RESUMO
OBJECTIVES: Among US-born preterm infants of Hispanic mothers, we analyzed the unadjusted and adjusted infant mortality rate (IMR) by country/region of origin and maternal nativity status. STUDY DESIGN: Using linked national US birth and death certificate data (2005-2014), we examined preterm infants of Hispanic mothers by subgroup and nativity. Clinical and sociodemographic covariates were included and the main outcome was death in the first year of life. RESULTS: In our cohort of 891,216 preterm Hispanic infants, we demonstrated different rates of infant mortality by country and region of origin, but no difference between infants of Hispanic mothers who were US vs. foreign-born. CONCLUSION: These findings highlight the need to disaggregate the heterogenous Hispanic birthing population into regional and national origin groups to better understand unique factors associated with adverse perinatal outcomes in order to develop more targeted interventions for these subgroups.
Assuntos
Hispânico ou Latino , Saúde do Lactente , Mortalidade Infantil , Recém-Nascido Prematuro , Mães , Feminino , Humanos , Recém-Nascido , Gravidez , Hispânico ou Latino/etnologia , Hispânico ou Latino/estatística & dados numéricos , Mortalidade Infantil/etnologia , Mães/estatística & dados numéricos , Saúde do Lactente/etnologia , Saúde do Lactente/estatística & dados numéricos , Estados Unidos/epidemiologia , Etnicidade/estatística & dados numéricos , México/etnologia , Porto Rico/etnologia , Cuba/etnologia , América Central/etnologia , América do Sul/etnologiaRESUMO
Neste boletim são apresentados: situação mundial, ocorrência de hospitalizações confirmadas para sars-cov-2, perfil das pessoas, distribuição espacial, Síndrome Inflamatória Multissistêmica Pediátrica (SIM-P), povos indígenas, descrição de surtos, trabalhadores da saúde, Vigilância sentinela de síndrome gripal e tabelas de descrição do surto. (AU)
Assuntos
Humanos , Masculino , Feminino , Gravidez , Recém-Nascido , Lactente , Pré-Escolar , Criança , Adolescente , Adulto , Pessoa de Meia-Idade , Idoso , Idoso de 80 Anos ou mais , Perfil de Saúde , Mortalidade Hospitalar/etnologia , Pessoal de Saúde/estatística & dados numéricos , Vigilância de Evento Sentinela , Grupos Populacionais/estatística & dados numéricos , Saúde de Populações Indígenas/estatística & dados numéricos , Teste para COVID-19 , COVID-19/epidemiologia , Hospitalização/estatística & dados numéricos , Saúde da Criança/estatística & dados numéricos , Surtos de Doenças , Saúde do Adolescente/estatística & dados numéricos , Saúde do Lactente/estatística & dados numéricos , Betacoronavirus , COVID-19/complicações , COVID-19/mortalidadeRESUMO
AIM: To explore indigenous communities' responses to the COVID-19 pandemic and its consequences for maternal and neonatal health (MNH) care in the Peruvian Amazon. METHODS: Mamás del Río is a community-based, MNH programme with comprehensive supervision covering monthly meetings with community health workers (CHW), community leaders and health facilities. With the onset of the lockdown, supervisors made telephone calls to discuss measures against COVID-19, governmental support, CHW activities in communities and provision of MNH care and COVID-19 preparedness at facilities. As part of the programme's ongoing mixed methods evaluation, we analysed written summaries of supervisor calls collected during the first 2 months of Peru's lockdown. RESULTS: Between March and May 2020, supervisors held two rounds of calls with CHWs and leaders of 68 communities and staff from 17 facilities. Most communities banned entry of foreigners, but about half tolerated residents travelling to regional towns for trade and social support. While social events were forbidden, strict home isolation was only practised in a third of communities as conflicting with daily routine. By the end of April, first clusters of suspected cases were reported in communities. COVID-19 test kits, training and medical face masks were not available in most rural facilities. Six out of seven facilities suspended routine antenatal and postnatal consultations while two-thirds of CHWs resumed home visits to pregnant women and newborns. CONCLUSIONS: Home isolation was hardly feasible in the rural Amazon context and community isolation was undermined by lack of external supplies and social support. With sustained community transmission, promotion of basic hygiene and mask use becomes essential. To avoid devastating effects on MNH, routine services at facilities need to be urgently re-established alongside COVID-19 preparedness plans. Community-based MNH programmes could offset detrimental indirect effects of the pandemic and provide an opportunity for local COVID-19 prevention and containment.
