Associations between cesarean delivery and child mortality: A national record linkage longitudinal study of 17.8 million births in Brazil

Background There is an increasing use of cesarean delivery (CD) based on preference rather than on medical indication. However, the extent to which nonmedically indicated CD benefits or harms child survival remains unclear. Our hypothesis was that in groups with a low indication for CD, this procedure would be associated with higher child mortality and in groups with a clear medical indication CD would be associated with improved child survival chances. Methods and findings We conducted a population-based cohort study in Brazil by linking routine data on live births between January 1, 2012 and December 31, 2018 and assessing mortality up to 5 years of age. Women with a live birth who contributed records during this period were classified into one of 10 Robson groups based on their pregnancy and delivery characteristics. We used propensity scores to match CD with vaginal deliveries (1:1) and prelabor CD with unscheduled CD (1:1) and estimated associations with child mortality using Cox regressions. A total of 17,838,115 live births were analyzed. After propensity score matching (PSM), we found that live births to women in groups with low expected frequencies of CD (Robson groups 1 to 4) had a higher death rate up to age 5 years if they were born via CD compared with vaginal deliveries (HR = 1.25, 95% CI: 1.22 to 1.28; p < 0.001). The relative rate was greatest in the neonatal period (HR = 1.39, 95% CI: 1.34 to 1.45; p < 0.001). There was no difference in mortality rate when comparing offspring born by a prelabor CD to those born by unscheduled CD. For the live births to women with a CD in a prior pregnancy (Robson group 5), the relative rates for child mortality were similar for those born by CD compared with vaginal deliveries (HR = 1.05, 95% CI: 1.00 to 1.10; p = 0.024). In contrast, for live births to women in groups with high expected rates of CD (Robson groups 6 to 10), the child mortality rate was lower for CD than for vaginal deliveries (HR = 0.90, 95% CI: 0.89 to 0.91; p < 0.001), particularly in the neonatal period (HR = 0.84, 95% CI: 0.83 to 0.85; p < 0.001). Our results should be interpreted with caution in clinical practice, since relevant clinical data on CD indication were not available. Conclusions In this study, we observed that in Robson groups with low expected frequencies of CD, this procedure was associated with a 25% increase in child mortality. However, in groups with high expected frequencies of CD, the findings suggest that clinically indicated CD is associated with a reduction in child mortality.

Download Full-text

Out-of-sequence DTP and measles vaccinations and child mortality in Guinea-Bissau: a reanalysis

BMJ Open ◽

10.1136/bmjopen-2018-024893 ◽

2019 ◽

Vol 9 (9) ◽

pp. e024893 ◽

Cited By ~ 1

Author(s):

Sanne M Thysen ◽

Amabelia Rodrigues ◽

Peter Aaby ◽

Ane B Fisker

Keyword(s):

Mortality Rate ◽

Child Mortality ◽

Proportional Hazards ◽

Child Survival ◽

Secondary Analysis ◽

Oral Polio Vaccine ◽

Vaccination Schedule ◽

Cox Proportional Hazards ◽

Vaccination Status ◽

Guinea Bissau

ObjectivesTo assess whether the sequence of diphtheria-tetanus-pertussis vaccine (DTP) and measles vaccine (MV) was associated with child survival in a dataset previously used to assess non-specific effects of vaccines with no consideration of vaccination sequence.DesignProspective cohort study analysed using the landmark approach.SettingBandim Health Project’s Health and Demographic Surveillance System covering 100 village clusters in rural Guinea-Bissau. The recommended vaccination schedule was BCG and oral polio vaccine (OPV) at birth, DTP and OPV at 6, 10 and 14 weeks, MV at 9 months and booster DTP and OPV at 18 months of age.ParticipantsChildren aged 9–17 months (main analysis) and 18–35 months (secondary analysis: age of booster DTP) with vaccination status assessed between April 1991 and April 1996.MethodsSurvival during the 6 months after assessing vaccination status was compared by vaccination sequence in Cox-proportional hazards models with age as underlying time. Analyses were stratified by sex and village cluster.Main outcome measureMortality rate ratio (MRR) for out-of-sequence vaccinations compared with in-sequence vaccinations.ResultsAmong children aged 9–17 months, 60% of observations (3574/5937) were from children who had received both MV and DTP. Among these, 1590 observations were classified as in-sequence vaccinations (last DTP before MV), and 1984 observations were out-of-sequence vaccinations (1491: MV with DTP and 493: MV before DTP). Out-of-sequence vaccinations were associated with higher mortality than in-sequence vaccinations (MRR 2.10, 95% CI 1.07 to 4.11); the MRR was 2.30 (95% CI 1.15 to 4.58) for MV with DTP and 1.45 (95% CI 0.50 to 4.22) for DTP after MV. Associations were similar for boys and girls (p=0.77). Between 18 and 35 months the mortality rate increased among children vaccinated in-sequence and the differential effect of out-of-sequence vaccinations disappeared.ConclusionOut-of-sequence vaccinations may increase child mortality. Hence, sequence of vaccinations should be considered when planning vaccination programmes or introducing new vaccines into the current vaccination schedule.

