Effects of the North Carolina Prematurity Prevention Program among public patients delivering at New Hanover Memorial Hospital.

Twelve per cent of the 847 women who delivered in one hospital prior to implementation of the North Carolina Prematurity Prevention Program had low-birthweight births compared with 9.5 per cent of the 748 women who delivered during the program. Controlling for known risk factors, both low- and very-low birthweight births among Whites (Odds Ratio 2.0 and 3.7 respectively) and very-low-birthweight births among Blacks (OR 2.9) were reduced.     

Hepatitis B Vaccination Coverage among U.S. Adolescents, National Immunization Survey–Teen, 2006

PurposeTo determine national estimates of hepatitis B vaccination among adolescents in the United States and factors associated with vaccination using provider-reported immunization histories.MethodsData were analyzed from the 2006 National Immunization Survey–Teen, a random-digit-dialed telephone survey sampling households with adolescents aged 13–17 years. Provider-reported immunization histories were obtained to determine hepatitis B vaccination coverage.ResultsThe household response rate was 56.2% (n = 5468); provider data was obtained from 52.7% (n = 2882). Overall up-to-date hepatitis B vaccination coverage was 81.3%; older adolescents aged 15–17 years old had lower coverage than younger adolescents aged 13–14 years old, (77.6% vs. 87.1%, p < .05). More than half of the 13–14-year-olds had received vaccination before age 3 years, while 15–17-year-olds received vaccination throughout childhood. Factors associated with vaccination coverage among adolescents 13–14 years old included private health insurance coverage and having a parent-reported health care visit at age of 11–12 years. Factors associated with vaccination coverage among adolescents 15–17 years old included living in the Northeast, having a mother who was married, and having a parent-reported health care visit at 11–12 years.ConclusionsIn 2006, adolescents 15–17 years old had lower hepatitis B vaccination coverage compared to those 13–14 years old. Younger adolescents likely benefited from universal recommendations in 1991 and received hepatitis B vaccination during early childhood. A healthcare visit at age 11–12 years has been recommended by professional organizations and was associated with hepatitis B vaccination in our survey. Parents and providers should routinely review adolescent immunizations.     

Birth rates and reproductive risk in adolescents in Chile, 1990-1999]

OBJECTIVE: For Chilean teenage mothers under 15 years old and from 15 to 19 years old, to evaluate the trends in birth rates and reproductive risk for the period of 1990-1999. METHODS: A database was constructed using data from the Demography Yearbook (Anuario de demografía) volumes published by Chile's National Institute of Statistics (Instituto Nacional de Estadísticas) for 1990-1999. From that database we calculated the trends in the number of live births and in the rates of maternal mortality, late fetal mortality, neonatal mortality, and infant mortality among the teenage mothers under 15 and from 15 to 19 years old. We calculated the risk odds ratio (OR) for both of those age groups in comparison with women from 20 to 34 years old. The groups were compared using Fisher's exact test or the chi-square test, and the analysis of trends in the period studied was carried out with Pearson's correlation, with an alpha level of 0.05. RESULTS: In the period studied, for the teenage mothers under age 15, the respective rates for maternal mortality, late fetal mortality, neonatal mortality, and infant mortality were 41.9 per 100 000 live births, 5.1 per 1 000 live births, 15.2 per 1 000 live births, and 27.4 per 1 000 live births. For the adolescents from 15 to 19 years, the corresponding rates were 19.3, 4.1, 8.1, and 16.6; for the women 20-34 years old, they were 26.8, 5.0, 6.7, and 12.1. The adolescents under 15 had higher risks of maternal mortality (OR = 1.56; 95% confidence interval (CI): 0.50 to 4.31; P = 0.372) and of fetal mortality (OR = 1.02; 95% CI: 0.76 to 1.36; P = 0.890), but those differences were not statistically significant. However, the younger adolescents did have significantly higher risks of neonatal mortality (OR = 2.27; 95% CI: 1.92-2.68; P < 0.0001) and of infant mortality (OR = 2.39; 95% CI: 2.04 to 2.62; P < 0.0001). In comparison to the women 20-34 years old, the teenage mothers from 15 to 19 years old had significantly lower risks of maternal mortality (OR = 0.72; 95% CI: 0.56 to 0.92; P < 0.008) and of fetal mortality (OR = 0.81; 95% CI: 0.77 to 0.86; P < 0.0001) but significantly higher risks of neonatal mortality (OR = 1.20; 95% CI: 1.16 to 1.25; P < 0.0001) and of infant mortality (OR = 1.38; 95% CI: 1.35 to 1.42; P < 0.0001). Among both the older teenage mothers and the mothers 20-34 years old there was a significant downward trend in maternal, fetal, neonatal, and infant mortality rates in the period studied; in the younger adolescents only neonatal mortality and infant mortality declined significantly. There was a rising trend in the number of live births among the two groups of teenage mothers, but that trend was statistically significant only for the mothers under 15; among mothers 20-34 years old there was a statistically significant downward trend. CONCLUSIONS: In the period studied, the Chilean teenage mothers faced greater reproductive risk than did the women 20-34 years old. The number of live births among teenage mothers tended to rise during the 1990-1999 period, but the change was significant only for the mothers under age 15. These results point to the need to develop programs that improve both sex education and birth control practices starting in early adolescence.     

