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1.
S D Med ; 75(1): 6-15, 2022 Jan.
Artículo en Inglés | MEDLINE | ID: mdl-35015937

RESUMEN

The total number of 2020 resident births in South Dakota continues to decline with a 4 percent decrease from the previous year yielding the state's lowest crude birth rate (12.3 per 1,000 population) since its first recording in 1910. Currently, similar to the U.S., approximately one-quarter of all births are minority. The percentage of American Indian births is decreasing in its contribution to this population of the state with a growing percent of African American and multi-race newborns comprising the minority population in the state. South Dakota had one more infant death in 2020 (n=81) compared to 2019. The decrease in births led to a non-significant increase in the state's infant mortality rate (IMR) from 7.0 to 7.4 that is significantly higher than the U.S. rate (5.6) in 2019. An increase in nine sudden unexpected infant deaths (SUID) from 2019 to 2020 contributed to the rising IMR. Compared to the U.S., South Dakota has a lower percent of its infant deaths among those who are low birth weight (55 vs. 66 percent). Approximately one-third of white infant deaths occurred after the first 27 days of life; this was true for approximately half of all minority infants. Overall, South Dakota's minority infants have significantly higher rates of neonatal and post neonatal death than its whites, specifically due to perinatal causes, SUID, and accidents/homicide. How SUID contributes to the state's IMR is an area for needed attention as these deaths are increasingly known to accompany risks that, if alleviated, could prevent loss of early life. An examination of data from the year 2020 is the first opportunity to see possible relationships between perinatal outcomes and the pandemic that spanned approximately three-quarters of this year. Drawing causal relationships is not possible, but several observations about the impact of the pandemic are made as natality and infant mortality data for this year are explored in this annual report.


Asunto(s)
Mortalidad Infantil , Muerte Súbita del Lactante , Tasa de Natalidad , Causas de Muerte , Niño , Femenino , Humanos , Lactante , Recién Nacido , Embarazo , South Dakota/epidemiología
2.
Bull World Health Organ ; 100(1): 10-19, 2022 Jan 01.
Artículo en Inglés | MEDLINE | ID: mdl-35017753

RESUMEN

Objective: To describe the implementation, coverage and performance of the national kangaroo mother care programme in Bangladesh. Methods: Kangaroo mother care services for clinically stable babies with birth weight under 2000 g were set up in government-run health-care facilities in rural and urban areas of Bangladesh. Each facility provided counselling on kangaroo mother care, ensured adequate nutrition, and followed up mothers and babies. We studied implementation of the programme from January 2016 to March 2020 using data from the national database. We tracked the number of eligible babies enrolled and their outcomes, mortality and post-discharge follow-up. Findings: The numbers of kangaroo mother care facilities increased from 16 in 2016 to 108 in 2020. Over the 4-year period 64 426 babies weighing under 2000 g were born in these facilities, 6410 of whom received kangaroo mother care. The quarterly percentage of eligible babies receiving kangaroo mother care increased from 4.7% (37/792) during the first quarter to 21.7% (917/4226) during the last five quarters of the programme. Deaths of babies receiving kangaroo mother care showed a downward trend over the study period. The overall mortality was 1.2% (77/6410), with large quarterly fluctuations in mortality. Post-discharge follow-up was low and only 15-20% of babies received four follow-up visits. Conclusion: Implementation of kangaroo mother care interventions is feasible in low-resource settings. Such care has the potential to reduce mortality among low-birth-weight and premature babies. Challenges include low coverage, expanding the programme to the community and strengthening the monitoring system.


Asunto(s)
Método Madre-Canguro , Cuidados Posteriores , Bangladesh , Niño , Femenino , Humanos , Lactante , Mortalidad Infantil , Alta del Paciente
3.
Mymensingh Med J ; 31(1): 129-134, 2022 Jan.
Artículo en Inglés | MEDLINE | ID: mdl-34999692

RESUMEN

Although huge improvement in neonatal mortality reduction in last two decades in Bangladesh but it is still very high compare with many other countries. High neonatal mortality also significantly contribute deaths among the under five children. Neonatal mortality reflects a nation's socio-economic status, efficiency and effectiveness of health care services. This was cross sectional study. The objective of this study was to analyse the diseases pattern and outcome of the neonates admitted in the newly established SCANU (Special care neonatal unit) of 250 bedded General Hospital of Tangail district, Bangladesh. Study period was one year from January 2017 to December 2017. Information from medical records of the SCANU was analysed. During the study period 1,379 neonates were admitted in the SCANU. The ratio between male and female was 1.5:1, 61% of the neonates admitted at first day of life. The reasons for admissions in SCANU were 31% of preterm and low birth weight, 23%birth asphyxia, 13% neonatal sepsis, 9% transient tachypnea of newborn, 5% congenital anomalies and 4% neonatal jaundice. Out of all neonates survival rate was 56% (779), while 25% (349) ended with fatality, 9% (122) were referred to tertiary level hospital and 10% (129) were left the hospital against medical advice. Among the fatal cases 63% died in first 24 hours and 88% in first week of life. Data shows that 47% deaths were due to preterm and low birth weight with its complication, other significant causes were birth asphyxia (30%), septicemia (16%) and congenital anomalies were (6%). Preterm and low birth weight, neonatal sepsis, birth asphyxia, transient tachypnea of newborn; congenital anomalies were the main reasons for admission in SCANU. Prematurity and its complication, birth asphyxia and neonatal sepsis as the major contributors to the neonatal mortality. The study findings will help researchers and policy makers to initiate further research and interventions to reduce fatality among the neonates in the SCANU.


