in infant mortality was observed. Compared with a similar study in 1982-83, infant mortality has decreased most in the highest educational group...

  7. Causes and risk factors for infant mortality in Nunavut, Canada 1999–2011

    Directory of Open Access Journals (Sweden)

    Collins Sorcha A

    2012-12-01

    Full Text Available Abstract Background The northern territory Nunavut has Canada’s largest jurisdictional land mass with 33,322 inhabitants, of which 85% self-identify as Inuit. Nunavut has rates of infant mortality, postneonatal mortality and hospitalisation of infants for respiratory infections that greatly exceed those for the rest of Canada. The infant mortality rate in Nunavut is 3 times the national average, and twice that of the neighbouring territory, the Northwest Territories. Nunavut has the largest Inuit population in Canada, a population which has been identified as having high rates of Sudden Infant Death Syndrome (SIDS and infant deaths due to infections. Methods To determine the causes and potential risk factors of infant mortality in Nunavut, we reviewed all infant deaths ( Results Sudden death in infancy (SIDS/SUDI; 48% and infection (21% were the leading causes of infant death, with rates significantly higher than for Canada (2003–2007. Of SIDS/SUDI cases with information on sleep position (n=42 and bed-sharing (n=47, 29 (69% were sleeping non-supine and 33 (70% were bed-sharing. Of those bed-sharing, 23 (70% had two or more additional risk factors present, usually non-supine sleep position. CPT1A P479L homozygosity, which has been previously associated with infant mortality in Alaska Native and British Columbia First Nations populations, was associated with unexpected infant death (SIDS/SUDI, infection throughout Nunavut (OR:3.43, 95% CI:1.30-11.47. Conclusion Unexpected infant deaths comprise the majority of infant deaths in Nunavut. Although the CPT1A P479L variant was associated with unexpected infant death in Nunavut as a whole, the association was less apparent when population stratification was considered. Strategies to promote safe sleep practices and further understand other potential risk factors for infant mortality (P479L variant, respiratory illness are underway with local partners.

  8. Effects of air pollution on infant and children respiratory mortality in four large Latin-American cities

    International Nuclear Information System (INIS)

    Gouveia, Nelson; Junger, Washington Leite; Romieu, Isabelle; Cifuentes, Luis A.; Ponce de Leon, Antonio; Vera, Jeanette; Strappa, Valentina; Hurtado-Díaz, Magali; Miranda-Soberanis, Victor; Rojas-Bracho, Leonora; Carbajal-Arroyo, Luz; Tzintzun-Cervantes, Guadalupe

    2018-01-01

    Objectives: Air pollution is an important public health concern especially for children who are particularly susceptible. Latin America has a large children population, is highly urbanized and levels of pollution are substantially high, making the potential health impact of air pollution quite large. We evaluated the effect of air pollution on children respiratory mortality in four large urban centers: Mexico City, Santiago, Chile, and Sao Paulo and Rio de Janeiro in Brazil. Methods: Generalized Additive Models in Poisson regression was used to fit daily time-series of mortality due to respiratory diseases in infants and children, and levels of PM 10 and O 3 . Single lag and constrained polynomial distributed lag models were explored. Analyses were carried out per cause for each age group and each city. Fixed- and random-effects meta-analysis was conducted in order to combine the city-specific results in a single summary estimate. Results: These cities host nearly 43 million people and pollution levels were above the WHO guidelines. For PM 10 the percentage increase in risk of death due to respiratory diseases in infants in a fixed effect model was 0.47% (0.09–0.85). For respiratory deaths in children 1–5 years old, the increase in risk was 0.58% (0.08–1.08) while a higher effect was observed for lower respiratory infections (LRI) in children 1–14 years old [1.38% (0.91–1.85)]. For O 3 , the only summarized estimate statistically significant was for LRI in infants. Analysis by season showed effects of O 3 in the warm season for respiratory diseases in infants, while negative effects were observed for respiratory and LRI deaths in children. Discussion: We provided comparable mortality impact estimates of air pollutants across these cities and age groups. This information is important because many public policies aimed at preventing the adverse effects of pollution on health consider children as the population group that deserves the highest protection

  9. Case-control study on infant mortality in Southern Brazil

    Directory of Open Access Journals (Sweden)

    Mendes Karina Giane

    2006-01-01

    Full Text Available OBJECTIVE: To identify risk factors associated with infant mortality and, more specifically, with neonatal mortality. METHODS: A case-control study was carried out in the municipality of Caxias do Sul, Southern Brazil. Characteristics of prenatal care and causes of mortality were assessed for all live births in the 2001-2002 period with a completed live-birth certificate and whose mothers lived in the municipality. Cases were defined as all deaths within the first year of life. As controls, there were selected the two children born immediately after each case in the same hospital, who were of the same sex, and did not die within their first year of life. Multivariate analysis was performed using conditional logistic regression. RESULTS: There was a reduction in infant mortality, the greatest reduction was observed in the post-neonatal period. The variables gestational age (<36 weeks, birth weight (<2,500 g, and 5-minute Apgar (<6 remained in the final model of the multivariate analysis, after adjustment. CONCLUSIONS: Perinatal conditions comprise almost the totality of neonatal deaths, and the majority of deaths occur at delivery. The challenge for reducing infant mortality rate in the city is to reduce the mortality by perinatal conditions in the neonatal period.

  10. Ethnic disparity in stillbirth and infant mortality in Denmark 1981-2003

    DEFF Research Database (Denmark)

    Villadsen, Sarah Fredsted; Mortensen, Laust Hvas; Andersen, Anne-Marie Nybo

    2009-01-01

    .60-2.77) for Somali women. The relative risks of infant mortality were 1.41 (1.22-1.63), 1.88 (1.53-2.30), 1.39 (1.03-1.89) for children born of Turkish, Pakistani, and Somali mothers, respectively. The fetal and infant mortality in offspring of Lebanese and Former Yugoslavian women was not different from...... the mortality in the Danish group. The differences found were, in general, not attributable to ethnic differences in socioeconomic position. Turkish, Pakistani, and Somali children had an excess relative risk of infant death due to congenital malformations and the risk of death of perinatal causes was increased...... among the Pakistani offspring. CONCLUSION: Among the five largest ethnic minorities, the Turkish. Pakistani, and Somali population had substantially higher fetal and infant mortality compared to the Danish majority population, while the Lebanese and Former Yugoslavian minorities were at the same level...

  11. Socioeconomic Inequality and Its Determinants Regarding Infant Mortality in Iran

    Science.gov (United States)

    Damghanian, Maryam; Shariati, Mohammad; Mirzaiinajmabadi, Khadigeh; Yunesian, Masud; Emamian, Mohammad Hassan

    2014-01-01

    Background: Infant mortality rate is a useful indicator of health conditions in the society, the racial and socioeconomic inequality of which is from the most important measures of social inequality. Objectives: The aim of this study was to determine the socioeconomic inequality and its determinants regarding infant mortality in an Iranian population. Patients and Methods: This cross-sectional study was performed on 3794 children born during 2010-2011 in Shahroud, Iran. Based on children’s addresses and phone numbers, 3412 were available and finally 3297 participated in the study. A data collection form was filled out through interviewing the mothers as well as using health records. Using principal component analysis, the study population was divided to high and low socioeconomic groups based on the case’s home asset, education and job of the household’s head, marital status, and composition of the household members. Inequality between the groups with regard to infant mortality was investigated by Blinder-Oaxaca decomposition method. Results: The mortality rate was 15.1 per 1000 live births in the high socioeconomic group and 42.3 per 1000 in the low socioeconomic group. Mother's education, consanguinity of parents, and infant's nutrition type and birth weight constituted 44% of the gap contributing factors. Child's gender, high-risk pregnancy, and living area had no impact on the gap. Conclusions: There was considerable socioeconomic inequality regarding infant mortality in Shahroud. Mother's education was the most contributing factor in this inequality. PMID:25068048

  12. [Eugenic abortion could explain the lower infant mortality in Cuba compared to that in Chile].

    Science.gov (United States)

    Donoso S, Enrique; Carvajal C, Jorge A

    2012-08-01

    Cuba and Chile have the lower infant mortality rates of Latin America. Infant mortality rate in Cuba is similar to that of developed countries. Chilean infant mortality rate is slightly higher than that of Cuba. To investigate if the lower infant mortality rate in Cuba, compared to Chile, could be explained by eugenic abortion, considering that abortion is legal in Cuba but not in Chile. We compared total and congenital abnormalities related infant mortality in Cuba and Chile during 2008, based on vital statistics of both countries. In 2008, infant mortality rates in Chile were significantly higher than those of Cuba (7.8 vs. 4.7 per 1,000 live born respectively, odds ratio (OR) 1.67; 95% confidence intervals (Cl) 1.52-1.83). Congenital abnormalities accounted for 33.8 and 19.2% of infant deaths in Chile and Cuba, respectively. Discarding infant deaths related to congenital abnormalities, infant mortality rate continued to be higher in Chile than in Cuba (5.19 vs. 3.82 per 1000 live born respectively, OR 1.36; 95%CI 1.221.52). Considering that antenatal diagnosis is widely available in both countries, but abortion is legal in Cuba but not in Chile, we conclude that eugenic abortion may partially explain the lower infant mortality rate observed in Cuba compared to that observed in Chile.

  13. Infant mortality in South Africa - distribution, associations and policy implications, 2007: an ecological spatial analysis

    Directory of Open Access Journals (Sweden)

    Sartorius Benn KD

    2011-11-01

    Full Text Available Abstract Background Many sub-Saharan countries are confronted with persistently high levels of infant mortality because of the impact of a range of biological and social determinants. In particular, infant mortality has increased in sub-Saharan Africa in recent decades due to the HIV/AIDS epidemic. The geographic distribution of health problems and their relationship to potential risk factors can be invaluable for cost effective intervention planning. The objective of this paper is to determine and map the spatial nature of infant mortality in South Africa at a sub district level in order to inform policy intervention. In particular, the paper identifies and maps high risk clusters of infant mortality, as well as examines the impact of a range of determinants on infant mortality. A Bayesian approach is used to quantify the spatial risk of infant mortality, as well as significant associations (given spatial correlation between neighbouring areas between infant mortality and a range of determinants. The most attributable determinants in each sub-district are calculated based on a combination of prevalence and model risk factor coefficient estimates. This integrated small area approach can be adapted and applied in other high burden settings to assist intervention planning and targeting. Results Infant mortality remains high in South Africa with seemingly little reduction since previous estimates in the early 2000's. Results showed marked geographical differences in infant mortality risk between provinces as well as within provinces as well as significantly higher risk in specific sub-districts and provinces. A number of determinants were found to have a significant adverse influence on infant mortality at the sub-district level. Following multivariable adjustment increasing maternal mortality, antenatal HIV prevalence, previous sibling mortality and male infant gender remained significantly associated with increased infant mortality risk. Of these

  14. Average age at death in infancy and infant mortality level: Reconsidering the Coale-Demeny formulas at current levels of low mortality

    Directory of Open Access Journals (Sweden)

    Evgeny M. Andreev

    2015-08-01

    Full Text Available Background: The long-term historical decline in infant mortality has been accompanied by increasing concentration of infant deaths at the earliest stages of infancy. In the mid-1960s Coale and Demeny developed formulas describing the dependency of the average age of death in infancy on the level of infant mortality, based on data obtained up to that time. Objective: In the more developed countries a steady rise in average age of infant death began in the mid-1960s. This paper documents this phenomenon and offers alternative formulas for calculation of the average age of death, taking into account the new mortality trends. Methods: Standard statistical methodologies and a specially developed method are applied to the linked individual birth and infant death datasets available from the US National Center for Health Statistics and the initial (raw numbers of deaths from the Human Mortality Database. Results: It is demonstrated that the trend of decline in the average age of infant death becomes interrupted when the infant mortality rate attains a level around 10 per 1000, and modifications of the Coale-Demeny formulas for practical application to contemporary low levels of mortality are offered. Conclusions: The average age of death in infancy is an important characteristic of infant mortality, although it does not influence the magnitude of life expectancy. That the increase in average age of death in infancy is connected with medical advances is proposed as a possible explanation.

  15. Thymus development and infant and child mortality in rural Bangladesh.

    Science.gov (United States)

    Moore, Sophie E; Fulford, Anthony J C; Wagatsuma, Yukiko; Persson, Lars Å; Arifeen, Shams E; Prentice, Andrew M

    2014-02-01

    Data from West Africa indicate that a small thymus at birth and at 6 months of age is a strong and independent risk factor for infection-related mortality up to 24 and 36 months of age, respectively. We investigated the association between thymus size (thymic index, TI) in infancy and subsequent infant and child survival in a contemporary South Asian population. The study focused on the follow-up of a randomized trial of prenatal nutritional interventions in rural Bangladesh (ISRCTN16581394), with TI measured longitudinally in infancy (at birth and weeks 8, 24 and 52 of age) and accurate recording of mortality up to 5 years of age. A total of 3267 infants were born into the Maternal and Infant Nutrition Interventions, Matlab study; data on TI were available for 1168 infants at birth, increasing to 2094 infants by 52 weeks of age. TI in relation to body size was largest at birth, decreasing through infancy. For infants with at least one measure of TI available, there were a total of 99 deaths up to the age of 5 years. No association was observed between TI and subsequent mortality when TI was measured at birth. However, an association with mortality was observed with TI at 8 weeks of age [odds ratio (OR) for change in mortality risk associated with 1 standard deviation change in TI: all deaths: OR = 0.64, 95% confidence interval (CI) 0.41, 0.98; P = 0.038; and infection-related deaths only: OR = 0.32, 95% CI 0.14, 0.74; P = 0.008]. For TI when measured at 24 and 52 weeks of age, the numbers of infection-related deaths were too few (3 and 1, respectively) for any meaningful association to be observed. These results confirm that thymus size in early infancy predicts subsequent survival in a lower mortality setting than West Africa. The absence of an effect at birth and its appearance at 8 weeks of age suggests early postnatal influences such as breast milk trophic factors.

  16. Gender imbalance in infant mortality: a cross-national study of social structure and female infanticide.

    Science.gov (United States)

    Fuse, Kana; Crenshaw, Edward M

    2006-01-01

    Sex differentials in infant mortality vary widely across nations. Because newborn girls are biologically advantaged in surviving to their first birthday, sex differentials in infant mortality typically arise from genetic factors that result in higher male infant mortality rates. Nonetheless, there are cases where mortality differentials arise from social or behavioral factors reflecting deliberate discrimination by adults in favor of boys over girls, resulting in atypical male to female infant mortality ratios. This cross-national study of 93 developed and developing countries uses such macro-social theories as modernization theory, gender perspectives, human ecology, and sociobiology/evolutionary psychology to predict gender differentials in infant mortality. We find strong evidence for modernization theory, human ecology, and the evolutionary psychology of group process, but mixed evidence for gender perspectives.

  17. Morbidity and mortality of very low birth weight infants in Taiwan—Changes in 15 years: A population based study

    Directory of Open Access Journals (Sweden)

    Yi-Yu Su

    2016-12-01

    Conclusion: Although the mortality and most of the morbidity of VLBW infants improved over time, the incidence of ROP remained constant. This requires us to further evaluate our strategy for preventing ROP in the future.

  18. Macrosomia, Perinatal and Infant Mortality in Cree Communities in Quebec, 1996-2010.

    Directory of Open Access Journals (Sweden)

    Lin Xiao

    Full Text Available Cree births in Quebec are characterized by the highest reported prevalence of macrosomia (~35% in the world. It is unclear whether Cree births are at greater elevated risk of perinatal and infant mortality than other First Nations relative to non-Aboriginal births in Quebec, and if macrosomia may be related.This was a population-based retrospective birth cohort study using the linked birth-infant death database for singleton births to mothers from Cree (n = 5,340, other First Nations (n = 10,810 and non-Aboriginal (n = 229,960 communities in Quebec, 1996-2010. Community type was ascertained by residential postal code and municipality name. The primary outcomes were perinatal and infant mortality.Macrosomia (birth weight for gestational age >90th percentile was substantially more frequent in Cree (38.0% and other First Nations (21.9% vs non-Aboriginal (9.4% communities. Comparing Cree and other First Nations vs non-Aboriginal communities, perinatal mortality rates were 1.52 (95% confidence intervals 1.17, 1.98 and 1.34 (1.10, 1.64 times higher, and infant mortality rates 2.27 (1.71, 3.02 and 1.49 (1.16, 1.91 times higher, respectively. The risk elevations in perinatal and infant death in Cree communities attenuated after adjusting for maternal characteristics (age, education, marital status, parity, but became greater after further adjustment for birth weight (small, appropriate, or large for gestational age.Cree communities had greater risk elevations in perinatal and infant mortality than other First Nations relative to non-Aboriginal communities in Quebec. High prevalence of macrosomia did not explain the elevated risk of perinatal and infant mortality in Cree communities.

  19. Spatial modelling of rural infant mortality and occupation in 19th-century Britain

    Directory of Open Access Journals (Sweden)

    Paul Atkinson

    2017-04-01

    Full Text Available Background: Infant mortality in 19th century rural places has been largely neglected: to study it offers new insight into rural demography. Objective: This study examines infant mortality, and census occupations, between 1851 and 1911 across all the rural Registration Districts (RDs of England and Wales. Methods: The decadal 1850s−1900s RD-level demographic data in the GB Historical GIS (GBHGIS is analysed using latent trajectory analysis to identify clusters of RDs whose infant mortality rate (IMR trajectories are most similar: these are mapped in ArcGIS. The recently published Integrated Census Microdata (I-CeM resource is then used to study relationships between IMR and census-reported occupation. Geographically Weighted Regression is employed to explore spatial variation in the coefficient with which occupation affected IMR. Results: The study describes a previously unreported pattern of mortality variation, identifying seven groups of RDs with distinctive trajectories of infant mortality. A spatially varying link between IMR and female occupation rates in agriculture is noted. Conclusions: Spatial variation in rural social structures had demographic consequences. The decline in female agricultural occupation may have removed a source of harm to infant lives in the arable economy of the south and east, but simultaneously a source of benefit in the upland, pastoral north and west. Contribution: Findings about the costs and benefits of female agricultural employment can help explain the different trajectories of infant mortality in different regions, suggesting that female occupation and the details of what work women did could be a strong influence, positive or negative, on infant mortality.

  20. Infant mortality in Pelotas, Brazil: a comparison of risk factors in two birth cohorts.

    Science.gov (United States)

    Menezes, Ana Maria Baptista; Hallal, Pedro Curi; Santos, Iná Silva dos; Victora, Cesar Gomes; Barros, Fernando Celso

    2005-12-01

    To compare two population-based birth cohorts to assess trends in infant mortality rates and the distribution of relevant risk factors, and how these changed after an 11-year period. Data from two population-based prospective birth cohorts (1982 and 1993) were analyzed. Both studies included all children born in a hospital (> 99% of all births) in the city of Pelotas, Southern Brazil. Infant mortality was monitored through surveillance of all maternity hospitals, mortality registries and cemeteries. There were 5,914 live-born children in 1982 and 5,249 in 1993. The infant mortality rate decreased by 41%, from 36.0 per 1,000 live births in 1982 to 21.1 per 1,000 in 1993. Socioeconomic and maternal factors tended to become more favorable during the study period, but there were unfavorable changes in birthweight and gestational age. Poverty, high parity, low birthweight, preterm delivery, and intrauterine growth restriction were the main risk factors for infant mortality in both cohorts. The 41% reduction in infant mortality between 1982 and 1993 would have been even greater had the prevalence of risk factors remained constant during the period studied here. There were impressive declines in infant mortality which were not due to changes in the risk factors we studied. Because no reduction was seen in the large social inequalities documented in the 1982 cohort, it is likely that the reduction in infant mortality resulted largely from improvements in health care.

  1. Infant, maternal, and geographic factors influencing gastroschisis related mortality in Zimbabwe.

    Science.gov (United States)

    Apfeld, Jordan C; Wren, Sherry M; Macheka, Nyasha; Mbuwayesango, Bothwell A; Bruzoni, Matias; Sylvester, Karl G; Kastenberg, Zachary J

    2015-12-01

    Survival for infants with gastroschisis in developed countries has improved dramatically in recent decades with reported mortality rates of 4-7%. Conversely, mortality rates for gastroschisis in sub-Saharan Africa remain as great as 60% in contemporary series. This study describes the burden of gastroschisis at the major pediatric hospital in Zimbabwe with the goal of identifying modifiable factors influencing gastroschisis-related infant mortality. We performed a retrospective cohort study of all cases of gastroschisis admitted to Harare Children's Hospital in 2013. Univariate and multivariate analyses were performed to describe infant, maternal, and geographic factors influencing survival. A total of 5,585 neonatal unit admissions were identified including 95 (1.7%) infants born with gastroschisis. Gastroschisis-related mortality was 84% (n = 80). Of infants with gastroschisis, 96% (n = 91) were born outside Harare Hospital, 82% (n = 78) were born outside Harare Province, and 23% (n = 25) were home births. The unadjusted odds of survival for these neonates with gastroschisis were decreased for low birth weight infants (age; OR, 0.06; 95% CI, 0.01-0.50), and for those born to teenage mothers (age; OR, 0.05; 95% CI, 0.01-0.46). There was also a trend toward decreased odds of survival for home births (OR, 0.16; 95% CI, 0.02-1.34) and for those born outside Harare Province (OR, 0.35; 95% CI, 0.10-1.22). Gastroschisis-related infant mortality in Zimbabwe is associated with well-known risk factors, including low birth weight, prematurity, and teenage mothers. However, modifiable factors identified in this study signify potential opportunities for developing innovative approaches to perinatal care in such a resource-constrained environment. Copyright © 2015 Elsevier Inc. All rights reserved.

  2. HIV, malaria, and infant anemia as risk factors for postneonatal infant mortality among HIV-seropositive women in Kisumu, Kenya

    NARCIS (Netherlands)

    van Eijk, Anna M.; Ayisi, John G.; ter Kuile, Feiko O.; Slutsker, Laurence; Shi, Ya Ping; Udhayakumar, Venkatachalam; Otieno, Juliana A.; Kager, Piet A.; Lal, Renu B.; Steketee, Richard W.; Nahlen, Bernard L.

    2007-01-01

    BACKGROUND: HIV and malaria in sub-Saharan Africa are associated with poor pregnancy outcome and infant survival. We studied the association of placental malaria, infant malaria and anemia, and infant HIV status with postneonatal infant mortality (PNIM) among infants of HIV-seropositive women.

  3. Integrated approaches to improve birth outcomes: perinatal periods of risk, infant mortality review, and the Los Angeles Mommy and Baby Project.

    Science.gov (United States)

    Chao, Shin Margaret; Donatoni, Giannina; Bemis, Cathleen; Donovan, Kevin; Harding, Cynthia; Davenport, Deborah; Gilbert, Carol; Kasehagen, Laurin; Peck, Magda G

    2010-11-01

    This article provides an example of how Perinatal Periods of Risk (PPOR) can provide a framework and offer analytic methods that move communities to productive action to address infant mortality. Between 1999 and 2002, the infant mortality rate in the Antelope Valley region of Los Angeles County increased from 5.0 to 10.6 per 1,000 live births. Of particular concern, infant mortality among African Americans in the Antelope Valley rose from 11.0 per 1,000 live births (7 cases) in 1999 to 32.7 per 1,000 live births (27 cases) in 2002. In response, the Los Angeles County Department of Public Health, Maternal, Child, and Adolescent Health Programs partnered with a community task force to develop an action plan to address the issue. Three stages of the PPOR approach were used: (1) Assuring Readiness; (2) Data and Assessment, which included: (a) Using 2002 vital records to identify areas with the highest excess rates of feto-infant mortality (Phase 1 PPOR), and (b) Implementing Infant Mortality Review (IMR) and the Los Angeles Mommy and Baby (LAMB) Project, a population-based study to identify potential factors associated with adverse birth outcomes. (Phase 2 PPOR); and (3) Strategy and Planning, to develop strategic actions for targeted prevention. A description of stakeholders' commitments to improve birth outcomes and monitor infant mortality is also given. The Antelope Valley community was engaged and ready to investigate the local rise in infant mortality. Phase 1 PPOR analysis identified Maternal Health/Prematurity and Infant Health as the most important periods of risk for further investigation and potential intervention. During the Phase 2 PPOR analyses, IMR found a significant proportion of mothers with previous fetal loss (45%) or low birth weight/preterm (LBW/PT) birth, late prenatal care (39%), maternal infections (47%), and infant safety issues (21%). After adjusting for potential confounders (maternal age, race, education level, and marital status), the

  4. INFANT MORTALITY IN THE SOUTHERN URALS IN THE 1930 YEARS

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    Ravilya Rakhimyanovna Khisamutdinova

    2018-02-01

    Full Text Available Purpose. The purpose of this paper is to study infant mortality in the southern Urals in the 1930 years and the establishment of its causes. The relevance of the researched problem is connected with difficulties of solving demographic problems in the country and the policy of the state to protect motherhood and childhood. Methodology. Basis of research is historical and comparative and historical and systematic methods and critical analysis. Results. Infant mortality is the most significant symptom of demographic decline among the population. This period has been one of the most difficult in the history of our nation, as it was accompanied by major economic, social and political processes that influenced the decline of natural increase among the population. Based on the analysis of Central and local archives, statistical information of mortality of the 1930 years in the region, the authors made the weather dynamics of the number of deaths among children under 1 year and came to the conclusion that the causes of high mortality in the early 1930 years were not only the political processes in society, and especially the famine of 1932–1933 years. The authors have proved that the population of the southern Urals in the 1930 years the mortality rate of children under 1 year was high, not only in relation to the population of the region but for the country as a whole. The number of child deaths in the region was the leader Chelyabinsk region, especially among the urban population. This was due to the high level of population, the predominance of urban population over the rural, the needs of industrialization, that is heavy physical labour of women, weak health care system. By the middle of the period under review, despite the measures taken by the state for the support of motherhood and childhood, the infant mortality rate in the southern Urals remains at a high level, increasing the number of illegal abortions, infectious diseases in the summer

  5. Infant mortality: a call to action overcoming health disparities in the United States

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    Allison A. Vanderbilt

    2013-09-01

    Full Text Available Among all of the industrialized countries, the United States has the highest infant mortality rate. Racial and ethnic disparities continue to plague the United States with a disproportionally high rate of infant death. Furthermore, racial disparities among infant and neonatal mortality rates remain a chronic health problem in the United States. These risks are based on the geographical variations in mortality and disparities among differences in maternal risk characteristics, low birth weights, and lack of access to health care.

  6. Trend in infant mortality rate in Argentina within the framework of the Millennium Development Goals.

    Science.gov (United States)

    Finkelstein, Juliana Z; Duhau, Mariana; Speranza, Ana

    2016-06-01

    Infant mortality rate (IMR) is an indicator of the health status of a population and of the quality of and access to health care services. In 2000, and within the framework of the Millennium Development Goals, Argentina committed to achieve by 2015 a reduction by two thirds of its 1990 infant mortality rate, and to identify and close inter-jurisdictional gaps. The objective of this article is to describe the trend in infant mortality rate in Argentina and interjurisdictional gaps, infant mortality magnitude and causes, in compliance with the Millennium Development Goals. A descriptive study on infant mortality was conducted in Argentina in 1990 and between 2000 and 2013, based on vital statistics data published by the Health Statistics and Information Department of the Ministry of Health of Argentina. The following reductions were confirmed: 57.8% in IMR, 52.6% in neonatal mortality rate and 63.8% in post-neonatal mortality rate. The inter-provincial Gini coefficient for IMR decreased by 27%. The population attributable risk decreased by 16.6% for IMR, 38.8% for neonatal mortality rate and 51.5% for post-neonatal mortality rate in 2013 versus 1990. A significant reduction in infant mortality and its components has been shown, but not enough to meet the Millennium Development Goals. The reduction in IMR gaps reached the set goal; however, inequalities still persist. Sociedad Argentina de Pediatría.

  7. Beriberi (thiamine deficiency and high infant mortality in northern Laos.

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    Hubert Barennes

    2015-03-01

    Full Text Available Infantile beriberi (thiamine deficiency occurs mainly in infants breastfed by mothers with inadequate intake of thiamine, typically among vulnerable populations. We describe possible and probable cases of infantile thiamine deficiency in northern Laos.Three surveys were conducted in Luang Namtha Province. First, we performed a retrospective survey of all infants with a diagnosis of thiamine deficiency admitted to the 5 hospitals in the province (2007-2009. Second, we prospectively recorded all infants with cardiac failure at Luang Namtha Hospital. Third, we further investigated all mothers with infants (1-6 months living in 22 villages of the thiamine deficiency patients' origin. We performed a cross-sectional survey of all mothers and infants using a pre-tested questionnaire, physical examination and squat test. Infant mortality was estimated by verbal autopsy. From March to June 2010, four suspected infants with thiamine deficiency were admitted to Luang Namtha Provincial hospital. All recovered after parenteral thiamine injection. Between 2007 and 2009, 54 infants with possible/probable thiamine deficiency were diagnosed with acute severe cardiac failure, 49 (90.2% were cured after parenteral thiamine; three died (5.6%. In the 22 villages, of 468 live born infants, 50 (10.6%, 95% CI: 8.0-13.8 died during the first year. A peak of mortality (36 deaths was reported between 1 and 3 months. Verbal autopsy suggested that 17 deaths (3.6% were due to suspected infantile thiamine deficiency. Of 127 mothers, 60 (47.2% reported edema and paresthesia as well as a positive squat test during pregnancy; 125 (98.4% respected post-partum food avoidance and all ate polished rice. Of 127 infants, 2 (1.6% had probable thiamine deficiency, and 8 (6.8% possible thiamine deficiency.Thiamine deficiency may be a major cause of infant mortality among ethnic groups in northern Laos. Mothers' and children's symptoms are compatible with thiamine deficiency. The severity

  8. A critical review of infant mortality rates reported by the Ministry of Health in Turkey

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    Muzaffer Eskiocak

    2014-12-01

    Full Text Available Objective:The infant mortality rate is an indicator that is calculated by dividing the number of infants who died before their first birthday by the number of live births in a given year. Infant mortality rates are the main determinants of the under-five mortality rate, which is used for the developmental ranking of countries by the United Nations Children’s Fund (UNICEF. It is also an important indicator for assessing the maternal and child health status of a country and for calculating life expectancy at birth. The aim of this review is to reassess the calculations that were made in recent years in Turkey in the light of the criteria mentioned in the text and to guide the steps that need to be taken to make future calculations.Methods: The infant mortality rates of Turkey were collected, and their values and methods of calculating the rates were compared. Results:According to the Annual Reports of Health Statistics by Ministry of Health, the infant mortality rate has dropped from 29,0% in 2003 to 7,4% in 2012 in Turkey; but in these reports, infant mortality rates were taken from various studies and by various methods and presented in the same charts. In the data of the Turkish Statistical Institute (TSI, UNICEF and the Turkey Demographic and Health Survey (TDHS and in references used, this value was reported by different numbers (11,6 and 12% for 2012; 13,6% for 2013, respectively. Conclusions: The infant mortality rate must be calculated by a scientific approach and with definitions according to international standards in terms of comparability. This must be consistent between countries and between years studied so that the report can be compared according to consistent standards.Keywords: Infant mortality rate, calculation of infant mortality rate, life expectancy at birth, Turkey

  9. Mortality, Morbidity, and Developmental Outcomes in Infants Born to Women Who Received Either Mefloquine or Sulfadoxine-Pyrimethamine as Intermittent Preventive Treatment of Malaria in Pregnancy: A Cohort Study.

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    María Rupérez

    2016-02-01

    Full Text Available Little is known about the effects of intermittent preventive treatment of malaria in pregnancy (IPTp on the health of sub-Saharan African infants. We have evaluated the safety of IPTp with mefloquine (MQ compared to sulfadoxine-pyrimethamine (SP for important infant health and developmental outcomes.In the context of a multicenter randomized controlled trial evaluating the safety and efficacy of IPTp with MQ compared to SP in pregnancy carried out in four sub-Saharan countries (Mozambique, Benin, Gabon, and Tanzania, 4,247 newborns, 2,815 born to women who received MQ and 1,432 born to women who received SP for IPTp, were followed up until 12 mo of age. Anthropometric parameters and psychomotor development were assessed at 1, 9, and 12 mo of age, and the incidence of malaria, anemia, hospital admissions, outpatient visits, and mortality were determined until 12 mo of age. No significant differences were found in the proportion of infants with stunting, underweight, wasting, and severe acute malnutrition at 1, 9, and 12 mo of age between infants born to women who were on IPTp with MQ versus SP. Except for three items evaluated at 9 mo of age, no significant differences were observed in the psychomotor development milestones assessed. Incidence of malaria, anemia, hospital admissions, outpatient visits, and mortality were similar between the two groups. Information on the outcomes at 12 mo of age was unavailable in 26% of the infants, 761 (27% from the MQ group and 377 (26% from the SP group. Reasons for not completing the study were death (4% of total study population, study withdrawal (6%, migration (8%, and loss to follow-up (9%.No significant differences were found between IPTp with MQ and SP administered in pregnancy on infant mortality, morbidity, and nutritional outcomes. The poorer performance on certain psychomotor development milestones at 9 mo of age in children born to women in the MQ group compared to those in the SP group may deserve

  10. White Infant Mortality in Appalachian States, 1976-1980 and 1996-2000: Changing Patterns and Persistent Disparities

    Science.gov (United States)

    Yao, Nengliang; Matthews, Stephen A.; Hillemeier, Marianne M.

    2012-01-01

    Purpose: Appalachian counties have historically had elevated infant mortality rates. Changes in infant mortality disparities over time in Appalachia are not well-understood. This study explores spatial inequalities in white infant mortality rates over time in the 13 Appalachian states, comparing counties in Appalachia with non-Appalachian…

  11. Neighborhood socio-environmental vulnerability and infant mortality in Hermosillo, Sonora.

    Science.gov (United States)

    Lara-Valencia, Francisco; Álvarez-Hernández, Gerardo; Harlow, Siobán D; Denman, Catalina; García-Pérez, Hilda

    2012-01-01

    This paper explores the impact of contextual variables at the neighborhood level on a health marker in the city of Hermosillo, Mexico and discusses the importance of collaboration between planners and health professional to minimize the negative effect of contextual factors on urban health. Few studies in Mexico have assessed health outcomes at the intra-urban scale and their interaction with neighborhood-level contextual variables. Using spatial analysis and geographical information systems, the paper explores the association between infant mortality and an index of socio-environmental vulnerability used to measure urban contextual factors. Two high infant mortality clusters were detected within neighborhoods characterized by relatively good environmental conditions and one in a neighborhood with a poor environment. Our results show the clustering of high infant mortality areas and some association with built environment factors in Hermosillo. The results support the need to reconnect public health and urban planning as a way to create healthier environments in Mexican cities.

  12. International Comparisons of Infant Mortality and Related Factors : United States and Europe, 2010

    NARCIS (Netherlands)

    MacDorman, M.F.; Mathews, T.J.; Mohangoo, A.D.; Zeitlin, J.

    2014-01-01

    OBJECTIVES: This report investigates the reasons for the United States' high infant mortality rate when compared with European countries. Specifically, the report measures the impact on infant mortality differences of two major factors: the percentage of preterm births and gestational age-specific

  13. Birth Order and Injury-Related Infant Mortality in the U.S.

    Science.gov (United States)

    Ahrens, Katherine A; Rossen, Lauren M; Thoma, Marie E; Warner, Margaret; Simon, Alan E

    2017-10-01

    The purpose of this study was to evaluate the risk of death during the first year of life due to injury, such as unintentional injury and homicide, by birth order in the U.S. Using national birth cohort-linked birth-infant death data (births, 2000-2010; deaths, 2000-2011), risks of infant mortality due to injury in second-, third-, fourth-, and fifth or later-born singleton infants were compared with first-born singleton infants. Risk ratios were estimated using log-binomial models adjusted for maternal age, marital status, race/ethnicity, and education. The statistical analyses were conducted in 2016. Approximately 40%, 32%, 16%, 7%, and 4% of singleton live births were first, second, third, fourth, and fifth or later born, respectively. From 2000 to 2011, a total of 15,866 infants died as a result of injury (approximately 1,442 deaths per year). Compared with first-born infants (2.9 deaths per 10,000 live births), second or later-born infants were at increased risk of infant mortality due to injury (second, 3.6 deaths; third, 4.2 deaths; fourth, 4.8 deaths; fifth or later, 6.4 deaths). The corresponding adjusted risk ratios were as follows: second, 1.84 (95% CI=1.76, 1.91); third, 2.42 (95% CI=2.30, 2.54); fourth, 2.96 (95% CI=2.77, 3.16); and fifth or later, 4.26 (95% CI=3.96, 4.57). Singleton infants born second or later were at increased risk of mortality due to injury during their first year of life in the U.S. This study's findings highlight the importance of investigating underlying mechanisms behind this increased risk. Published by Elsevier Inc.

  14. Population growth and infant mortality

    OpenAIRE

    Fabella, Christina

    2008-01-01

    The relationship between population growth and economic outcomes is an issue of great policy significance. In the era of the Millennium Development Goals, poverty and its correlates have become the compelling issues. Economic growth may not automatically translate into reductions in poverty and its correlates (may not trickle down) if income distribution is at the same time worsening. We therefore investigate the direct effect of population growth on infant mortality for various income catego...

  15. Natality and infant mortality in Roma children in the Prešov region

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    Ján Koval

    2012-06-01

    Full Text Available Background: Due to the lack of exact data on natality and infant mortality rates of the Roma living in Slovakia we aim to look closer into these parameters, analyze them and in this respect compare two ethnic groups: Roma and non-Roma Slovak children. Material and methods: In the time period from 1997 to 2011, we collected data in selected parameters (birth rate, infant mortality rate, the number of newborns with low birth weight, the number of children abandoned by their mothers after birth in the Prešov region, and we evaluated them. Findings: A declining natality rate was observed in non-Roma children, as opposed to an upward trend in Roma children. In 1997, every fourth child was born to a Roma woman; in 2011, it was every third child. A declining infant mortality rate was observed in all groups studied. In the Roma children, the decline in the infant mortality rate was the biggest, yet the mere infant mortality rate, in this group of children, was the highest – in 1997 and in 2011 approximately 3-times higher than in the children born to non-Roma mothers. Conclusion: In our study, the infant mortality rate of Roma children is on decline, yet still it is high when compared to the non-Roma population. This may be caused by low interest of the Roma in providing health care to their children and their low responsibility or their inability to take responsibility for health and health care education of their children.

  16. Reduction of infant mortality in India.

    Science.gov (United States)

    Kumar, V; Datta, N

    1982-01-01

    In India the infant mortality rate (IMR) registered an impressive decline during the first 5-6 decades of the 20th century, but in the last 30 years a significant decline has not been documented. The IMR continues to be in the range of 120-130/1000. In many developed countries it is reported as less than 20/1000. The World Health Organization (WHO) has recommended that by the year 2000 the IMR should be reduced to below 50/1000. India's government has set a target of 60/1000 to be reached by 2000. In Kerala this target has already been achieved. Several projects throughout India have indicated that this task can be accomplished. Many lessons can be learned from Kerala and the successful projects. 1 major constraint in information on IMR in India is the lack of uniformity and reliability in the system of recording vital events. Mere knowledge of IMR is insufficient for planning and execution of an appropriate intervention strategy. It is also important to understand the various causes of death. Based on the available information and a review of the literature, it is clear that 50% of the deaths in infancy occurred during the neonatal period. The common preventable causes of death in infancy identified are acute respiratory infections, acute diarrheal disease, low birth weight, protein energy malnutrition, tetanus neonatorum, and communicable diseases like measles, whooping cough, and typhoid. The high IMR can be reduced by general measures which can only be recommended as medium-term and longterm plans. These include an increase in the gross national product and female literacy, a decreasing birthrate, and an increasing capita food intake. At this time India is not experiencing rapid gains in any of these areas. Many of the strategies to reduce IMR have been reviewed objectively by Bhargava et al. Each strategy has merit, but, due to limited resources, it is essential to set priorities. The selection of priorities should be based on 4 basic questions: how common is

  17. Effects of vitamin A or beta carotene supplementation on pregnancy-related mortality and infant mortality in rural Bangladesh: a cluster randomized trial.

    Science.gov (United States)

    West, Keith P; Christian, Parul; Labrique, Alain B; Rashid, Mahbubur; Shamim, Abu Ahmed; Klemm, Rolf D W; Massie, Allan B; Mehra, Sucheta; Schulze, Kerry J; Ali, Hasmot; Ullah, Barkat; Wu, Lee S F; Katz, Joanne; Banu, Hashina; Akhter, Halida H; Sommer, Alfred

    2011-05-18

    Maternal vitamin A deficiency is a public health concern in the developing world. Its prevention may improve maternal and infant survival. To assess efficacy of maternal vitamin A or beta carotene supplementation in reducing pregnancy-related and infant mortality. Cluster randomized, double-masked, placebo-controlled trial among pregnant women 13 to 45 years of age and their live-born infants to 12 weeks (84 days) postpartum in rural northern Bangladesh between 2001 and 2007. Interventions Five hundred ninety-six community clusters (study sectors) were randomized for pregnant women to receive weekly, from the first trimester through 12 weeks postpartum, 7000 μg of retinol equivalents as retinyl palmitate, 42 mg of all-trans beta carotene, or placebo. Married women (n = 125,257) underwent 5-week surveillance for pregnancy, ascertained by a history of amenorrhea and confirmed by urine test. Blood samples were obtained from participants in 32 sectors (5%) for biochemical studies. All-cause mortality of women related to pregnancy, stillbirth, and infant mortality to 12 weeks (84 days) following pregnancy outcome. Groups were comparable across risk factors. For the mortality outcomes, neither of the supplement group outcomes was significantly different from the placebo group outcomes. The numbers of deaths and all-cause, pregnancy-related mortality rates (per 100,000 pregnancies) were 41 and 206 (95% confidence interval [CI], 140-273) in the placebo group, 47 and 237 (95% CI, 166-309) in the vitamin A group, and 50 and 250 (95% CI, 177-323) in the beta carotene group. Relative risks for mortality in the vitamin A and beta carotene groups were 1.15 (95% CI, 0.75-1.76) and 1.21 (95% CI, 0.81-1.81), respectively. In the placebo, vitamin A, and beta carotene groups the rates of stillbirth and infant mortality were 47.9 (95% CI, 44.3-51.5), 45.6 (95% CI, 42.1-49.2), and 51.8 (95% CI, 48.0-55.6) per 1000 births and 68.1 (95% CI, 63.7-72.5), 65.0 (95% CI, 60.7-69.4), and 69

  18. Causes of and contributors to infant mortality in a rural community of North India: evidence from verbal and social autopsy.

    Science.gov (United States)

    Rai, Sanjay Kumar; Kant, Shashi; Srivastava, Rahul; Gupta, Priti; Misra, Puneet; Pandav, Chandrakant Sambhaji; Singh, Arvind Kumar

    2017-08-11

    To identify the medical causes of death and contribution of non-biological factors towards infant mortality by a retrospective analysis of routinely collected data using verbal and social autopsy tools. The study site was Health and Demographic Surveillance System (HDSS), Ballabgarh, North India PARTICIPANTS: All infant deaths during the years 2008-2012 were included for verbal autopsy and infant deaths from July 2012 to December 2012 were included for social autopsy. Cause of death ascertained by a validated verbal autopsy tool and level of delay based on a three-delay model using the INDEPTH social autopsy tool were the main outcome measures. The level of delay was defined as follows: level 1, delay in identification of danger signs and decision making to seek care; level 2, delay in reaching a health facility from home; level 3, delay in getting healthcare at the health facility. The infant mortality rate during the study period was 46.5/1000 live births. Neonatal deaths contributed to 54.3% of infant deaths and 39% occurred on the first day of life. Birth asphyxia (31.5%) followed by low birth weight (LBW)/prematurity (26.5%) were the most common causes of neonatal death, while infection (57.8%) was the most common cause of post-neonatal death. Care-seeking was delayed among 50% of neonatal deaths and 41.2% of post-neonatal deaths. Delay at level 1 was most common and occurred in 32.4% of neonatal deaths and 29.4% of post-neonatal deaths. Deaths due to LBW/prematurity were mostly followed by delay at level 1. A high proportion of preventable infant mortality still exists in an area which is under continuous health and demographic surveillance. There is a need to enhance home-based preventive care to enable the mother to identify and respond to danger signs. Verbal autopsy and social autopsy could be routinely done to guide policy interventions aimed at reduction of infant mortality. © Article author(s) (or their employer(s) unless otherwise stated in the text

  19. [FACTORS RELATED TO MORTALITY IN NECROTIZINGENTEROCOLITIS(NEC) IN NEONATES AND OLDER INFANTS

    Science.gov (United States)

    Ríos D , Hugo; Rivera M , Juan

    1997-01-01

    In order to determine the factors related to mortality in Necrotizing enterocolitis (NEC), medical records of neonates and older infants diagnosed of NEC in the Instituto de Salud del Niño between 1984 and 1993 were retrospectively reviewed. Only the cases with a reliable roentgenologic, surgical or pathologic diagnosis were included. Sixty cases (46 infants and 14 neonates) were found, with a higher incidence in males (37 males vs 23 females). Twenty six cases required surgical treatment. Overall mortality was 77%, with no significant differences between neonates and infants, nor between those who were operated or not. Moderate or severe malnutrition, diarrhea as an early clinical manifestations, bronchopneumonia, shock and poor nutricional management were found as factors related to mortality.

  20. THE ROLE OF SOCIO-ECONOMIC ASPECTS OF WOMEN ON INFANT MORTALITY: A PANEL DATA ANALYSES FOR OECD COUNTRIES

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    Murat KÜRKCÜ

    2017-12-01

    Full Text Available Social and economic development of a nation is often reflected by the existing infant and child mortality rates. In this context, one of the millennium development goals is to reduce infant and child mortalities globally. In particular, women’s socio-economic positions are important variables in explaining infant/child mortality. The correlation between infant/child mortalities and socio-economic positions of women is very strong. This study uses a panel data analysis to measure the effect of labour force participation rate of women on infant/child mortalities. The present article analyzes how women’s socio-economic situations affect infant/child mortality in OECD countries for the era 2000-2014. Our results are statistically significant and also suitable for theoretical expectations. According to our conclusions mortality rates may decline as a result of the increase in labour force participation rates of women. In this context, there is a negative relationship between the labor force participation rate of women and gender inequality. So, as gender inequality decreases, infant/child mortality rates also decrease.

  1. Influence of birth weight on differences in infant mortality by social class and legitimacy.

    Science.gov (United States)

    Leon, D A

    1991-01-01

    OBJECTIVE--To investigate the influence of birth weight on the pronounced social class differences in infant mortality in Britain. DESIGN--Analysis of routine data on births and infant deaths. SETTING--England and Wales. SUBJECTS--All live births and infant deaths, 1983-5. MAIN OUTCOME MEASURE--Mortality in infants by social class, birth weight, and legitimacy according to birth and death certificates. RESULTS--Neonatal and postneonatal mortality (deaths/1000 births) increased with social class. Neonatal and postneonatal mortality was 4.2/1000 and 2.3/1000 respectively for social class I and 6.8/1000 and 5.6/1000 respectively for social class V. Mortality was lower among births registered within marriage (postneonatal 3.5/1000; neonatal 5.2/1000) than among those jointly registered outside marriage (5.1/1000; 6.4/1000); mortality was highest in those solely registered outside marriage (7.2/1000; 7.0/1000). For neonatal mortality the effect of social class varied with birth weight. Social class had little effect on neonatal mortality in low birthweight babies and increasing effect in heavier babies. For postneonatal mortality the effect of social class was similar for all birth weights and was almost as steep as for all birth weights combined. CONCLUSION--Birth weight mediates little of the effect of social class on postneonatal mortality. PMID:1954421

  2. A comparison of foetal and infant mortality in the United States and Canada.

    Science.gov (United States)

    Ananth, Cande V; Liu, Shiliang; Joseph, K S; Kramer, Michael S

    2009-04-01

    Infant mortality rates are higher in the United States than in Canada. We explored this difference by comparing gestational age distributions and gestational age-specific mortality rates in the two countries. Stillbirth and infant mortality rates were compared for singleton births at >or=22 weeks and newborns weighing>or=500 g in the United States and Canada (1996-2000). Since menstrual-based gestational age appears to misclassify gestational duration and overestimate both preterm and postterm birth rates, and because a clinical estimate of gestation is the only available measure of gestational age in Canada, all comparisons were based on the clinical estimate. Data for California were excluded because they lacked a clinical estimate. Gestational age-specific comparisons were based on the foetuses-at-risk approach. The overall stillbirth rate in the United States (37.9 per 10,000 births) was similar to that in Canada (38.2 per 10,000 births), while the overall infant mortality rate was 23% (95% CI 19-26%) higher (50.8 vs 41.4 per 10,000 births, respectively). The gestational age distribution was left-shifted in the United States relative to Canada; consequently, preterm birth rates were 8.0 and 6.0%, respectively. Stillbirth and early neonatal mortality rates in the United States were lower at term gestation only. However, gestational age-specific late neonatal, post-neonatal and infant mortality rates were higher in the United States at virtually every gestation. The overall stillbirth rates (per 10,000 foetuses at risk) among Blacks and Whites in the United States, and in Canada were 59.6, 35.0 and 38.3, respectively, whereas the corresponding infant mortality rates were 85.6, 49.7 and 42.2, respectively. Differences in gestational age distributions and in gestational age-specific stillbirth and infant mortality in the United States and Canada underscore substantial differences in healthcare services, population health status and health policy between the two

  3. Racial and Ethnic Infant Mortality Gaps and the Role of Socio-Economic Status

    OpenAIRE

    Elder, Todd E.; Goddeeris, John H.; Haider, Steven J.

    2016-01-01

    We assess the extent to which differences in socio-economic status are associated with racial and ethnic gaps in a fundamental measure of population health: the rate at which infants die. Using micro-level Vital Statistics data from 2000 to 2004, we examine mortality gaps of infants born to white, black, Mexican, Puerto Rican, Asian, and Native American mothers. We find that between-group mortality gaps are strongly and consistently (except for Mexican infants) associated with maternal marita...

  4. Permissive hypercapnia for the prevention of morbidity and mortality in mechanically ventilated newborn infants.

    Science.gov (United States)

    Woodgate, P G; Davies, M W

    2001-01-01

    Experimental animal data and uncontrolled, observational studies in human infants have suggested that hyperventilation and hypocapnia may be associated with increased pulmonary and neurodevelopmental morbidity. Protective ventilatory strategies allowing higher levels of arterial CO2 (permissive hypercapnia) are now widely used in adult critical care. The aggressive pursuit of normocapnia in ventilated newborn infants may contribute to the already present burden of lung disease. However, the safe or ideal range for PCO2 in this vulnerable population has not been established. To assess whether, in mechanically ventilated neonates, a strategy of permissive hypercapnia improves short and long term outcomes (esp. mortality, duration of respiratory support, incidence of chronic lung disease and neurodevelopmental outcome). Standard strategies of the Cochrane Neonatal Review Group were used. Searches were made of the Oxford Database of Perinatal Trials, MEDLINE, CINAHL, and Current Contents. Searches were also made of previous reviews including cross-referencing, abstracts, and conference and symposia proceedings published in Pediatric Research. All randomised controlled trials in which a strategy of permissive hypercapnia was compared with conventional strategies aimed at achieving normocapnia (or lower levels of hypercapnia) in newborn infants who are mechanically ventilated were eligible. Standard methods of the Cochrane Neonatal Review Group were used. Trials identified by the search strategy were independently reviewed by each author and assessed for eligibility and trial quality. Data were extracted separately. Differences were compared and resolved. Additional information was requested from trial authors. Only published data were available for review. Results are expressed as relative risk and risk difference for dichotomous outcomes, and weighted mean difference for continuous variables. Two trials involving 269 newborn infants were included. Meta-analysis of

  5. Regional socioeconomic indicators and ethnicity as predictors of regional infant mortality rate in Slovakia

    NARCIS (Netherlands)

    Rosicova, Katarina; Geckova, Andrea Madarasova; van Dijk, Jitse P.; Kollarova, Jana; Rosic, Martin; Groothoff, Johan W.

    2011-01-01

    Objective Exploring the associations of regional differences in infant mortality with selected socioeconomic indicators and ethnicity could offer important clues for designing public health policy measures. Methods Data included perinatal and infant mortality in the 79 districts of the Slovak

  6. Cohort-specific trends in stroke mortality in seven European countries were related to infant mortality rates

    NARCIS (Netherlands)

    Amiri, M.; Kunst, A. E.; Janssen, F.; Mackenbach, J. P.

    2006-01-01

    Objectives: To assess, in a population-based study, whether secular trends in cardiovascular disease mortality in seven European countries were correlated with past trends in infant mortality rate (IMR) in these countries. Study Design and Setting: Data on ischemic heart disease (IHD) and stroke

  7. Mortalidade infantil por causas evitáveis no Brasil: um estudo ecológico no período 2000-2002 Infant mortality from preventable causes in Brazil: an ecological study in 2000-2002

    Directory of Open Access Journals (Sweden)

    Antonio Fernando Boing

    2008-02-01

    Full Text Available O objetivo desse estudo foi testar as associações entre a mortalidade infantil por causas evitáveis no Brasil com indicadores sócio-econômicos e de serviços e investimentos em saúde. Trata-se de um estudo ecológico, cujas unidades de análise foram os 296 municípios brasileiros com população superior a 80 mil habitantes. Realizaram-se os testes de Kruskall-Wallis e ANOVA para identificar diferenças significativas entre os quartis de mortalidade infantil segundo as variáveis independentes, e foram calculados os coeficientes de correlação de Pearson e de Spearman para testar as associações entre todas as variáveis. Os municípios que compuseram os quartis com maior mortalidade infantil por causas evitáveis apresentaram também menor Índice de Desenvolvimento Humano Municipal, Produto Interno Bruto per capita, pessoas que vivem em domicílios com banheiro e água encanada, despesa total com saúde por habitante e médicos por mil habitantes; e maior coeficiente de Gini. A compreensão do papel protagonista das condições sócio-econômicas e de investimentos em saúde sobre a mortalidade infantil por causas evitáveis deve permear as ações que visem à minimização da magnitude e da desigualdade desses óbitos.This study aims to test the associations between infant mortality from preventable causes in Brazil and socioeconomic factors, including those pertaining to health services and investments. This was an ecological study using 296 Brazilian counties (municipalities with more than 80,000 inhabitants each as the analytical units. Kruskall-Wallis and ANOVA tests were performed to compare independent variables according to infant mortality quartile, and Pearson and Spearman's correlation coefficients were computed to test the associations. As the infant mortality quartile from preventable causes increases, there is a gradual decrease in the municipal human development index, per capita gross domestic product, households with

  8. Disaster, Deprivation and Death: Large but delayed infant mortality in the wake of Filipino tropical cyclones

    Science.gov (United States)

    Anttila-Hughes, J. K.; Hsiang, S. M.

    2011-12-01

    Tropical cyclones are some of the most disastrous and damaging of climate events, and estimates of their destructive potential abound in the natural and social sciences. Nonetheless, there have been few systematic estimates of cyclones' impact on children's health. This is concerning because cyclones leave in their wake a swath of asset losses and economic deprivation, both known to be strong drivers of poor health outcomes among children. In this paper we provide a household-level estimate of the effect of tropical cyclones on infant mortality in the Philippines, a country with one of the most active cyclone climatologies in the world. We reconstruct historical cyclones with detailed spatial and temporal resolution, allowing us to estimate the multi-year effects of cyclones on individuals living in specific locations. We combine the cyclone reconstruction with woman-level fertility and mortality data from four waves of the Filipino Demographic and Health Survey, providing birth histories for over 55,000 women. In multiple regressions that control for year and region fixed effects as well as intra-annual climate variation, we find that there is a pronounced and robust increase in female infant mortality among poor families in the 12-24 months after storms hit. The estimated mortality rate among this demographic subgroup is much larger than official mortality rates reported by the Filipino government immediately after storms, implying that much of a cyclone's human cost arrives well after the storm has passed. We find that high infant mortality rates are associated with declines in poor families' income and expenditures, including consumption of food and medical services, suggesting that the mechanism by which these deaths are effected may be economic deprivation. These results indicate that a major health and welfare impact of storms has been thus far overlooked, but may be easily prevented through appropriately targeted income support policies.

  9. Community variations in infant and child mortality in Peru.

    OpenAIRE

    Edmonston, B; Andes, N

    1983-01-01

    Data from the national Peru Fertility Survey are used to estimate infant and childhood mortality ratios, 1968--77, for 124 Peruvian communities, ranging from small Indian hamlets in the Andes to larger cities on the Pacific coast. Significant mortality variations are found: mortality is inversely related to community population size and is higher in the mountains than in the jungle or coast. Multivariate analysis is then used to assess the influence of community population size, average femal...

  10. Perinatal and infant mortality in urban slums under I.C.D.S. scheme.

    Science.gov (United States)

    Thora, S; Awadhiya, S; Chansoriya, M; Kaul, K K

    1986-08-01

    Perinatal and infant mortality during the year 1985 was analyzed through a prospective study conducted in 12 Anganwadis (total population of 13,054) located in slum areas of India's Jabalpur city. Overall, the infant mortality rate was 128.7/1000 live births and the perinatal mortality rate was 88.5/1000 live births. 58.5% of deaths occurred in the neonatal period. Causes of neonatal deaths included prematurity, respiratory distress syndrome, birth asphyxia, septicemia, and neonatal tetanus. Postneonatal deaths were largely attributable to dehydration from diarrhea, bronchopneumonia, malnutrition, and infectious diseases. All mortality rates were significantly higher in Muslims than among Hindus. Muslims accounted for 28% of the study population, but contributed 63% of stillbirths and 55% of total infant deaths. This phenomenon appears attributable to the large family size among Muslims coupled with inadequate maternal-child health care. The national neonatal and postneonatal mortality rates are 88/1000 and 52/1000, respectively. The fact that the neonatal mortality rate in the study area was slightly lower than the national average may reflect the impact of ICDS services.

  11. Vietnamese infant and childhood mortality in relation to the Vietnam War.

    Science.gov (United States)

    Savitz, D A; Thang, N M; Swenson, I E; Stone, E M

    1993-08-01

    There is obvious potential for war to adversely affect infant and childhood mortality through direct trauma and disruption of the societal infrastructure. This study examined trends in Vietnam through the period of the war. The 1988 Vietnam Demographic and Health Survey collected data on reproductive history and family planning from 4172 women aged 15 through 49 years in 12 selected provinces of Vietnam. The 13,137 births and 737 deaths to children younger than age 6 reported by the respondents were analyzed. For the country as a whole, infant and childhood mortality dropped by 30% to 80% from the prewar period to the wartime period and was stable thereafter. In provinces in which the war was most intense, mortality did not decline from the prewar period to the wartime period but declined after the war, consistent with an adverse effect during the wartime period. The data are limited by assignment of birth location on the basis of mother's current residence and by inadequate information on areas of war activity. Nonetheless, the data do not indicate a widespread, sizable adverse effect of the war on national infant and childhood mortality in Vietnam but suggest detrimental effects in selected provinces.

  12. The price of play: self-organized infant mortality cycles in chimpanzees.

    Directory of Open Access Journals (Sweden)

    Hjalmar S Kuehl

    Full Text Available Chimpanzees have been used extensively as a model system for laboratory research on infectious diseases. Ironically, we know next to nothing about disease dynamics in wild chimpanzee populations. Here, we analyze long-term demographic and behavioral data from two habituated chimpanzee communities in Taï National Park, Côte d'Ivoire, where previous work has shown respiratory pathogens to be an important source of infant mortality. In this paper we trace the effect of social connectivity on infant mortality dynamics. We focus on social play which, as the primary context of contact between young chimpanzees, may serve as a key venue for pathogen transmission. Infant abundance and mortality rates at Taï cycled regularly and in a way that was not well explained in terms of environmental forcing. Rather, infant mortality cycles appeared to self-organize in response to the ontogeny of social play. Each cycle started when the death of multiple infants in an outbreak synchronized the reproductive cycles of their mothers. A pulse of births predictably arrived about twelve months later, with social connectivity increasing over the following two years as the large birth cohort approached the peak of social play. The high social connectivity at this play peak then appeared to facilitate further outbreaks. Our results provide the first evidence that social play has a strong role in determining chimpanzee disease transmission risk and the first record of chimpanzee disease cycles similar to those seen in human children. They also lend more support to the view that infectious diseases are a major threat to the survival of remaining chimpanzee populations.

  13. Multiple strains probiotics appear to be the most effective probiotics in the prevention of necrotizing enterocolitis and mortality: An updated meta-analysis.

    Science.gov (United States)

    Chang, Hung-Yang; Chen, Jin-Hua; Chang, Jui-Hsing; Lin, Hung-Chih; Lin, Chien-Yu; Peng, Chun-Chih

    2017-01-01

    Some oral probiotics have been shown to prevent necrotizing enterocolitis (NEC) and decrease mortality effectively in preterm very low birth weight (PVLBW) infants. However, it is unclear whether a single probiotic or a mixture of probiotics is most effective for the prevention of NEC. A meta-analysis was conducted by reviewing the most up to date literature to investigate whether multiple strains probiotics are more effective than a single strain in reducing NEC and death in PVLBW infants. Relevant studies were identified by searches of the MEDLINE, EMBASE, and Cochrane CENTRAL databases, from 2001 to 2016. The inclusion criteria were randomized controlled trials of any enteral probiotic supplementation that was initiated within the first 7 days and continued for at least 14 days in preterm infants (≤ 34 weeks' gestation) and/or those of a birth weight ≤1500 g. A total of 25 trials (n = 7345 infants) were eligible for inclusion in the meta-analysis using a fixed-effects model. Multiple strains probiotics were associated with a marked reduction in the incidence of NEC, with a pooled OR of 0.36 (95% CI, 0.24-0.53; P probiotic using Lactobacillus species had a borderline effect in reducing NEC (OR of 0.60; 95% CI 0.36-1.0; P = .05), but not mortality. Multiple strains probiotics had a greater effectiveness in reducing mortality and were associated with a pooled OR of 0.58 (95% CI, 0.43-0.79; P = .0006). Trials using single strain of Bifidobacterium species and Saccharomyces boulardii did not reveal any beneficial effects in terms of reducing NEC or mortality. This updated report found that multiple strains probiotics appear to be the most feasible and effective strategy for the prevention of NEC and reduction of mortality in PVLBW neonates. Further clinical trials should focus on which probiotic combinations are most effective.

  14. Community variations in infant and child mortality in Peru.

    Science.gov (United States)

    Edmonston, B; Andes, N

    1983-06-01

    Data from the national Peru Fertility Survey are used to estimate infant and childhood mortality ratios, 1968--77, for 124 Peruvian communities, ranging from small Indian hamlets in the Andes to larger cities on the Pacific coast. Significant mortality variations are found: mortality is inversely related to community population size and is higher in the mountains than in the jungle or coast. Multivariate analysis is then used to assess the influence of community population size, average female education, medical facilities, and altitude on community mortality. Finally, this study concludes that large-scale sample surveys, which include maternal birth history, add useful data for epidemiological studies of childhood mortality.

  15. Infant mortality rates and structure in a town near a nuclear power enterprise

    International Nuclear Information System (INIS)

    Tret'yakov, F.D.; Voronina, Z.I.; Voronin, P.F.; Demin, S.N.

    1991-01-01

    The paper is devoted to analysis of the rates and structure of mortality of infants aged under 1 in a town, situated near a nuclear power enterprise (NPE). Altogether 38124 infants born in 1950-1978, were investigated. The dead infants (1160) were divided into 3 groups with relation to their parents' place of work: 1 - infants whose parents worked in the NPE; 2 - infants whose parents worked in town factories and offices; 3 - all infants in the town. The total doses of γ-irradiation for mothers were 10-400 cSv, those for fathers - 30-520 cSv, intrauterine irradiation of a fetus was 0.5-0.55 cSv. The individual effective equivalent dose of irradiation of the residents of the town was 17.3 cSv over 40 years. Occupational γ-irradiation of the parents at doses exceeding the maximum permissible ones in the first 10 years of work at the NPE made no effect on the mortality rates in infants of the first generation

  16. Infant Mortality in Germany in the 19th Century

    Directory of Open Access Journals (Sweden)

    Rolf Gehrmann

    2012-11-01

    Full Text Available Developments in infant mortality in Germany have previously only been documented in a fragmentary fashion for the 19th century as a whole, and only on a small scale for the period prior to 1871. For the first time, this paper lays a solid statistical foundation by reprocessing the figures assembled by the German states of that time. The reconstructed national statistical series (from 1826 onwards reveals a comparatively high infant mortality, with minor deviations until the turn of the 20th century. The impact of urbanisation and industrialisation is not denied, but an evaluation of the different regional patterns and trends leads to a new weighting. The living and working conditions in the countryside were thus highly determining. The relationship between fertility and infant mortality is assessed differently for the era of the sustained reduction in fertility than for the preceding period. All in all, the prevalent customs and attitudes are regarded as being vital to infants’ survival chances. We therefore need to look at attitudes among the educated public and the authorities. Efforts on the part of these groups to bring about change were particularly observed in the South West, where an awareness of the dramatic problem arose comparatively early. Further historic research at the regional level will be needed in order to achieve a final evaluation of these processes.

  17. Infant mortality and causes of infant deaths in rural Ethiopia: a population-based cohort of 3684 births.

    Science.gov (United States)

    Weldearegawi, Berhe; Melaku, Yohannes Adama; Abera, Semaw Ferede; Ashebir, Yemane; Haile, Fisaha; Mulugeta, Afework; Eshetu, Frehiwot; Spigt, Mark

    2015-08-11

    Ethiopia has made large-scale healthcare investments to improve child health and survival. However, there is insufficient population level data on the current estimates of infant mortality rate (IMR) in the country. The aim of this study was to measure infant mortality rate, investigate risk factors for infant deaths and identify causes of death in a rural population of northern Ethiopia. Live births to a cohort of mothers under the Kilite Awlaelo Health and Demographic Surveillance System were followed up to their first birthday or death, between September 11, 2009 and September 10, 2013. Maternal and infant characteristics were collected at baseline and during the regular follow-up visit. Multiple-Cox regression was used to investigate risk factors for infant death. Causes of infant death were identified using physician review verbal autopsy method. Of the total 3684 infants followed, 174 of them died before their first birthday, yielding an IMR of 47 per 1000 live births (95 % CI: 41, 54) over the four years of follow-up. About 96 % of infants survived up to their first birthday, and 56 % of infant deaths occurred during the neonatal period. Infants born to mothers aged 15-19 years old had higher risk of death (HR = 2.68, 95 % CI: 1. 74, 4.87) than those born to 25-29 years old. Infants of mothers who attained a secondary school and above had 56 % lower risk of death (HR = 0.44, 95 % CI: 0.24, 0.81) compared to those whose mothers did not attend formal education. Sepsis, prematurity and asphyxia and acute lower respiratory tract infections were the commonest causes of death. The IMR for the four-year period was lower than the national and regional estimates. Our findings suggest the need to improve the newborn care, and empower teenagers to delay teenage pregnancy and attain higher levels of education.

  18. Infant mortality in India: use of maternal and child health services in relation to literacy status.

    Science.gov (United States)

    Gokhale, Medha K; Rao, Shobha S; Garole, Varsha R

    2002-06-01

    Slow reduction in infant mortality rate in the last couple of decades is a major concern in India. State-level aggregate data from the National Family Health Survey 1992 and micro-level data on rural mothers (n=317) were used for examining the influence of female literacy on reduction of infant mortality through increased use of maternal and child health (MCH) services. Illiteracy of females was strongly associated with all variables relating to maternal care and also with infant mortality rate. States were grouped into best, medium, and worst on the basis of female illiteracy (about 11%, 48.5%, and 75% respectively). Infant mortality rate (per 1,000 livebirths) was significantly (pIlliteracy of females had a more detrimental impact on rural than on urban areas. In the event of high female illiteracy, male literacy was beneficial for improving the use of services for reducing infant mortality rate. The micro-level study supported all major findings obtained for the national-level aggregate data. Programmes, like providing free education to girls, will yield long-term health benefits.

  19. Pregnancy and Lifetime Exposure to Fine Particulate Matter and Infant Mortality in Massachusetts, 2001-2007.

    Science.gov (United States)

    Son, Ji-Young; Lee, Hyung Joo; Koutrakis, Petros; Bell, Michelle L

    2017-12-01

    Many studies have found associations between particulate matter having an aerodynamic diameter of ≤2.5 μm (PM2.5) and adult mortality. Comparatively few studies evaluated particles and infant mortality, although infants and children are particularly vulnerable to pollution. Moreover, existing studies mostly focused on short-term exposure to larger particles. We investigated PM2.5 exposure during pregnancy and lifetime and postneonatal infant mortality. The study included 465,682 births with 385 deaths in Massachusetts (2001-2007). Exposures were estimated from PM2.5-prediction models based on satellite imagery. We applied extended Cox proportional hazards modeling with time-dependent covariates to total, respiratory, and sudden infant death syndrome mortality. Exposure was calculated from birth to death (or end of eligibility for outcome, at age 1 year) and pregnancy (gestation and each trimester). Models adjusted for sex, birth weight, gestational length, season of birth, temperature, relative humidity, and maternal characteristics. Hazard ratios for total, respiratory, and sudden infant death syndrome mortality per-interquartile-range increase (1.3 μg/m3) in lifetime PM2.5 exposure were 2.66 (95% confidence interval (CI): 2.11, 3.36), 3.14 (95% CI: 2.39, 4.13), and 2.50 (95% CI: 1.56, 4.00), respectively. We did not observe a statistically significant relationship between gestational exposure and mortality. Our findings provide supportive evidence that lifetime exposure to PM2.5 increases risk of infant mortality. © The Author(s) 2017. Published by Oxford University Press on behalf of the Johns Hopkins Bloomberg School of Public Health. All rights reserved. For permissions, please e-mail: journals.permissions@oup.com.

