2008-2014年无锡市锡山区5岁以下儿童死因分析

摘要:目的　分析无锡市锡山区2008-2014年5岁以下儿童死亡情况及主要死亡原因,为制定有效干预措施提供科学依据。方法　对无锡市锡山区2008-2014年5岁以下儿童死亡状况、死亡原因及有关因素进行回顾性分析。结果　2008-2014年7年间,无锡市锡山区5岁以下儿童死亡率为4.45‰,前3位死因是早产儿和未成熟儿、溺水、先天性心脏病,57.55%的儿童死在医疗卫生机构,最高诊断机构居前3位的是地市级医院（65例）、卫生院（18例）和省级医院（10例）。结论　降低新生儿和婴儿的死亡率是降低5岁以下儿童死亡率的关键,应加强孕期和儿童保健工作,开展健康教育,提高产科、儿科的技术水平和对贫困家庭儿童的救治。     

西乡县2005至2010年5岁以下儿童死亡分析及干预

目的探讨西乡县5岁以下儿童死亡原因、现状、相关因素变化的趋势与规律，为制定降低5岁以下儿童死亡率和婴儿死亡率的卫生政策提供理论依据。方法对县乡村监测网逐级上报的2005至2010年发生的5岁以下儿童死亡报告卡、死亡补漏及死亡检测资料进行分析。结果5岁以下儿童死亡仍以新生儿、婴儿死亡为主，婴儿死亡占5岁以下儿童死亡的79．11％。在225例死亡儿童中，新生儿死亡113例，占50．22％；婴儿死亡的63．48％。结论实施妇幼公共卫生项目是降低5岁以下儿童死亡率的有力措施之一，降低5岁以下儿童死亡率主要在于降低婴儿死亡率，尤其是降低新生儿死亡率。重视婚前医学检查和围产期保健，加强基层产儿科建设和高危孕产妇的动态管理，提高基层人员对急性呼吸道感染病例的管理，可有效降低新生儿死亡。同时，提高家庭安全教育意识，也是降低5岁以下儿童死亡的重要工作。     

高死亡率地区早产儿死亡的路径分析

目的了解高死亡率地区早产儿死亡的死亡路径及就医情况。方法采用典型抽样的方法在新生儿高死亡率地区的4个县开展调查,对死亡早产儿的看护人进行一对一的问卷调查。结果266例新生儿死亡中有110例（41．4％）为早产儿,这些早产儿平均死亡年龄为2．5天。89．1％的早产儿出生在医疗机构,但是大部分死于家中（45．4％）,其次是县级医疗机构（27．3％）。结论加强孕期保健工作,预防早产发生,提高县级医疗机构对早产儿的护理和抢救水平是降低早产儿死亡率的主要措施。     

Infant mortality in Guatemala: an epidemiological perspective

Infant mortality is a major health problem in Guatemala where it accounts for for 25% of all registered deaths or 75 deaths for every 1000 livebirths. Infection and malnutrition are the main causes of infant death. Risk factors for death during infancy include low birthweight, high birth order, Indian race, rural residence, and lack of maternal education, with wide differences in risk among population subgroups. Intervention studies have shown that a simplified medical system relying on local personnel with limited training, combined with nutritional supplements for mothers and infants at high risk, can substantially reduce infant mortality at a reasonable cost. Lessons learned from Guatemala can be applied to much of the developing world.     

