The infant mortality rate at Cherbourg Aboriginal Community: An update

The infant mortality rate (IMR) at Cherbourg Aboriginal Community in south-eastern Queensland remained high from 1906 to about 1955-60, but since then has dropped from over 200/1000 live births in 1956-60 to 16/1000 live births in 1986-90, compared with the 1987 rate for Queensland (9.2/1000) and Australia (8.6/1000). The rapid improvement in the IMR was associated with the installation of a piped and chlorinated water supply, sewerage and an intensive campaign to eradicate intestinal worms. There has also been a change in community attitudes towards routine health practices and it is likely that this has been a major factor in the changes.     

Trends in perinatal and neonatal mortality and morbidity in India

Although the infant mortality rate (IMR) has reduced by 50% during the past century, it compares poorly with the advanced countries and some developing countries. The observed fall in IMR has been mostly in post-neonatal mortality, with the result that neonatal deaths now account for over 60% of all infant deaths. The overall perinatal mortality rate (PMR) in India is still over 50 per 1000 and has shown virtually no decline during the past decade, However, PMR differs widely in different states, urban/rural areas, different hospitals and so on. PMR is seen to correlate better with social development than economic development of the representative community. The causes of perinatal deaths suggest poor health of mother and poor health facilities and are hence potentially preventable. Various studies have shown that PMR can be significantly reduced within a short span of time. The registration of vital statistics continue to be highly unsatisfactory especially in rural areas.     

Changes in the neonatal and infant mortality rate and the causes of death in Korea

Neonatal mortality rate (NMR) or infant mortality rate (IMR) are the rate of deaths per 1,000 live births at which babies of either less than four weeks or of one year of age die, respectively. The NMR and IMR are commonly accepted as a measure of the general health and wellbeing of a population. Korea's NMR and IMR fell significantly between 1993 and 2009 from 6.6 and 9.9 to 1.7 and 3.2, respectively. Common causes of infantile death in 2008 had decreased compared with those in 1996 such as other disorders originating in the perinatal period, congenital malformation of the heart, bacterial sepsis of newborns, disorders related to length of gestation and fetal growth, intra-uterine hypoxia, birth asphyxia. However, some other causes are on the increase, such as respiratory distress of newborn, other respiratory conditions originating in the perinatal period, other congenital malformation, diseases of the blood and blood-forming organs and certain disorders involving the immune mechanism. In this study, we provide basic data about changes of NMR and IMR and the causes of neonatal and infantile death from 1983 to 2009 in Korea.     

An analysis of trends in the incidence of sudden infant death in The Netherlands 1969–89

There is considerable interest in the relationship between sleeping position and the occurrence of sudden infant death syndrome (SIDS). As changes have been reported in The Netherlands in the position infants have been placed to sleep, the national Dutch sudden infant death rates were analyzed over the time that such changes have taken place. The overall post-perinatal death rate (1 week less than 1 year) was around 4-4.5 per 1000 live births from 1969 until 1985. From 1985 until 1989 the rate fell from 4.1 to 2.9 per 1000 live births. During the same period the cot death/SIDS rate rose from 0.44 per 1000 in 1969 to between 1.08 and 1.31 per 1000 in 1977-87, and subsequently fell to 0.7 per 1000 in 1989. These trends coincided with changes in prone sleeping position demonstrated in national surveys. The problems of interpreting such national data, with only 50-60% of infant deaths being autopsied and with the possibilities of misclassification over time, are fully discussed. The data are supportive of the relationship between prone sleeping position and cot death.     

Influence of parental literacy and socio-economic status on infant mortality

The influence of parental literacy and socio-economic status (SES) on infant mortality rate (IMR) was studied. This report is only a part of much larger community-based prospective study conducted to determine the factors influencing infant mortality in Dakshina Kannada district of Karnataka, by the Department of Community Medicine, Kasturba Medical College, Manipal, with the financial assistance form IDRC, Canada. A total of 12,857 livebirths during the period of October 1, 1991, to September 30, 1992, where registered and followed up for one year. There were 391 infant deaths which gives an IMR of 30.4 per 1,000 livebirths. Univariate analysis and subsequent stepwise multiple logistic regression analysis revealed that, literacy and SES have a very significant role in reducing IMR.     

