An analysis of anemia and child mortality

The relationship of anemia as a risk factor for child mortality was analyzed by using cross-sectional, longitudinal and case-control studies, and randomized trials. Five methods of estimation were adopted: 1) the proportion of child deaths attributable to anemia; 2) the proportion of anemic children who die in hospital studies; 3) the population-attributable risk of child mortality due to anemia; 4) survival analyses of mortality in anemic children; and 5) cause-specific anemia-related child mortality. Most of the data available were hospital based. For children aged 0-5 y the percentage of deaths due to anemia was comparable for reports from highly malarious areas in Africa (Sierra Leone 11.2%, Zaire 12.2%, Kenya 14.3%). Ten values available for hemoglobin values <50 g/L showed a variation in case fatality from 2 to 29.3%. The data suggested little if any dose-response relating increasing hemoglobin level (whether by mean value or selected cut-off values) with decreasing mortality. Although mortality was increased in anemic children with hemoglobin <50 g/L, the evidence for increased risk with less severe anemia was inconclusive. The wide variation for mortality with hemoglobin <50 g/L is related to methodological variation and places severe limits on causal inference; in view of this, it is premature to generate projections on population-attributable risk. A preliminary survival analysis of an infant cohort from Malawi indicated that if the hemoglobin decreases by 10 g/L at age 6 mo, the risk of dying becomes 1.72 times higher. Evidence from a number of studies suggests that mortality due to malarial severe anemia is greater than that due to iron-deficiency anemia. Data are scarce on anemia and child mortality from non-malarious regions. Primary prevention of iron-deficiency anemia and malaria in young children could have substantive effects on reducing child mortality from severe anemia in children living in malarious areas.     

孕产妇死亡评审结果分析

目的 通过孕产妇死亡评审及时发现和掌握各个环节中存在的问题,为上级部门针对性地提出干预措施及管理办法提供准确依据,降低孕产妇死亡率.方法 根据"湖南省孕产妇死亡管理办法"规定,对上报到州级的资料依据世界卫生组织的"十二格法"进行评审分析.结果 2006年评审的14例孕产妇死亡病例:羊水栓塞3例,子痫2例,产后出血、输卵管妊娠破裂、子宫不全内翻各1例,麻醉意外、重度贫血、肺部感染、脑梗塞、脑出血、肾功能衰竭各1例,直接产科死因8例,占57.14%,间接产科死因6例,占42.86%;可避免死亡8例,占57.14%;创造条件可避免死亡3例,占21.43%;不可避免死亡,占21.43%.结论 建立稳定的妇幼卫生经费保障机制,加强妇幼保健三级网络建设;提高产科医护人员专业技术水平及产科质量;加强各部门间的协调、支持,保障母婴安全.     

An assessment of pregnancy-related mortality in the United States

Deaths from pregnancy complications remain an important public health concern. Nationally, two systems collect information on the number of deaths and characteristics of the women who died from complications of pregnancy. The Centers for Disease Control and Prevention's (CDC) National Center for Health Statistics (NCHS) reports maternal mortality through the National Vital Statistics System (NVSS); CDC National Center for Chronic Disease Prevention and Health Promotion's Pregnancy Mortality Surveillance System (PMSS) conducts epidemiological surveillance of pregnancy-related deaths. The numbers of deaths reported by these two systems have differed over the past two decades; our objective was to determine the magnitude and nature of these differences. For 1995-97, we compared maternal deaths in the NVSS with pregnancy-related deaths in PMSS for the 50 States, Washington DC and New York City. Pregnancy-related deaths whose underlying cause was assigned to ICD-9 codes 630-676 by NVSS were classified as maternal deaths; those coded outside 630-676 were not. There were 1387 pregnancy-related deaths in PMSS and 898 maternal deaths in the NVSS; 54% of these deaths were reported in both systems, 40% in PMSS only, and 6% in NVSS only. Pregnancy-related deaths due to haemorrhage, embolism, and hypertensive complications of pregnancy were proportionately more often identified by NVSS as maternal deaths than those from cardiovascular complications, medical conditions or infection. From the 1471 unduplicated deaths classified as maternal or pregnancy-related from either reporting system, we estimated a combined pregnancy-related mortality ratio of 12.6/100,000 live births for 1995-97, compared with 11.9 for PMSS only and 7.5 for NVSS only. The identification and classification of these events is dependent on the provision of complete and accurate cause-of-death information on death certificates. Changes in the guidelines for coding maternal deaths under ICD-10 may change the relationship in the number of deaths resulting from pregnancy reported by these two systems.     

