Risk factors of perinatal and neonatal mortality in Alexandria, Egypt

Background: Egypt has already achieved the goal of reducing the under-five mortality rate [U5MR] by two-thirds. However, one of the challenges that Egypt currently faces is how to reduce the perinatal and neonatal mortality [PM, NM]. This study aimed to identify the social and biomedical risk factors contributing toward PM and NM in Alexandria, Egypt

Participants and methods: A case-control design was used. Cases were 150 mothers whose index pregnancy terminated in perinatal [from the 28th week of pregnancy to less than 7 days after birth] and neonatal deaths [from the seventh day to less than the 28th day after birth]. They were selected from the antenatal clinic and neonatal care unit of ElShatby University hospital for Obstetrics and gynecology. Controls were 150 mothers with live births ranging in age from 28 days up to 2 months selected from the outpatient clinics of ElShatby University Hospital for Pediatrics

Results: Stepwise logistic regression analysis indicated a higher risk of PM/NM among very young or very old mothers [OR=4.1 and 6.46, respectively], those who had previous PM/NM [odds ratio [OR]=12.7; 95% confidence interval [CI]: 5.04-29.54], grand multiparous [OR=2.23; 95% CI: 1.50-5.42], those with infrequent antenatal visits [OR=3.88; 95% CI: 2.26-6.65], and mothers with complications during the index pregnancy [OR=9.21; 95% CI: 3.40-24.95]

Conclusion: This study confirms the evidence of a positive association between PM/NM and maternal age, obstetric history, and utilization of healthcare services. Appropriate age at marriage and pregnancy, spacing of and limiting the number of births, and improving antenatal, natal, and postnatal care are priority actions that can reduce PM/NM in Alexandria

Birth and death rates in Egypt: trends and forecasting

The present study was conducted with the aim of determining the trend of crude birth and death rates in Egypt and exploring the population growth in near future using the previous 25 years experience with these two rates. The crude birth and death rates in Egypt for the period 1960 to 1985 were collected. Time series analysis using the least square method for determination of the slop of the best-fit straight line was conducted. The trend and future predictive values of these rates were also calculated. A declining trend of crude birth rate was observed for the period 1960 to 1972, followed by an increasing trend, with almost stability after 1976. For this reason, analysis was conducted using three periods [1960 to 1972, 1972 to 1985, and 1977 to 1985]. The results indicated that, if the declining trend of 1970-1972 was maintained, the rate of natural increase would have reached about 13/1000 in 1985 as compared with an actual rate of 28.4/1000. Moreover, using 1972-1985 and 1977-1985 periods' data for forecasting, the rate of natural increase is expected to be about 30 to 33/1000 for 1990, and 31 to 36 for 1995. This is an alarming situation, and hence family planning activities should be intensified with conduction of population based studies to explore the factors behind the high birth rate

Reassessment of health insurance in patient hospital services in Alexandria Part I Bed supply, hospital utilization and bed requirement

The present study was carried out with the aims of exploring the effect of changes in bed supply on hospital utilization and operational efficiency, and for reassessment of required beds for the insured population in Alexandria. The results show that the overall bed population ratio as well as the bed population ratio for the different clinical sections are progressively declining year after year. This is mainly due to the continuous increase in the insured population without a corresponding increase in beds. This shortage in available beds resulted in marked decline in all the three indices of hospital utilization [admission rate, days of care rate and average length of stay] for both the overall and individual sections. Moreover, as a response to this shortage, operational efficiency as measured by occupancy rate and turnover period improved in the early years [up to 1975/76]. This improvement was not maintained in later years and on the contrary a deterioration was observed. A possible cause for this deterioration could be the over-concern of hospital staff and administration for bed shortage. It could be also explained by lack of coordination between and within the two hospitals providing the services. The results of the study also indicate that the bed population balance is negative, both in total and for almost all the clinical sections. An estimated ratio of 2 beds/1000 population is recommended, which is far higher than that currently available [1.31/1000] and for lower than that specified by the National Health Insurance ACT [4/1000]

Reassessment of health insurance in patient hospital services in Alexandria: Part II, effect of consolidation

The occupancy rate was shown by many authors to be higher in large hospitals [or units] than in small ones. This was explained by the fact that the larger the served population is, the higher the demand will be and hence the fluctuations in the demand will be relatively low. The delivery of services for the insured population in Alexandria is conducted through two independent hospitals. Further more, each hospital is divided into several independent sections. It was mentioned in part I of this study that this could be the reason for the low operational efficiency observed. Based on the previously mentioned situation, this study was conducted to explore the possible effect on consolidation of services. As an example to these effects, the general surgery section was chosen. The results of the study indicate that if consolidation of each of the three general surgery units in each of the two hospitals could be done,36 beds can be saved. This will result in total saving of 198,000 LE of the annual operating expences. Moreover, if consolidation can be further extended to cover all the 6 units of the two hospitals a total of 51 beds can be saved and consequently saving of about 280,000 LE annually can be achieved

Lanistes carinatus: for biological control of biomphalaria Alexandria snails I laboratory observations

This work was designed to study the role of ampullarid snail, Lanistes carinatus as biological control of Biomphalaria alexandrina. The obtained results showed that L.carinatus snail has a voracious appetite for B.alexandrina egg masses even in the presence of green aquatic vegetation. The survival rate of adult B.alexandrina snails and their egg masses production significantly decrease with the increase of L.carinatus snails