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1.
Clin Microbiol Infect ; 27(1): 36-46, 2021 Jan.
Artículo en Inglés | MEDLINE | ID: mdl-33148440

RESUMEN

BACKGROUND: Previous outbreaks of severe acute respiratory syndrome coronavirus 1 (SARS-CoV-1) and Middle East respiratory syndrome coronavirus (MERS-CoV) have been associated with unfavourable pregnancy outcomes. SARS-CoV-2 belongs to the human coronavirus family, and since this infection shows a pandemic trend it will involve many pregnant women. AIMS: This systematic review and meta-analysis aimed to assess the impact of coronavirus disease 19 (COVID-19) on maternal and neonatal outcomes. SOURCES: PubMed, EMBASE, MedRxiv, Scholar, Scopus, and Web of Science databases were searched up to 8th May 2020. Articles focusing on pregnancy and perinatal outcomes of COVID-19 were eligible. Participants were pregnant women with COVID-19. CONTENT: The meta-analysis was conducted following the PRISMA and MOOSE reporting guidelines. Bias risk was assessed using the Joanna Briggs Institute (JBI) manual. The protocol was registered with PROSPERO (CRD42042020184752). Twenty-four articles, including 1100 pregnancies, were selected. The pooled prevalence of pneumonia was 89% (95%CI 70-100), while the prevalence of women admitted to the intensive care unit was 8% (95%CI 1-20). Three stillbirths and five maternal deaths were reported. A pooled prevalence of 85% (95%CI 72-94) was observed for caesarean deliveries. There were three neonatal deaths. The prevalence of COVID-19-related admission to the neonatal intensive care unit was 2% (95%CI 0-6). Nineteen out of 444 neonates were positive for SARS-CoV-2 RNA at birth. Elevated levels of IgM and IgG Serum antibodies were reported in one case, but negative swab. IMPLICATIONS: Although adverse outcomes such as ICU admission or patient death can occur, the clinical course of COVID-19 in most women is not severe, and the infection does not significantly influence the pregnancy. A high caesarean delivery rate is reported, but there is no clinical evidence supporting this mode of delivery. Indeed, in most cases the disease does not threaten the mother, and vertical transmission has not been clearly demonstrated. Therefore, COVID-19 should not be considered as an indication for elective caesarean section.


Asunto(s)
/epidemiología , Cesárea/estadística & datos numéricos , Nacimiento Vivo/epidemiología , Mortinato/epidemiología , Adulto , /cirugía , Femenino , Humanos , Lactante , Mortalidad Infantil/tendencias , Recién Nacido , Unidades de Cuidado Intensivo Neonatal , Mortalidad Materna/tendencias , Embarazo , Prevalencia
3.
S Afr Med J ; 0(0): 13185, 2020 12 15.
Artículo en Inglés | MEDLINE | ID: mdl-33334393

RESUMEN

BACKGROUND: Current evidence indicates that children are relatively spared from direct COVID-19-related morbidity and mortality, but that the indirect effects of the pandemic pose significant risks to their health and wellbeing. OBJECTIVES: To assess the impact of the local COVID-19 outbreak on routine child health services. METHODS: The District Health Information System data set for KwaZulu-Natal (KZN) provincial health services was accessed, and monthly child health-related data were extracted for the period January 2018 - June 2020. Chronological and geographical variations in sentinel indicators for service access, service delivery and the wellbeing of children were assessed. RESULTS: During April - June 2020, following the start of the COVID-19 outbreak in KZN, significant declines were seen for clinic attendance (36%; p=0.001) and hospital admissions (50%; p=0.005) of children aged <5 years, with a modest recovery in clinic attendance only. Among service delivery indicators, immunisation coverage recovered most rapidly, with vitamin A supplementation, deworming and food supplementation remaining low. Changes were less pronounced for in- and out-of-hospital births and uptake rates of infant polymerase chain reaction testing for HIV at birth, albeit with wide interdistrict variations, indicating inequalities in access to and provision of maternal and neonatal care. A temporary 47% increase in neonatal facility deaths was reported in May 2020 that could potentially be attributed to COVID-19-related disruption and diversion of health resources. CONCLUSIONS: Multiple indicators demonstrated disruption in service access, service delivery and child wellbeing. Further studies are needed to establish the intermediate- and long-term impact of the COVID-19 outbreak on child health, as well as strategies to mitigate these.


Asunto(s)
Servicios de Salud del Niño , Accesibilidad a los Servicios de Salud , Control de Infecciones , Atención Perinatal , /epidemiología , Salud del Niño/normas , Servicios de Salud del Niño/organización & administración , Servicios de Salud del Niño/estadística & datos numéricos , Preescolar , Recursos en Salud/normas , Accesibilidad a los Servicios de Salud/estadística & datos numéricos , Accesibilidad a los Servicios de Salud/tendencias , Necesidades y Demandas de Servicios de Salud , Humanos , Lactante , Mortalidad Infantil , Recién Nacido , Control de Infecciones/métodos , Control de Infecciones/organización & administración , Atención Perinatal/normas , Atención Perinatal/estadística & datos numéricos , Sudáfrica/epidemiología
4.
Zhonghua Liu Xing Bing Xue Za Zhi ; 41(10): 1710-1716, 2020 Oct 10.
Artículo en Chino | MEDLINE | ID: mdl-33297631

