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1.
BMC Public Health ; 19(1): 811, 2019 Jun 24.
Artigo em Inglês | MEDLINE | ID: mdl-31234805

RESUMO

BACKGROUND: The perinatal mortality rate (PMR) in Nigeria rose by approximately 5% from 39 to 41 deaths per 1000 total births between 2008 and 2013, indicating a reversal in earlier gains. This study sought to identify factors associated with increased PMR. METHODS: Nationally representative data including 31,121 pregnancies of 7 months or longer obtained from the 2013 Nigeria Demographic and Health Survey were used to investigate the community-, socio-economic-, proximate- and environmental-level factors related to perinatal mortality (PM). Generalized linear latent and mixed models with the logit link and binomial family that adjusted for clustering and sampling weights was employed for the analyses. RESULTS: Babies born to obese women (adjusted odds ratio [aOR] = 1.46, 95% confidence interval [CI]: 1.13-1.89) and babies whose mothers perceived their body size after birth to be smaller than the average size (aOR = 1.92, 95% CI: 1.61-2.30) showed greater odds of PM. Babies delivered through caesarean section were more likely to die (aOR = 2.85, 95% CI: 2.02-4.02) than those born through vaginal delivery. Other factors that significantly increased PM included age of the women (≥40 years), living in rural areas, gender (being male) and a fourth or higher birth order with a birth interval ≤ 2 years. CONCLUSIONS: Newborn and maternal care interventions are needed, especially for rural communities, that aim at counselling women that are obese. Promoting well-timed caesarean delivery, Kangaroo mother care of small-for-gestational-age babies, child spacing, timely referral for ailing babies and adequate medical check-up for older pregnant women may substantially reduce PM in Nigeria.


Assuntos
Parto Obstétrico/mortalidade , Morte Perinatal/etiologia , Mortalidade Perinatal/tendências , Complicações na Gravidez/mortalidade , Adulto , Intervalo entre Nascimentos , Cesárea/mortalidade , Demografia , Feminino , Inquéritos Epidemiológicos , Humanos , Recém-Nascido , Modelos Lineares , Masculino , Serviços de Saúde Materna , Mães/estatística & dados numéricos , Nigéria , Obesidade/mortalidade , Razão de Chances , Gravidez , Adulto Jovem
2.
Scand J Trauma Resusc Emerg Med ; 27(1): 37, 2019 Apr 05.
Artigo em Inglês | MEDLINE | ID: mdl-30953532

RESUMO

The aim of this Letter to the Editor was to report some methodological shortcomings in a recently published Article. We proved that the obtained results are subjected to the sparse data bias and presented some remedial tools such as penalization approaches. In addition, model fitting and performance aroused some controversies. In conclusion, the results of this study should be interpreted with caution and further reanalysis is necessary.


Assuntos
Parto Obstétrico/estatística & dados numéricos , Parto Domiciliar/estatística & dados numéricos , Doenças do Recém-Nascido/mortalidade , Nascimento Prematuro/mortalidade , Medição de Risco , Feminino , Seguimentos , Humanos , Recém-Nascido , Irã (Geográfico)/epidemiologia , Mortalidade Perinatal/tendências , Gravidez , Estudos Prospectivos , Fatores de Risco
4.
Glob Health Action ; 12(1): 1581466, 2019.
Artigo em Inglês | MEDLINE | ID: mdl-30849300

RESUMO

BACKGROUND: The collaborative quality improvement approach proposed by the Institute for Healthcare Improvement has the potential to improve coverage of evidence-based maternal and newborn health practices. The Safe Care, Saving Lives initiative supported the implementation of 20 evidence-based maternal and newborn care practices, targeting labour wards and neonatal care units in 85 public and private hospitals in Telangana and Andhra Pradesh, India. OBJECTIVE: We present a protocol for the evaluation of this programme which aims to (a) estimate the effect of the initiative on evidence-based care practices and mortality; (b) evaluate the mechanisms leading to changes in adherence to evidence-based practices, and their relationship with contextual factors; (c) explore the feasibility of scaling-up the approach. METHODS: The mixed-method evaluation is based on a plausibility design nested within a phased implementation. The 29 non-randomly selected hospitals comprising wave II of the programme were compared to the 31 remaining hospitals where the quality improvement approach started later. We assessed mortality and adherence to evidence-based practices at baseline and endline using abstraction of registers, checklists, observations and interviews in intervention and comparison hospitals. We also explored the mechanisms and drivers of change in adherence to evidence-based practices. Qualitative methods investigated the mechanisms of change in purposefully selected case study hospitals. A readiness assessment complemented the analysis of what works and why. We used a difference-in-difference approach to estimate the effects of the intervention on mortality and coverage. Thematic analysis was used for the qualitative data. DISCUSSION: This is the first quality improvement collaborative targeting neonatal health in secondary and tertiary hospitals in a middle-income country linked to a government health insurance scheme. Our process evaluation is theory driven and will refine hypotheses about how this quality improvement approach contributes to institutionalization of evidence-based practices.


