Narrowing inequalities in infant mortality in Southern Brazil

OBJECTIVE: To determine the trends of infant mortality from 1995 to 1999 according to a geographic area-based measure of maternal education in Porto Alegre, Brazil. METHODS: A registry-based study was carried out and a municipal database created in 1994 was used. All live births (n=119,170) and infant deaths (n=1,934) were considered. Five different geographic areas were defined according to quintiles of the percentage of low maternal educational level (<8 years of schooling): high, medium high, medium, medium low, and low [corrected]. The chi-square test for trend was used to compare rates between years. Incidence rate ratio was calculated using Poisson regression to identify excess infant mortality in poorer areas compared to higher schooling areas. RESULTS: The infant mortality rate (IMR) decreased steadily from 18.38 deaths per 1,000 live births in 1995 to 12.21 in 1999 (chi-square for trend p<0.001). Both neonatal and post-neonatal mortality rates decreased although the drop seemed to be steeper for the post-neonatal component. The higher decline was seen in poorer areas. CONCLUSION: Inequalities in IMR seem to have decreased due to a steeper reduction in both neonatal and post-neonatal components of infant mortality in lower maternal schooling area.     

Infant mortality in the Federal District, Brazil: time trend and socioeconomic inequalities

This study examined the trend in the infant mortality rate in the Federal District of Brazil (or Greater Metropolitan Brasilia, the national capital) from 1990 to 2000, analyzing the rate according to 5 administrative areas stratified by mean family income, from 1996 to 2000. An ecological time-series study was conducted using the Information Systems on Live Births and Mortality, produced by the Brazilian Ministry of Health. The infant mortality rate (IMR) decreased by 45.2% from 1990 to 2000, from 26.3 per 1000 live births to 14.4, or a mean annual reduction of 5.34% (R(2) = 0.9397; p < 0.0001). During this period there was a higher proportion of neonatal deaths. However, a higher percentage change occurred in the post-neonatal period (-59.0%, R(2) = 0.8452, p < 0.0001). Investigation of the IMR in the various areas of the Federal District showed a reduction in differences among the regions with respect to the component rates; however, substantial disparities persisted in relation to the income variable. The results suggest the need for effective interventions in the determinants of neonatal and post-neonatal mortality in order to improve maternal and infant health in all socioeconomic groups in the Federal District.     

Trends in infant mortality in Scotland, 1970-1987

Infant mortality rates in Scotland have fallen by 56.6 per cent from 19.6 per 1000 live births in 1970 to 8.5 per 1000 in 1987. The reduction has been more marked in the early neonatal period than at later ages. The causes of death, based on generally high post-mortem rates, have been examined in functional groups and the changes over time are described. Ninety per cent of neonatal deaths throughout the period reviewed were due to congenital anomalies, asphyxia or immaturity-associated conditions. Eighty per cent of post-neonatal deaths are now due to congenital anomaly or sudden infant death syndrome (SIDS). The principal shifts in cause of death groups from infections and external causes in the 1970s to SIDS in the 1980s are described in detail and are probably related to improved recognition of the syndrome of sudden infant death, rather than to true changes.     

Risk factors for neonatal and post-neonatal mortality in the Central-West region of Brazil: linkage between live birth and infant death data banks

This article focused on risk factors for neonatal and post-neonatal mortality by linking live births and infant death records. The study was conducted in the municipality of Goiania, in the Central-West region of Brazil. A total of 20,981 live births and 342 infant deaths constitute the retrospective cohort. Neonatal and post-neonatal mortality risks were estimated in this cohort study of live births by logistic regression. In the neonatal period, the highest ORs were for delivery in public hospitals (OR = 2.28; 95% CI 1.57-3.32), pre-term neonates (OR = 8.94; 95% CI 5.85-13.67), and low birth weight (OR = 8.92; 95% CI 5.77-13.79). Cesarean delivery appeared as a protective factor (OR = 0.58; 95% CI 0.43-0.78). For post-neonatal mortality, the highest ORs were for illiterate mothers (OR = 6.25; 95% CI 1.25-31.27), low birth weight (OR = 3.12; 95% CI 1.67-5.84), and delivery in public hospitals (OR = 2.65; 95% CI 1. 13-6.23). The linkage identified socioeconomic variables that were more important risk factors for post-neonatal than neonatal mortality.     

