Timeliness, frequency and content of antenatal care: which is most important to reducing indigenous disparities in birth weight in Mexico?

This article examines the role of components of adequate antenatal care (ANC) in disparities in birth weight between indigenous and non-indigenous women in Mexico. We estimate the potential for added weight gain among indigenous infants if their mothers received timely, frequent ( ≥4 visits) and complete ANC (≥75% of recommended processes of care). We used population-based survey data (2012;N= 6612 women 12-49). We applied quantile regression to examine heterogeneity of the association between adequate ANC, indigenous ethnicity and birth weight across quantiles of the birth weight distribution. A greater proportion of indigenous women reported a low-birth weight infant (<2.5 kg) at last delivery (14 vs 8% among non-indigenous women). Coverage of adequate ANC (timely, frequent and complete care) is lower among indigenous (59%, CI:53;65) than non-indigenous (68%, CI:66;70) women. Indigenous ethnicity is associated with a lower birth weight across quantiles of the observed birth weight distribution: between 300 g in the 0.05, 0.10 and 0.25 quantiles. Among indigenous women, greater newborn weight gains are achieved in the lowest quantiles if they have access to ≥75% of the content of ANC compared with those that did not have access: ∼180 and 260 g are gained in both quantiles 0.05 and 0.10, respectively. This means that the smallest indigenous newborns could potentially reach 2.36 kg (from 1.86 kg), close to the normal weight threshold. The frequency of ANC was positively associated with birth weight for all women but complete ANC appears to differentially affect indigenous women at the bottom of the birth weight distribution. The marginal gains obtained among indigenous newborns that received complete ANC compared with indigenous/non-indigenous newborns did not receive it, is particularly important in low-birth weight quantiles. Delivering basic processes of ANC may therefore have the potential to impact the highest risk women and help them to overcome the low-birth weight threshold.

Fecal ESBL Escherichia coli carriage as a risk factor for bacteremia in patients with hematological malignancies.

PURPOSE: The purpose of this study is to evaluate the impact of fecal extended-spectrum ß-lactamase-producing Escherichia coli (ESBL-EC) colonization for bloodstream infection (BSI), clinical outcome, and costs in patients with hematologic malignancies (HM) and severe neutropenia. METHODS: This is a cohort study, carried out at a cancer-referral hospital. The study population comprises patients with HM, hospitalized prior to administration of the first chemotherapy cycle. A stool culture was taken during the first 48 h; they were grouped as colonized by ESBL-EC or non-ESBL-EC. Patients were followed upon completion of chemotherapy or death. The sum of the days of antibiotics and the length of stay of all hospitalizations in the different cycles of chemotherapy were recorded. RESULTS: We included 126 patients with a recent diagnosis of HM, grouped as 63 patients colonized by ESBL-EC and 63 colonized by non-ESBL-EC, aged 42 ± 16 years old, 78 males (62%). BSI by ESBL-EC developed in 14 patients (22.2%) colonized by the same strain and in 5 (7.9%) in the group colonized with non-ESBL-EC. BSI by non-ESBL-EC was observed in 3 patients (4.7%) colonized by ESBL-EC and in 17 (26.9%) patients colonized by non-ESBL-EC. Colonization with ESBL-EC increased the risk of BSI by the same strain (relative risk (RR) = 3.4, 95% confidence interval (95% CI) 1.5-7.8, p = 0.001), shorter time to death (74 ± 62 vs. 95 ± 83 days, p < 0.001), longer hospital stay (64 ± 39 vs. 48 ± 32 days, p = 0.01), and higher infection-related costs ($6528 ± $4348 vs. $4722 ± $3173, p = 0.01). There was no difference in overall mortality between both groups. CONCLUSIONS: Fecal colonization by ESBL-EC is associated with increased risk of BSI by this strain, longer hospital stay, and higher related costs.