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PubMedDate not supplied

Family planning in Burkina Faso: results of a survey.

A survey of women of reproductive age was undertaken during April and May 1986 as part of an operations research project in Ouagadougou, the capital of Burkina Faso. Data were collected on respondents' knowledge, attitudes, and practice (KAP) of contraception. Although the government family planning program had been operating only since February 1985, knowledge of modern methods was surprisingly high, with 64 percent of respondents having ever heard of at least one modern method. Only 4.9 percent, however, were currently using a modern method. Use of traditional methods was high in this traditional society, with 41 percent of women currently practicing abstinence. Both knowledge and current use varied significantly across several background characteristics, the most important of which was education. The respondents were very vocal about their fertility desires regarding both the spacing and limitation of births. Moreover, attitudes toward possible future contraceptive use were extremely positive. These factors may be contributing to the steadily increasing demand for family planning services, which the government program is striving to meet.

Adolescent↗
PubMed1989

[Experience with 3-stage screening for detection of congenital hip dysplasia].

We report an experience with a three-stage screening programme which has recently been recommended. It comprises the examination of children at three successive periods - at birth, at six weeks and at three months. In a prospective study we evaluated 789 children at all three periods. Pathological (unstable) hips were found at birth in about 20 per cent, the majority being lax hips and all underwent immediate treatment. At six weeks we were unable to detect any sign attributable to hip dysplasia except one instability persisting from birth. A limitation of abduction in one or another hip at six weeks or at three months was present in about 6 per cent; it was explained to be related rather to one of the signs of the moulded baby syndrome than to hip dysplasia. We do not regard the second examination in a three-stage screening programme as obsolete though it did not provide us in this series with additional informations; but our experience shows that three weeks would do better than six weeks, and the examination should be focused mainly on hip instability. We feel, however, that the greatest majority of pathological hips if not all should be detected at the maternity ward by a competent examiner.

Hip Dislocation, Congenital↗
PubMedDate not supplied

Sex preference and the value of sons and daughters in Nepal.

Sex preference and the specific value of sons and daughters to parents in Nepal are examined using rural and urban survey data from 1979. Ideal family size among all respondents was, on average, three children, with two sons and one daughter the preferred sex composition for about 90 percent of all respondents. Among those who reported current contraceptive use, the mean number of living sons was higher than the mean number of living daughters for all respondents. Most couples have at least one son before they adopt contraception; respondents had, on average, three to four births before adopting contraception. Sons are preferred to daughters by Nepalese parents mainly for socioeconomic and religious reasons, as opposed to the economic reasons reported elsewhere in many developing societies. The findings indicate that the economic motive for having both sons and daughters may be weakening in Nepal, but that a preference for sons does exist.

Adolescent↗
PubMed1996

Barriers to contraceptive use in Kenya.

This study was designed to identify and to better understand the barriers to contraceptive use among Kenyan-couples. Data were collected through structured interviews and focus group discussions among couples not planning for pregnancy and not using any effective contraceptive method. The study was conducted in the Baba Dogo urban slum area of Nairobi, and Chwele, a rural sub-location in Bungoma, western Kenya. Some important barriers to contraceptive use were identified in couples wishing to space or limit further births. Those barriers included lack of agreement on contraceptive use and on reproductive intentions; husband's attitude on his role as a decision maker; perceived undesirable side effects, distribution and infant mortality; negative traditional practices and desires such as naming relatives, and preference for sons as security in old age. There were also gaps in knowledge on contraceptive methods, fears, rumours and misconceptions about specific methods and unavailability or poor quality of services in the areas studied. This paper recommends that information and educational programmes should be instituted to increase contraceptive knowledge, to emphasise the value of quality of life over traditional reproductive practices and desires, and to improve availability and quality of services.

Adolescent↗
PubMed1998

Intrauterine and life course factors in the aetiology of adult cardiovascular disease.

International comparisons of age-adjusted coronary heart disease mortality show the high rates in the eastern and northern Europe, and northern Finland belongs to the areas with the highest rates. This stresses the importance of further studies on the determinants of the disease in this area. There is growing evidence to suggest that patterns of early growth and other life course factors play an important role in the origins and development of cardiovascular disease (CVD), but understanding the processes which mediate these effects is limited. Low birth weight and some other birth measures are related to increased CVD mortality, hypertension and type 2 diabetes, even though inconsistencies between and within the studies exist. With the present available evidence there is a need to address the key issues of possible confounding of perinatal and early life measures with those in later life in relation to the CVD risk. There is a need to replicate studies and establish new ones by assembling cohorts where indicators of prenatal and postnatal growth have been previously recorded drawn from different populations living under different conditions.

Adult↗
PubMed1993

[Geography of mortality and birth in Pikine (Senegal): value and limitations of findings of the Civil State in African villages].

