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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↗
PubMed1995

Mortality in a migrating Mennonite church congregation.

Preston's two-census method of demographic estimation is applied to three pairs of reconstructed censuses from the records of a migrating Mennonite church congregation covering the period 1780-1890. The three pairs of censuses correspond to three periods (1780-1790, 1850-1860, and 1880-1890) and to stays in three settings (Prussia, Russia, and Kansas, respectively). The Mennonites' stay in Prussia was a period of hardship. In Russia they expanded their economic base and developed new farming methods, dramatically increasing their productivity. The Mennonites took these skills to Kansas, where they continued to be successful. The increase in life expectancy at age 5 corroborates this picture. The Prussian period exhibits the shortest life expectancy for both sexes. After the move to Russia, life expectancy increased for both sexes and continued to increase with the move to Kansas. The model also provides limited evidence for fertility depression following the move to Kansas.

Adolescent↗
PubMed1995

Neonatal disease profile in Larkana before and after establishment of neonatal ward.

This is a study of 2050 neonatal admissions excluding neonatal tetanus in children hospital CMC Larkana from December, 1988 to July, 1993. Six hundred and eighty-nine cases were admitted in General Paediatrics Ward before establishment of neonatal unit and 1361 cases were admitted in neonatal ward. The aime of study was to compare the disease pattern and mortality rates before and after establishment of a neonatal unit in the same hospital. Number of admissions significantly increased after the establishment of neonatal unit but there was no decline in the mortality. Changes in disease pattern were observed particularly for Gastroenteritis and miscellaneous (undetermined) category. Seventy percent of admissions were males in Ist week of their life. Commonest cause of admission and mortality was birth anoxia.

Asphyxia Neonatorum↗
PubMed1996

Using community health workers for malaria control: experience in Zaire.

The potential for using community health workers (CHW) for administering timely and effective treatment for presumptive malaria attacks was evaluated in the Katana health zone in Zaire. In each of the 12 villages of an intervention area (area A) with 13000 inhabitants, a CHW was trained in the use of a simple fever management algorithm. The CHWs performed their services under the supervision of the nurse in charge of the area's health centre (HC). Malaria morbidity and mortality trends were monitored during 2 years in area A and in an ecologically comparable control area (area B), where malaria treatment continued to be available at the HC only. Health care behaviour changed dramatically in the intervention area, and by the end of the observation period 65% of malaria episodes were treated at the community level. Malaria morbidity declined 50% in area A but remained stable in the control area. Parasitological indices showed similar trends. Malaria-specific mortality rates remained, however, at essentially the same levels in both areas. The non-comprehensiveness of the CHWs' care and their ambiguous position in the health care system created problems that compromise the sustainability of the intervention.

Adolescent↗
PubMed1996

[Incidence and regression of sudden infant death in Austria. Is the change in the SIDS incidence real or virtual?].

After the rise in incidence of the sudden infant death syndrome (SIDS) in the 1980s to a peak of 1.7/1000 live births in Austria in 1988, the SIDS rate more than halved to 0.79/1000 live births in 1994. This trend can be regarded as typical of the epidemiology of SIDS in most Western countries. It is commonly interpreted as a result of preventive measures. However, the decline in incidence of SIDS started several years before systematic preventive activities were undertaken in Austria. Graphical presentation shows that the dynamics of SIDS does not affect the almost linear decline in postneonatal mortality over the past 25 years, as would be expected from the fact that SIDS is the most important cause of death in the postneonatal period. A comparative analysis of trends of postneonatal SIDS and non-SIDS mortality reveals that in Austria the increase of SIDS was accompanied by a rapid fall of non-SIDS mortality, whereas, on the contrary, the decline of SIDS went along with relative increase of non-SIDS mortality. Changing awareness of coroners and forensic pathologists of SIDS, with the resultant changes in frequency and performance of postmortem examinations, and changes in coding practices of causes of death should be taken into consideration as determinants of SIDS incidence before interpreting trends as resulting from public health interventions.

Austria↗
PubMed1996

Child mortality in a collapsing African society.

A cohort study of mortality among under-5-year-olds was carried out in two Somali villages in 1987-89, a period of economic and political collapse in the rural parts of the country. Analysed was the relative importance of the social characteristics for under-5-year-old mortality against a background of deteriorating political and economic conditions. Mortality increased among under-5-year-olds from 1987 (211 per 1000) to 1988 (323 per 1000) to 1989 (414 per 1000). The mortality risk was more pronounced for boys than girls and was more so for infants than children aged 1-4 years. The major signs prior to death were respiratory infections, diarrhoeal diseases, fever/malaria and tetanus in the neonatal period. Over the 3-year study period mortality rates for diarrhoeal diseases increased significantly, while those for respiratory infections and diseases preventable by immunization increased more slowly. The increasing trend in under-5-year-old mortality was more pronounced in instances when the mother derived her major income from sources other than farming and in larger households.

Child, Preschool↗
PubMed1997

[Trends in birth rates, general, infantile and neonatal mortality in Chile from 1850 to date].

BACKGROUND: Chile has experienced great changes in its health conditions, due to economical, social and demographic phenomena. AIM: To underline the moment of the demographic transition in Chile by means of a chronological epidemiological study, using available information. MATERIAL AND METHODS: Data was obtained from registries of the National Statistical Office, General Statistics Direction and National Institute of Statistics. RESULTS: Birth rate was 41/1000 in 1850, remained stable until the thirties, decreased to 35/1000 in 1965, to 21.3/1000 in 1978 and to 20.5/1000 in 1994. The mortality rate increased from 20.3 to 37/1000 from 1850 to 1901 and the it descended to 5.50/1000 in 1993. The annual population growth was 1% in the forties, increased to 2.5% in 1965 and is 1.6% at the present. The population thus increased from 1,400,000 inhabitants in 1850 to 14,000,000 in 1994. The nuptial rate has remained between 7 and 8/1000 since 1934. Infantile mortality was 337 per 1000 newborns in 1950 and dropped to 12 in 1994. It represented 36% of the total mortality until the sixties, and now represents only 5%. This has contributed to the increase in life expectancy and ageing of our population. Neonatal mortality dropped from 136 per 1000 newborns in 1915 to 6.8 in 1994. Fetal mortality changed from 50 per 1000 newborns in 1936 to 5.3 in 1993. CONCLUSIONS: Several causes have contributed to the changes in the above mentioned indicators. Currently, we are in the third stage of a Demographic transition that began in the sixties.

Adolescent↗