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Title: Compensation for the brain drain from developing countries [editorial]
Author: Agwu K; Llewelyn M
Source: Lancet. 2009 May 16;373(9676):1665-6.
Abstract: This article examines the consequences and roots of health-worker migration from Sub-Saharan Africa to the developed world, especially to UK, USA and Canada. It explores the results of the major transfer of riches from poor societies to the affluent and discusses a compensation proposal for global justice.
Language: English
Keywords:
DEVELOPING COUNTRIES | CRITIQUE | HEALTH PERSONNEL | BRAIN DRAIN | RISK FACTORS | MATERNAL MORTALITY | INFANT MORTALITY | EMPLOYMENT | IMPACT | Delivery of Health Care | Health | International Migration | Migration | Population Dynamics | Demographic Factors | Population | Mortality | Macroeconomic Factors | Economic Factors | Communication
Document Number: 341604

8.
Peer Reviewed

Title: [Opinions by physicians from the Family Health Program on four health care priorities proposed by the Agenda for Commitment to Comprehensive Child Health and Reduction of Infant Mortality] Perspectivas de medicos do Programa Saude da Familia acerca das linhas de cuidado
Author: Alves e Silva AC; Villar MA; Wuillaume SM; Cardoso MH
Source: Cadernos De Saude Publica. 2009 Feb;25(2):349-58.
Abstract: The aim of this study was to understand how physicians from a team in the Brazilian Family Health Program perceive their work in child health, as compared to the program's principles outlined in the Agenda for Commitment to Comprehensive Child Health and Reduction of Infant Mortality, under the Ministry of Health. The backdrop was the strategy for implementation of primary care under the Unified National Health System (SUS). Semi-structured interviews were held, and the material was submitted to content analysis. According to the findings, in general the Agenda is being met. However, there are difficulties with referral and counter-referral; the measures proposed by the Family Health Program require medical and sociological competence and face problems inherent to biomedical training; the infrastructure and inputs are precarious; and the training provided does not prepare physicians sufficiently for a more comprehensive approach. In conclusion, the primary care model in Brazil requires adjustments to the country's reality, and partnerships that transcend the system are necessary.
Language: Portuguese
Keywords:
BRAZIL | RESEARCH REPORT | PHYSICIANS | CHILD HEALTH | SELF-PERCEPTION | INFANT MORTALITY | PRIMARY HEALTH CARE | PROGRAM EVALUATION | South America, Eastern | South America | Latin America | Americas | Developing Countries | Health Personnel | Delivery of Health Care | Health | Perception | Psychological Factors | Behavior | Mortality | Population Dynamics | Demographic Factors | Population | Health Services | Programs | Organization and Administration
Document Number: 342669

Peer Reviewed

Title: Improved sanitation and income are associated with decreased rates of hospitalization for diarrhoea in Brazilian infants.
Author: Andrade IG; Queiroz JW; Cabral AP; Lieberman JA; Jeronimo SM
Source: Transactions of the Royal Society of Tropical Medicine and Hygiene. 2009 May;103(5):506-11.
Abstract: Diarrhoeal diseases remain a major cause of morbidity and mortality in Brazilian children. However, from 1992 to 2001 there was a significant decline in hospitalizations for acute diarrhoea in children below 1 year of age in Brazil. A significant improvement in child health was also observed in the state of Rio Grande do Norte (RN), with a decrease in child mortality from 70 to 40 deaths per 1000. Using distributed lag analysis we analysed a number of factors possibly connected with decreased hospitalization in RN and found that hospitalization was correlated up to lag 3 with poverty (P<0.001) and inflation (P<0.001). Improvements in public health infrastructure such as better waste collection, presence of city water supply and increased sanitation, socio-economic variables such as education and literacy, and increased investment in health services were all important in reducing severe early childhood diarrhoeas and thus directly associated with the decrease in hospitalization. We also observed a positive seasonal correlation between rainfall and hospitalizations with an increased in rainfall impacting positively on hospitalization in all lags. The data suggests that increased buying power and reductions in poverty played a crucial role in reducing hospitalizations for acute diarrhoea in infants in RN.
Language: English
Keywords:
BRAZIL | RESEARCH REPORT | INFANT | DIARRHEA, INFANTILE | POVERTY | INFANT MORTALITY | SANITATION | HOSPITALS | PUBLIC HEALTH | SOCIOECONOMIC FACTORS | PREVENTION AND CONTROL | South America, Eastern | South America | Latin America | Americas | Developing Countries | Youth | Age Factors | Population Characteristics | Demographic Factors | Population | Diarrhea | Diseases | Economic Factors | Mortality | Population Dynamics | Health | Health Facilities | Delivery of Health Care
Document Number: 342512

10.