Research conducted in Third World towns show the heterogeneity of health population status. Among the indicators, mortality and birth are the most frequent, but the quantity of data and the classical methods in demography make the localisation of high-risk population difficult. Civil Registration Data Base are seldom studied, especially by geographers. The author analyses the interest and limits of these data in a spatial perspective, i.e. mortality and birth rates, mortality and birth volumes, seasonal variations of mortality, and relations between seasonal variations and health system activities. The author's conclusion is on the necessity to include these indicators in the health information system after complementary research on possible bias.

Adolescent↗
PubMed1997

Environmental epidemiology at the Medical Birth Registry of Norway; strengths and limitations.

A national registry of all pregnancy-outcomes was started in Norway. in 1967 to facilitate epidemiological surveillance. One aim was to detect increases in birth detect prevalences that was caused by new harmful exposures. Over the years several studies of unexpected time-trends and regional differences have been performed, but specific harmful exposures have so far not been detected. In a study of possible effects of the Chernobyl fallout, the registry enabled a detailed investigation of a possible increase in prevalence of birth detects that occurred specifically in the most exposed areas of Norway. The strength of this approach was the population coverage of the registry, while important limitations were incomplete reporting (outcome misclassification) and crude exposure information (exposure misclassification). While still taking advantage of the population coverage of the medical birth registry, a new generation of studies with more complete case ascertainment and individual exposure information are being prepared. One particularly interesting new option is to use molecular genetic tools to identity susceptible mothers or children. Collection and storage of biological specimens on a large scale is challenging, but in the search for gene-environment interactions, population-based studies are particularly attractive.

Congenital Abnormalities↗
PubMed1997

Hazard proximities of childhood cancers in Great Britain from 1953-80.

STUDY OBJECTIVES: Firstly, to examine relationships between the birth and death addresses of children dying from leukaemia and cancer in Great Britain, and the sites of potential environmental hazards; and secondly to measure relative case densities close to, and at increasing distances from, different hazard types. DESIGN: Home address postcodes (PCs) and their map coordinates were identified at birth and at death in children who died from leukaemia or cancer. Potentially hazardous industrial addresses and PCs were listed from business and other directories, and map coordinates obtained from the Central Postcode Directory or else located directly on Ordnance Survey (OS) maps. Railway lines and motorways were digitised from OS maps. Numbers of deaths (and births) at successive radial distances from these hazards were counted and compared with expected numbers. The latter were based on a count of all PCs at similar distances. Relative case density ratios at successive distances from the hazards were obtained from observed and expected numbers, aggregated over similar sites. This was repeated for different hazard types and results were tested for evidence of systematic centrifugal case density gradients. PARTICIPANTS AND SETTING: All 22,458 children dying from leukaemia or cancer aged 0-15 years, in England, Wales, and Scotland, between 1953 and 1980. MAIN RESULTS: Relative excesses of leukaemias and of solid cancers were found near the following: (1) oil refineries, major oil storage installations, railside oil distribution terminals and factories making bitumen products; (2) motor car factories, coach builders, and car body repairers; (3) major users of petroleum products including manufacturers of solvents, paint sprayers, fibreglass fabricators, paint and varnish makers, plastics and detergent manufacturers, and galvanisers; (4) users of kilns and furnaces including steelworks, power stations, galvanisers, cement makers, brickworks, crematoria and aluminium, zinc, and iron/steel foundries; (5) airfields, railways, motorways and harbours. The findings for leukaemias and for solid cancers were indistinguishable. The hazard proximities of birth addresses were stronger than for death addresses. For children who had moved house between birth and death, the proximity effect was limited to the birth addresses. CONCLUSIONS: Childhood cancers are geographically associated with two main types of industrial atmospheric effluent namely: (1) petroleum derived volatiles and (2) kiln and furnace smoke and gases, and effluents from internal combustion engines.

Adolescent↗
PubMed1988

Principles of drug biodisposition in the neonate. A critical evaluation of the pharmacokinetic-pharmacodynamic interface (Part I).