Assuntos
Serviços de Saúde Materna/organização & administração , Melhoria de Qualidade/organização & administração , Comportamento Cooperativo , Prática Clínica Baseada em Evidências , Feminino , Humanos , Índia , Recém-Nascido , Relações Interinstitucionais , Serviços de Saúde Materna/normas , Mortalidade Materna/tendências , Mortalidade Perinatal/tendências , Gravidez
5.
Epidemiol Serv Saude ; 28(1): e2018132, 2019 02 18.
Artigo em Inglês, Português | MEDLINE | ID: mdl-30785573

RESUMO

OBJECTIVE: to calculate mortality rates on the first day of life from 2010 to 2015 in eight Brazilian Federative Units providing better quality information, to assess associated factors and to classify deaths by underlying causes and avoidability. METHODS: this was a descriptive study; mortality rates were compared according to maternal and child characteristics; avoidability analysis used the 'Brazilian list of avoidable causes of death'. RESULTS: 21.6% (n=20,791) of all infant deaths occurred on the first day of life; the mortality rate reduced from 2.7 to 2.3 deaths/1,000 live births; rates were higher in live births with low birthweight and preterm births, and among babies born to mothers with no schooling; main causes of death were respiratory distress syndrome (8.9%) and extreme immaturity (5.2%); 66.3% of causes of death were avoidable. CONCLUSION: 2/3 of deaths on the first day of life could have been avoided with adequate care for women during pregnancy and delivery and adequate care for live births.


Assuntos
Causas de Morte , Morte Perinatal , Mortalidade Perinatal/tendências , Nascimento Prematuro/mortalidade , Adulto , Brasil/epidemiologia , Parto Obstétrico/normas , Feminino , Humanos , Lactente Extremamente Prematuro , Recém-Nascido de Baixo Peso , Recém-Nascido , Nascimento Vivo , Masculino , Serviços de Saúde Materna/normas , Morte Perinatal/prevenção & controle , Gravidez , Síndrome do Desconforto Respiratório do Recém-Nascido/epidemiologia , Síndrome do Desconforto Respiratório do Recém-Nascido/mortalidade , Adulto Jovem
6.
BMJ ; 364: l344, 2019 02 20.
Artigo em Inglês | MEDLINE | ID: mdl-30786997

RESUMO

OBJECTIVE: To compare induction of labour at 41 weeks with expectant management until 42 weeks in low risk women. DESIGN: Open label, randomised controlled non-inferiority trial. SETTING: 123 primary care midwifery practices and 45 hospitals (secondary care) in the Netherlands, 2012-16. PARTICIPANTS: 1801 low risk women with an uncomplicated singleton pregnancy: randomised to induction (n=900) or to expectant management until 42 weeks (n=901). INTERVENTIONS: Induction at 41 weeks or expectant management until 42 weeks with induction if necessary. PRIMARY OUTCOME MEASURES: Primary outcome was a composite of perinatal mortality and neonatal morbidity (Apgar score <7 at five minutes, arterial pH <7.05, meconium aspiration syndrome, plexus brachialis injury, intracranial haemorrhage, and admission to a neonatal intensive care unit (NICU). Secondary outcomes included maternal outcomes and mode of delivery. The null hypothesis that expectant management is inferior to induction was tested with a non-inferiority margin of 2%. RESULTS: Median gestational age at delivery was 41 weeks+0 days (interquartile range 41 weeks+0 days-41 weeks+1 day) for the induction group and 41 weeks+2 days (41 weeks+0 days-41 weeks+5 days) for the expectant management group. The primary outcome was analysed for both the intention-to-treat population and the per protocol population. In the induction group, 15/900 (1.7%) women had an adverse perinatal outcome versus 28/901 (3.1%) in the expectant management group (absolute risk difference -1.4%, 95% confidence interval -2.9% to 0.0%, P=0.22 for non-inferiority). 11 (1.2%) infants in the induction group and 23 (2.6%) in the expectant management group had an Apgar score <7 at five minutes (relative risk (RR) 0.48, 95% CI 0.23 to 0.98). No infants in the induction group and three (0.3%) in the expectant management group had an Apgar score <4 at five minutes. One fetal death (0.1%) occurred in the induction group and two (0.2%) in the expectant management group. No neonatal deaths occurred. 3 (0.3%) neonates in the induction group versus 8 (0.9%) in the expectant management group were admitted to an NICU (RR 0.38, 95% CI 0.10 to 1.41). No significant difference was found in composite adverse maternal outcomes (induction n=122 (13.6%) v expectant management n=102 (11.3%)) or in caesarean section rate (both groups n=97 (10.8%)). CONCLUSIONS: This study could not show non-inferiority of expectant management compared with induction of labour in women with uncomplicated pregnancies at 41 weeks; instead a significant difference of 1.4% was found for risk of adverse perinatal outcomes in favour of induction, although the chances of a good perinatal outcome were high with both strategies and the incidence of perinatal mortality, Apgar score <4 at five minutes, and NICU admission low. TRIAL REGISTRATION: Netherlands Trial Register NTR3431.


