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2.
Rev. Ciênc. Plur ; 5(1): 71-88, jun. 2019. ilus
Artigo em Português | LILACS, BBO - Odontologia | ID: biblio-1007352

RESUMO

Introdução: Durante a trajetória histórica que envolve a política de saúde infantil no Brasil, houve pontos positivos e negativos no processo de cuidar, implementado por meio das políticas públicas. Nesse sentido, em vários anos e décadas, foram propostas diretrizes novas que vão ao encontro de uma assistência qualificada à saúde da criança. Objetivo: Analisar a trajetória histórica das políticas de saúde infantil no Brasil verificando as tendências do coeficiente de mortalidade infantil. Método: Revisão integrativa consolidada a partir de pesquisa realizada em documentos de domínio público, disponíveis em formato digital na rede de internet. Foram coletados dados sobre a saúde infantil do período de 1930 a 2016. Resultados: Entre 1930 e 2015 observa-se uma redução na taxa de mortalidade infantil e melhoria na economia do país, além da implantação de várias políticas com ações voltadas diretamente com o objetivo desta redução. Porém, em 2016, um ano após a implantação da última política infantil, observou-se um aumento com 10,2% na taxa de mortalidade infantil referente ao ano anterior. Conclusões: Dessa forma, este estudo mostra que nos últimos 80 anos a taxa de mortalidade infantil vem reduzindo concomitantemente com o aumento de implantações de políticas. Todavia, foi possível ver que ainda se faz necessário melhorias e uma atenção mais direcionada a esta parte da população (AU).


Introduction:During the historical trajectory that involves the policy of children's health in Brazil, there were positive and negative points in the care process, implemented through public policies. In this sense, in several years and decades, new guidelines have been proposed that meet assistance qualified child health care.Aim:To analyze the historical trajectory of child health policies in Brazil by verifying trends in the infant mortality coefficient.Methods:Consolidated integrative review based on research carried out in public domain documents, available in digital format on the internet network. Data were collected on child health from the period 1930 to 2016.Results:Between 1930 and 2015, there is a reduction in the infant mortality rate and improvement in the country's economy, as well as the implementation of several policies with actions aimed directly at the objective of this reduction. However, in 2016, one year after the implementation of the last child policy, there was a 10.2% increase in the infant mortality rate in relation to the previous year.Conclusions:Thus, this study shows that in the last 80 years the infant mortality rate has been reducing concomitantly with the increase in policy implementation. However, it was possible to see that there is still a need for improvements and more targeted attention to this part of the population (AU).


Assuntos
Política Pública , Brasil , Mortalidade Infantil , Saúde da Criança
3.
J Glob Health ; 9(1): 010801, 2019 Jun.
Artigo em Inglês | MEDLINE | ID: mdl-31263547

RESUMO

Background: In 2013, the World Health Organization (WHO) launched the Rapid Access Expansion (RAcE) programme in the Democratic Republic of Congo, Malawi, Mozambique, Niger, and Nigeria to increase coverage of diagnostic, treatment, and referral services for malaria, pneumonia, and diarrhea among children ages 2-59 months. In 2017, a final evaluation of the six RAcE sites was conducted to determine whether the programme goal was reached. A key evaluation objective was to estimate the reduction in childhood mortality and the number of under-five lives saved over the project period in the RAcE project areas. Methods: The Lives Saved Tool (LiST) was used to estimate reductions in all-cause child mortality due to changes in coverage of treatment for the integrated community case management (iCCM) illnesses - malaria, pneumonia, and diarrhea - while accounting for other changes in maternal and child health interventions in each RAcE project area. Data from RAcE baseline and endline household surveys, Demographic and Health Surveys, and routine health service data were used in each LiST model. The models yielded estimated change in under-five mortality rates, and estimated number of lives saved per year by malaria, pneumonia and diarrhea treatment. We adjusted the results to estimate the number of lives saved by community health worker (CHW)-provided treatment. Results: The LiST model accounts for coverage changes in iCCM intervention coverage and other health trends in each project area to estimate mortality reduction and child lives saved. Under five mortality declined in all six RAcE sites, with an average decline of 10 percent. An estimated 6200 under-five lives were saved by malaria, pneumonia, and diarrhea treatment in the DRC, Malawi, Niger, and Nigeria, of which approximately 4940 (75 percent) were saved by treatment provided by CHWs. This total excludes Mozambique, where there were no estimated under-five lives saved likely due to widespread stockouts of key medications. In all other project areas, lives saved by CHW-provided treatment contributed substantially to the estimated decline in under-five mortality. Conclusions: Our results suggest that iCCM is a strategy that can save lives and measurably decrease child mortality in settings where access to health facility services is low and adequate resources for iCCM implementation are provided for CHW services.