Download Full-text

Rate, Maternal and Fetal Outcome of Cesarean Delivery Performed by IESO at Shenen Gibe General Hospital, Jimma South West Ethiopia: A Descriptive Retrospective Data

Journal of Woman s Reproductive Health ◽

10.14302/issn.2381-862x.jwrh-20-3439 ◽

2020 ◽

Vol 2 (3) ◽

pp. 1-10

Author(s):

Worku Gebeyehu Gutema ◽

Teshome Kassa Jire ◽

Daniel Aboma

Keyword(s):

Mortality Rate ◽

Maternal Mortality ◽

General Hospital ◽

Cesarean Delivery ◽

Fetal Outcome ◽

Retrospective Data ◽

Live Births ◽

South West ◽

Cesarean Delivery Rate ◽

South West Ethiopia

Background Pregnancy and parturition are events of considerable significance in the life cycle of women. Though it is supposed that the quality of care during labor, birth, and postpartum period plays a great role for adverse outcomes of birth, various reports claimed that cesarean delivery carries a higher maternal and fetal morbidity and mortality compared to vaginal delivery. Therefore, this study assessed the Rate, Maternal and Fetal Outcome of Cesarean delivery performed by IESO at Shenen Gibe General Hospital, Jimma south west Ethiopia. Integrated Emergency surgical officer is a health professional qualified and authorized to perform emergency obstetrical-gynecological and emergency general surgical procedures. The training has started in 2010 in 3 universities and 10 affiliated sites with intake of 43 students. The MSc program in integrated emergency surgery is intended to achieve one of the millennium development goals (MDG): reducing the overwhelming maternal mortality ratio and perinatal mortality rate at the local and national level. (1) Methods Hospital based two-year retrospective descriptive cross-sectional study design was employed and data collected from November to December 2019 in shenen Gibe General Hospital ,Jimma south west Ethiopia. A total of 185 mothers who delivered by cesarean delivery from December 2017 to December 2018 and complete data were included in the study. Data were extracted using structured data collection format and cleaned, and entered into Epi data software version 3.1 and exported into SPSS version 26 for further descriptive analysis. Result Among 2115 deliveries in the two years of retrospective data, a total of 186 mothers were delivered by cesarean section, giving cesarean delivery rate 8.8 %. The leading indication for cesarean delivery was fetal distress (24.2%). Among the total cesarean delivery, 22 neonates were died, giving the proportion of neonate mortality rate 16.8%. One mothers were died following cesarean delivery, giving maternal mortality rate following cesarean delivery 12 per 1000 live births. The leading cause for maternal mortality was hemorrhagic shock Conclusion However, cesarean delivery rate in this study was within the WHO recommended range, the health outcome of mothers and neonates’ following cesarean delivery was not acceptable. The neonatal and maternal mortality following cesarean delivery was 16.8% and12 per 1000 live births respectively. The main cause of neonatal death was birth asphyxia.

Download Full-text

Spending on Health is a Complex Phenomenon in our Country

Annals of King Edward Medical University ◽

10.21649/akemu.v24is.2503 ◽

2018 ◽

Vol 24 (S) ◽

pp. 829-830

Author(s):

Sumair Anwar

Keyword(s):

Mortality Rate ◽

Neonatal Period ◽

Health Indicators ◽

Complex Phenomenon ◽

Live Births ◽

Under Five ◽

Under Five Children ◽

The Past

According to WHO statistics 2017, amongst health indicators of countries worldwide, Pakistan’s under five children mortality rate has been recorded up to 81.1 per 1000 live births, which is second highest in the list of SAARC countries.1 In Pakistan, over 57% of deaths under 5 years occur during the neonatal period (42 per 1000 live births) and have not changed over the past 6 years.2

Download Full-text

SOCIODEMOGRAPHIC FACTOR RELATIONSHIP WITH INFANT SURVIVAL IN INDONESIA

Jurnal Biometrika dan Kependudukan ◽

10.20473/jbk.v10i1.2021.11-17 ◽

2021 ◽

Vol 10 (1) ◽

pp. 11

Author(s):