Assuntos
Plexo Braquial/lesões , Trabalho de Parto Induzido/efeitos adversos , Trabalho de Parto/fisiologia , Conduta Expectante/estatística & dados numéricos , Adolescente , Adulto , Cesárea/métodos , Feminino , Morte Fetal/etiologia , Idade Gestacional , Humanos , Lactente , Mortalidade Infantil/tendências , Unidades de Terapia Intensiva Neonatal/estatística & dados numéricos , Hemorragias Intracranianas/complicações , Hemorragias Intracranianas/epidemiologia , Trabalho de Parto Induzido/métodos , Síndrome de Aspiração de Mecônio/complicações , Síndrome de Aspiração de Mecônio/epidemiologia , Países Baixos/epidemiologia , Avaliação de Resultados (Cuidados de Saúde) , Mortalidade Perinatal/tendências , Gravidez , Risco , Adulto Jovem
7.
Paediatr Perinat Epidemiol ; 33(2): 101-112, 2019 03.
Artigo em Inglês | MEDLINE | ID: mdl-30671994

RESUMO

BACKGROUND: There is a need to reconcile the opposing perspectives of the births-based and fetuses-at-risk models of perinatal mortality and to formulate a coherent and unified perinatal theory. METHODS: Information on births in the United States from 2004 to 2015 was used to calculate gestational age-specific perinatal death rates for low- and high-risk cohorts. Cubic splines were fitted to the fetuses-at-risk birth and perinatal death rates, and first and second derivatives were estimated. Births-based perinatal death rates, and fetuses-at-risk birth and perinatal death rates and their derivatives, were examined to identify potential inter-relationships. RESULTS: The rate of change in the birth rate dictated the pattern of births-based perinatal death rates in a triphasic manner: increases in the first derivative of the birth rate at early gestation corresponded with exponential declines in perinatal death rates, the peak in the first derivative presaged the nadir in perinatal death rates, and late gestation declines in the first derivative coincided with an upturn in perinatal death rates. Late gestation increases in the first derivative of the fetuses-at-risk perinatal death rate matched the upturn in births-based perinatal death rates. Differences in birth rate acceleration/deceleration among low- and high-risk cohorts resulted in intersecting perinatal mortality curves. CONCLUSION: The first derivative of the birth rate links a cohort's fetuses-at-risk perinatal death rate to its births-based perinatal death rate, and cohort-specific differences in birth rate acceleration/deceleration are responsible for the intersecting perinatal mortality curves paradox. This mechanistic explanation unifies extant models of perinatal mortality and provides diverse insights.


Assuntos
Coeficiente de Natalidade/tendências , Morte Perinatal , Mortalidade Perinatal/tendências , Feminino , Idade Gestacional , Humanos , Recém-Nascido , Recém-Nascido Prematuro , Estudos Longitudinais , Gravidez , Natimorto , Análise de Sobrevida , Estados Unidos/epidemiologia
8.
Manag Care ; 27(8): 9-10, 2018 08.
Artigo em Inglês | MEDLINE | ID: mdl-30142071

RESUMO

Given the startling statistic that the rate of women dying of pregnancy-and childbirth-related complications in the United States is increasing, it seems logical that the U.S. health system would focus on improving outcomes in this area of care. But not all health plans address this disparity in health care delivery.


Assuntos
Planos de Assistência de Saúde para Empregados , Serviços de Saúde Materna/organização & administração , Feminino , Humanos , Lactente , Mortalidade Infantil/tendências , Mortalidade Materna/tendências , Mortalidade Perinatal/tendências , Estados Unidos
9.
NCHS Data Brief ; (300): 1-8, 2018 Feb.
Artigo em Inglês | MEDLINE | ID: mdl-29638212

RESUMO

The leading causes of infant death vary by age at death but were consistent from 2005 to 2015 (1-6). Previous research shows higher infant mortality rates in rural counties compared with urban counties and differences in cause of death for individuals aged 1 year and over by urbanization level (4,5,7,8). No research, however, has examined if mortality rates from the leading causes of infant death differ by urbanization level. This report describes the mortality rates for the five leading causes of infant, neonatal, and postneonatal death in the United States across rural, small and medium urban, and large urban counties defined by maternal residence, as reported on the birth certificate for combined years 2013-2015.