Peer Reviewed

Title: Impact of the Family Health Project on infant mortality in Brazilian municipalities.
Author: Aquino R; de Oliveira NF; Barreto ML
Source: American Journal of Public Health. 2009 Jan;99(1):87-93.
Abstract: The authors evaluated the effects of the Family Health Program (FHP), a strategy for reorganization of primary health care at a nationwide level in Brazil, on infant mortality at a municipality level. They collected data on FHP coverage and infant mortality rates for 771 of 5561 Brazilian municipalities from 1996 to 2004. They performed a multivariable regression analysis for panel data with a negative binomial response by using fixed-effects models that controlled for demographic, social, and economic variables. The authors observed a statistically significant negative association between FHP coverage and infant mortality rate. After controlling for potential confounders, the reduction in the infant mortality rate was 13.0%, 16.0%, and 22.0%, respectively for the 3 levels of FHP coverage. The effect of the FHP was greater in municipalities with a higher infant mortality rate and lower human development index at the beginning of the study period. The FHP had an important effect on reducing the infant mortality rate in Brazilian municipalities from 1996 to 2004. The FHP may also contribute toward reducing health inequalities.
Language: English
Keywords:
BRAZIL | RESEARCH REPORT | EPIDEMIOLOGIC METHODS | MATHEMATICAL MODEL | EVALUATION INDEXES | INFANT | URBAN POPULATION | INFANT MORTALITY | AGE SPECIFIC DEATH RATE | PRIMARY HEALTH CARE | HEALTH STATUS INDEXES | INEQUALITIES | Developing Countries | South America, Eastern | South America | Latin America | Americas | Research Methodology | Theoretical Models | Quantitative Evaluation | Evaluation | Youth | Age Factors | Population Characteristics | Demographic Factors | Population | Mortality | Population Dynamics | Death Rate | Health Services | Delivery of Health Care | Health | Socioeconomic Factors | Economic Factors
Document Number: 328585

11.

Title: Pediatric emergency and critical care in low-income countries.
Author: Baker T
Source: Paediatric Anaesthesia. 2009 Jan;19(1):23-7.
Abstract: The United Nations' Millennium Development Goal 4 is to reduce the global under-five mortality rate by two-thirds by 2015. Achieving this goal requires substantial strengthening of health systems in low-income countries. Emergency and critical care services are often one of the weakest parts of the health system and improving such care has the potential to significantly reduce mortality. Introducing effective triage and emergency treatments, establishing hospital systems that prioritize the critically ill and ensuring a reliable oxygen delivery system need not be resource intensive. Improving intensive care units, training health staff in the fundamentals of critical care concentrating on ABC - airway, breathing, and circulation - and developing guidelines for the management of common medical emergencies could all improve the quality of inpatient pediatric care. Integration with obstetrics, adult medicine and surgery in a combined emergency and critical care service would concentrate resources and expertise.
Language: English
Keywords:
DEVELOPING COUNTRIES | RESEARCH REPORT | GOALS | SOCIAL DEVELOPMENT | EMERGENCY SERVICES | INFANT HEALTH | CHILD HEALTH | HEALTH SERVICES | INFANT MORTALITY | CHILD MORTALITY | PREVENTION AND CONTROL | Planning | Organization and Administration | Economic Factors | Delivery of Health Care | Health | Mortality | Population Dynamics | Demographic Factors | Population | Diseases
Document Number: 330534

12.
Peer Reviewed

Title: Emergence of a peak in early infant mortality due to HIV/AIDS in South Africa.
Author: Bourne DE; Thompson M; Brody LL; Cotton M; Draper B; Laubscher R; Abdullah MF; Myers JE
Source: AIDS. 2009 Jan 2;23(1):101-6.
Abstract: OBJECTIVES: South Africa has among the highest levels of HIV prevalence in the world. Our objectives are to describe the distribution of South African infant and child mortality by age at fine resolution, to identify any trends over recent time and to examine these trends for HIV-associated and non HIV-associated causes of mortality. METHODS: A retrospective review of vital registration data was conducted. All registered postneonatal deaths under 1 year of age in South Africa for the period 1997-2002 were analysed by age in months using a generalized linear model with a log link and Poisson family. RESULTS: Postneonatal mortality increased each year over the period 1997-2002. A peak in HIV-related deaths was observed, centred at 2-3 months of age, rising monotonically over time. CONCLUSION: We interpret the peak in mortality at 2-3 months as an indicator for paediatric AIDS in a South African population with high HIV prevalence and where other causes of death are not sufficiently high to mask HIV effects. Intrauterine and intrapartum infection may contribute to this peak. It is potentially a useful surveillance tool, not requiring an exact cause of death. The findings also illustrate the need for early treatment of mother and child in settings with very high HIV prevalence.
Language: English
Keywords:
SOUTH AFRICA | RESEARCH REPORT | EPIDEMIOLOGIC METHODS | RETROSPECTIVE STUDIES | LINEAR REGRESSION | INFANT | PERSONS LIVING WITH HIV/AIDS | INFANT MORTALITY | AIDS | CAUSES OF DEATH | CHILD MORTALITY | VITAL STATISTICS | MOTHER-TO-CHILD TRANSMISSION | DEATH RATE | AGE SPECIFIC DEATH RATE | Africa, Southern | Africa, Sub Saharan | Africa | Developing Countries | Research Methodology | Studies | Statistical Regression | Data Analysis | Youth | Age Factors | Population Characteristics | Demographic Factors | Population | Persons Living With HIV/AIDS | HIV Infections | Viral Diseases | Diseases | Mortality | Population Dynamics | Population Statistics | Transmission | Infections
Document Number: 330334

13.
Title: Rapid progression of HIV infection in infancy.
Author: Devi NP; Shenbagavalli R; Ramesh K; Rathinam SN; Swaminathan S
Source: Indian Pediatrics. 2009 Jan;46(1):53-6.
Abstract: Transmission of HIV from mother to child can occur in utero, during labor or after delivery via breast feeding. Data on the fate of babies born with HIV in India are scarce. We present details of 25 infants with perinatally acquired HIV infection (virologically confirmed) to highlight the observed high rate of morbidity and mortality within the first 18 months of life. Our findings of rapid disease progression among perinatally infected HIV positive children underline the importance of early diagnosis and treatment.
Language: English
Keywords:
INDIA | RESEARCH REPORT | CLINICAL RESEARCH | CASE STUDIES | EPIDEMIOLOGIC METHODS | PERSONS LIVING WITH HIV/AIDS | INFANT | MOTHER-TO-CHILD TRANSMISSION | HIV INFECTIONS | DEATH RATE | INFANT MORTALITY | AIDS | TIME FACTORS | Asia, Southern | Asia | Developing Countries | Research Methodology | Studies | Viral Diseases | Diseases | Youth | Age Factors | Population Characteristics | Demographic Factors | Population | Transmission | Infections | Mortality | Population Dynamics
Document Number: 331249

14.