Asunto(s)
Hospitales de Distrito , Mortalidad Infantil , Bangladesh/epidemiología , Niño , Estudios Transversales , Femenino , Humanos , Recién Nacido de Bajo Peso , Recién Nacido , Masculino
4.
BMC Health Serv Res ; 22(1): 4, 2022 Jan 02.
Artículo en Inglés | MEDLINE | ID: mdl-34974826

RESUMEN

BACKGROUND: Efforts to address infant mortality disparities in Ohio have historically been adversely affected by the lack of consistent data collection and infrastructure across the community-based organizations performing front-line work with expectant mothers, and there is no established template for implementing such systems in the context of diverse technological capacities and varying data collection magnitude among participating organizations. METHODS: Taking into account both the needs and limitations of participating community-based organizations, we created a data collection infrastructure that was refined by feedback from sponsors and the organizations to serve as both a solution to their existing needs and a template for future efforts in other settings. RESULTS: By standardizing the collected data elements across participating organizations, integration on a scale large enough to detect changes in a rare outcome such as infant mortality was made possible. Datasets generated through the use of the established infrastructure were robust enough to be matched with other records, such as Medicaid and birth records, to allow more extensive analysis. CONCLUSION: While a consistent data collection infrastructure across multiple organizations does require buy-in at the organizational level, especially among participants with little to no existing data collection experience, an approach that relies on an understanding of existing barriers, iterative development, and feedback from sponsors and participants can lead to better coordination and sharing of information when addressing health concerns that individual organizations may struggle to quantify alone.


Asunto(s)
Mortalidad Infantil , Medicaid , Humanos , Lactante , Ohio , Organizaciones , Estados Unidos
5.
Matern Child Health J ; 26(1): 79-101, 2022 Jan.
Artículo en Inglés | MEDLINE | ID: mdl-34981332

RESUMEN

OBJECTIVES: Community health worker (CHW) interventions have been shown to be effective in areas of maternal and child health (MCH), mostly in relation to infant and neonatal mortality. The specific aims of this review were to expand outcomes to include improving knowledge related to pregnancy and infant health and the receipt of antenatal care (ANC), along with birth outcomes. We also summarized the role, characteristics and activities of CHWs in interventions conducted in settings with demonstrated improvements in key MCH outcomes. METHODS: Articles were retrieved from: PubMed, CINAHL, Global Health, Scopus, Web of Science, and the Cochrane Library from January 2008 through 2018. We included evaluation studies that utilized CHWs as all or part of an intervention to improve outcomes, were printed in English, and published in peer-reviewed journals. RESULTS: Initial electronic database search identified 816 studies and 123 studies met inclusion criteria for full text review. The quality assessment resulted in 0 strong-, 19 moderate-, and 25 weak-rated studies. In most interventions, CHWs were a component of a larger intervention. The majority of the studies (n = 10) found that a CHW intervention can have a positive impact on outcomes. CHW interventions showed improvements in knowledge and ANC. When combined with clinical services, the interventions positively impacted birth outcomes. Most conducted home visits and utilized CHW that were members of the community. CONCLUSIONS FOR PRACTICE: CHWs serve an important role as health educators conducting home visits as a member of the community they serve. They should also continue to collaborate with clinical providers to address MCH outcomes.


Asunto(s)
Agentes Comunitarios de Salud , Atención Prenatal , Niño , Femenino , Humanos , Lactante , Salud del Lactante , Mortalidad Infantil , Recién Nacido , Parto , Embarazo
6.
Cien Saude Colet ; 26(12): 6247-6258, 2021 Dec.
Artículo en Portugués | MEDLINE | ID: mdl-34910014

RESUMEN

This study sought to analyze the correlation of the quality of Primary Health Care services in reducing child mortality, via geoprocessing. It involved an ecological study, with a cross-sectional approach, in which secondary data from all 5,565 Brazilian municipalities were used to analyze the infant mortality rate (IMR) and cause of infant death. The data related to IMR was obtained from the Mortality Information System. For the spatial analysis, 5,011 municipalities were included. The clustering analyses were performed using GEODA software and the spatial regression analyses were performed using ARCGIS 10.5 software. In Brazil, there was a 45.07% reduction in IMR between the years 2000 and 2015. The greatest reduction occurred in the northeastern region of the country, although it is still the region with the highest IMR. Of the 749 municipalities analyzed in the differential cluster for infant death, 153 had high IMR. The areas with the greatest increase in IMR were found in the North and Northeast regions. In Brazil, IMR proved to be inversely associated with the accessibility to high complexity services, health management strata and population size, reference for childbirth, live birth rate, per capita income and unemployment rate. A progressive reduction in IMR was recorded between 2000 and 2015.


Objetivou-se analisar a correlação da qualidade dos serviços da Atenção Primária na redução da mortalidade infantil, através do geoprocessamento. Um estudo ecológico, de abordagem transversal, em que foram utilizados dados secundários de todos os 5.565 municípios brasileiros para análise da taxa de mortalidade infantil (TMI) e causa de óbito infantil. Os dados da TMI foram obtidos no Sistema de Informação de Mortalidade. Para a análise espacial, incluímos 5.011 municípios. As análises de clusterização ocorreram no software GEODA e as análises de regressão espacial no ARCGIS 10.5. No Brasil houve uma redução de 45,07% da TMI entre os anos 2000 e 2015. A maior redução ocorreu na região nordeste do país, apesar de ainda ser a região com maior número na TMI. Dos 749 municípios analisados no cluster diferencial para óbito infantil, 153 apresentaram alta TMI. As áreas com maior expansão de alta TMI foram encontradas nas regiões Norte e Nordeste. No Brasil, a TMI mostrou-se inversamente associada à acessibilidade aos serviços de alta complexidade, ao estrato da gestão em saúde e porte populacional, à referência para o parto, à taxa de nascidos vivos, à renda per capita e à taxa de desemprego. Verificou-se uma crescente redução da TMI entre o período de 2000 a 2015.