RESUMEN

Objective: To analyze the level and trend of low birth weight mortality in children under 1 year old in China from 2004 to 2018. Methods: The published Data Set of National Mortality Surveillance from 2004 to 2018 was used to analyze the low birth weight mortality rate, constituent ratio and changing trend in boys and girls, in urban area and rural area and in different regions in China. The Joinpoint regression model fitted by the weighted least square method was used to analyze the time variation trend and calculate the annual percentage change (APC), the average annual percentage change (AAPC) and their 95% confidence intervals in each time period. Results: From 2004 to 2018, the low birth weight mortality rate in children under 1 year old in China showed a decreasing trend with an AAPC of -8.0% (95%CI: -10.6% --5.4%). The differences between boys and girls, between urban area and rural area and among different regions gradually reduced. From 2004 to 2018, the constituent ratio of low birth weight mortality showed an increasing trend with an AAPC of 1.6% (95%CI: 0.1%-3.2%). The mortality rate in urban area (38.74 per 100 000) was higher than that in rural area (30.44 per 100 000). The annual average declining speed of low birth weight mortality rate in urban area (AAPC=-3.4%, 95%CI: -7.0%-0.3%) was slower than that in rural area (AAPC=-9.3%, 95%CI: -12.0% --6.6%). The low birth weight mortality rate of boys (36.25 per 100 000) was higher than that of girls (28.22 per 100 000). The low birth weight mortality constituent ratio in western region showed an increasing trend, its average annual percentage change (AAPC=3.2%, 95%CI: 1.7%-4.8%) increased faster than that of the eastern region (AAPC=-0.5%, 95%CI: -2.3%-1.4%). In urban and rural areas and different regions, the rate of low birth weight mortality in boys was higher than that in girls. Conclusions: From 2004 to 2018, the mortality rate of low birth weight in children under 1 year old showed a downward trend, and the constituent ratio showed an upward trend. Boys and children living in central and western regions should be the key population for maternal and child health care.


Asunto(s)
Mortalidad Infantil , Recién Nacido de Bajo Peso , China/epidemiología , Femenino , Humanos , Lactante , Mortalidad Infantil/tendencias , Recién Nacido , Masculino
5.
Sci Rep ; 10(1): 20991, 2020 12 02.
Artículo en Inglés | MEDLINE | ID: mdl-33268799

RESUMEN

The public health burden of nutritional deficiency and child mortality is the major challenge India is facing upfront. In this context, using National Family Health Survey, 2015-16 data, this study estimated rate of composite index of anthropometric failure (CIAF) among Indian children by their population characteristics, across states and examined the multilevel contextual determinants. We further investigated district level burden of infant and child mortality in terms of multiple anthropometric failure prevalence across India. The multilevel analysis confirms a significant state, district and PSU level variation in the prevalence of anthropometric failures. Factors like- place of residence, household's economic wellbeing, mother's educational attainment, age, immunization status and drinking water significantly determine the different forms of multiple anthropometric failures. Wealth status of the household and mother's educational status show a clear gradient in terms of the estimated odds ratios. The district level estimation of infant and child mortality demonstrates that districts with higher burden of multiple anthropometric failures show elevated risk of infant and child mortality. Unlike previous studies, this study does not use the conventional indices, instead considered the CIAF to identify the exact and severe form of undernutrition among Indian children and the associated nexus with infant and child mortality at the district level.


Asunto(s)
Mortalidad del Niño , Trastornos del Crecimiento/epidemiología , Niño , Trastornos de la Nutrición del Niño/epidemiología , Trastornos de la Nutrición del Niño/mortalidad , Preescolar , Costo de Enfermedad , Femenino , Trastornos del Crecimiento/mortalidad , Humanos , India/epidemiología , Lactante , Mortalidad Infantil , Recién Nacido , Modelos Lineales , Masculino , Prevalencia , Factores de Riesgo , Factores Socioeconómicos
6.
Rev Saude Publica ; 54: 132, 2020.
Artículo en Inglés, Portugués | MEDLINE | ID: mdl-33331526

RESUMEN

OBJECTIVE: To analyze the trend of early neonatal infant mortality in the state of São Paulo according to preventability and region of residence. METHODS: Ecological study with secondary data from 2008 to 2017, obtained from the Sistema de Informação sobre Nascidos Vivos (Sinasc - Live Birth Information System) and the Sistema de Informação sobre Mortalidade (SIM - Mortality Information System). The causes of death were classified according to preventability groups, and the annual percentage changes in the death rates of each preventability group were estimated using the Joinpoint software. RESULTS: The early neonatal component showed a reduction trend with an annual percentage change of -1.18 (95%CI -1.63 to -0.72), less pronounced than the other age components of infant mortality. In the analysis according to preventability, the causes reducible by attention to the woman during pregnancy and those reducible by attention to the fetus and the newborn presented annual percentage change of -1.03 (95%CI: -1.92 to -0.13) and -2.6 (95%CI: -4.07 to -1.11), respectively. In the causes reducible by attention to women during delivery, no reduction trend was observed. Regional discrepancies occurred in the variation of early neonatal infant mortality rates according to type of preventability. CONCLUSIONS: Mortality up to the 6th day of life presented greater difficulty of reduction when compared with the other age components. The absence of a reduction trend in preventable deaths due to the attention to women during delivery points to possible fragility in the attention to delivery.


