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Infant mortality in Pelotas, Brazil: a comparison of risk factors in two birth cohorts
Menezes,Ana Maria Baptista; Hallal,Pedro Curi; Santos,Iná Silva dos; Victora,Cesar Gomes; Barros,Fernando Celso;
Revista Panamericana de Salud Pública , 2005, DOI: 10.1590/S1020-49892005001000007
Abstract: objectives: to compare two population-based birth cohorts to assess trends in infant mortality rates and the distribution of relevant risk factors, and how these changed after an 11-year period. methods: data from two population-based prospective birth cohorts (1982 and 1993) were analyzed. both studies included all children born in a hospital (> 99% of all births) in the city of pelotas, southern brazil. infant mortality was monitored through surveillance of all maternity hospitals, mortality registries and cemeteries. results: there were 5 914 live-born children in 1982 and 5 249 in 1993. the infant mortality rate decreased by 41%, from 36.0 per 1 000 live births in 1982 to 21.1 per 1 000 in 1993. socioeconomic and maternal factors tended to become more favorable during the study period, but there were unfavorable changes in birthweight and gestational age. poverty, high parity, low birthweight, preterm delivery, and intrauterine growth restriction were the main risk factors for infant mortality in both cohorts. the 41% reduction in infant mortality between 1982 and 1993 would have been even greater had the prevalence of risk factors remained constant during the period studied here. conclusions: there were impressive declines in infant mortality which were not due to changes in the risk factors we studied. because no reduction was seen in the large social inequalities documented in the 1982 cohort, it is likely that the reduction in infant mortality resulted largely from improvements in health care.
Infant mortality and low birth weight in cities of Northeastern and Southeastern Brazil
Silva,Ant?nio Augusto Moura da; Bettiol,Heloísa; Barbieri,Marco Ant?nio; Ribeiro,Valdinar Sousa; Arag?o,Vania Maria de Farias; Brito,Luiz Gustavo Oliveira; Pereira,Márcio Mendes;
Revista de Saúde Pública , 2003, DOI: 10.1590/S0034-89102003000600002
Abstract: objective: to compare estimates of low birth weight (lbw), preterm birth, small for gestational age (sga), and infant mortality in two birth cohorts in brazil. methods: the two cohorts were performed during the 1990s, in s?o luís, located in a less developed area in northeastern brazil, and ribeir?o preto, situated in a more developed region in southeastern brazil. data from one-third of all live births in ribeir?o preto in 1994 were collected (2,839 single deliveries). in s?o luís, systematic sampling of deliveries stratified by maternity hospital was performed from 1997 to 1998 (2,439 single deliveries). the chi-squared (for categories and trends) and student t tests were used in the statistical analyses. results: the lbw rate was lower in s?o luís, thus presenting an epidemiological paradox. the preterm birth rates were similar, although expected to be higher in ribeir?o preto because of the direct relationship between preterm birth and lbw. dissociation between lbw and infant mortality was observed, since s?o luís showed a lower lbw rate and higher infant mortality, while the opposite occurred in ribeir?o preto. conclusions: higher prevalence of maternal smoking and better access to and quality of perinatal care, thereby leading to earlier medical interventions (cesarean section and induced preterm births) that resulted in more low weight live births than stillbirths in ribeir?o preto, may explain these paradoxes. the ecological dissociation observed between lbw and infant mortality indicates that the lbw rate should no longer be systematically considered as an indicator of social development.
Infant mortality and low birth weight in cities of Northeastern and Southeastern Brazil  [cached]
Silva Ant?nio Augusto Moura da,Bettiol Heloísa,Barbieri Marco Ant?nio,Ribeiro Valdinar Sousa
Revista de Saúde Pública , 2003,
Abstract: OBJECTIVE: To compare estimates of low birth weight (LBW), preterm birth, small for gestational age (SGA), and infant mortality in two birth cohorts in Brazil. METHODS: The two cohorts were performed during the 1990s, in S o Luís, located in a less developed area in Northeastern Brazil, and Ribeir o Preto, situated in a more developed region in Southeastern Brazil. Data from one-third of all live births in Ribeir o Preto in 1994 were collected (2,839 single deliveries). In S o Luís, systematic sampling of deliveries stratified by maternity hospital was performed from 1997 to 1998 (2,439 single deliveries). The chi-squared (for categories and trends) and Student t tests were used in the statistical analyses. RESULTS: The LBW rate was lower in S o Luís, thus presenting an epidemiological paradox. The preterm birth rates were similar, although expected to be higher in Ribeir o Preto because of the direct relationship between preterm birth and LBW. Dissociation between LBW and infant mortality was observed, since S o Luís showed a lower LBW rate and higher infant mortality, while the opposite occurred in Ribeir o Preto. CONCLUSIONS: Higher prevalence of maternal smoking and better access to and quality of perinatal care, thereby leading to earlier medical interventions (cesarean section and induced preterm births) that resulted in more low weight live births than stillbirths in Ribeir o Preto, may explain these paradoxes. The ecological dissociation observed between LBW and infant mortality indicates that the LBW rate should no longer be systematically considered as an indicator of social development.
