Abortion Mortality Research Articles

Bacterial Causes of Ovine Abortion and Neonatal Mortality in Iran

Bacterial Causes of Ovine Abortion and Neonatal Mortality in Iran

Effects of drinking arsenic contaminated water on spontaneous abortion and neonatal mortality

Effects of drinking arsenic contaminated water on spontaneous abortion and neonatal mortality

Social inequality in fetal and perinatal mortality in the Nordic countries

The aim of this study is to review the epidemiological literature from the past 27 years on social inequality in fetal and perinatal mortality in the Nordic countries in order to examine whether social inequalities in fetal and perinatal mortality exist, and whether there are differences between the countries. The databases MEDLINE and EMBASE were searched for Nordic epidemiological studies published between January 1980 and August 2007 about the association between social indicators and the outcomes spontaneous abortion, stillbirth or perinatal mortality. Thirty-five studies that fulfilled the inclusion criteria were identified for this review. Social differences in stillbirth and perinatal mortality were found in all of the identified Finnish and Norwegian studies and in the majority of studies from Denmark, whereas in the Swedish studies the findings were less consistent. As only a small number of studies on spontaneous abortion were identified (n=3), no conclusions were drawn with regard to this outcome. There seems to be a reasonable body of evidence that social inequality in stillbirth and perinatal mortality exists in Norway, Finland and Denmark, whereas the conclusions regarding Sweden are more uncertain. A number of methodological problems complicate the comparison of the findings. Nordic collaborative analyses of social gradients in spontaneous abortion, stillbirth and perinatal mortality, which take these methodological concerns into account, are needed in order to draw inferences across countries.

Performance of camels (Camelus dromedrius) kept by pastoralists with different degrees of experience in camel keeping in Borana, Southern Ethiopia

ABSTRACTThe aim of the present study was to investigate the performances of camels kept by pastoralists with different degrees of experience in camel production. The study was conducted on 60 selected camel herds twice a year; during wet and dry seasons of 2003 and 2004 in Borana, Southern Ethiopia. The average ages at first parturition and calving intervals of breeding females were 68.1 ± 0.5 and 25.5 ± 0.4 months (LSMean ± SE), respectively. Age at first parturition was significantly reduced by use of veterinary services, while variation was not observed among Borana, Guji, Gabra and Somali herds. Calving intervals were significantly shorter (P < 0.05) in Borana (24.8 ± 0.6) and Guji (24.5 ± 1.5) than Somali herds (27.0 ± 0.5). Calving intervals were also prolonged (P < 0.05) by fixing breeding time. Annual calving, abortion and calf mortality rates were similar for the four populations and averaged 37.3%, 9.3%, 20.3% in 2003, and 41.3%, 8.2%, 14.9% in 2004, respectively. The overall mortality rate was significantly higher (P < 0.05) in Borana (10.0 ± 2.1) than in Gabra herds (4.2 ± 0.8). However, mortality was not statistically different for use of veterinary services and other managemental practices. The study showed an increase in annual herd growth by 5.7% in 2003 and 11.6% in 2004 with similarity of herd dynamics between the two years. Daily milk yield differed significantly (P < 0.05) depending on veterinary services, watering frequency and the season (7.6 L during wet and 4.3 L during dry season). Similarly, milk yield was significantly higher (P < 0.01) in Somali herds than in Borana and Gabra herds. In conclusion, the study revealed that some production and reproduction performances in camel herds have showed significant variation with varying levels of herding experience and veterinary services. This may suggest performance in pastoral camels can be enhanced with learning more about and using traditional management practices as well as improving animal health service delivery.