Infant mortality rates according to socioeconomic status in a Brazilian city

OBJECTIVE: Data from municipal databases can be used to plan interventions aimed at reducing inequities in health care. The objective of the study was to determine the distribution of infant mortality according to an urban geoeconomic classification using routinely collected municipal data. METHODS: All live births (total of 42,381) and infant deaths (total of 731) that occurred between 1994 and 1998 in Ribeir?o Preto, Brazil, were considered. Four different geoeconomic areas were defined according to the family head's income in each administrative urban zone. RESULTS: The trends for infant mortality rate and its different components, neonatal mortality rate and post-neonatal mortality rate, decreased in Ribeir?o Preto from 1994 to 1998 (chi-square for trend, p<0.05). These rates were inversely correlated with the distribution of lower salaries in the geoeconomic areas (less than 5 minimum wages per family head), in particular the post-neonatal mortality rate (chi-square for trend, p<0.05). Finally, the poor area showed a steady increase in excess infant mortality. CONCLUSIONS: The results indicate that infant mortality rates are associated with social inequality and can be monitored using municipal databases. The findings also suggest an increase in the impact of social inequality on infant health in Ribeir?o Preto, especially in the poor area. The monitoring of health inequalities using municipal databases may be an increasingly more useful tool given the continuous decentralization of health management at the municipal level in Brazil.     

四川省2001-2009年婴儿死亡率变化趋势及死因分析

目的 了解2001-2009年四川省婴儿年龄别和主要死因别死亡率的变化趋势.方法 采用四川省5岁以下儿童死亡监测收集的2001-2009年监测点儿童死亡资料,计算城乡新生儿、婴儿死亡率及婴儿死因别死亡率.结果 2009年四川省新生儿、婴儿死亡率分别为7.6‰和12.1‰,较2001年(18.6‰和25.5‰)分别下降了...     

Underregistration of neonatal deaths: an empirical study of the accuracy of infantile vital statistics in Taiwan

STUDY OBJECTIVE: The accuracy of the official statistic on infant deaths in Taiwan has been questioned. This study aimed to survey infant deaths nationwide, to measure associated vital statistics, and compare them with the official statistics to assess accuracy. DESIGN AND PARTICIPANTS: A nationwide survey of all gestational outcomes occurring at > or = 20 weeks' gestation over a three day study period (15-17 May 1989) was conducted to collect data from 23 counties and cities nationwide using a two stage data collection procedure. MAIN RESULTS: The survey derived infant death rate was 9.72 per 1000 live births, which was higher than the reported official statistic of 5.71 per 1000 live births. A more detailed examination of data on infant deaths showed that the estimated neonatal death rate of 6.68 per 1000 live births (95% confidence intervals: 3.33, 11.96 per 1000 live births) was significantly higher than the published official statistic of 1.94 per 1000 live births, while the postneonatal mortality of 3.04 per 1000 live births was comparable to the reported statistic of 3.37 per 1000 live births. CONCLUSIONS: This study empirically documented the underregistration of infant deaths in Taiwan, particularly those occurring during the first 27 days of life.

 

     

Gestational age- and birthweight-specific declines in infant mortality in Canada, 1985-94. Fetal and Infant Health Study Group of the Canadian Perinatal Surveillance System

We studied infant mortality rates in Canada within specific gestational age and birthweight categories after using probabilistic techniques to link information in Statistics Canada's live births data base (1985-94) with that in the death data base (1985-95). Gestational age- and birthweight-specific mortality rates in 1992-94 were contrasted with those in 1985-87 with changes expressed in terms of relative risks with 95% confidence intervals [CI]. Statistically significant reductions in infant mortality were observed beginning at 24-25 weeks of gestation and extended across the gestational age range to post-term births. Crude infant mortality rates, infant mortality rates among those > or = 500 g and among those > or = 1000 g decreased by 22%, 25% and 26%, respectively, from 1985-87 to 1992-94. The magnitude of the reductions in infant mortality rates ranged from 14% [95% CI 7, 21%] at 24-25 weeks of gestation to 40% [95% CI 31, 47%] at 28-31 weeks. Almost all reductions in gestational age- and birthweight-specific infant mortality between 1985-87 and 1992-94 were due to approximately equal reductions in neonatal and post-neonatal mortality. Live births > or = 42 weeks of gestation did not follow this rule; post-neonatal mortality rates among such live births decreased significantly by 51% [95% CI 26, 68%], although neonatal mortality rates showed no significant change. The mortality reductions observed across the gestational age and birthweight range are probably a consequence of specific clinical interventions complementing improvements in fetal growth. Temporal changes in the outcome of post-term pregnancies need to be carefully examined, especially in relation to recent changes in the obstetric management of such pregnancies.     