Assuntos
COVID-19 , Controle de Doenças Transmissíveis , Serviços de Saúde Comunitária , Saúde do Lactente , Saúde Materna , Adulto , COVID-19/epidemiologia , COVID-19/prevenção & controle , Controle de Doenças Transmissíveis/organização & administração , Controle de Doenças Transmissíveis/normas , Serviços de Saúde Comunitária/métodos , Serviços de Saúde Comunitária/organização & administração , Serviços de Saúde Comunitária/normas , Transmissão de Doença Infecciosa/prevenção & controle , Feminino , Conhecimentos, Atitudes e Prática em Saúde , Necessidades e Demandas de Serviços de Saúde , Serviços de Saúde do Indígena/tendências , Humanos , Saúde do Lactente/estatística & dados numéricos , Saúde do Lactente/tendências , Recém-Nascido , Masculino , Saúde Materna/estatística & dados numéricos , Saúde Materna/tendências , Peru/epidemiologia , Gravidez , Serviços Preventivos de Saúde/métodos , SARS-CoV-2RESUMO
Abstract Objectives: to evaluate the relation between breastfeeding and postpartum weight reten-tion. Methods: this prospective cohort study involved 641 newborns and their mothers, followed up to twelve months postpartum. Data were collected from June 2015 to February 2017. In the first interview, we investigated data regarding socioeconomic and demographic characteristics, obstetric history, weight, and gestational age of the infant at birth. Maternal weight and breastfeeding status were obtained at 3, 6, 9 and 12 months postpartum at the mother's home. A descriptive analysis of maternal weight retention according to the lactation status was performed. Multiple linear regression models evaluated the effect on exclusive breastfeeding and total breastfeeding duration on maternal weight retention at 6 and 12 months postpartum, considering potential confounders. Results: 512 and 490 mothers were evaluated at six months and at twelve months post-partum, and the mean weight retention was 1.79 (SD=5.52) and 1.69 (SD=6.69) kg, respectively. Regardless of the confounders, the mean postpartum weight reduction for each day of exclusive breastfeeding was 11 (CI95%= -0.019 to -0.003) and 16 grams (CI95%= -0.026 to -0.007) for 6 and 12 months, respectively. The total maternal breastfeeding duration had the same effect. Conclusions: longer periods of exclusive breastfeeding and total breastfeeding are associated with lower postpartum weight retention.
Resumo Objetivos: avaliar a relação entre aleitamento materno e retenção de peso pós-parto. Métodos. estudo de coorte prospectiva com 641 recém-nascidos/mães acompanhados até doze meses pós-parto. Os dados foram coletados de junho/2015 a fevereiro/2017; na primeira entrevista, investigou-se dados socioeconômicos, demográficos, história obstétrica, peso e idade gestacional do lactente ao nascer. Pesos maternos e situação de aleitamento dos lactentes foram obtidos aos 3, 6, 9 e 12 meses pós-parto, em domicílio. Realizou-se análise descritiva da retenção de peso materno segundo situação de aleitamento nesses períodos. Modelos de regressão linear múltiplos avaliaram o efeito da duração do aleitamento materno exclusivo e aleitamento materno sobre retenção de peso materno aos 6 e 12 meses pós-parto, considerando confundidores. Resultados: seis e doze meses pós-parto foram avaliadas 512 e 490 mães, com retenção ponderal média de 1,79 (DP=5,52) e 1,69 (DP=6,69) quilos, respectivamente. Independentemente de confundidores, cada dia a mais de aleitamento materno exclusivo reduziu, em média, 11 (IC95%= -0,019; -0,003) e 16 (IC95%= -0,026; -0,007) gramas a retenção de peso nos dois períodos. A duração do aleitamento materno total teve efeito semelhante. Conclusões: maior duração do aleitamento materno exclusivo e aleitamento materno associam-se com menor retenção de peso pós-parto.