Yasmine Nurfirdaus ◽

Philip Etabee Macdonald Bassey

Keyword(s):

Mortality Rate ◽

Infant Mortality ◽

Child Survival ◽

Infant Mortality Rate ◽

Infant Survival ◽

Chi Square ◽

Cross Sectional ◽

Live Births ◽

Bivariable Analysis ◽

Chi Square Analysis

Child survival can be reflected in the presence of the Infant Mortality Rate (IMR). Indonesia has an Infant Mortality Rate (IMR) according to the 2017 IDHS, which reaches 24 deaths per 1000 live births. This figure has decreased compared to a survey conducted by the 2012 IDHS, where infant mortality reached 32 deaths per 1000 live births. Even though it experienced a decrease, the IMR in Indonesia was higher when compared to the IMR in other Southeast Asian countries. Socioeconomic factors for individuals, families, and communities, including the influence of infant mortality. Not only that, but infant mortality can also be due to the absence of awareness of maternal health. Thus, this study aims to determine several variables related to survival in infants in Indonesia. This type of research is a non-reactive study. This study uses quantitative analysis and a methodical approach with a cross-sectional approach that takes data from the 2017 IDHS. This study took a sample following the 2017 IDHS with the criteria that mothers who had babies still drank breast milk, were born single, and were still alive after the first three days in Indonesia. The number of respondents in this study was 7,599 mothers with babies. Analysis of the research data using Chi-Square analysis. Bivariable analysis shows that infants' survival has a relationship with the mother's education, type of area, and welfare level. However, infant survival also has no association with the age of the mother and birth attendants. Counseling pregnant women regarding risks, causes,

Download Full-text

Birth weight and other determinants of infant and child mortality in three provinces of China

Journal of Biosocial Science ◽

10.1017/s002193200001957x ◽

1991 ◽

Vol 23 (4) ◽

pp. 477-489 ◽

Cited By ~ 4

Author(s):

G. Dankert ◽

J. van Ginneken

Keyword(s):

Birth Weight ◽

Child Mortality ◽

Neonatal Period ◽

Fertility Survey ◽

Female Mortality ◽

Place Of Residence ◽

Male Mortality ◽

Live Births ◽

Infant And Child Mortality ◽

Mother’S Education

SummaryInformation on levels, trends and determinants of infant and child mortality was available from the 1985 In-depth Fertility Survey which was conducted in three provinces of China. Mortality of children below age 5 varied from 49 per 1000 live births in Shaanxi to 20 in Shanghai in 1980–85 and has declined substantially since 1960, from 206 in Shaanxi and 66 in Shanghai. Male mortality was considerably higher than female mortality in the neonatal and post-neonatal period, and at ages 1–5 years. Birth weight, place of residence and mother's education were found to be important determinants of mortality; age of mother and parity were less important.

Download Full-text

Infant and Child health status ahead of implementation of an integrated intervention to improve nutrition and survival: A difference-in-difference quasi-experimental baseline assessment

10.21203/rs.2.16855/v1 ◽

2019 ◽

Author(s):

Emmanuel Nene Odjidja ◽

Sonia Hakizimana ◽

Ghislaine Gatasi ◽

Jean-Berchmans Masabo ◽

Gildas Irakoze ◽

...

Keyword(s):

