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PubMed1992

Expanded programme on immunization (EPI). Safety of high titre measles vaccines.

Unexpected results suggesting decreased survival when compared with standard titre vaccine administered at 9 months of age have been found in some field studies evaluating the performance of high titre measles vaccine. Analytical difficulties have arisen because the studies were not specifically designed to measure survival. Nonetheless, careful analysis of the results from all of the high titre vaccine trials showed decreased survival of high titre vaccine recipients, in areas with high background mortality rates, compared with recipients of standard measles vaccines at 9 months. No systematic biases could be found in the studies to explain these differences. Statistical analysis of these data suggested that the findings were unlikely to be attributable to chance alone. The panel recommended that high titre measles vaccine derived from the original Edmonston measles vaccine isolate should no longer be recommended for use in immunization programmes. Further post-licensure field studies of new measles vaccines should take into account the results of these studies. Additional detailed epidemiological studies in populations that have received high titre vaccines and their controls were encouraged.

Child, Preschool↗
PubMed1992

Patterns of demographic change in the Americas.

Considerable scholarly debate has focused on the nature of demographic change in the Americas before and after 1492. Recent research on human skeletal samples and related archeological materials suggests that morbidity and mortality were increasing throughout much of the Western Hemisphere before 1492 in response to increased population density, increased sedentism, and changing subsistence. The evidence suggests that after 1492 population reduction was caused not by continental pandemics but by localized or regional epidemics augmented by social and economic disruption. The twentieth century has witnessed remarkable Native American population recovery, fueled both by improvements in health care and changing definitions of "being Indian."

Disease Outbreaks↗
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

Maternal mortality and its prevention.

Maternal mortality rates in developed countries have declined steeply during the last 50 years. The introduction of sulphonamides and blood transfusion techniques contributed much to lowering maternal mortality rates. The maternal mortality rate in The Netherlands in 1983-1988 was 8.8/100,000 livebirths. In 57% substandard care factors could be identified. This suggests that further improvement in preventing maternal mortality is possible. Maternal mortality rates in developing countries are still unacceptably high as a result of high fertility and a high risk of dying each time a woman becomes pregnant. Complications of illegal abortion are responsible for 25-50% of maternal deaths. Safe contraception could probably result in an important reduction in the number of maternal deaths, but also the provision of accessible maternal health services is essential to reduce maternal mortality in developing countries.

Cause of Death↗
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↗
PubMed1989

Infant mortality in the Western Galilee, 1964-86.

The infant mortality rate (IMR) in the Jewish and Arab populations in the Western Galilee was studied during the 2-year period 1985-86, and compared with those of previous surveys conducted since 1964-65. The IMR declined steadily during the two decades, from 33.6 to 8.5/1,000 in the Jewish population and from 49.2 to 18.2/1,000 in the Arab population. The decline was noted in both neonatal and postneonatal periods. Analysis of the causes of death showed that enteric and respiratory infections ranked high in the first and second surveys (1964-65 and 1970) and decreased to a low level in both population groups in recent years, but were still relatively high among Arab infants living in villages. The decrease in the IMR seems to be the result of an improvement in the general living conditions of the population and the efficiency of the health services.

Ethnicity↗
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↗
PubMed1988

An analysis of mortality trends among refugee populations in Somalia, Sudan, and Thailand.

A review of mortality data from refugee camps in Thailand (1979-80), Somalia (1980-85), and Sudan (1984-85) indicates that crude mortality rates (CMRs) were up to 40 times higher than those for the non-refugee populations in the host countries. In eastern Sudan, approximately 5% of the population of eight camps died in the first 3 months of the emergency and daily CMRs as high as 14 per 10 000 were reported. These rates dropped to values comparable with those of the host country within 6 weeks in the Thai camps; however, in Somalia and Sudan this process took 12 months. Mortality rates among under-5-year olds in the early phases, which were as high as 32.6 per 10 000 per day, are six times greater than those in the world's least developed countries during non-emergency times. Among severely undernourished children in one camp in Sudan, the death rate reached 114 per 10 000 per day. Acute respiratory infections, diarrhoeal diseases, malaria, measles, and undernutrition were the causes of most reported deaths, the majority of which could have been prevented by adequate food rations, clean water, measles immunization, and an oral rehydration programme.

Adolescent↗
PubMed1988

Community-based health reporting.

A development monitoring service at the local level was established in 1978/79 in several communities in Kerala State (India) to collect socioeconomic and health-related data. These were collected from key community members and by household surveys using paid local staff as interviewers. Selected results for five years from three geographically distinct areas are presented, for three categories of data: health service infrastructure, infant mortality and overall morbidity, and weight and height of children under 10 years old. The three areas were a fishing village (A), a relatively remote highland community (B) and an agricultural area close to the state capital (C). During the five-year period there were rather modest improvements in the delivery of health and other services. Infant mortality rates fluctuated between 14 and 91 per 1,000 live births, reflecting the fact that the sample size (10,000 to around 25,000 for each area) was inadequate for calculating that rate. Morbidity rates also fluctuated markedly, without showing any definite trend. However, morbidity was defined as illness resulting in the inability to carry out normal activities, thus excluding cases of worm infestation and much diarrhoea, for example. A detailed analysis of reported symptoms for one year showed that respiratory tract diseases accounted for about half the cases of illness reported. The percentage of children with abnormally low weight- or height-for-age fell markedly in one area over three successive years (height-for-age from 41.6% to 33.2%, weight-for-age from 58.5% to 44.7%), but were significantly greater in another area with a higher average income, indicating that economic factors alone were not responsible for the improvement.(ABSTRACT TRUNCATED AT 250 WORDS)

Adolescent↗
PubMedDate not supplied

Maternal mortality in Matlab, Bangladesh: 1976-85.

This paper reports findings from a study of maternal mortality in Matlab, Bangladesh during the 1976-85 period. The study employed a multiple-step procedure to identify maternity-related deaths to all reproductive-aged women within the study area during this period. A total of 387 maternal deaths were identified, resulting in an overall maternal mortality ratio of 5.5 per 1,000 live births. The introduction of a family planning program in half of the Matlab study area led to a moderate but significant reduction in maternal mortality rates, relative to the comparison area. This appears to have been primarily due to a reduction in the overall number of pregnancies in the treatment area, since among women who became pregnant, mortality risks remained high. The results of this study underscore the need for a broad-based service strategy that includes but is not limited solely to family planning, in order to achieve significant reductions in maternal mortality levels in settings such as rural Bangladesh.

Adolescent↗