Asunto(s)
Mortalidad Infantil/tendencias , Brasil/epidemiología , Causas de Muerte , Femenino , Humanos , Lactante , Recién Nacido , Masculino , Servicios de Salud Materno-Infantil , Embarazo
7.
Cochrane Database Syst Rev ; 12: CD011545, 2020 12 16.
Artículo en Inglés | MEDLINE | ID: mdl-33325570

RESUMEN

BACKGROUND: Simulation-based obstetric team training focuses on building a system that will anticipate errors, improve patient outcomes and the performance of clinical care teams. Simulation-based obstetric team training has been proposed as a tool to improve the overall outcome of obstetric health care. OBJECTIVES: To assess the effects of simulation-based obstetric team training on patient outcomes, performance of obstetric care teams in practice and educational settings, and trainees' experience. SEARCH METHODS: The Cochrane Pregnancy and Childbirth Group's Trials Register, ClinicalTrials.gov and the WHO International Clinical Trials Registry Platform (ICTRP) were searched (14 April 2020), together with references checking and hand searching the available proceedings of 2 international conferences. SELECTION CRITERIA: We included randomised controlled trials (RCTs) (including cluster-randomised trials) comparing simulation-based obstetric team training with no, or other type of training. DATA COLLECTION AND ANALYSIS: We used standard methodological procedures expected by Cochrane, to identify articles, assess methodological quality and extract data. Data from three cluster-randomised trials could be used to perform generic inverse variance meta-analyses. The meta-analyses were based on risk ratios (RRs) and mean differences (MDs) with 95% confidence intervals (CIs). We used the GRADE approach to rate the certainty of the evidence. We used Kirkpatrick's model of training evaluation to categorise the outcomes of interest; we chose Level 3 (behavioural change) and Level 4 (patient outcome) to categorise the primary outcomes. MAIN RESULTS: We included eight RCTs, six of which were cluster-randomised trials, involving more than 1000 training participants and more than 200,000 pregnancies/births. Four studies reported on outcome measures on Kirkpatrick level 4 (patient outcome), three studies on Kirkpatrick level 3 (performance in practice), two studies on Kitkpatrick level 2 (performance in educational settings), and none on Kirkpatrick level 1 (trainees' experience). The included studies were from Mexico, the Netherlands, the UK and the USA, all middle- and high-income countries. Kirkpatrick level 4 (patient outcome) Simulation-based obstetric team training may make little or no difference for composite outcomes of maternal and/or perinatal adverse events compared with no training (3 studies; n = 28,731, low-certainty evidence, data not pooled due to different composite outcome definitions). We are uncertain whether simulation-based obstetric team training affects maternal mortality compared with no training (2 studies; 79,246 women; very low-certainty evidence). However, it may reduce neonatal mortality (RR 0.70, 95% CI 0.48 to 1.01; 2 studies, 79,246 pregnancies/births, low-certainty evidence). Simulation-based obstetric team training may have little to no effect on low Apgar score compared with no training (RR 0.99, 95% 0.85 to 1.15; 2 studies; 115,171 infants; low-certainty evidence), but it probably reduces trauma after shoulder dystocia (RR 0.50, 95% CI 0.25 to 0.99; 1 study; moderate-certainty evidence) and probably slightly reduces the number of caesarean deliveries (RR 0.79, 95% CI 0.67 to 0.93; 1 study; n = 50,589; moderate-certainty evidence) Kirkpatrick level 3 (performance in practice) We found that simulation-based obstetric team training probably improves the performance of the obstetric teams in practice, compared with no training (3 studies; 2398 obstetric staff members, moderate-certainty evidence, data not pooled due to different outcome definitions). AUTHORS' CONCLUSIONS: Simulation-based obstetric team training may help to improve team performance of obstetric teams, and it might contribute to improvement of specific maternal and perinatal outcomes, compared with no training. However, high-certainty evidence is lacking due to serious risk of bias and imprecision, and the effect cannot be generalised for all outcomes. Future studies investigating simulation-based obstetric team training compared to training courses with a different instructional design should carefully consider how and when to measure outcomes. Particular attention should be paid to effect measurement at the level of patient outcome, taking into consideration the low incidence of adverse maternal and perinatal events.


Asunto(s)
Obstetricia/educación , Grupo de Atención al Paciente/organización & administración , Entrenamiento Simulado/métodos , Puntaje de Apgar , Sesgo , Cesárea/estadística & datos numéricos , Competencia Clínica , Intervalos de Confianza , Urgencias Médicas , Femenino , Humanos , Lactante , Mortalidad Infantil , Recién Nacido , Mortalidad Materna , Errores Médicos/prevención & control , Embarazo , Ensayos Clínicos Controlados Aleatorios como Asunto , Distocia de Hombros/epidemiología , Resultado del Tratamiento
8.
Cochrane Database Syst Rev ; 12: CD013309, 2020 12 21.
Artículo en Inglés | MEDLINE | ID: mdl-33348448

