RESUMO
OBJECTIVES: To examine the socioeconomic gradients in birth outcomes among singleton infants in Argentina, 2003-2007. METHODS: We analyzed data of 3,230,031 singleton infants born in 2003-2007, obtained from vital statistics. Associations between birth outcomes [small for gestational age (SGA), low birth weight (LBW), and preterm birth (PTB)] and socioeconomic indicators (maternal education and area-based material deprivation quintiles) were assessed with logistic regression. RESULTS: The risk of SGA increased with higher socioeconomic disadvantage, but that of PTB decreased. Compared to mothers who attained a tertiary or university degree, mothers who did not complete primary school were more likely to have a SGA infant [adjusted OR (95 % CI): 1.65 (1.62, 1.68)], but less likely to deliver preterm [0.92 (0.90, 0.94)]. As a result of the conflicting trends in SGA and PTB, LBW exhibited inconsistent socioeconomic gradients. CONCLUSIONS: The excess risk of adverse birth outcomes associated with socioeconomic disadvantage was consistently reflected by SGA, but not by LBW and PTB. These findings challenge the usefulness of LBW as an indicator population health. Further research is needed to explain the reverse socioeconomic gradients in PTB.
Assuntos
Recém-Nascido Pequeno para a Idade Gestacional , Mães/estatística & dados numéricos , Resultado da Gravidez/economia , Nascimento Prematuro/economia , Adolescente , Adulto , Argentina , Escolaridade , Feminino , Humanos , Recém-Nascido , Modelos Logísticos , Masculino , Pessoa de Meia-Idade , Parto , Gravidez , Fatores de Risco , Fatores Socioeconômicos , Adulto JovemRESUMO
OBJECTIVE: To develop new and improved reference birthweights for the Argentine population as a whole with a breakdown by gestational age (GA), sex and multiplicity of birth. METHODS: The population studied included all live births resulting from single (n = 3,478,286) and double (n = 57,654) births in Argentina during the period 2003- 2007. The probable errors in classifying GA on the basis of last menstruation were corrected using normal mixture models. The percentiles were obtained by quantile regression, which also made it possible to smooth out the curves. RESULTS: Birthweight curves for single births were obtained between weeks 22 and 43 of gestation, and curves for double births between weeks 24 and 41, with a breakdown by the sex of the neonate. Compared with those of previous studies, these reference birthweights do not overestimate the proportion of live births large for their GA. An increase in birthweight was also observed during the period of study. CONCLUSIONS: The proposed curves have the advantages of being based on large numbers, of being representative of the most recent Argentine births, of distinguishing the number of births and the sex of the neonates, and of minimizing GA classification errors. They are therefore a useful tool for measuring inequalities and thus identifying population groups at higher risk of adverse perinatal events.
Assuntos
Peso ao Nascer , Adolescente , Adulto , Altitude , Argentina , Declaração de Nascimento , Feminino , Idade Gestacional , Humanos , Recém-Nascido , Recém-Nascido Prematuro , Nascido Vivo , Masculino , Idade Materna , Paridade , Gravidez , Valores de Referência , Caracteres Sexuais , Fatores Socioeconômicos , Gêmeos , Adulto JovemRESUMO
OBJETIVO: Desarrollar referencias nuevas y mejoradas de peso al nacer según la edad gestacional (EG), el sexo y la multiplicidad del parto, para la población argentina en su conjunto. MÉTODOS: La población de estudio incluyó a todos los nacidos vivos de partos simples (n = 3 478 286) y dobles (n = 57 654) en Argentina durante el período 2003-2007. Los probables errores en la clasificación de la EG basada en la fecha de la última menstruación fueron corregidos con el uso de modelos de distribuciones normales mixtas. Los percentiles se obtuvieron mediante la regresión de cuantiles, que además posibilitó el suavizamiento de las curvas. RESULTADOS: Se obtuvieron curvas de peso al nacer para partos simples entre las semanas 22 y 43 de gestación y para partos dobles entre las semanas 24 y 41, según el sexo del neonato. Comparadas con estudios previos, estas referencias no sobreestiman la proporción de nacidos vivos grandes para su EG. Se observó también un aumento del peso al nacer a lo largo del período de estudio. CONCLUSIONES: Las curvas propuestas tienen las ventajas de basarse en grandes números, de ser representativas de los nacimientos argentinos más recientes, de distinguir el tipo de parto y el sexo de los neonatos, y de minimizar los errores de clasificación de la EG. Constituyen por lo tanto una herramienta útil para medir desigualdades y así identificar grupos poblacionales con mayor riesgo de eventos perinatales adversos.
