Selected Health Indicators Research Articles

European Starlings (Sturnus vulgaris) As Sentinels of Urban Air Pollution: A Comprehensive Approach from Noninvasive to Post Mortem Investigation.

Urban, traffic-related air pollution remains a concern to health-care and environmental professionals, with mounting evidence connecting diverse disease conditions with exposure. Wildlife species such as European starlings (Sturnus vulgaris) cohabit urban neighborhoods and may serve as sentinels for these contaminants. In this novel approach, we use passive, personal-type air samplers to provide site-specific measurements of nitrogen dioxide (NO2), sulfur dioxide (SO2) and volatile organic compounds (VOCs, such as benzene, toluene, ethylbenzene, and xylenes, or BTEX), and account for the effects of confounding environmental factors when teasing out the responses to exposure. This study examines biomarkers of exposure to predominately traffic-related, urban air contaminants in European starlings, including morphometric measurements, immunotoxicology, oxidative stress and hepatic detoxification, and analyses responses in the context of multilayered factors including year, hatch date, weather and location, confirming that this experimental approach and the selected health indicators can be used for comparing locations with different levels of contaminants.

Regional health differences - developing a socioeconomic deprivation index for Germany.

For Germany, regional differences for various health indicators, which are also associated with socioeconomic factors, have been documented. This article aims to develop a regional socioeconomic deprivation index for Germany that (1) can be used to analyse regional socioeconomic inequalities in health and (2) provides a basis for explaining regional health differences in Germany. The core data stem from the INKAR (indicators and maps on spatial and urban development in Germany and Europe) database compiled by Germany's Federal Institute for Research on Building, Urban Affairs and Spatial Development. Factor analysis is used for indexing and the weighting of indicators for the three dimensions of education, occupation and income. The German Index of Socioeconomic Deprivation (GISD) is generated at the levels of associations of municipalities, administrative districts and administrative regions for the years 1998, 2003, 2008 and 2012. Aggregate data and individual data from the German Health Update 2014/2015-EHIS (GEDA 2014/2015-EHIS) study are used to analyse associations between the index and selected health indicators. For around two thirds of the causes of death, the German Index of Socioeconomic Deprivation reveals significant socioeconomic inequalities at the level of Germany's administrative regions. At district level, life expectancy in the bottom fifth of districts presenting the highest levels of deprivation is, depending on the observation period, 1.3 years lower for women and 2.6 years lower for men in comparison to the upper fifth of districts presenting the lowest levels of deprivation. The index can explain 45.5% and 62.2% of regional differences in life expectancy for women and men, respectively. Moreover, the population in regions characterised by high levels of deprivation has significantly higher rates of smokers, engages less frequently in leisure-time physical activities and is more often obese. The German Index of Socioeconomic Deprivation illustrates regional socioeconomic differences at different spatial levels and contributes to explaining regional health differences. This index is intended for use in research as well as by federal and federal state health reporting systems and should enable access to new sources of data for investigating the links between social inequalities and health in Germany.

Effect of circulating exosomes from transition cows on Madin-Darby bovine kidney cell function

