Reduce Infant Mortality Research Articles

Devolved health system capacity in the provision of care for sick newborns and young infants in four counties serving vulnerable populations in Kenya.

Possible severe bacterial infections (PSBI) is one of the three leading causes of newborn and young infant mortality globally that can be prevented by timely diagnosis and treatment using suitable antibiotics. High impact interventions such as use of out-patient injectable gentamicin and dispersible Amoxicillin with community-based follow up have been shown to reduce mortality in clinical trials. The objective of this study was to assess the health systems' preparedness and organizational gaps that may impact execution in providing care for newborns and sick young infants. This formative research study was embedded within a three-year implementation research project in 4 Counties in Kenya. The indicators were based on facility audits for existing capacity to care for newborns and young infants as well as County organizational capacity assessment. The organizational capacity assessment domains were derived from the World Health Organization's Health Systems Building blocks for health service delivery. The scores were computed by adding average scores in each domain and calculated against the total possible scores to generate a percentage outcome. Statistical analyses were descriptive with adjustment for clustering of data. Overall, the Counties have inadequate organizational capacity for management of sick young infants with Organizational Capacity Index scores of between 61-64%. Among the domains, the highest score was in Health Management Information System and service delivery. The lowest scores were in monitoring and evaluation (M&E). Counties scored relatively low scores in human resources for health and health products and commodities with one scoring poorly for both areas while the rest scored average performance. The four counties revealed varying levels of organizational capacity deficit to effectively manage sick young infants. The key underlying issues for the below par performance include poor coordination, low funding, inadequate supportive supervision, and M&E to enable data utilisation for quality improvement. It was evident that newborn and young infant health services suffer from inadequate infrastructure, equipment, staffing, and coordination. As Kenya, continuously rolls out the guidelines on management of sick young infants, there is need to focus attention to these challenges to enhance sustainable adoption and reduction of young infant morbidity and mortality.

Community and individual level determinants of infant mortality in rural Ethiopia using data from 2016 Ethiopian demographic and health survey

The infant mortality rate remains unacceptably high in sub-Saharan African countries. Ethiopia has one of the highest rates of infant death. This study aimed to identify individual-and community-level factors associated with infant death in the rural part of Ethiopia. The data for the study was obtained from the 2016 Ethiopian Demographic and Health Survey. A total of 8667 newborn children were included in the analysis. The multilevel logistic regression model was considered to identify the individual and community-level factors associated with new born mortality. The random effect model found that 87.68% of the variation in infant mortality was accounted for by individual and community level variables. Multiple births (AOR = 4.35; 95%CI: 2.18, 8.69), small birth size (AOR = 1.29; 95%CI: 1.10, 1.52), unvaccinated infants (AOR = 2.03; 95%CI: 1.75, 2.37), unprotected source of water (AOR = 1.40; 95%CI: 1.09, 1.80), and non-latrine facilities (AOR = 1.62; 95%CI: 1.20) were associated with a higher risk of infant mortality. While delivery in a health facility (AOR = 0.25; 95%CI: 0.19, 0.32), maternal age 35–49 years (AOR = 0.65; 95%CI: 0.49, 0.86), mothers receiving four or more TT injections during pregnancy (AOR = 0.043, 95% CI: 0.026, 0.071), and current breast feeders (AOR = 0.33; 95% CI: 0.26, 0.42) were associated with a lower risk of infant mortality. Furthermore, Infant mortality rates were also higher in Afar, Amhara, Oromia, Somalia, and Harari than in Tigray. Infant mortality in rural Ethiopia is higher than the national average. The government and other concerned bodies should mainly focus on multiple births, unimproved breastfeeding culture, and the spacing between the orders of birth to reduce infant mortality. Furthermore, community-based outreach activities and public health interventions focused on improving the latrine facility and source of drinking water as well as the importance of health facility delivery and received TT injections during the pregnancy.

Reduction of infant mortality from congenital heart defects in a middle-income country: Costa Rican experience.

