WorldWideScience

Sample records for subnational infant mortality

  1. 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...

  2. Sub-national assessment of inequality trends in neonatal and child mortality in Brazil

    Directory of Open Access Journals (Sweden)

    Sousa Angelica

    2010-09-01

    Full Text Available Abstract Objective Brazil's large socioeconomic inequalities together with the increase in neonatal mortality jeopardize the MDG-4 child mortality target by 2015. We measured inequality trends in neonatal and under five mortality across municipalities characterized by their socio-economic status in a period where major pro poor policies were implemented in Brazil to infer whether policies and interventions in newborn and child health have been successful in reaching the poor as well as the better off. Methods Using data from the 5,507 municipalities in 1991 and 2000, we developed accurate estimates of neonatal mortality at municipality level and used these data to investigate inequality trends in neonatal and under five mortality across municipalities characterized by socio-economic status. Results Child health policies and interventions have been more effective in reaching the better off than the worst off. Reduction of under five mortality at national level has been achieved by reducing the level of under five mortality among the better off. Poor municipalities suffer from worse newborn and child health than richer municipalities and the poor/rich gaps have increased. Conclusion Our analysis highlights the importance of monitoring progress on MDGs at sub-national level and measuring inequality gaps to accurately target health and inter-sectoral policies. Further efforts are required to improve the measurement and monitoring of trends in neonatal and under five mortality at sub-national level, particularly in developing countries and countries with large socioeconomic inequalities.

  3. Infant Mortality and Hispanic Americans

    Science.gov (United States)

    ... AIDS Immunizations Infant Health & Mortality Mental Health Obesity Organ and Tissue Donation Stroke Stay Connected OMH Home > Policy and Data > ... contents2016.htm Leading Causes of Infant Mortality: Infant deaths and mortality rates for the top 4 leading ...

  4. Global, regional, national, and selected subnational levels of stillbirths, neonatal, infant, and under-5 mortality, 1980–2015: a systematic analysis for the Global Burden of Disease Study 2015

    DEFF Research Database (Denmark)

    Moesgaard Iburg, Kim; Gyawali, Bishal

    2016-01-01

    markedly, highlighting a crucial need to further examine potential drivers of accelerated or slowed decreases in child mortality. The Global Burden of Disease 2015 Study (GBD 2015) provides an analytical framework to comprehensively assess these trends for under-5 mortality, age-specific and cause......-specific mortality among children under 5 years, and stillbirths by geography over time. Methods Drawing from analytical approaches developed and refined in previous iterations of the GBD study, we generated updated estimates of child mortality by age group (neonatal, post-neonatal, ages 1–4 years, and under 5...... for under-5 mortality for each geography. Age-specific mortality estimates were generated through a two-stage age–sex splitting process, and stillbirth estimates were produced with a mixed-effects model, which accounted for variable stillbirth definitions and data source-specific biases. For GBD 2015, we...

  5. Global, regional, national, and selected subnational levels of stillbirths, neonatal, infant, and under-5 mortality, 1980–2015: a systematic analysis for the Global Burden of Disease Study 2015

    DEFF Research Database (Denmark)

    Moesgaard Iburg, Kim; Gyawali, Bishal

    2016-01-01

    on the basis of improving SDI alone. Interpretation Gains in child survival have been large, widespread, and in many places in the world, faster than what was anticipated based on improving levels of development. Yet some countries, particularly in sub-Saharan Africa, still had high rates of under-5 mortality...... the 4·4% rate of decrease from 1990 met the MDG4 pace of decrease. However, absolute levels of under-5 mortality remained high in many countries, with 11 countries still recording rates exceeding 100 per 1000 livebirths in 2015. Marked decreases in under-5 deaths due to a number of communicable diseases....... At the global level, we recorded a divergence in observed and expected levels of under-5 mortality starting in 2000, with the observed trend falling much faster than what was expected based on SDI through 2015. Between 2000 and 2015, the world recorded 10·3 million fewer under-5 deaths than expected...

  6. Infant Mortality and African Americans

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    ... AIDS Immunizations Infant Health & Mortality Mental Health Obesity Organ and Tissue Donation Stroke Stay Connected OMH Home > Policy and Data > ... African Americans had over twice the sudden infant death syndrome mortality rate as non-Hispanic whites, in ...

  7. 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.

  8. CDC WONDER: Mortality - Infant Deaths

    Data.gov (United States)

    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...

  9. Stillbirth and Infant Mortality

    DEFF Research Database (Denmark)

    Nøhr, Ellen Aagaard

    2012-01-01

    indicating that some of the excess risk may have a placental origin. To further understand the associations between maternal obesity and late fetal and infant death, we need better and more detailed clinical data, which is difficult to obtain on a population level given the rarity of the outcomes. The best...

  10. America's Infant-Mortality Puzzle.

    Science.gov (United States)

    Eberstadt, Nicholas

    1991-01-01

    Conventional explanations attributing the high infant mortality rate in United States to the prevalence of poverty and lack of adequate health care do not tell the whole story. Contributions of parental behavior, lifestyles, and public health care availability versus utilization must be examined in determining public policies to address the…

  11. Infant Mortality and Asians and Pacific Islanders

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    ... AIDS Immunizations Infant Health & Mortality Mental Health Obesity Organ and Tissue Donation Stroke ... Mortality and Asians and Pacific Islanders Among Asian/Pacific Islanders, Sudden Infant Death Syndrome (SIDS) is the fourth leading cause of ...

  12. Infant Mortality and Native Hawaiians/Pacific Islanders

    Science.gov (United States)

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

  13. 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...

  14. VSRR - Quarterly provisional estimates for infant mortality

    Data.gov (United States)

    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...

  15. Under-5 mortality in 2851 Chinese counties, 1996–2012: a subnational assessment of achieving MDG 4 goals in China

    Science.gov (United States)

    Wang, Yanping; Li, Xiaohong; Zhou, Maigeng; Luo, Shusheng; Liang, Juan; Liddell, Chelsea A; Coates, Matthew M; Gao, Yanqiu; Wang, Linhong; He, Chunhua; Kang, Chuyun; Liu, Shiwei; Dai, Li; Schumacher, Austin E; Fraser, Maya S; Wolock, Timothy M; Pain, Amanda; Levitz, Carly E; Singh, Lavanya; Coggeshall, Megan; Lind, Margaret; Li, Yichong; Li, Qi; Deng, Kui; Mu, Yi; Deng, Changfei; Yi, Ling; Liu, Zheng; Ma, Xia; Li, Hongtian; Mu, Dezhi; Zhu, Jun; Murray, Christopher J L; Wang, Haidong

    2017-01-01

    Summary Background In the past two decades, the under-5 mortality rate in China has fallen substantially, but progress with regards to the Millennium Development Goal (MDG) 4 at the subnational level has not been quantified. We aimed to estimate under-5 mortality rates in mainland China for the years 1970 to 2012. Methods We estimated the under-5 mortality rate for 31 provinces in mainland China between 1970 and 2013 with data from censuses, surveys, surveillance sites, and disease surveillance points. We estimated under-5 mortality rates for 2851 counties in China from 1996 to 2012 with the reported child mortality numbers from the Annual Report System on Maternal and Child Health. We used a small area mortality estimation model, spatiotemporal smoothing, and Gaussian process regression to synthesise data and generate consistent provincial and county-level estimates. We compared progress at the county level with what was expected on the basis of income and educational attainment using an econometric model. We computed Gini coefficients to study the inequality of under-5 mortality rates across counties. Findings In 2012, the lowest provincial level under-5 mortality rate in China was about five per 1000 livebirths, lower than in Canada, New Zealand, and the USA. The highest provincial level under-5 mortality rate in China was higher than that of Bangladesh. 29 provinces achieved a decrease in under-5 mortality rates twice as fast as the MDG 4 target rate; only two provinces will not achieve MDG 4 by 2015. Although some counties in China have under-5 mortality rates similar to those in the most developed nations in 2012, some have similar rates to those recorded in Burkina Faso and Cameroon. Despite wide differences, the inter-county Gini coefficient has been decreasing. Improvement in maternal education and the economic boom have contributed to the fall in child mortality; more than 60% of the counties in China had rates of decline in under-5 mortality rates

  16. Selection and Adaptation Components of Infant Mortality

    DEFF Research Database (Denmark)

    Schöley, Jonas; Oeppen, James; Lindahl-Jacobsen, Rune

    We test the selection hypothesis of infant mortality against the adaptation hypothesis by decomposing the mortality age pattern over the first year of life into an adaptation- and a selection component. We show that the population level decline in mortality over the first hour of life...... is significantly influenced by mortality selection, i.e.~the frailest infants leaving the population shortly after birth. The subsequent mortality decline predominantly results from mortality changes observed in homogeneous sub-populations. This confirms the common view of the infant mortality age pattern being...

  17. Infant mortality in the Americas.

    Science.gov (United States)

    1981-01-01

    Data from the Pan American Health Organization (PAHO) show infant mortality per 1000 live births as follows (for the most recent year data was available): Argentina 44.9; Canada, 11.9; Colombia, 46.7; El Salvador, 53.4; Panama, 33; Peru, 61.4; U.S., 14.1; Chile 47.5; Costa Rica 33.3; Cuba 25.0; Dominican Republic 40.7; Ecuador 70.2; Guatemala 75.3; Martinique 22.8; Mexico 46.6; Montserrat 31.4; Nicaragua 35.2; Paraguay 95.2; Puerto Rico 20.9; Saint Kitts, Nevis, and Anguilla 41.76; Trinidad and Tobago 25.5; Uruguay 40.8; and Venezuela, 39.5. Neonatal mortality is more difficult to control than postneonatal mortality which can be reduced through primary health care measures. In 10 countries of the Americas neonatal mortality is higher than postneonatal mortality. The harmful environmental factors that cause deaths are expressed, inter alia, in data on diseases such as enteritis, other diarrheal diseases, influenza, and pneumonia. Deaths due to infectious and parastic disease fell 30%, from 693/100,000 to 484, between 1972-75. Mortality from respiratory diseases fell 23%, from 470/100,000 in 1972 to 361 in 1975. In South America and Middle America, deaths from infectious and parasitic diseases were about 7 times higher than in North America for the 0-1 age group. Malnutrition is among the 5 leading causes of death among those under 1 year in 19 out of 29 countries in the Americas, according to 1975 data.

  18. National and subnational mortality effects of metabolic risk factors and smoking in Iran: a comparative risk assessment

    Directory of Open Access Journals (Sweden)

    Farzadfar Farshad

    2011-10-01

    Full Text Available Abstract Background Mortality from cardiovascular and other chronic diseases has increased in Iran. Our aim was to estimate the effects of smoking and high systolic blood pressure (SBP, fasting plasma glucose (FPG, total cholesterol (TC, and high body mass index (BMI on mortality and life expectancy, nationally and subnationally, using representative data and comparable methods. Methods We used data from the Non-Communicable Disease Surveillance Survey to estimate means and standard deviations for the metabolic risk factors, nationally and by region. Lung cancer mortality was used to measure cumulative exposure to smoking. We used data from the death registration system to estimate age-, sex-, and disease-specific numbers of deaths in 2005, adjusted for incompleteness using demographic methods. We used systematic reviews and meta-analyses of epidemiologic studies to obtain the effect of risk factors on disease-specific mortality. We estimated deaths and life expectancy loss attributable to risk factors using the comparative risk assessment framework. Results In 2005, high SBP was responsible for 41,000 (95% uncertainty interval: 38,000, 44,000 deaths in men and 39,000 (36,000, 42,000 deaths in women in Iran. High FPG, BMI, and TC were responsible for about one-third to one-half of deaths attributable to SBP in men and/or women. Smoking was responsible for 9,000 deaths among men and 2,000 among women. If SBP were reduced to optimal levels, life expectancy at birth would increase by 3.2 years (2.6, 3.9 and 4.1 years (3.2, 4.9 in men and women, respectively; the life expectancy gains ranged from 1.1 to 1.8 years for TC, BMI, and FPG. SBP was also responsible for the largest number of deaths in every region, with age-standardized attributable mortality ranging from 257 to 333 deaths per 100,000 adults in different regions. Discussion Management of blood pressure through diet, lifestyle, and pharmacological interventions should be a priority in Iran

  19. Reducing Infant Mortality. KIDS COUNT Indicator Brief

    Science.gov (United States)

    Shore, Rima; Shore, Barbara

    2009-01-01

    Despite the wide range of expertise that has been brought to bear on reducing infant mortality across the nation, the first year of life remains a time of considerable risk for many babies. Although the U.S. spends more on health care than any other country, its infant mortality rate remains higher than that of most other industrialized nations.…

  20. Cigarette Tax Increase and Infant Mortality.

    Science.gov (United States)

    Patrick, Stephen W; Warner, Kenneth E; Pordes, Elisabeth; Davis, Matthew M

    2016-01-01

    Maternal smoking increases the risk for preterm birth, low birth weight, and sudden infant death syndrome, which are all causes of infant mortality. Our objective was to evaluate if changes in cigarette taxes and prices over time in the United States were associated with a decrease in infant mortality. We compiled data for all states from 1999 to 2010. Time-series models were constructed by infant race for cigarette tax and price with infant mortality as the outcome, controlling for state per-capita income, educational attainment, time trend, and state random effects. From 1999 through 2010, the mean overall state infant mortality rate in the United States decreased from 7.3 to 6.2 per 1000 live births, with decreases of 6.0 to 5.3 for non-Hispanic white and 14.3 to 11.3 for non-Hispanic African American infants (P infant deaths of -0.19 (95% confidence interval -0.33 to -0.05) per 1000 live births overall, including changes of -0.21 (-0.33 to -0.08) for non-Hispanic white infants and -0.46 (-0.90 to -0.01) for non-Hispanic African American infants. Models for cigarette price yielded similar findings. Increases in cigarette taxes and prices are associated with decreases in infant mortality rates, with stronger impact for African American infants. Federal and state policymakers may consider increases in cigarette taxes as a primary prevention strategy for infant mortality. Copyright © 2016 by the American Academy of Pediatrics.

  1. Developing a Standard Approach to Examine Infant Mortality: Findings from the State Infant Mortality Collaborative (SIMC)

    Science.gov (United States)

    Kroelinger, Charlan D.; Dudgeon, Matthew; Goodman, David; Ramos, Lauren Raskin; Barfield, Wanda D.

    2015-01-01

    States can improve pregnancy outcomes by using a standard approach to assess infant mortality. The State Infant Mortality Collaborative (SIMC) developed a series of analyses to describe infant mortality in states, identify contributing factors to infant death, and develop the evidence base for implementing new or modifying existing programs and policies addressing infant mortality. The SIMC was conducted between 2004 and 2006 among five states: Delaware, Hawaii, Louisiana, Missouri, and North Carolina. States used analytic strategies in an iterative process to investigate contributors to infant mortality. Analyses were conducted within three domains: data reporting (quality, reporting, definitional criteria, and timeliness), cause and timing of infant death (classification of cause and fetal, neonatal, and postneonatal timing), and maturity and weight at birth/maturity and birth weight-specific mortality. All states identified the SIMC analyses as useful for examining infant mortality trends. In each of the three domains, SIMC results were used to identify important direct contributors to infant mortality including disparities, design or implement interventions to reduce infant death, and identify foci for additional analyses. While each state has unique structural, political, and programmatic circumstances, the SIMC model provides a systematic approach to investigating increasing or static infant mortality rates that can be easily replicated in all other states and allows for cross-state comparison of results. PMID:23108735

  2. Unmasking inequalities: Sub-national maternal and child mortality data from two urban slums in Lagos, Nigeria tells the story.

    Science.gov (United States)

    Anastasi, Erin; Ekanem, Ekanem; Hill, Olivia; Adebayo Oluwakemi, Agnes; Abayomi, Oluwatosin; Bernasconi, Andrea

    2017-01-01

    Nigeria has one of the highest maternal mortality ratios in the world as well as high perinatal mortality. Unfortunately, the country does not have the resources to assess this critical indicator with the conventional health information system and measuring its progress toward the goal of ending preventable maternal deaths is almost impossible. Médecins Sans Frontières (MSF) conducted a cross-sectional study to assess maternal and perinatal mortality in Makoko Riverine and Badia East, two of the most vulnerable slums of Lagos. The study was a cross-sectional, community-based household survey. Nearly 4,000 households were surveyed. The sisterhood method was utilized to estimate maternal mortality and the preceding births technique was used to estimate newborn and child mortality. Questions regarding health seeking behavior were posed to female interviewees and self-reported data were collected. Data was collected from 3963 respondents for a total of 7018 sisters ever married. The maternal mortality ratio was calculated at 1,050/100,000 live births (95% CI: 894-1215), and the lifetime risk of maternal death at 1:18. The neonatal mortality rate was extracted from 1967 pregnancies reported and was estimated at 28.4/1,000; infant mortality at 43.8/1,000 and under-five mortality at 103/1,000. Living in Badia, giving birth at home and belonging to the Egun ethnic group were associated with higher perinatal mortality. Half of the last pregnancies were reportedly delivered in private health facilities. Proximity to home was the main influencing factor (32.4%) associated with delivery at the health facility. The maternal mortality ratio found in these urban slum populations within Lagos is extremely high, compared to the figure estimated for Lagos State of 545 per 100,000 live births. Urgent attention is required to address these neglected and vulnerable neighborhoods. Efforts should be invested in obtaining data from poor, marginalized, and hard-to-reach populations in

  3. Social Welfare Expenditures and Infant Mortality.

    Science.gov (United States)

    Shim, Joyce

    2015-01-01

    This study examines the effects of social welfare expenditures on infant mortality (deaths younger than age 1 per 1,000 live births) across 19 Organisation for Economic Co-operation and Development (OECD) countries from 1980 to 2010. Data are obtained from various sources including the OECD, World Health Organization, and World Bank. The findings indicate that among three social welfare expenditure measures for families, the expenditures on family cash allowances are predicted to reduce infant mortality. However, the other two measures-the expenditures on parental and maternity leave and expenditures on family services-have no significant effects on infant mortality.

  4. US infant mortality and the President's party.

    Science.gov (United States)

    Rodriguez, Javier M; Bound, John; Geronimus, Arline T

    2014-06-01

    Infant mortality rates in the US exceed those in all other developed countries and in many less developed countries, suggesting political factors may contribute. Annual time series on overall, White and Black infant mortality rates in the US were analysed over the 1965-2010 time period to ascertain whether infant mortality rates varied across presidential administrations. Data were de-trended using cubic splines and analysed using both graphical and time series regression methods. Across all nine presidential administrations, infant mortality rates were below trend when the President was a Democrat and above trend when the President was a Republican. This was true for overall, neonatal and postneonatal mortality. Regression estimates show that, relative to trend, Republican administrations were characterized by infant mortality rates that were, on average, 3% higher than Democratic administrations. In proportional terms, effect size is similar for US Whites and Blacks. US Black rates are more than twice as high as White, implying substantially larger absolute effects for Blacks. We found a robust, quantitatively important association between net of trend US infant mortality rates and the party affiliation of the president. There may be overlooked ways by which macro-dynamics of policy impact microdynamics of physiology, suggesting the political system is a component of the underlying mechanism generating health inequality in the USA. Published by Oxford University Press on behalf of the International Epidemiological Association © The Author 2013; all rights reserved.

  5. 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...

  6. Infant Mortality: A Challenge to the Nation.

    Science.gov (United States)

    Children's Bureau (DHEW), Washington, DC.

    From 1956-1960 an estimated 34,000 infants annually failed to survive in many parts of the United States due to risks far in excess of those for some areas of the country. There is a growing gap between death rates for white and nonwhite infants in the United States, with the excess mortality rate of nonwhite infants continuing to rise. Only 15…

  7. The apgar score and infant mortality.

    Science.gov (United States)

    Li, Fei; Wu, Ting; Lei, Xiaoping; Zhang, Hao; Mao, Meng; Zhang, Jun

    2013-01-01

    To evaluate if the Apgar score remains pertinent in contemporary practice after more than 50 years of wide use, and to assess the value of the Apgar score in predicting infant survival, expanding from the neonatal to the post-neonatal period. The U.S. linked live birth and infant death dataset was used, which included 25,168,052 singleton births and 768,305 twin births. The outcome of interest was infant death within 1 year after birth. Cox proportional hazard-model was used to estimate risk ratio of infant mortality with different Apgar scores. Among births with a very low Apgar score at five minutes (1-3), the neonatal and post-neonatal mortality rates remained high until term (≥ 37 weeks). On the other hand, among births with a high Apgar score (≥7), neonatal and post-neonatal mortality rate decreased progressively with gestational age. Non-Hispanic White had a consistently higher neonatal mortality than non-Hispanic Black in both preterm and term births. However, for post-neonatal mortality, Black had significantly higher rate than White. The pattern of changes in neonatal and post-neonatal mortality by Apgar score in twin births is essentially the same as that in singleton births. The Apgar score system has continuing value for predicting neonatal and post-neonatal adverse outcomes in term as well as preterm infants, and is applicable to twins and in various race/ethnic groups.

  8. The apgar score and infant mortality.

    Directory of Open Access Journals (Sweden)

    Fei Li

    Full Text Available OBJECTIVE: To evaluate if the Apgar score remains pertinent in contemporary practice after more than 50 years of wide use, and to assess the value of the Apgar score in predicting infant survival, expanding from the neonatal to the post-neonatal period. METHODS: The U.S. linked live birth and infant death dataset was used, which included 25,168,052 singleton births and 768,305 twin births. The outcome of interest was infant death within 1 year after birth. Cox proportional hazard-model was used to estimate risk ratio of infant mortality with different Apgar scores. RESULTS: Among births with a very low Apgar score at five minutes (1-3, the neonatal and post-neonatal mortality rates remained high until term (≥ 37 weeks. On the other hand, among births with a high Apgar score (≥7, neonatal and post-neonatal mortality rate decreased progressively with gestational age. Non-Hispanic White had a consistently higher neonatal mortality than non-Hispanic Black in both preterm and term births. However, for post-neonatal mortality, Black had significantly higher rate than White. The pattern of changes in neonatal and post-neonatal mortality by Apgar score in twin births is essentially the same as that in singleton births. CONCLUSIONS: The Apgar score system has continuing value for predicting neonatal and post-neonatal adverse outcomes in term as well as preterm infants, and is applicable to twins and in various race/ethnic groups.

  9. National and subnational all-cause and cause-specific child mortality in China, 1996-2015: a systematic analysis with implications for the Sustainable Development Goals.

    Science.gov (United States)

    He, Chunhua; Liu, Li; Chu, Yue; Perin, Jamie; Dai, Li; Li, Xiaohong; Miao, Lei; Kang, Leni; Li, Qi; Scherpbier, Robert; Guo, Sufang; Rudan, Igor; Song, Peige; Chan, Kit Yee; Guo, Yan; Black, Robert E; Wang, Yanping; Zhu, Jun

    2017-02-01

    China has achieved Millennium Development Goal 4 to reduce under-5 mortality rate by two-thirds between 1990 and 2015. In this study, we estimated the national and subnational levels and causes of child mortality in China annually from 1996 to 2015 to draw implications for achievement of the SDGs for China and other low-income and middle-income countries. In this systematic analysis, we adjusted empirical data on levels and causes of child mortality collected in the China Maternal and Child Health Surveillance System to generate representative estimates at the national and subnational levels. In adjusting the data, we considered the sampling design and probability, applied smoothing techniques to produce stable trends, fitted livebirth and age-specific death estimates to natvional estimates produced by the UN for international comparison, and partitioned national estimates of infrequent causes produced by independent sources to the subnational level. Between 1996 and 2015, the under-5 mortality rate in China declined from 50·8 per 1000 livebirths to 10·7 per 1000 livebirths, at an average annual rate of reduction of 8·2%. However, 181 600 children still died before their fifth birthday, with 93 400 (51·5%) deaths occurring in neonates. Great inequity exists in child mortality across regions and in urban versus rural areas. The leading causes of under-5 mortality in 2015 were congenital abnormalities (35 700 deaths, 95% uncertainty range [UR] 28 400-45 200), preterm birth complications (30 900 deaths, 24 200-40 800), and injuries (26 600 deaths, 21 000-33 400). Pneumonia contributed to a higher proportion of deaths in the western region of China than in the eastern and central regions, and injury was a main cause of death in rural areas. Variations in cause-of-death composition by age were also examined. The contribution of preterm birth complications to mortality decreased after the neonatal period; congenital abnormalities remained an

  10. 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

  11. The determinants of infant mortality in Pakistan.

    Science.gov (United States)

    Agha, S

    2000-07-01

    This study examines factors associated with infant survival in Pakistan. It uses data from the Pakistan Integrated Household Survey 1991, a nationally representative sample survey of the Government of Pakistan, funded by the World Bank. The infant mortality rate was still very high in Pakistan until the early 1990s, at 100 deaths per 1000 live births. The study shows that there is no evidence of a secular decline in infant mortality during the 1980s. Large differentials in infant survival by socio-economic factors and access to water and sanitation indicate that social and gender inequities are the underlying cause of the stagnation of infant mortality in Pakistan. Economic and social policies of earlier decades have resulted in tremendous disparities in wealth and access to resources in Pakistan. The low social, economic and legal status of women is intimately tied to the well-being of their children. Health interventions in Pakistan should be designed to reach the most under-served: women and children. Systematic evaluations of health interventions will be necessary to make informed decisions about health investments in the future.

  12. Infant mortality rates and decentralisation in Uganda.

    Science.gov (United States)

    Niringiye, Aggrey

    2015-01-01

    Many countries in the developing world have embarked on the path of decentralisation over the last three decades to improve the provision of public goods such as healthcare services. It is hypothesised that devolving power to local governments would improve efficiency as well as equity and thereby health outcomes by bringing decision makers closer to the people, and by enhancing the participation of the community in the decision-making and implementation processes. This paper aims to assess the impact of decentralisation on infant mortality rates in Uganda. The intervention model was used to analyse national representative data from Uganda Demographic Health Surveys (1988/89, 1995, 2001, 2006). Results indicate that infant mortality rates deteriorated during the decentralisation period in three out of four regions in Uganda, but not overall when analysed for the whole country. Decentralisation was supposed to lead to a decrease in infant mortality rates, however, the opposite effect was seen with rates increasing in individual regions. There is need for further detailed studies to understand why infant mortality rates increased during the period of decentralisation in Uganda.

  13. Infant Mortality and American Indians/Alaska Natives

    Science.gov (United States)

    ... AIDS Immunizations Infant Health & Mortality Mental Health Obesity Organ and Tissue Donation Stroke Stay Connected OMH Home > Policy and Data > ... Hispanic white babies to die from sudden infant death syndrome (SIDS). American Indian/Alaska Native infants are ...

  14. Associations between key intervention coverage and child mortality: an analysis of 241 sub-national regions of sub-Saharan Africa.

    Science.gov (United States)

    Akachi, Yoko; Steenland, Maria; Fink, Günther

    2017-12-21

    Reducing child mortality remains a key objective in the Sustainable Development Goals. Although remarkable progress has been made with respect to under-5 mortality over the last 25 years, little is known regarding the relative contributions of public health interventions and general improvements in socioeconomic status during this time period. We combined all available data from the Demographic and Health Survey (DHS) to construct a longitudinal, multi-level dataset with information on subnational-level key intervention coverage, household socioeconomic status and child health outcomes in sub-Saharan Africa. The dataset covers 562 896 child records and 769 region-year observations across 24 countries. We used multi-level multivariable logistics regression models to assess the associations between child mortality and changes in the coverage of 17 key reproductive, maternal, newborn and child health interventions such as bednets, water and sanitation infrastructure, vaccination and breastfeeding practices, as well as concurrent improvements in social and economic development. Full vaccination coverage was associated with a 30% decrease in the odds of child mortality [odds ratio (OR) 0.698, 95% confidence interval (CI) 0.564, 0.864], and continued breastfeeding was associated with a 24% decrease in the odds of child mortality (OR 0.759, 95% CI 0.642, 0.898). Our results suggest that changes in vaccination coverage, as well as increases in female education and economic development, made the largest contributions to the positive mortality trends observed. Breastfeeding was associated with child survival but accounts for little of the observed declines in mortality due to declining coverage levels during our study period. Our findings suggest that a large amount of progress has been made with respect to coverage levels of key health interventions. Whereas all socioeconomic variables considered appear to strongly predict health outcomes, the same was true only for very

  15. 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 were reviewed and analyzed. Results indicated infant mortality of 32/1000 live births and highlighted malaria, severe anemia, and neonatal sepsis as the leading causes of ...

  16. [Factors influencing infant mortality. Havana Province, 1983].

    Science.gov (United States)

    Castell-florit Serrate, P; Portuondo Dustet, N; Suarez Rosas, L; Ovies Garcia, A; Alvarez Fernandez, R; Lima Perez, M T

    1986-01-01

    Questionnaires intended to determine the factors involved in deaths in infants under 1 year have been completed in the province of Havana, Cuba, since 1980. The questionnaires are completed by obstetricians and pediatricians of the municipal health areas and analyzed at the secondary care level. This work examines the factors present in the 133 infant deaths occurring in Havana Province in 1983. The infant mortality rate in the province in 1983 was 14.1/1000 live births, the lowest ever recorded in the province. 74 of the deaths occurred in the early neonatal period, 13 in the late neonatal, and 46 in the postneonatal period. 22 of the early neonatal deaths were due to intrapartum anoxia, 15 to hyaline membrane disease, 10 to prematurity, 7 to bronchoaspiration, 3 to sepsis, 1 to bronchial pneumonia, and 13 to malformations. In the late neonatal and postneonatal periods, 11 deaths were attributed to acute diarrheal disease, 6 to meningitis, and 5 to accidents. 8 of the mothers were under 17 years old, 30 were 18-20, 57 were 21-30, and 16 were 31 or over. Maternal age was unknown for 22. 22 of the mothers were overweight, 29 were malnourished, 55 were of normal nutritional status, and the status of 27 was unknown. 67.7% of the early neonatal deaths were in low birth weight babies. Low educational level and rural residence were social factors in infant mortality.

  17. Infant mortality statistics from the 2009 period linked birth/infant death data set.

    Science.gov (United States)

    Mathews, T J; MacDorman, Marian F

    2013-01-24

    This report presents 2009 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 infant mortality rate in the United States in 2009 was 6.39 infant deaths per 1,000 live births, 3% lower than the rate of 6.61 in 2008. The number of infant deaths was 28,075 in 2008 and 26,408 in 2009, a decline of 1,667 infant deaths. Infant mortality rates ranged from 4.40 per 1,000 live births for Asian or Pacific Islander mothers to 12.40 for non-Hispanic black mothers. Infant mortality was higher for male infants and infants born preterm or at low birthweight. Infant mortality rates were also higher for those infants who were born in multiple deliveries, to mothers who were unmarried, and for those whose mothers were born in the 50 states or the District of Columbia. From 2008 to 2009, the neonatal mortality rate (under age 28 days) declined 3% to 4.18 neonatal deaths per 1,000 live births, while the postneonatal mortality rate (aged 28 days to under 1 year) declined 5% to 2.21. Preterm and low birthweight infants had the highest infant mortality rates and contributed greatly to overall U.S. infant mortality. The three leading causes of infant death--congenital malformations, low birthweight, and sudden infant death syndrome--accounted for 46% of all infant deaths. In 2009, 35.4% of infant deaths were "preterm-related."

  18. Infant mortality and life expectancy in China.

    Science.gov (United States)

    Xu, Yanhua; Zhang, Weifang; Yang, Rulai; Zou, Chaochun; Zhao, Zhengyan

    2014-03-07

    It is reported that the infant mortality (IM) rate decreased rapidly in China and the life expectancy (LE) also had a high increase. Our objective was to determine the health status of the Chinese population by investigating IM and LE and their inter-relationship. Based on a literature review on the history and current status of IM and LE in China and other major countries, the relationship between IM, LE, and per capita gross national income (GNI) was investigated in 2013. The decline in IM from 30% to 15% took China only 7 years, which was faster than in developed countries. The leading causes of infant death in China were perinatal diseases, infectious and parasitic diseases, congenital anomalies, accidents, and signs, symptoms, and ill-defined conditions. Most under-5 mortality occurred during infancy (80%), particularly during the neonatal period (55%). LE was negatively correlated with IM (r=-0.921, PChina are still below the level of developing countries. Some countries have a comparable IM and healthcare capabilities, but they have a much higher per capita GNI than China. In China, IM has decreased and IE increased rapidly. However, they were not in parallel with the current economic development. Deviation of these data might be attributed to many factors. In-house surveys and hospital-based follow-ups should be carried out to better understand infant death.

  19. Poverty and Infant Mortality in the United States.

    Science.gov (United States)

    Gortmaker, Steven L.

    1979-01-01

    This paper examines the theoretical and empirical relationship of income poverty to infant mortality differentials. Taken into consideration is the relative impact of a variety of biological, social, and economic factors upon the risk of infant death. (Author/EB)

  20. Infant mortality and life expectancy in China

    OpenAIRE

    Xu, Yanhua; Zhang, Weifang; Yang, Rulai; Zou, Chaochun; Zhao, Zhengyan

    2014-01-01

    Background It is reported that the infant mortality (IM) rate decreased rapidly in China and the life expectancy (LE) also had a high increase. Our objective was to determine the health status of the Chinese population by investigating IM and LE and their inter-relationship. Material/Methods Based on a literature review on the history and current status of IM and LE in China and other major countries, the relationship between IM, LE, and per capita gross national income (GNI) was investigated...

  1. CPV Cell Infant Mortality Study: Preprint

    Energy Technology Data Exchange (ETDEWEB)

    Bosco, N.; Sweet, C.; Silverman, T.; Kurtz, S.

    2011-05-01

    Six hundred and fifty CPV cells were characterized before packaging and then after a four-hour concentrated on-sun exposure. An observed fielded infant mortality failure rate was reproduced and attributed to epoxy die-attach voiding at the corners of the cells. These voids increase the local thermal resistance allowing thermal runaway to occur under normal operation conditions in otherwise defect-free cells. FEM simulations and experiments support this hypothesis. X-ray transmission imaging of the affected assemblies was not found capable of detecting all suspect voids and therefore cannot be considered a reliable screening technique in the case of epoxy die-attach.

  2. International infant mortality rankings: A look behind the numbers

    OpenAIRE

    Liu, Korbin; Moon, Marilyn; Sulvetta, Margaret; Chawla, Juhi

    1992-01-01

    The very unfavorable infant mortality ranking of the United States in international comparisons is often used to question the quality of health care there. Infant mortality rates, however, implicitly capture a complicated story, measuring much more than differences in health care across countries. This article examines reasons behind international infant mortality rate rankings, including variations in the measurement of vital events, and differences in risk factors across countries. Its goal...

  3. Infant mortality statistics from the 2007 period linked birth/infant death data set.

    Science.gov (United States)

    Mathews, T J; MacDorman, Marian F

    2011-06-29

    This report presents 2007 period infant mortality statistics from the linked birth/infant death data set (linked file) by a variety of 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 6.75 infant deaths per 1,000 live births in 2007, not significantly different than the rate of 6.68 in 2006. Infant mortality rates ranged from 4.57 per 1,000 live births for mothers of Central and South American origin to 13.31 for non-Hispanic black mothers. Infant mortality rates were higher for those infants who were born in multiple deliveries; for those whose mothers were born in the 50 states or the District of Columbia; and for mothers who were unmarried. Infant mortality was also higher for male infants and infants born preterm or at low birthweight. The neonatal mortality rate was essentially unchanged from 2006 (4.46) to 2007 (4.42). The postneonatal mortality rate increased 5 percent from 2.22 in 2006 to 2.33 in 2007, similar to the rate in 2005 (2.32). Infants born at the lowest gestational ages and birthweights have a large impact on overall U.S. infant mortality. For example, more than one-half of all infant deaths in the United States in 2007 (54 percent) occurred to the 2 percent of infants born very preterm (less than 32 weeks of gestation). Still, infant mortality rates for late preterm infants (34-36 weeks of gestation) were 3.6 times, and those for early term (37-38 weeks) infants were 1.5 times, those for infants born at 39-41 weeks of gestation, the gestational age with the lowest infant mortality rate. The three leading causes of infant death--congenital malformations, low birthweight, and sudden infant death syndrome--accounted for 45 percent of all infant deaths. The percentage of infant deaths that were "preterm-related" was 36.0 percent in 2007. The preterm-related infant

  4. Trends in Infant Mortality, North Carolina: 1940 to 1970.

    Science.gov (United States)

    Brannon, Yevonne S.; Clifford, William B.

    This report presents data analyzed by county and multicounty planning region which indicate that North Carolina's infant mortality rate has declined by 59 percent since 1940. (In 1940, approximately 58 infants for every 1,000 live births died in North Carolina before their first birthday.) This reduction in infant deaths is comparable to that…

  5. Does fiscal decentralization improve health outcomes? Evidence from infant mortality in Italy.

    Science.gov (United States)

    Cavalieri, Marina; Ferrante, Livio

    2016-09-01

    Despite financial and decision-making responsibilities having been increasingly devolved to lower levels of government worldwide, the potential impact of these reforms remains largely controversial. This paper investigates the hypothesis that a shift towards a higher degree of fiscal autonomy of sub-national governments could improve health outcomes, as measured by infant mortality rates. Italy is used as a case study since responsibilities for healthcare have been decentralized to regions, though the central government still retains a key role in ensuring all citizens uniform access to health services throughout the country. A linear fixed-effects regression model with robust standard errors is employed for a panel of 20 regions over the period 1996-2012 (340 observations in the full sample). Decentralization is proxied by two different indicators, capturing the degree of decision-making autonomy in the allocation of tax revenues and the extent to which regions rely on fiscal transfers from the central government. The results show that a higher proportion of tax revenues raised and/or controlled locally as well as a lower transfer dependency from the central government are consistently associated with lower infant mortality rates, ceteris paribus. The marginal benefit from fiscal decentralization, however, is not constant but depends on the level of regional wealth, favouring poorest regions. In terms of policy implications, this study outlines how the effectiveness of decentralization in improving health outcomes is contingent on the characteristics of the context in which the process takes place. Copyright © 2016 Elsevier Ltd. All rights reserved.

  6. [Infant mortality in the indigenous population: backwardness and contrasts].

    Science.gov (United States)

    Fernandez Ham, P

    1993-01-01

    Some 6.4 million speakers of indigenous languages were enumerated in the 1990 Mexican census. The same census provided the basis for an indirect estimate of infant mortality using data on the numbers of live born and surviving children. Municipios with 40% or more of the population speaking an indigenous language were studied. The overall estimated infant mortality rate for indigenous municipios was 55.1/1000 live births, the equivalent of the Mexican infant mortality rate around 1982. Mexico's national infant mortality rate in 1990 was 34.8/1000. Great contrasts were found in indigenous infant mortality rates. Campeche, Quintana Roo, and Yucatan, the states of the Mayan region, had a low rate of 35.09/1000, very close to the national average. Infant mortality levels were relatively low in the indigenous populations of Hidalgo, the state of Mexico, and Michoacan, with rates of 44 to 48. Chiapas, Oaxaca, Puebla, Durango, Guerrero, and San Luis Potosi had rates of 55 to 65. The highest rates were in states with few indigenous municipios, including Chihuahua, Jalisco, and Nayarit. The Huichol of Jalisco had the highest rate at 100.01/1000. Infant mortality levels were found to be correlated in different degrees with socioeconomic indicators. The highest infant mortality rates were in the indigenous regions with the poorest socioeconomic conditions.

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

    African Journals Online (AJOL)

    Prof. Osuagwwu

    2Department of Mathematics and Statistics, The Polytechnic, Ibadan, Nigeria, ... Introduction. One of the Millennium Development. Goals is the reduction of infant and child mortality by two-thirds by 2015. Infant and child mortality in the agenda of public health and international health .... alive by estimating the probability of a.

  8. Spatial and disaggregated patterns of infant mortality in Benin City ...

    African Journals Online (AJOL)

    The level of infant mortality correlates with the standard of living of the people and provides one of the most dependable indicators of economic growth and development of a country. In the past decades, infant mortality has decreased drastically but the rate of improvement still falls short of Millennium Development Goals ...

  9. Decomposing socioeconomic inequality in infant mortality in Iran

    NARCIS (Netherlands)

    A.R. Hosseinpor; E.K.A. van Doorslaer (Eddy); N. Speybroeck (Niko); M. Naghavi (Morteza); K. Mohammad (Kazem); R. Majdzadeh (Reza); B. Delavar (Bahram); H. Jamshidi (Hamidreza); J. Vega (Jeanette)

    2006-01-01

    textabstractBackground Although measuring socioeconomic inequality in population health indicators like infant mortality is important, more interesting for policy purposes is to try to explain infant mortality inequality. The objective of this paper is to quantify for the first time the

  10. 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

  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 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 potentially modifiable, significantly contributed to differences in state IMR. State risk

  12. Medicaid Expansion and Infant Mortality in the United States.

    Science.gov (United States)

    Bhatt, Chintan B; Beck-Sagué, Consuelo M

    2018-01-18

    To explore the effect of Medicaid expansion on US infant mortality rate. We examined data from 2010 to 2016 and 2014 to 2016 to compare infant mortality rates in states and Washington, DC, that accepted the Affordable Care Act Medicaid expansion (Medicaid expansion states) and states that did not (non-Medicaid expansion states), stratifying data by race/ethnicity. Mean infant mortality rate in non-Medicaid expansion states rose (6.4 to 6.5) from 2014 to 2016 but declined in Medicaid expansion states (5.9 to 5.6). Mean difference in infant mortality rate in Medicaid expansion versus non-Medicaid expansion states increased from 0.573 (P = .08) in 2014 to 0.838 in 2016 (P = .006) because of smaller declines in non-Medicaid expansion (11.0%) than in Medicaid expansion (15.2%) states. The 14.5% infant mortality rate decline from 11.7 to 10.0 in African American infants in Medicaid expansion states was more than twice that in non-Medicaid expansion states (6.6%: 12.2 to 11.4; P = .012). Infant mortality rate decline was greater in Medicaid expansion states, with greater declines among African American infants. Future research should explore what aspects of Medicaid expansion may improve infant survival. (Am J Public Health. Published online ahead of print January 18, 2018: e1-e3. doi:10.2105/AJPH.2017.304218).

  13. Low infant mortality among Palestine refugees despite the odds.

    Science.gov (United States)

    Riccardo, Flavia; Khader, Ali; Sabatinelli, Guido

    2011-04-01

    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. 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. 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. 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.

  14. 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

  15. 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.

  16. Correlation Between Human Development Index and Infant Mortality Rate Worldwide

    Directory of Open Access Journals (Sweden)

    Alijanzadeh

    2016-02-01

    Full Text Available Background Infant mortality rate (per 1000 live births is a vital index to monitor the standard of health and social inequality which is related to human development dimensions worldwide. Human development index (HDI includes basic social indicators such as life expectancy, education and income. Objectives The current study aimed to find the correlation between human development index and infant mortality rate. Patients and Methods This descriptive study that represents the relationship of infant mortality rate with human development index and human development index dimensions was performed on the profiles of 135 countries worldwide [Africa (35 countries, America (26 countries, Asia (30 countries, the Pacific (2 countries and Europe (42 countries]. Two databases were used in the study: the world health organization (WHO database (2010 and human development database (2010. Data were analyzed using Pearson correlation test by SPSS software. Results The study found that socio-economic factors or human development dimensions are significantly correlated with risk of chance mortality in the world. The per capita income (r = -0.625, life expectancy (r = -0.925 and education (r = -0.843 were negatively correlated with the infant mortality rate; human development index (r = -0.844 was also negatively correlated with the infant mortality rate (P < 0.01. Conclusions Human development index is one of the best indicators and predictors to perceive healthcare inequities. Worldwide improvement of these indicators, especially the education level, might promote infant life expectancy and decrease infant mortality.

  17. [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

  18. 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.

  19. [Regional disparities in infant mortality in Colombia].

    Science.gov (United States)

    Jaramillo-Mejía, Marta C; Chernichovsky, Dov; Jiménez-Moleón, José J

    2013-01-01

    To study the variations in infant mortality rate (IMR) across Colombia's 33 administrative departments over the period 2003-2009, examine persistency of variations across departments over time, and relate those variations to the impact of socio-economic conditions and availability of care on IMR. Using vital statistics and related socio-economic data we establish three types of analysis according to: (a) the variation of the departmental IMR (2003-2009), (b) the association between the departmental IMR and its key determinants over time, and (c) the lines of causality and relative impact of different factors, by using structural equations. The 4.7 fold ratio between the highest and lowest departmental IMR (2009) may be underestimated considering underreporting, especially in low-income departments. There is a negative association between the departmental IMR with time and a set of highly correlated variables, such as the mother education, income per capita, health insurance level and access to services. The effect of better insurance, availability of private beds, and having doctors attending mothers, eclipse the impact of better socioeconomic conditions. The range of services does not appear to be influenced by a rational policy; resources are not allocated according to the need, but with the general development. Private beds are made available where there is better health insurance.

  20. Alcohol drinking pattern during pregnancy and risk of infant mortality.

    Science.gov (United States)

    Strandberg-Larsen, Katrine; Grønboek, Morten; Andersen, Anne-Marie Nybo; Andersen, Per Kragh; Olsen, Jørn

    2009-11-01

    The safety of small amounts of alcohol drinking and occasional binge-level drinking during pregnancy remains unsettled. We examined the association of maternal average alcohol intake and binge drinking (>or=5 drinks per sitting) with infant mortality, both in the neonatal and postneonatal period. Participants were 79,216 mothers who were enrolled in the Danish National Birth Cohort in 1996-2002, gave birth to a live-born singleton, and provided information while they were pregnant on alcohol consumption during pregnancy. Information on infant mortality and causes of death was obtained from national registries and medical records. During the first year of life, 279 children (0.35%) died, 204 during the neonatal period. Infant mortality was not associated with alcohol drinking, even at a consumption level of either 4+ drinks per week or 3+ occasions of binge drinking. Postneonatal mortality was associated with an intake of 4+ drinks per week (hazard ratio = 3.56 [95% confidence interval = 1.15-8.43]) and with 3+ binge episodes (2.69 [1.27-5.69]). When restricting analyses to term births, both infant mortality and postneonatal mortality were associated with a weekly average intake of 4+ drinks or 3+ binge episodes. Among term infants, intake of at least 4 drinks of alcohol per week or binging on 3 or more occasions during pregnancy are associated with an increased risk of infant mortality, especially during the postneonatal period.

  1. Decomposition Socioeconomic Inequality in Infant Mortality in EMRO Countries

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    Sara Emamgholipour Sefiddashti

    2015-07-01

    The findings indicate that socioeconomic inequality in infant mortality in EMRO countries is determined not only by health system functions but also by factors beyond the scope of health authorities such as education system, and economic variables.

  2. Abortion and Infant Mortality on the First Day of Life.

    Science.gov (United States)

    Auger, Nathalie; Bilodeau-Bertrand, Marianne; Sauve, Reg

    2016-01-01

    Fetal imaging for congenital anomalies increases pregnancy terminations late in gestation. We assessed whether late-pregnancy terminations can accidentally result in live births, and how these births impact infant mortality rates over time. We carried out a population-level analysis of 12,141 infant deaths in Quebec, Canada from 1986 to 2012. We calculated the proportion of infants born alive who died following pregnancy termination. The exposure was pregnancy termination with or without congenital anomaly recorded on death certificates. The main outcome was mortality on the first day of life by the hour. Pregnancy termination was the cause of 19.4 infant deaths per 100,000 in 2000-2012, compared with 1.0 per 100,000 in 1986-1999. Most deaths after termination occurred in the first 3 h of life among infants with anomalies who weighed infants who died following pregnancy termination led to an excess of 0.2 deaths per 1,000 on the first day of life, i.e. an 8.6% increase in the infant mortality rate (p value = 0.002). Pregnancy termination in mid-gestation carries the risk of accidental live birth. These neonates increasingly affect infant mortality rates. Better recording is needed, including data on the prevention and management of accidental live births after pregnancy termination. © 2016 S. Karger AG, Basel.

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

    Directory of Open Access Journals (Sweden)

    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

    Energy Technology Data Exchange (ETDEWEB)

    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 Trends and Differences Between American Indian/Alaska Native Infants and White Infants in the United States, 1989–1991 and 1998–2000

    Science.gov (United States)

    Tomashek, Kay M.; Qin, Cheng; Hsia, Jason; Iyasu, Solomon; Barfield, Wanda D.; Flowers, Lisa M.

    2006-01-01

    Objectives. To describe changes in infant mortality rates, including birthweight-specific rates and rates by age at death and cause. Methods. We analyzed US linked birth/infant-death data for 1989–1991 and 1998–2000 for American Indians/Alaska Native (AIAN) and White singleton infants at ≥20 weeks’ gestation born to US residents. We calculated birthweight-specific infant mortality rates (deaths in each birthweight category per 1000 live births in that category), and overall and cause-specific infant mortality rates (deaths per 100000 live births) in infancy (0–364 days) and in the neonatal (0–27 days) and postneonatal (28–364 days) periods. Results. Birthweight-specific infant mortality rates declined among AIAN and White infants across all birthweight categories, but AIAN infants generally had higher birthweight-specific infant mortality rates. Infant mortality rates declined for both groups, yet in 1998–2000, AIAN infants were still 1.7 times more likely to die than White infants. Most of the disparity was because of elevated post-neonatal mortality, especially from sudden infant death syndrome, accidents, and pneumonia and influenza. Conclusions. Although birthweight-specific infant mortality rates and infant mortality rates declined among both AIAN and White infants, disparities in infant mortality persist. Preventable causes of infant mortality identified in this analysis should be targeted to reduce excess deaths among AIAN communities. PMID:17077400

  6. Infant mortality trends and differences between American Indian/Alaska Native infants and white infants in the United States, 1989-1991 and 1998-2000.

