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1.
East Mediterr Health J ; 26(2): 161-169, 2020 Feb 24.
Artículo en Inglés | MEDLINE | ID: mdl-32141593

RESUMEN

Background: Child mortality rates are considered to be one of the key indicators of child health. Aims: The main objective of this research was to calculate child mortality rates (CMRs) indirectly, using census data, and to investigate using spatial pattern analysis the presence of any clustering patterns among provincial regions. Methods: The Trussell version of the Brass method and Coale-Demeny West model were used to estimate CMRs and life expectancy (LE) at birth. The analyses were performed using the QFive program of MORTPAK 4 software. For cluster analysis, local and global Moran's I indexes were measured. Results: Infant mortality rate, under-5 mortality rate, 1-4 mortality rate and LE at birth were estimated as 21.9, 26, 4.1 (deaths per 1000 live births) and 72.1 years, respectively. Global Moran's I index was calculated as 0.09, 0.09, 0.08 and 0.12, respectively. Conclusion: Special attention must be paid in provinces with high clusters regarding the evaluation of public health programmes, and the cause of failure of these programmes in reduction of childhood mortality indices.


Asunto(s)
Censos , Mortalidad del Niño , Esperanza de Vida , Mortalidad/tendencias , Distribución por Edad , Niño , Mortalidad del Niño/tendencias , Preescolar , Análisis por Conglomerados , Femenino , Humanos , Lactante , Mortalidad Infantil , Recién Nacido , Irán/epidemiología , Esperanza de Vida/tendencias , Masculino , Análisis Espacial
2.
S D Med ; 73(1): 7-15, 2020 Jan.
Artículo en Inglés | MEDLINE | ID: mdl-32135046

RESUMEN

The year 2018 continued a three-year trend of decreasing live resident births in South Dakota with increased racial diversity among the minority cohort of newborns. In 2018 there was a decrease in very low birth weight newborns and this was reflected in a decline from the previous year's infant mortality rate (IMR) of 7.8 to 5.9 per 1,000 births. The state's 2018 IMR also is lower than its previous five year (2013-17) mean rate of 6.5 and is not significantly different than the most current 2017 rate (5.8) for the U.S. Decreases from 2017 were also seen in the state's neonatal mortality rate for its white and minority populations, although not for its post neonatal mortality rate. The distribution of causes of infant death in 2014-18 in South Dakota show that compared to the U.S. (2017), a lower percent of infant deaths were caused by perinatal causes and a higher percent were caused by sudden unexpected infant death (SUID). In South Dakota, there is a significantly higher rate of death due to SUID among its minority than white infants and the state's rate of death due to this cause is significanly higher than what is observed nationally in 2017. The complexity of addressing this cause of death in the state is discussed.


Asunto(s)
Tasa de Natalidad , Mortalidad Infantil , Muerte Súbita del Lactante , Causas de Muerte , Femenino , Humanos , Lactante , Recién Nacido , Embarazo , South Dakota/epidemiología
4.
REME rev. min. enferm ; 24: e-1288, fev.2020.
Artículo en Portugués | LILACS, BDENF - Enfermería | ID: biblio-1053367

RESUMEN

Introdução: a redução da mortalidade materna e infantil é prioridade internacional e nacional devido ao alto potencial de evitabilidade desses óbitos. Os Comitês de Prevenção de Óbitos Maternos, Fetais e Infantis se configuram como um importante mecanismo de vigilância da mortalidade materna e infantil. Objetivo: avaliar a estrutura, processos e resultados dos comitês de prevenção de óbitos nos municípios da Unidade Regional de Saúde de Belo Horizonte-MG segundo porte populacional. Método: tratase de estudo avaliativo desenvolvido na Regional de Saúde de Belo Horizonte no ano de 2015. Utilizou-se questionário aplicado às referências técnicas municipais responsáveis pela vigilância dos óbitos maternos, fetais e infantis. Os municípios foram analisados quanto à adequação às normas nacionais e estaduais, nos domínios estrutura, processo e resultado, segundo categorias de porte populacional. Para a avaliação de cada domínio foram somados os itens adequados, estabelecendo-se um escore de adequação. Resultados: foram avaliados 38 municípios e constatados diversos níveis de adequação dos comitês, sendo os piores percentuais para a estrutura (5,3% como adequados) e os municípios de menor porte. Nos domínios processo e resultado, o percentual de adequação foi 30,6%. Conclusão: as inadequações evidenciadas revelaram a necessidade de se estruturar os comitês municipais com provisão de investimentos financeiros, técnicos e profissionais, de forma a otimizar sua capacidade operacional e de resposta ao óbito ocorrido. Outra melhoria necessária é a expansão das ações técnicas e políticas dos comitês em conjunto com o controle social.(AU)