Assuntos
Mortalidade Infantil/tendências , População Rural/estatística & dados numéricos , População Urbana/estatística & dados numéricos , Anormalidades Congênitas/mortalidade , Feminino , Humanos , Lactente , Recém-Nascido de Baixo Peso , Recém-Nascido , Masculino , Mortalidade Perinatal/tendências , Gravidez , Complicações na Gravidez/mortalidade , Fatores Socioeconômicos , Morte Súbita do Lactente/epidemiologia , Estados Unidos/epidemiologia , Ferimentos e Lesões/mortalidade
10.
J Glob Health ; 8(1): 010408, 2018 Jun.
Artigo em Inglês | MEDLINE | ID: mdl-29564085

RESUMO

Background: Intrapartum complications increase the risk of perinatal deaths. However, population-based data from developing countries assessing the contribution of intrapartum complications to perinatal deaths is scarce. Methods: Using data from a cohort of pregnant women followed between 2011 and 2013 in Bangladesh, this study examined the rate and types of intrapartum complications, the association of intrapartum complications with perinatal mortality, and if facility delivery modified the risk of intrapartum-related perinatal deaths. Trained community health workers (CHWs) made two-monthly home visits to identify pregnant women, visited them twice during pregnancy and 10 times in the first two months postpartum. During prenatal visits, CHWs collected data on women's prior obstetric history, socio-demographic status, and complications during pregnancy. They collected data on intrapartum complications, delivery care, and pregnancy outcome during the first postnatal visit within 7 days of delivery. We examined the association of intrapartum complications and facility delivery with perinatal mortality by estimating odds ratios (OR) and 95% confidence intervals (CI) adjusting for covariates using multivariable logistic regression analysis. Results: The overall facility delivery rate was low (3922/24 271; 16.2%). Any intrapartum complications among pregnant women were 20.9% (5,061/24,271) and perinatal mortality was 64.7 per 1000 birth. Compared to women who delivered at home, the risk of perinatal mortality was 2.4 times higher (OR = 2.40; 95% CI = 2.08-2.76) when delivered in a public health facility and 1.3 times higher (OR = 1.32, 95% CI = 1.06-1.64) when delivered in a private health facility. Compared to women who had no intrapartum complications and delivered at home, women with intrapartum complications who delivered at home had a substantially higher risk of perinatal mortality (OR = 3.45; 95% CI = 3.04-3.91). Compared to women with intrapartum complications who delivered at home, the risk of perinatal mortality among women with intrapartum complications was 43.0% lower for women who delivered in a public health facility (OR = 0.57; 95% CI = 0.42-0.78) and 58.0% lower when delivered in a private health facility (OR = 0.42; 95% CI = 0.28-0.63). Conclusions: Maternal health programs need to promote timely recognition of intrapartum complications and delivery in health facilities to improve perinatal outcomes, particularly in populations where overall facility delivery rates are low. The differential risk between public and private health facilities may be due to differences in quality of care. Efforts should be made to improve the quality of care in all health facilities.


Assuntos
Parto Obstétrico/estatística & dados numéricos , Complicações do Trabalho de Parto/prevenção & controle , Mortalidade Perinatal/tendências , Adulto , Bangladesh/epidemiologia , Estudos de Coortes , Feminino , Parto Domiciliar/estatística & dados numéricos , Humanos , Recém-Nascido , Complicações do Trabalho de Parto/epidemiologia , Gravidez , Risco , Adulto Jovem
11.
BMJ ; 360: k817, 2018 03 05.
Artigo em Inglês | MEDLINE | ID: mdl-29506980

RESUMO

OBJECTIVE: To examine how the relaxation of the one child policy and policies to reduce caesarean section rates might have affected trends over time in caesarean section rates and perinatal and pregnancy related mortality in China. DESIGN: Observational study. SETTING: China's National Maternal Near Miss Surveillance System (NMNMSS). PARTICIPANTS: 6 838 582 births at 28 completed weeks or more of gestation or birth weight ≥1000 g in 438 hospitals in the NMNMSS between 2012 and 2016. MAIN OUTCOME MEASURES: Obstetric risk was defined using a modified Robson classification. The main outcome measures were changes in parity and age distributions and relative frequency of each Robson group, crude and adjusted trends over time in caesarean section rates within each risk category (using Poisson regression with a robust variance estimator), and trends in perinatal and pregnancy related mortality over time. RESULTS: Caesarean section rates declined steadily between 2012 and 2016 (crude relative risk 0.91, 95% confidence interval 0.89 to 0.93), reaching an overall hospital based rate of 41.1% in 2016. The relaxation of the one child policy was associated with an increase in the proportion of multiparous births (from 34.1% in 2012 to 46.7% in 2016), and births in women with a uterine scar nearly doubled (from 9.8% to 17.7% of all births). Taking account of these changes, the decline in caesarean sections was amplified over time (adjusted relative risk 0.82, 95% confidence interval 0.81 to 0.84). Caesarean sections declined noticeably in nulliparous women (0.75, 0.73 to 0.77) but also declined in multiparous women without a uterine scar (0.65, 0.62 to 0.77). The decrease in caesarean section rates was most pronounced in hospitals with the highest rates in 2012, consistent with the government's policy of targeting hospitals with the highest rates. Perinatal mortality declined from 10.1 to 7.2 per 1000 births over the same period (0.87, 0.83 to 0.91), and there was no change in pregnancy related mortality over time. CONCLUSIONS: China is the only country that has succeeded in reverting the rising trends in caesarean sections. China's success is remarkable given that the changes in obstetric risk associated with the relaxation of the one child policy would have led to an increase in the need for caesarean sections. China's experience suggests that change is possible when strategies are comprehensive and deal with the system level factors that underpin overuse as well as the various incentives at work during a clinical encounter.