We aimed to analyze recent infant and neonatal mortality from congenital heart defects (CHD) in Costa Rica, a middle-income country where CHD mortality was above expectations. A descriptive analysis of infant and neonatal mortality rates from CHD (IMR-CHD and NMR-CHD) during 2000-2019 was performed, according to province, sex, specific CHD, and sub-period, using data from the National Institute of Statistics and Censuses. We used joinpoint regression to identify any calendar-year where a significant change in trend occurred; the average annual percent change (AAPC) was determined. Using Poisson regression, marginal means and mortality ratios (MR) for IMR-CHD and NMR-CHD by sub-period (2000-2006-referent-, 2007-2013, 2014-2019) were estimated and compared using Wald's chi-square tests (α≤ .05). During 2000-2019, CHD accounted for 12% of overall infant mortality. IMR-CHD and NMR-CHD decreased linearly over the study period (AAPC=-3.4; p< .01). IMR-CHD decreased by 41%, from 13.6 per 10,000 in 2000-2006 (13.4% of infant mortality) to 8.1 per 10,000 in 2014-2019 (10% of infant mortality) (MR=0.59; 95% confidence intervals [CI]=0.52-0.68). NMR-CHD decreased by 38%, from 7.9 per 10,000 in 2000-2006 (11.1% of neonatal mortality) to 4.9 per 10,000 in 2014-2019 (7.9% of infant mortality) (MR=0.59; 95% CI=0.52-0.68). Male presented significantly higher NMR-CHD. The main causes of mortality (2014-2019) were total anomalous pulmonary venous connections, hypoplastic left heart syndrome, and double inlet ventricle. IMR-CHD, NMR-CHD, and their proportional contribution to mortality by all causes and by birth defects decreased significantly, demonstrating that all improvements implemented in the last decades have yielded favorable results.

Public health departments and the mortality transition in Latin America: Evidence from Puerto Rico

This paper examines the role of public health in reducing mortality prior to modern medicine by studying Puerto Rico in the early 20th century. From 1930 to 1960, Puerto Rico experienced one of the fastest increases in life expectancy in history and completed the first mortality transition outside of Europe and Western offshoots. Using municipal-level data in an event study framework, I show that public health units (county health departments) caused around half of the reduction in infant and tuberculosis mortality from 1923 to 1945, without significantly increasing public expenditures. Public health units also reduced maternal mortality and stillbirths. I present descriptive evidence that more assistant midwives per capita correspond to larger declines in maternal mortality, suggesting the importance of the training of midwives by health units. This investigation provides a window into Latin America more broadly, since most countries in Latin America subsequently adopted public health units.

The Role of the Community in the Posyandu Program in Tambakrejo Village

Posyandu activities are real activities that involve community participation in health service efforts from the community, which are carried out by health cadres who have received education and training from puskesmas regarding basic health services. The role of cadres is important for the operation of Posyandu in the regions. One form of community-based health effort that is managed and implemented from, by, for and with the community in the rimplementation of health development, in order to empower the community and provide convenience to the community in obtaining basic health services, especially to accelerate the reduction of maternal and infant mortality. Efforts to develop the quality of human resources by optimizing the potential for growth and development of children can be carried out evenly, if a community-based health service system such as Posyandu can be implemented effectively and efficiently to be able to reach all targets who want services for child growth and development, pregnant women, breastfeeding mothers, and postpartum. The method used is descriptive qualitative data obtained through observation, documentation, interviews and using sources from books, journals, and policy documents. The results of this study indicate that the role of posyandu cadres in Tambak Rejo Village, Krembung District, Sidoarjo Regency has been running effectively. It can be seen from their active role in routinely socializing the posyandu program, and their participatory role in assisting people who experience health problems by providing good services, and the passive role of posyandu cadres, namely socialization without an invitation for the community to join the posyandu program in Tambak Rejo Village. Krembung District, Sidoarjo Regency.

Availability and readiness of health care facilities and their effects on under-five mortality in Bangladesh: Analysis of linked data.

