Trends In Infant Mortality Research Articles

Correction of vital statistics based on a proactive search of deaths and live births: evidence from a study of the North and Northeast regions of Brazil.

BackgroundIn the last 20 years, Brazil has undergone dramatic changes in terms of socioeconomic development and health care. In the first decade of the 2000s, the Ministry of Health (MoH) developed a series of programs focused on reducing infant mortality, including the Family Health Program as a national policy for primary care. In this paper, we propose a method to correct underreporting of deaths and live births. After vital statistics are corrected, infant mortality trends are analyzed for the period 2000–2010 by macro-geographical region.MethodsA proactive search of live births and deaths was carried out in the Amazon and Northeast regions in 2010 to find vital events that occurred in 2008 and were not reported to the Ministry of Health. The probabilistic sample of 133 municipalities was stratified by adequacy of vital information reporting. For each municipality, the adequacy analysis was based on the reported age-standardized mortality rate per 1,000 population and the ratio between reported and estimated live births. Correction factors were estimated by strata based on additional vital events found in the proactive search. The procedure was generalized to correct municipal vital statistics for the period 2000–2010.ResultsIn the proactive search, 35% of non-reported deaths were found within the health system (hospitals and other health establishments), but 28% were found in non-official sources, like illegal cemeteries. In areas of extreme poverty and unreliable vital information, the estimated completeness of infant death reporting was only 33%. After correction of vital information, the estimated infant mortality rate decreased from 26.1 in 2000 to 16.0 in 2010, with an annual rate of decrease of 4.7%, greater than the required rate to achieve the Millennium Development Goal. Among Brazilian regions, the Northeast showed the largest decrease, from 38.4 to 20.1 per 1,000 live births.ConclusionsThe proactive search for vital events was shown to be a good strategy both in terms of understanding local irregularities and for correcting vital statistics. The methodology could be applied in other countries to routinely assess the pattern and extent of birth and death under-registration in order to improve the utility of these data to inform health policies.

Household Headship and Infant Mortality in India: Evaluating the Determinants and Differentials

There has been ample discussion on the levels and trends of infant mortality in India over time, but what remains less explored are, the differentials in infant mortality according to household headship. This paper examined the differences in the determinants of infant mortality between male-headed households (MHH) and female-headed households (FHH). The study used Cox proportional hazard model to examine the determinants of infant death, and Kaplan-Meier estimation technique to examine the survival pattern during infancy using data from Indian National Family Health Survey (2005-06). The analysis is restricted to women who had at least one live birth in the five years preceding the survey. The study observed that household size and number of children below five are significant risk factors of infant mortality in MHH while length of previous birth interval is the only significant risk factor of infant death in FHH. The results indicate that children from FHH have higher survival probability at each age than children from MHH irrespective of place of residence and sex of the child.

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.

Extremely Low Birth Weight and Infant Mortality Rates in the United States

Infant mortality rates (IMR) and neonatal mortality rates (NMR) in the United States have not decreased recently. The purpose of this study was to determine the contributions of birth weight and gestational age subgroups to the IMR and NMR in the United States. We used the most recent (1983-2005) US linked birth and infant death data and simple regression analysis to determine the contributions of specific birth weight and gestational age subgroups to trends in IMR and NMR. IMR and NMR decreased between 1983 and 2005 for all birth weight and gestational age subgroups. There was an increase in births of very low birth weight infants from 1.2% to 1.5% (P < .001) over this period. The proportion of very low birth weight-infant deaths increased from 42.9% to 54.8%, resulting in recent nonsignificant declines in IMR and NMR. The proportion of live-birth infants <500 g increased from 0.12% to 0.18% (P < .001). The adjusted IMR and NMR over time (excluding infants <500 g) have steeper declining trends than the ones including infants <500 g. The changes in overall IMR and NMR in recent years (2000-2005) are not statistically significant. However, the adjusted IMR and NMR trends during this time are highly significant. The increased proportions of infants <500 g and other low birth weight infants contribute greatly to the lack of a decrease in IMR and NMR from 2000 to 2005, although birth weight- and gestational age-specific IMR and NMR continue to decrease.