Assuntos
Cesárea/tendências , Características da Família , Política de Planejamento Familiar/legislação & jurisprudência , Hospitais/estatística & dados numéricos , Paridade , Adulto , Distribuição por Idade , China/epidemiologia , Parto Obstétrico , Feminino , Humanos , Recém-Nascido , Mortalidade Materna/tendências , Mortalidade Perinatal/tendências , Gravidez , Adulto Jovem
12.
Int J Qual Health Care ; 30(4): 271-275, 2018 May 01.
Artigo em Inglês | MEDLINE | ID: mdl-29385461

RESUMO

Objective: To trace and document smaller changes in perinatal survival over time. Design: Prospective observational study, with retrospective analysis. Setting: Labor ward and operating theater at Haydom Lutheran Hospital in rural north-central Tanzania. Participants: All women giving birth and birth attendants. Intervention: Helping Babies Breathe (HBB) simulation training on newborn care and resuscitation and some other efforts to improve perinatal outcome. Main outcome measure: Perinatal survival, including fresh stillbirths and early (24-h) newborn survival. Result: The variable life-adjusted plot and cumulative sum chart revealed a steady improvement in survival over time, after the baseline period. There were some variations throughout the study period, and some of these could be linked to different interventions and events. Conclusion: To our knowledge, this is the first time statistical process control methods have been used to document changes in perinatal mortality over time in a rural Sub-Saharan hospital, showing a steady increase in survival. These methods can be utilized to continuously monitor and describe changes in patient outcomes.


Assuntos
Asfixia Neonatal/terapia , Tocologia/educação , Mortalidade Perinatal/tendências , Ressuscitação/educação , Adulto , Feminino , Humanos , Lactente , Recém-Nascido , Gravidez , Estudos Prospectivos , Estudos Retrospectivos , Natimorto , Tanzânia , Centros de Atenção Terciária
13.
Enferm. glob ; 17(49): 448-457, ene. 2018. tab, graf
Artigo em Espanhol | IBECS | ID: ibc-169845

RESUMO

Objetivo: Analizar la mortalidad infantil en el estado de Piauí, en el período 2004-2014. Métodos: Estudio epidemiológico, descriptivo, utilizando datos secundarios extraídos de DATASUS, donde la población se compone de todos las óbitos infantiles de madres que viven en Piauí, en el período 2004-2014. Resultados: A pesar de las fluctuaciones, se produjo una disminución en la tasa de mortalidad infantil y sus componentes, neonatal y la mortalidad post-neonatal. Por otra parte, la mayoría de las muertes podrían minimizarse a través de acciones dirigidas a las mujeres durante el embarazo y el parto y el cuidado del recién nacido. Conclusión: Se ha demostrado que existe una necesidad de mejora en la atención a la salud maternoinfantil en Piauí para que la mortalidad infantil alcance niveles de las regiones del mundo más desarrolladas (AU)


Objetivo: Analisar a mortalidade infantil no Estado do Piauí, no período de 2004-2014. Métodos: Estudo epidemiológico, descritivo, com dados secundários extraídos do DATASUS, em que a população foi composta por todos os óbitos infantis de mães residentes no Piauí, no período de 2004-2014. Resultados: Apesar das flutuações, houve declínio no coeficiente de mortalidade infantil e nos seus componentes, neonatal e pós-neonatal. Ademais, a maioria dos óbitos poderia ser minimizada através de ações voltadas à mulher no ciclo gravídico-puerperal e ao recém-nascido. Conclusão: Evidenciou-se que existe a necessidade de melhoria na atenção à saúde materno-infantil no Piauí para que a mortalidade infantil atinja níveis de regiões mundiais mais desenvolvidas (AU)


Objective: To analyze infant mortality in the State of Piauí, during the period 2004-2014. Methods: Epidemiological, descriptive study with secondary data extracted from DATASUS, in which the population was composed of all infant deaths of mothers residing in Piauí, in the period 2004-2014. Results: Despite the fluctuations, there was a decline in the infant mortality coefficient and its components, neonatal and post-neonatal. In addition, most deaths could be minimized through actions directed at women in the pregnancy-puerperal cycle and the newborn. Conclusion: It has been shown that there is a need for improvement in maternal and child health care in Piauí so that infant mortality reaches the levels of more developed world regions (AU)


Assuntos
Humanos , Masculino , Feminino , Recém-Nascido , Lactente , Pré-Escolar , Criança , Mortalidade Infantil/tendências , Mortalidade da Criança/tendências , Mortalidade Perinatal/tendências , Enfermagem Materno-Infantil/métodos , Brasil/epidemiologia , Fatores de Risco
14.
Int J Public Health ; 63(Suppl 1): 63-77, 2018 May.
Artigo em Inglês | MEDLINE | ID: mdl-28776242