RESUMEN

BACKGROUND: Preterm infants are susceptible to hyperglycemia and hypoglycemia, conditions which may lead to adverse neurodevelopment. The use of continuous glucose monitoring devices (CGM) might help 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: Objective one: to assess the benefits and harms of CGM alone versus standard method of glycemic measure in preterm infants. Objective two: to assess the benefits and harms of CGM with automated algorithm versus standard method of glycemic measure in preterm infants. Objective three: to assess the benefits and harms of CGM with automated algorithm versus CGM without automated algorithm in preterm infants. SEARCH METHODS: We adopted the standard search strategy of Cochrane Neonatal to search the Cochrane Central Register of Controlled Trials (CENTRAL; 2020, Issue 9), in the Cochrane Library; MEDLINE via PubMed (1966 to 25 September 2020); Embase (1980 to 25 September 2020); and the Cumulative Index to Nursing and Allied Health Literature (CINAHL) (1982 to 25 September 2020). We also searched clinical trials databases, conference proceedings, and reference lists of retrieved articles for randomized controlled trials and quasi-randomized trials. SELECTION CRITERIA: Randomized controlled trials (RCTs) and quasi-RCTs in preterm infants comparing: 1) the use of CGM versus intermittent modalities to measure glycemia (comparison 1); or CGM associated with prespecified interventions to correct hypoglycemia or hyperglycemia versus CGM without such prespecified interventions (comparison 2). 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) 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: Four trials enrolling 138 infants met our inclusion criteria. Investigators in three trials (118 infants) compared the use of CGM to intermittent modalities (comparison one); however one of these trials was analyzed separately because CGM was used as a standalone device, without being coupled to a control algorithm like in the other trials. A fourth trial (20 infants) assessed CGM with an automated algorithm versus CGM with a manual algorithm. None of the four included trials reported the neurodevelopmental outcome, i.e. the primary outcome of this review. Within comparison one, the certainty of the evidence on the use of CGM on mortality during hospitalization is very uncertain (typical RR 3.00, 95% CI 0.13 to 70.30; typical RD 0.04, 95% CI -0.06 to 0.14; 50 participants; 1  study; very low certainty). The number of hypoglycemic episodes was reported in two studies with conflicting data. The number of hyperglycemic episodes was reported in one study (typical MD -1.40, 95% CI -2.84 to 0.04; 50 participants; 1 study). The certainty of the evidence was very low for all outcomes because of limitations in study design, and imprecision of estimates.  Three studies are ongoing. AUTHORS' CONCLUSIONS: There is insufficient evidence to determine if CGM improves preterm infant mortality or morbidities. Long-term outcomes were not reported. Clinical trials are required to determine the most effective CGM and glycemic 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. The absence of CGM labelled for neonatal use is still a major limit in its use as well as the absence of dedicated neonatal devices.


Asunto(s)
Algoritmos , Glucemia/análisis , Hiperglucemia/diagnóstico , Hipoglucemia/diagnóstico , Recien Nacido Prematuro/sangre , Sesgo , Técnicas Biosensibles/instrumentación , Mortalidad Hospitalaria , Humanos , Hiperglucemia/epidemiología , Hipoglucemia/epidemiología , Lactante , Mortalidad Infantil , Recién Nacido , Monitoreo Fisiológico/instrumentación , Monitoreo Fisiológico/métodos , Trastornos del Neurodesarrollo , Ensayos Clínicos Controlados Aleatorios como Asunto
9.
Cochrane Database Syst Rev ; 11: CD007090, 2020 11 20.
Artículo en Inglés | MEDLINE | ID: mdl-33215474

