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Copyright of Cahiers de l'IREA is the property of L'Harmattan Edition Diffusion and its content may not be copied or emailed to multiple sites or posted to a listserv without the copyright holder's express written permission. However, users may print, download, or email articles for individual use. This abstract may be abridged. No warranty is given about the accuracy of the copy. Users should refer to the original published version of the material for the full abstract. (Copyright applies to all Abstracts.)

Background: Tonga is a South Pacific Island country with a population of 100,651 (2016 Census). This study examines Tongan infant mortality rates (IMR), under-five mortality rates (U5MR), adult mortality and life expectancy (LE) at birth from 2010 to 2018 using a recent collation of empirical mortality data over the past decade for comparison with other previously published mortality estimates.Methods: Routinely collected mortality data for 2010-2018 from the Ministry of Health, national (Vaiola) hospital, community nursing reports, and the Civil Registry, were consolidated by deterministic and probabilistic linkage of individual death records. Completeness of empirical mortality reporting was assessed by capture-recapture analysis. The reconciled data were aggregated into triennia to reduce stochastic variation, and used to estimate IMR and U5MR (per 1000 live births), adult mortality (15-59, 15-34, 35-59, and 15-64 years), and LE at birth, employing the hypothetical cohort method (with statistical testing). Mortality trends and differences were assessed by Poisson regression. Mortality findings were compared with published national and international agency estimates.Results: Over the three triennia in 2010-2018, levels varied minimally for IMR (12-14) and U5MR (15-19) per 1000 births (both ns, p > 0.05), and also for male LE at birth of 64-65 years, and female LE at birth 69-70 years. Cumulated risks of adult mortality were significantly higher in men than women; period mortality increases in 15-59-year women from 18 to 21% were significant (p < 0.05). Estimated completeness of the reconciled data was > 95%. International agencies reported generally comparable estimates of IMR and U5MR, with varying uncertainty intervals; but they reported significantly lower adult mortality and higher LE than the empirical estimates from this study.Conclusions: Life expectancy in Tonga over 2010-2018 has remained relatively low and static, with low IMR and U5MR, indicating the substantial impact from premature adult mortality. This analysis of empirical data (> 95% complete) indicates lower LE and higher premature adult mortality than previously reported by international agencies using indirect and modelled methods. Continued integration of mortality recording and data systems in Tonga is important for improving the completeness and accuracy of mortality estimation for local health monitoring and planning. [ABSTRACT FROM AUTHOR]

This paper deals with the analysis of the under-5 mortality rate series in the G7 countries by using fractional integration techniques, including structural breaks and potential nonlinearities in the data. Several features were detected in the results: Firstly, we observed that for the neonatal data, the order of integration is equal to or higher than one in all cases, contrary to what happens for the remaining cases (< 1– < 5 years) where mean reversion is found in many cases, especially as we increase the age of death. Thus, shocks affecting the neonatal (< 1 month from delivery) mortality rates will have permanent effects requiring special attention to recover the original trends. As expected, all the time trend coefficients were significantly negative and the highest reduction in the mortality rates was obtained in Japan, which might be related with the 17-year increase in life expectancy for the country. Due to the sensitivity of the methodological approaches, the use of robust time series approaches when analyzing child mortality rates is highly recommended. [ABSTRACT FROM AUTHOR]

United Nations agencies report that by 1998, Iraqi infant mortality had risen from the pre-Gulf War rate of 3.7% to 12%. Insufficient food and medical supplies and deterioration of sewage and sanitation systems and electrical power systems reportedly caused an increase of 40,000 deaths annually of children under the age of 5 and of 50,000 deaths annually of older Iraqis. Why is this violence on Iraqis absent from analyses of sanctions in international relations and security studies? This paper is concerned with, first, situating sanctions against the Global South as violence by challenging the conventional theorisation of violence inflicted by the hegemon as a mechanism of 'national security'. Second, we offer a decolonial reading of the sanctions imposed on Iraq by shifting the locus of enunciation from the state to Iraqi people's suffering. [ABSTRACT FROM AUTHOR]

Big India has achieved high rates of economic growth post after economic liberalization in 1991. A sustained level of high growth was achieved resulting in a large GDP for the country. India is today the 6th largest economy (in terms of nominal GDP) of the world with a GDP of 2.597 trillion USD (Ranking of countries on gross domestic product as on 2017 by World Bank). However this GDP growth has not led to much improvement in social development indicators. One of the key social development indicators pertaining to health is infant mortality rate (IMR). Although, the initiatives of Government of India to bring down the infant mortality rate (IMR) have earned its kudos, they are not enough. Moreover, this improvement in IMR is not uniform across the country. In India, BIMARU (acronym of four Indian states Bihar, Madhya Pradesh, Rajasthan and Uttar Pradesh) states are economically poor and having serious deficit in health awareness. Therefore, any improvement in the overall IMR of the country cannot happen without improving the indicator significantly in these BIMARU states. This paper attempts to identify the determinants of IMR for the BIMARU states. A basic regression model (pooled OLS) of IMR has been developed on the basis of data collected from the Annual Health Survey (AHS) for 184 districts of BIMARU states for 3 consecutive years (2011, 2012 and 2013). The analysis presented in this paper lays out the determinants of IMR in BIMARU states in India and argues in favor of developing targeted initiatives to improve IMR. [ABSTRACT FROM AUTHOR]

Using a panel data set of Indian states between 1983–1984 and 2011–2012, this paper studies the impact of public health expenditure on the infant mortality rate (IMR), after controlling for other relevant covariates like political competition, per capita income, female literacy, and urbanisation. We find that public expenditure on health care reduces the IMR. Our baseline specification shows that an increase in public health expenditure by 1 per cent of state-level net domestic product is associated with a reduction in the IMR by about nine infant deaths per 1000 live births. We also find that political competition, female literacy and urbanisation reduce the IMR. [ABSTRACT FROM PUBLISHER]

