Evolución de la mortalidad infantil en Argentina en el marco de los Objetivos de Desarrollo del Milenio / Trend in infant mortality rate in Argentina within the framework of the Millennium Development Goals

Introducción. La tasa de mortalidad infantil (TMI) es un indicador del estado de salud de una población y de accesibilidad y calidad de los servicios de salud. En el año 2000, Argentina asumió, en el marco de los Objetivos de Desarrollo del Milenio, el compromiso de disminuir la TMI para el año 2015 a un tercio del valor del año 1990 y reducir las brechas entre jurisdicciones. El objetivo de este trabajo fue describir la evolución de la mortalidad infantil en Argentina y las brechas entre las jurisdicciones, su magnitud y sus causas, en función del cumplimiento de los Objetivos de Desarrollo del Milenio. Población y métodos. Se realizó un estudio descriptivo de la mortalidad infantil en Argentina en 1990 y de 2000 a 2013 sobre la base de publicaciones de estadísticas vitales de la Dirección de Estadísticas e Información de Salud del Ministerio de Salud de la Nación. Resultados. Se constató un descenso en la TMI de 57,8%, en la tasa de mortalidad neonatal de 52,6% y en la tasa de mortalidad posneonatal de 63,8%. El coeficiente de Gini interprovincial para la TMI disminuyó un 27%. El riesgo atribuible poblacional disminuyó 16,6% para la TMI, 38,8% para la tasa de mortalidad neonatal y 51,5% para la tasa de mortalidad posneonatal en el año 2013 respecto de 1990. Conclusión. Se constató un importante descenso en la mortalidad infantil y sus componentes, aunque insuficiente para alcanzar las metas de los Objetivos de Desarrollo del Milenio. La disminución de labrecha de la TMI alcanzó la meta asumida; sin embargo, aún persisten inequidades.

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

Trend in infant mortality rate in Argentina within the framework of the Millennium Development Goals. / Evolución de la mortalidad infantil en Argentina en el marco de los Objetivos de Desarrollo del Milenio.

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

INTRODUCCIÓN: La tasa de mortalidad infantil (TMI) es un indicador del estado de salud de una población y de accesibilidad y calidad de los servicios de salud. En el ano 2000, Argentina asumió, en el marco de los Objetivos de Desarrollo del Milenio, el compromiso de disminuir la TMI para el ano 2015 a un tercio del valor del ano 1990 y reducir las brechas entre jurisdicciones. El objetivo de este trabajo fue describir la evolución de la mortalidad infantil en Argentina y las brechas entre las jurisdicciones, su magnitud y sus causas, en función del cumplimiento de los Objetivos de Desarrollo del Milenio. POBLACIÓN Y MÉTODOS: Se realizó un estudio descriptivo de la mortalidad infantil en Argentina en 1990 y de 2000 a 2013 sobre la base de publicaciones de estadísticas vitales de la Dirección de Estadísticas e Información de Salud del Ministerio de Salud de la Nación. RESULTADOS: Se constató un descenso en la TMI de 57,8%, en la tasa de mortalidad neonatal de 52,6% y en la tasa de mortalidad posneonatal de 63,8%. El coeficiente de Gini interprovincial para la TMI disminuyó un 27%. El riesgo atribuible poblacional disminuyó 16,6% para la TMI, 38,8% para la tasa de mortalidad neonatal y 51,5% para la tasa de mortalidad posneonatal en el ano 2013 respecto de 1990. CONCLUSIONES: Se constató un importante descenso en la mortalidad infantil y sus componentes, aunque insuficiente para alcanzar las metas de los Objetivos de Desarrollo del Milenio. La disminución de labrecha de la TMI alcanzó la meta asumida; sin embargo, aún persisten inequidades. Palabras clave: tasa de mortalidad infantil, Objetivos de Desarrollo del Milenio, disparidades en atención de salud, inequidad.

[Infant Mortality in Argentina: reducibility criteria, 3rd review]. / Mortalidad infantil en Argentina: 3a revisión de los criterios de reducibilidad.