Legalized pregnancy termination and septic abortion mortality in South Africa

In 1996 the South African government passed new laws allowing termination of pregnancy (TOP) on demand prior to 13 weeks of gestation. In addition TOP is permitted for socioeconomic or medical reasons for pregnancies between 13 and 20 weeks of gestation. The legislation aimed to reduce morbidity and death resulting from septic abortion related to unsafe TOP. The law states that terminations should be performed by midwives or doctors in designated licensed institutions. National implementation was delayed with only 32% (92/292) of designated facilities functional in 2000. However this improved to 62% (189/ 306) by 2003. Confidential maternal death notification became compulsory in South Africa in 1997. The first national report reflected deaths occurring in 1998. Triennial reports followed for the years 1999-2001 and 2002-2004. With the recent release of the 2002-2004 report it became possible to measure trends in deaths caused by septic abortion. The objective of the present study was to determine septic abortion mortality trends following introduction of TOP legislation. The numbers of deaths from puerperal sepsis were also tabulated. (authors)

Preconception Counseling and Type 2 Diabetes

Editor's note: This is the first article in our newly revamped “Evidence-Based Clinical Decision Making” department. For more information about our new format and its rationale, please see the editorial on p. 69 of this issue. Diabetes has been associated with pregnancy-related complications.1,2 Rates of spontaneous abortion and perinatal mortality and the incidence of congenital anomalies in offspring of women with diabetes remain significantly higher than that of the background population. It is well accepted that achieving a level of glycemic control comparable to the nondiabetic population can decrease the incidence of adverse pregnancy outcomes. The American Diabetes Association (ADA)1 and the American College of Obstetricians and Gynecologists2 both recommend preconception counseling (PC) for all women with diabetes who have child-bearing potential. The ADA1 recommends that PC include the risks of congenital malformations associated with poor metabolic control and the use of effective contraception unless the woman is in good metabolic control. The goal for glycemic management is to obtain the lowest possible hemoglobin A1c (A1C) level without undue risk of hypoglycemia, preferably an A1C that is < 1% above the normal range. It is also recommended that providers identify and treat complications of diabetes, such as nephropathy, retinopathy, hypertension, coronary artery disease, and neuropathy, before conception.3 The majority of women with diabetes, however, do not obtain PC and continue to have unplanned pregnancies. The majority of studies (Table 1)4,5,7–19 report that up to 62% of women with type 1 diabetes received PC, whereas < 36% of women with type 2 diabetes received PC. In studies by Gunton et al.,4,5the rate of women with type 1 diabetes having received PC improved significantly over time (from 18.9 to 62.5%), but a …

Abortion and Maternal Mortality in the Developing World

Unsafe abortion is an important public health problem, accountingfor 13% of maternal mortality in developing countries. Of anestimated annual 70 000 deaths from unsafe abortion worldwide,over 99% occur in the developing countries of sub-Saharan Africa,Central and Southeast Asia, and Latin America and the Caribbean.Factors associated with increased maternal mortality from unsafeabortion in developing countries include inadequate deliverysystems for contraception needed to prevent unwantedpregnancies, restrictive abortion laws, pervading negative culturaland religious attitudes towards induced abortion, and poor healthinfrastructures for the management of abortion complications. Theapplication of a public health approach based on primary,secondary, and tertiary prevention can reduce morbidity andmortality associated with unsafe abortion in developing countries.Primary prevention includes the promotion of increased use ofcontraception by women (and by men) at risk for unwantedpregnancy; secondary prevention involves the liberalization ofabortion laws and the development of programs to increase accessto safe abortion care in developing countries. In contrast, tertiaryprevention includes the integration and institutionalization ofpost-abortion care for incomplete abortion and the early andappropriate treatment of more severe complications of abortion.Efforts to address these problems will contribute both to reducingmaternal mortality associated with induced abortion and toachieving the Millennium Development Goals in developingcountries.

Clinical, Hematological, and Biochemical Findings in an Outbreak of Abortion and Neonatal Mortality Associated with Trypanosoma evansi Infection in Dromedary Camels

This article presents the clinical and laboratorial findings in an outbreak of abortions and high neonatal mortality attributable to Trypanosoma evansi infection in camels. A total of 16 females were diagnosed, 2 of which showed moderate signs of chronic form, particularly hyporexia and intolerance to exercise. The main laboratorial findings were regenerative anemia (hemolytic anemia), lymphocytic and monocytic leukocytosis, hyperproteinemia, hyperglobulinemia, hypoglycemia, serum urea increased, and serum iron decreased. The most characteristic finding in the examined females would be the uremia, probably due to the higher protein metabolism.

