Estudo da mortalidade infantil nos estados brasileiros utilizando aplicação de dados em painel / Study of child mortality in brazilian states using panel data application / Estudio de mortalidad infantil en estados brasileños mediante aplicación de datos de panel

Este trabalho tem como objetivo determinar uma relação linear entre a Taxa de Mortalidade Infantil (TMI) e um conjunto de variáveis socioeconômicas observadas por unidades federativas no período de 2005 à 2010 utilizando o modelo de dados em painel de efeitos fixo e aleatório. Metodologia: trata-se de um estudo descritivo com abordagem quantitativa, com utilização dos Sistema de Informação sobre Mortalidade (SIM) e o Sistema de Informações sobre Nascidos Vivos (SINASC) e em seguida utilizou-se o software R para realizar esta análise de dados com a função plm. Resultados: os estudos mostram que o modelo mais adequado é o de efeito fixo com transformação logarítmica nas variáveis independentes e na variável dependente que foram as seguintes: TMI, taxa de analfabetismo, PIB per capita, proporção pessoas com baixa renda, percentual da população servida por rede de abastecimento de água e a proporção da população servida por coleta de lixo. Conclusão: As variáveis independentes que causam impacto significativo na TMI são taxa de analfabetismo, PIB per capita e proporção de pessoas com baixa renda.

This work aims to determine a linear relationship between the Infant Mortality Rate (IMR) and a set of socioeconomic variables observed by federative units in the period from 2005 to 2010 using the fixed and random effects panel data model. Methodology: this is a descriptive study with a quantitative approach, using the Mortality Information System (SIM) and the Live Birth Information System (SINASC) and then using the R software to perform this data analysis with the plm function. Results: studies show that the most appropriate model is the fixed effect model with logarithmic transformation in the independent variables and the dependent variable, which were as follows: IMR, illiteracy rate, GDP per capita, proportion of people with low income, percentage of the population served by water supply network and the proportion of the population served by garbage collection. Conclusion: The independent variables that have a significant impact on IMR are the illiteracy rate, GDP per capita and the proportion of people with low income.

Este trabajo tiene como objetivo determinar una relación lineal entre la Tasa de Mortalidad Infantil (TMI) y un conjunto de variables socioeconómicas observadas por las unidades federativas en el período 2005 a 2010 utilizando el modelo de datos de panel de efectos fijos y aleatorios. Metodología: se trata de un estudio descriptivo con enfoque cuantitativo, utilizando el Sistema de Información de Mortalidad (SIM) y el Sistema de Información de Nacidos Vivos (SINASC) y luego utilizando el software R para realizar este análisis de datos con la función plm. Resultados: los estudios muestran que el modelo más adecuado es el modelo de efectos fijos con transformación logarítmica en las variables independientes y la variable dependiente, las cuales fueron las siguientes: TMI, tasa de analfabetismo, PIB per cápita, proporción de personas con bajos ingresos, porcentaje de la población atendida por red de suministro de agua y la proporción de la población atendida por recolección de basura. Conclusión: Las variables independientes que tienen un impacto significativo en la TMI son la tasa de analfabetismo, el PIB per cápita y la proporción de personas con bajos ingresos.

An assessment of infant mortality rates in Colombia, 1980-2009 / Una evaluación de las tasas de mortalidad infantil en Colombia, 1980-2009

Abstract Purpose: The infant mortality rate is a key indicator of human welfare and development. However, in Colombia, the Departamento Administrativo Nacional de Estadística has set the registered rate for 2009 as 13.69 per 1,000 live births, while the estimated rate is 20.13, suggesting the presence of inconsistencies in the data, as in many other transitional economies. Objective: To set the record straight on Colombia's Infant mortality rate reporting since 1980 by using all available data that have recently become public. Methods: The study analyzes 8,636,510 records of live births (1998-2009) and 443,338 records of deaths (1979-2009), and considers information from all available sources: births and death registries, census data, Departamento Administrativo Nacional de Estadística, and Profamilia surveys. First, following a descriptive analysis, an exponential function is used to estimate the Infant mortality rates in Colombia for 1980-2009 while resolving internal inconsistencies in the data from all sources. The objective is to evaluate the infant mortality rate in Colombia, 1980-2009. Results: The analysis demonstrates that the registered and the estimated rates for 2009 are incompatible since they follow inconsistent long-term rates of decline in Infant mortality rate. While the registered rate underestimates the real situation, the estimated rate appears to grossly overestimate it. Analyses, based on other sources, put the Infant mortality rate between 15.81 and 17.58 in 2009, with rates of decline between 3.0 and 5.0 percent for the period 1980-2009. Conclusions: The study concludes that during the period 1980-2009, the Infant mortality rate for Colombia on average fell from about 54 to about 17, suggesting a long-term annual rate of decline of about 4.0 percent.