Cost-benefit of a nursing telephone intervention to reduce preterm and low-birthweight births in an African American clinic population

BACKGROUND: A cost-benefit analysis was performed to estimate the cost-savings obtained from a nursing telephone intervention delivered to pregnant women identified as being at risk for preterm or low-birthweight births. METHODS: After being screened for eligibility, a total of 1,554 women receiving prenatal care in a clinic located in Winston-Salem, North Carolina were randomized to intervention and control groups. Women in the intervention group received telephone calls from a registered nurse one or two times each week from the 24th through the 37th week of gestation. RESULTS: No clinical benefits were realized by Caucasian participants. The intervention reduced preterm and low-birthweight births, and resulted in cost savings, for African-American mothers ages 19 and over. No significant differences were seen in the rates of low-birthweight or preterm births and no cost savings were realized from intervention with women ages 18 and younger. CONCLUSIONS: A prenatal nursing support intervention in a clinic population of pregnant African American women was cost-beneficial for these adults (< or =19 years of age).     

Reducing low birthweight by resolving risks: results from Colorado's prenatal plus program

OBJECTIVES: We examined low-birthweight (LBW) rates among participants in Colorado's Prenatal Plus program by prenatal risk factors (smoking, inadequate weight gain during pregnancy, and psychosocial problems) and the effect of successful resolution of these risks during pregnancy. METHODS: Data for 3569 Medicaid-eligible women who received care coordination, nutritional counseling, or psychosocial counseling through the Prenatal Plus Program in 2002 were analyzed to determine the prevalence of specific risks, the proportion of women who resolved each specific risk, and the low birthweight rates for births to women who did and did not resolve risk. LBW rates were analyzed with chi(2) tests of significance. RESULTS: Women who quit smoking had an LBW rate of 8.5%, compared with an LBW rate of 13.7% among women who did not. Women with adequate weight gain had an LBW rate of 6.7%, compared with 17.2% among women with inadequate weight gain. Women who resolved all of their risks had a low-birthweight rate of 7.0%, compared with a rate of 13.2% among women who resolved no risks. Women who had at least 10 Prenatal Plus visits were more likely to resolve their risks than were women who had fewer visits. CONCLUSIONS: Multidisciplinary prenatal interventions targeted toward specific risks demonstrate success at significantly improving infant birthweight.     

Differences in low-birthweight among documented and undocumented foreign-born and US-born Latinas

In the USA foreign-born women tend to have fewer low-birthweight births than US-born women from the same ethnicity. This "healthy migrant" effect could be caused by immigration of the fittest or by healthy people being deliberately selected in the immigration process. This study tests these hypotheses by comparing self-reported history of low-birth-weight among foreign-born documented and undocumented Latinas and US-born Latinas. The sample includes 2398 (57.5%) documented foreign-born Latinas, 782 (18.7%) undocumented foreign-born Latinas, and 993 (23.4%) US-born Latinas who initiated prenatal care at MIC-Women's Health Services/MHRA in New York City during 1996-1997. Only women who reported previous live births were included in the sample. Documented foreign-born Latinas were less likely than US-born Latinas to have low-birth-weight babies taking into account parity, age, risk, and education. There were no significant differences between rates of low-birthweight for undocumented foreign-born Latinas and US-born Latinas, or documented foreign-born Latinas. There was, however, a significant trend for rates of low-birthweight to increase from documented foreign-born to undocumented foreign-born to US-born women. This suggests that both official screening and migration of the fittest play a role in lower rates of low-birthweight among foreign-born Latinas compared to US-born Latinas.     

Maternal smoking and low birthweight in the reproductive history of women in Puerto Rico, 1982.