The greatest risk of metabolic and infectious disease in dairy cows is during the transition from pregnancy to lactating (i.e., the transition period). The objective of this experiment was to determine the effects of extracellular vesicles (microvesicles involved in cell-to-cell signaling) isolated from transition cows on target cell function. We previously identified differences in the protein profiles of exosomes isolated from cows divergent in metabolic health status. Therefore, we hypothesized that these exosomes would affect target tissues differently. To investigate this, 2 groups of cows (n = 5/group) were selected based on the concentration of β-hydroxybutyrate and fatty acids in plasma and triacylglycerol concentration in liver at wk 1 and 2 postcalving. Cows with high concentrations of β-hydroxybutyrate, fatty acids, and triacylglycerol were considered at increased risk of clinical disease during the transition period (high-risk group; n = 5) and were compared with cows that had low concentrations of the selected health indicators (low-risk group; n = 5). At 2 time points during the transition period (postcalving at wk 1 and 4), blood was sampled and plasma exosomes were isolated from the high-risk and low-risk cows. The exosomes were applied at concentrations of 10 and 1 µg/mL to 5 × 103 Madin-Darby bovine kidney cells grown to 50% confluence in 96-well plates. Results indicate a numerical increase in cell proliferation when exosomes from high-risk cows were applied compared with those from low-risk cows. Consistent with an effect on cell proliferation, quantitative reverse transcriptase PCR indicated a trend for upregulation of 3 proinflammatory genes (granulocyte colony-stimulating factor, ciliary neurotrophic factor, and CD27 ligand) with the application of high-risk exosomes, which are involved in cellular growth and survival. Proteomic analysis indicated 2 proteins in the low-risk group that were not identified in the high-risk group (endoplasmin and catalase), which may also be indicative of the metabolic state of origin. It is likely that the metabolic state of the transition cow affects cellular function through exosomal messaging; however, more in-depth research into cross-talk between exosomes and target cells is required to determine whether exosomes influence Madin-Darby bovine kidney cells in this manner.

Monitoring of Selected Health Indicators in Children Living in a Copper Mine Development Area in Northwestern Zambia.

The epidemiology of malaria, anaemia and malnutrition in children is potentially altered in mining development areas. In a copper extraction project in northwestern Zambia, a health impact assessment (HIA) was commissioned to predict, manage and monitor health impacts. Two cross-sectional surveys were conducted: at baseline prior to project development (2011) and at four years into development (2015). Prevalence of Plasmodium falciparum, anaemia and stunting were assessed in under-five-year-old children, while hookworm infection was assessed in children aged 9–14 years in communities impacted and comparison communities not impacted by the project. P. falciparum prevalence was significantly higher in 2015 compared to 2011 in both impacted and comparison communities (odds ratio (OR) = 2.51 and OR = 6.97, respectively). Stunting was significantly lower in 2015 in impacted communities only (OR = 0.63). Anaemia was slightly lower in 2015 compared to baseline in both impacted and comparison communities. Resettlement due to the project and migration background (i.e., moving into the area within the past five years) were generally associated with better health outcomes in 2015. We conclude that repeated cross-sectional surveys to monitor health in communities impacted by projects should become an integral part of HIA to deepen the understanding of changing patterns of health and support implementation of setting-specific public health measures.

NU01.05 Indigenous Population with Lung Cancer

NU01.05 Indigenous Population with Lung Cancer

Trends in Between-Country Health Equity in Sub-Saharan Africa from 1990 to 2011: Improvement, Convergence and Reversal.

It is not clear whether between-country health inequity in Sub-Saharan Africa has been reduced over time due to economic development and increased foreign investments. We used the World Health Organization’s data about 46 nations in Sub-Saharan Africa to test if under-5 mortality rate (U5MR) and life expectancy (LE) converged or diverged from 1990 to 2011. We explored whether the standard deviation of selected health indicators decreased over time (i.e., sigma convergence), and whether the less developed countries moved toward the average level in the group (i.e., beta convergence). The variation of U5MR between countries became smaller from 1990 to 2001. Yet this sigma convergence trend did not continue after 2002. Life expectancy in Africa from 1990–2011 demonstrated a consistent convergence trend, even after controlling for initial differences of country-level factors. The lack of consistent convergence in U5MR partially resulted from the fact that countries with higher U5MR in 1990 eventually performed better than those countries with lower U5MRs in 1990, constituting a reversal in between-country health inequity. Thus, international aid agencies might consider to reassess the funding priority about which countries to invest in, especially in the field of early childhood health.