Allocation of health care resources in the state of Santa Catarina, Brazil: a contribution to a discussion on health financing]

OBJECTIVE: To describe the health situation in municipalities in the state of Santa Catarina, Brazil, in 1996, and to investigate how that correlated with federal health spending in 1997. METHODS: Multiple regression analysis was used to investigate the association between federal health care funding and proportional mortality, supply of health services (hospitals and outpatient clinics), and the municipality's population (number of inhabitants). Also investigated was the association between mortality from broad groups of causes and socioeconomic structure, supply of health services, and the municipality's population. RESULTS: The multiple regression analysis showed an association between proportional mortality due to: 1) infectious diseases and: infant mortality, number of non-doctor medical professionals per 10,000 inhabitants, and number of physicians per 10,000 inhabitants (negative association); 2) chronic degenerative diseases and: percentage of individuals 60 years and older, infant mortality (negative association), and number of non-doctor medical professionals per 10,000 inhabitants (negative association); and 3) external causes of death and: the municipality's population, number of hospitals per 10,000 inhabitants (negative association), and percentage of children younger than 1 year. Health spending per inhabitant in 1997 was mainly associated with the municipality's population, number of outpatient clinics per 10,000 inhabitants, Swaroop and Uemura mortality rate, and deaths due to chronic degenerative diseases in 1996. CONCLUSIONS: Municipalities with a better morbidity and mortality profile and a better health services structure received more federal health care resources. To improve this situation, special strategies should be considered in order to ensure additional resources for municipalities that have poorer health indicators.     

西藏山南市藏区2013－2018年5岁以下儿童死亡原因分析及对策研究

目的 分析山南市藏区5岁以下儿童死亡率、死亡原因、地域分布、时间分布、医疗服务及构成,为控制藏区5岁以下儿童死亡提供科学决策依据。 方法 收集2013－2018年山南市藏区5岁以下儿童死亡资料,根据藏区海拨高度分区,利用构成比、卡方检验等方法分析死亡情况、死因构成。 结果 6年间山南市藏区5岁以下儿童死亡率总体呈下降趋势(χ²=62.963、P=0.000)。5岁以下儿童死亡中以婴儿为主,占92.10%,新生儿死亡则占婴儿死亡的62.38%;男、女童死亡率分别为11.18‰、11.27‰;高海拔地区儿童死亡率11.33‰,沿雅江地区儿童死亡率11.15‰;死亡季节以一季度最高;5岁以下儿童前3位主要死因依次为出生窒息、早产或低出生体重、肺炎;5岁以下儿童死亡地点以医院为主占53.86%,死前治疗占81.76%,死亡出生地点省(市)、县占87.54%。 结论 2013－2018年山南市藏区5岁以下儿童死亡率呈逐年下降趋势,死亡年龄段以婴儿为主,死亡季节以一季度最高。加强新生儿窒息复苏培训,关注高海拔地区5岁以下儿童死亡,提高省(市)、县医疗保健机构助产技术,加强围生期保健工作,防治早产和低出生体重、重点关注一季度死亡,是控制山南市5岁以下儿童死亡率的关键。     

The role of the midwife

The role of midwife is unique in the care and treatment of a mother and child throughout the birth process; the role is comprehensive and involves education, treatment, and collaboration with a more skilled medical team. The Safe Motherhood Initiative of 1987 aimed at a 50% reduction in maternal mortality by the year 2000. The root causes of maternal mortality were identified as poverty, low status of women, female illiteracy, inadequate primary health care, poor communication networks, and harmful traditional practices in, for instance, childbirth or circumcision. The estimate of mortality due to poor delivery practices was over 110 maternal deaths/100,000 live births. Females with frequent pregnancies, prolonged lactation, heavy work, and local food taboos were at greater risk. About 40-60% of death to women aged 15-34 years was attributed to pregnancy and childbirth. The medical complications precipitating death, hemorrhage, hypertension, and infection, were also the major causes of mortality related to abortion. Women under 20 years old were at greater risk of anemia and preeclampsia. The midwife must be prepared for all emergencies, including medical factors such as obstetric complications, referral problems such as transportation inadequacies, and belief factors such as fear of hospitals. Specific actions that can reduce maternal mortality include training midwives and delivery personnel; increasing the availability of blood supplies and well-equipped hospitals and clinics; and providing grassroots health education. Traditional practices, such as confining new mothers indoors for the first 40 days or more, may contribute to thromboembolism. Risk can be reduced by frequent consultations with health workers during pregnancy, using a trained attendant at every birth, being aware of danger signs, spacing pregnancies over two years apart, avoiding pregnancies at young or old ages, maintaining proper nutrition and work load, and involving midwives at all levels of care.     