    Science.gov (United States)

    Tomashek, Kay M; Qin, Cheng; Hsia, Jason; Iyasu, Solomon; Barfield, Wanda D; Flowers, Lisa M

    2006-12-01

    To describe changes in infant mortality rates, including birthweight-specific rates and rates by age at death and cause. We analyzed US linked birth/infant-death data for 1989-1991 and 1998-2000 for American Indians/Alaska Native (AIAN) and White singleton infants at > or =20 weeks' gestation born to US residents. We calculated birthweight-specific infant mortality rates (deaths in each birthweight category per 1000 live births in that category), and overall and cause-specific infant mortality rates (deaths per 100000 live births) in infancy (0-364 days) and in the neonatal (0-27 days) and postneonatal (28-364 days) periods. Birthweight-specific infant mortality rates declined among AIAN and White infants across all birthweight categories, but AIAN infants generally had higher birthweight-specific infant mortality rates. Infant mortality rates declined for both groups, yet in 1998-2000, AIAN infants were still 1.7 times more likely to die than White infants. Most of the disparity was because of elevated post-neonatal mortality, especially from sudden infant death syndrome, accidents, and pneumonia and influenza. Although birthweight-specific infant mortality rates and infant mortality rates declined among both AIAN and White infants, disparities in infant mortality persist. Preventable causes of infant mortality identified in this analysis should be targeted to reduce excess deaths among AIAN communities.

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

    Directory of Open Access Journals (Sweden)

    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

  8. Different extent in decline of infant mortality by region and cause in Shenyang, China

    OpenAIRE

    Huang, Yan-Hong; Wu, Qi-Jun; Li, Li-Li; Li, Da; Li, Jing; Zhou, Chen; Wu, Lang; Zhu, Jingjing; Gong, Ting-Ting

    2016-01-01

    To compare the pattern of cause of death of infant mortality rates by urban/rural areas as well as to generate knowledge for potential strategies to decrease this mortality, we carried out a study by analyzing the infant mortality data from the Shenyang Women and Children Health Care Centre. From 1997 to 2014, 970,583 live births and 6510 infant deaths were registered. Infant mortality rates, percent change, and annual percent change (APC) were calculated. The infant mortality significantly d...

  9. Economic Development, Infant Mortality, and Their Dynamics in Latin America

    OpenAIRE

    Tadashi Yamada

    1983-01-01

    The main issue of this paper is to study infant mortality in Latin America in recent decades. In so doing, two questions must be answered: First, how large is the economic loss in terms of net national product due to child mortality under the age of 15 and what are the major causes of death? Second, has the decline of infant mortality been principally a product of economic development in Latin American countries?Surprisingly enough, there is significant variation of economic losses across Lat...

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

    Science.gov (United States)

    Barennes, Hubert; Sengkhamyong, Khouanheuan; René, Jean Pascal; Phimmasane, Maniphet

    2015-03-01

    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 of

  11. Infant and fetal mortality among a high fertility and mortality population in the Bolivian Amazon.

    Science.gov (United States)

    Gurven, Michael

    2012-12-01

    Indigenous populations experience higher rates of poverty, disease and mortality than non-indigenous populations. To gauge current and future risks among Tsimane Amerindians of Bolivia, I assess mortality rates and growth early in life, and changes in risks due to modernization, based on demographic interviews conducted Sept. 2002-July 2005. Tsimane have high fertility (total fertility rate = 9) and infant mortality (13%). Infections are the leading cause of infant death (55%). Infant mortality is greatest among women who are young, monolingual, space births close together, and live far from town. Infant mortality declined during the period 1990-2002, and a higher rate of reported miscarriages occurred during the 1950-1989 period. Infant deaths are more frequent among those born in the wet season. Infant stunting, underweight and wasting are common (34%, 15% and 12%, respectively) and greatest for low-weight mothers and high parity infants. Regression analysis of infant growth shows minimal regional differences in anthropometrics but greater stunting and underweight during the first two years of life. Males are more likely to be underweight, wasted, and spontaneously aborted. Whereas morbidity and stunting are prevalent in infancy, greater food availability later in life has not yet resulted in chronic diseases (e.g. hypertension, atherosclerosis and diabetes) in adulthood due to the relatively traditional Tsimane lifestyle. Copyright © 2012 Elsevier Ltd. All rights reserved.

  12. Infant and fetal mortality among a high fertility and mortality population in the Bolivian Amazon

    Science.gov (United States)

    Gurven, Michael

    2012-01-01

    Indigenous populations experience higher rates of poverty, disease and mortality than non-indigenous populations. To gauge current and future risks among Tsimane Amerindians of Bolivia, I assess mortality rates and growth early in life, and changes in risks due to modernization, based on demographic interviews conducted Sept. 2002–July 2005. Tsimane have high fertility (Total Fertility Rate = 9) and infant mortality (13%). Infections are the leading cause of infant death (55%). Infant mortality is greatest among women who are young, monolingual, space births close together, and live far from town. Infant mortality declined during the period 1990–2002, and a higher rate of reported miscarriages occurred during the 1950–1989 period. Infant deaths are more frequent among those born in the wet season. Infant stunting, underweight and wasting are common (34%, 15% and 12%, respectively) and greatest for low-weight mothers and high parity infants. Regression analysis of infant growth shows minimal regional differences in anthropometrics but greater stunting and underweight during the first two years of life. Males are more likely to be underweight, wasted, and spontaneously aborted. Whereas morbidity and stunting are prevalent in infancy, greater food availability later in life has not yet resulted in chronic diseases (e.g. hypertension, atherosclerosis and diabetes) in adulthood due to the relatively traditional Tsimane lifestyle. PMID:23092724

  13. 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.

  14. 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.

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

    OpenAIRE

    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 infant mortality rates. METHODS: Infant mortality and preterm birth data are compared between the United States and European countries. The percent contribution of the two factors to infant mortalit...

  16. Community perceptions of black infant mortality: a qualitative inquiry.

    Science.gov (United States)

    Close, Fran T; Suther, Sandra; Foster, Anika; El-Amin, Salimah; Battle, Arrie M

    2013-08-01

    Infant mortality is a key public health concern in the United States. Although infant mortality rates (IMRs) have declined, the rates among blacks are more than twice those of other racial/ethnic groups. Some Florida counties have black IMR more than four times the white IMR. The purpose of this study was to explore community awareness and perceptions of the rising Black IMR in Gadsden County, Florida. Sixty-four black men and women participated in eight focus groups. Data were transcribed then analyzed using NVivo 8. Many of the respondents discussed issues dealing with access to health care services, trust in providers, and perceived differential treatment. Inequities in health care may contribute to a culture in which blacks are resistant to seek care thus resulting in poorer outcomes. Overall, participants identified awareness and education as the most effective ways to address the higher rates of infant mortality among Blacks.

  17. 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.

  18. Reducing infant mortality in rural America: evaluation of the Rural Infant Care Program.

    OpenAIRE

    Gortmaker, S L; Clark, C. J.; Graven, S N; Sobol, A M; Geronimus, A

    1987-01-01

    The Rural Infant Care Program (RICP), initiated in 1979, was developed to improve perinatal health care in ten rural sites with histories of high infant mortality rates. Time-series regression models indicate that neonatal mortality rates were reduced, following program initiation, by 2.6 per 1,000 live births (p = .0002); black neonatal mortality rates were reduced by an estimated 4.5 per 1,000 (p = .0004). Three sets of comparison areas exhibited no significant changes in rates. Postneonata...

  19. Stillbirth and infant mortality in Aboriginal communities in Quebec.

    Science.gov (United States)

    Gilbert, Nicolas L; Auger, Nathalie; Tjepkema, Michael

    2015-02-01

    Infant mortality and stillbirth rates among Aboriginal people are higher than in the rest of Canada, but little is known on the perinatal health status of First Nations people living on reserves. This study examines stillbirth and infant mortality rates among Aboriginal people in Quebec, notably, First Nations people living on reserves, and compares these rates with those of the province's non-Aboriginal population. Data on live births and stillbirths in Quebec from 1989 to 2008 were extracted from Statistics Canada's Infant Birth-Death Linked File. Postal codes were used to identify births and stillbirths on First Nations reserves, in the Cree and Naskapi communities (not on reserves), and in Inuit communities. Associations between type of community and mortality were measured using logistic regression models. Aboriginal people had a higher stillbirth rate than non-Aboriginal people in Quebec, but this difference was not significant after adjusting for socio-demographic characteristics (mothers' age and education, community size and isolation). Neonatal mortality was also higher among the Inuit. Post-neonatal mortality was higher among Aboriginal people, and was unrelated to differences in the mothers' age and education or to community size and isolation. Adjusted odds ratios (95% confidence intervals) for post-neonatal mortality on reserves, in the Cree and Naskapi communities, and in Inuit communities were, respectively, 1.57 (1.16 - 2.12), 3.01 (2.14 - 4.24) and 4.29 (3.09 - 5.97). Stillbirth and infant mortality are higher among Aboriginal people than non-Aboriginal people in Quebec. The differences in post-neonatal mortality are particularly pronounced.

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

    Science.gov (United States)

    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.

  1. [Infant mortality in Cuba in the 1970-1979 decade].

    Science.gov (United States)

    Riverón Corteguera, R; Gutiérrez Muñiz, J A; Valdés Lazo, F

    1982-05-01

    This paper discusses the 50% reduction in infant mortality achieved in Cuba during the decade 1970-1979. After an analysis of the various factors that contributed to such a reduction, it is pointed out that early neonatal mortality during that period declined by 36.2%; late neonatal mortality by 67.2%, and postnatal mortality by 59.3%. By province, the lowest mortality rates were in Matanzas (14.9%), Villa Clara (15.6%), and the city of Havana (16.2%). The highest rates were in Las Tunas (26.1%), Guantanamo (24.1%), and Granma (23.9%) in infants of 1 year of age/1000 live births. With respect to cause of death, diarrheal diseases dropped from 2nd to 6th place, with a reduction of 71.4% in mortality. As a result of decreases in other causes, congenital malformations moved up to 2nd place. Also, acute respiratory diseases were lowered by 43.4%. Furthermore, it is pointed out that 11 consultations/delivery and 6.7 checkups/healthy infant under 1 year of age were attained as an annual average. In the same decade, the birth rate declined from 27.7 to 14.7/1000 inhabitants. (author's)

  2. Spatial variations and determinants of infant and under-five mortality in Bangladesh.

    Science.gov (United States)

    Gruebner, Oliver; Khan, Mmh; Burkart, Katrin; Lautenbach, Sven; Lakes, Tobia; Krämer, Alexander; Subramanian, S V; Galea, Sandro

    2017-09-01

    Reducing child mortality is a Sustainable Development Goal yet to be achieved by many low-income countries. We applied a subnational and spatial approach based on publicly available datasets and identified permanent insolvency, urbanicity, and malaria endemicity as factors associated with child mortality. We further detected spatial clusters in the east of Bangladesh and noted Sylhet and Jamalpur as those districts that need immediate attention to reduce child mortality. Our approach is transferable to other regions in comparable settings worldwide and may guide future studies to identify subnational regions in need for public health attention. Our study adds to our understanding where we may intervene to more effectively improve health, particularly among disadvantaged populations. Copyright © 2017 Elsevier Ltd. All rights reserved.

  3. Determinants of infant and child mortality in Mongolia.

    Science.gov (United States)

    Bayasgalan, B

    1996-10-01

    This study describes differences in infant and child mortality in Mongolia and examines the main possible determinants of mortality. The policy implications are discussed. Data were obtained from the 1994 Demographic Survey of Mongolia among 2030 women and 1026 men aged 15-49 years and 4685 children. Analysis was limited by the small sample size and the unavailability of data on access to health services and nutrition. Birth history data revealed 25.9% of births in the capital city, 24% in provincial capitals, and 50.1% in rural areas. The sex ratio was 100 females to 102 males. Rural mothers were less educated. Fertility was 4 children/woman in rural areas, 3.4 children/woman in provincial capitals, and 2.8 children/woman in the capital city. Over 60% of mothers were unemployed, and 76.5% of mothers were unemployed in rural areas. Rural mothers received lower salaries. About 50% had electricity in their homes. Almost 95% of the rural population lived in single rooms, portable tents made of felt. 31.3% lived in tents in the capital city. Hot and cold running water was available to 50% in the central city and to 19.1% in provincial capitals. Higher socioeconomic status was associated with lower infant and child mortality. There was a wide range in mortality levels by maternal salary. Infant and child mortality was lower in households that had consumer goods. The number of cows owned by the household was unrelated to child survival. 90% of Mongolian women were literate. The educational status of the mother had the strongest and most significant effect on the level of infant and child mortality. The level of infant and child mortality was still too high for all educational groups. Mortality was high for infants and children living in tents. Findings suggest that early-age mortality in Mongolia is not consistent with the level of social development. Access to health care and quality of health care may be key reasons for this disparity.

  4. Fiscal decentralisation and infant mortality rate: the Colombian case.

    Science.gov (United States)

    Soto, Victoria Eugenia; Farfan, Maria Isabel; Lorant, Vincent

    2012-05-01

    There is a paucity of research analysing the influence of fiscal decentralisation on health outcomes. Colombia is an interesting case study, as health expenditure there has been decentralising since 1993, leading to an improvement in health care insurance. However, it is unclear whether fiscal decentralisation has improved population health. We assess the effect of fiscal decentralisation of health expenditure on infant mortality rates in Colombia. Infant mortality rates for 1080 municipalities over a 10-year period (1998-2007) were related to fiscal decentralisation by using an unbalanced fixed-effect regression model with robust errors. Fiscal decentralisation was measured as the locally controlled health expenditure as a proportion of total health expenditure. We also evaluated the effect of transfers from central government and municipal institutional capacity. In addition, we compared the effect of fiscal decentralisation at different levels of municipal poverty. Fiscal decentralisation decreased infant mortality rates (the elasticity was equal to -0.06). However, this effect was stronger in non-poor municipalities (-0.12) than poor ones (-0.081). We conclude that decentralising the fiscal allocation of responsibilities to municipalities decreased infant mortality rates. However, this improved health outcome effect depended greatly on the socio-economic conditions of the localities. The policy instrument used by the Health Minister to evaluate municipal institutional capacity in the health sector needs to be revised. Copyright © 2012 Elsevier Ltd. All rights reserved.

  5. Alcohol drinking pattern during pregnancy and risk of infant mortality

    DEFF Research Database (Denmark)

    Strandberg-Larsen, Katrine; Grønboek, Morten; Andersen, Anne-Marie Nybo

    2009-01-01

    The safety of small amounts of alcohol drinking and occasional binge-level drinking during pregnancy remains unsettled. We examined the association of maternal average alcohol intake and binge drinking (>or=5 drinks per sitting) with infant mortality, both in the neonatal and postneonatal period....

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

    African Journals Online (AJOL)

    Cox proportional, logistic model were developed to timely hazardously and probabilistically continuous variable, mother age and other specific ... The Cox proportional analysis showed that the hazard risk and odds ratios of infant and child mortality ... identifying cost-effective strategies as many international agencies have ...

  7. 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 ...

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

    Directory of Open Access Journals (Sweden)

    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

  9. [Infant and child mortality in Latin America].

    Science.gov (United States)

    Behm, H; Primante, D A

    1978-04-01

    High mortality rates persist in Latin America, and data collection is made very difficult because of the lack of reliable statistics. A study was initiated in 1976 to measure the probability of mortality from birth to 2 years of age in 12 Latin American countries. The Brass method was used and applied to population censuses. Probability of mortality is extremely heterogeneous and regularly very high, varying between a maximum of 202/1000 in Bolivia, to a minimum of 112/1000 in Uruguay. In comparison, the same probability is 21/1000 in the U.S., and 11/1000 in sweden. Mortality in rural areas is much higher than in urban ones, and varies according to the degree of education of the mother, children being born to mothers who had 10 years of formal education having the lowest risk of death. Children born to the indigenous population, largely illiterate and living in the poorest of conditions, have the highest probability of death, a probability reaching 67% of all deaths under 2 years. National health services in Latin America, although vastly improved and improving, still do not meet the needs of the population, especially rural, and structural and historical conditions hamper a wider application of existing medical knowledge.

  10. Health trends in Sub-Saharan Africa: conflicting evidence from infant mortality rates and adult heights.

    Science.gov (United States)

    Akachi, Yoko; Canning, David

    2010-07-01

    We investigate trends in cohort infant mortality rates and adult heights in 39 developing countries since 1961. In most regions of the world improved nutrition, and reduced childhood exposure to disease, have lead to improvements in both infant mortality and adult stature. In Sub-Saharan Africa, however, despite declining infant mortality rates, adult heights have not increased. We argue that in Sub-Saharan Africa the decline in infant mortality may have been due to interventions that prevent infant deaths rather than improved nutrition and childhood morbidity. Despite declining infant mortality, Sub-Saharan Africa may not be experiencing increases in health human capital. 2010 Elsevier B.V. All rights reserved.

  11. 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

  12. Infant mortality, the birth rate, and development in Egypt.

    Science.gov (United States)

    Field, J O; Ropes, G

    1980-07-01

    This paper is a product of the Massachusetts Institute of Technology-Cairo University Health Care Delivery Systems Project which has examined the delivery of health services in Egypt in relation to malnutrition, early childhood mortality, and fertility. Egypt's economic progress since the 1952 Revolution has had only limited effect on high mortality among preschool children, infants and a high rate of population growth. This paper uses governorate data and simple analytical methods. 10% of Egyptian children die in the 1st year of life; subsequent mortality is also extensive in the preschool age children. The crude birthrate remains in the high 30s and overall population growth continues unabated. Early childhood mortality reflects the interplay of malnutrition and infection and population growth is caused by the fact that children, especially males, are considered economic assets. High fertility is a reflection of high mortality to a significant degree. 4 dimensions of development in Egypt are: 1) an urban cluster, 2) poverty, 3) the incidence of women in the paid labor force, 4) development in the rural sector, and 5) population density. Agricultural income increases as women enter the paid labor force and agricultural productivity is weakly related to the practice of women working for pay. Infant mortality in Egypt varies with and is most influenced by population pressures on the land, including urban crowdedness and by the proportion of households living below the poverty line. Female employment adds to family income and affects infant mortality indirectly. Policy implications are: 1) the government must deal with the density factor, 2) it must pursue a development strategy that stimulates productivity and raises the resource base of society, and 3) the government must address infant mortality along with malnutrition and morbidity. The author concludes that: 1) variation in the birth rate is less than variation in the infant mortality rate, 2) mortality and

  13. Behind international rankings of infant mortality: how the United States compares with Europe.

    Science.gov (United States)

    MacDorman, Marian F; Mathews, T J

    2010-01-01

    In 2005, the United States ranked 30th in the world in infant mortality. Infant mortality rates for preterm (infants are lower in the United States than in most European countries; however, infant mortality rates for infants born at 37 or more weeks of gestation are higher in the United States than in most European countries. One in 8 births in the United States were preterm in 2005, compared with 1 in 18 births in Ireland and Finland, and 1 in 16 in France and Sweden. If the United States had Sweden's distribution of births by gestational age, nearly 8,000 infant deaths in the United States would be averted each year, and the U.S. infant mortality rate would be one-third lower. The main cause of the United States' high infant mortality rate when compared with Europe is the very high percentage of preterm births in the United States, the period when infant mortality is greatest.

  14. [Mortality in Spain. I. Infant mortality in Spain 1900-1976. Regional evaluation].

    Science.gov (United States)

    Bolumar, F; Garrucho, G; Megía, M J; Muñoz Martińez, A; Valverde, A; Pérez Bermúdez, F; García Jiménez, D; Cortés Majo, M; Ruiz Peláez, M L; Soriano Parés, A; Nájera, E

    1981-01-01

    The overall incidence and evolution of infant mortality in Spain in the present century is assessed as a reflection of health and economic progress in the various regions and as a guide for future provision of health and social services for infants. Mortality on the 1st day of life is only included starting in 1932. In 1900 there were 128,395 deaths in the 1st year, of which 70,264 occurred in males and 58,131 in females. In 1976 there were a total of 11,590 deaths, of which 6735 were to males and 4855 to females. Rates declined from 213.29/1000 live births for males and 194.69/1000 live births for females in 1900 to 19.29 for males and 14.79 for females in 1976, a decline of 91% for males and 92% for females. Quinquennial rates declined continuously except in 1918, when an influenza outbreak occurred, and in 1937-41, during the Spanish civil war and immediate postwar period. The regions with the highest percentage decline in male infant mortality from 1900-76 were Aragon, Extremadura, Madrid, and Castilla-La Mancha, while Galicia had the smallest decline. Madrid, Castilla-La Mancha, and Navarra had the greatest decline for females, while Baleares and Galicia had the smallest declines. 3 factors in the greater than average declines in Aragon, Extremadura, and Castilla-La Mancha were probably their very high rates of infant mortality at the outset, their urbanization experience, and the considerable emigration from each. Galicia had a lower infant mortality rate at the outset and is still predominantly rural. The decline in fertility has not been as pronounced over the century as the decline in infant mortality.

  15. International comparisons of infant mortality and related factors: United States and Europe, 2010.

    Science.gov (United States)

    MacDorman, Marian F; Matthews, T J; Mohangoo, Ashna D; Zeitlin, Jennifer

    2014-09-24

    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 infant mortality rates. Infant mortality and preterm birth data are compared between the United States and European countries. The percent contribution of the two factors to infant mortality differences is computed using the Kitagawa method, with Sweden as the reference country. In 2010, the U.S. infant mortality rate was 6.1 infant deaths per 1,000 live births, and the United States ranked 26th in infant mortality among Organisation for Economic Co-operation and Development countries. After excluding births at less than 24 weeks of gestation to ensure international comparability, the U.S. infant mortality rate was 4.2, still higher than for most European countries and about twice the rates for Finland, Sweden, and Denmark. U.S. infant mortality rates for very preterm infants (24-31 weeks of gestation) compared favorably with most European rates. However, the U.S. mortality rate for infants at 32-36 weeks was second-highest, and the rate for infants at 37 weeks of gestation or more was highest, among the countries studied. About 39% of the United States' higher infant mortality rate when compared with that of Sweden was due to a higher percentage of preterm births, while 47% was due to a higher infant mortality rate at 37 weeks of gestation or more. If the United States could reduce these two factors to Sweden's levels, the U.S. infant mortality rate would fall by 43%, with nearly 7,300 infant deaths averted annually. 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.

  16. Infant mortality and mothers' religious involvement in Brazil

    Directory of Open Access Journals (Sweden)

    Ana Paula de Andrade Verona

    2010-06-01

    Full Text Available The growth of Protestantism in Brazil has been associated with changes in mortality and health-related outcomes. Recent research has suggested that affiliation with Protestant churches may positively influence their members' well being by: 1 providing moral directives, 2 creating formal or informal sanctions, and 3 promoting social networks and support. This article uses data from the 1996 and 2006 Brazilian Demographic Health Surveys (DHS and Cox's proportional hazard models to examine the relationship between infant mortality and mothers' religious involvement. Unadjusted results show that differences in the hazard ratios of infant mortality by mothers' religious involvement are considerable and statistically significant. When one controls demographic and socioeconomic variables in the 1996 DHS, the baseline relationship disappears, supporting the hypothesis of selectivity. Results using the 2006 DHS are somewhat different and suggest that the association between religious involvement and infant mortality was stronger in Brazil in 2006 than in 1996. This research should encourage future studies on religious involvement and health-related outcomes in Brazil. This topic deserves further consideration from Brazilian demographers not simply because this country has undergone enormous changes in its religious landscape over recent decades, but also because religion can affect believers' lifestyles and behaviors, and this can indirectly influence their health and well-being.

  17. 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.

  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. State-level analysis of variation in infant mortality rate: A socio-ecological approach

    OpenAIRE

    Sobiech, Nicole M

    2014-01-01

    Background: Infant mortality has been used as a predictor of population health, and was higher in the United States compared to other developed countries. The rate of infant mortality varies greatly at the State level, with infants born in southern States having an increase risk. ^ Methods: This paper investigates influential variables in all five dimensions of the socio-ecological model on State infant mortality in the U.S. Multiple regression analyses were conducted to determine the amount ...

  20. Regional disparities in infant mortality in Canada: a reversal of egalitarian trends

    Science.gov (United States)

    Joseph, K S; Huang, Ling; Dzakpasu, Susie; McCourt, Catherine

    2009-01-01

    Background Although national health insurance plans and social programs introduced in the 1960s led to reductions in regional disparities in infant mortality in Canada, it is unclear if such patterns prevailed in the 1990s when the health care and related systems were under fiscal duress. This study examined regional patterns of change in infant mortality in Canada in recent decades. Methods We analysed regional changes in crude infant mortality rates and in infant mortality rates among live births with a birth weight ≥ 500 g and ≥ 1,000 g in Canada from 1945 to 2002. Associations between baseline infant mortality rates in the provinces and territories (e.g., in 1985–89) and the change observed in infant mortality rates over the subsequent period (e.g., between 1985–89 and 1995–99) were assessed using Spearman's rank correlation coefficient. Trends in regional disparities were also assessed by calculating period-specific rate ratios between provinces/territories with the highest versus the lowest infant mortality. Results Provincial/territorial infant mortality rates in 1945–49 were not correlated with changes in infant mortality over the next 10 years (rho = 0.01, P = 0.99). However, there was a strong negative correlation between infant mortality rates in 1965–69 and the subsequent decline in infant mortality (rho = - 0.85, P = 0.002). Provinces/territories with higher infant mortality rates in 1965–69 (Northwest Territories 64.7 vs British Columbia 20.7 per 1,000 live births) experienced relatively larger reductions in infant mortality between 1965–69 and 1975–79 (53.7% decline in the Northwest Territories vs a 36.6% decline in British Columbia). This pattern was reversed in the more recent decades. Provinces/territories with higher infant mortality rates ≥ 500 g in 1985–89 experience relatively smaller reductions in infant mortality between 1985–89 and 2000–02 (rho = 0.82, P = 0.004). The infant mortality ≥ 500 g rate ratio

  1. Geographical disparities of infant mortality in rural China.

    Science.gov (United States)

    Wang, Yanping; Zhu, Jun; He, Chunhua; Li, Xiaohong; Miao, Lei; Liang, Juan

    2012-07-01

    The purpose of the study was to investigate the trends and causes of regional disparities of infant mortality rate (IMR) in rural China from 1996 to 2008. A population-based, longitudinal study. The national child mortality surveillance network. Population of the 79 surveillance counties. IMR, leading causes of infant death and the RR of IMR. The IMR in coastal, inland and remote regions declined by 72.4%, 62.9% and 58.2%, respectively, from 1996 to 2008. Compared with the coastal region, the RR of IMR were 1.7 (95% CI 1.6 to 1.9), 1.9 (95% CI 1.7 to 2.0) and 1.8 (95% CI 1.6 to 2.0) for inland region and 2.6 (95% CI 2.4 to 2.7), 3.2 (95% CI 3.0 to 3.5) and 3.1 (95% CI 2.7 to 3.4) for the remote region during 1996-2000, 2001-2005 and 2006-2008, respectively. The regional disparities existed for both male and female IMRs. The postneonatal mortality showed the highest regional disparities. Pneumonia, birth asphyxia, prematurity/low birth weight, injuries and diarrhoea were the main contributors to the regional disparities. There were significantly more infants who did not seek healthcare services before death in the remote region relative to the inland and coastal regions. The results indicated persistent existence of regional disparities in IMR in rural China. It is worth noting that regional disparities in IMR increased in the remote and coastal regions during 2001-2005 in rural China. These disparities remained unchanged during 2006-2008. The results indicate that strategies to reduce mortality caused by pneumonia, birth asphyxia and diarrhoea are keys to reducing IMR.

  2. [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.

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

    Directory of Open Access Journals (Sweden)

    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.

  4. [Subnational analysis of probability of premature mortality caused by four main non-communicable diseases in China during 1990-2015 and " Health China 2030" reduction target].

    Science.gov (United States)

    Zeng, X Y; Li, Y C; Liu, S W; Wang, L J; Liu, Y N; Liu, J M; Zhou, M G

    2017-03-06

    Objective: To investigate the current status, temporal trend and achieving Health China 2030 reduction target of probability of premature mortality caused by four main non-communicable diseases (NCDs) including cardiovascular and cerebrovascular diseases, tumour, diabetes, and chronic respiratory disease in China both at national and provincial level during 1990 to 2015. Methods: Using the results of Global Burden of Disease study 2015 (GBD 2015), according to the method of calculating premature mortality probability recommended by WHO, the current status and temporal trend by different gender from 1990 to 2015 were calculated, analyzed, and compared. Referring to " Health China 2030" target of reduction 30% of probability of premature mortality caused by major NCDs, we evaluated the difficulty of achieving the reduction target among provinces (not including Taiwan). Results: From 1990 to 2015, the probabilities of premature mortality in cardiovascular and cerebrovascular diseases, tumour, and chronic respiratory disease were all declined consistently for both men and women in China, the total of four main NCDs decreased from 30.69% to 18.54% with higher decreasing in women (from 25.97% to 12.40%) than that in men (from 34.94% to 24.19%). In 2015, the top five provinces in terms of probability of premature mortality caused by four main NCDs were Qinghai (28.81%), Tibet (25.88%), Guizhou (24.67%), Guangxi (23.56%), and Xinjiang (23.21%) in turn, while the top five provinces with the lowest probability were Shanghai (8.40%), Beijing (9.39%), Hong Kong (10.10%), Macao (10.31%), and Zhejiang (11.70%). If achieving the " Health China 2030" target, the probabilities of premature mortality in Qinghai and Tibet with the highest probability should decline to about 20.17%, and 18.12%, respectively in 2030, while 5.88%, and 6.57% in Shanghai and Beijing, respectively. From 1990 to 2015, the probability of premature mortality of four main NCDs declined by 2.00% a year on

  5. 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.

  6. Assessing the impact of paternal involvement on racial/ethnic disparities in infant mortality rates.

    Science.gov (United States)

    Alio, Amina P; Mbah, Alfred K; Kornosky, Jennifer L; Wathington, Deanna; Marty, Phillip J; Salihu, Hamisu M

    2011-02-01

    We sought to assess the contribution of paternal involvement to racial disparities in infant mortality. Using vital records data from singleton births in Florida between 1998 and 2005, we generated odds ratios (OR), 95% confidence intervals (CI), and preventative fractions to assess the association between paternal involvement and infant mortality. Paternal involvement status was based on presence/absence of paternal first and/or last name on the birth certificate. Disparities in infant mortality were observed between and within racial/ethnic subpopulations. When compared to Hispanic (NH)-white women with involved fathers, NH-black women with involved fathers had a two-fold increased risk of infant mortality whereas infants born to black women with absent fathers had a seven-fold increased risk of infant mortality. Elevated risks of infant mortality were also observed for Hispanic infants with absent fathers (OR = 3.33. 95%CI = 2.66-4.17). About 65-75% of excess mortality could be prevented with increased paternal involvement. Paternal absence widens the black-white gap in infant mortality almost four-fold. Intervention programs to improve perinatal paternal involvement may decrease the burden of absent father-associated infant mortality.

  7. Changes in infant mortality among extremely preterm infants: US vital statistics data 1990 vs 2000 vs 2010.

    Science.gov (United States)

    Malloy, M H

    2015-10-01

    Infant mortality among extremely preterm infants (22 to 28 weeks gestation) varies considerably by gestational age. The reduction in mortality over a 20-year period, when examined in gestational age week increments, may give a more precise estimate of progress or lack thereof in caring for these infants and provide information to better inform practitioners and parents of the risk of mortality among these small infants. The objective of this analysis is to examine infant mortality (birth to 365 days) by week of gestation for infants 22 to 28 weeks gestation comparing mortality rates, adjusting for maternal and infant birth characteristics, among US births for the years 1990, 2000 and 2010. US vital statistics period-linked birth and infant death certificate files for the years 1990, 2000 and 2010 were used. Maternal and infant characteristics for births at 22 to 28 weeks were abstracted from the files. A trimming procedure was used to remove records that had birth weights that exceeded the interquartile range of birth weights for a given week of gestational age. Infant mortality rates were calculated, and adjusted odds ratios for mortality were generated using logistic regression models. A total of 15,593 live births, 22 to 28 weeks gestation were available for the year 1990; 17,095 for the year 2000; and 14,721 for the year 2010. Infant mortality rates ranged from 904 per 1000 live births at 22 weeks gestation in 1990, to 835 in 2000, to 866 in 2010. Across all gestational age groups there was an adjusted reduction in the odds ratio for mortality of ~50% from 1990 to the year 2000. However, between 2000 and 2010 there was no significant reduction in infant mortality except at 25 weeks gestation (adjusted odds ratio=0.81, 95% confidence interval=0.70, 0.93). Despite a significant reduction in infant mortality among extremely preterm infants between the years 1990 and 2000, there has been little progress in reducing mortality between the years 2000 and 2010.

  8. Mapping Geographic Variation in Infant Mortality and Related Black-White Disparities in the US.

    Science.gov (United States)

    Rossen, Lauren M; Khan, Diba; Schoendorf, Kenneth C

    2016-09-01

    In the US, black infants remain more than twice as likely as white infants to die in the first year of life. Previous studies of geographic variation in infant mortality disparities have been limited to large metropolitan areas where stable estimates of infant mortality rates by race can be determined, leaving much of the US unexplored. The objective of this analysis was to describe geographic variation in county-level racial disparities in infant mortality rates across the 48 contiguous US states and District of Columbia using national linked birth and infant death period files (2004-2011). We implemented Bayesian shared component models in OpenBUGS, borrowing strength across both spatial units and racial groups. We mapped posterior estimates of mortality rates for black and white infants as well as relative and absolute disparities. Black infants had higher infant mortality rates than white infants in all counties, but there was geographic variation in the magnitude of both relative and absolute disparities. The mean difference between black and white rates was 5.9 per 1,000 (median: 5.8, interquartile range: 5.2 to 6.6 per 1,000), while those for black infants were 2.2 times higher than for white infants (median: 2.1, interquartile range: 1.9-2.3). One quarter of the county-level variation in rates for black infants was shared with white infants. Examining county-level variation in infant mortality rates among black and white infants and related racial disparities may inform efforts to redress inequities and reduce the burden of infant mortality in the US.

  9. Mapping Geographic Variation in Infant Mortality and Related Black–White Disparities in the US

    Science.gov (United States)

    Rossen, Lauren M.; Khan, Diba; Schoendorf, Kenneth C.

    2017-01-01

    Background In the US, black infants remain more than twice as likely as white infants to die in the first year of life. Previous studies of geographic variation in infant mortality disparities have been limited to large metropolitan areas where stable estimates of infant mortality rates by race can be determined, leaving much of the US unexplored. Methods The objective of this analysis was to describe geographic variation in county-level racial disparities in infant mortality rates across the 48 contiguous US states and District of Columbia using national linked birth and infant death period files (2004–2011). We implemented Bayesian shared component models in OpenBUGS, borrowing strength across both spatial units and racial groups. We mapped posterior estimates of mortality rates for black and white infants as well as relative and absolute disparities. Results Black infants had higher infant mortality rates than white infants in all counties, but there was geographic variation in the magnitude of both relative and absolute disparities. The mean difference between black and white rates was 5.9 per 1,000 (median: 5.8, interquartile range: 5.2 to 6.6 per 1,000), while those for black infants were 2.2 times higher than for white infants (median: 2.1, interquartile range: 1.9–2.3). One quarter of the county-level variation in rates for black infants was shared with white infants. Conclusions Examining county-level variation in infant mortality rates among black and white infants and related racial disparities may inform efforts to redress inequities and reduce the burden of infant mortality in the US. PMID:27196804

  10. Disparities in mortality rates among US infants born late preterm or early term, 2003-2005.

    Science.gov (United States)

    King, Jennifer P; Gazmararian, Julie A; Shapiro-Mendoza, Carrie K

    2014-01-01

    The purpose of this study was to identify disparities in neonatal, post-neonatal, and overall infant mortality rates among infants born late preterm (34-36 weeks gestation) and early term (37-38 weeks gestation) by race/ethnicity, maternal age, and plurality. In analyses of 2003-2005 data from US period linked birth/infant death datasets, we compared infant mortality rates by race/ethnicity, maternal age, and plurality among infants born late preterm or early term and also determined the leading causes of death among these infants. Among infants born late preterm, infants born to American Indian/Alaskan Native, non-Hispanic black, or teenage mothers had the highest infant mortality rates per 1,000 live births (14.85, 9.90, and 11.88 respectively). Among infants born early term, corresponding mortality rates were 5.69, 4.49, and 4.82, respectively. Among infants born late preterm, singletons had a higher infant mortality rate than twins (8.59 vs. 5.62), whereas among infants born early term, the rate was higher among twins (3.67 vs. 3.15). Congenital malformations and sudden infant death syndrome were the leading causes of death among both late preterm and early term infants. Infant mortality rates among infants born late preterm or early term varied substantially by maternal race/ethnicity, maternal age, and plurality. Information about these disparities may help in the development of clinical practice and prevention strategies targeting infants at highest risk.

  11. Disparities in Mortality Rates Among US Infants Born Late Preterm or Early Term, 2003–2005

    Science.gov (United States)

    Gazmararian, Julie A.; Shapiro-Mendoza, Carrie K.

    2015-01-01

    The purpose of this study was to identify disparities in neonatal, post-neonatal, and overall infant mortality rates among infants born late preterm (34–36 weeks gestation) and early term (37–38 weeks gestation) by race/ethnicity, maternal age, and plurality. In analyses of 2003–2005 data from US period linked birth/infant death datasets, we compared infant mortality rates by race/ethnicity, maternal age, and plurality among infants born late preterm or early term and also determined the leading causes of death among these infants. Among infants born late preterm, infants born to American Indian/Alaskan Native, non-Hispanic black, or teenage mothers had the highest infant mortality rates per 1,000 live births (14.85,9.90, and 11.88 respectively). Among infants born early term, corresponding mortality rates were 5.69, 4.49, and 4.82, respectively. Among infants born late preterm, singletons had a higher infant mortality rate than twins (8.59 vs. 5.62), whereas among infants born early term, the rate was higher among twins (3.67 vs. 3.15). Congenital malformations and sudden infant death syndrome were the leading causes of death among both late preterm and early term infants. Infant mortality rates among infants born late preterm or early term varied substantially by maternal race/ ethnicity, maternal age, and plurality. Information about these disparities may help in the development of clinical practice and prevention strategies targeting infants at highest risk. PMID:23519825

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

    Directory of Open Access Journals (Sweden)

    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.

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

    OpenAIRE

    Allison A. Vanderbilt; Wright, Marcie S.

    2013-01-01

    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 weight...

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

    Science.gov (United States)

    Vanderbilt, Allison A; Wright, Marcie S

    2013-01-01

    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.

  15. [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.

  16. Impact of vitamin A supplementation on infant and childhood mortality

    Directory of Open Access Journals (Sweden)

    Black Robert E

    2011-04-01

    Full Text Available Abstract Introduction Vitamin A is important for the integrity and regeneration of respiratory and gastrointestinal epithelia and is involved in regulating human immune function. It has been shown previously that vitamin A has a preventive effect on all-cause and disease specific mortality in children under five. The purpose of this paper was to get a point estimate of efficacy of vitamin A supplementation in reducing cause specific mortality by using Child Health Epidemiology Reference Group (CHERG guidelines. Methods A literature search was done on PubMed, Cochrane Library and WHO regional data bases using various free and Mesh terms for vitamin A and mortality. Data were abstracted into standardized forms and quality of studies was assessed according to standardized guidelines. Pooled estimates were generated for preventive effect of vitamin A supplementation on all-cause and disease specific mortality of diarrhea, measles, pneumonia, meningitis and sepsis. We did a subgroup analysis for vitamin A supplementation in neonates, infants 1-6 months and children aged 6-59 months. In this paper we have focused on estimation of efficacy of vitamin A supplementation in children 6-59 months of age. Results for neonatal vitamin A supplementation have been presented, however no recommendations are made as more evidence on it would be available soon. Results There were 21 studies evaluating preventive effect of vitamin A supplementation in community settings which reported all-cause mortality. Twelve of these also reported cause specific mortality for diarrhea and pneumonia and six reported measles specific mortality. Combined results from six studies showed that neonatal vitamin A supplementation reduced all-cause mortality by 12 % [Relative risk (RR 0.88; 95 % confidence interval (CI 0.79-0.98]. There was no effect of vitamin A supplementation in reducing all-cause mortality in infants 1-6 months of age [RR 1.05; 95 % CI 0.88-1.26]. Pooled results for

  17. Trends in the Mexican infant mortality paradox over the past two decades.

    Science.gov (United States)

    El-Sayed, Abdulrahman M; Paczkowski, Magdalena M; March, Dana; Galea, Sandro

    2014-11-01

    Mexicans in the United States have lower rates of several important population health metrics than non-Hispanic whites, including infant mortality. This mortality advantage is particularly pronounced among infants born to foreign-born Mexican mothers. However, the literature to date has been relegated to point-in-time studies that preclude a dynamic understanding of ethnic and nativity differences in infant mortality among Mexicans and non-Hispanic whites. We assessed secular trends in the relation between Mexican ethnicity, maternal nativity, and infant mortality between 1989 and 2006 using a linked birth-death data set from one US state. Congruent to previous research, we found a significant mortality advantage among infants of Mexican relative to non-Hispanic white mothers between 1989 and 1991 after adjustment for baseline demographic differences (relative risk = 0.78, 95% confidence interval, 0.62-0.98). However, because of an upward trend in infant mortality among infants of Mexican mothers, the risk of infant mortality was not significantly different from non-Hispanic white mothers in later periods. Our findings suggest that the "Mexican paradox" with respect to infant mortality is resolving. Changing sociocultural norms among Mexican mothers and changes in immigrant selection and immigration processes may explain these observations, suggesting directions for future research. Copyright © 2014 Elsevier Inc. All rights reserved.

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

    Science.gov (United States)

    Sartorius, Benn K D; Sartorius, Kurt; Chirwa, Tobias F; Fonn, Sharon

    2011-11-18

    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. 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 antenatal HIV sero-prevalence, previous

  19. 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.

  20. New estimates of infant and child mortality for blacks in South Africa ...

    African Journals Online (AJOL)

    This report is part of a project to evaluate and improve the quality of mortality data for blacks in South Africa. Infant and child mortality rates of 79/1 000 and 81/1 000 were estimated for 1968-1974 and 1975-1979 respectively. A child mortality rate of 43/1 000 was estimated for 1973-1977. Estimates of infant mortality rates for ...

  1. Different extent in decline of infant mortality by region and cause in Shenyang, China.

    Science.gov (United States)

    Huang, Yan-Hong; Wu, Qi-Jun; Li, Li-Li; Li, Da; Li, Jing; Zhou, Chen; Wu, Lang; Zhu, Jingjing; Gong, Ting-Ting

    2016-04-14

    To compare the pattern of cause of death of infant mortality rates by urban/rural areas as well as to generate knowledge for potential strategies to decrease this mortality, we carried out a study by analyzing the infant mortality data from the Shenyang Women and Children Health Care Centre. From 1997 to 2014, 970,583 live births and 6510 infant deaths were registered. Infant mortality rates, percent change, and annual percent change (APC) were calculated. The infant mortality significantly decreased by 5.92%, 7.41%, and 3.92% per year in overall, urban, and rural areas, respectively. Among the categories of causes of infant death, congenital anomalies (APC = -7.87%), asphyxia-related conditions (APC = -9.43), immaturity-related conditions (APC = -3.44%), diseases of the nervous system and sense organs (APC = -6.01%), and diseases of the respiratory system (APC = -6.29%) decreased significantly in the observational periods. Additionally, among selective causes of infant death, pneumonia, congenital heart disease, neural tube defects, preterm birth and low birth weight, birth asphyxia, and intracranial hemorrhage of the newborn significantly decreased by 5.45%, 5.45%, 16.47%, 2.18%, 10.95%, and 10.33% per year, respectively. In conclusion, infant mortality has been continuously decreased in Shenyang from 1997 to 2014, although further efforts are still needed to decrease the infant mortality in rural areas.

  2. 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.

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

    Science.gov (United States)

    ... for non-Hispanic white women. For non-Hispanic black women, preterm-related causes of death account for most of their higher infant mortality ... Infant mortality rates were higher for non-Hispanic black than for non-Hispanic ... of the causes of death shown in ( Figure 3 ). The largest difference was ...

  4. Poverty, Race, and Infant Mortality in the United States. Discussion Papers 404-77.

    Science.gov (United States)

    Gortmaker, Steven L.

    This paper examines the theoretical and empirical roles of income poverty and race in the determination of infant mortality differentials in the United States. A basic model of the process of infant mortality is conceptualized. It outlines a theory of the influence of a variety of biological, social, and economic factors upon the risk of infant…

  5. Social Environments, Genetics, and Black-White Disparities in Infant Mortality.

    Science.gov (United States)

    El-Sayed, Abdulrahman M; Paczkowski, Magdalena; Rutherford, Caroline G; Keyes, Katherine M; Galea, Sandro

    2015-11-01

    Genes and environments often interplay to produce population health. However, in some instances, the scientific literature has favoured one explanation, underplaying the other, even in the absence of rigorous support. We examine parental race disparity on the risk of infant mortality to see if such an analysis might provide clues to understanding the extent to which genes and environment may shape perinatal risks. We assessed parental racial disparities in infant mortality among singletons by analysing the risk of infant mortality among racially consonant vs. dissonant couples over time between 1989-1997 and 1998-2006 in the state of Michigan (n = 1 428 199). We calculated the degree of modification of the relation between maternal race and infant mortality by paternal race dynamically across the two time periods. Infant mortality among interracial couples decreased with time relative to white-white couples, while infant mortality among black-black couples increased with time after adjusting for socio-economic, demographic, and prenatal care differences. The degree to which paternal black race strengthened the relation between maternal black race and higher infant mortality risk relative to white mothers increased with time throughout our study. Evidence from these data suggests that environmental factors likely play the greater role in explaining the parental race disparity and risk of infant mortality. © 2015 John Wiley & Sons Ltd.

  6. Determinants of infant mortality in Ethiopia: A study based on the ...

    African Journals Online (AJOL)

    , the infant mortality rate in Ethiopia was estimated at 96.8 deaths per 1000 live births. Continuous follow up studies about infant mortality are vital to the development of the country. The present study is an undertaking against the background ...

  7. Infant and under five mortality rates for districts of Kwazulu-Natal ...

    African Journals Online (AJOL)

    Infant and under five mortality rates are key indicators used internationally as sensitive but non-specific ways of comparing health status and development. The purpose of this study was to estimate and compare infant and under-5 mortality rates for eleven health districts of KwaZulu-Natal province for priority health ...

  8. 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

  9. Mortality risk factors among HIV-exposed infants in rural and urban Cameroon

    NARCIS (Netherlands)

    Boerma, Ragna S.; Wit, Ferdinand W. N. M.; Orock, Sammy Oben; Schonenberg-Meinema, Dieneke; Hartdorff, Caroline M.; Bakia, Affuenti; van Hensbroek, Michael Boele

    2015-01-01

    HIV-exposed infants, including those who do not become infected, have higher morbidity and mortality rates than HIV unexposed infants. The underlying mechanisms of this difference are largely unknown. The objective of this study was to identify the risk factors for mortality among HIV-exposed

  10. Trends in infant mortality rates in Hungary between 1963 and 2012.

    Science.gov (United States)

    Nyári, Csaba; Nyári, Tibor András; McNally, Richard J Q

    2015-05-01

    This study investigated annual and seasonal death trends for infants of infant deaths were obtained from the published nationwide population register. Negative binomial regression was applied to investigate the yearly trends in rates and also the effect of possible risk factors - low birthweight, maternal education and sex - on infant mortality. Cyclic trends were investigated using logistic regression. Annual infant mortality declined significantly (p mortality was revealed, with a peak in deaths in late February for all infants and a double peak, in May and November, in the group of cases who died during the early neonatal period. This Hungarian study suggests that there was a significant seasonal effect on neonatal and infant mortality at the end of winter between 1963 and 2012. We speculate that this may have been related to respiratory infections. ©2015 Foundation Acta Paediatrica. Published by John Wiley & Sons Ltd.

  11. 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.

  12. Inequalities in health: living conditions and infant mortality in Northeastern Brazil.

    Science.gov (United States)

    Carvalho, Renata Alves da Silva; Santos, Victor Santana; Melo, Cláudia Moura de; Gurgel, Ricardo Queiroz; Oliveira, Cristiane Costa da Cunha

    2015-01-01

    OBJECTIVE To analyze the variation of infant mortality as per condition of life in the urban setting. METHODS Ecological study performed with data regarding registered deaths of children under the age of one who resided in Aracaju, SE, Northeastern Brazil, from 2001 to 2010. Infant mortality inequalities were assessed based on the spatial distribution of the Living Conditions Index for each neighborhood, classified into four strata. The average mortality rates of 2001-2005 and 2006-2010 were compared using the Student's t-test. RESULTS Average infant mortality rates decreased from 25.3 during 2001-2005 to 17.7 deaths per 1,000 live births in 2006-2010. Despite the decrease in the rates in all the strata during that decade, inequality of infant mortality risks increased in neighborhoods with worse living conditions compared with that in areas with better living conditions. CONCLUSIONS Infant mortality rates in Aracaju showed a decline, but with important differences among neighborhoods. The assessment based on a living condition perspective can explain the differences in the risks of infant mortality rates in urban areas, highlighting health inequalities in infant mortality as a multidimensional issue.

  13. Health Human Capital in Sub-Saharan Africa: Conflicting Evidence from Infant Mortality Rates and Adult Heights

    OpenAIRE

    Akachi, Yoko; Canning, David

    2010-01-01

    We investigate trends in cohort infant mortality rates and adult heights in 39 developing countries since 1960. In most regions of the world improved nutrition, and reduced childhood exposure to disease, have lead to improvements in both infant mortality and adult stature. In Sub-Saharan Africa, however, despite declining infant mortality rates, adult heights have not increased. We argue that in Sub-Saharan Africa the decline in infant mortality may have been due to interventions that prevent...