Introduction: the reduction of maternal and child mortality is an international and national priority due to the high potential for the avoidability of these deaths. The Maternal, Fetal, and Infant Death Prevention Committees (Comitês de Prevenção de Óbitos Maternos, Fetais e Infantis) are an important mechanism for monitoring maternal and child mortality. Objective: to evaluate the structure, processes, and results of death prevention committees in the municipalities of the Regional Health Unit (Unidade Regional de Saúde) of Belo Horizonte-MG according to the population size. Method: this is an evaluative study developed at the Belo Horizonte Health Region in 2015. We applied a questionnaire to the municipal technical references responsible for monitoring maternal, fetal and infant deaths. We analyzed the municipalities to the adequacy to national and state norms, in the domains structure, process and result, according to categories of the population size. We added the appropriate items were added for the assessment of each domain, establishing an adequacy score. Results...(AU)


Introducción: la reducción de la mortalidad materna e infantil es una prioridad internacional y nacional debido al alto potencial de muertes evitables. Los Comités de Prevención de Muerte Materna, Fetal e Infantil son mecanismos importantes para monitorear la mortalidad materna e infantil. Objetivo: evaluar la estructura, procesos y resultados de los comités de prevención de muerte en los municipios de la unidad regional de salud de Belo Horizonte-MG según el tamaño de la población. Método: estudio evaluativo desarrollado en 2015 en la regional de salud de Belo Horizonte. Se realizó una encuesta a técnicos municipales responsables del monitoreo de muertes maternas, fetales e infantiles. Los municipios fueron analizados en cuanto a la adecuación a las normas nacionales y estatales en los dominios estructura, proceso y resultado, según las categorías de tamaño de la población. Para la evaluación de cada dominio se agregaron los ítems adecuados, estableciendo un puntaje de adecuación. Resultados: se evaluaron 38 municipios y se encontraron varios niveles de adecuación de los comités, con los peores porcentajes para la estructura (5,3% como adecuado) y los municipios más pequeños. En los dominios proceso y resultado, el porcentaje de adecuación fue del 30,6%. Conclusión: las deficiencias evidenciadas revelaron la necesidad de estructurar los comités municipales con la provisión de inversiones financieras, técnicas y profesionales, a fin de optimar su capacidad operativa y de respuesta a la muerte ocurrida. Otra mejora necesaria es la expansión de las acciones técnicas y políticas de los comités en conjunto con el control social. (AU)


Asunto(s)
Evaluación en Salud , Mortalidad Infantil , Mortalidad Materna , Enfermería en Salud Comunitaria , Mortalidad Perinatal , Vigilancia en Salud Pública , Políticas Públicas de Salud
5.
BMC Public Health ; 20(1): 10, 2020 Jan 06.
Artículo en Inglés | MEDLINE | ID: mdl-31907008

RESUMEN

BACKGROUND: Limited knowledge on the magnitude of neonatal mortality and associated factors is hampering early intervention in African countries. OBJECTIVE: To determine neonatal mortality and associated factors in the Specialized Neonatal Care Unit Asmara, Eritrea. METHODS: Medical records of all neonates admitted to the Specialized Neonatal Care Unit in 2016 were reviewed using a cross-sectional study. The most important causes of admission and mortality were analyzed. Univariate and multivariate logistic regression analysis was used to evaluate the strength of risk factors associated with neonatal mortality. Variables significant at P < 0.20 level in the univariate analysis were retained in the multivariate model. Model fit was evaluated using Hosmer and Lemeshow test (Chi-square = 12.89, df = 8; P = 0.116), implies the model's estimates fit the data at an acceptable level. Collinearity was assessed using variance inflation factor (VIF) < 4. P-value < 0.05 was considered statistically significant. RESULTS: Of the 1204 (59.9% boys and 40.1% girls) neonates admitted in 2016, 79 (65.6/1000 live births) died. The major causes of admission were sepsis (35.5%), respiratory distress syndrome (15.4%) and perinatal asphyxia (10%). Major causes of death were respiratory distress syndrome (48.1%); extremely low birth weight (40.9%) and very low birth weight (30.5%). After adjustment, low birth weight (Adjusted odds ratio (AOR) = 4.55, 95% CI,1.97-10.50), very low birth weight (AOR = 19.24, 95% CI, 5.80-63.78), late admission (24 h after diagnosis) (AOR = 2.96, 95% CI, 1.34-6.52), apgar score (in 1 min AOR = 2.28, 95% CI, 1.09-4.76, in 5 min AOR = 2.07, 95% CI, 1.02-4.22), and congenital abnormalities (AOR = 3.95, 95% CI, 1.59-9.85) were significantly associated with neonatal mortality. Neonates that stayed > 24 h in the Specialized Neonatal Care Unit (AOR = 0.23, 95% CI, 0.11-0.46) had a lower likelihood of death. Overall 95.8% of mothers of neonates attended antenatal care and 96.6% were facility delivered. None of the maternal conditions were associated with neonatal mortality in this study. CONCLUSIONS: Low birth weight, late admission, low apgar scores and congenital abnormalities were significantly associated with neonatal mortality in the Specialized Neonatal Care Unit. Early management of low birth weight, preterm births, and neonatal complications should be the priority issues for controlling local neonatal deaths.