中国1岁以下儿童死因分析

目的:了解1岁以下儿童的主要死因,以采取措施,降低婴儿期死亡率。方法:对2005年中国卫生统计年鉴资料中的1岁以下儿童死亡资料进行分析。结果:2004年中国城乡1岁以下儿童首位死因为新生儿病,占1岁以下儿童死亡的1/2以上;先天异常是第2位死因。新生儿病、损伤和中毒、呼吸系病死亡率农村高于城市;肿瘤、先天异常死亡率城市较农村高。结论:改善农村医疗卫生保健条件;加强孕期、围产期保健工作,降低新生儿病死亡率;通过遗传咨询、产前诊断和选择性终止妊娠预防先天异常的发生;加强宣传教育,预防儿童损伤和中毒的发生,可降低婴儿期死亡率。     

Trends in preterm-related infant mortality by race and ethnicity, United States, 1999-2004.

Trends in preterm-related causes of death were examined by maternal race and ethnicity. A grouping of preterm-related causes of infant death was created by identifying causes that were a direct cause or consequence of preterm birth. Cause-of-death categories were considered to be preterm-related when 75 percent or more of total infant deaths attributed to that cause were deaths of infants born preterm, and the cause was considered to be a direct consequence of preterm birth based on a clinical evaluation and review of the literature. In 2004, 36.5 percent of all infant deaths in the United States were preterm-related, up from 35.4 percent in 1999. The preterm-related infant mortality rate for non-Hispanic black mothers was 3.5 times higher and the rate for Puerto Rican mothers was 75 percent higher than for non-Hispanic white mothers. The preterm-related infant mortality rate for non-Hispanic black mothers was higher than the total infant mortality rate for non-Hispanic white, Mexican, and Asian or Pacific Islander mothers. The leveling off of the U.S. infant mortality decline since 2000 has been attributed in part to an increase in preterm and low-birthweight births. Continued tracking of preterm-related causes of infant death will improve our understanding of trends in infant mortality in the United States.     

Risk-factors for antepartum fetal deaths in the city of São Paulo, Brazil

OBJECTIVE: To assess risk factors for antepartum fetal deaths. METHODS: A population-based case-control study was carried out in the city of S?o Paulo from August 2000 to January 2001. Subjects were selected from a birth cohort from a linked birth and death certificate database. Cases were 164 antepartum fetal deaths and controls were drawn from a random sample of 313 births surviving at least 28 days. Information was collected from birth and death certificates, hospital records and home interviews. A hierarchical conceptual framework guided the logistic regression analysis. RESULTS: Statistically significant factors associated with antepartum fetal death were: mother without or recent marital union; mother's education under four years; mothers with previous low birth weight infant; mothers with hypertension, diabetes, bleeding during pregnancy; no or inadequate prenatal care; congenital malformation and intrauterine growth restriction. The highest population attributable fractions were for inadequacy of prenatal care (40%), hypertension (27%), intrauterine growth restriction (30%) and absence of a long-standing union (26%). CONCLUSIONS: Proximal biological risk factors are most important in antepartum fetal deaths. However, distal factors - mother's low education and marital status - are also significant. Improving access to and quality of prenatal care could have a large impact on fetal mortality.     

