Biomedical subjects

S R Huttly

Publications and source records attributed to S R Huttly.

At least 37 records · Page 2Linked to original sources

PubMed1992

The risk approach to intervention in severe malnutrition in rural Bangladesh.

To determine whether clinical marasmus occurs in small groups of children from easily recognizable high-risk households, the authors conducted a case-control study to identify risk indicators that may be used in targeted interventions. Cases were children whose mid-upper arm circumference measured less than 110 mm, and controls were children matched for age and sex with arm circumferences greater than 120 mm. Between June 1988 and June 1989, 164 such pairs of children aged 1-4 years were studied in Matlab, Bangladesh. Conditional logistic regression analysis showed an increased risk of marasmus among children from families with other children under 5 years of age (odds ratio = 2.80, 95% confidence interval 1.56-5.02) and children who consumed formula foods (odds ratio = 18.81, 95% confidence interval 4.15-85). Higher maternal education was associated with reduced risk of marasmus. Further examination of these risk indicators suggests that the resources saved through targeting fewer households will be negated by missing many children with marasmus. The authors conclude that the application of targeted interventions against marasmus, using the risk approach, is unlikely to be efficient.

Arm↗

PubMed1992

Maternal education in relation to early and late child health outcomes: findings from a Brazilian cohort study.

In a population-based cohort of approximately 6000 Brazilian children, the associations between maternal education and a number of child health outcomes were studied while controlling for potentially confounding variables such as family income and education of the husband. In the crude analyses, maternal education was associated with perinatal and infant mortality, hospital admissions in the first 20 months of life and the three nutritional indicators (length-for-age, weight-for-age and weight-for-length) at mean age 20 months. After adjustment for confounding, the apparent associations with outcomes in early infancy--birthweight and perinatal mortality--were no longer present, while that with infant mortality persisted despite being reduced. Strong associations remained with later outcomes including hospital admissions, length-for-age and weight-for-age at mean age 20 months. Among infants born to women with little or no schooling, deaths due to diarrhoea, pneumonia and other infectious diseases were particularly common. These findings support the hypothesis that maternal education has an effect on child health which is partly independent from that of other socioeconomic factors; they also suggest that maternal care is more important than the biological characteristics of the mothers since stronger effects were observed for the late (postneonatal mortality, hospital admissions and nutritional status) than for the early (birthweight, perinatal mortality) outcomes.

Birth Weight↗

PubMed1992

Early childhood mortality in a Brazilian cohort: the roles of birthweight and socioeconomic status.

The deaths of children aged 1-4 years were studied in a cohort of 5914 Brazilian liveborns. A total of 29 early childhood deaths were recorded (cumulative mortality risk of approximately 6 per 1000), 17 of which (59%) were due to infectious diseases. The death rate was highest in the second year. Deaths were highly concentrated in children from low income (< US $50/month) families, where the cumulative risk of early childhood death was about 10 per 1000; on the other hand, there were no deaths among the 616 children from families with a monthly income of US $300 or more. Birthweight was also associated with mortality: the cumulative risk of children weighing less than 2000 g at birth was 21 per 1000, compared to 4 per 1000 among those with birthweights of 3500 g or more. Simultaneous adjustment for income and birthweight did not substantially change these differentials. These findings confirm the strong association between early childhood mortality and socioeconomic conditions, but also make evident the long-term effects of low birthweight.

Birth Weight↗

PubMed1992

Breast feeding duration in consecutive offspring: a prospective study from southern Brazil.

The association between breast feeding duration in two consecutive pregnancies was studied in a prospective study in southern Brazil. In a population-based sample of 5960 women giving birth in 1982, 1386 delivered a second child within 4 years. The data were analyzed using life table techniques. The duration of breast feeding of the second child increased directly according to the duration the previous child had been breast fed. In particular, when the previous child had been breast fed for 6 months or more, the subsequent child was clearly more likely to be breast fed. However, when the previous child had been breast fed for under 6 months, the differences among subsequent children disappeared after 3-6 months. These differences were still present after stratification by family income, maternal education and parity. Mothers with a previous unsuccessful or problematic breast feeding experience should receive special priority in promotion campaigns.

Birth Order↗

PubMed1992

Deaths due to dysentery, acute and persistent diarrhoea among Brazilian infants.