Resumen Propósito: La Tasa de Mortalidad Infantil es un indicador clave del bienestar y desarrollo humano. Sin embargo, en Colombia el Departamento Administrativo Nacional de Estadística reporta una tasa de mortalidad infantil registrada para 2009 de 13.69 por cada 1,000 nacidos vivos, mientras que, la tasa estimada es de 20.13 para el mismo año, como en muchas economías de transición, lo que sugiere la presencia de datos inconsistentes. El objetivo fue determinar la tasa de mortalidad infantil de Colombia desde 1980 a 2009, con los datos disponibles y publicados recientemente. Métodos: El estudio analiza 8 636 510 de registros individuales de nacidos vivos (1998-2009) y 443 338 registros individuales de mortalidad (1979-2009). Además, se incluyen todas las fuentes disponibles: nacimientos y defunciones registrados del Departamento Administrativo Nacional de Estadística (DANE), datos censales, y la Encuesta Nacional de Demografía y Salud (ENDS) de Profamilia Colombia. En primer lugar, tras un análisis descriptivo, se utilizó una función exponencial para estimar las tasas de mortalidad infantil en Colombia para 1980-2009 mientras se resuelven las incoherencias internas en los datos de todas las fuentes, con el objetivo de evaluar la tasa de mortalidad infantil en Colombia 1980-2009. Resultados: El análisis mostró que las tasas registradas y estimadas para 2009 eran incompatibles, debido a que la tasa de descenso de los nacimientos y las defunciones a lo largo del tiempo también eran inconsistentes. Si bien la tasa registrada de 13.69, estaba subestimada frente a la situación real, la tasa estimada de 20.13, parecía estar demasiado sobreestimada. Los análisis basados en otras fuentes muestran que la tasa de mortalidad infantil se encuentra entre 15.81 y 17.58 en 2009, con tasas de descenso anual entre un 3.0 y el 5.0 por ciento, para el período 1980-2009. Conclusiones: El estudio concluye que, durante el período 1980-2009 la tasa de mortalidad infantil para Colombia se redujo de 54 a 17 muertes por mil nacidos vivos, lo que sugiere una tasa anual de descenso aproximada para el período de 4.0 por ciento.

Infant Mortality and Infant-Care Practices in the Rural Field Practice Area of JNIMS, Manipur: A Cross-Sectional Study

Background: In spite of the weak health care delivery system, the Infant Mortality Rate (IMR) of the state of Manipur as reported in the Sample Registration System Bulletins has been consistently very low (≈11 per 1,000 live births) for the last five years or so. This warranted a study to re-affirm it and also to explore the important reasons of why and how the IMR could be brought down to very low levels. Objectives: The study objectives were to make an estimate of IMR in the Rural Field Practice Area (RFPA) of JN Institute of Medical Sciences, Manipur and also to assess the important infant-care practices starting from before the child is born till infancy. Methods: A community-based cross-sectional study was done in the RFPA of JNIMS during Sept-Oct 2018. Using a pre-tested semi-structured and semi-open interview schedule that had sections on socio-demographic profile, details of infant deaths and infant-care practices starting from ante-natal visits, information were collected from a scientifically calculated sample size of 150 women who had live births in the last one year prior to the study, immaterial of the survival status of the infant. Data collected were analysed and presented by using descriptive statistics. Results: Not even a single infant died in the last one year. Better infant care practices were seen in the study area when compared to the latest NFHS-4 Report for the state of Manipur. Some of these important better practices were pregnant women having ≥ 3 ANC visits (98%), institutional delivery rate (94%), conducting home deliveries by skilled health personnel (22.2%), exclusive breastfeeding rate (77.3%) and proportion of infants aged 6-12 months adequately fed (35%). Conclusion: The estimated IMR in the study area was zero. The better infant-care practices prevailing in the study area might have averted infant deaths.