The infant mortality rate is an indicator of quality of life, development, and quality and accessibility of health care. Improvements in science, technology and better access to health care have contributed to a major decrease in the infant mortality rate in Argentina. Since the 1980s, infant deaths have been classified based on the opportunities for reducibility yielded by scientific knowledge and available technologies, in order to obtain a basis for the monitoring and implementation of health policies. The last review of this classification was in 2011. In 2012, a total of 5,541 neonatal deaths (less than 28 days of life) were registered and, under this new classification, over 61% were reducible mainly by the improvement of perinatal health care and adequate and timely treatment of the at-risk newborn. In 2012, a total of 2,686 post-neonatal deaths (from 28 days of life to a year) were registered and, under this new classification, over 66.8% were reducible by improving prevention strategies and providing adequate and timely treatment. This new analysis demonstrates the need to improve the opportunity, accessibility and quality of perinatal care starting at pregnancy, guaranteeing quality care at delivery and reinforcing prevention and timely treatment of common diseases in childhood over the first year of life.

Primer informe nacional de relevamiento epidemiológico SIP-Gestión: desarrollo e implementación a escala nacional de un sistema de información en salud de la mujer y perinatal en Argentina

Presenta los antecedentes, justificación, marco de referencia y desarrollo del SIP-G (Sistema Informático Perinatal); difunde los resultados principales de la implementación y relevamiento epidemiológico del SIP-G a escala nacional; destaca la importancia de la cooperación técnica con OPS/OMS Argentina y CLAP-SMR; y, establece lineamientos sobre el seguimiento de la actual propuesta

Primer informe nacional de relevamiento epidemiológico SIP-Gestión: desarrollo e implementación a escala nacional de un sistema de información en salud de la mujer y perinatal en Argentina

Presenta los antecedentes, justificación, marco de referencia y desarrollo del SIP-G (Sistema Informático Perinatal); difunde los resultados principales de la implementación y relevamiento epidemiológico del SIP-G a escala nacional; destaca la importancia de la cooperación técnica con OPS/OMS Argentina y CLAP-SMR; y, establece lineamientos sobre el seguimiento de la actual propuesta

[Impact of a respiratory disease prevention program in high-risk preterm infants: a prospective, multicentric study]. / Impacto de un programa de prevención de infecciones respiratorias en lactantes prematuros de alto riesgo: estudio prospectivo y multicéntrico.

UNLABELLED: Respiratory tract infections (RTI), especially those caused by Respiratory Syncytial Virus (RSV), are of central concern in high-risk preterm infant care. Prevention programs including new and costly interventions should be evaluated in terms of effectiveness and impact. OBJECTIVES: To evaluate feasibility and results of a National Health Ministry pilot program for severe RTI prevention in high-risk infants. METHODS: Seven high-risk follow-up clinics from the public healthcare system were selected for a prospective, multicentric study. Between May and September 2007, a pilot program comprising healthcare team training, parental education, RSV passive immunoprophylaxis, RTI patient care end results evaluation was implemented. Indicators were used to evaluate feasibility; effectiveness was estimated comparing study results with two historical controls. RESULTS: 183 infants were incorporated, 5 were lost and 1 died from cardiac disease. A RTI management guideline was elaborated among participating centers; parents assisted to educational workshops; palivizumab was given to participating infants up to three doses. RTI hospital admission rate for the study group was 20% (7% RSV-related), compared to 42% (26% RSV-related) and 37% (29% RSV-related) in control groups (p< 0.0001 and p= 0.02, respectively). CONCLUSIONS: Program implementation was feasible and readily accepted by healthcare teams. RTI hospital admissions rates, in general and RSV-related, were significatively lower than local previous studies.

Impacto de un programa de prevención de infecciones respiratorias en lactantes prematuros de alto riesgo: estudio prospectivo y multicéntrico / Impact of a respiratory disease prevention program in high-risk preterm infants: a prospective, multicentric study