In a population-based study, all infant deaths occurring in a one-year period in the metropolitan areas of Porto Alegre and Pelotas, in southern Brazil, were studied. There were 227 infants who presented diarrhoea during the fatal illness, and in 75% of these diarrhoea was considered to be the underlying cause of death. Acute diarrhoea (< 14 days' duration) accounted for 28% of the deaths, persistent diarrhoea for 62% and dysentery for a further 10%. Approximately one-half of the children with persistent diarrhoea were admitted to a hospital in the first two weeks of the episode. Hospital-acquired infections were likely to have contributed to one- to two-thirds of deaths due to dysentery and persistent diarrhoea. A comparison with neighbourhood controls showed that breast milk provided substantial protection against deaths due to either acute or persistent diarrhoea.

Acute Disease↗

PubMed1992

Birth spacing and child health in urban Brazilian children.

The associations between birth interval and a range of child health outcomes were examined in a population-based cohort of approximately 3500 urban Brazilian children. The effects of several socioeconomic and maternal confounding factors were controlled for in the analyses. Children born after shorter birth intervals (less than 18 and 18 through 23 months) were disadvantaged with respect to most of the health outcomes when compared with children born after intermediate birth intervals (24 through 35, 36 through 47, and 48 through 71 months). Effects were particularly marked for birth weight, postneonatal mortality, and anthropometric status at mean age 19 months. Children born after a long birth interval (greater than 71 months) also showed some disadvantage for birth weight, perinatal mortality, and infant mortality. However, this group experienced lower risks of hospitalizations during the first 19 months of life and better anthropometric status at mean age 19 months. This study provides data that are scarce from such settings and contributes to the quantification of associations between birth spacing and child health. This information is important in the planning of appropriate intervention strategies.

Anthropometry↗

PubMed1992

Comparison of the causes and consequences of prematurity and intrauterine growth retardation: a longitudinal study in southern Brazil.

A cohort of 5914 liveborns (99% of the city births) was followed up to the age of 4 years in Pelotas, southern Brazil. Besides the perinatal evaluation, the cohort children were examined again at mean ages of 11, 23, and 47 months. During each visit the children were weighed and measured and information on morbidity was collected. Also, multiple sources of information were used for monitoring mortality throughout the study. Of the babies with known gestational age, 9.0% were classified as intrauterine growth-retarded and 6.3% as preterm. Excluding those of unknown gestational age, 62% of low birth weight babies were intrauterine growth-retarded and 36% were preterm. Intrauterine growth retardation was statistically associated with maternal height, prepregnancy weight, birth interval, and smoking, whereas preterm births were associated with maternal prepregnancy weight and maternal age. Preterm babies had a perinatal mortality rate 13 times higher than that of babies of appropriate birth weight and gestational age and 2 times higher than that of intrauterine growth-retarded babies. Infant mortality rates presented a similar pattern, with the differentials being more pronounced during the neonatal than in the postneonatal period. In the first 2 years of life intrauterine growth-retarded children were at almost twice the risk of being hospitalized for diarrhea compared with appropriate birth weight, term children, while preterm children experienced only a slightly greater risk. For pneumonia, however, both groups of children were hospitalized significantly more than appropriate birth weight, term children. In terms of growth, despite their earlier disadvantage, preterm children gradually caught up with their appropriate birth weight, term counterparts.(ABSTRACT TRUNCATED AT 250 WORDS)

Birth Weight↗

PubMed1991

Epidemic of caesarean sections in Brazil.

Brazil has one of the highest rates of caesarean section in the world. Patterns of caesarean sections were studied in a cohort of 5960 mothers followed from 1982 to 1986 in southern Brazil. Overall, 27.9% were delivered by caesarean section in 1982, this proportion being 30% for nulliparae, 80% for second deliveries when the first was by caesarean, and over 99% for third births when the first two were by caesarean. Socioeconomic status and requests for sterilisation by tubal ligation were important underlying factors. 9.4% of the women were sterilised during a caesarean section (3.7% in the lowest income group and 20.2% in the highest). 31% of women who had had their first child by a caesarean section and who were having a second operative delivery were sterilised. The high rates of caesarean sections and accompanying sterilisations reflect the lack of appropriate reproductive and contraceptive policies in the country.