Asunto(s)
Mortalidad Infantil , Unidades de Cuidado Intensivo Neonatal/estadística & datos numéricos , Estudios Transversales , Eritrea/epidemiología , Femenino , Humanos , Lactante , Recién Nacido de Bajo Peso , Recién Nacido , Masculino , Factores de Riesgo
9.
MMWR Morb Mortal Wkly Rep ; 69(2): 25-29, 2020 Jan 17.
Artículo en Inglés | MEDLINE | ID: mdl-31945037

RESUMEN

Birth defects are a leading cause of infant mortality in the United States, accounting for 20.6% of infant deaths in 2017 (1). Rates of infant mortality attributable to birth defects (IMBD) have generally declined since the 1970s (1-3). U.S. linked birth/infant death data from 2003-2017 were used to assess trends in IMBD. Overall, rates declined 10% during 2003-2017, but decreases varied by maternal and infant characteristics. During 2003-2017, IMBD rates decreased 4% for infants of Hispanic mothers, 11% for infants of non-Hispanic black (black) mothers, and 12% for infants of non-Hispanic white (white) mothers. In 2017, these rates were highest among infants of black mothers (13.3 per 10,000 live births) and were lowest among infants of white mothers (9.9). During 2003-2017, IMBD rates for infants who were born extremely preterm (20-27 completed gestational weeks), full term (39-40 weeks), and late term/postterm (41-44 weeks) declined 20%-29%; rates for moderate (32-33 weeks) and late preterm (34-36 weeks) infants increased 17%. Continued tracking of IMBD rates can help identify areas where efforts to reduce IMBD are needed, such as among infants born to black and Hispanic mothers and those born moderate and late preterm (32-36 weeks).


Asunto(s)
Anomalías Congénitas/mortalidad , Mortalidad Infantil/tendencias , Afroamericanos/estadística & datos numéricos , Anomalías Congénitas/etnología , Grupo de Ascendencia Continental Europea/estadística & datos numéricos , Femenino , Disparidades en el Estado de Salud , Hispanoamericanos/estadística & datos numéricos , Humanos , Lactante , Mortalidad Infantil/etnología , Recien Nacido Extremadamente Prematuro , Recién Nacido , Posmaduro , Recien Nacido Prematuro , Masculino , Estados Unidos/epidemiología
10.
N C Med J ; 81(1): 24-27, 2020.
Artículo en Inglés | MEDLINE | ID: mdl-31908328

RESUMEN

In working to improve the health of North Carolinians, a critical focus starts with our mothers and infants and their surrounding communities. North Carolina's perinatal outcomes, as evidenced by maternal morbidity and mortality, infant mortality, preterm births, and the larger context of lifelong physical and mental health of our citizens, offer areas for improvement and policy implications. In addition, the unacceptable disparities that remain despite some overall improvement in outcomes warrant full attention. This issue of the NCMJ highlights the state of perinatal health in North Carolina; the importance of a risk-appropriate perinatal system of care; the opportunities for supporting our parents, children, and families; and how we as a state and as a community can come together to improve the safety and experience of giving birth in North Carolina and beyond.


Asunto(s)
Salud del Lactante/estadística & datos numéricos , Salud Materna/estadística & datos numéricos , Femenino , Humanos , Lactante , Mortalidad Infantil/tendencias , Recién Nacido , Mortalidad Materna/tendencias , North Carolina/epidemiología , Embarazo , Nacimiento Prematuro/epidemiología
11.
N C Med J ; 81(1): 28-31, 2020.
Artículo en Inglés | MEDLINE | ID: mdl-31908329

RESUMEN

This commentary evaluates access and barriers to perinatal care in North Carolina utilizing key goals the state has identified in its strategic plans, such as expanding health care access for North Carolinians, increasing access to preconception care for women and men, improving access to prenatal care, and undoing racism.