  20. Infant mortality by color or race from Rondônia, Brazilian Amazon.

    Science.gov (United States)

    Gava, Caroline; Cardoso, Andrey Moreira; Basta, Paulo Cesar

    2017-04-10

    To analyze the quality of records for live births and infant deaths and to estimate the infant mortality rate for skin color or race, in order to explore possible racial inequalities in health. Descriptive study that analyzed the quality of records of the Live Births Information System and Mortality Information System in Rondônia, Brazilian Amazonian, between 2006-2009. The infant mortality rates were estimated for skin color or race with the direct method and corrected by: (1) proportional distribution of deaths with missing data related to skin color or race; and (2) application of correction factors. We also calculated proportional mortality by causes and age groups. The capture of live births and deaths improved in relation to 2006-2007, which required lower correction factors to estimate infant mortality rate. The risk of death of indigenous infant (31.3/1,000 live births) was higher than that noted for the other skin color or race groups, exceeding by 60% the infant mortality rate in Rondônia (19.9/1,000 live births). Black children had the highest neonatal infant mortality rate, while the indigenous had the highest post-neonatal infant mortality rate. Among the indigenous deaths, 15.2% were due to ill-defined causes, while the other groups did not exceed 5.4%. The proportional infant mortality due to infectious and parasitic diseases was higher among indigenous children (12.1%), while among black children it occurred due to external causes (8.7%). Expressive inequalities in infant mortality were noted between skin color or race categories, more unfavorable for indigenous infants. Correction factors proposed in the literature lack to consider differences in underreporting of deaths for skin color or race. The specific correction among the color or race categories would likely result in exacerbation of the observed inequalities. Analisar a qualidade dos registros de nascidos vivos e de óbitos infantis e estimar a taxa de mortalidade infantil segundo cor ou

  1. Vietnamese infant and childhood mortality in relation to the Vietnam War.

    Science.gov (United States)

    Savitz, D A; Thang, N M; Swenson, I E; Stone, E M

    1993-01-01

    OBJECTIVES. There is obvious potential for war to adversely affect infant and childhood mortality through direct trauma and disruption of the societal infrastructure. This study examined trends in Vietnam through the period of the war. METHODS. The 1988 Vietnam Demographic and Health Survey collected data on reproductive history and family planning from 4172 women aged 15 through 49 years in 12 selected provinces of Vietnam. The 13,137 births and 737 deaths to children younger than age 6 reported by the respondents were analyzed. RESULTS. For the country as a whole, infant and childhood mortality dropped by 30% to 80% from the prewar period to the wartime period and was stable thereafter. In provinces in which the war was most intense, mortality did not decline from the prewar period to the wartime period but declined after the war, consistent with an adverse effect during the wartime period. CONCLUSIONS. The data are limited by assignment of birth location on the basis of mother's current residence and by inadequate information on areas of war activity. Nonetheless, the data do not indicate a widespread, sizable adverse effect of the war on national infant and childhood mortality in Vietnam but suggest detrimental effects in selected provinces. PMID:8342722

  2. Preventing Hypothermia in Preterm Infants: A Program of Research ...

    African Journals Online (AJOL)

    Neonatal hypothermia is a worldwide problem and leads to increased morbidity and mortality in newborn infants. This paper describes a program of research to examine thermoregulation in premature infants and to decrease neonatal hypothermia. Our studies include 1) examining an intervention to reduce heat loss in ...

  3. Causes of death and infant mortality rates among full-term births in the United States between 2010 and 2012: An observational study.

    Science.gov (United States)

    Bairoliya, Neha; Fink, Günther

    2018-03-01

    were partially explained by state-level differences in maternal education, race, and maternal health, substantial state-level variation in infant mortality remained in fully adjusted models (SIDS OR 1.45, suffocation OR 2.92). The extent to which these state differentials are due to differential antenatal care standards as well as differential access to health services could not be determined due to data limitations. Overall, our estimates suggest that infant mortality could be reduced by 4,003 deaths (95% CI 2,284, 5,587) annually if all states were to achieve the mortality levels of the best-performing state in each cause-of-death category. Key limitations of the analysis are that information on termination rates at the state level was not available, and that causes of deaths may have been coded differentially across states. More than 7,000 full-term infants die in the US each year. The results presented in this paper suggest that a substantial share of these deaths may be preventable. Potential improvements seem particularly large for SUDI, where very low rates have been achieved in a few states while average mortality rates remain high in most other areas. Given the high mortality burden due to SIDS and suffocation, policy efforts to promote compliance with recommended sleeping arrangements could be an effective first step in this direction.

  4. [An explanation of recent trends in infant mortality in Venezuela].

    Science.gov (United States)

    Picouet, M R

    1984-01-01

    An analysis of recent trends in infant mortality in Venezuela is presented using official data. The results show a strong decline up to 1968, followed by a period of fluctuation due to sporadic outbreaks of epidemics. However, the most recent data reveal a continuing decline in mortality, indicating that the problems posed by epidemics have been resolved. (summary in ENG, SPA)

  5. Effect of Concomitant Birth Defects and Genetic Anomalies on Infant Mortality in Tetralogy of Fallot.

    Science.gov (United States)

    Jernigan, Eric G; Strassle, Paula D; Stebbins, Rebecca C; Meyer, Robert E; Nelson, Jennifer S

    2017-08-15

    A substantial proportion of infants born with tetralogy of Fallot (TOF) die in infancy. A better understanding of the heterogeneity associated with TOF, including extracardiac malformations and chromosomal anomalies is vital to stratifying risk and optimizing outcomes during infancy. Using the North Carolina Birth Defects Monitoring Program, infants diagnosed with TOF and born between 2003 and 2012 were included. Kaplan-Meier survival curves were used to estimate cumulative 1-year mortality, stratified by the presence of concomitant birth defects (BDs) and chromosomal anomalies. Multivariable logistic regression was used to estimate the direct effect of each concomitant BD, after adjusting for all others. A total of 496 infants with TOF were included, and 15% (n = 76) died. The number of concomitant BD systems was significantly associated with the risk of death at 1-year, p < 0.0001. Specifically, the risk of mortality was 8% among infants with TOF with or without additional cardiac defects, 16% among infants with TOF and 1 extracardiac BD system, 19% among infants with 2 extracardiac BD systems, and 39% among infants with ≥ 3 extracardiac BD systems. After adjustment, concomitant eye and gastrointestinal defects were significantly associated increased with 1-year mortality, odds ratio 2.83 (95% confidence interval, 1.08-7.32) and odds ratio 4.43 (95% confidence interval, 1.57, 12.45), respectively. Infants with trisomy 13 or trisomy 18 were also significantly more likely to die, p < 0.0001. Both concomitant BDs and genetic anomalies increase the risk of mortality among infants with TOF. Future studies are needed to identify the underlying genetic and socioeconomic risk factors for high-risk TOF infants. Birth Defects Research 109:1154-1165, 2017. © 2017 Wiley Periodicals, Inc. © 2017 Wiley Periodicals, Inc.

  6. Acute exposure to fine and coarse particulate matter and infant mortality in Tokyo, Japan (2002-2013).

    Science.gov (United States)

    Yorifuji, Takashi; Kashima, Saori; Doi, Hiroyuki

    2016-05-01

    Few studies have evaluated the effect of short-term exposure to particulate matter (PM) less than 2.5μm in diameter (PM2.5) or to coarse particles on infant mortality. We evaluated the association between short-term exposure to PM and infant mortality in Japan and assessed whether adverse health effects were observable at PM concentrations below Japanese air quality guidelines. We used a time-stratified, case-crossover design. The participants included 2086 infants who died in the 23 urbanized wards of the Tokyo Metropolitan Government between January 2002 and December 2013. We obtained measures of PM2.5 and suspended particulate matter (SPM; PMPM7-2.5 by subtracting PM2.5 from SPM. We then used conditional logistic regression to analyze the data. Same-day PM2.5 was associated with increased risks of infant and postneonatal mortality, especially for mortality related to respiratory causes. For a 10μg/m(3) increase in PM2.5, the odds ratios were 1.06 (95% confidence interval: 1.01-1.12) for infant mortality and 1.10 (1.02-1.19) for postneonatal mortality. PM7-2.5 was also associated with an increased risk of postneonatal mortality, independent of PM2.5. Even when PM2.5 and SPM concentrations were below Japanese air quality guidelines, we observed adverse health effects. This study provides further evidence that acute exposure to PM2.5 and coarse particles (PM7-2.5) is associated with an increased risk of infant mortality. Further, rigorous evaluation of air quality guidelines for daily average PM2.5 and larger particles is needed. Copyright © 2016 Elsevier B.V. All rights reserved.

  7. Seasonal Variation in Solar Ultra Violet Radiation and Early Mortality in Extremely Preterm Infants.

    Science.gov (United States)

    Salas, Ariel A; Smith, Kelly A; Rodgers, Mackenzie D; Phillips, Vivien; Ambalavanan, Namasivayam

    2015-11-01

    Vitamin D production during pregnancy promotes fetal lung development, a major determinant of infant survival after preterm birth. Because vitamin D synthesis in humans is regulated by solar ultraviolet B (UVB) radiation, we hypothesized that seasonal variation in solar UVB doses during fetal development would be associated with variation in neonatal mortality rates. This cohort study included infants born alive with gestational age (GA) between 23 and 28 weeks gestation admitted to a neonatal unit between 1996 and 2010. Three infant cohort groups were defined according to increasing intensities of solar UVB doses at 17 and 22 weeks gestation. The primary outcome was death during the first 28 days after birth. Outcome data of 2,319 infants were analyzed. Mean birth weight was 830 ± 230 g and median gestational age was 26 weeks. Mortality rates were significantly different across groups (p = 0.04). High-intensity solar UVB doses were associated with lower mortality when compared with normal intensity solar UVB doses (hazard ratio: 0.70; 95% confidence interval: 0.54-0.91; p = 0.01). High-intensity solar UVB doses during fetal development seem to be associated with risk reduction of early mortality in preterm infants. Prospective studies are needed to validate these preliminary findings. Thieme Medical Publishers 333 Seventh Avenue, New York, NY 10001, USA.

  8. Political gender inequality and infant mortality in the United States, 1990-2012.

    Science.gov (United States)

    Homan, Patricia

    2017-06-01

    Although gender inequality has been recognized as a crucial factor influencing population health in the developing world, research has not yet thoroughly documented the role it may play in shaping U.S. infant mortality rates (IMRs). This study uses administrative data with fixed-effects and random-effects models to (1) investigate the relationship between political gender inequality in state legislatures and state infant mortality rates in the United States from 1990 to 2012, and (2) project the population level costs associated with women's underrepresentation in 2012. Results indicate that higher percentages of women in state legislatures are associated with reduced IMRs, both between states and within-states over time. According to model predictions, if women were at parity with men in state legislatures, the expected number of infant deaths in the U.S. in 2012 would have been lower by approximately 14.6% (3,478 infant deaths). These findings underscore the importance of women's political representation for population health. Copyright © 2017 Elsevier Ltd. All rights reserved.

  9. Multiple strains probiotics appear to be the most effective probiotics in the prevention of necrotizing enterocolitis and mortality: An updated meta-analysis.

    Directory of Open Access Journals (Sweden)

    Hung-Yang Chang

    Full Text Available Some oral probiotics have been shown to prevent necrotizing enterocolitis (NEC and decrease mortality effectively in preterm very low birth weight (PVLBW infants. However, it is unclear whether a single probiotic or a mixture of probiotics is most effective for the prevention of NEC.A meta-analysis was conducted by reviewing the most up to date literature to investigate whether multiple strains probiotics are more effective than a single strain in reducing NEC and death in PVLBW infants.Relevant studies were identified by searches of the MEDLINE, EMBASE, and Cochrane CENTRAL databases, from 2001 to 2016.The inclusion criteria were randomized controlled trials of any enteral probiotic supplementation that was initiated within the first 7 days and continued for at least 14 days in preterm infants (≤ 34 weeks' gestation and/or those of a birth weight ≤1500 g.A total of 25 trials (n = 7345 infants were eligible for inclusion in the meta-analysis using a fixed-effects model. Multiple strains probiotics were associated with a marked reduction in the incidence of NEC, with a pooled OR of 0.36 (95% CI, 0.24-0.53; P < .00001. Single strain probiotic using Lactobacillus species had a borderline effect in reducing NEC (OR of 0.60; 95% CI 0.36-1.0; P = .05, but not mortality. Multiple strains probiotics had a greater effectiveness in reducing mortality and were associated with a pooled OR of 0.58 (95% CI, 0.43-0.79; P = .0006. Trials using single strain of Bifidobacterium species and Saccharomyces boulardii did not reveal any beneficial effects in terms of reducing NEC or mortality.This updated report found that multiple strains probiotics appear to be the most feasible and effective strategy for the prevention of NEC and reduction of mortality in PVLBW neonates. Further clinical trials should focus on which probiotic combinations are most effective.

  10. Effect Of Determinants Of Infant And Child Mortality In Nigeria ...

    African Journals Online (AJOL)

    Infant and child mortality is a major public health problem; however, ... measles, diarrhea, respiratory infections and other ... such as urban air pollution, water pollution, solid and ... hazards, infectious disease hazards, ecological changes.

  11. The Role of Immunonutrients in the Prevention of Necrotizing Enterocolitis in Preterm Very Low Birth Weight Infants

    Directory of Open Access Journals (Sweden)

    Ping Zhou

    2015-08-01

    Full Text Available Necrotizing enterocolitis (NEC is a critical intestinal emergency condition, which mainly occurs in preterm very low birth weight (PVLBW infants. Despite remarkable advances in the care of PVLBW infants, with considerable improvement of the survival rate in recent decades, the incidence of NEC and NEC-related mortality have not declined accordingly. The fast progression from nonspecific signs to extensive necrosis also makes primary prevention the first priority. Recently, increasing evidence has indicated the important role of several nutrients in primary prevention of NEC. Therefore, the aim of this review is to summarize some potential immunomodulatory nutrients in the prevention of NEC, including bovine colostrum, probiotics, prebiotics (e.g., human milk oligosaccharides, long chain polyunsaturated fatty acids, and amino acids (glutamine, cysteine and N-acetylcysteine, l-arginine and l-citrulline. Based on current research evidence, probiotics are the most documented effective method to prevent NEC, while others still require further investigation in animal studies and clinical randomized controlled trials.

  12. Is ambient temperature associated with risk of infant mortality? A multi-city study in Korea.

    Science.gov (United States)

    Son, Ji-Young; Lee, Jong-Tae; Bell, Michelle L

    2017-10-01

    Although numerous studies have shown increased risk of mortality from elevated temperatures for adults, limited studies have examined temperature's effect on mortality for infants. Our study investigated the city-specific and overall effects of ambient temperature on infant mortality in seven major cities in Korea, 2004-2007. Birth cohort using a linked birth and death records included 777,570 births with 557 all-cause deaths. We estimated city-specific hazard ratios for each city using an extended Cox proportional hazards model with time-dependent covariates. Then we combined city-specific hazard ratios to generate overall hazard ratio across the seven cities using a Bayesian hierarchical model. Stratified analyses were conducted by cause of death (total and SIDS), exposure period (whole gestation, each trimester, lifetime, 1 month before death, and 2 weeks before death), sex, and maternal characteristics. Overall across the cities, we found significantly positive associations between ambient temperature during 1 month before death or 2 weeks before death and infant mortality from total or SIDS. The overall hazard ratio of infant mortality from total deaths and SIDS for a 1°C increase during 1 month before death was 1.52 (95% CI, 1.46-1.57) and 1.50 (95% CI, 1.35-1.66), respectively. We also found suggestive evidence that some factors such as mother's age may modify the association. Our findings have implications for establishment of policy to reduce the risk of infant mortality from high ambient temperature under climate change. Copyright © 2017 Elsevier Inc. All rights reserved.

  13. Morbidity and Mortality in Small for Gestational Age Infants at 22 to 29 Weeks' Gestation.

    Science.gov (United States)

    Boghossian, Nansi S; Geraci, Marco; Edwards, Erika M; Horbar, Jeffrey D

    2018-02-01

    To identify the relative risks of mortality and morbidities for small for gestational age (SGA) infants in comparison with non-SGA infants born at 22 to 29 weeks' gestation. Data were collected (2006-2014) on 156 587 infants from 852 US centers participating in the Vermont Oxford Network. We defined SGA as sex-specific birth weight thin plate spline term on GA by SGA were used to calculate the adjusted relative risks and 95% confidence intervals for outcomes by GA. Compared with non-SGA infants, the risk of patent ductus arteriosus decreased for SGA infants in early GA and then increased in later GA. SGA infants were also at increased risks of mortality, respiratory distress syndrome, necrotizing enterocolitis, late-onset sepsis, severe retinopathy of prematurity, and chronic lung disease. These risks of adverse outcomes, however, were not homogeneous across the GA range. Early-onset sepsis was not different between the 2 groups for the majority of GAs, although severe intraventricular hemorrhage was decreased among SGA infants for only gestational week 24 through week 25. SGA was associated with additional risks to mortality and morbidities, but the risks differed across the GA range. Copyright © 2018 by the American Academy of Pediatrics.

  14. NCHS - Infant and neonatal mortality rates: United States, 1915-2013

    Data.gov (United States)

    U.S. Department of Health & Human Services — Rates are infants (under 1 year) and neonatal (under 28 days) deaths per 1,000 live births. https://www.cdc.gov/nchs/data-visualization/mortality-trends/

  15. Greater mortality and morbidity in extremely preterm infants fed a diet containing cow milk protein products.

    Science.gov (United States)

    Abrams, Steven A; Schanler, Richard J; Lee, Martin L; Rechtman, David J

    2014-01-01

    Provision of human milk has important implications for the health and outcomes of extremely preterm (EP) infants. This study evaluated the effects of an exclusive human milk diet on the health of EP infants during their stay in the neonatal intensive care unit. EP infants milk fortified with a human milk protein-based fortifier (HM) (n=167) or a diet containing variable amounts of milk containing cow milk-based protein (CM) (n=93). Principal outcomes were mortality, necrotizing enterocolitis (NEC), growth, and duration of parenteral nutrition (PN). Mortality (2% versus 8%, p=0.004) and NEC (5% versus 17%, p=0.002) differed significantly between the HM and CM groups, respectively. For every 10% increase in the volume of milk containing CM, the risk of sepsis increased by 17.9% (pmilk diet, devoid of CM-containing products, was associated with lower mortality and morbidity in EP infants without compromising growth and should be considered as an approach to nutritional care of these infants.

  16. Understanding Racial and Ethnic Disparities in U.S. Infant Mortality Rates

    Science.gov (United States)

    ... different compared with non-Hispanic white women. Table. Gestational age-specific infant mortality rates, by race and Hispanic origin of mother: United States, 2007 Gestational age (weeks) Total Less ...

  17. Small area estimation for estimating the number of infant mortality in West Java, Indonesia

    Science.gov (United States)

    Anggreyani, Arie; Indahwati, Kurnia, Anang

    2016-02-01

    Demographic and Health Survey Indonesia (DHSI) is a national designed survey to provide information regarding birth rate, mortality rate, family planning and health. DHSI was conducted by BPS in cooperation with National Population and Family Planning Institution (BKKBN), Indonesia Ministry of Health (KEMENKES) and USAID. Based on the publication of DHSI 2012, the infant mortality rate for a period of five years before survey conducted is 32 for 1000 birth lives. In this paper, Small Area Estimation (SAE) is used to estimate the number of infant mortality in districts of West Java. SAE is a special model of Generalized Linear Mixed Models (GLMM). In this case, the incidence of infant mortality is a Poisson distribution which has equdispersion assumption. The methods to handle overdispersion are binomial negative and quasi-likelihood model. Based on the results of analysis, quasi-likelihood model is the best model to overcome overdispersion problem. The basic model of the small area estimation used basic area level model. Mean square error (MSE) which based on resampling method is used to measure the accuracy of small area estimates.

  18. Cardiopulmonary resuscitation in hospitalized infants.

    Science.gov (United States)

    Hornik, Christoph P; Graham, Eric M; Hill, Kevin; Li, Jennifer S; Ofori-Amanfo, George; Clark, Reese H; Smith, P Brian

    2016-10-01

    Hospitalized infants requiring cardiopulmonary resuscitation (CPR) represent a high-risk group. Recent data on risk factors for mortality following CPR in this population are lacking. We hypothesized that infant demographic characteristics, diagnoses, and levels of cardiopulmonary support at the time of CPR requirement would be associated with survival to hospital discharge following CPR. Retrospective cohort study. All infants receiving CPR on day of life 2 to 120 admitted to 348 Pediatrix Medical Group neonatal intensive care units from 1997 to 2012. We collected data on demographics, interventions, center volume, and death prior to NICU discharge. We evaluated predictors of death after CPR using multivariable logistic regression with generalized estimating equations to account for clustering of the data by center. Our cohort consisted of 2231 infants receiving CPR. Of these, 1127 (51%) survived to hospital discharge. Lower gestational age, postnatal age, 5-min APGAR, congenital anomaly, and markers of severity of illness were associated with higher mortality. Mortality after CPR did not change significantly over time (Cochran-Armitage test for trend p=0.35). Mortality following CPR in infants is high, particularly for less mature, younger infants with congenital anomalies and those requiring cardiopulmonary support prior to CPR. Continued focus on at risk infants may identify targets for CPR prevention and improve outcomes. Copyright © 2016 Elsevier Ireland Ltd. All rights reserved.

  19. The effect of sociodemographic factors on infant mortality according to cause of death: a birth cohort in Seoul, Korea, 1999-2003.

    Science.gov (United States)

    Son, Ji-Young; Lee, Jong-Tae

    2011-02-01

    The aim of this study was to examine the effect of socioeconomic status and demographic factors on infant mortality, classified by cause of death, in a group of children born in Seoul, Korea during 1999-2003. Linked infant birth and death data were collected from the Korea National Statistical Office. Logistic regression models were used to investigate the effect of socioeconomic and demographic factors on infant mortality. The results were adjusted to take into account the infants' length of gestation and birth weight. Infant death rates from all causes tended to decrease as the parents' educational level increased. We observed a similar pattern for deaths from other specific causes. We also found higher mortality rates for mothers less than 20 years of age and over 35. Our analysis shows that socioeconomic and demographic factors affect infant mortality. In the case of postneonatal infant death, we confirmed that adequate follow-up care can reduce the risks of death from these acquired factors. This suggests that these are important factors to consider in reducing infant mortality.

  20. Political Gender Inequality and Infant Mortality in the United States, 1990–2012

    Science.gov (United States)

    Homan, Patricia

    2017-01-01

    Although gender inequality has been recognized as a crucial factor influencing population health in the developing world, research has not yet thoroughly documented the role it may play in shaping U.S. infant mortality rates (IMRs). This study uses administrative data with fixed-effects and random-effects models to (1) investigate the relationship between political gender inequality in state legislatures and state infant mortality rates in the United States from 1990 to 2012, and (2) project the population level costs associated with women’s underrepresentation in 2012. Results indicate that higher percentages of women in state legislatures are associated with reduced IMRs, both between states and within-states over time. According to model predictions, if women were at parity with men in state legislatures, the expected number of infant deaths in the U.S. in 2012 would have been lower by approximately 14.6% (3,478 infant deaths). These findings underscore the importance of women’s political representation for population health. PMID:28458098

  1. Increased Duration of Paid Maternity Leave Lowers Infant Mortality in Low- and Middle-Income Countries: A Quasi-Experimental Study.

    Directory of Open Access Journals (Sweden)

    Arijit Nandi

    2016-03-01

    Full Text Available Maternity leave reduces neonatal and infant mortality rates in high-income countries. However, the impact of maternity leave on infant health has not been rigorously evaluated in low- and middle-income countries (LMICs. In this study, we utilized a difference-in-differences approach to evaluate whether paid maternity leave policies affect infant mortality in LMICs.We used birth history data collected via the Demographic and Health Surveys to assemble a panel of approximately 300,000 live births in 20 countries from 2000 to 2008; these observational data were merged with longitudinal information on the duration of paid maternity leave provided by each country. We estimated the effect of an increase in maternity leave in the prior year on the probability of infant (<1 y, neonatal (<28 d, and post-neonatal (between 28 d and 1 y after birth mortality. Fixed effects for country and year were included to control for, respectively, unobserved time-invariant confounders that varied across countries and temporal trends in mortality that were shared across countries. Average rates of infant, neonatal, and post-neonatal mortality over the study period were 55.2, 30.7, and 23.0 per 1,000 live births, respectively. Each additional month of paid maternity was associated with 7.9 fewer infant deaths per 1,000 live births (95% CI 3.7, 12.0, reflecting a 13% relative reduction. Reductions in infant mortality associated with increases in the duration of paid maternity leave were concentrated in the post-neonatal period. Estimates were robust to adjustment for individual, household, and country-level characteristics, although there may be residual confounding by unmeasured time-varying confounders, such as coincident policy changes.More generous paid maternity leave policies represent a potential instrument for facilitating early-life interventions and reducing infant mortality in LMICs and warrant further discussion in the post-2015 sustainable development agenda

  2. [Probiotic associations in the prevention of necrotising enterocolitis and the reduction of late-onset sepsis and neonatal mortality in preterm infants under 1,500g: A systematic review].

    Science.gov (United States)

    Baucells, Benjamin James; Mercadal Hally, Maria; Álvarez Sánchez, Airam Tenesor; Figueras Aloy, Josep

    2016-11-01

    Necrotising enterocolitis (NEC) is one of the most common and serious acquired bowel diseases a premature newborn can face. This meta-analysis was performed comparing different probiotic mixtures to ascertain their benefits as a routine tool for preventing necrotising enterocolitis and reducing late-onset sepsis and mortality in premature neonates of less than 1500g. A systematic review of randomised controlled trials, between January 1980 and March 2014, on MEDLINE, the Cochrane Central Register of Controlled Trials, together with EMBASE, was carried out. Studies with infants Probiotics were found to reduce the NEC incidence (RR 0.39; 95%CI: 0.26-0.57) and mortality (RR 0.70; 95%CI: 0.52-0.93), with no difference to placebo regarding late-onset sepsis (RR 0.91; 95%CI: 0.78-1.06). Finally, when analysing the different strands, the use of a 2-probiotic combination (Lactobacillus acidophilus with Bifidobacterium bifidum) proved to be statistically significant in reducing all-cause mortality when compared to other probiotic combinations (RR 0.32; 95%CI: 0.15-0.66, NNT 20; 95%CI: 12-50). Probiotics are a beneficial tool in the prevention of NEC and mortality in preterm neonates. Moreover, the combination of 2 probiotics (Lactobacillus acidophilus with Bifidobacterium bifidum) seems to produce the greatest benefits. However, due to the differences in probiotic components and administration, it would be wise to perform a randomised controlled trial comparing different probiotic mixtures. Copyright © 2015 Asociación Española de Pediatría. Publicado por Elsevier España, S.L.U. All rights reserved.

  3. Rate and Time Trend of Perinatal, Infant, Maternal Mortality, Natality and Natural Population Growth in Kosovo

    Science.gov (United States)

    Azemi, Mehmedali; Gashi, Sanije; Berisha, Majlinda; Kolgeci, Selim; Ismaili-Jaha, Vlora

    2012-01-01

    Aim: The aim of work has been the presentation of the rate and time trends of some indicators of the heath condition of mothers and children in Kosovo: fetal mortality, early neonatal mortality, perinatal mortality, infant mortality, natality, natural growth of population etc. The treated patients were the newborn and infants in the post neonatal period, women during their pregnancy and those 42 days before and after the delivery. Methods: The data were taken from: register of the patients treated in the Pediatric Clinic of Prishtina, World Health Organization, Mother and Child Health Care, Reproductive Health Care, Ministry of Health of the Republic of Kosovo, Statistical Department of Kosovo, the National Institute of Public Health and several academic texts in the field of pediatrics. Some indicators were analyzed in a period between year 1945-2010 and 1950-2010, whereas some others were analyzed in a time period between year 2000 and 2011. Results: The perinatal mortality rate in 2000 was 29.1‰, whereas in 2011 it was 18.7‰. The fetal mortality rate was 14.5‰ during the year 2000, whereas in 2011 it was 11.0‰, in 2000 the early neonatal mortality was 14.8‰, in 2011 it was 7.5‰. The infant mortality in Kosovo was 164‰ in 1950, whereas in 2010 it was 20.5‰. The most frequent causes of infant mortality have been: lower respiratory tract infections, acute infective diarrhea, perinatal causes, congenital malformations and unclassified conditions. Maternal death rate varied during this time period. Maternal death in 2000 was 23 whereas in 2010 only two cases were reported. Regarding the natality, in 1950 it reached 46.1 ‰, whereas in 2010 it reached 14‰, natural growth of population rate in Kosovo was 29.1‰ in 1950, whereas in 2011 it was 11.0‰. Conclusion: Perinatal mortality rate in Kosovo is still high in comparison with other European countries (Turkey and Kyrgyzstan have the highest perinatal mortality rate), even though it is in a

  4. Wage inequality, the health system, and infant mortality in wealthy industrialized countries, 1970-1996.

    Science.gov (United States)

    Macinko, James A; Shi, Leiyu; Starfield, Barbara

    2004-01-01

    This pooled, cross-sectional, time-series study assesses the impact of health system variables on the relationship between wage inequality and infant mortality in 19 OECD countries over the period 1970-1996. Data are derived from the OECD, World Value Surveys, Luxembourg Income Study, and political economy databases. Analyses include Pearson correlation and fixed-effects multivariate regression. In year-specific and time-series analyses, the Theil measure of wage inequality (based on industrial sector wages) is positively and statistically significantly associated with infant mortality rates--even while controlling for GDP per capita. Health system variables--in particular the method of healthcare financing and the supply of physicians--significantly attenuated the effect of wage inequality on infant mortality. In fixed effects multivariate regression models controlling for GDP per capita and wage inequality, variables generally associated with better health include income per capita, the method of healthcare financing, and physicians per 1000 population. Alcohol consumption, the proportion of the population in unions, and government expenditures on health were associated with poorer health outcomes. Ambiguous effects were seen for the consumer price index, unemployment rates, the openness of the economy, and voting rates. This study provides international evidence for the impact of wage inequalities on infant mortality. Results suggest that improving aspects of the healthcare system may be one way to partially compensate for the negative effects of social inequalities on population health.

  5. Association of Cigarette Price Differentials With Infant Mortality in 23 European Union Countries.

    Science.gov (United States)

    Filippidis, Filippos T; Laverty, Anthony A; Hone, Thomas; Been, Jasper V; Millett, Christopher

    2017-11-01

    Raising the price of cigarettes by increasing taxation has been associated with improved perinatal and child health outcomes. Transnational tobacco companies have sought to undermine tobacco tax policy by adopting pricing strategies that maintain the availability of budget cigarettes. To assess associations between median cigarette prices, cigarette price differentials, and infant mortality across the European Union. A longitudinal, ecological study was conducted from January 1, 2004, to December 31, 2014, of infant populations in 23 countries (comprising 276 subnational regions) within the European Union. Median cigarette prices and the differential between these and minimum cigarette prices were obtained from Euromonitor International. Pricing differentials were calculated as the proportions (%) obtained by dividing the difference between median and minimum cigarette price by median price. Prices were adjusted for inflation. Annual infant mortality rates. Associations were assessed using linear fixed-effect panel regression models adjusted for smoke-free policies, gross domestic product, unemployment rate, education, maternal age, and underlining temporal trends. Among the 53 704 641 live births during the study period, an increase of €1 (US $1.18) per pack in the median cigarette price was associated with a decline of 0.23 deaths per 1000 live births in the same year (95% CI, -0.37 to -0.09) and a decline of 0.16 deaths per 1000 live births the following year (95% CI, -0.30 to -0.03). An increase of 10% in the price differential between median-priced and minimum-priced cigarettes was associated with an increase of 0.07 deaths per 1000 live births (95% CI, 0.01-0.13) the following year. Cigarette price increases across 23 European countries between 2004 and 2014 were associated with 9208 (95% CI, 8601-9814) fewer infant deaths; 3195 (95% CI, 3017-3372) infant deaths could have been avoided had there been no cost differential between the median-priced and

  6. Trends of Social Inequalities in the Specific Causes of Infant Mortality in a Nationwide Birth Cohort in Korea, 1995-2009.

    Science.gov (United States)

    Son, Mia; An, Soo Jeong; Kim, Young Ju

    2017-09-01

    The relationship between social disparity and specific causes of infant mortality has rarely been studied. The present study analyzed infant mortality trends according to the causes of death and the inequalities in specific causes of infant mortality between different parental social classes. We analyzed 8,209,836 births from the Statistics Korea between 1995 and 2009. The trends of disparity for cause-specific infant mortality according to parental education and employment were examined using the Cox proportional hazard model for the birth-year intervals of 1995-1999, 2000-2004, and 2005-2009. Adjusted hazard ratios were calculated after adjusting for infants' gender, parents' age, maternal obstetrical history, gestational age, and birth weight. An increasing trend in social inequalities in all-cause infant mortality according to paternal education was evident. Social inequalities in infant mortality were greater for "Not classified symptoms, signs and findings" (International Classification of Diseases 10th revision [ICD-10]: R00-R99) and "Injury, poisoning and of external causes" (S00-T98), particularly for "Ill-defined and unspecified causes" (R990) and "Sudden infant death syndrome (SIDS)" (R950); and increased overtime for "Not classified symptoms, signs and findings" (R00-R99), "Injury, poisoning and of external causes" (S00-T98) and "Conditions in perinatal period" (P00-P96), particularly for "SIDS" (R950) and "Respiratory distress syndrome of newborns (RDS)" (P220). The specific causes of infant mortality, in particular the "Not classified causes" (R00-R99 coded deaths) should be investigated more thoroughly to reduce inequality in health. © 2017 The Korean Academy of Medical Sciences.

  7. Effects of air pollution on infant and children respiratory mortality in four large Latin-American cities.

    Science.gov (United States)

    Gouveia, Nelson; Junger, Washington Leite

    2018-01-01

    Air pollution is an important public health concern especially for children who are particularly susceptible. Latin America has a large children population, is highly urbanized and levels of pollution are substantially high, making the potential health impact of air pollution quite large. We evaluated the effect of air pollution on children respiratory mortality in four large urban centers: Mexico City, Santiago, Chile, and Sao Paulo and Rio de Janeiro in Brazil. Generalized Additive Models in Poisson regression was used to fit daily time-series of mortality due to respiratory diseases in infants and children, and levels of PM 10 and O 3 . Single lag and constrained polynomial distributed lag models were explored. Analyses were carried out per cause for each age group and each city. Fixed- and random-effects meta-analysis was conducted in order to combine the city-specific results in a single summary estimate. These cities host nearly 43 million people and pollution levels were above the WHO guidelines. For PM 10 the percentage increase in risk of death due to respiratory diseases in infants in a fixed effect model was 0.47% (0.09-0.85). For respiratory deaths in children 1-5 years old, the increase in risk was 0.58% (0.08-1.08) while a higher effect was observed for lower respiratory infections (LRI) in children 1-14 years old [1.38% (0.91-1.85)]. For O 3 , the only summarized estimate statistically significant was for LRI in infants. Analysis by season showed effects of O 3 in the warm season for respiratory diseases in infants, while negative effects were observed for respiratory and LRI deaths in children. We provided comparable mortality impact estimates of air pollutants across these cities and age groups. This information is important because many public policies aimed at preventing the adverse effects of pollution on health consider children as the population group that deserves the highest protection. Copyright © 2017 Elsevier Ltd. All rights reserved.

  8. Infant mortality in a very low birth weight cohort from a public hospital in Rio de Janeiro, RJ, Brazil

    Directory of Open Access Journals (Sweden)

    Regina Coeli Azeredo Cardoso

    2013-09-01

    Full Text Available OBJECTIVES: to evaluate infant mortality in very low birth weight newborns from a public hospital in Rio de Janeiro, Brazil (2002-2006. METHODS: a retrospective cohort study was performed using the probabilistic linkage method to identify infant mortality. Mortality proportions were calculated according to birth weight intervals and period of death. The Kaplan-Meier method was used to estimate overall cumulative survival probability. The association between maternal schooling and survival of very low birth weight infants was evaluated by means of Cox proportional hazard models adjusted for: prenatal care, birth weight, and gestational age. RESULTS: the study included 782 very low birth weight newborns. Of these, (28.6% died before one year of age. Neonatal mortality was 19.5%, and earlyneonatal mortality was 14.9%. Mortality was highest in the lowest weight group (71.6%. Newborns whose mothers had less than four years of schooling had 2.5 times higher risk of death than those whose mothers had eight years of schooling or more, even after adjusting for intermediate factors. CONCLUSIONS: the results showed higher mortality among very low birth weight infants. Low schooling was an independent predictor of infant death in this low-income population sample.

  9. Analysis of the spatial distribution of infant mortality by cause of death in Austria in 1984 to 2006

    Directory of Open Access Journals (Sweden)

    Heinzl Harald

    2008-05-01

    Full Text Available Abstract Background In Austria, over the last 20 years infant mortality declined from 11.2 per 1,000 life births (1985 to 4.7 per 1,000 in1997 but remained rather constant since then. In addition to this time trend we already reported a non-random spatial distribution of infant mortality rates in a recent study covering the time period 1984 to 2002. This present study includes four additional years and now covers about 1.9 million individual birth certificates. It aimes to elucidate the observed non-random spatial distribution in more detail. We split up infant mortality into six groups according to the underlying cause of death. The underlying spatial distribution of standardized mortality ratios (SMR is estimated by univariate models as well as by two models incorporating all six groups simultaneously. Results We observe strong correlations between the individual spatial patterns of SMR's except for "Sudden Infant Death Syndrome" and to some extent for "Peripartal Problems". The spatial distribution of SMR's is non-random with an area of decreased risk in the South-East of Austria. The group "Sudden Infant Death Syndrome" clearly and the group "Peripartal Problems" slightly show deviations from the common pattern. When comparing univariate and multivariate SMR estimates we observe that the resulting spatial distributions are very similar. Conclusion We observe different non-random spatial distributions of infant mortality rates when grouped by cause of death. The models applied were based on individual data thereby avoiding ecological regression bias. The estimated spatial distributions do not substantially depend on the employed estimation method. The observed non-random spatial patterns of Austrian infant mortality remain to appear ambiguous.

  10. Inclusion of non-viable neonates in the birth record and its impact on infant mortality rates in Shelby County, Tennessee, USA

    Directory of Open Access Journals (Sweden)

    Bryan Lee Williams

    2010-02-01

    Full Text Available Rates of infant death are one of the most common indicators of a population’s overall health status. Infant mortality rates (IMRs are used to make broad inferences about the quality of health care, effects of health policies and even environmental quality. The purpose of our study was threefold: i to examine the characteristics of births in the area in relation to gestational age and birthweight; ii to estimate infant mortality using variable gestational age and/or birthweight criteria for live birth, and iii to calculate proportional mortality ratios for each cause of death using variable gestational age and/or birthweight criteria for live birth. We conducted a retrospective analysis of all Shelby County resident-linked birth and infant death certificates during the years 1999 to 2004. Descriptive test statistics were used to examine infant mortality rates in relation to specific maternal and infant risk factors. Through careful examination of 1999-2004 resident-linked birth and infant death data sets, we observed a disproportionate number of non-viable live births (≤20 weeks gestation or ≤350 grams in Shelby County. Issuance of birth certificates to these non-viable neonates is a factor that contributes to an inflated IMR. Our study demonstrates the complexity and the appropriateness of comparing infant mortality rates in smaller geographic units, given the unique characteristics of live births in Shelby County. The disproportionate number of pre-viable infants born in Shelby County greatly obfuscates neonatal mortality and de-emphasizes the importance of post-neonatal mortality.

  11. Multicentre trial of ethamsylate for prevention of periventricular haemorrhage in very low birthweight infants.

    Science.gov (United States)

    Benson, J W; Drayton, M R; Hayward, C; Murphy, J F; Osborne, J P; Rennie, J M; Schulte, J F; Speidel, B D; Cooke, R W

    1986-12-06

    The effectiveness of ethamsylate in the prevention of periventricular haemorrhage (PVH) in very low birthweight infants was evaluated by means of a multicentre, placebo-controlled, double-blind trial. In 330 infants without evidence of PVH on initial cranial ultrasound examination there was little difference between ethamsylate and placebo groups with respect to subependymal haemorrhage, but intraventricular and parenchymal haemorrhages developed in 30/162 infants (18.5%) in the treated group, compared with 50/168 (29.8%) in the control group (p less than 0.02). The incidence of intraventricular and parenchymal haemorrhage in survivors was 20/137 (14.6%) in the ethamsylate group and 37/146 (25.3%) in the controls (p less than 0.05). In 30 infants with evidence of PVH on the initial scan, ethamsylate treatment seemed to limit parenchymal extension. Analysis of the total cohort of 360 infants showed that the proportion of infants in whom an increase of two or more grades of severity of PVH was recorded during the trial was lower in the treated than in the placebo group (p less than 0.01). No adverse effects were attributed to ethamsylate therapy. The reported incidence of patent ductus arterious was lower in the treated than in the placebo group (p less than 0.02). Mortality was similar in the two groups.

  12. Effect of 50,000 IU vitamin A given with BCG vaccine on mortality in infants in Guinea-Bissau

    DEFF Research Database (Denmark)

    Benn, Christine Stabell; Diness, Birgitte Rode; Roth, Adam

    2008-01-01

    OBJECTIVE: To investigate the effect of high dose vitamin A supplementation given with BCG vaccine at birth in an African setting with high infant mortality. DESIGN: Randomised placebo controlled trial. Setting Bandim Health Project's demographic surveillance system in Guinea-Bissau, covering...... approximately 90,000 inhabitants. Participants 4345 infants due to receive BCG. INTERVENTION: Infants were randomised to 50,000 IU vitamin A or placebo and followed until age 12 months. MAIN OUTCOME MEASURE: Mortality rate ratios. RESULTS: 174 children died during follow-up (mortality=47/1000 person......-years). Vitamin A supplementation was not significantly associated with mortality; the mortality rate ratio was 1.07 (95% confidence interval 0.79 to 1.44). The effect was 1.00 (0.65 to 1.56) during the first four months and 1.13 (0.75 to 1.68) from 4 to 12 months of age. The mortality rate ratio in boys was 0...

  13. Use of plastic bags to prevent hypothermia at birth in preterm infants--do they work at lower gestations?

    Science.gov (United States)

    Ibrahim, C P H; Yoxall, C W

    2009-02-01

    Hypothermia at birth is strongly associated with mortality and morbidity in preterm infants. Occlusive wrapping of preterm infants during resuscitation, including polythene bags have been shown to prevent hypothermia. To evaluate the effectiveness of the introduction of polythene bags at resuscitation of infants born below 30 weeks gestation in a large tertiary neonatal centre. Retrospective audit of admission temperatures of all infants born below 30 weeks gestation for two years before and two years after the introduction of polythene bags. Hypothermia was defined as admission axillary temperature bags. The main reduction in hypothermia was seen in infants born above 28 weeks gestation (19.4% vs. 3.9%, p = 0.017). There was no significant effect in infants born between 28 weeks and 30 weeks (29.3% vs. 24.8%, p = 0.58). Polythene bags are effective in reducing the incidence of hypothermia at admission in infants born below 30 weeks gestation. The benefit in infants born below 28 weeks gestation was only marginal. This is in contrast to previously published studies. This may be related to the comparatively low incidence of hypothermia at the study centre even prior to introduction of polythene bags.

  14. City-Specific Spatiotemporal Infant and Neonatal Mortality Clusters: Links with Socioeconomic and Air Pollution Spatial Patterns in France

    Directory of Open Access Journals (Sweden)

    Cindy M. Padilla

    2016-06-01

    Full Text Available Infant and neonatal mortality indicators are known to vary geographically, possibly as a result of socioeconomic and environmental inequalities. To better understand how these factors contribute to spatial and temporal patterns, we conducted a French ecological study comparing two time periods between 2002 and 2009 for three (purposefully distinct Metropolitan Areas (MAs and the city of Paris, using the French census block of parental residence as the geographic unit of analysis. We identified areas of excess risk and assessed the role of neighborhood deprivation and average nitrogen dioxide concentrations using generalized additive models to generate maps smoothed on longitude and latitude. Comparison of the two time periods indicated that statistically significant areas of elevated infant and neonatal mortality shifted northwards for the city of Paris, are present only in the earlier time period for Lille MA, only in the later time period for Lyon MA, and decrease over time for Marseille MA. These city-specific geographic patterns in neonatal and infant mortality are largely explained by socioeconomic and environmental inequalities. Spatial analysis can be a useful tool for understanding how risk factors contribute to disparities in health outcomes ranging from infant mortality to infectious disease—a leading cause of infant mortality.

  15. City-Specific Spatiotemporal Infant and Neonatal Mortality Clusters: Links with Socioeconomic and Air Pollution Spatial Patterns in France.

    Science.gov (United States)

    Padilla, Cindy M; Kihal-Talantikit, Wahida; Vieira, Verónica M; Deguen, Séverine

    2016-06-22

    Infant and neonatal mortality indicators are known to vary geographically, possibly as a result of socioeconomic and environmental inequalities. To better understand how these factors contribute to spatial and temporal patterns, we conducted a French ecological study comparing two time periods between 2002 and 2009 for three (purposefully distinct) Metropolitan Areas (MAs) and the city of Paris, using the French census block of parental residence as the geographic unit of analysis. We identified areas of excess risk and assessed the role of neighborhood deprivation and average nitrogen dioxide concentrations using generalized additive models to generate maps smoothed on longitude and latitude. Comparison of the two time periods indicated that statistically significant areas of elevated infant and neonatal mortality shifted northwards for the city of Paris, are present only in the earlier time period for Lille MA, only in the later time period for Lyon MA, and decrease over time for Marseille MA. These city-specific geographic patterns in neonatal and infant mortality are largely explained by socioeconomic and environmental inequalities. Spatial analysis can be a useful tool for understanding how risk factors contribute to disparities in health outcomes ranging from infant mortality to infectious disease-a leading cause of infant mortality.

  16. [A study of infant mortality rate in Korean rural areas].

    Science.gov (United States)

    Cho, Y H

    1981-10-31

    This study was undertaken in an attempt to identify the level of birth and infant death in the KHDI demonstration areas. The objectives of this study were to collect available information on birth and infant death in the KHDI demonstration areas, and estimate actual levels of birth and infant mortality in these areas. Within these areas, events of birth and death are continuously recorded by the field health workers, such as the Family Folder, maternal health service card, and the infant-child health service card. Study areas included all the KHDI demonstration areas (Hongchon, Okgu, Gunee). However, 2 myons in the Okgu area were excluded from the study areas since there was no community health practitioner assigned there. The data were collected by 24 community health practitioners and 80 community health aides in the 3 demonstration areas, according to the survey format. These health workers examined and searched existing records. After filling out the survey questionnaires, these health workers made contact with village health workers, "Li" chiefs, mother's club chiefs, or Saemaul leaders at the village level in order that they might gather additional information on possible items which were omitted. Afterwards, health workers made home visits to selected households which were known to have had births or deaths during the 1 year period between January-December 1979. A review of the activities of the health workers during this study indicated that professional survey workers were needed. In addition, 8 surveyors were employed and trained by KHDI to strengthen field survey efforts; they were dispatched to Hongchon and Okgu for 17 days. A total number of 3302 live births and 120 infant deaths were recorded during 1979. All data collected were tabulated by manual counting in the KHDI office. Infant mortality was estimated to be 36.34/1000 births in the demonstration areas during 1979 (rate in Hongchon Gun was 34.5, 31.0 in Okgu Gun, and 46.2 in Gunee Gun). (author's)

  17. Increased Duration of Paid Maternity Leave Lowers Infant Mortality in Low- and Middle-Income Countries: A Quasi-Experimental Study.

    Science.gov (United States)

    Nandi, Arijit; Hajizadeh, Mohammad; Harper, Sam; Koski, Alissa; Strumpf, Erin C; Heymann, Jody

    2016-03-01

    Maternity leave reduces neonatal and infant mortality rates in high-income countries. However, the impact of maternity leave on infant health has not been rigorously evaluated in low- and middle-income countries (LMICs). In this study, we utilized a difference-in-differences approach to evaluate whether paid maternity leave policies affect infant mortality in LMICs. We used birth history data collected via the Demographic and Health Surveys to assemble a panel of approximately 300,000 live births in 20 countries from 2000 to 2008; these observational data were merged with longitudinal information on the duration of paid maternity leave provided by each country. We estimated the effect of an increase in maternity leave in the prior year on the probability of infant (maternity was associated with 7.9 fewer infant deaths per 1,000 live births (95% CI 3.7, 12.0), reflecting a 13% relative reduction. Reductions in infant mortality associated with increases in the duration of paid maternity leave were concentrated in the post-neonatal period. Estimates were robust to adjustment for individual, household, and country-level characteristics, although there may be residual confounding by unmeasured time-varying confounders, such as coincident policy changes. More generous paid maternity leave policies represent a potential instrument for facilitating early-life interventions and reducing infant mortality in LMICs and warrant further discussion in the post-2015 sustainable development agenda. From a policy planning perspective, further work is needed to elucidate the mechanisms that explain the benefits of paid maternity leave for infant mortality.

  18. Undoing Racism Through Genesee County's REACH Infant Mortality Reduction Initiative.

    Science.gov (United States)

    Kruger, Daniel J; Carty, Denise C; Turbeville, Ashley R; French-Turner, Tonya M; Brownlee, Shannon

    2015-01-01

    Genesee County Racial and Ethnic Approaches to Community Health Program (REACH) is a Community-Based Public Health partnership for reducing African American infant mortality rates that hosts the Undoing Racism Workshop (URW). Assess the URW's effectiveness in promoting an understanding of racism, institutional racism, and how issues related to race/ethnicity can affect maternal and infant health. Recent URW participants (n=84) completed brief preassessment and postassessment forms; participants (n=101) also completed an on-line, long-term assessment (LTA). URWs promoted understanding of racism and institutional racism, although they were less effective in addressing racism as related to maternal and infant health. The URWs were most effective in the domains related to their standard content. Additional effort is necessary to customize URWs when utilized for activities beyond their original purpose of community mobilization.

  19. Modelling infant mortality rate in Central Java, Indonesia use generalized poisson regression method

    Science.gov (United States)

    Prahutama, Alan; Sudarno

    2018-05-01

    The infant mortality rate is the number of deaths under one year of age occurring among the live births in a given geographical area during a given year, per 1,000 live births occurring among the population of the given geographical area during the same year. This problem needs to be addressed because it is an important element of a country’s economic development. High infant mortality rate will disrupt the stability of a country as it relates to the sustainability of the population in the country. One of regression model that can be used to analyze the relationship between dependent variable Y in the form of discrete data and independent variable X is Poisson regression model. Recently The regression modeling used for data with dependent variable is discrete, among others, poisson regression, negative binomial regression and generalized poisson regression. In this research, generalized poisson regression modeling gives better AIC value than poisson regression. The most significant variable is the Number of health facilities (X1), while the variable that gives the most influence to infant mortality rate is the average breastfeeding (X9).

  20. Correlation or causation? Income inequality and infant mortality in fixed effects models in the period 1960-2008 in 34 OECD countries.

    Science.gov (United States)

    Avendano, Mauricio

    2012-08-01

    Income inequality is strongly associated with infant mortality across countries, but whether this association is causal has not been established. In their commentary in this issue of Social Science & Medicine, Regidor et al. (2012) argue that this association has disappeared in recent years, and question the premise of a causal link. This paper empirically tests the impact of income inequality on infant mortality in a fixed effects model that exploits the evolution of income inequality over a 38-year period, controlling for all time-invariant differences across countries. Data came from the Standardized World Income Inequality Database, containing yearly estimates for the period 1960-2008 in 34 countries member of the Organization for Economic Co-operation and Development (OECD), linked to infant mortality data from the OECD Health database. Infant mortality was modelled as a function of income inequality in a country and year fixed effects model, incorporating controls for changing economic and labour conditions. In a model without country fixed effects, a one-point increase in the Gini coefficient was associated with a 7% increase in the infant mortality rate (Rate ratio[RR] = 1.07, 95% Confidence Interval [CI] 1.04, 1.09). Controlling for differences across countries in a country fixed effects model, however, income inequality was no longer associated with infant mortality (RR = 1.00, 0.98, 1.01). Similar results were obtained when using lagged values of income inequality for up to 15 years, and in models that controlled for changing labour and economic conditions. Findings suggest that in the short-run, changes in income inequality are not associated with changes in infant mortality. A possible interpretation of the discrepancy between cross-country correlations and fixed effects models is that social policies that reduce infant mortality cluster in countries with low income inequality, but their effects do not operate via income. Findings highlight the

  1. Patterns of Infant Mortality in Texas' Triethnic Population During 1993 Through 1995

    National Research Council Canada - National Science Library

    Guerra, Horacio

    1998-01-01

    This study evaluated the patterns of infant mortality in relation to birth weight, gestational and maternal age, parity, and prenatal care in Texas' triethnic population from 1993 through 1995 using...

  2. Pregnancy loss and role of infant HIV status on perinatal mortality among HIV-infected women

    Directory of Open Access Journals (Sweden)

    Kim Hae-Young

    2012-08-01

    Full Text Available Abstract Background HIV-infected women, particularly those with advanced disease, may have higher rates of pregnancy loss (miscarriage and stillbirth and neonatal mortality than uninfected women. Here we examine risk factors for these adverse pregnancy outcomes in a cohort of HIV-infected women in Zambia considering the impact of infant HIV status. Methods A total of 1229 HIV-infected pregnant women were enrolled (2001–2004 in Lusaka, Zambia and followed to pregnancy outcome. Live-born infants were tested for HIV by PCR at birth, 1 week and 5 weeks. Obstetric and neonatal data were collected after delivery and the rates of neonatal ( Results The ratio of miscarriage and stillbirth per 100 live-births were 3.1 and 2.6, respectively. Higher maternal plasma viral load (adjusted odds ratio [AOR] for each log10 increase in HIV RNA copies/ml = 1.90; 95% confidence interval [CI] 1.10–3.27 and being symptomatic were associated with an increased risk of stillbirth (AOR = 3.19; 95% CI 1.46–6.97, and decreasing maternal CD4 count by 100 cells/mm3 with an increased risk of miscarriage (OR = 1.25; 95% CI 1.02–1.54. The neonatal mortality rate was 4.3 per 100 increasing to 6.3 by 70 days. Intrauterine HIV infection was not associated with neonatal morality but became associated with mortality through 70 days (adjusted hazard ratio = 2.76; 95% CI 1.25–6.08. Low birth weight and cessation of breastfeeding were significant risk factors for both neonatal and early mortality independent of infant HIV infection. Conclusions More advanced maternal HIV disease was associated with adverse pregnancy outcomes. Excess neonatal mortality in HIV-infected women was not primarily explained by infant HIV infection but was strongly associated with low birth weight and prematurity. Intrauterine HIV infection contributed to mortality as early as 70 days of infant age. Interventions to improve pregnancy outcomes for HIV-infected women are needed to

  3. Impact of Socioeconomic and Health System Factors on Infant Mortality Rate in Organization of the Petroleum Exporting Countries (OPEC: Evidence from 2004 to 2013

    Directory of Open Access Journals (Sweden)

    Satar Rezaei

    2015-04-01

    Full Text Available Background: infant mortality rate is one of the main health indicators for assessing the health system’s performance over the world. We aim to examine the socioeconomic and health system factors affect infant mortality in OPEC from 2004 to 2013. Methods: was used to examine the effects of some of the key explanatory factors (total fertility rate per women, GDP per capita (current US$, public health expenditure as % of total health expenditure and female labor force participation rate on infant mortality in OPEC from 2004 to 2013.  These data were obtained from World Bank and World Health Organization data bank. Results: our results showed the total fertility rate had a positive and significant impact on infant mortality in the studied period. Also, there are negative significant associations between GDP per capita and public health expenditure with infant mortality. We did not observe any relationship between infant mortality and female labour force participation rate in the studied countries from 2004 to 2013. Conclusion: total fertility rate per women, GDP per capita (current US$, public health expenditure as % of total health expenditure were identified as the main factors affecting on infant mortality in OPEC over the ten years (2004-2013. This study enables health policy-makers to better understand the factors affecting on infant mortality and thereby take necessary steps in managing and decreasing the infant mortality rate in the studied countries.

  4. Regional Infant and Child Mortality Review Committee--2011 final report.

    Science.gov (United States)

    Wilson, Ann L; Sideras, James

    2012-12-01

    The 2011 annual report of the Regional Infant and Child Mortality Review Committee (RICMRC) is presented. Since 1997, the committee has reviewed 224 deaths to achieve its mission to "review infant and child deaths so that information can be transformed into action to protect young lives." In 2011, the committee reviewed 21 deaths (22 met the committee's criteria) of infants and children who were residents of Minnehaha, Turner, Lincoln, Hanson and Brookings counties in South Dakota. The manner of 12 of the reviewed deaths was natural with eight of these the result of progressive neurological diseases or conditions. In 2011 there were no deaths attributed to Sudden Infant Death Syndrome (SIDS), though there were two deaths of infants during sleep. One of these infants was ruled accidental as the baby died of aspiration and the other death occurred in an unsafe environment with its manner determined to be undecided. Six deaths were accidental, one of which occurred as a result of a fire in a home without functional smoke alarms. One motor vehicle death occurred, through no fault of the teen age driver. Another death resulted from tubing over a low head dam on the Big Sioux River. One youth suicide occurred to a resident of the region.

  5. The effect of systematic pediatric care on neonatal mortality and hospitalizations of infants born with oral clefts

    Directory of Open Access Journals (Sweden)

    Wehby George L

    2011-12-01

    Full Text Available Abstract Background Cleft lip and/or palate (CL/P increase mortality and morbidity risks for affected infants especially in less developed countries. This study aimed at assessing the effects of systematic pediatric care on neonatal mortality and hospitalizations of infants with cleft lip and/or palate (CL/P in South America. Methods The intervention group included live-born infants with isolated or associated CL/P in 47 hospitals between 2003 and 2005. The control group included live-born infants with CL/P between 2001 and 2002 in the same hospitals. The intervention group received systematic pediatric care between the 7th and 28th day of life. The primary outcomes were mortality between the 7th and 28th day of life and hospitalization days in this period among survivors adjusted for relevant baseline covariates. Results There were no significant mortality differences between the intervention and control groups. However, surviving infants with associated CL/P in the intervention group had fewer hospitalization days by about six days compared to the associated control group. Conclusions Early systematic pediatric care may significantly reduce neonatal hospitalizations of infants with CL/P and additional birth defects in South America. Given the large healthcare and financial burden of CL/P on affected families and the relatively low cost of systematic pediatric care, improving access to such care may be a cost-effective public policy intervention. Trial Registration ClinicalTrials.gov: NCT00097149

  6. Can better infrastructure and quality reduce hospital infant mortality rates in Mexico?

    Science.gov (United States)

    Aguilera, Nelly; Marrufo, Grecia M

    2007-02-01

    Preliminary evidence from hospital discharges hints enormous disparities in infant hospital mortality rates. At the same time, public health agencies acknowledge severe deficiencies and variations in the quality of medical services across public hospitals. Despite these concerns, there is limited evidence of the contribution of hospital infrastructure and quality in explaining variations in outcomes among those who have access to medical services provided at public hospitals. This paper provides evidence to address this question. We use probabilistic econometric methods to estimate the impact of material and human resources and hospital quality on the probability that an infant dies controlling for socioeconomic, maternal and reproductive risk factors. As a measure of quality, we calculate for the first time for Mexico patient safety indicators developed by the AHRQ. We find that the probability to die is affected by hospital infrastructure and by quality. In this last regard, having been treated in a hospital with the worse quality incidence doubles the probability to die. This paper also presents evidence on the contribution of other risk factors on perinatal mortality rates. The conclusions of this paper suggest that lower infant mortality rates can be reached by implementing a set of coherent public policy actions including an increase and reorganization of hospital infrastructure, quality improvement, and increasing demand for health by poor families.

  7. Unintentional injury and its prevention in infant: knowledge and self-reported practices of main caregivers.

    Science.gov (United States)

    Ramdzan, Siti Nurkamilla; Liew, Su May; Khoo, Ee Ming

    2014-05-29

    Unintentional injuries are the major cause of morbidity and mortality in infants. Prevention of unintentional injuries has been shown to be effective with education. Understanding the level of knowledge and practices of caregivers in infant safety would be useful to identify gaps for improvement. A cross-sectional study was conducted in an urban government health clinic in Malaysia among main caregivers of infants aged 11 to 15 months. Face-to-face interviews were conducted using a semi-structured self-designed questionnaire. Responses to the items were categorised by the percentage of correct answers: poor (70%). A total of 403 caregivers participated in the study. Of the 21 items in the questionnaire on knowledge, 19 had good-to-moderate responses and two had poor responses. The two items on knowledge with poor responses were on the use of infant walkers (26.8%) and allowing infants on motorcycles as pillion riders (27.3%). Self-reported practice of infant safety was poor. None of the participants followed all 19 safety practices measured. Eight (42.1%) items on self-reported practices had poor responses. The worst three of these were on the use of baby cots (16.4%), avoiding the use of infant walkers (23.8%) and putting infants to sleep in the supine position (25.6%). Better knowledge was associated with self-reported safety practices in infants (p safety was good but self-reported practice was poor. Further research in the future is required to identify interventions that target these potentially harmful practices.

  8. Infant mortality gap in the Baltic region - Latvia, Estonia, and Lithuania - in relation to macroeconomic factors in 1996-2010.

    Science.gov (United States)

    Ebela, Inguna; Zile, Irisa; Ebela, Danute Razuka; Rozenfelde, Ingrida Rumba

    2013-01-01

    BACKGROUND AND OBJECTIVE. A constant gap has appeared in infant mortality among the 3 Baltic States - Latvia, Estonia, and Lithuania - since the restoration of independence in 1991. The aim of the study was to compare infant mortality rates in all the 3 Baltic countries and examine some of the macro- and socioeconomic factors associated with infant mortality. MATERIAL AND METHODS. The data were obtained from international databases, such as World Health Organization and EUROSTAT, and the national statistical databases of the Baltic States. The time series data sets (1996-2010) were used in the regression and correlation analysis. RESULTS. In all the 3 Baltic States, a strong and significant correlation was found: Latvia (r=-0.81, P<0.01), Lithuania (r=-0.93, P<0.01), and Estonia (r=-0.91, P<0.01). There was also a correlation between infant mortality and healthcare expenditure in local currency per capita: Latvia (r=-0.81, P<0.01); Lithuania (r=-0.90, P<0.01) and Estonia (r=-0.88, P<0.01). In Latvia (r=0.87, P<0.01) and Estonia (r=0.70; P<0.01), a significant correlation between infant mortality and unemployment levels was observed from 1996 to 2008, whereas the statistical significance disappeared in the period from 1996 to 2010. In Lithuania, the relationship was not significant. CONCLUSIONS. Higher infant mortality rates and a less stable decreasing tendency in Latvia are apparently explained by less successful adaptation to a new political and economic situation and limited skills in adjusting the healthcare system to the reality of life.

  9. Health status of hostel dwellers: Part II. Infant mortality and ...

    African Journals Online (AJOL)

    Here a high infant mortality rate is examined against a low prevalence of diabetes, hypertension and syphilis and some of the effects of migrant labour on the health status of migrant hostel dwellers are identified. The low prevalence of disease among the Cape Town hostel residents suggests that migrant labour, by sifting ...

  10. Preconception maternal bereavement and infant and childhood mortality: A Danish population-based study

    Science.gov (United States)

    Class, Quetzal A.; Mortensen, Preben B.; Henriksen, Tine B.; Dalman, Christina; D’Onofrio, Brian M.; Khashan, Ali S.

    2015-01-01

    Objectives Preconception maternal bereavement may be associated with an increased risk for infant mortality, though these previously reported findings have not been replicated. We sought to examine if the association could be replicated and explore if risk extended into childhood. Methods Using a Danish population-based sample of offspring born 1979–2009 (N=1,865,454), we predicted neonatal (0–28 days), post-neonatal infant (29–364 days), and early childhood (1–5 years) mortality following maternal bereavement in the preconception (6–0 months before pregnancy) and prenatal (between conception and birth) periods. Maternal bereavement was defined as death of a first degree relative of the mother. Analyses were conducted using logistic and log-linear Poisson regression that were adjusted for offspring, mother, and father sociodemographic and health factors. Results We identified 6,541 (0.004%) neonates, 3,538 (0.002%) post-neonates, and 2,132 (0.001%) children between the ages of 1 to 5 years who died. After adjusting for covariates, bereavement during the preconception period was associated with an increased odds of neonatal (adjusted odds ratio [aOR] = 1.87, 95% CI: 1.53–2.30) and post-neonatal infant mortality (aOR=1.52, 95% CI: 1.15–2.02). Associations were timing-specific (6 months prior to pregnancy only) and consistent across sensitivity analyses. Bereavement during the prenatal period was not consistently associated with increased risk of offspring mortality, however this may reflect relatively low statistical power. Conclusions Results support and extend previous findings linking bereavement during the preconception period with increased odds of early offspring mortality. The period immediately prior to pregnancy may be a sensitive period with potential etiological implications and ramifications for offspring mortality. PMID:26374948

  11. [Risks factors associated with intra-partum foetal mortality in pre-term infants].

    Science.gov (United States)

    Zeballos Sarrato, Susana; Villar Castro, Sonia; Ramos Navarro, Cristina; Zeballos Sarrato, Gonzalo; Sánchez Luna, Manuel

    2017-03-01

    Pre-term delivery is one of the leading causes of foetal and perinatal mortality. However, perinatal risk factors associated with intra-partum foetal death in preterm deliveries have not been well studied. To analyse foetal mortality and perinatal risk factors associated with intra-partum foetal mortality in pregnancies of less than 32 weeks gestational age. The study included all preterm deliveries between 22 and 31 +1 weeks gestational age (WGA), born in a tertiary-referral hospital, over a period of 7 years (2008-2014). A logistic regression model was used to identify perinatal risk factors associated with intra-partum foetal mortality (foetal malformations and chromosomal abnormalities were excluded). During the study period, the overall foetal mortality was 63.1% (106/168) (≥22 weeks of gestation) occurred in pregnancies of less than 32 WGA. A total of 882 deliveries between 22 and 31+6 weeks of gestation were included for analysis. The rate of foetal mortality was 11.3% (100/882). The rate of intra-partum foetal death was 2.6% (23/882), with 78.2% (18/23) of these cases occurring in hospitalised pregnancies. It was found that Assisted Reproductive Techniques, abnormal foetal ultrasound, no administration of antenatal steroids, lower gestational age, and small for gestational age, were independent risk factors associated with intra-partum foetal mortality. This study showed that there is a significant percentage intra-partum foetal mortality in infants between 22 and 31+6 WGA. The analysis of intrapartum mortality and risk factors associated with this mortality is of clinical and epidemiological interest to optimise perinatal care and improve survival of preterm infants. Copyright © 2016 Asociación Española de Pediatría. Publicado por Elsevier España, S.L.U. All rights reserved.

  12. Mortality and morbidity risks vary with birth weight standard deviation score in growth restricted extremely preterm infants.

    Science.gov (United States)

    Yamakawa, Takuji; Itabashi, Kazuo; Kusuda, Satoshi

    2016-01-01

    To assess whether the mortality and morbidity risks vary with birth weight standard deviation score (BWSDS) in growth restricted extremely preterm infants. This was a multicenter retrospective cohort study using the database of the Neonatal Research Network of Japan and including 9149 infants born between 2003 and 2010 at <28 weeks gestation. According to the BWSDSs, the infants were classified as: <-2.0, -2.0 to -1.5, -1.5 to -1.0, -1.0 to -0.5, and ≥-0.5. Infants with BWSDS≥-0.5 were defined as non-growth restricted group. After adjusting for covariates, the risks of mortality and some morbidities were different among the BWSDS groups. Compared with non-growth restricted group, the adjusted odds ratio (aOR) for mortality [aOR, 1.69; 95% confidence interval (CI), 1.35-2.12] and chronic lung disease (CLD) (aOR, 1.28; 95% CI, 1.07-1.54) were higher among the infants with BWSDS -1.5 to <-1.0. The aOR for severe retinopathy of prematurity (ROP) (aOR, 1.36; 95% CI, 1.09-1.71) and sepsis (aOR, 1.72; 95% CI, 1.32-2.24) were higher among the infants with BWSDS -2.0 to <-1.5. The aOR for necrotizing enterocolitis (NEC) (aOR, 2.41; 95% CI, 1.64-3.55) was increased at a BWSDS<-2.0. Being growth restricted extremely preterm infants confer additional risks for mortality and morbidities such as CLD, ROP, sepsis and NEC, and these risks may vary with BWSDS. Copyright © 2015 Elsevier Ireland Ltd. All rights reserved.

  13. Time-trends and causes of infant, neonatal and postneonatal mortality in Mexico, 1980-1990

    Directory of Open Access Journals (Sweden)

    SUSAN VANDALE

    1997-01-01

    Full Text Available Objective. This article analyzes the time-trends and causes of infant, neonatal, and postneonatal mortality in Mexico during the 1980’s. Material and methods. Data on infant deaths came from yearly tabulations (1980 to 1990 published by the Mexican government. Time-trends of mortality rates were determined by simple linear regression models. The parallelism test was performed for evaluating similarities in trends in neonatal and postneonatal mortality rates by causes. Results. During the 1980’s, infant mortality rates in Mexico declined from 40.4 to 31.1/1 000 (ß= -0.791. Postneonatal mortality rates showed a strong decrease (ß= -0.892, while neonatal mortality rates were almost stationary (ß= 0.089. Significant rate decreases were observed for Intestinal infections, Pneumonia and influenza and all other causes while Certain perinatal problems, Congenital defects and Nutritional deficiencies increased. No changes were observed in Acute respiratory infections. The neonatal proportional mortality showed an incremental trend accounting for 37.6% in 1980 and ascending to 48.8% in 1990 of the mortality in the first year of life. Conclusions.This analysis indicates that the reduction in infant mortality in Mexico during the 1980’s was due to declining postneonatal mortality while neonatal mortality rates remain almost unchanged.Objetivo. Analizar las tendencias seculares de las tasas de mortalidad infantil (TMI neonatal (TMN y posneonatal (TMP en México de 1980-1990. Material y métodos. La información estudiada fue proporcionada por el Instituto Nacional de Estadística, Geografía e Informática. Las tendencias de los indicadores fueron determinadas mediante modelos de regresión lineal y se efectuaron pruebas de paralelismo para evaluar la semejanza en pendientes de TMN y TMP por causas. Resultados. Las TMI se redujeron de 40.4 a 31.1/1 000, (ß= -0.791. Las TMP mostraron un decremento significativo (ß= -0.892, mientras que las TMN

  14. What is the infant mortality rate in South Africa? The need for ...

    African Journals Online (AJOL)

    Estimates of infant mortality rates, proportion of births not registered, and ... and the 1993 Poverty Survey by the Southern African Labour and Development ... The October Household Survey conducted annually by the Central Statistical ...

  15. Cost-effectiveness of pneumococcal conjugate vaccination in the prevention of child mortality: an international economic analysis.

    Science.gov (United States)

    Sinha, Anushua; Levine, Orin; Knoll, Maria D; Muhib, Farzana; Lieu, Tracy A

    2007-02-03

    Routine vaccination of infants against Streptococcus pneumoniae (pneumococcus) needs substantial investment by governments and charitable organisations. Policymakers need information about the projected health benefits, costs, and cost-effectiveness of vaccination when considering these investments. Our aim was to incorporate these data into an economic analysis of pneumococcal vaccination of infants in countries eligible for financial support from the Global Alliance for Vaccines & Immunization (GAVI). We constructed a decision analysis model to compare pneumococcal vaccination of infants aged 6, 10, and 14 weeks with no vaccination in the 72 countries that were eligible as of 2005. We used published and unpublished data to estimate child mortality, effectiveness of pneumococcal conjugate vaccine, and immunisation rates. Pneumococcal vaccination at the rate of diptheria-tetanus-pertussis vaccine coverage was projected to prevent 262,000 deaths per year (7%) in children aged 3-29 months in the 72 developing countries studied, thus averting 8.34 million disability-adjusted life years (DALYs) yearly. If every child could be reached, up to 407,000 deaths per year would be prevented. At a vaccine cost of International 5 dollars per dose, vaccination would have a net cost of 838 million dollars, a cost of 100 dollars per DALY averted. Vaccination at this price was projected to be highly cost-effective in 68 of 72 countries when each country's per head gross domestic product per DALY averted was used as a benchmark. At a vaccine cost of between 1 dollar and 5 dollars per dose, purchase and accelerated uptake of pneumococcal vaccine in the world's poorest countries is projected to substantially reduce childhood mortality and to be highly cost-effective.

