Improvements In Infant Mortality Research Articles

Virginia Apgar (1909-1974): The Mother of Neonatal Resuscitation.

Dr. Virginia Apgar was an American anesthesiologist and researcher who heavily influenced the development of neonatal resuscitation in the immediate postpartum period with her simple five-point scoring system. Today, the APGAR scoring system is used around the world in delivery rooms to guide clinicians in the evaluation of newborns and to distinguish which might need urgent resuscitation. With a simple scoring system, timer, and clipboard, Dr. Virginia Apgar shifted focus from the parturient to the neonate, improving infant mortality as a result.

Public Health Policy at Scale: Impact of a Government-Sponsored Information Campaign on Infant Mortality in Denmark

Abstract We evaluate the impact of a nationwide public health intervention on deaths from sudden infant death syndrome (SIDS), using population data from Denmark in a regression discontinuity research design. The information campaign—implemented primarily through a universal nurse home visiting program—reduced infant mortality by 17.2% and saved between 11.6 and 13.5 lives over 10,000 births. The estimated effect sizes are 11–14 times larger among low-birthweight and preterm infants relative to the overall population. Improvement in infant mortality is concentrated among those with low socioeconomic status and with limited access to health information, thereby reducing health inequities at birth.

A Proof-of-Concept Model for Implementing a "Smart-NICU" to Improve Infant Mortality.

Low- and middle-income countries face limited critical care capacity due to constraints in staffing, resources, and technology. "Smart ICUs" that integrate telehealth to augment care delivery, communication, and data integration have the potential to bridge these gaps and reduce preventable morbidity and mortality. While their efficacy has been well validated in adult populations, applications of Smart-ICU services in the neonatal population have not been studied. Neonatal intensive care units (NICUs) in India using a common Smart-NICU platform, developed by CloudPhysician, utilize a hub-and-spokes framework along with locally designed technology to facilitate remote patient care in collaboration with local health systems. In this article, we investigate the operational characteristics and performance outcomes for Smart-NICU deployment from the 18 NICUs and 214 beds deployed to date. These findings highlight the potential impact of Smart-NICUs and establish generalizable principles for implementation in low-resource settings.

Socio-demographic variables for child immunisation among Khatik population of Delhi

ABSTRACT Background: In India, the Expanded Programme on Immunization was introduced in 1978 and renamed the Universal Immunization Programme in 1985 with the intention of immunising at least 85% of newborns. To improve infant mortality and health outcomes in India and other low and middle income countries, it is critical to understand the local immunisation barriers. Methodology: A community based cross sectional study was conducted amongst the Khatik population of North East Delhi. All childbearing women were included in the study, and data from 387 mothers was collected. Results: The illiteracy rate amongst women (18.3%) was found to be higher compared to that amongst men (7.1%). A high proportion of the children were immunised (98.7%). The results of the chisquare test revealed that the influence of socio demographic variables was not statistically associated, with the immunisation status of the children (P > 0.05). Conclusion: However, it was also evaluated that both mothers and fathers with high and intermediate school levels of education were more likely to immunise their child compared to those who were illiterate, and with primary and middle levels of education. Increasing mothers’ knowledge could help to reduce the number of children who are not immunised.

Health Expenditures, Health Infrastructure and Health Status in SAARC Countries: A Panel Data Analysis