Asunto(s)
Mortalidad del Niño , Mortalidad Infantil , Brasil/epidemiología , Niño , Servicios de Salud , Humanos , Lactante , Atención Primaria de Salud , Análisis Espacial
7.
JAMA Netw Open ; 4(12): e2141498, 2021 12 01.
Artículo en Inglés | MEDLINE | ID: mdl-34967878

RESUMEN

Importance: The associations of gestational weight gain (GWG) with infant morbidity and mortality are unclear, and the existing recommendations for GWG have not been stratified by the severity of obesity. Objectives: To identify optimal GWG ranges associated with reduced risks of infant morbidity and mortality across maternal body mass index (BMI) categories. Design, Setting, and Participants: This retrospective cohort study used US nationwide, linked birth and infant death data between 2011 and 2015 to assess the associations of GWG in 2.0-kg groups with infant morbidity and mortality and identified optimal GWG ranges associated with reduced risks of both outcomes, using multivariable logistic regression models. Statistical analysis was performed from February 11 to October 14, 2021. Exposure: Gestational weight gain equivalent to 40 weeks. Main Outcomes and Measures: The 2 main outcomes were (1) significant morbidity of the newborn infant, defined as any presence of assisted ventilation, admission to the neonatal intensive care unit, surfactant therapy, antibiotic therapy, or seizures; and (2) infant mortality younger than 1 year of age (<1 hour, 1-23 hours, 1-6 days, 7-27 days, or 28-365 days after birth). Results: In this study of 15 759 945 mother-infant dyads, the mean (SD) age of the women was 28.1 (5.9) years. Women gained a mean (SD) of 14.1 (7.3) kg during pregnancy, and the mean (SD) GWG decreased with BMI categories (underweight, 15.7 [6.4] kg; normal weight, 15.4 [6.2] kg; overweight, 14.2 [7.4] kg; obesity class 1, 12.2 [8.0] kg; obesity class 2, 10.3 [8.4] kg; obesity class 3, 8.2 [9.2] kg; P < .001). A total of 8.8% of the newborns experienced significant morbidity, with the lowest prevalence among infants delivered by women in the normal weight BMI class (8.0%) and the highest among infants delivered by women with class 3 obesity (12.4%); 0.34% of infants died within 1 year of birth, with the lowest prevalence among infants delivered by women in the normal weight BMI class (0.28%) and the highest among infants delivered by women with class 3 obesity (0.58%). Optimal GWG ranges were 12.0 to less than 24.0 kg for underweight and normal weight women, 10.0 to less than 20.0 kg for overweight women, 8.0 to less than 16.0 kg for women with class 1 obesity, 6.0 to less than 16.0 kg for class 2 obesity, and 6.0 to less than 10.0 kg for class 3 obesity. The lower bounds of the optimal GWG ranges appeared to be higher than the existing recommendations for overweight women (10.0 vs 7.0 kg) and for those with class 1 (8.0 vs 5.0 kg), class 2 (6.0 vs 5.0 kg), and class 3 (6.0 vs 5.0 kg) obesity. Conclusions and Relevance: This study analyzed the associations of GWG with infant morbidity and mortality across BMI categories and found that inadequate GWG was associated with increased risks of adverse infant outcomes even for women with obesity. The results suggested that weight maintenance or weight loss should not be used as routine guidelines.


Asunto(s)
Ganancia de Peso Gestacional , Mortalidad Infantil/tendencias , Obesidad , Complicaciones del Embarazo , Adulto , Estudios de Cohortes , Bases de Datos Factuales , Femenino , Humanos , Lactante , Recién Nacido , Embarazo , Resultado del Embarazo , Atención Prenatal , Estudios Retrospectivos , Factores de Riesgo , Estados Unidos/epidemiología
8.
Cochrane Database Syst Rev ; 12: CD013309, 2021 12 21.
Artículo en Inglés | MEDLINE | ID: mdl-34931697