Background: The human immunodeficiency virus (HIV) continues to be a major cause of maternal and infant mortality and morbidity in sub-Saharan Africa. Prevention of mother-to-child transmission of HIV (PMTCT) strategies have proven effective in decreasing the number of children infected in utero, intrapartum and during the breastfeeding period. This qualitative study explores knowledge and perceptions of HIV amongst pregnant women, healthcare workers' experiences of the national PMTCT services, and barriers to PMTCT, during a period of programme scale-up in urban Guinea-Bissau (2010-11).Methods: In-depth interviews were undertaken amongst 27 women and 19 key informants at local antenatal clinics and the national maternity ward in Bissau, Guinea-Bissau.Results: Amongst women who had been tested for HIV, awareness and knowledge of HIV and PMTCT remained low. Testing without informed consent was reported in some cases, in particular when the test was performed around the time of delivery. Possible drivers of inadequate counselling included lack of confidentiality, suboptimal healthcare worker training, lack of time, and perceived occupational risk. Demand-side barriers to PMTCT included lack of HIV and PMTCT knowledge, customary and cultural beliefs associated with HIV and ill-health, HIV stigma and discrimination, and fear of partnership dissolution.Conclusions: Socio-cultural and operational challenges, including HIV testing without informed consent, present significant barriers to the scale-up of PMTCT services in Bissau. Strengthening local capacity for effective counselling and testing in the antenatal setting is paramount. Further research into local customary beliefs relating to HIV is warranted. [ABSTRACT FROM AUTHOR]

The classic theory used to explain the demographic transition assumes that mortality is the key explanatory variable influencing the decline in fertility. However, the empirical results obtained in what is known as the Princeton European Fertility Project have led many specialists to question this assumption. Using both national and provincial aggregated data for 25 countries over a long time span, the analysis reported in this paper found that mortality does indeed play a fundamental role in accounting for the main demographic changes that occurred both before and during the transitional period. Others’ research based on individual data has shown clearly that the number of surviving children was indeed an important factor for reproductive decisions. My analysis, using aggregated data, reached largely similar conclusions regarding the role of mortality in changing reproductive trends, via its impact on nuptiality and marital fertility at different stages of the demographic transition. [ABSTRACT FROM PUBLISHER]

Researchers and policymakers often rely on the infant mortality rate as an indicator of a country's health. Despite arguments about its relevance, uniform measurement of infant mortality is necessary to guarantee its use as a valid measure of population health. Using important socioeconomic indicators, we develop a novel method to adjust country-specific reported infant mortality figures. We conclude that an augmented measure of mortality that includes both infant and late fetal deaths should be considered when assessing levels of social welfare in a country. In addition, mortality statistics that exhibit a substantially high ratio of late fetal to early neonatal deaths should be more closely scrutinized. [ABSTRACT FROM AUTHOR]

The article offers information on the NEWBORN Act that would help address the problem of infant mortality by awarding of grants to infant mortality pilot programs that seek to address one or more of the top five reasons for infant mortality. It mentions the federal policy would focus on targeting areas of the country with high rates of infant mortality; and also mentions that number corresponds to the reality that 982 Ohio infants died before their first birthday in 2017.

Background: Hypothermia is associated with increased morbidity and mortality rates. Preterm infants frequently have hypothermia when they are admitted to the NICU, but there is no data on the occurrence of hypothermia during the first hours after admission. Objective: To investigate the occurrence of hypothermia in preterm infants in the first three hours of admission and to identify risk factors. Methods: Infants < 32 weeks of gestation included in a randomized trial with admission temperature as primary outcome were retrospectively analyzed for the occurrence of hypothermia (< 36.5°C) in the first three hours after admission. Risk factors were identified using linear regression analysis and logistic regression. Results: In total 80 infants were included with a median (IQR) gestational age at birth of 29 (27–30) weeks. In 93% of the infants hypothermia occurred in the first three hours after admission. The median (IQR) duration of hypothermia was 101 (34–162) minutes, of which 24 (7–52) minutes the hypothermia was mild, 45 (4–111) minutes moderate, severe hypothermia hardly occurred. Gestational age and the occurrence of hypothermia at birth were independent risk factors for the occurrence of moderate and severe hypothermia and significantly correlated with duration of hypothermia. Conclusions: Hypothermia occurred often and for a long period in preterm infants in the first three hours of life, low gestational age and admission temperature were independent risk factors [ABSTRACT FROM AUTHOR]

To propose three methods to estimate associations between pregnancy exposures and outcomes before term, including the association between preeclampsia and preterm fetal-infant mortality, while avoiding the selection bias found in conventional analytic designs. Population-level analysis of 1,099,839 women who delivered live or stillborn infants in Quebec hospitals from 1989 to 2012, covering nearly a quarter of Canadian births. The exposure of interest was preeclampsia at 20-29, 30-33, 34-36, and ≥37 weeks of gestation. We compared preeclamptic with non-preeclamptic pregnancies in parametric survival models with a Weibull distribution using three analytic designs: (1) fetuses-at-risk; (2) bias correction factors; and (3) analysis of pregnancies at high risk of preterm delivery. Main outcome measures were occurrence of fetal or postnatal infant death before discharge. In models affected by bias due to selection of preterm births, women with preeclampsia early in gestation had paradoxically lower risks of fetal and infant mortality than women without preeclampsia. All three analytic approaches reversed the associations, showing a harmful effect of preeclampsia before term. At 20-29 weeks, for example, preeclampsia was associated with 1.35 times the risk of infant mortality (95 % confidence interval 1.14-1.60) and 1.40 times the risk of stillbirth (95 % confidence interval 1.18-1.67) with the fetuses-at-risk approach. Paradoxically protective benefits of exposures such as preeclampsia before term are artifacts of inappropriate analytic design. Outcomes before term should be analyzed with care, using methods that address bias due to selection of preterm deliveries. [ABSTRACT FROM AUTHOR]