Sudden infant death syndrome and infant mortality in Aboriginal and non-Aboriginal infants

The aim of this study was to investigate sudden infant death syndrome (SIDS) in the context of total infant mortality for Aboriginal and non-Aboriginal infants. Deaths for infants born in Western Australia from 1980 to 1988 inclusive were ascertained from a total population data base. Infant mortality rates and rates by period and cause of death were calculated for both populations. Aboriginal infants had a mortality rate three times that for non-Aboriginal infants (23.6 cf. 7.9 per 1000 live births) and both populations showed a similar rate of decline in mortality over the study period. There were differences in the proportion of deaths occurring neonatally and postneonatally in the two populations. In terms of SIDS, 21% of the deaths in Aboriginal infants occurred neonatally compared with 7% for non-Aboriginal infants. The overall cause of infant death distribution differed significantly between the two populations ( P < 0.001). During the study period, Aboriginal infants showed a significant increase in deaths due to SIDS and a significant decrease in those due to birth defects and low birthweight. These results suggest it would be useful to review the pathology and diagnosis of sudden unexplained death in infancy.     

Trend in mortality from respiratory distress syndrome in the United States, 1970-1995

OBJECTIVE: We examined the trend in mortality caused by respiratory distress syndrome (RDS) and its impact on changes in infant and neonatal mortality rates (IMR, NMR) in the United States.Study design: Data on infant deaths in the United States for the period 1970 through 1995 were used to compare RDS-specific IMR to other cause-specific IMR. Data from the U.S. birth cohorts of 1985 through 1991 were used to examine birth weight- and RDS-specific NMRs. RESULTS: IMR from RDS declined from 2.6 per 1000 live births in 1970 to 0.4 per 1000 in 1995. More than three quarters of this decline occurred between 1970 and 1985. RDS-specific NMR declined by 13% between 1985 and 1988 and by more than twofold greater, that is, 28%, between 1988 and 1991. There was also a significant reduction in postneonatal mortality from chronic lung diseases between 1988 and 1991. CONCLUSIONS: Most of the reduction in mortality from RDS occurred before the introduction of surfactant therapy. The recent accelerated reduction in mortality from RDS between 1988 and 1991 was temporally associated with widespread use of surfactant therapy and was the single most important factor for reduction in overall NMR in the United States.     

Has changing diagnostic preference been responsible for the recent fall in incidence of sudden infant death syndrome in South Australia?

Objective: An apparent decrease in deaths attributed to sudden infant death syndrome (SIDS) has been noted in a number of diverse geographical areas during the past several years. At the same time the definition of SIDS has been in a state of flux and some observers have raised the possibility that the fall in SIDS deaths is due to diagnostic transfer rather than to a genuine decrease in numbers. The present study was undertaken to investigate this possibility.
Methodology: All sudden and unexpected deaths in infants under 1 year of age in South Australia during a 10 year period from 1984 to 1993 were reviewed.
Results: The number of deaths due to SIDS fell from 40 in 1984 to 17 in 1993, with a maximum of 52 cases per year in 1987. In contrast, the number of cases of sudden death not due to SIDS remained under 10 per year. The overall infant death rate also fell, while the total number of births per year remained relatively unchanged.
Conclusions: The lack of major change in sudden infant death rates from other causes, combined with the fall in SIDS deaths, is not supportive of diagnostic transfer being a major determinant of the declining SIDS death rate. Therefore, other factors are likely to be responsible for the falling SIDS rate in this population.     

Secular Trends of Sudden Infant Death Syndrome and Other Causes of Post Perinatal Mortality in Norwegian Birth Cohorts 1967–1984

ABSTRACT. Lack of positive diagnostic criteria and increasing professional concern, probably causing increasing ascertainment, have rendered reported increases in SIDS-rates controversial. However, these problems related to cause specific mortality do not apply to the total mortality. Due to the exceptional age-at-death distribution of SIDS cases, the SIDS fraction of all deaths increases during the first year of life to reach a maximum, in the present study of 56%, from the 105th through the 125th day of life. During these days, the total mortality rate in Norway increased from 0.24 per 1000 in 1971–72 to 0.46 in 1983–84. Thus, the observed trend, with an increase in the SIDS rate from 1.02 per 1000 in 1971–72 to 2.34 in 1983–84, is considered true. Observed in a country where perinatal and neonatal mortality have decreased for a long period of time and still remain very low in a global perspective, the increasing SIDS rate is a matter of great concern.     