RESUMEN

BACKGROUND: Preterm infants are susceptible to hyperglycaemia and hypoglycaemia, which may lead to adverse neurodevelopment. The use of continuous glucose monitoring (CGM) devices might help in keeping glucose levels in the normal range, and reduce the need for blood sampling. However, the use of CGM might be associated with harms in the preterm infant. OBJECTIVES: To assess the benefits and harms of CGM versus intermittent modalities to measure glycaemia in preterm infants 1. at risk of hypoglycaemia or hyperglycaemia; 2. with proven hypoglycaemia; or 3. with proven hyperglycaemia. SEARCH METHODS: We searched CENTRAL (2021, Issue 4); PubMed; Embase; and CINAHL in April 2021. We also searched clinical trials databases, conference proceedings, and reference lists of retrieved articles for randomized controlled trials (RCTs) and quasi-RCTs. SELECTION CRITERIA: We included RCTs and quasi-RCTs comparing the use of CGM versus intermittent modalities to measure glycaemia in preterm infants at risk of hypoglycaemia or hyperglycaemia; with proven hypoglycaemia; or with proven hyperglycaemia. DATA COLLECTION AND ANALYSIS: We assessed the methodological quality of included trials using Cochrane Effective Practice and Organisation of Care Group (EPOC) criteria (assessing randomization, blinding, loss to follow-up, and handling of outcome data). We evaluated treatment effects using a fixed-effect model with risk ratio (RR) with 95% confidence intervals (CI) for categorical data and mean, standard deviation (SD), and mean difference (MD) for continuous data. We used the GRADE approach to assess the certainty of the evidence. MAIN RESULTS: We included four trials enrolling 300 infants in our updated review. We included one new study and excluded another previously included study (because the inclusion criteria of the review have been narrowed). We compared the use of CGM to intermittent modalities in preterm infants at risk of hypoglycaemia or hyperglycaemia; however, one of these trials was analyzed separately because CGM was used as a standalone device, without being coupled to a control algorithm as in the other trials. We identified no studies in preterm infants with proven hypoglycaemia or hyperglycaemia.  None of the four included trials reported the neurodevelopmental outcome (i.e. the primary outcome of this review), or seizures. The effect of the use of CGM on mortality during hospitalization is uncertain (RR 0.59, 95% CI 0.16 to 2.13; RD -0.02, 95% CI -0.07 to 0.03; 230 participants; 2 studies; very low-certainty evidence). The certainty of the evidence was very low for all outcomes because of limitations in study design, and imprecision of estimates. One study is ongoing (estimated sample size 60 infants) and planned to be completed in 2022. AUTHORS' CONCLUSIONS: There is insufficient evidence to determine if CGM affects preterm infant mortality or morbidities.  We are very uncertain of the safety of CGM and the available management algorithms, and many morbidities remain unreported. Preterm infants at risk of hypoglycaemia or hyperglycaemia were enrolled in all four included studies. No studies have been conducted in preterm infants with proven hypoglycaemia or hyperglycaemia. Long-term outcomes were not reported. Events of necrotizing enterocolitis, reported in the study published in 2021, were lower in the CGM group. However, the effect of CGM on this outcome remains very uncertain. Clinical trials are required to determine the most effective CGM and glycaemic management regimens in preterm infants before larger studies can be performed to assess the efficacy of CGM for reducing mortality, morbidity, and long-term neurodevelopmental impairments.


Asunto(s)
Hipoglucemia , Recien Nacido Prematuro , Glucemia , Humanos , Hipoglucemia/inducido químicamente , Hipoglucemia/prevención & control , Lactante , Mortalidad Infantil , Recién Nacido , Morbilidad , Ensayos Clínicos Controlados Aleatorios como Asunto
9.
PLoS One ; 16(12): e0260006, 2021.
Artículo en Inglés | MEDLINE | ID: mdl-34914748

RESUMEN

BACKGROUND: During the early COVID-19 pandemic travel in Uganda was tightly restricted which affected demand for and access to care for pregnant women and small and sick newborns. In this study we describe changes to neonatal outcomes in one rural central Ugandan newborn unit before and during the early phase of the COVID-19 pandemic. METHODS: We report outcomes from admissions captured in an electronic dataset of a well-established newborn unit before (September 2019 to March 2020) and during the early COVID-19 period (April-September 2020) as well as two seasonally matched periods one year prior. We report excess mortality as the percent change in mortality over what was expected based on seasonal trends. FINDINGS: The study included 2,494 patients, 567 of whom were admitted during the early COVID-19 period. During the pandemic admissions decreased by 14%. Patients born outside the facility were older on admission than previously (median 1 day of age vs. admission on the day of birth). There was an increase in admissions with birth asphyxia (22% vs. 15% of patients). Mortality was higher during COVID-19 than previously [16% vs. 11%, p = 0.017]. Patients born outside the facility had a relative increase of 55% above seasonal expected mortality (21% vs. 14%, p = 0.028). During this period patients had decreased antenatal care, restricted transport and difficulty with expenses and support. The hospital had difficulty with maternity staffing and supplies. There was significant community and staff fear of COVID-19. INTERPRETATION: Increased newborn mortality during the early COVID-19 pandemic at this facility was likely attributed to disruptions affecting maternal and newborn demand for, access to and quality of perinatal healthcare. Lockdown conditions and restrictions to public transit were significant barriers to maternal and newborn wellbeing, and require further focus by national and regional health officials.


Asunto(s)
COVID-19/epidemiología , Hospitales Rurales/estadística & datos numéricos , Mortalidad Infantil , Adulto , Presión de las Vías Aéreas Positiva Contínua/métodos , Femenino , Hospitales Rurales/organización & administración , Humanos , Lactante , Recién Nacido , Unidades de Cuidado Intensivo Neonatal/organización & administración , Unidades de Cuidado Intensivo Neonatal/estadística & datos numéricos , Edad Materna , Admisión del Paciente/estadística & datos numéricos , Embarazo , Estudios Retrospectivos , Salud Rural/estadística & datos numéricos , Uganda/epidemiología , Adulto Joven
10.
Ciênc. Saúde Colet ; 26(12): 6247-6258, Dez. 2021. tab, graf
Artículo en Portugués | LILACS | ID: biblio-1350487

RESUMEN

Resumo Objetivou-se analisar a correlação da qualidade dos serviços da Atenção Primária na redução da mortalidade infantil, através do geoprocessamento. Um estudo ecológico, de abordagem transversal, em que foram utilizados dados secundários de todos os 5.565 municípios brasileiros para análise da taxa de mortalidade infantil (TMI) e causa de óbito infantil. Os dados da TMI foram obtidos no Sistema de Informação de Mortalidade. Para a análise espacial, incluímos 5.011 municípios. As análises de clusterização ocorreram no software GEODA e as análises de regressão espacial no ARCGIS 10.5. No Brasil houve uma redução de 45,07% da TMI entre os anos 2000 e 2015. A maior redução ocorreu na região nordeste do país, apesar de ainda ser a região com maior número na TMI. Dos 749 municípios analisados no cluster diferencial para óbito infantil, 153 apresentaram alta TMI. As áreas com maior expansão de alta TMI foram encontradas nas regiões Norte e Nordeste. No Brasil, a TMI mostrou-se inversamente associada à acessibilidade aos serviços de alta complexidade, ao estrato da gestão em saúde e porte populacional, à referência para o parto, à taxa de nascidos vivos, à renda per capita e à taxa de desemprego. Verificou-se uma crescente redução da TMI entre o período de 2000 a 2015.