Aim: To investigate how two different strategies to form larger neonatal intensive care units (NICU) impact neonatal mortality rates. Methods: Cross-sectional study modeling admission volumes and mortality rates of 177,086 VLBW infants aggregated into 862 NICUs. Cumulative 3-year data was abstracted from Vermont Oxford Network. The model simulated a reduction in number of NICUs by stepwise exclusion using either admission volume (VOL) or quality (QUAL) cut-offs. After randomly redirecting infants of excluded to remaining NICUs resulting system mortality rates were calculated with and without adjusting for effects of experience levels (EL) using published data to reflect effects of different team-to-patient exposure. Results: The quality-based strategy is more effective in reducing mortality; while VOL alone was not able to reduce system mortality, QUAL already achieved a 5% improvement after reducing 8% of NICUs and redirecting 6% of infants. Including “EL”, a 5% improvement of mortality was achieved by reducing 77% (VOL) vs. 7% (QUAL) of NICUs and redirecting 54% (VOL) vs. 5% (QUAL) of VLBW infants, respectively. Conclusion: While a critical number of admissions is needed to maintain skills this study emphasizes the importance of including quality parameters to restructure neonatal care. The findings can be generalized to other medical fields. [ABSTRACT FROM AUTHOR]

As an emerging research area, application of satellite-based nighttime lights data in the social sciences has increased rapidly in recent years. This study, building on the recent surge in the use of satellite-based lights data, explores whether information provided by such data can be used to address attenuation bias in the estimated coefficient when the regressor variable, Gross Domestic Product (GDP), is measured with large error. Using an example of a study on infant mortality rates (IMRs) in the People’s Republic of China (PRC), this paper compares four models with different indicators of GDP as the regressor of IMR: (1) observed GDP alone, (2) lights variable as a substitute, (3) a synthetic measure based on weighted observed GDP and lights, and (4) GDP with lights as an instrumental variable. The results show that the inclusion of nighttime lights can reduce the bias in coefficient estimates compared with the model using observed GDP. Among the three approaches discussed, the instrumental-variable approach proves to be the best approach in correcting the bias caused by GDP measurement error and estimates the effect of GDP much higher than do the models using observed GDP. The study concludes that beyond the topic of this study, nighttime lights data have great potential to be used in other sociological research areas facing estimation bias problems due to measurement errors in economic indicators. The potential is especially great for those focusing on developing regions or small areas lacking high-quality measures of economic and demographic variables. [ABSTRACT FROM AUTHOR]

Objectives: The objective of the study was to identify the frequency of causes of intrauterine fetal deaths in patients presenting to a tertiary care setting. Study Design: Cross Sectional Survey. Settings: Study was conducted at department of obstetrics and gynaecology, unit- ii Lahore General Hospital, postgraduate medical institute, Lahore. Duration: From April 2010 to October 2010. Results: Majority of the patients of the subjects under the study were recorded between 21-30 years of age with mean age 26.24±3.58 years. Distribution of of causes of intrauterine fetal death shows 42% (n=63) with no cause, 23.33% (n=35) with more than two causes, 20.67% (n=31) with two causes and 14%(n=21) with one cause. Hypertensive disorders 41.43%(n=62), unexplained 42%(n=63), 35.33%(n=53) were found with physical injuries, 17%(n=24) with congenital anomaly, antiphospholipid syndrome in 14%(n=21) while diabetes mellitus was found in 12.67%(n=19) cases. Most of the women were found primiparity i.e. 49.33% (n=74), Multi para 2-4 in 31.33% (n=47) and only 19.34% (n=29) were found with > 4 grand multi para. Conclusion: The frequency of causes of intrauterine fetal death in patients presenting to a tertiary care setting shows most of the patients with hypertensive disorders, unexplained and physical injuries while antiphospholipid syndrome and diabetes mellitus were found the less common causes. [ABSTRACT FROM AUTHOR]

We investigate the effects of automobile congestion on ambient air pollution and local infant mortality rates using data from California spanning 2002 to 2007. Constructing instrumental variables (IV) using the relationship of traffic, weather conditions, and pollutants, we show that particulate matter, even at modern levels, has large marginal effects on weekly infant mortality rates, especially for premature or low birthweight infants. We also find suggestive evidence of large effects for carbon monoxide, though results are imprecise. Finally, we check estimate sensitivity to nonclassical measurement error in local pollution and show that our IV results are robust to such concerns. [ABSTRACT FROM AUTHOR]

This paper considers the relationship between healthcare expenditure (HCE) and gross domestic product using Baltagi and Li (Ann Econ Financ 3:103-116, ) semiparametric fixed effects regression estimator in a sample of 16 MENA countries over the 1995-2012 period. Findings indicate that income elasticity is not consistent but varies with income level and healthcare is a necessity for the non-oil rich countries (non-GCC) whereas it is an inferior good for the wealthiest countries in MENA; Qatar, United Arab Emirates (UAE) and Kuwait. Furthermore, it is found that the infant mortality rate per 1000 live births has a negative effect on per capita HCE in non-GCC countries and the proportion of the population age 65 and above is statistically significant in Bahrain, Oman and Saudi Arabia. [ABSTRACT FROM AUTHOR]