BackgroundUnder-five mortality is unacceptably high in Bangladesh instead of governmental level efforts to reduce its prevalence over the years. Increased availability and accessibility to the health care facility and its services can play a significant role to reduce its occurrence. We explored the associations of several forms of child mortality with health facility level factors.MethodsThe 2017-18 Bangladesh Demographic and Health Survey (BDHS) data and 2017 Bangladesh Health Facility Survey (BHFS) data were linked and analysed. The outcome variables were neonatal mortality, infant mortality, and under-five mortality. Health facility level factors were considered as major explanatory variables. They were the basic management and administrative system of the nearest health care facility where child health care services are available, degree of availability of the child health care services at the nearest health care facility, degree of readiness of the nearest health care facility (where child health care services are available) to provide child health care services and average distance of the nearest health care facility from mothers’ homes where child health care services are available. The associations between the outcome variables and explanatory variables were determined using the multilevel mixed-effect logistic regression model.ResultsReported under-five, infant and neonatal mortality were 40, 27, and 22 per 10 000 live births, respectively. The likelihood of neonatal mortality was found to be declined by 15% for every unit increase in the score of the basic management and administrative system of the mothers’ homes nearest health care facility where child health care services are available. Similarly, degree of availability and readiness of the mothers’ homes nearest health care facilities to provide child health care services were found to be linked with 18%-24% reduction in neonatal and infant mortality. On contrary, for every kilometre increased distance between mothers’ homes and its nearest health care facility was found to be associated with a 15%-20% increase in the likelihoods of neonatal, infant and under-five mortality.ConclusionsThe availability of health facilities providing child health care services close to mothers’ residence and its readiness to provide child health care services play a significant role in reducing under-five mortality in Bangladesh. Policies and programs should be taken to increase the availability and accessibility of health facilities that provide child health care services.

A review on development of placental transfusion in term and preterm infants.

In recent years, it has been verified that placental transfusion can replenish blood volume of neonates, improve organ perfusion in the early postnatal stage, and facilitate the transition from fetal circulation to adult circulation. Meanwhile, placental transfusion can reduce the need for blood transfusion and the onset of intraventricular hemorrhage, necrotizing enterocolitis, bronchopulmonary dysplasia, and other complications. Furthermore, it can improve the iron store and the long-term prognosis of central nervous system, and reduce infant mortality. Different methods have been used, including delayed cord clamping, intact umbilical cord milking, and cut umbilical cord milking. The World Health Organization (WHO) and other academic organizations recommend the routine use of delayed cord clamping at birth for the most vigorous term and preterm neonates. However, details of placental transfusion should be clarified, and the short/long-term impacts of this technology on some infants with special conditions still require further study.

O22 - Reducing Infant Mortality in Queensland: the impact of the Pēpi-Pod® Program

The Queensland Pēpi-Pod® Program was introduced as a staged research intervention in partnership with Aboriginal and Torres Strait Islander communities, and Change for our Children, New Zealand in 2012-2018 to determine cultural, community and individual acceptability, safety and feasibility. This three-part program (sleep space, safe care, family as safe sleep influencers) addressed the vulnerability of infants in unsafe sleep environments that increase suffocation risk. ‘If it’s safe to breathe, it’s safe to sleep’ was the underlying gist message promoted. While successfully implemented, and with some communities continuing to engage in the program post-research, the initial study was not designed to measure mortality benefit. The aim of this study was to determine if the Pēpi-Pod® Program implementation was temporally associated with a reduction in infant mortality in Queensland. Using research participant data (n=617) and linked Queensland population data, research locations were stratified into three subgroups based on participation rate within each geographic location and participant Indigeneity as a proportion of the location’s Indigenous population. Infant Mortality Rate (IMR) was the outcome, defined as all-cause post-neonatal infant mortality between one and six months of age. Outcomes within and between research location subgroups, and whole of Queensland Study IMR before and after the research intervention were compared. After the Pēpi-Pod® Program intervention study IMR fell in two of the three research location subgroups. The greatest fall occurred in the subgroup with the highest rate of participation and participant Indigeneity (Rate Ratio 0.25, {95% Confidence Intervals 0.06,1.08}, P=0.08). The whole of Queensland Study IMR decreased significantly after the intervention (RR 0.78 {95%CI 0.65,0.92}, P=0.004). The Pēpi-Pod® Program was hypothesised to be responsible for this reduction in Study IMR. This Program presents a practical and tangible strategy to reduce infant mortality experienced by priority populations.