Allele Frequency and Likely Impact of the Glycogen Branching Enzyme Deficiency Gene in Quarter Horse and Paint Horse Populations

Glycogen Branching Enzyme Deficiency (GBED), a fatal condition recently identified in fetuses and neonatal foals of the Quarter Horse and Paint Horse lineages, is caused by a nonsense mutation in codon 34 of the GBE1 gene, which prevents the synthesis of a functional GBE protein and severely disrupts glycogen metabolism. The aims of this project were to determine the mutant GBE1 allele frequency in random samples from the major relevant horse breeds, as well as the frequency with which GBED is associated with abortion and early neonatal death using the tissue archives from veterinary diagnostic laboratories. The mutant GBE1 allele frequency in registered Quarter Horse, Paint Horse, and Thoroughbred populations was 0.041, 0.036, and 0.000, respectively. Approximately 2.5% of fetal and early neonatal deaths in Quarter Horse‐related breeds submitted to 2 different US diagnostic laboratories were homozygous for the mutant GBE1 allele, with the majority of these being abortions. Retrospective histopathology of the homozygotes detected periodic acid Schiff's (PAS)‐positive inclusions in the cardiac or skeletal muscle, which is characteristic of GBED, in 8 out of the 9 cases. Pedigree and genotype analyses supported the hypothesis that GBED is inherited as a simple recessive trait from a single founder. The frequency with which GBED is associated with abortion and neonatal mortality in Quarter Horse‐related breeds makes the DNA‐based test valuable in determining specific diagnoses and designing matings that avoid conception of a GBED foal.

Peroxisome Proliferator-Activated Receptor α Deficiency Increases the Risk of Maternal Abortion and Neonatal Mortality in Murine Pregnancy with or without Diabetes Mellitus: Modulation of T Cell Differentiation

We assessed the implication of peroxisome proliferator-activated receptor (PPAR) alpha deficiency in pregnancy outcome and neonatal survival and in the modulation of T cell differentiation in murine diabetic pregnancy and their offspring. Pregnant wild-type (WT) and PPAR alpha-null mice of C57BL/6J genetic background were rendered diabetic by five low doses of streptozotocin. We observed that, in the absence of diabetes, PPAR alpha deficiency resulted in an increase in abortion rate, i.e. 0% in WT mice vs. 20% in PPAR alpha-null mice [odds ratio (OR) = 14.33; P = 0.013]. Under diabetic conditions, the abortion rate was enhanced, i.e. 8.3% in WT mice vs. 50% in PPAR alpha-null mice (OR = 4.28; P = 0.011). In the pups born to diabetic dams, the offspring mortality, due to the absence of PPAR alpha, was enhanced, i.e. 27.7% in WT mice vs. 78.9% in PPAR alpha-null animals (OR = 11.48; P < 0.001). Moreover, we observed that T helper (Th) 1/Th2 balance was shifted to a pregnancy protecting Th2 phenotype in WT diabetic dams and to a noxious Th1 phenotype in PPAR alpha-null mice with diabetic pregnancy. Furthermore, offspring born to diabetic WT dams were hyperinsulinemic and hyperglycemic, and they exhibited up-regulated profile of Th2 cytokines, whereas those born to diabetic PPAR alpha-null dams were hypoinsulinemic and hyperglycemic, and they showed down-regulated profile of Th2 cytokines. However, IFN-gamma, a Th1 cytokine, was up-regulated in the offspring of both diabetic WT and PPAR alpha-null dams. Altogether, our results suggest that PPAR alpha deficiency in mice may be implicated in the increase in maternal abortion, neonatal mortality, and T cell differentiation.

Fertility regulation and reproductive health in the Millennium Development Goals: the search for a perfect indicator.