Peer Reviewed

Title: The effect of changes in health sector resources on infant mortality in the short-run and the long-run: a longitudinal econometric analysis.
Author: Farahani M; Subramanian SV; Canning D
Source: Social Science and Medicine. 2009;68:1918-1925.
Abstract: While countries with higher levels of human resources for health typically have better population health, the evidence that increases in the level of human resources for health leads to improvements in population health is limited. We use a dynamic regression model to obtain estimates of both the short-run and long-term effects of changes in physicians per capita, our measure of health system resources, on infant mortality. Using a dataset of 99 countries at 5-year intervals from 1960-2000, we estimate that increasing the number of physicians by one per 1000 population (roughly a doubling of current levels of provision) decreases the infant mortality rate by 15% within 5 years and by 45% in the long-run with half the long-run gain being achieved in 15 years. We conclude that the long-run effects of heath system resources are substantially larger than previously estimated. Our results suggest, however, that countries that have delayed action on the Millennium Development Goal of reducing infant andchild mortality rate by two-thirds by 2015 (relative to 1990) may have difficulty meeting this goal even if they rapidly increase resources now.
Language: English
Keywords:
GLOBAL | RESEARCH REPORT | LONGITUDINAL STUDIES | PHYSICIANS | HUMAN RESOURCES | INFANT MORTALITY | HEALTH SERVICES | CHANGES | Studies | Research Methodology | Health Personnel | Delivery of Health Care | Health | Economic Factors | Mortality | Population Dynamics | Demographic Factors | Population | Social Change | Sociocultural Factors
Document Number: 340203

15.

Peer Reviewed

Title: Role of breastfeeding cessation in mediating the relationship between maternal HIV disease stage and increased child mortality among HIV-exposed uninfected children.
Author: Fox MP; Brooks DR; Kuhn L; Aldrovandi G; Sinkala M; Kankasa C; Horsburgh R; Thea DM
Source: International Journal of Epidemiology. 2009 Apr;38(2):569-76.
Abstract: BACKGROUND: Maternal CD4 count predicts child mortality in HIV-uninfected children born to HIV-infected women. METHODS: To explore the mediating role of breastfeeding cessation in this relationship, we compared marginal structural models of maternal CD4 count on child death with and without adjustment for breastfeeding. RESULTS: In crude analyses, children of mothers with CD4<200 during pregnancy were 3.2 times more likely to die by 18 months (CI 1.3-8.1) as children whose mothers had CD4>500. Earlier breastfeeding cessation was also associated with low CD4 (HR 1.8; CI 1.2-2.7). After adjusting for breastfeeding and low birth weight using a marginal structural model, the low CD4 count-child mortality association through 18 months was reduced 17%. The change was overestimated using a traditional Cox proportional hazards model (35% reduction in HR from 3.4 to 2.5). CONCLUSIONS: Our analysis suggests that only a small part of the effect of low vs high CD4 count on child mortality through 18 months is mediated through breastfeeding cessation. Our results must be taken into account when deciding whether or not to recommend breastfeeding for infants of HIV-infected mothers.
Language: English
Keywords:
AFRICA | RESEARCH REPORT | DATA ANALYSIS | CHILDREN | CHILD MORTALITY | BREASTFEEDING | INFANT MORTALITY | HIV | RESEARCH METHODOLOGY | Developing Countries | Youth | Age Factors | Population Characteristics | Demographic Factors | Population | Mortality | Population Dynamics | Infant Nutrition | Nutrition | Health | HIV Infections | Viral Diseases | Diseases
Document Number: 341015

16.

Title: Early motherhood, high mortality, and HIV/AIDS rates in Sub-Saharan Africa.
Author: Gant L; Heath KM; Ejikeme GG
Source: Social Work In Public Health. 2009 Jan-Apr;24(1-2):39-46.
Abstract: Despite billions of dollars devoted to HIV/AIDS prevention since 1990, rates of infection continue to climb worldwide, primarily through heterosexual contact, and Sub-Saharan Africa is the worst case scenario (UNAIDS, 2004). Traditional intervention programs based on the ABCs (abstinence, being faithful, and condom use) of safe sex practices have shown mixed success. Engaging in risky sexual behavior (behaviors not adhering to the ABCs of safe sex practices) continues to escalate the HIV/AIDS epidemic. Although research abounds with correlates to HIV/AIDS rates, few studies have addressed the basis of sexual behavior. Here we show that not only are HIV/AIDS rates significantly higher in Sub-Saharan Africa than in the rest of the world but also infant mortality rates and teenage birth rates are higher as well. Based on these findings, we argue that engaging in risky sexual behavior, in many circumstances associated with deplorable living conditions and high mortality, is the only viable option for avoiding reproductive failure: dying without leaving surviving descendents. We suggest that initiatives that improve overall health and living conditions in the at-risk populations are necessary before traditional intervention programs can effectively combat the spread of HIV/AIDS in Sub-Saharan Africa.
Language: English
Keywords:
AFRICA, SUB SAHARAN | RESEARCH REPORT | STATISTICAL STUDIES | HIV INFECTIONS | AIDS | PREVALENCE | MORTALITY | LIFE EXPECTANCY | INFANT MORTALITY | AGE SPECIFIC FERTILITY RATE | ADOLESCENT PREGNANCY | SEX BEHAVIOR | Africa | Developing Countries | Studies | Research Methodology | Viral Diseases | Diseases | Measurement | Population Dynamics | Demographic Factors | Population | Length of Life | Fertility Rate | Birth Rate | Fertility Measurements | Fertility | Reproductive Behavior | Behavior
Document Number: 341955