OBJECTIVE: To develop new and improved reference birthweights for the Argentine population as a whole with a breakdown by gestational age (GA), sex and multiplicity of birth. METHODS: The population studied included all live births resulting from single (n = 3,478,286) and double (n = 57,654) births in Argentina during the period 2003- 2007. The probable errors in classifying GA on the basis of last menstruation were corrected using normal mixture models. The percentiles were obtained by quantile regression, which also made it possible to smooth out the curves. RESULTS: Birthweight curves for single births were obtained between weeks 22 and 43 of gestation, and curves for double births between weeks 24 and 41, with a breakdown by the sex of the neonate. Compared with those of previous studies, these reference birthweights do not overestimate the proportion of live births large for their GA. An increase in birthweight was also observed during the period of study. CONCLUSIONS: The proposed curves have the advantages of being based on large numbers, of being representative of the most recent Argentine births, of distinguishing the number of births and the sex of the neonates, and of minimizing GA classification errors. They are therefore a useful tool for measuring inequalities and thus identifying population groups at higher risk of adverse perinatal events.
Assuntos
Humanos , Masculino , Feminino , Gravidez , Recém-Nascido , Adolescente , Adulto , Adulto Jovem , Peso ao Nascer , Altitude , Argentina , Declaração de Nascimento , Idade Gestacional , Recém-Nascido Prematuro , Nascido Vivo , Idade Materna , Paridade , Valores de Referência , Caracteres Sexuais , Fatores Socioeconômicos , GêmeosAssuntos
Peso ao Nascer , Idade Gestacional , Gravidez Múltipla , Recém-Nascido , Valores de Referência , Argentina , Peso ao Nascer , Idade Gestacional , Gravidez Múltipla , Recém-Nascido , Padrões de Referência , Peso ao Nascer , Altitude , Recém-Nascido Prematuro , Nascido Vivo , Paridade , Valores de Referência , Caracteres Sexuais , Gêmeos , Declaração de Nascimento , Idade Gestacional , Idade Materna , Fatores SocioeconômicosRESUMO
In a previous paper (Soc Sci Med 23, 995-1002, 1986), we described the development of a method for identifying households at high risk of childhood diarrhea based on a logit analysis of data collected as part of a diarrhea disease control project in Grenada. In this paper, we report the results of a follow-up study designed to replicate the first using data on diarrhea incidence and risk factors collected in a different set of rural communities in Grenada. The findings of the first study were not replicated. There was no significant association between the risk factors and diarrhea in the follow-up study in contrast to the very strong associations found in the first study. As a consequence, it was not possible to construct a logit model from the second data set. The possible reasons for the contrasting sets of results and their implications for the application of the risk approach are discussed with reference to a two by two true-false table. (AU)
Assuntos
Humanos , Diarreia/prevenção & controle , Diarreia/epidemiologia , Seguimentos , Educação em Saúde , Habitação , Higiene , Modelos Logísticos , Projetos de Pesquisa , Fatores de Risco , Saúde da População Rural , GranadaRESUMO
Diarrheal disease is a primary cause of childhood mortality and morbidity in developing countries. Significant reduction depends on the identification of high-risk households which can be targetted for proven-effective interventions, such as oral rehydration therapy. This paper describes the development of a household risk assessment model in the context of an on-going diarrheal disease control in Grenada. Contingency and logit analyses of household survey data are used to identify easily observed markers of high-risk households. A three-variable logit model gives accurate predictions of self-reported diarrhea, showing that the approach can be used to develop an effective and efficient risk assessment tool.(AU)