Brazil↗

PubMed1991

Cancer of the testis, socioeconomic status, and occupation.

The risk of testicular cancer in relation to lifetime histories of socioeconomic status, occupation, and occupational exposures was examined in a case-control study in England. Interviews were conducted with 259 cases, 238 control patients treated at radiotherapy and oncology centres, and 251 controls who were hospital inpatients in other departments. Risk of testicular cancer was raised in men of high socioeconomic status measured both by occupation and in other ways, and was similar in relation to status measured at birth and at various later stages of life. The occupations with highest risk of the tumour were paper and printing workers, professionals, and administrators. Exposures to various specific occupational agents that have been suggested in publications as potential risk factors were examined, but none showed an association with risk. The relative risk for occupational exposure to ionising radiation was 1.62 (95% confidence interval 0.83-3.17).

Adolescent↗

PubMed1991

The timing of nutritional status determination: implications for interventions and growth monitoring.

A population-based birth cohort of 1226 urban Brazilian children underwent anthropometric examinations at, on average, ages 11, 23 and 47 months. Multiple regression analyses showed that while birth weight was the single most important factor in predicting nutritional status at age 11 months, a wide range of other social, biological and morbidity factors also appeared to play a significant role. Environmental and dietary factors, however, showed no significant association. Nutritional status at age 11 months was a very strong predictor of nutritional status at ages 23 and 47 months and the other explanatory factors made a minimal additional contribution to the regression models. These results suggest that, in this population, childhood nutritional status is primarily determined before the end of the first year of life. These findings have implications for the timing and nature of nutritional interventions and for mechanisms for identifying those children who will suffer from poor nutritional status later in childhood.

Body Height↗

PubMed1991

Prolonged breastfeeding and malnutrition: confounding and effect modification in a Brazilian cohort study.

We examined the association between prolonged breastfeeding and anthropometric status in a population-based cohort study of 5,914 liveborns from the city of Pelotas in Southern Brazil. When children from all socioeconomic groups were studied, there was no important association between current breastfeeding and anthropometric status at age 12 months. Children who were still breastfed at age 20 months--and, to a lesser extent, at 43 months--presented with poorer anthropometric status than their nonbreastfed counterparts. We did not find the same pattern in all socioeconomic groups, however. Children from low-income families who were breastfed tended to present better anthropometric status than those who were not, whereas the reverse was observed for children of middle- and high-income families. After controlling for confounding variables, the nutritional advantage of breastfeeding among low-income families was no longer clear, while the superiority of nonbreastfed infants amongst middle- and high-income children persisted. These findings indicate that some of the controversy regarding the nutritional effects of prolonged breastfeeding may have been caused by confounding and effect modification. Any decisions on whether or not breastfeeding should be encouraged after the first year of life should take into account the characteristics of the population as well as the anti-infective and birth-spacing properties of breastfeeding.

Anthropometry↗

PubMed1990

Bacterial contamination of weaning foods and drinking water in rural Bangladesh.

The aim of this study was to determine what weaning foods and food preparation practices expose children to a high risk of diarrhoeal disease through exposure to a contaminated diet. Bacterial contamination of 897 food and 896 drinking water samples was assessed in a water and sanitation intervention project. The geometric mean of faecal coliforms per g or ml was 7.5 x 10(3) in left-over rice. 1.4 x 10(2) in other types of boiled rice, 2.5 x 10(2) in milk, 4.8 in household drinking water, and 3.5 in bread. Multiplication of faecal coliforms occurred when there was a delay of more than 4 h between preparation and consumption of food. All samples were more contaminated in the rainy than in the dry season. Strategies to reduce contamination should therefore focus on 'wet' foods, early consumption after preparation, and re-heating of left-over foods. Understanding the reasons for the faulty practices is also essential to the formulation of effective measures.

Bacteria↗

PubMed1990

Environmental sanitation, food and water contamination and diarrhoea in rural Bangladesh.

This study examined the role of food and water contamination in a health impact evaluation of a water and sanitation intervention project. Although lower diarrhoea rates were found in the improved area no consistent difference in food and water contamination was observed between areas. Furthermore, no relationship was found between contamination and diarrhoea in either area, even after controlling for the nutritional status of children. These results imply that other vehicles of transmission might be more important than food and water in diarrhoeal transmission. The focus of interventions should therefore be on changing behaviours to improve overall hygiene.