17.

Peer Reviewed

Title: [Impact of immunization measures by the Family Health Program on infant mortality from preventable diseases in Olinda, Pernambuco State, Brazil] Impacto das acoes de imunizacao pelo Programa Saude da Familia na mortalidade infantil por doencas evitaveis em Olinda, Pernambuco, Brasil.
Author: Guimaraes TM; Alves JG; Tavares MM
Source: Cadernos�de Saude Publica. 2009 Apr;25(4):868-876.
Abstract: This article analyzes the impact of the Family Health Program (FHP) on infant health in Olinda, Pernambuco State, Brazil, evaluating immunization and infant mortality from vaccine-preventable diseases. A time-series study was conducted with data from the principal health information systems, analyzing indicators before and after implementation of the FHP in 1995. The independent variable was year of birth, related to degree of population coverage by the FHP. Three periods were analyzed: 1990-1994 (prior), 1995-1996 (implementation phase: 0 to 30% coverage), and 1997-2002 (intervention: coverage of 38.6% to 54%). Trends in the indicators were analyzed by simple linear regression, testing significance with the t test. During the implementation period there was an increase in all the vaccination coverage rates (176% BCG, 223% polio, 52% DPT, 61% measures) and a decrease in infant mortality from preventable diseases (12.7 deaths/year), even without a decrease in absolute poverty in the municipality or an increase in either coverage by the public health care system or the sewage system. Improvement in the indicators demonstrates the effectiveness of FHP actions in the municipality.
Language: Portuguese
Keywords:
BRAZIL | RESEARCH REPORT | IMPACT | IMMUNIZATION | INFANT MORTALITY | DISEASE PREVENTION | PREVENTION AND CONTROL | PROGRAM EVALUATION | South America, Eastern | South America | Latin America | Americas | Developing Countries | Communication | Primary Health Care | Health Services | Delivery of Health Care | Health | Mortality | Population Dynamics | Demographic Factors | Population | Diseases | Programs | Organization and Administration
Document Number: 341866

18.
Title: Emergency maternal and child health training courses and advocacy to achieve millennium development goals in a poorly resourced country; challenges and opportunities.
Author: Hafeez A; Zafar S; Qureshi F; Mirza I; Bile K; Southall DP
Source: JPMA. Journal of the Pakistan Medical Association. 2009 Apr;59(4):243-6.
Abstract: Our three years' experience of Essential Surgical Skills-Emergency Maternal and Child Health (ESS-EMCH) Programme in Pakistan suggests that despite a compromised healthcare delivery system, a tangible improvement in the management of emergencies in pregnancy, the neonate and children can be achieved by adopting a novel but robust mechanism of effective advocacy along with provision of innovative, evidence based and high quality training for healthcare staff.
Language: English
Keywords:
PAKISTAN | RESEARCH REPORT | GOALS | CHILD HEALTH | CHILD MORTALITY | INFANT MORTALITY | TRAINING ACTIVITIES | IMPLEMENTATION | EMERGENCY SERVICES | QUALITY CONTROL | Developing Countries | Asia, Southern | Asia | Planning | Organization and Administration | Health | Mortality | Population Dynamics | Demographic Factors | Population | Training Programs | Education | Programs | Health Services | Delivery of Health Care
Document Number: 341536

19.

Title: Does health aid matter?
Author: Mishra P; Newhouse D
Source: Journal of Health Economics. 2009 Jun 13;
Abstract: This paper examines the relationship between health aid and infant mortality, using data from 118 countries between 1973 and 2004. Health aid has a beneficial and statistically significant effect on infant mortality: doubling per capita health aid is associated with a 2 percent reduction in the infant mortality rate. For the average country, this implies that increasing per capita health aid by US$1.60 per year is associated with 1.5 fewer infant deaths per thousand births. The estimated effect is small, relative to the 2015 target envisioned by the Millennium Development Goals. It implies that achieving the MDG target through additional health aid alone would require a roughly 15-fold increase in current levels of aid.
Language: English
Keywords:
GLOBAL | RESEARCH REPORT | HISTORICAL REVIEW | HEALTH | ESTIMATION TECHNIQUES | FOREIGN AID | INFANT MORTALITY | GOALS | GOVERNMENT FINANCING | RESOURCE ALLOCATION | PROGRAM EFFECTIVENESS | Research Methodology | Financial Activities | Economic Factors | Mortality | Population Dynamics | Demographic Factors | Population | Planning | Organization and Administration | Program Evaluation | Programs
Document Number: 342295