In 1982, a representative sample of 3,175 women ages 15 to 49 years living in Puerto Rico were interviewed and complete reproductive histories obtained. Births to mothers who started smoking regularly at some time before delivery and who were still smoking at the time of the interview (the exposure definition) were compared with unexposed births. Our analysis of 4,444 single, live births delivered in public and private hospitals from 1946 through 1982 demonstrates that births to smoking women aged 20 and older delivering in public hospitals were 2.5 times more likely to weigh less than 2,500 grams (95% confidence interval (CI) = 1.9, 2.3), and on the average weighed 207 grams less (95% CI = 130, 284) than births to a comparable group of nonsmoking mothers. However, we found no other difference in birthweight between newborns of smoking and nonsmoking women when comparing their births within the same hospital category and age group. The data in this study suggest that the effect of smoking on birthweight among births to Puerto Rican women may be modified by maternal age and by whether the infant was born in a private or public hospital.     

Etiology of Low-Birthweight Birth: A Population-Based Study

Background. Preterm and low-birthweight births remain the major correlates of infant mortality in the United States. The recognition that these births result from varying proximal etiologies is essential to the development of preventive strategies specific to each etiologic group. Methods. Using vital statistics data tapes provided by the North Carolina Center for Health and Environmental Statistics, mothers in 20 counties who delivered infants with birthweights between 1 pound and 5 pounds, 8 ounces were identified. Maternal hospital records of 4,754 women were reviewed for data about prenatal and intrapartal events. Two perinatologists classified births into four proximal etiology groups: term-lowbirthweight, medically indicated preterm birth, preterm premature rupture of membranes, and idiopathic preterm birth. Information from birth certificate and hospital records was merged to provide an expanded data set. Results. Race, age, education, and marital status are associated with different patterns of proximal etiology. Rates were higher for all etiologies in black women and in young women; however, the absolute number of LBW births was highest among white women. Idiopathic preterm birth was highest in black women and decreased as age increased; medical indications for preterm birth increased with increasing age. Conclusions. Classification of LBW births by etiologic group provides insights of value to both clinicians and researchers. Studies in which LBW and/or preterm birth are the outcome variables will be enhanced by identifying etiology. Multiple preventive strategies should address varying etiologic groups.     

Preterm delivery and later maternal cardiovascular disease risk

BACKGROUND: Women who have delivered a preterm infant are at elevated risk for cardiovascular disease (CVD), but mechanisms for this association are not understood. METHODS: In a cross-sectional study we investigated whether older women with a history of preterm birth (<37 weeks) had a higher prevalence of CVD. Participants were 446 women (mean age 80 years; 47% black) enrolled in the Pittsburgh, PA field center of The Health, Aging and Body Composition Study. Women reported preterm status, birth weight, smoking status, and selected complications for each pregnancy. CVD status was determined by self-report and hospital records. Analysis was limited to first births not explicitly complicated by hypertension or preeclampsia. RESULTS: Women who had delivered a preterm infant (on average 57 years in the past) had a higher prevalence of CVD. After adjustment for race, age, blood pressure, pulse wave velocity, interleukin-6, high-density lipoprotein cholesterol, and statin use, the odds ratio for CVD among women who delivered a preterm infant was 2.85 (95% confidence interval = 1.19-6.85) compared with women who had delivered term infants weighing more than 2500 g. This relationship was not altered by lifetime smoking history. There was evidence of negative confounding by statin use and high-density lipoprotein cholesterol. Among women delivering infants who were both preterm and low birth weight (<2500 g), the odds ratio was 3.31 (1.06-10.37) for CVD compared with women with term, normal weight infants. CONCLUSIONS: These results suggest that vascular and metabolic factors account for some but not all of the increased prevalence of CVD among women many years after a preterm birth.     

A plan to prevent adolescent pregnancy and reduce infant mortality

In Illinois, particularly in Chicago, the infant mortality rate is higher than that for the nation as a whole. Unless infant mortality in Illinois declines at a faster rate, the State will not meet the objective for reducing infant mortality specified by the Surgeon General of the Public Health Service. Low birth weight infants are at high risk of medical problems, if not death, and teenage mothers have an increased risk of bearing low birth weight infants. This paper presents a program aimed at the primary prevention of adolescent pregnancy. The three-component, interactive program--sex education, adolescent clinic services, and community support and involvement--is proposed for preventing adolescent pregnancy which, in turn, will decrease the rate of births of low birth weight infants and, consequently, the rate of infant mortality in target areas of Illinois. Medical and college students will be trained to teach the sex education course and to serve as counselors. A clinic will provide primary care, contraceptive education, and access to contraceptives. The clinic staff will be a resource for the community as well as for the adolescents. In the target areas, church and community members will sponsor health fairs and discussions of adolescent pregnancy at church and at parent-teacher association meetings. The overlapping activities of the instructors, clinic personnel, and church and community members will give continuity and consistency to the prevention message directed to the adolescents.     

