Syphilis-associated perinatal and infant mortality in rural Malawi.

In Mangochi District, a rural area of Malawi, the prevalence of active syphilis was 3.6% among 3591 women who had singleton births and who were negative for human immunodeficiency virus (HIV). Compared with non-syphilitic women, those with active syphilis (positive Venereal Disease Research Laboratory/rapid plasmin reagin tests (titre > or = 1:8) and a reactive microhaemagglutination assay) were more likely to experience stillbirths as well as the early and late neonatal deaths and even postneonatal deaths of their children. Characteristics associated with active syphilis were not very useful in targeting women at high risk of having the condition, which makes universal screening in antenatal programmes the most efficacious way to prevent syphilis-associated morbidity and mortality. The potential for a programme to prevent congenital syphilis in the perinatal, neonatal, and post-neonatal periods is evident. In considering resource allocation to child survival programmes in areas where the prevalence of syphilis is high, officials need to include antenatal syphilis screening, using rapid tests and treatment at the first contact of the mother with the health care system.     

Perinatal and infant mortality rates and place of birth in Italy, 1980.

In 1980, the ratio of home birth to public hospital perinatal and neonatal mortality rates decreased from Northern to Southern Italy, being inversely related to the proportion of home deliveries and probably reflecting the effect of planned versus unplanned home births. The post neonatal mortality rate in Southern Italy was about four times as high in children born at home (9.5/1,000 live births) than in those delivered in public hospitals (2.6/1,000 live births), probably reflecting differences in the socioeconomic status according to the birthplace selection in various regions.     

Trends in perinatal, neonatal and postneonatal mortality in Italy, 1955-84

Trends in stillbirth rates, perinatal, neonatal and postneonatal mortality in Italy over the perrod 1955–84 were analyzed. There was a 75% reduction (from 28.4 to 7.1/1000 births) in stillbirth rates, and a nearly 70% fall (from 46.2 to 14.5/1000 births) in overall perinatal mortality (from the 180th day of pregnancy to the first week of life). Further, mortality rates from the 8th to the 28th day of life dropped from 7.4 to 1.6/1000 livebirths, and mortality from the second month to the first year of life from 25.1 to 2.2/1000 livebirths. The fall in stillbirth rates was similarly evident across various indicators of maternal education and social class, and could only marginally be accounted for by changes in maternal age distribution. The causes of this large drop in perinatal, neonatal and postneonatal mortality are likely to be numerous and complex. In the absence of any comprehensive program of rationalization of obstetrical and neonatal care, a determinant role must have been played by a general improvement in economic and cultural conditions. However, the observation that decreased perinatal mortality was not due to a decline in the proportion of low birth weight indicates that improved perinatal care may have had an important role as well.Although the decrease in various measures of perinatal and postneonatal mortality in Italy was proportionally comparable with that registered in several other developed countries, Italian perinatal mortality rates (14.5/1000 births in 1984) still appear considerably higher than in other countries, and are clearly far from the optimal theoretical value.

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Entwicklung der perinatalen, neonatalen und postneonatalen Sterblichkeit in Italien von 1955 bis 1984

Zusammenfassung Analysiert wurden die Entwicklung der Totgeburtenziffer und der perinatalen, neonatalen und der postneonatalen Sterblichkeit in Italien zwischen 1955 und 1984. Für die Totgeburtenziffer wurde ein Rückgang von 75% (von 28,4 auf 7,1), für die perinatale Sterblichkeit von 70% beobachtet (von 46,2 auf 14,5). Die Sterblichkeit zwischen dem 8. und 28. Lebenstag ist von 7,4 auf l,6, die Sterblichkeit in der Zeit vom 2. Monat bis zum Ende des ersten Lebensjahres von 25,1 auf 2,2 gefallen. Der Rückgang der Totgeburten findet sich bei den Müttern unterschiedlicher Ausbildungsgrade und verschiedener soziokultureller Schichten gleichermassen und dann durch eine Veränderung in der Altersstruktur der Mütter nur teilweise erklärt werden. Die Gründe für diesen bemerkenswerten Rückgang der perinatalen, neonatalen und postneonatalen Sterblichkeit dürften zahlreich und komplex sein. Da es kein Programm zur Verbesserung der geburtshilflichen und neonatalen Pflege gibt, liegt die Vermutung nahe, dass die allgemeine Veränderung der wirtschaftlichen und sozialen Bedingungen eine entscheidende Rolle gespielt hat. Die Tatsache allerdings, dass der Abfall der perinatalen Sterblichkeit nicht auf einer Abnahme des Anteils von Kindern mit niedrigem Geburtsgewicht beruht, zeigt, dass die verbesserte perinatale Pflege ebenfalls von Bedeutung ist. Obwohl der Rückgang der perinatalen und postneonatalen Sterblichkeit in Italien vergleichbar ist mit jenem in anderen entwickelten Ländern, ist die neonatale Sterblichkeit (14,5 im Jahre 1984) doch noch beträchtlich höher als in anderen Ländern und weit von den Idealwerten entfernt.

