Trends in infant mortality in Venezuela between 1985 and 2016: a systematic analysis of demographic data.

BACKGROUND: Between the 1950s and 2000, Venezuela showed one of the most substantial improvements in infant mortality rates in Latin America. However, the recent economic crisis alongside an increase in infectious and parasitic diseases might be reversing previous patterns. Because no official updated mortality statistics have been published since 2013, the effect of these recent events has been difficult to assess accurately. We therefore aimed to estimate infant mortality rate trends and report the effect of the crisis. METHODS: We estimated infant mortality rates using direct methods (ie, death counts from Venezuelan Ministry of Health via yearbooks and notifiable diseases bulletins, and birth records published by the UN Economic Commission for Latin America and the Caribbean and the Venezuelan National Institute of Statistics) and indirect methods (using census data and a Living Conditions Survey ENCOVI 2016). We shaped yearly estimations using a semiparametric regression model, specifically a P-Spline model with a cubic thin plate base. The primary objective was to estimate infant mortality rate trends from 1985 to 2016. FINDINGS: Around 2009, the long-term decline in infant mortality rate stopped, and a new pattern of increase was observed. The infant mortality rate reached 21·1 deaths per 1000 livebirths (90% CI -17·8 to 24·3) in 2016, almost 1·4 times the rate of 2008 (15·0, -14·0 to 16·1). This increase represents a huge setback on previous achievements in reducing infant mortality. INTERPRETATION: Our conservative estimation indicates that Venezuela is in the throes of a humanitarian crisis. The increase in infant mortality rate in 2016 compared with 2008 takes the country back to the level observed at the end of the 1990s, wiping out 18 years of expected progress, and leaves the Venezuelan Government far from achieving the target of nine deaths per 1000 livebirths stated in the UN Millennium Development Goals. FUNDING: None.

The effect of preoperative nutritional status on postoperative outcomes in children undergoing surgery for congenital heart defects in San Francisco (UCSF) and Guatemala City (UNICAR).

OBJECTIVE: The objective of this study was to determine the association between preoperative nutritional status and postoperative outcomes in children undergoing surgery for congenital heart defects (CHD). METHODS: Seventy-one patients with CHD were enrolled in a prospective, 2-center cohort study. We adjusted for baseline risk differences using a standardized risk adjustment score for surgery for CHD. We assigned a World Health Organization z score for each subject's preoperative triceps skin-fold measurement, an assessment of total body fat mass. We obtained preoperative plasma concentrations of markers of nutritional status (prealbumin, albumin) and myocardial stress (B-type natriuretic peptide [BNP]). Associations between indices of preoperative nutritional status and clinical outcomes were sought. RESULTS: Subjects had a median (interquartile range [IQR]) age of 10.2 (33) months. In the University of California at San Francisco (UCSF) cohort, duration of mechanical ventilation (median, 19 hours; IQR, 29 hours), length of intensive care unit stay (median, 5 days; IQR 5 days), duration of any continuous inotropic infusion (median, 66 hours; IQR 72 hours), and preoperative BNP levels (median, 30 pg/mL; IQR, 75 pg/mL) were associated with a lower preoperative triceps skin-fold z score (P < .05). Longer duration of any continuous inotropic infusion and higher preoperative BNP levels were also associated with lower preoperative prealbumin (12.1 ± 0.5 mg/dL) and albumin (3.2 ± 0.1; P < .05) levels. CONCLUSIONS: Lower total body fat mass and acute and chronic malnourishment are associated with worse clinical outcomes in children undergoing surgery for CHD at UCSF, a resource-abundant institution. There is an inverse correlation between total body fat mass and BNP levels. Duration of inotropic support and BNP increase concomitantly as measures of nutritional status decrease, supporting the hypothesis that malnourishment is associated with decreased myocardial function.

Treatment of severe acute malnutrition in infants aged <6 months in Niger.