Geographical disparities in child mortality in the rural areas of Iran: 16-years trend

PurposeWe performed this study to assess the trend of geographical disparities between rural areas located in the catchment areas of 41 medical universities in Iran from 1993 to 2008. We...

Stagnant neonatal mortality and persistent health inequality in middle-income countries: a case study of the Philippines.

BackgroundThe probability of survival through childhood continues to be unequal in middle-income countries. This study uses data from the Philippines to assess trends in the prevalence and distribution of child mortality and to evaluate the country’s socioeconomic-related child health inequality.MethodologyUsing data from four Demographic and Health Surveys we estimated levels and trends of neonatal, infant, and under-five mortality from 1990 to 2007. Mortality estimates at national and subnational levels were produced using both direct and indirect methods. Concentration indices were computed to measure child health inequality by wealth status. Multivariate regression analyses were used to assess the contribution of interventions and socioeconomic factors to wealth-related inequality.FindingsDespite substantial reductions in national under-five and infant mortality rates in the early 1990s, the rates of declines have slowed in recent years and neonatal mortality rates remain stubbornly high. Substantial variations across urban-rural, regional, and wealth equity-markers are evident, and suggest that the gaps between the best and worst performing sub-populations will either be maintained or widen in the future. Of the variables tested, recent wealth-related inequalities are found to be strongly associated with social factors (e.g. maternal education), regional location, and access to health services, such as facility-based delivery.ConclusionThe Philippines has achieved substantial progress towards Millennium Development Goal 4, but this success masks substantial inequalities and stagnating neonatal mortality trends. This analysis supports a focus on health interventions of high quality – that is, not just facility-based delivery, but delivery by trained staff at well-functioning facilities and supported by a strong referral system – to re-start the long term decline in neonatal mortality and to reduce persistent within-country inequalities in child health.

Has the Rate of Reduction in Infant Mortality Increased in India Since the Launch of National Rural Health Mission? Analysis of Time Trends 2000-2009 with Projection to 2015.

National Rural Health Mission (NRHM) - India was launched in 2005 to tackle urban-rural health inequalities, especially in maternal and child health. We examined national and state level trends in Infant Mortality Rates (IMR) from 2000 through 2009 to: 1) assess whether the NRHM had increased the average annual reduction rate (AARR) of IMR 2) evaluate state-wise progress towards Millennium Development Goals (MDG4) and estimate required AARRs for 'off track' states. Log-linear regression models were applied to national and state IMR data collated from the Sample Registration System (SRS)-India to estimate average annual reduction rates and compare AAARs before and after introduction of NRHM. The log-linear trend of infant mortality rates was also projected forward to 2015. The infant mortality rate in rural India declined from 74 to 55/1000 live births between 2000 and 2009, with AARR of 3.0% (95% CI=2.6%-3.4%) and the urban-rural gap in infant mortality narrowed (p =0.036). However there was no evidence (p=0.49) that AARR in rural India increased post NRHM (3.4%, 95% CI 2.0-4.7%) compared to pre NRHM (2.8%, 95% CI 2.1%-3.5%). States varied widely in rates of infant mortality reduction. Projections of infant mortality rates suggested that only eight states might be on track to help India achieve MDG4 by 2015. Despite a narrowing urban-rural gap and high AARRs in some states, there was no evidence that the rate of reduction in infant mortality has increased in rural India post NRHM introduction. India appears unlikely to achieve child survival-related NRHM and millennium development goals. Government should revisit the child survival related NRHM strategies and ensure equitable access to health services. More robust monitoring and evaluation mechanisms must be inbuilt for following years.