A Descriptive Study of the Vital Health Indicators of Four Sub‐Saharan African Countries, 1960–2012

BackgroundThe importance of country‐level vital health statistics is recognized globally because of their use in initiating publichealth and development policies. Over the past few decades, economic growth has occurred in sub‐Saharan African countries, resulting in benefits to the population, such as increased access to quality health care and optimum nutrition. However, attaining the best possible levels of infant nutrition and maternal health remains a challenge.MethodsThe main objective of this study is to present aset of detailed time series analyses from 1960 to 2012 for selected health and wellness indicators, using country‐level aggregated data collected by the World Development Index (WDI) database of the World Bank, with specific focus on the countries of Ghana, Togo, Burkina Faso, and the Ivory Coast. The vital health indicators collected for this region can be used to analyze the health status of the vulnerable populations, epidemiological patterns, and the impact of economic growth on health outcomes; thus, we use these indicators to calculate descriptive statistics and identify trends that may inform hypotheses aimed at improving infant nutrition and maternal health. Gaps in the longitudinal record were imputed via polynomial smoothing. Linear trends over time and differences among countries were assessed using simple ANOVA models, and associations within countries were calculated using Spearman's rank correlation.ResultsSome general trends are common across the countries under consideration, but there are divergences. For example, although there has been a steep decline in infant mortality rates in all four countries since 1960, those of Burkina Faso and the Ivory Coast generally tended to be higher over the period of study (p<0.001). Likewise, life expectancy at birth among women, while generally increasing over the period of study, reversed course between the mid‐1980s and 2000 for all four countries. However, this decrease in life expectancy was significantly more pronounced in the Ivory Coast (p<0.001). Interestingly, the vital indicators in Ghana are more strongly associated(either directly on inversely) with each other over time than in Burkina Faso, Togo or the Ivory Coast; this is due to more consistent improvements in these measures over time and more frequent reporting to the WDI. Indeed, all four of these countries had several measures with less than four records across the period of interest.ConclusionsSub‐Saharan Africa has seen a general improvement in selected health indicators, but it has been mixed and inconsistent across countries. Research efforts in this area are hindered by alack of data consistently reported over time.Support or Funding InformationNone

Delineation of Districts of Uttarakhand

Through this article, an attempt has been made to identify levels of public health in various districts of the state of Uttarakhand. Data collected and published by the Office of the Registrar General & Census Commissioner, India in its publication entitled Annual Health Survey (2010–11): Fact Sheet has been used. Analysis is based specifically on the data of morbidity, which includes diseases, illnesses, injuries and disabilities. Development administrators, planners and health policy makers would find it supporting for decision making, importantly on developing medical and health services and infrastructure in relatively backward districts on select health indicators.

Anniston community health survey: Follow-up and dioxin analyses (ACHS-II)--methods.

High serum concentrations of polychlorinated biphenyls (PCBs) have been reported previously among residents of Anniston, Alabama, where a PCB production facility was located in the past. As the second of two cross-sectional studies of these Anniston residents, the Anniston Community Health Survey: Follow-Up and Dioxin Analyses (ACHS-II) will yield repeated measurements to be used to evaluate changes over time in ortho-PCB concentrations and selected health indicators in study participants. Dioxins, non-ortho PCBs, other chemicals, heavy metals, and a variety of additional clinical tests not previously measured in the original ACHS cohort will be examined in ACHS-II. The follow-up study also incorporates a questionnaire with extended sections on diet and occupational history for a more comprehensive assessment of possible exposure sources. Data collection for ACHS-II from 359 eligible participants took place in 2014, 7 to 9 years after ACHS.

A comparative analysis of early child health and development services and outcomes in countries with different redistributive policies

