Perinatal and maternal outcomes in Tuzla Canton during 1992-1995 war in Bosnia and Herzegovina

Aim

To compare perinatal and maternal outcomes in Tuzla Canton during the 1992-1995 war in Bosnia and Herzegovina with those before (1988-1991) and after (2000-2003) the war.

Methods

We retrospectively collected data on a total of 59 707 liveborn infants and their mothers from the databases of Tuzla University Department for Gynecology and Obstetrics and Tuzla Institute for Public Health. Data on the number of live births, stillbirths, early neonatal deaths, causes of death, gestational age, and birth weights were collected. We also collected data on the number of medically unattended deliveries, examinations during pregnancy, preterm deliveries, and causes of maternal deaths. Perinatal and maternal outcomes were determined for each study period.

Results

There were 23 194 live births in the prewar, 18 302 in the war, and 18 211 in the postwar period. Prewar perinatal mortality of 23.3 per 1000 live births increased to 25.8 per 1000 live births during the war (P<0.001), due to a significant increase in early neonatal mortality (10.3‰ before vs 15.1‰ after the war, P<0.001). After the war, both perinatal mortality (14.4‰) and early neonatal mortality (6.6‰) decreased (P<0.001 for both). The most frequent cause of early neonatal death during the war was prematurity (55.7%), with newborns most often dying within the first 24 hours after birth. During the war, there were more newborns with low birth weight (<2500 g), while term newborns had lower average body weight. Women underwent 2.4 examinations during pregnancy (5.4 before and 6.3 after the war, P<0.001 for both) and 75.9% had delivery attended by a health care professional (99.1% before and 99.8% after the war; P<0.001 for both). Maternal mortality rate of 65 per 100 000 deliveries during the war was significantly higher than that before (39 per 100 000 deliveries) and after (12 per 100 000 deliveries) the war (P<0.001 for both).

Conclusion

Perinatal and maternal mortality in Tuzla Canton were significantly higher during the war, mainly due to lower adequacy and accessibility of perinatal and maternal health care.Perinatal outcome is the measure of the quality of perinatal care given to the mother and child before, during, and after delivery. Although perinatal care amounts to only 0.5% of the total health care an average person receives in a lifetime, this type of care is crucial for general health later in life and a is good indicator of the health of the pediatric population (1-3). More deaths occur in the perinatal period than in the first 30 years of life, and this death rate depends on the organization, availability, quality, and level of the development of perinatal care (4). According to the World Health Organization (5), there are about 7 million perinatal deaths in the world per year, with perinatal death rates ranging from 4-7 per 1000 live births in developed countries, 39 per 1000 in South America, 53 per 1000 in Asia, to 75 per 1000 in Africa. Every year, approximately 600 000 women die of pregnancy-related causes (6).Before the 1992-1995 war in Bosnia and Herzegovina, primary health care was provided in health centers and their outpatient facilities, secondary health care in general and regional hospitals and only partially in health care centers (specialized counseling), and tertiary health services were provided in medical centers, which were also university teaching hospitals (7). Perinatal care in Bosnia and Herzegovina had not been provided at the primary health care level, mostly due to insufficient perinatal knowledge and clinical skills of primary care physicians and other staff, and a lack of adequate equipment and space. Thus, in addition to tertiary health care, secondary health care, which was easily accessible, provided most of health care services to pregnant women, women giving birth, and newborns (7).All deficiencies of the health care system organization in Bosnia and Herzegovina became obvious during the war period. Regular examinations during pregnancy could not be performed at any level of health care, health care at birth was inadequate, and neonatal health care was almost non-existent. Many hospital systems and the existing equipment were damaged or destroyed in war (8), shortage of medicines was evident, and a large proportion of health care staff either left the country or was needed on the battlefield. The existing hospital facilities were overcrowded with the wounded and patients with chronic diseases. The whole health care system was adapted to war circumstances. Perinatal care in Bosnia and Herzegovina rapidly deteriorated. Furthermore, there was massive migration of the population due to the war and some parts of the country, such as Tuzla Canton, were overburdened with a large number of refugees and displaced persons (8).The aim of this study was to determine how increased inaccessibility of perinatal and maternal health care during the war reflected on perinatal and maternal outcomes in Tuzla Canton, Bosnia and Herzegovina.     