Assuntos
Administração de Caso/organização & administração , Mortalidade da Criança/tendências , Serviços de Saúde Comunitária/organização & administração , Prestação Integrada de Cuidados de Saúde , Acesso aos Serviços de Saúde/organização & administração , Mortalidade Infantil/tendências , Pré-Escolar , República Democrática do Congo/epidemiologia , Diarreia/mortalidade , Diarreia/terapia , Humanos , Lactente , Malária/mortalidade , Malária/terapia , Malaui/epidemiologia , Moçambique/epidemiologia , Níger/epidemiologia , Nigéria/epidemiologia , Pneumonia/mortalidade , Pneumonia/terapia , Avaliação de Programas e Projetos de Saúde , Organização Mundial da Saúde
4.
Aust N Z J Public Health ; 43(4): 340-345, 2019 Aug.
Artigo em Inglês | MEDLINE | ID: mdl-31339611

RESUMO

OBJECTIVES: To assess whether progress is being made towards reducing Aboriginal and Torres Strait Islander inequality in life expectancy and under-five mortality in the Northern Territory. METHODS: Life tables for five-year periods from 1966-71 to 2011-16 were calculated using standard abridged life table methods with Aboriginal and Torres Strait Islander deaths and population estimates as inputs. The latter were calculated using reverse cohort survival. RESULTS: In 2011-16, life expectancy at birth for the Aboriginal and Torres Strait Islander population was 68.2 years for females and 64.9 years for males. Limited progress in under-five mortality rates has been made in recent years. CONCLUSIONS: Although Aboriginal and Torres Strait Islander life expectancy has increased in the long run, the gap with all-Australian life expectancy has not narrowed. The gap in under-five mortality rates is much lower than it was in the 1960s and 1970s, but progress has been limited over the past decade. Implications for public health: The 'Closing the Gap' target of halving the gap in under-five mortality by 2018 will not be met in the Northern Territory, and there is no evidence yet of progress on the target to eliminate the gap in life expectancy by 2031.


Assuntos
Mortalidade da Criança/etnologia , Mortalidade Infantil/etnologia , Expectativa de Vida , Grupo com Ancestrais Oceânicos/estatística & dados numéricos , Austrália/epidemiologia , Pré-Escolar , Feminino , Disparidades nos Níveis de Saúde , Humanos , Lactente , Recém-Nascido , Expectativa de Vida/tendências , Masculino , Grupo com Ancestrais Oceânicos/etnologia
5.
J Glob Health ; 9(2): 020501, 2019 Dec.
Artigo em Inglês | MEDLINE | ID: mdl-31360450

RESUMO

Background: The slow decline in neonatal mortality as compared to post-neonatal mortality in Nigeria calls for attention and efforts to reverse this trend. This paper examines how socioeconomic, cultural, behavioral, and contextual factors interact to influence survival time among deceased newborns in Nigeria. Methods: Using the neonatal deaths data from the 2014 Nigeria Verbal/ Social Autopsy survey, we examined the temporal distribution of overall and cause-specific mortality of a sample of 723 neonatal deaths. We fitted an extended Cox regression model that also allowed a time-dependent set of risk factors on time-to-neonatal death from all causes, and then separately, from birth injury/birth asphyxia (BIBA) and neonatal infections, while adjusting for possible confounding variables. Results: Approximately 26% of all neonatal deaths occurred during the first day, 52.8% during the first three days, and 73.9% during the first week of life. Almost all deaths (94.4%) due to BIBA and about 64% from neonatal infections occurred in the first week of life. The expected all-cause mortality hazard was 6.23 times higher on any particular illness day for the deceased newborns who had a severe illness at onset compared to those who did not. While the all-cause mortality hazard ratio of poor vs wealthier households was 0.77 (95% confidence interval (CI) = 0.648-0.922), the BIBA mortality hazard ratio of households with no electricity was 1.79 times higher compared to households with electricity (95% CI = 1.180-2.715). Conclusions: The findings suggest the need for continued improvement of the coverage and quality of maternal and neonatal health interventions at birth and in the immediate postnatal period. They may also require confirmation in real-world cohorts with detailed, time-varying information on neonatal mortality.