OBJECTIVES: This goal of this study was to shed light on the ecological context as a potential determinant of the infant mortality rate in nine high-focus states in India. METHODS: Data from the Annual Health Survey (2010-2011), the Census of India (2011), and the District Level Household and Facility Survey 3 (2007-08) were used in this study. In multiple regression analysis explanatory variable such as underdevelopment is measured by the non-working population, and income inequality, quantified as the proportion of households in the bottom wealth quintile. While, the trickle-down effect of education is measured by female literacy, and investment in health, as reflected by neonatal care facilities in primary health centres. RESULTS: A high spatial autocorrelation of district infant mortality rates was observed, and ecological factors were found to have a significant impact on district infant mortality rates. The result also revealed that nonworking population and income inequality were found to have a negative effect on the district infant mortality rate. Additionally, female literacy and new-born care facilities were found to have an inverse association with the infant mortality rate. CONCLUSIONS: Interventions at the community level can reduce district infant mortality rates. [ABSTRACT FROM AUTHOR]

Copyright of Estudios Demográficos y Urbanos is the property of El Colegio de Mexico AC and its content may not be copied or emailed to multiple sites or posted to a listserv without the copyright holder's express written permission. However, users may print, download, or email articles for individual use. This abstract may be abridged. No warranty is given about the accuracy of the copy. Users should refer to the original published version of the material for the full abstract. (Copyright applies to all Abstracts.)

Objectives: Under the prevailing conditions of imbalanced life table and historic gender discrimination in India, our study examines crossover between life expectancies at ages zero, one and five years for India and quantifies the relative share of infant and under-five mortality towards this crossover. Methods: We estimate threshold levels of infant and under-five mortality required for crossover using age specific death rates during 1981–2009 for 16 Indian states by sex (comprising of India’s 90% population in 2011). Kitagawa decomposition equations were used to analyse relative share of infant and under-five mortality towards crossover. Findings: India experienced crossover between life expectancies at ages zero and five in 2004 for menand in 2009 for women; eleven and nine Indian states have experienced this crossover for men and women, respectively. Men usually experienced crossover four years earlier than the women. Improvements in mortality below ages five have mostly contributed towards this crossover. Life expectancy at age one exceeds that at age zero for both men and women in India except for Kerala (the only state to experience this crossover in 2000 for men and 1999 for women). Conclusions: For India, using life expectancy at age zero and under-five mortality rate together may be more meaningful to measure overall health of its people until the crossover. Delayed crossover for women, despite higher life expectancy at birth than for men reiterates that Indian women are still disadvantaged and hence use of life expectancies at ages zero, one and five become important for India. Greater programmatic efforts to control leading causes of death during the first month and 1–59 months in high child mortality areas can help India to attain this crossover early. [ABSTRACT FROM AUTHOR]

Objectives. To explore the effect of Medicaid expansion on US infant mortality rate. Methods. We examined data from 2010 to 2016 and 2014 to 2016 to compare infant mortality rates in states and Washington, DC, that accepted the Affordable Care Act Medicaid expansion (Medicaid expansion states) and states that did not (non-Medicaid expansion states), stratifying data by race/ethnicity. Results. Mean infant mortality rate in non-Medicaid expansion states rose (6.4 to 6.5) from 2014 to 2016 but declined in Medicaid expansion states (5.9 to 5.6). Mean difference in infant mortality rate in Medicaid expansion versus non-Medicaid expansion states increased from 0.573 (P = .08) in 2014 to 0.838 in 2016 (P = .006) because of smaller declines in non-Medicaid expansion (11.0%) than in Medicaid expansion (15.2%) states. The 14.5% infant mortality rate decline from 11.7 to 10.0 in African American infants in Medicaid expansion states was more than twice that in non-Medicaid expansion states (6.6%: 12.2 to 11.4; P = .012). Conclusions. Infant mortality rate decline was greater in Medicaid expansion states, with greater declines among African American infants. Future research should explore what aspects of Medicaid expansion may improve infant survival. [ABSTRACT FROM AUTHOR]

A correction is provided for the article "State-Level Progress in Reducing the Black-White Infant Mortality Gap, United States, 1999-2013" from volume 107, issue five that addresses a calculation error in a table on arithmetic percent reduction in the black-white ratio.

Making effective use of digital texts is one of the major challenges facing the humanities. This article explores a novel method of using a large corpus of British newspapers to help explain why three neighboring rural districts in England showed very different patterns of infant mortality decline in the second half of the nineteenth century. Quantitative analysis does not reveal any major differences between these districts that might explain this. Repeatedly querying the corpus using different combinations of search terms and place-names, the authors show significant differences in the quality of local government between these districts. They argue that place-centered reading, as they term this approach, can be used to help explain patterns found using conventional quantitative geographical information systems (GIS) approaches. [ABSTRACT FROM PUBLISHER]

Birth month is broadly predictive of both under-5 mortality rates and stunting throughout most of sub-Saharan Africa (SSA). Observed factors, such as mother’s age at birth and educational status, are correlated with birth month but are not the main factors underlying the relationship between birth month and child health. Accounting for maternal selection via a fixed-effects model attenuates the relationship between birth month and health in many SSA countries. In the remaining countries, the effect of birth month may be mediated by environmental factors. This study found that birth month effects on mortality typically do not vary across age intervals; the differential mortality rates by birth month are evident in the neonatal period and continue across age intervals. The male-to-female sex ratio at birth did not vary by birth month, which suggests that in utero exposures are not influencing fetal loss, and that therefore the birth month effects are not likely a result of selective survival during the in utero period. In one-third of the sample, the birth month effects on stunting diminished after the age of 2 years; therefore, some children were able to catch up. Policies to improve child health should target pregnant women and infants and must take seasonality into account. [ABSTRACT FROM PUBLISHER]