Asunto(s)
Accesibilidad a los Servicios de Salud , Mortalidad Infantil/tendencias , Atención Perinatal , Calidad de la Atención de Salud , Femenino , Humanos , Lactante , Recién Nacido , Masculino , North Carolina/epidemiología , Embarazo
13.
Arch Dis Child Fetal Neonatal Ed ; 105(1): 56-63, 2020 Jan.
Artículo en Inglés | MEDLINE | ID: mdl-31123058

RESUMEN

OBJECTIVE: To describe ethnic and socioeconomic variation in cause-specific infant mortality of preterm babies by gestational age at birth. DESIGN: National birth cohort study. SETTING: England and Wales 2006-2012. SUBJECTS: Singleton live births at 24-36 completed weeks' gestation (n=256 142). OUTCOME MEASURES: Adjusted rate ratios for death in infancy by cause (three groups), within categories of gestational age at birth (24-27, 28-31, 32-36 weeks), by baby's ethnicity (nine groups) or area deprivation score (Index of Multiple Deprivation quintiles). RESULTS: Among 24-27 week births (5% of subjects; 47% of those who died in infancy), all minority ethnic groups had lower risk of immaturity-related death than White British, the lowest rate ratios being 0.63 (95% CI 0.49 to 0.80) for Black Caribbean, 0.74 (0.64 to 0.85) for Black African and 0.75 (0.60 to 0.94) for Indian. Among 32-36 week births, all minority groups had higher risk of death from congenital anomalies than White British, the highest rate ratios being 4.50 (3.78 to 5.37) for Pakistani, 2.89 (2.10 to 3.97) for Bangladeshi and 2.06 (1.59 to 2.68) for Black African; risks of death from congenital anomalies and combined rarer causes (infection, intrapartum conditions, SIDS and unclassified) increased with deprivation, the rate ratios comparing the most with the least deprived quintile being, respectively, 1.54 (1.22 to 1.93) and 2.05 (1.55 to 2.72). There was no evidence of socioeconomic variation in deaths from immaturity-related conditions. CONCLUSIONS: Gestation-specific preterm infant mortality shows contrasting ethnic patterns of death from immaturity-related conditions in extremely-preterm babies, and congenital anomalies in moderate/late-preterm babies. Socioeconomic variation derives from congenital anomalies and rarer causes in moderate/late-preterm babies. Future research should examine biological origins of extremely preterm birth.


Asunto(s)
Grupos de Población Continentales/estadística & datos numéricos , Mortalidad Infantil/etnología , Recien Nacido Prematuro , Grupos Minoritarios/estadística & datos numéricos , Pobreza , Causas de Muerte , Estudios de Cohortes , Anomalías Congénitas/mortalidad , Inglaterra/epidemiología , Edad Gestacional , Humanos , Lactante , Recién Nacido , Enfermedades del Prematuro/mortalidad , Gales/epidemiología
14.
J Matern Fetal Neonatal Med ; 33(1): 73-80, 2020 Jan.
Artículo en Inglés | MEDLINE | ID: mdl-29886760

RESUMEN

Background: A large recent study analyzed the relationship between multiple factors and neonatal outcome and in preterm births. Study variables included the reason for admission, indication for delivery, optimal steroid use, gestational age, and other potential prognostic factors. Using stepwise multivariable analysis, the only two variables independently associated with serious neonatal morbidity were gestational age and the presence of suspected intrauterine growth restriction as a reason for admission. This finding was surprising given the beneficial effects of antenatal steroids and hazards associated with some causes of preterm birth. Multivariable logistic regression techniques have limitations. Without testing for multiple interactions, linear regression will identify only individual factors with the strongest independent relationship to the outcome for the entire study group. There may not be a single "best set" of risk factors or one set that applies equally well to all subgroups. In contrast, machine learning techniques find the most predictive groupings of factors based on their frequency and strength of association, with no attempt to identify independence and no assumptions about linear relationships.Objective: To determine if machine learning techniques would identify specific clusters of conditions with different probability estimates for severe neonatal morbidity and to compare these findings to those based on the original multivariable analysis.Materials and methods: This was a secondary analysis of data collected in a multicenter, prospective study on all admissions to the neonatal intensive care unit between 2013 and 2015 in 10 hospitals. We included all patients with a singleton, stillborn, or live newborns, with a gestational age between 23 0/7 and 31 6/7 week. The composite endpoint, severe neonatal morbidity, defined by the presence of any of five outcomes: death, grade 3 or 4 intraventricular hemorrhage (IVH), and ≥28 days on ventilator, periventricular leukomalacia (PVL), or stage III necrotizing enterocolitis (NEC), was present in 238 of the 1039 study patients. We studied five explanatory variables: maternal age, parity, gestational age, admission reason, and status with respect to antenatal steroid administration. We concentrated on Classification and Regression Trees because the resulting structure defines clusters of risk factors that often bear resemblance to clinical reasoning. Model performance was measured using area under the receiver-operator characteristic curves (AUC) based on 10 repetitions of 10-fold cross-validation.Results: A hybrid technique using a combination of logistic regression and Classification and Regression Trees had a mean cross-validated AUC of 0.853. A selected point on its receiver-operator characteristic (ROC) curve corresponding to a sensitivity of 81% was associated with a specificity of 76%. Rather than a single curve representing the general relationship between gestational age and severe morbidity, this technique found seven clusters with distinct curves. Abnormal fetal testing as a reason for admission with or without growth restriction and incomplete steroid administration would place a 20-year-old patient on the highest risk curve.Conclusions: Using a relatively small database and a few simple factors known before birth it is possible to produce a more tailored estimate of the risk for severe neonatal morbidity on which clinicians can superimpose their medical judgment, experience, and intuition.