孕产妇死亡评审结果分析及干预措施探讨

目的 通过孕产妇死亡评审,了解死亡孕产妇主要死因、孕产妇死亡率变化趋势和变化特征.方法 采用回顾性研究的方法 ,对2008年贵州省65个"降消项目"县177例孕产妇死亡评审资料进行分析.结果 贵州项目县孕产妇死亡率2008年为57.79/10万,高出全国2007年近1倍(2007年全国监测数据显示孕产妇死亡率为36.6/10万),前3位死因分别为产科出血、妊娠期高血压疾病和羊水栓塞.结论 强化政府行为,严格考核制度、加强围产保健管理、增强县级产科急救能力、建立部门沟通机制、提高孕产妇死亡评审质量是降低孕产妇死亡的重要途径.     

陕西省麟游县孕产妇死亡监测结果分析

目的 掌握麟游县孕产妇死亡率的动态变化、主要死亡原因和影响因素,评估孕产妇接受卫生保健服务效果.方法 对县内所有长住及流动人口中的孕产妇死亡进行监测.结果 1988～2007年全县孕产妇死亡率为141.99/10万,后10年(1998～2007年)比前10年(1988～1997年)孕产妇死亡率下降,但无统计学差异.近10年孕产妇分娩地点及死亡地点有显著性变化.可避免及创造条件可避免的孕产妇死亡占84.00%.孕产妇主要死亡原因为产后出血、妊娠高血压疾病及合并症.贫困、偏远、生活条件差、资源缺乏等为孕产妇死亡的主要影响因素.结论 加强围产期保健,做好高危妊娠管理;加强各级产科建设,提高产科人员业务技能;加强健康教育,改变传统生育观念;开展贫困孕产妇救助工作,有效降低孕产妇死亡率.     

Reproducibility and validity of maternal recall of pregnancy-related events.

We assessed the reproducibility and validity of a questionnaire that asks mothers to recall pregnancy-related events from thirty or more years ago. Among 146 women who completed the questionnaire twice, responses were highly reproducible for pre-pregnancy height and weight (r = 0.95), pregnancy complications (r = 0.74), substance use (r = 0.80), preterm delivery (r = 0.82), birthweight (r = 0.94), and breastfeeding (r = 0.89). Among 154 women whose questionnaire responses were compared to data collected during their pregnancies, recall was highly accurate for height (r = 0.90), pre-pregnancy weight (r = 0.86), birthweight (r = 0.91), and smoking (sensitivity = 0.86, specificity = 0.94). These findings suggest that long-term maternal recall is both reproducible and accurate for many factors related to pregnancy and delivery.     

西安市10年孕产妇死亡分析

目的 通过孕产妇死亡资料分析.寻求制定行之有效的干预措施,降低孕不妇死亡率.方法 对西安市1995年～2004年度孕产妇死亡资料进行回顾性研究分析.结果 西安市十年内产妇总数为440 890例,孕产妇死亡221例,孕产妇死亡率平均为50.12/10万.孕产妇死亡前三位原因依次是:产科出血、妊娠期高血压疾病、羊水栓塞.结论 建立健全急诊产科救治体系是降低孕产妇死亡率的重要措施.     

影响县级孕产妇死亡率的相关因素分析

目的 利用世界银行贷款卫生六项目实施6年来的相关县级水平资料,对影响孕产妇死亡率的相关因素进行分析,以进一步降低孕产妇死亡率。方法 在县级水平对项目地区收集的1995至2000年孕产妇死亡情况,以及相关的经济、文化、卫生常规报表数据资料进行单因素分析。结果 项目地区的平均孕产妇死亡率自1995年的159．74／10万降至2000年的77．75／10万,下降了51．33％,但与全国水平相比仍有差距;孕产妇死亡率与当地的地形、经济文化水平、交通通讯、卫生资源和产科服务质量等因素有关。结论 为进一步降低孕产妇死亡率,建议增加卫生经费的投入,改善卫生服务设施;加强孕期健康教育的宣传;提高孕产妇对医疗保健服务的利用,提高产科服务质量;加强对卫技人员的培训,提高其知识技能水平;加强交通通讯设施的建设。     