Self-reported experiences of racial discrimination and Black-White differences in preterm and low-birthweight deliveries: the CARDIA Study

OBJECTIVES: We examined the effects of self-reported experiences of racial discrimination on Black-White differences in preterm (less than 37 weeks gestation) and low-birthweight (less than 2500 g) deliveries. METHODS: Using logistic regression models, we analyzed data on 352 births among women enrolled in the Coronary Artery Risk Development in Young Adults Study. RESULTS: Among Black women, 50% of those with preterm deliveries and 61% of those with low-birthweight infants reported having experienced racial discrimination in at least 3 situations; among White women, the corresponding percentages were 5% and 0%. The unadjusted odds ratio for preterm delivery among Black versus White women was 2.54 (95% confidence interval [CI]=1.33, 4.85), but this value decreased to 1.88 (95% CI=0.85, 4.12) after adjustment for experiences of racial discrimination and to 1.11 (95% CI=0.51, 2.41) after additional adjustment for alcohol and tobacco use, depression, education, and income. The corresponding odds ratios for low birthweight were 4.24 (95% CI=1.31, 13.67), 2.11 (95% CI=0.75, 5.93), and 2.43 (95% CI=0.79, 7.42). CONCLUSIONS: Self-reported experiences of racial discrimination were associated with preterm and low-birthweight deliveries, and such experiences may contribute to Black-White disparities in perinatal outcomes.     

Racial/ethnic differences in the likelihood of cesarean delivery, California.

OBJECTIVES. The purpose of this study was to determine whether women's sociodemographic characteristics are independently associated with cesarean delivery. METHODS. A retrospective review was conducted of hospital discharge data for singleton first births in California in 1991. RESULTS. After insurance and personal, community, medical, and hospital characteristics had been controlled, Blacks were 24% more likely to undergo cesarean delivery than Whites; only among low-birthweight and county hospital births were Blacks not at a significantly elevated risk. Among women who resided in substantially non-English-speaking communities, who delivered high-birthweight babies, or who gave birth at for-profit hospitals, cesarean delivery appeared to be more likely among non-Whites and was over 40% more likely among Blacks than among Whites. CONCLUSIONS. The findings cannot establish causation, but the significant racial/ethnic disparities in delivery mode, despite adjustment for social, economic, medical, and hospital factors, suggest inappropriate influences on clinical decision making that would not be addressed by changes in reimbursement. If practice variations among providers are involved, de facto racial differences in access to optimal care may be indicated. The role of provider and patient attitudes and expectations in the observed racial/ethnic differentials should also be explored.     

State family planning and abortion expenditures: their effect on public health.

OBJECTIVES. This study examines whether state family planning expenditures and abortion funding for Medicaid-eligible women might reduce the number of low-birthweight babies, babies with late or no prenatal care, and premature births, as well as the rates of infant and neonatal mortality. METHODS. Using a pooled time-series analysis from 1982 to 1988 with the 50 states as units of analysis, this study assessed the impact of family planning expenditures and abortion funding on several public health outcomes while controlling for other important variables and statistical problems inherent in pooled time-series studies. RESULTS. States that funded abortions had a significantly higher rate of abortions and significantly lower rates of teen pregnancy, low-birthweight babies, premature births, and births with late or no prenatal care. States that had higher expenditures for family planning had significantly fewer abortions, low-birthweight babies, births with late or no prenatal care, infant deaths, and neonatal deaths. CONCLUSIONS. Funding abortions for Medicaid-eligible women and increasing the level of expenditures for family planning are associated with major differences in infant and maternal health in the United States.     

Pregnancy outcomes of US-born and foreign-born Japanese Americans.