Examining life-course influences on chronic disease: the Ribeir?o Preto and S?o Luís birth cohort studies (Brazil)
Batty, G.D;
Brazilian Journal of Medical and Biological Research , 2007, DOI: 10.1590/S0100-879X2007000900001
Abstract: more than any other low- and middle-income country, brazil has the longest research tradition of establishing, maintaining and exploiting birth cohort studies. this research pedigree is highlighted in the present issue of the brazilian journal of medical and biological research, which contains a series of twelve papers from the ribeir?o preto and s?o luis birth cohort studies from the southeast and northeast of brazil, respectively. the topics covered in this raft of reports vary and include predictors of perinatal health and maternal risk factors, early life determinants of cardiovascular risk factors in childhood and adolescence, use of health services, and a description of dietary characteristics of young adults, amongst other topics. there is also a guide to the background, objectives, sampling and protocols employed across these studies, which, together with similar pieces published in past issues of the brazilian journal, serve as a very useful starting point, particularly for potential collaborators. in the fervent hope that further follow-up of these cohorts will take place - we provide our own justification for cohort maintenance and extension in this issue - future data collection could include: genetic material, atherosclerosis, ascertained, for instance, by intima-media thickness, and iq testing in children - scores from which are emerging as potentially important predictors of adult health outcomes up to six decades later.
Infant Feeding and School Attainment in Five Cohorts from Low- and Middle-Income Countries  [PDF]
Bernardo L. Horta, Abet Bas, Santosh K. Bhargava, Caroline H. D. Fall, Alan Feranil, Julia de Kadt, Reynaldo Martorell, Linda M. Richter, Aryeh D. Stein, Cesar G. Victora, The COHORTS group
PLOS ONE , 2013, DOI: 10.1371/journal.pone.0071548
Abstract: Background Performance in intelligence tests tends to be higher among individuals breastfed as infants, but little is known about the association between breastfeeding and achieved schooling. We assessed the association of infant feeding with school achievement in five cohorts from low- and middle-income countries. Unlike high-income country settings where most previous studies come from, breastfeeding is not positively associated with socioeconomic position in our cohorts, thus reducing the likelihood of a spurious positive association. Methodology and Principal Findings Participants included 10,082 young adults from five birth cohorts (Brazil, India, Guatemala, the Philippines, and South Africa). The exposures variables were whether the subject was ever breastfed, total duration of breastfeeding, and age at introduction of complementary foods. We adjusted the estimates for age at follow up, sex, maternal age, smoking during pregnancy, birthweight and socioeconomic position at birth. The key outcome was the highest grade achieved at school. In unadjusted analyses, the association between ever breastfeeding and schooling was positive in Brazil, inverse in the Philippines, and null in South Africa; in adjusted analyses, these associations were attenuated. In Brazil, schooling was highest among individuals breastfed for 3–12 months whereas in the Philippines duration of breastfeeding was inversely associated with schooling; and null associations were observed in South Africa and Guatemala. These associations were attenuated in adjusted models. Late introduction of solid foods was associated with lower schooling achievement in Brazil and South Africa. Conclusion Measures of breastfeeding are not consistently related to schooling achievement in contemporary cohorts of young adults in lower and middle-income countries.
Maternal-child health in Pelotas, Rio Grande do Sul State, Brazil: major conclusions from comparisons of the 1982, 1993, and 2004 birth cohorts
Barros, Fernando C.;Victora, Cesar G.;
Cadernos de Saúde Pública , 2008, DOI: 10.1590/S0102-311X2008001500012
Abstract: important changes were observed in maternal characteristics, health care indicators, and child health during the 22 years covered by the three population-based birth cohort studies conducted in the city of pelotas, southern brazil. maternal education levels improved, cigarette smoking during pregnancy was reduced, and birth intervals became longer. also, there were more single mothers, and maternal obesity increased. coverage of antenatal and delivery care by professionals improved, but inductions and caesarean sections increased markedly, the latter accounting for 45% of deliveries in 2004. with regard to child health, the reductions in neonatal and infant mortality rates were modest, and the significant increase in preterm births - 14.7% of all births in 2004 - appears to have colluded with this stagnation. other infant health indicators, such as immunization coverage and breastfeeding duration, showed improvements over the period. regarding infant nutrition, malnourishment at age 12 months decreased, but the prevalence of overweight was higher in 2004. the existence of three population-based birth cohorts using comparable methodology allowed for the study of important secular trends in maternal and child health.