Las infecciones respiratorias agudas (IRA), especialmente por virus sincicial respiratorio (VSR), constituyen un problema central en lactantes de alto riesgo. Los programas de prevención que incluyan tecnologías nuevas y costosas deben ser evaluados en términos de efectividad e impacto. Objetivos. Evaluar factibilidad y resultados de un programa piloto del Ministerio de Salud de la Nación para disminuir las IRA graves en lactantesprematuros. Métodos. Mediante un diseño prospectivo y multicéntrico se seleccionaron 7 consultorios de seguimiento de alto riesgo de instituciones públicas. El programa se desarrolló entre mayo y septiembre de 2007 y comprendió: capacitacióndel equipo de salud, educación a los padres, inmunoprofilaxis pasiva para VSR, atención de los pacientes con IRA y evaluación de resultados. La factibilidad se evaluó con indicadores y la efectividad comparando las tasas de internación por IRA con 2 cohortes históricas. Resultados. Se incorporaron 183 niños, 5 desertaron y 1 falleció por cardiopatía. Se elaboró entre los centros participantes un consenso sobre atención del prematuro con IRA; todos los padres participaron en talleres de educación; se administró palivizumab a todos los pacientes hasta un total de 3 dosis. La tasa de internación por IRA fue de 20% (7% por VSR) contra 42% (26% por VSR) y 37% (29% por VSR) en cada cohorte testigo (p< 0,0001 y p= 0,02 respectivamente). Conclusiones. El programa fue factible y aceptado favorablemente por los equipos de salud participantes. Las tasas de internación por IRA en general y por VSR en particular fueron significativamente inferiores a las de estudios locales previos.

Respiratory tract infections (RTI), specially those caused by Respiratory Syncytial Virus (RSV) are of central concern in high-risk preterm infant care. Prevention programs including new and costly interventions should be evaluated in terms of efectivity and impact. Objectives. To evaluate feasibility and results of a National Health Ministry pilot program for severe RTI prevention in high-risk infants. Methods. Seven high-risk follow-up clinics from the public healthcare system were selected for a prospective, multicentric study. Between May and September 2007, a pilot program comprising healthcare team training, parental education, RSV pasive immunoprophylaxis, RTI patient care end results evaluation was implemented. Indicators were used to evaluate feasibility; efectivity was estimated comparing study results withtwo historical controls. Results. 183 infants were incorporated, 5 were lost and 1 died from cardiac disease. A RTI management guideline was elaborated among participating centers; parents assisted to educational workshops; palivizumab was given to participatinginfants up to three doses. RTI hospital admission rate for the study group was 20% (7% RSV-related), compared to 42% (26% RSV-related) and 37% (29% RSV-related) in control groups(p< 0.0001 and p= 0.02, respectively).Conclusions. Program implementation was feasible and readily accepted by healthcare teams. RTI hospital admissions rates, in general and RSV-related, were significatively lower than local previous studies.

Impacto de un programa de prevención de infecciones respiratorias en lactantes prematuros de alto riesgo: estudio prospectivo y multicéntrico / Impact of a respiratory disease prevention program in high-risk preterm infants: a prospective, multicentric study

Las infecciones respiratorias agudas (IRA), especialmente por virus sincicial respiratorio (VSR), constituyen un problema central en lactantes de alto riesgo. Los programas de prevención que incluyan tecnologías nuevas y costosas deben ser evaluados en términos de efectividad e impacto. Objetivos. Evaluar factibilidad y resultados de un programa piloto del Ministerio de Salud de la Nación para disminuir las IRA graves en lactantesprematuros. Métodos. Mediante un diseño prospectivo y multicéntrico se seleccionaron 7 consultorios de seguimiento de alto riesgo de instituciones públicas. El programa se desarrolló entre mayo y septiembre de 2007 y comprendió: capacitacióndel equipo de salud, educación a los padres, inmunoprofilaxis pasiva para VSR, atención de los pacientes con IRA y evaluación de resultados. La factibilidad se evaluó con indicadores y la efectividad comparando las tasas de internación por IRA con 2 cohortes históricas. Resultados. Se incorporaron 183 niños, 5 desertaron y 1 falleció por cardiopatía. Se elaboró entre los centros participantes un consenso sobre atención del prematuro con IRA; todos los padres participaron en talleres de educación; se administró palivizumab a todos los pacientes hasta un total de 3 dosis. La tasa de internación por IRA fue de 20% (7% por VSR) contra 42% (26% por VSR) y 37% (29% por VSR) en cada cohorte testigo (p< 0,0001 y p= 0,02 respectivamente). Conclusiones. El programa fue factible y aceptado favorablemente por los equipos de salud participantes. Las tasas de internación por IRA en general y por VSR en particular fueron significativamente inferiores a las de estudios locales previos.(AU)