Survey of infant mortality in Mirebalais, Haiti

Infant mortality remains high in Haiti, at 74 deaths per 1,000 live births. In this study, we aimed to assess infant mortality in Mirebalais and to identify the associated risk factors. We carried out a census of pregnant women in Mirebalais, at the beginning of the study, over a three-week period. Twelve researchers visited the homes of the newborns to enroll the families in the study and to collect demographic data. Further visits were scheduled for two, four, six, nine and twelve months after birth. If the child died during this time, the investigator asked the mother about all the steps taken to prevent the death of the child, and an autopsy was carried out. The survey began on July 12 1994 and ended on December 31 1995. During that time, about 2,151 pregnant women were enrolled. Seven of these women died and 16 had abortions. In total, 2,069 children were born to the enrolled women. We enrolled 515 other children after birth or following referral by health workers or midwives. We therefore followed 2,584 children. We found that 10% of the mothers were aged between 15 and 19 years, 66.3% had had one to three pregnancies and 73% were entirely uneducated. The early neonatal mortality rate was 4.64 per 1,000 live births, late neonatal mortality was 6.96 per thousand and post-neonatal mortality was 45.6 per thousand live births. Diarrhea was responsible for 60% of the deaths and acute respiratory infections for 11%, these two causes accounting for 71% of the deaths of children aged 1 to 12 months. Thus, although infant mortality has decreased it remains high in Mirebalais, largely due to diarrhea and acute respiratory infections in the post-neonatal period.     

Causes of neonatal and postneonatal mortality in Nigerian children

Although infant mortality has decreased drastically in developed countries, the situation is still far from satisfactory in many developing countries. In Nigeria for example, the infant mortality rate currently ranges from 90 per 1000 in urban areas to as high as 100 per 1000 in rural areas. This study was undertaken to ascertain the causes of infant deaths among Nigerian children and to determine the relative contributions of neonatal and post neonatal mortality to the infant mortality. During the one - year study period #opMay, 1987 April, 1988#cp a total of 754 deaths were recorded in the study hospital.

The leading causes of death during the neonatal period were neonatal jaundice and prematurity-accounting for Proportionate Mortality Ratios of 23.0 and 18.7 respectively. Gastroenteritis marasmus#shkwashiokor were the major contributors to post-neonatal mortality #opPMRs, 14.7 and 11.4#cp. Post-neonatal mortality accounted for 36 percent of the total infant mortality. Implications of these findings to our primary health care strategies are discussed.     

中国2000-2006年5岁以下儿童死亡率和死亡原因分析

目的 了解中国5岁以下儿童死亡率的变化趋势.方法 利用全国5岁以下儿童死亡监测网资料,分析全国和不同地区5岁以下儿童死亡率的时间趋势和主要死因构成.结果 2000-2006年全国、城市、农村婴儿死亡率分别由32.2‰、11.8‰、37.0‰下降到17.2‰、8.0‰、19.7‰;全国、城市、农村5岁以下儿童死亡率分别由39.7‰、13.8‰、45.7‰下降到20.6‰、9.6‰、23.6‰.全国、城市、农村5岁以下儿童死于肺炎比例分别由2000年的19.5%、9.9%、20.1%下降为2006年的15.6%、9.8%、16.2%.全国、农村5岁以下儿童死于腹泻比例分别由2000年的4.9%、5.2%下降到2006年的3.7%、4.0%.结论 2000-2006年全国和各地区5岁以下儿童死亡率明显下降.     

Mortality due to sudden infant death syndrome in Northern Italy, 1990-2000: a baseline for the assessment of prevention campaigns

The aim of this paper is to estimate the infant mortality rate and the incidence of sudden infant death syndrome (SIDS) in Lombardy, Northern Italy, in the period 1990-2000 and to provide basic information for a subsequent comparison of the SIDS incidence before and after the risk-intervention campaign. A retrospective epidemiological study was carried out using all deaths of resident infants occurring up to 1 year of age as recorded by the health districts mortality registries of the Lombardy region, between 1990 and 2000. The infant mortality rate was 4.1 per 1000 live births, with a significant decreasing trend. This decrease is mainly due to the fall in mortality for congenital malformations and perinatal diseases. The SIDS incidence rate was 0.13 per 1000 live births; the annual incidence of SIDS during the study period decreased significantly by 60% from 0.20 to 0.08 deaths per 1000 live births (P = 0.001). When 'possible SIDS deaths', not directly labelled as SIDS, were also considered, the rate of SIDS was 0.54 per 1000 live births. The incidence of SIDS in Northern Italy appears much lower than anticipated. SIDS remains the single leading cause of death in the first year of life after the early neonatal period.     

中华医学会系列杂志从2009年开始标注数字对象惟一标识符

数字对象惟一标识符(digital o场ect id即tifier,DOI)是对包括互联网信息在内的数字信息进行标识的一种T具。在传统的出版物中,书刊、磁带、光盘都有国际标准编号(IsBN、IssN、IscN)及其条形码。作为出版物的惟一标识。     

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.     