Background: Almost all (99%) neonatal deaths arise in low-income and middle-income countries. Approximately 450 new-born children die every hour, which is mainly from preventable causes. There has been increased recognition of the need for these countries to implement public health interventions that specifically target neonatal deaths. The purpose of this paper is to identify the predictors of neonatal death in Type 4 rural (poorest) counties in Shaanxi Province of northwestern China. Methods: A cross-sectional study was conducted in Shaanxi Province, China. A single-stage survey design was identified to estimate standard errors. Because of concern about the complex sample design, the data were analysed using multivariate logistic regression analysis. Socioeconomic and maternal health service utilization factors were added into the model. Results: During the study period, a total of 4750 women who delivered in the past three years were randomly selected for interview in the five counties. There were 4880 live births and 54 neonatal deaths identified. In the multiple logistic regression, the odds of neonatal death was significantly higher for multiparous women (OR = 2.77; 95% CI: 1.34, 5.70) and women who did not receive antennal health care in the first trimester of pregnancy (OR = 2.49; 95% CI: 1.41, 4.40). Women who gave birth in a county-level hospital (OR = 0.18; 95% CI: 0.04, 0.86) and had junior high school or higher education level (OR = 0.20; 95% CI: 0.05, 0.84) were significantly protected from neonatal death. Conclusions: Public health interventions directed at reducing neonatal death should address the socioeconomic factors and maternal health service utilization, which significantly influence neonatal mortality in rural China. Multipara, low educational level of the women, availability of prenatal visits in the first trimester of pregnancy and hospital delivery should be considered when planning the interventions to reduce the neonatal mortality in rural areas. [ABSTRACT FROM AUTHOR]

This paper examines the existence of time trends in the infant mortality rates in a number of countries in the twentieth century. We test for the presence of deterministic trends by adopting a linear model for the log-transformed data. Instead of assuming that the error term is a stationaryI(0), or alternatively, a non-stationaryI(1) process, we allow for the possibility of fractional integration and hence for a much greater degree of flexibility in the dynamic specification of the series. Indeed, once the linear trend is removed, all series appear to beI(d) with 0

Background A trial to evaluate the Integrated Management of Neonatal and Childhood Illness (IMNCI) strategy showed that the intervention resulted in lower infant mortality and improved infant care practices. In this paper, we present the results of a secondary analysis to examine the effect of the IMNCI strategy on inequities in health indicators. Methods The trial was a cluster-randomized controlled trial in 18 primary health centre areas. For this analysis, the population was divided into subgroups by wealth status (using Principal Component Analysis), religion and caste, education of mother and sex of the infant. Multiple linear regression analysis was used to examine inequity gradients in neonatal and post-neonatal mortality, care practices and care seeking, and the differences in these gradients between intervention and control clusters. Findings Inequity in post-neonatal infant mortality by wealth status was lower in the intervention as compared to control clusters (adjusted difference in gradients 2.2 per 1000, 95% confidence interval (CI) 0 to 4.4 per 1000, P = 0.053). The intervention had no effect on inequities in neonatal mortality. The intervention resulted in a larger effect on breastfeeding within one hour of birth in poorer families (difference in inequity gradients 3.0%, CI 1.5 to 4.5, P < 0.001), in lower caste and minorities families, and in infants of mothers with fewer years of schooling. The intervention also reduced gender inequity in care seeking for severe neonatal illness from an appropriate provider (difference in ineguity gradients 9.3%, CI 0.4 to 18.2, P = 0.042). Conclusions Implementation of IMNCI reduced inequities in post-neonatal mortality, and newborn care practices (particularly starting breastfeeding within an hour of birth) and health care-seeking for severe illness. In spite of the intervention substantial inequities remained in the intervention group and therefore further efforts to ensure that health programs reach the vulnerable population subgroups are required. [ABSTRACT FROM AUTHOR]

Copyright of Cuban Studies is the property of University of Pittsburgh Press and its content may not be copied or emailed to multiple sites or posted to a listserv without the copyright holder's express written permission. However, users may print, download, or email articles for individual use. This abstract may be abridged. No warranty is given about the accuracy of the copy. Users should refer to the original published version of the material for the full abstract. (Copyright applies to all Abstracts.)

Objective The objectives of the study were to expand the literature on political violence and public health by exploring the possibility that the public health consequences of civil war not only apply to the host country, but also diffuse across international borders. We discuss and empirically test a diffusion mechanism absent from the literature in this area-the incentive of a proximate state to reallocate resources in response to intrastate violence and the presence of interstate rivalry. Methods Our hypotheses were tested using a directed dyad research design that included all politically relevant dyads from 1997 to 2001. We used fixed-effects panel regression to estimate the influence of proximate intrastate violence and interstate rivalry on changes in infant mortality rate (IMR). Results Our results indicated that proximate intrastate violence and interstate rivalry are associated with increases in IMR. In addition, the influence of proximate intrastate violence on IMR increases as the severity of the conflict increases. Conclusion The public health consequences of civil war do diffuse across international borders, especially in cases in which interstate rivalry was present and the political violence in a proximate state was severe. [ABSTRACT FROM AUTHOR]

Background The lessons learned from the study of maternal deaths depend on the accuracy of data. Our objective was to assess time trends in the underestimation of maternal mortality ( MM) in the national routine death statistics in France and to evaluate their current accuracy for the selection and causes of maternal deaths. Methods National data obtained by enhanced methods in 1989, 1999, and 2007-09 were used as the gold standard to assess time trends in the underestimation of MM ratios ( MMRs) in death statistics. Enhanced data and death statistics for 2007-09 were further compared by characterising false negatives ( FNs) and false positives ( FPs). The distribution of cause-specific MMRs, as assessed by each system, was described. Results Underestimation of MM in death statistics decreased from 55.6% in 1989 to 11.4% in 2007-09 ( P < 0.001). In 2007-09, of 787 pregnancy-associated deaths, 254 were classified as maternal by the enhanced system and 211 by the death statistics; 34% of maternal deaths in the enhanced system were FNs in the death statistics, and 20% of maternal deaths in the death statistics were FPs. The hierarchy of causes of MM differed between the two systems. The discordances were mainly explained by the lack of precision in the drafting of death certificates by clinicians. Conclusion Although the underestimation of MM in routine death statistics has decreased substantially over time, one third of maternal deaths remain unidentified, and the main causes of death are incorrectly identified in these data. Defining relevant priorities in maternal health requires the use of enhanced methods for MM study. [ABSTRACT FROM AUTHOR]

