Estimation of individual neonatal survival using birthweight and gestational age: a way to improve neonatal care.

The study was conducted to determine the combined effect of birthweight and gestational age at birth on neonatal mortality using individually-identified livebirths. Logistic regression was used for studying the interactive effect of birthweight and gestational age on the individual probability of neonatal death. All livebirths from Chile in 2000 were included in a linked file. Odds ratio models for birthweight and gestational age were developed for each sex. The probability of neonatal death by sex was presented using contour plots. The models were statistically significant, and odds ratios were different and non-linear for the effects of birthweight and gestational age. Contour plots of constant neonatal mortality according to birthweight and gestational age were presented; they were similar for each sex. A single graph for both sexes that estimates the survival potential of infants born too early or too small would improve neonatal care in developing countries.

The impact of mother-to-mother support on optimal breast-feeding: a controlled community intervention trial in peri-urban Guatemala City, Guatemala.

OBJECTIVE: To assess the impact that a mother-to-mother support program operated by La Leche League Guatemala had on early initiation of breast-feeding and on exclusive breast-feeding in peri-urban Guatemala City, Guatemala. MATERIALS AND METHODS: A population census was conducted to identify all mothers of infants < 6 months of age, and the mothers were then surveyed on their breast-feeding practices, in two program communities and two control communities. Data collection for this follow-up census and survey was carried out between November 2000 and January 2001, one year after a baseline census and survey had been conducted. RESULTS: At follow-up, 31% of mothers in the program communities indicated that counselors had advised them about breast-feeding, 21% said they had received a home visit, and 16% reported attending a support group. Community wide rates of early initiation of breast-feeding were significantly higher in program areas than in the control communities, at both baseline and follow-up. However, the change over time in early initiation in program communities was not significantly different from the change in control communities. Community wide rates of exclusive breast-feeding were similar in program and control sites and did not change significantly from baseline to follow-up. However, of the mothers in the program communities who both received home visits and attended support groups, 45% of them exclusively breast-fed, compared to 14% of women in program communities who did not participate in those two activities. In addition, women who were exposed to mother-to-mother support activities during the year following the baseline census and survey were more likely than mothers exposed before that period to exclusively breast-feed. This suggests that the program interventions became more effective over time. CONCLUSIONS: This study does not provide evidence of population impact of La Leche League's intervention after one year of implementation. In peri-urban Guatemala, long-term community-based interventions, in partnership with existing health care systems, may be needed to improve community wide exclusive breast-feeding rates.

Determinants of optimal breast-feeding in peri-urban Guatemala City, Guatemala.

OBJECTIVE: This survey was conducted to identify factors affecting early initiation of breast-feeding and exclusive breast-feeding among mothers in peri-urban Guatemala City, Guatemala. MATERIALS AND METHODS: In early November 1999 a census was begun in four communities of peri-urban Guatemala City, Guatemala, to identify all children < 6 months old as well as all pregnant women who were expected to deliver during the two-month data-gathering period. After the census was completed, a survey of breast-feeding practices was administered to all mothers of infants < 6 months of age. RESULTS: The most important determinant of early initiation of breast-feeding was place of delivery. Children born at home (odds ratio (OR) = 4.1, 95% confidence interval (CI): 1.2-13.3) and at Ministry of Health health centers (OR = 4.9, 95% CI: 1.6-15.0) were significantly more likely than children born at private hospitals to initiate breast-feeding early. The most important determinant of exclusive breast-feeding was whether or not the mother worked outside the home. After controlling for infant's age and sex and mother's ethnicity, women who did not work outside the home were 3.2 times as likely (95% CI: 1.6-6.4) to exclusively breast-feed as were women who worked outside the home. Lack of exclusive breast-feeding was often associated with giving a bottle. CONCLUSIONS: Our findings suggest that global efforts must be continued to improve breast-feeding practices in delivery hospitals. In addition, community-based support of breast-feeding is needed well after delivery. Mothers who work outside the home should be provided with options to maintain exclusive breast-feeding when they are physically separated from their infants due to the demands of work.