Predictors of maternal mortality in institutional deliveries in Nigeria

Background

Maternal mortality in poor countries reflects the under-development in these societies. Global recognition of the burden of maternal mortality and the urgency for a reversal of the trend underpin the Millenium Development Goals (MDGs).

Objective

To determine risk factors for maternal mortality in institutional births in Nigeria.

Method

Twenty one health facilities in three states were selected using stratified multi-stage cluster sampling strategy. Information on all delivered mothers and their newborn infants within a three-month period was culled from medical records.

Results

A total of 9 208 deliveries were recorded. About one-fifth (20.5%) of women had no antenatal care while 79.5% had at least one antenatal visit during pregnancy. Four-fifths (80.5%) of all deliveries were normal deliveries. Elective and emergency caesarean section rates were 3.1% and 11.5% respectively. There were 79 maternal deaths and 8 526 live births, giving a maternal mortality ratio of 927 maternal deaths per 100 000 live births. No antenatal care, parity, level of education, and mode of delivery were significantly associated with maternal mortality. Low maternal education, high parity, emergency caesarean delivery, and high risk patients risk independently predicted maternal mortality.

Conclusion

Meeting goal five of the MDGs remains a major challenge in Nigeria. Multi-sectoral approaches and focused political will are needed to revert the high maternal mortality.     

Applying the new concept of maternal near-miss in an intensive care unit

OBJECTIVES:

The World Health Organization has recommended investigating near-misses as a benchmark practice for monitoring maternal healthcare and has standardized the criteria for diagnosis. We aimed to study maternal morbidity and mortality among women admitted to a general intensive care unit during pregnancy or in the postpartum period, using the new World Health Organization criteria.

METHODS:

In a cross-sectional study, 158 cases of severe maternal morbidity were classified according to their outcomes: death, maternal near-miss, and potentially life-threatening conditions. The health indicators for obstetrical care were calculated. A bivariate analysis was performed using the Chi-square test with Yate''s correction or Fisher''s exact test. A multiple regression analysis was used to calculate the crude and adjusted odds ratios, together with their respective 95% confidence intervals.

RESULTS:

Among the 158 admissions, 5 deaths, 43 cases of maternal near-miss, and 110 cases of potentially life-threatening conditions occurred. The near-miss rate was 4.4 cases per 1,000 live births. The near-miss/death ratio was 8.6 near-misses for each maternal death, and the overall mortality index was 10.4%. Hypertensive syndromes were the main cause of admission (67.7% of the cases, 107/158); however, hemorrhage, mainly due to uterine atony and ectopic pregnancy complications, was the main cause of maternal near-misses and deaths (17/43 cases of near-miss and 2/5 deaths).

CONCLUSIONS:

Hypertension was the main cause of admission and of potentially life-threatening conditions; however, hemorrhage was the main cause of maternal near-misses and deaths at this institution, suggesting that delays may occur in implementing appropriate obstetrical care.     

Neonatal mortality in a referral hospital in Cameroon over a seven year period: trends,associated factors and causes

Background

The fourth Millennium Development Goals targets reduction by 2/3 the mortality rate of under-fives by 2015. This reduction starts with that of neonatal mortality representing 40% of childhood mortality. In Cameroon neonatal mortality was 31‰ in 2011.

Objectives

We assessed the trends, associated factors and causes of neonatal deaths at the Yaounde Gynaeco-Obstetric and Pediatric Hospital.

Methods

The study was a retrospective chart review. Data was collected from the hospital records, and included both maternal and neonatal variables from 1st January 2004 to 31st December 2010.

Results

The neonatal mortality was 10%. Out-borns represented 49.3% of the deceased neonates with 11.3% born at home. The neonatal mortality rate followed a downward trend dropping from 12.4% in 2004 to 7.2% in 2010. The major causes of deaths were: neonatal sepsis (37.85%), prematurity (31.26%), birth asphyxia (16%), and congenital malformations (10.54%). Most (74.2%) of the deaths occurred within the first week with 35% occurring within 24hours of life. Mortality was higher in neonates with birth weight less than 2500g and a gestational age of less than 37 weeks. In the mothers, it was high in single parenthood , primiparous and in housewives and students.