BackgroundThe social environment is a fundamental determinant of early child development and, in turn, early child development is a determinant of health, well-being, and learning skills across the life course. Redistributive policies aimed at reducing social inequalities, such as a welfare state and labour market policies, have shown a positive association with selected health indicators. In this study, we investigated the influence of redistributive policies specifically on the social environment of early child development in five countries with different political traditions. The objective of this analysis was to highlight similarities and differences in social and health services between the countries and their associations with other health outcomes that can inform better global early child development policies and improve early child health and development.MethodsFour social determinants of early child development were selected to provide a cross-section of key time periods in a child’s life from prenatal to kindergarten. They included: 1) prenatal care, 2) maternal leave, 3) child health care, and 4) child care and early childhood education. We searched international databases and reports (e.g. Organization for Economic Cooperation and Development, World Bank, and UNICEF) to obtain information about early child development policies, services and outcomes.ResultsAlthough a comparative analysis cannot claim causation, our analysis suggests that redistributive policies aimed at reducing social inequalities are associated with a positive influence on the social determinants of early child development. Generous redistributive policies are associated with a higher maternal leave allowance and pay and more preventive child healthcare visits. A decreasing trend in infant mortality, low birth weight rate, and under five mortality rate were observed with an increase in redistributive policies. No clear influence of redistributive policies was observed on breastfeeding and immunization rates. In the analysis of child care and early education, the lack of uniform measures of early child development outcomes was apparent.ConclusionsThis paper provides further support for an association between redistributive policies and early child health and development outcomes, along with the organization of early child health and development services.

Improving Maternal and Infant Health through CenteringPregnancy: Results of a 2‐Year Retrospective Chart Review Using a Matched Comparison Design

ObjectiveHealthy People 2020 goals include reducing infant mortality and morbidity associated with pregnancy. CenteringPregnancy is a model of health care delivery that unifies health assessment, education, and support into a group setting that has been shown to improve prenatal care compliance, prenatal health knowledge, and prematurity.Research QuestionIs there a difference in select maternal health indicators and pregnancy outcomes between women participating in CenteringPregnancy and traditional care?MethodsAn analysis was conducted comparing CenteringPregnancy participants with a matched comparison group (traditional care). Data were collected through retrospective records review. Institutional review board approval was obtained from Western Michigan University and Borgess Medical Center prior to data collection. For the period of data collection (January 2010 through April 2012), 173 CenteringPregnancy participants were identified and a comparison group of 170 traditional certified nurse‐midwife (CNM) care clients were selected matched on race, age, and insurance status. Additional maternal data collected included prior pregnancies, height, and prepregnancy weight. Prenatal variables included number and timing of prenatal care visits, weight gain, and smoking status. Intrapartum variables included mode of birth and gestational age. Postpartum data were collected regarding attendance at a 6‐week postpartum visit and breastfeeding.ResultsThere was a significant between‐groups difference in gestation at first prenatal visit (11.8 weeks for traditional care vs 10.3 for CenteringPregnancy, P = .031). There was not a significant difference in mean number of prenatal visits (14.2 for CenteringPregnancy vs 13.4 for traditional care, P = .266). There was not a significant difference in rates of smoking at pregnancy diagnosis (26% [n = 45] of CenteringPregnancy vs 30% [n = 49] of traditional care); however, 69% (n = 31) of the women in the CenteringPregnancy group quit with pregnancy diagnosis versus 18% (n = 9) of the traditional care group (P < .001). Additionally, 50% (n = 7) of those still smoking quit during CenteringPregnancy versus only 8% (n = 3) during traditional care (P < .001). There was no difference in pre‐pregnancy weights or weight gain between groups, with only 28% of traditional care and 25% of CenteringPregnancy participants gaining the optimal amount of weight. There was no difference in mean gestational age at birth (39.3 weeks for CenteringPregnancy vs 39.5 weeks for traditional care) or rates of preterm births (5.8% in CenteringPregnancy vs 5.9% in traditional care). There were no differences in cesarean rates (17% for CenteringPregnancy vs 14% for traditional care, P = .443). Both groups had high rates of attendance at their 6‐week postpartum visit (92% for CenteringPregnancy vs 88% for traditional care, P = .243). CenteringPregnancy participants were more likely to initiate breastfeeding (79% vs 60% for traditional care, P < .001) and more likely to still be breastfeeding at the 6‐week postpartum visit (65% vs 45% for traditional care, P < .001).ConclusionIn this study, CenteringPregnancy demonstrated promise in reducing smoking rates during pregnancy and improving breastfeeding rates. This study also demonstrates that optimal weight gain guidelines must be addressed with women during pregnancy regardless of type of prenatal care. Findings from this study must be viewed in light of the self‐selection bias. Despite our attempts to control for variance by utilizing a matched comparison design, women who chose CenteringPregnancy initiated prenatal care earlier and also were more likely to quit smoking prior to onset of prenatal care than those who chose traditional care.