An assessment of DHS maternal mortality indicators

This study presents an assessment of the quality of data relating to maternal mortality collected in 14 Demographic and Health Surveys (DHS) for 13 countries that included a complete sibling history. Four aspects of data quality are considered: completeness of the data for reported events, evidence of omission in the reporting of events, plausibility of the pattern of sibling deaths, and sampling errors of the maternal mortality estimates. Although the data relating to reported events are complete for most variables, comparisons of sibling-history-based estimates of adult mortality for both males and females with other independent estimates suggest that sibling estimates are more likely to be underestimates than overestimates. The downward bias is probably greater for female mortality than for male mortality. The sampling errors associated with maternal mortality ratios are substantially larger than those associated with other frequently used DHS indicators. This lack of precision precludes the use of these data for trend analysis and has led to the recommendation that this DHS module not be used more than once every ten years in the same country.     

汉中市160例孕产妇死亡原因分析及防治

目的 回顾性分析汉中市近10年孕产妇死亡情况,探讨其原因及相关因素变化,为降低孕产妇死亡提供科学依据,制定相应防治措施.方法 对近10年孕产妇死亡资料、年报数据卡册、个案调查报告进行回顾性分析.结果 10年来汉中市孕产妇死亡率平均为55.16/10万,呈下降趋势.后5年较前5年降低了18.53/10万,降低明显(χ2=4.508,P<0.05).农村、山区孕产妇死亡率高于城市,文化程度及经济收入越低、交通越差死亡构成比越高;死亡多发生在20～30岁、经产妇、孕期保健差、在家中和乡村医院分娩的孕妇.死因顺位前3位为:产科出血、内科合并症、羊水栓塞.结论 汉中市近10年孕产妇死亡率呈下降趋势,产科出血占死亡原因首位,针对孕产妇死亡的主要原因今后要加大防治力度和母婴保健宣传教育工作,分析讨论降低孕产妇死亡的对策.     

安庆市2001～2006年孕产妇死亡分析

目的 通过孕产妇死亡资料分析,寻求制定行之有效的干预措施,降低孕产妇死亡率.方法 对安庆市2001～2006年度死亡孕产妇资料进行回顾性研究分析.结果 安庆市2001～2006年度产妇总数为322 350人,孕产妇死亡123例,平均死亡率为38.16/10万,低于WHO报道的发展中国家水平(χ2=0.67,P＞0.05).孕产妇死亡的前两位原因依次为:产科出血和妊娠期高血压疾病.结论 建立健全孕产妇紧急救治网络,加强产科技术人员技术培训,扩大健康教育,提高自我保健意识是降低孕产妇死亡的重要措施.     

贵阳地区10年间孕产妇死亡分析

目的 监测贵阳地区10年来孕产妇死亡情况,为降低孕产妇死亡率提供科学依据.方法 对1998～2007年孕产妇死亡率资料、年报数据卡册资料进行分析.结果 10年间孕产妇死亡率呈下降趋势,其间2002～2003年出现了增高;产科出血死因顺位连续9年均为第1位;1998～2006年间,农村地区孕产妇死亡率均高于城市,而2007年城市孕产妇死亡率(61.71/10万)高于农村(49.98/10万).结论 提高产科出血的抢救诊治能力,提高农村住院分娩率,完善危重孕产妇的抢救、转诊网络是贵阳地区降低孕产妇死亡的关键.     

西安市2000～2008年孕产妇死亡趋势与原因探析

目的 探讨孕产妇死亡的变化趋势、影响因素、根本原因及其风险因素,以改善应对措施,确保母婴安全.方法 对西安市2000～2008年常住人口和流动人口中死亡的孕产妇资料,使用Excel数据库进行资料录入,利用SPSS 13.0软件包进行统计学分析.结果 西安市常住人口中孕产妇死亡率有逐年下降的趋势,平均为36.06/10万,2008年在2000年的基础上显著下降了57.28%(χ2=5.205,P=0.030<0.05);流动人口中的孕产妇死亡率平均为213.45/10万,流动人口中的孕产妇死亡率显著高于常住人口中的孕产妇死亡率(χ2=60.814,P=0.000<0.05);孕产妇死亡的前5位死因依次是产后出血、羊水栓塞、妊娠期高血压疾病、妊娠合并症、胎盘早剥;孕产妇产后出血的死亡率有逐年下降的趋势;死亡孕产妇中高危年龄占到17.24%,88.28%居住在农村地区;孕期仅有37.24%产前检查达到5次;死亡孕产妇的孕期系统保健管理率(χ2=410.648,P=0.000<0.05 )与住院分娩率(χ2=56.485,P=0.000<0.05)显著低于全市;孕产妇死亡率与孕期系统保健管理率(r =-0.719,P<0.05)、住院分娩率(r=-0.799,P<0.01)呈显著负相关;评审结果显示死亡孕产妇中有85.90%是可以避免或创造条件可以避免的死亡.结论 西安市常住人口中孕产妇死亡率已经达到<西安市妇女发展纲要(2001～2010年)>目标,但85.9%是可以避免的死亡.应不断提高孕产妇的早孕检查率、系统保健管理率、住院分娩率,加强高危孕产妇的监管,将可避免的孕产妇死亡降到最低水平.     