Levels and Trends of Fertility and Infant Mortality in the West Bank—Palestine

AbstractThis study aims at tracing and analyzing the prevailing trends and up-to-date levels of fertility rates, and infant and child mortality, among Palestinians in the occupied territories of the West Bank, depending on recent data from sample surveys conducted in the last two decades. The paper sheds light on the socioeconomic factors besides the medical ones. The findings show that fertility transition is, continuously, in progress; it is considered high compared to other countries, although data of the last decade of the last century revealed that fertility is declining. The researcher also finds that infant and child mortality is declining, despite being high, compared to other countries around the globe. These results may be attributed to improvement in the quality of life, access to medical services, development of health services, and increased health awareness among the population. To attain better results, the researcher calls for improving the quality of care and creating a culture of medical responsibility and accountability among citizens—let alone ending of the long dispute among the major Palestinian factions.

Developing a standard approach to examine infant mortality: findings from the State Infant Mortality Collaborative (SIMC).

States can improve pregnancy outcomes by using a standard approach to assess infant mortality. The State Infant Mortality Collaborative (SIMC) developed a series of analyses to describe infant mortality in states, identify contributing factors to infant death, and develop the evidence base for implementing new or modifying existing programs and policies addressing infant mortality. The SIMC was conducted between 2004 and 2006 among five states: Delaware, Hawaii, Louisiana, Missouri, and North Carolina. States used analytic strategies in an iterative process to investigate contributors to infant mortality. Analyses were conducted within three domains: data reporting (quality, reporting, definitional criteria, and timeliness), cause and timing of infant death (classification of cause and fetal, neonatal, and postneonatal timing), and maturity and weight at birth/maturity and birth weight-specific mortality. All states identified the SIMC analyses as useful for examining infant mortality trends. In each of the three domains, SIMC results were used to identify important direct contributors to infant mortality including disparities, design or implement interventions to reduce infant death, and identify foci for additional analyses. While each state has unique structural, political, and programmatic circumstances, the SIMC model provides a systematic approach to investigating increasing or static infant mortality rates that can be easily replicated in all other states and allows for cross-state comparison of results.

Reducing Neonatal Mortality in Jhagadia Block, Gujarat: We Need to go Beyond Promoting Hospital Deliveries

We examined data from a cohort of births that occurred in the period 2004-08 in the SEWA-Rural project area, covering a population of ∼175000, in Gujarat, India, to assess the trends and risk factors for neonatal mortality. In this population living in 168 villages, there has been a significant declining trend in infant and neonatal mortality, more marked in the tribal population, in whom this paralleled a rise in the proportion of women delivering in hospitals. The more important risk factors for neonatal mortality risk to emerge from multivariate analysis are low birth weight, prematurity, young age of mother, older mother and high birth order. Although community based interventions along with promotion of hospital birth has an impact in reducing neonatal deaths in this community, sustaining this momentum may demand more long-term policy interventions to promote better living standards and better reproductive health.

Preconception Women’s Health and Pediatrics: An Opportunity to Address Infant Mortality and Family Health

THE U.S. INFANT mortality rate remains unacceptably high, with large disparities found by race. Increasingly, research has demonstrated that interventions must go beyond ensuring access to care and prenatal focus to address the preconception health of women. Critical fetal development occurs in the earliest weeks after conception, often before a woman is aware of her pregnancy. The Maternal Child Health Bureau’s life course initiatives and the Centers for Disease Control’s preconception health initiatives are placing infant mortality and child health in a life course context, that is, uniting the reproductive health and pediatric longitudinal perspectives. In the recent report “Clinical Preventive Services forWomen”, the Institute ofMedicine recommended annual well-women visits incorporating preconception care, and Healthy People 2020 includes a section of objectives on preconception health and behaviors. With growing scientific recognition that early antecedents of child and adult health start prenatally and even preconceptionally, women’s health is key. Pediatric clinicians have been leaders in the efforts to reduce infant mortality and in family-centered care, but how can pediatrics further contribute? A golden opportunity exists to serve as preconception care (PCC) clinicians for preconceptional adolescents and interconceptional mothers seen in practice.