Although several key elements of sexual and reproductive health are included in the United Nations Millennium Development Goals, a measure of women's capacity to regulate their fertility safely and effectively is missing. We considered the usefulness of 3 pairs of indicators in monitoring this component of reproductive health: contraceptive prevalence and total fertility; unmet need for contraception and unplanned births; and unsafe abortion and abortion mortality. A single measure of contraceptive use is insufficient. The risks women face from unplanned births and unsafe abortion should also be incorporated into the monitoring process, either directly within the Millennium Development Goals framework or as a parallel effort by reporting governments and other agencies.

Maternal deaths in Sagamu in the new millennium: a facility-based retrospective analysis.

BackgroundHealth institutions need to contribute their quota towards the achievement of the Millennium Development Goal (MDG) with respect to maternal health. In order to do so, current data on maternal mortality is essential for careproviders and policy makers to appreciate the burden of the problem and understand how best to distribute resources. This study presents the magnitude and distribution of causes of maternal deaths at the beginning of the 21st century in a Nigerian referral hospital and derives recommendations to reduce its frequency.MethodsA retrospective descriptive analysis of all cases of maternal deaths at Olabisi Onabanjo University Teaching Hospital, Sagamu, Southwest Nigeria between 1 January 2000 to 30 June 2005.ResultsThere were 75 maternal deaths, 2509 live births and 2728 deliveries during the study period. Sixty-three (84.0%) of the deaths were direct maternal deaths while 12 (16.0%) were indirect maternal deaths. Major causes of deaths were hypertensive disorders in pregnancy (28.0%), haemorrhage (21.3%) and sepsis (20.0%). Overall, eclampsia was the leading cause of deaths singly accounting for 24.0% of all maternal deaths. Abortion and HIV-related mortality accounted for 1.3% and 4.0% of maternal deaths, respectively. The maternal mortality ratio of 2989.2 per 100,000 live births was significantly higher than that reported for 1988–1997 in the same institution. Up to 67/794 (8.4%) patients referred from other facilities died compared to 8/1934 (0.4%) booked patients (OR: 22.1; 95% CI: 10.2–50.1). Maternal death was more likely to follow operative deliveries than non-operative deliveries (27/545 vs 22/2161; OR: 5.07; 95% CI: 2.77–9.31).ConclusionAt the middle of the first decade of the new millennium, a large number of pregnant women receiving care in this centre continue to die from preventable causes of maternal death. Adoption of evidence-based protocol for the management of eclampsia and improvement in the quality of obstetric care for unbooked emergencies would go a long way to significantly reduce the frequency of maternal deaths in this institution.

Pregnancy Outcomes, Infant Mortality, and Arsenic in Drinking Water in West Bengal, India

Between 2001 and 2003, the authors studied pregnancy outcomes and infant mortality among 202 married women in West Bengal, India. Reproductive histories were ascertained using structured interviews. Arsenic exposure during each pregnancy, including all water sources used, was assessed; this involved measurements from 409 wells. Odds ratios for spontaneous abortion, stillbirth, neonatal mortality, and infant mortality were estimated with logistic regression based on the method of generalized estimating equations. Exposure to high concentrations of arsenic (> or =200 microg/liter) during pregnancy was associated with a sixfold increased risk of stillbirth after adjustment for potential confounders (odds ratio (OR) = 6.07, 95% confidence interval (CI): 1.54, 24.0; p = 0.01). Arsenic-related skin lesions were found in 12 women who had a substantially increased risk of stillbirth (OR = 13.1, 95% CI: 3.17, 54.0; p = 0.002). The odds ratio for neonatal death was 2.81 (95% CI: 0.73, 10.8). No association was found between arsenic exposure and spontaneous abortion (OR = 1.01, 95% CI: 0.38, 2.70) or overall infant mortality (OR = 1.33, 95% CI: 0.43, 4.04). This study adds to the limited evidence that exposure to high concentrations of arsenic during pregnancy increases the risk of stillbirth. However, there was no indication of the increased rates of spontaneous abortion and overall infant mortality that have been reported in some studies.