20.
Title: Perinatal death pattern in the four districts of Thailand: findings from the Prospective Cohort Study of Thai Children (PCTC).
Author: Mo-suwan L; Isaranurug S; Chanvitan P; Techasena W; Sutra S; Supakunpinyo C; Choprapawon C
Source: Journal of the Medical Association of Thailand. 2009 May;92(5):660-6.
Abstract: OBJECTIVE: To determine the magnitude and investigate causes of perinatal deaths of a cohort of the Prospective Cohort Study of Thai Children. MATERIAL AND METHOD: A semi-structured verbal autopsy questionnaire and review of medical records were used to ascertain the causes of deaths during the perinatal period in four districts of Thailand. RESULTS: The total numbers of 3,522 babies (with 28 pairs of twins) were born from 3,494 pregnant women. The perinatal mortality rate was 10.69 per 1,000 total births, the stillbirth rate was 6.75 per 1,000 births, and the early neonatal mortality rate was 3.97 per 1,000 live-births. About 37.8% of the perinatal deaths were agreed to by two pediatricians and a neonatologist as preventable. About 90% of the preventable stillbirths occurred in the antepartum period. CONCLUSION: Findings from the present study indicates that to further reduce the perinatal death rate, attention should be focused on reducing the stillbirths by a quality antenatal care.
Language: English
Keywords:
THAILAND | RESEARCH REPORT | PROSPECTIVE STUDIES | COHORT ANALYSIS | PREGNANT WOMEN | PERINATAL MORTALITY | DEATH RATE | CAUSES OF DEATH | FETAL DEATH | INFANT MORTALITY | PREMATURE BIRTH | LOW BIRTH WEIGHT | Developing Countries | Asia, Southeastern | Asia | Studies | Research Methodology | Population Characteristics | Demographic Factors | Population | Mortality | Population Dynamics | Pregnancy Outcomes | Pregnancy | Reproduction | Birth Weight | Body Weight | Physiology | Biology
Document Number: 341770

21.

Title: Ventilator-associated pneumonia in a paediatric intensive care unit in a developing country with high HIV prevalence.
Author: Morrow BM; Argent AC
Source: Journal of Paediatrics and Child Health. 2009 Mar;45(3):104-11.
Abstract: AIM: To obtain preliminary prevalence, aetiological and outcome data on South African paediatric patients with ventilator-associated pneumonia (VAP). METHODS: Non-bronchoscopic bronchoalveolar lavage (BAL) specimens taken between January 2004 and September 2005 were prospectively recorded and related clinical data were retrospectively reviewed. VAP was defined as a new isolate on BAL and a modified Clinical Pulmonary Infection Score > or =5. RESULTS: A total of 230 patients aged 3.9 (2.2-9.1) months (median interquartile range (IQR) ) underwent 309 BALs during 244 paediatric intensive care unit (PICU) admissions. Most patients (84%) were admitted with acute infectious diseases, with a 70% incidence of comorbidity. Thirty-three patients (14.3%) were HIV-exposed but uninfected and 58 (25.2%) were HIV-infected. Of 172 BALs taken > or =48 h after intubation, 63 specimens from 55 patients fulfilled VAP criteria. Acinetobacter baumannii was the most common VAP pathogen, followed by Klebsiella pneumoniae, viruses, yeasts and Staphylococcus aureus. Patients who developed VAP had a higher proportion of comorbid conditions (76% vs. 55%, P= 0.01) and reintubations (39% vs. 12%, P < 0.0001) when compared with non-VAP patients. Median (IQR) length of PICU stay was 12.5 (5-21) days versus 8 (5-14) days (P= 0.03); and the risk adjusted PICU mortality was 1.38 versus 0.79 (P= 0.002) in VAP versus non-VAP patients, respectively. CONCLUSIONS: VAP is associated with significant morbidity and mortality and may relate to the high incidence of comorbid conditions in this population. Primary VAP pathogens differ from developed countries.
Language: English
Keywords:
SOUTH AFRICA | RESEARCH REPORT | CLIENTS | INFANT | PNEUMONIA | SIGNS AND SYMPTOMS | HOSPITALS | ANTIBIOTICS | MORBIDITY | INFANT MORTALITY | HIV INFECTIONS | Developing Countries | Africa, Southern | Africa, Sub Saharan | Africa | Program Activities | Programs | Organization and Administration | Youth | Age Factors | Population Characteristics | Demographic Factors | Population | Pulmonary Effects | Physiology | Biology | Diseases | Health Facilities | Delivery of Health Care | Health | Drugs | Treatment | Medical Procedures | Medicine | Health Services | Mortality | Population Dynamics | Viral Diseases
Document Number: 341838