  16. Mineração de dados e características da mortalidade infantil Data mining and characteristics of infant mortality

    Directory of Open Access Journals (Sweden)

    Rossana Cristina Xavier Ferreira Vianna

    2010-03-01

    Full Text Available O estudo busca identificar padrões de características materno-fetais na predição da mortalidade infantil, por meio da incorporação de técnicas inovadoras, como a Mineração de Dados, que se mostram relevantes em Saúde Pública. Foi elaborada uma base de dados, com óbitos infantis analisados pelos Comitês de Prevenção da Mortalidade Infantil de 2000 a 2004, a partir da integração dos Sistemas de Informações de Nascidos Vivos, da Mortalidade e da Investigação da Mortalidade Infantil no Estado do Paraná. O programa da mineração foi o WEKA, de uso livre. A mineração faz busca em banco de dados e fornece regras que devem ser analisadas para transformação em informação útil. Após a mineração, selecionaram-se 4.230 regras, por exemplo: mãe adolescente e peso ao nascer This study aims to identify patterns in maternal and fetal characteristics in the prediction of infant mortality by incorporating innovative techniques like data mining, with proven relevance for public health. A database was developed with infant deaths from 2000 to 2004 analyzed by the Committees for the Prevention of Infant Mortality, based on integration of the Information System on Live Births (SINASC, Mortality Information System, and Investigation of Infant Mortality in the State of Paraná. The data mining software was WEKA (open source. The data mining conducts a database search and provides rules to be analyzed to transform the data into useful information. After mining, 4,230 rules were selected: teenage pregnancy plus birth weight < 2,500g, or post-term birth plus teenage mother with a previous child or intercurrent conditions increase the risk of neonatal death. The results highlight the need for greater attention to teenage mothers, newborns with birth weight < 2,500g, post-term neonates, and infants of mothers with intercurrent conditions, thus corroborating other studies.

  17. Seeking explanations for high levels of infant mortality in Pakistan.

    Science.gov (United States)

    Sathar, Z A

    1987-01-01

    Data from the Fertility Module of the 1979 Population, Labour Force and Migration (PLM) Survey of Pakistan were analyzed to determine which of 4 factors were primarily responsible for the high infant mortality rate. The factors examined were poverty, childbearing and childrearing practices, distribution of health care and lack of individual attention given to children due to ignorance. These items were presented in a discussion format. Infant mortality in Pakistan is high at about 125-140/1000, for a country with mid-level per capita income. Income was not a good indicator of child mortality, primarily because it was difficult to determine, particularly in rural areas where non-cash income predominates. Wealth and status were good indicators of child survival. Child-rearing practices were somewhat important, as judged by birth order, breastfeeding duration and gender. Childbearing practices as shown by spacing were important determinants of survival. Health care facilities were somewhat important, indicated by higher mortality in rural areas. Rural neonates die from tetanus due to lack of immunization, or later from diarrheal disease due to lack of potable water or poor weaning practices. Maternal education was a strong indicator of survival, much more so than paternal education. Similarly, female heads of households increased survival, probably because they control financial allocations. The study suggested that rather than attempting to eliminate poverty overall, improvements in maternal education, nutrition, health care facilities and their use, and childbearing and child-rearing methods would do more to improve child survival in Pakistan.

  18. International Ranking of Infant Mortality Rates: Taiwan Compared with European Countries

    Directory of Open Access Journals (Sweden)

    Fu-Wen Liang

    2016-08-01

    Conclusion: The ranking of Taiwan was similar (11th vs. 12th according the two definitions. However, after consideration of the confidence interval, only six countries (Sweden, Finland, Czech Republic, Belgium, Austria, and Germany had infant mortality rates statistically significantly lower than those of Taiwan in 2004.

  19. Determinants of neonatal mortality in Indonesia.

    Science.gov (United States)

    Titaley, Christiana R; Dibley, Michael J; Agho, Kingsley; Roberts, Christine L; Hall, John

    2008-07-09

    Neonatal mortality accounts for almost 40 per cent of under-five child mortality, globally. An understanding of the factors related to neonatal mortality is important to guide the development of focused and evidence-based health interventions to prevent neonatal deaths. This study aimed to identify the determinants of neonatal mortality in Indonesia, for a nationally representative sample of births from 1997 to 2002. The data source for the analysis was the 2002-2003 Indonesia Demographic and Health Survey from which survival information of 15,952 singleton live-born infants born between 1997 and 2002 was examined. Multilevel logistic regression using a hierarchical approach was performed to analyze the factors associated with neonatal deaths, using community, socio-economic status and proximate determinants. At the community level, the odds of neonatal death was significantly higher for infants from East Java (OR = 5.01, p = 0.00), and for North, Central and Southeast Sulawesi and Gorontalo combined (OR = 3.17, p = 0.03) compared to the lowest neonatal mortality regions of Bali, South Sulawesi and Jambi provinces. A progressive reduction in the odds was found as the percentage of deliveries assisted by trained delivery attendants in the cluster increased. The odds of neonatal death were higher for infants born to both mother and father who were employed (OR = 1.84, p = 0.00) and for infants born to father who were unemployed (OR = 2.99, p = 0.02). The odds were also higher for higher rank infants with a short birth interval (OR = 2.82, p = 0.00), male infants (OR = 1.49, p = 0.01), smaller than average-sized infants (OR = 2.80, p = 0.00), and infant's whose mother had a history of delivery complications (OR = 1.81, p = 0.00). Infants receiving any postnatal care were significantly protected from neonatal death (OR = 0.63, p = 0.03). Public health interventions directed at reducing neonatal death should address community, household and individual level factors

  20. Effects of Probiotics on Necrotizing Enterocolitis, Sepsis, Intraventricular Hemorrhage, Mortality, Length of Hospital Stay, and Weight Gain in Very Preterm Infants: A Meta-Analysis.

    Science.gov (United States)

    Sun, Jing; Marwah, Gayatri; Westgarth, Matthew; Buys, Nicholas; Ellwood, David; Gray, Peter H

    2017-09-01

    Probiotics are increasingly used as a supplement to prevent adverse health outcomes in preterm infants. We conducted a systematic review, meta-analysis, and subgroup analysis of findings from randomized controlled trials (RCTs) to assess the magnitude of the effect of the probiotics on health outcomes among very-low-birth-weight (VLBW) infants. Relevant articles from January 2003 to June 2017 were selected from a broad range of databases, including Medline, PubMed, Scopus, and Embase. Studies were included if they used an RCT design, involved a VLBW infant (birthweight probiotic intervention group, measured necrotizing enterocolitis (NEC) as a primary outcome, and measured sepsis, mortality, length of hospital stay, weight gain, and intraventricular hemorrhage (IVH) as additional outcomes. The initial database search yielded 132 potentially relevant articles and 32 ( n = 8998 infants) RCTs were included in the final meta-analysis. Subgroup analysis was used to evaluate the effects of the moderators on the outcome variables. In the probiotics group, it was found that NEC was reduced by 37% (95% CI: 0.51%, 0.78%), sepsis by 37% (95% CI: 0.72%, 0.97%), mortality by 20% (95% CI: 0.67%, 0.95%), and length of hospital stay by 3.77 d (95% CI: -5.94, -1.60 d). These findings were all significant when compared with the control group. There was inconsistent use of strain types among some of the studies. The results indicate that probiotic consumption can significantly reduce the risk of developing medical complications associated with NEC and sepsis, reduce mortality and length of hospital stay, and promote weight gain in VLBW infants. Probiotics are more effective when taken in breast milk and formula form, consumed for Probiotics are not effective in reducing the incidence of IVH in VLBW infants. © 2017 American Society for Nutrition.

  1. Prevention of Vitamin K deficiency bleeding in newborn infants

    DEFF Research Database (Denmark)

    Mihatsch, W. A.; Braegger, C P; Bronsky, J

    2016-01-01

    Vitamin K deficiency bleeding (VKDB) due to physiologically low vitamin K plasma concentrations is a serious risk for newborn and young infants and can be largely prevented by adequate vitamin K supplementation. The aim of this position paper is to define the condition, describe the prevalence......, discuss current prophylaxis practices and outcomes, and to provide recommendations for the prevention of VKDB in healthy term newborns and infants. All newborn infants should receive vitamin K prophylaxis and the date, dose, and mode of administration should be documented. Parental refusal of vitamin K...... prophylaxis after adequate information is provided should be recorded especially because of the risk of late VKDB. Healthy newborn infants should either receive 1 mg of vitamin K 1 by intramuscular injection at birth; or 3×2 mg vitamin K 1 orally at birth, at 4 to 6 days and at 4 to 6 weeks; or 2 mg vitamin K...

  2. Clinicians' perception of the preventability of inpatient mortality.

    Science.gov (United States)

    Nash, Robert; Srinivasan, Ramya; Kenway, Bruno; Quinn, James

    2018-03-12

    Purpose The purpose of this paper is to assess whether clinicians have an accurate perception of the preventability of their patients' mortality. Case note review estimates that approximately 5 percent of inpatient deaths are preventable. Design/methodology/approach The design involved in the study is a prospective audit of inpatient mortality in a single NHS hospital trust. The case study includes 979 inpatient mortalities. A number of outcome measures were recorded, including a Likert scale of the preventability of death- and NCEPOD-based grading of care quality. Findings Clinicians assessed only 1.4 percent of deaths as likely to be preventable. This is significantly lower than previously published values ( p<0.0001). Clinicians were also more likely to rate the quality of care as "good," and less likely to identify areas of substandard clinical or organizational management. Research limitations/implications The implications of objective assessment of the preventability of mortality are essential to drive quality improvement in this area. Practical implications There is a wide disparity between independent case note review and clinicians assessing the care of their own patients. This may be due to a "knowledge gap" between reviewers and treating clinicians, or an "objectivity gap" meaning clinicians may not recognize preventability of death of patients under their care. Social implications This study gives some insight into deficiencies in clinical governance processes. Originality/value No similar study has been performed. This has significant implications for the idea of the preventability of mortality.

  3. Infant mortality and prenatal care: contributions of the clinic in the light of Canguilhem and Foucault.

    Science.gov (United States)

    Figueiredo, Paula Pereira de; Lunardi Filho, Wilson Danilo; Lunardi, Valéria Lerch; Pimpão, Fernanda Demutti

    2012-01-01

    This review study aimed to verify how studies conducted in Brazil have related infant mortality to prenatal care and to present contributions of the clinic in the light of Canguilhem and Foucault for qualification of the care. An integrative literature review was conducted from searches in the databases SciELO, LILACS, MEDLINE and BDENF for the period 2000 to 2009. The relationship between infant mortality and prenatal care is related to the insufficient number of consultations or to the quality of the care provided. Even when the number of and routine consultations in the prenatal care were adequate, avoidable deaths were present. For the qualification of prenatal care, it is suggested that the clinical knowledge and other elements that comprise the process of human living are considered, in order that the clinical view is enlarged and articulated to the technologies available in the health system and, together, they are able to contribute to the reduction of infant mortality in Brazil.

  4. Trends in Overall Mortality, and Timing and Cause of Death among Extremely Preterm Infants near the Limit of Viability

    Science.gov (United States)

    Sung, Sein; Ahn, So Yoon; Park, Won Soon

    2017-01-01

    Objective To investigate the trends in mortality, as well as in the timing and cause of death, among extremely preterm infants at the limit of viability, and thus to identify the clinical factors that contribute to decreased mortality. Methods We retrospectively reviewed the medical records of 382 infants born at 23–26 weeks’ gestation; 124 of the infants were born between 2001 and 2005 (period I) and 258 were born between 2006 and 2011 (period II). We stratified the infants into two subgroups–“23–24 weeks” and “25–26 weeks”–and retrospectively analyzed the clinical characteristics and mortality in each group, as well as the timing and cause of death. Univariate and multivariate logistic regression analyses were done to identify the clinical factors associated with mortality. Results The overall mortality rate in period II was 16.7% (43/258), which was significantly lower than that in period I (30.6%; 38/124). For overall cause of death, there were significantly fewer deaths due to sepsis (2.4% [6/258] vs. 8.1% [10/124], respectively) and air-leak syndrome (0.8% [2/258] vs. 4.8% (6/124), respectively) during period II than during period I. Among the clinical factors of time period, 1-and 5-min Apgar score, antenatal steroid identified significant by univariate analyses. 5-min Apgar score and antenatal steroid use were significantly associated with mortality in multivariate analyses. Conclusion Improved mortality rate attributable to fewer deaths due to sepsis and air leak syndrome in the infants with 23–26 weeks’ gestation was associated with higher 5-minute Apgar score and more antenatal steroid use. PMID:28114330

  5. Level and determinants of infant and under-five mortality in Wad-Medani Town, Sudan

    Directory of Open Access Journals (Sweden)

    Huda M Haroun

    2007-01-01

    Full Text Available Aim: This study aimed to determine the level of infant and under-five mortality rates and to examine the effect of socioeconomic, demographic and environmental factors on the health status of the children under five years. Methods: The data for this study were collected by means of a questionnaire addressed to women in Wad-Medani, Sudan. Three hundred women in the reproductive age (15-49 years were chosen randomly for this study. The data were analyzed statistically using the Statistical Package for Social Sciences (SPSS. Frequency distributions and a statistical test based on Chi-square for independence was conducted. Results: Infant mortality rate was 77 per 100 and child mortality rate was 67 per 100. The results revealed that immunization, child order, child birth weight, birth interval and contraceptive use had a significant influence on the mortality of children under the age of five. The mother′s level of education is highly significant on the mortality of children under five years old. Conclusions: The Ministry of Health should give greater attention to improving immunization services and concentrate on health education campaigns for mothers and for the community.

  6. Oesophageal atresia in premature infants: an analysis of morbidity and mortality over a period of 20 years

    NARCIS (Netherlands)

    Deurloo, J. A.; Smit, B. J.; Ekkelkamp, S.; Aronson, D. C.

    2004-01-01

    Aim: To determine the morbidity and mortality of premature infants born with oesophageal atresia (OA) and to evaluate historical changes in morbidity and mortality over time. Methods: Retrospective analysis of morbidity and mortality of all patients admitted for OA, with or without

  7. The 2007 annual report of the Regional Infant and Child Mortality Review Committee.

    Science.gov (United States)

    Randall, Brad; Wilson, Ann L

    2008-08-01

    The mission of the Regional Infant and Child Mortality Review Committee (RICMRC) is to review infant and child deaths so that information can be transformed into action to protect young lives. The 2007 review area includes South Dakota's Minnehaha, Turner, Lincoln, Moody, Lake, McCook, Union, Hansen, Miner and Brookings counties. Although there were no deaths in 2007 that met the criteria of the Sudden Infant Death Syndrome (SIDS) in our region, there were three infant deaths associated with unsafe sleeping environments (including adult co-sleeping) that either caused or potentially may have caused these infants' deaths. We need to continue to promote the "Back to Sleep" campaign message of not only placing infants to sleep on their backs, but also making sure infants are put down to sleep on safe, firm sleeping surfaces and that they are appropriately dressed for the ambient temperature. Parents need to be aware of the potential hazards of co-sleeping with their infants. Compared to nine such deaths in 2006, only four deaths in 2007 involved motor-vehicle crashes, none of which were alcohol related. Two drowning deaths illustrated the rapidity in which even momentary caregiver distractions can lead to deaths in children in and around water. Since 1997 the Regional Infant and Child Mortality Review Committee (RICMRC) has sought to achieve its mission to "review infant and child deaths so that information can be transformed into action to protect young lives." For 2007, the committee reviewed 25 deaths from Minnehaha, Turner, Lincoln, Moody, Lake, McCook, Union, Hansen, Miner and Brookings counties that met the following criteria: Children under the age of 18 dying subsequent to hospital discharge following delivery. Children who either died in these counties from causes sustained in them, or residents who died elsewhere from causes sustained in the 10-county region. The report that follows reviews the committee's activities for 2007. No deaths meeting the criteria

  8. Cost-effectiveness analysis of infant feeding strategies to prevent ...

    African Journals Online (AJOL)

    Changing feeding practices is beneficial, depending on context. Breastfeeding is dominant (less costly, more effective) in rural settings, whilst formula feeding is a dominant strategy in urban settings. Cost-effectiveness was most sensitive to proportion of women on lifelong antiretroviral therapy (ART) and infant mortality rate ...

  9. Explanations for high levels of infant mortality in Pakistan--a dissenting view.

    Science.gov (United States)

    Zaidi, A

    1989-01-01

    The author critiques a paper by Zeba A. Sathar concerning the relationship between poverty and the infant mortality rate in Pakistan. The focus is on the socioeconomic determinants of fertility decline and policy implications. A reply by Sathar is included (pp. 258-9).

  10. Strategies to reduce infant mortality rate in India.

    Science.gov (United States)

    Ghai, O P

    1985-01-01

    As a systems approach is needed to develop strategies to reduce the infant mortality rate (IMR), it is appropriate to analyze the present situation in India, reasons for low IMR in some Indian states vis-a-vis others, the status in some neighboring countries, and the cost effectiveness of various available technological interventions and their organizational constraints. A 1981 survey revealed 1) a low IMR for the state of Kerala, one which was comparable with Western nations, despite the fact that nearly half of the population in Kerala lived below the poverty line; 2) a very high IMR for the state of Uttar Pradesh, even though the number of people living below the poverty line was not significantly by different from the state of Kerala; and a moderate IMR reduction in the state of Punjab, even though only 15% of the population was below the poverty line. Favorable factors for low IMR appear to be a high female literacy rate, good medical and educational facilities close to the place of residence, and an excellent transportation and communication system. To significantly reduce IMR in a short period of time, it is necessary to adopt certain immediate measures. Nearly 55% of infant deaths occur in the 1st month of life, and these generally are not amenable to general measures and technological interventions. The problem is difficult, but a solution can be found by reaching a broad consensus among professionals and administrators. The major recommendations of a seminar on the Strategies for Reducing infant Mortality in India, held during January 1984, were: provide antenatal care to 100% of pregnant women; work for early registration of pregnancy and identification of high risk pregnancies; immunize 100% of pregnant women with tetanus toxoid; make available intrapartum care for all pregnant women; delineate anticipated job requirements, duties, and functions of village level health workers; make presterilized packaged delivery kits available to all female health

  11. Synbiotics prevent asthma-like symptoms in infants with atopic dermatitis.

    Science.gov (United States)

    van der Aa, L B; van Aalderen, W M C; Heymans, H S A; Henk Sillevis Smitt, J; Nauta, A J; Knippels, L M J; Ben Amor, K; Sprikkelman, A B

    2011-02-01

    Infants with atopic dermatitis (AD) have a high risk of developing asthma. We investigated the effect of early intervention with synbiotics, a combination of probiotics and prebiotics, on the prevalence of asthma-like symptoms in infants with AD.   In a double-blind, placebo-controlled multicentre trial, ninety infants with AD, age cat (ARR -15.2%, 95% CI -27.4% to -2.9%).   These results suggest that this synbiotic mixture prevents asthma-like symptoms in infants with AD. © 2010 John Wiley & Sons A/S.

  12. Independent and combined effects of maternal smoking and solid fuel on infant and child mortality in sub-Saharan Africa.

    Science.gov (United States)

    Akinyemi, Joshua O; Adedini, Sunday A; Wandera, Stephen O; Odimegwu, Clifford O

    2016-12-01

    To estimate the independent and combined risks of infant and child mortality associated with maternal smoking and use of solid fuel in sub-Saharan Africa. Pooled weighted data on 143 602 under-five children in the most recent demographic and health surveys for 15 sub-Saharan African countries were analysed. The synthetic cohort life table technique and Cox proportional hazard models were employed to investigate the effect of maternal smoking and solid cooking fuel on infant (age 0-11 months) and child (age 12-59 months) mortality. Socio-economic and other confounding variables were included as controls. The distribution of the main explanatory variable in households was as follows: smoking + solid fuel - 4.6%; smoking + non-solid fuel - 0.22%; no smoking + solid fuel - 86.9%; and no smoking + non-solid fuel - 8.2%. The highest infant mortality rate was recorded among children exposed to maternal smoking + solid fuel (72 per 1000 live births); the child mortality rate was estimated to be 54 per 1000 for this group. In full multivariate models, the risk of infant death was 71% higher among those exposed to maternal smoking + solid fuel (HR = 1.71, CI: 1.29-2.28). For ages 12 to 59 months, the risk of death was 99% higher (HR = 1.99, CI: 1.28-3.08). Combined exposures to cigarette smoke and solid fuel increase the risks of infant and child mortality. Mothers of under-five children need to be educated about the danger of smoking while innovative approaches are needed to reduce the mortality risks associated with solid cooking fuel. © 2016 John Wiley & Sons Ltd.

  13. Analysis of risk factors for infant mortality in the 1992-3 and 2002-3 birth cohorts in rural Guinea-Bissau.

    Directory of Open Access Journals (Sweden)

    Stine Byberg

    Full Text Available Though still high, the infant mortality rate in Guinea-Bissau has declined. We aimed to identify risk factors including vaccination coverage, for infant mortality in the rural population of Guinea-Bissau and assess whether these risk factors changed from 1992-3 to 2002-3.The Bandim Health Project (BHP continuously surveys children in rural Guinea-Bissau. We investigated the association between maternal and infant factors (especially DTP and measles coverage and infant mortality. Hazard ratios (HR were calculated using Cox regression. We tested for interactions with sex, age groups (defined by current vaccination schedule and cohort to assess whether the risk factors were the same for boys and girls, in different age groups in 1992-3 and in 2002-3.The infant mortality rate declined from 148/1000 person years (PYRS in 1992-3 to 124/1000 PYRS in 2002-3 (HR = 0.88;95%CI:0.77-0.99; this decline was significant for girls (0.77;0.64-0.94 but not for boys (0.97;0.82-1.15 (p = 0.10 for interaction. Risk factors did not differ significantly by cohort in either distribution or effect. Mortality decline was most marked among girls aged 9-11 months (0.56;0.37-0.83. There was no significant mortality decline for girls 1.5-8 months of age (0.93;0.68-1.28 (p = 0.05 for interaction. DTP and measles coverage increased from 1992-3 to 2002-3.Risk factors did not change with the decline in mortality. Due to beneficial non-specific effects for girls, the increased coverage of measles vaccination may have contributed to the disproportional decline in mortality by sex and age group.

  14. Determinants of neonatal mortality in Indonesia

    Directory of Open Access Journals (Sweden)

    Agho Kingsley

    2008-07-01

    Full Text Available Abstract Background Neonatal mortality accounts for almost 40 per cent of under-five child mortality, globally. An understanding of the factors related to neonatal mortality is important to guide the development of focused and evidence-based health interventions to prevent neonatal deaths. This study aimed to identify the determinants of neonatal mortality in Indonesia, for a nationally representative sample of births from 1997 to 2002. Methods The data source for the analysis was the 2002–2003 Indonesia Demographic and Health Survey from which survival information of 15,952 singleton live-born infants born between 1997 and 2002 was examined. Multilevel logistic regression using a hierarchical approach was performed to analyze the factors associated with neonatal deaths, using community, socio-economic status and proximate determinants. Results At the community level, the odds of neonatal death was significantly higher for infants from East Java (OR = 5.01, p = 0.00, and for North, Central and Southeast Sulawesi and Gorontalo combined (OR = 3.17, p = 0.03 compared to the lowest neonatal mortality regions of Bali, South Sulawesi and Jambi provinces. A progressive reduction in the odds was found as the percentage of deliveries assisted by trained delivery attendants in the cluster increased. The odds of neonatal death were higher for infants born to both mother and father who were employed (OR = 1.84, p = 0.00 and for infants born to father who were unemployed (OR = 2.99, p = 0.02. The odds were also higher for higher rank infants with a short birth interval (OR = 2.82, p = 0.00, male infants (OR = 1.49, p = 0.01, smaller than average-sized infants (OR = 2.80, p = 0.00, and infant's whose mother had a history of delivery complications (OR = 1.81, p = 0.00. Infants receiving any postnatal care were significantly protected from neonatal death (OR = 0.63, p = 0.03. Conclusion Public health interventions directed at reducing neonatal death should

  15. The Role of Empowerment in the Association between a Woman's Educational Status and Infant Mortality in Ethiopia: Secondary Analysis of Demographic and Health Surveys.

    Science.gov (United States)

    Alemayehu, Yibeltal Kiflie; Theall, Katherine; Lemma, Wuleta; Hajito, Kifle Woldemichael; Tushune, Kora

    2015-10-01

    Socioeconomic status at national, sub-national, household, and individual levels explains a significant portion of variation in infant mortality. Women's education is among the major determinants of infant mortality. The mechanism through which a woman's own educational status, over her husband's as well as household characteristics, influences infant mortality has not been well studied in developing countries. The objective of this study was to explore the role of woman's empowerment and household wealth in the association between a woman's educational status and infant mortality. The association between a woman's educational status and infant death, and the role of woman's empowerment and household wealth in this relationship, were examined among married women in Ethiopia through a secondary, serial cross-sectional analysis utilizing data on birth history of married women from three rounds of the Ethiopian Demographic and Health Survey. Univariate, bivariate, and multivariate analyses were conducted to examine the association between woman's education and infant death, and the possible mediation or moderation roles of woman empowerment and household wealth. Female education and empowerment were inversely associated with infant death. The results indicated mediation by empowerment in the education-infant death association, and effect modification by household wealth. Both empowerment and education had strongest inverse association with infant death among women from the richest households. The findings suggest an important role of female empowerment in the education-infant death relation, and the complexity of these factors according to household wealth. Woman empowerment programs may prove effective as a shorter term intervention in reducing infant mortality.

  16. Plurality of Birth and Infant Mortality Due to External Causes in the United States, 2000-2010.

    Science.gov (United States)

    Ahrens, Katherine A; Thoma, Marie E; Rossen, Lauren M; Warner, Margaret; Simon, Alan E

    2017-03-01

    Risk of death during the first year of life due to external causes, such as unintentional injury and homicide, may be higher among twins and higher-order multiples than among singletons in the United States. We used national birth cohort linked birth-infant death data (2000-2010) to evaluate the risk of infant mortality due to external causes in multiples versus singletons in the United States. Risk of death from external causes during the study period was 3.6 per 10,000 live births in singletons and 5.1 per 10,000 live births in multiples. Using log-binomial regression, the corresponding unadjusted risk ratio was 1.40 (95% confidence interval (CI): 1.30, 1.50). After adjustment for maternal age, marital status, race/ethnicity, and education, the risk ratio was 1.68 (95% CI: 1.56, 1.81). Infant deaths due to external causes were most likely to occur between 2 and 7 months of age. Applying inverse probability weighting and assuming a hypothetical intervention where no infants were low birth weight, the adjusted controlled direct effect of plurality on infant mortality due to external causes was 1.64 (95% CI: 1.39, 1.97). Twins and higher-order multiples were at greater risk of infant mortality due to external causes, particularly between 2 and 7 months of age, and this risk appeared to be mediated largely by factors other than low-birth-weight status. Published by Oxford University Press on behalf of the Johns Hopkins Bloomberg School of Public Health 2017. This work is written by (a) US Government employee(s) and is in the public domain in the US.

  17. Weight change between successive pregnancies and risks of stillbirth and infant mortality: a nationwide cohort study.

    Science.gov (United States)

    Cnattingius, Sven; Villamor, Eduardo

    2016-02-06

    Maternal overweight and obesity are risk factors for stillbirth and infant mortality. Whether temporal changes in maternal weight affect these risks is not clear. We aimed to assess whether change of BMI between first and second pregnancies affects risks of stillbirth and infant mortality in the second-born offspring. In a Swedish population-based cohort of women who gave birth to their first and second child between Jan 1, 1992, and Dec 31, 2012, we investigated associations between change in maternal body-mass index (BMI) during early pregnancy from first to second pregnancies and risks of stillbirth and neonatal, postneonatal, and infant mortality after the second pregnancy. Relative risks (RRs) for each outcome according to BMI change categories were calculated with binomial regression. Complete information was available for 456,711 (77.7%) of 587,710 women who had their first and second single births in the study period. Compared with women with a stable BMI (change between -1 kg/m(2) and Karolinska Institutet. Copyright © 2016 Elsevier Ltd. All rights reserved.

  18. Cost-Effective Recruitment need for 24x7 Paediatricians in the State General Hospitals in Relation to the Reduction of Infant Mortality.

    Science.gov (United States)

    Chatterjee, Ranjana; Chatterjee, Sukanta

    2016-10-01

    According to World Health Organisation (WHO), improvement of hospital based care can have an impact of upto 30% in reducing Infant Mortality Rate (IMR), whereas, strengthening universal outreach and family-community based care is known to have a greater impact. The study intends to assess how far gaps in the public health facilities contribute towards infant mortality, as 2/3 rd of infant mortality is due to suboptimum care seeking and weak health system. To identify cost-effectiveness of employment of additional paediatric manpower to provide round the clock skilled service to reduce IMR in the present state health facilities at the district general hospitals. A cross-sectional observational study was conducted in a tertiary teaching hospital and district hospitals of 2 districts (Hooghly and Howrah in West Bengal). Factors affecting infant mortality and shift wise analysis of proportion of infant deaths were analysed in both tertiary and district level hospitals. Information was gathered in a predesigned proforma for one year period by verifying hospital records and by personal interview with service personnel in the health establishment. SPSS software version 17 (Chicago, IL) was used. The p-value was calculated by Fischer exact t-test. Available hospital beds per 1000 population were 1.1. Percentage of paediatric beds available in comparison to total hospital bed was disproportionately lower (10%). Dearth of skilled medical care provider at odd hours in district hospitals resulted in significantly greater infant death (p based infant mortality and it is cost-effective.

  19. Mortality risk in preterm and small-for-gestational-age infants in low-income and middle-income countries: a pooled country analysis

    NARCIS (Netherlands)

    Katz, Joanne; Lee, Anne C. C.; Kozuki, Naoko; Lawn, Joy E.; Cousens, Simon; Blencowe, Hannah; Ezzati, Majid; Bhutta, Zulfiqar A.; Marchant, Tanya; Willey, Barbara A.; Adair, Linda; Barros, Fernando; Baqui, Abdullah H.; Christian, Parul; Fawzi, Wafaie; Gonzalez, Rogelio; Humphrey, Jean; Huybregts, Lieven; Kolsteren, Patrick; Mongkolchati, Aroonsri; Mullany, Luke C.; Ndyomugyenyi, Richard; Nien, Jyh Kae; Osrin, David; Roberfroid, Dominique; Sania, Ayesha; Schmiegelow, Christentze; Silveira, Mariangela F.; Tielsch, James; Vaidya, Anjana; Velaphi, Sithembiso C.; Victora, Cesar G.; Watson-Jones, Deborah; Black, Robert E.; Clarke, Siân; Kariuki, Simon; Lusingu, John; Ndirangu, James; Newell, Marie-Louise; Ntozini, Robert; Rosen, Heather; ter Kuile, Feiko O.

    2013-01-01

    Babies with low birthweight ( <2500 g) are at increased risk of early mortality. However, low birthweight includes babies born preterm and with fetal growth restriction, and not all these infants have a birthweight less than 2500 g. We estimated the neonatal and infant mortality associated with

  20. WAYS TO DECREASE INFANT MORTALITY IN A LARGE AGRO INDUSTRIAL REGION IN RUSSIAN NORTH WEST BASED ON A PROGRAMMED GOAL ORIENTED APPROACH (MATERIALS FROM VOLOGDA REGION

    Directory of Open Access Journals (Sweden)

    V.I. Orel

    2007-01-01

    Full Text Available The authors analyze infant mortality situation in a large agroindustrial region to the north west of Russia. Basing on a programmed goal oriented approach and the example of Vologda region, the authors suggest ways to reduce the sickness rate, perinatal, early neonatal and infant mortality, as well as the methods to improve medical aid to early children.Key words: infant mortality, maternity and infant health protection, sickness rate, organization of health services.

  1. Differences Between Rural and Urban Areas in Mortality Rates for the Leading Causes of Infant Death: United States, 2013-2015.

    Science.gov (United States)

    Ely, Danielle M; Hoyert, Donna L

    2018-02-01

    The leading causes of infant death vary by age at death but were consistent from 2005 to 2015 (1-6). Previous research shows higher infant mortality rates in rural counties compared with urban counties and differences in cause of death for individuals aged 1 year and over by urbanization level (4,5,7,8). No research, however, has examined if mortality rates from the leading causes of infant death differ by urbanization level. This report describes the mortality rates for the five leading causes of infant, neonatal, and postneonatal death in the United States across rural, small and medium urban, and large urban counties defined by maternal residence, as reported on the birth certificate for combined years 2013-2015. All material appearing in this report is in the public domain and may be reproduced or copied without permission; citation as to source, however, is appreciated.

  2. Female infant in Egypt: mortality and child care.

    Science.gov (United States)

    Ahmed, W; Beheiri, F; El-drini, H; Manala-od; Bulbul, A

    1981-01-01

    lesser attention to health problems of female infants, the finding is not conclusively tested. Further research is recommended using more objective methods of studying parental behaviour in child sickness. With respect to psychological attitudes, the authors argue that "girl neglect" on the part of mothers is a reflex to the "boy preferance" displayed by fathrs. "Boy preferance" contributes to infant mortality and to increased fertility and should therefore be a common concern to both health and population planners. Finally, the authors argue for a change in attitude towards daughters which would promote sex equality in child care. A diversified and wide-reaching communication program for altering attitudes and behaviour could be based on relevant sayings from the Sunnah, a major source of Islamic ethics.

  3. Morbidity and mortality of low birth weight infants in the New Born ...

    African Journals Online (AJOL)

    Background: Morbidity and mortality of low birth weight (LBW) infants at Kenyatta National Hospital (KNH) has previously been found to be high. Other centres have shown that even with lack of neonatal intensive care facilities, selective interventions can be implemented that improve neonatal survival rates. It is important to ...

  4. Prophylactic Probiotics for Preterm Infants

    DEFF Research Database (Denmark)

    Olsen, Rie; Greisen, Gorm; Schrøder, Morten

    2016-01-01

    BACKGROUND: Necrotizing enterocolitis (NEC) is a major morbidity and cause of mortality in preterm neonates. Probiotics seem to have a beneficial role in preventing NEC, which is confirmed in meta-analyses of randomized controlled trials (RCTs). We therefore aimed to review and confirm the efficacy...... of probiotics in preterm neonates obtained in observational studies. OBJECTIVE: To assess the effects of prophylactic probiotics in preterm infants. METHODS: A meta-analysis was performed searching PubMed, EMBASE, CENTRAL (the Cochrane Library) and www.clinicaltrials.gov. Reference lists of reviews of RCTs were...... also searched. Included studies were observational studies that enrolled preterm infants probiotics and measured at least one clinical outcome (e.g. NEC, all-cause mortality, sepsis or long-term development scores). Two authors...

  5. [Estimation of infant and child mortality in the eastern provinces of Cuba].

    Science.gov (United States)

    Gonzalez, G; Herrera, L

    1986-01-01

    An estimate of infant and child mortality in the eastern provinces of Cuba is presented using the Brass method as adapted by Trussell. "Estimations by urban and rural zones are also performed within the provinces studied, and results are compared with those possible to obtain by continuous statistics. Results obtained show that in the eastern [part] of the country Holguin and Guantanamo are the provinces with highest infantile mortality rates, and the lowest rates correspond to Granma, followed by Santiago de Cuba." (SUMMARY IN ENG AND FRE) excerpt

  6. Does Family Planning Reduce Infant Mortality? Evidence from Surveillance Data in Matlab, Bangladesh

    NARCIS (Netherlands)

    van Soest, A.H.O.; Saha, U.R.

    2012-01-01

    Abstract: Analyzing the effect of family planning on child survival remains an important issue but is not straightforward because of several mechanisms linking family planning, birth intervals, total fertility, and child survival. This study uses a dynamic model jointly explaining infant mortality,

  7. Prevention and Management of Cow's Milk Allergy in Non-Exclusively Breastfed Infants.

    Science.gov (United States)

    Vandenplas, Yvan

    2017-07-10

    Introduction: The prevention and management of cow milk allergy (CMA) is still debated. Since CMA is much less frequent in breastfed infants, breastfeeding should be stimulated. Method: Literature was searched using databases to find original papers and reviews on this topic. Results: Hydrolysates with a clinical proof of efficacy are recommended in the prevention and treatment of CMA. However, not all meta-analyses conclude that hydrolysates do prevent CMA or other atopic manifestations such as atopic dermatitis. There are pros and cons to consider partially hydrolysed protein as an option for starter infant formula for each non-exclusively breastfed infant. A challenge test is still recommended as the most specific and sensitive diagnostic test, although a positive challenge test does not proof that the immune system is involved. The Cow Milk Symptom Score (CoMiSS™) is an awareness tool that enables healthcare professionals to better recognize symptoms related to the ingestion of cow milk, but it still needs validation as diagnostic tool. The current recommended elimination diet is a cow milk based extensive hydrolysate, although rice hydrolysates or soy infant formula can be considered in some cases. About 10 to 15% of infants allergic to cow milk will also react to soy. Mainly because of the higher cost, amino acid based formula is reserved for severe cases. There is no place for infant formula with intact protein from other animals as cross-over allergenicity is high. During recent years, attention focused also on the bifidogenic effect of prebiotics and more recently also on human milk oligosaccharides. A bifidogenic gastrointestinal microbiome may decrease the risk to develop allergic disease. The addition of probiotics and prebiotics to the elimination diet in treatment may enhance the development of tolerance development. Conclusion: Breastfeeding is the best way to feed infants. Cow milk based extensive hydrolysates remain the first option for the

  8. Comment on "Compromised birth outcomes and infant mortality among racial and ethnic groups"

    NARCIS (Netherlands)

    Van der Veen, WJ

    Frisbie, Forbes, and Pullum (1996) show that it is meaningful to account for low birth weight, preterm delivery, and intrauterine growth-retardation when analyzing differences in compromised birth outcomes and infant mortality among racial and ethnic groups. I compare their findings for the 1987

  9. Maternal vaccination to prevent pertussis in infants

    African Journals Online (AJOL)

    2016-09-09

    Sep 9, 2016 ... that maternal immunisation with the Tdap (tetanus, diphtheria and acellular pertussis) vaccine is safe. Indeed, maternal vaccination is now recommended to prevent pertussis infection in vulnerable young infants. In the USA and UK, the immunisation of pregnant women with a Tdap or dTaP/IPV (diphtheria, ...

  10. Juvenile marriages, child-brides and infant mortality among Serbian gypsies

    Directory of Open Access Journals (Sweden)

    Čvorović Jelena

    2011-01-01

    Full Text Available Gypsies/Roma make up the largest minority in Europe. Roma communities tend to be segregated and characterized by poverty, unemployment, poor education, and poor quality housing. So far, the European strategy for Gypsy/Roma integration proved insufficient because it fails to account to the normative nature of the isolationist and ethnocentric nature of certain elements of Gypsy culture, as well as the deep and mutual distrust between Gypsies and non-Gypsies within European countries. In Serbia, the Gypsy population tends to suffer disproportionately from higher rates of poverty, unemployment, illiteracy, and disease. At the same time, the Serbian Gypsy women average an infant mortality rate between 10-20%. For most of these girls/women, endogamous, arranged marriages are negotiated at an early age, usually without their consent. Among these women, a certain level of infant mortality is “expected”, following an underinvestment in some children manifested in their care, feeding, and the response to their illnesses. These juvenile arranged marriages, subsequent reproduction and child mortality are culturally self-sufficient and hence pose a challenge for international human rights: while many Gypsy girls/women are being denied the right to choose whom and when to marry, the Gypsy community itself openly accepts juvenile arranged marriage as a preservation strategy and means of cultural, economic, and societal maintenance and independence. Although efforts to improve education, health, living conditions, encourage employment and development opportunities for Gypsies/Roma are essential, these objectives cannot be attained without directing the changes needed within Gypsy/Roma culture itself. The initial point for change must come from an increased sense of responsibility among the Gypsies themselves.

  11. Analysis of risk factors for infant mortality in the 1992-3 and 2002-3 birth cohorts in rural Guinea-Bissau

    DEFF Research Database (Denmark)

    Byberg, Stine; Østergaard, Marie Louise Drivsholm; Rodrigues, Amabelia

    2017-01-01

    INTRODUCTION: Though still high, the infant mortality rate in Guinea-Bissau has declined. We aimed to identify risk factors including vaccination coverage, for infant mortality in the rural population of Guinea-Bissau and assess whether these risk factors changed from 1992-3 to 2002-3. METHODS......, age groups (defined by current vaccination schedule) and cohort to assess whether the risk factors were the same for boys and girls, in different age groups in 1992-3 and in 2002-3. RESULTS: The infant mortality rate declined from 148/1000 person years (PYRS) in 1992-3 to 124/1000 PYRS in 2002-3 (HR...... = 0.88;95%CI:0.77-0.99); this decline was significant for girls (0.77;0.64-0.94) but not for boys (0.97;0.82-1.15) (p = 0.10 for interaction). Risk factors did not differ significantly by cohort in either distribution or effect. Mortality decline was most marked among girls aged 9-11 months (0...

  12. Effect of 50,000 IU vitamin A given with BCG vaccine on mortality in infants in Guinea-Bissau: randomised placebo controlled trial.

    Science.gov (United States)

    Benn, Christine Stabell; Diness, Birgitte Rode; Roth, Adam; Nante, Ernesto; Fisker, Ane Baerent; Lisse, Ida Maria; Yazdanbakhsh, Maria; Whittle, Hilton; Rodrigues, Amabelia; Aaby, Peter

    2008-06-21

    To investigate the effect of high dose vitamin A supplementation given with BCG vaccine at birth in an African setting with high infant mortality. Randomised placebo controlled trial. Setting Bandim Health Project's demographic surveillance system in Guinea-Bissau, covering approximately 90,000 inhabitants. Participants 4345 infants due to receive BCG. Infants were randomised to 50,000 IU vitamin A or placebo and followed until age 12 months. Mortality rate ratios. 174 children died during follow-up (mortality=47/1000 person-years). Vitamin A supplementation was not significantly associated with mortality; the mortality rate ratio was 1.07 (95% confidence interval 0.79 to 1.44). The effect was 1.00 (0.65 to 1.56) during the first four months and 1.13 (0.75 to 1.68) from 4 to 12 months of age. The mortality rate ratio in boys was 0.84 (0.55 to 1.27) compared with 1.39 (0.90 to 2.14) in girls (P for interaction=0.10). An explorative analysis revealed a strong interaction between vitamin A and season of administration. Vitamin A supplementation given with BCG vaccine at birth had no significant benefit in this African setting. Although little doubt exists that vitamin A supplementation reduces mortality in older children, a global recommendation of supplementation for all newborn infants may not contribute to better survival. Clinical trials NCT00168597.

  13. Morbidity and Mortality in Preterm Infants following Antacid Use: A Retrospective Audit

    Directory of Open Access Journals (Sweden)

    Natasha Singh

    2016-01-01

    Full Text Available Background and Objectives. Antacids are often prescribed to preterm infants due to misdiagnosis of gastro-oesophageal reflux. This suppresses gastric acidity, a major defence mechanism against infection. This study aims to determine if ranitidine and omeprazole use in very low birth weight (VLBW neonates, <1500 grams, is associated with increased risk of late onset sepsis, necrotising enterocolitis (NEC, and mortality. Methods. Retrospective analysis was conducted on neonates, <1500 grams, born and admitted into the Neonatal Intensive Care Unit at The Canberra Hospital during the period from January 2008 to December 2012. Information regarding late onset sepsis, NEC, mortality, ranitidine/omeprazole use, and other neonatal/hospital factors was collected for each neonate. Results. 360 neonates were evaluated, 64 received ranitidine and/or omeprazole, and 296 had not. There were no statistically significant differences in incidence of late onset sepsis (OR = 0.52, CI = 0.24–1.1, and p = 0.117, NEC Stage 2 and above (OR = 0.4, CI = 0.05–3.2, and p = 0.7, or mortality (OR = 0.35, CI = 0.08–1.5, and p = 0.19 between the two groups. After adjusting significant differences in neonatal and hospital factors, risk of late onset sepsis was significantly lower in those that received ranitidine/omeprazole (OR = 0.28, CI = 0.13–0.65, and p = 0.003. Conclusions. Ranitidine and omeprazole use in VLBW preterm infants may not be associated with an increased risk of infection, NEC, and mortality.

  14. The neighbourhood method for measuring differences in maternal mortality, infant mortality and other rare demographic events.

    Directory of Open Access Journals (Sweden)

    Nurul Alam

    Full Text Available In the absence of reliable systems for registering rare types of vital events large surveys are required to measure changes in their rates. However some events such as maternal deaths are widely known about in the community. This study examined the utility of asking respondents about events in their neighbourhood as an efficient method for measuring relative rates of rare health events such as maternal and infant deaths. A survey was conducted in the health and demographic surveillance system (HDSS in Matlab, Bangladesh, which includes two areas with different health care regimes. Adult women were asked about any maternal deaths; multiple births; infant deaths, live births and some other events they knew of in a small specified area around their home. Agreement between HDSS records and survey responses was moderate or better (kappa≥0.44 for all the events and greatest for maternal deaths (kappa = 0.77 with 84% being reported. Most events were more likely to be reported if they were recent (p<0.05. Infant mortality rate in one area was 0.56 times that in the other which was well reflected by the ratio of survey results (0.53. Simulations were used to study the ability of the method to detect differences in maternal mortality ratio. These suggested that a sample size around 5000 would give 80% power to detect a 50% decrease from a baseline of 183 which compared well with an estimated sample size around 10 times larger using the direct sisterhood method. The findings suggest that the Neighbourhood Method has potential for monitoring relative differences between areas or changes over time in the rates of rare demographic events, requiring considerably smaller sample sizes than traditional methods. This raises the possibility for interventions to demonstrate real effects on outcomes such as maternal deaths where previously this was only feasible by indirect methods.

  15. [Socioeconomic inequalities and infant mortality in Bolivia].

    Science.gov (United States)

    Maydana, Edgar; Serral, Gemma; Borrell, Carme

    2009-05-01

    To evaluate socioeconomic inequalities and its relation to infant mortality in Bolivia's municipalities in 2001. An ecological study based on data from the 2001 National Census on Population and Housing (Censo Nacional de Población y Vivienda) covering the 327 municipalities in Bolivia's nine departments. The dependent variable was the infant mortality rate (IMR); the independent variables were indirect socioeconomic indicators (the percentage of illiterates older than 15 years of age, and the building materials and sanitation features of the houses). The geographic distribution of each indicator was determined and the associations between IMR and each socioeconomic indicator were calculate using Spearman's rank correlation coefficient and adjusted with Poisson regression models. The resulting IMR for Bolivia in 2001 was 67 per 1000 live births. Rates ranged from <0.1 per 1000 live births in the Magdalena municipality, Beni department, to 170.0 per 1000 live births in the Caripuyo municipality, Potosí department. The mean rate of illiteracy per municipality was 17.5%; the mean percentage of houses without running water was 90.4%, and for those lacking sanitation services, 67.6%. The IMR was inversely associated with all of the socioeconomic indicators studied. The highest relative risk was found in housing without sanitation services. Multifactorial models adjusted for illiteracy showed that the following indicators were still strongly associated with the IMR: no sanitation services (Relative risk (RR)=1.54; 95% Confidence Interval (95%CI)=1.38-1.66); adobe, stone, or mud walls (RR=1.54; 95%CI: 1.43-1.67); and, corrugated metal, straw, or palm branch roof (RR=1.34; 95%CI: 1.26-1.43). A significant association was found between poor socioeconomic status and high IMR in Bolivia's municipalities in 2001. The municipalities in the country's central and southeastern areas had lower socioeconomic status and higher IMR. The lack of education, absence of basic sanitation

  16. The recent fall in postperinatal mortality in New Zealand and the Safe Sleep programme.

    Science.gov (United States)

    Mitchell, Edwin A; Cowan, Stephanie; Tipene-Leach, David

    2016-11-01

    Postneonatal mortality rates changed very little from 2000 until recently. There has been a decrease in mortality in New Zealand from 2009 to 2015. This study describes an infant Safe Sleep programme and postulates it is the cause for the recent decrease in deaths. The Safe Sleep programme involved as follows: a focus on preventing accidental suffocation, a 'blitz' approach to SUDI education, the targeted provision of portable infant Safe Sleep devices (ISSD) and the development of Safe Sleep policy across all district health boards (DHBs). Participation in the education 'blitz' by health professionals exceeded one in 23 live births, distribution of Safe Sleep leaflets exceeded two for every live birth, and over 16 500 ISSDs have been distributed to vulnerable infants. Postperinatal mortality fell 29% from 2009 to 2015 (2.8 to 2.0/1000 live births). The fall has been greatest for Māori and in regions with the most intensive programmes. The recent fall in postperinatal mortality has not happened by chance. It is likely that the components of end-stage prevention strategy, a focus on preventing accidental suffocation, the education 'blitz', the targeted supply of ISSDs and strengthened health policy, have all contributed to varying degrees. ©2016 Foundation Acta Paediatrica. Published by John Wiley & Sons Ltd.

  17. Alcohol-attributable and alcohol-preventable mortality in Denmark

    DEFF Research Database (Denmark)

    Eliasen, Marie; Becker, Ulrik; Grønbæk, Morten

    2014-01-01

    The aim of the study was to quantify alcohol-attributable and -preventable mortality, totally and stratified on alcohol consumption in Denmark 2010, and to estimate alcohol-related mortality assuming different scenarios of changes in alcohol distribution in the population. We estimated alcohol......-attributable and -preventable fractions based on relative risks of conditions causally associated with alcohol from meta-analyses and information on alcohol consumption in Denmark obtained from 14,458 participants in the Danish National Health Survey 2010 and corrected for adult per capita consumption. Cause-specific mortality...... data were obtained from the Danish Register of Causes of Death. In total, 1,373 deaths among women (5.0 % of all deaths) and 2,522 deaths among men (9.5 % of all deaths) were attributable to alcohol, while an estimated number of 765 (2.8 %) and 583 (2.2 %) deaths were prevented by alcohol...

  18. Use of new World Health Organization child growth standards to assess how infant malnutrition relates to breastfeeding and mortality.

    Science.gov (United States)

    Vesel, Linda; Bahl, Rajiv; Martines, Jose; Penny, Mary; Bhandari, Nita; Kirkwood, Betty R

    2010-01-01

    To compare the estimated prevalence of malnutrition using the World Health Organization's (WHO) child growth standards versus the National Center for Health Statistics' (NCHS) growth reference, to examine the relationship between exclusive breastfeeding and malnutrition, and to determine the sensitivity and specificity of nutritional status indicators for predicting death during infancy. A secondary analysis of data on 9424 mother-infant pairs in Ghana, India and Peru was conducted. Mothers and infants were enrolled in a trial of vitamin A supplementation during which the infants' weight, length and feeding practices were assessed regularly. Malnutrition indicators were determined using WHO and NCHS growth standards. The prevalence of stunting, wasting and underweight in infants aged mortality in India. No indicator was a good predictor in Ghana or Peru. In infants aged 6-12 months, underweight at 6 months had the highest sensitivity and specificity for predicting mortality in Ghana (37.0% and 82.2%, respectively) and Peru (33.3% and 97.9% respectively), while wasting was the best predictor in India (sensitivity: 54.6%; specificity: 85.5%). Malnutrition indicators determined using WHO standards were better predictors of mortality than those determined using NCHS standards. No association was found between breastfeeding duration and malnutrition at 6 months. Use of WHO child growth standards highlighted the importance of malnutrition in the first 6 months of life.

  19. What explains the Rural-Urban Gap in Infant Mortality — Household or Community Characteristics?

    NARCIS (Netherlands)

    E. Van de Poel (Ellen); O.A. O'Donnell (Owen); E.K.A. van Doorslaer (Eddy)

    2007-01-01

    textabstractThe rural-urban gap in infant mortality rates is explained using a new decomposition method that permits identification of the ontribution of unobserved heterogeneity at the household and the community level. Using Demographic and Health Survey data for six Francophone countries in

  20. Mothers' and Clinicians' Priorities for Obesity Prevention Among Black, High-Risk Infants.

    Science.gov (United States)

    Virudachalam, Senbagam; Gruver, Rachel S; Gerdes, Marsha; Power, Thomas J; Magge, Sheela N; Shults, Justine; Faerber, Jennifer A; Kalra, Gurpreet K; Bishop-Gilyard, Chanelle T; Suh, Andrew W; Berkowitz, Robert I; Fiks, Alexander G

    2016-07-01

    Despite many recommended strategies for obesity prevention during infancy, effectively delivering recommendations to parents in clinical settings is challenging, especially among high-risk populations. This study describes and compares mothers' and clinicians' priorities for obesity prevention during infancy, to facilitate more-effective obesity prevention messaging. A discrete choice experiment using maximum difference scaling was administered in 2013 and analyzed in 2013-2014. Twenty-nine low-income, obese mothers of infants and 30 pediatric clinicians from three urban primary care practices rated the relative importance of 16 items relevant to obesity prevention during infancy, in response to this question: Which topic would be most helpful [for new mothers] to learn about to prevent your [their] child from becoming overweight? Response options encompassed the domains of feeding, sleep, parenting (including physical activity and screen time), and maternal self-care. Mothers (all Medicaid-enrolled and black; mean age, 27 years; mean BMI, 35 kg/m(2)) and clinicians (97% female, 87% pediatricians, 13% nurse practitioners) both highly prioritized recognizing infant satiety and hunger cues, and appropriate feeding volume. Mothers rated infant physical activity and maintaining regular routines as 3.5 times more important than clinicians did (presponsive to these priorities. Copyright © 2016 American Journal of Preventive Medicine. Published by Elsevier Inc. All rights reserved.

  1. Declínio e desigualdades sociais na mortalidade infantil por diarréia Decline and social inequalities of infant mortality from diarrhea

    Directory of Open Access Journals (Sweden)

    Zuleica Antunes Guimarães

    2001-10-01

    Full Text Available Este estudo ecológico, temporal e espacial descreve a evolução da mortalidade infantil por doenças infecciosas intestinais (DII em Salvador, Bahia, no período de 1977 a 1998 e a distribuição dessa mortalidade segundo condições de vida, em 1991. As Zonas de Informação (ZI, da cidade, foram agrupadas segundo um índice de condições de vida (ICV, em quartis. Foram calculados os seguintes indicadores: Mortalidade Infantil Proporcional (MIP, Coeficiente de Mortalidade Infantil (CMI e Razão de Mortalidade pela referida causa. A análise dos dados foi feita através do cálculo de médias móveis e do teste de qui-quadrado de tendência. Entre 1977 e 1998 o CMI/DII reduziu-se em 91,9%. A razão entre o CMI/DII do estrato de condições de vida "elevadas" para aquele onde as mesmas eram "muito baixas" foi de 1,9 e a MIP foi mais elevada onde eram piores as condições de vida o que requer reorientação das políticas de controle do problema na direção do enfrentamento das causas.This ecological study describes the temporal trend from 1977 to 1998, and spatial patterns of infant mortality from diarrhea in the city of Salvador, Bahia State, Brazil. The annual proportional of infant mortality and specific-cause mortality rate were estimated. Spatial units of geographical zones within the city's urban area were utilized for administrative purposes, which were aggregated according to quartile of living conditions indicators. Over the study period, the diarrhea-induced infant mortality rate decreased 91.9%. The mortality risk from diarrhea in the lowest living condition strata was 90% greater than in the highest conditions. Also, infant mortality due to diarrhea increases proportionally as living conditions worsen, which necessitates a review of the control policies concerning this important public health problem. Although the infant mortality rate declined during the study period, social inequalities related to infant mortality due to

  2. Pattern of injury mortality by age-group in children aged 0–14 years in Scotland, 2002–2006, and its implications for prevention

    Directory of Open Access Journals (Sweden)

    Stone David H

    2009-04-01

    Full Text Available Abstract Background Knowledge of the epidemiology of injuries in children is essential for the planning, implementation and evaluation of preventive measures but recent epidemiological information on injuries in children both in general and by age-group in Scotland is scarce. This study examines the recent pattern of childhood mortality from injury by age-group in Scotland and considers its implications for prevention. Methods Routine mortality data for the period 2002–2006 were obtained from the General Register Office for Scotland and were analysed in terms of number of deaths, mean annual mortality rates per 100,000 population, leading causes of death, and causes of injury death. Mid-year population estimates were used as the denominator. Chi-square tests were used to determine statistical significance. Results 186 children aged 0–14 died from an injury in Scotland during 2002–06 (MR 4.3 per 100,000. Injuries were the leading cause of death in 1–14, 5–9 and 10–14 year-olds (causing 25%, 29% and 32% of all deaths respectively. The leading individual causes of injury death (0–14 years were pedestrian and non-pedestrian road-traffic injuries and assault/homicide but there was variation by age-group. Assault/homicide, fire and suffocation caused most injury deaths in young children; road-traffic injuries in older ones. Collectively, intentional injuries were a bigger threat to the lives of under-15s than any single cause of unintentional injury. The mortality rate from assault/homicide was highest in infants ( Conclusion Injuries continue to be a leading cause of death in childhood in Scotland. Variation in causes of injury death by age-group is important when targeting preventive efforts. In particular, the threats of assault/homicide in infants, fire in 1–4 year-olds, pedestrian injury in 5–14 year-olds, and suicide in 10–14 year-olds need urgent consideration for preventive action.

  3. Determinants of infant mortality in the Jequitinhonha Valley and in the North and Northeast regions of Brazil

    Directory of Open Access Journals (Sweden)

    Maria do Carmo Leal

    Full Text Available ABSTRACT OBJECTIVE This study aims to identify the social and demographic determinants, in addition to the determinants of reproductive health and use of health services, associated with infant mortality in small and medium-sized cities of the North, Northeast and Southeast regions of Brazil. METHODS This is a case-control study with 803 cases of death of children under one year and 1,969 live births (controls, whose mothers lived in the selected cities in 2008. The lists of the names of cases and controls were extracted from the Sistema de Informação sobre Mortalidade (SIM – Mortality Information System and the Sistema de Informação sobre Nascidos Vivos (SINASC – Live Birth Information System and supplemented by data obtained by the research of “active search of death and birth”. Data was collected in the household using a semi-structured questionnaire, and the analysis was carried out using multiple logistic regression. RESULTS The final model indicates that the following items are positively and significantly associated with infant mortality: family working in agriculture, mother having a history of fetal and infant losses, no prenatal or inadequate prenatal, and not being associated to the maternity hospital during the prenatal period. We have observed significant interactions to explain the occurrence of infant mortality between race and socioeconomic score and between high-risk pregnancy and pilgrimage for childbirth. CONCLUSIONS The excessive number of home deliveries and pilgrimage for childbirth indicates flaws in the line of maternity care and a lack of collaboration between the levels of outpatient and hospital care. The study reinforces the need for an integrated management of the health care networks, leveraging the capabilities of cities in meeting the needs of pregnancy, delivery and birth with quality.

  4. Determinants of infant and early childhood mortality levels and their decline in the Netherlands in the late nineteenth century

    NARCIS (Netherlands)

    J.H. Wolleswinkel-van den Bosch (Judith); F.W.A. van Poppel (Frans); C.W.N. Looman (Caspar); J.P. Mackenbach (Johan)

    2000-01-01

    textabstractOBJECTIVE: To study the relative importance of various determinants of total and cause-specific infant and early childhood mortality rates and their decline in The Netherlands in the period 1875-1879 to 1895-1899. DATA AND METHODS: Mortality and population

  5. The Effect of an Increased Minimum Wage on Infant Mortality and Birth Weight.

    Science.gov (United States)

    Komro, Kelli A; Livingston, Melvin D; Markowitz, Sara; Wagenaar, Alexander C

    2016-08-01

    To investigate the effects of state minimum wage laws on low birth weight and infant mortality in the United States. We estimated the effects of state-level minimum wage laws using a difference-in-differences approach on rates of low birth weight (minimum wage above the federal level was associated with a 1% to 2% decrease in low birth weight births and a 4% decrease in postneonatal mortality. If all states in 2014 had increased their minimum wages by 1 dollar, there would likely have been 2790 fewer low birth weight births and 518 fewer postneonatal deaths for the year.

  6. Infant mortality among offspring of individuals living in the radioactively contaminated Techa River Area, Southern Urals

    International Nuclear Information System (INIS)

    Ostroumova, E.; Akleyev, A.; Hall, P.

    2005-01-01

    Massive discharge of liquid radioactive wastes into the Techa River in 1949-1956 by the industrial complex Mayak for production of plutonium for weapon resulted in protracted internal and external radiation exposure of the population living along the river. The Techa River Offspring Cohort comprises individuals born after December 31, 1949, whose one or both parents were exposed in the Techa riverside villages. The study group includes 7,897 individuals. About 40% of the Techa River Offspring Cohort members born in 1950-1956 could be exposed in utero and after birth. The mean dose estimates based on the Techa River Dosimetry System 2000 were: 0.07 Gy for parental gonads, 0.01 Gy for fetus and 0.02 Gy for postnatal exposure of bone marrow. Over 46 years of follow-up from 1950-1995, 916 subjects died and the cause of death was known in 93% of them. Out of 916 subjects dead, 456 (53%) died under 1 year of age, mainly due to respiratory tract diseases (38% of all infant deaths), infections (27%) and perinatal disorders (13%). It has been shown that the baseline infant mortality rate depends on gender, ethnicity and birth year. Radiation risk analysis was based on a simple parametric linear excess relative risk model with adjustment for gender, ethnicity and birth year. There was no evidence of increasing infant mortality risk with parental gonadal dose. The infant mortality rate significantly depended on fetal dose and dose to bone marrow received during the first year of life with a 3% increase in risk per 1 cGy of intrauterine and postnatal doses. (author)

  7. Association of urban slum residency with infant mortality and child stunting in low and middle income countries.

    Science.gov (United States)

    Kyu, Hmwe Hmwe; Shannon, Harry S; Georgiades, Katholiki; Boyle, Michael H

    2013-01-01

    This study aimed to (i) examine the contextual influences of urban slum residency on infant mortality and child stunting over and above individual and household characteristics and (ii) identify factors that might modify any adverse effects. We obtained data from Demographic and Health Surveys conducted in 45 countries between 2000 and 2009. The respondents were women (15-49 years) and their children (0-59 months). Results showed that living in a slum neighborhood was associated with infant mortality (OR = 1.34, 95% CI = 1.15-1.57) irrespective of individual and household characteristics and this risk was attenuated among children born to women who had received antenatal care from a health professional (OR = 0.79, 95% CI = 0.63-0.99). Results also indicated that increasing child age exacerbated the risk for stunting associated with slum residency (OR = 1.19, 95% CI = 1.16-1.23). The findings suggest that improving material circumstances in urban slums at the neighborhood level as well as increasing antenatal care coverage among women living in these neighborhoods could help reduce infant mortality and stunted child growth. The cumulative impact of long-term exposure to slum neighborhoods on child stunting should be corroborated by future studies.

  8. High mortality in HIV-infected children diagnosed in hospital underscores need for faster diagnostic turnaround time in prevention of mother-to-child transmission of HIV (PMTCT) programs.

    Science.gov (United States)

    Wagner, Anjuli; Slyker, Jennifer; Langat, Agnes; Inwani, Irene; Adhiambo, Judith; Benki-Nugent, Sarah; Tapia, Ken; Njuguna, Irene; Wamalwa, Dalton; John-Stewart, Grace

    2015-02-15

    Despite expanded programs for prevention of mother-to-child HIV transmission (PMTCT), HIV-infected infants may not be diagnosed until they are ill. Comparing HIV prevalence and outcomes in infants diagnosed in PMTCT programs to those in hospital settings may improve pediatric HIV diagnosis strategies. HIV-exposed infants turnaround time for tests were compared between PMTCT programs and hospital sites. Among the enrolled cohort, baseline characteristics, survival, and timing of antiretroviral therapy (ART) initiation were compared between infants diagnosed in PMTCT programs versus hospital. Among 1,923 HIV-exposed infants, HIV prevalence was higher among infants tested in hospital than PMTCT early infant diagnosis (EID) sites (41% vs. 11%, p 3 times as likely to die (HR = 3.1, 95% CI = 1.3-7.6). Among HIV-exposed infants, hospital-based testing was more likely to detect an HIV-infected infant than PMTCT testing. Because young symptomatic infants diagnosed with HIV during hospitalization have very high mortality, every effort should be made to diagnose HIV infections before symptom onset. Systems to expedite turnaround time at PMTCT EID sites and to routinize inpatient pediatric HIV testing are necessary to improve pediatric HIV outcomes.

  9. What has driven the decline of infant mortality in Kenya in the 2000s?

    Science.gov (United States)

    Demombynes, Gabriel; Trommlerová, Sofia Karina

    2016-05-01

    Substantial declines in early childhood mortality have taken place in many countries in Sub-Saharan Africa. Kenya's infant mortality rate fell by 7.6 percent per year between 2003 and 2008, the fastest rate of decline among the 20 countries in the region for which recent Demographic and Health Survey (DHS) data are available. The average rate of decline across all 20 countries was 3.6 percent per year. Among the possible causes of the observed decline in Kenya is a large-scale campaign to distribute insecticide-treated bednets (ITN) which started in 2004. A Oaxaca-Blinder decomposition using DHS data shows that the increased ownership of bednets in endemic malaria zones explains 79 percent of the decline in infant mortality. Although the Oaxaca-Blinder method cannot identify causal effects, given the wide evidence basis showing that ITN usage can reduce malaria prevalence and the huge surge in ITN ownership in Kenya, it is likely that the decomposition results reflect at least in part a causal effect. The widespread ownership of ITNs in areas of Kenya where malaria is rare suggests that better targeting of ITN provision could improve the cost-effectiveness of such programs. Copyright © 2016. Published by Elsevier B.V.

  10. Prevention and Management of Cow’s Milk Allergy in Non-Exclusively Breastfed Infants

    Science.gov (United States)

    2017-01-01

    Introduction: The prevention and management of cow milk allergy (CMA) is still debated. Since CMA is much less frequent in breastfed infants, breastfeeding should be stimulated. Method: Literature was searched using databases to find original papers and reviews on this topic. Results: Hydrolysates with a clinical proof of efficacy are recommended in the prevention and treatment of CMA. However, not all meta-analyses conclude that hydrolysates do prevent CMA or other atopic manifestations such as atopic dermatitis. There are pros and cons to consider partially hydrolysed protein as an option for starter infant formula for each non-exclusively breastfed infant. A challenge test is still recommended as the most specific and sensitive diagnostic test, although a positive challenge test does not proof that the immune system is involved. The Cow Milk Symptom Score (CoMiSS™) is an awareness tool that enables healthcare professionals to better recognize symptoms related to the ingestion of cow milk, but it still needs validation as diagnostic tool. The current recommended elimination diet is a cow milk based extensive hydrolysate, although rice hydrolysates or soy infant formula can be considered in some cases. About 10 to 15% of infants allergic to cow milk will also react to soy. Mainly because of the higher cost, amino acid based formula is reserved for severe cases. There is no place for infant formula with intact protein from other animals as cross-over allergenicity is high. During recent years, attention focused also on the bifidogenic effect of prebiotics and more recently also on human milk oligosaccharides. A bifidogenic gastrointestinal microbiome may decrease the risk to develop allergic disease. The addition of probiotics and prebiotics to the elimination diet in treatment may enhance the development of tolerance development. Conclusion: Breastfeeding is the best way to feed infants. Cow milk based extensive hydrolysates remain the first option for the

  11. The contribution of gestational age, area deprivation and mother’s country of birth to ethnic variations in infant mortality in England and Wales: A national cohort study using routinely collected data

    Science.gov (United States)

    Quigley, Maria A.; Dattani, Nirupa; Gray, Ron; Jayaweera, Hiranthi; Kurinczuk, Jennifer J.; Macfarlane, Alison; Hollowell, Jennifer

    2018-01-01

    Objectives We aimed to describe ethnic variations in infant mortality and explore the contribution of area deprivation, mother’s country of birth, and prematurity to these variations. Methods We analyzed routine birth and death data on singleton live births (gestational age≥22 weeks) in England and Wales, 2006–2012. Infant mortality by ethnic group was analyzed using logistic regression with adjustment for sociodemographic characteristics and gestational age. Results In the 4,634,932 births analyzed, crude infant mortality rates were higher in Pakistani, Black Caribbean, Black African, and Bangladeshi infants (6.92, 6.00, 5.17 and 4.40 per 1,000 live births, respectively vs. 2.87 in White British infants). Adjustment for maternal sociodemographic characteristics changed the results little. Further adjustment for gestational age strongly attenuated the risk in Black Caribbean (OR 1.02, 95% CI 0.89–1.17) and Black African infants (1.17, 1.06–1.29) but not in Pakistani (2.32, 2.15–2.50), Bangladeshi (1.47, 1.28–1.69), and Indian infants (1.24, 1.11–1.38). Ethnic variations in infant mortality differed significantly between term and preterm infants. At term, South Asian groups had higher risks which cannot be explained by sociodemographic characteristics. In preterm infants, adjustment for degree of prematurity (ethnic inequalities in infant mortality. PMID:29649290

  12. Preventing abusive head trauma resulting from a failure of normal interaction between infants and their caregivers.

    Science.gov (United States)

    Barr, Ronald G

    2012-10-16

    Head trauma from abuse, including shaken baby syndrome, is a devastating and potentially lethal form of infant physical abuse first recognized in the early 1970s. What has been less recognized is the role of the early increase in crying in otherwise normal infants in the first few months of life as a trigger for the abuse. In part, this is because infant crying, especially prolonged unsoothable crying, has been interpreted clinically as something wrong with the infant, the infant's caregiver, or the interactions between them. Here, we review an alternative developmental interpretation, namely, that the early increase in crying is a typical behavioral development in normal infants and usually does not reflect anything wrong or abnormal. We also review evidence indicating that this normal crying pattern is the most common trigger for abusive head trauma (AHT). Together, these findings point to a conceptualization of AHT as the consequence of a failure in an otherwise common, iterative, and developmentally normal infant-caregiver interaction. They also imply that there is a window of opportunity for prevention of AHT, and potentially other forms of infant abuse, through a public health primary universal prevention strategy aimed at changing knowledge and behaviors of caregivers and society in general concerning normal development of infants and the significance of early increased infant crying. If effective, there may be important implications for prevention of infant abuse nationally and internationally.

  13. Neonatal and Infant Mortality in Korea, Japan, and the U.S.: Effect of Birth Weight Distribution and Birth Weight-Specific Mortality Rates

    OpenAIRE

    Kim, Do-Hyun; Jeon, Jihyun; Park, Chang Gi; Sriram, Sudhir; Lee, Kwang-sun

    2016-01-01

    Difference in crude neonatal and infant mortality rates (NMR and IMR) among different countries is due to the differences in its two determinants: birth weight distribution (BWD) and birth weight-specific mortality rates (BW-SMRs). We aimed to determine impact of BWD and BW-SMRs on differences in crude NMR and IMR among Korea, Japan, and the U.S. Our study used the live birth data of the period 2009 through 2010. Crude NMR/IMR are the lowest in Japan, 1.1/2.1, compared to 1.8/3.2, in Korea, a...