Weight gain during pregnancy--a key factor in perinatal and infant mortality

OBJECTIVE: To identify risk factors for high perinatal (PMR) and infant (IMR) mortality in a rural area. DESIGN: In 49 randomly selected villages from two adjoining blocks of rural Varanasi, all pregnant women and live births were followed for perinatal and infant mortality, during the years 1988-1992. SUBJECTS: 6790 births and their 6649 live births. RESULTS: The PMR was 90.7 per thousand births and IMR was 98.6/1000 live births. These mortalities were significantly higher if weight gain during pregnancy was less than 7.0 kg. Low weight gain during pregnancy was also associated with significantly higher low birth weight deliveries and to some extent increased still birth rate. PMR and IMR decreased with higher levels of hemoglobin in third trimester and socioeconomic index; however, the calculated RR were not significant. CONCLUSION: Low weight gain during pregnancy is an important risk factor for PMR and IMR.     

Comparing Cause-Specific Infant Mortality in a West German State and the United States of America

ABSTRACT. The infant mortality rate in North Rhine Westphalia (NRW), the most populous West German state, has continuously been around 10 % higher than the German national average in the post-war period. Using white singleton data from the US 1980 National Infant Mortality Surveillance project (NIMS) and similar 1980/1981 data from NRW we compared infant mortality by birthweight and cause to describe the distribution of excess mortality in NRW. The US infant mortality rate was 8.7 deaths per 1000 live births, compared with 13.1/1000 for NRW (rate difference: 4.3/1000). Of the 4.3/1000 overall rate difference, 1.9/1000 was attributable to neonatal deaths, 2.4/1000 to postneonatal deaths. A major proportion, 2.0/1000, of the overall rate difference of 4.3/1000 was attributable to normal birthweight deaths postneonatally. 0.85/1000 of this 2.0/1000 rate difference was attributable to SIDS, 0.44/1000 to external causes and 0.42/1000 to infections.     

Annual summary of vital statistics--1998

Most vital statistics indicators of the health of Americans were stable or showed modest improvements between 1997 and 1998. The preliminary birth rate in 1998 was 14.6 births per 1000 population, up slightly from the record low reported for 1997 (14.5). The fertility rate, births per 1000 women aged 15 to 44 years, increased 1% to 65.6 in 1998, compared with 65.0 in 1997. The 1998 increases, although modest, were the first since 1990, halting the steady decline in the number of births and birth and fertility rates in the 1990s. Fertility rates for total white, non-Hispanic white, and Native American women each increased from 1% to 2% in 1998. The fertility rate for black women declined 19% from 1990 to 1996, but has changed little since 1996. The rate for Hispanic women, which dropped 2%, was lower than in any year for which national data have been available. Birth rates for women 30 years or older continued to increase. The proportion of births to unmarried women remained about the same at one third. The birth rate for teen mothers declined again for the seventh consecutive year, and the use of timely prenatal care (82.8%) improved for the ninth consecutive year, especially for black (73.3%) and Hispanic (74.3%) mothers. The number and rate of multiple births continued their dramatic rise; the number of triplet and higher-order multiple births jumped 16% between 1996 and 1997, accounting, in part, for the slight increase in the percentage of low birth weight (LBW) births. LBW continued to increase from 1997 to 1998 to 7.6%. The infant mortality rate (IMR) was unchanged from 1997 to 1998 (7.2 per 1000 live births). The ratio of the IMR among black infants to that for white infants (2.4) remained the same in 1998 as in 1997. Racial differences in infant mortality remain a major public health concern. In 1997, 65% of all infant deaths occurred to the 7.5% of infants born LBW. Among all of the states, Maine, Massachusetts, and New Hampshire had the lowest IMRs. State-by-state differences in IMR reflect racial composition, the percentage LBW, and birth weight-specific neonatal mortality rate for each state. The United States continues to rank poorly in international comparisons of infant mortality. Expectation of life at birth increased slightly to 76.7 years for all gender and race groups combined. Death rates in the United States continue to decline, including a drop in mortality from human immunodeficiency virus. The age-adjusted death rate for suicide declined 6% in 1998; homicide declined 14%. Death rates for children from all major causes declined again in 1998. A large proportion of childhood deaths, however, continue to occur as a result of preventable injuries.     

Race- and rank-specific infant mortality in a US military population.