2013-2017年余姚市5岁以下儿童死亡分析

  目的  分析2013-2017年余姚市5岁以下儿童死亡现状及主要死因,为制定相关干预措施提供科学依据。  方法  收集2013-2017年余姚市5岁以下儿童死亡监测资料,应用SPSS 18.0软件对5岁以下儿童的死亡趋势、死因顺位、地区差异和死前医疗保健服务利用情况等进行回顾性分析。  结果  2013-2017年余姚市新生儿、婴儿、1~4岁儿童、5岁以下儿童死亡率（under 5 mortality rate,U5MR）均有下降趋势（P=0.016,0.002,0.038,＜0.001）。监测死亡病例263例,5岁以下儿童死亡以婴儿为主,占68.82%（181/263）,先天畸形和意外伤害是5岁以下儿童主要死因。5岁以下儿童死亡地点以医疗机构为主,且93.54%的儿童接受过死前治疗,男童死亡率10.50‰,是女童死亡率的1.54倍（χ2=11.693,P<0.001）。经趋势χ2检验发现,5年来本地人口U5MR无明显下降趋势（χ_趋势2=0.195,P=0.658）,而流动人口U5MR波浪式下降趋势明显（χ_趋势2=17.706,P<0.001）。  结论  降低余姚市U5MR的关键是降低婴儿死亡率,而死亡干预的重点内容是预防先天畸形及意外伤害。继续做好妇幼保健工作和大力开展流动儿童安全教育是降低U5MR的两项有效举措。     

Infant mortality reviews in the Aberdeen Area of the Indian Health Service: strategies and outcomes

OBJECTIVE: To determine cause and manner of death for consecutive infant deaths in the Aberdeen Area of the Indian Health Service (AAIHS) from 1998 to 2002 and to identify risk markers for infant mortality. METHODS: Infant deaths in the AAIHS were identified from four data sources: death certificates from the four states in the AAIHS, deaths reported by local IHS Service Units, from obituaries in local and regional newspapers, and deaths reported by area hospitals. Each infant death is then sent to the local IHS service unit for review, where data from the infant and mother's chart is extracted and recorded. Local community factors, birth and death certificates, and autopsy reports are collected. The case is then reviewed at the Perinatal Infant Mortality Review (PIMR) meeting and a cause and manner of death is assigned. Summary data for the cohort was examined and then compared by mortality category and three age-at-death groups. RESULTS: Sudden infant death syndrome accounted for 33% of all infant deaths in the AAIHS. Prematurity was the second most prevalent cause-specific mortality category, accounting for 22% of all infant deaths. The authors found that infant mortality was surprisingly recurrent, with 32% of mothers of this infant having had a previous infant death. CONCLUSIONS: The PIMR committee requires substantial resources to support a review committee with appropriate expertise and their travel. Participation of local IHS staff and tribal members provides an important cultural and community perspective for the review process. Quality improvement changes are currently being implemented. These include increasing data on substance use, mental health needs, and reviews of fetal deaths. The process of mortality review has been very helpful in public education in the AAIHS.     

Perinatal mortality and evitability: a review

This is a literature review onperinatal mortality focusing its evitability. A Medline and Lilacs (Latin-America and Caribbean) search was conducted for the 90s. There are few research studies on this subject in Brazil due to the great number of underreported fetal deaths and the low quality information provided in death certificates. Different proposals for perinatal death classification are presented. Most are based on grouping the underlying causes of deaths in a functional system in order to facilitate the analysis. In the Wigglesworth classification system, one of the most recommended methods, deaths are related to the different stages of care for pregnant women and children, evidencing the possibilities of their prevention. The evitability approach of perinatal deaths in Brazil is highly recommended, as mortality rates are still very high and most of the deaths are considered avoidable. Premature deaths could be avoided improving the quality of health care. Besides improving the medical assistance, the organization of health care regarding pre-natal, birth and neonatal care must also be better developed to ensure access to qualified assistance.     

Evaluation of health care by means of infant death investigation

All deaths of children under one year of age and residing in the Pau da Lima Health District, in the city of Salvador, Bahia, Brazil, during the year 1991 were investigated through home visits and analysis of patient files. The study measured effectiveness of health services by verifying potentially avoidable deaths and the level of medical care these children received. More than half of the total of 47 deaths were related to causes considered amenable to prompt action by health services; 10 (21.3%) of the deaths occurred at home or in public (outside of health care facilities). Loss of information occurred in 36 (76.6%) of the mother's interviews, related to incomplete information on the death certificate and to changes of address. Analysis of patient files in the health clinics showed a 58.3% loss of information, indicating low-quality organization of hospital statistics; there was a prevalence of consultations classified as inadequate or barely adequate, due mainly to problems with physical examination and treatment. Despite this study's operational limitations, the results point to problems of access, effectiveness, and adequacy in the health care process.     

