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Infant, neonatal and perinatal mortality rates in Singapore.
Infant, neonatal and perinatal mortality rates are reliable indices of the health status and delivery of health care in a country. These rates have been declining in Singapore since World War II, and presently have become comparable to those of many developing countries. The pattern has also changed; postneonatal mortality has fallen markedly, resulting in neonatal mortality accounting for 75% of infant mortality, and first week mortality for 85% of neonatal mortality. Perinatal mortality rates have also declined over the years, due mainly to a decline in the first week mortality rates though a slight fall in stillbirth rates has also occurred. Further improvements can be expected in the perinatal and neonatal mortality rates. As neonatal intensive care improves, the prognosis of the very small and feeble infants will be brighter even though the efforts required might be very much greater. Such a challenge will prove to be very exciting and stimulating, and be an impetus to the raising of neonatal intensive care to a much higher level.
[Analysis of infantile and perinatal mortality and demographic indices in Sicily and Palermo from 1860 to 1979].
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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.
Changes in maternal and child mortality rates in three isolated Gambian villages over ten years.
As an adjunct to the general nutrition research programme, the MRC Dunn Nutrition Unit has provided for the past 10 years a continuous medical service to three adjacent rural Gambian villages. There have been substantial reductions in annual childhood mortality rates. Perinatal mortality fell from 109.6 to 45.5 per 1000 births, infant mortality from 148.5 to 24.5 per 1000 live births, and mortality in children aged 1-4 years from 109.1 to 13.3 per 1000. There have been no pregnancy-related maternal deaths in the community for 8 years; 16 could have been expected given current estimates of maternal mortality elsewhere in rural Gambia. Of all the health and nutritional interventions introduced the single most important factor has apparently been the on-the-spot, 24 h availability of a physician or qualified midwife.
Perinatal mortality: changes in the diagnostic panorama 1974-1980.
During the period 1974-1980, all late abortions (greater than 19 completed gestational weeks) (LA), late fetal deaths (LFD) and early neonatal deaths (END) were surveyed in a continuous material of 17813 births with an ascertained gestational age established by early ultrasound fetometry. There was no maternal death during the period. The total perinatal mortality (PM) was 0.98% with an END rate of 0.51%. In about 45% of LFD no diagnosis was found. Intrapartum death was extremely rare as was END caused by asphyxia or infection. In END, death from immaturity constituted the major group in the beginning of the period, while after 1977 lethal malformations was the dominating diagnosis. There was a continuous decrease in Idiopathic Respiratory Distress Syndrome (IRDS) as a cause of END. The proportion of END in extremely premature children showed a constant decrease in the beginning of the period. No difference in sex was found in END except for lethal malformations where there was a significant male preponderance. As a consequence of a more active obstetrical care, some fetuses who would previously have been classified as LA were probably delivered liveborn, extremely premature and appeared as END. The question of where to set the limits for what should be included in PM is thus highly relevant.
Infant and child mortality in Pakistan--some trends and differentials.
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Malaria chemoprophylaxis, birth weight and child survival.
Study of the effects of malaria chemoprophylaxis given during pregnancy on birthweight and investigation of the influence of birthweight on child survival suggest that, in a rural area of The Gambia, chemoprophylaxis given during pregnancy might reduce infant mortality by about one-fifth in the children of primigravidae but by less than 5% in the children of multigravidae. In malaria endemic areas, primigravidae should be protected against malaria not only for their own sake but also for that of their infants.
Outcome for infants of very low birthweight: survey of world literature.
Reports from developed countries world wide describing the outcome for infants of very low birthweight (VLBW, less than or equal to 1500 g) born since 1946 show that, in general, mortality rates and the prevalence of major handicap in survivors were high until 1960. Since then the chances of healthy survival have trebled, whereas the handicap-rate has remained stable and relatively low at 6--8% of VLBW live births.
Infant mortality and childhood nutritional status among Afghan refugees in Pakistan.
In 1984 and again in 1985, systematic surveys were undertaken to evaluate infant mortality and childhood nutritional status among the Afghan refugee population in Pakistan. The entire Afghan refugee population under the administration of the United Nations High Commissioner for Refugees was sampled. Infant mortality rates were estimated to be 156 per 1000 for 1984 and 119 per 1000 for 1985. A decline was also suggested in neonatal mortality rates from 61 per 1000 for 1984 to 46 per 1000 for 1985. For neither infant nor neonatal mortality was the difference statistically significant. Improvements were seen in the percentage of children who died before their fifth birthday (22.5% in 1984 and 18.8% in 1985), in the percentage of children who were malnourished (3.5% in 1984 and 2.3% in 1985), and an increase in the percentage of children above the WHO/NCHS/CDC weight-for-height reference median (26% in 1984 and 35% in 1985). Diarrhoea was the most frequently reported cause of death for both years and was a particularly important cause of death among one-year-old children. In 1985, measles was related to 24% of the deaths and neonatal tetanus to 9% of the deaths, an increase from 8% for measles and 6% for tetanus in 1984.
Perinatal mortality in Matlab, Bangladesh: a community-based study.
Perinatal deaths, comprising stillbirths and deaths during the first week of life, were monitored over the eight-year period 1979 to 1986 in a rural Bangladeshi population of 196,000. The perinatal mortality rate was 75 per 1000 total births. The rate was 13% higher in males than females. Stillbirth and early neonatal mortality rates were 37 and 38 per 1000 total births, respectively. The major causes of perinatal deaths are presented, as well as some of the maternal determinants. During the period under study, perinatal mortality declined regularly and significantly over time in an area covered by an intensive Family Planning and Health Services programme, but not in the adjacent control area. This raises the issue of the impact of such a programme upon perinatal mortality, and the need to include a strong maternity care component into primary healthcare strategies if further reductions of perinatal mortality are to be achieved.
Traditional midwives, tetanus immunization, and infant mortality in rural Haiti.
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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.
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.
[Trends in perinatal mortality by etiologies during the last years in Chile].
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[Relation of infant mortality to maternal age and birth order. Chile, 1969 - 1974 - 1979].
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A brief account of 30 years' mortality of Chinese population.
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