Abstract This study sought to analyze the correlation of the quality of Primary Health Care services in reducing child mortality, via geoprocessing. It involved an ecological study, with a cross-sectional approach, in which secondary data from all 5,565 Brazilian municipalities were used to analyze the infant mortality rate (IMR) and cause of infant death. The data related to IMR was obtained from the Mortality Information System. For the spatial analysis, 5,011 municipalities were included. The clustering analyses were performed using GEODA software and the spatial regression analyses were performed using ARCGIS 10.5 software. In Brazil, there was a 45.07% reduction in IMR between the years 2000 and 2015. The greatest reduction occurred in the northeastern region of the country, although it is still the region with the highest IMR. Of the 749 municipalities analyzed in the differential cluster for infant death, 153 had high IMR. The areas with the greatest increase in IMR were found in the North and Northeast regions. In Brazil, IMR proved to be inversely associated with the accessibility to high complexity services, health management strata and population size, reference for childbirth, live birth rate, per capita income and unemployment rate. A progressive reduction in IMR was recorded between 2000 and 2015.


Asunto(s)
Humanos , Lactante , Niño , Mortalidad Infantil , Mortalidad del Niño , Atención Primaria de Salud , Brasil/epidemiología , Análisis Espacial , Servicios de Salud
11.
Rev Med Chil ; 149(7): 1047-1057, 2021 Jul.
Artículo en Español | MEDLINE | ID: mdl-34751307

RESUMEN

BACKGROUND: During the twentieth century, Chile experienced an important reduction in general mortality. AIM: To describe both general and infant mortality of Chile from 1909 to 2017. MATERIAL AND METHODS: Analysis of information about births and deaths published by the Chilean National Institute of Statistics for the period between 1909 and 2017. RESULTS: Both general and infant mortality rates declined sharply from the 1930s to the late 1990s. However, during the last few years, general mortality rates increased slightly. This is the first increase in over a century. Another positive aspect is that there was a dramatic decrease in mortality rate gaps across Chilean regions, for both general and infant mortality. However, intraregional inequalities in infant mortality continue to be a detrimental factor. CONCLUSIONS: Public health efforts should be carried out to further reduce socioeconomic and regional gaps in adult and infant mortality in Chile.


Asunto(s)
Mortalidad Infantil , Salud Pública , Academias e Institutos , Adulto , Chile/epidemiología , Humanos , Lactante , Mortalidad
12.
J Glob Health ; 11: 04067, 2021.
Artículo en Inglés | MEDLINE | ID: mdl-34737867

RESUMEN

Background: Expanding social protection programme is a major target of the Sustainable Development Goals. Previous studies provided evidence for the relationship of social protection programme to greater use of health services and some improved health outcomes for children. Yet, its impact on child mortality has not been clearly revealed. In this study, we examined the association between social protection programmes and child mortality. Methods: We obtained child mortality data from 379 nationally representative surveys involving 101 low- and middle-income countries (LMICs). We included five child mortality outcomes in the study, which were neonatal mortality rate (NMR), post-neonatal mortality rate (PMR), childhood mortality rate (CMR), infant mortality rate (IMR), and under-5 mortality rate (U5MR). We extracted data on social protection programmes from multiple data sources (eg, Atlas of Social Protection Indicators of Resilience and Equity). Social protection and labour programme (SPL) was the major type of social protection we included. We also included four subtypes of SPL - social assistance, cash transfer, social insurance, and labour market protection. Both unadjusted and adjusted regressions were conducted to measure the associations between characteristics of social protection programmes and child mortality, as well as inequalities in child mortality. Results: Among the 101 countries, the median coverage rate of SPL was 28.5%, with an interquartile range between 6.5% and 55.2%. Using the adjusted model, we found a one-percentage-point increase in SPL coverage is associated with a reduction of 0.09 (95% confidence interval (CI) = 0.04, 0.14) per 1000 live births in NMR, 0.11 (95% CI = 0.04, 0.18) in PMR, and 0.25 (95% CI = 0.11, 0.38) in CMR. Social assistance programme was the only subtype of SPL to be significantly associated with lower mortality rates. A higher SPL coverage was associated with better equity in child mortality - as the coverage of SPL increased by one percentage point, the concentration index of CMR would increase by 0.08 (95% CI = 0.03, 0.13) in the adjusted model, suggesting an improvement in equity. Conclusions: The strong association between social protection programme and child mortality suggests that to achieve the SDG targets of universal social protection and to reduce child mortality, LMICs shall consider prioritizing the expansion of social protection programmes.


