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PubMed1996

Impact of incomplete coverage of neonatal dried blood spot screening on estimating HIV-1 seroprevalence.

The aim of this study was to determine the extent to which selective under-coverage of births to mothers more likely to be at risk of HIV-1 infection will result in a significant under-estimation of the true neonatal seroprevalence. Census data, local birth statistics, maternity data and data from the prevalence monitoring programme were used to produce a model to predict the effects of under-coverage in the uptake of neonatal metabolic screening which has been observed in babies with a mother of ethnic group black African. The adjustment factor which allows for under-coverage is the relative inclusion ratio (RIR); the probability that samples from a group at different risk of HIV infection were included in the survey divided by the probability of inclusion for samples from all other babies. The RIR was found to be close to unity (0.97), indicating a minimal bias. Under usual conditions only if the relative inclusion ratio (RIR) declined to values of 0.87 or below would there be a substantial bias. Despite some selective under representation, the results obtained from the Unlinked Anonymous HIV Monitoring Programme Dried Blood Spot Survey would seem to identify levels of prevalence in the population of child-bearing women with a good degree of accuracy and remains a useful tool for resource allocation, planning of services, provision of care and counselling.

Adolescent↗
PubMed1988

The completeness of cancer registration in England: an assessment from the Oxford-FPA contraceptive study.

The completeness of cancer registration in England for the period 1968-85 has been assessed in a cohort of 17,000 women who reported malignancies directly to the investigators. Of 325 cancers reported, 281 (86.5%) had been registered by mid-1987. Under-registration varied considerably between regional cancer registries. Eight (18%) of the 44 unregistered cancers were treated in private hospitals. Under-registration also varied considerably with cancer site: only 8% of 150 breast cancers were not registered, and at sites accounting for 79% of all tumours, under-registration was less than 15%; however, 40% of melanomas (20 cases) and 50% of lung cancers (6 cases) were not registered. Of 281 registered tumours, only 219 (78%) were notified to the investigators from the NHSCR at Southport, with a median lag-time of 2.5 years since diagnosis. There has been a tendency for notification of registered cancers to the investigator to become more prompt but less complete.

Adult↗
PubMedDate not supplied

Discrepancies between men and women in reporting number of sexual partners: a summary from four countries.

Men and women in national surveys from four countries, the United States, Canada, Great Britain, and Norway, give mutually inconsistent reports of numbers of opposite-gender sexual partners. In all cases the number of female partners reported by men exceeds the number of male partners reported by women. Gender difference in reporting bias seems to be the most plausible explanation for the discrepancies.

Adult↗
PubMedDate not supplied

Breastfeeding and waiting time to conception for Malay women: a tale of two surveys.

This study investigates the unusual relationship between breastfeeding and waiting time to conception in Malaysia as reported in Goldman et al. (1987). Using data from the Malaysian World Fertility Survey (MWFS), Goldman and her colleagues (1987) find that noncontracepting Malaysian women have an unusually long waiting time to conception, given their relatively short durations of breastfeeding. This study provides a similar analysis using data from the Malaysian Family Life Survey (MFLS) and finds a more typical relationship. I conclude that the distinction between full and partial breastfeeding made to respondents of the MFLS probably led to more reliable responses to questions about breastfeeding duration, especially for women who breastfeed for long durations.

Birth Intervals↗
PubMed1995

Reducing maternal mortality in Kigoma, Tanzania.

An intervention programme aiming at a reduction of maternal deaths in the Regional Hospital, Kigoma, Tanzania, is analyzed. A retrospective study was carried out from 1984-86 to constitute a background for an intervention programme in 1987-91. The retrospective study revealed gross under-registration of data and clarified a number of potentially useful issues regarding avoidable maternal mortality. An intervention programme comprising 22 items was launched and the maternal mortality ratio was carefully followed in 1987-91. The intervention programme paid attention to professional responsibilities with regular audit-oriented meeting, utilization of local material resources, schedules for regular maintenance of equipment, maintenance of working skills by regular on-the-job training of staff, norms for patient management, provision of blood, norms for referral of severely ill patients, use of antibiotics, regular staff evaluation, public complaints about patient management, travel distance of all essential staff to the hospital, supply of essential drugs, the need of a small infusion production unit, the creation of culture facilities for improved quality of microbiology findings, and to efforts to stimulate local fund-raising. The results indicate that the maternal mortality ratio fell from 933 to 186 per 100,000 live births over the period 1984-91. Thus it is underscored that the problem of maternal mortality can be successfully approached by a low-cost intervention programme aiming at identifying issues of avoidability and focusing upon locally available problem solutions.