OBJECTIVE: To report a nutritional rehabilitation program in Niger for the management of severe acute malnutrition in infants aged <6 months. STUDY DESIGN: This is a presentation of a case series (n = 632) of young infants who were admitted to a nutrition rehabilitation program in 2010-2011. The main characteristics of the inpatient treatment protocol where the use of diluted F-100 milk via a supplementary suckling technique until exclusive breastfeeding was reinitialized, coaching of mothers on infant feeding, and intensive antibiotic therapy as indicated during the stabilization phase. Semistructured interviews were conducted with 103 mothers. RESULTS: Rates of recovery, mortality, and default were 85% (537 of 632), 6% (37 of 632), and 9% (55 of 632), respectively. The majority of infants had an infectious disease at study entry (81%), particularly acute watery diarrhea and respiratory tract infections. Infection on admission was a predictor of death during treatment (OR, 3.9; 95% CI, 1.6-9.2). Anorexia at entry was a risk factor for treatment failure (OR, 4.4; 95% CI, 1.71-11.1). Interviews revealed a very low rate of exclusive breastfeeding (3%), with delayed initiation in 68% of cases. Traditional beliefs, perceived insufficiency of breast milk, and psychological problems played important roles in feeding choices. CONCLUSION: Severe acute malnutrition in infants aged <6 months can be successfully treated by managing cases as inpatients with an adapted protocol, intensive clinical supervision, and intensive drug treatment if indicated. Whether similar outcomes are achievable in community-based programs remains to be verified. Effective interventions for improving breastfeeding practices are needed.

Use of new World Health Organization child growth standards to assess how infant malnutrition relates to breastfeeding and mortality.

OBJECTIVE: To compare the estimated prevalence of malnutrition using the World Health Organization's (WHO) child growth standards versus the National Center for Health Statistics' (NCHS) growth reference, to examine the relationship between exclusive breastfeeding and malnutrition, and to determine the sensitivity and specificity of nutritional status indicators for predicting death during infancy. METHODS: A secondary analysis of data on 9424 mother-infant pairs in Ghana, India and Peru was conducted. Mothers and infants were enrolled in a trial of vitamin A supplementation during which the infants' weight, length and feeding practices were assessed regularly. Malnutrition indicators were determined using WHO and NCHS growth standards. FINDINGS: The prevalence of stunting, wasting and underweight in infants aged < 6 months was higher with WHO than NCHS standards. However, the prevalence of underweight in infants aged 6-12 months was much lower with WHO standards. The duration of exclusive breastfeeding was not associated with malnutrition in the first 6 months of life. In infants aged < 6 months, severe underweight at the first immunization visit as determined using WHO standards had the highest sensitivity (70.2%) and specificity (85.8%) for predicting mortality in India. No indicator was a good predictor in Ghana or Peru. In infants aged 6-12 months, underweight at 6 months had the highest sensitivity and specificity for predicting mortality in Ghana (37.0% and 82.2%, respectively) and Peru (33.3% and 97.9% respectively), while wasting was the best predictor in India (sensitivity: 54.6%; specificity: 85.5%). CONCLUSION: Malnutrition indicators determined using WHO standards were better predictors of mortality than those determined using NCHS standards. No association was found between breastfeeding duration and malnutrition at 6 months. Use of WHO child growth standards highlighted the importance of malnutrition in the first 6 months of life.

Formación a promotores de salud sobre alimentación complementaria de niños de 6 a 12 meses en la prevención de la desnutrición, distrito de Churubamba - Huánuco / Training health promoters on supplementary feeding of children from 6 to 12 months in the prevent of malnutrition. Churubamba district - Huanuco

El objetivo de la investigación fue determinar que la formación a promotores de salud sobre alimentación complementaria es eficaz en la prevención de la desnutrición de niños de 6 a 12 meses. Con esa finalidad se diseñó un estudio casi experimental con 21 madres y 21 niños del distrito de Churubamba, Huánuco durante el periodo 2006. Los datos se obtuvieron de cuestionarios y entrevistas: realizando un análisis bivariado y utilizando la prueba estadistica de comparación de proporciones Z; obteniendo que el buen nivel de conocimiento general alcanzado fue de 47,6 por ciento en el grupo caso y de 9,5 por ciento en el grupo control (P < 0,05); respectivamente. Esto gracias a que los promotores han tomado en sus manos el programa de vigilancia epidemiológica en nutrición infantil y en conjunto con las madres han mejorado la nutrición y los porcentajes de desnutrición en los niños que participan del programa de educación nutricional infantil, han iniciado un decenso. La tasa de desnutrición en el grupo experimental fue 33,3 por ciento frente al 71,4 por ciento en el grupo control (P < 0,05), se llegó a la conclusión que la formación a promotores de salud previno la desnutrición en los niños objeto d estudio, así mismo; incremento el nive de conocimientos y habilidades sobre el tema nutricional en las madres participantes.