22.
Peer Reviewed

Title: Pediatric HIV-1 in Kenya: pattern and correlates of viral load and association with mortality.
Author: Obimbo EM; Wamalwa D; Richardson B; Mbori-Ngacha D; Overbaugh J; Emery S; Otieno P; Farquhar C; Bosire R; Payne BL; John-Stewart G
Source: Journal of Acquired Immune Deficiency Syndromes. 2009 Jun 1;51(2):209-15.
Abstract: BACKGROUND: There is limited information regarding the pattern and correlates of viral replication in vertically HIV-1-infected children and its role on their outcomes in resource-limited settings. METHODS: HIV-1-infected infants were followed from birth to 24 months. Serial HIV-1 RNA levels were compared in infants infected in utero (<48 hours), peripartum (48 hours-1 month), and late postnatal (after 1 month). Cofactors for viral peak [highest viral load (VL) within 6 months of infection] and set point and mortality were determined. RESULTS: Among 85 HIV-1-infected infants, 24 were infected in utero, 41 peripartum, 13 late postnatal; 7 had no 48-hour assay. HIV-1 VL set point was significantly lower in infants infected >1 month vs. < or = 1 month (5.59 vs. 6.24 log10 copies per milliliter, P = 0.01). Maternal VL correlated with peak infant VL (P < 0.001). Univariately, infant peak and set point VL and 6-month CD4% <15% predicted mortality; and 6-month CD4% <15% remained independently predictive in multivariate analyses (hazard ratio = 4.85, 95% confidence interval: 1.90 to 12.36). CONCLUSIONS: Infants infected after the age of 1 month contained virus better than infants infected before 1 month of age. Maternal VL predicted infant VL, which, in turn was associated with early mortality.
Language: English
Keywords:
KENYA | RESEARCH REPORT | PROSPECTIVE STUDIES | INFANT | PERSONS LIVING WITH HIV/AIDS | HIV TRANSMISSION | INFANT MORTALITY | MOTHER-TO-CHILD TRANSMISSION | BREASTFEEDING | TIME FACTORS | Africa, Eastern | Africa, Sub Saharan | Africa | Developing Countries | Studies | Research Methodology | Youth | Age Factors | Population Characteristics | Demographic Factors | Population | HIV Infections | Viral Diseases | Diseases | Mortality | Population Dynamics | Transmission | Infections | Infant Nutrition | Nutrition | Health
Document Number: 341753

23.
Title: [Impact of maternal antecedents on neonatal mortality in a regional perinatal hospital] Repercusion de los antecedentes maternos en la mortalidad neonatal de un hospital
Author: Osorno Covarrubias L; Watty Caceres C; Alonzo Vazquez F; Davila Velazquez J; Echeverria Eguiluz M
Source: Ginecologia Y Obstetricia De Mexico. 2009 Jan;77(1):3-12.
Abstract: OBJECTIVE: Determine the prevalence of maternal risk factors and evaluate their impact on neonatal mortality in a regional perinatal center. MATERIALS AND METHODS: A cohort of 25,365 live newborns was studied between January 1st 2000 and December 31st 2004. Maternal antecedents were registered in a data base: sociodemographic; medical history; obstetric antecedents of previous pregnancies; as well as evolution of current pregnancy and birth. Newborn birth weight, gestational age and condition at discharge were registered too. Neonates who died were considered cases and controls those discharged alive. Mortality was compared to the presence or absence of risk factors in maternal medical history. Prevalence, odds ratio (OR) with 95% confidence interval, and attributable fraction in the exposed and the population were calculated with the SPSS 8.0 and Epi Info 6.4 programs. RESULTS: The most notable maternal factors associated with newborn mortality were maternal age > or = 30 years OR 1.5 (1.37-2.0), less than 7 prenatal exams OR 2.17 (1.52-3.09) (53.5% attributable fraction in the exposed and 23.3% in population), eclampsia OR 4.66 (2.82-7.64), type-II diabetes OR 5.41 (2.11-12.99), urinary tract infection OR 1.98 (1.40-2.78), positive serology to human immunodeficiency virus OR 41.75 (5.77-230.9), membrane rupture > or = 48 hours OR 22.99 (13.10-40.2), polyhydramnios OR 31.53 (19.12-51.6) and abruptio placentae OR 42.18 (21.06-83.1). CONCLUSIONS: Transpartum risk factors had a larger impact on mortality than pregnancy or pregestational factors.
Language: Spanish
Keywords:
BRAZIL | RESEARCH REPORT | PREVALENCE | COHORT ANALYSIS | INFANT MORTALITY | RISK FACTORS | PREGNANCY HISTORY | BIRTH HISTORY | SOCIOECONOMIC FACTORS | AGE FACTORS | PREECLAMPSIA | DIABETES | HIV INFECTIONS | South America, Eastern | South America | Latin America | Americas | Developing Countries | Measurement | Research Methodology | Mortality | Population Dynamics | Demographic Factors | Population | Health | Fertility Measurements | Fertility | Economic Factors | Population Characteristics | Pregnancy Complications | Diseases | Viral Diseases
Document Number: 341999

24.

Title: Rising U.S. teen fertility.
Author: Saenz R; Conde E
Source: Washington, D.C., Population Reference Bureau [PRB], 2009 Feb. [3] p.
Abstract: The United States has higher fertility rates among teenage girls compared with other developed countries of the world. For example, girls ages 15 to 19 have fertility rates more than five times higher than their counterparts in developed countries such as France, Italy, Japan, Slovenia, and Switzerland. Nonetheless, the fertility rate of girls ages 15 to 19 declined consecutively over the period from 1991 to 2005. During this time, the fertility rate of the age group dropped by one-third, from 61.8 births per 1,000 girls ages 15 to 19 in 1991 to 40.5 in 2005. However, the latest data for 2006 may point to a reversal of this trend, with the fertility rate inching upward to 41.9. This trend is of great concern because adolescent pregnancy has been associated with unemployment, poverty, repeated pregnancy, sexually transmitted diseases, infant mortality, high risk pregnancy, and lower educational achievement. Furthermore, teenage pregnancy is a primary indicator of adult poverty among women.
Language: English
Keywords:
FRANCE | ITALY | JAPAN | SLOVENIA | SWITZERLAND | SUMMARY REPORT | ADOLESCENTS, FEMALE | ADOLESCENT PREGNANCY | UNEMPLOYMENT | POVERTY | SEXUALLY TRANSMITTED DISEASES | INFANT MORTALITY | PREGNANCY, HIGH RISK | FERTILITY RATE | Developed Countries | Europe, Western | Europe | Europe, Southern | Asia, Eastern | Asia | Developing Countries | Europe, Central | Adolescents | Youth | Age Factors | Population Characteristics | Demographic Factors | Population | Reproductive Behavior | Fertility | Population Dynamics | Employment | Macroeconomic Factors | Economic Factors | Socioeconomic Factors | Reproductive Tract Infections | Infections | Diseases | Mortality | Pregnancy | Reproduction | Birth Rate | Fertility Measurements
Document Number: 331480