Scholars in health economics have been studying the relationship between healthcare expenditure and health outcomes for the last half-century. Researchers emphasized the increase of public health expenditure towards providing primary healthcare based on the logic that health expenditure has a direct effect on the health outcomes of the people. However, such studies have a lot of inconsistencies. Given the background, the present study has three research objectives. First, to investigate the effect of healthcare spending on multiple health outcomes in SAARC nations after controlling for country-specific health infrastructures and economic conditions. Second, to undertake a differential analysis of the effect of public and private healthcare spending (both aggregate and out of pocket) on specific health outcomes. Third, to explore the presence (if any) of the differential effect of health expenditure and health infrastructure variables on specific health outcome variables, including mortality and morbidity indicators. Based on a 20-year (1993–2012) panel data from seven SAARC countries, health expenditure was found to influence improved health outcomes in SAARC nations. In addition, the differential effect of public, private and out-of-pocket (OOP) health expenditure was observed on different health outcomes. Thus, OOP expenditures was found to be the major influencer of life expectancy, death rate and TB instances, while public expenditure was found to be influential for improving infant mortality rate (IMR). The present study supports the notion that disaggregated effects of health expenditure (by including the effect of public, private and OOP expenditures) are needed to get a complete understanding of the health expenditure–health outcome linkage. In addition, the findings emphasize on the role of proximal predictors of health outcomes (alongside expenditure variables in the same model) as important inclusion in the health expenditure-health outcome investigation.

Robust relationship between ambient air pollution and infant mortality in India

BackgroundAmbient exposure to fine particulate matter (PM2.5) is one of the top global health concerns. We estimate the associations between in-utero and perinatal exposure to PM2.5 and infant, neonatal and postneonatal mortality in India. We evaluate the sensitivity of this association to two widely-used exposure assessments. MethodWe linked nationally representative anthropometric data from India's 2015–2016 Demographic and Health Survey (n = 259,627 children under five across 640 districts of India) with satellite-based PM2.5 concentrations during the month of birth of each child. We then estimated the associations between PM2.5 from each dataset and child mortality, after controlling for child, mother and household factors including trends in time and seasonality. We examined if factors: urban/rural, sex, wealth quintile and state modified the associations derived from the two datasets using Wald tests. ResultsWe found evidence that PM2.5 impacts infant mortality primarily through neonatal mortality. The estimated association between neonatal mortality and PM2.5 in trimester 3 was OR: 1.016 (95% CI: 1.003, 1.030) for every 10 μg/m3 increase in exposure. This association was robust to the exposure assessment used. Child sex was a significant effect modifier, with PM2.5 impacting mortality in infant girls more than boys. ConclusionsOur results revealed a robust association between ambient exposure to PM2.5 in the latter period of pregnancy and early life with infant and neonatal mortality in India. Urgent air pollution management plans are needed to improve infant mortality in India.

Accelerating Upstream Together: Achieving Infant Health Equity in the United States by 2030.

Accelerating Upstream Together: Achieving Infant Health Equity in the United States by 2030.

Subnational variations in electricity access and infant mortality: Evidence from Ghana

ObjectivesThe study investigated the relationship between electricity access and infant mortality at the subnational level in Ghana, controlling for correlates such as birth interval, children living with both parents, women’s education, and income distribution. MethodsThe study employed a pooled cross-section regression approach using data from the Ghana Demographic and Health Survey (GDHS) for 10 administrative regions from 1993 to 2014. The GDHS is a detailed data set that provides comprehensive information on households and their socio-economic and demographic characteristics in Ghana. ResultsThe results show that in regions with low incidence of infant mortality, a 10% improvement in electricity access reduces infant death by 11.8 per 1,000 live births, whereas in high mortality regions, improvement in electricity access has no impact on infant death. Birth interval reduces the risk of infant death in low mortality regions but not in high mortality regions. Children living with both parents have a high probability of survivorship in high mortality regions. Women’s median years of education lowers the likelihood of infant death in high mortality regions but increases the likelihood in low mortality regions. Wealth distribution is inconsequential for infant death in low mortality regions, but in high mortality regions, both the wealthiest and the poorest experienced significant decline in infant death. ConclusionsThe findings underscore the fruitfulness of investigating the effects of electricity access and other correlates on infant mortality at the subnational level. The study recommends that the provision of reliable access to electricity is needed to improve infant mortality rates. However, policies that seek to improve access to reliable electricity should be implemented together with health infrastructure development policies, especially in the regions with high infant mortality rates, for electricity access to have the desired effect.