Trends and variations in infant mortality among 47 prefectures in Japan

To determine IMR trends and regional variations among 47 prefectures in Japan and to identify associated population-based factors. We conducted an ecological study of infant mortality rate (IMR) by analyzing publicly available data from the Ministry of Health, Labour and Welfare of Japan. Outcome measure for trend is the IMR for each of 47 prefectures from 1999 to 2007; for variation, IMRs for 2006 and 2007 in each prefecture were averaged. We considered as covariates prefecture-level variables related to public health, socio-economic status, clinical services and health care facilities. We conducted multivariate statistical analyses to determine covariates most strongly associated with both 1999-2007 IMR trends and 2006-2007 IMR. The mean IMR decreased from 3.42 deaths per 1000 live births (range 2.1 to 5.1) in 1999 to 2.54 (range 1.5 to 4.4) in 2007; reductions were greater in prefectures with higher concentrations of public health nurses (PHNs) and nurses. In 2006-2007, nine prefectures had IMRs ≤ 2.25; eight had IMRs ≥ 3.0. When low-, moderate- and high-IMR prefectures were compared, per capita PHNs, maternal education, centralized water supply and household income were identified as significant covariates. Both national and prefecture-level IMR in Japan decreased from 1999 to 2007; however, the degree of reduction varied by prefecture. Given that more nurses and PHNs per capita were associated with greater IMR reductions from 1999 to 2007 and more PHNs with lower 2006-2007 IMRs, distribution of preventive health services may play a major role in reducing regional disparities in IMR.

Trends of Mortality Indicators in Nagaland: A Time Series Analysis

Health is one of the vital aspects of human life. In the present modernized era, people are more conscious about their health. Since the last 62 years after independence, India has developed significantly in the health sector and as a result the country succeeded in many ways in controlling various diseases. Nagaland, being a poor tribal hill state also succeeded in many ways in controlling infant mortality rate, birth rate, death rate etc. Basic objective of the present study is to study the trend of infant mortality rate, birth rate and death rate in relation to various factors associated with their changes in Nagaland in comparison to the country as a whole, mostly during the period 1997-2008. This study is based entirely on secondary data. Infant mortality rate in Nagaland showed an increase over the years as against a declining trend seen in the country. However, infant mortality rate was recorded a bit low in Nagaland as compared to the rest of the country. Increase in infant mortality rate was reported in Nagaland mostly because of improper and unhygienic delivery at home for most of the cases. The percentage of pregnant women who received all types of care, pre and post natal, in Nagaland was recorded the lowest among the North Eastern States.

Análise de tendências das taxas de mortalidade infantil e de seus fatores de risco na cidade de Porto Alegre, Rio Grande do Sul, Brasil, no período de 1996 a 2008

The aim of this article was to determine trends in infant mortality and related risk factors in Porto Alegre, Rio Grande do Sul State, Brazil. The study was based on data from a live birth and infant death registry for the years 1996 to 2008. Times trends were analyzed for overall and partial infant mortality rates according to maternal schooling, number of prenatal visits, maternal age, number of live and dead children, sex of the newborn, type of delivery, birth weight, and type of hospital. Poisson regression was used to estimate the influence of socioeconomic status and other risk factors. The infant mortality rate dropped among mothers with less than 11 years of schooling. There were no significant changes among newborns of mothers with 12 or more years of schooling. Maternal socioeconomic status was the factor most closely associated with the reduction in infant mortality. Still, the downward trend failed to achieve its full potential, due to the increase in low birth weight.