  14. The epidemiology of fractures in infants--Which accidents are preventable?

    Science.gov (United States)

    Wegmann, Helmut; Orendi, Ingrid; Singer, Georg; Eberl, Robert; Castellani, Christoph; Schalamon, Johannes; Till, Holger

    2016-01-01

    In children, fractures have a huge impact on the health care system. In order to develop effective prevention strategies exact knowledge about the epidemiology of fractures is mandatory. This study aims to describe clinical and epidemiological data of fractures diagnosed in infants. A retrospective analysis of all infants (childrenfractures in an 11 years period (2001-2011) was performed. Information was obtained regarding the location of the fractures, sites of the accident, circumstances and mechanisms of injury and post-injury care. 248 infants (54% male, 46% female) with a mean age of 7 months presented with 253 fractures. In more than half of the cases skull fractures were diagnosed (n=151, 61%). Most frequently the accidents causing fractures happened at home (67%). Falls from the changing table, from the arm of the care-giver and out of bed were most commonly encountered (n=92, 37%). While the majority of skull fractures was caused from falls out of different heights, external impacts tended to lead to fractures of the extremities. 6 patients (2%) were victims of maltreatment and sustained 10 fractures (2 skull fractures, 4 proximal humeral fractures, 2 rib fractures, and 2 tibial fractures). Falls from the changing table, the arms of the caregivers and out of bed caused the majority of fractures (especially skull fracture) in infants. Therefore, awareness campaigns and prevention strategies should focus on these mechanisms of accident in order to decrease the rate of fractures in infants. Copyright © 2015 Elsevier Ltd. All rights reserved.

  15. Improving outcomes in infants of HIV-infected women in a developing country setting.

    Science.gov (United States)

    Noel, Francine; Mehta, Sapna; Zhu, Yuwei; Rouzier, Patricia De Matteis; Marcelin, Abdias; Shi, Jian R; Nolte, Claudine; Severe, Linda; Deschamps, Marie Marcelle; Fitzgerald, Daniel W; Johnson, Warren D; Wright, Peter F; Pape, Jean W

    2008-01-01

    Since 1999 GHESKIO, a large voluntary counseling and HIV testing center in Port-au-Prince, Haiti, has had an ongoing collaboration with the Haitian Ministry of Health to reduce the rate of mother to child HIV transmission. There are limited data on the ability to administer complex regimens for reducing mother to child transmission and on risk factors for continued transmission and infant mortality within programmatic settings in developing countries. We analyzed data from 551 infants born to HIV-infected mothers seen at GHESKIO, between 1999 and 2005. HIV-infected mothers and their infants were given "short-course" monotherapy with antiretrovirals for prophylaxis; and, since 2003, highly active antiretroviral therapy (HAART) when clinical or laboratory indications were met. Infected women seen in the pre-treatment era had 27% transmission rates, falling to 10% in this cohort of 551 infants, and to only 1.9% in infants of women on HAART. Mortality rate after HAART introduction (0.12 per year of follow-up [0.08-0.16]) was significantly lower than the period before the availability of such therapy (0.23 [0.16-0.30], Pbirth weight on mortality and transmission were determined using univariate and multivariate analysis. Infant HIV-1 infection and low birth weight were associated with infant mortality in less than 15 month olds in multivariate analysis. Our findings demonstrate success in prevention of mother-to-child HIV transmission and mortality in a highly resource constrained setting. Elements contributing to programmatic success include provision of HAART in the context of a comprehensive program with pre and postnatal care for both mother and infant.

  16. Outcomes for Extremely Premature Infants

    Science.gov (United States)

    Glass, Hannah C.; Costarino, Andrew T.; Stayer, Stephen A.; Brett, Claire; Cladis, Franklyn; Davis, Peter J.

    2015-01-01

    Premature birth is a significant cause of infant and child morbidity and mortality. In the United States, the premature birth rate, which had steadily increased during the 1990s and early 2000s, has decreased annually for four years and is now approximately 11.5%. Human viability, defined as gestational age at which the chance of survival is 50%, is currently approximately 23–24 weeks in developed countries. Infant girls, on average, have better outcomes than infant boys. A relatively uncomplicated course in the intensive care nursery for an extremely premature infant results in a discharge date close to the prenatal EDC. Despite technological advances and efforts of child health experts during the last generation, the extremely premature infant (less than 28 weeks gestation) and extremely low birth weight infant (ELBW) (CPAP, mechanical ventilation, and exogenous surfactant increased survival and spurred the development of neonatal intensive care in the 1970s through the early 1990s. Routine administration of antenatal steroids during premature labor improved neonatal mortality and morbidity in the late 1990s. The recognition that chronic postnatal administration of steroids to infants should be avoided may have improved outcomes in the early 2000s. Evidence from recent trials attempting to define the appropriate target for oxygen saturation in preterm infants suggests arterial oxygen saturation between 91–95% (compared to 85–89%) avoids excess mortality. However, final analyses of data from these trials have not been published, so definitive recommendations are still pending The development of neonatal neurocognitive care visits may improve neurocognitive outcomes in this high-risk group. Long-term follow up to detect and address developmental, learning, behavioral, and social problems is critical for children born at these early gestational ages. The striking similarities in response to extreme prematurity in the lung and brain imply that agents and

  17. The impact of prenatal care quality on neonatal, infant and child mortality in Zimbabwe: evidence from the demographic and health surveys.

    Science.gov (United States)

    Makate, Marshall; Makate, Clifton

    2017-04-01

    The impact of the quality of prenatal care on child mortality outcomes has received less attention in sub-Saharan Africa. This study endeavoured to explore the effect of the quality of prenatal care and its individual components on neonatal, infant and under-five mortality. The empirical analysis uses data from the three most recent waves of the nationally representative Demographic and Health Survey for Zimbabwe conducted in 1999, 2005/06 and 2010/11. The results indicate that a one-unit increase in the quality of prenatal care lowers the prospect of neonatal, infant and under-five mortality by approximately 42.33, 30.86 and 28.65%, respectively. These findings remained roughly the same even after adjusting for potential mediating factors. Examining the effect of individual prenatal care components on child mortality revealed that women who receive information on possible complications arising during pregnancy are less liable to experience a neonatal death. Similarly, women who had blood pressure checks and tetanus immunizations were less likely to experience an infant or under-five death. We did not find any statistically meaningful impact on child mortality outcomes of blood and urine sample checks, iron tablet consumption, and the receipt of malarial tablets. Overall, our results suggest the need for public health policymakers to focus on ensuring high-quality prenatal care to enhance the survival prospects of Zimbabwe's infants. © The Author 2016. Published by Oxford University Press in association with The London School of Hygiene and Tropical Medicine. All rights reserved. For permissions, please e-mail: journals.permissions@oup.com.

  18. Population based trends in mortality, morbidity and treatment for very preterm- and very low birth weight infants over 12 years

    Directory of Open Access Journals (Sweden)

    Rüegger Christoph

    2012-02-01

    Full Text Available Abstract Background Over the last two decades, improvements in medical care have been associated with a significant increase and better outcome of very preterm (VP, Methods Our population-based observational cohort study used the Minimal Neonatal Data Set, a database maintained by the Swiss Society of Neonatology including information of all VP- and VLBW infants. Perinatal characteristics, mortality and morbidity rates and the survival free of major complications were analysed and their temporal trends evaluated. Results In 1996, 2000, 2004, and 2008, a total number of 3090 infants were enrolled in the Network Database. At the same time the rate of VP- and VLBW neonates increased significantly from 0.87% in 1996 to 1.10% in 2008 (p Conclusions Over the 12-year observation period, the number of VP- and VLBW infants increased significantly. An unchanged overall mortality rate and an increase of survivors free of major complication resulted in a considerable net gain in infants with potentially good outcome.

  19. Economic and other determinants of infant and child mortality in small developing countries: the case of Central America and the Caribbean.

    Science.gov (United States)

    Hojman, D E

    1996-03-01

    This analysis involves empirically testing a theoretical model among 22 Central American and Caribbean countries during the 1990s that explains differences in infant and child mortality. Explanatory measures capture demographic, economic, health care, and educational characteristics. The model is expected to allow for an assessment of the potential impact of structural adjustment and external debt. It is pointed out that birth rates and child mortality rates followed similar patterns over time and between countries. In this study's regression analyses all variables in the three models that explain infant mortality are exogenous: low birth weight, immunization, gross domestic product per capita, years of schooling for women, population/nurse, and debt as a proportion of gross national product. As nations became richer, infant mortality declined. Infant mortality was lower in countries with high external debt. In models for explaining the birth rate and the child mortality rate, the best fit included variables for debt, real public expenditure on health care, water supply, and malnutrition. Analysis in a simultaneous model for 10 countries revealed that the birth rate and the child mortality rate were more responsive to shocks in exogenous variables in Barbados than in the Dominican Republic, and more responsive in the Dominican Republic than in Guatemala. The impact of each exogenous variable varied by country. In Barbados education was four times more effective in explaining the birth rate than water. In Guatemala, the most effective exogenous variable was malnutrition. Child mortality rates were affected more by multiplier effects. In richer countries, the most important impact on child survival was improved access to safe water, and the most important impact on the birth rate was increased real public expenditure on education per capita. For the poorest countries, findings suggest first improvement in malnutrition and then improvement in safe water supplies

  20. Improving outcomes in infants of HIV-infected women in a developing country setting.

    Directory of Open Access Journals (Sweden)

    Francine Noel

    Full Text Available Since 1999 GHESKIO, a large voluntary counseling and HIV testing center in Port-au-Prince, Haiti, has had an ongoing collaboration with the Haitian Ministry of Health to reduce the rate of mother to child HIV transmission. There are limited data on the ability to administer complex regimens for reducing mother to child transmission and on risk factors for continued transmission and infant mortality within programmatic settings in developing countries.We analyzed data from 551 infants born to HIV-infected mothers seen at GHESKIO, between 1999 and 2005. HIV-infected mothers and their infants were given "short-course" monotherapy with antiretrovirals for prophylaxis; and, since 2003, highly active antiretroviral therapy (HAART when clinical or laboratory indications were met. Infected women seen in the pre-treatment era had 27% transmission rates, falling to 10% in this cohort of 551 infants, and to only 1.9% in infants of women on HAART. Mortality rate after HAART introduction (0.12 per year of follow-up [0.08-0.16] was significantly lower than the period before the availability of such therapy (0.23 [0.16-0.30], P<0.0001. The effects of maternal health, infant feeding, completeness of prophylaxis, and birth weight on mortality and transmission were determined using univariate and multivariate analysis. Infant HIV-1 infection and low birth weight were associated with infant mortality in less than 15 month olds in multivariate analysis.Our findings demonstrate success in prevention of mother-to-child HIV transmission and mortality in a highly resource constrained setting. Elements contributing to programmatic success include provision of HAART in the context of a comprehensive program with pre and postnatal care for both mother and infant.

  1. Maternal supplementation for prevention and treatment of vitamin D deficiency in exclusively breastfed infants.

    Science.gov (United States)

    Haggerty, Linda L

    2011-06-01

    Current research links newborn and infant vitamin D deficiency with various clinical outcomes, including rickets, failure to thrive, type 1 diabetes, and other immune-related diseases. Breastfed infants are often at a greater risk of developing deficiency due to their mothers' low vitamin D status. Human milk reflects the vitamin D status of the mother and often contains inadequate levels of 25-hydroxyvitamin D for infant nutrition. In 2008 the American Academy of Pediatrics (AAP) recommended 400 IU of vitamin D supplementation of all infants. However, research has indicated low levels of compliance of vitamin D supplementation of breastfed infants and a high incidence of vitamin D deficiency in the United States. Many breastfeeding advocates believe that the AAP's recommendations undermine breastfeeding, implying that human milk is inadequate for infant nutrition. Lactating mothers are also reluctant to add any supplements to their breastmilk. The literature review will examine the effectiveness and safety of maternal vitamin D supplementation for prevention and/or treatment of vitamin D deficiency in breastfed infants and lactating mothers. This method of prevention and intervention provides pediatric providers and certified lactation consultants with an alternative approach for education, counseling, promotion of breastfeeding, and treatment to improve maternal and infant health.

  2. Vitamin D insufficiency in HIV-infected pregnant women receiving antiretroviral therapy is not associated with morbidity, mortality or growth impairment in their uninfected infants in Botswana.

    Science.gov (United States)

    Powis, Kathleen; Lockman, Shahin; Smeaton, Laura; Hughes, Michael D; Fawzi, Wafaie; Ogwu, Anthony; Moyo, Sikhulile; van Widenfelt, Erik; von Oettingen, Julia; Makhema, Joseph; Essex, Max; Shapiro, Roger L

    2014-11-01

    Low maternal 25(OH)D (vitamin D) values have been associated with higher mortality and impaired growth among HIV-exposed uninfected (HEU) infants of antiretroviral (ART)-naive women. These associations have not been studied among HEU infants of women receiving ART. We performed a nested case-control study in the Botswana Mma Bana Study, a study providing ART to women during pregnancy and breastfeeding. Median maternal vitamin D values, and the proportion with maternal vitamin D insufficiency, were compared between women whose HEU infants experienced morbidity/mortality during 24 months of follow-up and women with nonhospitalized HEU infants. Growth faltering was assessed for never hospitalized infants attending the 24-month-of-life visit. Multivariate logistic regression models determined associations between maternal vitamin D insufficiency and infant morbidity/mortality and growth faltering. Delivery plasma was available and vitamin D levels assayable from 119 (86%) of 139 cases and 233 (84%) of 278 controls, and did not differ significantly between cases and controls [median: 36.7 ng/mL, interquartile range (IQR): 29.1-44.7 vs. 37.1 ng/mL, IQR: 30.0-47.2, P = 0.32]. Vitamin D insufficiency (HIV disease progression did not show associations between maternal vitamin D insufficiency at delivery and child morbidity/mortality, or 24-month-of-life growth faltering. Vitamin D insufficiency was common among ART-treated pregnant women in Botswana, but was not associated with morbidity, mortality or growth impairment in their HIV-uninfected children.

  3. Reducing mortality in HIV-infected infants and achieving the 90-90-90 target through innovative diagnosis approaches.

    Science.gov (United States)

    Essajee, Shaffiq; Vojnov, Lara; Penazzato, Martina; Jani, Ilesh; Siberry, George K; Fiscus, Susan A; Markby, Jessica

    2015-01-01

    Despite significant gains in access to early infant diagnosis (EID) over the past decade, most HIV-exposed infants still do not get tested for HIV in the first two months of life. For those who are tested, the long turnaround time between when the sample is drawn and when the results are returned leads to a high rate of loss to follow-up, which in turn means that few infected infants start antiretroviral treatment. Consequently, there continues to be high mortality from perinatally acquired HIV, and the ambitious goals of 90% of infected children identified, 90% of identified children treated and 90% of treated children with sustained virologic suppression by 2020 seem far beyond our reach. The objective of this commentary is to review recent advances in the field of HIV diagnosis in infants and describe how these advances may overcome long-standing barriers to access to testing and treatment. Several innovative approaches to EID have recently been described. These include point-of-care testing, use of SMS printers to connect the central laboratory and the health facility through a mobile phone network, expanding paediatric testing to other entry points where children access the health system and testing HIV-exposed infants at birth as a rapid way to identify in utero infection. Each of these interventions is discussed here, together with the opportunities and challenges associated with scale-up. Point-of-care testing has the potential to provide immediate results but is less cost-effective in settings where test volumes are low. Virological testing at birth has been piloted in some countries to identify those infants who need urgent treatment, but a negative test at birth does not obviate the need for additional testing at six weeks. Routine testing of infants in child health settings is a useful strategy to identify exposed and infected children whose mothers were not enrolled in programmes for the prevention of mother-to-child transmission. Facility-based SMS

  4. [A possible objective from now to the year 2000: reducing infant mortality by one half in Third World countries].

    Science.gov (United States)

    Berthet, E

    1984-06-01

    Every day 40.000 children die throughout the world. Most of them in developing countries. There is a close relationship between infant mortality, life expectancy at birth, the adult illiteracy rate and national income per capita. Why such huge differences between the infant mortality rate of 7 per 1.000 (live births) in Sweden and 208 in Upper Volta? The four scourges which afflict developing countries: hunger (malnutrition), disease, ignorance and poverty are responsible for this state of affairs. The author suggests that coordinated action by governments and International Agencies should be taken to halve the infant mortality rate by the year 2.000. He notes that in the past three mistakes were made which should not be repeated. The first was to improve the living conditions of the population. The green Revolution in India provides a striking example of an important progress which benefited only the wealthier farmers. A second mistake was to believe that only a medical approach reduce the infant mortality rate. A third error was to overlook the importance of health education and not to seek the active participation of the people concerned. The author recalls that the International Union for Health Education carried out a sanitary and social programme from 1975 to 1978 in Africa, south of the Sahara. To this effect, the IUHE had to find out what the people really wanted, could be motivated, to increase the welfare of the villagers by measures adapted to existing possibilities, to study how the people could recruit among the villagers health workers and train them, to create village health committees.(ABSTRACT TRUNCATED AT 250 WORDS)

  5. La mortalidad infantil, indicador de excelencia Infant mortality, an indicator of excellence

    Directory of Open Access Journals (Sweden)

    Yurima Díaz Elejalde

    2008-06-01

    Full Text Available La mortalidad infantil es un indicador de gran importancia para el Sistema Nacional de Salud cubano y a nivel mundial. Es utilizado para evaluar el estado de salud de la población, por lo que se realizó un estudio descriptivo, retrospectivo y longitudinal con el objetivo de caracterizar el comportamiento de la mortalidad infantil en el municipio de Guanabacoa, desde el 1º de enero de 2000 al 30 de junio de 2005. Se estudió una muestra de 48 defunciones a través de variables maternas y del recién nacido, con la información obtenida de los registros médicos e historias clínicas. Se encontró que la tasa de mortalidad infantil de nuestro municipio, fundamentalmente en los 4 años iniciales, es irregular con tendencia decreciente, siendo las principales causas de muerte las infecciones (37,5 %, la sepsis (14,5 %, la asfixia (10,4 % y las malformaciones congénitas (10,4 %. Las variables maternas afectadas fueron los factores de riesgo en el embarazo: bajo peso materno, la moniliasis vaginal y la anemia ferropénica ; y en el recién nacido, el componente neonatal precoz y el sexo masculino.Infant mortality is an indicator of great importance for the Cuban National Health System and for the world. It is used to evaluate the health status of the population. A descriptive, retrospective and longitudinal study was conducted aimed at characterizing the behavior of infant mortality in the municipality of Guanabacoa from January 1st, 2000 to June 30th, 2005. A sample of 48 deaths was studied through variables of the mother and the newborn obtained from the medical registries and histories. It was found that infant mortality rate in our municipality, mainly in the 4 initial years is irregular with a decreasing trend. The main causes of death are infections (37.5 %, sepsis (14.5 %, asphyxia (10.4 % and congenital malformations (10.4 %. The affected maternal variables were the risk factors during pregnancy: maternal low weight, vaginal moniliasis

  6. Impact of maternal diabetes mellitus on mortality and morbidity of very low birth weight infants: a multicenter Latin America study.

    Science.gov (United States)

    Grandi, Carlos; Tapia, Jose L; Cardoso, Viviane C

    2015-01-01

    To compare mortality and morbidity in very low birth weight infants (VLBWI) born to women with and without diabetes mellitus (DM). This was a cohort study with retrospective data collection (2001-2010, n=11.991) from the NEOCOSUR network. Adjusted odds ratios and 95% confidence intervals were calculated for the outcome of neonatal mortality and morbidity as a function of maternal DM. Women with no DM served as the reference group. The rate of maternal DM was 2.8% (95% CI: 2.5-3.1), but a significant (p=0.019) increase was observed between 2001-2005 (2.4%, 2.1-2.8) and 2006-2010 (3.2%, 2.8-3.6). Mothers with DM were more likely to have received a complete course of prenatal steroids than those without DM. Infants of diabetic mothers had a slightly higher gestational age and birth weight than infants of born to non-DM mothers. Distribution of mean birth weight Z-scores, small for gestational age status, and Apgar scores were similar. There were no significant differences between the two groups regarding respiratory distress syndrome, bronchopulmonary dysplasia, intraventricular hemorrhage, periventricular leukomalacia, and patent ductus arteriosus. Delivery room mortality, total mortality, need for mechanical ventilation, and early-onset sepsis rates were significantly lower in the diabetic group, whereas necrotizing enterocolitis (NEC) was significantly higher in infants born to DM mothers. In the logistic regression analysis, NEC grades 2-3 was the only condition independently associated with DM (adjusted OR: 1.65 [95% CI: 1.2 -2.27]). VLBWI born to DM mothers do not appear to be at an excess risk of mortality or early morbidity, except for NEC. Copyright © 2014 Sociedade Brasileira de Pediatria. Published by Elsevier Editora Ltda. All rights reserved.

  7. Impact of maternal diabetes mellitus on mortality and morbidity of very low birth weight infants: a multicenter Latin America study

    Directory of Open Access Journals (Sweden)

    Carlos Grandi

    2015-06-01

    Full Text Available OBJECTIVES: To compare mortality and morbidity in very low birth weight infants (VLBWI born to women with and without diabetes mellitus (DM. METHODS: This was a cohort study with retrospective data collection (2001-2010, n = 11.991 from the NEOCOSUR network. Adjusted odds ratios and 95% confidence intervals were calculated for the outcome of neonatal mortality and morbidity as a function of maternal DM. Women with no DM served as the reference group. RESULTS: The rate of maternal DM was 2.8% (95% CI: 2.5-3.1, but a significant (p = 0.019 increase was observed between 2001-2005 (2.4%, 2.1-2.8 and 2006-2010 (3.2%, 2.8-3.6. Mothers with DM were more likely to have received a complete course of prenatal steroids than those without DM. Infants of diabetic mothers had a slightly higher gestational age and birth weight than infants of born to non-DM mothers. Distribution of mean birth weight Z-scores, small for gestational age status, and Apgar scores were similar. There were no significant differences between the two groups regarding respiratory distress syndrome, bronchopulmonary dysplasia, intraventricular hemorrhage, periventricular leukomalacia, and patent ductus arteriosus. Delivery room mortality, total mortality, need for mechanical ventilation, and early-onset sepsis rates were significantly lower in the diabetic group, whereas necrotizing enterocolitis (NEC was significantly higher in infants born to DM mothers. In the logistic regression analysis, NEC grades 2-3 was the only condition independently associated with DM (adjusted OR: 1.65 [95% CI: 1.2 -2.27]. CONCLUSIONS: VLBWI born to DM mothers do not appear to be at an excess risk of mortality or early morbidity, except for NEC.

  8. Relationship of infant and fetal mortality to operations at the Hanford Nuclear Reservation, Washington State, 1946-1982

    International Nuclear Information System (INIS)

    Cate, S.; Hansom, J.

    1986-01-01

    The relationship of infant and fetal mortality to numbers of nuclear reactors at the Hanford Nuclear Reservation was investigated. Mortality rates were obtained using 36 years of United States vital statistics data. Three different exposure groups were selected based on meteorologic studies of the Hanford area: group 1, counties downwind of Hanford all year; group 2, counties seasonally downwind; and group 3, counties not downwind. Washington state was used as an additional comparison group. Four periods of operation based on fluctuations in numbers of reactors were characterized. Log-linear analysis revealed that the three groups and Washington state had similar trends in infant mortality rates over the four time periods. On the other hand, the trend in fetal mortality rates for group 1 did differ significantly from trends for the two other groups and Washington state. The trends of fetal mortality rates for group 2, group 3, and Washington state were not statistically different. Fetal mortality rates in group 1, however, failed to decline from period 1 (1946-1954) to period 2 (1955-1964) as expected by the trends for the two groups and Washington state. During period 2, the greatest number of reactors were operating. County-specific analysis showed that, of the counties in group 1, the trend in fetal mortality for Benton County, where Hanford is located, was significantly different from that for Washington state. A possible link between Hanford and an excess in fetal deaths is suggested by the deviation in trend of group 1, which appears localized to Benton County and the period of peak activity at Hanford

  9. Variations and Determinants of Mortality and Length of Stay of Very Low Birth Weight and Very Low for Gestational Age Infants in Seven European Countries.

    Science.gov (United States)

    Fatttore, Giovanni; Numerato, Dino; Peltola, Mikko; Banks, Helen; Graziani, Rebecca; Heijink, Richard; Over, Eelco; Klitkou, Søren Toksvig; Fletcher, Eilidh; Mihalicza, Péter; Sveréus, Sofia

    2015-12-01

    The EuroHOPE very low birth weight and very low for gestational age infants study aimed to measure and explain variation in mortality and length of stay (LoS) in the populations of seven European nations (Finland, Hungary, Italy (only the province of Rome), the Netherlands, Norway, Scotland and Sweden). Data were linked from birth, hospital discharge and mortality registries. For each infant basic clinical and demographic information, infant mortality and LoS at 1 year were retrieved. In addition, socio-economic variables at the regional level were used. Results based on 16,087 infants confirm that gestational age and Apgar score at 5 min are important determinants of both mortality and LoS. In most countries, infants admitted or transferred to third-level hospitals showed lower probability of death and longer LoS. In the meta-analyses, the combined estimates show that being male, multiple births, presence of malformations, per capita income and low population density are significant risk factors for death. It is essential that national policies improve the quality of administrative datasets and address systemic problems in assigning identification numbers at birth. European policy should aim at improving the comparability of data across jurisdictions. Copyright © 2015 John Wiley & Sons, Ltd.

  10. Infant twin mortality and hospitalisations after the perinatal period - a prospective cohort study from Guinea-Bissau

    DEFF Research Database (Denmark)

    Bjerregaard-Andersen, M; Biering-Sørensen, S; Gomes, G M

    2014-01-01

    OBJECTIVE: To examine mortality and hospitalisations among infant twins and singletons after the perinatal period in Guinea-Bissau. METHODS: The study was conducted from September 2009 to November 2012 by the Bandim Health Project (BHP). Newborn twins and unmatched singleton controls were included...

  11. The 2008 annual report of the Regional Infant and Child Mortality Review Committee.

    Science.gov (United States)

    Randall, Brad; Wilson, Ann

    2009-12-01

    The 2008 annual report of the Regional Infant and Child Mortality Review Committee (RICMRC) is presented. This committee has as its mission the review of infant and child deaths so that information can be transformed into action to protect young lives. The 2008 review area includes South Dakota's Minnehaha, Turner, Lincoln, Moody, Lake, McCook, Union, Hansen, Miner and Brookings counties. Within our region in 2008, there were six infant deaths labeled as Sudden Unexpected Infant Deaths (SUID), of which two met the criteria for the Sudden Infant Death Syndrome (SIDS). The four non-SIDS SUID deaths all represented deaths where asphyxia from unsafe sleeping environments could not be excluded. In addition, there were two accidental deaths from asphyxia in unsafe sleeping enviroments. We need to continue to promote the "Back to Sleep" campaign message of not only placing infants to sleep on their backs, but also making sure infants are put down to sleep on safe, firm, sleeping surfaces and are appropriately dressed for the ambient temperature. Parents need to be aware of the potential hazards of bed-sharing with their infants. In both 2007 and 2008, four children died in motor vehicle crashes, none of which were alcohol-related. Three fire-related childhood deaths were associated with one house fire involving a nonfunctional smoke alarm and a sleeping arrangement without an easy egress from a fire. Since 1997, the RICMRC has sought to achieve its mission to "review infant and child deaths so that information can be transformed into action to protect young lives". For 2008, the committee reviewed 21 deaths from Minnehaha, Turner, Lincoln, Moody, Lake, McCook, Union, Hansen, Miner and Brookings counties that met the following criteria: Children under the age of 18 dying subsequent to hospital discharge following delivery. Children who either died in these counties from causes sustained in them, or residents who died elsewhere from causes sustained in the ten-county region.

  12. Socio-economic factors associated with infant mortality in Italy: an ecological study.

    Science.gov (United States)

    Dallolio, Laura; Di Gregori, Valentina; Lenzi, Jacopo; Franchino, Giuseppe; Calugi, Simona; Domenighetti, Gianfranco; Fantini, Maria Pia

    2012-08-16

    One issue that continues to attract the attention of public health researchers is the possible relationship in high-income countries between income, income inequality and infant mortality (IM). The aim of this study was to assess the associations between IM and major socio-economic determinants in Italy. Associations between infant mortality rates in the 20 Italian regions (2006-2008) and the Gini index of income inequality, mean household income, percentage of women with at least 8 years of education, and percentage of unemployed aged 15-64 years were assessed using Pearson correlation coefficients. Univariate linear regression and multiple stepwise linear regression analyses were performed to determine the magnitude and direction of the effect of the four socio-economic variables on IM. The Gini index and the total unemployment rate showed a positive strong correlation with IM (r = 0.70; p income showed a strong negative correlation (r = -0.78; p income country where health care is universally available, variations in IM were strongly associated with relative and absolute income and unemployment rate. These results suggest that in Italy IM is not only related to income distribution, as demonstrated for other developed countries, but also to economic factors such as absolute income and unemployment. In order to reduce IM and the existing inequalities, the challenge for Italian decision makers is to promote economic growth and enhance employment levels.

  13. AN AUDIT OF THE SUDDEN-INFANT-DEATH-SYNDROME PREVENTION PROGRAM IN THE AUCKLAND REGION

    NARCIS (Netherlands)

    Obdeijn, M. C.; Tonkin, S.; Mitchell, E. A.

    1995-01-01

    Aim. An audit of the sudden infant death syndrome (SIDS) prevention programme in the Auckland region. Methods. 107 health professionals working in antenatal classes, postnatal wards, domiciliary midwifery and the Plunket Society were interviewed. Results. Maternal smoking and infant sleeping

  14. Medical closure of patent ductus arteriosus does not reduce mortality and development of bronchopulmonary dysplasia in preterm infants.

    Science.gov (United States)

    Terek, Demet; Yalaz, Mehmet; Ulger, Zulal; Koroglu, Ozge Altun; Kultursay, Nilgun

    2014-11-01

    Although, patent ductus arteriosus (PDA) is associated with significant morbidity due to hemodynamic instability in preterm infants, the effect of ductus closure on mortality and morbidity is a controversial issue. The aim is to evaluate the efficacy of oral and intravenous (IV) ibuprofen treatment on ductal closure and effects on mortality and bronchoplumonary dysplasia. The medical records of 292 premature infants treated at Ege University Neonatal Intensive Care Unit were retrospectively evaluated. Patients were classified into 3 groups as; No PDA, hemodynamically insignificant PDA (hiPDA) and hemodynamically significant PDA (hsPDA) according to the presence and hemodynamical significance of PDA by echocardiography. hsPDA group was treated with IV or oral ibuprofen. Patent ductus arteriosus was diagnosed by routine echocardiography in 145 patients, of whom 78 (53.7%) had hsPDA. All 65 infants with hiPDA had spontaneous PDA closure. Echocardiographic measurements were similar to those patients treated with oral or IV ibuprofen, as in the response rate to treatment without serious adverse effects. The presence of respiratory distress syndrome, surfactant therapy, late sepsis, bronchopulmonary dysplasia (BPD) and mortality rates were significantly higher in patients with hsPDA. However, with stepwise logistic regression; 5(th) min Apgar score (odds ratio [OR], 1.321, 95% confidence interval [CI], 1.063-1.641, P = 0.012) and gestational age (OR, 1.422, 95% CI, 1.212-1.662, P closure with minimal side effects. HiPDA can close spontaneously; therefore treatment decision should be individualized. However, medical treatment of PDA does not reduce mortality and BPD.

  15. Medical closure of patent ductus arteriosus does not reduce mortality and development of bronchopulmonary dysplasia in preterm infants

    Directory of Open Access Journals (Sweden)

    Demet Terek

    2014-01-01

    Full Text Available Background: Although, patent ductus arteriosus (PDA is associated with significant morbidity due to hemodynamic instability in preterm infants, the effect of ductus closure on mortality and morbidity is a controversial issue. The aim is to evaluate the efficacy of oral and intravenous (IV ibuprofen treatment on ductal closure and effects on mortality and bronchoplumonary dysplasia. Materials and Methods: The medical records of 292 premature infants treated at Ege University Neonatal Intensive Care Unit were retrospectively evaluated. Patients were classified into 3 groups as; No PDA, hemodynamically insignificant PDA (hiPDA and hemodynamically significant PDA (hsPDA according to the presence and hemodynamical significance of PDA by echocardiography. hsPDA group was treated with IV or oral ibuprofen. Results: Patent ductus arteriosus was diagnosed by routine echocardiography in 145 patients, of whom 78 (53.7% had hsPDA. All 65 infants with hiPDA had spontaneous PDA closure. Echocardiographic measurements were similar to those patients treated with oral or IV ibuprofen, as in the response rate to treatment without serious adverse effects. The presence of respiratory distress syndrome, surfactant therapy, late sepsis, bronchopulmonary dysplasia (BPD and mortality rates were significantly higher in patients with hsPDA. However, with stepwise logistic regression; 5th min Apgar score (odds ratio [OR], 1.321, 95% confidence interval [CI], 1.063-1.641, P = 0.012 and gestational age (OR, 1.422, 95% CI, 1.212-1.662, P < 0.001 were the only significant variables associated with mortality. Gestational age (OR, 0.680, 95% CI, 0.531-0.871, P = 0.002 was the only significant variable associated with BPD shown with logistic regression. Conclusion: Ibuprofen treatment is effective for hsPDA closure with minimal side effects. HiPDA can close spontaneously; therefore treatment decision should be individualized. However, medical treatment of PDA does not reduce

  16. Early BCG-Denmark and Neonatal Mortality Among Infants Weighing <2500 g: A Randomized Controlled Trial

    DEFF Research Database (Denmark)

    Biering-Sørensen, Sofie; Aaby, Peter; Lund, Najaaraq

    2017-01-01

    -Denmark” (intervention group; n = 2083) or “control” (local policy for LW and no BCG-Denmark; n = 2089) at discharge from the maternity ward or at first contact with the health center. The infants were randomized (1:1) without blinding in blocks of 24. Data was analyzed in Cox hazards models providing mortality rate...... ratios (MRRs). We had prespecified an analysis censoring follow-up at oral poliovirus vaccine campaigns. Results. Early administration of BCG-Denmark was associated with a nonsignificant reduction in neonatal mortality rate (MRR, 0.70; 95% confidence interval [CI], .47–1.04) and a 34% reduction (0......Background. BCG vaccine may reduce overall mortality by increasing resistance to nontuberculosis infections. In 2 randomized trials in Guinea-Bissau of early BCG-Denmark (Statens Serum Institut) given to low-weight (LW) neonates (mortality rates, we observed...

  17. The impact of economic recession on maternal and infant mortality: lessons from history.

    Science.gov (United States)

    Ensor, Tim; Cooper, Stephanie; Davidson, Lisa; Fitzmaurice, Ann; Graham, Wendy J

    2010-11-24

    The effect of the recent world recession on population health has featured heavily in recent international meetings. Maternal health is a particular concern given that many countries were already falling short of their MDG targets for 2015. We utilise 20th century time series data from 14 high and middle income countries to investigate associations between previous economic recession and boom periods on maternal and infant outcomes (1936 to 2005). A first difference logarithmic model is used to investigate the association between short run fluctuations in GDP per capita (individual incomes) and changes in health outcomes. Separate models are estimated for four separate time periods. The results suggest a modest but significant association between maternal and infant mortality and economic growth for early periods (1936 to 1965) but not more recent periods. Individual country data display markedly different patterns of response to economic changes. Japan and Canada were vulnerable to economic shocks in the post war period. In contrast, mortality rates in countries such as the UK and Italy and particularly the US appear little affected by economic fluctuations. The data presented suggest that recessions do have a negative association with maternal and infant outcomes particularly in earlier stages of a country's development although the effects vary widely across different systems. Almost all of the 20 least wealthy countries have suffered a reduction of 10% or more in GDP per capita in at least one of the last five decades. The challenge for today's policy makers is the design and implementation of mechanisms that protect vulnerable populations from the effects of fluctuating national income.

  18. Temporal trends in childhood mortality in Ghana: impacts and challenges of health policies and programs

    Directory of Open Access Journals (Sweden)

    Gbenga A. Kayode

    2016-08-01

    Full Text Available Background: Following the adoption of the Millennium Development Goal 4 (MDG 4 in Ghana to reduce under-five mortality by two-thirds between 1990 and 2015, efforts were made towards its attainment. However, impacts and challenges of implemented intervention programs have not been examined to inform implementation of Sustainable Development Goal 3.2 (SDG 3.2 that seeks to end preventable deaths of newborns and children aged under-five. Thus, this study aimed to compare trends in neonatal, infant, and under-five mortality over two decades and to highlight the impacts and challenges of health policies and intervention programs implemented. Design: Ghana Demographic and Health Survey data (1988–2008 were analyzed using trend analysis. Poisson regression analysis was applied to quantify the incidence rate ratio of the trends. Implemented health policies and intervention programs to reduce childhood mortality in Ghana were reviewed to identify their impact and challenges. Results: Since 1988, the annual average rate of decline in neonatal, infant, and under-five mortality in Ghana was 0.6, 1.0, and 1.2%, respectively. From 1988 to 1989, neonatal, infant, and under-five mortality declined from 48 to 33 per 1,000, 72 to 58 per 1,000, and 108 to 83 per 1,000, respectively, whereas from 1989 to 2008, neonatal mortality increased by 2 per 1,000 while infant and under-five mortality further declined by 6 per 1,000 and 17 per 1,000, respectively. However, the observed declines were not statistically significant except for under-five mortality; thus, the proportion of infant and under-five mortality attributed to neonatal death has increased. Most intervention programs implemented to address childhood mortality seem not to have been implemented comprehensively. Conclusion: Progress towards attaining MDG 4 in Ghana was below the targeted rate, particularly for neonatal mortality as most health policies and programs targeted infant and under-five mortality

  19. The effect of early initiation of antiretroviral treatment in infants on pediatric AIDS mortality in South Africa: a model-based analysis.

    Science.gov (United States)

    Johnson, Leigh F; Davies, Mary-Ann; Moultrie, Harry; Sherman, Gayle G; Bland, Ruth M; Rehle, Thomas M; Dorrington, Rob E; Newell, Marie-Louise

    2012-05-01

    Guidelines for treatment of pediatric HIV have recently changed to recommend that all infants who are identified as HIV-infected should start antiretroviral treatment (ART) immediately, regardless of their immunologic or clinical status. This study aims to assess the likely impact of this change in guideline in South Africa. A mathematical model was developed to simulate mother-to-child transmission of HIV, disease progression, and death of HIV-infected children guidelines for infants will have a significant impact on pediatric AIDS mortality at young ages, but further efforts are required to reduce the substantial growing AIDS mortality in older children.

  20. Are tuition-free primary education policies associated with lower infant and neonatal mortality in low- and middle-income countries?

    Science.gov (United States)

    Quamruzzaman, Amm; Mendoza Rodríguez, José M; Heymann, Jody; Kaufman, Jay S; Nandi, Arijit

    2014-11-01

    Robust evidence from low- and middle-income countries (LMICs) suggests that maternal education is associated with better child health outcomes. However, whether or not policies aimed at increasing access to education, including tuition-free education policies, contribute to lower infant and neonatal mortality has not been empirically tested. We joined country-level data on national education policies for 37 LMICs to information on live births to young mothers aged 15-21 years, who were surveyed as part of the population-based Demographic and Health Surveys. We used propensity scores to match births to mothers who were exposed to a tuition-free primary education policy with births to mothers who were not, based on individual-level, household, and country-level characteristics, including GDP per capita, urbanization, and health expenditures per capita. Multilevel logistic regression models, fitted using generalized estimating equations, were used to estimate the effect of exposure to tuition-free primary education policies on the risk of infant and neonatal mortality. We also tested whether this effect was modified by household socioeconomic status. The propensity score matched samples for analyses of infant and neonatal mortality comprised 24,396 and 36,030 births, respectively, from 23 countries. Multilevel regression analyses showed that, on average, exposure to a tuition-free education policy was associated with 15 (95% CI=-32, 1) fewer infant and 5 (95% CI=-13, 4) fewer neonatal deaths per 1000 live births. We found no strong evidence of heterogeneity of this effect by socioeconomic level. Copyright © 2014. Published by Elsevier Ltd.

  1. Advice about infant feeding for allergy prevention: A confusing picture for Australian consumers?

    Science.gov (United States)

    Netting, Merryn J; Allen, Katrina J

    2017-09-01

    Early feeding plays an important role in programming the immune system, particularly the risk of food allergy. There are many infant feeding guides published for consumers available in Australia, with most based on the National Health and Medical Research Council (NHMRC) 2012 Infant Feeding Guidelines for Health Workers and the Australasian Society of Clinical Immunology and Allergy (ASCIA) Infant Feeding Advice for allergy prevention. We sought to compare allergy-specific content of infant feeding educational material written for parents with these two documents. Australian websites of children's hospitals, early child health organisations and consumer groups providing information about diet during pregnancy, breastfeeding and early infancy were compared with NHMRC and ASCIA guidelines. Twenty-five sets of infant feeding information were identified. Food allergy was discussed in 18 resources. Recommended length of exclusive breastfeeding and timing of commencing solid foods was consistently around 6 months, with some variation in wording. Advice regarding to include and not delay introduction of common allergens into babies' diets was generally consistent with NHMRC and ASCIA recommendations, however the audit identified some resources that still recommended delayed introduction of common allergens. As consumers have access to a plethora of health information it is imperative that information about infant feeding from health-care authorities is simple, evidence-based and consistent to avoid confusion. Use of consensus wording related to infant feeding guidelines to prevent allergies will provide clear messages related to the timing of introduction to solid foods and inclusion of allergens in the early diet. © 2017 Paediatrics and Child Health Division (The Royal Australasian College of Physicians).

  2. Moderately early (7-14 days) postnatal corticosteroids for preventing chronic lung disease in preterm infants.

    Science.gov (United States)

    Halliday, H L; Ehrenkranz, R A; Doyle, L W

    2003-01-01

    Corticosteroids have been used late in the neonatal period to treat chronic lung disease (CLD) in preterm babies, and early to try to prevent it. CLD is likely to be the result of persisting inflammation in the lung and the use of powerful anti-inflammatory drugs like dexamethasone has some rationale. Early use tends to be associated with increased adverse effects so that studies of moderately early treatment (7-14 days postnatal) might have the dual benefits of fewer side effects and onset of action before chronic inflammation is established. To determine if moderately early (7-14 days) postnatal corticosteroid treatment vs control (placebo or nothing) is of benefit in the prevention and/or treatment of early chronic lung disease in the preterm infant. Randomised controlled trials of postnatal corticosteroid therapy were sought from the Oxford Database of Perinatal Trials, Cochrane Database of Controlled Trials, MEDLINE (1966 - October 2002), hand searching paediatric and perinatal journals, examining previous review articles and information received from practicing neonatologists. Authors of all studies were contacted, where possible, to confirm details of reported follow-up studies, or to obtain any information about long-term follow-up where none had been reported. Randomised controlled trials of postnatal corticosteroid treatment from 7-14 days of birth in high risk preterm infants were selected for this review. Data regarding clinical outcomes including mortality, CLD (including late rescue with corticosteroids, or need for home oxygen therapy), death or CLD, failure to extubate, complications during the primary hospitalisation (including infection, hyperglycaemia, hypertension, hypertrophic cardiomyopathy, pneumothorax, severe intraventricular haemorrhage (IVH), necrotizing enterocolitis (NEC), gastrointestinal bleeding, and severe retinopathy of prematurity (ROP)), and long term outcome (including blindness, deafness, cerebral palsy and major neurosensory

  3. Community based retrospective study of sex in infant mortality in India

    Science.gov (United States)

    Khanna, R; Kumar, A; Vaghela, J F; Sreenivas, V; Puliyel, J M

    2003-01-01

    Objective To determine whether the imbalance in the sex ratio in India can be explained by less favourable treatment of girls in infancy. Design Analysis of results of verbal autopsy reports over a five year period. Setting Community health project in urban India. Main outcome measures Deaths from all causes in infants aged less than 1 year. Results The sex ratio at birth was 869 females per 1000 males. The mean infant mortality was 1.3 times higher in females than in males (72 v 55 per 1000). Diarrhoea was responsible for 22% of deaths overall, though twice as many girls died from diarrhoea. There were no significant differences in the numbers of deaths from causes such as birth asphyxia, septicaemia, prematurity, and congenital anomalies. In 10% of deaths there was no preceding illness and no satisfactory cause was found. Three out of every four such deaths were in girls. Conclusions The excess number of unexplained deaths and deaths due to treatable conditions such as diarrhoeal disease in girls may be because girls are regarded and treated less favourably in India. PMID:12869451

  4. Plastic bags for prevention of hypothermia in preterm and low birth weight infants.

    Science.gov (United States)

    Leadford, Alicia E; Warren, Jamie B; Manasyan, Albert; Chomba, Elwyn; Salas, Ariel A; Schelonka, Robert; Carlo, Waldemar A

    2013-07-01

    Hypothermia contributes to neonatal mortality and morbidity, especially in preterm and low birth weight infants in developing countries. Plastic bags covering the trunk and extremities of very low birth weight infants reduces hypothermia. This technique has not been studied in larger infants or in many resource-limited settings. The objective was to determine if placing preterm and low birth weight infants inside a plastic bag at birth maintains normothermia. Infants at 26 to 36 weeks' gestational age and/or with a birth weight of 1000 to 2500 g born at the University Teaching Hospital in Lusaka, Zambia, were randomized by using a 1:1 allocation and parallel design to standard thermoregulation (blanket or radiant warmer) care or to standard thermoregulation care plus placement inside a plastic bag at birth. The primary outcome measure was axillary temperature in the World Health Organization-defined normal range (36.5-37.5°C) at 1 hour after birth. A total of 104 infants were randomized. At 1 hour after birth, infants randomized to plastic bag (n = 49) were more likely to have a temperature in the normal range as compared with infants in the standard thermoregulation care group (n = 55; 59.2% vs 32.7%; relative risk 1.81; 95% confidence interval 1.16-2.81; P = .007). The temperature at 1 hour after birth in the infants randomized to plastic bag was 36.5 ± 0.5°C compared with 36.1 ± 0.6°C in standard care infants (P 38.0°C) did not occur in any infant. Placement of preterm/low birth weight infants inside a plastic bag at birth compared with standard thermoregulation care reduced hypothermia without resulting in hyperthermia, and is a low-cost, low-technology tool for resource-limited settings.

  5. [Epidemiological characteristics of neonatal mortality in Peru, 2011-2012].

    Science.gov (United States)

    Ávila, Jeannette; Tavera, Mario; Carrasco, Marco

    2015-01-01

    Describe the epidemiological characteristics of neonatal deaths in Peru. Descriptive study based on notifications to the Perinatal and Neonatal National Epidemiological Surveillance Subsystem (PNNESS) made in 2011-2012. The capture-recapture method was used to calculate the registration of the notification and estimate the neonatal mortality rate (NMR) nationally and by regions. Responses were made to the questions: where, when, who and why the newborns died. 6,748 neonatal deaths were reported to PNNESS, underreport 52.9%. A national NMR of 12.8 deaths/1,000 live births was estimated. 16% of deaths occurred at home and 74.2% of these were in the highlands region, predominantly in rural areas and poor districts. 30% died in the first 24 hours and 42% between 1 and 7 days of life. 60.6% were preterm infants and 39.4% were term infants. 37% had normal weight, 29.4% low weight, and 33.6% very low weight. Preventable neonatal mortality was 33%, being higher in urban and highland areas. 25.1% died of causes related with prematurity-immaturity; 23.5% by infections; 14.1% by asphyxiation and causes related to care during childbirth and 11% by lethal congenital malformation. Neonatal mortality in Peru is differentiated by setting; harms related to prematurity-immaturity dominated on the coast, while the highlands and jungle recorded more preventable neonatal mortality with a predominance of asphyxia and infections.

  6. A phase II randomized clinical trial on cerebral near-infrared spectroscopy plus a treatment guideline versus treatment as usual for extremely preterm infants during the first three days of life (SafeBoosC)

    DEFF Research Database (Denmark)

    Hyttel-Sorensen, Simon; Austin, Topun; van Bel, Frank

    2013-01-01

    Every year in Europe about 25,000 infants are born extremely preterm. These infants have a 20% mortality rate, and 25% of survivors have severe long-term cerebral impairment. Preventative measures are key to reduce mortality and morbidity in an extremely preterm population. The primary objective ...

  7. Mortality and Morbidity of Extremely Low Birth Weight Infants in the Mainland of China: A Multi-center Study

    Science.gov (United States)

    Lin, Hui-Jia; Du, Li-Zhong; Ma, Xiao-Lu; Shi, Li-Ping; Pan, Jia-Hua; Tong, Xiao-Mei; Li, Qiu-Ping; Zhou, Jian-Guo; Yi, Bing; Liu, Ling; Chen, Yun-Bing; Wei, Qiu-Fen; Wu, Hui-Qing; Li, Mei; Liu, Cui-Qing; Gao, Xi-Rong; Xia, Shi-Wen; Li, Wen-Bin; Yan, Chao-Ying; He, Ling; Liang, Kun; Zhou, Xiao-Yu; Han, Shu-Ping; Lyu, Qin; Qiu, Yin-Ping; Li, Wen; Chen, Dong-Mei; Lu, Hong-Ru; Liu, Xiao-Hong; Liu, Hong; Lin, Zhen-Lang; Liu, Li; Zhu, Jia-Jun; Xiong, Hong; Yue, Shao-Jie; Zhuang, Si-Qi

    2015-01-01

    Background: With the progress of perinatal medicine and neonatal technology, more and more extremely low birth weight (ELBW) survived all over the world. This study was designed to investigate the short-term outcomes of ELBW infants during their Neonatal Intensive Care Unit (NICU) stay in the mainland of China. Methods: All infants admitted to 26 NICUs with a birth weight (BW) patent ductus arteriosus, intraventricular hemorrhage, periventricular leukomalacia, bronchopulmonary dysplasia, retinopathy of prematurity was 26.2%, 33.7%, 6.7%, 48.1%, and 41.4%, respectively. Ventilator associated pneumonia was the most common hospital acquired infection during hospitalization. Conclusions: Our study was the first survey that revealed the present status of ELBW infants in the mainland of China. The mortality and morbidity of ELBW infants remained high as compared to other developed countries. PMID:26481740

  8. Multiplicity of Plasmodium falciparum infection following intermittent preventive treatment in infants

    NARCIS (Netherlands)

    Buchholz, Ulrike; Kobbe, Robin; Danquah, Ina; Zanger, Philipp; Reither, Klaus; Abruquah, Harry H.; Grobusch, Martin P.; Ziniel, Peter; May, Jürgen; Mockenhaupt, Frank P.

    2010-01-01

    Intermittent preventive treatment in infants with sulphadoxine-pyrimethamine (IPTi-SP) reduces malaria morbidity by 20% to 33%. Potentially, however, this intervention may compromise the acquisition of immunity, including the tolerance towards multiple infections with Plasmodium falciparum.

  9. Multiplicity of Plasmodium falciparum infection following intermittent preventive treatment in infants

    NARCIS (Netherlands)

    Buchholz, U.; Kobbe, R.; Danquah, I.; Zanger, P.; Reither, K.; Abruquah, H.H.; Grobusch, M.P.; Ziniel, P.; May, J.; Mockenhaupt, F.P.

    2010-01-01

    Background: Intermittent preventive treatment in infants with sulphadoxine-pyrimethamine (IPTi-SP) reduces malaria morbidity by 20% to 33%. Potentially, however, this intervention may compromise the acquisition of immunity, including the tolerance towards multiple infections with Plasmodium

  10. Socio-economic factors associated with infant mortality in Italy: an ecological study

    Directory of Open Access Journals (Sweden)

    Dallolio Laura

    2012-08-01

    Full Text Available Abstract Introduction One issue that continues to attract the attention of public health researchers is the possible relationship in high-income countries between income, income inequality and infant mortality (IM. The aim of this study was to assess the associations between IM and major socio-economic determinants in Italy. Methods Associations between infant mortality rates in the 20 Italian regions (2006–2008 and the Gini index of income inequality, mean household income, percentage of women with at least 8 years of education, and percentage of unemployed aged 15–64 years were assessed using Pearson correlation coefficients. Univariate linear regression and multiple stepwise linear regression analyses were performed to determine the magnitude and direction of the effect of the four socio-economic variables on IM. Results The Gini index and the total unemployment rate showed a positive strong correlation with IM (r = 0.70; p b = 0.15, p  Conclusions In Italy, a high-income country where health care is universally available, variations in IM were strongly associated with relative and absolute income and unemployment rate. These results suggest that in Italy IM is not only related to income distribution, as demonstrated for other developed countries, but also to economic factors such as absolute income and unemployment. In order to reduce IM and the existing inequalities, the challenge for Italian decision makers is to promote economic growth and enhance employment levels.

  11. Prevention of influenza-related illness in young infants by maternal vaccination during pregnancy [version 1; referees: 2 approved

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    Marta C Nunes

    2018-01-01

    Full Text Available The influenza virus circulates yearly and causes global epidemics. Influenza infection affects all age groups and causes mild to severe illness, and young infants are at particular risk for serious disease. The most effective measure to prevent influenza disease is vaccination; however, no vaccine is licensed for use in infants younger than 6 months old. Thus, there is a crucial need for other preventive strategies in this high-risk age group. Influenza vaccination during pregnancy protects both the mothers and the young infants against influenza infection. Vaccination during pregnancy boosts the maternal antibodies and increases the transfer of immunoglobulin G from the mother to the fetus through the placenta, which confers protection against infection in infants too young to be vaccinated. Data from clinical trials and observational studies did not demonstrate adverse effects to the mother, the fetus, or the infant after maternal influenza vaccination. We present the current data on the effectiveness and safety of influenza vaccination during pregnancy in preventing disease in the young infant.

  12. Macro-economic conditions and infant health: a changing relationship for black and white infants in the United States.

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    Orsini, Chiara; Avendano, Mauricio

    2015-01-01

    We study whether the relationship between the state unemployment rate at the time of conception and infant health, infant mortality and maternal characteristics in the United States has changed over the years 1980-2004. We use microdata on births and deaths for years 1980-2004 and find that the relationship between the state unemployment rate at the time of conception and infant mortality and birthweight changes over time and is stronger for blacks than whites. For years 1980-1989 increases in the state unemployment rate are associated with a decline in infant mortality among blacks, an effect driven by mortality from gestational development and birth weight, and complications of placenta while in utero. In contrast, state economic conditions are unrelated to black infant mortality in years 1990-2004 and white infant mortality in any period, although effects vary by cause of death. We explore potential mechanisms for our findings and, including mothers younger than 18 in the analysis, uncover evidence of age-related maternal selection in response to the business cycle. In particular, in years 1980-1989 an increase in the unemployment rate at the time of conception is associated with fewer babies born to young mothers. The magnitude and direction of the relationship between business cycles and infant mortality differs by race and period. Age-related selection into motherhood in response to the business cycle is a possible explanation for this changing relationship.

  13. Botulism mortality in the USA, 1975-2009.

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    Jackson, Kelly A; Mahon, Barbara E; Copeland, John; Fagan, Ryan P

    2015-01-01

    Botulism had mortality rates >60% before the 1950s. We reviewed confirmed botulism cases in the USA during 1975-2009 including infant, foodborne, wound, and other/unknown acquisition categories, and calculated mortality ratios. We created a multivariate logistic regression model for non-infant cases (foodborne, wound, and other/unknown). Overall mortality was 3.0% with 109 botulism-related deaths among 3,618 botulism cases [18 (<1%) deaths among 2,352 infant botulism cases, 61 (7.1%) deaths among 854 foodborne botulism cases, 18 (5.0%) deaths among 359 wound botulism cases, and 12 (22.6%) deaths among 53 other/unknown botulism cases]. Mortality among all cases increased with age; it was lowest among infants (0.8%) and highest among persons ≥80 years old (34.4%). Toxin type F had higher mortality (13.8%) than types A, B, or E (range, 1.4% to 4.1%). Efforts to reduce botulism mortality should target non-infant transmission categories and older adults.

  14. Underascertainment of child abuse fatalities in France: retrospective analysis of judicial data to assess underreporting of infant homicides in mortality statistics.

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    Tursz, Anne; Crost, Monique; Gerbouin-Rérolle, Pascale; Cook, Jon M

    2010-07-01

    Test the hypothesis of an underestimation of infant homicides in mortality statistics in France; identify its causes; examine data from the judicial system and their contribution in correcting this underestimation. A retrospective, cross-sectional study was carried out in 26 courts in three regions of France of cases of infant deaths submitted to the courts, 1996-2000, with follow-up of their files until case closing (1996-2008). For each case, cause of death established by the courts was compared with ICD cause of death as coded in official mortality statistics. We examined 247 cases. Shortcomings in investigations were noted (autopsies: 75% of cases; fundus examination: 11%; diagnosis of sudden infant death syndrome [SIDS] without autopsy: 41%). Eighty deaths were considered homicides by the courts. Homicide rates in the court study are 2-3.6 times higher than those in mortality statistics. Nearly 1/3 of "accidental" deaths and 1/4 of deaths from unknown cause in mortality statistics are homicides. Mechanisms of underascertainment are: physicians' inappropriate death certification and underreporting of suspicious cases; inadequate investigation of cases; incomplete communication of final medical and forensic results to the mortality statistics department. In a country where neither transportation of the body to a hospital nor autopsy is obligatory, judicial data can make an important contribution to correcting mortality statistics. This study led to the first French protocol for investigating sudden unexpected deaths in infancy (SUDI). The protocol includes a physician "training" section focused on understanding the symptomatology and risk factors of violence, as well as the quality of death certification. Copyright © 2010 Elsevier Ltd. All rights reserved.

  15. Spatial Modeling Of Infant Mortality Rate In South Central Timor Regency Using GWLR Method With Adaptive Bisquare Kernel And Gaussian Kernel

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    Teguh Prawono Sabat

    2017-08-01

    Full Text Available Geographically Weighted Logistic Regression (GWLR was regression model consider the spatial factor, which could be used to analyze the IMR. The number of Infant Mortality as big as 100 cases in 2015 or 12 per 1000 live birth in South Central Timor Regency. The aim of this study was to determine the best modeling of GWLR with fixed weighting function and Adaptive Gaussian Kernel in the case of infant mortality in South Central Timor District in 2015. The response variable (Y in this study was a case of infant mortality, while variable predictor was the percentage of neonatal first visit (KN1 (X1, the percentage of neonatal visit 3 times (Complete KN (X2, the percentage of pregnant get Fe tablet (X3, percentage of poor families pre prosperous (X4. This was a non-reactive study, which is a measurement which individuals surveyed did not realize that they are part of a study, with analysis unit in 32 sub-districts of South Central Timor Districts. Data analysis used open source program that was Excel, R program, Quantum GIS and GWR4. The best GWLR spatial modeling with Adaptive Gaussian Kernel weighting function, a global model parameters GWLR Adaptive Gaussian Kernel weighting function obtained by g (x = 0.941086 - 0,892506X4, GWLR local models with adaptive Kernel bisquare weighting function in the 13 Districts were obtained g(x = 0 − 0X4, factors that affect the cases of infant mortality in 13 sub-districts of South Central Timor Regency in 2015 was the percentage of poor families pre prosperous.

  16. Effects of a Birth Hospital's Neonatal Intensive Care Unit Level and Annual Volume of Very Low-Birth-Weight Infant Deliveries on Morbidity and Mortality.

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    Jensen, Erik A; Lorch, Scott A

    2015-08-01

    The annual volume of deliveries of very low-birth-weight (VLBW) infants has a greater effect on mortality risk than does neonatal intensive care unit (NICU) level. The differential effect of these hospital factors on morbidity among VLBW infants is uncertain. To assess the independent effects of a birth hospital's annual volume of VLBW infant deliveries and NICU level on the risk of several neonatal morbidities and morbidity-mortality composite outcomes that are predictive of future neurocognitive development. Retrospective, population-based cohort study (performed in 2014) of all VLBW infants without severe congenital anomalies delivered in all hospitals in California, Missouri, and Pennsylvania between January 1, 1999, and December 31, 2009 (N = 72,431). Risk-adjusted odds ratios and risk-adjusted probabilities were determined by logistic regression. The primary study outcomes were the individual composites of death or bronchopulmonary dysplasia, necrotizing enterocolitis, retinopathy of prematurity, and severe intraventricular hemorrhage. Among the 72,431 VLBW infants in the present study, birth at a hospital with 10 or less deliveries of VLBW infants per year was associated with the highest risk-adjusted probability of death (15.3% [95% CI, 14.4%-16.3%]), death or severe intraventricular hemorrhage (17.5% [95% CI, 16.5%-18.6%]), and death or necrotizing enterocolitis (19.3% [95% CI, 18.1%-20.4%]). These complications were also more common among infants born at hospitals with a level I or II NICU compared with infants delivered at hospitals with a level IIIB/C NICU. The risk-adjusted probability of death or retinopathy of prematurity was highest among infants born at hospitals with a level IIIB/C NICU and lowest among infants born at hospitals with a level IIIA NICU. When the effects of NICU level and annual volume of VLBW infant deliveries were evaluated simultaneously, the annual volume of deliveries was the stronger contributor to the risk of death, death or

  17. Has the Rate of Reduction in Infant Mortality Increased in India Since the Launch of National Rural Health Mission? Analysis of Time Trends 2000-2009 with Projection to 2015

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    Rajesh Narwal, MD, MPH

    2013-07-01

    Full Text Available Objectives: National Rural Health Mission (NRHM – India was launched in 2005 to tackle urban-rural health inequalities, especially in maternal and child health. We examined national and state level trends in Infant Mortality Rates (IMR from 2000 through 2009 to: 1 assess whether the NRHM had increased the average annual reduction rate (AARR of IMR 2 evaluate state-wise progress towards Millennium Development Goals (MDG4 and estimate required AARRs for ‘off track’ states. Methods: Log-linear regression models were applied to national and state IMR data collated from the Sample Registration System (SRS-India to estimate average annual reduction rates and compare AAARs before and after introduction of NRHM. The log-linear trend of infant mortality rates was also projected forward to 2015. Results: The infant mortality rate in rural India declined from 74 to 55/1000 live births between 2000 and 2009, with AARR of 3.0% (95% CI=2.6%-3.4% and the urban-rural gap in infant mortality narrowed (p =0.036. However there was no evidence (p=0.49 that AARR in rural India increased post NRHM (3.4%, 95% CI 2.0-4.7% compared to pre NRHM (2.8%, 95% CI 2.1%-3.5%. States varied widely in rates of infant mortality reduction. Projections of infant mortality rates suggested that only eight states might be on track to help India achieve MDG4 by 2015. Conclusions and Public Health Implications: Despite a narrowing urban-rural gap and high AARRs in some states, there was no evidence that the rate of reduction in infant mortality has increased in rural India post NRHM introduction. India appears unlikely to achieve child survival-related NRHM and millennium development goals. Government should revisit the child survival related NRHM strategies and ensure equitable access to health services. More robust monitoring and evaluation mechanisms must be inbuilt for following years.

  18. [Early diagnosis of human immunodeficiency virus-1 in infants: The prevention of mother-to-child transmission program in Equatorial Guinea].

    Science.gov (United States)

    Prieto-Tato, Luis Manuel; Vargas, Antonio; Álvarez, Patrícia; Avedillo, Pedro; Nzi, Eugenia; Abad, Carlota; Guillén, Sara; Fernández-McPhee, Carolina; Ramos, José Tomás; Holguín, África; Rojo, Pablo; Obiang, Jacinta

    2016-11-01

    Great efforts have been made in the last few years in order to implement the prevention of mother-to-child transmission (PMTCT) program in Equatorial Guinea (GQ). The aim of this study was to evaluate the rates of mother-to-child HIV transmission based on an HIV early infant diagnosis (EID) program. A prospective observational study was performed in the Regional Hospital of Bata and Primary Health Care Centre Maria Rafols, Bata, GQ. Epidemiological, clinical, and microbiological characteristics of HIV-1-infected mothers and their exposed infants were recorded. Dried blood spots (DBS) for HIV-1 EID were collected from November 2012 to December 2013. HIV-1 genome was detected using Siemens VERSANT HIV-1 RNA 1.0 kPCR assay. Sixty nine pairs of women and infants were included. Sixty women (88.2%) had WHO clinical stage 1. Forty seven women (69.2%) were on antiretroviral treatment during pregnancy. Forty five infants (66.1%) received postnatal antiretroviral prophylaxis. Age at first DBS analysis was 2.4 months (IQR 1.2-4.9). One infant died before a HIV-1 diagnosis could be ruled out. Two infants were HIV-1 infected and started HAART before any symptoms were observed. The rate of HIV-1 transmission observed was 2.9% (95%CI 0.2-10.5). The PMTCT rate was evaluated for the first time in GQ based on EID. EID is the key for early initiation of antiretroviral therapy and to reduce the mortality associated with HIV infection. Copyright © 2015 Elsevier España, S.L.U. and Sociedad Española de Enfermedades Infecciosas y Microbiología Clínica. All rights reserved.

  19. Reducing mortality in HIV-infected infants and achieving the 90–90–90 target through innovative diagnosis approaches

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    Essajee, Shaffiq; Vojnov, Lara; Penazzato, Martina; Jani, Ilesh; Siberry, George K; Fiscus, Susan A; Markby, Jessica

    2015-01-01

    Introduction Despite significant gains in access to early infant diagnosis (EID) over the past decade, most HIV-exposed infants still do not get tested for HIV in the first two months of life. For those who are tested, the long turnaround time between when the sample is drawn and when the results are returned leads to a high rate of loss to follow-up, which in turn means that few infected infants start antiretroviral treatment. Consequently, there continues to be high mortality from perinatally acquired HIV, and the ambitious goals of 90% of infected children identified, 90% of identified children treated and 90% of treated children with sustained virologic suppression by 2020 seem far beyond our reach. The objective of this commentary is to review recent advances in the field of HIV diagnosis in infants and describe how these advances may overcome long-standing barriers to access to testing and treatment. Discussion Several innovative approaches to EID have recently been described. These include point-of-care testing, use of SMS printers to connect the central laboratory and the health facility through a mobile phone network, expanding paediatric testing to other entry points where children access the health system and testing HIV-exposed infants at birth as a rapid way to identify in utero infection. Each of these interventions is discussed here, together with the opportunities and challenges associated with scale-up. Point-of-care testing has the potential to provide immediate results but is less cost-effective in settings where test volumes are low. Virological testing at birth has been piloted in some countries to identify those infants who need urgent treatment, but a negative test at birth does not obviate the need for additional testing at six weeks. Routine testing of infants in child health settings is a useful strategy to identify exposed and infected children whose mothers were not enrolled in programmes for the prevention of mother

  20. Parent "cocoon" immunization to prevent pertussis-related hospitalization in infants: the case of Piemonte in Italy.

    Science.gov (United States)

    Meregaglia, Michela; Ferrara, Lorenza; Melegaro, Alessia; Demicheli, Vittorio

    2013-02-06

    Pertussis incidence in Piemonte (Italy) is now at the lowest level ever reached (0.85 per 100,000 in 2010) but the disease is still endemic in infants (54 per 100,000 in 2005-2010). Parental "cocoon" immunization has been proposed in some countries (i.e. United States, France) as a measure to protect newborns from serious pertussis outcomes. We assessed the number needed to vaccinate (NNV) to prevent hospital admissions in infants (€100,000. The "cocoon" programme leads to net costs from a National Health Service (NHS) perspective (ROI<1). In contexts of low incidence and without reliable data on a high parent-attributable infant risk, the parental "cocoon" programme is poorly efficient and very resource intensive in preventing pertussis in infants. Copyright © 2012 Elsevier Ltd. All rights reserved.

  1. Exclusive breastfeeding, diarrhoeal morbidity and all-cause mortality in infants of HIV-infected and HIV uninfected mothers: an intervention cohort study in KwaZulu Natal, South Africa.

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    Nigel C Rollins

    Full Text Available INTRODUCTION: Antiretroviral drug interventions significantly reduce the risk of HIV transmission to infants through breastfeeding. We report diarrhoea prevalence and all-cause mortality at 12 months of age according to infant feeding practices, among infants born to HIV-infected and uninfected mothers in South Africa. METHODS: A non-randomised intervention cohort study that followed both HIV-infected and HIV-uninfected mothers and their infants until 18 months of age. Mothers were supported in their infant feeding choice. Detailed morbidity and vital status data were collected over the first year. At the time, only single dose nevirapine was available to prevent mother-to-child transmission of HIV. RESULTS: Among 2,589 infants, detailed feeding data and vital status were available for 1,082 HIV-exposed infants and 1,155 HIV non-exposed infants. Among exclusively breastfed (EBF infants there were 9.4 diarrhoeal days per 1,000 child days (95%CI. 9.12-9.82 while among infants who were never breastfed there were 15.6 diarrhoeal days per 1,000 child days (95%CI. 14.62-16.59. Exclusive breastfeeding was associated with fewer acute, persistent and total diarrhoeal events than mixed or no breastfeeding in both HIV-exposed infants and also infants of HIV uninfected mothers. In an adjusted cox regression analysis, the risk of death among all infants by 12 months of age was significantly greater in those who were never breastfed (aHR 3.5, p<0.001 or mixed fed (aHR 2.65, p<0.001 compared with those who were EBF. In separate multivariable analyses, infants who were EBF for shorter durations had an increased risk of death compared to those EBF for 5-6 months [aHR 2.18 (95% CI, 1.56-3.01; p<0.001]. DISCUSSION: In the context of antiretroviral drugs being scaled-up to eliminate new HIV infections among children, there is strong justification for financial and human resource investment to promote and support exclusive breastfeeding to improve HIV-free survival

  2. National, regional, and global sex ratios of infant, child, and under-5 mortality and identification of countries with outlying ratios: a systematic assessment.