RESUMEN

BACKGROUND: Human milk alone may provide inadequate amounts of protein to meet the growth requirements of preterm infants because of restrictions in the amount of fluid they can tolerate. It has become common practice to feed preterm infants with breast milk fortified with protein and other nutrients but there is debate about the optimal concentration of protein in commercially available fortifiers. OBJECTIVES: To compare the effects of different protein concentrations in human milk fortifier, fed to preterm infants, on growth and neurodevelopment. SEARCH METHODS: We used the standard search strategy of Cochrane Neonatal to search CENTRAL (2019, Issue 8), Ovid MEDLINE and CINAHL on 15 August 2019. We also searched clinical trials databases and the reference lists of retrieved articles for randomised controlled trials and quasi-randomised trials. SELECTION CRITERIA: We included all published and unpublished randomised, quasi-randomised and cluster-randomised trials comparing two different concentrations of protein in human milk fortifier. We included preterm infants (less than 37 weeks' gestational age). Participants may have been exclusively fed human milk or have been supplemented with formula. The concentration of protein was classified as low (< 1g protein/100 mL expressed breast milk (EBM)), moderate (≥ 1g to < 1.4g protein/100 mL EBM) or high (≥ 1.4g protein/100 mL EBM). We excluded trials that compared two protein concentrations that fell within the same category. DATA COLLECTION AND ANALYSIS: We undertook data collection and analyses using the standard methods of Cochrane Neonatal. Two review authors independently evaluated trials. Primary outcomes included growth, neurodevelopmental outcome and mortality. Data were synthesised using risk ratios (RR), risk differences and mean differences (MD), with 95% confidence intervals (CI). We used the GRADE approach to assess the certainty of the evidence. MAIN RESULTS: We identified nine trials involving 861 infants. There is one trial awaiting classification, and nine ongoing trials. The trials were mostly conducted in infants born < 32 weeks' gestational age or < 1500 g birthweight, or both. All used a fortifier derived from bovine milk. Two trials fed infants exclusively with mother's own milk, three trials gave supplementary feeds with donor human milk and four trials supplemented with preterm infant formula. Overall, trials were small but generally at low or unclear risk of bias. High versus moderate protein concentration of human milk fortifier There was moderate certainty evidence that a high protein concentration likely increased in-hospital weight gain compared to moderate concentration of human milk fortifier (MD 0.66 g/kg/day, 95% CI 0.51 to 0.82; trials = 6, participants = 606). The evidence was very uncertain about the effect of high versus moderate protein concentration on length gain (MD 0.01 cm/week, 95% CI -0.01 to 0.03; trials = 5, participants = 547; very low certainty evidence) and head circumference gain (MD 0.00 cm/week, 95% CI -0.01 to 0.02; trials = 5, participants = 549; very low certainty evidence). Only one trial reported neonatal mortality, with no deaths in either group (participants = 45). Moderate versus low protein concentration of human milk fortifier A moderate versus low protein concentration fortifier may increase weight gain (MD 2.08 g/kg/day, 95% CI 0.38 to 3.77; trials = 2, participants = 176; very low certainty evidence) with little to no effect on head circumference gain (MD 0.13 cm/week, 95% CI 0.00 to 0.26; I² = 85%; trials = 3, participants = 217; very low certainty evidence), but the evidence is very uncertain. There was low certainty evidence that a moderate protein concentration may increase length gain (MD 0.09 cm/week, 95% CI 0.05 to 0.14; trials = 3, participants = 217). Only one trial reported mortality and found no difference between groups (RR 0.48, 95% CI 0.05 to 5.17; participants = 112). No trials reported long term growth or neurodevelopmental outcomes including cerebral palsy and developmental delay. AUTHORS' CONCLUSIONS: Feeding preterm infants with a human milk fortifier containing high amounts of protein (≥ 1.4g/100 mL EBM) compared with a fortifier containing moderate protein concentration (≥ 1 g to < 1.4 g/100 mL EBM) results in small increases in weight gain during the neonatal admission. There may also be small increases in weight and length gain when infants are fed a fortifier containing moderate versus low protein concentration (< 1 g protein/100 mL EBM). The certainty of this evidence is very low to moderate; therefore, results may change when the findings of ongoing studies are available. There is insufficient evidence to assess the impact of protein concentration on adverse effects or long term outcomes such as neurodevelopment. Further trials are needed to determine whether modest increases in weight gain observed with higher protein concentration fortifiers are associated with benefits or harms to long term growth and neurodevelopment.


Asunto(s)
Desarrollo Infantil/fisiología , Fórmulas Infantiles/química , Recien Nacido Prematuro/crecimiento & desarrollo , Proteínas de la Leche/administración & dosificación , Leche Humana/química , Sesgo , Estatura , Intervalos de Confianza , Cabeza/crecimiento & desarrollo , Humanos , Lactante , Mortalidad Infantil , Recién Nacido , Recien Nacido Prematuro/sangre , Unidades de Cuidado Intensivo Neonatal , Tiempo de Internación , Ensayos Clínicos Controlados Aleatorios como Asunto , Aumento de Peso
10.
PLoS One ; 15(11): e0238673, 2020.
Artículo en Inglés | MEDLINE | ID: mdl-33253186

RESUMEN

BACKGROUND: The relationship between several intriguing perinatal phenomena, namely, modal, optimal, and relative birthweight and gestational age, remains poorly understood, especially the mechanism by which relative birthweight and gestational age resolve the paradox of intersecting perinatal mortality curves. METHODS: Birthweight and gestational age distributions and birthweight- and gestational age-specific perinatal death rates of low- and high-risk cohorts in the United States, 2004-2015, were estimated using births-based and extended fetuses-at-risk formulations. The relationships between these births-based distributions and rates, and the first derivatives of fetuses-at-risk birth and perinatal death rates were examined in order to assess how the rate of change in fetuses-at-risk rates affects gestational age distributions and births-based perinatal death rate patterns. RESULTS: Modal gestational age typically exceeded optimal gestational age because both were influenced by the peak in the first derivative of the birth rate, while optimal gestational age was additionally influenced by the point at which the first derivative of the fetuses-at-risk perinatal death rate showed a sharp increase in late gestation. The clustering and correlation between modal and optimal gestational age within cohorts, the higher perinatal death rate at optimal gestational age among higher-risk cohorts, and the symmetric left-shift in births-based gestational age-specific perinatal death rates in higher-risk cohorts explained how relative gestational age resolved the paradox of intersecting perinatal mortality curves. CONCLUSIONS: Changes in the first derivative of the fetuses-at-risk birth and perinatal death rates underlie several births-based perinatal phenomena and this explanation further unifies the fetuses-at-risk and births-based models of perinatal death.