The impact of mother-to-mother support on optimal breast-feeding: a controlled community intervention trial in peri-urban Guatemala City, Guatemala

Objective. To assess the impact that a mother-to-mother support program operated by La Leche League Guatemala had on early initiation of breast-feeding and on exclusive breast-feeding in peri-urban Guatemala City, Guatemala. Materials and Methods. A population census was conducted to identify all mothers of infants < 6 months of age, and the mothers were then surveyed on their breast-feeding practices, in two program communities and two control communities. Data collection for this follow-up census and survey was carried out between November 2000 and January 2001, one year after a baseline census and survey had been conducted. Results. At follow-up, 31 percent of mothers in the program communities indicated that counselors had advised them about breast-feeding, 21 percent said they had received a home visit, and 16 percent reported attending a support group. Communitywide rates of early initiation of breast-feeding were significantly higher in program areas than in the control communities, at both baseline and follow-up. However, the change over time in early initiation in program communities was not significantly different from the change in control communities. Communitywide rates of exclusive breast-feeding were similar in program and control sites and did not change significantly from baseline to follow-up. However, of the mothers in the program communities who both received home visits and attended support groups, 45 percent of them exclusively breast-fed, compared to 14 percent of women in program communities who did not participate in those two activities. In addition, women who were exposed to mother-to-mother support activities during the year following the baseline census and survey were more likely than mothers exposed before that period to exclusively breast-feed. This suggests that the program interventions became more effective over time. Conclusions. This study does not provide evidence of population impact of La Leche League's intervention after one year of implementation. In peri-urban Guatemala, long-term community-based interventions, in partnership with existing health care systems, may be needed to improve communitywide exclusive breast-feeding rates

Distance education with tutoring improves diarrhea case management in Guatemala.

OBJECTIVE: To evaluate the impact of distance education in diarrhea and cholera case management on the quality of physicians' and nurses' practice. DESIGN: The pre-post panel, program and control group design used trained physician observers to measure if doctors and nurses complied with case management standards. Extended observations and client exit interviews were used to analyze audience bias and the validity of counseling measurements. SETTING: Health care facilities in six districts of Guatemala. Ministries of Health in four Central American countries and the Institute of Nutrition for Central America and Panama implemented the course. STUDY PARTICIPANTS: The study panel consisted of 66 course graduates (program group) and 66 doctors and nurses who were interested in taking the course where the course was not offered (control group). RESULTS: The percentage of diarrhea cases assessed correctly and dehydration cases classified correctly increased by 25% more in the program group than in the control group, but post-course performance was still only approximately 60% in the program group. Rehydration treatment did not improve. Counseling improved insignificantly. Client exit interviews suggested that indicators for counseling may need to be re-examined for validity. No audience effect on health worker practice was found. Completion rates were high. The program cost 60 dollars US per enrollee. CONCLUSION: This is an effective, relatively low-cost program that substantially improved case management of diarrhea in Guatemala, in particular the quality of assessment and classification. However, many health workers who completed the course are still not performing to standard, so additional work is needed to resolve this problem.

Tasas estimadas de mortalidad infantil, cobertura de vacunación y uso de sales de rehidratación en Guatemala: variaciones según distintas fuentes / Variations in estimates of guatemalan infant mortality, vaccination coverage, and rehydration salts use reported by different sources

Se buscaron e investigaron todas las tasas estimativas de mortalidad infantil, cobertura por vacunación ( con la vacuna BCG, tres dosis de las vacunas DTP y antipoliomielítica, vacuna antisarampionosa y toxoide tetánico) y uso de sales de rehidratación oral (SRO) en Guatemala en el decenio de 1980. Se encontraron muchas fuentes y estimaciones, así como grandes discrepancias entre las estimaciones de un mismo indicador, aun tratándose de estimaciones para el mismo año procedentes de la misma fuente. Por ejemplo, los informes correspondientes a 1985 dieron 10 estimaciones distintas de la tasa de mortalidad infantil, que varió de 56,0 a 79,8 defunciones por 1000 niños nacidos vivos; estimaciones de cobertura de 30 a 60, 5 por ciento con la vacuna BCG, de 3,5 a 34,2 por ciento con las tres dosis de vacuna DPT, de 3,5 a 33,5 por ciento con las tres dosis de vacuna antipoliomielítica, de 11 a 58,2 por ciento con la vacuna antisarampionosa y de 1 a 8,2 por ciento con el toxoide tetánico; y tasas estimadas de uso de SRO que fluctuaron de 3,5 a 7,2 por ciento. Asimismo, tres estimaciones del número de defunciones infantiles por 1000 nacidos vivos en 1984 procedentes del Ministerio de Salud Pública y Asistencia Social de Guatemala variaron de 52,4 a 79,8; cuatro del Fondo de las Naciones Unidas para la Infancia correspondientes a 1985, de 65 a 79,8; y tres de la Agencia de los Estados Unidos para el Desarrollo Internacional correspondientes a 1987, de 59 a 72. Las principales razones de esa diversidad apuntan graves problemas que restan fiabilidad a los datos existentes

Variations in estimates of Guatemalan infant mortality, vaccination coverage, and ORS use reported by different resources