  14. Assimilation effects on infant mortality among immigrants in Norway: Does maternal source country matter?

    Directory of Open Access Journals (Sweden)

    Jonas Kinge

    2014-10-01

    Full Text Available Background: Assimilation models of infant outcomes among immigrants have received considerable attention in the social sciences. However, little effort has been made to investigate how these models are influenced by the source country. Objective: We investigate the relationship between infant mortality and the number of years since maternal migration and whether or not this relationship varies with maternal source country. Methods: We use an extensive dataset which includes all of the births in Norway between 1992-2010, augmented by information on the source country and other maternal characteristics. By measuring the source country infant mortality rate at the time the mother came to Norway, we are able to account for circumstances in the country the mother left behind. We apply assimilation models which allow for interactions between source country characteristics and maternal years since migration. We also fit models in which age at maternal migration replaces maternal years since migration. Results: Our analyses generated three main findings. First, an assimilation process has taken place, as the infant mortality rate declined with the number of years since maternal migration. Second, maternal source country characteristics are significantly associated with infant mortality rates in Norway. Mothers from countries with high infant mortality rates (e.g., countries in Africa and Asia had higher infant mortality rates than mothers from countries with low infant mortality rates (e.g., countries in Europe. Third, the assimilation process varied by maternal source country: i.e., the assimilation process was more pronounced among mothers from countries with high infant mortality rates than among those from countries with low infant mortality rates. Conclusions: The source country is an important predictor of the assimilation profiles. This studycontributes to the existing literature on assimilation by emphasising the significance ofthe source

  15. 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

  16. 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

  17. 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…

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

    Science.gov (United States)

    Liang, Fu-Wen; Lu, Tsung-Hsueh; Wu, Mei-Hwan; Lue, Hung-Chi; Chiang, Tung-Liang; Huang, Ya-Li; Chen, Lea-Hua

    2016-08-01

    Rankings of infant mortality rates are commonly cited international comparisons to assess the health status of individual countries. We compared the infant mortality rate of Taiwan with those of European countries for 2004 according to two definitions. First, the countries were ranked on the basis of crude infant, neonatal, and postneonatal mortality rates. The countries were then ranked according to the mortality rates calculated after exclusion of live births with a known birth weight of infant, neonatal, and postneonatal mortality rates, respectively. The ranks were 12(th), 16(th), and 15(th), respectively, for mortality rates, excluding live births with a birth weight of mortality rate ratios statistically significantly lower than Taiwan in infant, neonatal, and postneonatal mortality, respectively, according to the second definition. The ranking of Taiwan was similar (11(th) vs. 12(th)) 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. Copyright © 2015. Published by Elsevier B.V.

  19. Extremely preterm infant mortality rates and cesarean deliveries in the United States.

    Science.gov (United States)

    Batton, Beau; Burnett, Christopher; Verhulst, Steven; Batton, Daniel

    2011-07-01

    To estimate trends in infant mortality rates and cesarean delivery rates for extremely preterm infants born in the United States. This national population-based study used public data from the Centers for Disease Control and Prevention to investigate extremely preterm infants born alive between 22 0/7 and 27 6/7 weeks of gestational age from 1999 to 2005. There were 177,552 extremely preterm infant births (fewer than 1% of all births) from 1999 to 2005. The number of annual extremely preterm births increased by 7% compared with a 4.5% increase for births at all gestations. During the study years, the extremely preterm infant mortality rate (percentage of infants who died in the first year) remained steady (range 33-34%; P=.22), whereas the cesarean delivery rate increased from 43% to 54% (Pinfant mortality rate after cesarean delivery increased from 24% to 26% (P=.012). At each gestational age, the annual cesarean delivery rate increased over time (Pinfant mortality rates were unchanged except for a 2% decline from 2004 to 2005 for infants born at 24 weeks of gestation (P=.01). A significant rise in the cesarean delivery rate in the United States from 1999 to 2005 for infants born at less than 28 weeks of gestation was not associated with an improvement in the infant mortality rate.

  20. 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.

  1. 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...

  2. Effect of determinants of infant and child mortality in Nigeria: Hazard ...

    African Journals Online (AJOL)

    Infant and child mortality is a major public health problem; however, quantifying its burden in a population is a challenge. Routine data collected provided a proxy for measuring the incidence of mortality among children under five years of age and for crudely estimating mortality rate. The data collected from National ...

  3. Infant mortality in Delaware: the need to improve maternal health and reduce premature births.

    Science.gov (United States)

    Paul, David A

    2008-08-01

    Delaware's high infant mortality rate continues to be driven by an increasing number of premature births. Premature birth is a complex problem with both social and medical roots. Based on the CDC road map, programs aimed at improving preconception health of women of childbearing age are blossoming in Delaware. In addition, Delaware's infant mortality rate can only be reduced if we are able to diminish disparities in health care delivery, and improve the social factors influencing infant mortality. These factors include diminishing family support, low high school graduation rate, poor housing, and a lack of health insurance.

  4. Factors associated to infant mortality in Sub-Saharan Africa

    Directory of Open Access Journals (Sweden)

    Pablo Viguera Ester

    2011-09-01

    Full Text Available Half of the 10 million children who die annually in the world are from Sub-Saharan Africa (SSA. The reasons are known, but lack of will and resources avoid the development of sustainable policies. Associated factors to the high infant mortality rate (IMR in SSA have been investigated in this research. An ecological multi-group study was designed comparing rates within SSA. The dependent variable is the IMR and health services, economic and development indicators are the independent variables. Information and data sources were WHO, World Bank, UNICEF and UNDP (1997-2007. IMR mean value is 92.2 (per 1000 live births and a relationship with several of the factors could be observed. In the bi-variate analysis direct relationship was observed with maternal mortality rate and an inverse relationship was observed with prenatal care coverage, births assisted by skilled health personnel, gross national income per capita, per capita government expenditure on health, social security expenditure, adult literacy rate, net primary school enrolment rate, population with access to safe drinking water (in urban and rural areas and with population with access to basic sanitation in rural areas. In the multi-variate analysis IMR had an inverse relationship with children under 5 years with diarrhoea who receive oral re-hydration, with social security expenditure as percentage of general government expenditure on health and with per capita government expenditure on health. The situation in SSA would change if their inhabitants received education and information to demand more equitable polices and better investments from their governments.

  5. 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.

  6. 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

    2013-07-01

    Although preconception and prenatal maternal stress are associated with adverse outcomes in birth and childhood, their relation to infant mortality remains uncertain. We used logistic regression to study infant mortality risk following maternal stress within a population-based sample of infants born in Sweden between 1973 and 2008 (N = 3,055,361). Preconception (6-0 months before conception) and prenatal (between conception and birth) stress were defined as death of a first-degree relative of the mother. A total of 20,651 offspring were exposed to preconception stress, 26,731 offspring were exposed to prenatal stress, and 8,398 cases of infant mortality were identified. Preconception stress increased the risk of infant mortality independently of measured covariates, and this association was timing specific and robust across low-risk groups. Prenatal stress did not increase risk of infant mortality. These results suggest that the period immediately before conception may be a sensitive developmental period with ramifications for infant mortality risk.

  7. Higher cesarean delivery rates are associated with higher infant mortality rates in industrialized countries.

    Science.gov (United States)

    Xie, Ri-Hua; Gaudet, Laura; Krewski, Daniel; Graham, Ian D; Walker, Mark C; Wen, Shi Wu

    2015-03-01

    Recent data indicate that more than half of high-income industrialized countries have a cesarean delivery rate of  > 25 percent, which is higher than the appropriate level considered by most health professionals worldwide. Data for 31 high-income industrialized countries in 2010 (or the nearest year) obtained from the World Health Organization, Organization for Economic Cooperation and Development, World Bank, and individual countries were analyzed in this study. We examined the correlation between cesarean delivery rate and infant mortality rate with Pearson correlation coefficient analysis, and examined the independent effect of cesarean delivery on infant mortality with multiple linear regression analyses. The cesarean delivery and infant mortality rates varied substantially among the included countries: from 15.6 to 50.0 percent and from 1.9 per to 6.8 per 1,000 live births, respectively. Cesarean delivery rates were positively correlated with infant mortality rates (Pearson correlation coefficient: 0.41, p infant sex, per capita GDP, and the Gini index (p rate is associated with higher infant mortality rate among these high-income industrialized countries. One of the mechanisms by which cesarean delivery affects infant mortality is through iatrogenic prematurity. © 2015 Wiley Periodicals, Inc.

  8. 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/

  9. 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

    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 (infant mortality rates, we observed......-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...... by 38% (MRR, 0.62; 95% CI, .46–.83) within the neonatal period and 16% (0.84; .71–1.00) by age 12 months.ConclusionEarly administration of BCG-Denmark in LW infants is associated with major reductions in mortality rate. It is important that all LW infants receive early BCG in areas with high neonatal...

  10. Recent Declines in Infant Mortality in the United States, 2005-2011

    Science.gov (United States)

    ... in the Midwest. Infant mortality is an important indicator of the health of a nation ( 1 , 2 ). ... have been very similar for many years, and trends are unlikely to differ ( 3–5 ). Thus, data ...

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

    DEFF Research Database (Denmark)

    Olsen, O; Madsen, Mette

    1999-01-01

    This study examined inequalities in infant mortality in Denmark in relation to maternal educational level, and compared the inequalities to those observed in a similar study 10 years earlier. It was a register-based study of all singleton births in Denmark 1991-92, a study population of 113......,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...... 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...

  12. Euphemisms for hunger: know doctor, infant mortality and malnutrition in Colombia, 1888-1940

    Directory of Open Access Journals (Sweden)

    Jorge Humberto Márquez Valderrama,

    2017-01-01

    Full Text Available This article analyzes the medical discourses during the period 1888-1940 on infant mortality in Colombia. Relations between malnutrition, morbidity and mortality are one of the most important problems of Colombian medical-hygienist field. Medical objectification of these relationships involved hygiene, germ theory, childcare, eugenics and modern pediatrics. This knowledge produced nuances in the etiology of infant mortality and in medical explanations of epidemiological profiles of the first four decades of the twentieth century. Here, a contribution to the history of the relationship between malnutrition, morbidity and mortality in Colombia is presented.

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

    Directory of Open Access Journals (Sweden)

    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. The contribution of very low birth weight death to infant mortality ...

    African Journals Online (AJOL)

    Background: Infant mortality remains high in many developing countries in which the contribution of deaths among infants born very low birth weight (VLBW) may be considerable. This contribution has however not been quantified in most such countries. This paper explores a model that can be used in this respect.

  15. An epidemiological study of factors associated with preterm infant in-hospital mortality

    NARCIS (Netherlands)

    Lutomski, J.E.; Dempsey, E.; Molloy, E.

    2013-01-01

    Nationally representative in-hospital mortality rates among preterm infants are essentially unknown in Ireland. We examined preterm infants born in hospital and admitted to intensive care unit (ICU) between 2005 and 2008. Unadjusted incidence rates and risk ratios were derived. Overall, 6,599

  16. Infant Mortality Rates: Socioeconomic Factors. United States. National Vital Statistics System, Series 22, Number 14.

    Science.gov (United States)

    National Center for Health Statistics (DHEW/PHS), Hyattsville, MD.

    Statistics are presented on infant mortality rates according to race, sex, family income, education of mother, and education of father. The statistics are based on data collected by a questionnaire mailed to mothers of legitimate births and to medical care facilities and mothers of legitimate infant deaths. Samples were selected from records of…

  17. Determining the Amount, Timing and Causes of Mortality among Infants with Down Syndrome

    Science.gov (United States)

    Goldman, S. E.; Urbano, R. C.; Hodapp, R. M.

    2011-01-01

    Objective: To examine the amount, timing and causes/correlates of infant mortality among newborns with Down syndrome. Methods: Using the Tennessee Department of Health Birth, Hospital Discharge and Death records, infants were identified who were born with Down syndrome from 1990 to 2006. Those who died during the first year were separated into…

  18. Lead Water Pipes and Infant Mortality at the Turn of the Twentieth Century

    Science.gov (United States)

    Troesken, Werner

    2008-01-01

    In 1897, about half of all American municipalities used lead pipes to distribute water. Employing data from Massachusetts, this paper compares infant death rates in cities that used lead water pipes to rates in cities that used nonlead pipes. In the average town in 1900, the use of lead pipes increased infant mortality by 25 to 50 percent.…

  19. 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 (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.

  20. Militarism and mortality. An international analysis of arms spending and infant death rates.

    Science.gov (United States)

    Woolhandler, S; Himmelstein, D U

    1985-06-15

    Examination of data from 141 countries showed that infant mortality rates for 1979 were positively correlated with the proportion of gross national product devoted to military spending (r = 0.23, p less than 0.01) and negatively correlated with indicators of economic development, health resources, and social spending. In a multivariate analysis controlling for per caput gross national product, arms spending remained a significant positive predictor of infant mortality rate (p less than 0.0001), while the proportion of the population with access to clean water, the number of teachers per head, and caloric consumption per head were negative predictors. The multivariate model accounted for much of the observed variance in infant mortality rate (R2 = 0.78, p less than 0.0001), and showed good fit to similar data for the year 1972 (R2 = 0.80, p less than 0.0001). The model was also predictive of infant mortality rates in subgroup analysis of underdeveloped, middle developed, and developed nations. Analysis of time trends confirmed that an increase in military spending presages a poor record of improvement in infant mortality rate. These findings support the hypothesis that arms spending is causally related to infant mortality.

  1. Is economic inequality in infant mortality higher in urban than in rural India?

    Science.gov (United States)

    Kumar, Abhishek; Singh, Abhishek

    2014-11-01

    This paper examines the trends in economic inequality in infant mortality across urban-rural residence in India over last 14 years. We analysed data from the three successive rounds of the National Family Health Survey conducted in India during 1992-1993, 1998-1999, and 2005-2006. Asset-based household wealth index was used as the economic indicator for the study. Concentration index and pooled logistic regression analysis were applied to measure the extent of economic inequality in infant mortality in urban and rural India. Infant mortality rate differs considerably by urban-rural residence: infant mortality in rural India being substantially higher than that in urban India. The findings suggest that economic inequalities are higher in urban than in rural India in each of the three survey rounds. Pooled logistic regression results suggest that, in urban areas, infant mortality has declined by 22 % in poorest and 43 % in richest. In comparison, the decline is 29 and 32 % respectively in rural India. Economic inequality in infant mortality has widened more in urban than in rural India in the last two decades.

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

    Science.gov (United States)

    Ladusingh, Laishram; Gupta, Ashish Kumar; Yadav, Awdhesh

    2016-01-01

    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. 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. 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. Interventions at the community level can reduce district infant mortality rates.

  3. 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

    of 7012 healthy normal-birth-weight neonates were randomized to BCG only (intervention group) or OPV0 with BCG (usual practice). All children were to receive OPV with pentavalent vaccine (diphtheria, tetanus, pertussis, Haemophilus influenzae type b, and hepatitis B) at 6, 10, and 14 weeks of age. Seven......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...... national OPV campaigns were also conducted during the trial period. Children were followed to age 12 months. We used Cox regression to calculate hazard ratios (HRs) for mortality. RESULTS: The trial contradicted the original hypothesis about OPV0 increasing male infant mortality. Within 12 months, 73...

  4. Infant Mortality Rates in Rural and Urban Areas in the United States, 2014.

    Science.gov (United States)

    Ely, Danielle M; Driscoll, Anne K; Matthews, T J

    2017-09-01

    Key findings Data from the National Vital Statistics System ● Infant mortality rates decreased as urbanization level increased, from 6.55 deaths per 1,000 births in rural counties to 6.20 in small and medium urban counties and 5.44 in large urban counties. ● Neonatal mortality rates were higher in rural counties than in large urban counties, and postneonatal mortality rates decreased as urbanization level increased. ● Mortality rates decreased as urbanization level increased for infants of mothers aged 20-29, 30-39, and 40 and over. ● For infants of non-Hispanic white and non-Hispanic black mothers, mortality rates were lowest in large urban counties. 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.

  5. Air pollution attributable postneonatal infant mortality in U.S. metropolitan areas: a risk assessment study

    Directory of Open Access Journals (Sweden)

    Krzyzanowski Michal

    2004-05-01

    Full Text Available Abstract Background The impact of outdoor air pollution on infant mortality has not been quantified. Methods Based on exposure-response functions from a U.S. cohort study, we assessed the attributable risk of postneonatal infant mortality in 23 U.S. metropolitan areas related to particulate matter 10 as a surrogate of total air pollution. Results The estimated proportion of all cause mortality, sudden infant death syndrome (normal birth weight infants only and respiratory disease mortality (normal birth weight attributable to PM10 above a chosen reference value of 12.0 μg/m3 PM10 was 6% (95% confidence interval 3–11%, 16% (95% confidence interval 9–23% and 24% (95% confidence interval 7–44%, respectively. The expected number of infant deaths per year in the selected areas was 106 (95% confidence interval 53–185, 79 (95% confidence interval 46–111 and 15 (95% confidence interval 5–27, respectively. Approximately 75% of cases were from areas where the current levels are at or below the new U.S. PM2.5 standard of 15 μg/m3 (equivalent to 25 μg/m3 PM10. In a country where infant mortality rates and air pollution levels are relatively low, ambient air pollution as measured by particulate matter contributes to a substantial fraction of infant death, especially for those due to sudden infant death syndrome and respiratory disease. Even if all counties would comply to the new PM2.5 standard, the majority of the estimated burden would remain. Conclusion Given the inherent limitations of risk assessments, further studies are needed to support and quantify the relationship between infant mortality and air pollution.

  6. Investigating the Decline of Fetal and Infant Mortality Rates in Alaska During 2010 and 2011.

    Science.gov (United States)

    Prince, Cheryl B; Young, Margaret B; Sappenfield, William; Parrish, Jared W

    2016-04-01

    The U.S. infant mortality rate has been steadily declining since 2007. Although the downward trend has been notable in Alaska since 2006 when the rate was 6.9 infant deaths per 1000 live births, a dramatic drop in infant mortality occurred in 2010 and 2011 when the infant mortality rate fell to 3.8 infant deaths per 1000 live births during both years. The purpose of this study was to investigate the sudden decrease in fetal and infant mortality rates (FIMR) using the perinatal periods of risk (PPOR) method, an approach that has not been used previously in Alaska. The study was conducted for 251 fetal and infant deaths in 2004-2006, 265 deaths in 2007-2009, and 129 deaths in 2010-2011. Data were stratified by Alaska Native (AN) and White maternal race and urban/rural residence. Among both urban and rural White women, the rate ratios (RR) for FIMRs between the earlier and later time periods were not significantly different. The postneonatal mortality rate (PNMR) among AN infants living in rural areas decreased significantly (RR 0.40; 95 % confidence interval 0.21-0.76) between 2007-2009 and 2010-2011. An unexplained increase in sudden unexplained infant death was noted in 2009, followed by a precipitous decrease in 2010-2011. No other unusual distribution of the cause specific mortality rates was observed. The decrease in the Alaska Native FIMR might have been due to focused efforts for preventing postneonatal sleep associated deaths. Education for prevention of sleep related deaths, particularly in rural communities, is necessary to maintain Alaska's low PNMR.

  7. Persistent socioeconomic disparities in infant, neonatal, and postneonatal mortality rates in the United States, 1969-2001.

    Science.gov (United States)

    Singh, Gopal K; Kogan, Michael D

    2007-04-01

    This study examines changing patterns of inequalities in US infant, neonatal, and postneonatal mortality rates between 1969 and 2001 by area deprivation and maternal education. A deprivation index was linked to county vital records data to derive annual infant mortality rates by deprivation quintiles from 1969 to 2000. Rates by maternal education were computed for 1986, 1991, 1996, and 2001 using national linked birth/infant death files. Log-binomial regression was used to estimate relative risks of infant mortality by deprivation and time period. Cox regression was used to model overall and birth weight-specific infant mortality risks by maternal education after adjusting for covariates. Temporal disparities were summarized by log-linear regression and inequality indices. Although absolute disparities have narrowed over time, relative socioeconomic disparities in infant mortality have increased since 1985. In 1985-1989, infants in the most deprived group had, respectively, 36% and 57% higher risks of neonatal and postneonatal mortality than infants in the least deprived group. The corresponding relative risks increased to 43% and 96% in 1995-2000. The adjusted risk of infant mortality was 22% higher in 1986 for mothers with or = 16 years of education, with the relative risk increasing to 41% in 2001. Disparities were greatest among normal birth weight infants, with education-specific relative risks of neonatal and postneonatal mortality increasing significantly between 1986 and 2001. Dramatic declines in infant mortality among all of the socioeconomic groups during 1969-2001 represent a major public health success. However, substantial socioeconomic disparities persisted in both neonatal and postneonatal mortality. Relatively larger declines in infant and postneonatal mortality among higher socioeconomic groups have contributed to the widening gap in mortality since 1985. Persistent disparities in infant mortality may reflect increasing polarization among

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

    DEFF Research Database (Denmark)

    Villadsen, S Fredsted; Mortensen, L H; Andersen, A M Nybo

    2009-01-01

    Ethnic minorities constitute a growing part of the Danish population but little is known about ethnic disparity in early life mortality in this population. The aim of this study was to investigate ethnic disparities in stillbirth risk and infant mortality in Denmark from 1981 to 2003....

  9. Analyzing Infant and Child (Under-five) Mortality in Zaria: A ...

    African Journals Online (AJOL)

    info

    Department of Mathematics and Statistics ... continue to decrease if there can be improvement in the factors under study. Key Words: Infant and Child Mortality, Death and Birth Rates, Regression and. Correlation, Anova, Trend, Demography. Introduction ... Under-five Mortality: The probability of dying before the fifth birthday.

  10. Improvement in Infant and Perinatal Mortality in the United States, 1965-1973.

    Science.gov (United States)

    Information Sciences Research Inst., Washington, DC.

    Changes in United States infant and perinatal mortality during the period 1965-1973 are examined by race, age at death or length of gestation, and degree of urbanization. Several improvements in mortality rates are identified and discussed in relation to changes in the United States which have occurred in economic conditions and standards of…

  11. Infant mortality time series are random walks with drift: are they cointegrated with socioeconomic variables?

    Science.gov (United States)

    Bishai, D M

    1995-01-01

    Previous time series analyses of infant mortality have failed to provide evidence to support their implicit assumption that infant mortality data used behaved as a stationary time series. The present study applies the augmented Dickey Fuller Test to infant mortality time series for Sweden (1800-1989), United Kingdom (1839-1989) and United States (1915-1989). The null hypothesis that each of these series is non-stationary is accepted at standard levels of significance. A conceptual framework of infant mortality which uses a combination of physical and social overhead capital as factors in a production function is developed to explain the finding of non-stationarity as derivative from the non-stationarity of a stock of health-enhancing capital. Estimation of econometric models of the socioeconomic determinants of infant mortality using differenced data with ARIMA estimation is inconclusive. Estimation of a bivariate cointegration model supports the hypothesis that infant survival and GNP/Capita are cointegrated for 19th century Sweden but not for 19th century UK. Bivariate analysis of 20th century Sweden, UK, and US data demonstrated no cointegration. This may be due to the onset of disequilibrium in the economic determination of infant mortality in the present era as technological advances and demographic shifts began to play a larger role. Supplementing the bivariate analysis with measures of unemployment, and crude birth rate in the 20th century permitted the detection of cointegration in US and UK. The multivariate results may suggest that improvements in 20th century UK GNP/capita have had greater impact on infant survival relative to US GNP/capita.

  12. Extremely low birth weight and infant mortality rates in the United States.

    Science.gov (United States)

    Lau, Carissa; Ambalavanan, Namasivayam; Chakraborty, Hrishikesh; Wingate, Martha S; Carlo, Waldemar A

    2013-05-01

    Infant mortality rates (IMR) and neonatal mortality rates (NMR) in the United States have not decreased recently. The purpose of this study was to determine the contributions of birth weight and gestational age subgroups to the IMR and NMR in the United States. We used the most recent (1983-2005) US linked birth and infant death data and simple regression analysis to determine the contributions of specific birth weight and gestational age subgroups to trends in IMR and NMR. IMR and NMR decreased between 1983 and 2005 for all birth weight and gestational age subgroups. There was an increase in births of very low birth weight infants from 1.2% to 1.5% (P infant deaths increased from 42.9% to 54.8%, resulting in recent nonsignificant declines in IMR and NMR. The proportion of live-birth infants infants infants infants infants contribute greatly to the lack of a decrease in IMR and NMR from 2000 to 2005, although birth weight- and gestational age-specific IMR and NMR continue to decrease.

  13. Mortality risk factors among HIV-exposed infants in rural and urban Cameroon.

    Science.gov (United States)

    Boerma, Ragna S; Wit, Ferdinand W N M; Orock, Sammy Oben; Schonenberg-Meinema, Dieneke; Hartdorff, Caroline M; Bakia, Affuenti; van Hensbroek, Michael Boele

    2015-02-01

    HIV-exposed infants, including those who do not become infected, have higher morbidity and mortality rates than HIV unexposed infants. The underlying mechanisms of this difference are largely unknown. The objective of this study was to identify the risk factors for mortality among HIV-exposed (infected as well as uninfected) infants in a prevention of mother-to-child transmission (PMTCT) programme in Cameroon. We analysed the data from 319 mother-infant pairs included in a PMTCT programme at a rural and an urban hospital between 2004 and 2012. The programme offered free formula feeding, monthly follow-up visits and antiretroviral therapy (ART) according to national PMTCT guidelines. Mother-infant pairs were divided in three study groups, based on year of recruitment and study site: (I) rural hospital, 2004-07; (II) rural hospital, 2008-12; (III) urban hospital, 2008-12. Two hundred and eighty-five medical records were included in the final analysis. Infant mortality rates were 23.9%, 20.0% and 5.3% in group I, II and III, respectively (P = 0.02). Hazard ratios of infant mortality were 6.4 (P < 0.001) for prematurity, 4.6 (P = 0.04) for no maternal use of ARTs, 5.6 (P = 0.025) for mixed feeding, 2.7 for home deliveries (P = 0.087) and 0.4 (P = 0.138) for urban study group. In this programme, prematurity, no ART use, and the practice of mixed feeding were independent predictors of infant mortality. Mixed feeding and not using ART increased the hazard of death, probably through its increased risk of HIV infection. Although mortality rates were significantly higher in the rural area, rural setting was not a risk factor for infant mortality. These findings may contribute to the development of tailor-made programmes to reduce infant mortality rates among HIV-exposed infants. © 2014 John Wiley & Sons Ltd.

  14. Infant mortality in Kyrgyzstan before and after the break-up of the Soviet Union.

    Science.gov (United States)

    Guillot, Michel; Lim, So-Jung; Torgasheva, Liudmila; Denisenko, Mikhail

    2013-01-01

    There is a great deal of uncertainty over the levels of, and trends in, infant mortality in the former Soviet republics of Central Asia. As a result, the impact of the break-up of the Soviet Union on infant mortality in the region is not known, and proper monitoring of mortality levels is impaired. In this paper, a variety of data sources and methods are used to assess levels of infant mortality and their trend over time in one Central Asian republic, Kyrgyzstan, between 1980 and 2010. An abrupt halt to an already established decline in infant mortality was observed to occur during the decade following the break-up of the Soviet Union, contradicting the official statistics based on vital registration. Infants of Central Asian ethnicity and those born in rural areas were also considerably more at risk of mortality than suggested by the official sources. We discuss the implications of these findings, both for health policy in this seldom studied part of the former Soviet Union and for our understanding of the health crisis which it currently faces.

  15. Optimal breastfeeding practices and infant and child mortality: a systematic review and meta-analysis.

    Science.gov (United States)

    Sankar, Mari Jeeva; Sinha, Bireshwar; Chowdhury, Ranadip; Bhandari, Nita; Taneja, Sunita; Martines, Jose; Bahl, Rajiv

    2015-12-01

    To synthesise the evidence for effects of optimal breastfeeding on all-cause and infection-related mortality in infants and children aged 0-23 months. We conducted a systematic review to compare the effect of predominant, partial or nonbreastfeeding versus exclusive breastfeeding on mortality rates in the first six months of life and effect of no versus any breastfeeding on mortality rates between 6 and 23 months of age. A systematic literature search was conducted in PubMed, Cochrane CENTRAL and CABI. The risk of all-cause mortality was higher in predominantly (RR 1.5), partially (RR 4.8) and nonbreastfed (RR14.4) infants compared to exclusively breastfed infants 0-5 months of age. Children 6-11 and 12-23 months of age who were not breastfed had 1.8- and 2.0-fold higher risk of mortality, respectively, when compared to those who were breastfed. Risk of infection-related mortality in 0-5 months was higher in predominantly (RR 1.7), partially (RR 4.56) and nonbreastfed (RR 8.66) infants compared to exclusive breastfed infants. The risk was twofold higher in nonbreastfed children when compared to breastfed children aged 6-23 months. The findings underscore the importance of optimal breastfeeding practices during infancy and early childhood. ©2015 The Authors. Acta Paediatrica published by John Wiley & Sons Ltd on behalf of Foundation Acta Paediatrica.

  16. Working toward decreasing infant mortality in developing countries through change in the medical curriculum

    Directory of Open Access Journals (Sweden)

    Zaman Iffat F

    2011-08-01

    Full Text Available Abstract Background High infant and maternal mortality rates are one of the biggest health issues in Pakistan. Although these rates are given high priority at the national level (Millennium Development Goals 4 and 5, respectively, there has been no significant decrease in them so far. We hypothesize that this lack of success is because the undergraduate curriculum in Pakistan does not match local needs. Currently, the Pakistani medical curriculum deals with issues in maternal and child morbidity and mortality according to Western textbooks. Moreover, these are taught disjointedly through various departments. We undertook curriculum revision to sensitize medical students to maternal and infant mortality issues important in the Pakistani context and educate them about ways to reduce the same through an integrated teaching approach. Methods The major determinants of infant mortality in underdeveloped countries were identified through a literature review covering international research produced over the last 10 years and the Pakistan Demographic Health Survey 2006-07. An interdisciplinary maternal and child health module team was created by the Medical Education Department at Shifa College of Medicine. The curriculum was developed based on the role of identified determinants in infant and maternal mortality. It was delivered by an integrated team without any subject boundaries. Students' knowledge, skills, and attitudes were assessed by multiple modalities and the module itself by student feedback using questionnaires and focus group discussions. Results Assessment and feedback demonstrated that the students had developed a thorough understanding of the complexity of factors that contribute to infant mortality. Students also demonstrated knowledge and skill in counseling, antenatal care, and care of newborns and infants. Conclusions A carefully designed integrated curriculum can help sensitize undergraduate medical students and equip them to

  17. Geographic analysis of infant mortality in New Zealand, 1995-2008: an ethnicity perspective.

    Science.gov (United States)

    Campbell, Malcolm; Apparicio, Philippe; Day, Peter

    2014-06-01

    To detect spatial clusters of high infant mortality rates in New Zealand for Māori and non-Māori populations and verify if these clusters are stable over a certain time period (1995-2008) and similar between the two populations. We applied the Kulldorff's spatial scan statistics on data collected by New Zealand Ministry of Health (1995 to 2008) at the territorial local authorities (TLA) level. Kappa coefficient was used to assess the concordance between clusters obtained for Māori and non-Māori populations. T-test analyses were conducted to identify associations between spatial clusters and two predictors (population density and deprivation score). There are some significant spatial clusters of infant mortality in New Zealand for both Māori and Non-Māori. The concordance of the cluster locations between the two populations is strong (kappa=0.77). Unsurprisingly, infant mortality clusters for both Māori and Non-Māori are associated with the deprivation score. The population density predictor is only significantly and positively associated with clusters obtained for the non-Māori population. After controlling for deprivation the presence of spatial clusters is all but eliminated. Infant mortality patterns are geographically similar for both Māori and Non-Māori. However, there are differences geographically between the two populations after accounting for deprivation. Health services that can affect infant mortality should be aware of the geographical differences across NZ. Deprivation is an important factor in explaining infant mortality rates and policies that ameliorate its effects should be pursued, as it is the major determinant of the geographical pattern of infant mortality in NZ. © 2014 The Authors. ANZJPH © 2014 Public Health Association of Australia.

  18. Infant and child mortality in Ethiopia: A statistical analysis approach ...

    African Journals Online (AJOL)

    ... associated wi th child mortal ity. Furthermore, Mother's education, birth order has substantial impact on child mortality in E t h i o p i a . Finally these findings specified that an increase in Mothers' education, improve health care services which should in turn raise child survival and should decrease child mortality in Ethiopia ...

  19. Assessing the reduction in infant mortality rates in Malawi over the 1990-2010 decades.

    Science.gov (United States)

    Moise, Imelda K; Kalipeni, Ezekiel; Jusrut, Poonam; Iwelunmor, Juliet I

    2017-06-01

    One of the key objectives of the Millennium Development Goals (MDGs) was to improve the lives of infants and children, particularly the reduction of high infant and childhood mortality rates throughout the developing world. This paper examines the experiences of Malawi in tackling the problem of high infant and childhood mortality over recent decades, 1990-2010. We highlight the strategies that were used in Malawi which led to Malawi's stellar performance in achieving the targets set by the MDGs with reference to infant and childhood mortality. The data for the analysis were obtained from Demographic and Health Surveys and from the various censuses the country has conducted. Regression analysis using district as the unit of observation reveals several important factors that have led to the commendable declines in infant mortality. Significant factors included immunisation of infants as well as increasing levels of female education and the availability of skilled birth attendants. What Malawi's case demonstrates is that given a correct mix of strategies, even a poor country such as Malawi can meet some of the lofty targets set by the MDGs.

  20. Is excess male infant mortality from sudden infant death syndrome and other respiratory diseases X-linked?

    Science.gov (United States)

    Mage, David T; Donner, E Maria

    2014-02-01

    Male excess infant mortality is well known but unexplained. In 2004, we reported sudden infant death syndrome (SIDS) and other infant respiratory deaths showed a ~50% male excess in the United States between 1979 and 2002. This study analyses expanded US data from 1968 to 2010 to see whether infant respiratory deaths still show similar ~50% male excess and may be X-linked. The analysis compared infant mortality data from the US Centers for Disease Control and Prevention, 1968-2010, with 11 World Health Organization International Classification of Diseases (ICD) rubric groups for respiratory deaths by accidents, congenital anomalies, respiratory diseases and causes unknown. The 11 ICD groupings presented male excesses of ~50% and combining the 453,953 US cases produced a male fraction of 0.6034, a 52.1% male excess. A further 72,380 non-US respiratory cases showed a similar 0.6055 male fraction, a 53.5% male excess. The constant ~50% male excess for quite different causes of respiratory death suggests they all have a common terminal event and that is acute anoxic encephalopathy. We hypothesise that this constant male excess phenomenon must be caused by a single X-linked gene, with a recessive condition, leading to a predisposition to succumb to acute anoxic encephalopathy. ©2013 Foundation Acta Paediatrica. Published by John Wiley & Sons Ltd.

  1. Poor Infants, Poor Chances: A Longitudinal Study of Progress toward Reducing Low Birth Weight and Infant Mortality in the United States and Its Largest Cities, 1979-1984.

    Science.gov (United States)

    Ducey, Sara Bachman; And Others

    This study examined low birth weight and infant mortality in the 50 states and the 54 largest American cities between 1979 and 1984. Its findings confirm that progress in reducing low birth weight and infant mortality has slowed, and in some cases the progress has actually reversed. Some states and many cities had higher rates of low birth weight…

  2. The effect of war on infant mortality in the Democratic Republic of Congo.

    Science.gov (United States)

    Lindskog, Elina Elveborg

    2016-10-06

    The Democratic Republic of Congo (DRC) has suffered from war and lingering conflicts in East DRC and has one of the highest infant mortality rates in the world. Prior research has documented increases in infant and child mortality associated with war, but the empirical evidence is limited in several respects. Measures of conflict are quite crude or conflict is not tightly linked to periods of exposure to infant death. Few studies have distinguished between the effects of war on neonatal versus post-neonatal infants. No study has considered possible differences between women who give birth during wartime and those who do not that may be related to greater infant mortality. The analysis used the nationally representative sample of 15,103 mothers and 53,768 children from the 2007 and 2013/2014 Demographic Health Survey in the DRC and indicators of conflict events and conflict deaths from the 2013 Uppsala Conflict Data. To account for unobserved heterogeneity across women, a multi-level modeling approach was followed by grouping all births for each woman and estimating random intercepts in discrete time event history models. Post-neonatal mortality increased during the Congolese wars, and was highest where conflict events and deaths were extreme. Neonatal mortality was not associated with conflict levels. Infant mortality was not higher in East DRC, where conflicts continued during the post Congolese war period. Models specifying unobserved differences between mothers who give birth during war and those who have children in peacetime did not reduce the estimated effect of war, i.e., no support was found for selectivity in the sample of births during war. Differences in effects of the Congolese war on neonatal versus post-neonatal mortality suggest that conflict influences the conditions of infants' lives more than the aspects of mothers' pregnancy conditions and delivery that are relevant for infant mortality. These differences may, however, be specific to the nature

  3. Geographic analysis of low birthweight and infant mortality in Michigan using automated zoning methodology

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    Enander Helen

    2009-02-01

    Full Text Available Abstract Background Infant mortality is a major public health problem in the State of Michigan and the United States. The primary adverse reproductive outcome underlying infant mortality is low birthweight. Visualizing and exploring the spatial patterns of low birthweight and infant mortality rates and standardized incidence and mortality ratios is important for generating mechanistic hypotheses, targeting high-risk neighborhoods for monitoring and implementing maternal and child health intervention and prevention programs and evaluating the need for health care services. This study investigates the spatial patterns of low birthweight and infant mortality in the State of Michigan using automated zone matching (AZM methodology and minimum case and population threshold recommendations provided by the National Center for Health Statistics and the US Census Bureau to calculate stable rates and standardized incidence and mortality ratios at the Zip Code (n = 896 level. The results from this analysis are validated using SaTScan. Vital statistics birth (n = 370,587 and linked infant death (n = 2,972 records obtained from the Michigan Department of Community Health and aggregated for the years 2004 to 2006 are utilized. Results For a majority of Zip Codes the relative standard errors (RSEs of rates calculated prior to AZM were greater than 20%. Spurious results were the result of too few case and birth counts. Applying AZM with a target population of 25 cases and minimum threshold of 20 cases resulted in the reconstruction of zones with at least 50 births and RSEs of rates 20–22% and below respectively, demonstrating the stability reliability of these new estimates. Other AZM parameters included homogeneity constraints on maternal race and maximum shape compactness of zones to minimize potential confounding. AZM identified areas with elevated low birthweight and infant mortality rates and standardized incidence and mortality ratios. Most but not all

  4. Differences in perinatal and infant mortality in high-income countries: Artifacts of birth registration or evidence of true differences?

    OpenAIRE

    Deb-Rinker, Paromita; León, Juan Andrés; Gilbert, Nicolas L.; Rouleau, Jocelyn; Andersen, Anne-Marie Nybo; Bjarnadóttir, Ragnheiður I.; Gissler, Mika; Mortensen, Laust H.; Skjaerven, Rolv; Vollset, Stein Emil; Zhang, Xun; Shah, Prakesh S.; Sauve, Reg S.; Kramer, Michael S; Joseph, K.S.

    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 were artifacts of birth registration or reflected true differences in health status. Methods A retrospective population-based cohort study was done using data from Canada, United States, Denmark, Finl...

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

    Science.gov (United States)

    Xiao, Lin; Zhang, Dan-Li; Torrie, Jill; Auger, Nathalie; McHugh, Nancy Gros-Louis; Luo, Zhong-Cheng

    2016-01-01

    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.

  6. 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.

  7. 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

  8. Inequality as a Powerful Predictor of Infant and Maternal Mortality around the World.

    Science.gov (United States)

    Ruiz, Juan Ignacio; Nuhu, Kaamel; McDaniel, Justin Tyler; Popoff, Federico; Izcovich, Ariel; Criniti, Juan Martin

    2015-01-01

    Maternal and infant mortality are highly devastating, yet, in many cases, preventable events for a community. The human development of a country is a strong predictor of maternal and infant mortality, reflecting the importance of socioeconomic factors in determinants of health. Previous research has shown that the Human Development Index (HDI) predicts infant mortality rate (IMR) and the maternal mortality ratio (MMR). Inequality has also been shown to be associated with worse health in certain populations. The main purpose of the present study was to determine the correlation and predictive power of the Inequality Adjusted Human Development Index (IHDI) as a measure of inequality with the Infant Mortality Rate (IMR), Maternal Mortality Rate (MMR), Early Neonatal Mortality Rate (ENMR), Late Neonatal Mortality Rate (LNMR), and the Post Neonatal Mortality Rate (PNMR). Data for the present study were downloaded from two sources: infant and maternal mortality data were downloaded from the Global Burden of Disease 2013 Cause of Death Database and the Human Development Index (HDI) and Inequality-Adjusted Human Development Index (IHDI) data were downloaded from the United Nations Development Program (UNDP). Pearson correlation coefficients were estimated, following logarithmic transformations to the data, to examine the relationship between HDI and IHDI with MMR, IMR, ENMR, LNMR, and PNMR. Steiger's Z test for the equality of two dependent correlations was utilized in order to determine whether the HDI or IHDI was more strongly associated with the outcome variables. Lastly, we constructed OLS regression models in order to determine the predictive power of the HDI and IHDI in terms of the MMR, IMR, ENMR, LNMR, and PNMR. Maternal and infant mortality were both strongly and negatively correlated with both HDI and IHDI; however, Steiger's Z test for the equality of two dependent correlations revealed that IHDI was more strongly correlated than HDI with MMR (Z = 4.897, p

  9. Maternal education, birth weight, and infant mortality in the United States.

    Science.gov (United States)

    Gage, Timothy B; Fang, Fu; O'Neill, Erin; Dirienzo, Greg

    2013-04-01

    This research determines whether the observed decline in infant mortality with socioeconomic level, operationalized as maternal education (dichotomized as college or more, versus high school or less), is due to its "indirect" effect (operating through birth weight) and/or to its "direct" effect (independent of birth weight). The data used are the 2001 U.S. national African American, Mexican American, and European American birth cohorts by sex. The analysis explores the birth outcomes of infants undergoing normal and compromised fetal development separately by using covariate density defined mixture of logistic regressions (CDDmlr). Among normal births, mean birth weight increases significantly (by 27-108 g) with higher maternal education. Mortality declines significantly (by a factor of 0.40-0.96) through the direct effect of education. The indirect effect of education among normal births is small but significant in three cohorts. Furthermore, the indirect effect of maternal education tends to increase mortality despite improved birth weight. Among compromised births, education has small and inconsistent effects on birth weight and infant mortality. Overall, our results are consistent with the view that the decrease in infant death by socioeconomic level is not mediated by improved birth weight. Interventions targeting birth weight may not result in lower infant mortality.

  10. Dependency, democracy, and infant mortality: a quantitative, cross-national analysis of less developed countries.

    Science.gov (United States)

    Shandra, John M; Nobles, Jenna; London, Bruce; Williamson, John B

    2004-07-01

    This study presents quantitative, sociological models designed to account for cross-national variation in infant mortality rates. We consider variables linked to four different theoretical perspectives: the economic modernization, social modernization, political modernization, and dependency perspectives. The study is based on a panel regression analysis of a sample of 59 developing countries. Our preliminary analysis based on additive models replicates prior studies to the extent that we find that indicators linked to economic and social modernization have beneficial effects on infant mortality. We also find support for hypotheses derived from the dependency perspective suggesting that multinational corporate penetration fosters higher levels of infant mortality. Subsequent analysis incorporating interaction effects suggest that the level of political democracy conditions the effects of dependency relationships based upon exports, investments from multinational corporations, and international lending institutions. Transnational economic linkages associated with exports, multinational corporations, and international lending institutions adversely affect infant mortality more strongly at lower levels of democracy than at higher levels of democracy: intranational, political factors interact with the international, economic forces to affect infant mortality. We conclude with some brief policy recommendations and suggestions for the direction of future research.

  11. Residential segregation and infant mortality: a multilevel study using Iranian census data.

    Science.gov (United States)

    Nazari, Ss Hashemi; Mahmoodi, M; Mansournia, Ma; Naieni, K Holakouie

    2012-01-01

    There is a great amount of literature concerning the effect of racial segregation on health outcomes but few papers have discussed the effect of segregation on the basis of social, demographic and economic characteristics on health. We estimated the independent effect of segregation of determinants of socioeconomic status on infant mortality in Iranian population. For measuring segregation, we used generalized dissimilarity index for two group and multi group nominal variables and ordinal information theory index for ordinal variables. Sample data was obtained from Iranian latest national census and multilevel modeling with individual variables at level one and segregation indices measured at province level for socioeconomic status variables at level two were used to assess the effect of segregation on infant mortality. Among individual factors, mother activity was a risk factor for infant mortality. Segregated provinces in regard to size of the house, ownership of a house and motorcycle, number of literate individual in the family and use of natural gas for cooking and heating had higher infant mortality. Segregation indices measured for education level, migration history, activity, marital status and existence of bathroom were negatively associated with infant mortality. Segregation of different contextual characteristics of neighborhood had different effects on health outcomes. Studying segregation of social, economic, and demographic factors, especially in communities, which are racially homogenous, might reveal new insights into dissimilarities in health.

  12. Explaining the recent decrease in US infant mortality rate, 2007-2013.

    Science.gov (United States)

    Callaghan, William M; MacDorman, Marian F; Shapiro-Mendoza, Carrie K; Barfield, Wanda D

    2017-01-01

    The US infant mortality rate has been steadily decreasing in recent years as has the preterm birth rate; preterm birth is a major factor associated with death during the first year of life. The degree to which changes in gestational age-specific mortality and changes in the distribution of births by gestational age have contributed to the decrease in the infant mortality rate requires clarification. The objective of the study was to better understand the major contributors to the 2007-2013 infant mortality decline for the total population and for infants born to non-Hispanic black, non-Hispanic white, and Hispanic women. We identified births and infant deaths from 2007 and 2013 Centers for Disease Control and Prevention National Vital Statistics System's period linked birth and infant death files. We included all deaths and births for which there was a reported gestational age at birth on the birth certificate of 22 weeks or greater. The decrease in the infant mortality rate was disaggregated such that all of the change could be attributed to improvements in gestational age-specific infant mortality rates and changes in the distribution of gestational age, by week of gestation, using the Kitagawa method. Sensitivity analyses were performed to account for records in which the obstetric estimate of gestational age was missing and for deaths and births less than 22 weeks' gestation. Maternal race and ethnicity information was obtained from the birth certificate. The infant mortality rates after exclusions were 5.72 and 4.92 per 1000 live births for 2007 and 2013, respectively, with an absolute difference of -0.80 (14% decrease). Infant mortality rates declined by 11% for non-Hispanic whites, by 19% for non-Hispanic blacks, and by 14% for Hispanics during the period. Compared with 2007, the proportion of births in each gestational age category was lower in 2013 with the exception of 39 weeks during which there was an increase in the proportion of births from 30.1% in

  13. An assessment of infant and child mortality by social group and place of residence in districts of Orissa

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    Jyotishikha Nanda

    2012-05-01

    Full Text Available Objective: To provide an approximation of infant and child mortality rate for all the districts of Orissa using CEB (Children Ever Born and CS (Children Survival data of Census of India, 2001. And to find out the correlations of IMR and CMR with selected monitoring indicators. Methods: Trussell method has been used in estimating infant and child mortality rate. For a better understanding, the districts were classified into three groups on the basis of estimated infant mortality rate viz. i infant mortality rate lower than national average, ii infant mortality rate between state and national average and iii infant mortality rate more than state average. Results: Study reveals that most of the districts of Orissa are experiencing higher IMR and CMR as compared to estimated IMR and CMR of state average. Only one district of Orissa (Mayurbhanj has IMR and CMR lower than national average in comparison with other districts of Orissa. On the other hand, 17 districts have an infant mortality between the state and national average, 12 districts have an infant mortality higher than the state average. Conclusion: The ranking of districts helps to identify the backward and most backward districts in reproductive and child health programmes and to intensify the intervention strategies to reduce the infant and child mortality in the state of Orissa.

  14. Infant mortality rates according to socioeconomic status in a Brazilian city

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    Marcelo Zubaran Goldani

    2001-06-01

    Full Text Available OBJECTIVE: Data from municipal databases can be used to plan interventions aimed at reducing inequities in health care. The objective of the study was to determine the distribution of infant mortality according to an urban geoeconomic classification using routinely collected municipal data. METHODS: All live births (total of 42,381 and infant deaths (total of 731 that occurred between 1994 and 1998 in Ribeirão Preto, Brazil, were considered. Four different geoeconomic areas were defined according to the family head's income in each administrative urban zone. RESULTS: The trends for infant mortality rate and its different components, neonatal mortality rate and post-neonatal mortality rate, decreased in Ribeirão Preto from 1994 to 1998 (chi-square for trend, p<0.05. These rates were inversely correlated with the distribution of lower salaries in the geoeconomic areas (less than 5 minimum wages per family head, in particular the post-neonatal mortality rate (chi-square for trend, p<0.05. Finally, the poor area showed a steady increase in excess infant mortality. CONCLUSIONS: The results indicate that infant mortality rates are associated with social inequality and can be monitored using municipal databases. The findings also suggest an increase in the impact of social inequality on infant health in Ribeirão Preto, especially in the poor area. The monitoring of health inequalities using municipal databases may be an increasingly more useful tool given the continuous decentralization of health management at the municipal level in Brazil.