Asunto(s)
Peso al Nacer/fisiología , Feto/fisiología , Edad Gestacional , Adulto , Tasa de Natalidad , Femenino , Humanos , Lactante , Mortalidad Infantil , Recién Nacido , Recien Nacido Prematuro/crecimiento & desarrollo , Parto/fisiología , Muerte Perinatal , Mortalidad Perinatal , Embarazo , Mortinato/epidemiología , Estados Unidos
11.
PLoS One ; 15(11): e0242170, 2020.
Artículo en Inglés | MEDLINE | ID: mdl-33186395

RESUMEN

OBJECTIVE: To evaluate the cost-effectiveness of a program intended to reduce intrapartum and neonatal mortality in Accra, Ghana. DESIGN: Quasi-experimental, time-sequence intervention, retrospective cost-effectiveness analysis. METHODS: A program integrating leadership development, clinical skills and quality improvement training was piloted at the Greater Accra Regional Hospital from 2013 to 2016. The number of intrapartum and neonatal deaths prevented were estimated using the hospital's 2012 stillbirth and neonatal mortality rates as a steady-state assumption. The cost-effectiveness of the intervention was calculated as cost per disability-adjusted life year (DALY) averted. In order to test the assumptions included in this analysis, it was subjected to probabilistic and one-way sensitivity analyses. MAIN OUTCOME MEASURES: Incremental cost-effectiveness ratio (ICER), which measures the cost per disability-adjusted life-year averted by the intervention compared to status quo. RESULTS: From 2012 to 2016, there were 45,495 births at the Greater Accra Regional Hospital, of whom 5,734 were admitted to the newborn intensive care unit. The budget for the systems strengthening program was US $1,716,976. Based on program estimates, 307 (±82) neonatal deaths and 84 (±35) stillbirths were prevented, amounting to 12,342 DALYs averted. The systems strengthening intervention was found to be highly cost effective with an ICER of US $139 (±$44), an amount significantly lower than the established threshold of cost-effectiveness of the per capita gross domestic product, which averaged US $1,649 between 2012-2016. The results were found to be sensitive to the following parameters: DALYs averted, number of neonatal deaths, and number of stillbirths. CONCLUSION: An integrated approach to system strengthening in referral hospitals has the potential to reduce neonatal and intrapartum mortality in low resource settings and is likely to be cost-effective. Sustained change can be achieved by building organizational capacity through leadership and clinical training.


Asunto(s)
Análisis Costo-Beneficio , Mortalidad Infantil/tendencias , Mejoramiento de la Calidad/economía , Ghana , Implementación de Plan de Salud/economía , Humanos , Lactante , Años de Vida Ajustados por Calidad de Vida , Centros de Atención Terciaria/economía , Centros de Atención Terciaria/normas , Centros de Atención Terciaria/estadística & datos numéricos
12.
PLoS One ; 15(11): e0242796, 2020.
Artículo en Inglés | MEDLINE | ID: mdl-33232372

RESUMEN

There is a knowledge gap on abnormal birth weight in urban Nigeria where specific community contexts can have a significant impact on a child's health. Abnormal birth weight, classified into low birth weight and high birth weight, is often associated with adverse health outcomes and a leading risk for neonatal morbidity and mortality. The study used datasets from the birth recode file of 2013 and 2018 Nigeria Demographic and Health Survey (NDHS); a weighted sample of pooled 9,244 live births by 7,951 mothers within ten years (2008-2018) in urban Nigeria. The effects of individual, healthcare utilization and community-level variables on the two abnormal birth weight categories were explored with a multinomial logistic regression models using normal birth weight as a reference group. In urban Nigeria, the overall prevalence of ABW was 18.3%; high birth weight accounted for the majority (10.7%) of infants who were outside the normal birth weight range. Predictors of LBW were community (region), child characteristic (the type of birth) and household (wealth index) while that of HBW were community (regions), child characteristics (birth intervals and sex), maternal characteristic (education) and healthcare utilization (ANC registration). LBW was significantly more prevalent in the northern part while HBW was more common in the southern part of urban Nigeria. This pattern conforms to the expected north-south dichotomy in health indicators and outcomes. These differences can be linked to suggested variation in regional exposure to urbanization in Nigeria.


Asunto(s)
Peso al Nacer/fisiología , Mortalidad Infantil , Recién Nacido de Bajo Peso , Parto/fisiología , Adulto , Intervalo entre Nacimientos , Femenino , Encuestas Epidemiológicas , Humanos , Lactante , Recién Nacido , Modelos Logísticos , Masculino , Nigeria/epidemiología , Aceptación de la Atención de Salud , Embarazo , Atención Prenatal , Factores Socioeconómicos
13.
Environ Health Prev Med ; 25(1): 67, 2020 Nov 04.
Artículo en Inglés | MEDLINE | ID: mdl-33148165

RESUMEN

BACKGROUND: Globally, over four million deaths are attributed to exposure to household air pollution (HAP) annually. Evidence of the association between exposure to HAP and under-five mortality in sub-Saharan Africa (SSA) is insufficient. We assessed the association between exposure to HAP and under-five mortality risk in 14 SSA countries. METHODS: We pooled Demographic and Health Survey (DHS) data from 14 SSA countries (N = 164376) collected between 2015 and 2018. We defined exposure to HAP as the use of biomass fuel for cooking in the household. Under-five mortality was defined as deaths before age five. Data were analyzed using mixed effects logistic regression models. RESULTS: Of the study population, 73% were exposed to HAP and under-five mortality was observed in 5%. HAP exposure was associated with under-five mortality, adjusted odds ratio (OR) 1.33 (95% confidence interval (CI) [1.03-1.71]). Children from households who cooked inside the home had higher risk of under-five mortality compared to households that cooked in separate buildings [0.85 (0.73-0.98)] or outside [0.75 (0.64-0.87)]. Lower risk of under-five mortality was also observed in breastfed children [0.09 (0.05-0.18)] compared to non-breastfed children. CONCLUSIONS: HAP exposure may be associated with an increased risk of under-five mortality in sub-Saharan Africa. More carefully designed longitudinal studies are required to contribute to these findings. In addition, awareness campaigns on the effects of HAP exposure and interventions to reduce the use of biomass fuels are required in SSA.