    Science.gov (United States)

    Alkema, Leontine; Chao, Fengqing; You, Danzhen; Pedersen, Jon; Sawyer, Cheryl C

    2014-09-01

    Under natural circumstances, the sex ratio of male to female mortality up to the age of 5 years is greater than one but sex discrimination can change sex ratios. The estimation of mortality by sex and identification of countries with outlying levels is challenging because of issues with data availability and quality, and because sex ratios might vary naturally based on differences in mortality levels and associated cause of death distributions. For this systematic analysis, we estimated country-specific mortality sex ratios for infants, children aged 1-4 years, and children under the age of 5 years (under 5s) for all countries from 1990 (or the earliest year of data collection) to 2012 using a Bayesian hierarchical time series model, accounting for various data quality issues and assessing the uncertainty in sex ratios. We simultaneously estimated the global relation between sex ratios and mortality levels and constructed estimates of expected and excess female mortality rates to identify countries with outlying sex ratios. Global sex ratios in 2012 were 1·13 (90% uncertainty interval 1·12-1·15) for infants, 0·95 (0·93-0·97) for children aged 1-5 years, and 1·08 (1·07-1·09) for under 5s, an increase since 1990 of 0·01 (-0·01 to 0·02) for infants, 0·04 (0·02 to 0·06) for children aged 1-4 years, and 0·02 (0·01 to 0·04) for under 5s. Levels and trends varied across regions and countries. Sex ratios were lowest in southern Asia for 1990 and 2012 for all age groups. Highest sex ratios were seen in developed regions and the Caucasus and central Asia region. Decreasing mortality was associated with increasing sex ratios, except at very low infant mortality, where sex ratios decreased with total mortality. For 2012, we identified 15 countries with outlying under-5 sex ratios, of which ten countries had female mortality higher than expected (Afghanistan, Bahrain, Bangladesh, China, Egypt, India, Iran, Jordan, Nepal, and Pakistan). Although excess female

  3. Survival of infants born to HIV-positive mothers, by feeding modality, in Rakai, Uganda.

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    Joseph Kagaayi

    Full Text Available BACKGROUND: Data comparing survival of formula-fed to breast-fed infants in programmatic settings are limited. We compared mortality and HIV-free of breast and formula-fed infants born to HIV-positive mothers in a program in rural, Rakai District Uganda. METHODOLOGY/PRINCIPAL FINDINGS: One hundred eighty two infants born to HIV-positive mothers were followed at one, six and twelve months postpartum. Mothers were given infant-feeding counseling and allowed to make informed choices as to whether to formula-feed or breast-feed. Eligible mothers and infants received antiretroviral therapy (ART if indicated. Mothers and their newborns received prophylaxis for prevention of mother-to-child HIV transmission (pMTCT if they were not receiving ART. Infant HIV infection was detected by PCR (Roche Amplicor 1.5 during the follow-up visits. Kaplan Meier time-to-event methods were used to compare mortality and HIV-free survival. The adjusted hazard ratio (Adjusted HR of infant HIV-free survival was estimated by Cox regression. Seventy-five infants (41% were formula-fed while 107 (59% were breast-fed. Exclusive breast-feeding was practiced by only 25% of breast-feeding women at one month postpartum. The cumulative 12-month probability of infant mortality was 18% (95% CI = 11%-29% among the formula-fed compared to 3% (95% CI = 1%-9% among the breast-fed infants (unadjusted hazard ratio (HR = 6.1(95% CI = 1.7-21.4, P-value < 0.01. There were no statistically significant differentials in HIV-free survival by feeding choice (86% in the formula-fed compared to 96% in breast-fed group (Adjusted RH = 2.8[95%CI = 0.67-11.7, P-value = 0.16] CONCLUSIONS/SIGNIFICANCE: Formula-feeding was associated with a higher risk of infant mortality than breastfeeding in this rural population. Our findings suggest that formula-feeding should be discouraged in similar African settings.

  4. The effectiveness of antenatal care programmes to reduce infant mortality and preterm birth in socially disadvantaged and vulnerable women in high-income countries: a systematic review

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    Brocklehurst Peter

    2011-02-01

    Full Text Available Abstract Background Infant mortality has shown a steady decline in recent years but a marked socioeconomic gradient persists. Antenatal care is generally thought to be an effective method of improving pregnancy outcomes, but the effectiveness of specific antenatal care programmes as a means of reducing infant mortality in socioeconomically disadvantaged and vulnerable groups of women has not been rigorously evaluated. Methods We conducted a systematic review, focusing on evidence from high income countries, to evaluate the effectiveness of alternative models of organising or delivering antenatal care to disadvantaged and vulnerable groups of women vs. standard antenatal care. We searched Medline, Embase, Cinahl, PsychINFO, HMIC, CENTRAL, DARE, MIDIRS and a number of online resources to identify relevant randomised and observational studies. We assessed effects on infant mortality and its major medical causes (preterm birth, congenital anomalies and sudden infant death syndrome (SIDS Results We identified 36 distinct eligible studies covering a wide range of interventions, including group antenatal care, clinic-based augmented care, teenage clinics, prenatal substance abuse programmes, home visiting programmes, maternal care coordination and nutritional programmes. Fifteen studies had adequate internal validity: of these, only one was considered to demonstrate a beneficial effect on an outcome of interest. Six interventions were considered 'promising'. Conclusions There was insufficient evidence of adequate quality to recommend routine implementation of any of the programmes as a means of reducing infant mortality in disadvantaged/vulnerable women. Several interventions merit further more rigorous evaluation.

  5. Community response to intermittent preventive treatment of malaria in infants (IPTi in Papua New Guinea

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    Senn Nicolas

    2010-12-01

    Full Text Available Abstract Background Building on previous acceptability research undertaken in sub-Saharan Africa this article aims to investigate the acceptability of intermittent preventive treatment of malaria in infants (IPTi in Papua New Guinea (PNG. Methods A questionnaire was administered to mothers whose infants participated in the randomised placebo controlled trial of IPTi. Mothers whose infants participated and who refused to participate in the trial, health workers, community reporters and opinion leaders were interviewed. Men and women from the local community also participated in focus group discussions. Results Respondents viewed IPTi as acceptable in light of wider concern for infant health and the advantages of trial participation. Mothers reported complying with at-home administration of IPTi due to perceived benefits of IPTi and pressure from health workers. In spite of patchy knowledge, respondents also demonstrated a demand for infant vaccinations and considered non-vaccination to be neglect. There is little evidence that IPTi has negative impacts on attitudes to EPI, EPI adherence or existing malaria prevention practices. Conclusion The degree of similarity between findings from the acceptability studies undertaken in sub-Saharan Africa and PNG allows some generalization relating to the implementation of IPTi outside of Africa: IPTi fits well with local health cultures, appears to be accepted easily and has little impact on attitudes towards EPI or malaria prevention. The study adds to the evidence indicating that IPTi could be rolled out in a range of social and cultural contexts.

  6. Botulism mortality in the USA, 1975–2009

    Science.gov (United States)

    Jackson, Kelly A.; Mahon, Barbara E.; Copeland, John; Fagan, Ryan P.

    2017-01-01

    Botulism had mortality rates >60% before the 1950s. We reviewed confirmed botulism cases in the USA during 1975–2009 including infant, foodborne, wound, and other/unknown acquisition categories, and calculated mortality ratios. We created a multivariate logistic regression model for non-infant cases (foodborne, wound, and other/unknown). Overall mortality was 3.0% with 109 botulism-related deaths among 3,618 botulism cases [18 (<1%) deaths among 2,352 infant botulism cases, 61 (7.1%) deaths among 854 foodborne botulism cases, 18 (5.0%) deaths among 359 wound botulism cases, and 12 (22.6%) deaths among 53 other/unknown botulism cases]. Mortality among all cases increased with age; it was lowest among infants (0.8%) and highest among persons ≥80 years old (34.4%). Toxin type F had higher mortality (13.8%) than types A, B, or E (range, 1.4% to 4.1%). Efforts to reduce botulism mortality should target non-infant transmission categories and older adults. PMID:28603554

  7. Probiotics and prebiotics in prevention and treatment of diseases in infants and children.

    Science.gov (United States)

    Vandenplas, Yvan; Veereman-Wauters, Genevieve; De Greef, Elisabeth; Peeters, Stefaan; Casteels, Ann; Mahler, Tania; Devreker, Thierry; Hauser, Bruno

    2011-01-01

    To evaluate the impact of probiotics and prebiotics on the health of children. MEDLINE and LILACS were searched for relevant English and French-language articles. Human milk is rich in prebiotic oligosaccharides and may contain some probiotics. No data suggest that addition of probiotics to infant formula may be harmful, but evidence of its efficacy is insufficient for its recommendation. Since data suggest that addition of specific prebiotic oligosaccharides may reduce infections and atopy in healthy infants, their addition to infant formula seems reasonable. Long-term health benefits of pro- and prebiotics on the developing immune system remain to be proven. Selected probiotics reduce the duration of infectious diarrhea by 1 day, but evidence in prevention is lacking, except in antibiotic-associated diarrhea. Some specific probiotics prevent necrotizing enterocolitis, and other microorganisms may be beneficial in Helicobacter pylori gastritis and in infantile colic. Evidence is insufficient to recommend probiotics in prevention and treatment of atopic dermatitis. The use of probiotics in constipation, irritable bowel syndrome, inflammatory bowel disease, and extra-intestinal infections requires more studies. Duration of administration, microbial dosage, and species used need further validation for both pro- and prebiotics. Unjustified health claims are a major threat for the pro- and prebiotic concept.

  8. Routine use of daily oral vitamin K to treat infants with cystic fibrosis.

    Science.gov (United States)

    Cottam, Sophie T; Connett, Gary J

    2015-10-01

    Vitamin K is routinely administered after birth in the UK to prevent haemorrhagic disease of the newborn. Despite this, vitamin K-deficient coagulopathy still occurs in infants with high morbidity and mortality. Up to 50% of late onset bleeding presents with intracranial haemorrhage. The risk of developing vitamin K coagulopathy is higher in infants with cystic fibrosis (CF) and those that are exclusively breast fed due to low vitamin K levels in breast milk and intestinal changes in bacterial flora. Oral vitamin K supplementation is a simple addition to routine CF treatment during infancy to prevent complications from significant coagulopathy. Copyright © 2015 Elsevier Ltd. All rights reserved.

  9. Infant and Child Mortality in India in the Last Two Decades: A Geospatial Analysis

    Science.gov (United States)

    Singh, Abhishek; Pathak, Praveen Kumar; Chauhan, Rajesh Kumar; Pan, William

    2011-01-01

    Background Studies examining the intricate interplay between poverty, female literacy, child malnutrition, and child mortality are rare in demographic literature. Given the recent focus on Millennium Development Goals 4 (child survival) and 5 (maternal health), we explored whether the geographic regions that were underprivileged in terms of wealth, female literacy, child nutrition, or safe delivery were also grappling with the elevated risk of child mortality; whether there were any spatial outliers; whether these relationships have undergone any significant change over historical time periods. Methodology The present paper attempted to investigate these critical questions using data from household surveys like NFHS 1992–1993, NFHS 1998–1999 and DLHS 2002–2004. For the first time, we employed geo-spatial techniques like Moran's-I, univariate LISA, bivariate LISA, spatial error regression, and spatiotemporal regression to address the research problem. For carrying out the geospatial analysis, we classified India into 76 natural regions based on the agro-climatic scheme proposed by Bhat and Zavier (1999) following the Census of India Study and all estimates were generated for each of the geographic regions. Result/Conclusions This study brings out the stark intra-state and inter-regional disparities in infant and under-five mortality in India over the past two decades. It further reveals, for the first time, that geographic regions that were underprivileged in child nutrition or wealth or female literacy were also likely to be disadvantaged in terms of infant and child survival irrespective of the state to which they belong. While the role of economic status in explaining child malnutrition and child survival has weakened, the effect of mother's education has actually become stronger over time. PMID:22073208

  10. Infant-mortality testing of high-energy-density capacitors used on Nova

    International Nuclear Information System (INIS)

    Merritt, B.T.; Whitham, K.

    1983-01-01

    Nova is a solid-state large laser for inertial-confinement fusion research. Its flashlamps are driven by a 60-MJ capacitor bank. Part of this bank is being built with high-energy-density capacitors, 52-μF, 22 kV, 12.5 kJ. A total of 2645 of these capacitors have been purchased from two manufacturers. Each capacitor was infant-mortality tested. The first test consisted of a high-potential test, bushing-to-case, since these capacitors have dual bushings. Then the capacitors were discharged 500 times with circuit conditions approximating the capacitors normal flashlamp load. Failure of either of these tests or if the capacitor was leaking was cause for rejection

  11. The decline of infant and child mortality among Spanish Gitanos or Calé (1871−2005: A microdemographic study in Andalusia

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    Juan F. Gamella

    2017-03-01

    Full Text Available Background: Most Romani groups in Europe have experienced a decline in childhood mortality during recent decades. These crucial transformations are rarely addressed in research or public policy. Objective: This paper analyzes the timing and structure of the decline of childhood mortality among the Gitano people of Spain. Methods: The paper is based on the family and genealogy reconstitution of the Gitano population of 22 contiguous localities in Southern Spain. Registry data from over 19,100 people and 3,501 reconstituted families was included in a dense genealogical grid ranging over 150 years. From this database we produced annual time series of infant and child mortality and of the registered causes of death from 1871 to 2005. Results: The analyzed data shows a rapid decline in infant and child mortality from about 1949 to 1970. The onset of the definitive decline occurred in the late 1940s and early 1950s. Child mortality was higher in the pre-transitional period and started to decline earlier, although it took longer to converge with majority rates. The mortality transition in the Gitano minority paralleled that of the dominant majority, but with important delays and higher mortality rates. The causes of death show the deprivation suffered by Gitano people. Conclusions: The childhood mortality decline facilitated the most important changes experienced recently by the Gitano minority, including its fertility transition and the transformation of Gitanos' gender and family systems. Contribution: This is one of the first historical reconstructions of the mortality transition of a Romani population.

  12. [Pertussis vaccination in pregnancy: Security and effectiveness in the protection of the infant].

    Science.gov (United States)

    Villena, Rodolfo; Vidal, Pamela; Carrillo, Felipe; Salinas, Mónica

    2017-06-01

    Whooping cough is an immune preventable disease that can be life threatening. Despite infant immunization starting at 2 month of age, there are many cases and outbreaks in our country and also around the world, with a high risk of mortality specially in infants under 6 month of age. It has been proposed that antenatal vaccination with acellular pertussis component (Tdap) would be useful, safe and effective since it transfers a high antibody rate to the child, reducing the incidence of pertussis in this group by 85%. No higher incidence of adverse effects has been found in pregnant women with this vaccine. This strategy has been implemented in several developed and Latin American countries. The purpose of this manuscript is to review and discuss the benefits of antenatal vaccination with Tdap. It was concluded that maternal immunization with Tdap vaccine should be promoted to prevent infection and associated mortality in the less than 6 months of age by Bordetella pertussis.

  13. Autopsy as a tool in the prevention of maternal mortality | Daramola ...

    African Journals Online (AJOL)

    Maternal mortality rates are an index of the state of a nation's health system. Maternal autopsies help to determine these rates, provide information on avoidable/unavoidable causes of mortality, consequently leading to the development of strategies for treatment and prevention ofmaternalmortality andmorbidity. The lesson ...

  14. Infant mortality in the Federal Republic of Germany in the years after Chernobyl. Study into the influence of the Chernobyl reactor accident in April 1986 on infant mortality in lightly and heavily contaminated areas of the Federal Republic of Germany. Saeuglingssterblichkeit nach Tschernobyl in der BRD. Untersuchung der Auswirkungen des Reaktorunfalls von Tschernobyl im April 1986 auf die Saeuglingssterblichkeit in schwach- und hochbelasteten Gebieten der Bundesrepublik Deutschland

    Energy Technology Data Exchange (ETDEWEB)

    Martini, W; Scholz, H; Hacker, C; Beushausen, S; Heydenreich, B; Platiel, G

    1991-04-01

    Study into the influence of the Chernobyl reactor accident in April 1986 on infant mortility in lightly and heavily contaminated areas of the Federal Republic of Germany. In connection with this scientific study, official quarterly reports on population developments released by the Wiesbaden-based Federal Office of Statistics were subjected to a time-dependent analysis. On the basis of generally applicable stastical laws infant mortality curves plotted after 1958 were examined for changes after Chernobyl. In view of regional differences in the effects from radioactive precipitations due to the Chernobyl ractor accident, the examinations were performed in subgroups that were largely derived from the results of a study covering all of the Federal territory. The analysis revealed the following links: The curve of the infant mortality rates for the first 7 days after delivery (7-day mortalities) pointed to a linear-exponential relationship between the point of time investigated and number of infants dying. In heavily contaminated areas the 7-day mortality rates determined after 1986 show statistically significant deviations from developments as expected from normal rates. (orig./MG).

  15. Socio-economic determinants of mortality in Bangladesh.

    Science.gov (United States)

    Kabir, M; Howlader, A A

    1980-01-01

    Infant mortality in Bangladesh is 1 of the highest in Asian countries. There are several reasons why infant mortality is still high in Bangladesh. A large number of births occur prematurely, or there is poor handling by birth attendants leading to injury and infection. In addition, there is a gross shortage of maternity clinics, trained midwives, and other paramedical personnel in the country. The children are generally born in the most unhygienic of conditions. Malnutrition is a common factor. In recent years, the study of socioeconomic differentials of infant and child mortality has occupied an important position in demographic research. Given the limited data available to measure many variables which could have an effect on mortality as measured here by infant mortality, the analysis has been essentially confined to an analysis of differences in infant mortality by various socioeconomic characteristics. The factors and relative contributions of the combined effects of medical services, general socioeconomic and environmental factors need to be examined. Mortality can be seen in this context as a final consequence of the interactions between health, work, and income. Due to lack of data availability, very little work has been done on this. The World Fertility Survey has given a unique opportunity to researchers to explore this field more comprehensively.

  16. Mortality, neonatal morbidity and two year follow-up of extremely preterm infants born in The Netherlands in 2007.

    Directory of Open Access Journals (Sweden)

    Cornelia G de Waal

    Full Text Available Extremely preterm infants are at high risk of neonatal mortality and adverse outcome. Survival rates are slowly improving, but increased survival may come at the expense of more handicaps.Prospective population-based cohort study of all infants born at 23 to 27 weeks of gestation in The Netherlands in 2007. 276 of 345 (80% infants were born alive. Early neonatal death occurred in 96 (34.8% live born infants, including 61 cases of delivery room death. 29 (10.5% infants died during the late neonatal period. Survival rates for live born infants at 23, 24, 25 and 26 weeks of gestation were 0%, 6.7%, 57.9% and 71% respectively. 43.1% of 144 surviving infants developed severe neonatal morbidity (retinopathy of prematurity grade ≥3, bronchopulmonary dysplasia and/or severe brain injury. At two years of age 70.6% of the children had no disability, 17.6% was mild disabled and 11.8% had a moderate-to-severe disability. Severe brain injury (p = 0.028, retinopathy of prematurity grade ≥3 (p = 0.024, low gestational age (p = 0.019 and non-Dutch nationality of the mother (p = 0.004 increased the risk of disability.52% of extremely preterm infants born in The Netherlands in 2007 survived. Surviving infants had less severe neonatal morbidity compared to previous studies. At two years of age less than 30% of the infants were disabled. Disability was associated with gestational age and neonatal morbidity.

  17. Azithromycin in the extremely low birth weight infant for the prevention of Bronchopulmonary Dysplasia: a pilot study

    Directory of Open Access Journals (Sweden)

    Anstead Michael I

    2007-06-01

    Full Text Available Abstract Background Azithromycin reduces the severity of illness in patients with inflammatory lung disease such as cystic fibrosis and diffuse panbronchiolitis. Bronchopulmonary dysplasia (BPD is a pulmonary disorder which causes significant morbidity and mortality in premature infants. BPD is pathologically characterized by inflammation, fibrosis and impaired alveolar development. The purpose of this study was to obtain pilot data on the effectiveness and safety of prophylactic azithromycin in reducing the incidence and severity of BPD in an extremely low birth weight (≤ 1000 grams population. Methods Infants ≤ 1000 g birth weight admitted to the University of Kentucky Neonatal Intensive Care Unit (level III, regional referral center from 9/1/02-6/30/03 were eligible for this pilot study. The pilot study was double-blinded, randomized, and placebo-controlled. Infants were randomized to treatment or placebo within 12 hours of beginning mechanical ventilation (IMV and within 72 hours of birth. The treatment group received azithromycin 10 mg/kg/day for 7 days followed by 5 mg/kg/day for the duration of the study. Azithromycin or placebo was continued until the infant no longer required IMV or supplemental oxygen, to a maximum of 6 weeks. Primary endpoints were incidence of BPD as defined by oxygen requirement at 36 weeks gestation, post-natal steroid use, days of IMV, and mortality. Data was analyzed by intention to treat using Chi-square and ANOVA. Results A total of 43 extremely premature infants were enrolled in this pilot study. Mean gestational age and birth weight were similar between groups. Mortality, incidence of BPD, days of IMV, and other morbidities were not significantly different between groups. Post-natal steroid use was significantly less in the treatment group [31% (6/19] vs. placebo group [62% (10/16] (p = 0.05. Duration of mechanical ventilation was significantly less in treatment survivors, with a median of 13 days (1–47

  18. Postnatal fish oil supplementation in high-risk infants to prevent allergy: randomized controlled trial.

    Science.gov (United States)

    D'Vaz, N; Meldrum, S J; Dunstan, J A; Martino, D; McCarthy, S; Metcalfe, J; Tulic, M K; Mori, T A; Prescott, S L

    2012-10-01

    Relative deficiency of dietary omega 3 polyunsaturated fatty acids (n-3 PUFA) has been implicated in the rising allergy prevalence in Westernized countries. Fish oil supplementation may provide an intervention strategy for primary allergy prevention. The objective of this study was to assess the effect of fish oil n-3 PUFA supplementation from birth to 6 months of age on infant allergic disease. In a double-blind randomized controlled trial, 420 infants at high atopic risk received a daily supplement of fish oil containing 280 mg docosahexaenoic acid and 110 mg eicosapentaenoic acid or a control (olive oil), from birth to age 6 months. PUFA levels were measured in 6-month-old infants' erythrocytes and plasma and their mothers' breast milk. Eczema, food allergy, asthma and sensitization were assessed in 323 infants for whom clinical follow-up was completed at 12 months of age. At 6 months of age, infant docosahexaenoic acid and eicosapentaenoic acid levels were significantly higher (both P acid levels were lower (P = .003) in the fish oil group. Although n-3 PUFA levels at 6 months were associated with lower risk of eczema (P = .033) and recurrent wheeze (P = .027), the association with eczema was not significant after multiple comparisons and there was no effect of the intervention per se on the primary study outcomes. Specifically, between-group comparisons revealed no differences in the occurrence of allergic outcomes including sensitization, eczema, asthma, or food allergy. Postnatal fish oil supplementation improved infant n-3 status but did not prevent childhood allergic disease.

  19. The effect of changes in health sector resources on infant mortality in the short-run and the long-run: a longitudinal econometric analysis.

    Science.gov (United States)

    Farahani, Mansour; Subramanian, S V; Canning, David

    2009-06-01

    While countries with higher levels of human resources for health typically have better population health, the evidence that increases in the level of human resources for health leads to improvements in population health is limited. We use a dynamic regression model to obtain estimates of both the short-run and long-term effects of changes in physicians per capita, our measure of health system resources, on infant mortality. Using a dataset of 99 countries at 5-year intervals from 1960-2000, we estimate that increasing the number of physicians by one per 1000 population (roughly a doubling of current levels of provision) decreases the infant mortality rate by 15% within 5 years and by 45% in the long-run with half the long-run gain being achieved in 15 years. We conclude that the long-run effects of heath system resources are substantially larger than previously estimated. Our results suggest, however, that countries that have delayed action on the Millennium Development Goal of reducing infant and child mortality rate by two-thirds by 2015 (relative to 1990) may have difficulty meeting this goal even if they rapidly increase resources now.

  20. In Italy, North-South Differences in IQ Predict Differences in Income, Education, Infant Mortality, Stature, and Literacy

    Science.gov (United States)

    Lynn, Richard

    2010-01-01

    Regional differences in IQ are presented for 12 regions of Italy showing that IQs are highest in the north and lowest in the south. Regional IQs obtained in 2006 are highly correlated with average incomes at r = 0.937, and with stature, infant mortality, literacy and education. The lower IQ in southern Italy may be attributable to genetic…

  1. Spending to save? State health expenditure and infant mortality in India.

    Science.gov (United States)

    Bhalotra, Sonia

    2007-09-01

    There are severe inequalities in health in the world, poor health being concentrated amongst poor people in poor countries. Poor countries spend a much smaller share of national income on health expenditure than do richer countries. What potential lies in political or growth processes that raise this share? This depends upon how effective government health spending in developing countries is. Existing research presents little evidence of an impact on childhood mortality. Using specifications similar to those in the existing literature, this paper finds a similar result for India, which is that state health spending saves no lives. However, upon allowing lagged effects, controlling in a flexible way for trended unobservables and restricting the sample to rural households, a significant effect of health expenditure on infant mortality emerges, the long run elasticity being about -0.24. There are striking differences in the impact by social group. Slicing the data by gender, birth order, religion, maternal and paternal education and maternal age at birth, I find the weakest effects in the most vulnerable groups (with the exception of a large effect for scheduled tribes). Copyright (c) 2007 John Wiley & Sons, Ltd.

  2. Comitês de prevenção da mortalidade infantil no Paraná, Brasil: implantação e operacionalização Committees for the prevention of infant mortality in the State of Paraná, Brazil: implementation and operation

    Directory of Open Access Journals (Sweden)

    Nereu Henrique Mansano

    2004-02-01

    Full Text Available Este artigo tem por objetivo relatar a experiência de implantação e funcionamento dos Comitês de Prevenção da Mortalidade Infantil no Estado do Paraná, Brasil, apresentando as estratégias de operacionalização, composição e fluxo dos três níveis: estadual, regional e municipal. Para a efetiva implantação dessa proposta, foi necessário preparar profissionais para investigar o óbito infantil e, portanto, foram realizados treinamentos de Multiplicadores para Investigação dos Óbitos Infantis. Em dois anos, os comitês analisaram 50% dos óbitos do Estado. Pretende-se ampliar gradativamente o número de óbitos analisados, bem como dar continuidade ao acompanhamento e à reestruturação dos comitês, visando a obter melhor desempenho, mais agilidade e melhor qualidade dos dados.This article reports on the implementation and operation of committees for the prevention of infant mortality in the State of Paraná, Brazil, with the operational strategies, formation, and relations at three levels: State, regional, and municipal. To implement the committees it was necessary to train professionals to investigate infant deaths. In two years the committees analyzed 50% of the infant deaths occurring in the State. The goal is to increase the number of cases analyzed and to continue to monitor the committees' work, seeking improved performance, agility, and data quality.

  3. Perinatal mortality among infants born during health user-fees (Cash & Carry) and the national health insurance scheme (NHIS) eras in Ghana: a cross-sectional study.

    Science.gov (United States)

    Ibrahim, Abdallah; Maya, Ernest T; Donkor, Ernestina; Agyepong, Irene A; Adanu, Richard M

    2016-12-08

    This research determined the rates of perinatal mortality among infants delivered under Ghana's national health insurance scheme (NHIS) compared to infants delivered under the previous "Cash and Carry" system in Northern Region, especially as the country takes stock of its progress toward meeting the Millennium Development Goals (MDG) 4 and 5. The labor and maternity wards delivery records of infants delivered before and after the implementation of the NHIS in Northern Region were examined. Records of available daily deliveries during the two health systems were extracted. Fisher's exact tests of non-random association were used to examine the bivariate association between categorical independent variables and perinatal mortality. On average, 8% of infants delivered during the health user-fee (Cash & Carry) died compared to about 4% infant deaths during the NHIS delivery fee exemption period in Northern Region, Ghana. There were no remarkable difference in the rate of infant deaths among mothers in almost all age categories in both the Cash and Carry and the NHIS periods except in mothers age 35 years and older. Infants born to multiparous mothers were significantly more likely to die than those born to first time mothers. There were more twin deaths during the Cash and Carry system (p = 0.001) compared to the NHIS system. Deliveries by caesarean section increased from an average of 14% in the "Cash and Carry" era to an average of 20% in the NHIS era. The overall rate of perinatal mortality declined by half (50%) in infants born during the NHIS era compared to the Cash and Carry era. However, caesarean deliveries increased during the NHIS era. These findings suggest that pregnant women in the Northern Region of Ghana were able to access the opportunity to utilize the NHIS for antenatal visits and possibly utilized skilled care at delivery at no cost or very minimal cost to them, which therefore improved Ghana's progress towards meeting the MDG 4, (reducing

  4. Threshold Levels of Infant and Under-Five Mortality for Crossover between Life Expectancies at Ages Zero, One and Five in India: A Decomposition Analysis.

    Science.gov (United States)

    Dubey, Manisha; Ram, Usha; Ram, Faujdar

    2015-01-01

    Under the prevailing conditions of imbalanced life table and historic gender discrimination in India, our study examines crossover between life expectancies at ages zero, one and five years for India and quantifies the relative share of infant and under-five mortality towards this crossover. We estimate threshold levels of infant and under-five mortality required for crossover using age specific death rates during 1981-2009 for 16 Indian states by sex (comprising of India's 90% population in 2011). Kitagawa decomposition equations were used to analyse relative share of infant and under-five mortality towards crossover. India experienced crossover between life expectancies at ages zero and five in 2004 for menand in 2009 for women; eleven and nine Indian states have experienced this crossover for men and women, respectively. Men usually experienced crossover four years earlier than the women. Improvements in mortality below ages five have mostly contributed towards this crossover. Life expectancy at age one exceeds that at age zero for both men and women in India except for Kerala (the only state to experience this crossover in 2000 for men and 1999 for women). For India, using life expectancy at age zero and under-five mortality rate together may be more meaningful to measure overall health of its people until the crossover. Delayed crossover for women, despite higher life expectancy at birth than for men reiterates that Indian women are still disadvantaged and hence use of life expectancies at ages zero, one and five become important for India. Greater programmatic efforts to control leading causes of death during the first month and 1-59 months in high child mortality areas can help India to attain this crossover early.

  5. Successful prevention of HIV transmission from mother to infant in Brazil using a multidisciplinary team approach

    Directory of Open Access Journals (Sweden)

    Susie A. Nogueira

    Full Text Available OBJECTIVES: To determine the HIV vertical transmission rate (VTR and associated risk factors by use of zidovudine and infant care education in Brazil. METHODS: Since 1995, a prospective cohort of HIV infected pregnant women has been followed at the Federal University of Rio de Janeiro. A multidisciplinary team was established to implement the best available strategy to prevent maternal-infant HIV transmission. Patients with AIDS or low CD4 and high viral load received anti-retroviral drugs in addition to zidovudine. Children were considered infected if they had 2 positive PCR-RNA tests between 1 and 4 months of age, or were HIV antibody positive after 18 months. Education regarding infant treatment and use of formula instead of breast feeding was provided. RESULTS: Between 1995 and August, 2000, HIV status was determined for 145 infants. Compliance with intra-partum treatment, infant treatment and use of formula was 88.2%. Intra-partum zidovudine treatment was completed in 134/145 (92.6% of patients; 88.1% had rupture of membranes 4 hours were associated with increased HIV transmission. CONCLUSION: HIV vertical transmission in Brazil was reduced to a level similar to other countries with the most effective prevention programs using a multidisciplinary team approach. A high level of compliance for use of anti-retroviral drugs, the provision of health education to mothers, and use of formula for all exposed infants.

  6. Successful prevention of HIV transmission from mother to infant in Brazil using a multidisciplinary team approach

    Directory of Open Access Journals (Sweden)

    Nogueira Susie A.

    2001-01-01

    Full Text Available OBJECTIVES: To determine the HIV vertical transmission rate (VTR and associated risk factors by use of zidovudine and infant care education in Brazil. METHODS: Since 1995, a prospective cohort of HIV infected pregnant women has been followed at the Federal University of Rio de Janeiro. A multidisciplinary team was established to implement the best available strategy to prevent maternal-infant HIV transmission. Patients with AIDS or low CD4 and high viral load received anti-retroviral drugs in addition to zidovudine. Children were considered infected if they had 2 positive PCR-RNA tests between 1 and 4 months of age, or were HIV antibody positive after 18 months. Education regarding infant treatment and use of formula instead of breast feeding was provided. RESULTS: Between 1995 and August, 2000, HIV status was determined for 145 infants. Compliance with intra-partum treatment, infant treatment and use of formula was 88.2%. Intra-partum zidovudine treatment was completed in 134/145 (92.6% of patients; 88.1% had rupture of membranes 4 hours were associated with increased HIV transmission. CONCLUSION: HIV vertical transmission in Brazil was reduced to a level similar to other countries with the most effective prevention programs using a multidisciplinary team approach. A high level of compliance for use of anti-retroviral drugs, the provision of health education to mothers, and use of formula for all exposed infants.

  7. Sustainability of the prevention of passive infant smoking within well-baby clinics

    NARCIS (Netherlands)

    Crone, M.R.; Verlaan, M.; Willemsen, M.C.; Soelen, P. van; Reijneveld, S.A.; Sing, R.A.H.; Paulussen, T.G.W.M.

    2006-01-01

    This study assessed the antecedents of continued use of an education program to prevent passive smoking in infants. It consists of a booklet for parents and a manual for health professionals describing a five-step procedure for discussing passive smoking. Aquestionnairewas sent to 67 managers, 670

  8. Nutritional management of breastfeeding infants for the prevention of common nutrient deficiencies and excesses

    Directory of Open Access Journals (Sweden)

    Jin Soo Moon

    2011-07-01

    Full Text Available Breastfeeding is the best source of nutrition for every infant, and exclusive breastfeeding for 6 months is usually optimal in the common clinical situation. However, inappropriate complementary feeding could lead to a nutrient-deficient status, such as iron deficiency anemia, vitamin D deficiency, and growth faltering. The recent epidemic outbreak of obesity in Korean children emphasizes the need for us to control children’s daily sedentary life style and their intakes of high caloric foods in order to prevent obesity. Recent assessment of breastfeeding in Korea has shown that the rate is between 63% and 89%; thus, up-to-dated evidence-based nutritional management of breastfeeding infants to prevent common nutrient deficiencies or excesses should be taught to all clinicians and health care providers.

  9. Functional Gastrointestinal Disorders in Infants: Long-Tern Consequences and Modern Approaches for Prevention and Treatment

    Directory of Open Access Journals (Sweden)

    Evgeniya G. Makarova

    2017-01-01

    Full Text Available The article discusses modern ideas about the genesis of the most common variants of functional gastrointestinal disorders (FGID in infants, and their ability to lead to long-term negative consequences for the health of the child. The article provides data on role of intestinal microbiota in development of FGID in infants and current approaches to prevention and correction using probiotics with proven effectiveness. 

  10. Teenage motherhood and infant mortality in Bangladesh: maternal age-dependent effect of parity one.

    Science.gov (United States)

    Alam, N

    2000-04-01

    Nuptiality norms in rural Bangladesh favour birth during the teenage years. An appreciable proportion of teenage births are, in fact, second births. This study examines the relationship between teenage fertility and high infant mortality. It is hypothesized that if physiological immaturity is responsible, then the younger the mother, the higher would be the mortality risk, and the effect of mother's 'teenage' on mortality in infancy, particularly in the neonatal period, would be higher for the second than the first births. Vital events recorded by the longitudinal demographic surveillance system in Matlab, Bangladesh, in 1990-92 were used. Logistic regression was used to estimate the effects on early and late neonatal (0-3 days and 4-28 days respectively) and post-neonatal mortality of the following variables: mother's age at birth, parity, education and religion, sex of the child, household economic status and exposure to a health intervention programme. The younger the mother, the higher were the odds of her child dying as a neonate, and the odds were higher for second children than first children of teenage mothers. First-born children were at higher odds of dying in infancy than second births if mothers were in their twenties. Unfavourable mother's socioeconomic conditions were weakly, but significantly, associated with higher odds of dying during late neonatal and post-neonatal periods. The results suggest that physical immaturity may be of major importance in determining the relationship between teenage fertility and high neonatal mortality.

  11. Sustainability of the prevention of passive infant smoking within well-baby clinics

    NARCIS (Netherlands)

    Crone, MR; Verlaan, M; Willemsen, MC; van Soelen, P; Reijneveld, SA; Sing, RAH; Paulussen, TGWA

    This study assessed the antecedents of continued use of an education program to prevent passive smoking in infants. It consists of a booklet for parents and a manual for health professionals describing a five-step procedure for discussing passive smoking. A questionnaire was sent to 67 managers, 670

  12. Prevention of lymphocyte apoptosis in septic mice with cancer increases mortality.

    Science.gov (United States)

    Fox, Amy C; Breed, Elise R; Liang, Zhe; Clark, Andrew T; Zee-Cheng, Brendan R; Chang, Katherine C; Dominguez, Jessica A; Jung, Enjae; Dunne, W Michael; Burd, Eileen M; Farris, Alton B; Linehan, David C; Coopersmith, Craig M

    2011-08-15

    Lymphocyte apoptosis is thought to have a major role in the pathophysiology of sepsis. However, there is a disconnect between animal models of sepsis and patients with the disease, because the former use subjects that were healthy prior to the onset of infection while most patients have underlying comorbidities. The purpose of this study was to determine whether lymphocyte apoptosis prevention is effective in preventing mortality in septic mice with preexisting cancer. Mice with lymphocyte Bcl-2 overexpression (Bcl-2-Ig) and wild type (WT) mice were injected with a transplantable pancreatic adenocarcinoma cell line. Three weeks later, after development of palpable tumors, all animals received an intratracheal injection of Pseudomonas aeruginosa. Despite having decreased sepsis-induced T and B lymphocyte apoptosis, Bcl-2-Ig mice had markedly increased mortality compared with WT mice following P. aeruginosa pneumonia (85 versus 44% 7-d mortality; p = 0.004). The worsened survival in Bcl-2-Ig mice was associated with increases in Th1 cytokines TNF-α and IFN-γ in bronchoalveolar lavage fluid and decreased production of the Th2 cytokine IL-10 in stimulated splenocytes. There were no differences in tumor size or pulmonary pathology between Bcl-2-Ig and WT mice. To verify that the mortality difference was not specific to Bcl-2 overexpression, similar experiments were performed in Bim(-/-) mice. Septic Bim(-/-) mice with cancer also had increased mortality compared with septic WT mice with cancer. These data demonstrate that, despite overwhelming evidence that prevention of lymphocyte apoptosis is beneficial in septic hosts without comorbidities, the same strategy worsens survival in mice with cancer that are given pneumonia.

  13. All-Cause Mortality of Low Birthweight Infants in Infancy, Childhood, and Adolescence: Population Study of England and Wales.

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    W John Watkins

    2016-05-01

    Full Text Available Low birthweight (LBW is associated with increased mortality in infancy, but its association with mortality in later childhood and adolescence is less clear. We investigated the association between birthweight and all-cause mortality and identified major causes of mortality for different birthweight groups.We conducted a population study of all live births occurring in England and Wales between 1 January 1993 and 31 December 2011. Following exclusions, the 12,355,251 live births were classified by birthweight: 500-1,499 g (very LBW [VLBW], n = 139,608, 1,500-2,499 g (LBW, n = 759,283, 2,500-3,499 g (n = 6,511,411, and ≥3,500 g (n = 4,944,949. The association of birthweight group with mortality in infancy (<1 y of age and childhood/adolescence (1-18 y of age was quantified, with and without covariates, through hazard ratios using Cox regression. International Classification of Diseases codes identified causes of death. In all, 74,890 (0.61% individuals died between birth and 18 y of age, with 23% of deaths occurring after infancy. Adjusted hazard ratios for infant deaths were 145 (95% CI 141, 149 and 9.8 (95% CI 9.5, 10.1 for the VLBW and LBW groups, respectively, compared to the ≥3,500 g group. The respective hazard ratios for death occurring at age 1-18 y were 6.6 (95% CI 6.1, 7.1 and 2.9 (95% CI 2.8, 3.1. Male gender, the youngest and oldest maternal age bands, multiple births, and deprivation (Index of Multiple Deprivation score also contributed to increased deaths in the VLBW and LBW groups in both age ranges. In infancy, perinatal factors, particularly respiratory issues and infections, explained 84% and 31% of deaths in the VLBW and LBW groups, respectively; congenital malformations explained 36% and 23% in the LBW group and ≥2,500 g groups (2,500-3,499 g and ≥3,500 g groups combined, respectively. Central nervous system conditions explained 20% of deaths in childhood/adolescence in the VLBW group, with deaths from neoplasms and

  14. Neonatal Outcomes of Infants Admitted to a Large Government Hospital in Amman, Jordan

    Science.gov (United States)

    Sivasubramaniam, Priya G.; Quinn, Cristin E.; Blevins, Meridith; Hajajra, Ahmand Al; Khuri-Bulos, Najwa; Faouri, Samir; Halasa, Natasha

    2015-01-01

    Objective: To describe characteristics and outcomes of Jordanian newborns admitted to a large governmental neonatal intensive care unit (NICU). Methods: Newborns born at the government hospital, Al Bashir, in Amman, Jordan were prospectively enrolled. The study focused on newborns admitted to the NICU and a retrospective chart review was performed. Abstraction included in-hospital mortality, antibiotic days, ventilation, oxygen use, and CRP levels. Rank sum and chi-squared tests were used to compare across outcomes. Logistic regression of hypothesized risk factors with death adjusted for gestational age. Results: Of the 5,466 neonates enrolled from 2/10-2/11, medical records were available for 321/378(84.9%) infants admitted to the NICU. The median gestational age was 36 weeks, median birth weight was 2.3 kg, and 28(8.7%) infants died. The two most common reasons for admission and mortality were respiratory distress syndrome and prematurity. Low Apgar scores and positive CRP were predictors of mortality. Risk factors associated with increased use of antibiotics, oxygen hood, and mechanical ventilation included lower gestational age and prematurity. Conclusion: Infants admitted to the Jordanian NICU have significantly higher median gestational age and birth weights than in developed countries and were associated with significant morbidity and mortality. Continuations of global efforts to prevent prematurity are needed. PMID:25946927

  15. Mortality among Guarani Indians in Southeastern and Southern Brazil

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    Andrey Moreira Cardoso

    2011-01-01

    Full Text Available Worldwide, indigenous peoples display a high burden of disease, expressed by profound health inequalities in comparison to non-indigenous populations. This study describes mortality patterns among the Guarani in Southern and Southeastern Brazil, with a focus on health inequalities. The Guarani population structure is indicative of high birth and death rates, low median age and low life expectancy at birth. The crude mortality rate (crude MR = 5.0/1,000 was similar to the Brazilian national rate, but the under-five MR (44.5/1,000 and the infant mortality rate (29.6/1,000 were twice the corresponding MR in the South and Southeast of Brazil. The proportion of post-neonatal infant deaths was 83.3%, 2.4 times higher than general population. The proportions of ill-defined (15.8% and preventable causes (51.6% were high. The principal causes of death were respiratory (40.6% and infectious and parasitic diseases (18.8%, suggesting precarious living conditions and deficient health services. There is a need for greater investment in primary care and interventions in social determinants of health in order to reduce the health inequalities.

  16. Mortality among Guarani Indians in Southeastern and Southern Brazil.

    Science.gov (United States)

    Cardoso, Andrey Moreira; Coimbra, Carlos E A; Barreto, Carla Tatiana Garcia; Werneck, Guilherme Loureiro; Santos, Ricardo Ventura

    2011-01-01

    Worldwide, indigenous peoples display a high burden of disease, expressed by profound health inequalities in comparison to non-indigenous populations. This study describes mortality patterns among the Guarani in Southern and Southeastern Brazil, with a focus on health inequalities. The Guarani population structure is indicative of high birth and death rates, low median age and low life expectancy at birth. The crude mortality rate (crude MR = 5.0/1,000) was similar to the Brazilian national rate, but the under-five MR (44.5/1,000) and the infant mortality rate (29.6/1,000) were twice the corresponding MR in the South and Southeast of Brazil. The proportion of post-neonatal infant deaths was 83.3%, 2.4 times higher than general population. The proportions of ill-defined (15.8%) and preventable causes (51.6%) were high. The principal causes of death were respiratory (40.6%) and infectious and parasitic diseases (18.8%), suggesting precarious living conditions and deficient health services. There is a need for greater investment in primary care and interventions in social determinants of health in order to reduce the health inequalities.

  17. Dietary prevention of allergic diseases in infants and small children. Part I

    DEFF Research Database (Denmark)

    Muraro, Antonella; Dreborg, Sten; Halken, Susanne

    2004-01-01

    . Sensitization to food allergens occurs in the first year of life and cow's milk allergy is the first food allergy to appear in the susceptible infants. Hypoallergenicity of food formulas to be used is a critical issue both for treatment of cow's milk-allergic children and for prevention. Methods to document...

  18. Threshold Levels of Infant and Under-Five Mortality for Crossover between Life Expectancies at Ages Zero, One and Five in India: A Decomposition Analysis.

    Directory of Open Access Journals (Sweden)

    Manisha Dubey

    Full Text Available Under the prevailing conditions of imbalanced life table and historic gender discrimination in India, our study examines crossover between life expectancies at ages zero, one and five years for India and quantifies the relative share of infant and under-five mortality towards this crossover.We estimate threshold levels of infant and under-five mortality required for crossover using age specific death rates during 1981-2009 for 16 Indian states by sex (comprising of India's 90% population in 2011. Kitagawa decomposition equations were used to analyse relative share of infant and under-five mortality towards crossover.India experienced crossover between life expectancies at ages zero and five in 2004 for menand in 2009 for women; eleven and nine Indian states have experienced this crossover for men and women, respectively. Men usually experienced crossover four years earlier than the women. Improvements in mortality below ages five have mostly contributed towards this crossover. Life expectancy at age one exceeds that at age zero for both men and women in India except for Kerala (the only state to experience this crossover in 2000 for men and 1999 for women.For India, using life expectancy at age zero and under-five mortality rate together may be more meaningful to measure overall health of its people until the crossover. Delayed crossover for women, despite higher life expectancy at birth than for men reiterates that Indian women are still disadvantaged and hence use of life expectancies at ages zero, one and five become important for India. Greater programmatic efforts to control leading causes of death during the first month and 1-59 months in high child mortality areas can help India to attain this crossover early.

  19. Primary prevention of food allergy in infants who are at risk

    DEFF Research Database (Denmark)

    Høst, Arne; Halken, Susanne

    2005-01-01

    on primary prevention of food allergy. RECENT FINDINGS: In prospective observational controlled studies of high quality of birth cohorts, exclusive breastfeeding for at least 4 months combined with introduction of solid foods after 4 months of age is associated with a reduced risk of food allergy and atopic......: Breastfeeding should be encouraged for 4-6 months. In high-risk infants a documented hypoallergenic hydrolysed formula is recommended if exclusively breastfeeding is not possible for the first 4 months. As regards primary prevention of food allergy there is no evidence for preventive dietary intervention during......PURPOSE OF REVIEW: Allergic diseases represent a major burden of health problems in industrialized countries. Though several studies have focused on possible preventive measure and strategies much controversy still exists on this topic. The aim of this review is to discuss the recent literature...

  20. Beta-blockers for prevention and treatment of retinopathy of prematurity in preterm infants.

    Science.gov (United States)

    Kaempfen, Siree; Neumann, Roland P; Jost, Kerstin; Schulzke, Sven M

    2018-03-02

    Retinopathy of prematurity (ROP) is a vision-threatening disease of preterm neonates. The use of beta-adrenergic blocking agents (beta-blockers), which modulate the vasoproliferative retinal process, may reduce the progression of ROP or even reverse established ROP. To determine the effect of beta-blockers on short-term structural outcomes, long-term functional outcomes, and the need for additional treatment, when used either as prophylaxis in preterm infants without ROP, stage 1 ROP (zone I), or stage 2 ROP (zone II) without plus disease or as treatment in preterm infants with at least prethreshold ROP. We searched the Cochrane Neonatal Review Group Specialized Register; CENTRAL (in the Cochrane Library Issue 7, 2017); Embase (January 1974 to 7 August 2017); PubMed (January 1966 to 7 August 2017); and CINAHL (January 1982 to 7 August 2017). We checked references and cross-references and handsearched abstracts from the proceedings of the Pediatric Academic Societies Meetings. We considered for inclusion randomised or quasi-randomised clinical trials that used beta-blockers for prevention or treatment of ROP in preterm neonates of less than 37 weeks' gestational age. We used the standard methods of Cochrane and the Cochrane Neonatal Review Group. We used the GRADE approach to assess the quality of evidence. We included three randomised trials (N = 366) in this review. Two of these studies were at high risk of bias. All studies reported on prevention of ROP and compared oral propranolol with placebo or no treatment. We found no trials assessing beta-blockers in infants with established stage 2 or higher ROP with plus disease.In one trial, study medication was started after one week of life, i.e. prior to the first ROP screening. The other two trials included preterm infants if they had stage 2 or lower ROP without plus disease. Based on the GRADE assessment, we considered evidence to be of low quality for the following outcomes: rescue treatment with anti-VEGF or

  1. The associations of birth intervals with small-for-gestational-age, preterm, and neonatal and infant mortality: a meta-analysis

    Science.gov (United States)

    2013-01-01

    Background Short and long birth intervals have previously been linked to adverse neonatal outcomes. However, much of the existing literature uses cross-sectional studies, from which deriving causal inference is complex. We examine the association between short/long birth intervals and adverse neonatal outcomes by calculating and meta-analyzing associations using original data from cohort studies conducted in low-and middle-income countries (LMIC). Methods We identified five cohort studies. Adjusted odds ratios (aOR) were calculated for each study, with birth interval as the exposure and small-for-gestational-age (SGA) and/or preterm birth, and neonatal and infant mortality as outcomes. The associations were controlled for potential confounders and meta-analyzed. Results Birth interval of shorter than 18 months had statistically significant increased odds of SGA (pooled aOR: 1.51, 95% CI: 1.31-1.75), preterm (pooled aOR: 1.58, 95% CI: 1.19-2.10) and infant mortality (pooled aOR: 1.83, 95% CI: 1.19-2.81) after controlling for potential confounding factors (reference 36-gestational-age, and preterm-SGA. Birth interval over 60 months had increased risk of SGA (pooled aOR: 1.22, 95% CI: 1.07-1.39) and term-SGA (pooled aOR: 1.14, 95% CI: 1.03-1.27), but was not associated with other outcomes. Conclusions Birth intervals shorter than 18 months are significantly associated with SGA, preterm birth and death in the first year of life. Lack of access to family planning interventions thus contributes to the burden of adverse birth outcomes and infant mortality in LMICs. Programs and policies must assess ways to provide equitable access to reproductive health interventions to mothers before or soon after delivering a child, but also address underlying socioeconomic factors that may modify and worsen the effect of short intervals. PMID:24564484

  2. Infant mortality testing of high energy-density capacitors used on Nova

    International Nuclear Information System (INIS)

    Merritt, B.T.; Whitham, K.

    1983-01-01

    Nova is a solid state large laser for inertial confinement fusion research. Its flashlamps are driven by a 60 MJ capacitor bank. Part of this bank is being built with high energy-density capacitors, 52 μF, 22 KV, 12.5 KJ. A total of 2,645 of these capacitors have been purchased from two manufacturers. Each capacitor was infant mortality tested. The first test consisted of a high-potential test, bushing-to-case, since these capacitors have dual bushings. Then the capacitors were discharged 500 times with circuit conditions approximating the capacitors normal flashlamp load. Failure of either of these tests or if the capacitor was leaking was cause for rejection. The test results were remarkably good. Less than 0.5 percent failed the pulse-discharge test and less than 2.5 percent were rejected overall

  3. Maternal obesity and neonatal mortality according to subtypes of preterm birth

    DEFF Research Database (Denmark)

    Nøhr, Ellen Aagaard; Vaeth, Michael; Bech, Bodil H

    2007-01-01

    : Compared with infants of mothers who were at a normal weight before pregnancy (BMI of 18.5 or more but less than 25), neonatal mortality was increased in infants of mothers who were overweight (BMI of 25 or more but less than 30) or obese (BMI of 30 or more) (adjusted hazard ratios 1.7, CI 1.2-2.5, and 1.......6, CI 1.0-2.4, respectively). For preterm infants (n=3,934, 136 deaths), neonatal mortality in infants born after preterm premature rupture of membranes (PROM) was significantly increased if they were born to an overweight or obese mother (adjusted hazard ratios 3.5, CI 1.4-8.7, and 5.7, CI 2.......2-14.8). There were no associations between high BMI and neonatal mortality in infants born after spontaneous preterm birth without preterm PROM or in infants born after induced preterm delivery. CONCLUSION: High maternal weight seems to increase the risk of neonatal mortality, especially in infants born after...

  4. Interventions to reduce neonatal mortality: a mathematical model to evaluate impact of interventions in sub-Saharan Africa.

    Science.gov (United States)

    Griffin, Jennifer B; McClure, Elizabeth M; Kamath-Rayne, Beena D; Hepler, Bonnie M; Rouse, Doris J; Jobe, Alan H; Goldenberg, Robert L

    2017-08-01

    To determine which interventions would have the greatest impact on reducing neonatal mortality in sub-Saharan Africa in 2012. We used MANDATE, a mathematical model, to evaluate scenarios for the impact of available interventions on neonatal deaths from primary causes, including: (i) for birth asphyxia - obstetric care preventing intrapartum asphyxia, newborn resuscitation and treatment of asphyxiated infants; (ii) for preterm birth - corticosteroids, oxygen, continuous positive air pressure and surfactant; and, (iii) for serious newborn infection - clean delivery, chlorhexidine cord care and antibiotics. Reductions in infection-related mortality have occurred. Between 80 and 90% of deaths currently occurring from infections and asphyxia can be averted from available interventions, as can 58% of mortality from preterm birth. More than 200 000 neonatal deaths can each be averted from asphyxia, preterm birth and infections. Using available interventions, more than 80% of the neonatal deaths occurring today could be prevented in sub-Saharan Africa. Reducing neonatal deaths from asphyxia require improvements in infrastructure and obstetric care to manage maternal conditions such as obstructed labour and preeclampsia. Reducing deaths from preterm birth would also necessitate improved infrastructure and training for preterm infant care. Reducing infection-related mortality requires less infrastructure and lower-level providers. ©2017 Foundation Acta Paediatrica. Published by John Wiley & Sons Ltd.

  5. Reproductive health/family planning and the health of infants, girls and women.

    Science.gov (United States)

    Sadik, N

    1997-01-01

    The 1994 International Conference on Population and Development developed international consensus amongst health providers, policy makers, and group representing the whole of civil society regarding the concept of reproductive health and its definition. In line with this definition, reproductive health care is defined as the constellation of methods, techniques and services that contribute to reproductive health and well-being by preventing and solving reproductive health problems. Reproductive health care saves lives and prevents significant levels of morbidity through family planning programmes, antenatal, delivery and post-natal services, prevention and management programmes for reproductive tract infections (including sexually transmitted diseases and HIV/AIDS), prevention of abortion and management of its complications, cancers of the reproductive system, and harmful practices that impact on reproductive function. Reproductive health care needs are evident at all stages of the life cycle and account for a greater proportion of disability adjusted life years (DALYS) in girls and women than in boys and men. Reproductive health protects infant health by enabling birth spacing and birth limitation to be practiced through family planning. The prevention and early detection of reproductive tract infections, including sexually transmitted diseases and HIV, through the integration of preventive measures in family planning service delivery not only improves the quality of care provided but is also directly responsible for improvement in survival and health of infants. Addressing harmful practices such as son preference, sex selection, sexual violence and female genital mutilation complements the positive impact of planned and spaced children through family planning services on infant mortality and the reproductive health of young girls and women. They are also in addition to prenatal, delivery and postnatal services, positive determinants of low maternal mortality and

  6. The gestational age pattern of human mortality

    DEFF Research Database (Denmark)

    Schöley, Jonas; Vaupel, James W.; Jacobsen, Rune

    -infant lifetable by gestational age spanning week 23 until week 100 after the last menstrual period of the mother. This joint lifetable shows a remarkable regularity in the gestational age profile of fetal- and infant mortality: Mortality rates are declining over the whole observed age range with the exception......In order to check hypotheses about the cause for "ontogenescense" -- the phenomenon of a declining force of mortality prior to maturity -- I analyse data on human mortality by gestational age. Based on extensive microdata on births, fetal- and infant deaths in the US 2009 I calculate a joint fetal...... of a "birth hump" peaking week 38. The absolute rate of decline slows down over age. The observed gestational age pattern of the force of mortality is consistent with three hypotheses concerning the causes for ontogenescense: 1) Adaptation: as the organism growths it becomes more resilient towards death, 2...

  7. Dietary prevention of allergic diseases in infants and small children. Part III

    DEFF Research Database (Denmark)

    Muraro, Antonella; Dreborg, Sten; Halken, Susanne

    2004-01-01

    -reviewed observational and interventional studies was performed following the statements of evidence as defined by WHO. The results of the analysis indicate that breastfeeding is highly recommended for all infants irrespective of atopic heredity. A dietary regimen is unequivocally effective in the prevention of allergic...... diseases in high-risk children. In these patients breastfeeding combined with avoidance of solid food and cow's milk for at least 4-6 months is the most effective preventive regimen. In the absence of breast milk, formulas with documented reduced allergenicity for at least 4-6 months should be used....

  8. The effect of divorce on infant mortality in a remote area of Bangladesh.

    Science.gov (United States)

    Alam, N; Saha, S K; Razzaque, A; van Ginneken, J K

    2001-04-01

    The process of divorce is usually lengthy and hazardous, and can start quarrels that can lead to the abuse of women and their children. This study examines the effects of divorce on neonatal and postneonatal mortality of babies born before and after divorce in Teknaf, a remote area of Bangladesh. The longitudinal demographic surveillance system (DSS) followed 1,762 Muslim marriages in 1982-83 for 5 years to record divorce, deaths of spouse, emigration and births. It recorded 2,696 live births during the follow-up period, and their survival status during infancy. Logistic regression models were used to estimate the effect of divorce on neonatal and postneonatal mortality, controlling for maternal age at birth, parity, sex of the child and household economic status. The odds of neonatal and postneonatal deaths among babies born after divorce or less than 12 months before mothers were divorced were more than double the odds of those born to mothers of intact marriages. The odds of postneonatal deaths were two times higher among babies born more than 12 months before divorce happens than their peers. The high mortality of infants born before and after mothers were divorced may reflect how abusive marriage and divorce increase the vulnerability of women and children in rural Bangladesh. Divorce and abuse of women are difficult and intractable social and health problems that must be addressed.

  9. ?Look at the Whole Me?: A Mixed-Methods Examination of Black Infant Mortality in the US through Women?s Lived Experiences and Community Context

    OpenAIRE

    Wallace, Maeve E.; Green, Carmen; Richardson, Lisa; Theall, Katherine; Crear-Perry, Joia

    2017-01-01

    In the US, the non-Hispanic Black infant mortality rate exceeds the rate among non-Hispanic Whites by more than two-fold. To explore factors underlying this persistent disparity, we employed a mixed methods approach with concurrent quantitative and qualitative data collection and analysis. Eighteen women participated in interviews about their experience of infant loss. Several common themes emerged across interviews, grouped by domain: individual experiences (trauma, grieving and counseling; ...

  10. Neonatal morbidity and early outcome of very preterm infants

    Directory of Open Access Journals (Sweden)

    Heljić Suada

    2013-03-01

    Full Text Available Background: Although the mortality rate for preterm infants and the gestational age-specific mortality rate have dramatically improved over the last 3 to 4 decades, infants born preterm remain vulnerable to many complications, including respiratory distress syndrome, chronic lung disease, necrotizing enterocolitis, a compromised immune system, cardiovascular disorders, hearing and vision problems, and brain lesions. The aim is to determine mortality and morbidity rates and selected outcome variables for preterm infant’s grade 3 IVH or PVL 16.6%, NEC Bell stages II or III 9.8%, BPD 25/72 (33.3% of infants who survived to 36 weeks postmenstrual age. In 38 (37.2% infants, episodes of infections were noticed (one or more episodes in 25 infants, half of them were caused by Gram positive bacteria, most frequent coagulasa negative staphylococci. Klebsiella pneumoniae was the most frequent organism among Gram negative bacteria. One patient had invasive candidiasis caused by Candida albicans. In 5 infants (4.9% early onset of sepsis was documented. Conclusion: Very preterm infants remain very vulnerable group of population, and interventions to reduce the morbidity and mortality of preterm babies include tertiary interventions such as regionalized care, transportation in uterus, and treatment with antenatal steroids.

  11. TREATMENT AND VACCINE PREVENTION OF ROTAVIRAL INFECTION AMONG CHILDREN

    Directory of Open Access Journals (Sweden)

    T.V. Kulichenko

    2007-01-01

    Full Text Available Irrespective of the level of healthcare system development rotaviral infection is a serious medical, social and economic problem at all times. Any infant has to undergo rotaviral gastroenteritis. The run of the disease among infants is mostly often aggravated by dehydration and needs intense treatment of exicosis. The standard of treatment is an oral rehydration, which is in most cases contributes to a quicker improvement of the children’s status. In the meantime, according to the metaphor put forward by the who experts «the best solution» to prevent acute rotaviral diarrhea today may become a rotaviral vaccine. Nowadays, in different countries of the world, two vaccines, which showed high efficiency and safety in clinical research, have been registered. Application of these vaccines may contribute to the significant reduction of the acute forms of rotaviral infection among infants, hospitalizations and mortality caused by rotaviral gastroenteritis. This article highlights the principles of treatment and possibility for vaccine prevention of rotaviral infection among children.Key words: rotaviral infection, gastroenteritis, diarrhea, children, rehydration, vaccine prevention, rotaviral vaccine.

  12. Human cytomegalovirus infant infection adversely affects growth and development in maternally HIV-exposed and unexposed infants in Zambia.

    Science.gov (United States)

    Gompels, U A; Larke, N; Sanz-Ramos, M; Bates, M; Musonda, K; Manno, D; Siame, J; Monze, M; Filteau, S

    2012-02-01

    Human immunodeficiency virus (HIV) and human cytomegalovirus (HCMV) coinfections have been shown to increase infant morbidity, mortality, and AIDS progression. In HIV-endemic regions, maternal HIV-exposed but HIV-uninfected infants, which is the majority of children affected by HIV, also show poor growth and increased morbidity. Although nutrition has been examined, the effects of HCMV infection have not been evaluated. We studied the effects of HCMV infection on the growth, development, and health of maternally HIV-exposed and unexposed infants in Zambia. Infants were examined in a cohort recruited to a trial of micronutrient-fortified complementary foods. HIV-infected mothers and infants had received perinatal antiretroviral therapy to prevent mother-to-child HIV transmission. Growth, development, and morbidity were analyzed by linear regression analyses in relation to maternal HIV exposure and HCMV infection, as screened by sera DNA for viremia at 6 months of age and by antibody for infection at 18 months. All HCMV-seropositive infants had decreased length-for-age by 18 months compared with seronegative infants (standard deviation [z]-score difference: -0.44 [95% confidence interval {CI}, -.72 to -.17]; P = .002). In HIV-exposed infants, those who were HCMV positive compared with those who were negative, also had reduced head size (mean z-score difference: -0.72 [95% CI, -1.23 to -.22]; P = .01) and lower psychomotor development (Bayley test score difference: -4.1 [95% CI, -7.8 to -.5]; P = .03). HIV-exposed, HCMV-viremic infants were more commonly referred for hospital treatment than HCMV-negative infants. The effects of HCMV were unaffected by micronutrient fortification. HCMV affects child growth, development, and morbidity of African infants, particularly in those maternally exposed to HIV. HCMV is therefore a risk factor for child health in this region.

  13. Therapeutic Use of Prebiotics, Probiotics, and Postbiotics to Prevent Necrotizing Enterocolitis: What is the Current Evidence?

    Science.gov (United States)

    Patel, Ravi Mangal; Denning, Patricia Wei

    2013-01-01

    Synopsis Necrotizing enterocolitis (NEC) is a leading cause of neonatal morbidity and mortality and preventative therapies that are both effective and safe are urgently needed. Current evidence from therapeutic trials suggests that probiotics are effective in decreasing NEC in preterm infants and probiotics are currently the most promising therapy on the horizon for this devastating disease. However, concerns regarding safety and optimal dosing have limited the widespread adoption of routine clinical use of probiotics in preterm infants. In addition, prebiotics and postbiotics may be potential alternatives or adjunctive therapies to the administration of live microorganisms, although studies demonstrating their clinical efficacy in preventing NEC are lacking. This review summarizes the current evidence regarding the use of probiotics, prebiotics and postbiotics in the preterm infant, including its therapeutic role in preventing NEC. PMID:23415261

  14. Economic Crises, Maternal and Infant Mortality, Low Birth Weight and Enrollment Rates: Evidence from Argentina’s Downturns

    OpenAIRE

    Guillermo Cruces; Pablo Glüzman; Luis Felipe López Calva

    2011-01-01

    This study investigates the impact of recent crises in Argentina (including the severe downturn of 2001-2002) on health and education outcomes. The identification strategy relies on both the inter-temporal and the cross-provincial co-variation between changes in regional GDP and outcomes by province. These results indicate significant and substantial effects of aggregate fluctuations on maternal and infant mortality and low birth weight, with countercyclical though not significant patterns fo...

  15. Associations between wife-beating and fetal and infant death: impressions from a survey in rural India.

    Science.gov (United States)

    Jejeebhoy, S J

    1998-09-01

    This report examines the linkages between wife-beating and one health-related consequence for women, their experience of fetal and infant mortality. Community-based data are used drawn from women surveyed in two culturally distinct sites of rural India: Uttar Pradesh in the north, in which gender relations are highly stratified, and Tamil Nadu in the south, in which they are more egalitarian. Results suggest that wife-beating is deeply entrenched, that attitudes uniformly justify wife-beating, and that few women can escape an abusive marriage. They also suggest that the health consequences of domestic violence--in terms of pregnancy loss and infant mortality--are considerable and that Indian women's experience of infant and fetal mortality is powerfully conditioned by the strength of the patriarchal social system. Results are tentative because of data limitations, but they are consistent and strong enough to warrant concern. They argue for the integration of services to identify, refer, and prevent domestic violence in the primary or reproductive health programs of the country and for the safe motherhood programs to be particularly vigilant, sensitive, and responsive to the conditions of battered women during pregnancy and the postpartum period.

  16. Ethamsylate in the prevention of periventricular-intraventricular hemorrhage in premature infants.

    Science.gov (United States)

    Chen, J Y

    1993-10-01

    A random and controlled trial was conducted to evaluate the efficacy and safety of ethamsylate in the prevention of periventricular-intraventricular hemorrhage (PIVH) in premature infants. Between January 1990 and July 1992, 171 premature infants with a birth weight of ethamsylate 12.5 mg/kg (0.1 mL/kg from 250 mg/2mL ampoules) was given to group 1 intravenously within an hour of delivery and was followed by doses at six-hourly intervals for four days (total dose 200 mg/kg). Group 2 consisted of 85 premature infants with mean birth weight of 1.4 +/- 0.3 kg and mean gestational age of 30.4 +/- 2.2 weeks. Group 2 received 0.1 mL/kg normal saline intravenously in a similar fashion as the ethamsylate-treated group. Cranial ultrasound examinations were performed on postnatal days one, two, three, five, seven and 14. The incidence of PIVH in the ethamsylate-treated group was 24/86 (27.9%) and 39/85 (45.9%) in the control group (p ethamsylate-treated group was 9/86 (10.5%) and 20/85 (23.5%) in the control group (p ethamsylate therapy in this study.

  17. Preventing infant and child morbidity and mortality due to maternal depression.

    Science.gov (United States)

    Surkan, Pamela J; Patel, Shivani A; Rahman, Atif

    2016-10-01

    This review provides an overview of perinatal depression and its impacts on the health of mothers, their newborns, and young children in low- and middle-income countries (LMICs). We define and describe the urgency and scope of the problem of perinatal depression for mothers, while highlighting some specific issues such as suicidal ideation and decreased likelihood to seek health care. Pathways through which stress may link maternal depression to childhood growth and development (e.g., the hypo-pituitary axis) are discussed, followed by a summary of the adverse effects of depression on birth outcomes, parenting practices, and child growth and development. Although preliminary studies on the association between maternal depressive symptoms and maternal and child mortality exist, more research on these topics is needed. We describe the available interventions and suggest strategies to reduce maternal depressive symptoms in LMICs, including integration of services with existing primary health-care systems. Copyright © 2016. Published by Elsevier Ltd.

  18. The Infant Feeding Activity and Nutrition Trial (INFANT an early intervention to prevent childhood obesity: Cluster-randomised controlled trial

    Directory of Open Access Journals (Sweden)

    Campbell Karen

    2008-03-01

    Full Text Available Abstract Background Multiple factors combine to support a compelling case for interventions that target the development of obesity-promoting behaviours (poor diet, low physical activity and high sedentary behaviour from their inception. These factors include the rapidly increasing prevalence of fatness throughout childhood, the instigation of obesity-promoting behaviours in infancy, and the tracking of these behaviours from childhood through to adolescence and adulthood. The Infant Feeding Activity and Nutrition Trial (INFANT aims to determine the effectiveness of an early childhood obesity prevention intervention delivered to first-time parents. The intervention, conducted with parents over the infant's first 18 months of life, will use existing social networks (first-time parent's groups and an anticipatory guidance framework focusing on parenting skills which support the development of positive diet and physical activity behaviours, and reduced sedentary behaviours in infancy. Methods/Design This cluster-randomised controlled trial, with first-time parent groups as the unit of randomisation, will be conducted with a sample of 600 first-time parents and their newborn children who attend the first-time parents' group at Maternal and Child Health Centres. Using a two-stage sampling process, local government areas in Victoria, Australia will be randomly selected at the first stage. At the second stage, a proportional sample of first-time parent groups within selected local government areas will be randomly selected and invited to participate. Informed consent will be obtained and groups will then be randomly allocated to the intervention or control group. Discussion The early years hold promise as a time in which obesity prevention may be most effective. To our knowledge this will be the first randomised trial internationally to demonstrate whether an early health promotion program delivered to first-time parents in their existing social groups

  19. BIRTH ORDER, STAGE OF INFANCY AND INFANT MORTALITY IN INDIA.

    Science.gov (United States)

    Mishra, S K; Ram, Bali; Singh, Abhishek; Yadav, Awdhesh

    2017-10-02

    Using data from India's National Family Health Survey, 2005-06 (NFHS-3), this article examines the patterns of relationship between birth order and infant mortality. The analysis controls for a number of variables, including mother's characteristics such as age at the time of survey, current place of residence (urban/rural), years of schooling, religion, caste, and child's sex and birth weight. A modest J-shaped relationship between birth order of children and their risk of dying in the neonatal period is found, suggesting that although both first- and last-born children are at a significantly greater risk of dying compared with those in the middle, last-borns (i.e. fourth and higher order births) are at the worst risk. However, in the post-neonatal period first-borns are not as vulnerable, but the risk increases steadily with the addition of successive births and last-borns are at much greater risk, even worse than those in the neonatal period. Although the strength of relationship between birth order and mortality is attenuated after the potential confounders are taken into account, the relationship between the two variables remains curvilinear in the neonatal period and direct in the post-neonatal period. There are marked differences in these patterns by the child's sex. While female children are less prone to the risk of dying in the neonatal period in comparison with male children, the converse is true in the post-neonatal period. Female children not only run higher risks of dying in the post-neonatal period, but also become progressively more vulnerable with an increase in birth order.