Respiratory tract infections (RTI), specially those caused by Respiratory Syncytial Virus (RSV) are of central concern in high-risk preterm infant care. Prevention programs including new and costly interventions should be evaluated in terms of efectivity and impact. Objectives. To evaluate feasibility and results of a National Health Ministry pilot program for severe RTI prevention in high-risk infants. Methods. Seven high-risk follow-up clinics from the public healthcare system were selected for a prospective, multicentric study. Between May and September 2007, a pilot program comprising healthcare team training, parental education, RSV pasive immunoprophylaxis, RTI patient care end results evaluation was implemented. Indicators were used to evaluate feasibility; efectivity was estimated comparing study results withtwo historical controls. Results. 183 infants were incorporated, 5 were lost and 1 died from cardiac disease. A RTI management guideline was elaborated among participating centers; parents assisted to educational workshops; palivizumab was given to participatinginfants up to three doses. RTI hospital admission rate for the study group was 20% (7% RSV-related), compared to 42% (26% RSV-related) and 37% (29% RSV-related) in control groups(p< 0.0001 and p= 0.02, respectively).Conclusions. Program implementation was feasible and readily accepted by healthcare teams. RTI hospital admissions rates, in general and RSV-related, were significatively lower than local previous studies.(AU)

[Evolution of children one year post liver transplant]. / Evolución de niños post-trasplante hepático luego del primer año de sobrevida.

Orthotopic liver transplantation is the only definitive mode of therapy for children with end-stage liver disease. However, it remains challenging because of the necessity to prevent long-term complications. The aim of this study was to analyze the evolution of transplanted patients with more than one year of follow up. Between November 1992 and November 2001, 238 patients underwent 264 liver transplantations. A total of 143 patients with more than one year of follow up were included. The median age of patients +/- SD was 5.41 years +/- 5.26 (r: 0.58-21.7 years). All children received primary immunosuppression with cyclosporine. The indications for liver replacement were: fulminant hepatic failure (n: 50), biliary atresia (n: 38), cirrhosis (n: 37), chronic cholestasis (n: 13) and miscellaneous (n: 5). The indications for liver re-transplantation were: biliary cirrhosis (n: 7), hepatic artery thrombosis (n: 4) and chronic rejection (n: 3). Reduced-size liver allografts were used in 73/157 liver transplants, 14 of them were from living-related donors and 11 were split-livers. Patient and graft survival rates were 93% and 86% respectively. Death risk was statistically higher in retransplanted and reduced-size grafted patients. Growth retardation and low bone density were recovered before the first 3 years post-transplant. The incidence of lymphoproliferative disease was 7.69%. De novo hepatitis B was diagnosed in 7 patients (4.8%). Social risk did not affect the outcome of our population. The prevention, detection and early treatment of complications in the long-term follow up contributed to improve the outcome.

Evolución de niños post-trasplante hepático luego del primer año de sobrevida. / [Evolution of children one year post liver transplant]

Orthotopic liver transplantation is the only definitive mode of therapy for children with end-stage liver disease. However, it remains challenging because of the necessity to prevent long-term complications. The aim of this study was to analyze the evolution of transplanted patients with more than one year of follow up. Between November 1992 and November 2001, 238 patients underwent 264 liver transplantations. A total of 143 patients with more than one year of follow up were included. The median age of patients +/- SD was 5.41 years +/- 5.26 (r: 0.58-21.7 years). All children received primary immunosuppression with cyclosporine. The indications for liver replacement were: fulminant hepatic failure (n: 50), biliary atresia (n: 38), cirrhosis (n: 37), chronic cholestasis (n: 13) and miscellaneous (n: 5). The indications for liver re-transplantation were: biliary cirrhosis (n: 7), hepatic artery thrombosis (n: 4) and chronic rejection (n: 3). Reduced-size liver allografts were used in 73/157 liver transplants, 14 of them were from living-related donors and 11 were split-livers. Patient and graft survival rates were 93

and 86

respectively. Death risk was statistically higher in retransplanted and reduced-size grafted patients. Growth retardation and low bone density were recovered before the first 3 years post-transplant. The incidence of lymphoproliferative disease was 7.69

. De novo hepatitis B was diagnosed in 7 patients (4.8

). Social risk did not affect the outcome of our population. The prevention, detection and early treatment of complications in the long-term follow up contributed to improve the outcome.