Public Health Policy At Scale: Impact of a Government-sponsored Information Campaign on Infant Mortality in Denmark

We evaluate the impact of a nationwide public health intervention on deaths from sudden infant death syndrome (SIDS), using population data from Denmark in a regression discontinuity research design. The information campaign–implemented primarily through a universal nurse home visiting program–reduced infant mortality by 17.6 percent and saved between 11.5-14.5 lives over 10,000 births. The estimated effect sizes are 11-14 times larger among low birthweight and preterm infants relative to the overall population. Improvement in infant mortality is concentrated among those with lower socio-economic status and with limited access to health information, thereby reducing health inequities at birth in Denmark. Institutional subscribers to the NBER working paper series, and residents of developing countries may download this paper without additional charge at www.nber.org.

Decomposition of Improvements in Infant Mortality in Asian Developing Countries Over Three Decades.

Low- and middle-income countries in Asia have seen substantial improvements in infant mortality over the last three decades. This study examines the factors contributing to the improvement in infant survival in their first year in six Asian countries: Bangladesh, India, Indonesia, Nepal, Pakistan, and the Philippines. I decompose the overall improvement in the infant survival rate in the respective countries from the 1990s to the 2010s into the part that can be explained by the improvements in circumstantial environments in which infants develop and the remaining part that is due to the structural change in the hazard functions. This decomposition is achieved by employing the random survival forest, allowing me to predict the counterfactual infant survival probability that infants in the 2010s would have under the circumstantial environments of the 1990s. The results show that large parts of the improvement are explained by the improvement in the environments in all the countries being analyzed. I find that the reduction in family size, increased use of antenatal care, longer pregnancy periods, and improved living standards were associated with the improvement of the infant mortality rate in all six countries.

Public Health Policy at Scale: Impact of a Government-Sponsored Information Campaign on Infant Mortality in Denmark

We evaluate the impact of a nationwide public health intervention on deaths from sudden infant death syndrome (SIDS), using population data from Denmark in a regression discontinuity research design. The information campaign–implemented primarily through a universal nurse home visiting program–reduced infant mortality by 17.6 percent and saved between 11.5-14.5 lives over 10,000 births. The estimated effect sizes are 11-14 times larger among low birthweight and preterm infants relative to the overall population. Improvement in infant mortality is concentrated among those with lower socio-economic status and with limited access to health information, thereby reducing health inequities at birth in Denmark.

Costing and Cost-Effectiveness of a Mobile Health Intervention (ImTeCHO) in Improving Infant Mortality in Tribal Areas of Gujarat, India: Cluster Randomized Controlled Trial.

BackgroundDuring 2013, a mobile health (mHealth) program, Innovative Mobile Technology for Community Health Operation (ImTeCHO), was launched in predominantly tribal and rural communities of Gujarat, India. ImTeCHO was developed as a job aid for Accredited Social Health Activists (ASHAs) and staff of primary health centers to increase coverage of maternal, neonatal, and child health care.ObjectiveIn this study, we assessed the incremental cost per life-years saved as a result of the ImTeCHO intervention as compared to routine maternal, neonatal, and child health care programs.MethodsA two-arm, parallel, stratified cluster randomized trial with 11 clusters (primary health centers) randomly allocated to the intervention (280 ASHAs, n=2,34,134) and control (281 ASHAs, n=2,42,809) arms was initiated in 2015 in a predominantly tribal and rural community of Gujarat. A system of surveillance assessed all live births and infant deaths in the intervention and control areas. All costs, including those required during the start-up and implementation phases, were estimated from a program perspective. Incremental cost-effectiveness ratios were estimated by dividing the incremental cost of the intervention with the number of deaths averted to estimate the cost per infant death averted. This was further analyzed to estimate the cost per life-years saved for the purpose of comparability. Sensitivity analysis was undertaken to account for parameter uncertainties.ResultsOut of a total of 5754 live births (3014 in the intervention arm, 2740 in the control arm) reported in the study area, per protocol analysis showed that the implementation of ImTeCHO resulted in saving 11 infant deaths per 1000 live births in the study area at an annual incremental cost of US $163,841, which is equivalent to US $54,360 per 1000 live births. Overall, ImTeCHO is a cost-effective intervention from a program perspective at an incremental cost of US $74 per life-years saved or US $5057 per death averted. In a realistic environment with district scale-up, the program is expected to become even more cost-effective.ConclusionsOverall, the findings of our study strongly suggest that the mHealth intervention as part of the ImTeCHO program is cost-effective and should be considered for replication elsewhere in India.Trial RegistrationClinical Trials Registry of India CTRI/2015/06/005847; http://www.ctri.nic.in/Clinicaltrials/pdf_generate.php?trialid=11820&EncHid=&modid=&compid=%27,%2711820det%27