  20. Asociación de los tipos de carencia y grado de desarrollo humano con la mortalidad infantil en México, 2008 Association between types of need, human development index, and infant mortality in Mexico, 2008

    Directory of Open Access Journals (Sweden)

    Oswaldo Sinoe Medina-Gómez

    2011-08-01

    Full Text Available El objetivo del artículo fue conocer la asociación entre los diferentes tipos de carencia social y económica y los niveles de mortalidad infantil reportados durante el 2008 en México. Se realizó un estudio ecológico, analizando la correlación y el riesgo relativo entre el índice de desarrollo humano y distintos niveles de carencias sociales y económicas con las tasas de mortalidad infantil reportadas a nivel nacional y estatal. Existe una fuerte correlación entre un mayor nivel de desarrollo humano con una menor tasa de mortalidad. La carencia educativa y el atraso en la calidad y espacio de la vivienda se asocian con una mayor tasa de mortalidad infantil. Si bien la mortalidad infantil en México ha disminuido notablemente en los últimos 28 años, su reducción no ha sido homogénea y se mantienen inequidades que determinan las tasas de mortalidad en relación a los niveles diferenciados de pobreza. Es necesario el diseño de programas con una visión transdisciplinaria que permitan disminuir las tasas de mortalidad con el pleno desarrollo de los individuos y sus familiasThe aim of this study was to assess the association between different types of economic and social deprivation and infant mortality rates reported in 2008 in Mexico. We conducted an ecological study analyzing the correlation and relative risk between the human development index and levels of social and economic differences in State and national infant mortality rates. There was a strong correlation between higher human development and lower infant mortality. Low schooling and poor housing and crowding were associated with higher infant mortality. Although infant mortality has declined dramatically in Mexico over the last 28 years, the decrease has not been homogeneous, and there are persistent inequalities that determine mortality rates in relation to different poverty levels. Programs with a multidisciplinary approach are needed to decrease infant mortality rates

  1. Impact of the Garrett Lee Smith youth suicide prevention program on suicide mortality.

    Science.gov (United States)

    Walrath, Christine; Garraza, Lucas Godoy; Reid, Hailey; Goldston, David B; McKeon, Richard

    2015-05-01

    We examined whether a reduction in youth suicide mortality occurred between 2007 and 2010 that could reasonably be attributed to Garrett Lee Smith (GLS) program efforts. We compared youth mortality rates across time between counties that implemented GLS-funded gatekeeper training sessions (the most frequently implemented suicide prevention strategy among grantees) and a set of matched counties in which no GLS-funded training occurred. A rich set of background characteristics, including preintervention mortality rates, was accounted for with a combination of propensity score-based techniques. We also analyzed closely related outcomes that we did not expect to be affected by GLS as control outcomes. Counties implementing GLS training had significantly lower suicide rates among the population aged 10 to 24 years the year after GLS training than similar counties that did not implement GLS training (1.33 fewer deaths per 100 000; P = .02). Simultaneously, we found no significant difference in terms of adult suicide mortality rates or nonsuicide youth mortality the year after the implementation. These results support the existence of an important reduction in youth suicide rates resulting from the implementation of GLS suicide prevention programming.

  2. Neonatal mortality in Bavaria during 1972 to 1990

    International Nuclear Information System (INIS)

    Irl, C.; Schoetzau, A.; Steinhilber, B.; Grosche, B.; Jahraus, H.; Santen, E. van.

    1993-03-01

    The present report deals with the neonatal mortality in Bavaria during 1972 to 1990, the last period of which coincided with the reactor accident of Chernobyl. The question arose whether there was an increase in neonatal mortality in the more heavily exposed regions of Bavaria as an aftermath to this accident. The results of the study may be summarized as follows: During the period of interest there was a decrease in neonatal mortality in the Federal Republic of Germany (former Federal Lands) and in Bavaria from 22 permille (1972) to less than one third of this value. With a mortality rate of 6.2 permille . Bavaria was below the Federal average of 7.1 permille . in 1990. This decrease is mainly due to a decline in early mortality. Mortality during the first year of life was higher in male than in female infants. 57% of the deceased infants were male, 43% female. The spatial distribution of neonatal mortality in Bavaria showed large regional differences. Following standardisation of the raw data the lowest value of a rural district averaged over the 19 years covered was 7.1 permille , the highest being 21 permille . When the infant mortality rates of regions in Southern Bavaria which were defined as being more heavily exposed to radiation after the Chernobyl accident (> 30 kBq/m 2 Cs- 137), no statistically significant difference was detected for any of the year between 1980 to 1990. Similarly, no statistical correlation could be found between neonatal mortality and proximity of the residence to one of the five sites of nuclear reactors in Bavaria. Out of the further environmental variables included in the study the factors 'urbanity' and 'unemployment' showed a statistical correlation with the infant mortality rate. Over the entire study period (1972 to 1990) the infant mortality rate was found to be significantly increased in towns (constituting administrative districts of their own) compared to rural districts. (orig./MG) [de

  3. Dietary prevention of allergic diseases in infants and small children

    DEFF Research Database (Denmark)

    Høst, Arne; Halken, Susanne; Muraro, Antonella

    2008-01-01

    only on the results of randomized and quasi-randomized trials (selection criteria in the Cochrane review). However, regarding breastfeeding randomization is unethical, Therefore, in the development of recommendations on dietary primary prevention, high-quality systematic reviews of high-quality cohort......Because of scientific fraud four trials have been excluded from the original Cochrane meta-analysis on formulas containing hydrolyzed protein for prevention of allergy and food intolerance in infants. Unlike the conclusions of the revised Cochrane review the export group set up by the Section...... studies should be included in the evidence base. The study type combined with assessment of the methodological quality determines the level of evidence. In view of some methodological concerns in the Cochrane meta-analysis, particularly regarding definitions and diagnostic criteria for outcome measures...

  4. Association between probable postnatal depression and increased infant mortality and morbidity: findings from the DON population-based cohort study in rural Ghana

    NARCIS (Netherlands)

    Weobong, Benedict; ten Asbroek, Augustinus H. A.; Soremekun, Seyi; Gram, Lu; Amenga-Etego, Seeba; Danso, Samuel; Owusu-Agyei, Seth; Prince, Martin; Kirkwood, Betty R.

    2015-01-01

    To assess the impact of probable depression in the immediate postnatal period on subsequent infant mortality and morbidity. Cohort study nested within 4 weekly surveillance of all women of reproductive age to identify pregnancies and collect data on births and deaths. Rural/periurban communities

  5. Female literacy rate is a better predictor of birth rate and infant mortality rate in India

    Directory of Open Access Journals (Sweden)

    Suman Saurabh

    2013-01-01

    Full Text Available Background: Educated women are known to take informed reproductive and healthcare decisions. These result in population stabilization and better infant care reflected by lower birth rates and infant mortality rates (IMRs, respectively. Materials and Methods: Our objective was to study the relationship of male and female literacy rates with crude birth rates (CBRs and IMRs of the states and union territories (UTs of India. The data were analyzed using linear regression. CBR and IMR were taken as the dependent variables; while the overall literacy rates, male, and female literacy rates were the independent variables. Results: CBRs were inversely related to literacy rates (slope parameter = -0.402, P < 0.001. On multiple linear regression with male and female literacy rates, a significant inverse relationship emerged between female literacy rate and CBR (slope = -0.363, P < 0.001, while male literacy rate was not significantly related to CBR (P = 0.674. IMR of the states were also inversely related to their literacy rates (slope = -1.254, P < 0.001. Multiple linear regression revealed a significant inverse relationship between IMR and female literacy (slope = -0.816, P = 0.031, whereas male literacy rate was not significantly related (P = 0.630. Conclusion: Female literacy is relatively highly important for both population stabilization and better infant health.

  6. Effect of maternal multiple micronutrient vs iron-folic acid supplementation on infant mortality and adverse birth outcomes in rural Bangladesh: the JiVitA-3 randomized trial.

    Science.gov (United States)

    West, Keith P; Shamim, Abu Ahmed; Mehra, Sucheta; Labrique, Alain B; Ali, Hasmot; Shaikh, Saijuddin; Klemm, Rolf D W; Wu, Lee S-F; Mitra, Maithilee; Haque, Rezwanul; Hanif, Abu A M; Massie, Allan B; Merrill, Rebecca Day; Schulze, Kerry J; Christian, Parul

    Maternal micronutrient deficiencies may adversely affect fetal and infant health, yet there is insufficient evidence of effects on these outcomes to guide antenatal micronutrient supplementation in South Asia. To assess effects of antenatal multiple micronutrient vs iron-folic acid supplementation on 6-month infant mortality and adverse birth outcomes. Cluster randomized, double-masked trial in Bangladesh, with pregnancy surveillance starting December 4, 2007, and recruitment on January 11, 2008. Six-month infant follow-up ended August 30, 2012. Surveillance included 127,282 women; 44,567 became pregnant and were included in the analysis and delivered 28,516 live-born infants. Median gestation at enrollment was 9 weeks (interquartile range, 7-12). Women were provided supplements containing 15 micronutrients or iron-folic acid alone, taken daily from early pregnancy to 12 weeks postpartum. The primary outcome was all-cause infant mortality through 6 months (180 days). Prespecified secondary outcomes in this analysis included stillbirth, preterm birth (<37 weeks), and low birth weight (<2500 g). To maintain overall significance of α = .05, a Bonferroni-corrected α = .01 was calculated to evaluate statistical significance of primary and 4 secondary risk outcomes (.05/5). Among the 22,405 pregnancies in the multiple micronutrient group and the 22,162 pregnancies in the iron-folic acid group, there were 14,374 and 14,142 live-born infants, respectively, included in the analysis. At 6 months, multiple micronutrients did not significantly reduce infant mortality; there were 764 deaths (54.0 per 1000 live births) in the iron-folic acid group and 741 deaths (51.6 per 1000 live births) in the multiple micronutrient group (relative risk [RR], 0.95; 95% CI, 0.86-1.06). Multiple micronutrient supplementation resulted in a non-statistically significant reduction in stillbirths (43.1 vs 48.2 per 1000 births; RR, 0.89; 95% CI, 0.81-0.99; P = .02) and significant

  7. [Congenital heart disease mortality in Spain during a 10 year period (2003-2012)].

    Science.gov (United States)

    Pérez-Lescure Picarzo, Javier; Mosquera González, Margarita; Latasa Zamalloa, Pello; Crespo Marcos, David

    2018-05-01

    Congenital heart disease is a major cause of infant mortality in developed countries. In Spain, there are no publications at national level on mortality due to congenital heart disease. The aim of this study is to analyse mortality in infants with congenital heart disease, lethality of different types of congenital heart disease, and their variation over a ten-year period. A retrospective observational study was performed to evaluate mortality rate of children under one year old with congenital heart disease, using the minimum basic data set, from 2003 to 2012. Mortality rate and relative risk of mortality were estimated by Poisson regression. There were 2,970 (4.58%) infant deaths in a population of 64,831 patients with congenital heart disease, with 73.8% of deaths occurring during first week of life. Infant mortality rate in patients with congenital heart disease was 6.23 per 10,000 live births, and remained constant during the ten-year period of the study, representing 18% of total infant mortality rate in Spain. The congenital heart diseases with highest mortality rates were hypoplastic left heart syndrome (41.4%), interruption of aortic arch (20%), and total anomalous pulmonary drainage (16.8%). Atrial septal defect (1%) and pulmonary stenosis (1.1%) showed the lowest mortality rate. Congenital heart disease was a major cause of infant mortality with no variations during the study period. The proportion of infants who died in our study was similar to other similar countries. In spite of current medical advances, some forms of congenital heart disease show very high mortality rates. Copyright © 2017 Asociación Española de Pediatría. Publicado por Elsevier España, S.L.U. All rights reserved.

  8. Role of ethamsylate in preventing periventricular-intraventricular hemorrhage in premature infants below 34 weeks of gestation.

    Science.gov (United States)

    Sanghvi, K P; Merchant, R H; Karnik, A; Kulkarni, A

    1999-07-01

    To determine the role of ethamsylate in prevention of PVH-IVH in premature infants ethamsylate (12.5 mg/kg) six hourly for four days and Group B infants served as a control group. Regular cranial ultrasounds to detect the presence of PVH-IVH were done between days 3-5, 10-14 and 28-30 of post natal age, and before hospital discharge in all infants and weekly in infants detected to have PVH-IVH on earlier scans. Various antenatal and postnatal factors known to affect the incidence of PVH-IVH were recorded. A total of 192 infants underwent the trial, 93 in Group A and 99 in Group B. Antenatal corticosteroids (1 or 2 doses) were administered to 32 ( 34.4%) and 36 (36.3%) women in Group A and Group B, respectively. None of the mothers received phenobarbitone, vitamin K or indomethacin antenatally and none of the infants received phenobarbitone, vitamin E or indomethacin postnatally during the study period. PVH-IVH was seen in 26 infants in Group A, of which Grade I IVH occurred in 9, Grade II in 14, Grade III in 2 and Grade IV in one infant. Twenty-nine infants had PVH-IVH in Group B of which 11 had Grade I, 15 Grade II and 3 Grade III. None of the differences were statistically significant. Postnatal administration of ethamsylate did not decrease the incidence of PVH-IVH in the study infants.

  9. TEMPERAMENTAL ADAPTABILITY, PERSISTENCE, AND REGULARITY: PARENTAL RATINGS OF NORWEGIAN INFANTS AGED 6 TO 12 MONTHS, WITH SOME IMPLICATIONS FOR PREVENTIVE PRACTICE.

    Science.gov (United States)

    Olafsen, Kåre S; Ulvund, Stein Erik; Torgersen, Anne Mari; Wentzel-Larsen, Tore; Smith, Lars; Moe, Vibeke

    2018-03-01

    There is a need for standardized measures of infant temperament to strengthen current practices in prevention and early intervention. The present study provides Norwegian data on the Cameron-Rice Infant Temperament Questionnaire (CRITQ; J.R. Cameron & D.C. Rice, 1986a), which comprises 46 items and is used within a U.S. health maintenance organization. The CRITQ was filled out by mothers and fathers at 6 and again at 12 months as part of a longitudinal study of mental health during the first years of life (the "Little in Norway" study, N = 1,041 families enrolled; V. Moe & L. Smith, 2010). Results showed that internal consistencies were comparable with U.S. The temperament dimensions of persistence, adaptability, and regularity had acceptable or close-to-acceptable reliabilities in the U.S. study as well as in this study, and also were unifactorial in confirmatory factor analysis. These dimensions are the focus in this article. Findings concerning parents' differential ratings of their infants on the three dimensions are reported, as is the stability of parents' ratings of temperament from 6 to 12 months. In addition, results on the relation between temperament and parenting stress are presented. The study suggests that temperamental adaptability, persistence, and regularity may be relevant when assessing infant behavior, and may be applied in systematic prevention trials for families with infants. The inclusion of concepts related to individual differences in response tendencies and regulatory efforts may broaden the understanding of parent-infant transactions, and thus enrich prevention and sensitizing interventions with the aim of assisting infants' development. © 2018 Michigan Association for Infant Mental Health.

  10. Increasing Neonatal Mortality among Palestine Refugees in the Gaza Strip

    Science.gov (United States)

    van den Berg, Maartje M.; Madi, Haifa H.; Khader, Ali; Hababeh, Majed; Zeidan, Wafa’a; Wesley, Hannah; Abd El-Kader, Mariam; Maqadma, Mohamed; Seita, Akihiro

    2015-01-01

    Background The United Nations Relief and Works Agency for Palestine refugees in the Near East (UNRWA) has periodically estimated infant mortality rates among Palestine refugees in Gaza. These surveys have recorded a decline from 127 per 1000 live births in 1960 to 20.2 in 2008. Methods We used the same preceding-birth technique as in previous surveys. All multiparous mothers who came to the 22 UNRWA health centres to register their last-born child for immunization were asked if their preceding child was alive or dead. We based our target sample size on the infant mortality rate in 2008 and included 3128 mothers from August until October 2013. We used multiple logistic regression analyses to identify predictors of infant mortality. Findings Infant mortality in 2013 was 22.4 per 1000 live births compared with 20.2 in 2008 (p = 0.61), and this change reflected a statistically significant increase in neonatal mortality (from 12.0 to 20.3 per 1000 live births, p = 0.01). The main causes of the 65 infant deaths were preterm birth (n = 25, 39%), congenital anomalies (n = 19, 29%), and infections (n = 12, 19%). Risk factors for infant death were preterm birth (OR 9.88, 3.98–24.85), consanguinity (2.41, 1.35–4.30) and high-risk pregnancies (3.09, 1.46–6.53). Conclusion For the first time in five decades, mortality rates have increased among Palestine refugee newborns in Gaza. The possible causes of this trend may include inadequate neonatal care. We will estimate infant and neonatal mortality rates again in 2015 to see if this trend continues and, if so, to assess how it can be reversed. PMID:26241479

  11. Underascertainment of Child Abuse Fatalities in France: Retrospective Analysis of Judicial Data to Assess Underreporting of Infant Homicides in Mortality Statistics

    Science.gov (United States)

    Tursz, Anne; Crost, Monique; Gerbouin-Rerolle, Pascale; Cook, Jon M.

    2010-01-01

    Objectives: Test the hypothesis of an underestimation of infant homicides in mortality statistics in France; identify its causes; examine data from the judicial system and their contribution in correcting this underestimation. Methods: A retrospective, cross-sectional study was carried out in 26 courts in three regions of France of cases of infant…

  12. The eye of the begetter: predicting infant attachment disorganization from women's prenatal interpretations of infant facial expressions.

    Science.gov (United States)

    Bernstein, Rosemary E; Tenedios, Catherine M; Laurent, Heidemarie K; Measelle, Jeffery R; Ablow, Jennifer C

    2014-01-01

    Infant-caregiver attachment disorganization has been linked to many long-term negative psychosocial outcomes. While various prevention programs appear to be effective in preventing disorganized attachment, methods currently used to identify those at risk are unfortunately either overly general or impractical. The current investigation tested whether women's prenatal biases in identifying infant expressions of emotion--tendencies previously shown to relate to some of the maternal variables associated with infant attachment, including maternal traumatization, trauma symptoms, and maternal sensitivity--could predict infant attachment classification at 18 months postpartum. Logistic regression analyses revealed that together with women's adult history of high betrayal traumatization, response concordance with a normative reference sample in labeling infant expressions as negatively valenced, and the number of infant facial expressions that participants classified as "sad" and "angry" predicted subsequent infant attachment security versus disorganization. Implications for screening and prevention are discussed. © 2014 Michigan Association for Infant Mental Health.

  13. The potential for preventing the delivery and perinatal mortality of ...

    African Journals Online (AJOL)

    Objective. To determine the potentiaJ for preventing the delivery and perinatal mortality of low-birth-weight (LBW) babies in a black urban population. Design. Cross-sectionaJ descriptive study. Setting. All women delivering babies weighing less than 2 500 g at Kalafong Hospital in a 6-month period (December 1991 - May ...

  14. Applying Collaborative Learning and Quality Improvement to Public Health: Lessons from the Collaborative Improvement and Innovation Network (CoIIN) to Reduce Infant Mortality.

    Science.gov (United States)

    Ghandour, Reem M; Flaherty, Katherine; Hirai, Ashley; Lee, Vanessa; Walker, Deborah Klein; Lu, Michael C

    2017-06-01

    Infant mortality remains a significant public health problem in the U.S. The Collaborative Improvement & Innovation Network (CoIIN) model is an innovative approach, using the science of quality improvement and collaborative learning, which was applied across 13 Southern states in Public Health Regions IV and VI to reduce infant mortality and improve birth outcomes. We provide an in-depth discussion of the history, development, implementation, and adaptation of the model based on the experience of the original CoIIN organizers and participants. In addition to the political genesis and functional components of the initiative, 8 key lessons related to staffing, planning, and implementing future CoIINs are described in detail. This paper reports the findings from a process evaluation of the model. Data on the states' progress toward reducing infant mortality and improving birth outcomes were collected through a survey in the final months of a 24-month implementation period, as well as through ongoing team communications. The peer-to-peer exchange and platform for collaborative learning, as well as the sharing of data across the states, were major strengths and form the foundation for future CoIIN efforts. A lasting legacy of the initiative is the unique application and sharing of provisional "real time" data to inform "real time" decision-making. The CoIIN model of collaborative learning, QI, and innovation offers a promising approach to strengthening partnerships within and across states, bolstering data systems to inform and track progress more rapidly, and ultimately accelerating improvement toward healthier communities, States, and the Nation as a whole.

  15. Diagnostic criteria for severe acute malnutrition among infants aged under 6 mo.

    Science.gov (United States)

    Mwangome, Martha; Ngari, Moses; Fegan, Greg; Mturi, Neema; Shebe, Mohammed; Bauni, Evasius; Berkley, James A

    2017-06-01

    Background: There is an increasing recognition of malnutrition among infants under 6 mo of age (U6M). Current diagnosis criteria use weight-for-length z scores (WLZs), but the 2006 WHO standards exclude infants shorter than 45 cm. In older children, midupper arm circumference (MUAC) predicts mortality better than does WLZ. Outcomes may also be influenced by exposure to HIV and size or gestational age at birth. Diagnostic thresholds for WLZ, MUAC, and other indexes have not been fully evaluated against mortality risk among U6M infants. Objective: The aim was to determine the association of anthropometric indexes with risks of inpatient and postdischarge mortality among U6M infants recruited at the time of hospitalization. Design: We analyzed data from a cohort of U6M infants admitted to Kilifi County Hospital (2007-2013), Kenya. The primary outcomes were inpatient death and death during follow-up over 1 y after discharge. We calculated adjusted RRs for inpatient mortality and HRs for postdischarge mortality for different anthropometric measures and thresholds. Discriminatory value was assessed by using receiver operating characteristic curves. Results: A total of 2882 infants were admitted: 140 (4.9%) died in the hospital and 1405 infants were followed up after discharge. Of these, 75 (5.3%) died within 1 y during 1318 child-years of observation. MUAC and weight-for-age z score (WAZ) predicted inpatient and postdischarge mortality better than did WLZ ( P 0.05) and performed better than WLZ <-3 for both inpatient and postdischarge mortality (both P < 0.001). Reported small size at birth did not reduce the risk of death associated with anthropometric indexes. Conclusions: U6M infants at the highest risk of death are best targeted by using MUAC or WAZ. Further research into the effectiveness of potential interventions is required.

  16. Modelling the epidemiological impact of intermittent preventive treatment against malaria in infants.

    Directory of Open Access Journals (Sweden)

    Amanda Ross

    Full Text Available BACKGROUND: Trials of intermittent preventive treatment against malaria in infants (IPTi using sulphadoxine-pyrimethamine (SP have shown a positive, albeit variable, protective efficacy against clinical malaria episodes. The impact of IPTi in different epidemiological settings and over time is unknown and predictions are hampered by the lack of knowledge about how IPTi works. We investigated mechanisms proposed for the action of IPTi and made predictions of the likely impact on morbidity and mortality. METHODS/PRINCIPAL FINDINGS: We used a comprehensive, individual-based, stochastic model of malaria epidemiology to simulate recently published trials of IPTi using SP with site-specific characteristics as inputs. This baseline model was then modified to represent hypotheses concerning the duration of action of SP, the temporal pattern of fevers caused by individual infections, potential benefits of avoiding fevers on immunity and the effect of sub-therapeutic levels of SP on parasite dynamics. The baseline model reproduced the pattern of results reasonably well. None of the models based on alternative hypotheses improved the fit between the model predictions and observed data. Predictions suggest that IPTi would have a beneficial effect across a range of transmission intensities. IPTi was predicted to avert a greater number of episodes where IPTi coverage was higher, the health system treatment coverage lower, and for drugs which were more efficacious and had longer prophylactic periods. The predicted cumulative benefits were proportionately slightly greater for severe malaria episodes and malaria-attributable mortality than for acute episodes in the settings modelled. Modest increased susceptibility was predicted between doses and following the last dose, but these were outweighed by the cumulative benefits. The impact on transmission intensity was negligible. CONCLUSIONS: The pattern of trial results can be accounted for by differences between

  17. Changes in the incidence of pneumonia, bacterial meningitis, and infant mortality 5 years following introduction of the 13-valent pneumococcal conjugate vaccine in a "3+0" schedule.

    Science.gov (United States)

    Becker-Dreps, Sylvia; Blette, Bryan; Briceño, Rafaela; Alemán, Jorge; Hudgens, Michael G; Moreno, Gilberto; Ordoñez, Ana; Rocha, Julio; Weber, David J; Amaya, Erick

    2017-01-01

    Streptococcus pneumoniae causes about 826,000 deaths of children in the world each year and many health facility visits. To reduce the burden of pneumococcal disease, many nations have added pneumococcal conjugate vaccines to their national immunization schedules. Nicaragua was the first country eligible for GAVI Alliance funding to introduce the 13-valent pneumococcal conjugate vaccine (PCV13) in 2010, provided to infants at 2, 4, and 6 months of age. The goal of this study was to evaluate the population impact of the first five years of the program. Numbers of visits for pneumonia, pneumonia-related deaths, and bacterial meningitis in both children and adults, and infant deaths between 2008 and 2015 were collected from all 107 public health facilities in León Department. Vital statistics data provided additional counts of pneumonia-related deaths that occurred outside health facilities. Adjusted incidence rates and incidence rate ratios (IRRa) in the vaccine (2011-2015) and pre-vaccine periods (2008-2010) were estimated retrospectively using official population estimates as exposure time. The IRRa for pneumonia hospitalizations was 0.70 (95% confidence interval [CI]: 0.66, 0.75) for infants, and 0.92 (95% CI: 0.85, 0.99) for one year-olds. The IRRa for post-neonatal infant mortality was 0.56 (95% CI: 0.41, 0.77). In the population as a whole, ambulatory visits and hospitalizations for pneumonia, as well as pneumonia-related mortality and rates of bacterial meningitis were lower in the vaccine period. During the first five years of program implementation, reductions were observed in health facility visits for pneumonia in immunized age groups and infant mortality, which would be hard to achieve with any other single public health intervention. Future study is warranted to understand whether the lack of a booster dose (e.g., at 12 months) may be responsible for the small reductions in pneumonia hospitalizations observed in one year-olds as compared to infants.

  18. Risk Factors and In-Hospital Outcomes following Tracheostomy in Infants.

    Science.gov (United States)

    Lee, Jan Hau; Smith, P Brian; Quek, M Bin Huey; Laughon, Matthew M; Clark, Reese H; Hornik, Christoph P

    2016-06-01

    To describe the epidemiology, risk factors, and in-hospital outcomes of tracheostomy in infants in the neonatal intensive care unit. We analyzed electronic medical records from 348 neonatal intensive care units for the period 1997 to 2012, and evaluated the associations among infant demographics, diagnoses, and pretracheostomy cardiopulmonary support with in-hospital mortality. We also determined the trends in use of infant tracheostomy over time. We identified 885 of 887 910 infants (0.1%) who underwent tracheostomy at a median postnatal age of 72 days (IQR, 27-119 days) and a median postmenstrual age of 42 weeks (IQR, 39-46 weeks). The most common diagnoses associated with tracheostomy were bronchopulmonary dysplasia (396 of 885; 45%), other upper airway anomalies (202 of 885; 23%), and laryngeal anomalies (115 of 885; 13%). In-hospital mortality after tracheostomy was 14% (125 of 885). On adjusted analysis, near-term gestational age (GA), small for GA status, pulmonary diagnoses, number of days of forced fraction of inspired oxygen >0.4, and inotropic support before tracheostomy were associated with increased in-hospital mortality. The proportion of infants requiring tracheostomy increased from 0.01% in 1997 to 0.1% in 2005 (P Tracheostomy is not commonly performed in hospitalized infants, but the associated mortality is high. Risk factors for increased in-hospital mortality after tracheostomy include near-term GA, small for GA status, and pulmonary diagnoses. Copyright © 2016 Elsevier Inc. All rights reserved.

  19. VITAMIN DEFICIENCY IN CHILDREN: MAIN CAUSES, FORMS, AND MEANS OF PREVENTION IN INFANTS AND PRESCHOOL CHILDREN

    Directory of Open Access Journals (Sweden)

    L.Yu. Volkova

    2007-01-01

    Full Text Available The lecture deals with the main causes of development of hypo vitaminoses in infants and preschool children, with the emphasis made on the lack of pathognomonic signs of vitamin in sufficiency, showing the demands for the essential vitamins, and describing the natural sources of their entering the human body. The authors compare the composition of various multivitamin preparations registered in Russian the liquid dosage form convenient for use in 1ctoc7cyearcold children.Key words: avitaminosis, hypovitaminosis, prevention, infants, children.

  20. The cost-effectiveness of intermittent preventive treatment for malaria in infants in Sub-Saharan Africa

    NARCIS (Netherlands)

    Conteh, Lesong; Sicuri, Elisa; Manzi, Fatuma; Hutton, Guy; Obonyo, Benson; Tediosi, Fabrizio; Biao, Prosper; Masika, Paul; Matovu, Fred; Otieno, Peter; Gosling, Roly D.; Hamel, Mary; Odhiambo, Frank O.; Grobusch, Martin P.; Kremsner, Peter G.; Chandramohan, Daniel; Aponte, John J.; Egan, Andrea; Schellenberg, David; Macete, Eusebio; Slutsker, Laurence; Newman, Robert D.; Alonso, Pedro; Menéndez, Clara; Tanner, Marcel

    2010-01-01

    BACKGROUND: Intermittent preventive treatment in infants (IPTi) has been shown to decrease clinical malaria by approximately 30% in the first year of life and is a promising malaria control strategy for Sub-Saharan Africa which can be delivered alongside the Expanded Programme on Immunisation (EPI).

  1. Changes in mortality for extremely low birth weight infants in the 1990s: implications for treatment decisions and resource use.

    Science.gov (United States)

    Meadow, William; Lee, Grace; Lin, Kathy; Lantos, John

    2004-05-01

    Much has changed in neonatal intensive care unit (NICU) care over the past decade. High-frequency oscillation, inhaled nitric oxide, and antenatal corticosteroids are now widely available. We wondered how these medical advances had affected both the epidemiology and ethics of life and death for extremely low birth weight (ELBW) infants in the NICU. We identified 1142 ELBW infants (birth weight [BW] NICU between 1991 and 2001. We abstracted BW, gestational age, survival or death, and length of stay in the NICU. Statistical analyses were performed by using linear regression and 2-way analysis of variance. Both increasing BW and later year were significantly associated with improved survival. However, for larger ELBW infants, survival was approximately 90% for the entire decade, and large-scale improvement was hardly possible. For smaller infants, greater improvements were both possible and observed, at least early in the decade. From 1991 to 1997, overall ELBW survival increased steadily (approximately 4% per year). However, from 1997 to 2001, there was no significant improvement in survival for ELBW infants. There was no change in the distribution of deaths accounted for by BW subgroups within the ELBW population from 1991 to 2001. Median length of stay for infants who eventually expired before discharge rose from 2 days in 1991 to 10 days in 2001. As a consequence, during the past decade, the percentage of infants whose outcome was "undeclared" by day of life 4 rose from 10% to 20% for ELBW infants overall and to 33% for infants with BWs of 450 to 700 g. The percentage of ELBW NICU bed-days occupied by nonsurvivors remained very low (approximately 7%) from 1991 to 2001. 1) Fewer infants in all ELBW subgroups are dying, compared with a decade ago, and the improvement has been most prominent for BWs of 450 to 700 g, at which mortality was and remains to be greatest. 2) This progress seems to have slowed, or even stopped, by the end of the decade. 3) Although most

  2. Systemic hydrocortisone to prevent bronchopulmonary dysplasia in preterm infants (the SToP-BPD study; a multicenter randomized placebo controlled trial

    Directory of Open Access Journals (Sweden)

    Onland Wes

    2011-11-01

    Full Text Available Abstract Background Randomized controlled trials have shown that treatment of chronically ventilated preterm infants after the first week of life with dexamethasone reduces the incidence of the combined outcome death or bronchopulmonary dysplasia (BPD. However, there are concerns that dexamethasone may increase the risk of adverse neurodevelopmental outcome. Hydrocortisone has been suggested as an alternative therapy. So far no randomized controlled trial has investigated its efficacy when administered after the first week of life to ventilated preterm infants. Methods/Design The SToP-BPD trial is a randomized double blind placebo controlled multicenter study including 400 very low birth weight infants (gestational age Discussion This trial will determine the efficacy and safety of postnatal hydrocortisone administration at a moderately early postnatal onset compared to placebo for the reduction of the combined outcome mortality and BPD at 36 weeks postmenstrual age in ventilator dependent preterm infants. Trial registration number Netherlands Trial Register (NTR: NTR2768

  3. Baby Business: a randomised controlled trial of a universal parenting program that aims to prevent early infant sleep and cry problems and associated parental depression.

    Science.gov (United States)

    Cook, Fallon; Bayer, Jordana; Le, Ha N D; Mensah, Fiona; Cann, Warren; Hiscock, Harriet

    2012-02-06

    Infant crying and sleep problems (e.g. frequent night waking, difficulties settling to sleep) each affect up to 30% of infants and often co-exist. They are costly to manage and associated with adverse outcomes including postnatal depression symptoms, early weaning from breast milk, and later child behaviour problems. Preventing such problems could improve these adverse outcomes and reduce costs to families and the health care system. Anticipatory guidance-i.e. providing parents with information about normal infant sleep and cry patterns, ways to encourage self-settling in infants, and ways to develop feeding and settling routines before the onset of problems-could prevent such problems. This paper outlines the protocol for our study which aims to test an anticipatory guidance approach. 750 families from four Local Government Areas in Melbourne, Australia have been randomised to receive the Baby Business program (intervention group) or usual care (control group) offered by health services. The Baby Business program provides parents with information about infant sleep and crying via a DVD and booklet (mailed soon after birth), telephone consultation (at infant age 6-8 weeks) and parent group session (at infant age 12 weeks). All English speaking parents of healthy newborn infants born at > 32 weeks gestation and referred by their maternal and child health nurse at their first post partum home visit (day 7-10 postpartum), are eligible. The primary outcome is parent report of infant night time sleep as a problem at four months of age and secondary outcomes include parent report of infant daytime sleep or crying as a problem, mean duration of infant sleep and crying/24 hours, parental depression symptoms, parent sleep quality and quantity and health service use. Data will be collected at two weeks (baseline), four months and six months of age. An economic evaluation using a cost-consequences approach will, from a societal perspective, compare costs and health outcomes

  4. Political Economy of Infant Mortality Rate: Role of Democracy Versus Good Governance.

    Science.gov (United States)

    Rosenberg, Dina Y

    2018-01-01

    Despite numerous studies on whether democracy reduces the infant mortality rate (IMR), the empirical results remain mixed at best. In this article, I perform several theoretical and empirical exercises that help explain why and under what conditions we should expect politics to matter most for a decrease in IMR. First, I capitalize on the epidemiological view that IMR - the most commonly used indicator of health in social sciences - is better suited to reflect public health micromanagement than overall social development. Second, I theorize that autocrats have incentives to invest in health up to a certain point, which could lead to a reduction in IMR. Third, I introduce an omitted variable - good governance - that trumps the importance of a political regime for IMR: (1) it directly affects public health micromanagement, and (2) many autocrats made inroads in achieving good governance. Finally, for the first time in such research, I use a disaggregated IMR approach to corroborate my hypotheses.

  5. Effect of kangaroo method on the risk of hypothermia and duration of birth weight regain in low birth weight infants: A randomized controlled trial

    OpenAIRE

    I G. A. P. Eka Pratiwi; Soetjiningsih Soetjiningsih; I Made Kardana

    2009-01-01

    Background In Indonesia, the infant mortality rate in 2001 was 50 per 1000 live births, with 34.7% due to perinatal death. This perinatal death was associated with low birth weight (LBW) newborn, which was caused by prematurity, infection, birth asphyxia, hypothermia, and inadequate breast feeding. In developing countries, lack of facilities of LBW infant care leads to the utilization of kangaroo method as care to prevent hypothermia in LBW newborn. Objective To evaluate the differences of...

  6. Infant botulism

    Science.gov (United States)

    ... your infant has symptoms of botulism. Prevention In theory, the disease might be avoided by preventing exposure ... M. is also a founding member of Hi-Ethics and subscribes to the principles of the Health ...

  7. A review of life expectancy and infant mortality estimations for Australian Aboriginal people

    Science.gov (United States)

    2014-01-01

    Background Significant variation exists in published Aboriginal mortality and life expectancy (LE) estimates due to differing and evolving methodologies required to correct for inadequate recording of Aboriginality in death data, under-counting of Aboriginal people in population censuses, and unexplained growth in the Aboriginal population attributed to changes in the propensity of individuals to identify as Aboriginal at population censuses. The objective of this paper is to analyse variation in reported Australian Aboriginal mortality in terms of LE and infant mortality rates (IMR), compared with all Australians. Methods Published data for Aboriginal LE and IMR were obtained and analysed for data quality and method of estimation. Trends in reported LE and IMR estimates were assessed and compared with those in the entire Australian population. Results LE estimates derived from different methodologies vary by as much as 7.2 years for the same comparison period. Indirect methods for estimating Aboriginal LE have produced LE estimates sensitive to small changes in underlying assumptions, some of which are subject to circular reasoning. Most indirect methods appear to under-estimate Aboriginal LE. Estimated LE gaps between Aboriginal people and the overall Australian population have varied between 11 and 20 years. Latest mortality estimates, based on linking census and death data, are likely to over-estimate Aboriginal LE. Temporal LE changes by each methodology indicate that Aboriginal LE has improved at rates similar to the Australian population overall. Consequently the gap in LE between Aboriginal people and the total Australian population appears to be unchanged since the early 1980s, and at the end of the first decade of the 21st century remains at least 11–12 years. In contrast, focussing on the 1990–2010 period Aboriginal IMR declined steeply over 2001–08, from more than 12 to around 8 deaths per 1,000 live births, the same level as Australia overall in

  8. Infant Mortality Risk and Paternity Certainty Are Associated with Postnatal Maternal Behavior toward Adult Male Mountain Gorillas (Gorilla beringei beringei)

    Science.gov (United States)

    Rosenbaum, Stacy; Hirwa, Jean Paul; Silk, Joan B.; Vigilant, Linda; Stoinski, Tara S.

    2016-01-01

    Sexually selected infanticide is an important source of infant mortality in many mammalian species. In species with long-term male-female associations, females may benefit from male protection against infanticidal outsiders. We tested whether mountain gorilla (Gorilla beringei beringei) mothers in single and multi-male groups monitored by the Dian Fossey Gorilla Fund’s Karisoke Research Center actively facilitated interactions between their infants and a potentially protective male. We also evaluated the criteria mothers in multi-male groups used to choose a preferred male social partner. In single male groups, where infanticide risk and paternity certainty are high, females with infants <1 year old spent more time near and affiliated more with males than females without young infants. In multi-male groups, where infanticide rates and paternity certainty are lower, mothers with new infants exhibited few behavioral changes toward males. The sole notable change was that females with young infants proportionally increased their time near males they previously spent little time near when compared to males they had previously preferred, perhaps to encourage paternity uncertainty and deter aggression. Rank was a much better predictor of females’ social partner choice than paternity. Older infants (2–3 years) in multi-male groups mirrored their mothers’ preferences for individual male social partners; 89% spent the most time in close proximity to the male their mother had spent the most time near when they were <1 year old. Observed discrepancies between female behavior in single and multi-male groups likely reflect different levels of postpartum intersexual conflict; in groups where paternity certainty and infanticide risk are both high, male-female interests align and females behave accordingly. This highlights the importance of considering individual and group-level variation when evaluating intersexual conflict across the reproductive cycle. PMID:26863300

  9. Infant Mortality Risk and Paternity Certainty Are Associated with Postnatal Maternal Behavior toward Adult Male Mountain Gorillas (Gorilla beringei beringei.

    Directory of Open Access Journals (Sweden)

    Stacy Rosenbaum

    Full Text Available Sexually selected infanticide is an important source of infant mortality in many mammalian species. In species with long-term male-female associations, females may benefit from male protection against infanticidal outsiders. We tested whether mountain gorilla (Gorilla beringei beringei mothers in single and multi-male groups monitored by the Dian Fossey Gorilla Fund's Karisoke Research Center actively facilitated interactions between their infants and a potentially protective male. We also evaluated the criteria mothers in multi-male groups used to choose a preferred male social partner. In single male groups, where infanticide risk and paternity certainty are high, females with infants <1 year old spent more time near and affiliated more with males than females without young infants. In multi-male groups, where infanticide rates and paternity certainty are lower, mothers with new infants exhibited few behavioral changes toward males. The sole notable change was that females with young infants proportionally increased their time near males they previously spent little time near when compared to males they had previously preferred, perhaps to encourage paternity uncertainty and deter aggression. Rank was a much better predictor of females' social partner choice than paternity. Older infants (2-3 years in multi-male groups mirrored their mothers' preferences for individual male social partners; 89% spent the most time in close proximity to the male their mother had spent the most time near when they were <1 year old. Observed discrepancies between female behavior in single and multi-male groups likely reflect different levels of postpartum intersexual conflict; in groups where paternity certainty and infanticide risk are both high, male-female interests align and females behave accordingly. This highlights the importance of considering individual and group-level variation when evaluating intersexual conflict across the reproductive cycle.

  10. Impact of Secondary Prevention on Mortality after a First Ischemic Stroke in Puerto Rico.

    Science.gov (United States)

    Rojas, Maria E; Marsh, Wallace; Felici-Giovanini, Marcos E; Rodríguez-Benitez, Rosa J; Zevallos, Juan C

    2017-03-01

    The objective of this study was to evaluate the impact of the prescription of secondary prevention therapies on mortality in Puerto Rican patients hospitalized with a first ischemic stroke. This was a retrospective secondary data analysis of the 2007 and 2009 Puerto Rico Stroke Registry electronic database. Information was obtained from the medical charts of patients discharged with ICD-9 codes 434 and 436 from 20 hospitals located in Puerto Rico. Descriptive analyses were conducted for demographics and comorbidities. Chi2 statistics compared the proportion of patients prescribed secondary prevention therapy and the proportion of patients not prescribed secondary prevention therapy. Lastly, survival rates were calculated from 2007 up to and including December 2010. The mean age of the 3,965 patients was 70 (±14) years. Secondary prevention therapy was prescribed to only 1% of the patients. The most frequent comorbidities were hypertension (85%), diabetes (52%), and hyperlipidemia (25%). The case fatality rate for patients prescribed secondary prevention therapy was 16%, compared to 26% for patients not prescribed secondary prevention therapy (p<0.01). The mean survival for stroke patients prescribed secondary preventions was 450 days (95% CI;182−718), compared to 266 days (95% CI; 244−287) for those not prescribed secondary prevention therapy (p = 0.175). A low percentage of patients with a first ischemic stroke were prescribed secondary prevention therapy. While not statistically significant, survival analysis suggests that secondary prevention therapy decreased mortality in patients with a stroke.

  11. Optimal foetal growth in the reduction of learning and behaviour disorder and prevention of sudden infant death (SIDS) after the first month.

    Science.gov (United States)

    Saugstad, L F

    1997-09-01

    A theory is presented that a diet low in polyunsaturated fatty acids (PUFA) in the third trimester of pregnancy may delay myelination and brain maturation. This may underpin learning and behaviour disorders and sudden infant death (SIDS) after the first month, conditions that are associated with lower than average birthweight. Epidemiological evidence is reviewed showing an inverse relation between the proportion of heavy newborns (> 3500 g) and infant mortality rate. Some countries with a lower proportion of heavy newborns despite equally high standards of living and medical care have higher post-neonatal death rates. The higher rates are solely due to SIDS which has a peak mortality within 80-100 days. It is hypothesised that as this is a time when myelination peaks, SIDS may be due to maturational delay. Evidence of subtle CNS changes in brainstem structures and in the neuromuscular system supports an instability in brainstem control systems. Moderate iatrogenic dietary restriction predominates today, but a rising number of women favour a low-caloric low-fat diet especially in the third trimester when the foetus is most susceptible. This may lead to a depressed birthweight, delayed somatic growth and neuronal maturation, such as is observed in SIDS victims. The majority exposed to suboptimal conditions survive, but a few suffer SIDS; confirming post-neonatal susceptibility. Many, especially males, present minor CNS signs and learning/behaviour disorders that could be the sequelae of repeated hypoxic episodes, such as recorded in more than 80% of SIDS victims. To reduce learning/behaviour disorders and prevent death from SIDS after the first month, it is necessary to ensure optimal development by promoting foetal growth. It is advised to avoid unnecessary dieting and to favour a diet high in PUFAs, thus prolonging pregnancy and so increasing birthweight.

  12. An Assessment of the Cocooning Strategy for Preventing Infant Pertussis—United States, 2011

    Science.gov (United States)

    Blain, Amy E.; Lewis, Melissa; Banerjee, Emily; Kudish, Kathy; Liko, Juventila; McGuire, Suzanne; Selvage, David; Watt, James; Martin, Stacey W.; Skoff, Tami H.

    2017-01-01

    Background Infants are at greatest risk for severe pertussis. In 2006, the Advisory Committee on Immunization Practices recommended that adolescents and adults, especially those with infant contact, receive a single dose of Tdap (tetanus toxoid, reduced diphtheria toxoid, and acellular pertussis vaccine). To assess the effectiveness of cocooning, we conducted a case-control evaluation of infant close contacts. Methods Pertussis cases aged <2 months with onset between 1 January 2011 and 31 December 2011 were identified in Emerging Infections Program Network sites. For each case, we recruited 3 controls from birth certificates and interviewed identified adult close contacts (CCs) or parents of CCs aged <18 years. Pertussis vaccination was verified through medical providers and/or immunization registries. Results Forty-two cases were enrolled, with 154 matched controls. Around enrolled infants, 859 CCs were identified (600 adult and 259 nonadult). An average of 5.4 CCs was identified per case and 4.1 CCs per control. Five hundred fifty-four (64.5%) CCs were enrolled (371 adult and 183 non-adult CCs); 119 (32.1% of enrolled) adult CCs had received Tdap. The proportion of Tdap-vaccinated adult CCs was similar between cases and controls (P = .89). The 600 identified adult CCs comprised 172 potential cocoons; 71 (41.3%) potential cocoons had all identified adult CCs enrolled. Of these, 9 were fully vaccinated and 43.7% contained no Tdap-vaccinated adults. The proportion of fully vaccinated case (4.8%) and control (10.0%) cocoons was similar (P = .43). Conclusions Low Tdap coverage among adult CCs reinforces the difficulty of implementing the cocooning strategy and the importance of vaccination during pregnancy to prevent infant pertussis. PMID:27838676

  13. Cluster-randomized study of intermittent preventive treatment for malaria in infants (IPTi in southern Tanzania: evaluation of impact on survival

    Directory of Open Access Journals (Sweden)

    Schellenberg Joanna

    2011-12-01

    Full Text Available Abstract Background Intermittent Preventive Treatment for malaria control in infants (IPTi consists of the administration of a treatment dose of an anti-malarial drug, usually sulphadoxine-pyrimethamine, at scheduled intervals, regardless of the presence of Plasmodium falciparum infection. A pooled analysis of individually randomized trials reported that IPTi reduced clinical episodes by 30%. This study evaluated the effect of IPTi on child survival in the context of a five-district implementation project in southern Tanzania. [Trial registration: clinical trials.gov NCT00152204]. Methods After baseline household and health facility surveys in 2004, five districts comprising 24 divisions were randomly assigned either to receive IPTi (n = 12 or not (n = 12. Implementation started in March 2005, led by routine health services with support from the research team. In 2007, a large household survey was undertaken to assess the impact of IPTi on survival in infants aged two-11 months through birth history interviews with all women aged 13-49 years. The analysis is based on an "intention-to-treat" ecological design, with survival outcomes analysed according to the cluster in which the mothers lived. Results Survival in infants aged two-11 months was comparable in IPTi and comparison areas at baseline. In intervention areas in 2007, 48% of children aged 12-23 months had documented evidence of receiving three doses of IPTi, compared to 2% in comparison areas (P P = 0.31. Conclusion The lack of evidence of an effect of IPTi on survival could be a false negative result due to a lack of power or imbalance of unmeasured confounders. Alternatively, there could be no mortality impact of IPTi due to low coverage, late administration, drug resistance, decreased malaria transmission or improvements in vector control and case management. This study raises important questions for programme evaluation design.

  14. Improving the outcome of infants born at <30 weeks' gestation - a randomized controlled trial of preventative care at home

    Directory of Open Access Journals (Sweden)

    Orton Jane

    2009-12-01

    Full Text Available Abstract Background Early developmental interventions to prevent the high rate of neurodevelopmental problems in very preterm children, including cognitive, motor and behavioral impairments, are urgently needed. These interventions should be multi-faceted and include modules for caregivers given their high rates of mental health problems. Methods/Design We have designed a randomized controlled trial to assess the effectiveness of a preventative care program delivered at home over the first 12 months of life for infants born very preterm ( Discussion This paper presents the background, study design and protocol for a randomized controlled trial in very preterm infants utilizing a preventative care program in the first year after discharge home designed to improve cognitive, motor and behavioral outcomes of very preterm children and caregiver mental health at two-years' corrected age. Clinical Trial Registration Number ACTRN12605000492651

  15. Parents' beliefs about appropriate infant size, growth and feeding behaviour: implications for the prevention of childhood obesity

    Directory of Open Access Journals (Sweden)

    Swift Judy A

    2010-11-01

    Full Text Available Abstract Background A number of risk factors are associated with the development of childhood obesity which can be identified during infancy. These include infant feeding practices, parental response to infant temperament and parental perception of infant growth and appetite. Parental beliefs and understanding are crucial determinants of infant feeding behaviour; therefore any intervention would need to take account of their views. This study aimed to explore UK parents' beliefs concerning their infant's size, growth and feeding behaviour and parental receptiveness to early intervention aimed at reducing the risk of childhood obesity. Method Six focus groups were undertaken in a range of different demographic localities, with parents of infants less than one year of age. The focus groups were audio-recorded, transcribed verbatim and thematic analysis applied using an interpretative, inductive approach. Results 38 parents (n = 36 female, n = 2 male, age range 19-45 years (mean 30.1 years, SD 6.28 participated in the focus groups. 12/38 were overweight (BMI 25-29.99 and 8/38 obese (BMI >30. Five main themes were identified. These were a parental concern about breast milk, infant contentment and growth; b the belief that the main cause of infant distress is hunger is widespread and drives inappropriate feeding; c rationalisation for infants' larger size; d parental uncertainty about identifying and managing infants at risk of obesity and e intentions and behaviour in relation to a healthy lifestyle. Conclusions There are a number of barriers to early intervention with parents of infants at risk of developing obesity. Parents are receptive to prevention prior to weaning and need better support with best practice in infant feeding. In particular, this should focus on helping them understand the physiology of breast feeding, how to differentiate between infant distress caused by hunger and other causes and the timing of weaning. Some parents also need

  16. Breastfeeding and the risk for diarrhea morbidity and mortality

    Directory of Open Access Journals (Sweden)

    Victora Cesar

    2011-04-01

    Full Text Available Abstract Background Lack of exclusive breastfeeding among infants 0-5 months of age and no breastfeeding among children 6-23 months of age are associated with increased diarrhea morbidity and mortality in developing countries. We estimate the protective effects conferred by varying levels of breastfeeding exposure against diarrhea incidence, diarrhea prevalence, diarrhea mortality, all-cause mortality, and hospitalization for diarrhea illness. Methods We systematically reviewed all literature published from 1980 to 2009 assessing levels of suboptimal breastfeeding as a risk factor for selected diarrhea morbidity and mortality outcomes. We conducted random effects meta-analyses to generate pooled relative risks by outcome and age category. Results We found a large body of evidence for the protective effects of breastfeeding against diarrhea incidence, prevalence, hospitalizations, diarrhea mortality, and all-cause mortality. The results of random effects meta-analyses of eighteen included studies indicated varying degrees of protection across levels of breastfeeding exposure with the greatest protection conferred by exclusive breastfeeding among infants 0-5 months of age and by any breastfeeding among infants and young children 6-23 months of age. Specifically, not breastfeeding resulted in an excess risk of diarrhea mortality in comparison to exclusive breastfeeding among infants 0-5 months of age (RR: 10.52 and to any breastfeeding among children aged 6-23 months (RR: 2.18. Conclusions Our findings support the current WHO recommendation for exclusive breastfeeding during the first 6 months of life as a key child survival intervention. Our findings also highlight the importance of breastfeeding to protect against diarrhea-specific morbidity and mortality throughout the first 2 years of life.

  17. Probiotics Prevent Late-Onset Sepsis in Human Milk-Fed, Very Low Birth Weight Preterm Infants: Systematic Review and Meta-Analysis

    Directory of Open Access Journals (Sweden)

    Arianna Aceti

    2017-08-01

    Full Text Available Growing evidence supports the role of probiotics in reducing the risk of necrotizing enterocolitis, time to achieve full enteral feeding, and late-onset sepsis (LOS in preterm infants. As reported for several neonatal clinical outcomes, recent data have suggested that nutrition might affect probiotics’ efficacy. Nevertheless, the currently available literature does not explore the relationship between LOS prevention and type of feeding in preterm infants receiving probiotics. Thus, the aim of this systematic review and meta-analysis was to evaluate the effect of probiotics for LOS prevention in preterm infants according to type of feeding (exclusive human milk (HM vs. exclusive formula or mixed feeding. Randomized-controlled trials involving preterm infants receiving probiotics and reporting on LOS were included in the systematic review. Only trials reporting on outcome according to feeding type were included in the meta-analysis. Fixed-effects models were used and random-effects models were used when significant heterogeneity was found. The results were expressed as risk ratio (RR with 95% confidence interval (CI. Twenty-five studies were included in the meta-analysis. Overall, probiotic supplementation resulted in a significantly lower incidence of LOS (RR 0.79 (95% CI 0.71–0.88, p < 0.0001. According to feeding type, the beneficial effect of probiotics was confirmed only in exclusively HM-fed preterm infants (RR 0.75 (95% CI 0.65–0.86, p < 0.0001. Among HM-fed infants, only probiotic mixtures, and not single-strain products, were effective in reducing LOS incidence (RR 0.68 (95% CI 0.57–0.80 p < 0.00001. The results of the present meta-analysis show that probiotics reduce LOS incidence in exclusively HM-fed preterm infants. Further efforts are required to clarify the relationship between probiotics supplementation, HM, and feeding practices in preterm infants.

  18. Research report--Volunteer infant feeding and care counselors: a health education intervention to improve mother and child health and reduce mortality in rural Malawi.

    Science.gov (United States)

    Rosato, Mikey; Lewycka, Sonia; Mwansambo, Charles; Kazembe, Peter; Phiri, Tambosi; Chapota, Hilda; Vergnano, Stefania; Newell, Marie-Louise; Osrin, David; Costello, Anthony

    2012-06-01

    The aim of this report is to describe a health education intervention involving volunteer infant feeding and care counselors being implemented in Mchinji district, Malawi. The intervention was established in January 2004 and involves 72 volunteer infant feeding and care counselors, supervised by 24 government Health Surveillance Assistants, covering 355 villages in Mchinji district. It aims to change the knowledge, attitudes and behaviour of women to promote exclusive breastfeeding and other infant care practices. The main target population are women of child bearing age who are visited at five key points during pregnancy and after birth. Where possible, their partners are also involved. The visits cover exclusive breastfeeding and other important neonatal and infant care practices. Volunteers are provided with an intervention manual and picture book. Resource inputs are low and include training allowances and equipment for counselors and supervisors, and a salary, equipment and materials for a coordinator. It is hypothesized that the counselors will encourage informational and attitudinal change to enhance motivation and risk reduction skills and self-efficacy to promote exclusive breastfeeding and other infant care practices and reduce infant mortality. The impact is being evaluated through a cluster randomised controlled trial and results will be reported in 2012.

  19. Non-fatal injuries among Pacific infants in Auckland: data from the Pacific Islands families first two years of life study.

    Science.gov (United States)

    Schluter, Philip J; Paterson, Janis; Percival, Teuila

    2006-03-01

    Child injury is the leading cause of mortality and morbidity in developed countries. While Pacific infant death rates are relatively high in New Zealand, little is known about non-fatal injury rates. We seek to describe maternally reported injury in Pacific infants aged between 0-24 months. A cohort of Pacific infants born during 2000 in Auckland, New Zealand, was followed. Maternal home interviews were conducted at 6 weeks, 12 months and 24 months postpartum and injury events were recalled. Marginal models using generalized estimating equations (GEEs) were used to analysis the longitudinal data. The inception cohort included 1398 infants at 6 weeks, 1241 infants at 12 months and 1161 infants at 24 months. The age-specific injury incidence per 1000 person-years exposure was estimated at 48 (95% CI: 23, 88) injuries for infants aged 0-6 weeks, 106 (95% CI: 88, 127) injuries for infants aged 7 weeks-12 months and 174 (95% CI: 151, 199) injuries for infants aged 13-24 months. In the multivariable GEE model, older infants (P culturally appropriate prevention strategies for all Pacific families with young children is required to reduce injury rates for Pacific infants in New Zealand.

  20. Maternal incarceration, child protection, and infant mortality: a descriptive study of infant children of women prisoners in Western Australia.

    Science.gov (United States)

    Dowell, Caitlin McMillen; Mejia, Gloria C; Preen, David B; Segal, Leonie

    2018-01-15

    There are no population statistics collected on a routine basis on the children of prisoners in Australia. Accordingly, their potential vulnerability to adverse outcomes remains unclear. This study draws on linked administrative data to describe the exposure of children aged less than 2 years to maternal imprisonment in Western Australia, their contact with child protection services, and infant mortality rates. In Western Australia, 36.5 per 1000 Indigenous (n = 804) and 1.3 per 1000 non-Indigenous (n = 395) children born between 2001 and 2011 had mothers imprisoned after birth to age 2 years. One-third of infants' mothers had multiple imprisonments (maximum of 11). Nearly half (46%) of prison stays were for ≤2 weeks, 12% were between 2 and 4 weeks, 14% were for 1-3 months, and 28% were longer than three months. Additionally, 17.4 per 1000 Indigenous (n = 383) and 0.5 per 1000 non-Indigenous (n = 150) children had mothers imprisoned during pregnancy. Half of the children with a history of maternal incarceration in pregnancy to age 2 years came into contact with child protection services by their second birthday, with 31% of Indigenous and 35% of non-Indigenous children entering out-of-home care. Rates of placement in care were significantly higher for Indigenous children (Relative Risk (RR) 27.30; 95%CI 19.19 to 38.84; p policies and procedures. Prison may present an opportunity to identify and work with vulnerable families to help improve outcomes for children as well as mothers.

  1. Baby Business: a randomised controlled trial of a universal parenting program that aims to prevent early infant sleep and cry problems and associated parental depression

    Directory of Open Access Journals (Sweden)

    Cook Fallon

    2012-02-01

    Full Text Available Abstract Background Infant crying and sleep problems (e.g. frequent night waking, difficulties settling to sleep each affect up to 30% of infants and often co-exist. They are costly to manage and associated with adverse outcomes including postnatal depression symptoms, early weaning from breast milk, and later child behaviour problems. Preventing such problems could improve these adverse outcomes and reduce costs to families and the health care system. Anticipatory guidance-i.e. providing parents with information about normal infant sleep and cry patterns, ways to encourage self-settling in infants, and ways to develop feeding and settling routines before the onset of problems-could prevent such problems. This paper outlines the protocol for our study which aims to test an anticipatory guidance approach. Methods/Design 750 families from four Local Government Areas in Melbourne, Australia have been randomised to receive the Baby Business program (intervention group or usual care (control group offered by health services. The Baby Business program provides parents with information about infant sleep and crying via a DVD and booklet (mailed soon after birth, telephone consultation (at infant age 6-8 weeks and parent group session (at infant age 12 weeks. All English speaking parents of healthy newborn infants born at > 32 weeks gestation and referred by their maternal and child health nurse at their first post partum home visit (day 7-10 postpartum, are eligible. The primary outcome is parent report of infant night time sleep as a problem at four months of age and secondary outcomes include parent report of infant daytime sleep or crying as a problem, mean duration of infant sleep and crying/24 hours, parental depression symptoms, parent sleep quality and quantity and health service use. Data will be collected at two weeks (baseline, four months and six months of age. An economic evaluation using a cost-consequences approach will, from a societal

  2. Sex differences in child and adolescent mortality in the Nordic countries, 1981--2000

    DEFF Research Database (Denmark)

    Gissler, Mika; Rahkonen, Ossi; Mortensen, Laust

    2009-01-01

    Unlike the situation for infant and adult mortality, there are only a few studies on child and adolescent mortality. The purpose of this study was to examine sex differences in child and adolescent mortality by age and cohort in four Nordic countries over a 20-year period.......Unlike the situation for infant and adult mortality, there are only a few studies on child and adolescent mortality. The purpose of this study was to examine sex differences in child and adolescent mortality by age and cohort in four Nordic countries over a 20-year period....

  3. Probiotics Prevent Late-Onset Sepsis in Human Milk-Fed, Very Low Birth Weight Preterm Infants: Systematic Review and Meta-Analysis.

    Science.gov (United States)

    Aceti, Arianna; Maggio, Luca; Beghetti, Isadora; Gori, Davide; Barone, Giovanni; Callegari, Maria Luisa; Fantini, Maria Pia; Indrio, Flavia; Meneghin, Fabio; Morelli, Lorenzo; Zuccotti, Gianvincenzo; Corvaglia, Luigi

    2017-08-22

    Growing evidence supports the role of probiotics in reducing the risk of necrotizing enterocolitis, time to achieve full enteral feeding, and late-onset sepsis (LOS) in preterm infants. As reported for several neonatal clinical outcomes, recent data have suggested that nutrition might affect probiotics' efficacy. Nevertheless, the currently available literature does not explore the relationship between LOS prevention and type of feeding in preterm infants receiving probiotics. Thus, the aim of this systematic review and meta-analysis was to evaluate the effect of probiotics for LOS prevention in preterm infants according to type of feeding (exclusive human milk (HM) vs. exclusive formula or mixed feeding). Randomized-controlled trials involving preterm infants receiving probiotics and reporting on LOS were included in the systematic review. Only trials reporting on outcome according to feeding type were included in the meta-analysis. Fixed-effects models were used and random-effects models were used when significant heterogeneity was found. The results were expressed as risk ratio (RR) with 95% confidence interval (CI). Twenty-five studies were included in the meta-analysis. Overall, probiotic supplementation resulted in a significantly lower incidence of LOS (RR 0.79 (95% CI 0.71-0.88), p probiotics was confirmed only in exclusively HM-fed preterm infants (RR 0.75 (95% CI 0.65-0.86), p probiotic mixtures, and not single-strain products, were effective in reducing LOS incidence (RR 0.68 (95% CI 0.57-0.80) p probiotics reduce LOS incidence in exclusively HM-fed preterm infants. Further efforts are required to clarify the relationship between probiotics supplementation, HM, and feeding practices in preterm infants.

  4. NEONATAL MORBIDITY AND EARLY OUTCOME OF VERY PRETERM INFANTS

    Directory of Open Access Journals (Sweden)

    Heljić Suada

    2013-01-01

    Full Text Available Background: Although the mortality rate for preterm infants and the gestational age-specific mortality rate have dramatically improved over the last 3 to 4 decades, infants born preterm remain vulnerable to many complications, including respiratory distress syndrome, chronic lung disease, necrotizing enterocolitis, a compromised immune system, cardiovascular disorders, hearing and vision problems, and brain lesions.The aim is to determine mortality and morbidity rates and selected outcome variables for preterm infant’s < 30 weeks’ gestation, who were admitted to the NICU. Patients and methods: This study enrolled 102 infants with gestational age less than 30 weeks’ gestation, hospitalized in Neonatal Intensive Care Unit, Pediatric Hospital, Clinical University Center Sarajevo, from Jan. 2010 to Dec. 2010. Parameters taken at admission were: birth weight, gestational age, Apgar score, excess base and CRIB score. Early outcome is considered as a survival at discharge or common preterm morbidities presented during hospitalizationResults: The mean BW of evaluated preterm infants was 1086 ± 250 g, the mean GA27.89 ± 1.97, Apgar score 5.41 ± 1.76, excess base at admission 6.39 ± 1.74 and mean CRIB score 3.72 ± 3.16. The overall survival rate was 70.5%. Selected outcomes at discharge were: RDS with 70.5% infants treated with natural surfactant, PDA treated with NSAIDS (23.5%, brain injury ( ≥ grade 3 IVH or PVL 16.6%, NEC Bell stages II or III 9.8%, BPD 25/72 (33.3% of infants who survived to 36 weeks postmenstrual age. In 38 (37.2% infants, episodes of infections were noticed (one or more episodes in 25 infants, half of them were caused by Gram positive bacteria, most frequent coagulasa negative staphylococci. Klebsiella pneumoniae was the mostfrequent organism among Gram negative bacteria. One patient had invasive candidiasis caused by Candida albicans. In 5 infants (4.9% early onset of sepsis was documented. Conclusion: Very preterm

  5. Specialist teams for neonatal transport to neonatal intensive care units for prevention of morbidity and mortality.

    Science.gov (United States)

    Chang, Alvin S M; Berry, Andrew; Jones, Lisa J; Sivasangari, Subramaniam

    2015-10-28

    Maternal antenatal transfers provide better neonatal outcomes. However, there will inevitably be some infants who require acute transport to a neonatal intensive care unit (NICU). Because of this, many institutions develop services to provide neonatal transport by specially trained health personnel. However, few studies report on relevant clinical outcomes in infants requiring transport to NICU. To determine the effects of specialist transport teams compared with non-specialist transport teams on the risk of neonatal mortality and morbidity among high-risk newborn infants requiring transport to neonatal intensive care. We used the standard search strategy of the Cochrane Neonatal Review Group to search the Cochrane Central Register of Controlled Trials (CENTRAL 2015, Issue 7), MEDLINE (1966 to 31 July 2015), EMBASE (1980 to 31 July 2015), CINAHL (1982 to 31 July 2015), conference proceedings, and the reference lists of retrieved articles for randomised controlled trials and quasi-randomised trials. randomised, quasi-randomised or cluster randomised controlled trials. neonates requiring transport to a neonatal intensive care unit. transport by a specialist team compared to a non-specialist team. any of the following outcomes - death; adverse events during transport leading to respiratory compromise; and condition on admission to the neonatal intensive care unit. The methodological quality of the trials was assessed using the information provided in the studies and by personal communication with the author. Data on relevant outcomes were extracted and the effect size estimated and reported as risk ratio (RR), risk difference (RD), number needed to treat for an additional beneficial outcome (NNTB) or number needed to treat for an additional harmful outcome (NNTH) and mean difference (MD) for continuous outcomes. Data from cluster randomised trials were not combined for analysis. One trial met the inclusion criteria of this review but was considered ineligible owing to

  6. Evolución de la mortalidad infantil en la ciudad de Barcelona (1983-1998 Trends in infant mortality in Barcelona [Spain], 1983-1998

    Directory of Open Access Journals (Sweden)

    Emma Albacar

    2004-02-01

    Full Text Available Objetivo: Analizar las tendencias de la mortalidad infantil, teniendo en cuenta sus componentes y las principales causas de defunción entre los años 1983 y 1998 en la ciudad de Barcelona. Métodos: Se han calculado las tasas globales y por sexos de la mortalidad infantil, posneonatal, neonatal, neonatal tardía y neonatal precoz de los residentes de la ciudad de Barcelona entre los años 1983 y 1998, con los datos procedentes de los registros de mortalidad y natalidad. Los datos se han agrupado en períodos de 4 años y se han ajustado los modelos de regresión de Poisson con la finalidad de calcular los riesgos relativos de mortalidad que comparen estos períodos. También se ha calculado la variación porcentual entre las tasas de los períodos definidos. Resultados: En total, durante estos 16 años hubo 1.564 muertes. De éstas, 896 corresponden a niños (57,3% y las 668 restantes a niñas (42,7%. Las tasas de mortalidad infantil oscilan entre 10,5 por 1.000 nacidos vivos en el año 1986 y 3,4 10 años después, en el año 1996. Entre los años 1983 y 1988 se observa un estancamiento de la mortalidad infantil, y a partir del año 1989 se nota una disminución en las tasas de mortalidad infantil. La tasa de mortalidad neonatal, y sobre todo la neonatal precoz, experimentan un descenso más pronunciado que la mortalidad posneonatal. Las causas de defunción más frecuentes son las debidas a defectos congénitos (47,4% seguidas por las causas perinatales (32,1%. Conclusiones: Tras analizar la tendencia de la mortalidad infantil y haber observado la de años anteriores, se concluye que las tasas de mortalidad infantil han disminuido durante el período estudiado, aunque no con la misma intensidad que en décadas anteriores.Objective: To analyze trends in infant mortality, taking into account its main components and the principal causes of death between 1983 and 1998 in the city of Barcelona (Spain. Methods: We calculated overall mortality rates

  7. [Role of donor human milk feeding in preventing nosocomial infection in very low birth weight infants].

    Science.gov (United States)

    Bi, Hong-Juan; Xu, Jing; Wei, Qiu-Fen

    2018-02-01

    To investigate the role of donor human milk in the prevention of nosocomial infection in very low birth weight infants. MeETHODS: A total of 105 hospitalized preterm infants with a very low birth weight were enrolled. They were classified into mother's own milk feeding group, donor human milk feeding group, and preterm formula feeding group, with 35 infants in each group. The three groups were compared in terms of incidence rates of nosocomial infection, necrotizing enterocolitis, and feeding intolerance, time to full enteral feeding, and early growth indices. Compared with the preterm formula feeding group, the donor human milk feeding group and the mother's own milk feeding group had significantly lower incidence rates of nosocomial infection and necrotizing enterocolitis and shorter time to full enteral feeding (Pmilk can be used in case of a lack of mother's own milk and may help to reduce nosocomial infection.

  8. Quality-Improvement Effort to Reduce Hypothermia Among High-Risk Infants on a Mother-Infant Unit.

    Science.gov (United States)

    Andrews, Christine; Whatley, Colleen; Smith, Meaghan; Brayton, Emily Caron; Simone, Suzanne; Holmes, Alison Volpe

    2018-02-14

    Neonatal hypothermia is common in low birth weight (LBW) (preventive measures for LPIs and/or LBW infants in a mother-infant unit. We conducted plan-do-study-act (PDSA) cycles aimed at decreasing environmental hypothermia for LPIs and/or LBW infants in a mother-infant unit with no other indications for NICU-level care. Interventions included using warm towels after delivery, a risk identification card, an occlusive hat, delayed timing of first bath, submersion instead of sponge-bathing, and conducting all assessments under a radiant warmer during the initial hours of life. We implemented these interventions in 3 PDSA cycles and followed hypothermia rates by using statistical process control methods. The baseline mean monthly hypothermia rate among mother-infant unit LPIs and/or LBW infants was 29.8%. Postintervention, the rate fell to 13.3% (-16.5%; P = .002). This decrease occurred in a stepwise fashion in conjunction with the PDSA cycles. In the final, full-intervention period, the rate was 10.0% (-19.8%; P = .0003). A special-cause signal shift was observed in this final period. Targeted interventions can significantly reduce hypothermia in otherwise healthy LPIs and/or LBW newborns and allow them to safely remain in a mother-infant unit. If applied broadly, such preventive practices could decrease preventable hypothermia in high-risk populations. Copyright © 2018 by the American Academy of Pediatrics.

  9. Mortalidade infantil no Rio de Janeiro, Brasil: áreas de risco e trajetória dos pacientes até os serviços de saúde Infant mortality in Rio de Janeiro, Brazil: areas with higher risk, and where patients travel for health services

    Directory of Open Access Journals (Sweden)

    Tatiana P. Campos

    2000-09-01

    mortalidade infantil.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.