Rational pharmacotherapy is dependent upon an understanding of the clinical pharmacokinetic and pharmacodynamic properties of the drugs employed. Although the available data on drug biodisposition and action in the neonate have increased considerably in the last few years, pharmacokinetic-pharmacodynamic interactions for many drugs remain poorly understood. The ontogeny of drug absorption, distribution, metabolism, and elimination are addressed in this review. Drug absorption from any site depends upon both the physicochemical properties of the drug and a variety of patient factors. Absorption of orally administered drugs may be affected by changes in gastric acidity and emptying time as well as by bile salt pool size, bacterial colonisation, and extraintestinal disease states such as congestive heart failure. Factors affecting drug absorption following intramuscular, percutaneous, and rectal administration are also discussed. Drug distribution in the neonate is influenced by a variety of important and predictable age-dependent factors. The developmental aspects of protein binding and body water compartments are described. Additionally, hepatic drug metabolism assumes an important role in understanding the pharmacokinetic and pharmacodynamic properties of many compounds. Certain biotransformation pathways, including hydroxylation by the P450 mono-oxygenase system and glucuronidation, demonstrate only limited activity at birth, while other pathways, such as sulphate or glycine conjugation, appear very efficient at birth. Elimination of drugs excreted unchanged in the urine is dramatically reduced in the newborn, compared with older infants and children, due to immaturity of both glomerular filtration and tubular secretory processes. The glomerular filtration rate remains markedly reduced prior to 34 weeks gestational age, increasing as a function of post-conceptual age until adult values are achieved by approximately 2.5 to 5 months of age. Tubular secretory capacity is also limited at birth, approaching adult values by approximately 7 months of age. Published reports describing the pharmacokinetics and pharmacodynamics of commonly used drugs in the neonatal period, as well as differences in drug biodisposition among premature infants, full term neonates, and older infants and children, are reviewed. Our recommendations for neonatal drug therapy are based upon a critical interpretation of these data, an understanding of fetal development and maturational processes, and an understanding of how disease states may affect drug biodisposition in the neonate.

Absorption↗
PubMed2005

Preterm birth in twins after subfertility treatment: population based cohort study.

OBJECTIVES: To assess gestational length and prevalence of preterm birth among medically and naturally conceived twins; to establish the role of zygosity and chorionicity in assessing gestational length in twins born after subfertility treatment. DESIGN: Population based cohort study. SETTING: Collaborative network of 19 maternity facilities in East Flanders, Belgium (East Flanders prospective twin survey). PARTICIPANTS: 4368 twin pairs born between 1976 and 2002, including 2915 spontaneous twin pairs, 710 twin pairs born after ovarian stimulation, and 743 twin pairs born after in vitro fertilisation or intracytoplasmic sperm injection. MAIN OUTCOME MEASURES: Gestational length and prevalence of preterm birth. RESULTS: Compared with naturally conceived twins, twins resulting from subfertility treatment had on average a slightly decreased gestational age at birth (mean difference 4.0 days, 95% confidence interval 2.7 to 5.2), corresponding to an odds ratio of 1.6 (1.4 to 1.8) for preterm birth, albeit confined to mild preterm birth (34-36 weeks). The adjusted odds ratios of preterm birth after subfertility treatment were 1.3 (1.1 to 1.5) when controlled for birth year, maternal age, and parity and 1.6 (1.3 to 1.8) with additional control for fetal sex, caesarean section, zygosity, and chorionicity. Although an increased risk of preterm birth was therefore seen among twins resulting from subfertility treatment, the risk was largely caused by a first birth effect among subfertile couples; conversely, the risk of prematurity was substantially levelled off by the protective effect of dizygotic twinning. CONCLUSIONS: Twins resulting from subfertility treatment have an increased risk of preterm birth, but the risk is limited to mild preterm birth, primarily by virtue of dizygotic twinning.

Birth Weight↗
PubMed2006

Association between infant birth weight and maternal cardiovascular risk factors in the health, aging, and body composition study.

PURPOSE: Mothers who deliver a low-birth-weight (LBW) infant may themselves be at excess risk for cardiovascular disease. We investigated whether older women who bore LBW infants had higher blood pressure, lipid, glucose, insulin, interleukin 6 (IL-6), and C-reactive protein concentrations, and pulse wave velocity compared to women with normal-weight births. METHODS: Participants were 446 women with a mean age of 80 years and 47% black. Women reported birth weight and complications for each pregnancy. Analysis was limited to first births not complicated by hypertension or preeclampsia. RESULTS: Women who had delivered a first-birth infant weighing less than 2500 g had a lower body mass index (BMI) compared with women with a normal-weight (>or=2500 g) infant (26.7 versus 28.4 kg/m2; p=0.02), but they had a larger abdominal circumference for BMI (97.9 versus 95.5 cm; p=0.05). They also were marginally more likely to be administered antihypertensive medication (p=0.06). After adjustment for BMI, race, and age, women with a history of a small infant had elevations in systolic blood pressure (p=0.05) and greater IL-6 levels (p=0.02) and were more insulin resistant (p=0.05) compared with women with a normal-weight infant. CONCLUSIONS: These findings suggest that a history of LBW delivery identifies women with elevated cardiovascular risk factors.

Black or African American↗
PubMed2000

Randomized trial of vitamin supplements in relation to vertical transmission of HIV-1 in Tanzania.