Asunto(s)
Técnicas de Diagnóstico Obstétrico y Ginecológico , Enfermedades del Prematuro/diagnóstico , Aprendizaje Automático , Nacimiento Prematuro/diagnóstico , Adulto , Femenino , Edad Gestacional , Humanos , Lactante , Mortalidad Infantil , Recién Nacido , Enfermedades del Prematuro/epidemiología , Enfermedades del Prematuro/patología , Recién Nacido Pequeño para la Edad Gestacional , Masculino , Morbilidad , Valor Predictivo de las Pruebas , Embarazo , Nacimiento Prematuro/epidemiología , Nacimiento Prematuro/mortalidad , Probabilidad , Pronóstico , Estudios Prospectivos , Medición de Riesgo , Factores de Riesgo , Índice de Severidad de la Enfermedad , Mortinato/epidemiología
15.
Zhonghua Er Ke Za Zhi ; 57(12): 934-942, 2019 Dec 02.
Artículo en Chino | MEDLINE | ID: mdl-31795560

RESUMEN

Objective: To study the short-term outcomes and their related risk factors of extremely preterm infants (EPI) and extremely low birth weight infants (ELBWI) in Guangdong province. Methods: The neonatal and corresponding maternal medical records of 2 392 cases of EPI and ELBWI discharged from 26 tertiary hospitals in Guangdong province during 2013-2017 were collected. Chi-square test or linear-by-linear association chi-square was used to analyze the following data on an annual basis: (1) the proportion of EPI and ELBWI in all discharged infants and preterm infants; (2) the difference in survival rate of EPI and ELBWI in different regions and types of hospital; and (3) the difference in incidence of complications. A binary Logistic regression model was established to analyze the death-related risk factors. Results: From 2013 to 2017, the enrolled infants each year were 331, 418, 458, 574 and 611, respectively. Totally, there were 1 352 (56.5%) male infants. The gestational age was (27.7±1.9) weeks, and the birth weight was (919±158) g. The proportion of EPI and ELBWI in all discharged infants increased from 2013 to 2017 (χ(2)=68.636, P<0.01), and so did the proportion in all discharged preterm infants (χ(2)=73.463, P<0.01). The overall survival rate was 60.4% (1 445/2 392), which increased from 2013 to 2017 (χ(2)=11.424, P<0.01). Besides, the survival rate was higher in the Pearl River Delta region than that in the non-Pearl River Delta region (61.7% (1 325/2 146) vs. 48.8% (120/246), χ(2)=15.505, P<0.01), and also higher in women and children specialist hospitals than that in general hospitals (66.5% (702/1 056) vs. 55.6% (743/1 336), χ(2)=29.104, P<0.01). The overall incidence of complications was 89.0% (2 130/2 392) for neonatal respiratory distress syndrome (NRDS), 72.2% (1 041/1 442) for bronchopulmonary dysplasia (BPD), 40.5% (625/1 544) for retinopathy of prematurity (ROP), 12.3% (237/1 922) for necrotizing enterocolitis (NEC), 31.0% (578/1 865) for periventricular-intraventricular hemorrhage (PV-IVH), 34.1% (656/1 922) for nosocomial infection, 26.9% (625/2 327) for patent ductus arteriosus (PDA), and 4.4% (82/1 865) for periventricular leukomalacia (PVL). From 2013 to 2017, the incidence of PVL decreased (χ(2)=6.093, P=0.014), but the incidence of BPD and PDA increased (χ(2)=24.476 and 11.741, respectively, both P<0.01). Multivariate Logistic regression analysis showed that Apgar score ≤7 at 5-minute (OR=1.830, 95%CI 1.373-2.437, P<0.01), NRDS (OR=1.407, 95%CI 1.222-1.621, P<0.01), invasive assisted ventilation (OR=1.825, 95%CI 1.241-2.683, P<0.01), maternal cervical insufficiency (OR=2.044, 95%CI 1.002-4.169, P=0.049), and medical care withdrawal (OR=25.532, 95%CI 18.867-34.553, P<0.01) increased the risk of early neonatal death, while the increase in gestational age (OR=0.869, 95%CI 0.802-0.941, P<0.01), discharged from Guangzhou and Shenzhen (OR=0.606, 95%CI 0.451-0.813, P<0.01), antenatal use of steroids (OR=0.624, 95%CI 0.471-0.828, P<0.01), premature rupture of membranes (OR=0.667, 95%CI 0.466-0.955, P=0.027), and pulmonary surfactant treatment (OR=0.532, 95%CI 0.419-0.676, P<0.01) could decrease the risk. For the mortality in the late or post-neonatal period, placenta previa (OR=2.355, 95%CI 1.006-5.516, P=0.048), cervical insufficiency (OR=3.306, 95%CI 1.259-8.679, P=0.015), PV-IVH (OR=1.486, 95%CI 1.135-1.946, P<0.01), invasive assisted ventilation (OR=2.143, 95%CI 1.208-3.801, P<0.01), and medical care withdrawal (OR=286.532, 95%CI 87.840-934.661, P<0.01) increased the risk, while the increase of birthweight (OR=0.997, 95%CI 0.996-0.999, P<0.01) decreased the risk. Conclusions: The survival rate of EPI and ELBWI increases annually, but the incidence of complications is still high. Invasive assisted ventilation, medical care withdrawal and maternal cervical insufficiency are associated with mortality in both early and late neonatal or post-neonatal period.