Background Infants born moderate to late preterm are twice as likely to be rehospitalised within the first few weeks following discharge from the birth admission. It is not understood how rehospitalisation risk changes with age or how risks have changed over time. Methods A retrospective birth cohort study of all live, singleton births in Western Australia 1 January 1980-31 December 2010, without congenital anomalies, followed to 18 years of age. Rehospitalisation rates for gestational age categories (<28, 28-31, 32-33, 34-36, 37-38 and ≥42 weeks) were compared with term births (39-41 weeks) using negative binomial regression. To assess whether rehospitalisation risk changed with age or over time, analyses were conducted for different age intervals and for 5-year birth cohorts. Results Rehospitalisation rates were higher up to 18 years for all preterm and early term categories including early term (37-38 weeks) [130.2/1000 person-years at risk (pyr); 95% confidence interval 129.1, 131.4]; late preterm (34-36 weeks) (164.2/1000 pyr; 161.1, 167.4), and post-term (≥42 weeks) (115.3/1000 pyr; 111.7, 119.0) compared with term births (109.1/1000 pyr; 108.5, 109.7). The effect of gestational age on rehospitalisation was highest during the first year of life and declined by adolescence [e.g. 34-36 weeks: rate ratio = 2.10 (2.04, 2.15) for 29 days-1 year; 1.14 (1.11, 1.18) for 12-18 years]. The risk of rehospitalisation up to 1 year of age has declined since 1980, except for those born <32 weeks. Conclusions Rehospitalisation risk is greater for singleton children born at all gestational ages compared with those born full term. This effect of gestational age on rehospitalisation is highest in the first year post-discharge, but has almost disappeared by adolescence. [ABSTRACT FROM AUTHOR]

The timing and sequencing of fertility transitions and early-life mortality declines in historical Western societies indicate that reductions in sibship (number of siblings) may have contributed to improvements in infant health. Surprisingly, however, this demographic relationship has received little attention in empirical research. We outline the difficulties associated with establishing the effect of sibship on infant mortality and discuss the inherent bias associated with conventional empirical approaches. We offer a solution that permits an empirical test of this relationship while accounting for reverse causality and potential omitted variable bias. Our approach is illustrated by evaluating the causal impact of family size on infant mortality using genealogical data from 13 German parishes spanning the sixteenth, seventeenth, eighteenth, and nineteenth centuries. Overall, our findings do not support the hypothesis that declining fertility led to increased infant survival probabilities in historical populations. [ABSTRACT FROM AUTHOR]

This paper examines the effect of waterborne lead exposure on infant mortality in American cities over the period 1900 to 1920. Variation across cities in water acidity and the types of service pipes, which together determined the extent of lead exposure, identifies the effects of lead on infant mortality. In 1900, a decline in exposure equivalent to an increase in pH from 6.675 (25th percentile) to 7.3 (50th percentile) in cities with lead-only pipes would have been associated with a decrease in infant mortality of 7% to 33%, or at least twelve fewer infant deaths per 1,000 live births. [ABSTRACT FROM AUTHOR]

Background: The literature is full of lively discussion on the determinants of population health outcomes. However, different papers focus on small and different sets of variables according to their research agenda. Because many of these variables are measures of different aspects of development and are thus correlated, the results for one variable can be sensitive to the inclusion/exclusion of others. Method: We tested for the robustness of potential predictors of population health using the extreme bounds analysis. Population health was measured by life expectancy at birth and infant mortality rate. Results: We found that only about half a dozen variables are robust predictors for life expectancy and infant mortality rate. Among them, adolescent fertility rate, improved water sources, and gender equality are the most robust. All institutional variables and environment variables are systematically non-robust predictors of population health. Conclusion: The results highlight the importance of robustness tests in identifying predictors or potential determinants of population health, and cast doubts on the findings of previous studies that fail to do so. [ABSTRACT FROM AUTHOR]

Objectives: To investigate the association between per capita pesticide consumption and infant mortality rates from CNS and CVS congenital malformations in microregions in the South and Southeast Region of Brazil. Material and Methods: An ecological study was conducted using data on pesticide expenditure in 1985 and 1996, and deaths caused by CNS and CVS malformations in infants under 1 year old in 1986-1990 and 1997-2001, respectively. Per capita pesticide consumption and infant mortality rates were calculated for each microregion. Microregions were grouped according to quintiles of pesticide consumption, taking the first quintile as reference. The association between pesticide consumption and infant mortality was examined by calculating Spearman correlation coefficients (r) and mortality rate ratios (RR), stratifying by gender and type of microregion (urban or rural). Results: Significant and positive correlations between per capita pesticide consumption and rates of mortality due to CNS and CVS defects were observed in rural but not urban microregions. In general, mortality RRs for the 2 types of malformations in rural microregions were significantly higher in each quintile of pesticide consumption compared to the lowest quintile in the 2 study periods, with elevations ranging between 10% and 30%. Likewise, mortality RRs in these microregions showed significant trends of increase across quintiles of pesticide consumption in both study periods. In urban areas, however, mortality RRs from both CNS and CVS malformations were weak and not statistically significant, and a trend of increase of mortality with increasing pesticide usage was not observed. Conclusions: The results show the relevance of pesticide exposure in rural areas with intense agricultural activity, suggesting that such prenatal exposures may be related with the occurrence of certain congenital defects. [ABSTRACT FROM AUTHOR]