Lactation Care: Advocating for Equitable Access at the Ohio Department of Medicaid

BackgroundLactation consultants understand the mechanisms and research supporting breastfeeding's positive impact on infant mortality reduction, including lifelong health outcomes and associated cost savings. Lactation services can enhance the success of programs intended to improve infant mortality rates, health outcomes, and cost effectiveness.ProgramAs leaders serving the Ohio Lactation Consultant Association (OLCA), we pursued engagement with Ohio Department of Medicaid policy chiefs to ensure incorporation of these facts as programs are created to improve health and optimize allocation of Medicaid resources.ResultAfter a productive meeting, we specifically proposed that professional lactation services be standard care and fully integrated across the healthcare continuum regardless of setting and ability to pay.

The heterogeneous causal effects of neonatal care: a model of endogenous demand for multiple treatment options based on geographical access to care.

Neonatal units in the UK are organised into three levels, from highest Neonatal Intensive Care Unit (NICU), to Local Neonatal Unit (LNU) to lowest Special Care Unit (SCU). We model the endogenous treatment selection of neonatal care unit of birth to estimate the average and marginal treatment effects of different neonatal designations on infant mortality, length of stay and hospital costs. We use prognostic factors, survival and hospital care use data on all preterm births in England for 2014-2015, supplemented by national reimbursement tariffs and instrumental variables of travel time from a geographic information system. The data were consistent with a model of demand for preterm birth care driven by physical access. In-hospital mortality of infants born before 32weeks was 8.5% overall, and 1.2 (95% CI: -0.7, 3.2) percentage points lower for live births in hospitals with NICU or SCU compared to those with an LNU according to instrumental variable estimates. We find imprecise differences in average total hospital costs by unit designation, with positive unobserved selection of those with higher unexplained absolute and incremental costs into NICU. Our results suggest a limited scope for improvement in infant mortality by increasing in-utero transfers based on unit designation alone.

Can Adoption of Cuban Maternity Care Policy Guide the Rural United States to Improve Maternal and Infant Mortality?

In the rural United States the infant mortality rate (IMR) is 6.5 per 1,000, and in rural states like Alabama this rate jumps to 9.1. Rural obstetric services are disappearing such that over half of U.S. rural counties do not have enough obstetric services. In contrast, Cuba's IMR is 4.3 while spending half as much as a percent of their gross domestic product than the United States. This raises the question: how has Cuba achieved this health outcome and what lessons can be learned and applied in the United States given decreased availability of obstetric services? This paper presents a field case study of one of Cuba's national public health policies. Specifically, we explore Cuba's Hogares Maternos, or maternity homes. We argue that the Cuban model, which focuses on social determinants of health, ought to be explored. We discuss how Hogares Maternos may be adopted and adapted within the rural United States by leveraging existing infrastructure.