Conclusion

There has been a steady decline of neonatal mortality since 2004.Neonatal sepsis, prematurity, birth asphyxia and congenital malformations were the major causes of neonatal deaths. Neonatal sepsis remained constant although at lower rates over the study period.     

Neonatal mortality in a referral hospital in Cameroon over a seven year period: trends,associated factors and causes

Background

The fourth Millennium Development Goals targets reduction of the mortality rate of under-fives by 2/3 by the year 2015. This reduction starts with that of neonatal mortality representing 40% of childhood mortality. In Cameroon neonatal mortality was 31% in 2011.

Objectives

We assessed the trends, associated factors and causes of neonatal deaths at the Yaounde Gynaeco-Obstetric and Pediatric Hospital.

Methods

The study was a retrospective chart review. Data was collected from the hospital records, and included both maternal and neonatal variables from 1^st January 2004 to 31^st December 2010.

Results

The neonatal mortality was 10%. Out-borns represented 49.3% of the deceased neonates with 11.3% born at home. The neonatal mortality rate followed a downward trend dropping from 12.4% in 2004 to 7.2% in 2010. The major causes of deaths were: neonatal sepsis (37.85%), prematurity (31.26%), birth asphyxia (16%), and congenital malformations (10.54%). Most (74.2%) of the deaths occurred within the first week with 35% occurring within 24hours of life. Mortality was higher in neonates with birth weight less than 2500g and a gestational age of less than 37 weeks. In the mothers, it was high in single parenthood, primiparous and in housewives and students..

Conclusion

There has been a steady decline of neonatal mortality since 2004.Neonatal sepsis, prematurity, birth asphyxia and congenital malformations were the major causes of neonatal deaths. Neonatal sepsis remained constant although at lower rates over the study period.     

Predicting mortality and length-of-stay for neonatal admissions to private hospital neonatal intensive care units: a Southern African retrospective study

Objectives

To predict neonatal mortality and length of stay (LOS) from readily available perinatal data for neonatal intensive care unit (NICU) admissions in Southern African private hospitals.

Methods

Retrospective observational study using perinatal data from a large multicentre sample. Fifteen participating NICU centres in the Medi-Clinic private hospital group in Southern Africa. We used 2376 infants born between 1 January – 31 December 2008 to build the regression models, and a further 1 578 infants born between 1 January – 31 December 2007 to test the models. Outcome measures were mortality and length of hospital stay for NICU admissions.

Results

Of the infants included in the 2008 dataset, ninety-one (3.8%) died after being admitted to NICU centres. The median LOS for non-transferred survivors was 11 days. An analysis of the structural peculiarities of the data showed high correlations between groups of the perinatal variables pertaining to the size and Apgar scores of the newborn infants, respectively. The logistic regression model to predict neonatal mortality had a good fit (AUC: 0.8507, misclassification rate: 13.6%), but the low positive predictive value of this model reduces its usefulness. The poisson log-linear model to predict LOS had a good fit (predicted R²: 0.7027).

Conclusions

Apgar score at one minute, birth weight, and delivery mode significantly influence the odds of neonatal death and are associated with significant effects on LOS.     

Epidemiology of Trauma Patients and Analysis of 268 Mortality Cases: Trends of a Single Center in Korea

Purpose

There is an increasing incidence of mortality among trauma patients; therefore, it is important to analyze the trauma epidemiology in order to prevent trauma death. The authors reviewed the trauma epidemiology retrospectively at a regional emergency center of Korea and evaluated the main factors that led to trauma-related deaths.

Materials and Methods

A total of 17007 trauma patients were registered to the trauma registry of the regional emergency center at Wonju Severance Christian Hospital in Korea from January 2010 to December 2012.

Results

The mean age of patients was 35.2 years old. The most frequent trauma mechanism was blunt injury (90.8%), as well as slip-and-fall down injury, motor vehicle accidents, and others. Aside from 142 early trauma deaths, a total of 4673 patients were admitted for further treatment. The most common major trauma sites of admitted patients were on the extremities (38.4%), followed by craniocerebral, abdominopelvis, and thorax. With deaths of 126 patients during in-hospital treatment, the overall mortality (142 early and 126 late deaths) was 5.6% for admitted patients. Ages ≥55, injury severity score ≥16, major craniocerebral injury, cardiopulmonary resuscitation at arrival, probability of survival <25% calculated from the trauma and injury severity score were independent predictors of trauma mortality in multivariate analysis.