Studi Literatur: Pengalaman Menyusui pada Ibu Usia Remaja

Breastfeeding in one of the best ways to reduce infant mortality. However, UNICEF data in 2019 recorded that only 43% of newborns started breastfeeding in the first hour and 41% received exclusively breastfed. The causes of initiation and continuation of breastfeeding are closely related to the age of the mother. Adolescent mothers were found to not continue exclusive breastfeeding. This article aims to explore the experience of exclusive breastfeeding for adolescent mothers. The method used is a literature study. Research questions were identified using the PEOS (Population, Exposure, Outcome, Study Design) framework. The journals used in the literature review were obtained through the Pubmed, Science Direct and Google Scholar databases from 2010-2020. The keywords used according to MESH (Medical Subject Heading) are "experience", "exclusive breastfeeding", and "adolescent mothers", and selected full text. The results of the review of 6 articles include: mother’ decisions to breastfeed such as, breastfeeding is a natural, easy, and fun way, a supportive environment, breastfeeding can improve baby’s health, provide benefits for mothers, save costs. The obstacles faced by adolescent mother include, lack of knowledge and skills, uncontrollable and unplesant physical experiences, inadequate response to health services, lack of support for breastfeeding at work/school, and difficulty breastfeeding in public places. So, adolescent mothers need breastfeeding support such as information support, instrumental support, emotional support, and apraisal support.

The Influence Of Exclusive Breastfeeding On Babies With Mother's Knowledge

Giving of exclusive breastfeeding to infants is a program which is created by the government to prevent and reduce infant mortality. The benefits of breastfeeding protect children from various inflammatory diseases, such as diarrhea, otitis media, and chronic inflammation of the lower respiratory tract. Breast milk colostrum has 10 to 17 times more immune substances than raw milk (Andayani, D, et al, 2017). UNICEF states that exclusive breastfeeding for infants aged 0 to 6 months can prevent the death of at least 1.3 million children under the age of 5 years. The purpose of this study was to determine whether there was knowledge of mothers with exclusive breastfeeding in Lhokseumawe City. The research design is an analytical survey with a cross sectional approach. The population and sample of this study were all mothers who had babies aged 6 to 11 months that visited the Muara Dua Health Center in Lhokseumawe City. The inclusion criteria with a sample size of 62 people. The research used consecutive sampling technique with computer application software. There are two data analysis used in this study, namely univariate analysis and bivariate analysis. The results of study was concluded that there was an influence between mother's knowledge and giving exclusive breastfeeding by showed p-value 0.006 (p&lt;0.05), with mothers who have good knowledge, which are 8,325 times giving exclusive breastfeeding to their babies more than the mothers who have lack of knowledge with a confidence value of 1.638 - 42.315.

Does the conditional maternal benefit programme reduce infant mortality in India?

India, which suffers from the largest number of infant deaths in the world, introduced the conditional maternity benefit programme, 'Indira Gandhi Matritva Sahyog Yojana' (IGMSY), to provide cash directly to pregnant and lactating women contingent on specified maternal and infant healthcare uses. This study estimates the impact of this programme on infant mortality for the first 12 months after birth, exploiting the pilot phase of IGMSY as a natural experiment in which 52 districts were randomly chosen as pilot districts. In the matched-pair difference-in-differences framework, the treatment effect on survival rate is estimated through the fully data-driven random survival forest approach. The results show that IGMSY reduced the infant mortality rate by 8.32% in treatment districts, with 1.53 fewer deaths per 1000 live births [95% prediction interval: 1.26-1.80]. The size of the effect substantially varies even within the first 12 months, indicating larger reductions in the neonatal period, and after the first 6 months. The results also reveal greater reductions among boys and children in urban areas.

Modified Stange test gives new gynecological criteria and recommendations for choosing caesarean section childbirth.