Assuntos
Mortalidade Infantil/tendências , Autopsia/métodos , Feminino , Humanos , Lactente , Recém-Nascido , Masculino , Nigéria/epidemiologia , Fatores de Risco , Análise de Sobrevida , Fatores de Tempo
6.
J Glob Health ; 9(1): 010809, 2019 Jun.
Artigo em Inglês | MEDLINE | ID: mdl-31275569

RESUMO

Background: Mozambique has one of the highest under-5 mortality rates in the world. Community health workers (CHWs) are deployed to increase access to care; in Mozambique they are known as agentes polivalentes elementares (APEs). This study aimed to investigate child deaths in an area served by APEs by analysing the causes, care seeking patterns, and the influence of social capital. Methods: Caregivers of children under-5 who died in 2015 in Inhambane province, Mozambique, were interviewed using Verbal Autopsy/Social Autopsy (VA/SA) tools with a social capital module. VA data were analysed using the WHO InterVA analytical tool to determine cause of death. SA was analysed using the INDEPTH SA framework for illnesses lasting no more than three weeks. Social capital scores were calculated. Results: 117 child deaths were reported; VA/SA was conducted for 115. Eighty-five had died from an acute illness lasting no more than three weeks, which in most cases could have been treated at community level; 50.6% died from malaria, 11.8% from HIV/AIDS, and 9.4% for each of diarrhoea and acute respiratory infections. In 35.3% the caregiver only noticed that the child was sick when symptoms of very severe illness developed. One in four children were never taken outside the home before dying. Sixteen children were first taken to an APE; of these 7 had signs of very severe illness. Caregivers who waited to seek care until the illness was very severe had a lower social capital score. The mean travel time to go to the APE was 2hrs 50min, which was not different from any other provider. Most received treatment from the APE, 3 were referred. The majority went to another provider after the APE; most to a health centre. Conclusions: The leading causes of death in children under-5 can be detected, treated or referred by APEs. Major care seeking delays took place in the home, largely due to lack of early disease recognition and late decision-making. Low social capital, distance to APEs and to referral facilities likely contribute to these delays. Increasing caregiver illness awareness is urgently needed, as well as stronger referral linkages. A review of the geographical coverage and scope of work of APEs should be conducted.


Assuntos
Causas de Morte/tendências , Mortalidade da Criança/tendências , Serviços de Saúde Comunitária/organização & administração , Agentes Comunitários de Saúde , Acesso aos Serviços de Saúde , Mortalidade Infantil/tendências , Pré-Escolar , Pesquisa sobre Serviços de Saúde , Humanos , Lactente , Moçambique/epidemiologia , Aceitação pelo Paciente de Cuidados de Saúde/estatística & dados numéricos , Capital Social , Tempo para o Tratamento/estatística & dados numéricos
7.
Rev. Bras. Saúde Mater. Infant. (Online) ; 19(2): 295-301, Apr.-June 2019. tab, graf
Artigo em Inglês | LILACS | ID: biblio-1013134

RESUMO

Abstract Objectives: to analyze the difference among geographical units and the evolution of infant mortality rate (IMR) based on Ecuadorian censuses (1990-2001-2010). Methods: artificial Neural Network analyzed the impact of sociodemographic factors over the variability of IMR. Poisson regression analyzed the variation of the standardized IMR (sIMR). Results: the decrease in the national IMR was 63.8%; however, 42.8% provinces showed an increase in 2001-2010. The variability was explained mainly by illiteracy decrease. The adjusted RR between provincial sIMR with illiteracy and poverty revealed a trend towards the unit. Conclusions: the variation of IMR reflects a complex interaction of the sociodemographic factors.


Resumen Objetivos: analizar las diferencias de la evolución de la tasa de mortalidad infantil (TMI) entre unidades geográficas basada en los censos ecuatorianos (1990-2001-2010). Métodos: la red neuronal artificial analizó el impacto de los factores sociodemográficos sobre la variabilidad de la TMI. La regresión de Poisson analizó la cuantificación de la variación de la TMI estandarizada (TMIs). Resultados: la disminución en la TMI nacional fue de 63.8%; sin embargo, 42.8% de las provincias mostraron un incremento en el periodo 2001-2010. La variabilidad se explica principalmente por la disminución del analfabetismo. El RR ajustado entre TMIs provincial con analfabetismo y pobreza reveló una tendencia hacia la unidad. Conclusiones: la variación de la TMI refleja una interacción compleja de los factores sociodemográficos estudiados.


Assuntos
Criança , Pobreza , Fatores Socioeconômicos , Mortalidade Infantil , Morbidade , Distribuição de Poisson , Redes Neurais (Computação) , Equador , Alfabetização
8.
MMWR Morb Mortal Wkly Rep ; 68(24): 544-551, 2019 Jun 21.
Artigo em Inglês | MEDLINE | ID: mdl-31220057

RESUMO

Influenza activity* in the United States during the 2018-19 season (September 30, 2018-May 18, 2019) was of moderate severity (1). Nationally, influenza-like illness (ILI)† activity began increasing in November, peaked during mid-February, and returned to below baseline in mid-April; the season lasted 21 weeks,§ making it the longest season in 10 years. Illness attributed to influenza A viruses predominated, with very little influenza B activity. Two waves of influenza A were notable during this extended season: influenza A(H1N1)pdm09 viruses from October 2018 to mid-February 2019 and influenza A(H3N2) viruses from February through May 2019. Compared with the 2017-18 influenza season, rates of hospitalization this season were lower for adults, but were similar for children. Although influenza activity is currently below surveillance baselines, testing for seasonal influenza viruses and monitoring for novel influenza A virus infections should continue year-round. Receiving a seasonal influenza vaccine each year remains the best way to protect against seasonal influenza and its potentially severe consequences.