  15. Infant mortality rates according to socioeconomic status in a Brazilian city

    Directory of Open Access Journals (Sweden)

    Goldani Marcelo Zubaran

    2001-01-01

    Full Text Available OBJECTIVE: Data from municipal databases can be used to plan interventions aimed at reducing inequities in health care. The objective of the study was to determine the distribution of infant mortality according to an urban geoeconomic classification using routinely collected municipal data. METHODS: All live births (total of 42,381 and infant deaths (total of 731 that occurred between 1994 and 1998 in Ribeirão Preto, Brazil, were considered. Four different geoeconomic areas were defined according to the family head's income in each administrative urban zone. RESULTS: The trends for infant mortality rate and its different components, neonatal mortality rate and post-neonatal mortality rate, decreased in Ribeirão Preto from 1994 to 1998 (chi-square for trend, p<0.05. These rates were inversely correlated with the distribution of lower salaries in the geoeconomic areas (less than 5 minimum wages per family head, in particular the post-neonatal mortality rate (chi-square for trend, p<0.05. Finally, the poor area showed a steady increase in excess infant mortality. CONCLUSIONS: The results indicate that infant mortality rates are associated with social inequality and can be monitored using municipal databases. The findings also suggest an increase in the impact of social inequality on infant health in Ribeirão Preto, especially in the poor area. The monitoring of health inequalities using municipal databases may be an increasingly more useful tool given the continuous decentralization of health management at the municipal level in Brazil.

  16. 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

    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. 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. 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‰. 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 continuous decrease. Infant mortality

  17. The effect of war on infant mortality in the Democratic Republic of Congo

    Directory of Open Access Journals (Sweden)

    Elina Elveborg Lindskog

    2016-10-01

    Full Text Available Abstract Background The Democratic Republic of Congo (DRC has suffered from war and lingering conflicts in East DRC and has one of the highest infant mortality rates in the world. Prior research has documented increases in infant and child mortality associated with war, but the empirical evidence is limited in several respects. Measures of conflict are quite crude or conflict is not tightly linked to periods of exposure to infant death. Few studies have distinguished between the effects of war on neonatal versus post-neonatal infants. No study has considered possible differences between women who give birth during wartime and those who do not that may be related to greater infant mortality. Methods The analysis used the nationally representative sample of 15,103 mothers and 53,768 children from the 2007 and 2013/2014 Demographic Health Survey in the DRC and indicators of conflict events and conflict deaths from the 2013 Uppsala Conflict Data. To account for unobserved heterogeneity across women, a multi-level modeling approach was followed by grouping all births for each woman and estimating random intercepts in discrete time event history models. Results Post-neonatal mortality increased during the Congolese wars, and was highest where conflict events and deaths were extreme. Neonatal mortality was not associated with conflict levels. Infant mortality was not higher in East DRC, where conflicts continued during the post Congolese war period. Models specifying unobserved differences between mothers who give birth during war and those who have children in peacetime did not reduce the estimated effect of war, i.e., no support was found for selectivity in the sample of births during war. Conclusion Differences in effects of the Congolese war on neonatal versus post-neonatal mortality suggest that conflict influences the conditions of infants’ lives more than the aspects of mothers’ pregnancy conditions and delivery that are relevant for infant

  18. Contributors to Excess Infant Mortality in the U.S. South

    Science.gov (United States)

    Hirai, Ashley H.; Sappenfield, William M.; Kogan, Michael D.; Barfield, Wanda D.; Goodman, David A.; Ghandour, Reem M.; Lu, Michael C.

    2015-01-01

    Background Infant mortality rates (IMRs) are disproportionally high in the U.S. South; however, the proximate contributors that could inform regional action remain unclear. Purpose To quantify the components of excess infant mortality in the U.S. South by maternal race/ethnicity, underlying cause of death, and gestational age. Methods U.S. Period Linked Birth/Infant Death Data Files 2007–2009 (analyzed in 2013) were used to compare IMRs between the South (U.S. Public Health Regions IV and VI) and all other regions combined. Results Compared to other regions, there were 1.18 excess infant deaths per 1000 live births in the South, representing about 1600 excess infant deaths annually. New Mexico and Texas did not have elevated IMRs relative to other regions; excess death rates among other states ranged from 0.62 per 1000 in Kentucky to 3.82 per 1000 in Mississippi. Racial/ethnic compositional differences, generally the greater proportion of non-Hispanic black births in the South, explained 59% of the overall regional difference; the remainder was mostly explained by higher IMRs among non-Hispanic whites. The leading causes of excess Southern infant mortality were sudden unexpected infant death (SUID; 36%, range=12% in Florida to 90% in Kentucky) and preterm-related death (22%, range=−71% in Kentucky to 51% in North Carolina). Higher rates of preterm birth, predominantly infant mortality, comprehensive strategies addressing SUID and preterm birth prevention for both non-Hispanic black and white births are needed, with state-level findings used to tailor state-specific efforts. PMID:24512860

  19. US infant mortality trends attributable to accidental suffocation and strangulation in bed from 1984 through 2004: are rates increasing?

    Science.gov (United States)

    Shapiro-Mendoza, Carrie K; Kimball, Melissa; Tomashek, Kay M; Anderson, Robert N; Blanding, Sarah

    2009-02-01

    Accidental suffocation and strangulation in bed, a subgroup of sudden, unexpected infant deaths, is a leading mechanism of injury-related infant deaths. We explored trends and characteristics of these potentially preventable deaths. In this descriptive study, we analyzed US infant mortality data from 1984 through 2004. To explore trends in accidental suffocation and strangulation in bed and other sudden, unexpected infant deaths, we calculated cause-specific infant mortality rates and estimated proportionate mortality. Sudden, unexpected infant death was defined as a combination of all deaths attributed to accidental suffocation and strangulation in bed, sudden infant death syndrome, and unknown causes. Finally, we examined factors that were reported as contributing to these accidental suffocation and strangulation in bed deaths. Between 1984 and 2004, infant mortality rates attributed to accidental suffocation and strangulation in bed increased from 2.8 to 12.5 deaths per 100000 live births. These rates remained relatively stagnant between 1984 and 1992 and increased between 1992 and 2004; the most dramatic increase occurred between 1996 and 2004 (14% average annual increase). In contrast, total sudden, unexpected infant death rates remained stagnant between 1996 and 2004, whereas the proportion of deaths attributed to sudden infant death syndrome declined and to unknown cause increased. Black male infants Infant mortality rates attributable to accidental suffocation and strangulation in bed have quadrupled since 1984. The reason for this increase is unknown. Prevention efforts should target those at highest risk and focus on helping parents and caregivers provide safer sleep environments.

  20. Environmental regulations on air pollution in China and their impact on infant mortality.

    Science.gov (United States)

    Tanaka, Shinsuke

    2015-07-01

    This study explores the impact of environmental regulations in China on infant mortality. In 1998, the Chinese government imposed stringent air pollution regulations, in one of the first large-scale regulatory attempts in a developing country. We find that the infant mortality rate fell by 20 percent in the treatment cities designated as "Two Control Zones." The greatest reduction in mortality occurred during the neonatal period, highlighting an important pathophysiologic mechanism, and was largest among infants born to mothers with low levels of education. The finding is robust to various alternative hypotheses and specifications. Further, a falsification test using deaths from causes unrelated to air pollution supports these findings. Copyright © 2015 Elsevier B.V. All rights reserved.

  1. 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.

  2. Risk factors for infant mortality in rural and urban Nigeria: evidence from the national household survey.

    Science.gov (United States)

    Adewuyi, Emmanuel Olorunleke; Zhao, Yun; Lamichhane, Reeta

    2017-07-01

    This study investigates the rural-urban differences in infant mortality rates (IMRs) and the associated risk factors in Nigeria. The dataset from the 2013 Nigeria demographic and health survey (NDHS), disaggregated by rural-urban residence, was analyzed using complex samples statistics. A multivariable logistic regression analysis was computed to explore the adjusted relationship and identify risk factors for infant mortality. In rural and urban Nigeria, IMRs were 70 and 49 deaths per 1000 live births, respectively. Risk factors in rural residence were past maternal marital union (adjusted odds ratio (AOR): 1.625, p = 0.020), small birth size (AOR: 1.550, p Infants in rural residence had higher rates of mortality than their urban counterparts and disparities in risk factors exist between the residences.

  3. 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.

  4. 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.

  5. 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.

  6. Moving beyond the historical quagmire of measuring infant mortality for the First Nations population in Canada.

    Science.gov (United States)

    Elias, Brenda

    2014-12-01

    Infant mortality is a metric influenced by societal, political and medical advances. The way vital events are collected and reported are not always uniform. A lack of uniformity has disadvantaged some groups in society. In Canada, a multi-jurisdictional vital statistics system has truncated our ability to produce infant mortality rates for the Indigenous population. To understand how this evolved, this paper outlines the history of infant mortality, generally and internationally, and then documents the efforts to harmonize the collection and reporting of vital statistics (births and deaths) in Canada. Following this analysis is a historical review of vital event reporting for Canada's Indigenous population. A major finding of this paper is that racism, reframing, and jurisdictional posturing has limited our ability to accurately estimate live births and infant deaths for the Indigenous population. To improve Indigenous infant mortality estimation, Canada's governments need to transcend multijurisdictional challenges and fulfill international reporting obligations to Indigenous communities. Copyright © 2014 The Author. Published by Elsevier Ltd.. All rights reserved.

  7. Perinatal and infant mortality and low birth weight among residents near cokeworks in Great Britain

    Energy Technology Data Exchange (ETDEWEB)

    Dolk, H.; Pattenden, S.; Vrijheid, M.; Thakrar, B.; Armstrong, B.

    2000-02-01

    With growing evidence of the adverse health effects of air pollution--especially fine particulates--investigators must concentrate on the fetus, neonate, and infant as potentially vulnerable groups. Cokeworks are a major source of smoke and sulfur dioxide. In the current study, the authors investigated whether populations residing near cokeworks had a higher risk of adverse perinatal and infant outcomes. Zones of 7.5-km radius around 22 cokeworks in Great Britain were studied, within which the authors assumed that exposure declined from highest levels within 2 km to background levels. Routinely recorded birth and death data for Great Britain during the period 1981--1992 were analyzed. Each individual record had a postcode that referred to a small geographical area of typically 15--17 addresses. The authors calculated expected numbers on the basis of regional rates, stratified by year, sex, and a small-area socio-economic deprivation score. For all cokeworks combined, the observed/expected ratio within 2 km of cokeworks was 1.00 for low-birth-weight infants; 0.94 for still births; 0.95 for infant mortality; 0.86 for neonatal mortality; 1.10 for postneonatal mortality; 0.79 for respiratory postneonatal mortality; and 1.07 for postneonatal Sudden Infant Death Syndrome. Respiratory postneonatal mortality was low throughout the entire 0--7.5-km study area. There was no statistically significant decline in risk with distance from cokeworks for any of the outcomes studied. The authors concluded that there was no evidence of an increased risk of low birth weight, stillbirths, and/or neonatal mortality near cokeworks, and there was no strong evidence for any association between residence near cokeworks and postneonatal mortality. One must remember, however, the limited statistical power of the study to detect small risks.

  8. CCURRENT TRENDS IN INFANT MORTALITY AND PERINATAL LOSS RATES IN ST. PETERSBURG

    Directory of Open Access Journals (Sweden)

    N. V. Andriyanycheva

    2013-01-01

    Full Text Available Over the last decade, the positive trends in the demographic indicators of St. Petersburg are related, among the others, to the sustainable reduction of infant mortality, however the specifics of demography of a large city of federal importance is characterized by high migratory increase. Now the megalopolis is the region with the lowest infant mortality rates. This target demographic indicator is the pride of St. Petersburg and is closely monitored. Achievements in reducing of infant mortality were fulfilled through a system of work with pregnant women and newborns with low, very low and extremely low birth weight. Significant impact has also been adopted by the legislative acts, which, at present, are included into a single normative document — «Social code of St. Petersburg». The main purpose of the article is an extended analysis of the mortality rate due to transition to the new medical criteria of birth. The analysis demonstrates that the transition to the new criteria of live birth has made changes in the structure of infant and perinatal mortality, which requires further improvement and new approaches to the executive monitoring of this important social marker.

  9. United States black:white infant mortality disparities are not inevitable: identification of community resilience independent of socioeconomic status.

    Science.gov (United States)

    Fry-Johnson, Yvonne W; Levine, Robert; Rowley, Diane; Agboto, Vincent; Rust, George

    2010-01-01

    U.S. disparities in Black:White infant mortality are persistent. National trends, however, may obscure local successes. Zero-corrected, negative binomial multivariable modeling was used to predict Black infant mortality (1999-2003) in all U.S. counties with reliable rates. Independent variables included county population size, racial composition, educational attainment, poverty, income and geographic origin. Resilient counties were defined as those whose Black infant mortality rate residual score was Mortality data was accessed from the Compressed Mortality File compiled by the National Center for Health Statistics and found on the CDC WONDER website. Demographic information was obtained from the US Census. The final model included the percentage of Blacks, age 18 to 64 years, speaking little or no English (P infant mortality in the resilient stratum (23.6 per 1000 live births) exceeded Black US infant mortality (22.6). By 2001, Black infant mortality in the resilient stratum (5.6) was below the corresponding value for Whites (5.7). Resilient county neonatal mortality declined both early and late in the observation period, while post-neonatal declines were most marked after 1996. Models for reduction/elimination of racial disparities in US infant mortality, independent from county-level contextual measures of socioeconomic status, may already exist.

  10. The Effect of Oil Spills on Infant Mortality: Evidence from Nigeria

    OpenAIRE

    Bruederle, Anna; Hodler, Roland

    2017-01-01

    Oil spills can lead to irreversible environmental degradation and pose hazards to human health. We are the first to study the causal effects of onshore oil spills on neonatal and infant mortality rates. We use spatial data from the Nigerian Oil Spill Monitor and the Demographic and Health Surveys, and rely on the comparison of siblings conceived before and after nearby oil spills. We find that nearby oil spills double the neonatal mortality rate. These effects are fairly uniform across locati...

  11. [Trends in avoidable causes of infant mortality in Belo Horizonte, Brazil, 1984 to 1998].

    Science.gov (United States)

    Caldeira, Antônio Prates; França, Elisabeth; Perpétuo, Ignez Helena Oliva; Goulart, Eugênio Marcos Andrade

    2005-02-01

    To analyze the infant mortality trend in a metropolitan area, from 1984 to 1998. The main focus was on avoidable causes of neonatal and post-neonatal mortality. Sources of data were the Sistema de Informacoes em Mortalidade do Ministerio da Saude (SIM-MS) [Mortality Information System of the Ministry of Health] and Fundacao Instituto Brasileiro de Geografia e Estatistica (IBGE) [Brazilian Institute of Geography and Statistics Foundation] (official live birth and death records) for the metropolitan region of Belo Horizonte, in the State of Minas Gerais. A simple linear regression model was used to evaluate time-trends of mortality rates. Statistical significance of the inclination of the regression curves was considered for the p<0.05 level. During the 15 year period in question, the infant mortality rate declined from 48.5 to 22.1/1,000 live births. However, the most accentuated decrease was observed during the last four years of the study period. The post-neonatal group was greatly responsible for this decline both in the capital and in the other districts within the metropolitan region of Belo Horizonte. Although a significant decrease in the infant mortality rate has been observed, particularly in the post-neonatal mortality, it is still larger than the rates found in developed countries. Deaths due to perinatal morbidities as well as the group of causes represented by diarrhea-pneumonia-malnutrition still present an important potential for reduction. The authors discuss the role of the health services in improving the rates of these avoidable causes of infant mortality.

  12. Elevated infant mortality rate among Dutch oral cleft cases: a retrospective analysis from 1997 to 2011

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    Daan Pieter Frederik Van Nunen

    2014-12-01

    Full Text Available Objectives: First, to determine the infant mortality rate for Dutch patients with isolated oral clefts as well as for patients with clefts seen in association with other malformations. Second, to conduct a similar analysis per cleft type: cleft lip with or without cleft palate, cleft palate (including Robin sequence. Third, to examine the underlying causes of death. Material and methods: A retrospective review of the charts of patients with oral clefts born in the period 1997-2011 and treated in three regional cleft centers in the Netherlands. Results: 1530 patients with oral clefts were born during the study period and treated in the cleft centers. The overall infant mortality rate for all clefts was 2.09%, significantly higher than the general Dutch infant mortality rate of 0.45%. In a subanalysis per cleft type the infant mortality rates were 1.22%, 1.38%, 2.45% and 3.62% for cleft lip, cleft lip with cleft palate, cleft palate and Robin sequence. The mortality rates for isolated oral clefts did not differ significantly from the general Dutch rate. Causes of death were congenital malformations of the heart in 40.6%, airway / lungs in 15.6%, nervous system in 15.6%, infectious disease in 12.5% and other or unknown in 15.6%. Conclusion: The elevated infant mortality rate observed in Dutch patients with oral clefts is almost exclusively caused by associated congenital malformations. After diagnosis of an oral cleft an in-depth medical examination and a consult by the pediatrician and clinical geneticist is imperative to instigate the appropriate medical management.

  13. 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.

  14. Using Fetal and Infant Mortality Reviews to improve birth outcomes in an urban community.

    Science.gov (United States)

    Johnson, Teresa S; Malnory, Margaret E; Nowak, Emily W; Kelber, Sheryl

    2011-01-01

    To describe the implementation of a Fetal and Infant Mortality Review (FIMR) in a small urban community to improve perinatal birth outcomes. Descriptive study. Urban community within a Wisconsin city, population 85,000. Between January 1, 2007 and December 31, 2008, all women (N=82) in a targeted five zip-code area within an urban city were identified who experienced a fetal loss >14 weeks, neonatal or infant death (College of Obstetricians and Gynecologists and the Maternal and Child Health Bureau (2008) provided the framework for the systematic review of available records for all fetal and infant deaths during a 2-year period. Based on these findings, targeted evidence-based interventions were implemented. The infant mortality rate was higher in two of the five targeted zip-code areas. The mean ages of women who experienced fetal and infant mortality were in their 20s as opposed to teenage mothers. A higher proportion of Black women experienced fetal/perinatal losses than other race/ethnicities, many of which were related to prematurity. Many social, environmental, and maternal health issues such as poverty, racism, and perception of stress negatively contributed to the general health of women's subsequent birth outcomes. Nurses have the opportunity to promote and improve health to eliminate racial disparities in birth outcomes within their communities. © 2010 AWHONN, the Association of Women's Health, Obstetric and Neonatal Nurses.

  15. Trends in Infant Mortality in United States: A Brief Study of the Southeastern States from 2005–2009

    OpenAIRE

    Xiaojia He; Luma Akil; Aker, Winfred G.; Huey-Min Hwang; Ahmad, Hafiz A.

    2015-01-01

    While overall infant mortality rates have declined over the past several decades, the Southeastern states have remained the leading states in high infant death in the United States. In this study, we studied the differences in infant mortality in the southeastern United States from 2005 through 2009 according to mother’s characteristics (age of mother, marital status, maternal race, maternal education), birth characteristics (month when maternal prenatal care began, birth weight), and infant’...

  16. Identifying the intergenerational effects of the 1959-1961 Chinese Great Leap Forward Famine on infant mortality.

    Science.gov (United States)

    Song, Shige

    2013-12-01

    Using the 1959-1961 Chinese Great Leap Forward Famine as a natural experiment, this study examines the relationship between mothers' prenatal exposure to acute malnutrition and their children's infant mortality risk. According to the results, the effect of mothers' prenatal famine exposure status on children's infant mortality risk depends on the level of famine severity. In regions of low famine severity, mothers' prenatal famine exposure significantly reduces children's infant mortality, whereas in regions of high famine severity, such prenatal exposure increases children's infant mortality although the effect is not statistically significant. Such a curvilinear relationship between mothers' prenatal malnutrition status and their children's infant mortality risk is more complicated than the linear relationship predicted by the original fetal origins hypothesis but is consistent with the more recent developmental origins of health and disease theory. Copyright © 2013 Elsevier B.V. All rights reserved.

  17. Dynamics of Inequality: Mother's Education and Infant Mortality in China, 1970-2001

    Science.gov (United States)

    Song, Shige; Burgard, Sarah A.

    2011-01-01

    In this study, the authors analyze the dynamic relationship between Chinese women's education, their utilization of newly available medical pregnancy care, and their infants' mortality risk. China has undergone enormous social, economic, and political changes over recent decades and is a novel context in which to examine the potential influence of…

  18. Sex Ratio at Birth and Infant Mortality Rate in China: An Empirical Study

    Science.gov (United States)

    Lai, Denjian

    2005-01-01

    In this article, we used the data from the last three population censuses of China in 1982, 1990 and 2000, to study the dynamics of the sex ratio at birth and the infant mortality rate in China. In the late 1970s, China started its economic reform and implemented many family planning programs. Since then there has been great economic development…

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

    African Journals Online (AJOL)

    modern analogue in the work of Nancy Scheper-Hughes which explores 'passive infanticide' or 'benign euthanogenic neglect' in poverty stricken north-east Brazil.I. 2.13 The role of volunteer organisations and special programmes in reducing infant mortality is discussed in a number of the reports. The lack of community ...

  20. Hyperbilirubinemia in infants with Gram-negative sepsis does not affect mortality

    NARCIS (Netherlands)

    van den Broek, Paul; Verkade, Henkjan J.; Hulzebos, Christian V.

    Background: Sepsis is associated with an increased production of oxidant species and a decrease in endogenous antioxidant defenses. Mortality is high, especially when endotoxins are involved, e.g., in infants with Gram-negative sepsis. Yet, chronic as well as acute unconjugated hyperbilirubinemia

  1. 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,

  2. Admission Hypothermia in Very Preterm Infants and Neonatal Mortality and Morbidity

    DEFF Research Database (Denmark)

    Wilson, Emilija; Maier, Rolf F; Norman, Mikael

    2016-01-01

    OBJECTIVE: To investigate the association between body temperature at admission to neonatal intensive care and in-hospital mortality in very preterm infants, stratified by postnatal age of death. Moreover, we assessed the association between admission temperature and neonatal morbidity. STUDY DES...

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

    African Journals Online (AJOL)

    The number of births recorded in the health services was analysed by province in order to assess and explore alternatives within health authorities that could complement the existing system. Results. 1. Published estimates of infant mortality for the period from 1990 range from 40 to 71 / 1 000 births and estimates based on ...

  4. 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

  5. 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.

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

    African Journals Online (AJOL)

    Morbidity and mortality of low birth weight infants in the New Born Unit of Kenyatta National Hospital, Nairobi. ... The only mode of nutrition was enteric feeding in 59% with breast milk, formula or pasteurized cows milk by nasogastric tube, breast feeding or cup feeding. Except for dextrose water, parenteral nutrition was not ...

  7. Hospital volume and neonatal mortality among very low birth weight infants.

    Science.gov (United States)

    Bartels, Dorothee B; Wypij, David; Wenzlaff, Paul; Dammann, Olaf; Poets, Christian F

    2006-06-01

    Very low birth weight infants ( 1000 births per year) and large NICUs, the adjusted odds ratio was 1.94 for neonates for whom both units were small, 1.75 for those from large delivery units but small neonatal units, and 1.16 for those for whom only the NICU was large. Stratification according to gestational age revealed the greatest impact on mortality for infants of < 29 weeks. Results suggest that creating larger perinatal centers may improve perinatal health care. The volume of the NICU was associated more strongly with 28-day mortality than was the volume of the delivery hospital, and it had the largest impact on survival for infants of < 29 weeks.

  8. Using social marketing to increase awareness of the African American infant mortality disparity.

    Science.gov (United States)

    Rienks, Jennifer; Oliva, Geraldine

    2013-05-01

    African American infants in San Francisco suffer a mortality rate two to three times higher than Whites, yet prior discussion groups with African American residents suggested they were unaware of this disparity. Social marketing techniques were used to develop and implement three campaigns to increase awareness. The campaign themes were (1) infant mortality disparities, (2) proper infant sleep position, and (3) taking action to reduce disparities. Mediums to carry messages included bus ads, radio ads, church fans, and posters and cards distributed at clinics, daycares, agency waiting rooms, and community organizations. Campaign effectiveness was evaluated using telephone surveys of African Americans. Almost 62% report some exposure to Campaign 1, 48.5% to Campaign 2, and 48.9% to Campaign 3. Chi-square analyses reveal a statistically ignificant increase in awareness of the disparity (39.6% vs. 62.7%, p Social marketing is an effective tool to increase disparity awareness, especially among groups disproportionately affected by the disparity.

  9. Effects of antenatal testing laws on infant mortality.

    Science.gov (United States)

    Fung, Winnie; Robles, Omar

    2016-01-01

    Even though syphilis can be prevented effectively and treated inexpensively, it has remained a global public health problem. Untreated congenital syphilis results in neonatal death, stillbirth, preterm birth, or congenital deformities. Many developing countries have recently instituted syphilis prevention programs in antenatal care, but there has not been a systematic study of the effects of such programs. This paper is the first to study antenatal testing laws initiated in the U.S. in 1938-1947 which mandated physicians and other persons permitted by law to attend to a pregnant woman to test her for syphilis. We use the variation in the timing of state antenatal testing laws to estimate the laws' effect on neonatal mortality rates and deaths due to preterm birth. Using 1931-1947 Vital Statistics data, we find that these laws decreased neonatal mortality rates of nonwhites by 3.15 per 1000 live births (a 8.6% reduction) while having no discernible impact on whites. The laws contributed to an 18% narrowing of the white-nonwhite neonatal mortality gap by 1947. Using 1950 U.S. Census data, we find that mandatory antenatal testing led to a 7% increase in the cohort size of nonwhite poor, which is consistent with the neonatal mortality results. We find universal antenatal testing to be very cost-effective, with an estimated $7600 cost (in 2013 dollars) per life-year saved. Copyright © 2015 Elsevier B.V. All rights reserved.

  10. Morbidity and mortality in infant mountain gorillas (Gorilla beringei beringei): A 46-year retrospective review.

    Science.gov (United States)

    Hassell, James M; Zimmerman, Dawn; Cranfield, Michael R; Gilardi, Kirsten; Mudakikwa, Antoine; Ramer, Jan; Nyirakaragire, Elisabeth; Lowenstine, Linda J

    2017-10-01

    Long-term studies of morbidity and mortality in free-ranging primates are scarce, but may have important implications for the conservation of extant populations. Infants comprise a particularly important age group, as variation in survival rates may have a strong influence on population dynamics. Since 1968, the Mountain Gorilla Veterinary Project (MGVP, Inc.) and government partners have conducted a comprehensive health monitoring and disease investigation program on mountain gorillas (Gorilla beringei beringei) in Rwanda, Uganda, and the Democratic Republic of the Congo. In an effort to better understand diseases in this species, we reviewed reliable field reports (n = 37), gross post-mortem (n = 66), and histopathology (n = 53) reports for 103 infants (less than 3.5 years) mountain gorillas in the Virunga Massif. Our aim was to conduct the first comprehensive analysis of causes of infant mortality and to correlate histological evidence with antemortem morbidity in infant mountain gorillas. Causes of morbidity and mortality were described, and compared by age, sex, and over time. Trauma was the most common cause of death in infants (56%), followed by respiratory infections and aspiration (13%). Gastrointestinal parasitism (33%), atypical lymphoid hyperplasia (suggestive of infectious disease) (31%), and hepatic capillariasis (25%) were the most significant causes of antemortem morbidity identified post-mortem. Identifying the causes of mortality and morbidity in infants of this critically endangered species will help to inform policy aimed at their protection and guide ante- and post-mortem health monitoring and clinical decision-making in the future. © 2017 Wiley Periodicals, Inc.

  11. Spatial modeling of geographic inequalities in infant and child mortality across Nepal.

    Science.gov (United States)

    Chin, Brian; Montana, Livia; Basagaña, Xavier

    2011-07-01

    A survival regression model that allows for spatially correlated random effects is used to predict the hazard of dying among 12,714 children born between 1996 and 2006 in Nepal. The maps of fitted hazard rates show that even after accounting for individual and community-level covariates, a residual spatial pattern in infant mortality remains, with higher mortality concentrated in parts of Nepal's Far-Western and Mid-Western development regions. Results suggest a need to consider health policies and programs that reach children in spatially concentrated high-mortality areas. Copyright © 2011 Elsevier Ltd. All rights reserved.

  12. Why was Infant Mortality so High in Eastern England in the mid Nineteenth Century?

    Science.gov (United States)

    Hinde, Andrew; Fairhurst, Victoria

    2015-01-01

    This paper re-examines the high rates of infant mortality observed in rural areas of eastern England in the early years of civil registration. Infant mortality rates in some rural registration districts in the East Riding of Yorkshire, Cambridgeshire and Norfolk were higher than those in the mill towns of Lancashire. After describing the areas affected, this paper considers three potential explanations: environmental factors, poor-quality child care associated with the employment of women in agriculture, and the possibility that the high rates were the artefactual consequence of migrant women workers bringing their children to these areas. These explanations are then assessed using a range of evidence. In the absence of reliable cause of death data, recourse is had to three alternative approaches. The first involves the use of the exceptionally detailed tabulations of ages at death within the first year of life provided in the Registrar General's Annual Reports for the 1840s to assess whether the 'excess' infant deaths in rural areas of eastern England happened in the immediate post-natal period or later in the first year of life. Second, data on the seasonality of mortality in the 1840s are examined to see whether the zone of 'excess' infant mortality manifested a distinctive seasonal pattern. Finally, a regression approach is employed involving the addition of covariates to regression models. The conclusion is that no single factor was responsible for the 'excess' infant mortality, but a plausible account can be constructed which blends elements of all three of the potential explanations mentioned above with the specific historical context of these areas of eastern England.

  13. 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

  14. Monitoring subnational violence in Asia | IDRC - International ...

    International Development Research Centre (IDRC) Digital Library (Canada)

    This makes it difficult to understand why some countries experience ethnic riots and others do not, or why many stable, middle-income countries, especially in Asia, have protracted subnational conflicts. Previous research supported by The Asia Foundation has highlighted that more and better data, produced at a ...

  15. Avoiding the Fiscal Pitfalls of Subnational Regulation

    OpenAIRE

    International Finance Corporation; World Bank; Multilateral Investment Guarantee Agency

    2011-01-01

    Since investment climate reforms in developing countries started gaining traction in the 1990s, most efforts have focused on issues at the national level, achieving varying degrees of success for reasons that are relatively well understood. This handbook provides an overview of efforts and achievements in subnational investment climate reforms. It is organized as follows. Chapter 2 reviews...

  16. Electronic fetal heart rate monitoring and its relationship to neonatal and infant mortality in the United States.

    Science.gov (United States)

    Chen, Han-Yang; Chauhan, Suneet P; Ananth, Cande V; Vintzileos, Anthony M; Abuhamad, Alfred Z

    2011-06-01

    To examine the association between electronic fetal heart rate monitoring and neonatal and infant mortality, as well as neonatal morbidity. We used the United States 2004 linked birth and infant death data. Multivariable log-binomial regression models were fitted to estimate risk ratio for association between electronic fetal heart rate monitoring and mortality, while adjusting for potential confounders. In 2004, 89% of singleton pregnancies had electronic fetal heart rate monitoring. Electronic fetal heart rate monitoring was associated with significantly lower infant mortality (adjusted relative risk, 0.75); this was mainly driven by the lower risk of early neonatal mortality (adjusted relative risk, 0.50). In low-risk pregnancies, electronic fetal heart rate monitoring was associated with decreased risk for Apgar scores electronic fetal heart rate monitoring was associated with a substantial decrease in early neonatal mortality and morbidity that lowered infant mortality. Copyright © 2011 Mosby, Inc. All rights reserved.

  17. Subnational insolvency : cross-country experiences and lessons

    OpenAIRE

    Liu, Lili; Waibel, Michael

    2008-01-01

    Subnational insolvency is a reoccurring event in development, as demonstrated by historical and modern episodes of subnational defaults in both developed and developing countries. Insolvency procedures become more important as countries decentralize expenditure, taxation, and borrowing, and broaden subnational credit markets. As the first cross-country survey of procedures to resolve subna...

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

    Directory of Open Access Journals (Sweden)

    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.

  19. Obstetrical volume and early neonatal mortality in preterm infants.

    Science.gov (United States)

    Bartels, Dorothee B; Wenzlaff, Paul; Poets, Christian F

    2007-01-01

    Regionalised perinatal care with antenatal transfer of high risk pregnancies to Level III centres is beneficial. However, levels of care are usually not linked to caseload requirements, which remain a point for discussion. We aimed to investigate the impact of annual delivery volume on early neonatal mortality among very preterm births. All neonates with gestational age 24-30 weeks, born 1991-1999 in Lower Saxony were included into this population-based cohort study (n = 5,083). Large units were defined as caring for more than 1,000 deliveries/year, large NICUs as those with at least 36 annual very low birthweight (<1,500 g, VLBW) admissions. Main outcome criterion was mortality until day 7. Adjusted Odds Ratios (adj. OR) and 95% confidence intervals (CI) were calculated based on generalised estimating equation models, accounting for correlation of individuals within units. Within the first week of life, 20.6% of all neonates deceased; 10.2% were stillbirths, 3.7% died in the delivery unit, and 6.7% in the NICU. The crude OR for early neonatal mortality after having been delivered in a small delivery unit (excluding stillbirths) was 1.36 (95%CI 1.04-1.78; adj. OR 1.16 (0.82-1.63)). It increased to 1.96 (1.54-2.48; adj. OR 1.21 (0.86-1.70)) after the inclusion of stillbirths. This study has shown a slight, but non-significant association between obstetrical volume and early neonatal mortality. In future studies the impact of caseload on outcome may become more evident when referring to high-risk patients instead of to the overall number of deliveries.

  20. Correlation of Cesarean rates to maternal and infant mortality rates: an ecologic study of official international data.

    Science.gov (United States)

    Volpe, Fernando Madalena

    2011-05-01

    To correlate international official data on Cesarean delivery rates to infant and maternal mortality rates and low weight-at-birth rates; and to test the hypothesis that Cesarean rates greater than 15% correlate to higher maternal and infant mortality rates. Analyses were based on the most recent official data (2000-2009) available for 193 countries. Exponential models were compared to quadratic models to regress infant mortality rates, neonatal mortality rates, maternal mortality rates, and low weight-at-birth rates to Cesarean rates. Separate regressions were performed for countries with Cesarean rates greater than 15%. In countries with Cesarean rates less than 15%, higher Cesarean rates were associated to lower infant, neonatal, and maternal mortality rates, and to lower rates of low weight-at-birth. In countries with Cesarean rates greater than 15%, Cesarean rates were not significantly associated with infant or maternal mortality rates. There is an inverse exponential relation between countries' rates of Cesarean deliveries and infant or maternal mortality rates. Very low Cesarean rates (less than 15%) are associated with poorer maternal and child outcomes. Cesarean rates greater than 15% were neither correlated to higher maternal nor child mortality, nor to low weight-at-birth.

  1. Trends in infant mortality in United States: a brief study of the Southeastern states from 2005-2009.

    Science.gov (United States)

    He, Xiaojia; Akil, Luma; Aker, Winfred G; Hwang, Huey-Min; Ahmad, Hafiz A

    2015-05-06

    While overall infant mortality rates have declined over the past several decades, the Southeastern states have remained the leading states in high infant death in the United States. In this study, we studied the differences in infant mortality in the southeastern United States from 2005 through 2009 according to mother's characteristics (age of mother, marital status, maternal race, maternal education), birth characteristics (month when maternal prenatal care began, birth weight), and infant's characteristics (age of infant at death). This paper illustrates the significance level of each characteristic of mothers and infants, as well as socioeconomic factors that contribute to significant infant mortality that impacts subgroups within the US population. Descriptive statistics and analysis of variance studies were performed and presented. Statistical analysis of the contribution of causes of infant death to infant mortality at the national and state level was elaborated. Data suggest that mothers with no prenatal care had a very high overall infant death rate (5281.83 and 4262.16 deaths per 100,000 births in Mississippi and Louisiana, respectively, whereas the US average was 3074.82 deaths (p < 0.01)). It is suggested that better education and living quality should be available and improved for the residents in Alabama, Louisiana, and Mississippi.

  2. 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.

  3. [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.

  4. 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.

  5. Delivery indications at late-preterm gestations and infant mortality rates in the United States.

    Science.gov (United States)

    Reddy, Uma M; Ko, Chia-Wen; Raju, Tonse N K; Willinger, Marian

    2009-07-01

    The rate of preterm births has been increasing in the United States, especially for births 34 to 36 weeks of gestation (late preterm), which now constitute 71% of all preterm births. The causes for these trends remain unclear. We characterized the delivery indications for late preterm births and their potential impact on neonatal and infant mortality rates. Using the 2001 US Birth Cohort Linked birth/death files of 3 483 496 singleton births, we categorized delivery indications as follows: (1) maternal medical conditions; (2) obstetric complications; (3) major congenital anomalies; (4) isolated spontaneous labor: vaginal delivery without induction and without associated medical/obstetric factors; and (5) no recorded indication. Of the 292 627 late-preterm births, the first 4 categories (those with indications and isolated spontaneous labor) accounted for 76.8%. The remaining 23.2% (67 909) were classified as deliveries with no recorded indication. Factors significantly increasing the chance of no recorded indication were older maternal age; non-Hispanic, white mother; >/=13 years of education; Southern, Midwestern, and Western region; multiparity; or previous infant with a >/=4000-g birth weight. The neonatal and infant mortality rates were significantly higher among deliveries with no recorded indication compared with deliveries secondary to isolated spontaneous labor but lower compared with deliveries with an obstetric indication or congenital anomaly. A total of 23% of late preterm births had no recorded indication for delivery noted on birth certificates. Patient factors may be playing a role in these deliveries. It is concerning that these infants had higher mortality rates compared with those born after spontaneous labor at similar gestational ages. Given the excess risk of mortality, patients and providers need to discuss the risks of delivering a preterm infant in the absence of medical indications at 34 to 36 weeks.

  6. Inequality as a Powerful Predictor of Infant and Maternal Mortality around the World.

    Directory of Open Access Journals (Sweden)

    Juan Ignacio Ruiz

    Full Text Available Maternal and infant mortality are highly devastating, yet, in many cases, preventable events for a community. The human development of a country is a strong predictor of maternal and infant mortality, reflecting the importance of socioeconomic factors in determinants of health. Previous research has shown that the Human Development Index (HDI predicts infant mortality rate (IMR and the maternal mortality ratio (MMR. Inequality has also been shown to be associated with worse health in certain populations. The main purpose of the present study was to determine the correlation and predictive power of the Inequality Adjusted Human Development Index (IHDI as a measure of inequality with the Infant Mortality Rate (IMR, Maternal Mortality Rate (MMR, Early Neonatal Mortality Rate (ENMR, Late Neonatal Mortality Rate (LNMR, and the Post Neonatal Mortality Rate (PNMR.Data for the present study were downloaded from two sources: infant and maternal mortality data were downloaded from the Global Burden of Disease 2013 Cause of Death Database and the Human Development Index (HDI and Inequality-Adjusted Human Development Index (IHDI data were downloaded from the United Nations Development Program (UNDP. Pearson correlation coefficients were estimated, following logarithmic transformations to the data, to examine the relationship between HDI and IHDI with MMR, IMR, ENMR, LNMR, and PNMR. Steiger's Z test for the equality of two dependent correlations was utilized in order to determine whether the HDI or IHDI was more strongly associated with the outcome variables. Lastly, we constructed OLS regression models in order to determine the predictive power of the HDI and IHDI in terms of the MMR, IMR, ENMR, LNMR, and PNMR. Maternal and infant mortality were both strongly and negatively correlated with both HDI and IHDI; however, Steiger's Z test for the equality of two dependent correlations revealed that IHDI was more strongly correlated than HDI with MMR (Z = 4

  7. Public health care funding modifies the effect of out-of-pocket spending on maternal, infant, and child mortality.

    Science.gov (United States)

    Noel, Jonathan K

    2017-03-01

    Increased out-of-pocket (OOP) health care spending has been associated with increased maternal, infant, and child mortality, but the effect of public health care spending on mortality has not been studied. I identified a statistically significant interaction between public health care expenditure and OOP health care spending for maternal, infant, and child mortality. Generally, increases in public expenditure coincide with decreased rates of mortality, regardless of OOP spending levels. Specifically, higher levels of public expenditure with moderate levels of OOP spending may result in the lowest mortality rates. Increased public health care spending may improve health outcomes better than efforts to reduce OOP expenditure alone.

  8. The role of medicine in the decline of post-War infant mortality in Japan.

    Science.gov (United States)

    Yorifuji, Takashi; Tanihara, Shinichi; Inoue, Sachiko; Takao, Soshi; Kawachi, Ichiro

    2011-11-01

    The infant mortality rate (IMR) in Japan declined dramatically in the immediate post-War period (1947-60) in Japan. We compared the time trends in Growth Domestic Product (GDP) in Japan against declines in IMR. We then conducted a prefecture-level ecological analysis of the rate of decline in IMR and post-neonatal mortality from 1947 to 1960, focusing on variations in medical resources and public health strategies. IMR in Japan started to decline after World War II, even before the era of rapid economic growth and the introduction of a universal health insurance system in the 1960s. The mortality rates per 1000 infants in 2009 were 2.38 for IMR, 1.17 for neonatal mortality and 1.21 for post-neonatal mortality. The rate of decline in IMR and preventable IMR (PIMR) during the post-War period was strongly correlated with prefectural variations in medical resources (per capita physicians, nurses, and proportion of in-hospital births). The correlation coefficients comparing the number of physicians in 1955 with the declines in IMR and PIMR from 1947 to 1960 were 0.46 [95% confidence interval (CI) 0.19, 0.66] and 0.39 [95% CI 0.11, 0.61], respectively. By contrast, indicators of public health strategies were not associated with IMR decline. The IMR in Japan has been decreasing and seems to be entering a new era characterised by lower neonatal compared with post-neonatal mortality. Furthermore, the post-War history of Japan illustrates that improvement in infant mortality is attributable to the influence of medical care, even in the absence of rapid economic development. © 2011 Blackwell Publishing Ltd.

  9. 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

  10. 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.

  11. Differential Neonatal and Postneonatal Infant Mortality Rates across US Counties: The Role of Socioeconomic Conditions and Rurality

    Science.gov (United States)

    Sparks, P. Johnelle; McLaughlin, Diane K.; Stokes, C. Shannon

    2009-01-01

    Purpose: To examine differences in correlates of neonatal and postneonatal infant mortality rates, across counties, by degree of rurality. Methods: Neonatal and postneonatal mortality rates were calculated from the 1998 to 2002 Compressed Mortality Files from the National Center for Health Statistics. Bivariate analyses assessed the relationship…

  12. Trends in Infant Mortality in United States: A Brief Study of the Southeastern States from 2005–2009

    Science.gov (United States)

    He, Xiaojia; Akil, Luma; Aker, Winfred G.; Hwang, Huey-Min; Ahmad, Hafiz A.

    2015-01-01

    While overall infant mortality rates have declined over the past several decades, the Southeastern states have remained the leading states in high infant death in the United States. In this study, we studied the differences in infant mortality in the southeastern United States from 2005 through 2009 according to mother’s characteristics (age of mother, marital status, maternal race, maternal education), birth characteristics (month when maternal prenatal care began, birth weight), and infant’s characteristics (age of infant at death). This paper illustrates the significance level of each characteristic of mothers and infants, as well as socioeconomic factors that contribute to significant infant mortality that impacts subgroups within the US population. Descriptive statistics and analysis of variance studies were performed and presented. Statistical analysis of the contribution of causes of infant death to infant mortality at the national and state level was elaborated. Data suggest that mothers with no prenatal care had a very high overall infant death rate (5281.83 and 4262.16 deaths per 100,000 births in Mississippi and Louisiana, respectively, whereas the US average was 3074.82 deaths (p < 0.01)). It is suggested that better education and living quality should be available and improved for the residents in Alabama, Louisiana, and Mississippi. PMID:25955527

  13. Trends in Infant Mortality in United States: A Brief Study of the Southeastern States from 2005–2009

    Directory of Open Access Journals (Sweden)

    Xiaojia He

    2015-05-01

    Full Text Available While overall infant mortality rates have declined over the past several decades, the Southeastern states have remained the leading states in high infant death in the United States. In this study, we studied the differences in infant mortality in the southeastern United States from 2005 through 2009 according to mother’s characteristics (age of mother, marital status, maternal race, maternal education, birth characteristics (month when maternal prenatal care began, birth weight, and infant’s characteristics (age of infant at death. This paper illustrates the significance level of each characteristic of mothers and infants, as well as socioeconomic factors that contribute to significant infant mortality that impacts subgroups within the US population. Descriptive statistics and analysis of variance studies were performed and presented. Statistical analysis of the contribution of causes of infant death to infant mortality at the national and state level was elaborated. Data suggest that mothers with no prenatal care had a very high overall infant death rate (5281.83 and 4262.16 deaths per 100,000 births in Mississippi and Louisiana, respectively, whereas the US average was 3074.82 deaths (p < 0.01. It is suggested that better education and living quality should be available and improved for the residents in Alabama, Louisiana, and Mississippi.

  14. Temporal changes in rates of stillbirth, neonatal and infant mortality among triplet gestations in the United States.

    Science.gov (United States)

    Getahun, Darios; Amre, Devendra K; Ananth, Cande V; Demissie, Kitaw; Rhoads, George G

    2006-12-01

    The purpose of this study was to examine temporal changes in stillbirth, neonatal and infant mortality rates among triplet births in the US, and to assess the contributions of triplet delivery at infant deaths (1990-2002) delivered at > or = 22 weeks and fetuses weighing > or = 500 g (n = 66,986) were derived from the US linked birth/infant death data files. Relative risk (RR), quantifying changes in triplet stillbirth, neonatal (death within the first 28 days) and infant mortality (death within the first year) rates between 1990 and 1991 and 2001 and 2002, were derived. Temporal changes in triplet births at infant mortality rates were examined through logistic regression models before and after adjusting for confounders. Triplet births at infant mortality rates declined by 52% (RR 0.48, 95% confidence interval [CI] 0.36-0.63), 32% (RR 0.68, 95% CI 0.58-0.80), and 38% (RR 0.62, 95% CI 0.53-0.71), respectively, between 1990 and 1991 and 2001 and 2002. The increase in triplet births at infant deaths, respectively. Our findings suggest that the increase in triplet births at infant mortality.

  15. Individual, Household, and Community U.S. Migration Experience and Infant Mortality in Rural and Urban Mexico.

    Science.gov (United States)

    Hamilton, Erin R; Villarreal, Andrés; Hummer, Robert A

    2009-01-01

    This study explores rural and urban differences in the relationship between U.S. migration experience measured at the individual, household, and community levels and individual-level infant mortality outcomes in a national sample of recent births in Mexico. Using 2000 Mexican Census data and multi-level regression models, we find that women's own U.S. migration experience is associated with lower odds of infant mortality in both rural and urban Mexico, possibly reflecting a process of healthy migrant selectivity. Household migration has mixed blessings for infant health in rural places: remittances are beneficial for infant survival, but recent out-migration is disruptive. Recent community-level migration experience is not significantly associated with infant mortality overall, although in rural places, there is some evidence that higher levels of community migration are associated with lower infant mortality. Household- and community-level migration have no relationship with infant mortality in urban places. Thus, international migration is associated with infant outcomes in Mexico in fairly complex ways, and the relationships are expressed most profoundly in rural areas of Mexico.

  16. 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.

  17. 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.

  18. 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; DʼOnofrio, Brian M; Khashan, Ali S

    2015-10-01

    Preconception maternal bereavement may be associated with an increased risk for infant mortality, although 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. Using a Danish population-based sample of offspring born 1979 to 2009 (N = 1,865,454), we analyzed neonatal (0-28 days), postneonatal infant (29-364 days), and early childhood (1-5 years) mortality after 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 regressions that were adjusted for offspring, mother, and father sociodemographic and health factors. We identified 6541 (0.004%) neonates, 3538 (0.002%) postneonates, and 2132 (0.001%) children between the ages of 1 and 5 years who died. After adjusting for covariates, bereavement during the preconception period was associated with increased odds of neonatal (adjusted odds ratio = 1.87, 95% confidence interval = 1.53-2.30) and postneonatal infant mortality (adjusted odds ratio = 1.52, 95% confidence interval = 1.15-2.02). Associations were timing specific (6 months before 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. Results support and extend previous findings linking bereavement during the preconception period with increased odds of early offspring mortality. The period immediately before pregnancy may be a sensitive period with potential etiological implications and ramifications for offspring mortality.

  19. Reactor accident and infant mortality?; Reaktorkatastrophe und Saeuglingssterblichkeit?

    Energy Technology Data Exchange (ETDEWEB)

    Kellerer, A.M. [Gesellschaft fuer Strahlen- und Umweltforschung mbH Muenchen, Neuherberg (Germany). Inst. fuer Strahlenbiologie]|[Muenchen Univ. (Germany). Strahlenbiologisches Inst.

    1998-12-31

    The publication discusses a hypothesis that for some years now has been an item of debate in the public media and by political groups. Having a closer look at the statements of the hypothesis, they actually do not convince an expert and do not really justify scientific debate. However, in view of the many publications issued by the time, of which most rather obscured an unbiased view of the problems involved by presenting mathematical formalism, it seems appropriate to make an attempt for clarification. In addition, it is hoped that a discussion of facts and figures beyond the problem of perinatal mortality in this context will help facilitate an understanding of the risks of low-dose exposure to ionizing radiation. (orig./CB) [Deutsch] Es geht um eine Hypothese, die bereits seit mehreren Jahren die Medien und selbst politische Gremien beschaeftigt. Ihre Ueberzeugungskraft koennte bei genauerer Inspektion der Daten als zu gering erscheinen, um ausfuehrliche Eroerterungen wirklich zu rechtfertigen. Andererseits ist nach einer Vielzahl von Veroeffentlichungen und Schriftsaetzen, in denen Annahmen und Ueberlegungen meist hinter mathematischem Formalismus verborgen blieben, eine Klaerung angebracht. Zudem kann die Diskussion, ueber das Beispiel der perinatalen Sterblichkeit hinaus, generell das Verstaendnis der Risiken kleiner Strahlendosen erleichtern. (orig.)