Application and comparison of residual autoregressive model and Holt’s two-parameter exponential smoothing model in infant mortality prediction in some countries along the Belt and Road Initiative / 中华疾病控制杂志

@# Objective To explore the application of residual autoregressive model and Holt's two-parameter exponential model in the prediction of infant mortality rate in some countries along the “Belt and Road” (China-Indo-China Peninsula Economic Corridor). Methods The time series data of infant mortality rate in Vietnam, Laos, Cambodia, Myanmar, Thailand, Singapore, Malaysia, and China for 1978-2013 were used as training set to fit residual autoregressive model and Holt's two-parameter exponential model. The 2014-2016 data was used as the validation set to compare the performance of model prediction. Results The akaike information criterion (AIC) value of the residual autoregressive model was superior to Holt's two-parameter exponential model. Both prediction models showed high accuracy, and most evaluation indicators (absolute error and relative error) of residual autoregressive prediction model were smaller than Holt's two-parameter exponential model. The residual autoregressive models of Laos, Myanmar and Cambodia were better than the Holt’s two-parameter exponential model for the infant mortality rate(IMR) prediction in different years. Conclusions The residual autoregressive model and Holt's two-parameter exponential model performed well in infant mortality rate prediction in some countries along the China-Indo-china Peninsula Economic Corridor. The residual autoregressive model has better fitting effect. The residual autoregressive model for infant mortality prediction is superior to the Holt two-parameter exponential model in most countries in most years.

Relación de la mortalidad infantil con la altura geográfica en el Noroeste Argentino / Relationship between infant mortality and altitude in the Northwest region of Argentina

Introducción. Por su localización sobre los Andes, el Noroeste Argentino presenta una heterogeneidad geográfica, socioeconómica, cultural y biológica reflejada en tasas de mortalidad infantil (TMI) superiores a casi todas las regiones argentinas. Objetivo. Calcular la TMI, tasa de mortalidad neonatal (TMN) y la tasa de mortalidad posneonatal (TMP) para analizar su variación temporal y espacial, a través de la tendencia secular y el riesgo relativo de acuerdo con el nivel altitudinal. Población y método. En un estudio retrospectivo, descriptivo y de correlación basado en datos de nacimientos y defunciones infantiles sucedidos en el Noroeste Argentino (1998-2010), se calcularon por departamentos y nivel altitudinal (departamentos a < 2000metros sobre el nivel del mar, tierras bajas y > 2000 msnm, tierras altas) TMI, TMN y TMP, tendencia secular y riesgo relativo de muerte, realizando un análisis de agrupamiento. Resultados y conclusiones. Las tasas fueron más elevadas en tierras altas, la TMI fue de 29,8%o (en tierras bajas, 15,6%); la TMP en tierras altas fue de 17,7% y 5,2% en tierras bajas. Las tierras altas mostraron un descenso promedio anual del 3,9% para la TMI y del 4,1% para la TMP; en tierras bajas, el descenso fue de 7,0% para la TMI y del 9,3% para la TMP. El riesgo relativo fue significativamente mayor a grandes alturas para TMI y TMP. La TMN, su tendencia secular y riesgo relativo no mostraron diferencias estadísticamente significativas entre niveles de altura.