Assuntos
Vírus da Influenza A Subtipo H1N1/isolamento & purificação , Vírus da Influenza A Subtipo H3N2/isolamento & purificação , Vírus da Influenza B/isolamento & purificação , Influenza Humana/epidemiologia , Vigilância da População , Adolescente , Adulto , Idoso , Antivirais/farmacologia , Criança , Mortalidade da Criança , Pré-Escolar , Efeitos Psicossociais da Doença , Farmacorresistência Viral , Hospitalização/estatística & dados numéricos , Humanos , Lactente , Mortalidade Infantil , Recém-Nascido , Vírus da Influenza A Subtipo H1N1/efeitos dos fármacos , Vírus da Influenza A Subtipo H1N1/genética , Vírus da Influenza A Subtipo H3N2/efeitos dos fármacos , Vírus da Influenza A Subtipo H3N2/genética , Vírus da Influenza B/efeitos dos fármacos , Vírus da Influenza B/genética , Vacinas contra Influenza/administração & dosagem , Vacinas contra Influenza/química , Influenza Humana/mortalidade , Influenza Humana/prevenção & controle , Influenza Humana/virologia , Pessoa de Meia-Idade , Pacientes Ambulatoriais/estatística & dados numéricos , Pneumonia/mortalidade , Estações do Ano , Índice de Gravidade de Doença , Estados Unidos/epidemiologia , Adulto Jovem
9.
Artigo em Russo | MEDLINE | ID: mdl-31251864

RESUMO

On the basis of official statistics of 1995-2014 a comparative analysis of the dynamics of stillbirths of boys and girls in the Bryansk region and the Russian Federation was carried out. The study established exceeding of rate of stillbirths in boys over stillbirths in girls at 14.4% and 9.0% correspondingly both in the Bryansk Oblast and the Russian Federation that confirms the global trend of higher risk of stillbirth in boys by approximately to 10%. In case the stillbirth rate in the Bryansk Oblast will proceed established trend the ratio of stillbirths will increase relatively to the nationwide values in 2016 - 2021 and will reach 30% in 2021. At that, the gap between indices of boys and girls will increase up to 32,8%.


Assuntos
Mortalidade Infantil , Natimorto , Feminino , Humanos , Lactente , Mortalidade Infantil/tendências , Recém-Nascido , Masculino , Gravidez , Federação Russa/epidemiologia
10.
BMC Public Health ; 19(1): 760, 2019 Jun 14.
Artigo em Inglês | MEDLINE | ID: mdl-31200681

RESUMO

BACKGROUND: In sub-Saharan Africa, socioeconomic factors such as place of residence, mother's educational level, or household wealth, are strongly associated with risk factors of under-five mortality (U5M) such as health behavior or exposure to diseases and injuries. The aim of the study was to assess the relative contribution of four known socioeconomic factors to the variability in U5M in sub-Saharan countries. METHODS: The study was based on birth histories from the Demographic and Health Surveys conducted in 32 sub-Saharan countries in 2010-2016. The relative contribution of sex of the child, place of residence, mother's educational level, and household wealth to the variability in U5M was assessed using a regression-based decomposition of a Gini-type index. RESULTS: The Gini index - measuring the variability in U5M related to the four socioeconomic factors - varied from 0.006 (95%CI: 0.001-0.010) in Liberia 2013 to 0.034 (95%CI: 0.029-0.039) in Côte d'Ivoire 2011/12. The main contributors to the Gini index (with a relative contribution higher than 25%) were different across countries: mother's educational level in 13 countries, sex of the child in 12 countries, household wealth in 11 countries, and place of residence in 8 countries (in some countries, more than one main contributor was identified). CONCLUSIONS: Factors related to socioeconomic status exert varied effects on the variability in U5M in sub-Saharan African countries. The findings provide evidence in support of prioritizing intersectoral interventions aiming at improving child survival in all subgroups of a population.


Assuntos
Mortalidade da Criança/tendências , Mortalidade Infantil/tendências , África ao Sul do Saara/epidemiologia , Pré-Escolar , Feminino , Humanos , Lactente , Masculino , Fatores de Risco , Fatores Socioeconômicos
11.
Manag Care ; 28(6): 46-47, 2019 Jun.
Artigo em Inglês | MEDLINE | ID: mdl-31188102

RESUMO

The U.S. rate is now higher than infant mortality rates in Antigua or Cuba. Furthermore, the overall U.S. rate masks significant disparities. The infant mortality rate of non-Hispanic black infants is 11.2 per 1,000 live births, which is comparable to the rate in Libya or Tunisia.