Asunto(s)
Contaminación del Aire Interior/efectos adversos , Biomasa , Culinaria , Mortalidad Infantil , Mortalidad , África del Sur del Sahara , Femenino , Encuestas Epidemiológicas , Vivienda , Humanos , Lactante , Recién Nacido , Masculino
14.
Afr Health Sci ; 20(2): 715-723, 2020 Jun.
Artículo en Inglés | MEDLINE | ID: mdl-33163036

RESUMEN

Background: The first 28 days of life, the neonatal period, are the most vulnerable time for a child's survival. Neonatal mortality accounts for about 38% of under-five deaths in low and middle income countries. This study aimed to identify the determinants of neonatal mortality in Ethiopia. Methods: The study used data from the nationally representative 2016 Ethiopia Demographic and Health Survey (EDHS). Once the data were extracted; editing, coding and cleaning were done by using SAS 9.4.Sampling weights was applied to ensure the representativeness of the sample in this study. Both bivariate and multivariable logistic regression statistical analysis was used to identify determinants of neonatal mortality in Ethiopia. Results: A total of 11,023 weighted live-born neonates born within five years preceding the 2016 EDHS were included this in this study. Multiple logistic regression analysis showed that multiple birth neonates (Adjusted Odds Ratio (AOR)=6.38;95%-Confidence Interval (CI):4.42-9.21), large birth size (AOR=1.35; 95% CI: 0.28-1.62), neonates born to mothers who did not utilize ANC (AOR=1.41; 95% CI: 1.11-1.81), neonates from rural area (AOR=1.88; 95% CI: 1.15-3.05) and neonates born in Harari region (AOR=1.45; 95% CI: 0.61-3.45)had higher odds of neonatal mortality. On the other hand, female neonates (AOR=0.60; 95% CI: 0.47-0.75), neonates born within the interval of more than 36 months of the preceding birth (AOR=0.56; 95% CI: 0.43-0.75), neonates born to fathers with secondary and higher education level (AOR=0.51; 95%CI: 0.22-0.88) had lower odds of neonatal mortality in Ethiopia. Conclusion: To reduce neonatal mortality in Ethiopia, there is a need to implement sex specific public health intervention mainly focusing on male neonate during pregnancy, child birth and postnatal period. A relatively simple and cost-effective public health intervention should be implemented to make sure that all pregnant women are screened for multiple pregnancy and if positive, extra care should be given during pregnancy, child birth and postnatal.


Asunto(s)
Parto Obstétrico/métodos , Parto Domiciliario/estadística & datos numéricos , Mortalidad Infantil/etnología , Aceptación de la Atención de Salud/etnología , Atención Prenatal/estadística & datos numéricos , Adolescente , Adulto , Intervalo entre Nacimientos , Etiopía , Femenino , Humanos , Lactante , Recién Nacido , Masculino , Persona de Mediana Edad , Madres/estadística & datos numéricos , Embarazo , Factores Socioeconómicos , Adulto Joven
15.
Eur J Obstet Gynecol Reprod Biol ; 255: 172-176, 2020 Dec.
Artículo en Inglés | MEDLINE | ID: mdl-33142263

RESUMEN

OBJECTIVE: To explore any apparent trends in maternal or neonatal outcomes during the Covid-19 pandemic by comparing the maternity outcomes before, during and after the pandemic. STUDY DESIGN: A retrospective review was performed of maternity statistics recorded on the hospital database of a large tertiary referral centre in Dublin with over 8000 deliveries per annum from 1st January to 31st July 2020. This time period represented the months prior to, during the peak and following the pandemic in Ireland. RESULTS: There was no correlation between the monthly number of Covid deaths and the monthly number of perinatal deaths (r = 0.465, NS), preterm births (r = 0.339, NS) or hypertensive pregnancies (r = 0.48, NS). Compared to the combined numbers for the same month in 2018 and 2019, there were no significant changes in perinatal deaths or preterm births in the months when Covid deaths were at their height. The rate of preterm birth was significantly less common in January-July 2020 compared to January-July in 2018/2019 (7.4 % v 8.6 %, chi-sq 4.53, P = 0.03). CONCLUSION: The was no evidence of a negative impact of the Covid-19 pandemic on maternity services, as demonstrated by maternal and neonatal outcomes.