  20. The impact of fiscal decentralization on infant mortality rates: evidence from OECD countries.

    Science.gov (United States)

    Jiménez-Rubio, Dolores

    2011-11-01

    This study re-examines the hypothesis that shifts towards more decentralization would be accompanied by improvements in population health on a panel of 20 OECD countries over a thirty year period (1970-2001). Decentralization is proxied using a conventional indicator of revenue decentralization and a new measure of fiscal decentralization that reflects better than previous measures the existence of autonomy in the decision-making authority of lower tiers of government, a crucial issue in the decentralization process. The results show a considerable and positive effect of fiscal decentralization on infant mortality only if a substantial degree of autonomy in the sources of revenue is devolved to local governments. The proportion of health care expenditure on GDP and, in particular, education, were found to have a larger contribution to the reduction of infant mortality in the sample of OECD countries analysed over the period of study. Copyright © 2011 Elsevier Ltd. All rights reserved.

  1. Subnational electoral contexts and corruption in Mexico

    OpenAIRE

    Faughnan, Brian M.; Hiskey, Jonathan; Revey, Scott D.

    2014-01-01

    "Scholars of the world's most recent democratization processes have tended to focus on how national-level institutions have developed and how citizens have interpreted and responded to those developments. In this paper, we argue that the distinct subnational political environments that emerge from uneven national regime transitions are important determinants of how people view their political world. Specifically, we argue that citizens' experiences with and attitudes towards corruption are pa...

  2. Sub-national Revenue Mobilization in Peru

    OpenAIRE

    Canavire-Bacarreza, Gustavo; Martinez-Vazquez, Jorge; Sepulveda, Cristian

    2012-01-01

    This paper analyzes the problem of sub-national revenue mobilization in Peru and proposes several policy reforms to improve collection performance while maintaining a sound revenue structure. In particular, the paper analyzes the current revenues of regional and municipal governments and identifies the main priorities for reform. Among the most important problems are the acute inequalities and inefficiencies associated with revenue sharing from extractive industries. These revenues represent ...

  3. 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.

  4. Variations of Infant and Under-five Child Mortality Rates around the World, the Role of Human Development Index (HDI

    Directory of Open Access Journals (Sweden)

    Salman Khazaei

    2016-05-01

    Full Text Available Background: The Human Development Index (HDI is a composite statistic of life expectancy, education, and income per capita indicators, which apart from measuring the socio-economic development of countries can predict health outcomes. The current study aimed at determination of the effects of HDI individual components on infant and child mortality. Materials and Methods: At a cross- sectional study,data on infant and child mortality rates and values for HDI individual components were obtained from the World Health Organization (WHO and the World Bank respectively. The effect of HDI individual components on infant and child mortality were derived from linear regression models. Results: During 1990-2015, infant and child mortality have declined in all countries. Most proportion of child mortality is attributed to death in infants. All HDI individual components significantly  inversely were related to infant mortality rate (IMR and among them expected years of schooling has the strongest effect with regression coefficient of β= -5.9 (95% CI: -6.63, -5.13. Conclusion: The highest IMRs have been observed for EMRO and AFRO regions of the WHO. Policies targeting women health and empowerment can have a tremendous impact on reducing child mortality rates around the world.

  5. Trends and Disparities in Infant and Child Mortality in Nigeria Using Pooled 2003 and 2008 Demographic and Health Survey Data

    Directory of Open Access Journals (Sweden)

    Okechukwu D. Anyamele

    2015-10-01

    Full Text Available We analyze infant and under-5 mortality trends in Nigeria using data from the demographic and health surveys (DHS of 2003 and 2008. We use pooled data to enable us carry out logistic regression analysis at the state level and allow for robustness of our results. Our analysis shows wide disparities in both infant and under-5 mortality rates in the six geopolitical zones of Nigeria and the 36 states and the Federal Capital Territory Abuja. Furthermore, the results show highly significant differences in infant and under-5 mortality rates among the six geopolitical zones and among the 36 states of Nigeria. Our result shows that urban advantage over rural areas in under-5 mortality rate only exist among the richest quintiles in Nigeria. We find no evidence of statistically significant difference between the urban poorest and poorer quintiles and the rural poorest and poorer quintiles in both infant and under-5 mortality in Nigeria. We find wealth, educational attainment of the mother, the use of health facility, religion, gender of a child, and number of births in the last 3 years to be highly correlated with infant and under-5 mortality in Nigeria. Both infant and under-5 mortality rates declined between 2003 and 2008 in Nigeria.

  6. Laryngotracheobronchial anomalies in infants and the related risk factors of in-hospital mortality

    Directory of Open Access Journals (Sweden)

    Kang-Lung Lee

    2016-04-01

    Conclusion: Most infants with LTBAs were initially diagnosed and hospitalized when they were aged 3 months or younger. The risk factors for in-hospital mortality of the children with LTBAs included being diagnosed and treated at an age of 4 months and older, and the presence of perinatal disease, cardiovascular anomalies, other congenital anomalies, neurological diseases, and an age of 4 months and older.

  7. Social Conditions and Infant Mortality in China: A Test of the Fundamental Cause

    OpenAIRE

    Song, Shige; Burgard, Sarah A

    2008-01-01

    The fundamental cause argument represents a distinctively sociological approach to explaining persistent social disparities in health across a range of sociohistorical contexts. We elaborate and test this U.S.-based argument using nationally representative survey data from China covering births from 1970 to 2001, and focusing on social disparities in infant mortality over a period of dramatic social, political, and macroeconomic change. Our results show that despite the massive changes during...

  8. Elevated Infant Mortality Rate among Dutch Oral Cleft Cases: A Retrospective Analysis from 1997 to 2011

    OpenAIRE

    Daan Pieter Frederik Van Nunen; van den Boogaard, Marie-José H; J. Peter W. eDon Griot; Mike eRüttermann; Lars TJ Van der Veken; Corstiaan eBreugem

    2014-01-01

    Objectives: First, to determine the infant mortality rate for Dutch patients with isolated oral clefts as well as for patients with clefts seen in association with other malformations. Second, to conduct a similar analysis per cleft type: cleft lip with or without cleft palate, cleft palate (including Robin sequence). Third, to examine the underlying causes of death. Material and methods: A retrospective review of the charts of patients with oral clefts born in the period 1997-2011 and treate...

  9. State downsizing as a determinant of infant mortality and achievement of Millennium Development Goal 4

    OpenAIRE

    Palma Solís, Marco Antonio; Álvarez-Dardet Díaz, Carlos; Franco Giraldo,Álvaro; Hernández Aguado, Ildefonso; Pérez Hoyos, Santiago

    2009-01-01

    The aim of this study was to evaluate the worldwide effect of state downsizing policies on achievement of U.N. Millennium Development Goal 4 (MDG4) on infant mortality rates. In an ecological retrospective cohort study of 161 countries, from 1978 to 2002, the authors analyzed changes in government consumption (GC) as determining exposure to achievement of MDG4. Descriptive methods and a multiple logistic regression were applied to adjust for changes in gross domestic product, level of democra...

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

    OpenAIRE

    Lawvere Silvana; Mahoney Martin C; Zichittella Lauren J; Michalek Arthur M; Chunikhovskiy Sergey P; Khotianov Natan

    2004-01-01

    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 d...

  11. Infant mortality in Brazil, 1980-2000: A spatial panel data analysis

    Directory of Open Access Journals (Sweden)

    Barufi Ana

    2012-03-01

    Full Text Available Abstract Background Infant mortality is an important measure of human development, related to the level of welfare of a society. In order to inform public policy, various studies have tried to identify the factors that influence, at an aggregated level, infant mortality. The objective of this paper is to analyze the regional pattern of infant mortality in Brazil, evaluating the effect of infrastructure, socio-economic, and demographic variables to understand its distribution across the country. Methods Regressions including socio-economic and living conditions variables are conducted in a structure of panel data. More specifically, a spatial panel data model with fixed effects and a spatial error autocorrelation structure is used to help to solve spatial dependence problems. The use of a spatial modeling approach takes into account the potential presence of spillovers between neighboring spatial units. The spatial units considered are Minimum Comparable Areas, defined to provide a consistent definition across Census years. Data are drawn from the 1980, 1991 and 2000 Census of Brazil, and from data collected by the Ministry of Health (DATASUS. In order to identify the influence of health care infrastructure, variables related to the number of public and private hospitals are included. Results The results indicate that the panel model with spatial effects provides the best fit to the data. The analysis confirms that the provision of health care infrastructure and social policy measures (e.g. improving education attainment are linked to reduced rates of infant mortality. An original finding concerns the role of spatial effects in the analysis of IMR. Spillover effects associated with health infrastructure and water and sanitation facilities imply that there are regional benefits beyond the unit of analysis. Conclusions A spatial modeling approach is important to produce reliable estimates in the analysis of panel IMR data. Substantively, this paper

  12. A Major Cause of Mortality and Morbidity of Very Low Birth Weight Infants: Patent Ductus Arteriosus

    OpenAIRE

    Fatih Aygün; Nilgün Köksal; Özlem M. Bostan; Fahrettin Uysal; İpek Güney Varal; Pelin Doğan

    2012-01-01

    In­tro­duc­ti­on: Patent Ductus Arteriosus (PDA), a cardiac pathology commonly seen in preterm infants, has negative effects on mortality and morbidity. Persistent patency of PDA is positively correlated with respiratory distress syndrome (RDS), prolonged respiratory support, pulmonary hemorrhage, broncopulmonary dysplasia (BPD), necrotizing enterocolitis (NEC), intraventricular hemorrhage, renal failure, neurodevelopmental impairment (cerebral palsy), retinopathy of prematurity and death. Th...

  13. Women's education, infant and child mortality, and fertility decline in urban and rural sub-Saharan Africa

    National Research Council Canada - National Science Library

    David Shapiro; Michel Tenikue

    2017-01-01

    Background: This paper provides estimates of the contributions of increased women's education and reduced infant and child mortality to fertility declines in urban and rural areas of countries in Sub-Saharan...

  14. A Review of Aboriginal Infant Mortality Rates in Canada: Striking and Persistent Aboriginal/Non-Aboriginal Inequities

    National Research Council Canada - National Science Library

    Janet Smylie; Deshayne Fell; Arne Ohlsson

    2010-01-01

    ... of national Aboriginal organizations and federal and provincial/territorial stakeholders. Our objective was to better understand what is currently known about Aboriginal infant mortality rates (IMR) in Canada. Methods...

  15. Factors associated with infant mortality in Nepal: a comparative analysis of Nepal demographic and health surveys (NDHS) 2006 and 2011.

    Science.gov (United States)

    Lamichhane, Reeta; Zhao, Yun; Paudel, Susan; Adewuyi, Emmanuel O

    2017-01-10

    Infant mortality is one of the priority public health issues in developing countries like Nepal. The infant mortality rate (IMR) was 48 and 46 per 1000 live births for the year 2006 and 2011, respectively, a slight reduction during the 5 years' period. A comprehensive analysis that has identified and compared key factors associated with infant mortality is limited in Nepal, and, therefore, this study aims to fill the gap. Datasets from Nepal Demographic and Health Surveys (NDHS) 2006 and 2011 were used to identify and compare the major factors associated with infant mortality. Both surveys used multistage stratified cluster sampling techniques. A total of 8707 and 10,826 households were interviewed in 2006 and 2011, with more than 99% response rate in both studies. The survival information of singleton live-born infants born 5 years preceding the two surveys were extracted from the 'childbirth' dataset. Multiple logistic regression analysis using a hierarchical modelling approach with the backward elimination method was conducted. Complex Samples Analysis was used to adjust for unequal selection probability due to the multistage stratified cluster-sampling procedure used in both NDHS. Based on NDHS 2006, ecological region, succeeding birth interval, breastfeeding status and type of delivery assistance were found to be significant predictors of infant mortality. Infants born in hilly region (AOR = 0.43, p = 0.013) and with professional assistance (AOR = 0.27, p = 0.039) had a lower risk of mortality. On the other hand, infants with succeeding birth interval less than 24 months (AOR = 6.66, p = 0.001) and those who were never breastfed (AOR = 1.62, p = 0.044) had a higher risk of mortality. Based on NDHS 2011, birth interval (preceding and succeeding) and baby's size at birth were identified to be significantly associated with infant mortality. Infants born with preceding birth interval (AOR = 1.94, p = 0.022) or succeeding

  16. Maternal social characteristics and mortality from injuries among infants and toddlers in Estonia.

    Science.gov (United States)

    Tiikkaja, S; Rahu, K; Koupil, I; Rahu, M

    2009-08-01

    Injuries are a major cause of ill health among children, with a social gradient in child injuries documented in many countries. The effects of maternal sociodemographic characteristics on injury mortality in Estonian infants and toddlers were investigated. A population-based study using linkage of data from the Estonian Medical Birth Registry with Mortality Database. A total of 148 521 children born 1992-2002 were followed for injury mortality (ICD-9 E800-E999) from birth to third birthday. Associations of maternal age, education, marital status, nationality, place of residence and child's birth order and multiplicity with risk of injury death were studied using logistic regression. Maternal age ( or =30 years: OR 2.12; 95% CI 1.00 to 4.51), education (basic compared with secondary or higher: OR 3.22; 95% CI 2.12 to 4.87), marital status (single, divorced or widowed compared with married: OR 2.74; 95% CI 1.53 to 4.91), nationality (other compared with Estonian: OR 2.00; 95% CI 1.32 to 3.02), birth order (fourth or higher compared with first: OR 6.66; 95% CI 3.42 to 12.99), and multiple birth (twin or triplet compared with singleton: OR 3.12; 95% CI 1.44 to 6.73) affected the risk of injury death among infants (birth order (fourth or higher compared with first: OR 7.88; 95% CI 3.90 to 15.90) increased the risk of injury death. Maternal sociodemographic characteristics are associated with injury mortality among infants and toddlers. Substantial variation in injury mortality rates within Estonia suggests potential for prevention.

  17. An Investigation of the Mortality Rate and Risk Factors in Newborn Infants With Meconium Aspiration Syndrome

    Directory of Open Access Journals (Sweden)

    Sabzehei

    2016-08-01

    Full Text Available Background One of the serious challenges facing neonatal medicine is meconium aspiration syndrome, delays in the treatment of which can lead to high mortality. Objectives This study was designed and conducted with the aim of determining the mortality rate and risk factors affecting this rate in newborn infants with meconium aspiration syndrome. Methods This study was conducted as a retrospective descriptive research on newborn infants with meconium aspiration syndrome hospitalized at the neonatal intensive care unit (NICU of Fatemieh and Be’sat hospitals in Hamadan city during a 10-year period from 2004 to 2014. Demographic information of the mother and the newborn, hospitalization course, the need for mechanical ventilation, and complications and outcomes of disease were extracted and were analyzed using the SPSS software version 22. Results Sixty-three newborn infants, diagnosed with meconium aspiration syndrome, were entered in this study, 40% of them were male, 85.7% wighed more than 2500 g, and 17.5% were post term, 25.3% had a five-minute Apgar Score (AS5min of less than seven, 39.6% were nonvigorous at birth, 31.8% needed to be placed on mechanical ventilation, and 14.3% died during the hospitalization course. There was a significant relationship between the need for mechanical ventilation, nonvigorous state at the birth, complications of disease and mortality rate. Conclusions Despite the progress made in medicine, meconium aspiration syndrome is still one of the causes of newborn infants’ mortality. The mortality and morbidity rates can be reduced by improvement in perinatal care, prevention of post term delivery, timely caesarean and effective neonatal resuscitation at birth.

  18. Denied their ‘natural nourishment’: religion, causes of death and infant mortality in the Netherlands, 1875-1899

    NARCIS (Netherlands)

    van den Boomen, N.; Ekamper, P.

    2015-01-01

    At the end of the nineteenth century, infant mortality rates started to fall rapidly in the Netherlands. Unfortunately, not all regions benefited from this development. High infant death in the Roman Catholic provinces of North-Brabant and Limburg has often been ascribed to a growing reluctance of

  19. Trends in racial and ethnic disparities in infant mortality rates in the United States, 1989-2006

    National Research Council Canada - National Science Library

    Rossen, Lauren M; Schoendorf, Kenneth C

    2014-01-01

    ... may have changed over time. We used Birth Cohort Linked Birth-Infant Death Data Files from US Vital Statistics from 1989-1990 and 2005-2006 to examine multigroup indices of racial and ethnic disparities in the overall infant mortality rate (IMR...

  20. Paradox Revisited: A Further Investigation of Race/Ethnic Differences in Infant Mortality by Maternal Age1

    Science.gov (United States)

    Powers, Daniel A.

    2013-01-01

    We reexamine the epidemiological paradox of lower overall infant mortality rates in the Mexican-origin population relative to US-born non-Hispanic whites using the 1995–2002 U.S. NCHS linked cohort birth-infant death files. A comparison of infant mortality rates among US-born non-Hispanic white and Mexican-origin mothers by maternal age reveals an infant survival advantage at younger maternal ages when compared to non-Hispanic whites, which is consistent with the Hispanic infant mortality paradox. However, this is accompanied by higher infant mortality at older ages for Mexican-origin women, which is consistent with the weathering framework. These patterns vary by nativity of the mother and do not change when rates are adjusted for risk factors. The relative infant survival disadvantage among Mexican-origin infants born to older mothers may be attributed to differences in the socioeconomic attributes of US-born non-Hispanic white and Mexican-origin women. PMID:23055238

  1. Effects of antenatal corticosteroid administration on mortality and long-term morbidity in early preterm, growth-restricted infants

    NARCIS (Netherlands)

    Schaap, AH; Wolf, H; Bruinse, HW; Smolders-De Haas, H; Van Ertbruggen, [No Value; Treffers, PE

    Objective: To evaluate the effect of antenatal corticosteroids on mortality, morbidity, and disability or handicap rate in early preterm, growth-restricted infants. Methods: This case-control study in two tertiary care centers included all live-born singleton infants with growth-restriction due to

  2. Kangaroo mother care to reduce morbidity and mortality in low birthweight infants.

    Science.gov (United States)

    Conde-Agudelo, Agustin; Díaz-Rossello, José L

    2016-08-23

    Kangaroo mother care (KMC), originally defined as skin-to-skin contact between a mother and her newborn, frequent and exclusive or nearly exclusive breastfeeding, and early discharge from hospital, has been proposed as an alternative to conventional neonatal care for low birthweight (LBW) infants. To determine whether evidence is available to support the use of KMC in LBW infants as an alternative to conventional neonatal care before or after the initial period of stabilization with conventional care, and to assess beneficial and adverse effects. We used the standard search strategy of the Cochrane Neonatal Review Group. This included searches in CENTRAL (Cochrane Central Register of Controlled Trials; 2016, Issue 6), MEDLINE, Embase, CINAHL (Cumulative Index to Nursing and Allied Health Literature), LILACS (Latin American and Caribbean Health Science Information database), and POPLINE (Population Information Online) databases (all from inception to June 30, 2016), as well as the WHO (World Health Organization) Trial Registration Data Set (up to June 30, 2016). In addition, we searched the web page of the Kangaroo Foundation, conference and symposia proceedings on KMC, and Google Scholar. Randomized controlled trials comparing KMC versus conventional neonatal care, or early-onset KMC versus late-onset KMC, in LBW infants. Data collection and analysis were performed according to the methods of the Cochrane Neonatal Review Group. Twenty-one studies, including 3042 infants, fulfilled inclusion criteria. Nineteen studies evaluated KMC in LBW infants after stabilization, one evaluated KMC in LBW infants before stabilization, and one compared early-onset KMC with late-onset KMC in relatively stable LBW infants. Sixteen studies evaluated intermittent KMC, and five evaluated continuous KMC. KMC versus conventional neonatal care: At discharge or 40 to 41 weeks' postmenstrual age, KMC was associated with a statistically significant reduction in the risk of mortality (risk

  3. Examining the spatially non-stationary associations between the second demographic transition and infant mortality: A Poisson GWR approach

    Science.gov (United States)

    Yang, Tse-Chuan; Shoff, Carla; Matthews, Stephen A.

    2014-01-01

    Based on ecological studies, second demographic transition (SDT) theorists concluded that some areas in the US were in vanguard of the SDT compared to others, implying spatial nonstationarity may be inherent in the SDT process. Linking the SDT to the infant mortality literature, we sought out to answer two related questions: Are the main components of the SDT, specifically marriage postponement, cohabitation, and divorce, associated with infant mortality? If yes, do these associations vary across the US? We applied global Poisson and geographically weighted Poisson regression (GWPR) models, a place-specific analytic approach, to county-level data in the contiguous US. After accounting for the racial/ethnic and socioeconomic compositions of counties and prenatal care utilization, we found (1) marriage postponement was negatively related to infant mortality in the southwestern states, but positively associated with infant mortality in parts of Indiana, Kentucky, and Tennessee, (2) cohabitation rates were positively related to infant mortality, and this relationship was stronger in California, coastal Virginia, and the Carolinas than other areas, and (3) a positive association between divorce rates and infant mortality in southwestern and northeastern areas of the US. These spatial patterns suggested that the associations between the SDT and infant mortality were stronger in the areas in vanguard of the SDT than in others. The comparison between global Poisson and GWPR results indicated that a place-specific spatial analysis not only fit the data better, but also provided insights into understanding the non-stationarity of the associations between the SDT and infant mortality. PMID:25383259

  4. [Factor analysis on trend of infant mortality and maternal health management in Henan province from 2000 to 2010].

    Science.gov (United States)

    Zhu, Xin-yi; Huang, Zuo-jun; Liu, Li-rong; Cui, Zhao-lin

    2012-09-01

    To understand the trends and influential factors on infant mortality in Henan province from 2000 to 2010. Descriptive method, Cox-Stuart trend test and multiple linear regression were used to study the infant mortality trends and related influential factors in the regions with monitoring programs of Henan province, from 2000 to 2010. The total urban and rural infant mortality rates dropped significantly, from 30.91 per thousand, 10.05 per thousand, 33.99 per thousand in 2000 to 7.12 per thousand, 5.51 per thousand, 8.03 per thousand in 2010, respectively. The average annual rates of decrease were 13.65 percent, 5.83 percent and 13.44 percent. The downward trends were statistically significant (P infant mortality rates dropped more significantly in rural areas (25.96%) than in the urban areas (4.54%). Difference between urban and rural areas reduced from 23.49% to 2.52%. Rates on factors as setting up maternal record cards, carrying on postpartum visits, hospital delivery, or under help by new midwives and low birth weight rate etc. were remarkably influencing the rate on infant mortality (F = 229.738, P = 0.004). In order, the impact of strengths on those factors showed as: hospitalized delivery rate, low birth weight rate, the rate of 'clean' delivery, setting up record cards on postpartum visits. Total provincial, urban and rural infant mortality rates all showed downward trends. The infant mortality rates dropped more significantly in rural areas than in urban areas. Difference between urban and rural areas was gradually getting small. Rates on setting up maternal record cards, carrying on postpartum visit, hospital delivery and under help by new midwives rate were important factors that significantly impacting the infant mortality rate. Work on setting up record cards and hospital delivery should be further strengthened.

  5. Infant mortality evolution in Romania: perspectives from a country in transition

    Science.gov (United States)

    Burlea, A.-M.; Muntele, I.

    2012-04-01

    In the last two decades transition was a word used to describe the important mutations that have characterized social and economic structures in Romania. All the changes left their mark on every aspects of life including on population health status, and all modifications were reflected in the evolution of health indicators. Considered one of the most sensitive indicators of living conditions, population health literacy level and healthcare system efficiency infant mortality rate is a negative indicator which reflects the intensity of children deaths before their first anniversary. Based on the current statistical data collected at county level, this research aims to underline the existing spatial differences in Romania at county level, to identify spatial patterns, time trend and to point out the territories that need special attention and a more profound analysis for understanding the causes that are generating them. Using mathematical and statistical methods we have calculated infant mortality for a previous and available period of time (1990 - 2010) and identified a trend influenced by exogenous and endogenous factors. With the help of GIS techniques we have created cartographic material for allowing us an easier identification of spatial disparities. Following the global trend, Romania achieved significant progress in reduction infant mortality. From values that exceeded 26 ‰ at the beginning of the nineties this indicator has continued to diminish until 9.79 ‰ in 2010. But, with all the improvements, value is still double in compare with European Union average. Although characteristic for Romania is the general downward trend, at the county level there can be identified different types of evolution and different spatial pattern. Having the lowest economic development level in the country, Northeast and Southeast counties maintain high values for infant mortality rate. Positive examples are given by Bucharest and some central and western districts, all with

  6. Effect of fluconazole prophylaxis on candidiasis and mortality in premature infants: A randomized clinical trial

    Science.gov (United States)

    Benjamin, Daniel K.; Hudak, Mark L.; Duara, Shahnaz; Randolph, David A.; Bidegain, Margarita; Mundakel, Gratias T.; Natarajan, Girija; Burchfield, David J.; White, Robert D.; Shattuck, Karen E.; Neu, Natalie; Bendel, Catherine M.; Kim, M. Roger; Finer, Neil N.; Stewart, Dan L.; Arrieta, Antonio C.; Wade, Kelly C.; Kaufman, David A.; Manzoni, Paolo; Prather, Kristi O.; Testoni, Daniela; Berezny, Katherine Y.; Smith, P. Brian

    2014-01-01

    IMPORTANCE Invasive candidiasis in premature infants causes mortality and neurodevelopmental impairment. Fluconazole prophylaxis reduces candidiasis, but its effect on mortality and the safety of fluconazole is unknown. OBJECTIVE To evaluate the efficacy and safety of fluconazole in preventing death or invasive candidiasis in extremely low-birth-weight infants. DESIGN, SETTING, AND PATIENTS This study was a randomized, blinded, placebo-controlled trial of fluconazole in premature infants. Infants weighing less than 750 g at birth (N = 361) from 32 neonatal intensive care units (NICUs) in the United States were randomly assigned to receive either fluconazole or placebo twice weekly for 42 days. Surviving infants were evaluated at 18 to 22 months corrected age for neurodevelopmental outcomes. The study was conducted between November 2008 and February 2013. INTERVENTIONS Fluconazole (6 mg/kg of body weight) or placebo. MAIN OUTCOMES AND MEASURES The primary end point was a composite of death or definite or probable invasive candidiasis prior to study day 49 (1 week after completion of study drug). Secondary and safety outcomes included invasive candidiasis, liver function, bacterial infection, length of stay, intracranial hemorrhage, periventricular leukomalacia, chronic lung disease, patent ductus arteriosus requiring surgery, retinopathy of prematurity requiring surgery, necrotizing enterocolitis, spontaneous intestinal perforation, and neurodevelopmental outcomes—defined as a Bayley-III cognition composite score of less than 70, blindness, deafness, or cerebral palsy at 18–22-months corrected age. RESULTS Among infants receiving fluconazole, the composite primary end point of death or invasive candidiasis was 16% (95% CI, 11%–22%) vs 21% in the placebo group (95% CI, 15%–28%; odds ratio 0.73 [95% CI 0.43–1.23]; P=.24; treatment difference −5% [95% CI, −13%–3%]). Invasive candidiasis occurred less frequently in the fluconazole group (3% [95% CI, 1%

  7. Brazil's conditional cash transfer program associated with declines in infant mortality rates.

    Science.gov (United States)

    Shei, Amie

    2013-07-01

    Conditional cash transfer programs are innovative social safety-net programs that aim to relieve poverty. They provide a regular source of income to poor families and are "conditional" in that they require poor families to invest in the health and education of their children through greater use of educational and preventive health services. Brazil's Bolsa Família conditional cash transfer program, created in 2003, is the world's largest program of its kind. During the first five years of the program, it was associated with a significant 9.3 percent reduction in overall infant mortality rates, with greater declines in postneonatal mortality rates than in mortality rates at an earlier age and in municipalities with many users of Brazil's Family Health Program than in those with lower use rates. There were also larger effects in municipalities with higher infant mortality rates at baseline. Programs like Bolsa Família can improve child health and reduce long-standing health inequalities. Policy makers should review the adequacy of basic health services to ensure that the services can respond to the increased demand created by such programs. Programs should also target vulnerable groups at greatest risk and include careful monitoring and evaluation.

  8. 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

    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 (... a very beneficial effect in the neonatal period. We therefore conducted the present trial to test whether early BCG-Denmark reduces neonatal mortality by 45%. We also conducted a meta-analysis of the 3 BCG-Denmark trials. Methods. In 2008–2013, we randomized LW neonates to “early BCG......-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...

  9. 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 (mortality (28-364 days) by state and month from 1980 through 2011. All models included state and year fixed effects as well as state-specific covariates. Across all models, a dollar increase in the 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.

  10. EVALUATION OF THE SUB-NATIONAL DECENTRALIZATION OF THE HEALTH IN VENEZUELA INFANTILE MATERNAL PROGRAM

    Directory of Open Access Journals (Sweden)

    Maritza Ávila Urdaneta

    2009-11-01

    Full Text Available The work approaches the evaluation of the decentralization of the health at sub-national level in Venezuela, maternal program Infantile (PROMIN, period 1998-2004: Case of study, Estado Zulia. With the samples of ten Municipalities and Coordinators of Health (CH. Of the results and conclusions, it is appraised that in Venezuela with the Model of Integral Attention with respect to the PROMIN (1998-2004, the reason of Maternal Mortality RMM average for the country ascends to 60 by 100,000 NVR (OPS, 2003, whereas in Zulia was in 79,9; they emphasize the Municipalities: Cañada de Urdaneta with but the high one of 214.13, followed of Mara 149.44 by 100,000 NVR. Key words: Sub-national decentralization of the Health, Infantile Maternal Program, Indicating of Morbidity and Mortality, Coordination of the Municipal Health.

  11. 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

  12. 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.

  13. 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

  14. Differences in perinatal and infant mortality in high-income countries: artifacts of birth registration or evidence of true differences?

    Science.gov (United States)

    Deb-Rinker, Paromita; León, Juan Andrés; Gilbert, Nicolas L; Rouleau, Jocelyn; Andersen, Anne-Marie Nybo; Bjarnadóttir, Ragnheiður I; Gissler, Mika; Mortensen, Laust H; Skjærven, Rolv; Vollset, Stein Emil; Zhang, Xun; Shah, Prakesh S; Sauve, Reg S; Kramer, Michael S; Joseph, K S

    2015-09-04

    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 were artifacts of birth registration or reflected true differences in health status. A retrospective population-based cohort study was done using data from Canada, United States, Denmark, Finland, Iceland, Norway, and Sweden from 1995-2005. Main outcome measures included live births by gestational age and birth weight; gestational age-and birth weight-specific stillbirth rates; neonatal, post-neonatal, and cause-specific infant mortality. Proportion of live births 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 ratios at 22-23 weeks were significantly lower in the United States (79.2 stillbirths per 100 live births) and Finland (90.8) than in Canada (112.1), Iceland (176.2) and Norway (173.9). Crude neonatal mortality rates were 83% higher in Canada and 96% higher in the United States than Finland. Neonatal mortality rates among live births ≥ 28 weeks were lower in Canada and United States compared with Finland. Post-neonatal mortality rates were higher in Canada and United States than in Nordic countries. Live birth frequencies and stillbirth and neonatal mortality patterns at the borderline of viability are likely due to differences in birth registration practices, although true differences in maternal, fetal and infant health cannot be ruled out. This study emphasises the need for further standardisations, in order to enhance the relevance of international comparisons of infant mortality.

  15. Trends in socioeconomic inequalities in risk of sudden infant death syndrome, other causes of infant mortality, and stillbirth in Scotland: population based study.

    Science.gov (United States)

    Wood, Angela M; Pasupathy, Dharmintra; Pell, Jill P; Fleming, Michael; Smith, Gordon C S

    2012-03-16

    To compare changes in inequalities in sudden infant death syndrome with other causes of infant mortality and stillbirth in Scotland, 1985-2008. Retrospective cohort study. Scotland 1985-2008, analysed by four epochs of six years. Singleton births of infants with birth weight >500 g born at 28-43 weeks' gestation. Sudden infant death syndrome, other causes of postneonatal infant death, neonatal death, and stillbirth. Odds ratios expressed as the association across the range of seven categories of Carstairs deprivation score. The association between deprivation and the risk of all cause stillbirth and infant death varied between the four epochs (P=0.04). This was wholly explained by variation in the risk of sudden infant death syndrome (Psudden infant death syndrome from 1990 to 1993. Among women living in areas of high deprivation, there was a slower decline in sudden infant death syndrome rates between 1992 and 2004. Consequently, the odds ratio for the association between socioeconomic deprivation and sudden infant death syndrome increased from 2.04 (95% confidence interval 1.53 to 2.72) in 1985-90, to 7.52 (4.62 to 12.25) in 1991-6, and 9.50 (5.46 to 16.53) in 1997-2002 but fell to 1.78 (0.87 to 3.65) in 2002-8. The interaction remained significant after adjustment for maternal characteristics. The rate of sudden infant death syndrome declined throughout Scotland in the early 1990s. The decline had a later onset and was slower among women living in areas of high deprivation, probably because of slower uptake of recommended changes in infant sleeping position. The effect was to create a strong independent association between deprivation and sudden infant death syndrome where one did not exist before.

  16. Trends in socioeconomic inequalities in risk of sudden infant death syndrome, other causes of infant mortality, and stillbirth in Scotland: population based study

    Science.gov (United States)

    Wood, Angela M; Pasupathy, Dharmintra; Pell, Jill P; Fleming, Michael

    2012-01-01

    Objectives To compare changes in inequalities in sudden infant death syndrome with other causes of infant mortality and stillbirth in Scotland, 1985-2008. Design Retrospective cohort study. Setting Scotland 1985-2008, analysed by four epochs of six years. Participants Singleton births of infants with birth weight >500 g born at 28-43 weeks’ gestation. Main outcome measures Sudden infant death syndrome, other causes of postneonatal infant death, neonatal death, and stillbirth. Odds ratios expressed as the association across the range of seven categories of Carstairs deprivation score. Results The association between deprivation and the risk of all cause stillbirth and infant death varied between the four epochs (P=0.04). This was wholly explained by variation in the risk of sudden infant death syndrome (Prate of sudden infant death syndrome from 1990 to 1993. Among women living in areas of high deprivation, there was a slower decline in sudden infant death syndrome rates between 1992 and 2004. Consequently, the odds ratio for the association between socioeconomic deprivation and sudden infant death syndrome increased from 2.04 (95% confidence interval 1.53 to 2.72) in 1985-90, to 7.52 (4.62 to 12.25) in 1991-6, and 9.50 (5.46 to 16.53) in 1997-2002 but fell to 1.78 (0.87 to 3.65) in 2002-8. The interaction remained significant after adjustment for maternal characteristics. Conclusion The rate of sudden infant death syndrome declined throughout Scotland in the early 1990s. The decline had a later onset and was slower among women living in areas of high deprivation, probably because of slower uptake of recommended changes in infant sleeping position. The effect was to create a strong independent association between deprivation and sudden infant death syndrome where one did not exist before. PMID:22427307

  17. [Infant mortality from congenital malformations in Mexico: an issue of opportunity and access to treatment].

    Science.gov (United States)

    Gómez-Alcalá, Alejandro V; Rascón-Pacheco, Ramón A

    2008-11-01

    To evaluate the role that Mexico's National Health System (Sistema Nacional de Salud-SNS) has played in the task of reducing the number of deaths due to congenital malformations through a trends analysis of cause-specific infant mortality rates (IMRcs). Time-series analysis of deaths of boys and girls under 1 year of age from 1980-2005, according to databases of national and annual mortality maintained by the Secretariat of Health of Mexico. Cause-specific mortality rates were calculated for the most frequently occurring, severe, congenital malformations in Mexico: neural tube defects, diaphragmatic hernias, exomphalos (omphalocele and gastroschisis), and heart and digestive tract defects, grouped according to severity, degree of technological sophistication required for treatment, and most frequent outcome. From 1980-2005, the infant mortality rate in Mexico decreased from 40.7 to 16.9 per 1 000 births (beta = -0.86; P < 0.001); however, the mortality rate for congenital malformations rose from 2.2 to 3.5 per 1 000 births (beta = 0.05; P < 0.001). Only infantile hypertrophic pyloric stenosis and anorectal atresia, anomalies with good prognoses and treatments available in minimally-equipped facilities, exhibited downward trends in their IMRcs (beta = -0.01 to -0.09; P < 0.001); while malformations requiring immediate treatment in specialized facilities showed rising IMRcs (beta = 0.03 to 0.05; P < 0.001). The development of Mexico's SNS from 1980-2005 has not translated into a reduction of mortality from congenital malformations; this deficiency was more pronounced for anomalies that require immediate treatment and sophisticated technology.

  18. Trends in infant/child mortality and life expectancy in Indigenous populations in Yunnan Province, China.

    Science.gov (United States)

    Li, Jianghong; Luo, Chun; de Klerk, Nicholas

    2008-06-01

    The 2000 Census in China registered 55 groups of Indigenous population, including 104.49 million people, making up 8.1% of China's total population. Yunnan Province, located in Southwest China, is the only province where all 55 Indigenous nationalities are represented (14.15 million), making up 33.4% of Yunnan's total population. This study aimed to examine trends in infant and child mortality and life expectancy at birth of the 22 largest Indigenous nationalities and compared these trends with those of the majority Han Chinese in Yunnan and China as a whole. Data sources of mortality and socioeconomic status came from the population censuses of China (1953, 1964, 1982, 1990, and 2000) and Yunnan (1990-2000) and from the Provincial Health Department (1990, 1995, 1996 and 2000). Weighted linear regression analysis was used to examine the associations between infant/child mortality and life expectancy at birth, socioeconomic indicators and the use of preventive health services. In 2000, the infant mortality rate was 26.90 for China and 53.64 for Han Chinese in Yunnan per 1,000 live birth versus 77.75 for the 22 largest minority nationalities in Yunnan, despite improvements in health status indicators since 1990. The inequalities in life expectancy at birth between China as a whole and some minority nationalities remained striking in 2000 (57.18 versus 71.40). Literacy, prenatal examination, hospital deliveries, economic development were important predictors of these health indicators. Efforts to continue to improve these intermediate proximate determinants and to target the most disadvantaged Indigenous groups are likely to further reduce health disparities between the Chinese and Indigenous populations.

  19. American Indian and Alaska Native Infant and Pediatric Mortality, United States, 1999–2009

    Science.gov (United States)

    Gachupin, Francine C.; Holman, Robert C.; MacDorman, Marian F.; Cheek, James E.; Holve, Steve; Singleton, Rosalyn J.

    2014-01-01

    Objectives. We described American Indian/Alaska Native (AI/AN) infant and pediatric death rates and leading causes of death. Methods. We adjusted National Vital Statistics System mortality data for AI/AN racial misclassification by linkage with Indian Health Service (IHS) registration records. We determined average annual death rates and leading causes of death for 1999 to 2009 for AI/AN versus White infants and children. We limited the analysis to IHS Contract Health Service Delivery Area counties. Results. The AI/AN infant death rate was 914 (rate ratio [RR] = 1.61; 95% confidence interval [CI] = 1.55, 1.67). Sudden infant death syndrome, unintentional injuries, and influenza or pneumonia were more common in AI/AN versus White infants. The overall AI/AN pediatric death rates were 69.6 for ages 1 to 4 years (RR = 2.56; 95% CI = 2.38, 2.75), 28.9 for ages 5 to 9 years (RR = 2.12; 95% CI = 1.92, 2.34), 37.3 for ages 10 to 14 years (RR = 2.22; 95% CI = 2.04, 2.40), and 158.4 for ages 15 to 19 years (RR = 2.71; 95% CI = 2.60, 2.82). Unintentional injuries and suicide occurred at higher rates among AI/AN youths versus White youths. Conclusions. Death rates for AI/AN infants and children were higher than for Whites, with regional disparities. Several leading causes of death in the AI/AN pediatric population are potentially preventable. PMID:24754619

  20. American Indian and Alaska Native infant and pediatric mortality, United States, 1999-2009.

    Science.gov (United States)

    Wong, Charlene A; Gachupin, Francine C; Holman, Robert C; MacDorman, Marian F; Cheek, James E; Holve, Steve; Singleton, Rosalyn J

    2014-06-01

    We described American Indian/Alaska Native (AI/AN) infant and pediatric death rates and leading causes of death. We adjusted National Vital Statistics System mortality data for AI/AN racial misclassification by linkage with Indian Health Service (IHS) registration records. We determined average annual death rates and leading causes of death for 1999 to 2009 for AI/AN versus White infants and children. We limited the analysis to IHS Contract Health Service Delivery Area counties. The AI/AN infant death rate was 914 (rate ratio [RR] = 1.61; 95% confidence interval [CI] = 1.55, 1.67). Sudden infant death syndrome, unintentional injuries, and influenza or pneumonia were more common in AI/AN versus White infants. The overall AI/AN pediatric death rates were 69.6 for ages 1 to 4 years (RR = 2.56; 95% CI = 2.38, 2.75), 28.9 for ages 5 to 9 years (RR = 2.12; 95% CI = 1.92, 2.34), 37.3 for ages 10 to 14 years (RR = 2.22; 95% CI = 2.04, 2.40), and 158.4 for ages 15 to 19 years (RR = 2.71; 95% CI = 2.60, 2.82). Unintentional injuries and suicide occurred at higher rates among AI/AN youths versus White youths. Death rates for AI/AN infants and children were higher than for Whites, with regional disparities. Several leading causes of death in the AI/AN pediatric population are potentially preventable.

  1. Maternal overweight and obesity in early pregnancy and risk of infant mortality: a population based cohort study in Sweden

    Science.gov (United States)

    Villamor, Eduardo; Altman, Maria; Bonamy, Anna-Karin Edstedt; Granath, Fredrik; Cnattingius, Sven

    2014-01-01

    Objective To investigate associations between maternal overweight and obesity and infant mortality outcomes, including cause-specific mortality. Design Population based cohort study. Setting and participants 1 857 822 live single births in Sweden 1992–2010. Main outcome measures Associations between maternal body mass index (BMI) in early pregnancy and risks of infant, neonatal, and postneonatal mortality, overall and stratified by gestational length and by causes of infant death. Odds ratios were adjusted for maternal age, parity, smoking, education, height, country of birth, and year of delivery. Results Infant mortality rates increased from 2.4/1000 among normal weight women (BMI 18.5–24.9) to 5.8/1000 among women with obesity grade 3 (BMI ≥40.0). Compared with normal weight, overweight (BMI 25.0–29.9) and obesity grade 1 (BMI 30.0–34.9) were associated with modestly increased risks of infant mortality (adjusted odds ratios 1.25 (95% confidence interval 1.16 to 1.35) and 1.37 (1.22 to 1.53), respectively), and obesity grade 2 (BMI 35.0–39.9) and grade 3 were associated with more than doubled risks (adjusted odds ratios 2.11 (1.79 to 2.49) and 2.44 (1.88 to 3.17)). In analyses stratified by preterm and term births, maternal BMI was related to risks of infant mortality primarily in term births (≥37 weeks), where risks of deaths due to birth asphyxia and other neonatal morbidities increased with maternal overweight and obesity. Obesity grade 2–3 was also associated with increased infant mortality due to congenital anomalies and sudden infant death syndrome. Conclusions Maternal overweight and obesity are associated with increased risks of infant mortality due to increased mortality risk in term births and an increased prevalence of preterm births. Maternal overweight and obesity may be an important preventable risk factor for infant mortality in many countries. PMID:25467170

  2. Infant feeding, HIV transmission and mortality at 18 months: the need for appropriate choices by mothers and prioritization within programmes.

    Science.gov (United States)

    Rollins, Nigel C; Becquet, Renaud; Bland, Ruth M; Coutsoudis, Anna; Coovadia, Hoosen M; Newell, Marie-Louise

    2008-11-12

    To determine the late HIV transmission and survival risks associated with early infant feeding practices. A nonrandomized intervention cohort. HIV-infected pregnant women were supported in their infant feeding choices. Infant feeding data were obtained weekly; blood samples from infants were taken monthly to diagnose HIV infection. Eighteen-month mortality and HIV transmission risk were assessed according to infant feeding practices at 6 months. One thousand one hundred and ninety-three live-born infants were included. Overall 18-month probabilities of death (95% confidence interval) were 0.04 (0.03-0.06) and 0.53 (0.46-0.60) for HIV-uninfected and HIV-infected children, respectively. The eighteen-month probability of survival was not statistically significantly different for HIV-uninfected infants breastfed or replacement fed from birth. In univariate analysis of infant feeding practices, the probability of HIV-free survival beyond the first 6 months of life in children alive at 6 months was 0.98 (0.89-1.00) amongst infants replacement fed from birth, 0.96 (0.90-0.98; P = 0.25) and 0.91 (0.87-0.94; P = 0.03) in those breastfed for less or more than 6 months, respectively. In multivariable analyses, maternal unemployment and low antenatal CD4 cell count were independently associated with more than three-fold increased risk of infant HIV infection or death. Breastfeeding and replacement feeding of HIV-uninfected infants were associated with similar mortality rates at 18 months. However, these findings were amongst mothers and infants who received excellent support to first make, and then practice, appropriate infant feeding choices. For programmes to achieve similar results, the quality of counselling and identification of mothers with low CD4 cell count need to be the targets of improvement strategies.

  3. 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

  4. Infant Mortality: District Profiles for the Congressional Black Caucus, 102nd Congress. Report for the Congressional Black Caucus.

    Science.gov (United States)

    National Commission To Prevent Infant Mortality, Washington, DC.

    This report provides an overview of infant mortality rates in congressional districts represented by members of the Congressional Black Caucus (CBC). The 1989 or 1990 mortality rates for Blacks and Whites for the 25 districts represented by CBC members are presented, as well as rates for the overall population. An appendix provides data on Black,…

  5. Infant Mortality

    Science.gov (United States)

    ... grams at birth. Starting with 2007 data, the obstetric estimate (OE) of gestation at delivery replaces the ... Committee on Understanding Premature Birth and Assuring Healthy Outcomes and Board on Health Sciences Policy. (2005). Preterm ...

  6. Infant Mortality

    Science.gov (United States)

    ... Data Toolkit for Crisis Situations The CastCost Contraceptive Projection Tool The CastCost Toolkit en Español Contraceptive Logistics ... States. This joint approach can help address the social, behavioral, and health risk factors that contribute to ...

  7. Dynamics of inequality: mother's education and infant mortality in China, 1970-2001.

    Science.gov (United States)

    Song, Shige; Burgard, Sarah A

    2011-09-01

    In this study, the authors analyze the dynamic relationship between Chinese women's education, their utilization of newly available medical pregnancy care, and their infants' mortality risk. China has undergone enormous social, economic, and political changes over recent decades and is a novel context in which to examine the potential influence of social change and technological innovation on health disparities. The authors consider efficacy, or the ability to quickly absorb and effectively utilize new medical innovations, and argue that the social stratification of efficacy provides an important conceptual link between education and the greater likelihood of benefitting from medical innovations. Using the 2001 National Family Planning and Reproductive Health Survey data and multilevel, multiprocess models, the authors show that Chinese infants born to better educated mothers retained a survival advantage over the turbulent decades between 1970 and 2000. This occurs largely because educated mothers more actively sought prenatal care and professional delivery assistance use.

  8. Does health intervention improve socioeconomic inequalities of neonatal, infant and child mortality? Evidence from Matlab, Bangladesh

    Directory of Open Access Journals (Sweden)

    Streatfield Peter

    2007-06-01

    Full Text Available Abstract Background Although there are wide variations in mortality between developed and developing countries, socioeconomic inequalities in health exist in both the societies. The study examined socioeconomic inequalities of neonatal, infant and child mortality using data from the Matlab Health and Demographic Surveillance System of the International Centre for Diarrhoeal Disease Research, Bangladesh (ICDDR,B. Methods Four birth cohorts (1983–85, 1988–90, 1993–95, 1998–00 were followed for five years for death and out-migration in two adjacent areas (ICDDR,B-service and government-service with similar socioeconomic but differ health services. Based on asset quintiles, inequality was measured through both poor-rich ratio and concentration index. Results The study found that the socioeconomic inequalities of neonatal, infant and under-five mortality increased over time in both the ICDDR,B-service and government-service areas but it declined substantially for 1–4 years in the ICDDR,B- service area. Conclusion The study concluded that usual health intervention programs (non-targeted do not reduce poor-rich gap, rather the gap increases initially but might decrease in long run if the program is very intensive.

  9. Neighbourhood income and neonatal, postneonatal and sudden infant death syndrome (SIDS) mortality in Canada, 1991-2005.

    Science.gov (United States)

    Gilbert, Nicolas L; Auger, Nathalie; Wilkins, Russell; Kramer, Michael S

    2013-03-07

    Rates of infant mortality declined in Canada in the 1990s and 2000s, but the extent to which all socio-economic levels benefitted from this progress is unknown. This study investigated differences and time trends in neonatal, postneonatal and sudden infant death syndrome (SIDS) mortality across neighbourhood income quintiles among live births in Canada from 1991 through 2005. The Canadian linked live birth and infant death file was used, excluding births from Ontario, Yukon, Northwest Territories and Nunavut. Mortality rates for neonatal, postneonatal and sudden infant death syndrome (SIDS) were calculated by neighbourhood income quintile and period (1991-1995, 1996-2000, 2001-2005). Hazard ratios (HR) for neighbourhood income quintile and period were computed, adjusting for province of residence, maternal age, parity, infant sex and multiple birth. In urban areas, for the entire study period (1991-2005), the poorest neighbourhood income quintile had a higher hazard of neonatal death (adjusted HR 1.24, 95% CI 1.15-1.34), postneonatal death (adjusted HR 1.58, 95% CI 1.41-1.76) and SIDS (adjusted HR 1.83, 95% CI 1.49-2.26) compared to the richest quintile. Postneonatal and SIDS mortality rates declined by 37% and 57%, respectively, between 1991-1995 and 2001-2005 whereas no significant change was observed in neonatal mortality. The decrease in postneonatal and SIDS mortality rates occurred across all income quintiles. This study shows that despite a decrease in infant mortality and SIDS across all neighbourhood income quintiles over time in Canada, socio-economic inequalities persist. This finding highlights the need for effective infant health promotion strategies in vulnerable populations.

  10. An ecological quantification of the relationships between water, sanitation and infant, child, and maternal mortality.