Asunto(s)
Mortalidad del Niño , Países en Desarrollo , Niño , Humanos , Lactante , Mortalidad Infantil , Recién Nacido , Pobreza , Desarrollo Sostenible
13.
Epidemiol Prev ; 45(5): 343-352, 2021.
Artículo en Inglés | MEDLINE | ID: mdl-34738456

RESUMEN

OBJECTIVES: to describe the methodology of a pilot perinatal mortality surveillance system (SPItOSS) aimed to improve quality of care and prevent avoidable perinatal severe morbidity and mortality in three Italian regions. DESIGN: population-based surveillance project monitoring incident cases of stillbirths, born dead ≥ 28 weeks of gestation and live births dying within 7 days. Local multidisciplinary audits in obstetric and neonatal units were conducted to assess causes of each death. A selection of deaths was also discussed by experts in regional and national Confidential Enquiries to assess causes and avoidability. The WHO perinatal mortality definition and the ICD-PM classification were adopted to codify perinatal deaths. SETTING AND PARTICIPANTS: health professionals working in any obstetric and neonatal unit in Lombardy (Northern Italy), Tuscany (Central Italy), and Sicily (Southern Italy), accounting for 32.3% of births in Italy. Data collection started on 01.07.2017 and ended on 30.06.2019. MAIN OUTCOME MEASURES: obstetric and neonatal units' participation rate in the participating regions, facility structural organisation description, health professionals' training course participation, estimate of perinatal death rates, clinical audits and Confidential Enquiries rates. RESULTS: health professionals from all obstetric and/or neonatal units (N. 138) joined the pilot project. Overall, 830 incident perinatal deaths were reported; 699 underwent a facility-based clinical audit, and 94 selected cases were analysed in detail through regional and national Confidential Enquiries. Among the latter, 16.0% were assessed as avoidable deaths. Interregional differences related to the facility structural organisation were identified. CONCLUSIONS: SPItOSS was efficient in identifying and analysing incident cases of perinatal deaths and detecting improvable aspects of care and avoidable perinatal deaths. The next objective is to extend the surveillance at the national level, considering that stable funding and a higher number of participating healthcare professionals and experts will be needed.


Asunto(s)
Muerte Perinatal , Femenino , Humanos , Mortalidad Infantil , Muerte Perinatal/prevención & control , Mortalidad Perinatal , Proyectos Piloto , Embarazo , Sicilia , Mortinato/epidemiología
14.
BMC Pregnancy Childbirth ; 21(1): 761, 2021 Nov 10.
Artículo en Inglés | MEDLINE | ID: mdl-34758778

RESUMEN

BACKGROUND: The ongoing spread coronavirus disease worldwide has caused major disruptions and led to lockdowns. Everyday lifestyle changes and antenatal care inaccessibility during the coronavirus disease 2019 (COVID-19) pandemic have variable results that affect pregnancy outcomes. This study aimed to assess the alterations in stillbirth, neonatal-perinatal mortality, preterm birth, and birth weight during the COVID-19 national lockdown. METHODS: We used the data from the Jordan stillbirths and neonatal death surveillance system to compare pregnancy outcomes (gestational age, birth weight, small for gestational age, stillbirth, neonatal death, and perinatal death) between two studied periods (11 months before the pandemic (May 2019 to March 2020) vs. 9 months during the pandemic (April 2020 to March 1st 2020). Separate multinomial logistic and binary logistic regression models were used to compare the studied outcomes between the two studied periods after adjusting for the effects of mother's age, income, education, occupation, nationality, health sector, and multiplicity. RESULTS: There were 31106 registered babies during the study period; among them, 15311 (49.2%) and 15795 (50.8%) births occurred before and during the COVID-19 lockdown, respectively. We found no significant differences in preterm birth and stillbirth rates, neonatal mortality, or perinatal mortality before and during the COVID-19 lockdown. Our findings report a significantly lower incidence of extreme low birth weight (ELBW) infants (<1kg) during the COVID-19 lockdown period than that before the lockdown (adjusted OR 0.39, 95% CI 0.3-0.5: P value <0.001) CONCLUSIONS: During the COVID-19 lockdown period, the number of infants born with extreme low birth weight (ELBW) decreased significantly. More research is needed to determine the impact of cumulative socio-environmental and maternal behavioral changes that occurred during the pandemic on the factors that contribute to ELBW infants.


Asunto(s)
COVID-19/epidemiología , Complicaciones Infecciosas del Embarazo/epidemiología , Resultado del Embarazo/epidemiología , Adulto , Femenino , Humanos , Lactante , Mortalidad Infantil , Recién Nacido , Recién Nacido Pequeño para la Edad Gestacional , Transmisión Vertical de Enfermedad Infecciosa/estadística & datos numéricos , Jordania , Mortalidad Perinatal , Embarazo , Nacimiento Prematuro/epidemiología , Mortinato/epidemiología
15.
BMC Health Serv Res ; 21(1): 1249, 2021 Nov 19.
Artículo en Inglés | MEDLINE | ID: mdl-34794442

RESUMEN

BACKGROUND: Omphalitis is an important contributor to neonatal mortality in Kenya. Chlorhexidine digluconate 7.1 % w/w (CHX; equivalent to 4 % w/w chlorhexidine) was identified as a life-saving commodity for newborn cord care by the United Nations and is included on World Health Organization and Kenyan Essential Medicines Lists. This pilot study assessed the potential resource savings and breakeven price of implementing CHX for neonatal umbilical cord care versus dry cord care (DCC) in Kenya. METHODS: We employed a cost-consequence model in a Kenyan birth cohort. Firstly, the number of omphalitis cases and cases avoided by healthcare sector were estimated. Incidence rates and treatment effect inputs were calculated from a Cochrane meta-analysis of randomised clinical trials (RCTs) (base case) and 2 other RCTs. Economic outcomes associated with omphalitis cases avoided were determined, including direct, indirect and total cost of care associated with omphalitis, resource use (outpatient visits and bed days) and societal impact (caregiver workdays lost). Costs and other inputs were sourced from literature and supplemented by expert clinical opinion/informed inputs, making necessary assumptions. RESULTS: The model estimated that, over 1 year, ~ 23,000 omphalitis cases per 500,000 births could be avoided through CHX application versus DCC, circumventing ~ 13,000 outpatient visits, ~ 43,000 bed days and preserving ~ 114,000 workdays. CHX was associated with annual direct cost savings of ~ 590,000 US dollars (USD) versus DCC (not including drug-acquisition cost), increasing to ~ 2.5 million USD after including indirect costs (productivity, notional salary loss). The most-influential model parameter was relative risk of omphalitis with CHX versus DCC. Breakeven analysis identified a budget-neutral price for CHX use of 1.18 USD/course when accounting for direct cost savings only, and 5.43 USD/course when including indirect cost savings. The estimated breakeven price was robust to parameter input changes. DCC does not necessarily represent standard of care in Kenya; other, potentially harmful, approaches may be used, meaning cost savings may be understated. CONCLUSIONS: Estimated healthcare cost savings and potential health benefits provide compelling evidence to implement CHX for umbilical cord care in Kenya. We encourage comprehensive data collection to make future models and estimates of impacts of upscaling CHX use more robust.