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Evolution des mortalités périnatale, néonatale et postnéonatale en Italie, 1955–1984

Résumé Les évolutions de la mortinatalité et des mortalités périnatale, néonatale et postnéonatale en Italie entre 1955 et 1984 ont été analysées. La mortinatalité a été réduite de 75% (de 28,4 à 7,1) et la mortalité périnatale de 70% (de 46,2 à 14,5). Les taux de mortalité entre le 8^c et le 28^c jour de vie sont tombés de 7,4 à 1,6, et la mortalité entre le deuxième mois et la fin de la première année de vie de 25,1 à 2,2. La chute de la mortinatalité est semblable parmi les différentes strates du niveau d'éducation maternel et de la classe sociale, et le changement de la distribution des âges maternels n'influe que marginalement dans cette évolution. Les raisons de cette importante chute des mortalités périnatale, néonatale et postnéonatale sont vraisemblablement nombreuses et complexes. L'absence de tout programme explicite d'amélioration des soins obstétricaux et néonatals rend vraisemblable le rôle déterminant qu'a dû jouer l'amélioration générale des conditions économiques et culturelles. Cependant, le fait que la chute de la mortalité périnatale n'est pas attribuable à une diminution de la proportion des faibles poids de naissance indique qu'une amélioration des soins périnataux a pu également jouer un rôle important. Bien que cette évolution favorable des mortalités périnatale et postnéonatale en Italie soit comparable à celles observées dans d'autres pays développés, les taux italiens de mortalité périnatale (14,5 en 1984) sont considérablement plus hauts que ceux d'autres pays et clairement loin d'avoir atteint une valeur optimale.

     

Trends in perinatal,neonatal and postneonatal mortality in Italy, 1955–84

Trends in stillbirth rates, perinatal, neonatal and postneonatal mortality in Italy over the perrod 1955–84 were analyzed. There was a 75% reduction (from 28.4 to 7.1/1000 births) in stillbirth rates, and a nearly 70% fall (from 46.2 to 14.5/1000 births) in overall perinatal mortality (from the 180th day of pregnancy to the first week of life). Further, mortality rates from the 8th to the 28th day of life dropped from 7.4 to 1.6/1000 livebirths, and mortality from the second month to the first year of life from 25.1 to 2.2/1000 livebirths. The fall in stillbirth rates was similarly evident across various indicators of maternal education and social class, and could only marginally be accounted for by changes in maternal age distribution. The causes of this large drop in perinatal, neonatal and postneonatal mortality are likely to be numerous and complex. In the absence of any comprehensive program of rationalization of obstetrical and neonatal care, a determinant role must have been played by a general improvement in economic and cultural conditions. However, the observation that decreased perinatal mortality was not due to a decline in the proportion of low birth weight indicates that improved perinatal care may have had an important role as well. Although the decrease in various measures of perinatal and postneonatal mortality in Italy was proportionally comparable with that registered in several other developed countries, Italian perinatal mortality rates (14.5/1000 births in 1984) still appear considerably higher than in other countries, and are clearly far from the optimal theoretical value.     

Influence of socioeconomic and health care development on infant and perinatal mortality in Spain 1975-86.

STUDY OBJECTIVE--This study aimed to analyse the influence of social, economic, and health development on infant and perinatal mortality in Spain between 1975 and 1986, and to identify possible changes in these relationships over time. DESIGN--Study of the association between mortality and a range of variables. SETTING--50 Spanish provinces. MEASUREMENTS AND MAIN RESULTS--Mean infant and perinatal mortality were estimated for two periods--1975-8 and 1983-6. Social, economic, and health care indicators were collected as independent variables for these two periods. The rates of variation between periods were estimated for each variable. Multiple linear regression models were used to define the association between infant and perinatal mortality and their respective rate of variation with the former indicators. Mean familial income was the main predictive factor for infant and perinatal mortality in the first period but in the second period health care indicators were more relevant. CONCLUSIONS--The reduction in Spanish infant and perinatal mortality over the period can be attributed mainly to the improvement in prenatal and neonatal health care in Spain in recent years, while economic factors seem less important.     