    Science.gov (United States)

    Cheng, June J; Schuster-Wallace, Corinne J; Watt, Susan; Newbold, Bruce K; Mente, Andrew

    2012-01-27

    Water and sanitation access are known to be related to newborn, child, and maternal health. Our study attempts to quantify these relationships globally using country-level data: How much does improving access to water and sanitation influence infant, child, and maternal mortality? Data for 193 countries were abstracted from global databases (World Bank, WHO, and UNICEF). Linear regression was used for the outcomes of under-five mortality rate and infant mortality rate (IMR). These results are presented as events per 1000 live births. Ordinal logistic regression was used to compute odds ratios for the outcome of maternal mortality ratio (MMR). Under-five mortality rate decreased by 1.17 (95%CI 1.08-1.26) deaths per 1000, p < 0.001, for every quartile increase in population water access after adjustments for confounders. There was a similar relationship between quartile increase of sanitation access and under-five mortality rate, with a decrease of 1.66 (95%CI 1.11-1.32) deaths per 1000, p < 0.001. Improved water access was also related to IMR, with the IMR decreasing by 1.14 (95%CI 1.05-1.23) deaths per 1000, p < 0.001, with increasing quartile of access to improved water source. The significance of this relationship was retained with quartile improvement in sanitation access, where the decrease in IMR was 1.66 (95%CI 1.11-1.32) deaths per 1000, p < 0.001. The estimated odds ratio that increased quartile of water access was significantly associated with increased quartile of MMR was 0.58 (95%CI 0.39-0.86), p = 0.008. The corresponding odds ratio for sanitation was 0.52 (95%CI 0.32-0.85), p = 0.009, both suggesting that better water and sanitation were associated with decreased MMR. Our analyses suggest that access to water and sanitation independently contribute to child and maternal mortality outcomes. If the world is to seriously address the Millennium Development Goals of reducing child and maternal mortality, then improved water and sanitation accesses are key

  11. 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; PM<7μm in diameter) from one general monitoring station. As a measure of coarse particles, we calculated PM7-2.5 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.

  12. Socioeconomic inequalities and mortality trends in BRICS, 1990-2010.

    Science.gov (United States)

    Mújica, Oscar J; Vázquez, Enrique; Duarte, Elisabeth C; Cortez-Escalante, Juan J; Molina, Joaquin; Barbosa da Silva Junior, Jarbas

    2014-06-01

    To explore the presence and magnitude of--and change in--socioeconomic and health inequalities between and within Brazil, the Russian Federation, India, China and South Africa--the countries known as BRICS--between 1990 and 2010. Comparable data on socioeconomic and health indicators, at both country and primary subnational levels, were obtained from publicly available sources. Health inequalities between and within countries were identified and summarized by using standard gap and gradient metrics. Four of the BRICS countries showed increases in both income level and income inequality between 1990 and 2010. The exception was Brazil, where income inequality decreased over the same period. Between-country inequalities in level of education and access to sanitation remained mostly unchanged but the largest between-country difference in mean life expectancy increased, from 9 years in 1990 to 20 years in 2010. Throughout the study period, there was disproportionality in the burden of disease between BRICS. However, the national infant mortality rate fell substantially over the study period in all five countries. In Brazil and China, the magnitude of subnational income-related inequalities in infant mortality, both absolute and relative, also decreased substantially. Despite the economic prosperity and general improvements in health seen since 1990, profound inequalities in health persist both within and between BRICS. However, the substantial reductions observed--within Brazil and China--in the inequalities in income-related levels of infant mortality are encouraging.

  13. Socioeconomic inequalities and mortality trends in BRICS, 1990–2010

    Science.gov (United States)

    Mújica, Oscar J; Vázquez, Enrique; Duarte, Elisabeth C; Cortez-Escalante, Juan J; Molina, Joaquin

    2014-01-01

    Abstract Objective To explore the presence and magnitude of – and change in – socioeconomic and health inequalities between and within Brazil, the Russian Federation, India, China and South Africa – the countries known as BRICS – between 1990 and 2010. Methods Comparable data on socioeconomic and health indicators, at both country and primary subnational levels, were obtained from publicly available sources. Health inequalities between and within countries were identified and summarized by using standard gap and gradient metrics. Findings Four of the BRICS countries showed increases in both income level and income inequality between 1990 and 2010. The exception was Brazil, where income inequality decreased over the same period. Between-country inequalities in level of education and access to sanitation remained mostly unchanged but the largest between-country difference in mean life expectancy increased, from 9 years in 1990 to 20 years in 2010. Throughout the study period, there was disproportionality in the burden of disease between BRICS. However, the national infant mortality rate fell substantially over the study period in all five countries. In Brazil and China, the magnitude of subnational income-related inequalities in infant mortality, both absolute and relative, also decreased substantially. Conclusion Despite the economic prosperity and general improvements in health seen since 1990, profound inequalities in health persist both within and between BRICS. However, the substantial reductions observed – within Brazil and China – in the inequalities in income-related levels of infant mortality are encouraging. PMID:24940014

  14. Association Between Infant Mortality Attributable to Birth Defects and Payment Source for Delivery - United States, 2011-2013.

    Science.gov (United States)

    Almli, Lynn M; Alter, Caroline C; Russell, Rebecca B; Tinker, Sarah C; Howards, Penelope P; Cragan, Janet; Petersen, Emily; Carrino, Gerard E; Reefhuis, Jennita

    2017-01-27

    Birth defects are a leading cause of infant mortality in the United States (1), accounting for approximately 20% of infant deaths. The rate of infant mortality attributable to birth defects (IMBD) in the United States in 2014 was 11.9 per 10,000 live births (1). Rates of IMBD differ by race/ethnicity (2), age group at death (2), and gestational age at birth (3). Insurance type is associated with survival among infants with congenital heart defects (CHD) (4). In 2003, a checkbox indicating principal payment source for delivery was added to the U.S. standard birth certificate (5). To assess IMBD by payment source for delivery, CDC analyzed linked U.S. birth/infant death data for 2011-2013 from states that adopted the 2003 revision of the birth certificate. The results indicated that IMBD rates for preterm (infants whose deliveries were covered by Medicaid were higher during the neonatal (infants whose deliveries were covered by private insurance. Similar differences in postneonatal mortality were observed for the three most common categories of birth defects listed as a cause of death: central nervous system (CNS) defects, CHD, and chromosomal abnormalities. Strategies to ensure quality of care and access to care might reduce the difference between deliveries covered by Medicaid and those covered by private insurance.

  15. 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

  16. Trends and determinants of infant and under-five childhood mortality in Vietnam, 1986–2011

    Science.gov (United States)

    Lee, Hwa-Young; Van Do, Dung; Choi, Sugy; Trinh, Oanh Thi Hoang; To, Kien Gia

    2016-01-01

    Background Although Vietnam has taken great efforts to reduce child mortality in recent years, a large number of children still die at early age. Only a few studies have been conducted to identify at-risk groups in order to provide baseline information for effective interventions. Objective The study estimated the overall trends in infant mortality rate (IMR) and under-five mortality rate (U5MR) during 1986–2011 and identified demographic and socioeconomic determinants of child mortality. Design Data from the Vietnam Multiple Indicator Cluster Surveys (MICSs) in 2000 (MICS2), 2006 (MICS3) and 2011 (MICS4) were analysed. The IMR and U5MR were calculated using the indirect method developed by William Brass. Unadjusted and adjusted odds ratios were estimated to assess the association between child death and demographic and socioeconomic variables. Region-stratified stepwise logistic regression was conducted to test the sensitivity of the results. Results The IMR and U5MR significantly decreased for both male and female children between 1986 and 2010. Male children had higher IMR and U5MR compared with females in all 3 years. Women who were living in the Northern Midlands and Mountain areas were more likely to experience child deaths compared with women who were living in the Red River Delta. Women who were from minor ethnic groups, had low education, living in urban areas, and had multiple children were more likely to have experienced child deaths. Conclusion Baby boys require more healthcare attention during the first year of their life. Comprehensive strategies are necessary for tackling child mortality problems in Vietnam. This study shows that child mortality is not just a problem of poverty but involves many other factors. Further studies are needed to investigate pathways underlying associations between demographic and socioeconomic conditions and childhood mortality. PMID:26950560

  17. Trends and determinants of infant and under-five childhood mortality in Vietnam, 1986-2011.

    Science.gov (United States)

    Lee, Hwa-Young; Van Do, Dung; Choi, Sugy; Trinh, Oanh Thi Hoang; To, Kien Gia

    2016-01-01

    Although Vietnam has taken great efforts to reduce child mortality in recent years, a large number of children still die at early age. Only a few studies have been conducted to identify at-risk groups in order to provide baseline information for effective interventions. The study estimated the overall trends in infant mortality rate (IMR) and under-five mortality rate (U5MR) during 1986-2011 and identified demographic and socioeconomic determinants of child mortality. Data from the Vietnam Multiple Indicator Cluster Surveys (MICSs) in 2000 (MICS2), 2006 (MICS3) and 2011 (MICS4) were analysed. The IMR and U5MR were calculated using the indirect method developed by William Brass. Unadjusted and adjusted odds ratios were estimated to assess the association between child death and demographic and socioeconomic variables. Region-stratified stepwise logistic regression was conducted to test the sensitivity of the results. The IMR and U5MR significantly decreased for both male and female children between 1986 and 2010. Male children had higher IMR and U5MR compared with females in all 3 years. Women who were living in the Northern Midlands and Mountain areas were more likely to experience child deaths compared with women who were living in the Red River Delta. Women who were from minor ethnic groups, had low education, living in urban areas, and had multiple children were more likely to have experienced child deaths. Baby boys require more healthcare attention during the first year of their life. Comprehensive strategies are necessary for tackling child mortality problems in Vietnam. This study shows that child mortality is not just a problem of poverty but involves many other factors. Further studies are needed to investigate pathways underlying associations between demographic and socioeconomic conditions and childhood mortality.

  18. The impact of changes in preterm birth among twins on stillbirth and infant mortality in the United States.

    Science.gov (United States)

    Getahun, D; Demissie, K; Marcella, S W; Rhoads, G G

    2014-11-01

    To examine trends for preterm births, stillbirths, neonatal and infant deaths in twin births by gestational age and birth weight categories, as well as trends in induction of labor and cesarean delivery during 1995-2006. A trend analysis was performed on data derived from the National Centers for Health Statistics' Vital Statistics Data files (1995-2006). The primary outcomes examined were preterm birth, stillbirth, neonatal and infant mortality. During the study period, rates of labor induction among twins decreased by 8% and rates of cesarean delivery increased by 35%. Concurrently, the preterm birth rate increased by 13% from 54% in 1995-96 to 61% in 2005-06. The overall stillbirth rate, and neonatal and infant death rates decreased during the same period by 21% (95% confidence interval (CI): 18-25%), 13% (95% CI: 9-16%) and 12% (95% CI: 8-15%), respectively. There were significant reductions in neonatal death rates related to respiratory distress syndrome (RDS; 48%, 95% CI: 41-54%) and congenital anomalies (25%, 95% CI: 16-33%) during the study period. Reductions in post-neonatal infant mortality were mainly in RDS (88%) and sudden infant death syndrome (26%). Mortality rates among infants born by either induction of labor or cesarean delivery fell during the study period and remained much lower than the overall infant mortality rate. The findings of this study suggest that during 1995-2006 there was an increase in preterm birth rates and a decrease in labor inductions with a sharp decline in stillbirth, neonatal and infant mortality rates.

  19. Subnational taxation in developing countries : a review of the literature

    OpenAIRE

    Bird, Richard M.

    2010-01-01

    This paper reviews the literature on tax assignment in decentralized countries. Ideally, own-source revenues should be sufficient to enable at least the richest subnational governments to finance from their own resources all locally-provided services that primarily benefit local residents. Subnational taxes should also not unduly distort the allocation of resources. Most importantly, to the extent ...

  20. Laws for fiscal responsibility for subnational discipline : international experience

    OpenAIRE

    Liu, Lili; Steven B. Webb

    2011-01-01

    Fiscal responsibility laws are institutions with which multiple governments in the same economy -- national and subnational --can commit to help avoid irresponsible fiscal behavior that could have short-term advantages to one of them but that would be collectively damaging. Coordination failures with subnational governments in the 1990s contributed to macroeconomic instability and led seve...

  1. 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.

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

    Directory of Open Access Journals (Sweden)

    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

  3. The expression of vulnerability through infant mortality in the municipality of Embu.

    Science.gov (United States)

    Ventura, Renato Nabas; Puccini, Rosana Fiorini; da Silva, Nilza Nunes; da Silva, Edina Mariko Koga; de Oliveira, Eleonora Menicucci

    2008-09-01

    Infant mortality expresses a set of living, working and healthcare access conditions and opens up possibilities for adopting interventions to expand equity in healthcare. This study aimed to investigate vulnerability and the consequent differences in access to health services and occurrences of deaths among infants under one year of age in the municipality of Embu. This was a descriptive study in the municipality of Embu. Primary data were collected through interviews with the families of children living in the municipality of Embu who died in the years 1996 and 1997 before reaching one year of age. Secondary data were obtained from death certificates. The variables collected related to living conditions, income, occupation, prenatal care, delivery and the healthcare provided for children. These data were compared with the results obtained from a study carried out in 1996. Statistically significant differences were found with regard to income, working without a formal employment contract and access to private health plans among the families of the children who died. There were also differences in access to and quality of prenatal care, frequency of low birth weight and neonatal inter-ocurrences. The employment/unemployment situation was decisive in determining the degree of family stability and vulnerability to the occurrence of infant deaths, in addition to the conditions of access to and quality of healthcare services.

  4. Infant mortality -- critical analysis of factors and new approach for calculation of I.M.R.

    Science.gov (United States)

    Gupta, R; Gupta, B D; Singh, R N; Mehta, S C

    1991-01-01

    In India, researchers conducted a household survey of 1050 infants in an urban slum and rural and urban areas of Jodhpur Region to determine the infant mortality rate (IMR) and its correlation with various socioeconomic and demographic factors. They used the data to develop a concrete formula intended to allow precise estimation of IMR, given knowledge of these factors. Overall IMR was 106/1000 live births. The IMR for the slum, rural, and urban areas was 137, 123, and 57, respectively. The 4 most significant quantifiable factors that could be changed to reduce IMR were maternal age (IMR increases with maternal age of 30 years and older), parity (IMR increases with parity, especially at parity 5), literacy (IMR is higher among illiterates than literates), and low socioeconomic status [SES] (IMR increases as SES decreases). Based on the data from the survey, the researchers used regression analysis and other calculations to determine the values of the coefficients and constants. The results of their formula compared favorably with those of the household survey. For example, the IMR for the slum, rural area, urban area, and overall were actually 137, 123, 57, and 106, respectively. The respective IMRs based on the formula were 140, 120, 54, and 100. Assuming that all infant deaths are recorded, the formula allows one to estimate IMR of any area, country, or region.

  5. Quality Indicators but Not Admission Volumes of Neonatal Intensive Care Units Are Effective in Reducing Mortality Rates of Preterm Infants.

    Science.gov (United States)

    Rochow, Niels; Landau-Crangle, Erin; Lee, Sauyoung; Schünemann, Holger; Fusch, Christoph

    2016-01-01

    To investigate how two different strategies to form larger neonatal intensive care units (NICU) impact neonatal mortality rates. Cross-sectional study modeling admission volumes and mortality rates of 177,086 VLBW infants aggregated into 862 NICUs. Cumulative 3-year data was abstracted from Vermont Oxford Network. The model simulated a reduction in number of NICUs by stepwise exclusion using either admission volume (VOL) or quality (QUAL) cut-offs. After randomly redirecting infants of excluded to remaining NICUs resulting system mortality rates were calculated with and without adjusting for effects of experience levels (EL) using published data to reflect effects of different team-to-patient exposure. The quality-based strategy is more effective in reducing mortality; while VOL alone was not able to reduce system mortality, QUAL already achieved a 5% improvement after reducing 8% of NICUs and redirecting 6% of infants. Including "EL", a 5% improvement of mortality was achieved by reducing 77% (VOL) vs. 7% (QUAL) of NICUs and redirecting 54% (VOL) vs. 5% (QUAL) of VLBW infants, respectively. While a critical number of admissions is needed to maintain skills this study emphasizes the importance of including quality parameters to restructure neonatal care. The findings can be generalized to other medical fields.

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

    Directory of Open Access Journals (Sweden)

    Fitzmaurice Ann

    2010-11-01

    Full Text Available Abstract Background 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. Methods 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. Results 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. Conclusions 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.

  7. Genesee County REACH Windshield Tours: enhancing health professionals understanding of community conditions that influence infant mortality.

    Science.gov (United States)

    Kruger, Daniel J; French-Turner, Tonya; Brownlee, Shannon

    2013-06-01

    The Genesee County Racial and Ethnic Approaches to Community Health (REACH) program is a community-based program designed to reduce African American infant mortality rates in Flint, Michigan. Genesee County REACH activities address three core themes: fostering community mobilization, reducing racism, and enhancing the maternal-infant health care system. The REACH Community Action Plan was generated using a community-based participatory approach, and is based on a socio-ecological model with interventions focused at the individual, organizational, health system, and community levels. Genesee County REACH's Community Windshield Tours were developed to raise awareness of social and environmental barriers to health promotion among health care system staff in Flint, Michigan. These tours provide a close-up examination of the community's environmental conditions and the experiences of mothers, children, and families at risk for poor birth outcomes. In this article, we report our findings from pre-/post-tour surveys, as well as long-term follow-up surveys, to assess the impact of this REACH activity on participants' knowledge and beliefs about Genesee County residents, and to determine any resultant individual, policy, system, or environmental changes. We used t tests to compare participants' responses before and after the tours. We found that several individual- and systems-level changes have resulted from these tours, reflecting greater cultural sensitivity and increased understanding of patients' circumstances. African American infant mortality rates in Genesee County declined to a historic low in 2005, and they remain lower than in previous years. Although REACH coalition partners recognize that this reduction cannot be attributed to a single intervention or activity, REACH activities such as the Community Windshield Tours addressing multiple levels of the socio-ecological model may have had a synergistic effect.

  8. Acute kidney injury is associated with bronchopulmonary dysplasia/mortality in premature infants.

    Science.gov (United States)

    Askenazi, David; Patil, Neha R; Ambalavanan, Namasivayam; Balena-Borneman, Jessica; Lozano, David J; Ramani, Manimaran; Collins, Monica; Griffin, Russell L

    2015-09-01

    Acute kidney injury (AKI) impairs electrolyte balance, alters fluid homeostasis and decreases toxin excretion. More recent data suggest it also affects the physiology of distant organs. We performed a prospective cohort study which invloved 122 premature infants [birth weight (BW) ≤1200 g and/or gestational age (GA) bronchopulmonary dysplasia (BPD)/mortality. Days until oxygen discontinuation was compared between those with and without AKI in survivors who received oxygen for ≥24 h. Acute kidney disease, defined by a rise in serum creatinine (SCr) of ≥0.3 mg/dl or an increase in SCr of ≥150%, occurred in 36/122 (30%) of the premature infants. Those with AKI had a 70% higher risk of oxygen requirement or of dying at 28 days of life [relative risk (RR) 1.71, 95% confidence interval (CI) 1.22-2.39; p < 0.002]. This association remained after controlling for GA, pre-eclampsia, 5 min Apgar score and percentage maximum weight change (max % weight Δ) in the first 4 days (RR 1.45, 95% CI 1.07-1.97); p < 0.02). Similar findings were noted for receipt of mechanical ventilation/death by day 28 (adjusted RR 1.53, 95% CI 1.05-2.22; p < 0.03). Those without AKI were 2.5-fold more likely to come off oxygen [hazard ratio (HR) 1.3-5; p < 0.02) than those with AKI, even when controlling for GA, pre-eclampsia, 5 min Apgar and max % weight Δ (multivariate HR 2.0, 95% CI 0.9-4.0; p < 0.06). In premature infants, AKI is associated with BPD/mortality. As AKI could lead to altered lung physiology, interventions to ameliorate AKI could improve long-term BPD.

  9. NATIONAL INSTITUTIONS AND SUBNATIONAL DEVELOPMENT IN AFRICA.

    Science.gov (United States)

    Michalopoulos, Stelios; Papaioannou, Elias

    We investigate the role of national institutions on subnational African development in a novel framework that accounts for both local geography and cultural-genetic traits. We exploit the fact that the political boundaries on the eve of African independence partitioned more than 200 ethnic groups across adjacent countries subjecting similar cultures, residing in homogeneous geographic areas, to different formal institutions. Using both a matching type and a spatial regression discontinuity approach we show that differences in countrywide institutional structures across the national border do not explain within-ethnicity differences in economic performance, as captured by satellite images of light density. The average noneffect of national institutions on ethnic development masks considerable heterogeneity partially driven by the diminishing role of national institutions in areas further from the capital cities.

  10. NATIONAL INSTITUTIONS AND SUBNATIONAL DEVELOPMENT IN AFRICA*

    Science.gov (United States)

    Michalopoulos, Stelios; Papaioannou, Elias

    2014-01-01

    We investigate the role of national institutions on subnational African development in a novel framework that accounts for both local geography and cultural-genetic traits. We exploit the fact that the political boundaries on the eve of African independence partitioned more than 200 ethnic groups across adjacent countries subjecting similar cultures, residing in homogeneous geographic areas, to different formal institutions. Using both a matching type and a spatial regression discontinuity approach we show that differences in countrywide institutional structures across the national border do not explain within-ethnicity differences in economic performance, as captured by satellite images of light density. The average noneffect of national institutions on ethnic development masks considerable heterogeneity partially driven by the diminishing role of national institutions in areas further from the capital cities. PMID:25802926

  11. 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.......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...

  12. 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.

  13. A review of Aboriginal infant mortality rates in Canada: striking and persistent Aboriginal/non-Aboriginal inequities.

    Science.gov (United States)

    Smylie, Janet; Fell, Deshayne; Ohlsson, Arne

    2010-01-01

    The Joint Working Group on First Nations, Indian, Inuit, and Métis Infant Mortality of the Canadian Perinatal Surveillance System is a collaboration of national Aboriginal organizations and federal and provincial/territorial stakeholders. Our objective was to better understand what is currently known about Aboriginal infant mortality rates (IMR) in Canada. As part of a larger international systematic review of Indigenous IMR calculation, we searched the published literature for original research regarding the calculation of First Nations, Inuit, and Métis infant mortality rates at the national and provincial/territorial level. We identified major deficiencies in the coverage and quality of infant mortality data for Aboriginal populations in Canada. The review of provincial and territorial reporting of infant mortality for Aboriginal populations revealed substantial provincial and territorial variation in the way that birth and death data were collected. With respect to coverage, high-quality IMRs were available only for Status Indians and communities with a high proportion of Inuit residents. No rates were available for Métis or non-Status Indians. Striking and persistent disparities persist in the IMRs for Status Indians and in communities with a high proportion of Inuit residents, compared to the general Canadian population. There is an urgent need to work in partnership with First Nations, Indian, Inuit, and Métis stakeholder groups to improve the quality and coverage of Aboriginal IMR information and to acquire information that would help to better understand and address the underlying causes of disparities in infant mortality between the Aboriginal and non-Aboriginal population in Canada.

  14. The differential association between education and infant mortality by nativity status of Chinese American mothers: a life-course perspective.

    Science.gov (United States)

    Li, Qing; Keith, Louis G

    2011-05-01

    Integrating evidence from demography and epidemiology, we investigated whether the association between maternal achieved status (education) and infant mortality differed by maternal place of origin (nativity) over the life course of Chinese Americans. We conducted a population-based cohort study of singleton live births to US-resident Chinese American mothers using National Center for Health Statistics 1995 to 2000 linked live birth and infant death cohort files. We categorized mothers by nativity (US born [n = 15 040] or foreign born [n = 150 620]) and education (≥ 16 years, 13-15 years, or ≤ 12 years), forming 6 life-course trajectories. We performed Cox proportional hazards regressions of infant mortality. We found significant nativity-by-education interaction via stratified analyses and testing interaction terms (P infant mortality across divergent maternal life-course trajectories. Low education was more detrimental for the US born, with the highest risk among US-born mothers with 12 years or less of education (adjusted hazard ratio = 2.39; 95% confidence interval = 1.33, 4.27). Maternal nativity and education synergistically affect infant mortality among Chinese Americans, suggesting the importance of searching for potential mechanisms over the maternal life course and targeting identified high-risk groups and potential downward mobility.

  15. 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.

  16. 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

    2015-10-20

    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. All infants admitted to 26 NICUs with a birth weight (BW) infants were admitted to 26 NICUs, of whom the mean gestational age (GA) was 28.1 ± 2.2 weeks, and the mean BW was 868 ± 97 g. The overall survival rate at discharge was 50.0%. Despite aggressive treatment 60 infants (23.3%) died and another 69 infants (26.7%) died after medical care withdrawal. Furthermore, the survival rate was significantly higher in coastal areas than inland areas (53.6% vs. 35.3%, P = 0.019). BW mortality. Respiratory distress syndrome was the most common complication. The incidence of 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. 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.

  17. Infant Maltreatment-Related Mortality in Alaska: Correcting the Count and Using Birth Certificates to Predict Mortality

    Science.gov (United States)

    Parrish, Jared W.; Gessner, Bradford D.

    2010-01-01

    Objectives: To accurately count the number of infant maltreatment-related fatalities and to use information from the birth certificates to predict infant maltreatment-related deaths. Methods: A population-based retrospective cohort study of infants born in Alaska for the years 1992 through 2005 was conducted. Risk factor variables were ascertained…

  18. In search for an explanation to the upsurge in infant mortality in Kenya during the 1988–2003 period

    Science.gov (United States)

    2012-01-01

    Background In Kenya, infant mortality rate increased from 59 deaths per 1000 live births in 1988 to 78 deaths per 1000 live births by 2003. This was an increase of about 32 percent in 15 years. The reasons behind this upturn are poorly understood. This paper investigates the probable factors behind the upsurge in infant mortality in Kenya during the 1988–2003 period. Understanding the causes behind the upsurge is critical in designing high impact public health strategies for the acceleration of national and international public health goals such as the Millennium Development Goals (MDGs). The reversals in early child mortality is also regarded as one of the most important topics in contemporary demography. Methods A merged dataset drawn from the Kenya Demographic and Health Surveys of 1993, 1998 and 2003 was used. The merged KDHS included a total of 5265 singletons. Permission to use the KDHS data was obtained from ICF international on the following website: http://www.measuredhs.com. Stata version 11.0 was used for data analysis. The paper used regression decomposition techniques as the main method for analysing the contribution of the selected covariates on the upsurge in infant mortality. Results The duration of breastfeeding; maternal education, regional HIV prevalence and malaria endemicity were the factors that appeared to have contributed much to the observed rise in infant mortality in Kenya over the period. If all the live births that occurred in the 1996/03 period had the same mean values of all explanatory variables as those of live births that occurred in the 1988/95 period, then infant mortality would have increased by a massive 14 deaths per 1000 live births. However, if the live births that occurred in the 1988/95 period had the same mean values of all explanatory variables as those that occurred in the 1996/03 period, the upsurge in infant mortality would have been negligible. While the role of HIV in the upturn in infant mortality in Kenya and

  19. TulaSalud: An m-health system for maternal and infant mortality reduction in Guatemala.

    Science.gov (United States)

    Martínez-Fernández, Andrés; Lobos-Medina, Isabel; Díaz-Molina, Cesar Augusto; Chen-Cruz, Moisés Faraón; Prieto-Egido, Ignacio

    2015-07-01

    The Guatemalan NGO (Non-Governmental Organization) TulaSalud has implemented an m-health project in the Department of Alta Verapaz. This Department has 1.2 million inhabitants (78% living in rural areas and 89% from indigenous communities) and in 2012, had a maternal mortality rate of 273 for every 100,000 live births. This m-health initiative is based on the provision of a cell phone to community facilitators (CFs). The CFs are volunteers in rural communities who perform health prevention, promotion and care. Thanks to the cell phone, the CFs have become tele-CFs who able to carry out consultations when they have questions; send full epidemiological and clinical information related to the cases they attend to; receive continuous training; and perform activities for the prevention and promotion of community health through distance learning sessions in the Q'eqchí and/or Poqomchi' languages. In this study, rural populations served by tele-CFs were selected as the intervention group while the control group was composed of the rural population served by CFs without Information and Communication Technology (ICT) tools. As well as the achievement of important process results (116,275 medical consultations, monitoring of 6,783 pregnant women, and coordination of 2,014 emergency transfers), the project has demonstrated a statistically significant decrease in maternal mortality (p < 0.05) and in child mortality (p = 0.054) in the intervention group compared with rates in the control group. As a result of the telemedicine initiative, the intervention areas, which were selected for their high maternal and infant mortality rates, currently show maternal and child mortality indicators that are not only lower than the indicators in the control area, but also lower than the provincial average (which includes urban areas). © The Author(s) 2015.

  20. Impact of maternal diabetes mellitus on mortality and morbidity of preterm infants (24-33 weeks' gestation).

    Science.gov (United States)

    Bental, Yoram; Reichman, Brian; Shiff, Yakov; Weisbrod, Meir; Boyko, Valentina; Lerner-Geva, Liat; Mimouni, Francis B

    2011-10-01

    We hypothesized that maternal diabetes mellitus (DM) increases the risk for mortality, respiratory distress syndrome (RDS), and major complications of prematurity. Analysis of prospectively collected (1995-2007) Israel National Very Low Birth Weight Infant Database. Maternal DM was recorded as pregestational or gestational. Multivariable logistic regression analysis was used to assess the independent effect of maternal DM status on infant mortality, RDS, and other complications of prematurity. Infants of mothers with pregestational (n = 120) and gestational (n = 825) DM were similar, and their data were pooled for analyses. Mothers with DM were more likely to have received a complete course of prenatal steroids than control mothers. Infants of diabetic mothers (IDM) had a slightly higher gestational age and birthweight than non-IDM's. Distribution of birthweight percentiles and the mean birthweight z scores were similar. Apgar scores were statistically higher in the IDM group. There were no significant differences between the 2 groups in terms of delivery room mortality, RDS, and other major complications of prematurity. Total mortality and bronchopulmonary dysplasia rates were significantly higher in the nondiabetic group. The adjusted odds ratios for mortality, RDS, bronchopulmonary dysplasia, intraventricular hemorrhage, periventricular leukomalacia, retinopathy of prematurity, necrotizing enterocolitis, and patent ductus arteriosus were not significantly increased in the IDM group. With modern management and adequate prenatal care, IDM born very low birthweight do not seem to be at an excess risk of developing RDS or other major complications of prematurity compared with non-IDM.

  1. 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.

  2. 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

  3. Neighborhood Socioeconomic Characteristics, Birth Outcomes and Infant Mortality among First Nations and Non-First Nations in Manitoba, Canada

    Science.gov (United States)

    Luo, Zhong-Cheng; Wilkins, Russell; Heaman, Maureen; Martens, Patricia; Smylie, Janet; Hart, Lyna; Wassimi, Spogmai; Simonet, Fabienne; Wu, Yuquan; Fraser, William D.

    2011-01-01

    Objective Little is known about the possible impacts of neighborhood socioeconomic status on birth outcomes and infant mortality among Aboriginal populations. We assessed birth outcomes and infant mortality by neighborhood socioeconomic status among First Nations and non-First Nations in Manitoba. Study Design We conducted a retrospective birth cohort study of all live births (26,176 First Nations, 129,623 non-First Nations) to Manitoba residents, 1991–2000. Maternal residential postal codes were used to assign four measures of neighborhood socioeconomic status (concerning income, education, unemployment, and lone parenthood) obtained from 1996 census data. Results First Nations women were much more likely to live in neighborhoods of low socioeconomic status. First Nations infants were much more likely to die during their first year of life [risk ratio (RR) =1.9] especially during the postneonatal period (RR=3.6). For both First Nations and non-First Nations, living in neighborhoods of low socioeconomic status was associated with an increased risk of infant death, especially postneonatal death. For non-First Nations, higher rates of pre-term and small-for-gestational-age birth were consistently observed in low socioeconomic status neighborhoods, but for First Nations the associations were less consistent across the four measures of socioeconomic status. Adjusting for neighborhood socioeconomic status, the disparities in infant and postneonatal mortality between First Nations and non-First Nations were attenuated. Conclusion Low neighborhood socioeconomic status was associated with an elevated risk of infant death even among First Nations, and may partly account for their higher rates of infant mortality compared to non-First Nations in Manitoba. PMID:22287997

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

    Science.gov (United States)

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

    2017-07-05

    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; criminalization); negative interactions with healthcare providers and the healthcare system; and broader contextual factors. Concurrently, we estimated the Black infant mortality rate (deaths per 1000 live births) using linked live birth-infant death records from 2010 to 2013 in every metropolitan statistical area in the US. Poisson regression examined how contextual indicators of population health, socioeconomic conditions of the Black population, and features of the communities in which they live were associated with Black infant mortality and inequity in Black-White infant mortality rates across 100 metropolitan statistical areas with the highest Black infant mortality rates. We used principal components analysis to create a Birth Equity Index in order to examine the collective impact of contextual indicators on Black infant mortality and racial inequity in mortality rates. The association between the Index and Black infant mortality was stronger than any single indicator alone: in metropolitan areas with the worst social, economic, and environmental conditions, Black infant mortality rates were on average 1.24 times higher than rates in areas where conditions were better (95% CI = 1.16, 1.32). The experiences of Black women in their homes, neighborhoods, and health care centers and the contexts in which they live may individually and collectively contribute to persistent racial inequity in infant mortality.

  5. 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

  6. Birth Outcomes and Infant Mortality by the Degree of Rural Isolation among First Nations and Non-First Nations in Manitoba, Canada

    Science.gov (United States)

    Luo, Zhong-Cheng; Wilkins, Russell; Heaman, Maureen; Martens, Patricia; Smylie, Janet; Hart, Lyna; Simonet, Fabienne; Wassimi, Spogmai; Wu, Yuquan; Fraser, William D.

    2010-01-01

    Context: It is unknown whether rural isolation may affect birth outcomes and infant mortality differentially for Indigenous versus non-Indigenous populations. We assessed birth outcomes and infant mortality by the degree of rural isolation among First Nations (North American Indians) and non-First Nations populations in Manitoba, Canada, a setting…

  7. 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.

  8. Evaluation and Estimation of the Provincial Infant Mortality Rate in China's Sixth Census.

    Science.gov (United States)

    Hu, Song Bo; Wang, Fang; Yu, Chuan Hua

    2015-06-01

    To assess the data quality and estimate the provincial infant mortality rate (1q0) from China's sixth census. A log-quadratic model is applied to under-fifteen data. We analyze and compare the average relative errors (AREs) for 1q0 between the estimated and reported values using the leave-one-out cross-validation method. For the sixth census, the AREs are more than 100% for almost all provinces. The estimated average 1q0 level for 31 provinces is 12.3‰ for males and 10.7‰ for females. The data for the provincial 1q0 from China's sixth census have a serious data quality problem. The actual levels of 1q0 for each province are significantly higher than the reported values. Copyright © 2015 The Editorial Board of Biomedical and Environmental Sciences. Published by China CDC. All rights reserved.

  9. Comparing relative effects of education and economic resources on infant mortality in developing countries.

    Science.gov (United States)

    Pamuk, Elsie R; Fuchs, Regina; Lutz, Wolfgang

    2011-01-01

    Research on the social determinants of health has often considered education and economic resources as separate indicators of socioeconomic status. From a policy perspective, however, it is important to understand the relative strength of the effect of these social factors on health outcomes, particularly in developing countries. It is also important to examine not only the impact of education and economic resources of individuals, but also whether community and country levels of these factors affect health outcomes. This analysis uses multilevel regression models to assess the relative effects of education and economic resources on infant mortality at the family, community, and country level using data from demographic and Health Surveys in 43 low-and lower-middle-income countries. We find strong effects for both per capita gross national income and completed secondary education at the country level, but a greater impact of education within families and communities.

  10. Morbidity and mortality amongst infants of diabetic mothers admitted into Soba university hospital, Khartoum, Sudan

    Science.gov (United States)

    Berair, Rabih; Gulfan, Islam G.I.; Karrar, Mohamed Z.; Mohammed, Zuhlel A.O.

    2012-01-01

    The prevalence of diabetes during pregnancy is increasing and this is associated with an increased risk of complications in both mother and fetus. The aim of this research is to study the neonatal complications of maternal diabetes. This was a prospective observational study that was conducted in Soba university hospital between September 2010 and March 2011. All infants born to diabetic mothers during the study period were admitted to the neonatal care unit for evaluation. Data on sex, gestational age, and birth weight, mode of delivery, complications, investigations, birth injury, and length of hospital stay were recorded. Maternal data were retrieved from records. Data was analyzed using Minitab 15. A total of 50 infants of diabetic mothers (IDMs) were included in the study. Thirty infants (60%) were females and 20 (40%) were males. Forty two (84%) of the neonates were born by caesarian section, only 7(14%) were born by spontaneous vaginal delivery. Birth injury was observed in 4% of them. The mean gestational age was 37.2±2.051 weeks. The median birth weight was 3.5 kg. 14 (28%) of the babies were macrosomic, and 17 (34%) were large for gestational age (LGA). Congenital anomalies were found in 3 (6%), hypoglycemia in 6 (12%), hyperbillirubinaemia in 10 (20%), hypocalcaemia and hypomagnesaemia each occurred in 2%, transient tachypnea of the newborn occurred in 5 (10%) of the neonates and respiratory distress syndrome in 2%. Cardiomyopathy occurred in 2% and mortality was 4%. We concluded that macrosomia, LGA, and hyperbillirubinaemia were the commonest complications in IDMs, maternal glycaemic control was found to have a significant effect on a number of outcomes. PMID:27493328

  11. State-Level Progress in Reducing the Black-White Infant Mortality Gap, United States, 1999-2013.

    Science.gov (United States)

    Brown Speights, Joedrecka S; Goldfarb, Samantha Sittig; Wells, Brittny A; Beitsch, Leslie; Levine, Robert S; Rust, George

    2017-05-01

    To assess state-level progress on eliminating racial disparities in infant mortality. Using linked infant birth-death files from 1999 to 2013, we calculated state-level 3-year rolling average infant mortality rates (IMRs) and Black-White IMR ratios. We also calculated percentage improvement and a projected year for achieving equality if current trend lines are sustained. We found substantial state-level variation in Black IMRs (range = 6.6-13.8) and Black-White rate ratios (1.5-2.7), and also in percentage relative improvement in IMR (range = 2.7% to 36.5% improvement) and in Black-White rate ratios (from 11.7% relative worsening to 24.0% improvement). Thirteen states achieved statistically significant reductions in Black-White IMR disparities. Eliminating the Black-White IMR gap would have saved 64 876 babies during these 15 years. Eighteen states would achieve IMR racial equality by the year 2050 if current trends are sustained. States are achieving varying levels of progress in reducing Black infant mortality and Black-White IMR disparities. Public Health Implications. Racial equality in infant survival is achievable, but will require shifting our focus to determinants of progress and strategies for success.

  12. The politics of subnational undemocratic regime reproduction in Argentina and Mexico

    OpenAIRE

    Giraudy, Agustina

    2010-01-01

    This article studies the continued existence of subnational undemocraticregimes in Argentina and Mexico, two countries that have recently experiencednational democratization. The first part of the article offers a conceptualizationof subnational democracy and measures its territorial extension across all subnational units. The second part explores a common, albeit not systematically tested explanation about subnational undemocratic regime continuity, namely, that these regimes persist because...

  13. Secular trend of infant mortality rate during wars and sanctions in Western Iraq.

    Science.gov (United States)

    Al-Ani, Zaid R; Al-Hiali, Sahar J; Al-Farraji, Hussain H

    2011-12-01

    To study the infant mortality rate (IMR) trend during wars and sanction periods in Western Iraq. Data collected from the birth and death certificates of Haditha Health Vital Statistics Center, Haditha city (80,000 population), Western Iraq, included name, age, gender, residence, and infant's place and date of births and deaths, in 5 different sanction and war stages of the country from 1987 to 2010, in a study period from July to December, 2010. The IMRs were analyzed and compared between these stages and with other studies. The IMR of last 2 years of the Iraq-Iran war (1980-1988) was 35.6/1000 and 33.8/1000, this decreased in the war free period (1989-1990) to 28.6/1000, then increased during the sanction period (1991-2003) to 46/1000 in 2002, decreased to 16/1000 in 2006 during no sanctions but increased violence, then increased to 24.5/1000 in 2010. Approximately two-thirds of deaths occurred during the neonatal period, and one third in the post neonatal periods. Males had higher IMR than females, and rural residence higher than urban. Economic sanctions increased IMR more than wars or violence in Haditha city. When compared with other parts of Iraq, and despite the different conflicts that faced the country during the 24 studied years, Haditha had a lower IMR, however, this was still higher than developed, and many developing countries.

  14. Poverty Mapping Project: Global Subnational Prevalence of Child Malnutrition

    Data.gov (United States)

    National Aeronautics and Space Administration — The Global Subnational Prevalence of Child Malnutrition dataset consists of estimates of the percentage of children with weight-for-age z-scores that are more than...

  15. A MULTIDISCIPLINARY APPROACH TO SUB-NATIONAL SUSTAINABILITY

    Science.gov (United States)

    The USEPA is investigating sustainability metrics from an economic and environmental perspective to determine their applicability at a sub-national level. Metrics are derived from Ecological Footprint, Emergy Analysis, Net Regional Product, and Fisher Information. We chose severa...

  16. SUB-NATIONAL SUSTAINABILITY FROM A MULTIDISCIPLINARY APPROACH

    Science.gov (United States)

    The USEPA is investigating sustainability metrics from an economic and environmental perspective to determine their applicability at a sub-national level. Metrics are derived from Ecological Footprint, Emergy Analysis, Net Regional Product, and Fisher Information. We chose severa...

  17. Mortality, neonatal morbidity and two year follow-up of extremely preterm infants born in the netherlands in 2007

    NARCIS (Netherlands)

    C.G. de Waal (Cornelia); N. Weisglas-Kuperus (Nynke); J.B. van Goudoever (Hans); F.J. Walther (Frans)

    2012-01-01

    textabstractBackground: 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. Methodology/Principal Findings: Prospective population-based cohort study of all

  18. 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…

  19. Prenatal sex selection and female infant mortality are more common in India after firstborn and second-born daughters

    NARCIS (Netherlands)

    Gellatly, C.

    2016-01-01

    Background: The Indian sex ratio has become highly male-biased in recent decades. This may be attributed to prenatal sex selection (PSS) and excess female infant mortality. However, the question of whether these factors are related has not been adequately studied. Here we examine whether increased

  20. [Infant mortality according to color or race based on the 2010 Population Census and national health information systems in Brazil].

    Science.gov (United States)

    Caldas, Aline Diniz Rodrigues; Santos, Ricardo Ventura; Borges, Gabriel Mendes; Valente, Joaquim Gonçalves; Portela, Margareth Crisóstomo; Marinho, Gerson Luiz

    2017-08-07

    The aim of this study was to investigate infant mortality data according to color or race in Brazil with a focus on indigenous individuals, based on data from the 2010 Population Census and the Brazilian Mortality Information System (SIM) and Brazilian Information System on Live Births (SINASC). In both sources, the infant mortality rate (IMR) for indigenous individuals was the highest of all the various population segments. Although the census data indicate inequalities by color or race, the infant mortality rates for indigenous and black individuals were lower than those based on data from SIM/SINASC. Methodological specificities in the data collection in the two sources should be considered. The reduction in IMR in Brazil in recent decades is largely attributed to the priority of infant health on the policy agenda. The study's findings indicate that the impact of public policies failed to reach indigenous peoples on the same scale as in the rest of the population. New sources of nationwide data on deaths in households, as in the case of the 2010 Census, can contribute to a better understanding of inequalities by color or race in Brazil.

  1. [Electronic fetal monitoring and its relationship to neonatal and infant mortality in a national database: A sensitivity analysis].

    Science.gov (United States)

    Philopoulos, D

    2015-05-01

    Sensitivity analysis of the association between electronic fetal monitoring and neonatal and infant mortality previously reported from a United States database. Retrospective cohort study of 11,916,806 live births linked to neonatal and infant deaths during the years 1997-2002 from the United States Centers for Disease Control's National Center of Health Statistics (NCHS) linked birth and infant death data. Restrictions were performed to exclude deliveries occurring outside of a hospital, precipitous labors, breech deliveries, eleven risk factors of pregnancy, multiple gestations, deliveries before 24 and after 44 weeks, implausible birthweights, repeat cesarean sections, and congenital anomalies. An additional analysis explored the effect of further restrictions to term births, birth weight≥2500 g, absence of maternal fever (>38°C), and absence of labor induction or augmentation. For each year, adjusted relative risks (RR) were estimated with log binomial regression. A six-year pooled association was estimated by the generic inverse variance method using a random effects model. For the six-year period, there was a significant reduction in risk in the group with electronic fetal monitoring for early neonatal mortality (RR=0.54, 95 % CI: 0.52-0.57), late neonatal mortality (RR=0.84, 95 % CI: 0.78-0.90), post-neonatal mortality (RR=0.86, 95 % CI: 0.83-0.90), and infant mortality from all causes (RR=0.75, 95 % CI: 0.73-0.77), from perinatal causes (RR=0.60, 95 % CI: 0.57-0.63), and from hypoxia (RR=0.67, 95 % CI: 0.54-0.84). In the additional analysis, which only examined the outcome of infant mortality from all causes, there was also a significant reduction in risk (RR=0.91, 95 % CI: 0.85-0.97). Using the NCHS linked birth and infant death data over a 6-year period, electronic fetal monitoring was associated with decreased neonatal and infant mortality as has been previously reported. These results were robust to two levels of restriction applied on potential

  2. Changes in childhood pneumonia and infant mortality rates following introduction of the 13-valent pneumococcal conjugate vaccine in Nicaragua.

    Science.gov (United States)

    Becker-Dreps, Sylvia; Amaya, Erick; Liu, Lan; Moreno, Gilberto; Rocha, Julio; Briceño, Rafaela; Alemán, Jorge; Hudgens, Michael G; Woods, Christopher W; Weber, David J

    2014-06-01

    In 2010, Nicaragua became the first developing nation to add 13-valent pneumococcal conjugate vaccine (PCV-13) to its national immunization schedule, using a "3+0" dosing schedule. We assessed changes in incidence rates of health facility visits for childhood pneumonia and infant mortality after PCV-13 introduction in the Department of León, Nicaragua. We collected visit diagnoses from all 107 public health facilities in León between 2008 and 2012. We compared rates of pneumonia hospitalizations, ambulatory visits for pneumonia and infant mortality during the prevaccine (2008-2010) and vaccine (2011-2012) periods among different age groups of children using generalized estimating equations, accounting for clustering by municipality. Exposure time was estimated by official municipality population estimates. The adjusted incidence rate ratio for pneumonia hospitalization in the vaccine versus prevaccine period was 0.67 (0.59-0.75) among infants and 0.74 (0.67-0.81) among 1-year olds. The adjusted incidence rate ratio for ambulatory visits for pneumonia was 0.87 (0.75-1.01) among infants, and 0.84 (0.74, 0.95) among 1-year olds. The adjusted incidence rate ratio for infant mortality was 0.67 (0.57-0.80). We also observed lower rates of health facility visits for pneumonia among age groups (2- to 4-year old and 5- to 14-year old) not eligible to receive PCV-13. Within the first 2 years of a PCV-13 immunization program in Nicaragua, we observed lower rates of hospitalizations and ambulatory visits for pneumonia among children of all ages and a lower infant mortality rate. Lower rates of pneumonia among age groups not eligible to receive PCV-13 suggest an indirect effect of the vaccine.

  3. 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 BACKGROUND: 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. METHODOLOGY/PRINCIPAL FINDINGS: 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. CONCLUSIONS/SIGNIFICANCE: 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.

  4. Influence of definition based versus pragmatic birth registration on international comparisons of perinatal and infant mortality: population based retrospective study.

    Science.gov (United States)

    Joseph, K S; Liu, Shiliang; Rouleau, Jocelyn; Lisonkova, Sarka; Hutcheon, Jennifer A; Sauve, Reg; Allen, Alexander C; Kramer, Michael S

    2012-02-17

    To examine variations in the registration of extremely low birthweight and early gestation births and to assess their effect on perinatal and infant mortality rankings of industrialised countries. Retrospective population based study. Australia, Canada, European countries, and the United States for 2004; Australia, Canada, and New Zealand for 2007. National data on live births and on fetal, neonatal, and infant deaths. Reported proportions of live births with birth weight/gestational age of less than 500 g, less than 1000 g, less than 24 weeks, and less than 28 weeks; crude rates of fetal, neonatal, and infant mortality; mortality rates calculated after exclusion of births under 500 g, under 1000 g, less than 24 weeks, and less than 28 weeks. The proportion of live births under 500 g varied widely from less than 1 per 10,000 live births in Belgium and Ireland to 10.8 per 10,000 live births in Canada and 16.9 in the United States. Neonatal deaths under 500 g, as a proportion of all neonatal deaths, also ranged from less than 1% in countries such as Luxembourg and Malta to 29.6% in Canada and 31.1% in the United States. Rankings of countries based on crude fetal, neonatal, and infant mortality rates differed substantially from rankings based on rates calculated after exclusion of births with a birth weight of less than 1000 g or a gestational age of less than 28 weeks. International differences in reported rates of extremely low birthweight and very early gestation births probably reflect variations in registration of births and compromise the validity of international rankings of perinatal and infant mortality.

  5. Widening Disparities In Infant Mortality And Life Expectancy Between Appalachia And The Rest Of The United States, 1990-2013.