Can use of healthcare services among 15–16-year-olds predict an increased level of high school dropout? A longitudinal community study

ObjectivesTo study associations between healthcare seeking in 15–16-year-olds and high school dropout 5 years later.DesignLongitudinal community study.SettingData from a comprehensive youth health survey conducted in 2000–2004, linked to data from...

A Comparative Analysis of Health Indicators of Nigeria and Rwanda: A Nigerian Volunteer’s Perspective

Background: Nigeria and Rwanda are both developing countries located in Sub-Saharan Africa. They are differently endowed with natural and human resources but what does that translates into in terms of health care?This study aimed at a critical comparative analysis of selected health indicators of Nigeria and Rwanda(a country ravaged by genocide 16 years ago). Materials and Methods: I performed MEDLINE and bibliographic searches for English-language studies relevant to health indicators of Nigeria and Rwanda, including a search of non-indexed local journals. Personal observation and experience as Nigerian Technical Aid Corp Volunteer in Rwanda from May 2005 to May 2007 was also used. The information obtained included: demographic and socioeconomic data, mortality statistics, selected burden of diseases, health service coverage, risk factors for some diseases, health system resources and health expenditure of Nigeria and Rwanda. Results: The findings showed that most of the health indicators such as poverty index, life expectancy, child mortalities, immunisation coverage, contraceptive prevalence, access to improved drinking water, tuberculosis treatment success, hospital beds per population, among others of Rwanda are better than that of Nigeria despite the huge human and natural resources Nigeria is endowed with. Conclusion: There is need for concerted effort at the Federal, State and Local levels in Nigeria to harness the human and natural resources of the nations to improve on the health status of the people, and this should bemulti-sectoral, multi-dimensional and disciplinary in nature.

The equity lens in the health care performance evaluation system

The main objective of this paper is to describe how indicators of the equity of access to health care according to socioeconomic conditions may be included in a performance evaluation system (PES) in the regional context level and in the planning and strategic control system of healthcare organisations. In particular, the paper investigates how the PES adopted, in the experience of the Tuscany region in Italy, indicators of vertical equity over time. Studies that testify inequality of access to health services often remain just a research output and are not used as targets and measurements in planning and control systems. After a brief introduction to the concept of horizontal and vertical equity in health care systems and equity measures in PES, the paper describes the 'equity process' by which selected health indicators declined by socioeconomic conditions were shared and used in the evaluation of health care institutions and in the CEOs' rewarding system, and subsequently analyses the initial results. Results on the maternal and child path and the chronicity care path not only show improvements in addressing health care inequalities, but also verify whether the health system responds appropriately to different population groups.

Trends in health and health inequalities among major states of India: assessing progress through convergence models

Convergence in health and health inequalities reflects not only a sense of equity, but also provides a critical assessment tool for monitoring the health progress of differently placed individuals. This study examines convergence hypothesis for health and health inequalities across major Indian states, using both standard and cutting-edge convergence metrics. The findings lend support to the convergence in average health status among the states and the socioeconomic group of India, examined through select health indicators. However, results also suggest a setback in convergence in decline of health inequalities in recent times, particularly in life expectancy at birth, child immunization and underweight. Evidence signals that from the late 1990s, convergence in decline of health inequalities are replaced by emerging divergence. This paper contributes to health policy and planning by identifying areas where, India needs to work to achieve efficiency with equity in health status across geographical divisions and social groups.