Pregnancy and childbirth often threaten the life and health of the fetus. The greatest threat to the fetus during these periods is intrauterine hypoxia. The threat of intrauterine fetal hypoxia increases during natural childbirth and decreases during caesarean section. Therefore, it is no coincidence that the rate of C-section births is increasing worldwide. However, the generally accepted recommendations on the choice of caesarean delivery need to be clarified. A new test is needed to simulate intrauterine hypoxia and predict fetal survival during natural childbirth. Such a test would improve current C-section recommendations and newborn health outcomes. The most appropriate basis for such a functional test is the generally accepted Stange test. The fact is that the Stange test is a very easy to use and accurate functional test based on the duration of the longest breath hold. For more than 100 years, the Stange test has been successfully used to assess the adaptation reserves of adults to hypoxia in real time. The purpose of this letter is to present a new easy-to-use functional test designed to assess the resistance to hypoxia not only of the pregnant woman, but also of her fetus in real time. This new test could be a new vector in obstetric practice aimed at improving neonatal health and reducing infant mortality during delivery.

Effect of &lt;i&gt;Katuk&lt;/i&gt; Leaves (&lt;i&gt;Sauropus androgynus&lt;/i&gt; (L.) Merr) on Breast Milk Production

Exclusive breastfeeding can reduce infant mortality in Indonesia. Lack of breastfeeding is one of the causes of the low achievement of exclusive breastfeeding. Sauropus androgynus (L.) Merr (katuk) leaves are believed to increase milk production. Most people process katuk leaves to make vegetable soup, while improper processing methods can reduce the beneficial effects. This study aimed to analyze the effect of katuk leaf soup consumption on breast milk production. The subjects in the study were postpartum mothers and their babies from October to November 2021 at the PONED Health Center in West Lombok regency who met the sample criteria. This research is a randomized controlled trial. The sample used is 32 respondents. Katuk clear soup was given to the intervention group and Asifit to the control group. The data collected was processed by a nonparametric test. The analysis showed no difference in katuk clear soup and Asifit on breast milk production (p=0.105). Therefore, breast milk production increased due to katuk clear soup and Asifit made from katuk leaves. This research concludes that katuk leaves are proven to increase breast milk production. Therefore, katuk leaf vegetables can be used as an effort to increase breast milk.

Breastfeeding Knowledge among a Sample of Women Attending Maternal and Pediatric Hospital of Soran City

Background and objectives: Breastfeeding is the ideal method suited for the physiological andpsychological needs of an infant and the most vital intervention for reducing infant mortality andensuring optimal growth and development of a child. Human breast milk is considered the healthiestform of milk for children and contains essential nutrients, vitamins, and minerals during the first sixmonths. The purpose of this study was to find out about breastfeeding knowledge and its relationshipwith women’s socio-demographic characteristics.Methods: A descriptive study was carried out from December 2020 through February 2021, involvinga simple random sample of 100 women who visited the Maternal and Pediatric Hospital in Soran city.Results: This study revealed that the mean age (M ± SD) was 32.15 ± 7.373 and nearly one-third ofwomen were illiterate and in the age group 26-30 years. 76% were housewives and 85% indicatedthat had a normal delivery type. A good knowledge level is shown about different aspects ofbreastfeeding such as the effect of breastfeeding on a baby’s intelligence, the definition of Colostrum,and the effect of breast milk on producing natural immunity. Concerning breastfeeding practice, themajority correctly indicated breastfeeding initiation within one hour after birth and continuity ondemand for up to 2 years. Overall knowledge about breastfeeding was good and no statisticallysignificant association was found between breastfeeding knowledge levels with socio-demographiccharacteristics of age, education level, occupation, parity, and type of delivery.Conclusions: According to study findings overall knowledge about breastfeeding was good and nostatistically significant association was found between breastfeeding knowledge levels and sociodemographic characteristics of participants

Timing of first bath in term healthy newborns: A systematic review.