Assuntos
Humanos , Feminino , Gravidez , Recém-Nascido , Lactente , Cuidado Pré-Natal/estatística & dados numéricos , Aleitamento Materno/estatística & dados numéricos , Ganho de Peso na Gestação/fisiologia , Fatores Socioeconômicos , Peso ao Nascer , Brasil/epidemiologia , Modelos Lineares , Fatores de Risco , Estudos de Coortes , Idade Gestacional , Período Pós-Parto/fisiologia , Saúde do Lactente/estatística & dados numéricosRESUMO
BACKGROUND: On Dec 1, 2006, Mexico's public health-care insurance scheme, Seguro Popular, implemented the Medical Insurance Century XXI (SMSXXI) programme, to provide insurance to children younger than 5 years without social security. SMSXXI aims to increase access to health services, decrease out-of-pocket health expenses (OOPHE), and reduce health inequities. SMSXXI covers uninsured, primarily low-income, populations who might be most at risk of the financial and health consequences of costly medical interventions. METHODS: We assessed the effects of SMSXXI on health outcomes and financial protection for Mexico's children using multiple nationally representative surveys and administrative data sources spanning 2001-16. The identification of effects relied on detailed hospital-level affiliation data mapping the geographical expansion of SMSXXI's coverage across the country over time. The units of analysis included hospitals, households, and children. Primary outcomes were neonatal and infant mortality, self-reported morbidity (health status, influenza, and diarrhoea), and child's height. Secondary outcomes were OOPHE, hospital discharges, and quality of service provision. Effects controlled for fixed and time-variant confounders using double-difference and triple-difference estimation strategies. Where feasible, we also estimated effects using exogenous variation in programme eligibility rules that limited enrolment in SMSXXI to children born after Dec 1, 2006. FINDINGS: SMSXXI was not associated with early (<1 week) neonatal mortality, but was associated with a reduction in late (<28 days) neonatal mortality by 0·139 deaths per 1000 livebirths (95% CI 0·032-0·246), or 7% (2-12) relative to the comparison base of 1·98 deaths per 1000 livebirths in 2006. SMSXI was associated with a reduction in infant mortality from conditions covered by the programme by 0·147 deaths per 1000 livebirths (0·023-0·271), or 5% (1-10) relative to the comparison base of 2·73 deaths per 1000 livebirths. The effects were largest in high baseline mortality areas. Long-term health effects, 8 years after the onset of SMSXXI, were reflected in a 0·434 cm (0·404-0·459) height increase for birth cohorts exposed to the programme and an average effect on height of 0·879 cm (0·821-0·932) for low-income populations. About 3-6 years after SMSXXI started, children reported having better health status and lower incidence of influenza and diarrhoea. The programme led to a 14% reduction (7-28) in OOPHE, primarily from hospital-related expenses. No effects were detected on hospital discharges, suggesting that SMSXXI might not have increased use. INTERPRETATION: SMSXXI promoted access to covered interventions and encouraged better primary care. The programme also promoted increased supply and quality of care by improving human and physical resources sensitive to unmet needs. Increased resource availability and improved supply of health care, rather than increased use, contributed to reduce infant mortality and improved long-term health as proxied by self-reported morbidity and child height. Consistent with the programme's focus on uninsured and low-income populations, the effects on mortality, long-term health status, and OOPHE were concentrated in vulnerable groups. FUNDING: Inter-American Development Bank.