25.

Title: Purchase of drinking water is associated with increased child morbidity and mortality among urban slum-dwelling families in Indonesia.
Author: Semba RD; de Pee S; Kraemer K; Sun K; Thorne-Lyman A; Moench-Pfanner R; Sari M; Akhter N; Bloem MW
Source: International Journal of Hygiene and Environmental Health. 2009 Jul;212(4):387-97.
Abstract: In developing countries, poor families in urban slums often do not receive municipal services including water. The objectives of our study were to characterize families who purchased drinking water and to examine the relation between purchasing drinking water and child morbidity and mortality in urban slums of Indonesia, using data collected between 1999 and 2003. Of 143,126 families, 46.8% purchased inexpensive drinking water from street vendors, 47.4% did not purchase water, i.e., had running or spring/well water within household, and 5.8% purchased more expensive water in the previous 7 days. Families that purchased inexpensive drinking water had less educated parents, a more crowded household, a father who smoked, and lower socioeconomic level compared with the other families. Among children of families that purchased inexpensive drinking water, did not purchase drinking water, or purchased more expensive water, the prevalence was, respectively, for diarrhea in last 7 days (11.2%, 8.1%, 7.7%), underweight (28.9%, 24.1%, 24.1%), stunting (35.6%, 30.5%, 30.5%), wasting (12.0%, 10.5%, 10.9%), family history of infant mortality (8.0%, 5.6%, 5.1%), and of under-five child mortality (10.4%, 7.1%, 6.4%) (all P<0.0001). Use of inexpensive drinking water was associated with under-five child mortality (Odds Ratio [O.R.] 1.32, 95% Confidence Interval [C.I.] 1.20-1.45, P<0.0001) and diarrhea (O.R. 1.43, 95% C.I. 1.29-1.60, P<0.0001) in multivariate logistic regression models, adjusting for potential confounders. Purchase of inexpensive drinking water was common and associated with greater child malnutrition, diarrhea, and infant and under-five child mortality in the family. Greater efforts must be made to ensure access to safe drinking water, a basic human right and target of the Millennium Development Goals, in urban slums.
Language: English
Keywords:
INDONESIA | SLUMS | RESEARCH REPORT | SAMPLING STUDIES | CHILDREN | HOUSEHOLDS | WATER SUPPLY | EXPENDITURES | CHILD MORTALITY | INFANT MORTALITY | DIARRHEA | MALNUTRITION | PREVALENCE | Developing Countries | Asia, Southeastern | Asia | Urbanization | Urban Population Distribution | Population Distribution | Geographic Factors | Population | Studies | Research Methodology | Youth | Age Factors | Population Characteristics | Demographic Factors | Family and Household | Sociocultural Factors | Natural Resources | Environment | Financial Activities | Economic Factors | Mortality | Population Dynamics | Diseases | Nutrition Disorders | Measurement
Document Number: 342114

26.
Title: Early breast-feeding cessation and infant mortality in low-income countries: workshop summary.
Author: Simondon KB
Source: Advances In Experimental Medicine and Biology. 2009;639:319-29.
Abstract: The importance of breast-feeding for infant and child health and survival in less developed countries has been the subject of a number of studies over the last 25 years. However, the epidemic of AIDS in low-income countries, together with the discovery of an important risk of mother-to-child transmission of HIV-1 through breast-milk, has prompted renewed interest in this subject. Indeed, in order to weigh the mortality risks associated with different infant feeding practices against the risk of mother-to-child transmission of the virus, it is essential to have precise estimates of relative risk of death of non-breastfed infants within narrow age intervals. Available 'decision guides' mostly use relative mortality risks published by a WHO working group, based on 6 retrospective or prospective studies, among which 3 contributed to risk estimations during infancy. The mortality risk was not analysed by mode of breast-feeding (i.e. exclusive, predominant or partial), because such data were not available for all studies included. In addition, exclusive breast-feeding is rare in many settings and sample sizes are therefore insufficient to assess mortality risks associated with this mode of feeding. This is unfortunate since a cohort study in South Africa suggested that exclusive breast-feeding up to 3 months postpartum may be associated with a lower risk of postnatal HIV-1 transmission to the child than when other fluids or foods are added. As for all observational epidemiological studies, those dealing with the association between child mortality and breast-feeding may be subject to a number of methodological problems. The objective of this workshop was to illustrate some of these, using examples from the literature, and mostly consider confounding, reverse causality and bias by indication. (excerpt)
Language: English
Keywords:
DEVELOPING COUNTRIES | RESEARCH REPORT | LOW INCOME POPULATION | MOTHERS | BREASTFEEDING | INFANT MORTALITY | CHILD SURVIVAL | WEANING | TIME FACTORS | RISK FACTORS | Social Class | Socioeconomic Status | Socioeconomic Factors | Economic Factors | Parents | Family Relationships | Family Characteristics | Family and Household | Sociocultural Factors | Infant Nutrition | Nutrition | Health | Mortality | Population Dynamics | Demographic Factors | Population | Survivorship | Length of Life
Document Number: 330899