  10. A review of the current treatment methods for posthaemorrhagic hydrocephalus of infants

    Directory of Open Access Journals (Sweden)

    Sparrow Owen

    2009-01-01

    Full Text Available Abstract Posthaemorrhagic hydrocephalus (PHH is a major problem for premature infants, generally requiring lifelong care. It results from small blood clots inducing scarring within CSF channels impeding CSF circulation. Transforming growth factor – beta is released into CSF and cytokines stimulate deposition of extracellular matrix proteins which potentially obstruct CSF pathways. Prolonged raised pressures and free radical damage incur poor neurodevelopmental outcomes. The most common treatment involves permanent ventricular shunting with all its risks and consequences. This is a review of the current evidence for the treatment and prevention of PHH and shunt dependency. The Cochrane Central Register of Controlled Trials (CENTRAL, The Cochrane Library and PubMed (from 1966 to August 2008 were searched. Trials using random or quasi-random patient allocation for any intervention were considered in infants less than 12 months old with PHH. Thirteen trials were identified although speculative interventions were also evaluated. The literature confirms that lumbar punctures, diuretic drugs and intraventricular fibrinolytic therapy can have significant adverse effects and fail to prevent shunt dependence, death or disability. There is no evidence that postnatal phenobarbital administration prevents intraventricular haemorrhage (IVH. Subcutaneous reservoirs and external drains have not been tested in randomized controlled trials, but can be useful as a temporising measure. Drainage, irrigation and fibrinolytic therapy as a way of removing blood to inhibit progressive deposition of matrix proteins, permanent hydrocephalus and shunt dependency, are invasive and experimental. Studies of ventriculo-subgaleal shunts show potential as a temporary method of CSF diversion, but have high infection rates. At present no clinical intervention has been shown to reduce shunt surgery in these infants. A ventricular shunt is not advisable in the early phase after

  11. Effect of an allergy prevention programme on incidence of atopic symptoms in infancy. A prospective study of 159 "high-risk" infants

    DEFF Research Database (Denmark)

    Halken, S; Høst, A; Hansen, L G

    1992-01-01

    unrestricted diet. Avoidance of daily exposure to tobacco smoke, furred pets and dust-collecting materials in the bedroom were advised. This prevention group was compared with a control group consisting of 54 identically defined "high-risk" infants born in 1985 in the same area. All infants had either severe...... comparable. The parents were highly motivated and compliance was good. The rate of participation was 97%, and 85% followed the dietary measures strictly. The cumulative prevalence of atopic symptoms was significantly lower at 18 months in the prevention group (32%), as compared with the control group (74...... single atopic predisposition combined with cord blood IgE > or = 0.5 KU/l or biparental atopic predisposition. The control group had unrestricted diet and was not advised about environmental factors. Apart from the prevention programme and year of birth the prevention group and the control group were...

  12. Evaluating the Effectiveness of Various Methods of Iron Deficiency Prevention in Infants

    Directory of Open Access Journals (Sweden)

    N.А. Bielykh

    2015-02-01

    Full Text Available Objective: to evaluate the effectiveness of various methods of iron deficiency prevention in infants. Materials and Methods. Within 30-cluster regional epidemiological study on the prevalence of iodine and iron deficiency in children, we have analyzed the results of screening for anemia in 948 children, carried out questioning of mothers, determined the concentration of iron in breast milk. The effectiveness of preventive measures was assessed by indicators of iron supplementation of the body in 96 children depending on the existing method of iron prophylaxis. Results of the Study. It was found that the use by mother during lactation of iron-containing vitamin-mineral complexes had no effect on the iron content in breast milk. It is proved that administration of iron (III hydroxide polymaltose complex 1 mg/kg/day for 2 months is the most effective way to prevent iron deficiency in children who are exclusively breastfed.

  13. Birth spacing, sibling rivalry and child mortality in India.

    Science.gov (United States)

    Whitworth, Alison; Stephenson, Rob

    2002-12-01

    The detrimental impact of short preceding birth intervals on infant and early childhood mortality is well documented in demographic literature, although the pathways of influence within the relationship remain an area of debate. This paper examines the impact of the length of the preceding birth interval on under-two mortality in India, and examines the pathways through which short preceding birth intervals may lead to an increased risk of mortality. Three mortality periods are examined: neonatal, early post neonatal and late post-neonatal and toddler, using the 1992 Indian National Family Health Survey. A multilevel modelling approach is used to account for the hierarchical nature of the data. The determinants of infants following a short or long birth interval are also examined. The results show that short preceding birth intervals (sibling rivalry is a pathway through which short birth intervals influence mortality, with the death of the previous sibling removing the competition for scarce resources, and resulting in lower risks of mortality than if the previous sibling was still alive. The greatest risks of an infant following a short birth interval are among those whose previous sibling died, high parities, those with young mothers, and those whose previous sibling was breastfed for a short duration. Copyright 2002 Elsevier Science Ltd.

  14. Impact of maternal diabetes mellitus on mortality and morbidity of very low birth weight infants: a multicenter Latin America study

    Directory of Open Access Journals (Sweden)

    Carlos Grandi

    2015-05-01

    Full Text Available Objectives: To compare mortality and morbidity in very low birth weight infants (VLBWI born to women with and without diabetes mellitus (DM. Methods: This was a cohort study with retrospective data collection (2001–2010, n = 11.991 from the NEOCOSUR network. Adjusted odds ratios and 95% confidence intervals were calculated for the outcome of neonatal mortality and morbidity as a function of maternal DM. Women with no DM served as the reference group. Results: The rate of maternal DM was 2.8% (95% CI: 2.5-3.1, but a significant (p = 0.019 increase was observed between 2001-2005 (2.4%, 2.1-2.8 and 2006-2010 (3.2%, 2.8-3.6. Mothers with DM were more likely to have received a complete course of prenatal steroids than those without DM. Infants of diabetic mothers had a slightly higher gestational age and birth weight than infants of born to non-DM mothers. Distribution of mean birth weight Z-scores, small for gestational age status, and Apgar scores were similar. There were no significant differences between the two groups regarding respiratory distress syndrome, bronchopulmonary dysplasia, intraventricular hemorrhage, periventricular leukomalacia, and patent ductus arteriosus. Delivery room mortality, total mortality, need for mechanical ventilation, and early-onset sepsis rates were significantly lower in the diabetic group, whereas necrotizing enterocolitis (NEC was significantly higher in infants born to DM mothers. In the logistic regression analysis, NEC grades 2-3 was the only condition independently associated with DM (adjusted OR: 1.65 [95% CI: 1.2 -2.27]. Conclusions: VLBWI born to DM mothers do not appear to be at an excess risk of mortality or early morbidity, except for NEC. Resumo: Objetivos: Comparar mortalidade e morbidade em crianças de muito baixo peso (MBP filhas de mães com e sem diabetes mellitus (DM. Métodos: Estudo de coorte com coleta retrospectiva de dados (2001 - 2010, n = 11.991 da rede NEOCOSUR. Odds ratios

  15. Neonatal outcomes following extensive cardiopulmonary resuscitation in the delivery room for infants born at less than 33 weeks gestational age.

    Science.gov (United States)

    Soraisham, Amuchou Singh; Lodha, Abhay Kumar; Singhal, Nalini; Aziz, Khalid; Yang, Junmin; Lee, Shoo K; Shah, Prakesh S

    2014-02-01

    To examine the neonatal mortality and morbidity of infants born at CPR) immediately after birth. In this retrospective cohort study, we performed secondary analyses of data from infants born at Neonatal Network between January 2010 and December 2011. Infants were divided into two groups based on birth weight (neonatal morbidity and mortality compared using bivariate and multivariate analyses. Of the 8033 eligible infants, 419 (5.2%) received DR-CPR. For infants weighing CPR, whereas 3.4% (outborn: 9.6%, inborn: 2.2%) of those weighing ≥1000 g received DR-CPR. If infants received DR-CPR there was increased risk of mortality, bronchopulmonary dysplasia (BPD) and severe brain injury. Logistic regression analysis showed DR-CPR was associated with increased mortality (adjusted odds ratio [aOR]: 2.09, 95% CI [1.39, 3.14]) in infants born weighing CPR was associated with increased mortality (aOR: 7.16, 95% CI [3.88, 13.2]), severe brain injury (aOR: 3.08, 95% CI [1.82, 5.22]), BPD (aOR: 2.14, 95% CI [1.25, 3.65]), pneumothorax (aOR: 3.11, 95% CI [1.53, 6.31]) and intestinal perforation (aOR: 3.47, 95% CI [1.46, 8.24]). DR-CPR is associated with increased risk of mortality and morbidity especially in preterm infants born weighing ≥1000 g. Long-term neurodevelopmental follow up is warranted for these infants.

  16. The interplay of race, socioeconomic status and neighborhood residence upon birth outcomes in a high black infant mortality community

    Directory of Open Access Journals (Sweden)

    Catherine L. Kothari

    2016-12-01

    Full Text Available This study examined the interrelationship of race and socioeconomic status (SES upon infant birthweight at the individual and neighborhood levels within a Midwestern US county marked by high Black infant mortality. The study conducted a multi-level analysis utilizing individual birth records and census tract datasets from 2010, linked through a spatial join with ArcGIS 10.0. The maternal population of 2861 Black and White women delivering infants in 2010, residing in 57 census tracts within the county, constituted the study samples. The main outcome was infant birthweight. The predictors, race and SES were dichotomized into Black and White, low-SES and higher-SES, at both the individual and census tract levels. A two-part Bayesian model demonstrated that individual-level race and SES were more influential birthweight predictors than community-level factors. Specifically, Black women had 1.6 higher odds of delivering a low birthweight (LBW infant than White women, and low-SES women had 1.7 higher odds of delivering a LBW infant than higher-SES women. Moderate support was found for a three-way interaction between individual-level race, SES and community-level race, such that Black women achieved equity with White women (4.0% Black LBW and 4.1% White LBW when they each had higher-SES and lived in a racially congruous neighborhood (e.g., Black women lived in disproportionately Black neighborhood and White women lived in disproportionately White neighborhood. In sharp contrast, Black women with higher-SES who lived in a racially incongruous neighborhood (e.g., disproportionately White had the worst outcomes (14.5% LBW. Demonstrating the layered influence of personal and community circumstances upon health, in a community with substantial racial disparities, personal race and SES independently contribute to birth outcomes, while environmental context, specifically neighborhood racial congruity, is associated with mitigated health risk. Keywords: Birth

  17. Efficacy and safety of intermittent preventive treatment with sulfadoxine-pyrimethamine for malaria in African infants: a pooled analysis of six randomised, placebo-controlled trials

    NARCIS (Netherlands)

    Aponte, John J.; Schellenberg, David; Egan, Andrea; Breckenridge, Alasdair; Carneiro, Ilona; Critchley, Julia; Danquah, Ina; Dodoo, Alexander; Kobbe, Robin; Lell, Bertrand; May, Jürgen; Premji, Zul; Sanz, Sergi; Sevene, Esperanza; Soulaymani-Becheikh, Rachida; Winstanley, Peter; Adjei, Samuel; Anemana, Sylvester; Chandramohan, Daniel; Issifou, Saadou; Mockenhaupt, Frank; Owusu-Agyei, Seth; Greenwood, Brian; Grobusch, Martin P.; Kremsner, Peter G.; Macete, Eusebio; Mshinda, Hassan; Newman, Robert D.; Slutsker, Laurence; Tanner, Marcel; Alonso, Pedro; Menendez, Clara

    2009-01-01

    BACKGROUND: Intermittent preventive treatment (IPT) is a promising strategy for malaria control in infants. We undertook a pooled analysis of the safety and efficacy of IPT in infants (IPTi) with sulfadoxine-pyrimethamine in Africa. METHODS: We pooled data from six double-blind, randomised,

  18. Low birth weight and fetal anaemia as risk factors for infant morbidity ...

    African Journals Online (AJOL)

    Low birth weight (LBW) and fetal anaemia (FA) are common in malaria endemic areas. To investigate the ... In sub-Saharan Africa, infant morbidity and mortality are excessively high and reductions in mortality rates .... lower respiratory infection for children under two months of age, for older infants, a cut-off value of 50 per ...

  19. Determinants of infant mortality in the Jequitinhonha Valley and in the North and Northeast regions of Brazil.

    Science.gov (United States)

    Leal, Maria do Carmo; Bittencourt, Sonia Duarte de Azevedo; Torres, Raquel Maria Cardoso; Niquini, Roberta Pereira; Souza, Paulo Roberto Borges de

    2017-03-02

    This study aims to identify the social and demographic determinants, in addition to the determinants of reproductive health and use of health services, associated with infant mortality in small and medium-sized cities of the North, Northeast and Southeast regions of Brazil. This is a case-control study with 803 cases of death of children under one year and 1,969 live births (controls), whose mothers lived in the selected cities in 2008. The lists of the names of cases and controls were extracted from the Sistema de Informação sobre Mortalidade (SIM - Mortality Information System) and the Sistema de Informação sobre Nascidos Vivos (SINASC - Live Birth Information System) and supplemented by data obtained by the research of "active search of death and birth". Data was collected in the household using a semi-structured questionnaire, and the analysis was carried out using multiple logistic regression. The final model indicates that the following items are positively and significantly associated with infant mortality: family working in agriculture, mother having a history of fetal and infant losses, no prenatal or inadequate prenatal, and not being associated to the maternity hospital during the prenatal period. We have observed significant interactions to explain the occurrence of infant mortality between race and socioeconomic score and between high-risk pregnancy and pilgrimage for childbirth. The excessive number of home deliveries and pilgrimage for childbirth indicates flaws in the line of maternity care and a lack of collaboration between the levels of outpatient and hospital care. The study reinforces the need for an integrated management of the health care networks, leveraging the capabilities of cities in meeting the needs of pregnancy, delivery and birth with quality. Identificar os determinantes sociais, demográficos, da saúde reprodutiva e de utilização dos serviços de saúde associados ao óbito infantil em municípios de pequeno e médio porte

  20. Customised and Noncustomised Birth Weight Centiles and Prediction of Stillbirth and Infant Mortality and Morbidity: A Cohort Study of 979,912 Term Singleton Pregnancies in Scotland.

    Directory of Open Access Journals (Sweden)

    Stamatina Iliodromiti

    2017-01-01

    Full Text Available There is limited evidence to support the use of customised centile charts to identify those at risk of stillbirth and infant death at term. We sought to determine birth weight thresholds at which mortality and morbidity increased and the predictive ability of noncustomised (accounting for gestational age and sex and partially customised centiles (additionally accounting for maternal height and parity to identify fetuses at risk.This is a population-based linkage study of 979,912 term singleton pregnancies in Scotland, United Kingdom, between 1992 and 2010. The main exposures were noncustomised and partially customised birth weight centiles. The primary outcomes were infant death, stillbirth, overall mortality (infant and stillbirth, Apgar score <7 at 5 min, and admission to the neonatal unit. Optimal thresholds that predicted outcomes for both non- and partially customised birth weight centiles were calculated. Prediction of mortality between non- and partially customised birth weight centiles was compared using area under the receiver operator characteristic curve (AUROC and net reclassification index (NRI.Birth weight ≤25th centile was associated with higher risk for all mortality and morbidity outcomes. For stillbirth, low Apgar score, and neonatal unit admission, risk also increased from the 85th centile. Similar patterns and magnitude of associations were observed for both non- and partially customised birth weight centiles. Partially customised birth weight centiles did not improve the discrimination of mortality (AUROC 0.61 [95%CI 0.60, 0.62] compared with noncustomised birth weight centiles (AUROC 0.62 [95%CI 0.60, 0.63] and slightly underperformed in reclassifying pregnancies to different risk categories for both fatal and non-fatal adverse outcomes (NRI -0.027 [95% CI -0.039, -0.016], p < 0.001. We were unable to fully customise centile charts because we lacked data on maternal weight and ethnicity. Additional analyses in an

  1. Antioxidant supplements for prevention of mortality in healthy participants and patients with various diseases

    DEFF Research Database (Denmark)

    Bjelakovic, Goran; Nikolova, Dimitrinka; Gluud, Lise Lotte

    2012-01-01

    and secondary prevention randomised clinical trials on antioxidant supplements (beta-carotene, vitamin A, vitamin C, vitamin E, and selenium) versus placebo or no intervention. DATA COLLECTION AND ANALYSIS: Three authors extracted data. Random-effects and fixed-effect model meta-analyses were conducted. Risk......BACKGROUND: Our systematic review has demonstrated that antioxidant supplements may increase mortality. We have now updated this review. OBJECTIVES: To assess the beneficial and harmful effects of antioxidant supplements for prevention of mortality in adults. SEARCH METHODS: We searched...... years). The mean proportion of women was 46%. Of the 78 trials, 46 used the parallel-group design, 30 the factorial design, and 2 the cross-over design. All antioxidants were administered orally, either alone or in combination with vitamins, minerals, or other interventions. The duration...

  2. Black/white differences in very low birth weight neonatal mortality rates among New York City hospitals.

    Science.gov (United States)

    Howell, Elizabeth A; Hebert, Paul; Chatterjee, Samprit; Kleinman, Lawrence C; Chassin, Mark R

    2008-03-01

    We sought to determine whether differences in the hospitals at which black and white infants are born contribute to black/white disparities in very low birth weight neonatal mortality rates in New York City. We performed a population-based cohort study using New York City vital statistics records on all live births and deaths of infants weighing 500 to 1499 g who were born in 45 hospitals between January 1, 1996, and December 31, 2001 (N = 11 781). We measured very low birth weight risk-adjusted neonatal mortality rates for each New York City hospital and assessed differences in the distributions of non-Hispanic black and non-Hispanic white very low birth weight births among these hospitals. Risk-adjusted neonatal mortality rates for very low birth weight infants in New York City hospitals ranged from 9.6 to 27.2 deaths per 1000 births. White very low birth weight infants were more likely to be born in the lowest mortality tertile of hospitals (49%), compared with black very low birth weight infants (29%). We estimated that, if black women delivered in the same hospitals as white women, then black very low birth weight mortality rates would be reduced by 6.7 deaths per 1000 very low birth weight births, removing 34.5% of the black/white disparity in very low birth weight neonatal mortality rates in New York City. Volume of very low birth weight deliveries was modestly associated with very low birth weight mortality rates but explained little of the racial disparity. Black very low birth weight infants more likely to be born in New York City hospitals with higher risk-adjusted neonatal mortality rates than were very low birth weight infants, contributing substantially to black-white disparities.

  3. Maternal obesity and gestational weight gain are risk factors for infant death.

    Science.gov (United States)

    Bodnar, Lisa M; Siminerio, Lara L; Himes, Katherine P; Hutcheon, Jennifer A; Lash, Timothy L; Parisi, Sara M; Abrams, Barbara

    2016-02-01

    Assessment of the joint and independent relationships of gestational weight gain and prepregnancy body mass index (BMI) on risk of infant mortality was performed. This study used Pennsylvania linked birth-infant death records (2003-2011) from infants without anomalies born to mothers with prepregnancy BMI categorized as underweight (n = 58,973), normal weight (n = 610,118), overweight (n = 296,630), grade 1 obesity (n = 147,608), grade 2 obesity (n = 71,740), and grade 3 obesity (n = 47,277). Multivariable logistic regression models stratified by BMI category were used to estimate dose-response associations between z scores of gestational weight gain and infant death after confounder adjustment. Infant mortality risk was lowest among normal-weight women and increased with rising BMI category. For all BMI groups except for grade 3 obesity, there were U-shaped associations between gestational weight gain and risk of infant death. Weight loss and very low weight gain among women with grades 1 and 2 obesity were associated with high risks of infant mortality. However, even when gestational weight gain in women with obesity was optimized, the predicted risk of infant death remained higher than that of normal-weight women. Interventions aimed at substantially reducing preconception weight among women with obesity and avoiding very low or very high gestational weight gain may reduce risk of infant death. © 2015 The Obesity Society.

  4. Sudden infant death syndrome: an unrecognized killer in developing countries

    Directory of Open Access Journals (Sweden)

    Ndu IK

    2016-02-01

    Full Text Available Ikenna Kingsley Ndu Department of Paediatrics, Enugu State University Teaching Hospital, Enugu, Nigeria Abstract: Sudden infant death syndrome (SIDS is defined as the sudden unexpected death of an infant <1 year of age, with onset of the fatal episode apparently occurring during sleep, that remains unexplained after a thorough investigation including performance of a complete autopsy and review of the circumstances of death and the clinical history. SIDS contributes to infant mortality and resulted in ~15,000 deaths globally in 2013. Most of the risk factors of SIDS are common in developing countries; yet, there has been little interest in SIDS by researchers in Africa. This review looks at the extent of the attention given to SIDS in a developing country like Nigeria, and factors responsible for the scarce data concerning this significant cause of mortality. Keywords: SIDS, mortality, Nigeria

  5. The Relationship Between Maternal Domestic Violence and Infant and Toddlers' Emotional Regulation: Highlighting the Need for Preventive Services.

    Science.gov (United States)

    Geyer, Chelsea; Ogbonnaya, Ijeoma Nwabuzor

    2017-11-01

    In an effort to further understand the impact of domestic violence (DV) on infant and toddlers' development, this research utilized data from the second cohort of National Survey of Child and Adolescent Well-Being (NSCAW II) to examine the relationship between maternal DV and infant and toddlers' emotional regulation, and determine whether mothers' receipt of DV services mediated this relationship. The sample was limited to children aged 0 to 3 years and included (a) infants less than 1 year old ( n = 603), (b) infants 1 to less than 2 years old ( n = 310), and (c) toddlers 2 to 3 years old ( n = 268). Infant/toddlers' emotional regulation was measured using mothers' response on the How My Infant/Toddler/Child Usually Acts questionnaire. In addition, data were collected to assess whether (a) active DV was present during the time of the Child Protective Services (CPS) investigation and (b) mothers received DV services during the past year. Study research questions were examined using a series of multiple regression analyses. Mediation was tested based on Baron and Kenny's recommended model for establishing mediation. The mediational model was not found to be significant; however, a positive relationship existed between maternal DV and emotional regulation among infants aged less than 1 year old (β = 1.61, p = .039). There were no statistically significant relationships between DV and emotional regulation in the other age groups. These findings highlight the need to provide CPS-involved families victimized by DV with services that focus on preventing poor infant emotional regulation.

  6. Estimativa dos coeficientes específicos de mortalidade infantil segundo peso ao nascer no município de São Paulo (Brasil An estimate of the specific infant mortality rates by birth-weight in the city of S. Paulo (Brazil

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    Carlos Augusto Monteiro

    1981-12-01

    Full Text Available Foi estimada a distribuição do peso ao nascer da coorte dos recém-nascidos que deu origem aos óbitos infantis estudados pela Investigação Interamericana de Mortalidade na Infância no projeto de São Paulo (1968-70 e determinados os riscos de óbito associados a cada intervalo de peso de nascimento. Assim, foram apurados coeficientes de mortalidade infantil de 305,5, 50,2 e 34,4 para recém-nascidos de baixo peso, peso deficiente e peso superior a 3.000 g. A comparação destes coeficientes com os registrados na área americana incluída na investigação citada (Califórnia, revelou excesso de mortalidade, particularmente notável não para os recém-nascidos de baixo peso, mas para os recém-nascidos de peso superior a 3.000 g. O ajuste da mortalidade de São Paulo (Brasil à distribuição do peso ao nascer observada na Califórnia foi capaz de explicar 15% do excesso da mortalidade infantil e 21% do excesso da mortalidade neonatal de São Paulo.By means of the birth-rate distribution found to exist during the Inter-American Investigation of Mortality in Childhood in S. Paulo (1968-70 the infant death rate association with each birth-weight interval was estimated. The infant mortality rates were 305.5, 50.2 and 34.4 respectively for low birth-weight, deficient weight and weight above 3,000 grams. Compared with the rates found in California, USA, by the same Investigation, the infant mortality rates in S. Paulo are higher, particularly for mortality associated with birth-weight of above 3,000 grams. The adjustment of infant mortality rates in S. Paulo according to the birth-weight distribution found in California led to the conclusion that, at that period, only 15% of the excess of the infant mortality of S. Paulo could be attributed exclusively to birth-weight. In the case of neonatal mortality, 21% of the mortality excess in S. Paulo could be attributed to birth-weight.

  7. SPACIAL DISTRIBUTION AND ASSOCIATION BETWEEN INFANT MORTALITY AND LOW BIRTH WEIGHT WITH SOCIOECONOMIC FACTORS AND HEALTH SERVICES IN THE SOUTHERN REGION OF BRAZIL.

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    Antonio Fernando Boing, Fernando Kel e Alexandra Crispim Boing

    2006-12-01

    Full Text Available This research aimed to realize the spacial distribution of the infant mortality rates and of the proportion of low weight newborns in the southern area of Brazil and to test the association of those indicators with socioeconomic factors and health services. It is an ecological study put together from data collected from the 1,159 municipalities comprising the southern area of Brazil in the year 2000. The independent variables were the Municipal Human Development Rate, the illiteracy rate, the Gini coefficient, the proportion of poor people and people in homes with indoor plumbing and bathrooms, the annual average of medical visits for basic medical specialties, the monthly average of home visits per family and the number of medical clinics per 10,000 inhabitants. Kolmogorov-Smirnov, ANOVA and Kruskall-Wallis tests were performed and the Spearman coefficient of correlation was calculated. A significant statistical association was established between infant mortality and all the socioeconomic indicators. As for the proportion of low birth weight, it was associated with the proportion of people in homes with indoor plumbing and bathrooms, the annual average of medical visits for basic medical specialties, the Gini coefficient, poverty levels and monthly average of home visits per family. The spacial distribution of the diseases investigated allowed the identification of areas with the worst indicators investigated and which need greater government investment and attention. The public policies in infant health care should consider the need to improve the socioeconomic conditions and accessible health services in order to reduce the inequalities in health and the magnitude of the disease.

  8. Intensity of delivery room resuscitation and neonatal outcomes in infants born at 33 to 36 weeks' gestation.

    Science.gov (United States)

    Jiang, S; Lyu, Y; Ye, X Y; Monterrosa, L; Shah, P S; Lee, S K

    2016-02-01

    Examine the relationship between delivery room resuscitation intensity and mortality, morbidities and resource use in late preterm infants. Retrospective cohort study of inborn infants born at 33 to 36 weeks' gestation and admitted to Canadian neonatal intensive care units during 2010 to 2013. The 13 619 infants were grouped according to delivery room resuscitation intensity: no or minimal resuscitation (64.5%); continuous positive airway pressure (10.2%); bag-mask ventilation (21.7%); endotracheal intubation (3.1%); and cardiopulmonary resuscitation (CPR) (0.6%). Overall mortality, early mortality, respiratory distress, pneumothorax, late-onset sepsis and resource use increased with higher intensity resuscitation. Compared with no or minimal resuscitation, intubation and CPR were associated with increased odds of mortality (adjusted odds ratio (95% confidence interval): 50 (20 to 125) and 180 (63 to 518), respectively). Intubation or higher intensity delivery room resuscitation is associated with increased mortality, morbidities and resource use in late preterm infants. Extra intensive care is required for such infants, especially during the first week of life.

  9. Nutritional Rickets and Osteomalacia in the Twenty-first Century: Revised Concepts, Public Health, and Prevention Strategies.

    Science.gov (United States)

    Uday, Suma; Högler, Wolfgang

    2017-08-01

    Nutritional rickets and osteomalacia are common in dark-skinned and migrant populations. Their global incidence is rising due to changing population demographics, failing prevention policies and missing implementation strategies. The calcium deprivation spectrum has hypocalcaemic (seizures, tetany and dilated cardiomyopathy) and late hypophosphataemic (rickets, osteomalacia and muscle weakness) complications. This article reviews sustainable prevention strategies and identifies areas for future research. The global rickets consensus recognises the equal contribution of vitamin D and dietary calcium in the causation of calcium deprivation and provides a three stage categorisation for sufficiency, insufficiency and deficiency. For rickets prevention, 400 IU daily is recommended for all infants from birth and 600 IU in pregnancy, alongside monitoring in antenatal and child health surveillance programmes. High-risk populations require lifelong supplementation and food fortification with vitamin D or calcium. Future research should identify the true prevalence of rickets and osteomalacia, their role in bone fragility and infant mortality, and best screening and public health prevention tools.

  10. Prevention of vitamin K deficiency bleeding in breastfed infants : Lessons from the Dutch and Danish biliary atresia registries

    NARCIS (Netherlands)

    van Hasselt, Peter M.; de Koning, Tom J.; Kvist, Nina; de Vries, Elsemieke; Lundin, Christina Rydahl; Berger, Ruud; Kimpen, Jan L. L.; Houwen, Roderick H. J.; Jorgensen, Marianne Horby; Verkade, Henkjan J.

    OBJECTIVE. Newborns routinely receive vitamin K to prevent vitamin K deficiency bleeding. The efficacy of oral vitamin K administration may be compromised in infants with unrecognized cholestasis. We aimed to compare the risk of vitamin K deficiency bleeding under different propylactic regimens in

  11. Antiviral therapy for prevention of hepatocellular carcinoma and mortality in chronic hepatitis B

    DEFF Research Database (Denmark)

    Thiele, Maja; Gluud, Lise Lotte; Dahl, Emilie K

    2013-01-01

    The effect of antiviral therapy on clinical outcomes in chronic hepatitis B virus (HBV) is not established. We aimed to assess the effects of interferon and/or nucleos(t)ide analogues versus placebo or no intervention on prevention of hepatocellular carcinoma (HCC) and mortality in chronic HBV....

  12. Protective Effect of Dual-Strain Probiotics in Preterm Infants: A Multi-Center Time Series Analysis

    Science.gov (United States)

    Schwab, Frank; Garten, Lars; Geffers, Christine; Gastmeier, Petra; Piening, Brar

    2016-01-01

    Objective To determine the effect of dual-strain probiotics on the development of necrotizing enterocolitis (NEC), mortality and nosocomial bloodstream infections (BSI) in preterm infants in German neonatal intensive care units (NICUs). Design A multi-center interrupted time series analysis. Setting 44 German NICUs with routine use of dual-strain probiotics on neonatal ward level. Patients Preterm infants documented by NEO-KISS, the German surveillance system for nosocomial infections in preterm infants with birth weights below 1,500 g, between 2004 and 2014. Intervention Routine use of dual-strain probiotics containing Lactobacillus acidophilus and Bifidobacterium spp. (Infloran) on the neonatal ward level. Main outcome measures Incidences of NEC, overall mortality, mortality following NEC and nosocomial BSI. Results Data from 10,890 preterm infants in 44 neonatal wards was included in this study. Incidences of NEC and BSI were 2.5% (n = 274) and 15.0%, (n = 1631), respectively. Mortality rate was 6.1% (n = 665). The use of dual-strain probiotics significantly reduced the risk of NEC (HR = 0.48; 95% CI = 0.38–0.62), overall mortality (HR = 0.60, 95% CI = 0.44–0.83), mortality after NEC (HR = 0.51, 95% CI = 0.26–0.999) and nosocomial BSI (HR = 0.89, 95% CI = 0.81–0.98). These effects were even more pronounced in the subgroup analysis of preterm infants with birth weights below 1,000 g. Conclusion In order to reduce NEC and mortality in preterm infants, it is advisable to add routine prophylaxis with dual-strain probiotics to clinical practice in neonatal wards. PMID:27332554

  13. Pilot study with a glutamine-supplemented enteral formula in critically ill infants

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    Barbosa Eliana

    1999-01-01

    Full Text Available Seriously ill infants often display protein-calorie malnutrition due to the metabolic demands of sepsis and respiratory failure. Glutamine has been classified as a conditionally essential amino acid, with special usefulness in critical patients. Immunomodulation, gut protection, and prevention of protein depletion are mentioned among its positive effects in such circumstances. With the intent of evaluating the tolerance and clinical impact of a glutamine supplement in seriously ill infants, a prospective randomized study was done with nine patients. Anthropometric and biochemical determinations were made, and length of stay in the intensive care unit (ICU, in the hospital, and under artificial ventilation, and septic morbidity and mortality were tabulated. Infants in the treatment group (n=5 were enterally administered 0.3 g/kg of glutamine, whereas controls received 0.3 g/kg of casein during a standard period of five days. Septic complications occurred in 75% of the controls (3/4 versus 20% of the glutamine-treated group (1/5, p<=0.10, and two patients in the control group died of bacterial infections (50% vs. 0%, p<=0.10. Days in the ICU, in the hospital, and with ventilation numerically favored glutamine therapy, although without statistical significance. The supplements were usually well tolerated, and no patient required discontinuation of the program. The conclusion was that glutamine supplementation was safe and tended to be associated with less infectious morbidity and mortality in this high-risk population.

  14. Smoking as the main factor of preventable mortality in Serbia

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    Marinković Ivan

    2017-01-01

    to smoking. Besides Hungary, where mortality in men is also relatively high (42%, other countries have significantly lower shares. Observed at the level of the entire continent, countries of the Balkan Peninsula (and their neighbours have the highest shares of smoking-attributable death. Women in Serbia have a moderately high share of 9% and are among the ten most vulnerable countries in Europe. The biggest difference in smoking-related mortality by gender is observed in the Pyrenees Peninsula and in the eastern and south-eastern parts of Europe. These are also the countries with the largest absolute difference in the mortality rate of men and women, thus confirming the hypothesis that tobacco smoke, as a single mortality factor, plays the most important role in establishing a different gender mortality pattern. A high percentage of smokers in the total population limits the growth of life expectancy and affects the difference in gender mortality rate. If a certain mortality factor potentially affects the life expectancy of up to three years for men in Serbia, as shown in the paper, then it is especially important to pay attention to measures of prevention and awareness of the population regarding this issue. Moreover, it is particularly important to recognise the consequences of passive smoking the youth and children are exposed to, since in Serbia there is a great deal of tolerance for smoking indoors. [Project of the Serbian Ministry of Education, Science and Technological Development, Grant no. III47006

  15. [Analysis on violence injury incidence and prevention in China].

    Science.gov (United States)

    Er, Yuliang; Gao, Xin; Duan, Leilei; Wang, Yuan; Deng, Xiao; Ji, Cuirong; Ye, Pengpeng; Jin, Ye; Wang, Linhong

    2016-01-01

    To understand the incidence of violence injury and its prevention in China, and provide reference for the prevention and control of violence injury. The violence injury data in China were collected from national death surveillance data set (2006-2013) and national injury surveillance system (2013) for the descriptive epidemiological analysis on the incidence of violence injury and related death. The laws and policies about violence injury prevention, related data collection capacity and violence injury prevention programs in China were described. The violence injury mortality declined by 46.3% during 2006-2013 from 1.21/100000 to 0.65/100000. The incidence of violence injury death in males peaked in age group 30-34 years (1.42/100000), and it was low in age groupviolence injury death were found in females, i.e. 0.84/100000 in infants, 0.72/100000 in age group 30-34 years and 1.18/100000 in age group≥85 years. The laws and policies about violence injury prevention were imperfect, and the data about violence injury were limited. Most prevention programs were limited in scale and duration. The crude and standardized violence injury mortality declined in China during 2006-2013. It is necessary to conduct gender specific prevention strategies and improve the related law and policy development, data collection and prevention service.

  16. The Correlation of Human Development Index on Fertility and Mortality Rate: a Global Ecological Study

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    Amir Almasi-Hashiani

    2016-12-01

    Full Text Available BackgroundSeveral studies have examined the relationship between Human Development Index (HDI and various health outcomes. The aim of this study was to investigate the relationship between HDI, and infant mortality rate, mortality rate of children under one year and under 5 years, maternal mortality rate, and total fertility rate.Materials and MethodsIn this ecologic study, data on HDI, total fertility rate (TFR, maternal mortality rate (MMR, neonatal mortality rate (NMR, infant mortality rate (IMR and mortality rate in children under 5 years of age (< 5MR, were extracted from 188 countries in 2014 in the world. The data required in this study was obtained from the World Bank. Data analysis was performed using Pearson correlation in Stata version 12.0 software. ResultsIn this study, a negative significant correlation was observed between HDI and IMR (r = -0.878, P = 0.001, NMR (r = -0.870, 95% CI: -0.902, -0.828, P = 0.001, ConclusionIMR, children under one year old and under 5 years, and MMR mostly occur in developing countries. There was a correlation between HDI and its components, and the neonatal, infants, children under 5 years, maternal mortality rate and total fertility. The average annual percentage change of HDI also had a correlation with neonatal, infants, children under 5- year mortality rate, total fertility and maternal deaths.

  17. Neighborhood socio-environmental vulnerability and infant mortality in Hermosillo, Sonora Vulnerabilidad socioambiental y mortalidad infantil en barrios de Hermosillo, Sonora

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    Francisco Lara-Valencia

    2012-08-01

    Full Text Available OBJECTIVE: This paper explores the impact of contextual variables at the neighborhood level on a health marker in the city of Hermosillo, Mexico and discusses the importance of collaboration between planners and health professional to minimize the negative effect of contextual factors on urban health. MATERIALS AND METHODS: Few studies in Mexico have assessed health outcomes at the intra-urban scale and their interaction with neighborhood-level contextual variables. Using spatial analysis and geographical information systems, the paper explores the association between infant mortality and an index of socio-environmental vulnerability used to measure urban contextual factors. RESULTS: Two high infant mortality clusters were detected within neighborhoods characterized by relatively good environmental conditions and one in a neighborhood with a poor environment. CONCLUSIONS: Our results show the clustering of high infant mortality areas and some association with built environment factors in Hermosillo. The results support the need to reconnect public health and urban planning as a way to create healthier environments in Mexican cities.OBJETIVO: Este artículo explora el papel de factores contextuales a nivel de colonia sobre un marcador de salud en la ciudad de Hermosillo, México y discute la importancia de la colaboración entre planificadores urbanos y profesionales de la salud para minimizar el impacto negativo de factores contextuales sobre la salud de la población urbana. MATERIAL Y MÉTODOS: Pocos estudios en México han evaluado las condiciones de salud a escala intra-urbana y su interacción con variables contextuales a nivel de colonia. Utilizando análisis espacial y sistemas de información geográfica, el artículo explora la relación entre mortalidad infantil y un índice de vulnerabilidad socio-ambiental construido para medir factores contextuales urbanos. RESULTADOS: Dos conglomerados de alta mortalidad infantil fueron detectados

  18. Infant hearing screening in India: Current status and way forward

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    Suneela Garg

    2015-01-01

    Full Text Available Loss or impairment of auditory sense is the most prevalent deficit of all the sensory organs. With virtually no mortality, hearing impairment causes huge impact on one′s social, educational and economic well-being. There are 5-6 infants who are hard of hearing out of 1000 neonates. They will not be identified till they attain 2 or more years of age, by then irreversible damage would have been done. Universal screening for hearing of new-borns is the only way to decrease the burden of deafness in our society. There are tools available which can be administered by health workers after initial training for screening the infants for hearing impairment. Under the aegis of National Programme for Prevention and Control of Deafness (NPPCD of India universal screening can and should be applied. The programme would entail additional financial burden for the initial purchase of screening machines and rehabilitating the identified children.

  19. Serotonin’s role in piglet mortality and thriftiness

    Science.gov (United States)

    Improving piglet survivability rates is of high priority for swine production as well as for piglet well-being. Dysfunction in the serotonin system has been associated with growth deficiencies, infant mortalities or failure to thrive in human infants. The aim of this research was to determine if a r...

  20. A role for serotonin in piglet preweaning mortality

    Science.gov (United States)

    Improving piglet survivability rate is of high priority for swine production as well as for piglet well-being. Dysfunction in the serotonin system has been associated with growth deficiencies, infant mortality or failure to thrive (FTT) in human infants. The aim of this study was to examine the role...

  1. Prevention of vitamin K deficiency bleeding in breastfed infants: lessons from the Dutch and Danish biliary atresia registries

    DEFF Research Database (Denmark)

    Hasselt, P.M. van; Koning, T.J. de; Vries, E. de

    2008-01-01

    OBJECTIVE: Newborns routinely receive vitamin K to prevent vitamin K deficiency bleeding. The efficacy of oral vitamin K administration may be compromised in infants with unrecognized cholestasis. We aimed to compare the risk of vitamin K deficiency bleeding under different prophylactic regimens...... in infants with biliary atresia. PATIENTS AND METHODS: From Dutch and Danish national biliary atresia registries, we retrieved infants who were either breastfed and received 1 mg of oral vitamin K at birth followed by 25 microg of daily oral vitamin K prophylaxis (Netherlands, 1991-2003), 2 mg of oral...... vitamin K at birth followed by 1 mg of weekly oral prophylaxis (Denmark, 1994 to May 2000), or 2 mg of intramuscular prophylaxis at birth (Denmark, June 2000-2005) or were fed by formula. We determined the absolute and relative risk of severe vitamin K deficiency and vitamin K deficiency bleeding...

  2. The extended Infant Feeding, Activity and Nutrition Trial (InFANT Extend Program: a cluster-randomized controlled trial of an early intervention to prevent childhood obesity

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    Karen J. Campbell

    2016-02-01

    Full Text Available Abstract Background Understanding how we can prevent childhood obesity in scalable and sustainable ways is imperative. Early RCT interventions focused on the first two years of life have shown promise however, differences in Body Mass Index between intervention and control groups diminish once the interventions cease. Innovative and cost-effective strategies seeking to continue to support parents to engender appropriate energy balance behaviours in young children need to be explored. Methods/Design The Infant Feeding Activity and Nutrition Trial (InFANT Extend Program builds on the early outcomes of the Melbourne InFANT Program. This cluster randomized controlled trial will test the efficacy of an extended (33 versus 15 month and enhanced (use of web-based materials, and Facebook® engagement, version of the original Melbourne InFANT Program intervention in a new cohort. Outcomes at 36 months of age will be compared against the control group. Discussion This trial will provide important information regarding capacity and opportunities to maximize early childhood intervention effectiveness over the first three years of life. This study continues to build the evidence base regarding the design of cost-effective, scalable interventions to promote protective energy balance behaviors in early childhood, and in turn, promote improved child weight and health across the life course. Trial registration ACTRN12611000386932 . Registered 13 April 2011.

  3. Dietary exposures and allergy prevention in high-risk infants: A joint statement with the Canadian Society of Allergy and Clinical Immunology.

    Science.gov (United States)

    Chan, Edmond S; Cummings, Carl

    2013-12-01

    Allergic conditions in children are a prevalent health concern in Canada. The burden of disease and the societal costs of proper diagnosis and management are considerable, making the primary prevention of allergic conditions a desirable health care objective. This position statement reviews current evidence on dietary exposures and allergy prevention in infants at high risk for developing allergic conditions. It revisits previous dietary recommendations for pregnancy, breastfeeding and formula feeding, and provides an approach for introducing solid foods to high-risk infants. While there is no evidence that delaying the introduction of any specific food beyond six months of age helps to prevent allergy, the protective effect of early introduction of potentially allergenic foods (at four to six months of age) remains under investigation. Recent research appears to suggest that regularly ingesting a new, potentially allergenic food may be as important as when that food is first introduced.

  4. Prevention of Vitamin K Deficiency Bleeding in Newborn Infants: A Position Paper by the ESPGHAN Committee on Nutrition

    NARCIS (Netherlands)

    Mihatsch, Walter A.; Braegger, Christian; Bronsky, Jiri; Campoy, Cristina; Domellöf, Magnus; Fewtrell, Mary; Mis, Nataša F.; Hojsak, Iva; Hulst, Jessie; Indrio, Flavia; Lapillonne, Alexandre; Mlgaard, Christian; Embleton, Nicholas; van Goudoever, Johannes

    2016-01-01

    Vitamin K deficiency bleeding (VKDB) due to physiologically low vitamin K plasma concentrations is a serious risk for newborn and young infants and can be largely prevented by adequate vitamin K supplementation. The aim of this position paper is to define the condition, describe the prevalence,

  5. Perinatal risk factors for pneumothorax and morbidity and mortality in very low birth weight infants.

    Science.gov (United States)

    García-Muñoz Rodrigo, Fermín; Urquía Martí, Lourdes; Galán Henríquez, Gloria; Rivero Rodríguez, Sonia; Tejera Carreño, Patricia; Molo Amorós, Silvia; Cabrera Vega, Pedro; Rodríguez Ramón, Fernando

    2017-11-01

    To determine the perinatal risk factors for pneumothorax in Very-Low-Birth-Weight (VLBW) infants and the associated morbidity and mortality in this population. Retrospective analysis of data collected prospectively from a cohort of VLBW neonates assisted in our Unit (2006-2013). We included all consecutive in-born patients with ≤ 1500 g, without severe congenital anomalies. Perinatal history, demographics, interventions and clinical outcomes were collected. Associations were evaluated by logistic regression analysis. During the study period, 803 VLBW infants were assisted in our Unit, of whom 763 were inborn. Ten patients (1.2%) died in delivery room, and 18 (2.2%) with major congenital anomalies were excluded. Finally, 735 (91.5%) neonates were included in the study. Seventeen (2.3%) developed pneumothorax during the first week of life [median (IQR): 2 (1-2) days]. After correcting for GA and other confounders, prolonged rupture of membranes [aOR =1.002 (95% CI 1.000-1.003); p = 0.040] and surfactant administration [aOR = 6.281 (95% CI 1.688-23.373); p = 0.006] were the independent risk factors associated with pneumothorax. Patients with pneumothorax had lower probabilities of survival without major brain damage (MBD): aOR = 0.283 (95% CI = 0.095-0.879); p = 0.029. Pneumothorax in VLBW seems to be related to perinatal inflammation and surfactant administration, and it is significantly associated with a reduction in the probabilities of survival without MBD.

  6. An alternative method for assessing early mortality in contemporary populations.

    Science.gov (United States)

    Wiley, A S; Pike, I L

    1998-11-01

    Biological anthropologists are interested in a population's early mortality rates for a variety of reasons. Early mortality (infant or juvenile) is of obvious importance to those interested in demography, but early mortality statistics are useful for life history analysis, paleodemography, and human adaptability studies, among others. In general, the form of mortality statistics is derived from demography, where chronological age is the gold standard for statistical calculation and comparison. However, there are numerous problems associated with the collection, analysis, and interpretation of early mortality statistics based on age, particularly for anthropological research, which is often conducted in small or non-calendrical-age numerate populations. The infant mortality rate (IMR), for example, is notoriously difficult to determine in populations where accurate accounting of age is not routine, and yet it is widely used in demography, public health, medicine, and social science research. Here we offer an alternative to age-based early mortality statistics that makes use of human biologists' interest in, and skill at, assessing human growth and development. Our proposal is to use developmental stages of juveniles instead of relying exclusively on age as the basis for mortality statistics. Death or survival according to a developmental stage (such as crawling or weaning) may provide more accurate data that are also more closely related to the cause of death. Developmental stages have the added advantage of putting infants and children back at the center of the discussion of early mortality by focusing on their activities in relation to their environment. A case study from the Turkana population of Kenya illustrates the use of developmental stages in describing early mortality.

  7. HIV drug resistance in infants increases with changing prevention of mother-to-child transmission regimens.

    Science.gov (United States)

    Poppe, Lisa K; Chunda-Liyoka, Catherine; Kwon, Eun H; Gondwe, Clement; West, John T; Kankasa, Chipepo; Ndongmo, Clement B; Wood, Charles

    2017-08-24

    The objectives of this study were to determine HIV drug resistance (HIVDR) prevalence in Zambian infants upon diagnosis, and to determine how changing prevention of mother-to-child transmission (PMTCT) drug regimens affect drug resistance. Dried blood spot (DBS) samples from infants in the Lusaka District of Zambia, obtained during routine diagnostic screening, were collected during four different years representing three different PMTCT drug treatment regimens. DNA extracted from dried blood spot samples was used to sequence a 1493 bp region of the reverse transcriptase gene. Sequences were analyzed via the Stanford HIVDRdatabase (http://hivdb.standford.edu) to screen for resistance mutations. HIVDR in infants increased from 21.5 in 2007/2009 to 40.2% in 2014. Nonnucleoside reverse transcriptase inhibitor resistance increased steadily over the sampling period, whereas nucleoside reverse transcriptase inhibitor resistance and dual class resistance both increased more than threefold in 2014. Analysis of drug resistance scores in each group revealed increasing strength of resistance over time. In 2014, children with reported PMTCT exposure, defined as infant prophylaxis and/or maternal treatment, showed a higher prevalence and strength of resistance compared to those with no reported exposure. HIVDR is on the rise in Zambia and presents a serious problem for the successful lifelong treatment of HIV-infected children. PMTCT affects both the prevalence and strength of resistance and further research is needed to determine how to mitigate its role leading to resistance.

  8. Association between proximity to a health center and early childhood mortality in Madagascar.

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    Saori Kashima

    Full Text Available OBJECTIVE: To evaluate the association between proximity to a health center and early childhood mortality in Madagascar, and to assess the influence of household wealth, maternal educational attainment, and maternal health on the effects of distance. METHODS: From birth records of subjects in the Demographic and Health Survey, we identified 12565 singleton births from January 2004 to August 2009. After excluding 220 births that lacked global positioning system information for exposure assessment, odds ratios (ORs and their 95% confidence intervals (CIs for neonatal mortality and infant mortality were estimated using multilevel logistic regression models, with 12345 subjects (level 1, nested within 584 village locations (level 2, and in turn nested within 22 regions (level 3. We additionally stratified the subjects by the birth order. We estimated predicted probabilities of each outcome by a three-level model including cross-level interactions between proximity to a health center and household wealth, maternal educational attainment, and maternal anemia. RESULTS: Compared with those who lived >1.5-3.0 km from a health center, the risks for neonatal mortality and infant mortality tended to increase among those who lived further than 5.0 km from a health center; the adjusted ORs for neonatal mortality and infant mortality for those who lived >5.0-10.0 km away from a health center were 1.36 (95% CI: 0.92-2.01 and 1.42 (95% CI: 1.06-1.90, respectively. The positive associations were more pronounced among the second or later child. The distance effects were not modified by household wealth status, maternal educational attainment, or maternal health status. CONCLUSIONS: Our study suggests that distance from a health center is a risk factor for early childhood mortality (primarily, infant mortality in Madagascar by using a large-scale nationally representative dataset. The accessibility to health care in remote areas would be a key factor to achieve

  9. A novel six consecutive monthly doses of palivizumab prophylaxis protocol for the prevention of respiratory syncytial virus infection in high-risk preterm infants in Taiwan.

    Directory of Open Access Journals (Sweden)

    Hsin Chi

    Full Text Available Respiratory syncytial virus (RSV circulates year round in Taiwan. A novel six consecutive monthly doses of palivizumab for RSV prevention protocol has been approved for high risk preterm infants since December 2010. This study aimed to determine the clinical effectiveness and safety of this novel protocol for the prevention of RSV infection.From April 2011 to March 2013, we enrolled infants born at ≤28 weeks gestation and infants born at ≤35 weeks gestation with chronic lung disease (CLD who received palivizumab prophylaxis as study group and followed up for 12 months. Historic control, those who were born and followed up between July 2000 and June 2008, were retrieved for propensity score matching. Primary endpoint was RSV-related hospitalization, and secondary endpoints included the length of hospital stay and intensive care unit (ICU care.We enrolled 127 infants (108 infants born at ≤28 weeks and 19 infants born at 29-35 weeks with CLD. They completed 6-dose palivizumab as scheduled. Among the study group, the RSV-related hospitalizations were 2 (1.6% within 6 months and 5 (3.9% within 12 months after discharge. We matched 127 infants in the control group with 127 infants in the study group by propensity score matching. The reduction of RSV-related hospitalization rates were 86% (10.2% vs 1.6%, p = 0.002 within 6 months after discharge and 78% (15.7% vs 3.9%, p = 0.004 within 12 months after discharge. Compared to the control group, the rate of ICU care significantly decreased from 7.1% to 0.8% (p = 0.024 within 6 months after discharge and from 7.9% to 0.8% (p = 0.014 within 12 months after discharge. Adverse events were recorded in 6.4% injections.Six monthly intramuscular administration of palivizumab is effective for prevention of RSV hospitalization in regions with no single seasonal peak of RSV infection such as Taiwan.

  10. Invasive bacterial disease trends and characterization of group B streptococcal isolates among young infants in southern Mozambique, 2001-2015.

    Directory of Open Access Journals (Sweden)

    Betuel Sigaúque

    Full Text Available Maternal group B streptococcal (GBS vaccines under development hold promise to prevent GBS disease in young infants. Sub-Saharan Africa has the highest estimated disease burden, although data on incidence and circulating strains are limited. We described invasive bacterial disease (IBD trends among infants <90 days in rural Mozambique during 2001-2015, with a focus on GBS epidemiology and strain characteristics.Community-level birth and mortality data were obtained from Manhiça's demographic surveillance system. IBD cases were captured through ongoing surveillance at Manhiça district hospital. Stored GBS isolates from cases underwent serotyping by multiplex PCR, antimicrobial susceptibility testing, and whole genome sequencing.There were 437 IBD cases, including 57 GBS cases. Significant declines in overall IBD, neonatal mortality, and stillbirth rates were observed (P<0.0001, but not for GBS (P = 0.17. In 2015, GBS was the leading cause of young infant IBD (2.7 per 1,000 live births. Among 35 GBS isolates available for testing, 31 (88.6% were highly related serotype III isolates within multilocus sequence types (STs 17 (68.6% or 109 (20.0%. All seven ST109 isolates (21.9% had elevated minimum inhibitory concentration (MIC to penicillin (≥0.12 μg/mL associated with penicillin-binding protein (PBP 2x substitution G398A. Epidemiologic and molecular data suggest this is a well-established clone.A notable young infant GBS disease burden persisted despite improvements in overall maternal and neonatal health. We report an established strain with pbp2x point mutation, a first-step mutation associated with reduced penicillin susceptibility within a well-known virulent lineage in rural Mozambique. Our findings further underscores the need for non-antibiotic GBS prevention strategies.

  11. The ProPrems trial: investigating the effects of probiotics on late onset sepsis in very preterm infants

    Directory of Open Access Journals (Sweden)

    Opie Gillian

    2011-08-01

    Full Text Available Abstract Background Late onset sepsis is a frequent complication of prematurity associated with increased mortality and morbidity. The commensal bacteria of the gastrointestinal tract play a key role in the development of healthy immune responses. Healthy term infants acquire these commensal organisms rapidly after birth. However, colonisation in preterm infants is adversely affected by delivery mode, antibiotic treatment and the intensive care environment. Altered microbiota composition may lead to increased colonisation with pathogenic bacteria, poor immune development and susceptibility to sepsis in the preterm infant. Probiotics are live microorganisms, which when administered in adequate amounts confer health benefits on the host. Amongst numerous bacteriocidal and nutritional roles, they may also favourably modulate host immune responses in local and remote tissues. Meta-analyses of probiotic supplementation in preterm infants report a reduction in mortality and necrotising enterocolitis. Studies with sepsis as an outcome have reported mixed results to date. Allergic diseases are increasing in incidence in "westernised" countries. There is evidence that probiotics may reduce the incidence of these diseases by altering the intestinal microbiota to influence immune function. Methods/Design This is a multi-centre, randomised, double blinded, placebo controlled trial investigating supplementing preterm infants born at Bifidobacterium infantis, Streptococcus thermophilus and Bifidobacterium lactis. A total of 1,100 subjects are being recruited in Australia and New Zealand. Infants commence the allocated intervention from soon after the start of feeds until discharge home or term corrected age. The primary outcome is the incidence of at least one episode of definite (blood culture positive late onset sepsis before 40 weeks corrected age or discharge home. Secondary outcomes include: Necrotising enterocolitis, mortality, antibiotic usage, time to

  12. Maternal and obstetrical predictors of sudden infant death syndrome (SIDS).

    Science.gov (United States)

    Friedmann, Isabel; Dahdouh, Elias M; Kugler, Perlyne; Mimran, Gracia; Balayla, Jacques

    2017-10-01

    Public Health initiatives, such as the "Safe to Sleep" campaign, have traditionally targeted infants' risk factors for the prevention of Sudden Infant Death Syndrome (SIDS). However, controversy remains regarding maternal and obstetrical risk factors for SIDS. In our study, we sought out to determine both modifiable and non-modifiable obstetrical and maternal risk factors associated with SIDS. We conducted a population-based cohort study using the CDC's Linked Birth-Infant Death data from the United States for the year 2010. The impact of several obstetrical and maternal risk factors on the risk of overall infant mortality and SIDS was estimated using unconditional regression analysis, adjusting for relevant confounders. Our cohort consisted of 4,007,105 deliveries and 24,174 infant deaths during the first year of life, of which 1991 (8.2%) were due to SIDS. Prominent risk factors for SIDS included (OR [95% CI]): black race, 1.89 [1.68-2.13]; maternal smoking, 3.56 [3.18-3.99]; maternal chronic hypertension, 1.73 [1.21-2.48]; gestational hypertension, 1.51 [1.23-1.87]; premature birth <37 weeks, 2.16 [1.82-2.55]; IUGR, 2.46 [2.14-2.82]; and being a twin, 1.81 [1.43-2.29], p < 0.0001. Relative to a cohort of infants who died of other causes, risk factors with a predilection for SIDS were maternal smoking, 2.48 [2.16-2.83] and being a twin, 1.52 [1.21-1.91], p < 0.0001. Conclusions for practice: While certain socio-demographic and gestational characteristics are important risk factors, maternal smoking remains the strongest prenatal modifiable risk factor for SIDS. We recommend the continuation of Public Health initiatives that promote safe infant sleeping practices and smoking cessation during and after pregnancy.

  13. Protective efficacy of standard Edmonston-Zagreb measles vaccination in infants aged 4.5 months: interim analysis of a randomised clinical trial.

    Science.gov (United States)

    Martins, Cesário L; Garly, May-Lill; Balé, Carlito; Rodrigues, Amabelia; Ravn, Henrik; Whittle, Hilton C; Lisse, Ida M; Aaby, Peter

    2008-07-24

    To examine the protective efficacy of measles vaccination in infants in a low income country before 9 months of age. Randomised clinical trial. 1333 infants aged 4.5 months: 441 in treatment group and 892 in control group. Urban area in Guinea-Bissau. Measles vaccination using standard titre Edmonston-Zagreb vaccine at 4.5 months of age. Vaccine efficacy against measles infection, admission to hospital for measles, and measles mortality before standard vaccination at 9 months of age. 28% of the children tested at 4.5 months of age had protective levels of maternal antibodies against measles at enrolment. After early vaccination against measles 92% had measles antibodies at 9 months of age. A measles outbreak offered a unique situation for testing the efficacy of early measles vaccination. During the outbreak, 96 children developed measles; 19% of unvaccinated children had measles before 9 months of age. The monthly incidence of measles among the 441 children enrolled in the treatment arm was 0.7% and among the 892 enrolled in the control arm was 3.1%. Early vaccination with the Edmonston-Zagreb measles vaccine prevented infection; vaccine efficacy for children with serologically confirmed measles and definite clinical measles was 94% (95% confidence interval 77% to 99%), for admissions to hospital for measles was 100% (46% to 100%), and for measles mortality was 100% (-42% to 100%). The number needed to treat to prevent one case of measles between ages 4.5 months and 9 months during the epidemic was 7.2 (6.8 to 9.2). The treatment group tended to have lower overall mortality (mortality rate ratio 0.18, 0.02 to 1.36) although this was not significant. In low income countries, maternal antibody levels against measles may be low and severe outbreaks of measles can occur in infants before the recommended age of vaccination at 9 months. Outbreaks of measles may be curtailed by measles vaccination using the Edmonston-Zagreb vaccine as early as 4.5 months of age. TRIAL

  14. A study on the effective factors of mortalities with unknown causes among one month old infants of Tehran and Central provinces

    Directory of Open Access Journals (Sweden)

    Moshkani Z

    1998-07-01

    Full Text Available In this work, the net effect of birth type (one or more children, the number of previous dead children, the mother tongue, mother's age at infant birth, number of deliveries, consanguineous marriages, and the father's education on the mortality of one-month-old infants in families of residents of Tehran and the Central Province is studied. The data referred to in this study was taken from a survey conducted by the Department of Vital Statistics in 1991. Applying multiple logistic regreession to analyze the data I removed the effect of a number of variables to conclude that the consanguineous marriage is significantly effective by itself and in interaction with the number of previous dead children. The odds ratio among consanguine parents for those who had one previous dead child to those without a previous dead child is 5.45. This ratio for non-consanguineous parents is 4.96. Thus the significant effect of consanguinity is proven.

  15. Ibubrofen in the treatment of patent ductus arteriosus in preterm infants: what we know, what we still do not know.

    Science.gov (United States)

    Mercanti, Isabelle; Ligi, Isabelle; Boubred, Farid; Grandvuillemin, Isabelle; Buffat, Christophe; Fayol, Laurance; Millet, Veronique; Simeoni, Umberto

    2012-01-01

    The patency of the ductus arteriosus has ever been considered as a pathological situation in preterm infants and one likely cause of mortality and morbidity, including broncho-pulmonary dysplasia, necrotizing enterocolitis, intraventricular haemorrhage, retinopathy of prematurity. The incidence of patent ductus arteriosus is inversely proportional to gestational age and infants with the lowest gestational ages are the most exposed to the complications of prematurity. So, associations between patent ductus arteriosus and the other morbidities may not be causative and patent ductus arteriosus could be more a sign of immaturity and severity of disease than the cause of these problems. Non-steroidal anti-inflammatory agents, such as indomethacin or ibuprofen, have been shown to be effective in closing or preventing patent ductus arteriosus, with differences in side effects. However nearly all randomized controlled trials have been designed with the closure of the ductus arteriosus, not mortality or morbidity, as the main endpoint. Thus, evidence is still lacking on the eventual benefits for the patient of pharmacological or surgical intervention on PDA. Moreover, both ibuprofen and indomethacin efficacy seems markedly reduced in extremely low gestational age infants, who are the most likely to benefit from such intervention. The explanation of the reduced pharmacodymanic effect in such population is unclear; so far, studies using increased dosing of ibuprofen have failed to show a clear benefit. Prophylaxis with indomethacin or ibuprofen has failed to show sustained benefits on neurodevelopment at 2 years of age in low gestational age infants. New curative trials may aim at investigating the effects of early curative administration of ibuprofen, which has reduced side effects compared to indomethacin, on immature kidney function, on mortality and morbidity in very low gestational age infants, ideally with a combined endpoint such as survival in the absence of severe

  16. Probiotics to prevent necrotising enterocolitis in very preterm infants

    DEFF Research Database (Denmark)

    Lambæk, Irina Dobychina; Fonnest, Gert; Gormsen, Magdalena

    2016-01-01

    (bifidobacillus and lactobacillus) once daily by nasogastric tube from the third day of life. The main outcome: NEC grades 2 and 3 were assessed in a blinded fashion from a clinical abstract and available X-rays. RESULTS: A total of 381 infants treated before the change of policy were compared with 333 infants...

  17. Mortalidad infantil en el Hospital Docente Ginecoobstétrico de Guanabacoa (1998-2010 Infant mortality in the Guanabacoa Gynecology-Obstetric Teaching Hospital (1998-2010

    Directory of Open Access Journals (Sweden)

    Vivian Asunción Álvarez Ponce

    2011-12-01

    Full Text Available Introducción: La mortalidad infantil constituye un importante indicador que se utiliza para medir el estado de salud de la población. Entre sus componentes, la defunción neonatal precoz representa un reto para el ginecoobstetra, ya que su disminución está fundamentalmente relacionada con el seguimiento obstétrico durante el embarazo y el periodo del parto. Objetivo: Determinar el comportamiento de la tasa de mortalidad infantil, en el Hospital Docente Ginecoobstétrico de Guanabacoa, en el periodo comprendido entre el 1 de enero de 1998 y el 31 de diciembre del 2010. Métodos: Se realizó un estudio descriptivo, transversal y retrospectivo de todas las defunciones infantiles que ocurrieron en la institución. El universo de estudio estuvo conformado por las 74 defunciones infantiles de un total de 23 533 nacidos vivos. La información fue obtenida a partir del Comité de Mortalidad y de los registros del Departamento de Estadística de la Institución. Resultados: Se encontró que la tasa de mortalidad infantil durante esos 13 años fue de 3,9 x 1000 nacidos vivos, con tendencia al decrecimiento a partir de 2004. Las principales causas de muerte fueron infecciones, asfixia y malformaciones. Aunque predominó también el componente neonatal precoz, de 2,7 x 1000 nacidos vivos, este mostró una disminución en el periodo estudiado. Asimismo, vale señalar que desde el año 2008 no ha habido muertes neonatales tardías. Conclusiones: La tasa de mortalidad infantil del decenio fue 3,9 x 1000 nacidos vivos, con tendencia a la disminución del componente neonatal precoz. La sepsis constituyó el principal problema para la institución.Introduction: Infant mortality is an important indicator used to measure the population health status. Among its components, the early neonatal death is a challenge for the gynecology-obstetric specialist since its decrease is mainly related to the obstetric follow-up over pregnancy and delivery period. Objective

  18. Nutritional recommendations for the late-preterm infant and the preterm infant after hospital discharge.

    Science.gov (United States)

    Lapillonne, Alexandre; O'Connor, Deborah L; Wang, Danhua; Rigo, Jacques

    2013-03-01

    Early nutritional support of preterm infants is critical to life-long health and well being. Numerous studies have demonstrated that preterm infants are at increased risk of mortality and morbidity, including disturbances in brain development. To date, much attention has focused on enhancing the nutritional support of very low and extremely low birth weight infants to improve survival and quality of life. In most countries, preterm infants are sent home before their expected date of term birth for economic or other reasons. It is debatable whether these newborns require special nutritional regimens or discharge formulas. Furthermore, guidelines that specify how to feed very preterm infants after hospital discharge are scarce and conflicting. On the other hand, the late-preterm infant presents a challenge to health care providers immediately after birth when decisions must be made about how and where to care for these newborns. Considering these infants as well babies may place them at a disadvantage. Late-preterm infants have unique and often-unrecognized medical vulnerabilities and nutritional needs that predispose them to greater rates of morbidity and hospital readmissions. Poor or inadequate feeding during hospitalization may be one of the main reasons why late-preterm infants have difficulty gaining weight right after birth. Providing optimal nutritional support to late premature infants may improve survival and quality of life as it does for very preterm infants. In this work, we present a review of the literature and provide separate recommendations for the care and feeding of late-preterm infants and very preterm infants after discharge. We identify gaps in current knowledge as well as priorities for future research. Copyright © 2013 Mosby, Inc. All rights reserved.

  19. [The preventive and health promotion services for infants, children and youth. What is problematic for clients of the CLSCs].

    Science.gov (United States)

    Richard, Lucie; D'Amour, Danielle; Labadie, Jean-François; Brodeur, Jean-Marc; Pineault, Raynald; Séguin, Louise; Latour, Robert

    2003-01-01

    This article presents the results of a survey on preventive and health promotion (PHP) services provided by Quebec CLSCs for infants, children and youth. Two dimensions of services are examined: the diversity of PHP issues addressed and the type of clientele targeted by the CLSC team. Questionnaire survey. Although identified a priori as public health priorities, many PHP issues remain less often addressed by CLSCs. This is particularly the case for activities aimed at children and youth as compared to infants. In addition, the data show that CLSC teams are less inclined to target specific clienteles; when they do so, it is more often in the context of services for infants. This study is important in that it constitutes one of the first efforts to systematically document PHP services for infants, children, and youth. In shedding new light on intervention sectors that need to be reinforced, these results should help managers and policymakers as they reflect on the role of PHP services in CLSCs within the context of health reform.

  20. Investigating the variations in survival rates for very preterm infants in ten European regions: the MOSAIC birth cohort

    DEFF Research Database (Denmark)

    Draper, Elizabeth S; Zeitlin, Jennifer; Fenton, Alan C

    2008-01-01

    OBJECTIVE: To investigate the variation in the survival rate and the mortality rates for very preterm infants across Europe. DESIGN: A prospective birth cohort of very preterm infants for ten geographically defined European regions during 2003 followed to discharge home from hospital. PARTICIPANTS...... to directly compare international statistics for mortality in very preterm infants, data collection needs to be standardised. We believe that the standard point of comparison should be using all those infants alive at the onset of labour as the denominator for comparisons of mortality rates for very preterm...... for NIC. For babies rates to discharge from NIC for very preterm deliveries and in the timing of death across the MOSAIC regions. In order...

  1. Management of ovarian cysts in infants.

    Science.gov (United States)

    Xue-Qiang, Yan; Nan-Nan, Zheng; Lei, Yu; Wei, Lu; Hong-Qiang, Bian; Jun, Yang; Xu-Fei, Duan; Xin-Ke, Qin

    2015-12-01

    To discuss the experience of diagnosis and treatment of ovarian cyst in infants. A retrospective review was conducted on 20 infants who suffered from ovarian cyst. There were no dysplasia ovarian was found in children which were preoperatively diagnosed simplex cyst. Within thirteen children preoperatively detected mixed cystic-solid lesion, six cases ovarian cysts disappeared and two cases underwent poor blood supply in the following time. Adverse effects for ovarian cyst in infants can be prevented by agressive surgical intervention. Harmful effects of ovarian cyst can be prevented by positive surgical intervention despite the diagnostic difficulties in children with clinical symptoms of this condition.

  2. Pictorial Essay: Infants of diabetic mothers

    International Nuclear Information System (INIS)

    Alorainy, Ibrahim A; Barlas, Nauman B; Al-Boukai, Amer A

    2010-01-01

    About 3 to 10% of pregnancies are complicated by glycemic control abnormalities. Maternal diabetes results in significantly greater risk for antenatal, perinatal, and neonatal morbidity and mortality, as well as congenital malformations. The number of diabetic mothers is expected to rise, as more and more of the obese pediatric female population in developed and some developing countries progresses to childbearing age. Radiologists, being part of the teams managing such pregnancies, should be well aware of the findings that may be encountered in infants of diabetic mothers. Timely, accurate, and proper radiological evaluation can reduce morbidity and mortality in these infants. The purpose of this essay is to illustrate the imaging findings in the various pathological conditions involving the major body systems in the offspring of women with diabetes

  3. Pictorial Essay: Infants of diabetic mothers

    Directory of Open Access Journals (Sweden)

    Alorainy Ibrahim

    2010-01-01

    Full Text Available About 3 to 10% of pregnancies are complicated by glycemic control abnormalities. Maternal diabetes results in significantly greater risk for antenatal, perinatal, and neonatal morbidity and mortality, as well as congenital malformations. The number of diabetic mothers is expected to rise, as more and more of the obese pediatric female population in developed and some developing countries progresses to childbearing age. Radiologists, being part of the teams managing such pregnancies, should be well aware of the findings that may be encountered in infants of diabetic mothers. Timely, accurate, and proper radiological evaluation can reduce morbidity and mortality in these infants. The purpose of this essay is to illustrate the imaging findings in the various pathological conditions involving the major body systems in the offspring of women with diabetes

  4. immunisation fever amongst infants receiving Diphtheria

    African Journals Online (AJOL)

    PROF. EZECHUKWU

    2013-08-06

    Aug 6, 2013 ... fects of human milk in decreasing infant mortality and morbidity from acute and chronic ..... 3 Furthermore, the practice of prophylactic administra- tion of analgesics ... and a haemophilus influenza type. B conjugate vaccine.