All available estimates of rates of infant mortality, vaccination coverage (for BCG, DPT 3, polio 3, measles, and tetanus toxoid), and ORS use in Guatemala in the 1980s were identified and investigated. A large number of sources and estimates were found. Large discrepancies were also found between the estimates for a given indicator, even when the estimates were reported for the same year by the same source. For instance, reports for 1985 yielded 10 different infant mortality estimates ranging from 56.0 to 79.8 deaths per 1 000 live births; vaccination coverage estimates ranging from 30 percent to 60.5 percent for BCG, 3.5 percent to 34.2 percent for DPT 3,3.5 percent for polio 3,11 percent to 58.2 percent for measles, and 1 percent to 8.2 percent for tetanus toxoid; and estimated use rates of oral rehydration solution ranging from 3.5 percent to 7.2 percent. In this same vein, three Guatemalan Ministry of Health estimates of infant deaths per 1 000 live births in 1984 ranged from 52.4 to 79.8; four UNICEF estimates for 1985 ranged from 65 to 79.8; and three USAID estimates for 1987 ranged from 58 to 72. The many reasons found for this diversity point to significant problems influencing the reliability of current data

Tasas estimadas de mortalidad infantil, cobertura de vacunación y uso de sales de rehidratación en Guatemala: variaciones según distintas fuentes / Variations in estimates of guatemalan infant mortality, vaccination coverage, and rehydration salts use reported by different sources

Se buscaron e investigaron todas las tasas estimativas de mortalidad infantil, cobertura por vacunación ( con la vacuna BCG, tres dosis de las vacunas DTP y antipoliomielítica, vacuna antisarampionosa y toxoide tetánico) y uso de sales de rehidratación oral (SRO) en Guatemala en el decenio de 1980. Se encontraron muchas fuentes y estimaciones, así como grandes discrepancias entre las estimaciones de un mismo indicador, aun tratándose de estimaciones para el mismo año procedentes de la misma fuente. Por ejemplo, los informes correspondientes a 1985 dieron 10 estimaciones distintas de la tasa de mortalidad infantil, que varió de 56,0 a 79,8 defunciones por 1000 niños nacidos vivos; estimaciones de cobertura de 30 a 60, 5 por ciento con la vacuna BCG, de 3,5 a 34,2 por ciento con las tres dosis de vacuna DPT, de 3,5 a 33,5 por ciento con las tres dosis de vacuna antipoliomielítica, de 11 a 58,2 por ciento con la vacuna antisarampionosa y de 1 a 8,2 por ciento con el toxoide tetánico; y tasas estimadas de uso de SRO que fluctuaron de 3,5 a 7,2 por ciento. Asimismo, tres estimaciones del número de defunciones infantiles por 1000 nacidos vivos en 1984 procedentes del Ministerio de Salud Pública y Asistencia Social de Guatemala variaron de 52,4 a 79,8; cuatro del Fondo de las Naciones Unidas para la Infancia correspondientes a 1985, de 65 a 79,8; y tres de la Agencia de los Estados Unidos para el Desarrollo Internacional correspondientes a 1987, de 59 a 72. Las principales razones de esa diversidad apuntan graves problemas que restan fiabilidad a los datos existentes

Se publica en inglés en Bull. PAHO Vol. 29(1), 1995

Variations in estimates of Guatemalan infant mortality, vaccination coverage, and ORS use reported by different resources

All available estimates of rates of infant mortality, vaccination coverage (for BCG, DPT 3, polio 3, measles, and tetanus toxoid), and ORS use in Guatemala in the 1980s were identified and investigated. A large number of sources and estimates were found. Large discrepancies were also found between the estimates for a given indicator, even when the estimates were reported for the same year by the same source. For instance, reports for 1985 yielded 10 different infant mortality estimates ranging from 56.0 to 79.8 deaths per 1 000 live births; vaccination coverage estimates ranging from 30 percent to 60.5 percent for BCG, 3.5 percent to 34.2 percent for DPT 3,3.5 percent for polio 3,11 percent to 58.2 percent for measles, and 1 percent to 8.2 percent for tetanus toxoid; and estimated use rates of oral rehydration solution ranging from 3.5 percent to 7.2 percent. In this same vein, three Guatemalan Ministry of Health estimates of infant deaths per 1 000 live births in 1984 ranged from 52.4 to 79.8; four UNICEF estimates for 1985 ranged from 65 to 79.8; and three USAID estimates for 1987 ranged from 58 to 72. The many reasons found for this diversity point to significant problems influencing the reliability of current data

This article will also be published in Spanish in the BOSP. Vol. 118, 1995