Asunto(s)
Displasia Broncopulmonar/epidemiología , Enterocolitis Necrotizante/epidemiología , Mortalidad Infantil , Recien Nacido con Peso al Nacer Extremadamente Bajo , Recien Nacido Extremadamente Prematuro , Retinopatía de la Prematuridad/epidemiología , China , Femenino , Humanos , Lactante , Recién Nacido , Masculino , Embarazo , Factores de Riesgo
16.
Rev Bras Epidemiol ; 22: e190053, 2019.
Artículo en Portugués, Inglés | MEDLINE | ID: mdl-31826109

RESUMEN

OBJECTIVE: To identify spatial patterns in the distribution of hospitalization rates of children with pneumonia in the state of São Paulo, Brazil from 2009 to 2013. METHODS: This was an exploratory ecological study with data obtained from DATASUS of hospitalizations of children with pneumonia in the municipalities in São Paulo from 2009 to 2013/ Data on maternal education and family income were obtained and rates per thousand children were calculated and inserted in a database of municipalities obtained from IBGE. Thematic, kernel and Moran maps were constructed for the hospitalization rates and the Moran indices were calculated. The TerraView program was used for spatial analysis. RESULTS: A total of 43,809 children were hospitalized in the study period, with a minimum of zero and a maximum of 69,072. The mean rate per municipality was 11.51 ± 8.62 (SD). The Moran index was 0.21 (p = 0.01). The thematic map showed clusters in the northern, northwestern, midwestern and southwestern regions of the state; the kernel map showed a higher density of rates in the northwestern and midwestern areas, and the Moran map identified 39 municipalities that deserve the attention of municipal and regional managers. CONCLUSIONS: Geoprocessing identifies regions with higher hospitalization rates for pneumonia and also municipalities that deserve a high intervention priority.


Asunto(s)
Hospitalización/estadística & datos numéricos , Neumonía/mortalidad , Análisis Espacial , Brasil/epidemiología , Niño , Escolaridad , Sistemas de Información Geográfica , Mapeo Geográfico , Humanos , Lactante , Mortalidad Infantil , Programas Nacionales de Salud , Características de la Residencia
17.
Harefuah ; 158(12): 826-831, 2019 Dec.
Artículo en Hebreo | MEDLINE | ID: mdl-31823540