Reasons for the Increasing Hispanic Infant Mortality Rate: Florida, 2004–2007

Assess whether the 55% increase in Florida's Hispanic infant mortality rate (HIMR) during 2004-2007 was real or artifactual. Using linked data from Florida resident live births and infant deaths for 2004-2007, we calculated traditional (infant Hispanic ethnicity from death certificates and maternal Hispanic ethnicity from birth certificates) and nontraditional (infant and maternal Hispanic ethnicity from birth certificate maternal ethnicity) HIMRs. We assessed trends in HIMRs (per 1,000 live births) using Chi-square statistics. We tested agreement in Hispanic ethnicity after implementation of a revised 2005 death certificate by using kappa statistics and used logistic regression to test the associations of infant mortality risk factors. Hispanic was defined as being of Mexican, Puerto Rican, Cuban, Central/South American, or other/unknown Hispanic origin. During 2004-2007 traditional HIMR increased 55%, from 4.0 to 6.2 (Chi-square, P < 0.001) and nontraditional HIMR increased 20%, from 4.5 to 5.4 (Chi-square, P = 0.03). During 2004-2005, agreement in Hispanic ethnicity did not change with use of the revised certificate (kappa = 0.70 in 2004; kappa = 0.76 in 2005). Birth weight was the most significant risk factor for trends in Hispanic infant mortality (OR = 1.33, 95% CI = 1.10-1.61). Differences in Hispanic reporting on revised death certificates likely accounted for the majority of traditional HIMR increase, indicating a primarily artifactual increase. Reasons for the 20% increase in nontraditional HIMR during 2004-2007 should be further explored through other individual and community factors. Use of nontraditional HIMRs, which use a consistent source of Hispanic classification, should be considered.

Levels and trends in under-five mortality in Zimbabwe: findings from an analysis of recent Demographic and Health Surveys

This study describes levels and trends in infant and childhood mortality in Zimbabwe over the past 50 years with emphasis on the past fifteen years. The most important data source consisted of four Demographic and Health Surveys (DHS) surveys conducted in Zimbabwe between 1988 and 2005-06. Under-five mortality increased between 1990-1994 and 1995-1999 (from 77 per 1,000 live births to 102) and declined from 1995-1999 to 2001-2005 (from 102 to 82). The decline in this last period, as derived from Zimbabwe DHS 2005-06, was unexpected and probably not genuine. A great deal of evidence is presented to support the view that this decline in mortality probably did not take place. It is much more likely that both infant and under-five mortality increased in the period between 1995-1999 and 2001-2005. Using various procedures, this study estimates that the under-five mortality rate would actually be about 110 per 1,000 live births in 2001-2005 instead of 82 as observed in the Zimbabwe DHS 2005-06. These and other results are expected to assist policy makers and programme managers in the child health sector to formulate appropriate strategies to improve the health and well-being of children under-five in Zimbabwe.

Extremely Preterm Infant Mortality Rates and Cesarean Deliveries in the United States

To estimate trends in infant mortality rates and cesarean delivery rates for extremely preterm infants born in the United States. This national population-based study used public data from the Centers for Disease Control and Prevention to investigate extremely preterm infants born alive between 22 0/7 and 27 6/7 weeks of gestational age from 1999 to 2005. There were 177,552 extremely preterm infant births (fewer than 1% of all births) from 1999 to 2005. The number of annual extremely preterm births increased by 7% compared with a 4.5% increase for births at all gestations. During the study years, the extremely preterm infant mortality rate (percentage of infants who died in the first year) remained steady (range 33-34%; P=.22), whereas the cesarean delivery rate increased from 43% to 54% (P<.001). The infant mortality rate after cesarean delivery increased from 24% to 26% (P=.012). At each gestational age, the annual cesarean delivery rate increased over time (P<.001 for each), whereas gestational age-specific infant mortality rates were unchanged except for a 2% decline from 2004 to 2005 for infants born at 24 weeks of gestation (P=.01). A significant rise in the cesarean delivery rate in the United States from 1999 to 2005 for infants born at less than 28 weeks of gestation was not associated with an improvement in the infant mortality rate.