Child mortality in the developing countries of Africa

Infant mortality statistics in developing African countries are reviewed. According to the World Health Organization (WHO) surveys, there was an overall decrease in infant mortality from 1960-1986, although the infant mortality rate in the African region remains higher than in other WHO regions (119.4, compared with 40.6 in the European region, 11.8 in the Eastern Mediterranean region, 110.2 in the South- Eastern Asia, 49.7 in the American Region, and 44.5 in the Western part of the Pacific ocean). In infants younger than 28 days old, mortality is associated with pregnancy and labor complications, congenital birth defects, and birth trauma. In Algeria, Sierra Leone, Nigeria, Mozambique, Malawi, and Zimbabwe, 70-90% of all deaths were caused by tetanus (70-80% of African women give birth at home without any medical help). In a 1 month to 1 year old age group, the leading cause of mortality is diarrhea (52% in Sudan, 29.2% in Sierra Leone); other causes of death are measles (15.8%), acute respiratory diseases (14.3%), malaria (8.5%), and infectious meningitis (6%). In a 1-4 years old age group, leading cause of mortality is nutritional deficiencies (9%). In addition to medical causes, infant mortality is also associated with a number of socioeconomic factors: insufficient nutrition of mothers, heavy physical work during pregnancy, young age of mothers and short interval between pregnancies, lack of proper medical care during pregnancy and labor, and early switching to infant formula not following proper hygienic recommendations.     

Infant mortality in three population-based cohorts in Southern Brazil: trends and differentials

We studied time trends in infant mortality and associated factors between three cohort studies carried out in Pelotas, Rio Grande do Sul State, Brazil, in 1982, 1993, and 2004. All hospital births and deaths were determined by means of regular visits to hospitals, registrar's offices, and cemeteries. This data was used to calculate neonatal, post-neonatal, and infant mortality rates per thousand live births. Rates were also calculated according to cause of death, sex, birth weight, gestational age, and family income. The infant mortality rate fell from 36.4 per 1,000 live births in 1982 to 21.1 in 1993 and 19.4 in 2004. Major causes of infant mortality in 2004 were perinatal causes and respiratory infections. Mortality among low birth weight children from poor families fell 16% between 1993 and 2004; however, this rate increased by more than 100% among high-income families due to the increase in the number of preterm deliveries in this group. The stabilization of infant mortality in the last decade is likely to be due to excess medical interventions relating to pregnancies and delivery care.     

Persistent and acute diarrhoea as the leading causes of child mortality in urban Guinea Bissau.

An investigation of child mortality in a semi-urban community, Bandim II, in the capital of Guinea Bissau was carried out from April 1987 to March 1990. 153 deaths were recorded among 1426 live-born children who were followed for 2753 child-years. The under-five mortality risk was 215 per 1000 children (95% confidence interval [CI] 176-264), infant mortality 94 per 1000 (95% CI 73-115), and perinatal mortality 52 per 1000 (95% CI 41-63). By prospective registration of morbidity, post-mortem interviews, and examination of available hospital records, a presumptive cause of death was established in 86% of the deaths. Persistent and acute diarrhoea were the most frequent causes of death, accounting for 43 and 31 deaths per 1000 children, respectively. Fever deaths (possibly malaria), neonatal deaths, acute respiratory infections, and measles were other frequent causes. The access to health services was relatively easy: 75% of the children who died had attended for treatment at a hospital or a health centre. It is important to find ways of preventing and managing persistent diarrhoea, the major cause of death, and to improve the control of acute diarrhoea by a targeted approach.