BackgroundThis systematic review of intervention trials and observational studies assessed the effect of delaying the first bath for at least 24 hours after birth, compared to conducting it within the first 24 hours, in term healthy newborns.MethodsWe searched MEDLINE via PubMed, Cochrane CENTRAL, Embase, CINAHL (updated till November 2021), and clinical trials databases and reference lists of retrieved articles. Key outcomes were neonatal mortality, systemic infections, hypothermia, hypoglycaemia, and exclusive breastfeeding (EBF) rates. Two authors separately evaluated the risk of bias, extracted data, and synthesized effect estimates using relative risk (RR) or odds ratio (OR). The GRADE approach was used to assess the certainty of evidence.ResultsWe included 16 studies (two trials and 14 observational studies) involving 39 020 term or near-term healthy newborns. Delayed and early baths were defined variably in the studies, most commonly as >24 hours (six studies) and as ≤6 hours (12 studies), respectively. We performed a post-hoc analysis for studies that defined early bath as ≤6 hours. Low certainty evidence suggested that bathing the newborn 24 hours after birth might reduce the risk of infant mortality (OR = 0.46, 95% confidence interval (CI) = 0.28 to 0.77; one study, 789 participants) and neonatal hypothermia (OR = 0.50, 95% CI = 0.28-0.88; one study, 660 newborns), compared to bathing within first 24 hours. The evidence on the effect on EBF at discharge was very uncertain. Delayed bath beyond 6 hours (at or after nine, 12, or 24 hours) after birth compared to that within 6 hours might reduce the risk of hypothermia (OR = 0.47, 95% CI = 0.36-0.61; four studies, 2711 newborns) and hypoglycaemia (OR = 0.39, 95% CI = 0.23-0.66; three studies, 2775 newborns) and improve the incidence of EBF at discharge (OR = 1.12, 95% CI = 1.08-1.34; six studies, 6768 newborns); the evidence of the effect on neonatal mortality was very uncertain.ConclusionDelayed first bath for at least 24 hours may reduce infant mortality and hypothermia. Delayed bath for at least 6 hours may prevent hypothermia and hypoglycaemia and improve EBF rates at discharge. However, most of these conclusions are limited by low certainty evidence.RegistrationPROSPERO 2020 CRD42020177430.

Health care services use, stillbirth, and neonatal and infant survival following implementation of the Maternal Health Voucher Scheme in Bangladesh: A difference-in-differences analysis of Bangladesh Demographic and Health Survey data, 2000 to 2016.

Starting in 2006 to 2007, the Government of Bangladesh implemented the Maternal Health Voucher Scheme (MHVS). This program provides pregnant women with vouchers that can be exchanged for health services from eligible public and private sector providers. In this study, we examined whether access to the MHVS was associated with maternal health services utilization, stillbirth, and neonatal and infant mortality. We used information on pregnancies and live births between 2000 to 2016 reported by women 15 to 49 years of age surveyed as part of the Bangladesh Demographic and Health Surveys. Our analytic sample included 23,275 pregnancies lasting at least 7 months for analyses of stillbirth and between 15,125 and 21,668 live births for analyses of health services use, neonatal, and infant mortality. With respect to live births occurring prior to the introduction of the MHVS, 31.3%, 14.1%, and 18.0% of women, respectively, reported receiving at least 3 antenatal care visits, delivering in a health institution, and having a skilled birth attendant at delivery. Rates of neonatal and infant mortality during this period were 40 and 63 per 1,000 live births, respectively, and there were 32 stillbirths per 1,000 pregnancies lasting at least 7 months. We applied a difference-in-differences design to estimate the effect of providing subdistrict-level access to the MHVS program, with inverse probability of treatment weights to address selection into the program. The introduction of the MHVS program was associated with a lagged improvement in the probability of delivering in a health facility, one of the primary targets of the program, although associations with other health services were less evident. After 6 years of access to the MHVS, the probabilities of reporting at least 3 antenatal care visits, delivering in a health facility, and having a skilled birth attendant present increased by 3.0 [95% confidence interval (95% CI) = -4.8, 10.7], 6.5 (95% CI = -0.6, 13.6), and 5.8 (95% CI = -1.8, 13.3) percentage points, respectively. We did not observe evidence consistent with the program improving health outcomes, with probabilities of stillbirth, neonatal mortality, and infant mortality decreasing by 0.7 (95% CI = -1.3, 2.6), 0.8 (95% CI = -1.7, 3.4), and 1.3 (95% CI = -2.5, 5.1) percentage points, respectively, after 6 years of access to the MHVS. The sample size was insufficient to detect smaller associations with adequate precision. Additionally, we cannot rule out the possibility of measurement error, although it was likely nondifferential by treatment group, or unmeasured confounding by concomitant interventions that were implemented differentially in treated and control areas. In this study, we found that the introduction of the MHVS was positively associated with the probability of delivering in a health facility, but despite a longer period of follow-up than most extant evaluations, we did not observe attendant reductions in stillbirth, neonatal mortality, or infant mortality. Further work and engagement with stakeholders is needed to assess if the MHVS has affected the quality of care and health inequalities and whether the design and eligibility of the program should be modified to improve maternal and neonatal health outcomes.