Conclusion

The epidemiology of the trauma patients studied was found to be mainly blunt trauma. This finding is similar to previous papers in terms of demographics and mechanism. Trauma patients who have risk factors of mortality require careful management in order to prevent trauma-related deaths.     

Trends in under-five mortality in Uganda 1954-2000: can Millennium Development Goals be met?

Background

The under five mortality rate (U5MR) is measure of wellbeing and decreasing the U5MR by two thirds is the target towards the achievement of the millennium development goal number four (MDG4).

Objective

To describe the changes in U5MR in Uganda from 1954 to 2000 and use them to project future trends up to 2015.

Methods

We did a retrospective analysis of the Uganda national censuses of 1969, 1991 and 2002. We calculated the percentage of the annual average reduction rate (AARR) of U5MR between the years 1954–1966, 1966–1975, 1975–1988 and from 1988 to 2000. The AARRs of U5MR between 1954 and 2000 were then compared to that of 4.4% required to achieve MDG4.

Results

The U5MR in Uganda between 1954 and 1966 decreased from 261 to 180 deaths per 1000 live births with an AARR of 3.05%. Between 1975 and 1988, the U5MR increased with AARR from 1966 to 1975 being −1.05% while the AARR from 1976 to 1988 was −0.11%. From 1988 to 2000 U5MR decreased from 205 to 152 deaths per 1000 live births with an AARR of 2.46%.

Conclusions

The AARRs for the U5MR of −1.05–3.05% were below the 4.4% required to achieve MDG4.     

Child deaths: confidential enquiry into the role and quality of UK primary care

Background

In 2006 the Confidential Enquiry into Maternal and Perinatal Deaths was extended to pilot a collection of child deaths. This helped optimise data collection for local safeguarding children''s boards, which, since April 2008, have a statutory responsibility to review all child deaths. Reviewing primary care records may highlight areas in which systems, skills, and care could be improved.

Aim

To review the role and quality of primary care in child deaths.

Design of study

Confidential enquiry into child deaths.

Setting

Five regions of the UK: North-East, South-West and West Midlands, Wales, and Northern Ireland.

Method

The confidential enquiry collected core data for all child deaths (age range 28 days to 17 years) and an age-stratified sample was assessed by multidisciplinary panels for avoidable factors. An independent detailed review was conducted of the primary care records on all children in the North-East region and all children who were reviewed by panel in the other four regions.

Results

Primary care records were reviewed for 168 child deaths. There were 25 (15%) deaths from acute infection, 22 (13%) from cancer, and 11 (7%) from asthma or epilepsy. Fifty-nine (35%) deaths were sudden: sudden unexplained death in infancy, suicides, and assaults. Of 149 with immunisation records, only 88 (59%) had been fully vaccinated on time. One or more primary care professionals were involved in the management of 90 (54%) children. Avoidable primary care factors were identified in 18 (20%) of these deaths. Avoidable primary care factors included failure in the recognition and management of serious infection, failure to vaccinate, and inadequate management of asthma and epilepsy.

Conclusion

Decisions made about diagnosis and management in primary care may affect the cause, time, and circumstances of a child''s death. Maintaining skills in assessing the acutely ill child remains an essential part of good clinical practice.     

Manifestations, quality of emergency care and outcome of severe malaria in Mulago Hospital, Uganda

Background

About 100,000 children die annually from severe malaria in Uganda and more than 75% of health unit based deaths occur within 24 hours of admission. Most of these deaths are associated with poor resuscitation systems, delays within the units by health workers and lack of essential drugs and supplies.

Objective

To describe the manifestations and quality of care children with severe malaria receive in Mulago Hospital Paediatric emergency unit and evaluate its impact on outcome.

Methods

A cohort of 784 children with severe malaria was recruited at admission and followed up. Selected measures of quality were the exposure factor and death, the outcome measure.