The objective of the research was to determine that training health promoters on supplementary feeding is effective in preventing malnutrition in children from 6 to 12 months. To that end is al almost designed a pilot study with 21 mothers and 21 children in the district Churubamba, Huanuco during the period 2006. The data were collected from questionnaires and interviews: bivariate analysis and conducting a test using statistical comparison of proportions Z; getting that good general knowledge level reached was 47.6 per cent in the case group and 9.5 per cent in the control group (P <0.05), respectively. This is because the promoters have taken into their hands the epidemiological surveillance program in child nutrition and together with mothers have underkaten a series of actions to improve nutrition and rates of malnutrition in children who participate in the program of nutrition education infant, have begund to fall. The rates of malnutrition in the experimental group was 33.3 per cent versus 71.4 per cent in the control group (P <0.05), concluded that the training of agent promoters of health warner malnutrition in children studied, also, increase the level of knowledge and skills on the topic nutritional mothers participating.

Severity of meningococcal infections is related to anthropometrical parameters.

BACKGROUND: Invasive meningococcal infections remain an important cause of death in children. In addition, malnutrition has been classically associated with increased severity of infectious diseases. However, in our experience lethal meningococcaemia in clinically malnourished children is extremely rare. Our purpose was to determine whether there is an association between nutritional status and outcome in children with invasive meningococcal infection. METHODS: We carried out an observational study and prospectively determined anthropometrical parameters in 127 children aged 1 month to 4 years with invasive meningococcal infection seen in our inpatient facilities from August 1999 to May 2004. Severity and survival were the clinical end points analysed. RESULTS: Children with severe disease had higher weight for age (1.02 vs -0.19) and height for age (1.12 vs -0.58) z scores than those with non-severe disease. Non-survivors had higher weight for age (0.90 vs -0.16) and height for age (0.73 vs -0.57) z scores than survivors. Clinical and biological variables usually accepted as predictors of high mortality or severity in patients with meningococcal infection were not significantly associated with weight for age and height for age z scores. CONCLUSION: In the present prospective series of children with invasive meningococcal disease, severity and death were linked to anthropometrical parameters and seemed to be associated with a very good nutritional status, which confirmed our previous uncontrolled observations.

[Nutritional status and social determinants of child height in the Guarita Indigenous Territory, Southern Brazil]. / Estado nutricional e fatores associados à estatura de crianças da Terra Indígena Guarita, Sul do Brasil.

The nutritional status of under-five children and the association between social conditions and child stature were examined using data from the program to control malnutrition and mortality in the Guarita Indigenous Territory, southern Brazil, 2001-2002. Anthropometric indices were calculated in z-scores of the CDC 2000 reference. At entrance into the program, 34.7% of the children presented stunting, 12.9% low weight for age, 4.2% wasting, and 8.7% overweight. Stunting was most prevalent among boys and children older than one year. Multivariate linear regression showed that, on average, children were shorter when the drinking water was collected directly in the environment (p = 0.046), there was no refrigerator for food preservation (p = 0.021), maternal age was less than 16 years at the birth of the oldest child among the under-fives (p = 0.019), and the mother was illiterate (p = 0.083). Sewage facilities only had an effect on the unadjusted model. There was no evidence that the number of under-five children had an effect on stature. Social inclusion policies and health and social provision which takes these factors into account are potentially relevant for improving health and nutrition in this population.

Estadísticas vitales y sanitarias: primer semestre -1995- / Vital and health statistics: first semester -1995-

Estadísticas vitales. Tabla de tasas de hechos vitales. Gráfico de tasas de mortalidad infantil y de 1 año por zonas sanitarias. Tabla de defunciones infantiles del área del Gran Resistencia por barrios y villas; defunciones de menores de 28 días, y de 28 días a 11 meses de edad, según grupo de causas por zonas sanitarias con aplicación de criterios de evitabilidad; defunciones generales por grupo de edad y causas. Gráfico de las principales causas de defunciones infantiles; generales. Tabla de defunciones generales; de niños menores de 1 año; de niños de 1 año, clasificadas según grupo de vulnerabilidad, por zonas sanitarias y áreas programáticas. Tabla de la distribución de las defunciones según grupo etáreo por zonas sanitarias y áreas programáticas. Tabla de muertes maternas y fallecidos por enfermedades inmunoprevenibles, por zonas sanitarias y áreas programáticas. Tabla de defunciones por diarreas, deshidratación, inrespa y desnutrición de 0 - 4 años por zonas sanitarias y áreas programáticas. Estadísticas sanitarias. Tabla movimiento de consultorio externo por establecimiento, sector, tipo de consulta y grupos etáreos; de movimiento e indicadores hospitalarios; semestral de vacunaciones (preescolares, escolares, adultos y embarazadas); de cobertura de vacunados por grupo de edad, zonas sanitarias, y áreas programáticas; del plan materno infantil