Mortality transition in the interwar Baltic states: findings from cross-country comparison of new life tables

ABSTRACT This paper is the first comparative analysis of mortality transition, as part of the demographic transition, in all the three Baltic countries during the interwar period. We address the following research questions: Which type of mortality transition is exemplified by the interwar Baltic countries’ mortality patterns? Was the mortality transition completed already before WWII? What were Baltic cross-country differences in the advancement of mortality and demographic transitions? We present and use newly constructed life tables for Lithuania, 1925–1934, and draw on the work of the Estonian demographer Kalev Katus (1955–2008), publishing for the first time his life tables for Latvia in 1925–1938. Main findings: The three countries were part of the Western model of mortality transition. However, the reduction of infant and childhood mortality was lagging in Lithuania. Women of childbearing age in Estonia and mainland Latvia, as a result of earlier fertility decline, experienced longer life expectancy due to the decreased mortality from birth complications. Nevertheless, in all three countries mortality transition was still incomplete by WWII. A comparison of death causes in 1925–1939 serves to corroborate the last conclusion.

Evaluation of a Program to Reduce Infant Mortality Risk Factors in Central Indiana.

The purpose of the program WeCare was to provide a personalized approach to addressing the wide array of psycho-social-cultural-fiscal needs to reduce risk factors for infant mortality (IM) by supporting maternal and infant health through health coaching by community health workers (CHWs). A prospective cohort study of 1,513 women from highest risk ZIP codes for IM in central Indiana were followed over three years. The WeCare program focused on training and deploying CHWs to provide evidence-based, patient-centered social care and support to pregnant and postpartum women and tracked outcomes in health risk categories (mental health, nutrition, safe sleep, breastfeeding) targeted for behavioral change. The low birth weight rate among program participants was lower (8.9%) than Marion County's rate (10%) (p=0.23) with statistically significant improvement in many risk behaviors. Despite limitations, the personalized coaching provided by the CHWs provided an effective, practical approach to maternal and child health disparities.

Penyuluhan Kesehatan tentang Inisiasi Menyusu Dini (IMD) di Desa Pandai Woha

Early Initiation of Breastfeeding is the giving of breast milk to the baby in the first hour after birth, where the baby is placed on the mother's chest and allows the baby to find the mother's nipple. Early initiation of breastfeeding is one way to reduce infant mortality. The practice of early initiation of breastfeeding, especially in Indonesia, is still very low. According to the 2002 Indonesian Health Demographic Survey, Early Breastfeeding Initiation in Indonesia is only 3.7%. This service was carried out at the Pandai village polindes in February 2021. This activity aims to increase mother's knowledge about Early Initiation of Breastfeeding and add insight that early initiation of breastfeeding is very important because it is the first step for the success of exclusive breastfeeding. The method of service is by lecture/counseling, discussion and question and answer by explaining the extension material in the form of powerpoint. As a result of our dedication, we got the enthusiasm of active participants in asking questions so that they are committed to trying to carry out Early Breastfeeding Initiation as soon as the baby is born. Participants said their knowledge increased about Early Initiation of Breastfeeding

Clean Water and Infant Health: Evidence from Piped Water Provision in China

We examine the impact of clean drinking water on infant mortality in China using a novel instrumental variable: the least-cost distance of piped water infrastructure between water sources and infant mortality surveillance areas. We find that the provision of piped water significantly decreases infant mortality, with a 10 percentage point increase in piped water coverage reducing infant mortality by 15%. Compared with regions with highly polluted surface waters, access to piped water is particularly beneficial in regions with slightly polluted surface waters, in which the pollution is difficult to observe. A simple cost-benefit analysis indicates that the benefits of piped water provision in rural China significantly outweigh the estimated costs.