Asunto(s)
Antiinfecciosos Locales , Clorhexidina , Humanos , Mortalidad Infantil , Recién Nacido , Kenia/epidemiología , Cordón Umbilical
16.
Artículo en Inglés | MEDLINE | ID: mdl-34770185

RESUMEN

This is an ecological and time-series study using secondary data on perinatal mortality and its components from 2008 to 2017 in Espírito Santo, Brazil. The data were collected from the Mortality Information System (SIM) and Live Births Information System (SINASC) of the Unified Health System Informatics Department (DATASUS) in June 2019. The perinatal mortality rate (×1000 total births) was calculated. Time series were constructed from the perinatal mortality rate for the regions and Espírito Santo. To analyze the trend, the Prais-Winsten model was used. From 2008 to 2017 there were 8132 perinatal deaths (4939 fetal and 3193 early neonatal) out of a total of 542,802 births, a perinatal mortality rate of 15.0/1000 total births. The fetal/early neonatal ratio was 1.5:1, with a strong positive correlation early neonatal mortality rate, perinatal mortality rate, r (9) = 0.8893, with a significance level of p = 0.000574. The presence of differences in trends by health region was observed. Risk factors that stood out were as follows: mother's age ranging between 10 and 19 or 40 and 49 years old, with no education, a gestational age between 22 and 36 weeks, triple and double pregnancy, and a birth weight below 2499 g. Among the causes of death, 49.70% of deaths were concentrated in category of the tenth edition of the International Classification of Diseases, fetuses and newborns affected by maternal factors and complications of pregnancy, labor, and delivery (P00-P04), and 11.03% were in the category of intrauterine hypoxia and birth asphyxia (P20-P21), both related to proper care during pregnancy and childbirth. We observed a slow reduction in the perinatal mortality rate in the state of Espírito Santo from 2008 to 2017.


Asunto(s)
Muerte Perinatal , Mortalidad Perinatal , Adolescente , Adulto , Brasil/epidemiología , Niño , Femenino , Humanos , Lactante , Mortalidad Infantil , Recién Nacido , Embarazo , Atención Prenatal , Adulto Joven
17.
J Pregnancy ; 2021: 3248850, 2021.
Artículo en Inglés | MEDLINE | ID: mdl-34616573

RESUMEN

Objectives: This study is aimed at evaluating the maternal and perinatal characteristics and pregnancy outcomes of ES. Material and Methods. This is a retrospective cohort study of pregnancy with Eisenmenger syndrome (ES) in Dr. Soetomo Hospital from January 2018 to December 2019. Total sampling size was obtained. We collected all baseline maternal-perinatal characteristic data, cardiac status, and pregnancy outcomes as primary outcomes. The maternal death cases were also evaluated, and we compared characteristics based on defect size (< or >3 cm). Results: During study periods, we collected 18 cases with ES from a total of 152 pregnancies with heart disease. The underlying heart disease type includes atrial septal defect (ASD), ventricle septal defect (VSD), and patent ductus arteriosus (PDA). All cases suffered pulmonary hypertension (PH), 3 cases moderate, and 15 cases as severe. 94% of cases fall into heart failure (DC FC NYHA III-IV) during treatment. The majority of cases are delivered by cesarean section (88.9%). Pregnancy complications found include preterm birth (78%), low birthweight (94%), intrauterine growth restriction (55%), oligohydramnios (16%), severe preeclampsia (33%), and placenta previa (5.5%). Large defect group has an older maternal ages (30.18 ± 4.60 vs. 24.15 ± 2.75; p = 0.002), higher clinical sign (100 vs. 40%, p = 0.003), and higher preterm delivery rate (100% vs. 69%, p = 0.047) compared to small defect groups. The R to L or bidirectional shunt is significantly higher at the large defect group (13 vs. 5 cases, p = 0.006, 95% confidence interval: -1.156 to -0.228). There were seven maternal death cases caused by shock cardiogenic. Conclusions: Pregnancy with ES is still associated with very high maternal neonatal mortality and morbidity. The larger defect size is correlated with clinical performances and pregnancy outcomes. Effective preconception counseling is the best strategy to reduce the risk of maternal and neonatal death in ES women.