Assuntos
Mortalidade Infantil/tendências , Mortalidade Materna/tendências , Humanos , Lactente , Estados Unidos/epidemiologia
12.
Implement Sci ; 14(1): 65, 2019 06 19.
Artigo em Inglês | MEDLINE | ID: mdl-31217028

RESUMO

BACKGROUND: Each year, 2.2 million intrapartum-related deaths (intrapartum stillbirths and first day neonatal deaths) occur worldwide with 99% of them taking place in low- and middle-income countries. Despite the accelerated increase in the proportion of deliveries taking place in health facilities in these settings, the stillborn and neonatal mortality rates have not reduced proportionately. Poor quality of care in health facilities is attributed to two-thirds of these deaths. Improving quality of care during the intrapartum period needs investments in evidence-based interventions. We aim to evaluate the quality improvement package-Scaling Up Safer Bundle Through Quality Improvement in Nepal (SUSTAIN)-on intrapartum care and intrapartum-related mortality in public hospitals of Nepal. METHODS: We will conduct a stepped wedge cluster randomized controlled trial in eight public hospitals with each having least 3000 deliveries a year. Each hospital will represent a cluster with an intervention transition period of 2 months in each. With a level of significance of 95%, the statistical power of 90% and an intra-cluster correlation of 0.00015, a study period of 19 months should detect at least a 15% change in intrapartum-related mortality. Quality improvement training, mentoring, systematic feedback, and a continuous improvement cycle will be instituted based on bottleneck analyses in each hospital. All concerned health workers will be trained on standard basic neonatal resuscitation and essential newborn care. Portable fetal heart monitors (Moyo®) and neonatal heart rate monitors (Neobeat®) will be introduced in the hospitals to identify fetal distress during labor and to improve neonatal resuscitation. Independent research teams will collect data in each hospital on intervention inputs, processes, and outcomes by reviewing records and carrying out observations and interviews. The dose-response effect will be evaluated through process evaluations. DISCUSSION: With the global momentum to improve quality of intrapartum care, better understanding of QI package within a health facility context is important. The proposed package is based on experiences from a similar previous scale-up trial carried out in Nepal. The proposed evaluation will provide evidence on QI package and technology for implementation and scale up in similar settings. TRIAL REGISTRATION NUMBER: ISRCTN16741720 . Registered on 2 March 2019.


Assuntos
Hospitais Públicos/organização & administração , Pacotes de Assistência ao Paciente , Assistência Perinatal/normas , Melhoria de Qualidade , Países em Desenvolvimento , Feminino , Humanos , Lactente , Mortalidade Infantil , Recém-Nascido , Mortalidade Materna , Monitorização Fisiológica/normas , Nepal , Gravidez , Ressuscitação/normas
13.
N Engl J Med ; 380(23): 2207-2214, 2019 06 06.
Artigo em Inglês | MEDLINE | ID: mdl-31167050

RESUMO

BACKGROUND: The MORDOR I trial (Macrolides Oraux pour Réduire les Décès avec un Oeil sur la Résistance) showed that in Niger, mass administration of azithromycin twice a year for 2 years resulted in 18% lower postneonatal childhood mortality than administration of placebo. Whether this benefit could increase with each administration or wane owing to antibiotic resistance was unknown. METHODS: In the Niger component of the MORDOR I trial, we randomly assigned 594 communities to four twice-yearly distributions of either azithromycin or placebo to children 1 to 59 months of age. In MORDOR II, all these communities received two additional open-label azithromycin distributions. All-cause mortality was assessed twice yearly by census workers who were unaware of participants' original assignments. RESULTS: In the MORDOR II trial, the mean (±SD) azithromycin coverage was 91.3±7.2% in the communities that received twice-yearly azithromycin for the first time (i.e., had received placebo for 2 years in MORDOR I) and 92.0±6.6% in communities that received azithromycin for the third year (i.e., had received azithromycin for 2 years in MORDOR I). In MORDOR II, mortality was 24.0 per 1000 person-years (95% confidence interval [CI], 22.1 to 26.3) in communities that had originally received placebo in the first year and 23.3 per 1000 person-years (95% CI, 21.4 to 25.5) in those that had originally received azithromycin in the first year, with no significant difference between groups (P = 0.55). In communities that had originally received placebo, mortality decreased by 13.3% (95% CI, 5.8 to 20.2) when the communities received azithromycin (P = 0.007). In communities that had originally received azithromycin and continued receiving it for an additional year, the difference in mortality between the third year and the first 2 years was not significant (-3.6%; 95% CI, -12.3 to 4.5; P = 0.50). CONCLUSIONS: We found no evidence that the effect of mass administration of azithromycin on childhood mortality in Niger waned in the third year of treatment. Childhood mortality decreased when communities that had originally received placebo received azithromycin. (Funded by the Bill and Melinda Gates Foundation; ClinicalTrials.gov number, NCT02047981.).