OBJECTIVES: This study investigated the birth outcomes of Japanese Americans, focusing on the role of the mother's place of birth. METHODS: Single live births to US-resident Japanese American mothers (n = 37,941) were selected from the 1983 through 1987 US linked live birth-infant death files. RESULTS: US-born mothers were more likely than foreign-born mothers to be less than 18 years old and not married, to start prenatal care early, and to more adequately use prenatal care. Infants of foreign-born Japanese Americans had a slightly lower risk of low birthweight.No significant differences were found between nativity groups for very low birthweight or neonatal, postneonatal, and infant mortality. The mortality rates of infants of US-born (6.2) and foreign-born (5.4) Japanese American women were below the US Year 2000 objective but still exceeded Japan's 1990 rate (4.6). However, low-birthweight percentages of the US-born group (5.7%) and the foreign-born group (5.0%) were similar to that of Japan (5.5%). CONCLUSIONS: The infants of foreign-born Japanese-American women exhibited modestly better low-birthweight percentages than those of US-born Japanese Americans. This finding supports theories of the healthy immigrant.     

The effect of expanding Medicaid prenatal services on birth outcomes.

OBJECTIVES: Over 80% of US states have implemented expansions in prenatal services for Medicaid-enrolled women, including case management, nutritional and psychosocial counseling, health education, and home visiting. This study evaluates the effect of Washington State's expansion of such services on prenatal care use and low-birthweight rates. METHODS: The change in prenatal care use and low-birthweight rates among Washington's Medicaid-enrolled pregnant women before and after initiation of expanded prenatal services was compared with the change in these outcomes in Colorado, a control state. RESULTS: The percentage of expected prenatal visits completed increased significantly, from 84% to 87%, in both states. Washington's low-birthweight rate decreased (7.1% to 6.4%, P = .12), while Colorado's rate increased slightly (10.4% to 10.6%, P = .74). Washington's improvement was largely due to decreases in low-birthweight rates for medically high-risk women (18.0% to 13.7%, P = .01, for adults; 22.5% to 11.5%, P = .03, for teenagers), especially those with preexisting medical conditions. CONCLUSIONS: A statewide Medicaid-sponsored support service and case management program was associated with a decrease in the low-birthweight rate of medically high-risk women.     

Physical abuse during pregnancy and risk of low-birthweight infants among aborigines in Taiwan

OBJECTIVES: The aim of this study was to assess whether physical abuse during pregnancy is associated with an increased risk of giving birth to a low-birthweight (LBW) infant. STUDY DESIGN AND METHODS: A cross-sectional survey was conducted and 1143 aboriginal women were recruited into this study. The Abuse Assessment Screen was used to collect information regarding maternal physical abuse, and infants' birth weights were obtained from hospital medical records. Multiple logistic regression was used to estimate the association of LBW with physical abuse during pregnancy, adjusting for behavioural and sociodemographic variables. RESULTS: Of the women experiencing physical abuse during their recent pregnancy, 11.76% delivered a LBW infant, compared with 5.78% of women who did not experience physical abuse [odds ratio (OR) 1.97, 95% confidence intervals (CI) 1.07-3.63]. Physical abuse during pregnancy was also significantly associated with low weight gain in the prenatal period. Univariate analysis revealed that delivery of a LBW infant was associated with maternal alcohol use, maternal betel chewing and maternal educational level. Multiple logistic regression was performed, adjusting for prenatal weight gain, maternal height, maternal years of education, maternal alcohol use and maternal betel quid use. It was found that women who reported physical abuse with injuries during pregnancy had a 2.4-fold higher risk of delivering a LBW infant compared with women who did not report physical abuse with injuries (adjusted OR=2.43, 95%CI 1.06-5.55). CONCLUSIONS: These findings suggest that physical abuse during pregnancy is an independent risk factor for delivery of a LBW infant. Prenatal care for aboriginal women should be coupled with routine systematic screening for the presence of abuse during pregnancy, and adequate support and interventions for abused women.     

Moderate alcohol intake during pregnancy and the risk of stillbirth and death in the first year of life

The authors evaluated the association between alcohol intake during pregnancy and risk of stillbirth and infant death in a cohort of pregnant women receiving routine antenatal care at Aarhus University Hospital (Aarhus, Denmark) between 1989 and 1996. Prospective information on alcohol intake, other lifestyle factors, maternal characteristics, and obstetric risk factors was obtained from self-administered questionnaires and hospital files, and 24,768 singleton pregnancies were included in the analyses (116 stillbirths, 119 infant deaths). The risk ratio for stillbirth among women who consumed > or =5 drinks/week during pregnancy was 2.96 (95% confidence interval: 1.37, 6.41) as compared with women who consumed <1 drink/week. Adjustment for smoking habits, caffeine intake, age, prepregnancy body mass index, marital status, occupational status, education, parity, and sex of the child did not change the conclusions, nor did restriction of the highest intake group to women who consumed 5-14 drinks/week (risk ratio = 3.13, 95% confidence interval: 1.45, 6.77). The rate of stillbirth due to fetoplacental dysfunction increased across alcohol categories, from 1.37 per 1,000 births for women consuming <1 drink/week to 8.83 per 1,000 births for women consuming > or = 5 drinks/week. The increased risk could not be attributed to the effect of alcohol on the risk of low birth weight, preterm delivery, or malformations. There was little if any association between alcohol intake and infant death.     