    Science.gov (United States)

    Singh, Gopal K; Kogan, Michael D; Slifkin, Rebecca T

    2017-08-01

    Appalachia-a region that stretches from Mississippi to New York-has historically been recognized as a socially and economically disadvantaged part of the United States, and growing evidence suggests that health disparities between it and the rest of the country are widening. We compared infant mortality and life expectancy disparities in Appalachia to those outside the region during the period 1990-2013. We found that infant mortality disparities widened for both whites and blacks, with infant mortality 16 percent higher in Appalachia in 2009-13, and the region's deficit in life expectancy increased from 0.6 years in 1990-92 to 2.4 years in 2009-13. The association between area poverty and life expectancy was stronger in Appalachia than in the rest of the United States. We found wide health disparities, including a thirteen-year gap in life expectancy among black men in high-poverty areas of Appalachia, compared to white women in low-poverty areas elsewhere. Higher mortality in Appalachia from cardiovascular diseases, lung cancer, chronic lower respiratory diseases or chronic obstructive pulmonary disease, diabetes, nephritis or kidney diseases, suicide, unintentional injuries, and drug overdose contributed to lower life expectancy in the region, compared to the rest of the country. Widening health disparities were also due to slower mortality improvements in Appalachia. Project HOPE—The People-to-People Health Foundation, Inc.

  6. Association of labor induction or stimulation with infant mortality in women with failed versus successful trial of labor after prior cesarean.

    Science.gov (United States)

    Chen, Han-Yang; Chauhan, Suneet P; Grobman, William A; Ananth, Cande V; Vintzileos, Anthony M; Abuhamad, Alfred Z

    2013-08-01

    To compare infant mortality rates among women with a failed versus successful trial of labor after cesarean (TOLAC) following labor induction or stimulation. Using US linked birth and infant death cohort data (2000-2004), we identified women who delivered non-anomalous singleton births at 34-41 weeks with TOLAC whose labors were induced or stimulated. Multivariable log-binomial regression models were fitted to estimate the association between TOLAC success and infant mortality. Of the 164,113 women who underwent TOLAC, 41% were unsuccessful. After adjustment for potential confounding factors, a failed TOLAC was associated with a 1.4 fold (95% confidence interval [CI] 1.1, 1.7) increased risk of infant mortality. Among women undergoing labor induction or stimulation, a failed TOLAC is associated with higher likelihood of infant mortality.

  7. 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......: 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...

  8. Meta-analysis shows that infants who have suffered neonatal sepsis face an increased risk of mortality and severe complications.

    Science.gov (United States)

    Bakhuizen, Sabine E; de Haan, Timo R; Teune, Margreet J; van Wassenaer-Leemhuis, Aleid G; van der Heyden, Jantien L; van der Ham, David P; Mol, Ben Willem J

    2014-12-01

    Infants suffering from neonatal sepsis face an increased risk of early death and long-term neurodevelopmental delay. This paper analyses and summarises the existing data on short-term and long-term outcomes of neonatal sepsis, based on 12 studies published between January 2000 and 1 April 2012 and covering 3669 neonates with sepsis. Infants who have suffered neonatal sepsis face an increased risk of mortality and severe complications such as brain damage and, or, neurodevelopmental delay. ©2014 Foundation Acta Paediatrica. Published by John Wiley & Sons Ltd.

  9. [The drama of maternal, infant and child mortality in Latin America and the Caribbean].

    Science.gov (United States)

    1990-12-01

    99% of the half-million maternal deaths in the world each year occur in developing countries, and many are the result of inopportune or undesired pregnancies. Each month over a million infants an small children also die. In Latin America and the caribbean, women have a risk 50-100 times greater of dying as a result of pregnancy or delivery than women in the US, and their children have a 5 times greater risk of dying before heir 1st birthday. The majority of infant and maternal deaths are preventable. Education and family planning services, which are neither costly nor complicated, could significantly reduce these high mortality rates. A woman's lifetime risk of maternal death is related in great part to her economic and social environment, how many pregnancies she has had, and the availability of maternal health services, It is often difficult for women in developing countries to maintain good health especially if they are poor. They are frequently poorly nourished, and may be required to perform hard physical labor. Pregnancy places greater physical demands on them and may worsen existing health problems. Maternal health risks are substantially increased as well by age under 18 or over 40 years, parity over 4, previous delivery during the last 2 years, and preexisting health problems that could affect pregnancy. Some 75% of maternal deaths are believed to result from obstetrical complications. Hemorrhage, 1 of the most frequent,is more common among older women who have already had 4 or more deliveries. Hemorrhages can be fatal in areas lacking the capability to provide immediate transfusions. Toxemia can lead to convulsions and death if not treated early. Sepsis usually results from complications of an obstructed delivery in very young mothers. Illegal abortion is another major cause of maternal death. In some Latin American ad Caribbean countries, 1/2 of maternal deaths are due to illegal abortions under unhygienic conditions. The same obstetrical risks exist

  10. How can we make international comparisons of infant mortality in high income countries based on aggregate data more relevant to policy?

    Science.gov (United States)

    Zylbersztejn, Ania; Gilbert, Ruth; Hjern, Anders; Hardelid, Pia

    2017-12-19

    Infant mortality rates are commonly used to compare the health of populations. Observed differences are often attributed to variation in child health care quality. However, any differences are at least partly explained by variation in the prevalence of risk factors at birth, such as low birth weight. This distinction is important for designing interventions to reduce infant mortality. We suggest a simple method for decomposing inter-country differences in crude infant mortality rates into two metrics representing risk factors operating before and after birth. We used data from 7 European countries participating in the EURO-PERISTAT project in 2010. We calculated crude and birth weight-standardised stillbirth and infant mortality rates using Norway as the standard population. We decomposed between-country differences in crude stillbirth and infant mortality rates into the within-country difference in crude and birth weight-standardised stillbirth and infant mortality rates (metric 1), reflecting prenatal risk factors, and the between-country difference in birth weight-standardised stillbirth and infant mortality rates (metric 2), reflecting risk factors operating after birth. We also calculated birth weight-specific mortality. Using our metrics, we showed that for England, Wales and Scotland risk factors before and after birth contributed equally to the differences in crude stillbirth and infant mortality rates relative to Norway. In Austria, Czech Republic and Switzerland the differences were driven primarily by metric 1, reflecting high rate of low birth weight. The highest values of metric 2 observed in Poland partially reflected high rates of congenital anomalies. Our suggested metrics can be used to guide policy decisions on preventing infant deaths through reducing risk factors at birth or improving the care of babies after birth. Aggregate data tabulated by birth weight/gestational age should be routinely collected and published in high-income countries where

  11. 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.

  12. SUBNATIONAL REGIONALISM IN A SUPRANATIONAL CONTEXT: THE CASE OF HUNGARY

    Directory of Open Access Journals (Sweden)

    David Ellison

    2008-04-01

    Full Text Available European economic integration drives a political economy of regionalism that—far more than traditional divisions between labor and capital—defines the principal axis of political-economic division in the New Europe. The New Economy drives a radical shift in EU policy from cohesion or redistribution toward innovation promotion, affecting distributional struggles and policy approaches at the EU, national and subnational levels. Shifting strategies pose significant challenges at the national and subnational levels with important implications for future EU, national and subnational economic and regional development policy goals. At the national level, and in particular less developed economies, the New Economy creates incentives for the increasing centralization of decision-making. EU-level reforms, such as the Lisbon Agenda and an increasing emphasis on cohesion as opposed to structural funding, do much to strengthen these trends. Subnational regions, at least in the near term, may be the principal losers. But such trends are likely to strengthen future demands for greater subnational political decentralization.

  13. [Trendency analysis of infant mortality rate due to premature birth or low birth weight in China from 1996 to 2013].

    Science.gov (United States)

    Cui, Hao; He, Chunhua; Miao, Lei; Zhu, Jun; Wang, Yanping; Li, Qi; Li, Xiaohong; Shen, Liqin

    2015-02-01

    To study the secular trend and characteristics of infant mortality rate due to premature birth or low birth weight (IMRPL) in China from 1996 to 2013. Data used in this study was collected from the population-based Child's Health Surveillance Network of China. The Cochran-Armitage Trend test and Poisson regression were used to test the trend of IMRPL and explore the differences of the trend among different regions or areas. The nationwide IMRPL was 629.9 per 100 000 live births in 1996 and it decreased to 214.6 per 100 000 live births in 2013. The average annual decline rate was 6.14%, while the proportion of infant mortality due to premature birth or low birth weight in all infant deaths was on the rise with the average annual growth rate of 1.52%. And the proportion increased to 22.6% in 2013. IMRPLin rural and urban areas fell 28.1% and 66.6% respectively during 1996 and 2013. But the differences between urban and rural areas was obvious. During the same period, the average IMRPLin the central region was 1.40 times (95%CI:1.31-1.49) of that in the eastern region. And the average IMRPL in the western region was 2.25 times (95%CI:2.12-2.40) of that in the eastern region. The differences among different regions was obvious. Male infant mortality rate due to premature birth or low birth weight was 1.09 times (95%CI:1.05-1.14) of that in female infant from 1996 to 2013. The risk of IMRPL decreased substantially in China from 1996 to 2013. And the risk of IMRPL decreased more in rural areas than that in urban areas. The differences among different regions and areas were obvious. Premature birth or low birth weight as one of main factors has become a serious threat for health of Chinese children.

  14. Morbidity and mortality amongst infants of diabetic mothers admitted into a special care baby unit in Port Harcourt, Nigeria

    Directory of Open Access Journals (Sweden)

    Onubogu Uche C

    2010-12-01

    Full Text Available Abstract Background Infants born to diabetic women have certain distinctive characteristics, including large size and high morbidity risks. The neonatal mortality rate is over five times that of infants of non diabetic mothers and is higher at all gestational ages and birth weight for gestational age (GA categories. The study aimed to determine morbidity and mortality pattern amongst infants of diabetic mothers (IDMS admitted into the Special Care Baby Unit of University of Port Harcourt Teaching Hospital. Methods This was a study of prevalence of morbidity and mortality among IDMs carried out prospectively over a two year period. All IDMs (pregestational and gestational admitted into the Unit within the period were recruited into the study. Data on delivery mode, GA, birth weight, other associated morbidities, investigation results, treatment, duration of hospital stay and outcome were collated and compared with those of infants of non diabetic mothers matched for GA and birth weight admitted within the same period. Maternal data were reviewed retrospectively. Data were analyzed using SPSS 16.0. Results Sixty percent of the IDMs were born to mothers with gestational diabetes, while 40% were born to mothers with pregestational DM. 38 (74.3% were born by Caesarian section (CS, of which 20 (52.6% were by emergency CS. There was no significant difference in emergency CS rates, when compared with controls, but non-IDMs were more likely to be delivered vaginally. The mean GA of IDMs was 37.84 weeks ± 1.88. 29 (61.7% of them were macrosomic. The commonest morbidities were Hypoglycemia (significantly higher in IDMs than non-IDMs and hyperbilirubinaemia in 30 (63.8% and 26 (57.4% respectively. There was no difference in morbidity pattern between infants of pre- gestational and gestational diabetic mothers. Mortality rate was not significantly higher in IDMs Conclusions The incidence of macrosomia in IDMs was high but high rates of emergency CS was not

  15. Morbidity and mortality amongst infants of diabetic mothers admitted into a special care baby unit in Port Harcourt, Nigeria.

    Science.gov (United States)

    Opara, Peace I; Jaja, Tamunopriye; Onubogu, Uche C

    2010-12-07

    Infants born to diabetic women have certain distinctive characteristics, including large size and high morbidity risks. The neonatal mortality rate is over five times that of infants of non diabetic mothers and is higher at all gestational ages and birth weight for gestational age (GA) categories.The study aimed to determine morbidity and mortality pattern amongst infants of diabetic mothers (IDMS) admitted into the Special Care Baby Unit of University of Port Harcourt Teaching Hospital. This was a study of prevalence of morbidity and mortality among IDMs carried out prospectively over a two year period. All IDMs (pregestational and gestational) admitted into the Unit within the period were recruited into the study.Data on delivery mode, GA, birth weight, other associated morbidities, investigation results, treatment, duration of hospital stay and outcome were collated and compared with those of infants of non diabetic mothers matched for GA and birth weight admitted within the same period. Maternal data were reviewed retrospectively. Data were analyzed using SPSS 16.0. Sixty percent of the IDMs were born to mothers with gestational diabetes, while 40% were born to mothers with pregestational DM. 38 (74.3%) were born by Caesarian section (CS), of which 20 (52.6%) were by emergency CS. There was no significant difference in emergency CS rates, when compared with controls, but non-IDMs were more likely to be delivered vaginally. The mean GA of IDMs was 37.84 weeks ± 1.88. 29 (61.7%) of them were macrosomic. The commonest morbidities were Hypoglycemia (significantly higher in IDMs than non-IDMs) and hyperbilirubinaemia in 30 (63.8%) and 26 (57.4%) respectively.There was no difference in morbidity pattern between infants of pre- gestational and gestational diabetic mothers. Mortality rate was not significantly higher in IDMs The incidence of macrosomia in IDMs was high but high rates of emergency CS was not peculiar to them. Hypoglycaemia and hyperbilirubinaemia were

  16. 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

    .09-4.07). In a multivariable analysis among twins only, birth weight death of the cotwin perinatally [2.54, (1.16-5.57)] and severe maternal illness during pregnancy [2.35, (1.00-5.51)] were significant risk factors for twin death. In the subgroup with available HIV status, maternal HIV infection......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...... at the National Hospital. RESULTS: About 495 twins and 333 singletons were alive on day 7 after birth. In total, 36 twins and 12 singletons died during follow-up, the post-perinatal infant mortality rate being 91/1000 person-years for twins and 42/1000 for singletons (HR = 2.11, 95% CI: 1...

  17. Decline of infant and child mortality rates in rural Senegal over a 37-year period (1963-1999).

    Science.gov (United States)

    Delaunay, V; Etard, J F; Préziosi, M P; Marra, A; Simondon, F

    2001-12-01

    In spite of an improving trend, childhood mortality in rural sub-Saharan Africa remains high and has recently risen in some countries. The factors associated with the long-term decline in childhood mortality are poorly known, due to a lack of data. A Senegalese rural population has been under demographic surveillance since 1963. Infant and under-5 mortality rates were calculated for different periods to generate a long-term trend in childhood mortality. Evolution of age and seasonal patterns of mortality were observed. During the observation period (1963-1999), infant and under-5 mortality rates decreased from 223 per thousand to 80 per thousand and 485 per thousand to 213 per thousand , respectively, with a constant annual rate of decline in the probability of dying since the 1960s (-3.7% and -3.1%, respectively). The age pattern of the under-5 mortality changed drastically, with a large decrease in the death rate between 6 and 24 months of age (from 321 per thousand to 87 per thousand ). This change took place during the 1970s. The seasonal variation, characterized by a greater proportion of deaths during the rainy season, was very marked during the 1960s, then decreased during the 1980s but it has tended to increase again in the 1990s, particularly among children 1-4 years old. This study confirms the long-term trend of decrease in child mortality in rural West Africa. Historical knowledge on healthcare developments suggests that immunizations have contributed to the decrease and the change in the age pattern. The re-emergence of malaria seems the most likely explanation for the recent rebound in seasonal variation. Attention to immunization and malaria should continue to be a priority.

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

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    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. Infant mortality rates regressed against number of vaccine doses routinely given: Is there a biochemical or synergistic toxicity?

    Science.gov (United States)

    Miller, Neil Z; Goldman, Gary S

    2011-01-01

    The infant mortality rate (IMR) is one of the most important indicators of the socio-economic well-being and public health conditions of a country. The US childhood immunization schedule specifies 26 vaccine doses for infants aged less than 1 year—the most in the world—yet 33 nations have lower IMRs. Using linear regression, the immunization schedules of these 34 nations were examined and a correlation coefficient of r = 0.70 (p infants. Nations were also grouped into five different vaccine dose ranges: 12–14, 15–17, 18–20, 21–23, and 24–26. The mean IMRs of all nations within each group were then calculated. Linear regression analysis of unweighted mean IMRs showed a high statistically significant correlation between increasing number of vaccine doses and increasing infant mortality rates, with r = 0.992 (p = 0.0009). Using the Tukey-Kramer test, statistically significant differences in mean IMRs were found between nations giving 12–14 vaccine doses and those giving 21–23, and 24–26 doses. A closer inspection of correlations between vaccine doses, biochemical or synergistic toxicity, and IMRs is essential. PMID:21543527

  20. Apgar score and the risk of cause-specific infant mortality: a population-based cohort study.

    Science.gov (United States)

    Iliodromiti, Stamatina; Mackay, Daniel F; Smith, Gordon C S; Pell, Jill P; Nelson, Scott M

    2014-11-15

    The Apgar score has been used worldwide as an index of early neonatal condition for more than 60 years. With advances in health-care service provision, neonatal resuscitation, and infant care, its present relevance is unclear. The aim of the study was to establish the strength of the relation between Apgar score at 5 min and the risk of neonatal and infant mortality, subdivided by specific causes. We linked routine discharge and mortality data for all births in Scotland, UK between 1992 and 2010. We restricted our analyses to singleton livebirths, in women aged over 10 years, with a gestational age at delivery between 22 and 44 weeks, and excluded deaths due to congenital anomalies or isoimmunisation. We calculated the relative risks (RRs) of neonatal and infant death of neonates with low (0-3) and intermediate (4-6) Apgar scores at 5 min referent to neonates with normal Apgar score (7-10) using binomial log-linear modelling with adjustment for confounders. Analyses were stratified by gestational age at birth because it was a significant effect modifier. Missing covariate data were imputed. Complete data were available for 1,029,207 eligible livebirths. Across all gestational strata, low Apgar score at 5 min was associated with an increased risk of neonatal and infant death. However, the strength of the association (adjusted RR, 95% CI referent to Apgar 7-10) was strongest at term (pApgar (0-3) was associated with an adjusted RR of 359·4 (95% CI 277·3-465·9) for early neonatal death, 30·5 (18·0-51·6) for late neonatal death, and 50·2 (42·8-59·0) for infant death. We noted similar associations of a lower magnitude for intermediate Apgar (4-6). The strongest associations were for deaths attributed to anoxia and low Apgar (0-3) for term infants (RR 961·7, 95% CI 681·3-1357·5) and preterm infants (141·7, 90·1-222·8). No association between Apgar score at 5 min and the risk of sudden infant death syndrome was noted at any gestational age (RR 0·6, 95% CI

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

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    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.

  2. [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)

  3. Infant mortality in Central Europe: effects of transition Mortalidad infantil en Europa central: efectos de la transición

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    Witold Zatoñski

    2006-02-01

    Full Text Available Objective: To address the issue of infant mortality as an important health indicator, we systematically analyzed trends in infant mortality in five central and eastern European (CEE countries (the Czech Republic, Hungary, Poland, Slovakia and Slovenia. Methods: Infant mortality rates (per 1,000 live births and trends were computed using the World Health Organization database, as well as selected European databases. Results: In 1990, mortality rates in most CEE countries were appreciably higher than the mean European Union value of 9.2/1,000 (up to 14.8/1,000 in Hungary and 19.4/1,000 in Poland. However, between 1990 and 2001, infant mortality decreased substantially in all CEE countries, and in 2001 the rates in the Czech Republic (4.0/1,000 and Slovenia (4.3/1,000 were lower than the EU average of 4.6/1,000. Discussion: Infant mortality is an important indicator of the improvements in health observed in CEE countries over the last decade.Objetivo: Para estudiar la aplicación específica de la mortalidad infantil como indicador relevante de la salud, hemos considerado sistemáticamente las tendencias en la mortalidad infantil en 5 países de Europa central y del este (República Checa, Hungría, Polonia, Eslovaquia y Eslovenia. Métodos: Hemos calculado las tasas de mortalidad infantil (por 1.000 nacidos vivos y las tendencias a partir de la base de datos de mortalidad de la Organización Mundial de la Salud, así como otras bases de datos europeas y nacionales seleccionadas. Resultados: En 1990, la mayoría de los países de Europa central y del este tenían tasas apreciablemente mayores que el valor medio de la Unión Europea de 9,2/1.000, hasta 14,8/1.000 en Hungría y 19,4/1.000 en Polonia. Sin embargo, entre 1990 y 2001, la mortalidad infantil disminuyó sustancialmente en todos los países de Europa central y del este, y en 2001 las tasas en la República Checa (4,0/1.000 y Eslovenia (4,3/1.000 fueron menores que la media de la Uni

  4. Infant mortality among singletons and twins in Japan during 1999-2008 on the basis of risk factors.

    Science.gov (United States)

    Imaizumi, Yoko; Hayakawa, Kazuo

    2013-04-01

    The infant mortality rate (IMR) among single and twin births from 1999 to 2008 was analyzed using Japanese Vital Statistics. The IMR was 5.3-fold higher in twins than in singletons in 1999 and decreased to 3.9-fold in 2008. The reduced risk of infant mortality in twins relative to singletons may be related, partially, to survival rates, which improved after fetoscopic laser photocoagulation for twin - twin transfusion syndrome. The proportion of neonatal deaths among total infant deaths was 54% for singletons and 74% for twins. Thus, intensive care of single and twin births may be very important during the first month of life to reduce the IMR. The IMR decreased as gestational age (GA) rose in singletons, whereas the IMR in twins decreased as GA rose until 37 weeks and increased thereafter. The IMR was significantly higher in twins than in singletons from the shortest GA (twins from 30 to 36 weeks. As for maternal age, the early neonatal and neonatal mortality rates as well as the IMR in singletons were significantly higher in the youngest maternal age group than in the oldest one, whereas the opposite result was obtained in twins. The lowest IMR in singletons was 1.1 per 1,000 live births for ≥38 weeks of gestation and heaviest birth weight (≥2,000 g), while the lowest IMR in twins was 1.8 at 37 weeks and ≥2,000 g.

  5. Association of Urban Slum Residency with Infant Mortality and Child Stunting in Low and Middle Income Countries

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    Hmwe Hmwe Kyu

    2013-01-01

    Full Text Available 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.

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

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    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.

  7. Infant Mortality Risk and Paternity Certainty Are Associated with Postnatal Maternal Behavior toward Adult Male Mountain Gorillas (Gorilla beringei beringei.

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    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.

  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. Potential impact of infant feeding recommendations on mortality and HIV-infection in children born to HIV-infected mothers in Africa: a simulation

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    Seksaria Vidyunmala

    2008-05-01

    Full Text Available Abstract Background Although breast-feeding accounts for 15–20% of mother-to-child transmission (MTCT of HIV, it is not prohibited in some developing countries because of the higher mortality associated with not breast-feeding. We assessed the potential impact, on HIV infection and infant mortality, of a recommendation for shorter durations of exclusive breast-feeding (EBF and poor compliance to these recommendations. Methods We developed a deterministic mathematical model using primarily parameters from published studies conducted in Uganda or Kenya and took into account non-compliance resulting in mixed-feeding practices. Outcomes included the number of children HIV-infected and/or dead (cumulative mortality at 2 years following each of 6 scenarios of infant-feeding recommendations in children born to HIV-infected women: Exclusive replacement-feeding (ERF with 100% compliance, EBF for 6 months with 100% compliance, EBF for 4 months with 100% compliance, ERF with 70% compliance, EBF for 6 months with 85% compliance, EBF for 4 months with 85% compliance Results In the base model, reducing the duration of EBF from 6 to 4 months reduced HIV infection by 11.8% while increasing mortality by 0.4%. Mixed-feeding in 15% of the infants increased HIV infection and mortality respectively by 2.1% and 0.5% when EBF for 6 months was recommended; and by 1.7% and 0.3% when EBF for 4 months was recommended. In sensitivity analysis, recommending EBF resulted in the least cumulative mortality when the a mortality in replacement-fed infants was greater than 50 per 1000 person-years, b rate of infection in exclusively breast-fed infants was less than 2 per 1000 breast-fed infants per week, c rate of progression from HIV to AIDS was less than 15 per 1000 infected infants per week, or d mortality due to HIV/AIDS was less than 200 per 1000 infants with HIV/AIDS per year. Conclusion Recommending shorter durations of breast-feeding in infants born to HIV

  10. Why birthplace still matters for infants born before 32 weeks: Infant mortality associated with birth at 22-31 weeks' gestation in non-tertiary hospitals in Victoria over two decades.

    Science.gov (United States)

    Boland, Rosemarie Anne; Dawson, Jennifer Anne; Davis, Peter Graham; Doyle, Lex William

    2015-04-01

    Very preterm infants born in non-tertiary hospitals ('outborn') are known to have higher mortality rates compared with infants 'inborn' in tertiary centres. The aim of this study was to report changes over time in the incidence of outborn livebirths, 22-31 weeks and infant mortality rates for outborn compared with inborn births. We conducted a population-based cohort study of consecutive livebirths, 22-31 weeks' gestation in Victoria from 1990 to 2009. The relationship between birthplace, gestational age, birthweight, sex and infant mortality were analysed by logistic regression. There were 13,760 livebirths, 22-31 weeks: 14% were outborn. The proportion of outborn livebirths fell from 19% in 1991 to a nadir of 9% in 1997, but climbed to 17% by 2009. At all times, outborns had higher mortality rates compared with inborns. The overall infant mortality rate was 250.6 per 1000 outborn compared with 113.3 per 1000 inborn livebirths (adjusted odds ratio (aOR) 2.76 (95% CI 2.32, 3.27, P mortality risks for 22-week livebirths (OR 7.04, 95% CI 0.87, 56.8, P = 0.067), but there were at 23-27 weeks (aOR 3.16, 95% CI 2.52, 3.96, P mortality rates fell for inborn 23-27 week infants. Mortality rates fell for outborn 23-27 week infants in 1990-2005, but rose in 2006-2009. Outborn livebirths at 22-31 weeks' gestation occur too frequently and are associated with a significantly increased risk of mortality. Strategies to reduce outborn livebirths are required. © 2015 The Royal Australian and New Zealand College of Obstetricians and Gynaecologists.

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

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    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

  12. Effect of Donor Milk on Severe Infections and Mortality in Very Low-Birth-Weight Infants The Early Nutrition Study Randomized Clinical Trial

    NARCIS (Netherlands)

    Corpeleijn, Willemijn E.; de Waard, Marita; Christmann, Viola; van Goudoever, Johannes B.; Jansen-van der Weide, Marijke C.; Kooi, Elisabeth M. W.; Koper, Jan F.; Kouwenhoven, Stefanie M. P.; Lafeber, Hendrik N.; Mank, Elise; van Toledo, Letty; Vermeulen, Marijn J.; van Vliet, Ineke; van Zoeren-Grobben, Diny

    IMPORTANCE Infections and necrotizing enterocolitis, major causes of mortality and morbidity in preterm infants, are reduced in infants fed their own mother's milk when compared with formula. When own mother's milk is not available, human donor milk is considered a good alternative, albeit an

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

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    Shaffiq Essajee

    2015-12-01

    Full Text Available 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

  14. Empirical validation of the UNAIDS Spectrum model for subnational HIV estimates: case-study of children and adults in Manicaland, Zimbabwe.

    Science.gov (United States)

    Silhol, Romain; Gregson, Simon; Nyamukapa, Constance; Mhangara, Mutsa; Dzangare, Janet; Gonese, Elizabeth; Eaton, Jeffrey W; Case, Kelsey K; Mahy, Mary; Stover, John; Mugurungi, Owen

    2017-04-01

    More cost-effective HIV control may be achieved by targeting geographical areas with high infection rates. The AIDS Impact model of Spectrum - used routinely to produce national HIV estimates - could provide the required subnational estimates but is rarely validated with empirical data, even at a national level. The validity of the Spectrum model estimates were compared with empirical estimates. Antenatal surveillance and population survey data from a population HIV cohort study in Manicaland, East Zimbabwe, were input into Spectrum 5.441 to create a simulation representative of the cohort population. Model and empirical estimates were compared for key demographic and epidemiological outcomes. Alternative scenarios for data availability were examined and sensitivity analyses were conducted for model assumptions considered important for subnational estimates. Spectrum estimates generally agreed with observed data but HIV incidence estimates were higher than empirical estimates, whereas estimates of early age all-cause adult mortality were lower. Child HIV prevalence estimates matched well with the survey prevalence among children. Estimated paternal orphanhood was lower than empirical estimates. Including observations from earlier in the epidemic did not improve the HIV incidence model fit. Migration had little effect on observed discrepancies - possibly because the model ignores differences in HIV prevalence between migrants and residents. The Spectrum model, using subnational surveillance and population data, provided reasonable subnational estimates although some discrepancies were noted. Differences in HIV prevalence between migrants and residents may need to be captured in the model if applied to subnational epidemics.

  15. Does higher income inequality adversely influence infant mortality rates? Reconciling descriptive patterns and recent research findings.

    Science.gov (United States)

    Siddiqi, Arjumand; Jones, Marcella K; Erwin, Paul Campbell

    2015-04-01

    As the struggle continues to explain the relatively high rates of infant mortality (IMR) exhibited in the United States, a renewed emphasis is being placed on the role of possible 'contextual' determinants. Cross-sectional and short time-series studies have found that higher income inequality is associated with higher IMR at the state level. Yet, descriptively, the longer-term trends in income inequality and in IMR seem to call such results into question. To assess whether, over the period 1990-2007, state-level income inequality is associated with state-level IMR; to examine whether the overall effect of income inequality on IMR over this period varies by state; to test whether the association between income inequality and IMR varies across this time period. IMR data--number of deaths per 1000 live births in a given state and year--were obtained from the U.S. Centers for Disease Control Wonder database. Income inequality was measured using the Gini coefficient, which varies from zero (complete equality) to 100 (complete inequality). Covariates included state-level poverty rate, median income, and proportion of high school graduates. Fixed and random effects regressions were conducted to test hypotheses. Fixed effects models suggested that, overall, during the period 1990-2007, income inequality was inversely associated with IMR (β = -0.07, SE (0.01)). Random effects models suggested that when the relationship was allowed to vary at the state-level, it remained inverse (β = -0.05, SE (0.01)). However, an interaction between income inequality and time suggested that, as time increased, the effect of income inequality had an increasingly positive association with total IMR (β = 0.009, SE (0.002)). The influence of state income inequality on IMR is dependent on time, which may proxy for time-dependent aspects of societal context. Copyright © 2015 Elsevier Ltd. All rights reserved.

  16. Health system determinants of infant, child and maternal mortality: A cross-sectional study of UN member countries.

    Science.gov (United States)

    Muldoon, Katherine A; Galway, Lindsay P; Nakajima, Maya; Kanters, Steve; Hogg, Robert S; Bendavid, Eran; Mills, Edward J

    2011-10-24

    Few studies have examined the link between health system strength and important public health outcomes across nations. We examined the association between health system indicators and mortality rates. We used mixed effects linear regression models to investigate the strength of association between outcome and explanatory variables, while accounting for geographic clustering of countries. We modelled infant mortality rate (IMR), child mortality rate (CMR), and maternal mortality rate (MMR) using 13 explanatory variables as outlined by the World Health Organization. Significant protective health system determinants related to IMR included higher physician density (adjusted rate ratio [aRR] 0.81; 95% Confidence Interval [CI] 0.71-0.91), higher sustainable access to water and sanitation (aRR 0.85; 95% CI 0.78-0.93), and having a less corrupt government (aRR 0.57; 95% CI 0.40-0.80). Out-of-pocket expenditures on health (aRR 1.29; 95% CI 1.03-1.62) were a risk factor. The same four variables were significantly related to CMR after controlling for other variables. Protective determinants of MMR included access to water and sanitation (aRR 0.88; 95% CI 0.82-0.94), having a less corrupt government (aRR 0.49; 95%; CI 0.36-0.66), and higher total expenditures on health per capita (aRR 0.84; 95% CI 0.77-0.92). Higher fertility rates (aRR 2.85; 95% CI: 2.02-4.00) were found to be a significant risk factor for MMR. Several key measures of a health system predict mortality in infants, children, and maternal mortality rates at the national level. Improving access to water and sanitation and reducing corruption within the health sector should become priorities.

  17. Health system determinants of infant, child and maternal mortality: A cross-sectional study of UN member countries

    Directory of Open Access Journals (Sweden)

    Muldoon Katherine A

    2011-10-01

    Full Text Available Abstract Objective Few studies have examined the link between health system strength and important public health outcomes across nations. We examined the association between health system indicators and mortality rates. Methods We used mixed effects linear regression models to investigate the strength of association between outcome and explanatory variables, while accounting for geographic clustering of countries. We modelled infant mortality rate (IMR, child mortality rate (CMR, and maternal mortality rate (MMR using 13 explanatory variables as outlined by the World Health Organization. Results Significant protective health system determinants related to IMR included higher physician density (adjusted rate ratio [aRR] 0.81; 95% Confidence Interval [CI] 0.71-0.91, higher sustainable access to water and sanitation (aRR 0.85; 95% CI 0.78-0.93, and having a less corrupt government (aRR 0.57; 95% CI 0.40-0.80. Out-of-pocket expenditures on health (aRR 1.29; 95% CI 1.03-1.62 were a risk factor. The same four variables were significantly related to CMR after controlling for other variables. Protective determinants of MMR included access to water and sanitation (aRR 0.88; 95% CI 0.82-0.94, having a less corrupt government (aRR 0.49; 95%; CI 0.36-0.66, and higher total expenditures on health per capita (aRR 0.84; 95% CI 0.77-0.92. Higher fertility rates (aRR 2.85; 95% CI: 2.02-4.00 were found to be a significant risk factor for MMR. Conclusion Several key measures of a health system predict mortality in infants, children, and maternal mortality rates at the national level. Improving access to water and sanitation and reducing corruption within the health sector should become priorities.

  18. Association between Off-Peak Hour Birth and Neonatal Morbidity and Mortality among Very Low Birth Weight Infants.

    Science.gov (United States)

    Jensen, Erik A; Lorch, Scott A

    2017-07-01

    To assess the independent association between overnight or "off-peak" hour delivery and 3 neonatal morbidities strongly associated with childhood neurocognitive impairment. Retrospective population based cohort study of all infants with birth weights of 500-1499 g born without severe congenital anomalies in California or Pennsylvania between 2002 and 2009. Off-peak hour delivery was defined as birth between 12:00 a.m. and 6:59 a.m. The study outcomes were death; bronchopulmonary dysplasia, retinopathy of prematurity, and severe (grade 3 or 4) intraventricular hemorrhage among survivors; the composite of each morbidity or mortality; and the composite of death or 1 or more of the evaluated morbidities. Of 47 617 evaluated infants, 9317 (19.6%) were born during off-peak hours. The frequencies of all study outcomes were higher among infants born during off-peak compared with peak hours. After adjusting for maternal, infant, and hospital characteristics, off-peak hour delivery was associated with increased odds of severe intraventricular hemorrhage among survivors (OR 1.39, 95% CI 1.23-1.57) and the composite outcomes of death or severe intraventricular hemorrhage (OR 1.16, 95% CI 1.07-1.25) and death or major morbidity (OR 1.08, 95% CI 1.02-1.15). There was no evidence of subgroup effects based on delivery mode, birth hospital neonatal intensive care level or annual very low birth weight infant delivery volume, or weekday vs weekend off-peak hour delivery for any study outcome. Very low birth weight infants born between midnight and 7:00 a.m. are at increased risk for severe intraventricular hemorrhage and death or major neonatal morbidity. Copyright © 2017 Elsevier Inc. All rights reserved.

  19. morbidity and mortality of low birth weight infants in the new born

    African Journals Online (AJOL)

    hi-tech

    2004-07-01

    Jul 1, 2004 ... culture done. Antibiotics were started in 460 (86%) of infants yet only 37% had diagnosis of suspected sepsis. Change of antibiotics was guided by culture ...... 30. H. J.J. Late onset infection in very low birth weight infants in. Malaysian level 3. Neonatal nurseries. Malaysia very low birth weight study group.

  20. Trends in Racial and Ethnic Disparities in Infant Mortality Rates in the United States, 1989–2006

    Science.gov (United States)

    Rossen, Lauren M.; Schoendorf, Kenneth C.

    2014-01-01

    Objectives. We sought to measure overall disparities in pregnancy outcome, incorporating data from the many race and ethnic groups that compose the US population, to improve understanding of how disparities may have changed over time. Methods. We used Birth Cohort Linked Birth–Infant Death Data Files from US Vital Statistics from 1989–1990 and 2005–2006 to examine multigroup indices of racial and ethnic disparities in the overall infant mortality rate (IMR), preterm birth rate, and gestational age–specific IMRs. We calculated selected absolute and relative multigroup disparity metrics weighting subgroups equally and by population size. Results. Overall IMR decreased on the absolute scale, but increased on the population-weighted relative scale. Disparities in the preterm birth rate decreased on both the absolute and relative scales, and across equally weighted and population-weighted indices. Disparities in preterm IMR increased on both the absolute and relative scales. Conclusions. Infant mortality is a common bellwether of general and maternal and child health. Despite significant decreases in disparities in the preterm birth rate, relative disparities in overall and preterm IMRs increased significantly over the past 20 years. PMID:24028239

  1. Trends in racial and ethnic disparities in infant mortality rates in the United States, 1989-2006.

    Science.gov (United States)

    Rossen, Lauren M; Schoendorf, Kenneth C

    2014-08-01

    We sought to measure overall disparities in pregnancy outcome, incorporating data from the many race and ethnic groups that compose the US population, to improve understanding of how disparities may have changed over time. We used Birth Cohort Linked Birth-Infant Death Data Files from US Vital Statistics from 1989-1990 and 2005-2006 to examine multigroup indices of racial and ethnic disparities in the overall infant mortality rate (IMR), preterm birth rate, and gestational age-specific IMRs. We calculated selected absolute and relative multigroup disparity metrics weighting subgroups equally and by population size. Overall IMR decreased on the absolute scale, but increased on the population-weighted relative scale. Disparities in the preterm birth rate decreased on both the absolute and relative scales, and across equally weighted and population-weighted indices. Disparities in preterm IMR increased on both the absolute and relative scales. Infant mortality is a common bellwether of general and maternal and child health. Despite significant decreases in disparities in the preterm birth rate, relative disparities in overall and preterm IMRs increased significantly over the past 20 years.

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

    Directory of Open Access Journals (Sweden)

    Hui-Jia Lin

    2015-01-01

    Full Text Available 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 < l000 g were included between January l, 2011 and December 31, 2011. All the data were collected retrospectively from clinical records by a prospectively designed questionnaire. The data collected from each NICU transmitted to the main institution where the results were aggregated and analyzed. Categorical variables were performed with Pearson Chi-square test. Binary Logistic regression analysis was used to detect risk factors. Results: A total of 258 ELBW infants were admitted to 26 NICUs, of whom the mean gestational age (GA was 28.1 ± 2.2 weeks, and the mean BW was 868 ± 97 g. The overall survival rate at discharge was 50.0%. Despite aggressive treatment 60 infants (23.3% died and another 69 infants (26.7% died after medical care withdrawal. Furthermore, the survival rate was significantly higher in coastal areas than inland areas (53.6% vs. 35.3%, P = 0.019. BW < 750 g and GA < 28 weeks were the largest risk factors, and being small for gestational age was a protective factor related to mortality. Respiratory distress syndrome was the most common complication. The incidence of 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

  3. The Effect of Plurality and Gestation on the Prevention or Postponement of Infant Mortality: 1989–1991 Versus 1999–2001

    Science.gov (United States)

    Luke, Barbara; Brown, Morton B.

    2013-01-01

    Advances in perinatal technology that improved survival may have also resulted in prolonged death from the neonatal to the postneonatal period for some infants. The objectives of this study were to determine if the medical advances that occurred in the 1990s benefited infants of multiple births more than their singleton counterparts, and if these changes prevented or postponed mortality for the smallest and most immature infants. The study population included live births of 22 to 43 weeks’ gestation from the 1989–1991 and 1999–2001 US Birth Cohort Linked Birth/Infant Death Data Sets. Odds ratios were calculated to evaluate the change in risk by plurality, gestation, and to compare the change to that for singletons. Neonatal and infant mortality rates declined for all pluralities; postneonatal mortality increased for births at less than 26 weeks, but declined at later gestations. In general, the risk of death for twins and triplets compared to singletons decreased, and the improvement in survival was greater for multiples during the early neonatal period and overall. Infant mortality rates improved by 28% for singletons, 32% for twins and triplets during the 1990s, although for the most premature infants, some deaths were postponed from the early to the late neonatal period. PMID:17564510

  4. 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; Martines, Jose; Penny, Mary; Bhandari, Nita; Kirkwood, Betty R

    2010-01-01

    Abstract Objective 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. Methods 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. Findings The prevalence of stunting, wasting and underweight in infants aged malnutrition in the first 6 months of life. In infants aged 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. PMID:20428352

  5. Apgar Score at 5 Minutes Is Associated with Mortality in Extremely Preterm Infants Even after Transfer to an All Referral NICU.

    Science.gov (United States)

    Bartman, Thomas; Bapat, Roopali; Martin, Elizabeth M; Shepherd, Edward G; Nelin, Leif D; Reber, Kristina M

    2015-11-01

    The Apgar score has been shown to have utility in predicting mortality in the extremely preterm infant in delivery hospital populations, where most mortality occurs within 12 hours of birth. We tested the hypothesis that the 5 minute Apgar score would remain associated with mortality in extremely preterm infants after transfer from the delivery hospital to an all referral neonatal intensive care unit at an average age of 10 days. A retrospective analysis of 454 infants born at Apgar score was 3 at 1 minute (interquartile range [IQR] 2-6) and 6 at 5 minutes (IQR 4-7). The Apgar score increased from 1 to 5 minutes by 2.0 ± 1.7 (p Apgar score of Apgar Apgar score given at delivery even in the extremely preterm infant referred to a nondelivery children's hospital. Thieme Medical Publishers 333 Seventh Avenue, New York, NY 10001, USA.

  6. Elevated infant mortality rates among oral cleft and isolated oral cleft cases: a meta-analysis of studies from 1943 to 2010.

    Science.gov (United States)

    Carlson, Lucas; Hatcher, Kristin Ward; Vander Burg, Richard

    2013-01-01

    Objective : To review available published literature in order to obtain a more comprehensive assessment of the association between infant mortality and oral clefts, overall and isolated. Design : A wide-ranging search of published studies relating infant mortality rates to oral clefts and congenital malformations was conducted, yielding applicable data sets. Settings of the included studies varied to a limited extent, although all were conducted within high-income countries with superior health indicators. These results were tabulated and meta-analyzed. Random effects odds ratios comparing each data set with its respective population have been used to account for differing settings and specific infant mortality rates. Results : Nine articles with relatable data were included in these meta-analyses. The calculated odds ratio of infant mortality associated with oral cleft cases, including those with associated malformations, was substantial: 9.466 (95% confidence interval, 6.153 to 14.560). Excluding oral cleft cases with associated malformations, the odds ratio, although lower, was still significant: 2.073 (95% confidence interval, 1.390 to 3.092). Conclusions : Compared with the overall population, infants with oral clefts have nine times the odds of dying within the first year of life. Furthermore, even without additional malformations, infants with oral clefts are still twice as likely to die before 1 year of age. Current research points to a substantially higher relative risk of infant mortality among oral cleft cases in developing countries. Additional research is essential to determine the sources of these raised infant mortality rates and possible interventions to decrease them.

  7. Distinctive identity claims in federal systems: Judicial policing of subnational variance

    DEFF Research Database (Denmark)

    Abat Ninet, Antoni; Gardner, James A.

    2016-01-01

    It is characteristic of federal states that the scope of subnational power and autonomy are subjects of frequent dispute, and that disagreements over the reach of national and subnational power may be contested in a wide and diverse array of settings. Subnational units determined to challenge...... nationally imposed limits on their power typically have at their disposal many tools with which to press against formal boundaries. Federal systems, moreover, frequently display a surprising degree of tolerance for subnational obstruction, disobedience, and other behaviors intended to expand subnational...

  8. Infant mortality in twin pregnancies following in-utero demise of the co-twin

    Directory of Open Access Journals (Sweden)

    Boubakari Ibrahimou

    2015-09-01

    Conclusions: Risks for all mortality types were lower among converted co-twins than their unconverted or same-quantile counterparts. The lower neonatal and higher post-neonatal mortality among black require future research.

  9. Association of regional disparity of obstetrics and gynecologic services with children and infants mortality rates: A cross-sectional study

    Directory of Open Access Journals (Sweden)

    Sogand Tourani

    2017-08-01

    Full Text Available Background: Equity in distribution of resources is considered as an important priority in health care systems. Equitable distribution of obstetrics and gynecology (Ob/Gyn services in the country level is critical in maternal and neonatal health for qualitative promotion of maternal care in pregnancy, delivery, and post-delivery periods. Objective: The present study aimed at determining regional disparity of obstetrics and gynecology services and its association with children and infants mortality rates. Materials and Methods: This was a descriptive-analytical study conducted in 2015 to investigate distribution of Ob/Gyn services using three indicators of number of nursing and midwifery personnel, total Ob/Gyn specialists, and total delivery beds among 30 provinces of the country. Equity criteria in the present study included population, normal vaginal deliveries, cesarean sections, and total deliveries. Data were gathered using a researcher-made form and Stata 12 was used to calculate Gini coefficient. The association of Ob/Gyn services with children and infant mortality rates was investigated using SPSS package and linear regression test. Results: The lowest Gini coefficient was observed in distribution of nursing and midwifery personnel in delivery wards in terms of vaginal delivery (0.38 from 1 and the highest value was related to distribution of Ob/Gyn specialists in terms of vaginal delivery (0.73 from 1. Infant mortality was significantly associated with number of nursing and midwifery personnel in delivery wards, and total number of Ob/Gyn specialists. Conclusion: Considering new population policies in Iran and increased fertility rate, it is recommended to facilitate accessibility of the required services for the women, particularly those of reproductive age.

  10. Girl child marriage and its association with national rates of HIV, maternal health, and infant mortality across 97 countries.

    Science.gov (United States)

    Raj, Anita; Boehmer, Ulrike

    2013-04-01

    This study was designed to assess associations between national rates of girl child marriage and national rates of HIV and maternal and child health (MCH) concerns, using national indicator data from 2009 United Nations reports. Current analyses were limited to the N = 97 nations (of 188 nations) for which girl child marriage data were available. Regression analyses adjusted for development and world region demonstrate that nations with higher rates of girl child marriage are significantly more likely to contend with higher rates of maternal and infant mortality and nonutilization of maternal health services, but not HIV.

  11. Disparities and Trends in Birth Outcomes, Perinatal and Infant Mortality in Aboriginal vs. Non-Aboriginal Populations: A Population-Based Study in Quebec, Canada 1996-2010.

    Directory of Open Access Journals (Sweden)

    Lu Chen

    Full Text Available Aboriginal populations are at substantially higher risks of adverse birth outcomes, perinatal and infant mortality than their non-Aboriginal counterparts even in developed countries including Australia, U.S. and Canada. There is a lack of data on recent trends in Canada.We conducted a population-based retrospective cohort study (n = 254,410 using the linked vital events registry databases for singleton births in Quebec 1996-2010. Aboriginal (First Nations, Inuit births were identified by mother tongue, place of residence and Indian Registration System membership. Outcomes included preterm birth, small-for-gestational-age, large-for-gestational-age, low birth weight, high birth weight, stillbirth, neonatal death, postneonatal death, perinatal death and infant death.Perinatal and infant mortality rates were 1.47 and 1.80 times higher in First Nations (10.1 and 7.3 per 1000, respectively, and 2.37 and 4.46 times higher in Inuit (16.3 and 18.1 per 1000, respectively relative to non-Aboriginal (6.9 and 4.1 per 1000, respectively births (all p<0.001. Compared to non-Aboriginal births, preterm birth rates were persistently (1.7-1.8 times higher in Inuit, large-for-gestational-age birth rates were persistently (2.7-3.0 times higher in First Nations births over the study period. Between 1996-2000 and 2006-2010, as compared to non-Aboriginal infants, the relative risk disparities increased for infant mortality (from 4.10 to 5.19 times in Inuit, and for postneonatal mortality in Inuit (from 6.97 to 12.33 times or First Nations (from 3.76 to 4.25 times infants. Adjusting for maternal characteristics (age, marital status, parity, education and rural vs. urban residence attenuated the risk differences, but significantly elevated risks remained in both Inuit and First Nations births for the risks of perinatal mortality (1.70 and 1.28 times, respectively, infant mortality (3.66 and 1.47 times, respectively and postneonatal mortality (6.01 and 2.28 times

  12. Association Between the Birth of an Infant With Major Congenital Anomalies and Subsequent Risk of Mortality in Their Mothers.

    Science.gov (United States)

    Cohen, Eyal; Horváth-Puhó, Erzsébet; Ray, Joel G; Pedersen, Lars; Adler, Nancy; Ording, Anne Gulbech; Wise, Paul H; Milstein, Arnold; Toft Sørensen, Henrik

    2016-12-20

    Giving birth to a child with a major birth defect is a serious life event for a woman, yet little is known about the long-term health consequences for the mother. To assess whether birth of an infant born with a major congenital anomaly was associated with higher maternal risk of mortality. This population-based cohort study (n = 455 250 women) used individual-level linked Danish registry data for mothers who gave birth to an infant with a major congenital anomaly (41 508) between 1979 and 2010, with follow-up until December 31, 2014. A comparison cohort (413 742) was constructed by randomly sampling, for each mother with an affected infant, up to 10 mothers matched on maternal age, parity, and year of infant's birth. Live birth of an infant with a major congenital anomaly as defined by the European Surveillance of Congenital Anomalies classification system. Primary outcome was all-cause mortality. Secondary outcomes included cause-specific mortality. Hazard ratios (HRs) were adjusted for marital status, immigration status, income quartile (since 1980), educational level (since 1981), diabetes mellitus, modified Charlson comorbidity index score, hypertension, depression, history of alcohol-related disease, previous spontaneous abortion, pregnancy complications, smoking (since 1991), and body mass index (since 2004). Mothers in both groups were a mean (SD) age of 28.9 (5.1) years at delivery. After a median (IQR) follow-up of 21 (12-28) years, there were 1275 deaths (1.60 per 1000 person-years) among 41 508 mothers of a child with a major congenital anomaly vs 10 112 deaths (1.27 per 1000 person-years) among 413 742 mothers in the comparison cohort, corresponding to an absolute mortality rate difference of 0.33 per 1000 person-years (95% CI, 0.24-0.42), an unadjusted HR of 1.27 (95% CI, 1.20-1.35), and an adjusted HR of 1.22 (95% CI, 1.15-1.29). Mothers with affected infants were more likely to die of cardiovascular disease (rate difference, 0.05 per

  13. Growing a Best Babies Zone: Lessons Learned from the Pilot Phase of a Multi-Sector, Place-Based Initiative to Reduce Infant Mortality.