RESUMEN

INTRODUCTION: Preventive medical services for mothers and infants or "Tipat Halav" (Mother & Child clinics) - as they have been known since the earliest times in Eretz Yisrael (pre-statehood Israel) - have been based over many years on a tradition of quality service that assures public health in Israel. This paper presents the policy and services over the years and highlights its contribution to the development of preventive medicine in Israel. This is due to the renewed debate concerning the existence of preventive services within the structure of the health system, and also for the sake of historical truth. The material presented here is based on the examination of documents and research studies conducted within the medical services in years that were fateful for public health in Israel. Two medical institutions - Hadassah and Clalit Health Services (known as Kupat Holim Clalit until 1995) - laid the foundations for the health system in Eretz Yisrael at a time when health-promoting measures consisted of no more than treating illness and preventing infections and the spread of epidemics. In the years before statehood in 1948, mortality rates in Eretz Yisrael were falling. Infant mortality, had declined to 48 deaths per 1,000 live births, was one of the world's lowest rates. It was a significant improvement, since in 1927, for example, infant mortality in Eretz Yisrael had reached 108 per 1,000 live births - one of the world's highest rates at the time. These dramatically improved statistics resulted from the development of Jewish health services in Eretz Yisrael during the British Mandate period. With the declaration of Israel's independence, Hadassah and Kupat Holim Clalit were the chief factors supplying neonatal services in Israel. Following statehood, the Ministry of Health started acting as the state organ that supervised all those entities. In the 1990s, following the recommendations of the Netanyahu Committee that had been appointed to examine the health system, and according to whose recommendations the State Health Law was legislated in 1995, it was decided to transfer preventive personal medical services (Mother & Child) to the various health funds, and to leave the Ministry of Health with a purely supervisory role. In the final decade of the previous century, and in the early years of the present one, that same recommendation was repeated by additional committees and other professional bodies but has still not been implemented.


Asunto(s)
Servicios de Salud Materno-Infantil , Servicios Preventivos de Salud , Niño , Femenino , Humanos , Lactante , Mortalidad Infantil , Israel , Judíos , Madres
18.
Rev Fac Cien Med Univ Nac Cordoba ; 76(4): 217-221, 2019 12 03.
Artículo en Inglés | MEDLINE | ID: mdl-31833744

RESUMEN

Introduction: We present temporal and spatial variation of deaths from microcephaly in children under 1 year of age is analyzed at regional, state, and municipal level in the pre-Zika period in Brazil. Materials and Methods: Data on births and deaths of infants with microcephaly was obtained from DATASUS from 1996 to 2013. Infant mortality rate from microcephaly (IMR-M) was estimated at Region, Federative Unit (UF), and Municipality level. Secular trend (ST) and risk of death variation were estimated using a Poisson regression model. Satscan software was used to obtain a statistic spatial scan for the Poisson model. Results: IMR-M shows a non-significant negative ST in the Southeast, South and Central West Regions of Brazil. A greater IMR-M risk of death variation is found in the North and Northeast Regions. Most UFs in the Southeast, South and Central West Regions showed a negative ST, in contrast to what occurs in the UFs of the North and Northeast Regions showed a positive ST. Six high risk significant clusters were found: 3 in the North-Northeast and 3 in the South-SouthWest-Center-West. Conclusions: The North and Northeast Regions showed positive ST for IRM-M and higher death risk, which was not observed in the other regions. Cluster distribution for higher IMR-M and risk resembles the distribution of the microcephaly and Zika cases in the outbreak period.


Asunto(s)
Mortalidad Infantil , Microcefalia/mortalidad , Microcefalia/virología , Infección por el Virus Zika/epidemiología , Infección por el Virus Zika/mortalidad , Brasil/epidemiología , Brotes de Enfermedades , Humanos , Lactante , Recién Nacido , Análisis Espacio-Temporal
19.
PLoS One ; 14(12): e0221691, 2019.
Artículo en Inglés | MEDLINE | ID: mdl-31887122