RESUMO

OBJECTIVES: Although substantial reductions in under-5 mortality have been observed during the past 35 years, progress in the Eastern Mediterranean Region (EMR) has been uneven. This paper provides an overview of child mortality and morbidity in the EMR based on the Global Burden of Disease (GBD) study. METHODS: We used GBD 2015 study results to explore under-5 mortality and morbidity in EMR countries. RESULTS: In 2015, 755,844 (95% uncertainty interval (UI) 712,064-801,565) children under 5 died in the EMR. In the early neonatal category, deaths in the EMR decreased by 22.4%, compared to 42.4% globally. The rate of years of life lost per 100,000 population under 5 decreased 54.38% from 177,537 (173,812-181,463) in 1990 to 80,985 (76,308-85,876) in 2015; the rate of years lived with disability decreased by 0.57% in the EMR compared to 9.97% globally. CONCLUSIONS: Our findings call for accelerated action to decrease child morbidity and mortality in the EMR. Governments and organizations should coordinate efforts to address this burden. Political commitment is needed to ensure that child health receives the resources needed to end preventable deaths.


Assuntos
Saúde da Criança/economia , Saúde da Criança/tendências , Mortalidade da Criança/tendências , Carga Global da Doença/estatística & dados numéricos , Mortalidade Infantil/tendências , Pré-Escolar , Feminino , Saúde Global , Humanos , Lactente , Recém-Nascido , Masculino , Região do Mediterrâneo/epidemiologia , Oriente Médio/epidemiologia , Morbidade , Mortalidade Perinatal/tendências
15.
J Matern Fetal Neonatal Med ; 31(13): 1748-1755, 2018 Jul.
Artigo em Inglês | MEDLINE | ID: mdl-28532280

RESUMO

OBJECTIVE: To describe fetal and neonatal mortality due to congenital anomalies in Colombia. METHODS: We analyzed all fetal and neonatal deaths due to a congenital anomaly registered with the Colombian vital statistics system during 1999-2008. RESULTS: The registry included 213,293 fetal deaths and 7,216,727 live births. Of the live births, 77,738 (1.08%) resulted in neonatal deaths. Congenital anomalies were responsible for 7321 fetal deaths (3.4% of all fetal deaths) and 15,040 neonatal deaths (19.3% of all neonatal deaths). The fetal mortality rate due to congenital anomalies was 9.9 per 10,000 live births and fetal deaths; the neonatal mortality rate due to congenital anomalies was 20.8 per 10,000 live births. Mortality rates due to congenital anomalies remained relatively stable during the study period. The most frequent fatal congenital anomalies were congenital heart defects (32.0%), central nervous system anomalies (15.8%), and chromosomal anomalies (8.0%). Risk factors for fetal and neonatal death included: male or undetermined sex, living in villages or rural areas, mother's age >35 years, low and very low birthweight, and <28 weeks gestation at birth. CONCLUSIONS: Congenital anomalies are an important cause of fetal and neonatal deaths in Colombia, but many of the anomalies may be preventable or treatable.


Assuntos
Anormalidades Congênitas/mortalidade , Mortalidade Infantil/tendências , Mortalidade Perinatal/tendências , Adulto , Colômbia/epidemiologia , Feminino , Humanos , Lactente , Recém-Nascido de Peso Extremamente Baixo ao Nascer , Lactente Extremamente Prematuro , Recém-Nascido , Masculino , Vigilância da População , Gravidez , Sistema de Registros , Fatores de Risco , População Rural , Fatores Sexuais , Adulto Jovem
16.
Fetal Diagn Ther ; 43(2): 105-112, 2018.
Artigo em Inglês | MEDLINE | ID: mdl-28535541

RESUMO

INTRODUCTION: To evaluate the largest vertical pocket (LVP) of amniotic fluid as a time-dependent factor to predict perinatal mortality in women with early preterm premature rupture of membranes (EPPROM). MATERIAL AND METHODS: Observational cohort study of singleton pregnancies with EPPROM <24 weeks. Termination of pregnancy (TOP) was considered if the LVP was <2 cm at 7 days. The maternal and neonatal characteristics of ongoing pregnancies were recorded. Prediction of perinatal mortality was estimated based on the influence of the LVP as a time-dependent factor after adjustment for maternal age, prior invasive procedure, and gestational age at EPPROM. RESULTS: Of 104 women, 39 requested TOP. Neonatal survival to discharge was 40%, increasing to 74% if pregnancies achieved 24 weeks. LVP at admission <1 cm, latency to delivery, and gestational age at delivery were independent predictors of perinatal mortality. When evaluating the LVP at different time points of gestation, the highest perinatal mortality risk was established at 2 weeks (odds ratio 14.67, p < 0.001) after membrane rupture, being 5.75 (p = 0.05) the week after and 10.93 (p = 0.037) beyond 2 weeks of EPPROM. DISCUSSION: When LVP measurement, gestational age at EPPROM, maternal age, and prior invasive procedure were considered, we found that the worst prognosis related to perinatal mortality was at 2 weeks after EPPROM.