Assuntos
Antibacterianos/uso terapêutico , Azitromicina/uso terapêutico , Mortalidade da Criança , Antibacterianos/administração & dosagem , Azitromicina/administração & dosagem , Pré-Escolar , Esquema de Medicação , Feminino , Humanos , Lactente , Mortalidade Infantil , Masculino , Administração Massiva de Medicamentos , Níger/epidemiologia
14.
Wiad Lek ; 72(5 cz 2): 1136-1139, 2019.
Artigo em Inglês | MEDLINE | ID: mdl-31175759

RESUMO

OBJECTIVE: Introduction: Providing high-quality health care to the newborn is part of the national health system. The number of healthy children in Ukraine decreases annually. One of the main directions of development of the pediatric service is reduction of indicators of child mortality, increase of birth rate and strengthening of children's health. The aim: To analyze the dynamics of morbidity and causes of infant mortality in the city of Poltava. PATIENTS AND METHODS: Materials and methods: Medical and statistical - for collecting, processing and analyzing data, (descriptive and analytical statistics for determining relative indicators, absolute growth indicators), a systems approach and system analysis. RESULTS: Review: According to a study in the city of Poltava, there is a negative absolute increase in the birth rate of children. In the structure of the causes of death of the child population in the first place are the diseases of the period of birth of the newborn, in the second place - congenital anomalies of development. The third place in the structure of causes of death is occupied by diseases of the central nervous system. There is a clear decrease in the incidence of hemolytic disease, anemia, cardiac disorders, intrauterine hypoxia and asphyxiation. In the structure of birth injuries in newborns occupy closed clavicle fractures, plexitis of the newborn. CONCLUSION: Conclusions: Analysis of the incidence and causes of infant mortality in the city of Poltava suggests that in recent years there has been a decrease in fertility rates, an increase in morbidity rates. The reform should be aimed at improving the state of the pediatric service and the prevention of preterm labor.


Assuntos
Mortalidade Infantil , Mortalidade , Humanos , Incidência , Lactente , Recém-Nascido , Morbidade , Ucrânia
15.
Wiad Lek ; 72(5 cz 2): 1145-1149, 2019.
Artigo em Inglês | MEDLINE | ID: mdl-31175761

RESUMO

OBJECTIVE: Introduction: Ukraine has made a commitment to reduce preventable deaths of newborns and children under 5 years of age, within the framework of the relevant task of the Sustainable Development Goals. For a purposeful and effective struggle, it is necessary to realize the scope and structure of losses. The aim: Identify differences in child mortality rates in Ukraine compared to other countries, to calculate and estimate the number of years of potential life lost (YPLL) due to infant mortality. PATIENTS AND METHODS: Materials and methods: The information base of the study was official data of the State Statistics Service of Ukraine on the distribution of the deceased by age and causes of death in 2017 and World Health Statistics 2016 data. The method of potential demography was used to estimate demographic losses. RESULTS: Review: In Ukraine, in 2017 the absolute number of years of potential life lost (YPLL) was estimated to be almost 217,000 person-years due to under-five mortality, most of them - more than 179,000 person-years - due to infant mortality. The rest were losses due to mortality within the interval of 1-4 years - almost 40 thousand person-years. 55.6% of all potential life losses due to infant mortality determined Certain conditions occurring in the perinatal period, Congenital malformations, deformities and chromosomal anomalies - 23.4%. CONCLUSION: Conclusions: Ukraine has significant reserves for reducing under five mortality rates, primarily through minimization of preventable mortality.


Assuntos
Mortalidade da Criança , Mortalidade Infantil , Desenvolvimento Sustentável , Causas de Morte , Pré-Escolar , Metas , Humanos , Lactente , Recém-Nascido , Ucrânia
16.
BJOG ; 126(10): 1258, 2019 09.
Artigo em Inglês | MEDLINE | ID: mdl-31166069
17.
Medicine (Baltimore) ; 98(20): e15733, 2019 May.
Artigo em Inglês | MEDLINE | ID: mdl-31096533