中国孕产妇死亡状况的国际比较

目的:分析中国孕产妇死亡率在世界各国中的相对位置。方法:收集1990、2005年中国以及世界有可利用数据的172个国家孕产妇死亡率、死亡数,以及相关国情数据。计算死亡率平均年下降速率,并与和中国有相似国情的国家进行比较。结果:2005年世界孕产妇死亡率为386.75/10万,1990～2005年世界孕产妇死亡率平均年下降速率为0.95%;2005年中国孕产妇死亡率为45.00/10万,1990～2005年中国孕产妇死亡率平均年下降速率为4.86%,两项均位居172个有可利用数据国家的第109位。结论:1990～2005年世界孕产妇死亡率整体呈下降趋势,中国2005年孕产妇死亡率低于世界平均水平,1990～2005年孕产妇死亡率平均年下降速率高于世界平均水平。     

National estimates for maternal mortality: an analysis based on the WHO systematic review of maternal mortality and morbidity

Background  

Despite the worldwide commitment to improving maternal health, measuring, monitoring and comparing maternal mortality estimates remain a challenge. Due to lack of data, international agencies have to rely on mathematical models to assess its global burden. In order to assist in mapping the burden of reproductive ill-health, we conducted a systematic review of incidence/prevalence of maternal mortality and morbidity.     

黑河市2004～2007年孕产妇死亡情况分析

目的 通过孕产妇死亡资料分析,寻求有效干预措施,降低孕产妇死亡率.方法 对黑河市2004～2007年死亡孕产妇资料进行回顾性分析.结果 黑河市2004～2007年度活产数为44 906人,孕产妇死亡22人,平均死亡率为48.99/10万,各年度间孕产妇死亡率无统计学意义(χ2＝1.66,P＞0.05);2005～2007年度4个"降消"项目县与2个非"降消"项目县孕产妇死亡17人,平均死亡率为50.74/10万,项目县孕产妇死亡率低于非项目县(χ2＝3.65,P＜0.05);文化程度低(P=0.023＜0.05)、经济水平差(P=0.043＜0.05)的孕产妇住院分娩率低.结论 建立健全产科急诊救治网络,加强对产科技术人员管理培训,做好孕产期保健服务,加强健康教育,提高孕产妇自我保健意识,推广"降消"项目经验是降低孕产妇死亡的重要措施.     

广西孕产妇死亡率变化趋势分析及预测研究

目的 分析广西2006-2015年孕产妇死亡率及变化速率,预测其发展趋势,为科学制定相关策略和措施提供理论依据。方法 利用GM（1,1）灰色预测模型建立微分动态方程模拟广西2006-2015年孕产妇死亡率,判断其动态趋势,并外延预测2016-2018年广西孕产妇死亡率。结果 孕产妇死亡率灰色GM（1,1）预测模型为：（1）（k+1）=-322.242e-0.079k+349.402（C=0.187,P=1.000）;孕产妇死亡率呈下降趋势;灰色预测模型预测符合率>90%;下降趋势变化速率逐渐降低,2014年以来趋于平稳;预测2016-2018年广西孕产妇死亡率分别为12.04/10万、11.12/10万和10.27/10万。结论 近十年广西孕产妇死亡率下降态势呈现"先快速后平稳"的趋势,预测2016-2018年广西孕产妇死亡率将持续稳步降低。     

河南省克山病病情调查分析

目的　掌握我省克山病病情现状 ,制定进一步的防治措施。方法　采用分层随机抽样的方法分别在各病区抽取 3- 14岁儿童及 2 0 - 40岁妇女进行克山病检查。结果　我省克山病患病率为 2 .16% ,达到国家基本控制标准。结论　寻找病因 ,加强监测 ,是我们今后最主要的任务