Assuntos
Líquido Amniótico/diagnóstico por imagem , Líquido Amniótico/metabolismo , Ruptura Prematura de Membranas Fetais/diagnóstico por imagem , Ruptura Prematura de Membranas Fetais/metabolismo , Mortalidade Perinatal/tendências , Adulto , Estudos de Coortes , Feminino , Seguimentos , Humanos , Recém-Nascido , Valor Preditivo dos Testes , Gravidez
17.
Fetal Diagn Ther ; 43(2): 123-128, 2018.
Artigo em Inglês | MEDLINE | ID: mdl-28647738

RESUMO

INTRODUCTION: The objectives of this study were to evaluate the outcome of nonimmune hydrops fetalis in an attempt to identify independent predictors of perinatal mortality. MATERIAL AND METHODS: A retrospective cohort study was conducted including all cases of nonimmune hydrops from two tertiary care centers. Perinatal outcome was evaluated after classifying nonimmune hydrops into ten etiological groups. We examined the effect of etiology, site of fluid accumulation, and gestational age at delivery on postnatal survival. Neonatal mortality and hospital discharge survival were compared between the expectant management and fetal intervention groups among those with idiopathic etiology. RESULTS: A total of 142 subjects were available for analysis. Generally, nonimmune hydrops carried 37% risk of neonatal mortality and 50% chance of survival to discharge, which varies markedly based on the underlying etiology. Ascites was an independent predictor of perinatal mortality (p value = 0.003). There was nonsignificant difference in neonatal mortality and hospital discharge survival among idiopathic cases that were managed expectantly versus those in whom fetal intervention was carried out. DISCUSSION: The outcome of nonimmune hydrops varies largely according to the underlying etiology and the presence of ascites is an independent risk factor for perinatal mortality. In our series, fetal intervention did not offer survival advantage among fetuses with idiopathic nonimmune hydrops.


Assuntos
Hidropisia Fetal/diagnóstico por imagem , Hidropisia Fetal/mortalidade , Ultrassonografia Pré-Natal/tendências , Estudos de Coortes , Feminino , Humanos , Hidropisia Fetal/terapia , Recém-Nascido , Mortalidade Perinatal/tendências , Gravidez , Estudos Retrospectivos , Resultado do Tratamento
18.
Ultrasound Obstet Gynecol ; 52(1): 11-23, 2018 07.
Artigo em Inglês | MEDLINE | ID: mdl-29155475

RESUMO

OBJECTIVES: The primary aim of this systematic review was to explore the strength of association between birth-weight (BW) discordance and perinatal mortality in twin pregnancy. The secondary aim was to ascertain the contribution of gestational age and growth restriction in predicting mortality in growth-discordant twins. METHODS: MEDLINE, EMBASE, CINAHL and ClinicalTrials.gov databases were searched. Only studies reporting on the risk of mortality in twin pregnancies affected compared with those not affected by BW discordance were included. The primary outcomes explored were incidence of intrauterine death (IUD), neonatal death (NND) and perinatal death. Outcome was assessed separately for monochorionic (MC) and dichorionic (DC) twin pregnancies. Analyses were stratified according to BW discordance cut-off (≥ 15%, ≥ 20%, ≥ 25% and ≥ 30%) and selected gestational characteristics, including incidence of IUD or NND before and after 34 weeks' gestation, presence of at least one small-for-gestational age (SGA) fetus in the twin pair and both twins being appropriate-for-gestational age. Risk of mortality in the larger vs smaller twin was also assessed. Meta-analyses using individual data random-effects logistic regression and meta-analyses of proportion were used to analyze the data. RESULTS: Twenty-two studies (10 877 twin pregnancies) were included in the analysis. In DC pregnancies, a higher risk of IUD, but not of NND, was observed in twins with BW discordance ≥ 15% (odds ratio (OR) 9.8, 95% CI, 3.9-29.4), ≥ 20% (OR 7.0, 95% CI, 4.15-11.8), ≥ 25% (OR 17.4, 95% CI, 8.3-36.7) and ≥ 30% (OR 22.9, 95% CI, 10.2-51.6) compared with those without weight discordance. For each cut-off of BW discordance explored in DC pregnancies, the smaller twin was at higher risk of mortality compared with the larger one. In MC twin pregnancies, excluding cases affected by twin-twin transfusion syndrome, twins with BW discordance ≥ 20% (OR 2.8, 95% CI, 1.3-5.8) or ≥ 25% (OR 3.2, 95% CI, 1.5-6.7) were at higher risk of IUD, compared with controls. MC pregnancies with ≥ 25% weight discordance were also at increased risk of NND (OR 4.66, 95% CI, 1.8-12.4) compared with those with concordant weight. The risk of IUD was higher when considering discordant pregnancies involving at least one SGA fetus. The overall risk of mortality in MC pregnancies was similar between the smaller and larger twin, except in those with BW discordance ≥ 20%. CONCLUSION: DC and MC twin pregnancies discordant for fetal growth are at higher risk of IUD but not of NND compared with pregnancies with concordant BW. The risk of IUD in BW-discordant DC and MC twins is higher when at least one fetus is SGA. Copyright © 2017 ISUOG. Published by John Wiley & Sons Ltd.