Mortality among black infants in the United States is approximately twice that among white infants. The disparity has been attributed in large part to the higher incidence of poverty and limited access to health care among black Americans. We investigated race- and rank-specific infant mortality rates among dependents of military officers and soldiers at Madigan Army Medical Center, Tacoma, Wash, between 1985 and 1990. The overall infant mortality rate was 9.3 deaths per 1000 live births compared with 10.1 deaths per 1000 live births in the United States in 1987. Mortality rates for infants born to families of junior enlisted soldiers were similar to those for infants born to families of noncommissioned and commissioned officers. The mortality rate among black infants was 11.1 deaths per 1000 live births compared with 17.9 deaths per 1000 live births among all black Americans in 1987. These lower rates of mortality among black infants may be due to guaranteed access to health care and higher levels of family education and income in the multiracial subpopulation served by our medical center compared with the nation as a whole.     

Changing patterns of childhood mortality in Wolverhampton.

OBJECTIVES: To review the incidence and characteristics of preventable childhood deaths in an urban population in the UK and to determine whether the excess of preventable deaths seen previously in Asian girls still exists. DESIGN: A retrospective survey of childhood deaths from 1996-2002 classified in terms of preventability and compared with a previous study conducted 20 years earlier from 1976-82. SETTING: The city of Wolverhampton in the UK. MAIN OUTCOME MEASURES: Deaths from all causes in children under the age of 5 years. RESULTS: There has been a reduction in the number of deaths in all age groups and from all causes. The postneonatal mortality rate fell from 6.5/1000 in 1976 to 3.1/1000 live births in 2002 largely because of the fall in the numbers of deaths caused by sudden infant death syndrome (SIDS). Preventable deaths are still associated with low birth weight (p<0.001) and poverty (unemployment and overcrowding in the earlier study (p<0.05) and with the Townsend score in this study (p<0.02)). There were fewer deaths among Asians and no female excess. There was a new category not seen in the previous study, deaths caused by homicide. The death rate for homicide in the first year of life was much higher in Wolverhampton (18.7/100,000) than in England and Wales (4.6/100,000). CONCLUSIONS: Low birth weight and adverse socioeconomic conditions remain important factors associated with preventable deaths. There is no longer an increased risk of preventable death in Asian girls. The number of non-accidental deaths is a major cause for concern.     

Postneonatal mortality in Western Australia 1970–78

ABSTRACT. Postneonatal deaths in Western Australia from 1970–78 were studied using a linked file of birth and death registrations. Postneonatal mortality fell during the period under study. The fall occurred in both male and female rates and the former were higher than the latter in all years. The infants at high risk during the postneonatal period were those born to unmarried teenage mothers residing in rural areas, especially if the infants were of low birthweight (<2500g). Multiple births and those infants born to mothers whose previous issues were over 4 were also at high risk. Infants born to Aboriginal mothers experienced a significantly higher rate of postneonatal mortality than those born to non-Aboriginal mothers. However, a significant improvement in the Aboriginal rate occurred between 1976 and 1977. The major causes of postneonatal death were sudden infant death syndrome, infections and congenital abnormalities.     

Prevalence of hypospadias and other genital anomalies among singleton births, 1988-1997, in Scotland

BACKGROUND: Considerable debate exists on the epidemiology of genital anomalies. METHODS: All genital anomalies, excluding undescended testes, were identified from neonatal returns, stillbirth and infant death survey records, and returns relating to hospital admissions and linked to form infant profiles on a cohort of singleton births between 1988 and 1997 with follow up for a minimum of three years. FINDINGS: The mean genital anomaly prevalence rate in Scotland was calculated at 4.6 per 1000 births varying from 4.0 per 1000 births in 1988 to 5.9 per 1000 births in 1996. However, there was no evidence of a clear trend to an increasing prevalence of hypospadias, which constituted 73% of the anomalies studied. Logistic regression analysis of the data also showed this rate to be independently associated with being relatively small for gestational age (odds ratio (OR) 1.43, p < 0.001) and increasing maternal age (OR 1.2, p < 0.05). Infants born in deprived areas, as judged by the Carstairs deprivation score, were least likely to have a genital anomaly (OR 0.73, p < 0.01). INTERPRETATION: A new linked register of congenital genital anomalies in Scotland suggests that over a decade, the birth prevalence of genital anomalies has changed little. The associations between genital anomalies, maternal age, and socioeconomic deprivation require further study.     