27.
Title: Family planning saves lives. 4th ed.
Author: Smith R; Ashford L; Gribble J; Clifton D
Source: Washington, D.C., Population Reference Bureau [PRB], 2009. [2], 23 p.
Abstract: To better address the cost implications of investing in mothers and children, the report provides useful data on the cost-benefits of family planning programs. Long considered a "best buy" among health investments, family planning is even more important in today's financially strapped environment. As countries grapple with recession and search for better ways to stretch limited budgets, family planning stands out as one of the most cost-effective, high-yield interventions available. At an average supply cost of US$1.55 per user annually, it offers a safe, affordable, and effective way for governments to reduce maternal and child illness and deaths, as well as reduce national health expenditures on reproductive and children's health problems. This latest edition also includes new information on how family planning reduces the rate of new HIV infections and deaths from AIDS as well as a "Special Focus" section on the challenges of repositioning family planning in sub-Saharan Africa, where programs have languished in many countries over the last decade.
Language: English
Keywords:
DEVELOPING COUNTRIES | FAMILY PLANNING | CHILD SURVIVAL | INFANT MORTALITY | BIRTH INTERVALS | BREASTFEEDING | BIRTH SPACING | MATERNAL MORTALITY | REPRODUCTIVE HEALTH | ABORTION | SEXUALLY TRANSMITTED DISEASE PREVENTION | HIV PREVENTION | AIDS PREVENTION | MATERNAL HEALTH | CHILD HEALTH | ADOLESCENTS | CONTRACEPTION | NEEDS | PROGRAM ACCESSIBILITY | ATTITUDES | Survivorship | Length of Life | Mortality | Population Dynamics | Demographic Factors | Population | Fertility Measurements | Fertility | Infant Nutrition | Nutrition | Health | Fertility Control, Postconception | Sexually Transmitted Diseases | Reproductive Tract Infections | Infections | Diseases | HIV Infections | Viral Diseases | AIDS | Youth | Age Factors | Population Characteristics | Economic Factors | Program Evaluation | Programs | Organization and Administration | Psychological Factors | Behavior
Document Number: 325185 Notification

28.

Title: Attacking inequality in the health sector: a synthesis of evidence and tools.
Author: Yazbeck AS
Source: Washington, D.C., World Bank, 2009. [330] p.
Abstract: The main purpose of this book is to make available the accumulated knowledge of successful policy and analytical tools in this fight to reverse the vicious circle of income-poverty and ill health. The book presents both a practical set of analytical tools for understanding the causes of inequality in the use of health services and a menu of proven pro-poor policy actions. It is based on the evaluation of 14 successful policy changes in low- and middle-income countries in Africa, Asia, and Latin America, and a review of the published literature on inequality in the health sector. (Excerpt)
Language: English
Keywords:
DEVELOPING COUNTRIES | SUMMARY REPORT | DATA COLLECTION | LITERATURE REVIEW | LOW INCOME POPULATION | POVERTY | INEQUALITIES | DELIVERY OF HEALTH CARE | HEALTH POLICY | INFANT MORTALITY | FERTILITY | MATERNAL-CHILD HEALTH SERVICES | ANTENATAL CARE | CHILD HEALTH | IMMUNIZATION | CHILD NUTRITION | Research Methodology | Social Class | Socioeconomic Status | Socioeconomic Factors | Economic Factors | Health | Policy | Political Factors | Sociocultural Factors | Mortality | Population Dynamics | Demographic Factors | Population | Primary Health Care | Health Services | Maternal Health Services | Nutrition
Document Number: 331451

29.

Peer Reviewed

Title: How contraceptive use affects birth intervals: results of a literature review.
Author: Yeakey MP; Muntifering CJ; Ramachandran DV; Myint Y; Creanga AA
Source: Studies in Family Planning. 2009 Sep;40(3):205-214.
Abstract: Short birth intervals can have adverse consequences for maternal and infant outcomes. Optimal birth spacing is often presumed to be achieved through the practice of family planning and use of contraceptives, yet most of the available research does not address explicitly the contribution of contraceptive-method use to birth spacing or maternal and infant survival. We conducted a systematic literature review to assess the body of evidence linking contraceptive use to birth-interval length. Fourteen studies published in English between 1980 and 2008 met our eligibility criteria for inclusion. The findings from these studies are mixed but suggest that the use of contraceptives is protective against short birth intervals. Although results are favorable, many of the studies are methodologies employed are dated. More current research is needed to determine the impact of contraceptive-method use on birth-interval length in order to inform the promotion of family planning for reducing maternal and infant morbidity and mortality through birth spacing.
Language: English
Keywords:
AFRICA | RESEARCH REPORT | LITERATURE REVIEW | BIRTH SPACING | CONTRACEPTION | CONTRACEPTIVE USAGE | INFANT MORTALITY | MATERNAL MORTALITY | PREVENTION AND CONTROL | Developing Countries | Family Planning | Mortality | Population Dynamics | Demographic Factors | Population | Diseases
Document Number: 339702

30.


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