BACKGROUND: Observational studies suggest that poor nutritional status among HIV-infected pregnant women is associated with a higher risk of vertical transmission of HIV. METHODS: We randomized 1083 pregnant women infected with HIV-1 in a double-blind, placebo-controlled trial to examine the effects of supplements of vitamin A and/or multivitamins (excluding vitamin A) using a 2-x-2 factorial design. We report the effects of the supplements on HIV infection defined using polymerase chain reaction (PCR), or death up to 6 weeks postpartum. RESULTS: Of babies in the multivitamin arm 38, (10.1%) were HIV-positive at birth compared with 24 (6.6%) in the no-multivitamin arm (relative risk [RR] = 1.54; 95% CI, 0.94-2.51; p = .08). Of babies born to mothers in the vitamin A arm, 38 (10.0%) were HIV-positive at birth compared with 24 (6.7%) in the no-vitamin A arm (RR, 1.49; 95% CI, 0.91-2.43; p = 0.11). Neither multivitamins nor vitamin A had an effect on HIV status at 6 weeks among those who were HIV-negative at birth (RR = 1.04; 95% CI, 0.65-1.66; p = 0.88) and (RR = 1.30; 95% CI, 0.80-2.09; p = .29, respectively). Similarly, neither supplement was associated with being either HIV-infected or dead at birth (RR, 0.98; 95% CI, 0.76-1.27; p = .89 and RR, 1.01; 95% CI, 0.78-1.31; p = .95, respectively. A beneficial effect of multivitamins on birth weight was limited to babies who were HIV-negative at birth; babies in the multivitamin arm weighed +94 g more compared with those in the no-multivitamin arm (p = .02). Among babies who were HIV-positive at birth, the corresponding difference was -31 g (p = .82). CONCLUSIONS: Vitamin A and multivitamins did not affect the risk of vertical transmission of HIV in utero nor during the intrapartum and early breastfeeding periods. Multivitamins resulted in a significant improvement in birth weight of babies who were HIV-negative at birth but had no effect among those who were HIV-positive. The effect of vitamin supplements on HIV transmission through breastfeeding and on clinical progression of HIV disease is yet to be ascertained.

Adult↗
PubMed1998

[Sequelae of premature birth: substantial medical consumption and physical limitations; survey among parents of 10-year-olds].

OBJECTIVE: To determine health and disabilities of preterm infants at age 10. DESIGN: Prospective follow-up study. SETTING: TNO Preventive en Gezondheid, sector Jeugd. Leiden, the Netherlands. METHOD: A questionnaire on medical consumption and physical disabilities was sent to the parents of a Dutch cohort of infants born alive in 1983 with a gestational age < 32 weeks and (or) a birth weight < 1500 g. The data were compared with outcomes at 5 years of age and with a peer group in mainstream education (data collected in a representative sample from the school health care system). RESULTS: Questionnaires on 75% of the eligible children were returned. Almost 40% of the preterm children had been admitted to hospital after the age of 5. Children in special education were significantly more often treated by a physiotherapist and (or) speech therapist. Overall 45% of the children suffered from a physical disability. This was six times as frequent as in a peer group from the school health survey. Although the assessment of physical disabilities was based on a paediatric examination at age 5 and on a parental questionnaire at age 10, differences were small. CONCLUSION: Mild developmental problems and learning disabilities are frequent in preterm infants. Research of preventive methods and timely interventions are needed and should be incorporated in the facilities for neonatal intensive care.

Child↗
PubMed1998

Changes in the black-white infant mortality gap from 1983 to 1991 in the United States.

BACKGROUND: The long-standing difference in infant mortality in the United States between black and white infants has increased in recent years. To help identify the cause, we evaluated changes in birthweight distributions (BDs) and birthweight-specific mortality rates (BSMRs) among black and white infants born in the United States between 1983 and 1991. METHODS: Using national linked birth and death certificate data, we limited analyses to singleton births that occurred in the United States to resident, non-Hispanic black and white women. Birthweight data were analyzed in 500 g increments. The black-white gap was partitioned into deaths due to differences in BDs and BSMRs. RESULTS: The black-white infant mortality rate ratio increased from 2.1 in 1983 to 2.4 in 1991. Decreases in BSMRs among infants weighing from 500 to 2499 g occurred in both groups but were smaller among black than white infants; consequently, the percentage of excess deaths to black infants due to differences in BSMRs almost doubled during the study period, from 6.5% to 11.9%. Rates of very low birthweight (VLBW, < 1,500 g) increased for black infants, but the BD for white infants changed little. Although about 90% of the excess deaths to black infants resulted from differences in BDs, the changes in BDs had a minimal effect on the widening infant mortality gap. CONCLUSIONS: A significant reduction in the black-white infant mortality gap will require a reduction in VLBW and low birthweight (LBW, < 2,500 g). To keep the gap from growing, we must also investigate why decreases in BSMRs were smaller among black than white infants between 1983 and 1991.

Black or African American↗