Assuntos
Saúde da Criança/estatística & dados numéricos , Saúde do Lactente/estatística & dados numéricos , Cobertura Universal do Seguro de Saúde/estatística & dados numéricos , Pré-Escolar , Feminino , Humanos , Lactente , Recém-Nascido , Masculino , México/epidemiologia , Estudos RetrospectivosRESUMO
BACKGROUND: Trials have examined on the benefits of vitamin D supplementation in pregnant women. OBJECTIVE: This review aimed to evaluate whether oral vitamin D supplements, when given to pregnant women with gestational diabetes mellitus (GDM), would improve maternal and neonatal outcomes, compared with no treatment or placebo. METHOD: We performed a systematic review following Cochrane methodology, and randomized trials were included where pregnant women with GDM received vitamin D supplementation versus placebo/no treatment or vitamin D and calcium versus placebo/no treatment. Primary outcomes were preeclampsia, preterm birth, cesarean delivery, gestational hypertension, and adverse events related to vitamin D supplementation. The search strategies were applied to the following databases: MEDLINE, Embase, LILACS, and CENTRAL. Similar outcomes in at least two trials were plotted using Review Manager 5.3 software. The quality of evidence was generated according to the Grading of Recommendations Assessment, Development, and Evaluation (GRADE). RESULTS: The total of 1224 references were identified, eleven trials were potentially eligible, and six were included in this review (totaling 456 women). The meta-analysis of frequency of cesarean deliveries did not show significant differences between groups, none of the trials evaluated the remaining primary outcomes. For secondary outcomes, our results suggest that vitamin D supplementation in pregnant women with GDM may reduce newborn complications such as hyperbilirubinemia, polyhydramnios (RR: 0.40, 95% CI: 0.23 to 0.68; RR: 0.17, 95% CI: 0.03 to 0.89; respectively), and the need for maternal or infant hospitalization (RR: 0.13; 95% CI: 0.02 to 0.98; RR: 0.40, 95% CI: 0.23 to 0.69). However, the evidence was of low or very low quality. CONCLUSION: We did not find moderate or high quality evidence indicating that vitamin D supplementation, when compared with placebo, improves glucose metabolism, adverse maternal and neonatal outcomes related to GDM in pregnant women.
Assuntos
Diabetes Gestacional/dietoterapia , Suplementos Nutricionais , Vitamina D/administração & dosagem , Cesárea/estatística & dados numéricos , Feminino , Hospitalização/estatística & dados numéricos , Humanos , Saúde do Lactente/estatística & dados numéricos , Recém-Nascido , Doenças do Recém-Nascido/epidemiologia , Doenças do Recém-Nascido/prevenção & controle , Saúde Materna/estatística & dados numéricos , Placebos/administração & dosagem , Gravidez , Nascimento Prematuro/etiologia , Nascimento Prematuro/prevenção & controle , Ensaios Clínicos Controlados Aleatórios como Assunto , Resultado do TratamentoRESUMO
AIM: To evaluate the use of analgesia for vaginal birth, in women with and without severe maternal morbidity (SMM) and to describe sociodemographic, clinical, and obstetric characteristics and maternal and perinatal outcomes associated with labor analgesia. METHODS: Secondary analysis of the WHO Multicountry Survey on Maternal and Newborn Health (WHO-MCS), a global cross-sectional study performed between May 2010 and December 2011 in 29 countries. Women who delivered vaginally and had an SMM were included in this analysis and were then divided into two groups: those who received and those who did not receive analgesia for labor/delivery. We further compared maternal characteristics and maternal and perinatal outcomes between these two groups. RESULTS: From 314,623 women originally included in WHO-MCS, 9,788 developed SMM and delivered vaginally, 601 (6.1%) with analgesia and 9,187 (93.9%) without analgesia. Women with SMM were more likely to receive analgesia than those who did not experience SMM. Global distribution of SMM was similar; however, the use of analgesia was less prevalent in Africa. Higher maternal education, previous cesarean section, and nulliparity were factors associated with analgesia use. Analgesia was not an independent factor associated with an increase of severe maternal outcome (Maternal Near Miss + Maternal Death). CONCLUSIONS: The overall use of analgesia for vaginal delivery is low but women with SMM are more likely to receive analgesia during labor. Social conditions are closely linked with the likelihood of having analgesia during delivery and such a procedure is not associated with increased adverse maternal outcomes. Expanding the availability of analgesia in different levels of care should be a concern worldwide.