Results

Only 22.5% of the children were brought at night. The commonest defining manifestations were severe anaemia (39.4%), respiratory distress (17.1%), multiple generalized convulsions (13.3%), hypoglycaemia (11.4%) and cerebral malaria (7.2%). Over 50% lacked an essential drug or supply needed for resuscitation and 23.4% were seen within 1 hour of arrival. Commonly lacking items were intravenous cannulae (53.1%) syringes (23.3%) and blood transfusion sets (15.0%). Children brought at night took a shorter time before being seen by a doctor (1.9 SD 2.4 vs 2.5 SD 2.0 hours, p=0.002), received the first dose of quinine earlier (4.1 SD 3.2 vs 5.2 SD 3.2 hours, p<0.0001), fewer lacked essential drugs and supplies (45% vs 57.9%, p=0.003) and fewer died (0.6% vs 3.8%, p=0.028). Children who lacked an item for resuscitation took 30 minutes longer to receive the first dose of quinine. Caretaker satisfaction was predictive of mortality in the unit.

Conclusions

Quality of care for severe malaria in Mulago paediatric emergency unit is still poor although nighttime services are comparatively better. Caretakers buy at least one resuscitation item in over 50% of cases and their level of satisfaction is predictive of mortality.

Recommendations

The unit should set targets for quality improvement to include increased staffing and supplies, a time limit within which children should be seen and measures of decongestion. Determination of blood sugar in patients with severe malaria should be made a basic requirement.     

The distribution of apolipoprotein E alleles in Scottish perinatal deaths

Background

The apolipoprotein E (ApoE) polymorphism has been well studied in the adult human population, in part because the e4 allele is a known risk factor for Alzheimer''s disease. Little is known of the distribution of ApoE alleles in newborns, and their association with perinatal brain damage has not been investigated.

Methods

ApoE genotyping was undertaken in a Scottish cohort of perinatal deaths (n = 261), some of whom had prenatal brain damage. The distribution of ApoE alleles in perinatal deaths was compared with that in healthy liveborn infants and in adults in Scotland.

Results

ApoE e2 was over‐represented in 251 perinatal deaths (13% v 8% in healthy newborns, odds ratio (OR) = 1.63, 95% confidence interval (CI) 1.13 to 2.36 and 13% v 8% in adults, OR = 1.67, 95% CI 1.16 to 2.41), both in liveborn and stillborn perinatal deaths. In contrast, the prevalence of ApoE e4 was raised in healthy liveborn infants (19%) compared with stillbirths (13%, OR = 1.59, 95% CI 1.11 to 2.26) and with adults (15%, OR = 1.35, 95% CI 1.04 to 1.76). However, no correlation was found between ApoE genotype and the presence or absence of perinatal brain damage.

Conclusions

This study shows a shift in ApoE allelic distribution in early life compared with adults. The raised prevalence of ApoE e2 associated with perinatal death suggests that this allele is detrimental to pregnancy outcome, whereas ApoE e4 may be less so. However, ApoE genotype did not appear to influence the vulnerability for perinatal hypoxic/ischaemic brain damage, in agreement with findings in adult brains and in animal models.     

Anaesthetic and Obstetric challenges of morbid obesity in caesarean deliveries-a study in South-eastern Nigeria

Background

Morbid obesity of parturient has become very important in perinatal medicine because of a worldwide obesity epidemic. Morbid obesity of parturient is reportedly associated with severely increased anaesthetic and obstetric risk.

Objective

To determine the prevalence rate, anaesthetic and obstetric complications in morbidly obese parturient that had caesarean delivery in a Nigerian tertiary care centre.

Methods

The obstetric theatre records and case files were reviewed for caesarean deliveries in the University of Nigeria Teaching Hospital, Enugu, Nigeria from May 2008 to December 2010. A sample size of 250 patients, calculated based on a prevalence rate of 19%, confidence interval of 95% , a power of 80% and a finite population of zero was used to determine the prevalence rate of morbid obesity (Body Mass Index of greater than or equal to 35kg/m²).

Results

There were thirty-one patients with morbid obesity (12.4%). The average Body Mass Index (BMI) was 38.3kg/m²(SD ± 2.99). Other findings included macrosomia (7 or 25.8%), gestational diabetes (13%) and pregnancy induced hypertension (7 or 22.5%).There were two neonatal deaths but no maternal deaths.

Conclusion

The prevalence rate of morbid obesity is about 10% in Nigerian women of child bearing age. This mirrors a World Health Organisation report published in the World Health Organisation Global Information Base.     