Why are Thai official perinatal and infant mortality rates so low?

The accuracy of perinatal and infant mortality rates in most developing countries is questionable. We measured perinatal and infant mortality rates in a rural district of Thailand and compared them with the official statistics to assess accuracy. All births and infant deaths in a rural district of Thailand over a one-year period were surveyed. The corresponding official statistics were also collected. The mothers or the relatives of all stillbirths and infant deaths were interviewed about the registration of the stillbirths or infant deaths. The surveyed perinatal and infant mortality rates were 22.0 and 23.1 respectively. The under-registration of stillbirths was 100% and for infant deaths 45%. All the non-registered infant deaths were in situations in which the infant died before the registration of birth. These results document the degree and nature of under-reporting of perinatal and infant mortality in rural Thailand.     

Determinants of within-country variation in traffic accident mortality in Italy: a geographical analysis

Objective  

To identify determinants of regional differences in traffic accident mortality in Italy.     

Socio-economic factors associated with infant mortality in Italy: an ecological study

ABSTRACT: INTRODUCTION: One issue that continues to attract the attention of public health researchers is the possible relationship in high-income countries between income, income inequality and infant mortality (IM). The aim of this study was to assess the associations between IM and major socio-economic determinants in Italy. METHODS: Associations between infant mortality rates in the 20 Italian regions (2006-2008) and the Gini index of income inequality, mean household income, percentage of women with at least 8 years of education, and percentage of unemployed aged 15-64 years were assessed using Pearson correlation coefficients. Univariate linear regression and multiple stepwise linear regression analyses were performed to determine the magnitude and direction of the effect of the four socio-economic variables on IM. RESULTS: The Gini index and the total unemployment rate showed a positive strong correlation with IM (r=0.70; p<0.001 and r=0.84; p<0.001 respectively), mean household income showed a strong negative correlation (r=-0.78; p<0.001), while female educational attainment presented a weak negative correlation (r=-0.45; p<0.05). Using a multiple stepwise linear regression model, only unemployment rate was independently associated with IM (b=0.15, p<0.001). CONCLUSIONS: In Italy, a high-income country where health care is universally available, variations in IM were strongly associated with relative and absolute income and unemployment rate. These results suggest that in Italy IM is not only related to income distribution, as demonstrated for other developed countries, but also to economic factors such as absolute income and unemployment. In order to reduce IM and the existing inequalities, the challenge for Italian decision makers is to promote economic growth and enhance employment levels.     

Birthweight and relationship with infant, child and adult mortality in the Jerusalem perinatal study

There is growing evidence that several chronic adult diseases, such as coronary heart disease and stroke, can result from events occurring in fetal life. The aim of this study was to examine the relation between birthweight and all-cause mortality in young adults. We studied total mortality in a population-based cohort of 80 936 offspring born in Jerusalem in 1964-76. During an average follow-up of 28.8 years 2 324 984 person-years were contributed and 2092 deaths occurred. Overall, in both genders, the univariable and the multivariable Cox-proportional hazard models indicated a strong negative relationship between birthweight and total mortality, mostly because of infant deaths. At ages 1-14 birthweight seemed unrelated to all-cause mortality. In males aged 15+, birthweight was again a significant predictor of death (Hazard ratio (HR) = 0.88, 95% confidence interval (CI) [0.78, 0.99], for 1 standard deviation (SD) increase in birthweight). The analysis by categories suggested a general decreasing of the risk of mortality with increasing birthweight (HRs = 1.0, 1.02, 0.85, 0.77, 0.57 for those belonging to birthweight groups of < 2500 g, 2500-2999 g, 3000-3499 g, 3500-3999 g and > or = 4000 g, respectively). In females aged 15+ there was a J-shaped relation between birthweight and mortality but these associations were not statistically significant. These findings add to a growing body of evidence that events during intrauterine life have remote consequences for adult health and underline the need to consider gender differences.