Assuntos
Analgesia/estatística & dados numéricos , Saúde do Lactente/estatística & dados numéricos , Internacionalidade , Trabalho de Parto/fisiologia , Saúde Materna/estatística & dados numéricos , Mortalidade Materna , Inquéritos e Questionários , Organização Mundial da Saúde , Adulto , Feminino , Humanos , Análise Multivariada , Gravidez , Resultado da Gravidez , Prevalência , Adulto JovemRESUMO
BACKGROUND: Twin pregnancy was associated with significantly higher rates of adverse neonatal and perinatal outcomes, especially for the second twin. In addition, the maternal complications (potentially life-threatening conditions-PLTC, maternal near miss-MNM, and maternal mortality-MM) are directly related to twin pregnancy and independently associated with adverse perinatal outcome. The objective of the preset study is to evaluate perinatal outcomes associated with twin pregnancies, stratified by severe maternal morbidity and order of birth. METHODS: Secondary analysis of the WHO Multicountry Survey on Maternal and Newborn Health (WHOMCS), a cross-sectional study implemented in 29 countries. Data from 8568 twin deliveries were compared with 308,127 singleton deliveries. The occurrence of adverse perinatal outcomes and maternal complications were assessed. Factors independently associated with adverse perinatal outcomes were reported with adjusted PR (Prevalence Ratio) and 95%CI. RESULTS: The occurrence of severe maternal morbidity and maternal death was significantly higher among twin compared to singleton pregnancies in all regions. Twin deliveries were associated with higher rates of preterm delivery (37.1%), Apgar scores less than 7 at 5th minute (7.8 and 10.1% respectively for first and second twins), low birth weight (53.2% for the first and 61.1% for the second twin), stillbirth (3.6% for the first and 5.7% for the second twin), early neonatal death (3.5% for the first and 5.2% for the second twin), admission to NICU (23.6% for the first and 29.3% for the second twin) and any adverse perinatal outcomes (67% for the first twin and 72.3% for the second). Outcomes were consistently worse for the second twin across all outcomes. Poisson multiple regression analysis identified several factors independently associated with an adverse perinatal outcome, including both maternal complications and twin pregnancy. CONCLUSION: Twin pregnancy is significantly associated with severe maternal morbidity and with worse perinatal outcomes, especially for the second twin.
Assuntos
Saúde do Lactente/estatística & dados numéricos , Saúde Materna/estatística & dados numéricos , Complicações na Gravidez/epidemiologia , Resultado da Gravidez/epidemiologia , Gravidez de Gêmeos , Adulto , Índice de Apgar , Estudos Transversais , Feminino , Inquéritos Epidemiológicos , Hospitalização/estatística & dados numéricos , Humanos , Recém-Nascido de Baixo Peso , Recém-Nascido , Unidades de Terapia Intensiva Neonatal/estatística & dados numéricos , Mortalidade Materna , Distribuição de Poisson , Gravidez , Complicações na Gravidez/etiologia , Nascimento Prematuro/epidemiologia , Prevalência , Análise de Regressão , Natimorto/epidemiologia , Gêmeos/estatística & dados numéricos , Adulto JovemRESUMO
OBJECTIVE: Conditional cash transfer programs are popular internationally and represent a large investment in child health. Evidence of their impact on child nutrition status remains weak and inconsistent, particularly for Bolsa Família, the Brazilian conditional cash transfer program and one of the world's largest. Our objective was to estimate the effect of the Brazilian conditional cash transfer program, Bolsa Família (BF), on child nutritional status as measured by length-for-age z-score (LAZ) and weight-for-age z-score (WAZ) at 24 months. METHODS: We analyzed the 1703 children eligible for BF from the 2004 Pelotas Birth Cohort. Children were divided into three exposure groups by total amount of money their household received from BF in 24 months: no BF, low BF (≤R$1000) and high BF (>R$1000). Using a doubly robust semiparametric estimation method we estimated the effect of receiving low and high levels of BF on LAZ and WAZ at 24 months. RESULTS: After adjustment for measured confounders, the expected difference in LAZ between children that received low or high levels of BF compared to no BF was -0.14 [95% confidence interval (CI): -0.27, -0.02] and -0.20 (95% CI: -0.33, -0.08) respectively. For WAZ the estimated differences were -0.04 (95% CI: -0.17, 0.08) for low levels versus no BF and -0.18 (95% CI: -0.30, -0.05) for high levels versus no BF. The expected difference in population LAZ had all eligible households received it and population LAZ under no BF was -0.15 (95% CI: -0.26, -0.04). Sensitivity analyses suggested only a strong confounder could explain away these results. CONCLUSIONS: Among participants of the 2004 Pelotas Birth Cohort, BF was associated with a reduction in LAZ and WAZ in 24 month old children.
