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Engmann C Walega P Aborigo RA Adongo P Moyer CA Lavasani L Williams J Bose C Binka F Hodgson A 《Tropical medicine & international health : TM & IH》2012,17(3):272-282
Objective To calculate perinatal mortality (stillbirth and early neonatal death: END) rates in the Upper East region of Ghana and characterize community‐based stillbirths and END in terms of timing, cause of death, and maternal and infant risk factors. Methods Birth outcomes were obtained from the Navrongo Health and Demographic Surveillance System over a 7‐year period. Results Twenty thousand four hundred and ninty seven pregnant women were registered in the study. The perinatal mortality rate was 39 deaths/1000 deliveries, stillbirth rate 23/1000 deliveries and END rates 16/1000 live births. Most stillbirths were 31 weeks gestation or less. Prematurity, first‐time delivery and multiple gestation all significantly increased the odds of perinatal death. Approximately 70% of END occurred during the first 3 postnatal days, and the most common causes of death were birth asphyxia and injury, infections and prematurity. Conclusion Stillbirths and END remain a significant problem in Navrongo. The main causes of END occur during the first 3 days and may be modifiable with simple targeted perinatal policies. 相似文献
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Heidi Spillane Sarala Nicholas Zhirong Tang Elisabeth Szumilin Suna Balkan Mar Pujades‐Rodriguez 《Tropical medicine & international health : TM & IH》2012,17(10):1255-1263
Objectives To identify factors influencing mortality in an HIV programme providing care to large numbers of injecting drug users (IDUs) and patients co‐infected with hepatitis C (HCV). Methods A longitudinal analysis of monitoring data from HIV‐infected adults who started antiretroviral therapy (ART) between 2003 and 2009 was performed. Mortality and programme attrition rates within 2 years of ART initiation were estimated. Associations with individual‐level factors were assessed with multivariable Cox and piece‐wise Cox regression. Results A total of 1671 person‐years of follow‐up from 1014 individuals was analysed. Thirty‐four percent of patients were women and 33% were current or ex‐IDUs. 36.2% of patients (90.8% of IDUs) were co‐infected with HCV. Two‐year all‐cause mortality rate was 5.4 per 100 person‐years (95% CI, 4.4–6.7). Most HIV‐related deaths occurred within 6 months of ART start (36, 67.9%), but only 5 (25.0%) non‐HIV‐related deaths were recorded during this period. Mortality was higher in older patients (HR = 2.50; 95% CI, 1.42–4.40 for ≥40 compared to 15–29 years), and in those with initial BMI < 18.5 kg/m2 (HR = 3.38; 95% CI, 1.82–5.32), poor adherence to treatment (HR = 5.13; 95% CI, 2.47–10.65 during the second year of therapy), or low initial CD4 cell count (HR = 4.55; 95% CI, 1.54–13.41 for <100 compared to ≥100 cells/μl). Risk of death was not associated with IDU status (P = 0.38). Conclusion Increased mortality was associated with late presentation of patients. In this programme, death rates were similar regardless of injection drug exposure, supporting the notion that satisfactory treatment outcomes can be achieved when comprehensive care is provided to these patients. 相似文献
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Koura GK Ouedraogo S Le Port A Watier L Cottrell G Guerra J Choudat I Rachas A Bouscaillou J Massougbodji A Garcia A 《Tropical medicine & international health : TM & IH》2012,17(3):283-291
To determine the effect of maternal anaemia on pregnancy outcome and describe its impact on infant haemoglobin level in the first 18 months of life, we conducted a prospective study of 617 pregnant women and their children in Benin. Prevalence of maternal anaemia at delivery was 39.5%, and 61.1% of newborns were anaemic at birth. Maternal anaemia was not associated with low birth weight [OR = 1.2 (0.6-2.2)] or preterm birth [OR = 1.3 (0.7-2.4)], whereas the newborn's anaemia was related to maternal anaemia [OR = 1.8 (1.2-2.5)]. There was no association between an infant's haemoglobin level until 18 months and maternal anaemia. However, malaria attacks during follow-up, male gender and sickle cell trait were all associated with a lower infant haemoglobin level until 18 months, whereas good infant feeding practices and a polygamous family were positively associated with a higher haemoglobin level during the first 18 months of life. 相似文献
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Vincent De Brouwere Fabienne Richard Sophie Witter 《Tropical medicine & international health : TM & IH》2010,15(8):901-909