RESUMO

BACKGROUND: Antiphospholipid syndrome (APS) is a rare heterogenous autoimmune disorder with severe life-threatening complications shown during pregnancy. In this analysis, we aimed to systematically compare the pregnancy outcomes (both maternal and fetal) in patients with APS. METHODS: Web of Science, Google Scholar, Medicus, Cochrane Central, Embase, and Medline were searched for relevant English publications. The main inclusion criteria were based on studies that compared pregnancy outcomes in patients with APS vs a control group. Statistical analysis was carried out by the RevMan software version 5.3. This analysis involved dichotomous data, and risk ratios (RR) with 95% confidence intervals (CIs) were used to represent the analysis. RESULTS: Eight studies consisting of a total number of 212,954 participants were included. Seven hundred seventy participants were pregnant women with APS and 212,184 participants were assigned to the control group. Pregnancy-induced hypertension was significantly higher in women with APS (RR: 1.81, 95% CI: 1.33 - 2.45; P = .0002). The risks of fetal loss (RR: 1.33, 95% CI: 1.00-1.76; P = .05), abortion (RR: 2.42, 95% CI: 1.46-4.01; P = .0006), thrombosis (RR: 2.83, 95% CI: 1.47-5.44; P = .002), and preterm delivery (RR: 1.89, 95% CI: 1.52-2.35; P = .00001) were also significantly higher in women with APS. However, placental abruption (RR: 1.35, 95% CI: 0.78-2.34; P = .29) and pulmonary embolism were not significantly different (RR: 1.47, 95% CI: 0.11-19.20; P = .77). The risk of neonatal mortality (RR: 3.95, 95% CI: 1.98-7.86; P = .0001), infants small for gestational age (RR: 1.38, 95% CI: 1.04-1.82; P = .02), premature infants (RR: 1.86, 95% CI: 1.52-2.28; P = .0001), and infants who were admitted to neonatal intensive care unit (RR: 3.35, 95% CI: 2.29-4.89; P = .00001) were also significantly higher in women with APS. CONCLUSION: This analysis showed APS to be associated with significantly worse pregnancy outcomes when compared to the control group. A significantly higher risk of maternal and fetal complications was observed in this category of patients. Therefore, intense care should be given to pregnant women with APS to monitor unwanted outcomes and allow a successful pregnancy.


Assuntos
Síndrome Antifosfolipídica/complicações , Complicações na Gravidez/epidemiologia , Aborto Espontâneo/epidemiologia , Aborto Espontâneo/etiologia , Síndrome Antifosfolipídica/epidemiologia , Estudos de Casos e Controles , Feminino , Humanos , Hipertensão Induzida pela Gravidez/epidemiologia , Hipertensão Induzida pela Gravidez/etiologia , Lactente , Mortalidade Infantil , Recém-Nascido Prematuro , Recém-Nascido Pequeno para a Idade Gestacional , Gravidez , Complicações na Gravidez/classificação , Resultado da Gravidez , Nascimento Prematuro/epidemiologia , Nascimento Prematuro/etiologia
18.
BMJ ; 365: l1656, 2019 05 07.
Artigo em Inglês | MEDLINE | ID: mdl-31064770

RESUMO

OBJECTIVE: To investigate associations between Apgar scores of 7, 8, and 9 (versus 10) at 1, 5, and 10 minutes, and neonatal mortality and morbidity. DESIGN: Population based cohort study. SETTING: Sweden. PARTICIPANTS: 1 551 436 non-malformed live singleton infants, born at term (≥37 weeks' gestation) between 1999 and 2016, with Apgar scores of ≥7 at 1, 5, and 10 minutes. EXPOSURES: Infants with Apgar scores of 7, 8, and 9 at 1, 5, and 10 minutes were compared with those with an Apgar score of 10 at 1, 5, and 10 minutes, respectively. MAIN OUTCOME MEASURES: Neonatal mortality and morbidity, including neonatal infections, asphyxia related complications, respiratory distress, and neonatal hypoglycaemia. Adjusted odds ratios (aOR), adjusted rate differences (aRD), and 95% confidence intervals were estimated. RESULTS: Compared with infants with an Apgar score of 10, aORs for neonatal mortality, neonatal infections, asphyxia related complications, respiratory distress, and neonatal hypoglycaemia were higher among infants with lower Apgar scores, especially at 5 and 10 minutes. For example, the aORs for respiratory distress for an Apgar score of 9 versus 10 were 2.0 (95% confidence interval 1.9 to 2.1) at 1 minute, 5.2 (5.1 to 5.4) at 5 minutes, and 12.4 (12.0 to 12.9) at 10 minutes. Compared with an Apgar score of 10 at 10 minutes, the aRD for respiratory distress was 9.5% (95% confidence interval 9.2% to 9.9%) for an Apgar score of 9 at 10 minutes, and 41.9% (37.7% to 46.4%) for an Apgar score of 7 at 10 minutes. A reduction in Apgar score from 10 at 5 minutes to 9 at 10 minutes was also associated with higher odds of neonatal morbidity, compared with a stable Apgar score of 10 at 5 and 10 minutes. CONCLUSIONS: In term non-malformed infants with Apgar scores within the normal range (7 to 10), risks of neonatal mortality and morbidity are higher among infants with lower Apgar score values, and also among those experiencing a reduction in score from 5 minutes to 10 minutes (compared with infants with stable Apgar scores of 10).