Cancer incidence and mortality in the municipality of Pasto, 1998 - 2007

Introduction:

In Colombia, information on cancer morbidity at the population level is limited. Incidence estimates for most regions are based on mortality data. To improve the validity of these estimates, it is necessary that other population-based cancer registries, as well as Cali, provide cancer risk information.

Objective:

To describe the incidence and cancer mortality in the municipality of Pasto within the 1998-2007 period.

Methods:

The study population belongs to rural and urban areas of the municipality of Pasto. Collection, processing, and systematization of the data were performed according to internationally standardized parameters for population-based cancer registries. The cancer incidence and mortality rates were calculated by gender, age, and tumor

Results:

During the 1998-2007 period 4,986 new cases of cancer were recorded of which 57.7% were in female. 2,503 deaths were presented, 52% in female. Neoplasm-associated infections are the leading cause of cancer morbidity in Pasto: stomach cancer in males and cervical cancer in females.

Discussion:

Cancer in general is a major health problem for the population of the municipality of Pasto. The overall behavior of the increasing incidence and cancer mortality in relation to other causes of death show the need to implement and strengthen prevention and promotion programs, focusing especially on tumors that produce greater morbidity and mortality in the population.     

Cancer incidence and mortality in Manizales 2003-2007

Objective:

To describe cancer incidence and mortality in Manizales during the 2003-2007 period from population-based information.

Methods:

The information was obtained from the Manizales Cancer Registry and DANE. We analyzed new cases and cancer deaths of individuals residing in Manizales from 1 January 2003 to 31 December 2007. Cases reported correspond to primary invasive malignant tumors, in all locations, except basal cell carcinoma of the skin. We checked the internal consistency of the data and applied quality indicators suggested by the IARC. The population at risk was obtained from population projections (1985 -- 2020, DANE). Specific rates were estimated by gender and age (18 quinquennial groups), and standardized to the world population directly referenced.

Results:

There were 3416 new cases and 1895 deaths from cancer. The age- standardized incidence rate (ASR) per 100,000 people-years for all primary locations (except skin) was 162.4 in women and 166.2 in men. Cancer accounted for 19.8% of mortality in Manizales with ASR per 100,000 people-years of 92.1 in men and 83.6 in women.

Conclusions:

The risk of developing cancer or dying from cancer in Manizales is intermediate and similar to national estimates. The information generated by the PCR-M meets international quality standards, so it is necessary to ensure sustainability and improvement.     

Hypoxemia predicts death from severe falciparum malaria among children under 5 years of age in Nigeria: the need for pulse oximetry in case management

Background

Oxygen saturation is a good marker for disease severity in emergency care. However, studies have not considered its use in identifying individuals infected with Plasmodium falciparum at risk of deaths.

Objective

To investigate the prevalence and predictive value of hypoxaemia for deaths in under-5s with severe falciparum malaria infection.

Methods

Oxygen saturation was prospectively measured alongside other indicators of disease severity in 369 under-5s admitted to a tertiary hospital in Nigeria. Participants were children in whom falciparum malaria parasitaemia was confirmed with blood film microscopy in the presence of any of the World Health Organization-defined life-threatening features for malaria.

Results

Overall mortality rate was 8.1%. Of the 16 indicators of the disease severity assessed, hypoxaemia (OR=7.54; 95% CI=2.80, 20.29), co-morbidity with pneumonia (OR=19.27; 95% CI=2.87, 29.59), metabolic acidosis (OR=6.21; 95% CI=2.21, 17.47) and hypoglycaemia (OR=19.71; 95% CI=2.61, 25.47) were independent predictors of death. Cerebral malaria, male gender, wasting, hypokalaemia, hyponatriaemia, azotaemia and renal impairment were significantly associated with death in univariate analysis but not logistic regression model.

Conclusions

Hypoxaemia predicts deaths in Nigerian children with severe malaria, irrespective of other features. Efforts should always be made to measure oxygen saturation as part of the treatments for severe malaria in children.     

Prevalence and outcomes of acute kidney injury in term neonates with perinatal asphyxia

Background

The kidney is the most damaged organ in asphyxiated full-term infants. The severity of its damage is correlated with the severity of neurological damage. We determined the prevalence of perinatal asphyxia-associated acute kidney injury (AKI).

