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PubMed2002

Registration artifacts in international comparisons of infant mortality.

Large differences in infant mortality are reported among and within industrialised countries. We hypothesised that these differences are at least partly the result of intercountry differences in registration of infants near the borderline of viability (<750 g birthweight) and/or their classification as stillbirths vs. live births. We used the database of the International Collaborative Effort (ICE) on Perinatal and Infant Mortality to compare infant mortality rates and registration practices in Norway (n = 112484), Sweden (n = 215 908), Israeli Jews (n = 148123), Israeli non-Jews (n = 52 606), US Whites (n = 6 074 222) and US Blacks (n = 1328332). To avoid confounding by strong secular trends in these outcomes, we restricted our analysis to 1987-88, the most recent years for which data are available in the ICE database for all six groups. Compared with Norway (with an infant mortality rate of 8.5 per 1000), the crude relative risks [95% confidence intervals] were 0.75 [0.69,0.81] in Sweden, 0.97 [0.90,1.06] in Israeli Jews, 1.98 [1.81,2.17] in Israeli non-Jews, 0.95 [0.89,1.01] in US Whites and 2.05 [1.95,2.19] in US Blacks. For borderline-viable infants, fetal deaths varied twofold as a proportion of perinatal deaths, with Norway reporting the highest (83.9% for births <500 g and 61.8% for births 500-749 g) and US Blacks the lowest (40.3% and 37.6% respectively) proportions. Reported proportions of live births <500 g varied 50-fold from 0.6 and 0.7 per 10000 in Sweden and Israeli Jews and non-Jews to 9.1 and 33.8 per 10000 in US Whites and Blacks respectively. Reported proportions 500-749 g varied sevenfold from 7.5 per 10000 in Sweden to 16.2 and 55.4 in US Whites and Blacks respectively. After eliminating births <750 g, the relative risks (again with Norway as the reference) of infant mortality changed drastically for US Whites and Blacks: 0.82 [0.76,0.87] and 1.42 [1.33,1.53] respectively. The huge disparities in the ratio of fetal to infant deaths <750 g and in the proportion of live births <750 g among these developed countries probably result from differences in birth and death registration practices. International comparisons and rankings of infant mortality should be interpreted with caution.

Adult↗
PubMed1988

Neonatal vital statistics: a 5-year review in Saudi Arabia.

Neonatal mortality and causes of death at King Fahd Hospital of the University in Al Khobar, Saudi Arabia from June 1981 to May 1986 were analysed. The overall neonatal mortality rate declined from 15.6 to 8.1/1000 live births (LB), and after excluding lethal malformations mortality fell from 14.0 to 5.6/1000 LB. The reduction in mortality was most marked in infants weighing 1500 g or less, among whom mortality fell from 92.3 to 33% (P less than 0.001) during the 5-year period. Further, when annual variation in the very low birthweight rate was eliminated, a reduction in the mortality risk ratio from 1.47 to 0.81 was demonstrated. These significant reductions in mortality appear to be related to the establishment of neonatal intensive care. Major identified causes of death amenable to modern perinatal care were hyaline membrane disease, birth asphyxia, meconium aspiration and septicaemia.

Asphyxia Neonatorum↗
PubMedDate not supplied

Women's status and infant mortality in rural Colombia.

This paper investigates the effects of maternal demographic characteristics and social and economic statuses on infant mortality in rural Colombia. Demographic characteristics include the age of the mother, parity and length of preceding interbirth interval, and sex of infant. Measures of women's status at the time of birth include education, wage labor and occupation, economic stratum, place of residence, and whether the mother is living with a husband. The life history data for the study (involving 4,928 births) were collected in 1986 from a representative sample of two cohorts of women resident in rural central Colombia. Overall differentials in infant mortality by measures of women's status are small and are in good part associated with the differing reproductive behaviors of the women and variations in breastfeeding practices. The sharp declines in infant mortality recorded in rural Colombia in recent years appear less related to improved status of women than to reductions in fertility that enhance infant survivorship and to public health interventions shared by all segments of the population.

Adult↗
PubMedDate not supplied

[An increase in differential mortality by sex in the state of Sao Paulo].

"Historical data series from the vital registration system of the State of Sao Paulo are used to identify the age-groups where the increase of male surplus mortality has been most intense. In these age-groups, the evolution of the principal causes of death which account for this increase of the sex differential of mortality are analyzed over the past 40 years." The results show that despite a general decline in mortality, there has been an increase in mortality differentials by sex, particularly between ages 15 and 39. This is primarily due to a decrease in female deaths related to pregnancy and an increase in accidents and homicides among males. (summary in ENG)

Age Factors↗
PubMed1991

Perinatal mortality statistics in Harare 1980-1989.

Perinatal and neonatal mortality rates, in the Greater Harare Maternity Unit, which showed a modest decline from 1980 to 1985, have rise dramatically since then. Half of the rise in neonatal mortality rate is due to increased numbers and an increased mortality rate in babies of birth weight less than 1001g. There is also an increase in the numbers of deaths of large babies. There is a strong case for a broad-based on-going enquiry into the reasons for such changes.