RESUMEN

BACKGROUND: Globally, low birthweight (LBW) infants (<2.5 kilograms) contribute up to 80% of neonatal mortality. In Bangladesh, approximately 62% of all births occur at home and therefore, weighing newborns immediately after birth is not feasible. Thus, estimates of birthweight in Bangladesh are mostly obtained based on maternal perception of the newborn's birth size. Little is known about how birthweight is perceived in rural communities, and whether families associate birthweight with newborn's health status. Our objective was to explore families' perceptions of newborn's birthweight, and preventive and care practices for a LBW newborn in rural Bangladesh. METHODS: We conducted a qualitative study in two rural settings of Bangladesh, including 32 in-depth interviews (11 with pregnant women, 12 with recently delivered women, 4 with husbands whose wives were pregnant or had a recent birth, 5 with mothers-in-law whose daughters-in-law were pregnant or had a recent birth), 2 focus group discussions with husbands and 4 key-informant interviews with community health workers. We used thematic analysis to analyse the data. RESULTS: Most participants did not consider birthweight a priority for assessing a newborn's health status, although there was a desire for a healthy newborn. Recognition of different categories of birthweight was subjective and often included several physical descriptors including birth size of the newborn. LBW was not considered as a criterion of a newborn's illness unless the newborn appeared unwell. Maternal poor nutrition, inadequate diet in pregnancy, anaemia, illness during pregnancy, short stature, twin births and influence of supernatural spirit were identified as the major causes of LBW. Women's preventive practices for LBW or small newborns were predominantly constrained by a lack of awareness of birthweight and fear of caesarean section. As an effort to avoid caesarean section during birth, several women tended to perform potentially harmful practices in order to give birth to a small size newborn; such as avoiding nutritious food and eating less in pregnancy. Common practices to treat a LBW or small newborn who appeared ill included breastfeeding, feeding animal milk, feeding sugary water, feeding formula, oil massage, keeping the small newborn warm and seeking care from formal and informal care providers including a spiritual leader. Maternal lack of decision-making power, financial constraint, home birth and superstition were the major challenges to caring for a LBW newborn. CONCLUSION: Birthweight was not well-understood in the rural community, which highlighted substantial challenges to the prevention and care practices of LBW newborns. Community-level health education is needed to promote awareness related to the recognition of birthweight in rural settings.


Asunto(s)
Parto Domiciliario/ética , Salud del Lactante/etnología , Salud del Lactante/tendencias , Adulto , Bangladesh/epidemiología , Peso al Nacer , Cesárea , Femenino , Parto Domiciliario/tendencias , Humanos , Renta , Lactante , Mortalidad Infantil , Recién Nacido de Bajo Peso/fisiología , Recién Nacido , Madres/psicología , Parto , Aceptación de la Atención de Salud/psicología , Embarazo , Población Rural , Factores Socioeconómicos
20.
PLoS One ; 14(12): e0226339, 2019.
Artículo en Inglés | MEDLINE | ID: mdl-31877153

RESUMEN

BACKGROUND: Lifelong antiretroviral therapy (ART) reduces mother-to-child HIV transmission (MTCT) and improves maternal health. Data on the outcomes of HIV-exposed infants (HEI) compared to their unexposed counterparts in the era of universal ART is limited. We compared birth and 6-week outcomes among infants born to HIV-positive and HIV-negative women in Lesotho. METHODS: 941 HIV-negative and 653 HIV-positive pregnant women were enrolled in an observational cohort to evaluate the effectiveness of prevention of mother-to-child HIV transmission (PMTCT) program after implementation of universal maternal ART in 14 health facilities. Pregnancy, delivery, birth, and 6-week data were collected through participant interviews and medical record review. DNA PCR testing for HEI was conducted within 2 weeks of birth and at around 6 weeks of age. Data were analysed to estimate the distribution of birth outcomes, mortality, HIV transmission and HIV-free survival at 6 weeks. RESULTS: HIV-positive women were older (mean age of 28.7 vs. 24.4 years) and presented for antenatal care earlier (mean gestational age of 23.0 weeks vs 25.3 weeks) than HIV-negative women. Prematurity was more frequent among HEI, 7.8% vs. 3.6%. There was no difference in rates of congenital anomalies between HEI (1.0%) and HIV-unexposed infants (HUI) (0.6%). Cumulative HIV transmission was 0.9% (N = 4/431) (95% CI:0.25-2.36) at birth and 1.0% (N = 6/583) (95% CI:0.38-2.23) at 6 weeks. Overall mortality, including stillbirths, was 5.2% and 6.0% by 6 weeks for HUI and HEI respectively. Among liveborn infants, 6-week HIV-free survival for HEI was 95.6% (95% CI:93.7-97.1) compared to 96.8% (95% CI:95.4-97.9) survival for HUI. CONCLUSIONS: Implementation of universal maternal ART lowers MTCT at 6 weeks of age with no differences in congenital anomalies or early mortality between HIV exposed Infants and HIV unexposed infants. However, HIV exposed infants continue to have high rates of prematurity despite improved maternal health on ART.


Asunto(s)
Fármacos Anti-VIH/uso terapéutico , Infecciones por VIH/tratamiento farmacológico , Infecciones por VIH/transmisión , Transmisión Vertical de Enfermedad Infecciosa/prevención & control , Complicaciones Infecciosas del Embarazo/tratamiento farmacológico , Adulto , Estudios de Casos y Controles , Femenino , VIH/genética , Infecciones por VIH/epidemiología , Humanos , Lactante , Mortalidad Infantil , Transmisión Vertical de Enfermedad Infecciosa/estadística & datos numéricos , Lesotho , Edad Materna , Embarazo , Nacimiento Prematuro/epidemiología , Estudios Prospectivos , ARN Viral/genética
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