A comparison of prevalence estimates for selected health indicators and chronic diseases or conditions from the Behavioral Risk Factor Surveillance System, the National Health Interview Survey, and the National Health and Nutrition Examination Survey, 2007–2008

ObjectiveTo compare the prevalence estimates of selected health indicators and chronic diseases or conditions among three national health surveys in the United States. MethodsData from adults aged 18years or older who participated in the Behavioral Risk Factor Surveillance System (BRFSS) in 2007 and 2008 (n=807,524), the National Health Interview Survey (NHIS) in 2007 and 2008 (n=44,262), and the National Health and Nutrition Examination Survey (NHANES) during 2007 and 2008 (n=5871) were analyzed. ResultsThe prevalence estimates of current smoking, obesity, hypertension, and no health insurance were similar across the three surveys, with absolute differences ranging from 0.7% to 3.9% (relative differences: 2.3% to 20.2%). The prevalence estimate of poor or fair health from BRFSS was similar to that from NHANES, but higher than that from NHIS. The prevalence estimates of diabetes, coronary heart disease, and stroke were similar across the three surveys, with absolute differences ranging from 0.0% to 0.8% (relative differences: 0.2% to 17.1%). ConclusionWhile the BRFSS continues to provide invaluable health information at state and local level, it is reassuring to observe consistency in the prevalence estimates of key health indicators of similar caliber between BRFSS and other national surveys.

Effect of feeding genetically modified Bt MON810 maize to ∼40-day-old pigs for 110 days on growth and health indicators

A total of 72 male weaned pigs were used in a 110-day study to investigate the effect of feeding genetically modified (GM) Bt MON810 maize on selected growth and health indicators. It was hypothesised that in pigs fed Bt maize, growth and health are not impacted compared with pigs fed isogenic maize-based diets. Following a 12-day basal period, pigs (10.7 ± 1.9 kg body weight (BW); ∼40 days old) were blocked by weight and ancestry and randomly assigned to treatments: (1) non-GM maize diet for 110 days (non-GM), (2) GM maize diet for 110 days (GM), (3) non-GM maize diet for 30 days followed by GM maize diet up to day 110 (non-GM/GM) and (4) GM maize diet for 30 days followed by non-GM maize diet up to day 110 (GM/non-GM). BW and daily feed intake were recorded on days 0, 30, 60 and 110 (n = 15). Body composition was determined by dual energy X-ray absorptiometry (n = 10) on day 80. Following slaughter on day 110, organs and intestines were weighed and sampled for histological analysis and urine was collected for biochemical analysis (n = 10). Serum biochemistry analysis was performed on days 0, 30, 60, 100 and 110. Growth performance and serum biochemistry were analysed as repeated measures with time and treatment as main factors. The slice option of SAS was used to determine treatment differences at individual time points. There was no effect of feeding GM maize on overall growth, body composition, organ and intestinal weight and histology or serum biochemistry on days 60 and 100 and on urine biochemistry on day 110. A treatment × time interaction was observed for serum urea (SU; P < 0.05), creatinine (SC; P < 0.05) and aspartate aminotransferase (AST; P < 0.05). On day 30, SU was lower for the non-GM/GM treatment compared with the non-GM, GM and GM/non-GM treatments (P < 0.05). On day 110, SC was higher for the non-GM/GM and GM/non-GM treatments compared with non-GM and GM treatments (P < 0.05). Overall, serum total protein was lower for the GM/non-GM treatment compared with the non-GM/GM treatment (P < 0.05). The magnitude of change observed in some serum biochemical parameters did not indicate organ dysfunction and the changes were not accompanied by histological lesions. Long-term feeding of GM maize to pigs did not adversely affect growth or the selected health indicators investigated.

Explaining the variability in recommended intakes of folate, vitamin B12, iron and zinc for adults and elderly people