Background To better understand factors that may impact infant mortality rates (IMR), we evaluated the consistency across birth hospitals in the classification of a birth event as either a fetal death or an early neonatal (infant) death using natality data from North Carolina for the years 1995- 2000. Methods A database consisting of fetal deaths and infant deaths occurring within the first 24 hours after birth was constructed. Bivariate, followed by multivariable regression, analyses were used to control for relevant maternal and infant factors. Based upon hospital variances, adjustments were made to evaluate the impact of the classification on statewide infant mortality rate. Results After controlling for multiple maternal and infant factors, birth hospital remained a factor related to the classification of early neonatal versus fetal death. Reporting of early neonatal deaths versus fetal deaths consistent with the lowest or highest hospital strata would have resulted in an adjusted IMR varying from 7.5 to 10.64 compared with the actual rate of 8.95. Conclusions Valid comparisons of IMR among geographic regions within and between countries require consistent classification of perinatal deaths. This study demonstrates that local variation in categorization of death events as fetal death versus neonatal death within the first 24 hours after delivery may impact a state-level IMR in a meaningful magnitude. The potential impact of this issue on IMRs should be examined in other state and national populations. [ABSTRACT FROM AUTHOR]

The burden of influenza is unevenly distributed, with more severe outcomes in children aged <5 years than older children and adults. In spite of this, immunisation policies for young children are far from universal. This article provides an overview of the published evidence on the burden of influenza in children worldwide, with a particular interest in the impact of pandemic influenza in 2009-2010 (caused by the H1N1pdm09 virus). In an average season, up to 9.8 % of 0- to 14-year olds present with influenza, but incidence rates can be markedly higher in younger children. Children aged <5 years have greater rates of hospitalisation and complications than their older counterparts, particularly if the children have co-existing illnesses; historically, this age group have had higher mortality rates from the disease than other children, although during the 2009-2010 pandemic the median age of those who died of influenza was higher than in previous seasons. Admissions to hospital and emergency departments appear to have been more frequent in children with H1N1pdm09 infections than during previous seasonal epidemics, with pneumonia continuing to be a common complication in this setting. Outcomes in children hospitalised with severe disease also seem to have been worse for those infected with H1N1pdm09 viruses compared with seasonal viruses. Studies in children confirm that vaccination reduces the incidence of seasonal influenza and the associated burden, underlining the importance of targeting this group in national immunisation policies. Conclusions: Children aged <5 years are especially vulnerable to influenza, particularly that caused by seasonal viruses, and vaccination in this group can be an effective strategy for reducing disease burden. [ABSTRACT FROM AUTHOR]

We provide the first analyses of infant mortality rates by indigenous ethnic group in Finland, a country that has one of the lowest relative numbers of infant deaths in the world. Using files from the Finnish population register, we identified both of the parents of children born in the period from 1975-2003 according to ethnic affiliation, socioeconomic profile, and demographic position. The infant mortality rate in homogamous Finnish unions is similar to that in homogamous Swedish unions, which reflects a lack of social disparities between the two groups. Surprisingly, infants from ethnically mixed unions have markedly lower mortality rates, with an adjusted rate ratio of 0.81 relative to homogamous Swedish unions (95% CI: 0.67-0.98). Although not empirically verified, we argue that the lower infant mortality rate in ethnically mixed unions may be due to lower levels of inbreeding, and hence related to historically low intermarriage rates between the two ethnic groups, remote consanguinities, and restricted inter-community gene flow. [ABSTRACT FROM AUTHOR]

Background Significant variation exists in published Aboriginal mortality and life expectancy (LE) estimates due to differing and evolving methodologies required to correct for inadequate recording of Aboriginality in death data, under-counting of Aboriginal people in population censuses, and unexplained growth in the Aboriginal population attributed to changes in the propensity of individuals to identify as Aboriginal at population censuses. The objective of this paper is to analyse variation in reported Australian Aboriginal mortality in terms of LE and infant mortality rates (IMR), compared with all Australians. Methods Published data for Aboriginal LE and IMR were obtained and analysed for data quality and method of estimation. Trends in reported LE and IMR estimates were assessed and compared with those in the entire Australian population. Results LE estimates derived from different methodologies vary by as much as 7.2 years for the same comparison period. Indirect methods for estimating Aboriginal LE have produced LE estimates sensitive to small changes in underlying assumptions, some of which are subject to circular reasoning. Most indirect methods appear to under-estimate Aboriginal LE. Estimated LE gaps between Aboriginal people and the overall Australian population have varied between 11 and 20 years. Latest mortality estimates, based on linking census and death data, are likely to over-estimate Aboriginal LE. Temporal LE changes by each methodology indicate that Aboriginal LE has improved at rates similar to the Australian population overall. Consequently the gap in LE between Aboriginal people and the total Australian population appears to be unchanged since the early 1980s, and at the end of the first decade of the 21st century remains at least 11-12 years. In contrast, focussing on the 1990-2010 period Aboriginal IMR declined steeply over 2001-08, from more than 12 to around 8 deaths per 1,000 live births, the same level as Australia overall in 1993-95. The IMR gap between Aboriginal people and the total Australian population, while still unacceptable, has declined considerably, from over 8 before 2000 to around 4 per 1,000 live births by 2008. Conclusions Regardless of estimation method used, mortality and LE gaps between Aboriginal and non-Aboriginal people are substantial, but remain difficult to estimate accurately. [ABSTRACT FROM AUTHOR]

The article discusses the analysis on infant mortality in the U.S. from 2005-2008. Topics mentioned include the information on mortality rates based on race/ethnicity, state and region, and birthplace of the mother, the purpose on raising awareness on the different characteristics of the deaths and prompt actions in reducing the disparities, and the result on the declined rate with persistence to male infants which is explained by the disease susceptibility of genes.