Allele Frequency and Likely Impact of the Glycogen Branching Enzyme Deficiency Gene in Quarter Horse and Paint Horse Populations

Glycogen Branching Enzyme Deficiency (GBED), a fatal condition recently identified in fetuses and neonatal foals of the Quarter Horse and Paint Horse lineages, is caused by a nonsense mutation in codon 34 of the GBE1 gene, which prevents the synthesis of a functional GBE protein and severely disrupts glycogen metabolism. The aims of this project were to determine the mutant GBE1 allele frequency in random samples from the major relevant horse breeds, as well as the frequency with which GBED is associated with abortion and early neonatal death using the tissue archives from veterinary diagnostic laboratories. The mutant GBE1 allele frequency in registered Quarter Horse, Paint Horse, and Thoroughbred populations was 0.041, 0.036, and 0.000, respectively. Approximately 2.5% of fetal and early neonatal deaths in Quarter Horse-related breeds submitted to 2 different US diagnostic laboratories were homozygous for the mutant GBE1 allele, with the majority of these being abortions. Retrospective histopathology of the homozygotes detected periodic acid Schiff's (PAS)-positive inclusions in the cardiac or skeletal muscle, which is characteristic of GBED, in 8 out of the 9 cases. Pedigree and genotype analyses supported the hypothesis that GBED is inherited as a simple recessive trait from a single founder. The frequency with which GBED is associated with abortion and neonatal mortality in Quarter Horse-related breeds makes the DNA-based test valuable in determining specific diagnoses and designing matings that avoid conception of a GBED foal.

RELATIONSHIP BETWEEN AIR QUALITY AND SELECTED CARDIAC DEFECTS AND ORAL CLEFTS, SEVEN COUNTY STUDY, TEXAS, 1997-2000

ISEE-326 Introduction: A number of epidemiologic investigations have shown adverse effects of ambient air pollution on reproductive outcomes including spontaneous abortion, fetal growth, preterm delivery, and infant mortality. A southern California study found associations between carbon monoxide exposure and an increased risk for isolated ventricular septal defects, and ozone exposure and an elevated risk for isolated aortic artery and valve defects, pulmonary artery and valve defects, and conotruncal defects. Aim: Our population-based case-control study attempted to corroborate the results from the California study and expand the scope to include additional air pollutants and birth defects. We investigated the association between maternal exposures to carbon monoxide, nitrogen dioxide, ozone, sulphur dioxide, and PM10, during weeks three through eight of pregnancy, and the risk of selected cardiac birth defects and oral clefts among live births and foetal deaths between 1997 and 2000, in seven Texas counties. Methods: Cases were selected from the Texas Birth Defects Registry (n=4570). Non-malformed controls were sampled from vital records and frequency matched to cases on year of birth, vital status, and maternal county of residence at delivery (n=3667). Maternal address at delivery as reported in the vital record or Texas Birth Defects Registry was geocoded. Data from United States Environmental Protection Agency stationary monitors were used to estimate air pollution exposures. The risks for eight clinical diagnostic groupings and nine individual birth defects were analyzed. Unconditional binary and polytomous logistic regression models were used to adjust for covariates available in the vital record. Results: Comparing the highest quartile of exposure to the lowest, there were positive associations between carbon monoxide and tetralogy of Fallot (adjusted odds ratio (OR) = 2.04; 95% confidence interval (CI) 1.26, 3.29), PM10 and isolated atrial septal defects (OR = 2.27; 95% CI: 1.43, 3.60), and sulphur dioxide and isolated ventricular septal defects (OR = 2.16; 95% CI: 1.51, 3.09). Inverse associations were found between nitrogen dioxide and ventricular septal defects, and between sulphur dioxide and isolated atrial septal defects. The study provides limited evidence that air pollution exposure influences the risk of oral clefts. Conclusion: This study contributes to a growing body of epidemiologic literature on the adverse reproductive effects of ambient air pollution exposure, but does not provide strong evidence that air pollution influences the risk of birth defects. These results support one previously reported finding of an association between ozone exposure and pulmonary artery and valve defects. This is an abstract of a proposed presentation and does not necessarily reflect EPA policy.