Costing and Cost-Effectiveness of mHealth Intervention ImTeCHO in Improving Infant Mortality in Tribal Areas of Gujarat, India

Background: During 2013, an mHealth programme, Innovative Mobile Technology for Community Health Operation or ImTeCHO, was launched in predominantly tribal and rural communities of Gujarat, India. ImTeCHO was developed as job-aid for ASHAs and staff of primary health centres, to increase coverage of maternal, neonatal and child health (MNCH) care. In this paper, we assess the incremental cost per life years saved as a result of ImTeCHO intervention as compared to routine maternal and child health programmes. Methods: A two-arm, parallel, stratified cluster randomized trial with 11 clusters (PHC) randomly allocated to intervention (280 ASHAs, population: 2,34,134) and control (281 ASHAs, population: 2,42,809) arms was started in 2015 in a predominantly tribal and rural community of Gujarat. A system of surveillance in the intervention and control area assessed all live births and infant deaths in the intervention and control area. All costs, including those during start-up and implementation phase, were estimated from a programme perspective. Incremental cost-effectiveness ratios were estimated by dividing the incremental cost of the intervention with the number of deaths averted to estimate the cost per infant death averted. This was further analysed to estimate the cost per life years saved for the purpose of comparability. Sensitivity analysis was undertaken to account for parameter uncertainties. Results: Out of a total of 5,754 live births (3,014 in intervention arm, 2,740 in control arm) reported in the study area, per protocol, the implementation of ImTeCHO resulted in saving 11 infant deaths per 1,000 live births in the study area at an annual incremental cost of US$163,841. This is equivalent to US$54,360 per 1,000 live births. Overall, ImTeCHO is a cost-effective intervention from a programme perspective at an incremental cost of US$74 per life years saved or US$5,057 per death averted. In a realistic environment with district scale-up, the programme is expected to be more cost-effective. Conclusion: Overall, findings of our study suggest strongly that the mHealth intervention as part of ImTeCHO program is cost-effective and should be considered for replication elsewhere in India. Funding: Indian Council of Medical Research, John D. and Catherine T. MacArthur. Declaration of Interest: None declared. Ethical Approval: The study protocol was approved by SEWA - Rural Institutional Ethics Committee on 29th January 2016.

Child Mortality Trends, 1961–2010

Letters Health AffairsVol. 37, No. 4: Culture Of Health, The ACA & More Child Mortality Trends, 1961–2010Cyprian M. Mostert AffiliationsUniversity of Witwatersrand Johannesburg, South AfricaPUBLISHED:April 2018Free Accesshttps://doi.org/10.1377/hlthaff.2018.0108AboutSectionsView PDFPermissions ShareShare onFacebookTwitterLinked InRedditEmail ToolsAdd to favoritesDownload CitationsTrack CitationsPermissionsDownload Exhibits TOPICSMortalityCosts and spendingMortality ratesI thank Ashish Thakrar and colleagues (Jan 2018) for analyzing child mortality trends in the United States and nineteen other high-income countries in the Organization for Economic Cooperation and Development (OECD) over a fifty-year period. The authors report that “the United States has poorer child health outcomes than other wealthy nations despite greater per capita spending on health care for children.”I submit that national wealth and health spending are not key factors that explain improvement in infant mortality. Take Cuba, for example. Since 1999 until at least 2015 it has had better infant mortality outcomes than the US,1 despite being a developing country and having lower health spending per capita.2 In fact, Cuba’s infant mortality rates have improved more than those for an average of OECD countries.1 Two factors have been identified as key enablers of fast improvement in infant mortality: good governance and women’s political and socioeconomic participation.3Thakrar and colleagues’ analysis would have been more beneficial if it had compared US infant mortality rates with those of other countries that have similar governance and women’s political and socioeconomic participation, instead of focusing on health spending and country wealth.NOTES1 IndexMundi. Mortality rate, infant (per 1,000 live births) [Internet]. Charlotte (NC): IndexMundi; [last updated 2016 Jun 30; cited 2018 Jan 18]. Available from: https://www.indexmundi.com/facts/indicators/SP.DYN.IMRT.IN/compare#country=cu:oe:us Google Scholar 2 IndexMundi. Health expenditure per capita (current US$) [Internet]. Charlotte (NC): IndexMundi; [last updated 2016 Jun 30; cited 2018 Jan 18]. Available from: https://www.indexmundi.com/facts/indicators/SH.XPD.PCAP/compare#country=cu:oe:us Google Scholar 3 Kuruvilla S, Schweitzer J, Bishai D, Chowdhury S, Caramani D, Frost Let al. Success factors for reducing maternal and child mortality. Bull World Health Organ. 2014;92(7):533–44B. Crossref, Medline, Google Scholar Loading Comments... Please enable JavaScript to view the comments powered by Disqus. DetailsExhibitsReferencesRelated Article Metrics History Published online 2 April 2018 Information© 2018 Project HOPE—The People-to-People Health Foundation, Inc.PDF download