Assuntos
Peso ao Nascer/fisiologia , Retardo do Crescimento Fetal/mortalidade , Morte Perinatal , Mortalidade Perinatal/tendências , Gravidez de Gêmeos , Estatura Cabeça-Cóccix , Feminino , Idade Gestacional , Humanos , Recém-Nascido , Gravidez , Resultado da Gravidez , Ensaios Clínicos Controlados Aleatórios como Assunto , Ultrassonografia Pré-Natal
19.
Ceska Gynekol ; 83(6): 423-433, 2018.
Artigo em Inglês | MEDLINE | ID: mdl-30848147

RESUMO

OBJECTIVE: Comparison of perinatal mortality in Slovak Republic in three periods during the years 2007-2015. DESIGN: Epidemiological perinatal nation-wide. SETTINGS: 1st Department of Gynaecology and Obstetrics Faculty of Medicine, Comenius University and University Hospital, Bratislava, Slovak Republic. METHODS: The analysis of prospectively collected selected perinatal data in the years 2007-2015. RESULTS: In the year 2007 there were 63 obstetrics units, 51,146 deliveries and that of live births 51,650 in Slovak Republic. The number of obstetrics units decreased to 54 in the years 2015, but total number of deliveries increased to 55,139 and that of live births increased to 55,643. Preterm deliveries rate increased from 7.3% in the year 2007 to 8.5% in the year 2010 and decreased to 7.5% in the year 2015. Perinatal mortality rate decreased from 6.2 in the year 2007 to 4.8 in the year 2013, and increased again in the years 2014 and 2015 to 5.3 and 5.6 per 1,000 still- and live-births respectively. During the years 2007-2015 stillbirth participate at perinatal mortality with 64%, low birth weight with 64% and severe congenital anomalies with 20%. Transport in utero to perinatological centres in the years 2007-2015 has increased from 57% to 66% for infants 1000-1499 g and from 75% to 79% for infants below 1000 g. CONCLUSION: In the year 2013 perinatology in Slovak Republic reached the best result in perinatal mortality rate 4.8 (0.48%), but in next two years has increased over 5. Prenatal detection of severe congenital abnormalities, transport in utero very low birth weight infants, centralisation of high-risk pregnancies and obstetric and neonatal intensive care units equipment need still to be improved in Slovak Republic. Keywords perinatal mortality, preterm delivery, multiple pregnancy, neonatal intensive care unit, low birth weight, very low birth weight.


Assuntos
Parto Obstétrico/estatística & dados numéricos , Mortalidade Perinatal/tendências , Natimorto/epidemiologia , Criança , Feminino , Humanos , Recém-Nascido , Recém-Nascido de muito Baixo Peso , Morbidade , Gravidez , Nascimento Prematuro/epidemiologia , Eslováquia
20.
Afr Health Sci ; 18(4): 1214-1225, 2018 Dec.
Artigo em Inglês | MEDLINE | ID: mdl-30766588

RESUMO

Background: Over two-thirds of the five million annual deaths in children under five occur in infants, mostly in developing countries and many after hospital discharge. However, there is a lack of understanding of which children are at higher risk based on early clinical predictors. Early identification of vulnerable infants at high-risk for death post-discharge is important in order to craft interventional programs. Objectives: To determine potential predictor variables for post-discharge mortality in infants less than one year of age who are likely to die after discharge from health facilities in the developing world. Methods: A two-round modified Delphi process was conducted, wherein a panel of experts evaluated variables selected from a systematic literature review. Variables were evaluated based on (1) predictive value, (2) measurement reliability, (3) availability, and (4) applicability in low-resource settings. Results: In the first round, 18 experts evaluated 37 candidate variables and suggested 26 additional variables. Twenty-seven variables derived from those suggested in the first round were evaluated by 17 experts during the second round. A final total of 55 candidate variables were retained. Conclusion: A systematic approach yielded 55 candidate predictor variables to use in devising predictive models for post-discharge mortality in infants in a low-resource setting.


Assuntos
Mortalidade Infantil/tendências , Alta do Paciente/estatística & dados numéricos , Técnicas de Laboratório Clínico/estatística & dados numéricos , Comorbidade , Técnica Delfos , Países em Desenvolvimento , Feminino , Humanos , Lactente , Recém-Nascido , Masculino , Mortalidade Perinatal/tendências , Valor Preditivo dos Testes , Gravidez , Resultado da Gravidez/epidemiologia , Reprodutibilidade dos Testes , Fatores Socioeconômicos
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