Birth Rate↗
PubMed1991

A study of 8 year neonatal deaths (1982-1989) of Toa Payoh Hospital.

A study of 233 neonatal deaths out of 30910 livebirths over an 8 year period in the Toa Payoh Hospital is done. The Hospital has since ceased providing obstetric and neonatal intensive services from April 1990 due to restructuring of hospital care. The Neonatal Mortality Rates (NNMR) from 1982-1989 ranged from 6.52 to 9.55 and there was no significant fall in trend (p = 0.13). One hundred and thirteen (48.5%) neonates who died were below 1500gm (VLBW). Various causes of neonatal deaths were examined and there was a decline in respiratory distress syndrome (RDS) death rates (p less than 0.0002). Deaths due to asphyxia (p greater than 0.05) and infections (p greater than 0.05) have not declined significantly over the same period. It is also observed that less VLBW babies died over this 8 year period and the VLBW mortality rates (p less than 0.02) have declined. However, the congenital malformation mortality has also not declined significantly (p = 0.92) though early study (1972-1981) showed an increasing trend of malformation deaths among total neonatal deaths (p less than 0.02). Improvement in VLBW and RDS management has not contributed to a significant decline in NNMR. It is observed that more VLBW babies were born during this 8 year period (p = 0.01) especially so in the less than 1000 gm group (p = 0.0005) and the survival of VLBW babies has improved (45.5% to 75.8% alive) as a result of advances in neonatal intensive care. The reasons for increase in incidence of VLBW births in the past few years are not known.(ABSTRACT TRUNCATED AT 250 WORDS)

Cause of Death↗
PubMedDate not supplied

[Fertility and health in Mexico].

Fertility, health, and family planning are not independent factors, but rather involve a series of biological and social mechanisms in close interaction with one another. The impact that a high fertility rate has on health is reflected mainly in a rise in the rates of maternal and child mortality. Similarly, fertility has a greater negative effect upon the health of groups characterized by high reproductive risk, high parity, short intergenesic intervals, and unwanted pregnancies. On the other hand, family planning -and specifically the use of contraceptive methods-helps to achieve a lowering of the fertility rate and also has a positive effect on maternal-child health. This situation can be observed in the case of Mexico, where fertility rates and tendencies, as well as maternal and child mortality, have been reduced during the past decade.

Family Planning Services↗
PubMed1987

Reducing infant mortality in rural America: evaluation of the Rural Infant Care Program.

The Rural Infant Care Program (RICP), initiated in 1979, was developed to improve perinatal health care in ten rural sites with histories of high infant mortality rates. Time-series regression models indicate that neonatal mortality rates were reduced, following program initiation, by 2.6 per 1,000 live births (p = .0002); black neonatal mortality rates were reduced by an estimated 4.5 per 1,000 (p = .0004). Three sets of comparison areas exhibited no significant changes in rates. Postneonatal mortality rates did not increase in the target areas following initiation of RICP, indicating that deaths were not merely being postponed. Nine of ten individual sites showed reductions in infant mortality following program initiation. Birthweight-specific mortality data indicated that the decline was due mainly to reductions in neonatal mortality among low-birthweight infants. No reductions in the incidence of low birthweight were observed in the target areas. Substantial gaps in the delivery of prenatal care remained due to the continuing poverty of the population and the resultant lack of financial coverage for health services. We conclude that improved perinatal medical care can reduce infant mortality in poor rural areas to average levels experienced in the United States, and that the high rates still observed in some rural counties are unnecessary.

Black or African American↗
PubMedDate not supplied

Trends in low birth weight infants and changes in Baltimore's childbearing population, 1972-77.

Linked birth and death records provided the population for a study of trends in low birth weight (LBW) rates in Baltimore between 1972 and 1977 and of the effect of changes in the characteristics of the childbearing population on these trends. The impact of shifts in the birth weight distribution on neonatal mortality rates was also investigated. Trends were analyzed for unstandardized LBW rates as well as for rates standardized on the distributions of maternal age, education, gravidity, prior pregnancy losses, and marital status.Between 1972 and 1977, the 1,500 and 2,000 gm rates rose significantly by approximately 1 infant per 1,000 live births per year among whites and 2 infants per 1,000 live births among nonwhites. Despite declines in rates for most weights, the effect of these increases was a rise in neonatal mortality rates for both races, but especially for nonwhites.The population of women delivering in Baltimore in 1977 became slightly older, slightly more educated, and of higher gravidity than in 1972, but these changes had little impact on yearly fluctuations in LBW rates. In contrast, increases in births to unmarried women and to women with at least one prior pregnancy loss were related to rising LBW rates. For both races, standardization on marital status and prior pregnancy losses diminishes the increase in the LBW rate over the study period, especially when standardization is performed simultaneously for both variables. These findings hold within maternal age, education, and gravidity groups. However, the LBW rates for nonwhite teenage mothers and for nonwhite women with 12 years of less education increased significantly over the study period, regardless of standardization.

Abortion, Induced↗