RESUMEN
Using data from United Nations sources we conducted an international comparison study of infant and maternal mortality rates and life expectancy at birth. We examined these three dependent variables in relation to a range of independent variables including dietary factors, medical resource availability, gross national product (GNP/capita), literacy rates, growth in the labor force, and provision of sanitation facilities and safe water. Based on exploratory stepwise regression models, we fitted a series of general linear models for each of the three dependent variables. For the models with the highest explanatory ability, the percent of households without sanitation facilities showed the strongest association with all three dependent variables: life expectancy at birth (R2 = 0.83, B = -0.088, P = 0.0007); infant mortality rate (R2 = 0.87, B = +0.611, P < 0.0001); and maternal mortality rate (R2 = 0.54, B = +8.297, P = 0.002). Additional significant predictors of life expectancy at birth and infant mortality rate included the quantity of animal products consumed, the percent of households without safe water, excess calories consumed as fat, and the total literacy level. Maternal mortality rate was significantly associated with total energy consumption and excess energy consumed as fat. Using residuals from the general linear models we chose three outlying countries: Costa Rica, Sri Lanka and Egypt, on which to do case studies. These country case studies are discussed briefly in regard to characteristics that could account for their differing statistical relationships.
Asunto(s)
Ambiente , Salud Global , Indicadores de Salud , Mortalidad Infantil , Esperanza de Vida , Mortalidad Materna , Vigilancia de la Población , Adulto , Costa Rica/epidemiología , Comparación Transcultural , Dieta , Escolaridad , Egipto/epidemiología , Empleo , Humanos , Recién Nacido , Modelos Lineales , Salud Pública , Factores Socioeconómicos , Sri Lanka/epidemiologíaRESUMEN
The examination of monthly (or quarterly) increments in weight or length is important for assessing the nutritional and health status of children. Growth velocities are widely thought to be more important than actual weight or length measurements per se. However, there are no standards by which clinicians, researchers, or parents can gauge a child's growth. This paper describes a method for computing growth velocities (monthly increments) for physical growth measurements with substantial measurement error and irregular spacing over time. These features are characteristic of data collected in the field where conditions are less than ideal. The technique of smoothing by splines provides a powerful tool to deal with the variability and irregularity of the measurements. The technique consists of approximating the observed data by a smooth curve as a clinician might have drawn on the child's growth chart. Spline functions are particularly appropriate to describe bio-physical processes such as growth, for which no model can be postulated a priori. This paper describes how the technique was used for the analysis of a large data base collected on pre-school aged children in rural Haiti. The sex-specific length and weight velocities derived from the spline-smoothed data are presented as reference data for researchers and others interested in longitudinal growth of children in the Third World.
Asunto(s)
Crecimiento , Estatura , Peso Corporal , Preescolar , Femenino , Haití , Humanos , Lactante , Cinética , Masculino , Matemática , Población RuralRESUMEN
PIP: Weight-for-height and height-for-age data were compared for preschool-age Haitian children enrolled in a community health and nutrition intervention program and children measured in the Haiti national nutrition survey of 1978. Cross-sections of the longitudinal data of the intervention program corresponding to the season when the national survey was conducted (May-September) were chosen for the 3 years of available program data (1969-71). Significantly less stunting was found in children in the 1970 and 1971 intervention group than in the children covered by the national survey. Tests of trend also showed that the height (or length) status of the children in the intervention program improved from 1969-71. Wasting, or low weight status, was in general not significantly different in any of the comparisons. Nevertheless, the data were more favorable to children in the intervention groups, even in 1970, a year of food shortages. The results of the comparison are consistent with a positive program effect. (author's)^ieng