Mortality Rate ◽

Child Health ◽

Neonatal Period ◽

Baseline Assessment ◽

Difference In Difference ◽

Chronic Malnutrition ◽

Live Births ◽

Under Five ◽

Quasi Experimental ◽

Child Health Status

Abstract Background Burundi has one of the poorest child health outcomes in the world. With an acute malnutrition rate of 5% and a chronic malnutrition rate of 56%, under five death is 78 per 1000 live births and 47 children in every 1000 children will not celebrate their first birthday. In response, Village Health Works, a Burundian-American organisation has invested in an integrated clinical and community intervention model. Ahead of implementation of this initiative, we conduct a baseline assessment using a difference-in-difference design in an effort to measure incremental effects. Methods A quasi-experimental evaluation design (difference-in-difference) was employed. Adopting the methodology of the DHS, a sample of 952 and 990 households comprising of 2675 and 3311 birth histories respectively in the treatment and control areas were reached. Mortality data were analysed with R package for mortality computation, Complex Samples Module of IBM – SPSS for other outcomes and Emergency Nutrition Assessment software for nutrition data. Logistic regression was used to assess strength of associations and cox regression model for assessing risk of mortality Results The incidence of low birth weight (LBW) was 5.7% at the program area compared to 7.2% at the controlled area with the strongest predictor being malnourished women (OR 1.4 95%CI 1.2 – 7.2 p=0.043). Fever incidence was higher in the program area (50.5%) in comparison to 48.4% in the control. Non-consumption of minimum acceptable diet was significantly associated with fever (OR 1.67 95%CI 1.07 – 2.61). Acute and chronic malnutrition was 7.6% and 45.8% respectively with non-receipt of Vitamin A was significantly associated with chronic malnutrition. Under-five mortality rate was 32.1 per 1000 live births in the program area and 33.6 in the control. Infant mortality rate was 25.7 in program area and 20.4 in the control. Risk of under-five mortality was higher in the neonatal period (HR 20.72 95% 8.64 – 49.65 p=0.001). Conclusion Improving child health status is complex and therefore investing into an integrated intervention yields best results. Given that the risk of all under-five was higher at the neonatal period, strengthening the health system to provide quality care is crucial.

Download Full-text

Predictive analytics framework for accurate estimation of child mortality rates for Internet of Things enabled smart healthcare systems

International Journal of Distributed Sensor Networks ◽

10.1177/1550147720928897 ◽

2020 ◽

Vol 16 (5) ◽

pp. 155014772092889 ◽

Cited By ~ 1

Author(s):

Muhammad Islam ◽

Muhammad Usman ◽

Azhar Mahmood ◽

Aaqif Afzaal Abbasi ◽

Oh-Young Song

Keyword(s):

Mortality Rate ◽

Child Mortality ◽

Death Rate ◽

Predictive Analytics ◽

Healthcare Systems ◽

Data Sets ◽

Demographic Health Survey ◽

Live Births ◽

Under Five ◽

Smart Healthcare

Globally, under-five child mortality is a substantial health problem. In developing countries, reducing child mortality and improving child health are the key priorities in health sectors. Despite the significant reduction in deaths of under-five children globally, developing countries are still struggling to maintain an acceptable mortality rate. Globally, the death rate of under-five children is 41 per 1000 live births. However, the death rate of children in developing nations like Pakistan and Ethiopia per 1000 live births is 74 and 54, respectively. Such nations find it very challenging to decrease the mortality rate. Data analytics on healthcare data plays a pivotal role in identifying the trends and highlighting the key factors behind the children deaths. Similarly, predictive analytics with the help of Internet of Things based frameworks significantly advances the smart healthcare systems to forecast death trends for timely intervention. Moreover, it helps in capturing hidden associations between health-related variables and key death factors among children. In this study, a predictive analytics framework has been developed to predict the death rates with high accuracy and to find the significant determinants that cause high child mortality. Our framework uses an automated method of information gain to rank the information-rich mortality variables for accurate predictions. Ethiopian Demographic Health Survey and Pakistan Demographic Health Survey data sets have been used for the validation of our proposed framework. These real-world data sets have been tested using machine learning classifiers, such as Naïve Bayes, decision tree, rule induction, random forest, and multi-layer perceptron, for the prediction task. It has been revealed through our experimentation that Naïve Bayes classifier predicts the child mortality rate with the highest average accuracy of 96.4% and decision tree helps in identifying key classification rules covering the factors behind children deaths.

Download Full-text

Mother’s Health-seeking Behaviour and Childhood Mortality in Pakistan

The Pakistan Development Review ◽

10.30541/v35i4iipp.719-731 ◽

1996 ◽

Vol 35 (4II) ◽

pp. 719-731 ◽

Cited By ~ 11

Author(s):

Ghulam Mustafa Zahid

Keyword(s):

Health Care ◽

Mortality Rate ◽

Child Mortality ◽

Child Survival ◽

Educational Status ◽

Childhood Mortality ◽

Health Seeking Behaviour ◽

Health Seeking ◽

Infant And Child Mortality ◽

Child Mortality Rate

The paper examines the Mother’s Health-seeking Behaviour and Childhood Mortality in Pakistan. This is based on the 1990-91 Pakistan Demographic and Health Survey (PDHS), a nationally representative survey covering all four provinces of the country. It was found that neonatal, infant, and child mortality rate is the highest among children of mothers aged less than 20 years. Infant and Child mortality rate is likewise higher among first and higher order births than among births of second or third order. It has further found that mortality declines as the length of the birth interval increases. The results reveal that the education of mother has significant effect on the neonatal, infant and child survival, as mother’s education increases the chances of survival of neonatal, infant and child also increases. Health care factors such as antenatal care, place of delivery, assistance at delivery and immunisation also influenced neonatal, infant and child mortality. The paper suggests that for the improvement of the health conditions of children in Pakistan, first, it is necessary that the educational status of the population in general, and of mothers in particular, should be improved, and second, the health services should be accessible and available for the promotion of health care practices.