Estadísticas vitales y sanitarias: primer semestre -1995- / Vital and health statistics: first semester -1995-

Estadísticas vitales. Tabla de tasas de hechos vitales. Gráfico de tasas de mortalidad infantil y de 1 año por zonas sanitarias. Tabla de defunciones infantiles del área del Gran Resistencia por barrios y villas; defunciones de menores de 28 días, y de 28 días a 11 meses de edad, según grupo de causas por zonas sanitarias con aplicación de criterios de evitabilidad; defunciones generales por grupo de edad y causas. Gráfico de las principales causas de defunciones infantiles; generales. Tabla de defunciones generales; de niños menores de 1 año; de niños de 1 año, clasificadas según grupo de vulnerabilidad, por zonas sanitarias y áreas programáticas. Tabla de la distribución de las defunciones según grupo etáreo por zonas sanitarias y áreas programáticas. Tabla de muertes maternas y fallecidos por enfermedades inmunoprevenibles, por zonas sanitarias y áreas programáticas. Tabla de defunciones por diarreas, deshidratación, inrespa y desnutrición de 0 - 4 años por zonas sanitarias y áreas programáticas. Estadísticas sanitarias. Tabla movimiento de consultorio externo por establecimiento, sector, tipo de consulta y grupos etáreos; de movimiento e indicadores hospitalarios; semestral de vacunaciones (preescolares, escolares, adultos y embarazadas); de cobertura de vacunados por grupo de edad, zonas sanitarias, y áreas programáticas; del plan materno infantil

Trends in admission and case fatality for acute malnutrition, Kingston 1982-1992 - abstract

The principal of this study was to compare the case fatality rate (CFR) in acute protein-energy malnutrition (PEM) achieved in the Tropical Metabolism Research Unit (TMRU) in recent years with that of other tertiary care facilities. We also examined trends in admission and fatality rates, case severity and complications. From ward admission registers for Bustamante Hospital for Children (BHC), the University Hospital of the West Indies (UWHI) Children's Wards and the TMRU Ward, all cases of PEM admitted from 1982 through 1991 were enumerated, and the outcome noted. There was docket search for random subsamples. Ten-year mean CFR percent for BHC was 8.8 (n=1948); for UWHI Wards 5.5 (n=658); for TMRU 7.1 (n=662). BHC has the least restrictions on admission and showed most clearly that the peak time in Kingston for admission of PEM was around 1985, falling to a minimum in 1988-1990, and rising again in 1991. However, the other sites also showed similar trends. BHC had a range of CFR percent p.a. of 20.0 to 3.0 with a striking fall in the second half of the decade. There was no temporal CFR trend for the UHWI or TMRU. TMRU had the highest proportion of admissions with marasmic kwashiorkor and the lowest proportion with recorded infection. Through multiple regression analysis, we estimate that 75 percent of the annual variation in numbers of PEM deaths at BHC was accounted for by (a) percentage change in consumer price index; (b) percentage change in US$ value of the Jamaican dollar, in the proceeding year; and (c) annual number of admissions, together. Generally, our findings suggest a minor role for expert in-patient management in reducing deaths from PEM (AU)

As caracteristicas nutricionais sao fatores de risco para desenvolver diarreia complicada por desidratacao moderada a grave / Are nutritional characteristics risk factors to develop dehydrating diarrhoea?

