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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↗
PubMed1987

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.

Afghanistan↗
PubMed1988

Secular trends of infectious disease mortality in The Netherlands, 1911-1978: quantitative estimates of changes coinciding with the introduction of antibiotics.

Secular trends of mortality from 21 infectious diseases in the Netherlands were studied by inspection of age/sex-standardized mortality curves and by log-linear regression analysis. An attempt was made to obtain quantitative estimates for changes coinciding with the introduction of antibiotics. Two possible types of effect were considered: a sharp reduction of mortality at the moment of the introduction of antibiotics, and a longer lasting (acceleration of) mortality decline after the introduction. Changes resembling the first type of effect were possibly present for many infectious diseases, but were difficult to measure exactly, due to late effects on mortality of World War II. Changes resembling the second type of effect were present in 16 infectious diseases and were sometimes quite large. For example, estimated differences in per cent per annum mortality change were 10% or larger for puerperal fever, scarlet fever, rheumatic fever, erysipelas, otitis media, tuberculosis, and bacillary dysentery. No acceleration of mortality decline after the introduction of antibiotics was present in mortality from 'all other diseases'. Although the exact contribution of antibiotics to the observed changes cannot be inferred from this time trend analysis, the quantitative estimates of the changes show that even a partial contribution would represent a substantial effect of antibiotics on mortality from infectious diseases in the Netherlands.

Adolescent↗
PubMed1991

Mortality trend in a rapidly developing economy in Taiwan. Part II: Life expectancy and "potential years of life lost".

Taiwan has made remarkable economic progress in the last 30 years. The life expectancy of its population improved steadily during this period. A male child born in 1983 could look forward to 70.4 years of life and a female child to 75.3 years, gains of 17.5 years and 19.0 years, respectively, since 1950. The potential gains in life expectancy of the Taiwan population are also examined if the five leading causes of death are reduced or eliminated. In addition, this paper discusses the concept of potential productive years of life lost (PYLL), examines the leading causes of premature death and shows how this measure can be used to target prevention programs and health care planning.

Adolescent↗
PubMed1985

Pursuing longevity: delay vs elimination of degenerative diseases.

Using a new model which allows for projection of mortality change resulting from preventive health care measures, prospective changes in longevity for the resident United States population in 1978 were compared with projections of longevity gains occurring under a standard single cause-elimination model. Results indicate that equal or greater gains accrue from the prevention or delay of several major degenerative diseases, than from the complete elimination of some single major degenerative diseases. Observed declines in mortality from 1960 to 1978 have resulted in gains in longevity equivalent to the successful elimination of some major degenerative diseases.

Adolescent↗
PubMed1992

Standardized mortality ratios for Israel, 1983-86.

Standardized mortality ratios (SMRs), standardized by age, sex, continent of birth, and religion are presented by cause and region for the period 1983-86. Regional SMRs ranged from 90.6 in Jerusalem to 107.6 in Ramla. These differences may be due to direct and indirect occupational, environmental and socioeconomic effects as well as to possible health service differences. SMRs can be used to indicate regions where further in-depth epidemiological investigations are called for in order to ascertain the reasons for elevated disease specific SMRs. In addition, SMRs could be used as a global measure of all effects in order to adjust any regional budgetary allocation formula, based on capitation.

Adolescent↗
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↗
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↗
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↗
PubMed1988

On the decomposition of changes in expectation of life and differentials in life expectancy.

The projection of mortality rates requires inter alia close examination of the mortality experience of a population over a long period of time and will usually also involve the analysis of mortality trends by cause of death. In two of the more important recent contributions, techniques were devised for explaining change in life expectancy in terms of mortality changes in particular age groups and by different causes of death. The approaches adopted by the authors differ, and the purpose of this article is to reconcile the two and tie the results in with those obtained by earlier writers. A new method for explaining the change in a life expectancy differential in terms of the observed changes in the mortality differentials and the observed change in overall mortality level is also described.

Adolescent↗
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↗