Repeated neonatal deaths in families with special reference to causes of death

It is recognized that one infant death in a family indicates an increased risk of death of a subsequent sibling. This study examines which cause of death of a sibling is related to the mortality of the younger sibling and when. Longitudinal vital events data from the maternal and child health and family planning (MCH-FP) project and the comparison areas in Matlab, Bangladesh, were used. Primary causes of 868 neonatal deaths and 624 post-neonatal deaths resulting from 18 865 singleton live births in 1989–92 and those (967 as neonates and 708 as post-neonates) of their immediate elder siblings were categorised into infectious and non-infectious diseases. Multinomial logistic regression was used to estimate the risk of younger siblings dying in each age period from infectious and non-infectious diseases given the age and cause of deaths of older siblings and controlling for other biosocial correlates of infant mortality. A neonatal death of non-infectious causes in a family was twice as likely to be followed by another one occurring at the same age from similar causes compared with a surviving infant followed by a neonatal death from non-infectious causes. The MCH-FP project, though successful in reducing the risk of neonatal and post-neonatal mortality from infectious diseases, did not reduce the risk of dying from non-infectious diseases.     

Certain aspects of infant mortality -- a prospective study in a rural community

A prospective study on infant mortality was conducted in the field practice area of Rural Health Training Center (RHTC), Jawan, Aligarh. A sample of 1792 registered families in 9 villages under RHTC with a population of 12,118 were selected. The household survey was done in March 1989 by a questionnaire on type and composition of family, socioeconomic status, family environment, age, parity, and interval between the births. All live births and infant deaths in these villages during the period of April 1989 to March 1990 were considered. There were 416 births in the study year, giving a birth rate of 34.02/1000 mid-year population. Male and female births were 52.8% and 47.12%, respectively. 33 infants died during the period, giving an infant mortality rate of 79.32/1000 live births. Infant deaths equalled 39.4% for males and 60.6% for females. Neonatal and postneonatal deaths made up 63.6% and 36.4%, respectively. 33.3% of the neonatal deaths occurred in the first 24 hours, 23.8% in the next 6 days, and 42.9% beyond this period. The mortality risk was high in 5th and higher parity births and lowest in 2nd to 4th parity births. Diarrhea (21.2%), pneumonia (18.18%), tetanus (15.15%), prematurity (9.1%), and unqualified fever (9.1%) constituted main causes of infant death. Pneumonia and prematurity were responsible for more than 70% of infant deaths. In the 2nd to 4th parity groups, diarrhea and tetanus were the main causes. Deaths during the first 24 hours were mainly caused by birth injury, while, during the next 6 days, pneumonia and tetanus were the leading causes. Beyond this period, in addition to the above causes, diarrhea played a major role. In the postnatal period, diarrhea, pneumonia, and malnutrition were the main causes. To reduce infant mortality further, training of health workers, strengthening of delivery systems, maximum utilization of existing health infrastructure, environmental hygiene and health education regarding oral rehydration, and control of respiratory infection are needed.     

Trends in infant mortality in Barcelona [Spain], 1983-1998

OBJECTIVE: To analyze trends in infant mortality, taking into account its main components and the principal causes of death between 1983 and 1998 in the city of Barcelona (Spain). METHODS: We calculated overall mortality rates and mortality rates by sex for infant, postneonatal, neonatal, early neonatal, and late neonatal mortality in residents of the city of Barcelona from 1983 to 1998. Data were obtained from the births and deaths register. Data were grouped in 4-year periods. Poisson regression models were adjusted to obtain relative risks of mortality for comparison among the 4-year periods. The percentage of variation between rates in the different periods was also calculated. RESULTS: There were 1.564 deaths in the 16 years. 896 (57.3%) were males and 668 (42.7%) were females. Infant mortality rates varied from 10.5 per 1,000 live births in 1986 to 3.4 ten years later (1996). Between 1983 and 1988 mortality rates remained stable, decreasing after 1989. The neonatal mortality rate, and especially the early neonatal mortality rate, showed a greater decrease than the postneonatal mortality rate. The main causes of death were congenital defects (47.4%) and perinatal causes (32.1%). CONCLUSIONS: Mortality rates decreased over the study period but not with the same intensity as in previous deca des.     

Mortality from neonatal tetanus in Indonesia: results of two surveys

Two, 30-cluster, retrospective surveys of deaths from neonatal tetanus in Indonesia were conducted during 1982. The first survey, in the city of Jakarta, identified 16 deaths from neonatal tetanus among 2310 live births, giving a mortality rate of 6.9 per 1000 live births. The second survey covered 19 of Indonesia''s 27 provinces. Fifty-three neonatal tetanus deaths occurred among 4971 live births, giving a mortality rate of 10.7 per 1000 live births. Overall, 68.8% of mothers interviewed in the second survey received antenatal care on at least two occasions when tetanus toxoid was, in principle, available.