Contraceptive practice among Hispanic adolescents

19% of births to Hispanics in 1980 occurred among women 20 years old, while the out-of-wedlock birth rate among Hispanics aged 15-19 was 40/1000 births (figures for Blacks were 89 and Whites 16/1000). However adolescent pregnancy-related behavior and levels of pregnancy for Hispanics have not been adequately studied. This study is based on data from the 1982 US National Survey of Family Growth. 20% of Hispanic women aged 15-19 are or have been married; 16% are currently living with their spouse or partner; 4% are divorced or separated. The proportion in union is higher than for Whites and Blacks. 30% of Hispanic adolescent women are never-married and have had intercourse, as opposed to 36% of Whites and 55% of Blacks. Although 1/2 of Hispanic women have had sexual experience, only 1/2 are at risk for unintended pregnancy. Almost all sexually active adolescents regardless of race know of the pill; the condom is almost as well known (92% of Hispanics, 95% overall). With most nethods, awareness levels among Hispanics are similar to those among whites. Only 23% of sexually active Hispanic adolescents ever having intercourse used contraception with their 1st intercourse, 1/2 the proportion among Whites. Among sexually active adolescents, 76% of Hispanics and whites, and 83% of Blacks have visited a physician or clinic to discuss or obtain contraceptives. 54% of Hispancis paid for visits with private funds as opposed to 51% overall. 18% of Hispanics' visits were covered by Medicaid. 25% of Hispanics' visits were covered by another program or were free and very few were covered by insurance. It would be useful to differentiate subgroups within the general class of "Hispanics" (i.e. by place of origin, generations in the US), but this was not possible with this small sample.     

Hospital use and health status of women during the 5 years following the birth of a premature, low-birthweight infant.

OBJECTIVE: This study examined the health status and hospital use of women after the birth of a premature, low-birthweight infant. METHODS: The subjects were women with infants who participated in a multisite, randomized trial of an early intervention program. The outcomes examined were (1) a maternal health rating of poor or fair (i.e., poorer health) 5 years following delivery and (2) hospital use for a non-pregnancy-related condition. RESULTS: By the fifth year after delivery, 29.7% of the women had been hospitalized for a non-pregnancy-related condition. Women who reported poorer health status (adjusted relative risk [RR] = 2.39; 95% confidence interval [CI] = 1.86, 3.07) or who had asthma (RR = 2.24; CI = 1.31, 3.80) were at greatest risk. After 5 years, 16.9% of the women said they were in poorer health. The number of intervening years in poorer health (1 year, RR = 3.17; CI = 2.04, 4.94; > 1 year, RR = 8.42; CI = 2.20, 12.88), more than 1 year of poverty (RR = 3.28; CI = 1.90, 5.66), obesity (RR = 3.30; CI = 1.44, 7.55), and more than 1 year of employment (RR = 0.55; CI = 0.36, 0.86) were all significantly associated with poorer health. CONCLUSIONS: The continued, substantial morbidity and hospital use of women with a premature, low-birthweight infant has not previously been reported. This observation needs to be verified.     

Low use of skilled attendants' delivery services in rural Kenya

The aim of the study was to estimate the use of skilled attendants' delivery services among users of antenatal care and the coverage of skilled attendants' delivery services in the general population in Kikoneni location, Kenya. Data collected from the registers at the Kikoneni Health Centre (KHC) from March 2001 through March 2003 were retrospectively reviewed. Antenatal care attendance, deliveries by skilled attendants, and the percentage of antenatal care attendees who delivered in a healthcare facility were assessed. Deliveries at the KHC were compared with expected births in the population to estimate the coverage of deliveries assisted by skilled attendants in the community. Of 994 women who attended the antenatal care clinic, 74 (7.4%) presented for delivery services. 5.4% of expected births in the population occurred in health facilities. The coverage of deliveries assisted by skilled attendants was far below the national and international goals. The use of institutional delivery services was very low even among antenatal care attendees. Targeted programmatic efforts are necessary to increase skilled attendant-assisted births, with the ultimate goal of reducing maternal mortality.