Assuntos
Financiamento Governamental/métodos , Saúde do Lactente/normas , Pesos e Medidas/instrumentação , Adulto , Peso Corporal/fisiologia , Brasil , Criança , Fenômenos Fisiológicos da Nutrição Infantil , Pré-Escolar , Estudos de Coortes , Feminino , Financiamento Governamental/normas , Financiamento Governamental/estatística & dados numéricos , Humanos , Lactente , Saúde do Lactente/estatística & dados numéricos , Masculino , Inquéritos e QuestionáriosRESUMO
OBJECTIVES: To establish and quantify the effect of the internal armed conflict in Colombia on infant health, particularly birth weight. METHODS: This document explores time differences in relation to the impact of the internal armed conflict in Colombia, measured by municipal homicide rates, on infant health, quantified as infant mortality and birth weight. Based on individual data from the 1995 and 2000 Colombian National Demographic and Health Surveys, along with annual municipal data on violence and economic performance, results obtained from two biological siblings are compared using a maternal fixed logistic regression, as one was born in a violent era and the other during a peaceful moment. RESULTS: Political violence negatively affected infant health outcomes during the peak of violence experienced by Colombia in the 1990s, with worse outcomes for male infants than for females. Controlling fixed maternal effects shows a three times greater probability of being born with low birth in infants born during increased violence, compared to their siblings born in more peaceful times. CONCLUSIONS: These results make visible all the effects of intense and long-lasting armed conflicts, as is the case of Colombia, since not only direct actors involved in conflict are affected, but also infants who show worse health outcomes. These results allows targeting policies for reducing the effects on populations in conflict or during the reconstruction period; in this case, the provision of maternal care during the gestational period and special care for newborns in areas under high violence levels should be a priority.
Assuntos
Peso ao Nascer , Saúde do Lactente/estatística & dados numéricos , Mortalidade Infantil , Recém-Nascido de Baixo Peso , Exposição à Guerra/efeitos adversos , Colômbia/epidemiologia , Estudos Transversais , Feminino , Inquéritos Epidemiológicos , Humanos , Lactente , Recém-Nascido , Modelos Logísticos , Masculino , Irmãos , Violência/estatística & dados numéricos , Exposição à Guerra/estatística & dados numéricosRESUMO
Las condiciones de salud de una población son el resultado del efecto conjunto de factores genéticos, estilos de vida y aspectos del contexto donde desarrolla su vida. Es decir, la situación de la salud y sus desigualdades están determinadas tanto individual como histórica y socialmente. Si bien los factores genéticos pueden tener un peso relevante en la salud individual, a nivel de la población son los condicionantes socioeconómicos, culturales, ambientales y políticos los que tienen el rol fundamental como determinantes de los niveles de salud. Si bien la Ciudad, como unidad territorial, registra históricamente los menores niveles de mortalidad infantil del país, en su interior persisten sectores con índices muy superiores al promedio. El propósito de este informe es mostrar la tendencia histórica seguida en la Ciudad de Buenos Aires a través del análisis de la mortalidad infantil, sus tasas, su estructura y sus causas y analizar la situación reciente según distribución espacial. (AU)
Assuntos
Humanos , Masculino , Feminino , Recém-Nascido , Lactente , Pobreza/tendências , Mortalidade Infantil/tendências , Causa Básica de Morte , Saúde da Criança/tendências , Saúde da Criança/estatística & dados numéricos , Estatísticas Vitais , Mortalidade/tendências , Menores de Idade/estatística & dados numéricos , Morte Perinatal , Saúde do Lactente/estatística & dados numéricosRESUMO
OBJECTIVES: The purpose of this study is to examine the effects of economic cycles in Argentina on infant and maternal health between 1994 and 2006, a period that spans the major economic crisis in 1999-2002. METHODS: We evaluate the effects of province-level unemployment rates on several infant health outcomes, including birth weight, gestational age, fetal growth rate, and hospital discharge status after birth in a sample of 15,000 infants born in 13 provinces. Maternal health and healthcare outcomes include acute and chronic illnesses, infectious diseases, and use of prenatal visits and technology. Regression models control for hospital and year fixed effects and province-specific time trends. RESULTS: Unemployment rise reduces fetal growth rate particularly among high educated parents. Also, maternal poverty-related infectious diseases increase, although reporting of acute illnesses declines (an effect more pronounced among low educated parents). There is also some evidence for reduced access to prenatal care and technology among less educated parents with higher unemployment. CONCLUSIONS: Unemployment rise in Argentina has adversely affected certain infant and maternal health outcomes, but several measures show no evidence of significant change.