Anencephaly related infant mortality in Argentina: spatial and temporal analysis (1998-2007)

Analyze the spatial and temporal distribution of infant mortality by anencephaly in Argentina in relation with folic acid fortification phases. Data came from certificates of live births and deaths in children under 1 year, for the 1998-2007 period (Argentine Ministry of Health). The infant mortality rate attributable to anencephaly for Argentina, geographical regions, provinces and departments were estimated according to the different phases of mandatory fortification with folic acid. Secular trend of infant mortality rate attributable to anencephaly and death risk due to anencephaly, spatial distribution by infant mortality rate attributable to anencephaly cluster and its correlation to latitude and longitude were also analyzed. Reduced risk of mortality due to anencephaly (53%) was observed at national level. The greatest decline occurred in Cuyo (69%) and lowest in the Northeast (35%) at regional level. Considerable infant mortality rate attributable to anencephaly heterogeneity was found at departmental level and less at provincial level. A cluster of 5.15/10 000 infant mortality rate attributable to anencephaly was identified in the northeast of Buenos Aires province, consisting of 29 departments, significantly different from the rest of the country. While there was a statistically significant negative secular trend of infant mortality rate attributable to anencephaly, spatial disparities persist. The geographical distribution of anencephaly would guide the search for environmental/ genetic risk factors and strengthen primary prevention strategies, through mandatory fortification, folate intake and folic acid supplementation.

Infant mortality and its leading causes in Sichuan province, from 2001 to 2009

To study the trend of infant mortality and the leading cause of the deaths in Sichuan province from 2001 to 2009. Data presented in this report was obtained from the child mortality surveillance network with target population as children under 5 years of age. Rates on infant mortality, neonatal mortality and indirect estimation of infant mortality were calculated. The neonatal mortality rate and infant mortality rate in Sichuan dropped from 18.6, 25.5 in 2001 to 7.6, 12.1 per 1000 live birth in 2009, with rates of decline as 59.1% and 35.0%, from 2001 to 2009. In urban areas of Sichuan, the neonatal and infant mortality rates dropped from 4.7, 7.5 in 2001 to 3.7 and 6.5 per 1000 live birth in 2009, with the rates of decline as 22.3% and 13.1%. In the rural areas of Sichuan, the neonatal and infant mortality rates dropped from 25.2 and 34.0 in 2001 to 9.6, 14.3 per 1000 live birth in 2009, with rates of decline as 62.0%, 57.9% from 2001 to 2009. In both urban and rural areas, the neonatal and infant mortality rates had decreased drastically from 2001 to 2009, due to the decrease of avoidable deaths as pneumonia and diarrhea in infants.

Low infant mortality among Palestine refugees despite the odds

To present data from a 2008 infant mortality survey conducted in Jordan, Lebanon, the Syrian Arab Republic, the Gaza Strip and the West Bank and analyse infant mortality trends among Palestine refugees in 1995-2005. Following the preceding birth technique, mothers who were registering a new birth were asked if the preceding child was alive or dead, the day the child was born and the date of birth of the neonate whose birth was being registered. From this information, neonatal, infant and early child mortality rates were estimated. The age at death for early child mortality was determined by the mean interval between successive births and the mean age of neonates at registration. In 2005-2006, infant mortality among Palestine refugees ranged from 28 deaths per 100 000 live births in the Syrian Arab Republic to 19 in Lebanon. Thus, infant mortality in Palestine refugees is among the lowest in the Near East. However, infant mortality has stopped decreasing in recent years, although it remains at a level compatible with the attainment of Millennium Development Goal 4. Largely owing to the primary health care provided by the United Nations Relief and Works Agency (UNRWA) for Palestine Refugees in the Near East and other entities, infant mortality among Palestine refugees had consistently decreased. However, it is no longer dropping. Measures to address the most likely reasons - early marriage and childbearing, poor socioeconomic conditions and limited access to good perinatal care - are needed.