Methods

We conducted a prospective cohort study including 60 full-term neonates admitted at the Kenyatta National Hospital newborn unit (NBU) in Nairobi with hypoxic ischaemic encephalopathy (HIE) from June 2012 to November 2012. Renal function was assessed by measuring serum creatinine on day 3 of life. AKI was defined by a level of creatinine above 133 µmol/l. The degree of neurological impairment was determined daily until patient discharge, death or day 7 of life.

Results

Of the 60 infants 36.6% had HIE I, 51.6% HIE II and 11.8% HIE III. The prevalence of AKI was 11.7 %. There was a 15 fold increase risk of developing AKI in HIE III versus HIE I, p=0.034. Mortality rate in perinatal asphyxia associated AKI was 71.4 % with a 24 fold increase risk of death in neonates with AKI, p=0.001.

Conclusions

AKI is common and associated with poorer outcomes in perinatal asphyxia. Larger studies need to be done to correlate maternal factors and perinatal asphyxia-associated AKI.     

Recognising patients who will die in the near future: a nationwide study via the Dutch Sentinel Network of GPs

Background

Recognising patients who will die in the near future is important for adequate planning and provision of end-of-life care. GPs can play a key role in this.

Aim

To explore the following questions: How long before death do GPs recognise patients likely to die in the near future? Which patient, illness, and care-related characteristics are related to such recognition? How does recognising death in the near future, before the last week of life, relate to care in during this period?

Design and setting

One-year follow-back study via a surveillance GP network in the Netherlands.

Method

Registration of demographic and care-related characteristics.

Results

Of 252 non-sudden deaths, 70% occurred in the home or care home and 30% in hospital. GP recognition of death in the near future was absent in 30%, and occurred prior to the last month in 15%, within the last month in 19%, and in the last week in 34%. Logistic regression analyses showed cancer and low functional status were positively associated with death in the near future; cancer and discussing palliative care options were positively associated with recognising death in the near future before the last week of life. Recognising death in the near future before patients’ last week of life was associated with fewer hospital deaths, more GP–patient contacts in the last week, more deaths in a preferred place, and more-frequent GP–patient discussions about specific topics in the last 7 days of life.

Conclusion

Recognising death in the near future precedes several aspects of end-of-life care. The proportion in whom death in the near future is never recognised is large, suggesting GPs could be assisted in this process through training and implementation of care protocols that promote timely recognition of the dying phase.     

Cancer incidence and mortality in the Bucaramanga metropolitan area, 2003-2007

Introduction:

Cancer is an important cause of morbidity and mortality worldwide. Population-based cancer registries (PBCRs) make possible to estimate the burden of this condition.

Aim:

To estimate cancer incidence and mortality rates in the Bucaramanga Metropolitan Area (BMA) during 2003-2007.

Methods:

Incident cases of invasive cancer diagnosed during 2003-2007 were identified from the Bucaramanga Metropolitan Area PBCR (BMA-PBCR). Population counts and mortality were obtained from the Colombian National Administrative Department of Statistics (NADS). We estimated total and cancer-specific crude incidence and mortality rates by age group and sex, as well as age-standardized (Segi''s world population) incidence (ASIR(W)) and mortality (ASMR(W)) rates. Statistical analyses were conducted using CanReg4 and Stata/IC 10.1.

Results:

We identified 8,225 new cases of cancer excluding non-melanoma skin cancer (54.3% among women). Of all cases, 6,943 (84.4%) were verified by microscopy and 669 (8.1%) were detected only by death certificate. ASIR(W) for all invasive cancers was 162.8 per 100,000 women and 177.6 per 100,000 men. Breast, cervix, colorectal, stomach and thyroid were the most common types of cancer in women. In men, the corresponding malignancies were prostate, stomach, colorectal, lung and lymphoma. ASMR(W) was 84.5 per 100,000 person-years in women and 106.2 per 100,000 person-years in men. Breast and stomach cancer ranked first as causes of death in those groups, respectively.

Conclusion:

Overall, mortality rates in our region are higher than national estimates possibly due to limited effectiveness of secondary prevention strategies. Our work emphasizes the importance of maintaining high-quality, nationwide PBCRs.