Assuntos
Recessão Econômica , Saúde do Lactente/estatística & dados numéricos , Saúde Materna/estatística & dados numéricos , Desemprego/estatística & dados numéricos , Adolescente , Adulto , Argentina , Feminino , Humanos , Lactente , Recém-Nascido , Gravidez , Adulto JovemRESUMO
BACKGROUND: Peru has impressively reduced its neonatal mortality rate (NMR). We aimed, for the period 2000-2013, to: (a) describe national and district NMR variations over time; (b) assess NMR trends by wealth quintile and place of residence; (c) describe evolution of mortality causes; (d) assess completeness of registered mortality; (e) assess coverage and equity of NMR-related interventions; and (f) explore underlying driving factors. METHODS: We compared national NMR time trends from different sources. To describe NMR trends by wealth quintiles, place of residence and districts, we pooled data on births and deaths by calendar year for neonates born to women interviewed in multiple surveys. We disaggregated coverage of NMR-related interventions by wealth quintiles and place of residence. To identify success factors, we ran regression analyses and combined desk reviews with qualitative interviews and group discussions. RESULTS: NMR fell by 51 % from 2000 to 2013, second only to Brazil in Latin America. Reduction was higher in rural and poorest segments (52 and 58 %). District NMR change varied by source. Regarding cause-specific NMRs, prematurity decreased from 7.0 to 3.2 per 1,000 live births, intra-partum related events from 2.9 to 1.2, congenital abnormalities from 2.4 to 1.8, sepsis from 1.9 to 0.8, pneumonia from 0.9 to 0.4, and other conditions from 1.2 to 0.7. Under-registration of neonatal deaths decreased recently, more in districts with higher development index and lower rural population. Coverage of family planning, antenatal care and skilled birth attendance increased more in rural areas and in the poorest quintile. Regressions did not show consistent associations between mortality and predictors. During the study period social determinants improved substantially, and dramatic out-of-health-sector and health-sector changes occurred. Rural areas and the poorest quintile experienced greater NMR reduction. This progress was driven, within a context of economic growth and poverty reduction, by a combination of strong societal advocacy and political will, which translated into pro-poor implementation of evidence-based interventions with a rights-based approach. CONCLUSIONS: Although progress in Peru for reducing NMR has been remarkable, future challenges include closing remaining gaps for urban and rural populations and improving newborn health with qualified staff and intermediate- and intensive-level health facilities.
Assuntos
Saúde do Lactente/estatística & dados numéricos , Características de Residência/estatística & dados numéricos , Adulto , Serviços de Planejamento Familiar/estatística & dados numéricos , Feminino , Habitação , Humanos , Lactente , Mortalidade Infantil/tendências , Recém-Nascido , Recém-Nascido Prematuro , Peru/epidemiologia , Gravidez , Cuidado Pré-Natal/estatística & dados numéricos , População RuralRESUMO
Avaliar o impacto da iniciativa Hospital Amigo da Criança (IHAC) nas taxas de aleitamento materno nos primeiros seis meses de vida da criança.Este é um estudo observacional prospectivo, que acompanhou duas coortes de crianças nascidas em hospital de Porto Alegre (Brasil), uma antes (n=187)e outra após (n=250) a implantação da IHAC. Todas as crianças saudáveis, com peso de nascimento igual ou maior do que 2500g e com amamentação iniciada. O acompanhamento foi realizado mediante visitas domiciliares ou contato telefônico no final do primeiro, segundo, quarto e sexto mês de vida da criança, ou até interrupção do aleitamento materno se ocorrida antes dos seis meses...