To signal key issues for harmonising approaches for establishing micronutrient recommendations by explaining observed variation in recommended intakes of folate, vitamin B12, Fe and Zn for adults and elderly people. We explored differences in recommended intakes of folate, vitamin B12, Fe and Zn for adults between nine reports on micronutrient recommendations. Approaches used for setting recommendations were compared as well as eminence-based decisions regarding the selection of health indicators indicating adequacy of intakes and the consulted evidence base. In nearly all reports, recommendations were based on the average nutrient requirement. Variation in recommended folate intakes (200-400 μg/d) was related to differences in the consulted evidence base, whereas variation in vitamin B12 recommendations (1.4-3.0 μg/d) was due to the selection of different CV (10-20 %) and health indicators (maintenance of haematological status or basal losses). Variation in recommended Fe intakes (men 8-10 mg/d, premenopausal women 14.8-19.6 mg/d, postmenopausal women 7.5-10.0 mg/d) was explained by different assumed reference weights and bioavailability factors (10-18 %). Variation in Zn recommendations (men 7-14 mg/d, women 4.9-9.0 mg/d) was also explained by different bioavailability factors (24-48 %) as well as differences in the consulted evidence base. For the harmonisation of approaches for setting recommended intakes of folate, vitamin B12, Fe and Zn across European countries, standardised methods are needed to (i) select health indicators and define adequate biomarker concentrations, (ii) make assumptions about inter-individual variation in requirements, (iii) derive bioavailability factors and (iv) collate, select, interpret and integrate evidence on requirements.

State of child health among poor and non-poor in urban India

This paper examines the gaps in four child health indicators, namely, underweight, stunting, wasting, and infant mortality among the urban poor and non-poor in India, using data from the National Family Health Surveys, 1992–93 and 2005–06. Based on economic proxies, a composite wealth index is computed for urban areas using Principal Component Analysis. The urban poor, derived from the composite wealth index, are equated with the official poverty estimates of the selected state. Poor non-poor ratio, concentration index, logistic regression, and Cox Proportional Hazard regression models are used in the analyses. Results depict considerable gaps between the urban poor and non-poor for all selected child health indicators in the country. However, regional patterns in inequalities are mixed. Controlling for other variables, poverty is found to be a significant determinant of all selected child health indicators over the periods (1992-93 and 2005-06). The study calls for specific programs to improve the health of children belonging to poor households in urban India. Abhishek KUMAR , Research Scholar, International Institute for Population Sciences, Govandi Station Road, Deonar Mumbai, 400088, India. E.mail: abhi85_iips@rediffmail.com . Sanjay K. MOHANTY, Associate Professor, Department of Fertility Studies, International Institute for Population Sciences, Mumbai, India. E-mail: sanjayiips@yahoo.co.in .

The impact of changing health indicators on infant mortality rates in Brazil, 2000 and 2005

To investigate the associations between changes in indicators of health-related resources and coverage, and variations in infant mortality rates (IMR) in Brazil's 27 states in 2000 and 2005. Data were obtained from the Ministry of Health's online database, DATASUS. Stepwise multiple regressions were performed to model changes in IMR and its components (early, late, and post-neonatal mortality), using changes in the selected health indicators as predictors. Regression analysis showed that improving access to prenatal care (B = -0.89 per 1 000; P < 0.001), increasing public expenditure on health as a proportion of gross domestic product (GDP) (B = -0.72 per 1 000; P = 0.031), and increasing access to the water supply (B = -0.22 per 1 000; P = 0.033) were associated with significant reductions in IMR. Declining early neonatal mortality rates were associated with prenatal care (B = -0.14 per 1 000; P = 0.026) and access to sanitation services (B = -0.05 per 1 000; P = 0.026). Reductions in late neonatal mortality rates were associated with prenatal care (B = -0.12 per 1 000; P = 0.003) and inversely correlated to the rate of cesarean deliveries (B = 0.13 per 1 000; P = 0.005). Post-neonatal mortality rate reductions were associated with prenatal care (B = -0.64 per 1 000; P < 0.001), increasing public expenditure on health as a proportion of GDP (B = -0.76 per 1 000; P = 0.005), and access to the water supply (B = -0.17 per 1 000; P = 0.037). Improving access to prenatal care, increasing public expenditure on health, and access to sanitation and water supply were all independently correlated to declining IMR; however, higher rates of cesarean deliveries were associated with higher late neonatal mortality rates. Continuous collection and analysis of relevant health indicators is recommended for developing evidence-based health policies and accurate predictions of how specific public health interventions might impact IMR.