The huge majority of the annual 6.3 million perinatal deaths and half a million maternal deaths take place in developing countries and are avoidable. However, most of the interventions aiming at reducing perinatal and maternal deaths need a health care system offering appropriate antenatal care and quality delivery care, including basic and comprehensive emergency obstetric care facilities. To promote the uptake of quality care, there are two possible approaches: influencing the demand and/or the supply of care. Five lessons emerged from experiences. First, it is difficult to obtain robust evidence of the effects of a particular intervention in a context, where they are always associated with other interventions. Second, the interventions tend to have relatively modest short‐term impacts, when they address only part of the health system. Third, the long‐term effects of an intervention on the whole health system are uncertain. Fourth, because newborn health is intimately linked with maternal health, it is of paramount importance to organise the continuum of care between mother and newborn. Finally, the transfer of experiences is delicate, and an intervention package that has proved to have a positive effect in one setting may have very different effects in other settings. 相似文献
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Julián Martínez-Villanueva Rocío González-Leal Jesús Argente Gabriel Ángel Martos-Moreno 《Anales de pediatría (Barcelona, Spain : 2003)》2019,90(4):224-231
Introduction
The influence of parental obesity on their obese offsprings is acknowledged but insufficiently characterised.Patients and methods
Retrospective study of 800 obese patients (45.2% girls; age: 10.35 ± 3.40 years, body mass index [BMI]: + 4.22 ± 1.68 standard deviation score [SDS]). Group comparison according to the presence of obesity in none (n = 347) or any of the parents (n = 453), and then whether the obese parent was the father (n = 185), the mother (n = 151), or both parents (n = 117) were performed. The parameters analysed were: Age at the onset of the obesity and at their first visit, birth weight (BW), BMI-SDS, blood glucose, insulin level, homeostatic model assessment (HOMA) index, total cholesterol (TC), HDL, LDL, triglycerides, 25-OH-vitamin-D, area under the curve (AUC) for insulin in the oral glucose tolerance test (OGTT), whole body insulin sensitivity index (WBISI), LDL/HDL and TC/HDL ratios, and weight loss after 12 month follow-up.Results
No differences were observed between groups as regarding gender, ethnic background, or pubertal stage. Patients with one obese parent showed higher BW-SDS and BMI-SDS (P < .01), more severe impairment of carbohydrate metabolism (blood insulin, insulin-AUC, HOMA, HbA1c [P < .01] and lower WBISI [P < .05]) than those with no obese parent. Among those patients with a single obese parent, higher BW-SDS, insulin, HOMA, and lower 25-OH-vitamin D (P < .05) was observed when obesity was present in the mother. There was a higher prevalence of metabolic syndrome when both parents were obese (χ2 = 5.96, P < .05). A total of 132 patients reduced their BMI by ≥ 1.5 SDS, or their weight by ≥ 10%, with no influence of the background of parental obesity.Conclusions
Obesity in any parent determines a higher severity of their offspring obesity and metabolic comorbidities, more importantly when obesity is present in the mother or in both parents, but without interference in the options of therapeutic success. 相似文献8.
M. Diéguez Felechosa C. Sánchez Ragnarsson M. Riestra Fernández P. Suárez Gil E. Delgado Alvarez E. Menéndez Torre 《Clínica e investigación en ginecología y obstetricia》2019,46(1):9-14
Objective
To estimate the effectiveness of selective versus universal screening for thyroid dysfunction (TD) during pregnancy.Material and methods
Cross-sectional study applying a selective screening protocol, based on the presence of TD risk factors (RF), in a cohort of pregnant women with a positive universal screening result in the Oviedo Healthcare District. Two hundred and twenty pregnant women with TD were studied between April 2010 and March 2011.Results
Selective screening identified 83.6% of pregnant women with TD. The most prevalent RF were maternal age ≥ 30 years (70.5%), history of miscarriage (21.8%) and family history of thyroid disease (20.9%). Excluding the age factor, only 51.8% of the pregnant women included in the group had risk factors.Conclusions
Selective screening identifies a high proportion of pregnant women with TD but at the expense of screening a large number of women, so it does not appear to be an effective strategy. 相似文献9.
Helen de Nobrega-CorreaJuan Perozo-Romero Eduardo Reyna-Villasmil Duly Torres-CepedaIsabel Sabatini-Saéz 《Progresos de Obstetricia y Ginecología》2011,54(8):420-422
Amniotic fluid embolism is undoubtedly one of the most dangerous conditions of pregnancy and treatment is mainly supportive. We report the case of a patient with an amniotic fluid embolism at 41 weeks of pregnancy with a sudden episode of thoracic pain accompanied by dyspnea. The clinical presentation consisted of hypotension, hypoxia and coagulopathy, causing maternal and fetal death. 相似文献
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Dolores Borrás Suñer Sara Fortuño SalaisCésar Díaz García Vicente Diago AlmelaAlfredo Perales Marín 《Progresos de Obstetricia y Ginecología》2009
We present the case of a 41 years old pregnant, diagnosed of preeclampsia in her 39 weeks with catastrophic result, ending in maternal death. We show the deterioration of this patient since the diagnosis of preeclampsia, with evolution to eclampsia, HELLP syndrome, respiratory distress, septic shock and finally, maternal death. 相似文献