Assuntos
Recém-Nascido , Lactente , Aleitamento Materno , Lactente , Nutrição do Lactente , Saúde do Lactente/estatística & dados numéricos , Política de Saúde , Promoção da SaúdeRESUMO
This paper studies the relationship between single motherhood and children's height-for-age z-scores in Brazil. In order to isolate the causal effect between family structure and children's condition, we estimate an econometric model that uses male preference for firstborn sons and local sex ratios to instrument the probability of a woman becoming a single mother. Our results have a local average treatment effect interpretation (LATE). We find that children being raised by a single mother (whose marital status is affected by a firstborn girl and a low sex ratio) have a height-for-age z-score that is lower than that of children of similar characteristics that cohabit with both progenitors. We claim that the increasing trend of single motherhood in Brazil should be of concern in health policy design.
Assuntos
Estatura , Saúde da Criança/estatística & dados numéricos , Saúde do Lactente/estatística & dados numéricos , Modelos Econométricos , Mães/estatística & dados numéricos , Família Monoparental/estatística & dados numéricos , Adulto , Peso Corporal , Brasil/epidemiologia , Transtornos da Nutrição Infantil/epidemiologia , Pré-Escolar , Feminino , Nível de Saúde , Humanos , Lactente , Masculino , Obesidade , Fatores Sexuais , Razão de Masculinidade , Fatores SocioeconômicosRESUMO
BACKGROUND: Child health is significantly poorer in homes with intimate partner violence (IPV). However, a possible link to parental provision of childcare has been neglected. METHODS: Utilizing data from Demographic and Health Surveys, this study examined the association between IPV and illness signs in children 0-59 months in Bolivia (n = 3586), Colombia (n = 9955) and Peru (n = 6260), taking into account socio-demographic factors, childcare and severe child physical punishment. Data were collected in the years 2008, 2010 and 2012 for Bolivia, Colombia and Peru respectively. RESULTS: The study found weak but persistent effects of IPV on illness signs in Bolivia (OR 1.37, 95% CI 1.14-1.63) and Peru (OR 1.49, 95% CI 1.26-1.77), after adjusting for the effects of childcare. These effects were not observed in Colombia. CONCLUSIONS: The results call for a mix of qualitative and quantitative research that can map direct, mediating and moderating patterns of relationships between IPV, childcare practices and child health. Can good childcare mitigate the negative effects of IPV? Can poor childcare exacerbate the negative effects of IPV? Such interactions were not observed in the present study, but should be the focus of much more intensive investigation, to help inform child health promotion. Answers could lead to better interventions to improve child health, and perhaps to tackle IPV.
Assuntos
Cuidado da Criança/estatística & dados numéricos , Saúde do Lactente/estatística & dados numéricos , Violência por Parceiro Íntimo/estatística & dados numéricos , Bolívia/epidemiologia , Criança , Pré-Escolar , Colômbia/epidemiologia , Estudos Transversais , Feminino , Inquéritos Epidemiológicos , Humanos , Lactente , Recém-Nascido , Masculino , Peru/epidemiologia , Fatores SocioeconômicosRESUMO
Research on the relationship between migration and infant health in Mexico finds that migration has mixed impacts on the risk of low birthweight (LBW). Whereas the departure and absence of household and community members are harmful, remittances are beneficial. We extend this work by considering a different measure of infant health in addition to LBW: macrosomia (i.e., heavy birthweight), which is associated with infant, child, and maternal morbidities but has a different social risk profile from LBW. We link the 2008 and 2009 Mexican birth certificates with community data from the 2000 Mexican census to analyze the association between various dimensions of community-level migration (i.e., rates of out-migration, receipt of remittances, and return migration) and the risk of LBW and macrosomia. We examine this association using two sets of models which differ in the extent to which they account for endogeneity. We find that the health impacts of migration differ depending not only on the dimension of migration, but also on the measure of health, and that they are robust to potential sources of endogeneity. Whereas community remittances and return migration are associated with lower risk of LBW, they are associated with increased risk of macrosomia. By contrast, out-migration is associated with increased risk of LBW and lower risk of macrosomia. Our analysis of endogeneity suggests that bias resulting from unmeasured differences between communities with different levels of migration may result in an underestimate of the impacts of community migration on birthweight.