The seasonal distribution of infant deaths by age: A comparison of sudden infant death syndrome and other causes of death

Objective: To examine the possibility that among deaths in infancy the increase in the winter/summer ratio with increasing age is not peculiar to sudden infant death syndrome (SIDS).
Methodology: Details of the winter (December-February)/summer (June-August) ratio among deaths in neonates (<28 days) and post neonates dying in the United States of America between 1979 and 1990 were abstracted from published statistics. The primary causes of death were classified according to the ninth Revision of the International Classification of Diseases.
Results: For every non-traumatic cause of death including SIDS, the winter/summer ratio was higher among postneonates than neonates. This was not seen for deaths due to trauma. Cases of SIDS and deaths due to infection had the highest ratios in both age categories. Causes of death occurring predominantly in the neonatal period (e.g. anencephaly) had the lowest overall ratios.
Conclusions: Neither the greater number of SIDS cases in the winter, nor the increasing winter/summer ratio with increasing age is unique to SIDS.     

Neonatal mortality patterns in an urban hospital.

Neonatal mortality rate is perhaps the most reliable indicator of the perinatal outcome. An assessment of perinatal outcome can be made through knowledge of causes of death. This study was carried out to evaluate the neonatal deaths in our hospital. Live births (n = 7309) and deaths (n = 328) during a 6 months period were retrospectively analyzed. These were grouped into non-preventable and potentially preventable causes of death. The single most important factor contributing to the mortality was respiratory distress (29.3%) followed by sepsis (24.4%) and birth asphyxia (16.2%). The non-preventable causes of mortality (e.g., lethal congenital malformations, extremely low birth weight) accounted for 10.4% of the total mortality. The idealized neonatal mortality rate was 4.6/1000 live births, while the salvageable death rate was 40.2/1000 live births. The mortality increased significantly if the birth weight fell below 2 kg. The salvageable deaths could perhaps be prevented through better antenatal and intranatal care, ventilatory support and prevention of sepsis.     

Association of maternal HIV infection with increase of infant mortality in Malawi

Aim:   To determine the association between maternal HIV infection and infant mortality in Malawi.
Methods:   A synthetic cohort life table based on the birth history of 2618 childbirths during 1999 and 2004, from the subsample of 2020 mothers who completed interview and were tested for HIV virus in the 2004 Malawi Demographic and Health Survey was used. The survey collected socio-demographic and health data of a natural representative sample of women aged 15 to 49; and obtained voluntary counselling tests for HIV infection from one-third of the representatives of the sample. Associations of maternal HIV status and other factors with infant mortality were estimated using survival regression analysis and the results are presented as hazard ratios (HR) with level of statistical significance ( P -value).
Results:   Children born to HIV-infected mothers were more than two times as likely to die during infancy as those born to uninfected mothers (HR = 2.21; P  < 0.01). Controlling for other risk factors and confounding factors for infant mortality further sharpened this relationship (HR = 2.70; P  < 0.01). Boys are more likely to die in infancy than girls. Young mothers and mothers not receiving prenatal care, and low-birthweight children and children living in rural areas, particular so in the northern region, were associated with a higher risk of infant mortality.
Conclusion:   Maternal HIV infection is strongly associated with infant mortality in Malawi independent of many other factors. Results from this study suggest that the HIV/AIDS epidemic has had an enormous impact on child well-being, child survival and infant mortality. The impact increases as the HIV/AIDS epidemic matures and infection in mothers and adults increases.     

Autopsies of sudden infant death syndrome—classification and epidemiology

An enquiry into sudden infant death syndrome (SIDS) in 1987 furnished us with detailed epidemiological data for 281 cases that underwent a thorough post-mortem examination. This analysis uses these data to evaluate the role the autopsy plays in explaining sudden death. The cases were classified into three diagnostic groups: explained causes of death (group 1), unexplained deaths with anomalies (group 2), and no anomaly (group 3). These 281 cases show the three essential features that characterize SIDS: over-representation of males, increased deaths during the second and third months of life, and increased deaths during winter. The autopsy examination revealed that many of these deaths had a medical explanation. Almost half were assigned to group 1. At the time of autopsy, no precise pathology could be diagnosed for 147 deaths; of these, 140 showed histological anomalies. There were only seven sudden deaths for which no abnormal sign was evident at the autopsy. These results are compared with those of similar studies and discussed in connection with three factors: the initial selection of cases, the nature and degree of the investigations, and the possible interpretations of the symptoms uncovered.