Asunto(s)
Complejo de Eisenmenger , Nacimiento Prematuro , Cesárea , Complejo de Eisenmenger/epidemiología , Femenino , Humanos , Mortalidad Infantil , Recién Nacido , Morbilidad , Embarazo , Resultado del Embarazo/epidemiología , Nacimiento Prematuro/epidemiología , Estudios Retrospectivos
18.
Pediatrics ; 148(5)2021 11.
Artículo en Inglés | MEDLINE | ID: mdl-34642233

RESUMEN

BACKGROUND: A woman's health in the interconception period has an impact on birth outcomes. Pediatric visits offer a unique opportunity to provide interconception care (ICC). Our aim was to screen and provide interconception and safe sleep screening, counseling, and interventions for 50% of caregivers of children <2 years of age in a pediatric medical setting. METHODS: Two pediatric clinics implemented the March of Dimes' Interventions to Minimize Preterm and Low Birth Weight Infants Through Continuous Improvement Techniques (IMPLICIT) toolkit, in addition to standardized safe sleep assessments. A quality improvement learning collaborative was formed with a local "infant mortality champion" leading quality improvement efforts. Monthly webinars with the clinic teams reviewed project successes and challenges. Framework for Reporting Adaptations and Modifications was used to document adaptations. RESULTS: For each individual IMPLICIT domain, clinics screened and provided needed interventions for ICC and safe sleep in >50% of eligible encounters. Over the course of the quality improvement learning collaborative, the number of caregivers screened for at least 4 of the 5 IMPLICIT domains increased from 0% to 95%. CONCLUSIONS: To successfully implement the IMPLICIT toolkit in pediatrics, adaptations were made to the existing model, which had previously been used in family medicine clinics. Pediatricians should consider providing ICC as an innovative way to impact infant mortality rates in their community. Framework for Reporting Adaptations and Modifications can be used to systematically describe the adaptations needed to improve the fit of IMPLICIT in the pediatric clinic, understand the process of change and potential application to local context.


Asunto(s)
Recién Nacido de Bajo Peso , Bienestar Materno , Pediatría , Atención Preconceptiva/métodos , Sueño , Intervalo entre Nacimientos , Femenino , Humanos , Lactante , Cuidado del Lactante , Mortalidad Infantil , Bienestar del Lactante , Recién Nacido , Atención Preconceptiva/normas , Nacimiento Prematuro/prevención & control , Mejoramiento de la Calidad
19.
Front Public Health ; 9: 760124, 2021.
Artículo en Inglés | MEDLINE | ID: mdl-34671589

RESUMEN

Background: Accessible, equitable, and efficient pediatric service is critical to achieve optimal child health. This study aimed to evaluate the effectiveness of a multi-component intervention on the pediatric health system over two different periods in Guangzhou. Methods: Based on the World Health Organization (WHO) "six building blocks" model and Donabedian's "Structure-Process-Outcomes" framework, an intervention package was developed to increase financial and human resouce investment to strengthen basic health care and strive for a better quality of pediatric care. This multi-component intervention package was conducted in Guangzhou to improve the pediatric service delivery during two stages (2011-2014 and 2016-2019). The main outcome indicators were the changes in the allocation of pediatricians and pediatric beds, pediatric service efficiency, and the impact of pediatricians on child mortality. Results: We found that pediatricians per 1,000 children (PPTC) and pediatric beds per 1,000 children (PBPTC) increased from 1.07 and 2.37 in 2010 to 1.37 and 2.39 in 2014, then to 1.47 and 2.93 in 2019, respectively. Infant mortality rate (IMR) and under-5 mortality rate (U5MR) dropped from 5.46‰ and 4.04‰ in 2010 to 4.35‰ and 3.30‰ in 2014 then to 3.26‰ and 2.37‰ in 2019. The Gini coefficients of PPTC and PBPTC decreased from 0.48 and 0.38 in 2010, to 0.35 and 0.28 in 2014, then to 0.35 and 0.22 in 2019, respectively, representing the improvement of pediatric resources distribution according to service population. However, equalities in the spatial distribution were not improved much. The average efficiency of pediatric service fluctuated from 2010 to 2019. A unit increase in PPTC was associated with an 11% reduction in IMR and a 16% reduction in U5MR. Conclusions: Findings suggest this multi-component intervention strategy is effective, particularly on the reduction of child mortality. In future, more rigorous and multi-faceted indicators should be integrated in a comprehensive evaluation of the intervention.


Asunto(s)
Mortalidad del Niño , Mortalidad Infantil , Niño , Atención a la Salud , Humanos
20.
Eur J Epidemiol ; 36(10): 985-991, 2021 Oct.
Artículo en Inglés | MEDLINE | ID: mdl-34661814

RESUMEN

SGA (small for gestational age) is widely used to identify high-risk infants, although with inconsistent definitions. Cut points range from 2.5th to 10th percentile of birthweight-for-gestational age. We used receiver operator characteristic curves (ROC) to identify the cut point with maximum sensitivity and specificity (Youden Index), and the area under the curve (AUC), which assesses overall discriminating power. Analysis was conducted on 3,836,034 US births (2015) and 292,279 Norwegian births (2010-14). Birthweight percentiles were calculated using exact birthweights at each week of gestational age, and then summarized across gestational ages. We also conducted a companion analysis of gestational age itself to consider the predictive power of gestational week of birth. Outcomes were neonatal mortality and cerebral palsy, both strongly associated with birthweight. Birthweight percentiles performed poorly in all analyses. The AUC for birthweight percentiles as a discriminator of neonatal mortality was 60% (where 50% is no better than a coin-toss). At such low discrimination, the Youden Index provides no useful SGA cut point. Results in Norway were virtually identical, with an AUC of 58%. The AUC with cerebral palsy as the outcome was even lower, at 54%. In contrast, gestational age had an AUC of 85% as a predictor of neonatal mortality, with < 37 weeks as the optimum cut point. SGA provides surprisingly poor identification of at-risk infants, while gestational age performs well. Similar results in two countries that differ in mean birthweight, percent preterm, and neonatal mortality suggest robustness across populations.


Asunto(s)
Mortalidad Infantil , Recién Nacido Pequeño para la Edad Gestacional , Nacimiento Prematuro , Peso al Nacer , Edad Gestacional , Humanos , Lactante , Curva ROC , Valores de Referencia
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