RELATIONSHIP BETWEEN AIR QUALITY AND SELECTED CARDIAC DEFECTS AND ORAL CLEFTS, SEVEN COUNTY STUDY, TEXAS, 1997-2000

ISEE-102 Introduction: A number of epidemiologic investigations have shown adverse effects of ambient air pollution on reproductive outcomes including spontaneous abortion, fetal growth, preterm delivery, and infant mortality. A southern California study found associations between carbon monoxide exposure and an increased risk for isolated ventricular septal defects, and ozone exposure and an elevated risk for isolated aortic artery and valve defects, pulmonary artery and valve defects, and conotruncal defects. Our population-based case-control study attempted to corroborate the results from the California study and expand the scope to include additional air pollutants and birth defects. Aim: We investigated the association between maternal exposures to carbon monoxide, nitrogen dioxide, ozone, sulphur dioxide, and PM10 during weeks three through eight of pregnancy and the risk of selected cardiac birth defects and oral clefts among live births, and foetal deaths between 1997 and 2000, in seven Texas counties. Methods: Cases were selected from the Texas Birth Defects Registry (n=4570). Non-malformed controls were sampled from vital records and frequency matched to cases on year of birth, vital status, and maternal county of residence at delivery (n=3667). Maternal address at delivery as reported in the vital record or Texas Birth Defects Registry was geocoded. Data from United States Environmental Protection Agency stationary monitors were used to estimate air pollution exposures. The risks for eight clinical diagnostic groupings and nine individual birth defects were analyzed. Unconditional binary and polytomous logistic regression models were used to adjust for covariates available in the vital record. Results: Comparing the highest quartile of exposure to the lowest, there were positive associations between carbon monoxide and tetralogy of Fallot (adjusted odds ratio (OR) = 2.04; 95% confidence interval (CI) 1.26, 3.29), PM10 and isolated atrial septal defects (OR = 2.27; 95% CI: 1.43, 3.60), and sulphur dioxide and isolated ventricular septal defects (OR = 2.16; 95% CI: 1.51, 3.09). Inverse associations were found between nitrogen dioxide and ventricular septal defects and between sulphur dioxide and isolated atrial septal defects. The study provides limited evidence that air pollution exposure influences the risk of oral clefts. Conclusion: This study contributes to a growing body of epidemiologic literature on the adverse reproductive effects of ambient air pollution exposure but does not provide strong evidence that air pollution influences the risk of birth defects. These results support one previously reported finding of an association between ozone exposure and pulmonary artery and valve defects. This is an abstract of a proposed presentation and does not necessarily reflect EPA policy.

Histologic, Infectious, and Molecular Correlates of Idiopathic Spontaneous Abortion and Perinatal Mortality

The purpose of this study was to analyze the placental and neonatal tissues in fatal cases for a wide variety of infectious agents and cytokine expression. Placentas and corresponding neonatal tissues in 21 consecutive cases of idiopathic spontaneous abortion or perinatal death, before or within 2 days of birth, were tested for an infectious agent. The controls included 10 consecutive cases of fetal and placental tissues from therapeutic abortions, 5 placentas from unremarkable childbirths, and 11 placentas from cases of spontaneous abortion or perinatal death of known cause (ruptured uterus, placenta abruption, prolapsed cord). An intrauterine infection was noted in 16 of 21 (76%) of the placentas associated with neonatal mortality; in each case, the same infectious agent was found in the neonatal tissues, primarily the spleen. The most common infectious agent was enterovirus/coxsackie virus (10 cases); the histologic findings in the placenta were nonspecific. There was strong expression of TNF-alpha in the placenta and spleen of each of the cases of intrauterine infection and in none of the 26 controls. It is concluded that in utero infection and the associated cytokine up-regulation are responsible for many cases of unexplained fetal and neonatal loss.