    Science.gov (United States)

    Pies, Cheri; Barr, Monica; Strouse, Carly; Kotelchuck, Milton

    2016-05-01

    Infant mortality reduction in the U.S. has been addressed predominantly through clinical approaches. While these efforts have reduced the infant mortality rate overall, they have not reduced disparities between different racial/socioeconomic groups. To address the interrelated social, economic and environmental factors contributing to infant mortality, a place-based approach is needed to complement existing initiatives and clinical practices. Best Babies Zone (BBZ) is an early attempt to put life course theory into practice, taking a place-based approach to reducing infant mortality by aligning resources, building community leadership, and transforming educational opportunities, economic development, and community systems in concentrated neighborhoods. BBZ is currently in three neighborhoods: Price Hill (Cincinnati, OH), Hollygrove (New Orleans, LA), and Castlemont (Oakland, CA). Assessment In its first 4 years, each BBZ crafted resident-driven strategies for decreasing the root causes of toxic stress and poor birth outcomes. To address resident priorities, BBZ sites experimented with tools from other fields (like design thinking and health impact assessment), and emphasized existing MCH strategies like leadership development. Early challenges, including shifting from traditional MCH interventions and addressing health equity, point to areas of growth in implementing this approach in the maternal and child health field. BBZ aims to elevate local voice and mobilize multiple sectors in order to address the social determinants of infant mortality, and other initiatives working to improve MCH outcomes can learn from the successes and challenges of the first 4 years of BBZ in order to bring life course theory into practice.

  14. Comparisons of mortality and pre-discharge respiratory outcomes in small-for-gestational-age and appropriate-for-gestational-age premature infants.

    Science.gov (United States)

    Sharma, Puneet; McKay, Kathleen; Rosenkrantz, Ted S; Hussain, Naveed

    2004-06-08

    There are differences in the literature regarding outcomes of premature small-for-gestational-age (SGA) and appropriate-for gestational-age (AGA) infants, possibly due to failure to take into account gestational age at birth. To compare mortality and respiratory morbidity of SGA and AGA premature newborn infants. A retrospective study was done of the 2,487 infants born without congenital anomalies at Hospital, between Jan. 1992 and Dec. 1999. Recent (1994-96) U.S. birth weight percentiles for gestational age (GA), race and gender were used to classify neonates as SGA ( 32 wk (OR = 0.41, 95% CI 0.27 - 0.63; p hospital stay was significantly higher in SGA infants born between 26-36 wks GA than AGA infants. Premature SGA infants have significantly higher mortality, significantly higher risk of developing chronic lung disease and longer hospital stay as compared to premature AGA infants. Even the reduced risk of RDS in infants born at >/=32 wk GA, (conferred possibly by intra-uterine stress leading to accelerated lung maturation) appears to be of transient effect and is counterbalanced by adverse effects of poor intrauterine growth on long term pulmonary outcomes such as chronic lung disease.

  15. 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.

  16. Disparities and Trends in Birth Outcomes, Perinatal and Infant Mortality in Aboriginal vs. Non-Aboriginal Populations: A Population-Based Study in Quebec, Canada 1996–2010

    Science.gov (United States)

    Chen, Lu; Xiao, Lin; Auger, Nathalie; Torrie, Jill; McHugh, Nancy Gros-Louis; Zoungrana, Hamado; Luo, Zhong-Cheng

    2015-01-01

    Background Aboriginal populations are at substantially higher risks of adverse birth outcomes, perinatal and infant mortality than their non-Aboriginal counterparts even in developed countries including Australia, U.S. and Canada. There is a lack of data on recent trends in Canada. Methods We conducted a population-based retrospective cohort study (n = 254,410) using the linked vital events registry databases for singleton births in Quebec 1996–2010. Aboriginal (First Nations, Inuit) births were identified by mother tongue, place of residence and Indian Registration System membership. Outcomes included preterm birth, small-for-gestational-age, large-for-gestational-age, low birth weight, high birth weight, stillbirth, neonatal death, postneonatal death, perinatal death and infant death. Results Perinatal and infant mortality rates were 1.47 and 1.80 times higher in First Nations (10.1 and 7.3 per 1000, respectively), and 2.37 and 4.46 times higher in Inuit (16.3 and 18.1 per 1000, respectively) relative to non-Aboriginal (6.9 and 4.1 per 1000, respectively) births (all prates were persistently (1.7–1.8 times) higher in Inuit, large-for-gestational-age birth rates were persistently (2.7–3.0 times) higher in First Nations births over the study period. Between 1996–2000 and 2006–2010, as compared to non-Aboriginal infants, the relative risk disparities increased for infant mortality (from 4.10 to 5.19 times) in Inuit, and for postneonatal mortality in Inuit (from 6.97 to 12.33 times) or First Nations (from 3.76 to 4.25 times) infants. Adjusting for maternal characteristics (age, marital status, parity, education and rural vs. urban residence) attenuated the risk differences, but significantly elevated risks remained in both Inuit and First Nations births for the risks of perinatal mortality (1.70 and 1.28 times, respectively), infant mortality (3.66 and 1.47 times, respectively) and postneonatal mortality (6.01 and 2.28 times, respectively) in Inuit and

  17. Disparities and Trends in Birth Outcomes, Perinatal and Infant Mortality in Aboriginal vs. Non-Aboriginal Populations: A Population-Based Study in Quebec, Canada 1996-2010.

    Science.gov (United States)

    Chen, Lu; Xiao, Lin; Auger, Nathalie; Torrie, Jill; McHugh, Nancy Gros-Louis; Zoungrana, Hamado; Luo, Zhong-Cheng

    2015-01-01

    Aboriginal populations are at substantially higher risks of adverse birth outcomes, perinatal and infant mortality than their non-Aboriginal counterparts even in developed countries including Australia, U.S. and Canada. There is a lack of data on recent trends in Canada. We conducted a population-based retrospective cohort study (n = 254,410) using the linked vital events registry databases for singleton births in Quebec 1996-2010. Aboriginal (First Nations, Inuit) births were identified by mother tongue, place of residence and Indian Registration System membership. Outcomes included preterm birth, small-for-gestational-age, large-for-gestational-age, low birth weight, high birth weight, stillbirth, neonatal death, postneonatal death, perinatal death and infant death. Perinatal and infant mortality rates were 1.47 and 1.80 times higher in First Nations (10.1 and 7.3 per 1000, respectively), and 2.37 and 4.46 times higher in Inuit (16.3 and 18.1 per 1000, respectively) relative to non-Aboriginal (6.9 and 4.1 per 1000, respectively) births (all prates were persistently (1.7-1.8 times) higher in Inuit, large-for-gestational-age birth rates were persistently (2.7-3.0 times) higher in First Nations births over the study period. Between 1996-2000 and 2006-2010, as compared to non-Aboriginal infants, the relative risk disparities increased for infant mortality (from 4.10 to 5.19 times) in Inuit, and for postneonatal mortality in Inuit (from 6.97 to 12.33 times) or First Nations (from 3.76 to 4.25 times) infants. Adjusting for maternal characteristics (age, marital status, parity, education and rural vs. urban residence) attenuated the risk differences, but significantly elevated risks remained in both Inuit and First Nations births for the risks of perinatal mortality (1.70 and 1.28 times, respectively), infant mortality (3.66 and 1.47 times, respectively) and postneonatal mortality (6.01 and 2.28 times, respectively) in Inuit and First Nations infants (all pinfant

  18. 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

  19. The pattern of association between U.S. economic indicators and infant mortality rates at the state level.

    Science.gov (United States)

    Kershenbaum, Anne; Price, Joshua; Nagle, Nicholas N; Erwin, Paul Campbell

    2014-08-01

    This cross-sectional ecological study examines the pattern of association of state income and income inequality (measured by Gini coefficient) with state infant mortality rates (IMRs) in the U.S. Scatter plots and correlation coefficients were used to examine bivariate associations and bubble plots to examine three-way relationships. Infant mortality rate was positively associated with Gini (R=0.397, p=.004) and negatively with income (R=-0.482, p <.001). However using Black and White IMRs, the associations with Gini were non-significant, but with income remained significant. The bubble plot of Gini versus White IMR (income represented by bubble size) showed increasing IMR as Gini increases and income decreases, except for a subgroup of high-gini, high-income states with low IMRs. State income appears to be a stronger and more consistent predictor of U.S. IMRs for both Black and White races and can explain the pattern of association of White IMR with state Gini coefficient.

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

    Directory of Open Access Journals (Sweden)

    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

  1. Disparities in death: Inequality in cause-specific infant and child mortality in Stockholm, 1878‒1926

    Directory of Open Access Journals (Sweden)

    Joseph Molitoris

    2017-02-01

    Full Text Available Background: The decline of child mortality during the late 19th century is one of the most significant demographic changes in human history. However, there is evidence suggesting that the substantial reductions in mortality during the era did little to reduce mortality inequality between socioeconomic groups. Objective: The aim of this study is to examine the development of socioeconomic inequalities in cause-specific infant and child mortality during Stockholm's demographic transition. Methods: Using an individual-level longitudinal population register for Stockholm, Sweden, between 1878 and 1926, I estimate Cox proportional hazards models to study how inequality in cause-specific hazards of dying from six categories of causes varied over time. The categories included are 1 airborne and 2 food and waterborne infectious diseases, 3 other infectious diseases, 4 noninfectious diseases and accidents, 5 perinatal causes, and 6 unspecified causes. Results: The results show that class differentials in nearly all causes of death converged during the demographic transition. The only exception was the airborne infectious disease category, for which the gap between white-collar and unskilled blue-collar workers widened over time. Conclusions: The results demonstrate that, even in a context of falling mortality and a changing epidemiological environment, higher socioeconomic groups were able to maintain a health advantage for their children by reducing their risks of dying from airborne disease to a greater extent than other groups. Potential explanations for these patterns are suggested, as well as suggestions for future research. Contribution: This is the first paper to use individual-level cause-of-death data to study the long-term trends in inequality of cause-specific child mortality during the demographic transition.

  2. The European Union and the autonomy of sub-national authorities: Towards an analysis of constraints and opportunities in sub-national decision-making

    NARCIS (Netherlands)

    Fleurke, F.; Willemse, R.

    2006-01-01

    This paper explores what is known about the actual impact of the EU on sub-national (local and regional) government. Existing research on the impact of the EU on sub-national authorities appears to have a strong emphasis on the positive effects or the opportunities that emanate from the EU. By

  3. 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.

  4. 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...... 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.......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...

  5. Modifiers of the effect of maternal multiple micronutrient supplementation on stillbirth, birth outcomes, and infant mortality

    DEFF Research Database (Denmark)

    Smith, Emily R; Shankar, Anuraj H; Wu, Lee S-F

    2017-01-01

    . Multiple micronutrient supplements also had a greater effect on preterm births among underweight pregnant women (BMI ... to multiple micronutrient supplements also provided greater overall benefits. Studies should now aim to elucidate the mechanisms accounting for differences in the effect of antenatal multiple micronutrient supplements on infant health by maternal nutrition status and sex. FUNDING: None....

  6. 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

    Directory of Open Access Journals (Sweden)

    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.

  7. Race/Ethnic differences and age-variation in the effects of birth outcomes on infant mortality in the U.S.

    Directory of Open Access Journals (Sweden)

    Patricio Solis

    2006-03-01

    Full Text Available This paper investigates the effects of birth outcomes on infant mortality for non-Hispanic white, black, and Mexican-American females in the U.S. (1995-1998. Proportional hazard models with age-varying effects of continuous birth outcome measures reveal larger birth outcome effects on neonatal mortality, smaller effects on postneonatal mortality, and moderate age-variation within the neonatal period. Unlike static models, age-varying effect models of early and late gestational age and small birth weight statistically adjust for the black neonatal mortality disadvantage relative to whites.

  8. 76 FR 39112 - Advisory Committee on Infant Mortality; Notice of Meeting

    Science.gov (United States)

    2011-07-05

    .... Status: The meeting is open to the public with attendance limited to space availability. Purpose: The... Mortality; Quality Improvement in Perinatal Health Care; Patient Centered Medical Home; Centering Pregnancy...

  9. Evaluating the Effect of Hospital and Insurance Type on the Risk of 1-Year Mortality of Very Low Birth Weight Infants: Controlling for Selection Bias

    Science.gov (United States)

    Ounpraseuth, Songthip; Gauss, C. Heath; Bronstein, Janet; Lowery, Curtis; Nugent, Richard; Hall, Richard

    2012-01-01

    OBJECTIVES We examined the effect of hospital type and medical coverage on the risk of 1-year mortality of very low birth weight (VLBW) infants while adjusting for possible selection bias. METHODS The study population was limited to singleton live birth infants having birth weight between 500 and 1,500 grams with no congenital anomalies who were born in Arkansas hospitals between 2001 and 2007. Propensity score (PS) matching and PS covariate adjustment were used to mitigate selection bias. Additionally, a conventional multivariable logistic regression model was used for comparison purposes. RESULTS Generally, all three analytical approaches provided consistent results in terms of the estimated relative risk, absolute risk reduction, and the number needed to treat (NNT). Using the PS matching method, VLBW infants delivered at a hospital with a neonatal intensive care unit (NICU) were associated with a 35% relative decrease (95% bootstrap CI: 18.5% – 48.9%) in the risk of 1-year mortality as compared to those infants delivered at non-NICU hospitals. Furthermore, our results showed that on average, 16 VLBW infants (95% bootstrap CI: 11 – 32), would need to be delivered at a hospital with an NICU to prevent one additional death at one year. However, there was not a difference in the risk of 1-year mortality between VLBW infants born to Medicaid-insured versus non-Medicaid-insured women. CONCLUSIONS Estimated relative risk of infant mortality was significantly lower for births that occurred in hospitals with an NICU; therefore, greater efforts should be made to deliver VLBW neonates in an NICU hospital. PMID:22422056

  10. Comparisons of mortality and pre-discharge respiratory outcomes in small-for-gestational-age and appropriate-for-gestational-age premature infants

    Directory of Open Access Journals (Sweden)

    Sharma Puneet

    2004-06-01

    Full Text Available Abstract Background There are differences in the literature regarding outcomes of premature small-for-gestational-age (SGA and appropriate-for gestational-age (AGA infants, possibly due to failure to take into account gestational age at birth. Objective To compare mortality and respiratory morbidity of SGA and AGA premature newborn infants. Design/Methods A retrospective study was done of the 2,487 infants born without congenital anomalies at ≤36 weeks of gestation and admitted to the neonatal intensive care unit (NICU at John Dempsey Hospital, between Jan. 1992 and Dec. 1999. Recent (1994–96 U.S. birth weight percentiles for gestational age (GA, race and gender were used to classify neonates as SGA (th–90th percentile for GA. Using multivariate logistic regression and survival analyses to control for GA, SGA and AGA infants were compared for mortality and respiratory morbidity. Results Controlling for GA, premature SGA infants were at a higher risk for mortality (Odds ratio 3.1, P = 0.001 and at lower risk of respiratory distress syndrome (OR = 0.71, p = 0.02 than AGA infants. However multivariate logistic regression modeling found that the odds of having respiratory distress syndrome (RDS varied between SGA and AGA infants by GA. There was no change in RDS risk in SGA infants at GA ≤ 32 wk (OR = 1.27, 95% CI 0.32 – 1.98 but significantly decreased risk for RDS at GA > 32 wk (OR = 0.41, 95% CI 0.27 – 0.63; p Conclusions Premature SGA infants have significantly higher mortality, significantly higher risk of developing chronic lung disease and longer hospital stay as compared to premature AGA infants. Even the reduced risk of RDS in infants born at ≥32 wk GA, (conferred possibly by intra-uterine stress leading to accelerated lung maturation appears to be of transient effect and is counterbalanced by adverse effects of poor intrauterine growth on long term pulmonary outcomes such as chronic lung disease.

  11. Surgical findings during exploratory laparotomy are closely related to mortality in premature infants with necrotising enterocolitis

    DEFF Research Database (Denmark)

    Hansen, M L; Juhl, Sandra Meinich; Fonnest, G

    2017-01-01

    AIM: This study investigated whether a correlation existed between surgical findings during the first laparotomy for necrotising enterocolitis (NEC) and death and, or, disease progression. METHODS: We included infants admitted within one day of birth to our tertiary neonatal department at Rigshos...... the discouraging outcome, further studies should focus on alternative surgical approaches, such as proximal diverting jejunostomy and the clip and drop technique for the treatment of severe NEC....

  12. Individual- and Community-Level Disparities in Birth Outcomes and Infant Mortality among First Nations, Inuit and Other Populations in Quebec

    Science.gov (United States)

    Simonet, Fabienne; Wassimi, Spogmai; Heaman, Maureen; Smylie, Janet; Martens, Patricia; Mchugh, Nancy G.L.; Labranche, Elena; Wilkins, Russell; Fraser, William D.; Luo, Zhong-Cheng

    2011-01-01

    Objective We assessed individual- and community-level disparities and trends in birth outcomes and infant mortality among First Nations (North American Indians) and Inuit versus other populations in Quebec, Canada. Methods A retrospective birth cohort study of all births to Quebec residents, 1991–2000. At the individual level, we examined outcomes comparing births to First Nations and Inuit versus other mother tongue women. At the community level, we compared outcomes among First Nations and Inuit communities versus other communities. Results First Nations and Inuit births were much less likely to be small-for-gestational-age but much more likely to be large-for-gestational-age compared to other births at the individual or community level, especially for First Nations. At both levels, Inuit births were 1.5 times as likely to be preterm. At the individual level, total fetal and infant mortality rates were 2 times as high for First Nations, and 3 times as high for Inuit. Infant mortality rates were 2 times as high for First Nations, and 4 times as high for Inuit. There were no reductions in these disparities between 1991–1995 and 1996–2000. Modestly smaller disparities in total fetal and infant mortality were observed for First Nations at the community level (risk ratio=1.6), but for Inuit there were similar disparities at both levels. These disparities remained substantial after adjusting for maternal characteristics. Conclusion There were large and persistent disparities in fetal and infant mortality among First Nations and Inuit versus other populations in Quebec based on individual- or community-level assessments, indicating a need to improve socioeconomic conditions as well as perinatal and infant care for Aboriginal peoples. PMID:22282716

  13. Respiratory severity score on day of life 30 is predictive of mortality and the length of mechanical ventilation in premature infants with protracted ventilation.

    Science.gov (United States)

    Malkar, Manish B; Gardner, William P; Mandy, George T; Stenger, Michael R; Nelin, Leif D; Shepherd, Edward G; Welty, Stephen E

    2015-04-01

    We tested the hypothesis that Respiratory Severity Score (RSS) on day of life 30 is predictive of mortality and length of mechanical ventilation in premature infants on prolonged mechanical ventilation. A retrospective chart review was performed using the Nationwide Children's Hospital medical record and Vermont-Oxford Network databases. The primary outcome variable was survival to hospital discharge and the secondary outcome was length of mechanical ventilation after day of life 30. We identified 199 neonates admitted to Nationwide Children's Hospital between 2004 and 2007 with birth weight less than 1,500 g that received prolonged mechanical ventilation in the first 30 days of their life. A total of 184 infants were included in the analysis, excluding 14 patients with congenital anomalies and one infant with incomplete data. RSS on day of life 30 was significantly greater in the group of infants that died compared to those that survived (P = 0.003, 95% CI = [0.08, 0.40]). Further analysis demonstrated that the maximum difference in mortality was obtained with a threshold RSS of 6. Of the 109 patients who had RSS less than 6 on day of life 30, mortality rate was 4.6% (5/109) while those greater than or equal to 6 had a mortality rate of 21.3% (16/75). Both Kaplan-Meier survival curves comparing mortality and length of mechanical ventilation in infants with RSS ventilation after day of life 30 (P mechanical ventilation in premature infants requiring mechanical ventilation through 30 days of life. © 2014 Wiley Periodicals, Inc.

  14. 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

  15. 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

  16. Sub-national population policy: the case of North Sulawesi.

    Science.gov (United States)

    Jones, G W

    1989-04-01

    Since the 1970s, Indonesia has placed increasing emphasis on the development of stronger planning capacity at the regional level; however, the concept of regional autonomy is still viewed with suspicion given Indonesia's history of regional separatist movements. This fact has implications for the need for national population policy to be formulated and implemented with a view toward the varying conditions faced by different provinces and regions. The author presents a case study of fertility, mortality, migration, urbanization, and the development of human capital in 1 Indonesian province--North Sulawesi--to illustrate that special characteristics and internal diversity can demand individualized responses by policy makers. In terms of these 5 areas, the following observations can be made about conditions in North Sulawesi: 1) mortality rates are already below the national average, although infant mortality remains unacceptably high; 2) fertility rates are also well below the national average and approaching replacement level without any aggressive family planning outreach activities, but there remains a need to identify the ultimate fertility target and the extent to which intervention is required; 3) there is little scope for absorbing transmigrants, but there are some major issues regarding population redistribution within the province; 4) although there are no large cities, the increasing dominance of Manado is a concern; and 5) the quality of education and an employment structure to match the well-educated labor force are more important than an expansion of these services. A central concern is the ability of North Sulawesi to prevent "brain drain" to Jakarta; however, the province's capacity to do so is dependent on decisions made in Jakarta about the allocation of revenue, regulations regarding the processing of copra and cloves, new air routes, and the extent of regional autonomy to be tolerated in decisions affecting provincial growth.

  17. A 20th century miracle in a 19th century village--infant mortality...zero... Part II.

    Science.gov (United States)

    Araki, M

    1983-01-01

    Sawauchi Village (Wage District, Iwate Prefecture) in Japan once had the reputation of being a place of poverty, sickness, and heavy snowfalls. These conditions have changed thanks to the efforts of the late Mr. Masao Fukazawa who became the Village Mayor in 1967. Fukazawa put special emphasis on public health administration, first, by buying bulldozers to clear the village's roads in the winter. This action enabled access to the hospitals. The bulldozers that cleared the snow in winter displayed their usefulness in summer as well. The machines turned uncultivated land into farmland and reinforced the irrigation systems. Fukazawa hammered out various concrete measures in health administration, including the establishment of a Health Committee, the appointment of the Committee members as well as 2 public health nurses, the initiation of regular health examination for babies, and a 10-year plan to reduce infant mortality to half the level of the past. The Committee, which became the Council on Community Health in 1975, became famous throughout Japan in 1977 when it started complete examinations for degenerative diseases. The overall physical examination is given to all residents within the 35-39 age group, in addition to those who wish to be examined. Dr. Susumu Masuda, Director of the Sawauchi Village Hospital, has greatly contributed to health care improvement in Sawauchi Village, which is known to be 1 of the first villages in Japan that succeeded in reducing the infant mortality rate to zero. It is also famous for its maternal and child health activities. Sawauchi Village, which once suffered from a high birth rate just as today's developing nations, is now anticipating a lower birth rate and an aging society, an inevitable outcome of the village's development.

  18. A cluster randomised controlled trial of the community effectiveness of two interventions in rural Malawi to improve health care and to reduce maternal, newborn and infant mortality

    Directory of Open Access Journals (Sweden)

    Vergnano Stefania

    2010-09-01

    Full Text Available Abstract Background The UN Millennium Development Goals call for substantial reductions in maternal and child mortality, to be achieved through reductions in morbidity and mortality during pregnancy, delivery, postpartum and early childhood. The MaiMwana Project aims to test community-based interventions that tackle maternal and child health problems through increasing awareness and local action. Methods/Design This study uses a two-by-two factorial cluster-randomised controlled trial design to test the impact of two interventions. The impact of a community mobilisation intervention run through women's groups, on home care, health care-seeking behaviours and maternal and infant mortality, will be tested. The impact of a volunteer-led infant feeding and care support intervention, on rates of exclusive breastfeeding, uptake of HIV-prevention services and infant mortality, will also be tested. The women's group intervention will employ local female facilitators to guide women's groups through a four-phase cycle of problem identification and prioritisation, strategy identification, implementation and evaluation. Meetings will be held monthly at village level. The infant feeding intervention will select local volunteers to provide advice and support for breastfeeding, birth preparedness, newborn care and immunisation. They will visit pregnant and new mothers in their homes five times during and after pregnancy. The unit of intervention allocation will be clusters of rural villages of 2500-4000 population. 48 clusters have been defined and randomly allocated to either women's groups only, infant feeding support only, both interventions, or no intervention. Study villages are surrounded by 'buffer areas' of non-study villages to reduce contamination between intervention and control areas. Outcome indicators will be measured through a demographic surveillance system. Primary outcomes will be maternal, infant, neonatal and perinatal mortality for the

  19. 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…

  20. 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.

  1. morbidity and mortality of low birth weight infants in the new born

    African Journals Online (AJOL)

    hi-tech

    2004-07-07

    Jul 7, 2004 ... breast milk, formula or pasteurized cows milk by nasogastric tube, breast feeding or cup feeding. Except for ..... case was mainly realized for the larger babies(5). From Thailand, Ratrisawadi et al. also showed that effective neonatal care can have positive impact on morbidity and mortality of neonates across.

  2. Neonatal, infant and under-five mortalities in Nigeria: An examination of trends and drivers (2003-2013.

    Directory of Open Access Journals (Sweden)

    Oyewale Mayowa Morakinyo

    Full Text Available Neonatal (NMR, infant (IMR and under-five (U5M mortality rates remain high in Nigeria. Evidence-based knowledge of trends and drivers of child mortality will aid proper interventions needed to combat the menace. Therefore, this study assessed the trends and drivers of NMR, IMR, and U5M over a decade in Nigeria. A nationally representative data from three consecutive Nigeria Demographic and Household Surveys (NDHS was used. A total of 66,158 live births within the five years preceding the 2003 (6029, 2008 (28647 and 2013 (31482 NDHS were included in the analyses. NMR was computed using proportions while IMR and U5 were computed using life table techniques embedded in Stata version 12. Probit regression model and its associated marginal effects were used to identify the predisposing factors to NMR, IMR, and U5M. The NMR, IMR, and U5M per 1000 live births in 2003, 2008 and 2013 were 52, 41, 39; 100, 75, 69; and 201, 157, 128 respectively. The NMR, IMR, and U5M were consistently lower among children whose mothers were younger, living in rural areas and from richer households. Generally, the probability of neonate death in 2003, 2008 and 2013 were 0.049, 0.039 and 0.038 respectively, the probability of infant death was 0.093, 0.071 and 0.064 while the probability of under-five death was 0.140, 0.112 and 0.092 for the respective survey years. While adjusting for other variables, the likelihood of infant and under-five deaths was significantly reduced across the survey years. Maternal age, mothers' education, place of residence, child's sex, birth interval, weight at birth, skill of birth attendant, delivery by caesarean operation or not significantly influenced NMR, IMR, and U5M. The NMR, IMR, and U5M in Nigeria reduced over the studied period. Multi-sectoral interventions targeted towards the identified drivers should be instituted to improve child survival.

  3. 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

  4. Infant mortality among the Canadian-born offspring of immigrants and non-immigrants in Canada: a population-based study.

    Science.gov (United States)

    Vang, Zoua M

    2016-01-01

    Adult immigrants in Canada have a survival advantage over their Canadian-born counterparts. It is unknown whether migrants are able to transmit their survival advantage to their Canadian-born children. Neonatal and postneonatal mortality between the Canadian-born population and 12 immigrant subgroups were compared using 1990-2005 linked birth-infant death records. Age-at-death specific mortality rates and rate differences were calculated by nativity status and maternal birthplace. A chi-square statistic was used to compare group differences in maternal sociodemographic characteristics. Multivariate survival analysis was used to estimate the effect of maternal birthplace on neonatal and postneonatal mortality, net of maternal sociodemographic and infant characteristics. Overall, immigrants had lower rates of neonatal and postneonatal mortality than the Canadian-born population. But the adjusted risk of neonatal mortality was higher for Sub-Saharan African (hazard ratio [HR] = 1.32; 95 % confidence interval [CI] = 1.05, 1.66), Haitian (HR = 2.29, 95 % CI = 1.90, 2.76), non-Spanish Caribbean (HR = 1.38; 95 % CI = 1.01, 1.89), and Pakistani (HR = 1.87; 95 % CI = 1.31, 2.68) migrants relative to Canadian-born women. There were fewer significant disparities in postneonatal death, with higher adjusted risks of mortality observed for Pakistani (HR = 2.67, 95 % CI = 1.77, 4.02) and Haitian (HR = 1.41, 95 % CI = 1.02, 1.97) migrants only. Inequalities in infant mortality are more concentrated in the neonatal period. Contingent on surviving the first 27 days after birth, the infants of most immigrants (except those from Haiti and Pakistan) have the same chances of survival as the infants of Canadian-born women. Improvements in prenatal care and access to postpartum care may reduce disparities in infant mortality.

  5. Decreasing trends of neonatal and infant mortality rates in Korea: compared with Japan, USA, and OECD nations.

    Science.gov (United States)

    Chang, Ji-Young; Lee, Kyung Suk; Hahn, Won-Ho; Chung, Sung-Hoon; Choi, Yong-Sung; Shim, Kye Shik; Bae, Chong-Woo

    2011-09-01

    Neonatal mortality rate (NMR) and infant mortality rate (IMR) are two of the most important indices reflecting the level of public health of a country. In this review, we investigated changes in NMR and IMR in Korea and compared the results with those of Japan, USA, and OECD nations. During the past 20 yr, NMR and IMR have lowered remarkably from 6.6 and 9.9 in 1993 to 1.7 and 3.2 in 2009, respectively, in Korea. It is an impressive finding that Korean IMR (3.2 in 2009) is lower than the average of OECD nations (4.7 in 2008), and USA (6.3 in 2009), although higher than Japanese IMR (2.8 in 2009). The proportion of NMR among the IMR calculation decreased from 66.7% in 1993 to 53.1% in 2009. The reason the value of Korea was higher than Japan but lower than USA was speculated to be an aspect of the health care service system. Several suggestions in perinatal, neonatal and infantile health care such as establishment of perinatal care center, research network system, regionalization, and new policies for care of pre-term and high risk pregnancy, are elucidated to achieve further improvement on NMR and IMR in Korea.

  6. Global, regional, and national levels of neonatal, infant, and under-5 mortality during 1990-2013

    DEFF Research Database (Denmark)

    Wang, Haidong; Liddell, Chelsea A; Coates, Matthew M

    2014-01-01

    to estimate mortality for more detailed age groups. We used explanatory mixed effects regression models to assess the association between under-5 mortality and income per person, maternal education, HIV child death rates, secular shifts, and other factors. To quantify the contribution of these different......·0-6·6) children under-5 died in 2013, a 64% reduction from 17·6 million (17·1-18·1) in 1970. In 2013, child mortality rates ranged from 152·5 per 1000 livebirths (130·6-177·4) in Guinea-Bissau to 2·3 (1·8-2·9) per 1000 in Singapore. The annualised rates of change from 1990 to 2013 ranged from -6·8% to 0·1%. 99...... in sub-Saharan Africa, led to 1·4 million more child deaths, and rising income per person and maternal education led to 0·9 million and 2·2 million fewer deaths, respectively. Changes in secular trends led to 4·2 million fewer deaths. Unexplained factors accounted for only -1% of the change in child...

  7. Characterizing the epidemiological transition in Mexico: national and subnational burden of diseases, injuries, and risk factors.

    Science.gov (United States)

    Stevens, Gretchen; Dias, Rodrigo H; Thomas, Kevin J A; Rivera, Juan A; Carvalho, Natalie; Barquera, Simón; Hill, Kenneth; Ezzati, Majid

    2008-06-17

    Rates of diseases and injuries and the effects of their risk factors can have substantial subnational heterogeneity, especially in middle-income countries like Mexico. Subnational analysis of the burden of diseases, injuries, and risk factors can improve characterization of the epidemiological transition and identify policy priorities. We estimated deaths and loss of healthy life years (measured in disability-adjusted life years [DALYs]) in 2004 from a comprehensive list of diseases and injuries, and 16 major risk factors, by sex and age for Mexico and its states. Data sources included the vital statistics, national censuses, health examination surveys, and published epidemiological studies. Mortality statistics were adjusted for underreporting, misreporting of age at death, and for misclassification and incomparability of cause-of-death assignment. Nationally, noncommunicable diseases caused 75% of total deaths and 68% of total DALYs, with another 14% of deaths and 18% of DALYs caused by undernutrition and communicable, maternal, and perinatal diseases. The leading causes of death were ischemic heart disease, diabetes mellitus, cerebrovascular disease, liver cirrhosis, and road traffic injuries. High body mass index, high blood glucose, and alcohol use were the leading risk factors for disease burden, causing 5.1%, 5.0%, and 7.3% of total burden of disease, respectively. Mexico City had the lowest mortality rates (4.2 per 1,000) and the Southern region the highest (5.0 per 1,000); under-five mortality in the Southern region was nearly twice that of Mexico City. In the Southern region undernutrition and communicable, maternal, and perinatal diseases caused 23% of DALYs; in Chiapas, they caused 29% of DALYs. At the same time, the absolute rates of noncommunicable disease and injury burdens were highest in the Southern region (105 DALYs per 1,000 population versus 97 nationally for noncommunicable diseases; 22 versus 19 for injuries). Mexico is at an advanced stage

  8. Characterizing the epidemiological transition in Mexico: national and subnational burden of diseases, injuries, and risk factors.

    Directory of Open Access Journals (Sweden)

    Gretchen Stevens

    2008-06-01

    Full Text Available BACKGROUND: Rates of diseases and injuries and the effects of their risk factors can have substantial subnational heterogeneity, especially in middle-income countries like Mexico. Subnational analysis of the burden of diseases, injuries, and risk factors can improve characterization of the epidemiological transition and identify policy priorities. METHODS AND FINDINGS: We estimated deaths and loss of healthy life years (measured in disability-adjusted life years [DALYs] in 2004 from a comprehensive list of diseases and injuries, and 16 major risk factors, by sex and age for Mexico and its states. Data sources included the vital statistics, national censuses, health examination surveys, and published epidemiological studies. Mortality statistics were adjusted for underreporting, misreporting of age at death, and for misclassification and incomparability of cause-of-death assignment. Nationally, noncommunicable diseases caused 75% of total deaths and 68% of total DALYs, with another 14% of deaths and 18% of DALYs caused by undernutrition and communicable, maternal, and perinatal diseases. The leading causes of death were ischemic heart disease, diabetes mellitus, cerebrovascular disease, liver cirrhosis, and road traffic injuries. High body mass index, high blood glucose, and alcohol use were the leading risk factors for disease burden, causing 5.1%, 5.0%, and 7.3% of total burden of disease, respectively. Mexico City had the lowest mortality rates (4.2 per 1,000 and the Southern region the highest (5.0 per 1,000; under-five mortality in the Southern region was nearly twice that of Mexico City. In the Southern region undernutrition and communicable, maternal, and perinatal diseases caused 23% of DALYs; in Chiapas, they caused 29% of DALYs. At the same time, the absolute rates of noncommunicable disease and injury burdens were highest in the Southern region (105 DALYs per 1,000 population versus 97 nationally for noncommunicable diseases; 22 versus

  9. Characterizing the Epidemiological Transition in Mexico: National and Subnational Burden of Diseases, Injuries, and Risk Factors

    Science.gov (United States)

    Stevens, Gretchen; Dias, Rodrigo H; Thomas, Kevin J. A; Rivera, Juan A; Carvalho, Natalie; Barquera, Simón; Hill, Kenneth; Ezzati, Majid

    2008-01-01

    Background Rates of diseases and injuries and the effects of their risk factors can have substantial subnational heterogeneity, especially in middle-income countries like Mexico. Subnational analysis of the burden of diseases, injuries, and risk factors can improve characterization of the epidemiological transition and identify policy priorities. Methods and Findings We estimated deaths and loss of healthy life years (measured in disability-adjusted life years [DALYs]) in 2004 from a comprehensive list of diseases and injuries, and 16 major risk factors, by sex and age for Mexico and its states. Data sources included the vital statistics, national censuses, health examination surveys, and published epidemiological studies. Mortality statistics were adjusted for underreporting, misreporting of age at death, and for misclassification and incomparability of cause-of-death assignment. Nationally, noncommunicable diseases caused 75% of total deaths and 68% of total DALYs, with another 14% of deaths and 18% of DALYs caused by undernutrition and communicable, maternal, and perinatal diseases. The leading causes of death were ischemic heart disease, diabetes mellitus, cerebrovascular disease, liver cirrhosis, and road traffic injuries. High body mass index, high blood glucose, and alcohol use were the leading risk factors for disease burden, causing 5.1%, 5.0%, and 7.3% of total burden of disease, respectively. Mexico City had the lowest mortality rates (4.2 per 1,000) and the Southern region the highest (5.0 per 1,000); under-five mortality in the Southern region was nearly twice that of Mexico City. In the Southern region undernutrition and communicable, maternal, and perinatal diseases caused 23% of DALYs; in Chiapas, they caused 29% of DALYs. At the same time, the absolute rates of noncommunicable disease and injury burdens were highest in the Southern region (105 DALYs per 1,000 population versus 97 nationally for noncommunicable diseases; 22 versus 19 for injuries

  10. Estimativa de impacto da amamentação sobre a mortalidade infantil Impact estimates of breastfeeding over infant mortality

    Directory of Open Access Journals (Sweden)

    Maria Mercedes Loureiro Escuder

    2003-06-01

    Full Text Available OBJETIVO: A mortalidade infantil no Estado de São Paulo tem mostrado uma redução progressiva nos últimos anos. Atualmente, atinge níveis para além dos quais uma maior redução parece desafiadora. Causas neonatais precoces correspondem a 50% desses óbitos. Entre os óbitos não neonatais precoces, destacam-se a pneumonia e a diarréia como as principais causas. O objetivo da pesquisa é estudar o impacto da amamentação na redução dos óbitos. MÉTODOS: Foram estudados 14 municípios da Grande São Paulo, onde coletaram-se informações relativas à amamentação por entrevistas, em uma amostra por conglomerados em dias nacionais de vacinação (Projeto Amamentação e Municípios. Também foram consultadas informações sobre mortalidade infantil, recolhidas de fontes oficiais, dos anos de 1999 e 2000. Com base em parâmetros da literatura sobre o risco de óbito por infecção respiratória e diarréia para crianças não amamentadas, calculou-se a fração de mortalidade evitável por cada doença. Os valores, aplicados ao número de óbitos registrados em cada município, permitiram o cálculo do impacto da amamentação sobre o Coeficiente de Mortalidade Infantil (CMI. RESULTADOS: A fração de mortalidade evitável por infecção respiratória variou, segundo o município e a faixa etária, entre 33% e 72%. Para diarréia, a variação ficou entre 35% e 86%. A estimativa média de impacto foi de 9,3% no CMI, com variações, segundo o município, entre 3,6% e 13%. CONCLUSÕES: A amamentação no primeiro ano de vida pode ser a estratégia mais exeqüível de redução da mortalidade pós-neonatal para além dos níveis já alcançados em municípios do Estado de São Paulo.OBJECTIVE: Infant mortality in the state of São Paulo has decreased in the last years and it seems to be leveling off at a limit beyond which further reductions are challenging. Early neonatal causes account for 50% of these deaths and the remaining are mostly

  11. mortality

    African Journals Online (AJOL)

    and Department of Pediatric Surgery, Aseer Central Hospital', Abha, Saudi Arabia. E-mail: taam .... Esophageal atresia with tracheoesophageal fistula and early postoperative mortality - T. A.Al-Malki et al further supported by the presence .... nal (e.g. premature rupture of membranes) or neonatal fac- tors (e.g. impaired host ...

  12. FACTORS WHICH DETERMINED MORTALITY OF NEWBORNS AND INFANTS IN THE FIRST AND LAST DECADE OF THE 20TH CENTURY IN SERBIA

    Directory of Open Access Journals (Sweden)

    Biljana Stojanović

    2014-06-01

    Full Text Available The risk of dying is the highest in newborns and infants. This is one of the most vulnerable periods in development because newborns and infants are exposed to the influence of many risk factors, such as genetics, family or socioeconomic environmental factors. Annual statistics for the first decade of the 20th century showed that one quarter of liveborns died during the first year of life. Data also showed a higher mortality of small children in the country compared to urban areas. Poor food hygiene was the major cause of newborns’ death, both at birth and during the first few months. The last decade of the 20th century was particularly interesting and important to perceive mortality of newborns and infants, because of significant political and socioeconomic disturbances after international sanctions against Serbia and bombing in 1999. Sudden rise of mortality rate of newborns and infants was noticed in all parts of Serbia in 1992 and 1993. It has constantly been decreasing ever since.

  13. First- and fifth-minute Apgar scores of 0-3 and infant mortality: a population-based study in São Paulo State of Brazil.

    Science.gov (United States)

    Viau, Ângela Cristina; Kawakami, Mandira Daripa; Teixeira, Monica La Porte; Waldvogel, Bernadette Cunha; Guinsburg, Ruth; Almeida, Maria Fernanda Branco de

    2015-09-01

    To determine the infant mortality of newborns with 1- and 5-min Apgar scores of 0-3. Population cohort study with neonates with birth weight ≥400 g, gestational age ≥22 weeks and 1- and 5-min Apgar scores of 0-3, without malformations, born in São Paulo State (Brazil) from January 2006 to December 2007. Apgar scores were confirmed in the original certificates of live births and/or medical records. During this period, among 1,027,132 live births, 1640 met the study criteria, with an incidence of 1.6 per 1000 live births. When the 5-min Apgar score was 0, 1, 2 and 3, the infant mortality rate was 97%, 94%, 64% and 47%, respectively. Risk factors associated with infant deaths were 5-min Apgar score of 0 or 1 [odds ratio (OR) 16.6, 95% confidence interval (CI) 11.1-24.8], birth weight Apgar scores of 0-3, the infant mortality is high. Besides the biological variables associated with the chance of dying, the organization of the perinatal care influences the outcome.

  14. Mortality of babies enrolled in a community-based support programme: CONI PLUS (Care of Next Infant Plus).

    Science.gov (United States)

    Waite, Alison J; Coombs, Robert C; McKenzie, Angela; Daman-Willems, Charlotte; Cohen, Marta C; Campbell, Michael J; Carpenter, Robert G

    2015-07-01

    To report mortality in babies enrolled on a community-based programme, Care of Next Infant Plus (CONI PLUS), which primarily supports parents anxious because of previous sudden unexpected death in infancy (SUDI) in their extended family or following an apparent life threatening event (ALTE) in their baby. Prospective observational study from 1996 to 2010 in the UK. Of 6487 babies enrolled, 37 died (5.7 per 1000). There were 2789 (43.0%) SUDI related babies of whom, six died suddenly and unexpectedly (2.15 per 1000). Four babies were sharing a sofa at night or a bed with parent(s) who smoked or had consumed alcohol. Of the 1882 (29.0%) babies enrolled following an ALTE, five died suddenly and unexpectedly (2.66 per 1000): four unexplained and one due to infection. None occurred while sharing a sleep surface, and at least three died during the day. The remaining 1816 (28%) babies were enrolled for other reasons. Seven died suddenly and unexpectedly (3.85 per 1000), two were unexplained and none associated with bed sharing. The number of SUDI deaths in babies enrolled on CONI PLUS is higher than expected from UK averages. Deaths in babies enrolled because of family history of SUDI were mostly associated with inappropriate sharing of a sleep surface at night and mostly outside the peak age range for sudden infant death. The opposite is true for those enrolled following an ALTE. The number of deaths is small but findings suggest a different mechanism for death in these two groups. Published by the BMJ Publishing Group Limited. For permission to use (where not already granted under a licence) please go to http://group.bmj.com/group/rights-licensing/permissions.

  15. Association Between Antibiotic Use and Neonatal Mortality and Morbidities in Very Low-Birth-Weight Infants Without Culture-Proven Sepsis or Necrotizing Enterocolitis.

    Science.gov (United States)

    Ting, Joseph Y; Synnes, Anne; Roberts, Ashley; Deshpandey, Akhil; Dow, Kimberly; Yoon, Eugene W; Lee, Kyong-Soon; Dobson, Simon; Lee, Shoo K; Shah, Prakesh S

    2016-12-01

    Excessive antibiotic use has been associated with altered bacterial colonization and may result in antibiotic resistance, fungemia, necrotizing enterocolitis (NEC), and mortality. Exploring the association between antibiotic exposure and neonatal outcomes other than infection-related morbidities may provide insight on the importance of rational antibiotic use, especially in the setting of culture-negative neonatal sepsis. To evaluate the trend of antibiotic use among all hospitalized very low-birth-weight (VLBW) infants across Canada and the association between antibiotic use rates (AURs) and mortality and morbidity among neonates without culture-proven sepsis or NEC. A retrospective cohort study was conducted among VLBW infants (neonatal intensive care units between January 1, 2010, and December 31, 2014, using data obtained from the Canadian Neonatal Network database. Duration of antibiotic use during the hospitalization period. The AUR was defined as the number of days an infant was exposed to 1 or more antimicrobial agents divided by the total length of hospital stay. The composite primary outcome was defined as mortality or major morbidity, including any of the following: persistent periventricular echogenicity or echolucency on neuroimaging, chronic lung disease, and stage 3 or higher retinopathy of prematurity. Multivariable regression analysis was used to calculate adjusted odds ratios (aORs) and 95% CIs for the association between AURs and outcomes. Among 13 738 eligible VLBW infants, 11 669 (84.9%) (mean [SD] gestational age, 27.7 [2.5] weeks; 47.4% female) received antibiotics during their hospital course and were included in the study. The annual AUR decreased from 0.29 in 2010 to 0.25 in 2014 (slope for the best-fit line, -0.011; 95% CI, -0.016 to -0.006; P sepsis from 19.0% in 2010 to 13.8% in 2014 during the same period. Of the 11 669 infants who were treated with antibiotics of varying duration during their hospital stay, 2845 were diagnosed

  16. Preventable infant mortality and quality of health care: maternal perception of the child's illness and treatment

    Directory of Open Access Journals (Sweden)

    Hadad Salime

    2002-01-01

    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.

  17. 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.

  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. Promoting hand hygiene in healthcare through national/subnational campaigns.

    Science.gov (United States)

    Mathai, E; Allegranzi, B; Kilpatrick, C; Bagheri Nejad, S; Graafmans, W; Pittet, D

    2011-04-01

    The World Health Organization (WHO) First Global Patient Safety Challenge conducted a baseline survey of coordinated large-scale activities in improving hand hygiene in healthcare in 2007. The survey was repeated in early 2009 to assess current status and generate information on factors contributing to success. Coordinated activities were identified through WHO regional offices and experts in the field. An online survey using a structured questionnaire was conducted during March-April 2009. Personnel involved in all 38 campaigns/programmes in 2009 completed the survey. Of these, 29 were active national/subnational-level initiatives and 22 (75.8%) were initiated after the Challenge launch in October 2005. Main targets were general, district, and university hospitals with increasing coverage of long-term care facilities and primary care. The scope varied from awareness-raising to formal scaled-up activities with ongoing evaluation. Most initiatives (20/29) obtained funding from multiple sources with governments among the main funders; governments also initiated 25/29 (86.2%) programmes. The facilitator role played by the Challenge in initiating and supporting activities with tools and recommendations was clearly identified. The perceived significance of specific barriers varied considerably across initiatives. Those related to commitment (priority and support) and resource availability were important across all regions. Hand hygiene is being promoted in healthcare in many nations/subnations with clear objectives, strategies, and governmental support through policies and resource allocation. While this is important for sustainability, further action is required to initiate coordinated activities across the world, including countries with limited resources. Copyright © 2011 World Health Organization. Published by Elsevier Ltd on behalf of the Healthcare Infection Society. Published by Elsevier Ltd.. All rights reserved.

  20. Comparing methods for assessing the effectiveness of subnational REDD+ initiatives

    Science.gov (United States)

    Bos, Astrid B.; Duchelle, Amy E.; Angelsen, Arild; Avitabile, Valerio; De Sy, Veronique; Herold, Martin; Joseph, Shijo; de Sassi, Claudio; Sills, Erin O.; Sunderlin, William D.; Wunder, Sven

    2017-07-01

    The central role of forests in climate change mitigation, as recognized in the Paris agreement, makes it increasingly important to develop and test methods for monitoring and evaluating the carbon effectiveness of REDD+. Over the last decade, hundreds of subnational REDD+ initiatives have emerged, presenting an opportunity to pilot and compare different approaches to quantifying impacts on carbon emissions. This study (1) develops a Before-After-Control-Intervention (BACI) method to assess the effectiveness of these REDD+ initiatives; (2) compares the results at the meso (initiative) and micro (village) scales; and (3) compares BACI with the simpler Before-After (BA) results. Our study covers 23 subnational REDD+ initiatives in Brazil, Peru, Cameroon, Tanzania, Indonesia and Vietnam. As a proxy for deforestation, we use annual tree cover loss. We aggregate data into two periods (before and after the start of each initiative). Analysis using control areas (‘control-intervention’) suggests better REDD+ performance, although the effect is more pronounced at the micro than at the meso level. Yet, BACI requires more data than BA, and is subject to possible bias in the before period. Selection of proper control areas is vital, but at either scale is not straightforward. Low absolute deforestation numbers and peak years influence both our BA and BACI results. In principle, BACI is superior, with its potential to effectively control for confounding factors. We conclude that the more local the scale of performance assessment, the more relevant is the use of the BACI approach. For various reasons, we find overall minimal impact of REDD+ in reducing deforestation on the ground thus far. Incorporating results from micro and meso level monitoring into national reporting systems is important, since overall REDD+ impact depends on land use decisions on the ground.

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

    Directory of Open Access Journals (Sweden)

    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.