Background & Objectives: The desired impact of IMNCI is the reduction of mortality, morbidity and suffering, through assuring children's access to quality health care in health facilities and improved case management at home. Maintaining the performance of health and village workers is essential to achieve this impact. So objective of this study is to assess IMNCI implementation in Bhavnagar district of Gujarat to strategize for accelerating effective implementation. Methods: A cross sectional study was carried out in March 2012 in Bhavnagar district. Four blocks of Bhavnagar district were purposefully selected out of seven blocks on the basis of immunization coverage of previous year. From each block one best PHC and from selected PHC one best sub-centre and one best Anganwadi were selected purposefully by solely on basis of perception of Medical Officer in charge PHC and BHO for implementation of IMNCI in their area in last one year. The purpose of adopting such method was to evaluate the performance of IMNCI implementation in centres (PHC, SC, AW) that was judged best by their supervisors. After selection, PHC, SC and Anganwadi centre were visited to assess the practice of IMNCI by ANM and Anganwadi Worker. Medical Officer, Health Supervisors and ICDS officers were interviewed to understand overall implementation process. For collecting data pre-tested and predesigned questionnaire was utilized. Results: Basic IMNCI training in Bhavnagar was completed in 90% of health and ICDS workers. More than 87.5% workers said that their knowledge, skill, confidence and credibility among community were increased after IMNCI training. Logistic and drugs supply were insufficient at sub centre and Anganwadi centre. Out of the total 80 filled IMNCI case sheets by the health and ICDS workers, 32(40%) were found accurately complete as the correctly filling of all the column (assessment and classification and treatment) in form considered as complete form. Accurate classification, management and advice of cases according to IMNCI guidelines were 62 (77.5%), 42 (52.5%) and 38 (47.5%) respectively as the accurate classification (assessment, classification and treatment) of the entire column in form correctly. Combination of one correct and other incorrect assessment or classification or treatment considered as partial accurate and inaccurate if all the column were not assessed or not classified or not given the treatment correctly. While observing actual practice of IMNCI, accuracy among health and ICDS workers was found in assessment 5(31.3%), Classification 8(50%) and treatment 7(43.8%). Supportive supervision and feedback mechanism were lacking at all level. Interpretation & Conclusion: Supportive supervision and feedback mechanism are key concern and must address. Proper logistic and drugs planning and management also main concern for IMNCI programme. [ABSTRACT FROM AUTHOR]

There is a great deal of uncertainty over the levels of, and trends in, infant mortality in the former Soviet republics of Central Asia. As a result, the impact of the break-up of the Soviet Union on infant mortality in the region is not known, and proper monitoring of mortality levels is impaired. In this paper, a variety of data sources and methods are used to assess levels of infant mortality and their trend over time in one Central Asian republic, Kyrgyzstan, between 1980 and 2010. An abrupt halt to an already established decline in infant mortality was observed to occur during the decade following the break-up of the Soviet Union, contradicting the official statistics based on vital registration. Infants of Central Asian ethnicity and those born in rural areas were also considerably more at risk of mortality than suggested by the official sources. We discuss the implications of these findings, both for health policy in this seldom studied part of the former Soviet Union and for our understanding of the health crisis which it currently faces. [ABSTRACT FROM PUBLISHER]

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The author discusses the need of investigations to confirm that whether the infant mortality rate is more for medically uninsured infants. Several parameters used by author for investigating the issue including the differences in medical care and charges for medically uninsured infants are discussed. The author mentions the statistics that is available for confirming the factors about increased mortality rate for uninsured neonates are not sufficient and requires further investigations.

Objective: To study the utilization of health services by mothers during antenatal, natal and post-natal period under Janani Suraksha Yojna (JSY). Materials and Methods: This cross-sectional study was conducted in rural areas of two districts of Haryana as per the rate of institutional deliveries. A total of 48 sub-centers were selected by multistage random sampling. 1386 JSY beneficiary mothers were interviewed by house-to-house visits, after obtaining informed consent. Results: Majority 1216 (87.5%) of the study subjects were registered between 12-26 weeks of pregnancy whereas only 170 (12.3%) of them were registered within first 12 weeks. Around one-fourth of the mothers did not receive the recommended minimum three antenatal check-ups. The coverage of TT immunization was 92.1%. Majority 1253 (90.4%) of the deliveries were institutional. More than three-fourth of the home deliveries were conducted by trained dais and 15% of the home deliveries were conducted by untrained persons. Out of the 1253 institutional deliveries, 84.6% were conducted in Government institutions while 15.4% deliveries were conducted in Private hospitals. About two-third mothers received at least three post-natal care visits by the health functionaries. Discussion: Janani Suraksha Yojna is an ambitious scheme serving as a safe motherhood intervention under NRHM. It has been fairly successful in promoting institutional deliveries but the key components of Essential Obstetric Care i.e., early antenatal registration, minimum three antenatal care visits, three post-natal care visits still need strengthening. [ABSTRACT FROM AUTHOR]

The purpose of this article is to explore the connection between household composition and infant mortality in the first half of the twentieth century in Taiwan. The research results claim that illegitimate infants have higher death risk than legitimate infants; that contrary to expectation female infants have mortality rates as high as boys; and that same sex sibling order effects are approximately same among boys and girls. The significance for infant mortality of the sex of household head is the other major finding of this article: female-headed families have higher rates of infant mortality. [ABSTRACT FROM PUBLISHER]