Developing Countries↗
PubMed1990

Why are Thai official perinatal and infant mortality rates so low?

The accuracy of perinatal and infant mortality rates in most developing countries is questionable. We measured perinatal and infant mortality rates in a rural district of Thailand and compared them with the official statistics to assess accuracy. All births and infant deaths in a rural district of Thailand over a one-year period were surveyed. The corresponding official statistics were also collected. The mothers or the relatives of all stillbirths and infant deaths were interviewed about the registration of the stillbirths or infant deaths. The surveyed perinatal and infant mortality rates were 22.0 and 23.1 respectively. The under-registration of stillbirths was 100% and for infant deaths 45%. All the non-registered infant deaths were in situations in which the infant died before the registration of birth. These results document the degree and nature of under-reporting of perinatal and infant mortality in rural Thailand.

Developing Countries↗
PubMed1992

Choosing an appropriate measure of diarrhoea occurrence: examples from a community-based study in rural Kenya.

Epidemiological studies which aim to identify protective or risk factors for diarrhoea may rely on any of several established measures of disease occurrence, including cumulative incidence, (CI), incidence density (ID), and point prevalence (P); each with its own strengths and limitations. Comparison of these measures was afforded by a community-based study in rural Kenya in which the incidence and prevalence of diarrhoea were measured simultaneously but by independent means in the same group of children. In a cohort study, CI and ID among 138 infants (aged 0-6 months) were 26.1% and 1.41 episodes per 100 infant-weeks, respectively. Among 111 toddlers (aged 18-29 months) CI and ID were 39.6% and 1.96 episodes per 100 toddler-weeks, respectively. In a cross-sectional study of these children, the Ps among infants and toddlers were 9.8 and 6.1%, respectively. Data on incident cases required more time and resources to obtain and evidenced more underreporting of diarrhoea episodes relative to the prevalence data. Other community-based studies have reported the ID of diarrhoea five times more often than any other measure, but appear to have calculated ID incorrectly. The infrequency with which CI and P are reported does not reflect their actual utility.

Child, Preschool↗
PubMed1996

Child and maternal mortality during a period of conflict in Beira City, Mozambique.

BACKGROUND: Child mortality rates have been declining in most developing countries. We studied child and maternal mortality risk factors for child mortality in Beira city in July 1993, after a decade of conflict in Mozambique. METHODS: A community-based cluster sample survey of 4609 women of childbearing age was conducted. Indirect techniques were used to estimate child mortality ('children ever born' method and Preceding Birth Techniques (PBT) and maternal mortality (sisterhood method). Deaths among the most recent born child, born since July 1990, were classified as cases (n = 106), and two controls, matched by age and cluster, were selected per case. RESULTS: Indirect estimates of the probability of dying from birth to age 5 (deaths before age 5 years, (5)q(0) per 1000) decreased from 246 in 1977/8 to 212 in 1988/9. The PBT estimate of 1990/91 was 154 (95 percent confidence interval [CI]: 124-184), but recent deaths may have been underreported. Lack of beds in the household (odds ratio [OR] = 2.0, 95 percent CI: 1.1-3.8), absence of the father (OR = 2.4, 95 percent CI : 1.2-4.8), low paternal educational level (OR = 2.1, 95 percent CI: 0.8-5.4), young maternal age (OR = 2.0, 95 percent CI: 1.0-3.7), self-reported maternal illness (OR = 2.4, 95 percent CI : 1.2-4.9), and home delivery of the child (OR = 2.3, 95 percent CI : 1.2-4.5) were associated with increased mortality, but the sensitivity of risk factors was low. Estimated maternal mortality was 410/100 000 live births with a reference date of 1982. CONCLUSIONS: Child mortality decreased slowly over the 1980s in Beira despite poor living conditions caused by the indirect effects of the war. Coverage of health services increased over this period. The appropriateness of a risk approach to maternal-child-health care needs further evaluation.