Son Preference, Fertility Decline, and the Nonmissing Girls of Turkey.

Couples in Turkey exhibit son preference through son-biased differential stopping behavior that does not cause a sex ratio imbalance in the population. Demand for sons leads to lower ratios of boys to girls in larger families but higher ratios in smaller families. Girls are born earlier than their male siblings, and son-biased fertility behavior is persistent in response to decline in fertility over time and across households with parents from different backgrounds. Parents use contraceptive methods to halt fertility following a male birth. The sibling sex composition is associated with gender disparities in health. Among third- or later-born children, female infant mortality is 1.5 percentage points lower if the previous sibling is male. The female survival advantage, however, disappears if the previous sibling is female. Having an older female sibling shifts the gender gap in infant mortality rate by 2 percentage points in favor of males. The improvement in infant mortality is strongest in favor of males who have no older male siblings.

Effectiveness of Community Nurse Home Visits in Improvement of Infant Mortality and Health from the Perspectives of Community Health Nurses in Jordan

Objective: Pregnant mothers in the rural areas of Jordan are known to face multiple health risks for their infants. Currently, individuals tend to face barriers to access clinic-based services. Evidence indicates that majority of infant deaths in Jordan occur due to this reason, which can be prevented through provision and promotion of infant care practices through home visits. This study aims to assess the effectiveness of community nurse home visits from the perspectives of community health nurses to improve infant mortality rates within the rural areas of Jordan. Methods: A hundred community health nurses were recruited from the rural areas of Jordan (the response rate was 100%). Quantitative method along with descriptive techniques and Pearson correlation test is utilized for analyzing responses obtained from participants. Results: The majority of community health nurses revealed that the inclusion of community nursing is beneficial for healthcare sector. Approximately, 49% of experienced community nurses revealed that infant mortality rates can be easily controlled through home visits. A significant relationship exists between the increase in community nurse home visits and declined rates of infant mortality. Conclusion: Home visits by community nurses play a crucial role in improving infant mortality rates and health. Various interventions are required to inspect the most efficient strategy to promote infant care practices and reach families living in the rural areas of Jordan. The community health visiting profession needs to embrace the national guidelines to offer safer information to mothers during pregnancy and throughout the initial year of a child’s life.

Enhancing survival of Young Infants to improve Infant Mortality Rate

Background: About 40% of the estimated 10.8 million annual child deaths worldwide occur in first two months of life. Besides mortality infants experience at least five to six episodes of illnesses per year. Despite having the problem well defined there is no consistent evaluations and management approach to infants aged less than three months. Objective: To quantify the nature and burden of illnesses in the first months of life. Methods: This Prospective study was conducted among all consecutive subjects between 8 days to 90 days of age admitted during this period were subjects of this study. They underwent through a standardized set of enquiry clinical examination and investigations. A precoded standardized assessment form was used for data recording. The study subjects were diagnosed and managed according to the protocol of treating unit under the supervision of the senior faculty. Results: The most common clinical signs was chest indrawing- 98 (64.9%) followed by tachycardia- 65 (44.4%). Following factors may have a higher risk of death: wasting rapid breathing and respiratory distress slow / irregular respiration diarrhea dehydration low body temperature with or without impaired perfusion on admission and cyanosis. Conclusion: Presence of risk factors identified in this study should warrant immediate and appropriate measures.