Download Full-text

Baseline Socio-Demographic and Mortality Profile of a Peri-urban Coastal Community in Karachi, Pakistan Before the Introduction of a Comprehensive Maternal, Newborn and Child Health Intervention Package

10.21203/rs.3.rs-67851/v1 ◽

2021 ◽

Author(s):

Muhammad Ilyas ◽

Kanwal Nayani ◽

Ameer Muhammad ◽

Yasir Shafiq ◽

Benazir Baloch ◽

...

Keyword(s):

Mortality Rate ◽

Child Health ◽

Neonatal Mortality ◽

Child Mortality ◽

Mortality Rates ◽

Evidence Based ◽

Intervention Package ◽

Newborn And Child Health ◽

Live Births ◽

And Child Health

Abstract Objective Pakistan has the highest neonatal mortality rate and one of the highest under-5 mortality rates in the world, at 42 deaths and 74 deaths per thousand live births respectively. We undertook implementation of an evidence-based maternal, newborn and child health (MNCH) intervention package to reduce under-five mortality in Rehri Goth, a peri-urban coastal community on the outskirts of Karachi, Pakistan. This paper aims to present the socio-demographic and under-5 mortality profile of Rehri Goth prior to implementation of the intervention package. We conducted a detailed census of all households on socio-demographic variables. ResultsOver the course of the census period, 6,962 households were visited. The total population of Rehri Goth was found to be 42,980. The male to female ratio was 52:48. Among adults aged 15 years and above, 67.1% had no formal education. The neonatal mortality and under-five mortality rates were 59 and 109 deaths per 1,000 live births respectively. Rehri Goth has a baseline child mortality rate that is higher than the national average in Pakistan. This provides an opportunity to deliver an evidence-based, targeted MNCH package to reduce child mortality.

Download Full-text

Neonatal mortality and its determinates in public hospitals of Gamo and Gofa zones, southern Ethiopia: prospective follow up study

BMC Pediatrics ◽

10.1186/s12887-019-1881-0 ◽

2019 ◽

Vol 19 (1) ◽

Author(s):

Abera Mersha ◽

Agegnehu Bante ◽

Shitaye Shibiru

Keyword(s):

Mortality Rate ◽

Neonatal Mortality ◽

Goodness Of Fit ◽

Neonatal Period ◽

Public Hospitals ◽

Southern Ethiopia ◽

Neonatal Mortality Rate ◽

Live Births ◽

Follow Up Study

Abstract Background The neonatal period is the most vulnerable time for child survival. The declines in the neonatal mortality rate have been slower than the post-neonatal under-five mortality rate in the majority of countries. This trend is also similar in Ethiopia, that neonatal mortality was high as compared to the post-neonatal mortality rate. A large proportion of neonatal deaths occur during the 48 h after delivery. Different studies were conducted in assessing determinates for neonatal mortality but there is a need to assess the immediate postnatal (within 2 days following delivery) cause of neonatal mortality that the majority of deaths occurred at that time. So, this study is to fill those gaps of the aforementioned studies, in assessing the determinate factors affecting neonatal mortality in public hospitals of Gamo and Gofa Zones, Southern Ethiopia. Methods A prospective follow up study was conducted among 6769 study participants from April 5, 2018, to March 5, 2019. All live births at the hospitals during the study period were included in this study. A structured verbal autopsy questionnaire was used to collect the data on the causes of neonatal death. Data were entered into Epi data version 3.1 and exported to Stata version 15 for analysis. Crude and adjusted estimate β with 95%CI was calculated in the binary logistic regression model. A log-likelihood ratio (LR) was tested for goodness of fit. In this study P-value < 0.05 was considered to declare a result as a statistically significant association. Results In this study, neonatal mortality incidence ratio was 9.6 (95%CI: 7.5, 12.2) per 1000 live births. Age of the mother, number of antenatal care visits, sex of the neonate, presentation, and gestational age were identified as the significant determinates for neonatal mortality cases. Prematurity, infection, and birth asphyxia were the most common causes of neonatal mortality cases. Conclusions This study indicated that a significant number of neonates died during the neonatal period. Both maternal and neonatal factors were identified. Therefore, early identification of obstetric complications and immediate interventions, strengthening the provision of quality antenatal and postnatal care services are recommended.

Download Full-text