Bangladesh↗

PubMed1990

Do mothers overestimate breast feeding duration? An example of recall bias from a study in southern Brazil.

The problem of recall bias when reporting breast feeding duration is investigated. Data are presented from the follow-up of over 1,000 children from a birth cohort (1982) in southern Brazil, when they were on average 11, 23, and 47 months of age. Compared with the response given at 11 months of age, 24% of mothers misclassified the duration (grouped into 3-month categories) at age 23 months and 30% at age 47 months. Women who were richer and/or better educated were significantly more likely to report longer durations, while those poorer and less educated did not tend to misclassify more in one direction than in the other.

Brazil↗

PubMed1990

Caesarean section and duration of breast feeding among Brazilians.

A birth cohort study of 4912 Brazilian infants showed that the incidence and duration of breast feeding for children delivered vaginally and for those born by elective caesarean section were similar. Those delivered by emergency caesarean section, however, were not breast fed for as long. This difference persisted after adjustment for confounding variables.

Brazil↗

PubMed1990

Subsequent pregnancies: who has them and who wants them? Observations from an urban center in southern Brazil.

Subsequent pregnancies in mothers of a birth cohort from Pelotas, Southern Brazil, were studied in relation to maternal and socio-economic factors. Within about 3 1/2 years of the cohort child's birth, 39% of mothers had experienced at least one further pregnancy. This proportion decreased with increasing maternal age, years of schooling and family income. A U-shaped trend was observed with respect to parity. Mothers who had delivered the cohort child by caesarean section were also less likely to have another pregnancy within that time. Logistic regression analysis showed that each of these factors remained significantly associated with further pregnancies after controlling for the remaining variables. Analysis of the first subsequent pregnancy showed that a high proportion of mothers had not wanted the pregnancy. Unwanted pregnancies were also significantly associated with older women, low educational status, higher parity and low family income.

Birth Rate↗

PubMed1990

The impact of inadequate sanitary conditions on health in developing countries.

One of the achievements of the International Drinking Water Supply and Sanitation Decade (1981-1990) is a better understanding of the relationship between poor sanitary conditions and health. This article reviews current knowledge of the major water- and excreta-related diseases and the potential impact of improved sanitary facilities on health. Four health indicators are considered--diarrhoeal diseases, soil-transmitted nematode infections, dracunculiasis (guinea-worm disease) and nutritional status. These constitute some of the major health problems in the developing world. Although there are large variations in morbidity and mortality rates both between and within geographical areas, some global estimates are presented. Children under 5 experience an average of 3.4 episodes of diarrhoea per year and a diarrhoeal mortality rate estimated at 12 per 1,000, leading to 4 million diarrhoea-associated deaths per year. Diarrhoea may also be associated with a sizeable proportion of adult deaths. Approximately 1,000 million people are believed to be infected with Ascaris lumbricoides, 900 million with hookworms and 500 million with Trichuris trichiura. Dracunculiasis, primarily occurring in remote rural areas, is known to be greatly underreported, but estimates suggest that 10 million people are infected each year. Malnutrition is widely prevalent and a common cause or associated cause of child death. The complex issues involved in measuring the health impact of improved sanitary facilities and the mechanisms by which these impacts may occur are discussed. These complexities, plus the differences in sanitary improvements and environmental settings, and the diverse nature of the health indicators considered, all contribute substantial variations in the health impact observed.(ABSTRACT TRUNCATED AT 250 WORDS)

Adult↗

PubMed1990

Effectiveness of BCG vaccination against tuberculous meningitis: a case-control study in São Paulo, Brazil.

A case-control study was carried out in the Metropolitan Region of São Paulo, Brazil, to determine the protection against tuberculous meningitis conferred by BCG vaccination to children aged less than 5 years. The BCG vaccination coverage in the study area was about 88%. A total of 72 tuberculous meningitis patients were studied as well as 505 neighbourhood and 81 hospital controls. Analysis of the data using a conditional logistic regression for matched case-control studies indicated that the efficacy of BCG was similar for both groups of controls, that for neighbourhood controls (84.5%) being slightly greater than that for hospital controls (80.2%). No significant interactions were found between vaccination status and sex, age, or socioeconomic status.

BCG Vaccine↗