Adult↗
PubMedDate not supplied

Factors associated with self-reported STDs: data from a national survey.

BACKGROUND AND OBJECTIVES: STD prevention programs need to identify population subgroups and risk behaviors that are associated with higher rates of disease. GOAL OF THE STUDY: To see what levels of STD experience were reported by respondents to a national survey and what factors were associated with self-reported STDs. STUDY DESIGN: The survey data are from Cycle IV (1988) of the National Survey of Family Growth (NSFG), a nationally representative household-based sample of 8450 women ages 15 to 44 years. We examined characteristics of survey respondents who reported STD experience, characteristics of STD cases reported to the national STD surveillance system, and factors related to self-reported STDs using multiple logistic regression. RESULTS: The self-reported survey data indicate that the majority of respondents who ever had gonorrhea (55%) were white, but white women account for only 19% of the annual cases in the surveillance system. Logistic regression analysis of survey data indicates factors associated with reported gonorrhea experience, sexual behavior, race/ethnicity, socioeconomic background, perceived risk of AIDS, receiving birth control education, and region of residence. Reporting of chlamydia appears to be strongly related to knowledge of this infection. CONCLUSIONS: Because of basic differences in the statistics being compared, we cannot rule out other explanations. Our results suggest that the surveillance data may reflect underreporting of higher socioeconomic groups making use of private health care. Survey data, on the other hand, are probably affected by underreporting of STD experience. Questions to measure STD experience, treatment, and source of care on surveys of this type would greatly increase the understanding of STDs in the national population.

Adolescent↗
PubMed1983

Underrecording of infant homicide in the United States.

Homicide rates for infants dropped suddenly between 1967 and 1969. The abrupt nature of this decline suggested the change was artifactual. Investigation suggests that two classification revisions instituted at this time were causes of this decline: changes in related codes set forth in the Eighth Revision of the International Classification of Diseases, Adapted, and revision of the standard certificate of death in 1968. Infant homicides may have been disproportionately underrecorded after 1968. (Am J Public Health 1983; 73:195-197.)

Adolescent↗
PubMedDate not supplied

Contraceptive failure rates: new estimates from the 1995 National Survey of Family Growth.

CONTEXT: Unintended pregnancy remains a major public health concern in the United States. Information on pregnancy rates among contraceptive users is needed to guide medical professionals' recommendations and individuals' choices of contraceptive methods. METHODS: Data were taken from the 1995 National Survey of Family Growth (NSFG) and the 1994-1995 Abortion Patient Survey (APS). Hazards models were used to estimate method-specific contraceptive failure rates during the first six months and during the first year of contraceptive use for all U.S. women. In addition, rates were corrected to take into account the underreporting of induced abortion in the NSFG. Corrected 12-month failure rates were also estimated for subgroups of women by age, union status, poverty level, race or ethnicity, and religion. RESULTS: When contraceptive methods are ranked by effectiveness over the first 12 months of use (corrected for abortion underreporting), the implant and injectables have the lowest failure rates (2-3%), followed by the pill (8%), the diaphragm and the cervical cap (12%), the male condom (14%), periodic abstinence (21%), withdrawal (24%) and spermicides (26%). In general, failure rates are highest among cohabiting and other unmarried women, among those with an annual family income below 200% of the federal poverty level, among black and Hispanic women, among adolescents and among women in their 20s. For example, adolescent women who are not married but are cohabiting experience a failure rate of about 31% in the first year of contraceptive use, while the 12-month failure rate among married women aged 30 and older is only 7%. Black women have a contraceptive failure rate of about 19%, and this rate does not vary by family income; in contrast, overall 12-month rates are lower among Hispanic women (15%) and white women (10%), but vary by income, with poorer women having substantially greater failure rates than more affluent women. CONCLUSIONS: Levels of contraceptive failure vary widely by method, as well as by personal and background characteristics. Income's strong influence on contraceptive failure suggests that access barriers and the general disadvantage associated with poverty seriously impede effective contraceptive practice in the United States.

Abortion, Induced↗
PubMed1982

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Americas↗