Asunto(s)
/epidemiología , Mortalidad Infantil/tendencias , Servicios de Salud Materna/tendencias , Complicaciones Infecciosas del Embarazo/epidemiología , Complicaciones del Embarazo/epidemiología , Adulto , Femenino , Humanos , Hipertensión Inducida en el Embarazo/epidemiología , Hipertensión Inducida en el Embarazo/virología , Lactante , Recién Nacido , Irlanda/epidemiología , Embarazo , Complicaciones del Embarazo/virología , Complicaciones Infecciosas del Embarazo/virología , Nacimiento Prematuro/epidemiología , Nacimiento Prematuro/virología , Estudios Retrospectivos
18.
Hum Resour Health ; 18(1): 75, 2020 10 07.
Artículo en Inglés | MEDLINE | ID: mdl-33028347

RESUMEN

Peripartum deaths remain significantly high in low- and middle-income countries, including Kenya. The COVID-19 pandemic has disrupted essential services, which could lead to an increase in maternal and neonatal mortality and morbidity. Furthermore, the lockdowns, curfews, and increased risk for contracting COVID-19 may affect how women access health facilities. SARS-CoV-2 is a novel coronavirus that requires a community-centred response, not just hospital-based interventions. In this prolonged health crisis, pregnant women deserve a safe and humanised birth that prioritises the physical and emotional safety of the mother and the baby. There is an urgent need for innovative strategies to prevent the deterioration of maternal and child outcomes in an already strained health system. We propose strengthening community-based midwifery to avoid unnecessary movements, decrease the burden on hospitals, and minimise the risk of COVID-19 infection among women and their newborns.


Asunto(s)
Infecciones por Coronavirus/epidemiología , Cuidado del Lactante/organización & administración , Servicios de Salud Materna/organización & administración , Partería , Neumonía Viral/epidemiología , Adolescente , Adulto , Betacoronavirus , Femenino , Accesibilidad a los Servicios de Salud , Humanos , Lactante , Mortalidad Infantil , Recién Nacido , Kenia/epidemiología , Pandemias , Embarazo
19.
Pediatrics ; 146(5)2020 11.
Artículo en Inglés | MEDLINE | ID: mdl-33077539

RESUMEN

BACKGROUND AND OBJECTIVES: Rural counties have the highest infant mortality rates across the United States when compared with rates in more urban counties. We use a social-ecological framework to explain infant mortality disparities across the rural-urban continuum. METHODS: We created a cohort of all births in the United States linked to infant death records for 2014 to 2016. Records were linked to county-level data from the Area Health Resources File and the American Community Survey and classified using the National Center for Health Statistics Urban-Rural Classification Scheme. Using multilevel generalized linear models, we investigated the association of infant mortality with county urban-rural classification, considering county health system resources and measures of socioeconomic advantage, net of individual-level characteristics, and controlling for US region and county centroid. RESULTS: Infant mortality rates were highest in noncore (odds ratio [OR] = 1.32, 95% confidence interval [CI]: 1.26-1.39) and micropolitan counties (OR = 1.26, 95% CI: 1.20-1.32) when compared with large metropolitan fringe counties, controlling for geospatial measures. Inclusion of county health system characteristics did little to attenuate the greater odds of infant mortality in rural counties. Instead, a composite measure of county-level socioeconomic advantage was highly protective (adjusted OR = 0.84; 95% CI: 0.82-0.86) and eliminated any difference between the micropolitan and noncore counties and the large metropolitan fringe counties. CONCLUSIONS: Higher infant mortality rates in rural counties are best explained by their greater socioeconomic disadvantage than more-limited access to health care or the greater prevalence of mothers' individual health risks.


Asunto(s)
Mortalidad Infantil , Estudios de Cohortes , Femenino , Humanos , Lactante , Masculino , Población Rural , Estados Unidos/epidemiología , Población Urbana
20.
Pediatrics ; 146(5)2020 11.
Artículo en Inglés | MEDLINE | ID: mdl-33077541

RESUMEN

BACKGROUND AND OBJECTIVES: Evidence suggests that government expenditures on non-health care services can reduce infant mortality, but it is unclear what types of spending have the greatest impact among groups at highest risk. Thus, we sought to quantify how US state government spending on various services impacted infant mortality rates (IMRs) over time and whether spending differentially reduced mortality in some subpopulations. METHODS: A longitudinal, repeated-measures study of US state-level infant mortality and state and local government spending for the years 2000-2016, the most recent data available. Expenditures included spending on education, social services, and environment and housing. Using generalized linear regression models, we assessed how changes in spending impacted infant mortality over time, overall and stratified by race and ethnicity and maternal age group. RESULTS: State and local governments spend, on average, $9 per person. A $0.30 per-person increase in environmental spending was associated with a decrease of 0.03 deaths per 1000 live births, and a $0.73 per-person increase in social services spending was associated with a decrease of 0.02 deaths per 1000 live births. Infants born to mothers aged <20 years had the single greatest benefit from an increase in expenditures compared with all other groups. Increased expenditures in public health, housing, parks and recreation, and solid waste management were associated with the greatest reduction in overall IMR. CONCLUSIONS: Investment in non-health care services was associated with lower IMRs among certain high-risk populations. Continued investments into improved social and environmental services hold promise for further reducing IMR disparities.


Asunto(s)
Mortalidad Infantil , Inversiones en Salud/economía , Gobierno Local , Gastos Públicos/estadística & datos numéricos , Gobierno Estatal , Humanos , Lactante , Estudios Longitudinales , Estados Unidos
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