Assuntos
Índice de Apgar , Mortalidade Infantil , Doenças do Recém-Nascido/mortalidade , Mães/estatística & dados numéricos , Adulto , Índice de Massa Corporal , Escolaridade , Feminino , Inquéritos Epidemiológicos , Humanos , Lactente , Mortalidade Infantil/tendências , Recém-Nascido , Masculino , Idade Materna , Razão de Chances , Gravidez , Estudos Prospectivos , Fatores de Risco , Índice de Gravidade de Doença , Suécia/epidemiologia , Nascimento a Termo , Fatores de Tempo , Adulto Jovem
19.
J Glob Health ; 9(1): 011102, 2019 Jun.
Artigo em Inglês | MEDLINE | ID: mdl-31131106

RESUMO

Background: Over the past 20 years, Mozambique has achieved substantial reductions in maternal, neonatal, and child mortality. However, mortality rates are still high, and to achieve the Sustainable Development Goals (SDGs) for maternal and child health, further gains are needed. One technique that can guide policy makers to more effectively allocate health resources is to model the coverage increases and lives saved that would be achieved if trends continue as they have in the past, and under differing alternative scenarios. Methods: We used historical coverage data to project future coverage levels for 22 child and maternal interventions for 2015-2030 using a Bayesian regression model. We then used the Lives Saved Tool (LiST) to estimate the additional lives saved by the projected coverage increases, and the further child lives saved if Mozambique were to achieve universal coverage levels of selected individual interventions. Results: If historical trends continue, coverage of all interventions will increase from 2015 to 2030. As a result, 180 080 child lives (0-59 months) and 3640 maternal lives will be saved that would not be saved if coverage instead stays constant from 2015 to 2030. Most child lives will be saved by preventing malaria deaths: 40.9% of the mortality reduction will come from increased coverage of artemisinin-based compounds for malaria treatment (ACTs) and insecticide treated bednets (ITNs). Most maternal lives will be saved from increased labor and delivery management (29.4%) and clean birth practices (17.1%). The biggest opportunity to save even more lives, beyond those expected by historical trends, is to further invest in malaria treatment. If coverage of ACTs was increased to 90% in 2030, rather than the anticipated coverage of 68.4% in 2030, an additional 3456 child lives would be saved per year. Conclusions: Mozambique can expect to see continued reductions in mortality rates in the coming years, although due to population growth the absolute number of child deaths will decrease only marginally, the absolute number of maternal deaths will continue to increase, and the country will not achieve current SDG targets for either child or maternal mortality. Significant further health investments are needed to eliminate all preventable child and maternal deaths in the coming decades.


Assuntos
Saúde da Criança , Mortalidade da Criança/tendências , Promoção da Saúde/organização & administração , Mortalidade Infantil/tendências , Saúde Materna , Mortalidade Materna/tendências , Teorema de Bayes , Pré-Escolar , Feminino , Humanos , Lactente , Recém-Nascido , Moçambique/epidemiologia , Gravidez , Avaliação de Programas e Projetos de Saúde
20.
Int J Public Health ; 64(5): 773-783, 2019 Jun.
Artigo em Inglês | MEDLINE | ID: mdl-31115590

RESUMO

OBJECTIVES: The life expectancy and mortality rate always exhibit remarkable spatial variations. Their spatial distribution patterns and economic determinants in China were explored. METHODS: Four indexes including lifespan expectancy at birth (LEB), infant mortality rate (IMR), under-5 mortality rate (U5MR) and crude mortality rate (CMR) at county level in China were calculated. The spatial distribution patterns of these indexes were illustrated. Meanwhile, spatial regressive model was applied to explore the relations between major macroeconomic determinants and these indexes. RESULTS: Spatial dependence of these four indexes in China was identified, and the positive spatial autocorrelation indicated a clustering feature rather than stochastic distribution. Additionally, local Moran's I statistics revealed opposite local spatial clusters of LEB and IMR, U5MR in China, that LEB showed that high value clusters in the southwest and low value clusters in the eastern part and northern Xinjiang, and IMR/U5MR exhibited that low value clusters in the east and high value clusters in the west. The spatial regression revealed that income per capita influenced positively on LEB and CMR, and GDP per capita was associated positively with IMR and U5MR. CONCLUSIONS: Geographical factors should be highly considered, and the L-L LEB or H-H IMR/U5MR clustered areas need to be integrated as a whole to formulate public health and economic development plans.


Assuntos
Mortalidade da Criança/tendências , Geografia/estatística & dados numéricos , Mortalidade Infantil/tendências , Expectativa de Vida/tendências , Longevidade , Vigilância da População , Classe Social , Adolescente , Criança , Pré-Escolar , China , Feminino , Previsões , Humanos , Lactente , Recém-Nascido , Masculino , Fatores Socioeconômicos , Análise Espacial
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