  5. National estimates for maternal mortality: an analysis based on the WHO systematic review of maternal mortality and morbidity

    Directory of Open Access Journals (Sweden)

    Gülmezoglu A Metin

    2005-12-01

    Full Text Available Abstract Background Despite the worldwide commitment to improving maternal health, measuring, monitoring and comparing maternal mortality estimates remain a challenge. Due to lack of data, international agencies have to rely on mathematical models to assess its global burden. In order to assist in mapping the burden of reproductive ill-health, we conducted a systematic review of incidence/prevalence of maternal mortality and morbidity. Methods We followed the standard methodology for systematic reviews. This manuscript presents nationally representative estimates of maternal mortality derived from the systematic review. Using regression models, relationships between study-specific and country-specific variables with the maternal mortality estimates are explored in order to assist further modelling to predict maternal mortality. Results Maternal mortality estimates included 141 countries and represent 78.1% of the live births worldwide. As expected, large variability between countries, and within regions and subregions, is identified. Analysis of variability according to study characteristics did not yield useful results given the high correlation with each other, with development status and region. A regression model including selected country-specific variables was able to explain 90% of the variability of the maternal mortality estimates. Among all country-specific variables selected for the analysis, three had the strongest relationships with maternal mortality: proportion of deliveries assisted by a skilled birth attendant, infant mortality rate and health expenditure per capita. Conclusion With the exception of developed countries, variability of national maternal mortality estimates is large even within subregions. It seems more appropriate to study such variation through differentials in other national and subnational characteristics. Other than region, study of country-specific variables suggests infant mortality rate, skilled birth

  6. Long-term Effects of Hepatitis B Immunization of Infants in Preventing Liver Cancer.

    Science.gov (United States)

    Chang, Mei-Hwei; You, San-Lin; Chen, Chien-Jen; Liu, Chun-Jen; Lai, Ming-Wei; Wu, Tzee-Chung; Wu, Shu-Fen; Lee, Chuan-Mo; Yang, Sheng-Shun; Chu, Heng-Cheng; Wang, Tsang-Eng; Chen, Bor-Wen; Chuang, Wan-Long; Soon, Maw-Soan; Lin, Ching-Yih; Chiou, Shu-Ti; Kuo, Hsu-Sung; Chen, Ding-Shinn

    2016-09-01

    The incidence of hepatocellular carcinoma (HCC) increases with age, but protective antibody responses decrease with time after infants are immunized against hepatitis B virus (HBV). We investigated whether immunization of infants against HBV prevents their developing HCC as adults. We also searched for strategies to maximize the cancer-preventive effects. We collected data from 2 Taiwan HCC registry systems on 1509 patients (6-26 years old) diagnosed with HCC from 1983 through 2011. Data on history of HBV immunization and prenatal maternal levels of HBV antigens of all HCC patients born after July 1984 were retrieved from the HBV immunization data bank of the Taiwan Center for Disease Control. We collected data on birth cohort-specific populations (6-26 years old) of Taiwan using the National Household Registry System. Rates of HCC incidence per 10(5) person-years were derived by dividing the number of patients with HCC by the person-years of the general population. Relative risks (RR) for HCC were estimated by Poisson regression analysis in vaccinated vs unvaccinated birth cohorts. We stratified patients by age group to evaluate the association of birth cohorts and HCC risks. Of the 1509 patients with HCC, 1343 were born before, and 166 were born after, the HBV vaccination program began. HCC incidence per 10(5) person-years was 0.92 in the unvaccinated cohort and 0.23 in the vaccinated birth cohorts. The RRs for HCC in patients 6-9 years old, 10-14 years old, 15-19 years old, and 20-26 years old who were vaccinated vs unvaccinated were 0.26 (95% confidence interval [CI], 0.17-0.40), 0.34 (95% CI, 0.25-0.48), 0.37 (95% CI, 0.25-0.51), and 0.42 (95% CI, 0.32-0.56), respectively. The RR for HCC in 6- to 26-year-olds was lower in the later vs the earlier cohorts (born in 1992-2005 vs 1986-1992; P Taiwan, immunization of infants against HBV reduces their risk of developing HCC as children and young adults. Improving HBV vaccination strategies and overcoming risk

  7. Indomethacin prophylaxis or expectant treatment of patent ductus arteriosus in extremely low birth weight infants?

    Science.gov (United States)

    Cordero, L; Nankervis, C A; Delooze, D; Giannone, P J

    2007-03-01

    Indomethacin prophylaxis or expectant treatment are common strategies for the prevention or management of symptomatic patent ductus arteriosus (sPDA). To compare the clinical responses of extremely low birth weight (ELBW) infants to indomethacin prophylaxis with that of other infants who were managed expectantly by being treated with indomethacin or surgically only after an sPDA was detected. Retrospective cohort investigation of 167 ELBW infants who received indomethacin prophylaxis (study) and 167 ELBW infants (control) treated expectantly who were matched by year of birth (1999 to 2006), birth weight, gestational age (GA) and gender. Mothers of the two groups of infants were comparable demographically and on the history of preterm labor, pre-eclampsia, antepartum steroids and cesarean delivery. Study and control infants were similar in birth weight, GA, low 5 min Apgar scores, surfactant administration, the need for arterial blood pressure control, bronchopulmonary dysplasia and neonatal mortality. Necrotizing enterocolitis, spontaneous intestinal perforations, intraventricular hemorrhage grade III to IV, periventricular leukomalacia and stage 3 to 5 retinopathy of prematurity occurred also with similar frequency in both groups of infants. In the indomethacin prophylaxis group, 29% of the infants developed sPDA, and of them 38% responded to indomethacin treatment. In the expectantly treated group, 37% developed sPDA, and of them 59% responded to indomethacin treatment. Overall, surgical ligation rate for sPDA was similar between both groups of patients. In our experience, indomethacin prophylaxis does not show any advantages over expectant early treatment on the management of sPDA in ELBW infants. Although no deleterious effects were observed, prophylaxis exposed a significant number of infants who may have never developed sPDA, to potential indomethacin-related complications.

  8. Nighttime parenting strategies and sleep-related risks to infants.

    Science.gov (United States)

    Volpe, Lane E; Ball, Helen L; McKenna, James J

    2013-02-01

    A large social science and public health literature addresses infant sleep safety, with implications for infant mortality in the context of accidental deaths and Sudden Infant Death Syndrome (SIDS). As part of risk reduction campaigns in the USA, parents are encouraged to place infants supine and to alter infant bedding and elements of the sleep environment, and are discouraged from allowing infants to sleep unsupervised, from bed-sharing either at all or under specific circumstances, or from sofa-sharing. These recommendations are based on findings from large-scale epidemiological studies that generate odds ratios or relative risk statistics for various practices; however, detailed behavioural data on nighttime parenting and infant sleep environments are limited. To address this issue, this paper presents and discusses the implications of four case studies based on overnight observations conducted with first-time mothers and their four-month old infants. These case studies were collected at the Mother-Baby Behavioral Sleep Lab at the University of Notre Dame USA between September 2002 and June 2004. Each case study provides a detailed description based on video analysis of sleep-related risks observed while mother-infant dyads spent the night in a sleep lab. The case studies provide examples of mothers engaged in the strategic management of nighttime parenting for whom sleep-related risks to infants arose as a result of these strategies. Although risk reduction guidelines focus on eliminating potentially risky infant sleep practices as if the probability of death from each were equal, the majority of instances in which these occur are unlikely to result in infant mortality. Therefore, we hypothesise that mothers assess potential costs and benefits within margins of risk which are not acknowledged by risk-reduction campaigns. Exploring why mothers might choose to manage sleep and nighttime parenting in ways that appear to increase potential risks to infants may

  9. Antioxidant supplements for prevention of mortality in healthy participants and patients with various diseases

    Directory of Open Access Journals (Sweden)

    Goran Bjelakovic

    Full Text Available BACKGROUND: Our previous systematic review has demonstrated that antioxidant supplements may increase mortality. We have now updated this review. OBJECTIVES: To assess the beneficial and harmful effects of antioxidant supplements for prevention of mortality in adults. METHODS: Search methods: We searched The Cochrane Library, Medline, Embase, Lilacs, the Science Citation Index Expanded, and Conference Proceedings Citation Index-Science to February 2011. We scanned bibliographies of relevant publications and asked pharmaceutical companies for additional trials. Selection criteria: We included all primary and secondary prevention randomized clinical trials on antioxidant supplements (beta-carotene, vitamin A, vitamin C, vitamin E, and selenium versus placebo or no intervention. Data collection and analysis: Three authors extracted data. Random-effects and fixed-effect model meta-analyses were conducted. Risk of bias was considered in order to minimize the risk of systematic errors. Trial sequential analyses were conducted to minimize the risk of random errors. Random effects model meta-regression analyses were performed to assess sources of intertrial heterogeneity. MAIN RESULTS: Seventy-eight randomized trials with 296,707 participants were included. Fifty-six trials including 244,056 participants had low risk of bias. Twenty-six trials included 215,900 healthy participants. Fifty-two trials included 80,807 participants with various diseases in a stable phase. The mean age was 63 years (range 18 to 103 years. The mean proportion of women was 46%. Of the 78 trials, 46 used the parallel-group design, 30 the factorial design, and 2 the cross-over design. All antioxidants were administered orally, either alone or in combination with vitamins, minerals, or other interventions. The duration of supplementation varied from 28 days to 12 years (mean duration 3 years; median duration 2 years. Overall, the antioxidant supplements had no significant effect

  10. Antenatal interventions for preventing the transmission of cytomegalovirus (CMV) from the mother to fetus during pregnancy and adverse outcomes in the congenitally infected infant.

    LENUS (Irish Health Repository)

    McCarthy, Fergus P

    2012-01-31

    BACKGROUND: Cytomegalovirus (CMV) is a herpesvirus and the most common cause of congenital infection in developed countries. Congenital CMV infection can have devastating consequences to the fetus. The high incidence and the serious morbidity associated with congenital CMV infection emphasise the need for effective interventions to prevent the antenatal transmission of CMV infection. OBJECTIVES: The aim of this review was to assess the benefits and harms of interventions used during pregnancy to prevent mother to fetus transmission of CMV infection. SEARCH STRATEGY: We searched the Cochrane Pregnancy and Childbirth Group\\'s Trials Register (31 December 2010). SELECTION CRITERIA: All randomised controlled trials (RCTs) and quasi RCTs investigating antenatal interventions for preventing the transmission of CMV from the mother to fetus during pregnancy and adverse outcomes in the congenitally infected infant. DATA COLLECTION AND ANALYSIS: Two review authors independently assessed studies for inclusion. MAIN RESULTS: We identified six studies from the search. None of these studies met the pre-defined criteria for inclusion in this review. AUTHORS\\' CONCLUSIONS: To date, no RCTs are available that examine antenatal interventions for preventing the transmission of CMV from the infected mother to fetus during pregnancy and adverse outcomes in the congenitally infected infant. Further research is needed to assess the efficacy of interventions aimed at preventing the transmission of CMV from the mother to fetus during pregnancy including a long-term follow-up of exposed infants and a cost effective analysis.

  11. Minimal intervention dentistry: part 3. Paediatric dental care--prevention and management protocols using caries risk assessment for infants and young children.

    Science.gov (United States)

    Ramos-Gomez, F J; Crystal, Y O; Domejean, S; Featherstone, J D B

    2012-11-01

    Recent increases in caries prevalence in young children throughout the world highlight the need for a simple but effective infant oral care programme. This programme needs to include a medical disease prevention management model with an early establishment of a dental home and a treatment approach based on individual patient risk. This article presents an updated approach with practical forms and tools based on the principles of caries management by risk assessment, CAMBRA. This method will aid the general practitioner to develop and maintain a comprehensive protocol adequate for infant and young children oral care visits. Perinatal oral health is vitally important in preventing early childhood caries (ECC) in young children. Providing dental treatment to expectant mothers and their young children in a 'dual parallel track' is an effective innovative strategy and an efficient practice builder. It promotes prevention rather than intervention, and this may be the best way to achieve long-lasting oral health for young patients. General dental practice can adopt easy protocols that will promote early preventive visits and anticipatory guidance/counselling rather than waiting for the need for restorative treatment.

  12. Child health and mortality in Guinea-Bissau

    DEFF Research Database (Denmark)

    Kovsted, Jens Anders; Pörtner, Claus Christian; Tarp, Finn

    2002-01-01

    This paper studies factors that influence child health in Bissau, the capital of Guinea-Bissau. This environment is characterised by high infant mortality, but not by malnutrition. We show that although maternal education is important in determining child health and mortality this effect diminishes...... or disappears when health knowledge is introduced as an explanatory variable. It emerges that health knowledge has large and positive effects on both child mortality and health when instrumented for to capture endogeneity...

  13. Health impacts of air pollution on morbidity and mortality among children of Ciudad Juarez, Chihuahua, Mexico : working paper

    International Nuclear Information System (INIS)

    Romieu, I.; Aguilar, M.R.; Macias, H.M.; Villarreal, A.B.; Cadena, L.H.; Arroyo, L.C.

    2003-01-01

    This study evaluated the impact of air pollution on a group of children in Ciudad Juarez, Mexico where a large urban population of children live in poor conditions. In particular, the study examined the associations between ozone ambient levels and respiratory-related emergency visits to hospitals by children. The impact of PM10 on respiratory health was also examined. Upper respiratory infections and asthma were found to be associated with ozone ambient levels for all age groups. In children aged 5 or less, ozone exposure was related to lower respiratory infections as well. Ambient air pollutants were not related to respiratory deaths in the population of children involved in this study, but data suggests that that PM10 ambient levels might increase the risk of respiratory mortality in infants less than one year old. An increase in respiratory mortality was noted among infants from the lowest socio-economic status (SES) group. This report emphasizes the need for implementing cost effective interventions to control existing air pollution problems and to prevent the situation from worsening. 22 refs., 27 tabs., 5 figs

  14. Infant feeding practice and associated factors of HIV positive mothers attending prevention of mother to child transmission and antiretroviral therapy clinics in Gondar Town health institutions, Northwest Ethiopia

    Directory of Open Access Journals (Sweden)

    Muluye Dagnachew

    2012-03-01

    Full Text Available Abstract Background It has been estimated that 430,000 children under 15 years of age were newly infected with HIV in 2008, and more than 71% are living in sub-Saharan Africa. In the absence of intervention to prevent mother-to-child transmission, 30-45% of infants born to HIV-positive mothers in developing countries become infected during pregnancy, delivery and breastfeeding. The aim of this study was to assess infant feeding practice and associated factors of HIV positive mothers attending prevention of mother to child transmission and antiretroviral therapy clinics of Northwest Ethiopia. Methods Institution based cross sectional study was conducted from January to May 2011 among all HIV positive mothers with less than two years old child attending prevention of mother to child transmission and antiretroviral therapy clinics in Gondar Town health institutions. A structured pre-tested questionnaire using interview technique was used for data collection. The data was entered and analyzed using SPSS version 16 statistical package. Results A total of 209 HIV positive mothers were included in the study. Of these, 187 (89.5% had followed the recommended way of infant feeding practice while significant percentage (10.5% had practiced mixed breast feeding. In multivariate analysis, disclosure of HIV status with their spouse, insufficient breast milk and occupational status were found to be independently associated (p-value of Conclusions Higher proportion of respondents used the recommended way of infant feeding practice by WHO as well as by Ethiopian Ministry of Health. However, mixed feeding in the first 6 months of age, an undesirable practice in infant feeding, were reported in this study. Infant feeding education that is aligned to national policy should be strengthened in primary health care, particularly in situations where prevention of mother to child transmission of HIV is prioritized.

  15. Tracheostomy Among Infants With Hypoplastic Left Heart Syndrome Undergoing Cardiac Operations: A Multicenter Analysis.

    Science.gov (United States)

    Prodhan, Parthak; Agarwal, Amit; ElHassan, Nahed O; Bolin, Elijah H; Beam, Brandon; Garcia, Xiomara; Gaies, Michael; Tang, Xinyu

    2017-04-01

    Less than 2.7% of infants undergoing congenital heart disease operations have difficulty weaning from invasive mechanical ventilation. In such instances, clinicians may choose to perform tracheostomy. Limited literature has examined tracheostomy placement specifically in infants with hypoplastic left heart syndrome (HLHS). This study evaluated the risk factors for tracheostomy placement in infants with HLHS and examined the outcomes of these infants before their first hospital discharge. This retrospective analysis of the Pediatric Heath Information System data set included infants with HLHS who underwent stage 1 Norwood operation, a hybrid procedure, or heart transplant from 2004 through 2013. We identified 5721 infants with HLHS, and 126 underwent tracheostomy placement. Infants in the tracheostomy group had more morbidities and a higher mortality rate across the study period. Diagnosis of chromosomal abnormalities, anomalies of the trachea and esophagus, larynx, diaphragm and nervous system, bilateral vocal cord paralysis, and necrotizing enterocolitis, and procedures including extracorporeal membrane oxygenation support, cardiac catheterization, and gastrostomy tube were independently associated with tracheostomy placement in the study population. Despite an overall increase in rates of tracheostomy performed in infants with HLHS during the study period, the mortality rate did not improve among tracheostomy patients. Several risk factors were identified in infants with HLHS in whom a tracheostomy was placed during their first hospitalization. Despite an overall increase in rates of tracheostomies during the study period, the mortality rate did not improve among these patients. Appropriate family counseling and thorough preoperative case selection is suggested when discussing possible tracheostomy placement in infants with HLHS. Copyright © 2017 The Society of Thoracic Surgeons. Published by Elsevier Inc. All rights reserved.

  16. Child mortality in rural India

    NARCIS (Netherlands)

    B. van der Klaauw (Bas); L. Wang (Lihong)

    2011-01-01

    textabstractThis paper focuses on infant and child mortality in rural areas of India. We construct a flexible duration model, which allows for frailty at multiple levels and interactions between the child's age and individual, socioeconomic, and environmental characteristics. The model is estimated

  17. Management of ovarian cysts in infants

    Directory of Open Access Journals (Sweden)

    Yan Xue-qiang

    2015-01-01

    Full Text Available Background: To discuss the experience of diagnosis and treatment of ovarian cyst in infants. Materials and Methods: A retrospective review was conducted on 20 infants who suffered from ovarian cyst. Results: There were no dysplasia ovarian was found in children which were preoperatively diagnosed simplex cyst. Within thirteen children preoperatively detected mixed cystic-solid lesion, six cases ovarian cysts disappeared and two cases underwent poor blood supply in the following time. Conclusion: Adverse effects for ovarian cyst in infants can be prevented by agressive surgical intervention. Harmful effects of ovarian cyst can be prevented by positive surgical intervention despite the diagnostic difficulties in children with clinical symptoms of this condition.

  18. Probiotics to prevent necrotising enterocolitis in very preterm infants

    DEFF Research Database (Denmark)

    Lambæk, Irina Dobychina; Fonnest, Gert; Gormsen, Magdalena

    2016-01-01

    INTRODUCTION: Meta-analyses of randomised trials have shown that probiotics reduce the risk of necrotising enterocolitis (NEC) in preterm infants. However, the generalisability of these results, particularly for the most preterm infants, remains unresolved. Hence, we wanted to evaluate the benefit...... of implementing prophylactic use of probiotics as standard care in infants younger than 30 weeks of gestation. METHODS: Two three-year periods were compared. The first period was prior to a policy change. In this period no probiotics were used. The second period featured routine administration of probiotics...... period (median six versus 14 days, p = 0.004). No side effects and no blood cultures with lactobacillus or bifidobacterium were observed. CONCLUSIONS: This historically controlled study did not indicate that probiotics had a significant effect on NEC. We continue our practice, but larger cohort studies...

  19. Effects of severe obstetric complications on women's health and infant mortality in Benin.

    Science.gov (United States)

    Filippi, Véronique; Goufodji, Sourou; Sismanidis, Charalambos; Kanhonou, Lydie; Fottrell, Edward; Ronsmans, Carine; Alihonou, Eusèbe; Patel, Vikram

    2010-06-01

    To document the impact of severe obstetric complications on post-partum health in mothers and mortality in babies over 12 months in Benin and to assess whether severe complications associated with perinatal death are particularly likely to lead to adverse health consequences. Cohort study which followed women and their babies after a severe complication or an uncomplicated childbirth. Women were selected in hospitals and interviewed at home at discharge, and at 6 and 12 months post-partum. Women were invited for a medical check-up at 6 months and 12 months. The cohort includes 205 women with severe complications and a live birth, 64 women with severe complications and perinatal death and 440 women with uncomplicated delivery. Women with severe complications and a live birth were not dissimilar to women with a normal delivery in terms of post-partum health, except for hypertension [adjusted OR = 5.8 (1.9-17.0)], fever [adjusted OR = 1.71 (1.1-2.8)] and infant mortality [adjusted OR = 11.0 (0.8-158.2)]. Women with complications and perinatal death were at increased risk of depression [adjusted OR = 3.4 (1.3-9.0)], urine leakages [adjusted OR = 2.7 (1.2-5.8)], and to report poor health [adjusted OR = 5.27 (2.2-12.4)] and pregnancy's negative effects on their life [adjusted OR = 4.11 (1.9-9.0)]. Uptake of post-natal services was poor in all groups. Women in developing countries face a high risk of severe complications during pregnancy and delivery. These can lead to adverse consequences for their own health and that of their offspring. Resources are needed to ensure that pregnant women receive adequate care before, during and after discharge from hospital. Near-miss women with a perinatal death appear a particularly high-risk group.

  20. A current approach to using additional foods for the early prevention of deficiency states in infants during the first year of life

    Directory of Open Access Journals (Sweden)

    L. V. Levchuk

    2014-01-01

    Full Text Available The paper considers how to organize properly balanced feeding in infants during the first year of life, by using additional foods. It highlights current approaches to using the latter in the babies and provides a rationale for the tune of giving additional foods, by taking into account the readiness of an infant to eat new foods and the need to incorporate micronutrients for the prevention of anemia, rickets, and food allergy. The benefits of using commercial products are discussed.

  1. Child mortality in rural India

    NARCIS (Netherlands)

    van der Klaauw, B.; Wang, L.

    2011-01-01

    This paper focuses on infant and child mortality in rural areas of India. We construct a flexible duration model, which allows for frailty at multiple levels and interactions between the child's age and individual, socioeconomic, and environmental characteristics. The model is estimated using the

  2. Infant feeding and allergy prevention: a review of current knowledge and recommendations. A EuroPrevall state of the art paper

    DEFF Research Database (Denmark)

    Grimshaw, K.E.C.; Allen, K.; Edwards, C.A.

    2009-01-01

    of firm evidence the recommendations differ widely. This review has been developed as part of EuroPrevall, a European multicentre research project funded by the European Union, to document the differing feeding recommendations made across Europe, to investigate the current evidence base for any allergy......The relationship between infant feeding patterns and the later development of food allergies has been the focus of much debate and research over the last decade. National recommendations have been made by many countries on how to feed infants to reduce the risk of food allergy but due to the lack...... prevention feeding recommendations and to identify areas where further research is needed. This review will also provide information which, when combined with the infant feeding data collected as part of EuroPrevall, will give an indication of compliance to national feeding guidelines which can be utilised...

  3. Effect of 50 000 IU vitamin A given with BCG vaccine on mortality in infants in Guinea-Bissau: randomised placebo controlled trial

    DEFF Research Database (Denmark)

    Diness, B.R.; Roth, A.; Nante, E.

    2008-01-01

    Objective To investigate the effect of high dose vitamin A supplementation given with BCG vaccine at birth in an African setting with high infant mortality. Design Randomised placebo controlled trial. Setting Bandim Health Project's demographic surveillance system in Guinea-Bissau, covering.......84 (0.55 to 1.27) compared with 1.39 (0.90 to 2.14) in girls (P for interaction=0.10). An explorative analysis revealed a strong interaction between vitamin A and season of administration. Conclusions Vitamin A supplementation given with BCG vaccine at birth had no significant benefit in this African...

  4. Cause-specific childhood mortality in Africa and Asia: evidence from INDEPTH health and demographic surveillance system sites

    Directory of Open Access Journals (Sweden)

    P. Kim Streatfield

    2014-10-01

    Full Text Available Background: Childhood mortality, particularly in the first 5 years of life, is a major global concern and the target of Millennium Development Goal 4. Although the majority of childhood deaths occur in Africa and Asia, these are also the regions where such deaths are least likely to be registered. The INDEPTH Network works to alleviate this problem by collating detailed individual data from defined Health and Demographic Surveillance sites. By registering deaths and carrying out verbal autopsies to determine cause of death across many such sites, using standardised methods, the Network seeks to generate population-based mortality statistics that are not otherwise available. Objective: To present a description of cause-specific mortality rates and fractions over the first 15 years of life as documented by INDEPTH Network sites in sub-Saharan Africa and south-east Asia. Design: All childhood deaths at INDEPTH sites are routinely registered and followed up with verbal autopsy (VA interviews. For this study, VA archives were transformed into the WHO 2012 VA standard format and processed using the InterVA-4 model to assign cause of death. Routine surveillance data also provided person-time denominators for mortality rates. Cause-specific mortality rates and cause-specific mortality fractions are presented according to WHO 2012 VA cause groups for neonatal, infant, 1–4 year and 5–14 year age groups. Results: A total of 28,751 childhood deaths were documented during 4,387,824 person-years over 18 sites. Infant mortality ranged from 11 to 78 per 1,000 live births, with under-5 mortality from 15 to 152 per 1,000 live births. Sites in Vietnam and Kenya accounted for the lowest and highest mortality rates reported. Conclusions: Many children continue to die from relatively preventable causes, particularly in areas with high rates of malaria and HIV/AIDS. Neonatal mortality persists at relatively high, and perhaps sometimes under-documented, rates

  5. Prevention of Allergy: From Immunology of Pregnancy To Infant Feeding in the First Months of Life

    Directory of Open Access Journals (Sweden)

    Sergey E. Ukraintsev

    2016-01-01

    Full Text Available The continued increase in the incidence of allergic diseases in children population generates reasonable interest of allergists. The article describes the basic mechanisms of immunological response in light of the allergy risk modulation in children. It discusses a new approach to the prescription of hypoallergenic diets for healthy pregnant and lactating women to prevent allergies in children. A separate section examines the influence of the infant feeding mode in the first months of life on the risk of formation of allergies as a child grows, as well as key mechanisms for the formation of the oral tolerance phenomenon. The results from the study of immunological processes that underlie the phenomenon of oral tolerance confirm the ability to reduce the risk of formation of cow's milk protein allergy in formula-fed infants by using formulas based on hydrolysed protein.

  6. Impacto das ações de imunização pelo Programa Saúde da Família na mortalidade infantil por doenças evitáveis em Olinda, Pernambuco, Brasil Impact of immunization measures by the Family Health Program on infant mortality from preventable diseases in Olinda, Pernambuco State, Brazil

    Directory of Open Access Journals (Sweden)

    Tânia Maria Rocha Guimarães

    2009-04-01

    Full Text Available Este artigo aborda o impacto do Programa Saúde da Família (PSF na saúde infantil no Município de Olinda, Pernambuco, Brasil, por meio da avaliação da vacinação e mortalidade infantil por causas evitáveis. Realizou-se um estudo de série temporal com os dados dos principais sistemas de informação em saúde, usando-se a análise dos indicadores ex-ante e ex-post da implantação do PSF, em 1995. A variável independente foi o ano de nascimento relacionado com grau de cobertura da população pelo PSF. Analisou-se três períodos: 1990/1994 (anterior, 1995/1996 (implantação: cobertura de 0% a 30%, 1997/2002 (intervenção: cobertura de 38,6% a 54%. A tendência dos indicadores foi analisada pela regressão linear simples, sendo testada a significância pelo teste t. No período de implantação houve aumento de todas as médias das coberturas vacinais (176% BCG, 223% pólio, 52% DPT, 61% sarampo e redução da mortalidade infantil por causas evitáveis (12,7 óbitos/ano, mesmo não havendo diminuição da pobreza absoluta no município ou aumento das coberturas das redes públicas de saúde nem de esgotamento. A melhoria nos indicadores demonstra a efetividade das ações do PSF no município.This article analyzes the impact of the Family Health Program (FHP on infant health in Olinda, Pernambuco State, Brazil, evaluating immunization and infant mortality from vaccine-preventable diseases. A time-series study was conducted with data from the principal health information systems, analyzing indicators before and after implementation of the FHP in 1995. The independent variable was year of birth, related to degree of population coverage by the FHP. Three periods were analyzed: 1990-1994 (prior, 1995-1996 (implementation phase: 0 to 30% coverage, and 1997-2002 (intervention: coverage of 38.6% to 54%. Trends in the indicators were analyzed by simple linear regression, testing significance with the t test. During the implementation period

  7. MODERN POSSIBILITIES OF THE DIET THERAPY FOR THE PREVENTION AND CORRECTION OF THE CALCIUM DEFICIENCY AMONG INFANTS

    Directory of Open Access Journals (Sweden)

    N.E. Sannikova

    2007-01-01

    Full Text Available The work studies the efficiency of the specialized milk formula inclusion into the diet to prevent and correct the calcium deficiency among infants (aged between 1 and 3 years old. The authors discovered the positive impact of the milk formula on the values of the phosphoric and calcic exchange: the level of the ionized calcium, daily excretion of calcium with urine, osteocalcin. They identified the significant effect of the diet therapy for the prevention of the pathologic symptoms on the part of the musculoskeletal system (bearing disorder, reduction of the muscular tonus and etc..Key words: children, milk formula, calcium, exchange, diet therapy.

  8. Malnutrition and excess mortality in Shangri-La.

    Science.gov (United States)

    Solomons, Noel W

    2002-02-01

    Populations living at high altitude in the Tibetan highlands suffer extraordinarily high rates of maternal mortality, infant and juvenile mortality, and infectious morbidity. Poverty and living condition, more than altitude, contribute to the adverse statistics. The traditional nomadic herders are the most affected among the residents. The question remains whether contemporary standards of adequate health and nutrition are compatible with the integral folkways of traditional tribal groups.

  9. Evolução da mortalidade geral, infantil e proporcional no Brasil Trends in general, infant and proportional mortality in Brazil

    Directory of Open Access Journals (Sweden)

    João Yunes

    1974-06-01

    Full Text Available Estudo da evolução da mortalidade geral, infantil e proporcional para o Brasil e Regiões Fisiográficas de 1941 a 1970. Nos últimos 30 anos a redução de mortalidade geral para o Brasil foi de 47,5%, tendo sido maior a queda na região Centro-Oeste. No último decênio observa-se o aumento do coeficiente em todas as regiões iniciando-se em diferentes períodos, sendo em parte devido ao aumento da mortalidade infantil. Ao se comparar a mortalidade geral do Brasil com a de países mais desenvolvidos, ela pode ser considerada elevada, uma vez que cerca de 42% da população tem menos de 14 anos de idade, indicando nível de saúde insatisfatório. Para a mortalidade infantil, em 30 anos houve uma redução de seu coeficiente em 46,2%, tendo sido maior esta queda na região Centro-Oeste. No último decênio, observa-se um aumento deste coeficiente, sugerindo, portanto, uma piora do nível de saúde e ao se comparar com outros países é notória a diferença observada. Ao se comparar a mortalidade proporcional (percentagem do total de óbitos de crianças menores de 1 ano de 1940/1970, observa-se uma elevação de 16,3%, sendo no último decênio o maior aumento para as regiões Centro-Oeste (57,7% e Sudeste (36,1%. Ao se comparar os dados do Brasil com o Estado e Município mais desenvolvido (São Paulo, observa-se sempre que estes indicadores para o país como um todo apresentam-se mais elevados, sugerindo um pior nível de saúde. Entre os principais fatores condicionantes da piora do nível de saúde do Brasil no último decênio, destaca-se o econômico onde ocorre um aumento na concentração da distribuição de renda, declíneo do salário mínimo real de 20%, com conseqüente diminuição do poder aquisitivo da população assalariada. Acresce-se ainda, o aumento da população descoberta dos recursos de saneamento básico.Study of the evolution of general mortality, infant mortality rate and mortality ratio in Brazil and

  10. Old Disease and New Challenges: Major Obstacles of Current Strategies in the Prevention of Pertussis

    Science.gov (United States)

    Sedighi, Iraj; Karimi, Abdollah; Amanati, Ali

    2016-01-01

    Context Universal immunization against Bordetella pertussis has partially controlled the burden of the disease and its transmission. However, according to recent data, the epidemiology of this vaccine-preventable disease has changed. Now, younger infants, adolescents, and adults are at greater risk of infection. This article has studied the interaction between the various factors involved in the changing epidemiology of pertussis and the major obstacles faced by the current strategies in its prevention. Evidence Acquisition In this narrative review, the most recently published sources of information on pertussis control measures, consisting of textbooks and articles, have been reviewed. We focused on the more recent data about the changing epidemiology or pertussis in Scopus through the use of the MeSH-term words [pertussis] or [whooping cough] and [epidemiology] or [outbreak] or [resurgence], but our search was not restricted to this particular strategy; we also tried to find all of the most recent available data in the general field through other means. Results Primary and booster doses of the pertussis vaccine seem to partially control transmission of the disease, but despite the different preventive strategies available, pertussis continues to cause mortality and morbidity among high-risk groups. Conclusions Adding booster doses of acellular pertussis vaccine to the current national immunization practices with whole-cell vaccines for young adults and pregnant women seems to be a good option for controlling mortality and morbidity among high-risk groups such as very young infants. PMID:27729960

  11. Midwives’ Professional Competency for Preventing Neonatal Mortality in Disasters

    Directory of Open Access Journals (Sweden)

    Ziba Taghizadeh

    2016-04-01

    Full Text Available Background: Infants are the most vulnerable people with special needs in natural disasters. Since midwives are responsible for providing reproductive health services to infants in disastrous situations, assessing their professional competence is of great importance. Materials and Methods: This cross-sectional study was conducted in Tehran, Iran. A total of 361 midwives were selected by cluster sampling method. After giving their informed consents, they participated in the study and completed the researcher-made questionnaire about providing health services to infants in natural disasters. Midwives’ professional competence was investigated through self-assessment in terms of their perceived importance, knowledge, and skill. Then, the data were analyzed using SPSS. Results: Mean(SD total score of professional competency of midwives in providing services to infants in disasters was 91.95(20.2 obtained from 3 subcategories: perceived importance, 39.83(9.55; knowledge, 22.5(5.06; and skill 30.16(6.86. There were significant relationships between the scores of professional competency of midwives with age (P=0.053, degree of education (P=0.028, the workplace (P=0.053, and experience in disaster (P=0.047. About 49.86% of midwives demonstrated middle level of professional competency. The lowest knowledge and skill score were reported in managing common neonatal problems such as asphyxia, sepsis, physical trauma, which requires referral and stability. Conclusion: The average scores of professional competency of midwives to deliver reproductive health service to infants in disasters shows the necessity of related and integrated education. It is recommended that by holding training exercises and simulations, midwives be educated with regard to disasters and how to respond in these situations.

  12. Mortality in babies with achondroplasia: revisited.

    Science.gov (United States)

    Simmons, Kristen; Hashmi, S Shahrukh; Scheuerle, Angela; Canfield, Mark; Hecht, Jacqueline T

    2014-04-01

    Natural history studies performed 30 years ago identifying higher mortality among children born with achondroplasia, a genetic dwarfing condition, resulted in clinical recommendations aimed at improving mortality in childhood. The objective of this study was to determine if mortality rates have changed over the past few decades. Children born with achondroplasia during 1996 to 2003 were ascertained from the Texas Birth Defects Registry and matched with death certificate data from the Bureau of Vital Statistics through 2007. Infant and overall mortality rates, both crude and standardized to the 2005 (SMR2005 ) and 1975 (SMR1975 ) U.S. populations, were calculated. 106 children born with achondroplasia were identified. Four deaths were reported, with all occurring in the first year of life (mortality rate: 41.4 /1000 live-births). Infant mortality was higher when standardized to the 2005 U.S. population (SMR2005 :6.02, 95% CI:1.64-15.42) than the 1975 population (SMR1975 :2.58, 95% CI:0.70-6.61). The higher SMR2005 compared with SMR1975 , along with the fact that SMR1975 was nearly half that of a previous cohort reported 25 years ago (rate ratio: 0.53, 95% CI: 0.11-2.25), reflect a discrepancy in the changes in mortality in the overall population and in our cohort. Although an overall improvement in mortality, especially after the first year of life, is observed in our cohort, children with achondroplasia are still at a much higher risk of death compared with the general population. A longer follow-up is needed to elucidate whether evaluation/intervention changes have resulted in significant improvement in long-term survival among these patients. Copyright © 2014 Wiley Periodicals, Inc.

  13. Regional Deprivation Index and Socioeconomic Inequalities Related to Infant Deaths in Korea.

    Science.gov (United States)

    Yun, Jae-Won; Kim, Young-Ju; Son, Mia

    2016-04-01

    Deprivation indices have been widely used to evaluate neighborhood socioeconomic status and therefore examine individuals within their regional context. Although some studies on the development of deprivation indices were conducted in Korea, additional research is needed to construct a more valid and reliable deprivation index. Therefore, a new deprivation index, named the K index, was constructed using principal component analysis. This index was compared with the Carstairs, Townsend and Choi indices. A possible association between infant death and deprivation was explored using the K index. The K index had a higher correlation with the infant mortality rate than did the other three indices. The regional deprivation quintiles were unequally distributed throughout the country. Despite the overall trend of gradually decreasing infant mortality rates, inequalities in infant deaths according to the deprivation quintiles persisted and widened. Despite its significance, the regional deprivation variable had a smaller effect on infant deaths than did individual variables. The K index functions as a deprivation index, and we may use this index to estimate the regional socioeconomic status in Korea. We found that inequalities in infant deaths according to the time trend persisted. To reduce the health inequalities among infants in Korea, regional deprivation should be considered.

  14. Neonatal and Infant Mortality in Korea, Japan, and the U.S.: Effect of Birth Weight Distribution and Birth Weight-Specific Mortality Rates.

    Science.gov (United States)

    Kim, Do Hyun; Jeon, Jihyun; Park, Chang Gi; Sriram, Sudhir; Lee, Kwang Sun

    2016-09-01

    Difference in crude neonatal and infant mortality rates (NMR and IMR) among different countries is due to the differences in its two determinants: birth weight distribution (BWD) and birth weight-specific mortality rates (BW-SMRs). We aimed to determine impact of BWD and BW-SMRs on differences in crude NMR and IMR among Korea, Japan, and the U.S. Our study used the live birth data of the period 2009 through 2010. Crude NMR/IMR are the lowest in Japan, 1.1/2.1, compared to 1.8/3.2, in Korea, and 4.1/6.2, in the U.S., respectively. Japanese had the best BW-SMRs of all birth weight groups compared to the Koreans and the U.S. The U.S. BWD was unfavorable with very low birth weight (rate of 1.4%, compared to 0.6% in Korea, and 0.8% in Japan. If Koreans and Japanese had the same BWD as in the U.S., their crude NMR/IMR would be 3.9/6.1 for the Koreans and 1.5/2.5 for the Japanese. If both Koreans and Japanese had the same BW-SMRs as in the U.S., the crude NMR/IMR would be 2.0/3.8 for the Koreans and 2.7/5.0 for the Japanese. In conclusion, compared to the U.S., lower crude NMR or IMR in Japan is mainly attributable to its better BW-SMRs. Koreans had lower crude NMR and IMR, primarily from its favorable BWD. Comparing crude NMR or IMR among different countries should include further exploration of its two determinants, BW-SMRs reflecting medical care, and BWD reflecting socio-demographic conditions.

  15. [A multicenter randomized controlled study of Saccharomyces boulardii in the prevention of antibiotic-associated diarrhea in infants and young children].

    Science.gov (United States)

    Wan, C M; Yu, H; Liu, G; Xu, H M; Mao, Z Q; Xu, Y; Jin, Y; Luo, R P; Wang, W J; Fang, F

    2017-05-04

    Objective: To evaluate the efficacy and safety of Saccharomyces boulardii in the prevention of antibiotic-associated diarrhea (AAD) in infants and young children. Method: From November 2012 to September 2013, ten research units of large teaching hospitals or children's hospitals participated in this multicenter randomized controlled clinical trial. Hospitalized young children aged between 1 month and 3 years (nongastrointestinal infection and antibiotic therapy required)were involved in our study. The children were randomly divided into control group and prevention group by means of block random allocation method. The control group received antibiotic therapy and other conventional treatment. The prevention group was given additional Saccharomyces boulardii (250 mg/d) orally. Diarrhea rates of two groups were compared both during the usage of antibiotics and within 14 days after the antibiotics withdrawal. The adverse reactions of Saccharomyces boulardii were observed all through this study. The results were analyzed by χ(2) test or Kruskal-Wallis test or t test. Result: Totally 408 cases (213 cases in prevention group and 195 cases in control group) were enrolled. The age ranged from 1 month to 3 years, with an average age of 1.14 years. The basic diseases were parenteral infections: 368 cases with different kinds of respiratory tract infections or pneumonia, 10 cases of bacterial meningitis, 9 cases with septicemia or sepsis, 6 cases with pertussis or pertussis like syndrome, 5 cases with urinary infection, 5 cases with skin or subcutaneous tissue infections, 3 cases of Kawasaki disease, one with scarlet fever and one with congenital syphilis. During the administration of antibiotics, the incidence of AAD in prevention group was 10.3% (22 cases), which was significantly lower than that of control group (57 cases, 29.2%, χ(2)=23.296, P 1 year old); the risk of diarrhea was reduced by 86% (χ(2)=9.57, P 0.05). No adverse effects related with Saccharomyces

  16. Potential Cost-Effectiveness of RSV Vaccination of Infants and Pregnant Women in Turkey: An Illustration Based on Bursa Data.

    Directory of Open Access Journals (Sweden)

    Koen B Pouwels

    Full Text Available Worldwide, respiratory syncytial virus (RSV is considered to be the most important viral cause of respiratory morbidity and mortality among infants and young children. Although no active vaccine is available on the market yet, there are several active vaccine development programs in various stages. To assess whether one of these vaccines might be a future asset for national immunization programs, modeling the costs and benefits of various vaccination strategies is needed.To evaluate the potential cost-effectiveness of RSV vaccination of infants and/or pregnant women in Turkey.A multi-cohort static Markov model with cycles of one month was used to compare the cost-effectiveness of vaccinated cohorts versus non-vaccinated cohorts. The 2014 Turkish birth cohort was divided by twelve to construct twelve monthly birth cohorts of equal size (111,459 new-borns. Model input was based on clinical data from a multicenter prospective study from Bursa, Turkey, combined with figures from the (international literature and publicly available data from the Turkish Statistical Institute (TÜÏK. Incremental cost-effectiveness ratios (ICERs were expressed in Turkish Lira (TL per quality-adjusted life year (QALY gained.Vaccinating infants at 2 and 4 months of age would prevent 145,802 GP visits, 8,201 hospitalizations and 48 deaths during the first year of life, corresponding to a total gain of 1650 QALYs. The discounted ICER was estimated at 51,969 TL (26,220 US $ in 2013 per QALY gained. Vaccinating both pregnant women and infants would prevent more cases, but was less attractive from a pure economic point of view with a discounted ICER of 61,653 TL (31,106 US $ in 2013 per QALY. Vaccinating only during pregnancy would result in fewer cases prevented than infant vaccination and a less favorable ICER.RSV vaccination of infants and/or pregnant women has the potential to be cost-effective in Turkey. Although using relatively conservative assumptions, all evaluated

  17. Early infant diagnosis and post-exposure prophylaxis for HIV- exposed infants.

    Science.gov (United States)

    Gawde, Nilesh Chandrakant

    2016-01-01

    Recent scientific evidence suggests that early initiation of antiretroviral therapy (ART) among infants exposed perinatally to HIV has beneficial effects on their health and survival, and may even induce remission. This has led to the roll-out of early infant diagnosis (EID) of HIV and early treatment. Also, there is talk of using ART as post-exposure prophylaxis (PEP) to prevent mother-to-child transmission. EID involves carrying out diagnostic tests before initiating ART. In India, current programme design of centralised diagnosis has been resulting in poor access to diagnosis and treatment. To save the lives of HIV-infected infants, it is important to prevent delay. Another issue to be kept in mind is that the results of HIV tests may turn negative after the initiation of ART. This could be due to viral remission induced by ART or false positive initial results. Differentiating between the two is difficult. To deal with such cases, we need to develop a clinical algorithm and tools for capacity-building in counselling. The use of ART as PEP is expected to encounter further challenges. Between ART as PEP and EID, the later has advantages from an ethical perspective. There is a need to address the ethical issues within the EID programme by strengthening the current mechanisms for protecting the rights of HIV-exposed infants.

  18. Diarrhea in infants

    Science.gov (United States)

    ... Rare diseases such as cystic fibrosis . Diarrhea Causes Dehydration Infants and young children under age 3 can ... as: Apple juice Milk Fried foods Full-strength fruit juice Preventing Diaper Rash Your baby might get ...

  19. Tracheostomy in Infants With Congenital Heart Disease: A Nationwide Population-Based Study in Taiwan.

    Science.gov (United States)

    Lee, Yu-Sheng; Jeng, Mei-Jy; Tsao, Pei-Chen; Soong, Wen-Jue; Chou, Pesus

    2016-07-01

    This study aimed to use the National Health Insurance Research Database in Taiwan to examine the risk factors for tracheostomy in infants with congenital heart disease (CHD) and to evaluate the associated mortality risk in those who received a tracheostomy. The study was conducted between 2000 and 2011 with infants assigned to either a CHD group (34,943 subjects) or an age- and sex-matched control group (136,600 subjects). We then performed descriptive, logistic regression, Kaplan-Meier, and Cox regression analyses for the investigation. Infants with CHD had an increased risk of tracheostomy (adjusted hazard ratio [HR], 6.67, 95% CI 4.40-10.10). Congenital airway anomaly (adjusted odds ratio [OR], 15.25, 95% CI 10.56-22.02), neuromuscular impairment (adjusted OR 6.24, 95% CI 4.35-8.94), and time (0-3 y) after CHD diagnosis (adjusted OR 3.27, 95% CI 2.19-4.89) were most highly correlated with tracheostomy placement. The mortality risk was increased in infants with CHD and a tracheostomy even after adjusting for confounders (adjusted HR 3.88, 95% CI 2.96-5.08). Mortality risk (adjusted HR and 95% CI) increased by 2.06 (1.56-2.71), 7.19 (2.42-21.38), and 14.76 (1.46-149.69) after 0-3, 4-7, and 8-11 y of follow-up, respectively. Infants with CHD had an increased risk of undergoing tracheostomy. The mortality risk is significantly increased in infants with CHD and tracheostomy, and the risk increases progressively with time. Further studies are warranted to clarify the mechanisms underlying the risks associated with tracheostomy. Copyright © 2016 by Daedalus Enterprises.

  20. The Effectiveness of Community Health Workers Approach in Preventing Moderate Malnutrition among Infants and Young Children in Bethlehem villages in Palestine

    International Nuclear Information System (INIS)

    Al-Rabadi, Hana

    2014-01-01

    Full text: Background and aims: Infant and young child feeding practices are critically important for preventing and managing moderate malnutrition. The Palestinian Central Bureau of Statistics report 2011 revealed that malnutrition among children under-five in Palestine is on rise. Between the years 2000 and 2010, prevalence of malnutrition rose by 41.3% on the national level. Currently, 11 out of 100 children under-five suffer malnutrition. An assessment on maternal child health and nutrition conducted by World Vision in the same year in Bethlehem governorate in Palestine ,showed that malnutrition among children are mostly attributed to poor knowledge and practices among caregivers especially mothers in regards to breastfeeding, complementary feeding, feeding during illness and supplementation. The objective of this intervention is to assess the effectiveness of home targeted and timely visits by trained community health workers (CHWs) for increased knowledge and improved practices among caregivers regarding IYCF as a preventive approach to moderate malnutrition. Method: An intervention study was carried out by World Vision in eleven villages surrounding Bethlehem. Mothers (n = 360) of infants born during the year 2011, 2012 were identified by 17 trained CHWs. The CHWs targeted the mothers with key messages and support for positive infant and young child feeding practices during organized home-visits throughout 14 months. Baseline and end-line data were collected through household interviews. Results and discussion: Infant and young child feeding practices were significantly improved after the intervention; exclusive breastfeeding until 6 months increased from 44.7% to 65.7% (P <0.001), duration of breastfeeding above one year increased from 66.8% to 82.5% (P <0.001),timely introduction of the complementary meals increased from 71.5% to 87%,offering the minimum meal diversity increased from 28.5% to 78.9% (P <0.001), meal frequency increased from 4.2%-75.9% (P <0

  1. [Morbidity among mothers and infants after ambulatory deliveries].

    Science.gov (United States)

    Kierkegaard, O

    1991-07-29

    Postpartum early discharge programs are reviewed. Few programs were mandatory and both primi- and multiparae were included. Discharge varied from two to 72 hours after delivery. Nearly all programs had prenatal preparation and all patients had postpartum follow-up at home. Approximately one per cent of the infants were readmitted mostly on account of hyperbilirubinemia and infections, and half as many mothers were readmitted mostly for hemorrhage and endometritis. Infants discharged very early were readmitted more frequently than others. There were no statistical significant difference in mortality or morbidity between mothers or infants in early discharge groups and control groups.

  2. Prebiotics in healthy infants and children for prevention of acute infectious diseases: a systematic review and meta-analysis.

    Science.gov (United States)

    Lohner, Szimonetta; Küllenberg, Daniela; Antes, Gerd; Decsi, Tamás; Meerpohl, Joerg J

    2014-08-01

    Prebiotics, defined as nondigestible dietary ingredients resistant to gastric acidity and fermented by the intestinal flora, are used to positively influence the composition of intestinal flora, thereby promoting health benefits. The objective of this systematic review was to assess the efficacy of prebiotics in the prevention of acute infectious diseases in children. A systematic literature search was conducted using the Ovid Medline, Scopus, Web of Science, and Cochrane Library's Central databases. Finally, five randomized controlled trials, all of them investigating infants and children 0-24 months of age, were included in the review. Pooled estimates from three studies revealed a statistically significant decrease in the number of infectious episodes requiring antibiotic therapy in the prebiotic group as compared with the placebo group (rate ratio 0.68; 95% confidence interval 0.61-0.77). Studies available indicate that prebiotics may also be effective in decreasing the rate of overall infections in infants and children 0-24 months of age. Further studies in the age group 3-18 years are required to determine whether prebiotics can be considered for the prevention of acute infectious diseases in the older pediatric population. © 2014 International Life Sciences Institute.

  3. 'Tweaking' the model for understanding and preventing maternal and neonatal morbidity and mortality in Low Income Countries: "inserting new ideas into a timeless wine skin".

    Science.gov (United States)

    Mwaniki, Michael K; Baya, Evaline J; Mwangi-Powell, Faith; Sidebotham, Peter

    2016-01-25

    Maternal and neonatal morbidity and mortality in Low Income Countries, especially in sub-Saharan Africa involves numerous interrelated causes. The three-delay model/framework was advanced to better understand the causes and associated Contextual factors. It continues to inform many aspects of programming and research on combating maternal and child morbidity and mortality in the said countries. Although this model addresses some of the core areas that can be targeted to drastically reduce maternal and neonatal morbidity and mortality, it potentially omits other critical facets especially around primary prevention, and pre- and post-hospitalization continuum of care. The final causes of Maternal and Neonatal mortality and morbidity maybe limited to a few themes largely centering on infections, preterm births, and pregnancy and childbirth related complications. However, to effectively tackle these causes of morbidity and mortality, a broad based approach is required. Some of the core issues that need to be addressed include:-i) prevention of vertically transmitted infections, intra-partum related adverse events and broad primary prevention strategies, ii) overall health care seeking behavior and delays therein, iii) quality of care at point of service delivery, and iv) post-insult treatment follow up and rehabilitation. In this article we propose a five-pronged framework that takes all the above into consideration. This frameworks further builds on the three-delay model and offers a more comprehensive approach to understanding and preventing maternal and neonatal morbidity and mortality in Low Income Countries In shaping the post 2015 agenda, the scope of engagement in maternal and newborn health need to be widened if further gains are to be realized and sustained. Our proposed five pronged approach incorporates the need for continued investment in tackling the recognized three delays, but broadens this to also address earlier aspects of primary prevention, and the

  4. [Mortality in children under 5 years of age in families of marginal settlements in Guadalajara].

    Science.gov (United States)

    Nápoles-Rodríguez, F; Vásquez-Garibay, E M; Romero-Velarde, E

    1991-09-01

    The purpose was, to determine the frequency of infant mortality in the marginal areas of Guadalajara and, find its association with sociodemographic and economical factors, which are known as determinant of the nutritional status of children. There were included 898 families in a cross sectional design among children who applied to the food supplementation program of ONI of Guadalajara. Through an interview and home visit, it was obtained information about sociodemographic and economical characteristics and food habits. The data was recorded and analyzed by the Dbase III Plus and Epi-Info program. It was also used Chi square test and Odds Ratio for the statistical analysis. Education of the mother and income per capita for feeding (as a percentage of the minimum salary) had a significantly and inverse association with infant mortality (P less than 0.0001 and P less than 0.001 respectively). There was also major mortality among children with no social security (P less than 0.05). The Odds Ratio for infant mortality was of 3.02 for education of the father, 8.42 for education of the mother and 6.8 for income per capita for feeding. Meanwhile the level of education and the economical situation of the studied population remain so low, it seems improbable to decrease the rate of infant mortality.

  5. Nasal continuous positive airways pressure immediately after extubation for preventing morbidity in preterm infants.

    Science.gov (United States)

    Davis, P G; Henderson-Smart, D J

    2003-01-01

    CPAP is effective in preventing failure of extubation in preterm infants following a period of endotracheal intubation and IPPV. Implication for research: further definition of the gestational age and weight groups in whom these results apply is required. Optimal levels of NCPAP as well as methods of administration remain to be determined.

  6. Decline in Coronary Mortality in Sweden between 1986 and 2002: Comparing Contributions from Primary and Secondary Prevention.

    Directory of Open Access Journals (Sweden)

    Lena Björck

    Full Text Available The relative importance of risk factor reduction in healthy people (primary prevention versus that in patients with coronary heart disease (secondary prevention has been debated. We aimed to quantify the contribution of the two.We used the previously validated IMPACT model to estimate contributions from primary prevention (reducing risk factors in the population, particularly smoking, cholesterol and systolic blood pressure and from secondary prevention (reducing risk factors in coronary heart disease patients in the Swedish population.Between 1986 and 2002, about 8,690 fewer deaths were related to changes in the three major risk factors. Population cholesterol fell by 0.64 mmol/L, with approximately 5,210 fewer deaths attributable to diet changes (4,470 in healthy people740 in patients. plus 810 to statin treatment (200 in healthy people, 610 in patients. Overall smoking prevalence decreased by 10.3%, resulting in 1,195 fewer deaths, attributable to smoking cessation (595 in healthy people, 600 in patients. Mean population systolic blood pressure fell by 2.6 mmHg, resulting in 900 fewer deaths (865 in healthy people, 35 in patients, plus 575 fewer deaths attributable to antihypertensive medication in healthy people. The majority of falls in deaths attributable to risk factors occurred in people without known heart disease: 6,705 fewer deaths compared with 1,985 fewer deaths in patients (secondary prevention, emphasizing the importance of promoting health interventions in the general population.The largest effects on mortality came from primary prevention, giving markedly larger mortality reductions than secondary prevention.

  7. Improvement of outcome for infants of birth weight under 1000 g. The Victorian Infant Collaborative Study Group.

    Science.gov (United States)

    1991-07-01

    The two year outcome of extremely low birth-weight (ELBW) infants (birth weight 500 to 999 g), born in the state of Victoria over two distinct eras, 1979-80 and 1985-7, were compared. In the 1979-80 era, 25.4% of the ELBW infants survived to 2 years of age; only 12.5% of liveborn ELBW infants survived to 2 years with no neurological disabilities. In the 1979-80 era, ELBW infants born outside the level III centres in the state were significantly disadvantaged in both mortality and neurological morbidity. By 1985-7, the two year survival rate of ELBW infants rose significantly from 25.4% to 37.9%. By 1985-7, the proportion of ELBW infants who survived to 2 years free of neurological disabilities increased from 12.5% to 26.2%. Despite the improved survival, the absolute number of 2 year old children survivors with severe neurological disabilities remained constant at 8/year in both eras. By 1985-7, fewer ELBW infants were born outside the level III centres, their survival rate remained lower, but the severe neurological disability rate in survivors was no longer significantly higher. There has been a concomitant improvement in both survival and reduction in neurological morbidity.

  8. Backcasting to identify food waste prevention and mitigation opportunities for infant feeding in maternity services.

    Science.gov (United States)

    Ryan-Fogarty, Yvonne; Becker, Genevieve; Moles, Richard; O'Regan, Bernadette

    2017-03-01

    Food waste in hospitals is of major concern for two reasons: one, healthcare needs to move toward preventative and demand led models for sustainability and two, food system sustainability needs to seek preventative measures such as diet adaptation and waste prevention. The impact of breast-milk substitute use on health services are well established in literature in terms of healthcare implications, cost and resourcing, however as a food demand and waste management issue little has been published to date. This paper presents the use of a desk based backcasting method to analyse food waste prevention, mitigation and management options within the Irish Maternity Service. Best practice in healthcare provision and waste management regulations are used to frame solutions. Strategic problem orientation revealed that 61% of the volume of ready to use breast-milk substitutes purchased by maternity services remains unconsumed and ends up as waste. Thirteen viable strategies to prevent and manage this waste were identified. Significant opportunities exist to prevent waste and also decrease food demand leading to both positive health and environmental outcomes. Backcasting methods display great promise in delivering food waste management strategies in healthcare settings, especially where evidenced best practice policies exist to inform solution forming processes. In terms of food waste prevention and management, difficulties arise in distinguishing between demand reduction, waste prevention and waste reduction measures under the current Waste Management Hierarchy definitions. Ultimately demand reduction at source requires prioritisation, a strategy which is complimentary to health policy on infant feeding. Copyright © 2016 Elsevier Ltd. All rights reserved.

  9. Vaccine-Preventable Admissions to an Irish Paediatric Intensive Care

    LENUS (Irish Health Repository)

    Doyle, Y

    2017-05-01

    In the Republic of Ireland, the schedule of state-funded immunisation for children is comprehensive and includes diphtheria, pertussis, tetanus, pneumococcus, hepatitis B, meningococcus C, haemophilus B, polio, measles, rubella and mumps. Varicella and meningococcal B vaccines are commercially available but are not currently funded by the government. Each of the illnesses preventable by these vaccines can cause substantial morbidity, and rarely mortality, in infants and children. Our PICU continues to see serious illness due to avoidable infection. There were 39 admissions in a 4 year period, with 34 children surviving to discharge. Nine children were infected with pneumococcus, with 4 deaths. There was one case of pertussis, causing death. Most infections occurred in previously healthy children. These preventable conditions represent a significant burden on children, families, and on social and healthcare resources

  10. Use of evidence based practices to improve survival without severe morbidity for very preterm infants

    DEFF Research Database (Denmark)

    Zeitlin, Jennifer; Manktelow, Bradley N; Piedvache, Aurelie

    2016-01-01

    for which they were eligible. Infants with low gestational age, growth restriction, low Apgar scores, and who were born on the day of maternal admission to hospital were less likely to receive evidence based care. After adjustment, evidence based care was associated with lower in-hospital mortality (risk...... ratio 0.72, 95% confidence interval 0.60 to 0.87) and in-hospital mortality or severe morbidity, or both (0.82, 0.73 to 0.92), corresponding to an estimated 18% decrease in all deaths without an increase in severe morbidity if these interventions had been provided to all infants. CONCLUSIONS: More......OBJECTIVES: To evaluate the implementation of four high evidence practices for the care of very preterm infants to assess their use and impact in routine clinical practice and whether they constitute a driver for reducing mortality and neonatal morbidity. DESIGN: Prospective multinational...

  11. A new multidimensional population health indicator for policy makers: absolute level, inequality and spatial clustering - an empirical application using global sub-national infant mortality data

    Directory of Open Access Journals (Sweden)

    Benn K.D. Sartorius

    2014-11-01

    Full Text Available The need for a multidimensional measure of population health that accounts for its distribution remains a central problem to guide the allocation of limited resources. Absolute proxy measures, like the infant mortality rate (IMR, are limi- ted because they ignore inequality and spatial clustering. We propose a novel, three-part, multidimensional mortality indi- cator that can be used as the first step to differentiate interventions in a region or country. The three-part indicator (MortalityABC index combines absolute mortality rate, the Theil Index to calculate mortality inequality and the Getis-Ord G statistic to determine the degree of spatial clustering. The analysis utilises global sub-national IMR data to empirically illu- strate the proposed indicator. The three-part indicator is mapped globally to display regional/country variation and further highlight its potential application. Developing countries (e.g. in sub-Saharan Africa display high levels of absolute mortality as well as variable mortality inequality with evidence of spatial clustering within certain sub-national units (“hotspots”. Although greater inequality is observed outside developed regions, high mortality inequality and spatial clustering are com- mon in both developed and developing countries. Significant positive correlation was observed between the degree of spatial clustering and absolute mortality. The proposed multidimensional indicator should prove useful for spatial allocation of healthcare resources within a country, because it can prompt a wide range of policy options and prioritise high-risk areas. The new indicator demonstrates the inadequacy of IMR as a single measure of population health, and it can also be adapted to lower administrative levels within a country and other population health measures.

  12. Dopamine therapy is associated with impaired cerebral autoregulation in preterm infants

    DEFF Research Database (Denmark)

    Eriksen, Vibeke R; Hahn, Gitte H; Greisen, Gorm

    2014-01-01

    AIM: Hypotension is a common problem in newborn infants and is associated with increased mortality and morbidity. Dopamine is the most commonly used antihypotensive drug therapy, but has never been shown to improve neurological outcomes. This study tested our hypothesis that dopamine affects...... cerebral autoregulation (CA). METHODS: Near-infrared spectroscopy was used to measure the cerebral oxygenation index in 60 very preterm infants, and mean arterial blood pressure was monitored towards the end of their first day of life. Measurements were performed continuously for two to three hour periods......, but the anticipated difference in cerebral oxygenation was not detected. The need for mechanical ventilation in the first day of life and incidences of mortality was higher in the dopamine group. CONCLUSION: Dopamine therapy was associated with decreased CA in preterm infants. We were unable to determine whether...

  13. Infant feeding and allergy prevention: a review of current knowledge and recommendations. A EuroPrevall state of the art paper.

    LENUS (Irish Health Repository)

    Grimshaw, K E C

    2009-10-01

    The relationship between infant feeding patterns and the later development of food allergies has been the focus of much debate and research over the last decade. National recommendations have been made by many countries on how to feed infants to reduce the risk of food allergy but due to the lack of firm evidence the recommendations differ widely. This review has been developed as part of EuroPrevall, a European multicentre research project funded by the European Union, to document the differing feeding recommendations made across Europe, to investigate the current evidence base for any allergy prevention feeding recommendations and to identify areas where further research is needed. This review will also provide information which, when combined with the infant feeding data collected as part of EuroPrevall, will give an indication of compliance to national feeding guidelines which can be utilised to assess the effectiveness of current dissemination and implementation strategies.

  14. The Role of Breastfeeding in the Prevention of Childhood Malnutrition.

    Science.gov (United States)

    Scherbaum, Veronika; Srour, M Leila

    2016-01-01

    Breastfeeding has an important role in the prevention of different forms of childhood malnutrition, including wasting, stunting, over- and underweight and micronutrient deficiencies. This chapter reviews research that demonstrates how improved breastfeeding rates have the potential to improve childhood nutrition, with associated impacts on infectious and noninfectious disease prevention. The unique composition of breastmilk, the importance of breastfeeding in infectious disease prevention, the iron status of breastfed infants, and breastfeeding's protective effect on overweight and obesity are discussed based on currently available research. Early and tailored dietary counseling is needed to improve maternal diets, which can affect the nutritional status of breastmilk. Promotion and support of breastfeeding are important to prevent childhood morbidity and mortality. A review of the literature reveals key factors shown to be effective in improving breastfeeding rates, especially including legislation to control the marketing of breastmilk substitutes. In conclusion, breastfeeding is shown to be the best natural resource to improve childhood nutrition throughout the world. © 2016 S. Karger AG, Basel.

  15. Infant mortality in Pelotas, Brazil: a comparison of risk factors in two birth cohorts La mortalidad de menores de un año en Pelotas, Brasil: comparación de factores de riesgo en dos cohortes de nacimiento

    Directory of Open Access Journals (Sweden)

    Ana Maria Baptista Menezes

    2005-12-01

    Full Text Available OBJECTIVES: To compare two population-based birth cohorts to assess trends in infant mortality rates and the distribution of relevant risk factors, and how these changed after an 11-year period. METHODS: Data from two population-based prospective birth cohorts (1982 and 1993 were analyzed. Both studies included all children born in a hospital (> 99% of all births in the city of Pelotas, Southern Brazil. Infant mortality was monitored through surveillance of all maternity hospitals, mortality registries and cemeteries. RESULTS: There were 5 914 live-born children in 1982 and 5 249 in 1993. The infant mortality rate decreased by 41%, from 36.0 per 1 000 live births in 1982 to 21.1 per 1 000 in 1993. Socioeconomic and maternal factors tended to become more favorable during the study period, but there were unfavorable changes in birthweight and gestational age. Poverty, high parity, low birthweight, preterm delivery, and intrauterine growth restriction were the main risk factors for infant mortality in both cohorts. The 41% reduction in infant mortality between 1982 and 1993 would have been even greater had the prevalence of risk factors remained constant during the period studied here. CONCLUSIONS: There were impressive declines in infant mortality which were not due to changes in the risk factors we studied. Because no reduction was seen in the large social inequalities documented in the 1982 cohort, it is likely that the reduction in infant mortality resulted largely from improvements in health care.OBJETIVOS: Comparar dos cohortes de nacimiento tomadas de la población en general a fin de evaluar las tendencias observadas en las tasas de mortalidad de menores de un año y la distribución de los factores de riesgo asociados con ella, así como los cambios sufridos por ambas cosas al cabo de un período de 11 años. MÉTODOS: Se analizaron los datos procedentes de dos cohortes de nacimiento prospectivas (1982 y 1993 tomadas de la población en

  16. Interrelationships between mortality and fertility in Germany: rural and urban Prussia and modern Germany.

    Science.gov (United States)

    Entorf, H; Zimmermann, K F

    1990-01-01

    "The paper investigates the interrelationship between fertility and infant mortality and its economic determinants by time-series methods for historical and modern Germany. It is studied whether the causal effects of infant mortality on fertility have to be considered as hoarding or replacement, and whether the costs of nutrition have an influence on family decision making about demographic variables. Results show that there are indications for replacement motives, and that economic factors matter." (SUMMARY IN FRE AND ITA) excerpt

  17. Enterobacter sakazakii in infants: Novel phenomenon in India

    Directory of Open Access Journals (Sweden)

    Ray P

    2007-01-01

    Full Text Available E. sakazakii has been implicated in necrotizing enterocolitis, bloodstream and central nervous system infections, with mortality rates of 40-80%. Two cases of E. sakazakii infections; one preterm very low birth weight neonate with meningitis and a two month infant with bacteraemia, are described for the first time in India. The first baby succumbed to the infection while the other responded to appropriate therapy. Powdered infant milk formulae have been implicated in causing neonatal infections and the first baby was on formula feed with classic signs of sepsis and meningitis. The second infant was on breast feed and probably developed nosocomial E. sakazakii bacteraemia.

  18. Pragmatic controlled trial to prevent childhood obesity in maternity and child health care clinics: pregnancy and infant weight outcomes (The VACOPP Study)

    OpenAIRE

    Mustila, Taina; Raitanen, Jani; Keskinen, P?ivi; Saari, Antti; Luoto, Riitta

    2013-01-01

    Background According to current evidence, the prevention of obesity should start early in life. Even the prenatal environment may expose a child to unhealthy weight gain; maternal gestational diabetes is known to be among the prenatal risk factors conducive to obesity. Here we report the effects of antenatal dietary and physical activity counselling on pregnancy and infant weight gain outcomes. Methods The study was a non-randomised controlled pragmatic trial aiming to prevent childhood obesi...

  19. Comparison of Risk Factors in Necrotizing Enterocolitis among Infants in Neonatal Intensive Care Unit

    Directory of Open Access Journals (Sweden)

    Ferda Ozlu

    2013-08-01

    Full Text Available Purpose: Necrotizing enterocolitis is one of the important problems of premature infants. The incidence is about 1-5% in infants followed in neonatal care units and inversely related to gestational age and birth weight. Materials and Methods: In this study, 31 infants with necrotizing enterocolitis and 31 infants with similar gestational age and birth weight as control group hospitalized in Cukurova University Neonatal Care Unit between 1 January 2001-31 January 2004 were evaluated. Results: The incidence of necrotizing enterocolitis in this period was 1.4 (31/2214 admission. Mean gestational age was 30.5  3.2 weeks (25-36, mean birth weight was 1331  384 (730-2150 grams while 71% was younger than 32 gestational weeks and 67.7% was under 1500 grams. The signs of NEC were detected at a mean of 11.2  10. (2-38 days. Twenty-six (83.9% were being fed at the time of the necrotizing enterocolitis signs appeared. According to the Walsh and Kliegman classification, 19 (61.3% infants were in stage 1 (17 were 1a, 2 were 1b; 3 (9.6% infants were in stage 2a, 9 (%29.1 infants were in stage 3 (7 were in 3b. Blood culture was positive in 7 (%22.6 infants with predominance of gram negative microorganisms (5 infants. Eleven (%35.5 infants were exitus, 12 were discharged. Hypoxia, respiratory distress syndrome, intraventricular hemorrhage and umbilical catheterization were significant risk factors in necrotizing enterocolitis . Thrombocytopenia, leucopenia and high C-reactive protein levels were significantly high in necrotizing enterocolitis group. Breast feeding is significantly high in control group. Conclusion: Necrotizing enterocolitis, is a leading cause of morbidity and mortality in neonatal intensive care units. Early breast feeding with small amounts, increasing amount of milk slowly, antenatal steroids, caring hygiene rules can prevent the development of it. [Cukurova Med J 2013; 38(4.000: 642-647

  20. Preventable infant mortality and quality of health care: maternal perception of the child's illness and treatment

    Directory of Open Access Journals (Sweden)

    Salime Hadad

    2002-12-01

    Full Text Available This study used a qualitative methodology to analyze the discourse of mothers from Greater Metropolitan Belo Horizonte, Minas Gerais, Brazil, whose infant children had died from what were considered avoidable causes (diarrhea, malnutrition, and pneumonia, seeking to elucidate the factors associated with utilization of health care services. Identification of the illness by the mother was related to perception of specific alterations in the child's state of health. Analysis of the alterations helped identify the principal characteristics ascribed to each alteration and their relationship to the search for treatment. The authors also studied the mother's assessment of treatment received at health care facilities; 43.0% of the cases involved problems related to the structure of health care services or the attending health care professionals. In 46.0% of the cases, mothers associated the child's death with flaws in the health care service. The study group showed a variety of interpretations of illness, often distinct from the corresponding biomedical concepts. The fact that attending health care personnel overlooked or underrated the mother's perception of the illness and the lack of communications between health care personnel and the child's family had an influence on the child's evolution and subsequent death.