A doenca diarreia persiste como uma causa importante de mortalidade de criancas menores de cinco anos, especialmente para paises em desenvolvimento. Apos a implantacao da terapia de reidratacao oral houve reducao da mortalidade, especialmente devido a diarreia aquosa aguda. Contudo estima-se que 2 a 3 por cento dos episodios de diarreia evoluam para desidratacao e choque, representando a causa de obito para aproximadamente 22 por cento das criancas menores de um ano. Investigaram-se os fatores associados ao risco de desenvolver diarreia complicada por desidratacao moderada ou grave atraves de um estudo de casos e controles, conduzido na area metropolitana de Porto Alegre, Os casos eram de criancas menores de dois anos com diarreia aguda hospitalizadas por desidratacao moderada ou grave. Os controles constituiram-se de criancas sem diarreia, residentes na mesma vizinhganca e do mesmo grupo etario dos casos. Identificaram-se fatores de risco socioeconomicos, ambientais, maternos reprodutivos e de assistencia a saude da crianca. Destacam-se como fatores de risco independentemente associados as exposicoes a idade menor do que quatro meses e, poara as criancas acima de um ano, idade menor do que dezoito meses; baixo peso de nascimento, substituicao do leite materno por leite artificial e menor tempo decorrido apos a suspensao do leite materno

Transmission of HIV-1 infections from mothers to infants in Haiti. Impact on childhood mortality and malnutrition. The CDS/JHU AIDS Project Team.

Of 4588 pregnant women in a high-risk Haitian population, 443 (9.7%) were serologically positive for the human immunodeficiency virus type 1 (HIV-1). Infants born to women who were HIV-1 seropositive were more likely to be premature, of low birth weight, and malnourished at 3 and 6 months of age than were infants born to women who were HIV-1 seronegative. Increased mortality was observed in infants born to women who were HIV-1 seropositive by 3 months of age. At 12 months of age, 23.4% of the infants born to women who were HIV-1 seropositive had died compared with 10.8% of the infants born to women who were HIV-1 seronegative; at 24 months of age, the mortality rates were 31.3% and 14.2%, respectively. Maternal HIV-1 infections resulted in an 11.7% increase in the overall infant mortality rate in this population. The estimated mother-to-infant HIV-1 transmission rate in these breast-fed infants was 25%, similar to the rates reported for non-breast-fed populations in the United States and Europe.

Nosocomial and community-acquired infections in malnourished children.

A total of 206 community-acquired and 73 nosocomial infections in 50 malnourished Jamaican children were studied prospectively. Predominant community-acquired infections in the 50 children, included gastroenteritis (68%), otitis media (60%), rhinopharyngitis (60%), oral candidiasis (46%), skin infections (40%), pneumonia (28%), bacteraemia (24%) and bacteriuria (18%). The most frequent nosocomial infections were rhinopharyngitis (34%), lower respiratory tract infections (24%) and septicaemia (18%). In those infections where an aetiological agent was identified, Giardia lamblia was the commonest enteric pathogen, Staphylococcus epidermidis, the most frequent blood culture isolate and Klebsiella sp. were recovered from the majority of urines. The lack of clinical signs and symptoms and atypical clinical presentation in some infected malnourished children were attributed to impairment of the acute inflammatory response. Diagnosis of infection in these children required a high index of suspicion and a comprehensive screening system. Nasal, throat and axilla swabs taken on admission revealed significant colonization with coliforms and pneumococcus; however, these swabs were not useful as indicators of potentially infective organisms. Four of the 50 children died and two of these deaths were attributed to infection.

Nosocomial and community acquired infections in malnourished children

A total of 206 community-acquired and 73 nosocomial infections in 50 malnourished Jamaican children were studied prospectively. Predominantly community-acquired infections in the 50 children, included gastroenteritis (68 percent), otitis media (60 percent), rhinopharyngitis (60 percent), oral candidiasis (46 percent), skin infections (40 percent), pneumonia (28 percent), bacteraemia (24 percent) and bacteriuria (18 percent). The most frequent nosocomial infections were rhinopharyngitis (34 percent), lower respiratory tract infections (24 percent) and septicaemia (18 percent). In those infections where an aetiological agent was identified, Giardia lamblia was the commonest enteric pathogen, Staphylococcus epidermidis, the most frequent blood culture isolate and Klebsiella sp. were recovered from the majority of urines. The lack of clinical signs and symptoms and atypical clinical presentation in some infected malnourished children were attributed to impairment of the acute inflammatory response. Diagnosis of infection in these children required a high index of suspicion and a comprehensive screening system. Nasal throat and axial swabs taken on admission revealed significant colonization with coliforms and pneumococcus; however, these swabs were not useful as indicators of potentially infective organisms. Four of the fifty children died and two of these deaths were attributed to infection. (AU)