Breastfeeding and feeding patterns in three birth cohorts in Southern Brazil: trends and differentials
Victora, Cesar G.;Matijasevich, Alicia;Santos, Iná S.;Barros, Aluisio J. D.;Horta, Bernardo L.;Barros, Fernando C.;
Cadernos de Saúde Pública , 2008, DOI: 10.1590/S0102-311X2008001500006
Abstract: breastfeeding is fundamental for child health. changes in the duration of breastfeeding are compared for three population-based cohorts of children born in 1982, 1993 and 2004 in the city of pelotas, southern brazil. samples of the 1982 and 1993 children and all of the children from the 2004 cohort study were sought at home when they were aged around 12 months. both the duration of breastfeeding and the stage at which different kind of foods were regularly introduced were investigated. the median duration of breastfeeding increased from 3.1 to 6.8 months in this period. exclusive breastfeeding at three months was practically non-existent in 1982 and had reached one third of infants by 2004. the increase was faster after 1993, suggesting an important impact made by promotion activities. up to about 6-9 months, breastfeeding was more prevalent in high-income families, but after this age it became more common among the poor. low birth weight babies were breastfeed for shorter durations. the duration of breastfeeding is still far short of international recommendations, justifying further campaigns. special attention should be given to low birth weight babies and those from low-income families.
Environmental exposure assessment in European birth cohorts: results from the ENRIECO project
Ulrike Gehring, Maribel Casas, Bert Brunekreef, Anna Bergstr?m, Jens Peter Bonde, Jérémie Botton, Cecile Chévrier, Sylvaine Cordier, Joachim Heinrich, Cynthia Hohmann, Thomas Keil, Jordi Sunyer, Christina G Tischer, Gunnar Toft, Magnus Wickman, Martine Vrijheid, Mark Nieuwenhuijsen
Environmental Health , 2013, DOI: 10.1186/1476-069x-12-8
Abstract: Pregnancy and birth cohort studies provide the possibility of repeated measurements of health outcomes and exposures at different time points from pregnancy through childhood and adolescence into adulthood. Therefore, they present an ideal framework for the prospective study of the effects of environmental exposures on the health and development of children. Furthermore, they allow the study of temporal variability in exposure. If temporal variability is sufficient, the relevance of exposure at different time points (e.g. prenatal and postnatal) and the health impact associated with changes in exposure can be investigated, which may help to focus preventive actions.Currently, many European birth cohort studies of children’s environment-health relationships exist and provide evidence for relationships that can be used to develop strategies to reduce environmental exposures and to improve health. However, single studies often lack statistical power to lead to conclusive results on their own, in particular when health outcomes and/or exposures with low prevalence are studied. Combining data from different studies is a powerful remedy for this. Also, collaboration between birth cohorts enables us to replicate and corroborate or refute findings as well as to explore reasons for heterogeneity. Therefore, there is an urgent need to evaluate, and where possible combine, the existing data, methods and tools from European birth cohort studies in order to evaluate possible links between environmental exposures and health [1].The assessment of exposure is a crucial element of the study of the potential adverse effects associated with exposure. Error in exposure measurements reduces the statistical power of a study [2] and the estimated effect is likely to be smaller than the true effect [3], both increasing the likelihood that real associations are not detected. Exposure can be assessed by means of direct approaches including biological and personal monitoring, by means of indi
Violence Research in Northeast and Southeast Asia: Main Themes and Directions  [cached]
Oliver Hensengerth
International Journal of Conflict and Violence , 2011,
Abstract: The study analyses research on violence in the Northeast and Southeast Asia with respect to four types: political, urban, domestic and youth violence, highlighting current research themes, tendencies and gaps in violence research on and in the region, and identifying needs for further research. Commonalities and differences between countries and subregions are examined, along with a treatment of the colonial experience that influenced political violence in postcolonial countries.
Developmental status at age 12 months according to birth weight and family income: a comparison of two Brazilian birth cohorts
Halpern, Ricardo;Barros, Aluísio J. D.;Matijasevich, Alicia;Santos, Iná S.;Victora, Cesar G.;Barros, Fernando C.;
Cadernos de Saúde Pública , 2008, DOI: 10.1590/S0102-311X2008001500010
Abstract: two cohorts of children born in the city of pelotas, southern brazil, in 1993 and 2004, were compared in terms of neuro-psychomotor development at the age of 12 months. children were evaluated using the denver ii screening test. analyses were performed using the poisson regression technique. the prevalence of suspected developmental delay fell from 37,1% in 1993 to 21.4% in 2004 and was inversely proportional to family income and birth weight. among children born weighing under 2,000 g, there was a fourfold reduction in the prevalence of developmental delay between 1993 and 2004. with regard to family income, the poorest group showed the greatest reduction between the two cohorts - a 30% reduction in risk. our results confirm the influence of income and birth weight on child development. the decrease in the prevalence of developmental delay in the last decade reflects, among other factors, improvements in neonatal care, increased coverage of developmental monitoring in the first year of life, and longer breastfeeding duration. despite this reduction, the prevalence of developmental delay is still high, reinforcing the need for early diagnosis and intervention.
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