Safety of mifepristone abortions in clinical use

Objectives Extensive data from clinical trials document mifepristone's safety and efficacy for induced abortion, but less information is available about its safety in routine clinical use. Methods Data on mifepristone abortion use from the Planned Parenthood Federation of America, the largest provider of mifepristone abortion in the United States, from 2001 through the first quarter of 2004 were collected using a centralized reporting system. Over the study period, 95,163 mifepristone abortions were provided. Reportable events are complications requiring inpatient or outpatient hospital treatment. Results Overall, 2.2 per 1000 women (95% CI 1.9–2.5) experienced a complication, most commonly, heavy bleeding. Mifepristone abortion mortality is estimated to be 1.1 per 100,000 based on one death (95% CI 0.3–5.9). Conclusions The safety of mifepristone is high; few serious medical complications occur in routine clinical use.

Scale-dependent mechanisms in the population dynamics of an insect herbivore

A multiscale approach has lead to significant advances in the understanding of species population dynamics. The scale-dependent nature of population processes has been particularly clearly illustrated for insect herbivores. However, one of the most well-studied insect herbivores, the galling sawfly Euura lasiolepis, has to date been examined almost exclusively at fine spatial scales. The preference-performance, plant vigour and larval survival hypotheses are well supported by this species. Here, we test these hypotheses at a spatial scale larger than that previously considered, i.e. across a landscape in northern Arizona represented by an altitudinal gradient encompassing a series of drainages. We also develop a qualitative model for understanding the population dynamics of E. lasiolepis based on patterns of survival and mortality found in this study and previous ones. Gall density was highly variable across the altitudinal gradient, not explained by host plant variables, and thus a poor surrogate for population abundance. These findings for the first time fail to support the plant vigour and preference hierarchy hypotheses for E. lasiolepis. Dispersal limitation most likely explains the lack of support for these hypotheses at this scale. By contrast, sawfly survival, gall abortion, parasitism and larval mortality were well explained by host plant quality variables and altitude. The larval survival hypothesis was well supported and is thus comparatively scale-invariant. A qualitative model developed here highlighted the importance of both willow water status and disturbance in determining host plant quality, as well as an apparent trade off between shoot length and plant moisture status in determining vital rates across the altitudinal gradient. This study thus demonstrated for the first time the scale-dependent nature of mechanisms underlying the population dynamics E. lasiolepis, and identified the interaction between parasitism and altitude as a novel mechanism underlying spatial patterns in the survival and mortality patterns of this species.

The magnitude of abortion complications in Kenya

To estimate and describe the magnitude of abortion complications presenting at public hospitals in Kenya. Cross-sectional descriptive study. Hospital-based. Population Records of all women presenting prior to 22 weeks of gestation with abortion-related complications at selected hospitals during a three-week study period. All public tertiary and provincial hospitals were included; stratified random sampling was employed to select a subset of 54 district hospitals nationwide. Data collectors identified 809 patients with abortion complications on all hospital wards and completed a standardised questionnaire for each by extracting information from the patient's hospital record. Incidence, aetiology, morbidity and mortality of abortion complications. Most women (80%) presented with incomplete abortion. Approximately 34% of the women had reached the second trimester of pregnancy. Adolescents (14-19 years old) accounted for approximately 16% of the study sample. Manual vacuum aspiration was used to manage 80% of first trimester cases. The projected annual number of women with abortion complications admitted to public hospitals in Kenya is 20,893. The case fatality rate was estimated to be 0.87% (95% CI 0.71-1.02%), so an estimated 182 (95% CI 148-213) of these women die annually. The annual incidence of incomplete abortion and other abortion-related complications per 1000 women aged 15 to 49 years is projected to be 3.03. The high rate of abortion-related morbidity and mortality documented in the study highlights the critical need to address the issue of unsafe abortion in Kenya.