Introduction. Given its location on the Andes, the Northwest region of Argentina is geographically, socioeconomically, culturally, and biologically heterogeneous, and this is reflected on an infant mortality rate (IMR) that is higher than in any other Argentine region. Objective. To estimate IMR, neonatal mortality rate (NMR), and post-neonatal mortality rate (PNMR), and to analyze their spatial and temporal variations using secular trends and the relative risk based on altitudinal zones. Population and method. This was a retrospective, descriptive, correlational study based on birth and death data recorded in the Northwest region of Argentina (1998-2010); IMR, NMR, PNMR, secular trends, and the relative risk of death were calculated by district and altitudinal zone (districts at < 2000 meters above sea level, lowlands; at > 2000 meters above sea level, highlands) by means of a cluster analysis. Results and conclusions. Rates were higher in the highlands; IMR was 29.8%o (versus 15.6%o in the lowlands); PNMR was 17.7% in the highlands (versus 5.2% in the lowlands). In the highlands, there was an annual average reduction of 3.9% in IMR and of 4.1% in PNMR; in the lowlands, such reduction was of 7.0% in IMR and of 9.3% in PNMR. The relative risk of IMR and PNMR was significantly higher at high-altitude zones. NMR, its secular trend, and the relative risk did not show statistically significant differences between both altitudinal zones.

The Causal Relationship Between Infant Mortality Rate, Health Expenditure And Economic Growth In India

The Infant Mortality Rate defined as the risk for a live born child to die before its first birthday, is known to be one of the most sensitive and commonly used indicators of the social and economic development of a nation. This paper investigates the causal relationship between infant mortality rate, economic growth and private health expenditure [% Gross Domestic Product (GDP)] in India using the co-integration and Granger causality frameworks for the period from 1995 to 2013 using secondary data from various sources. We have examined the presence of a long-run equilibrium relationship using the bounds testing approach to co-integration within the Unrestricted Error- Correction Model (UECM). We have also examined the direction of causality between infant mortality rate, economic growth and private health expenditure (% GDP) in India using the Granger causality test within the Vector Error-Correction Model (VECM). As a summary of the empirical findings, we find the Infant Mortality Rate (IMR), Per-Capita Gross Domestic Product (PCGDP) and private health expenditure (% GDP) are co-integrated. The results of Granger Causality suggested that no short-run effect was existing between all the three variables. The error-correction term implies that the variable is non-explosive and long-run equilibrium relationship is attainable.​​

Evolución de la mortalidad infantil en Argentina en el marco de los Objetivos de Desarrollo del Milenio / Trend in infant mortality rate in Argentina within the framework of the Millennium Development Goals

Introducción. La tasa de mortalidad infantil (TMI) es un indicador del estado de salud de una población y de accesibilidad y calidad de los servicios de salud. En el año 2000, Argentina asumió, en el marco de los Objetivos de Desarrollo del Milenio, el compromiso de disminuir la TMI para el año 2015 a un tercio del valor del año 1990 y reducir las brechas entre jurisdicciones. El objetivo de este trabajo fue describir la evolución de la mortalidad infantil en Argentina y las brechas entre las jurisdicciones, su magnitud y sus causas, en función del cumplimiento de los Objetivos de Desarrollo del Milenio. Población y métodos. Se realizó un estudio descriptivo de la mortalidad infantil en Argentina en 1990 y de 2000 a 2013 sobre la base de publicaciones de estadísticas vitales de la Dirección de Estadísticas e Información de Salud del Ministerio de Salud de la Nación. Resultados. Se constató un descenso en la TMI de 57,8%, en la tasa de mortalidad neonatal de 52,6% y en la tasa de mortalidad posneonatal de 63,8%. El coeficiente de Gini interprovincial para la TMI disminuyó un 27%. El riesgo atribuible poblacional disminuyó 16,6% para la TMI, 38,8% para la tasa de mortalidad neonatal y 51,5% para la tasa de mortalidad posneonatal en el año 2013 respecto de 1990. Conclusión. Se constató un importante descenso en la mortalidad infantil y sus componentes, aunque insuficiente para alcanzar las metas de los Objetivos de Desarrollo del Milenio. La disminución de labrecha de la TMI alcanzó la meta asumida; sin embargo, aún persisten inequidades.

Introduction. Infant mortality rate (IMR) is an indicator of the health status of a population and of the quality of and access to health care services. In 2000, and within the framework of the Millennium Development Goals, Argentina committed to achieve by 2015 a reduction by two thirds of its 1990 infant mortality rate, and to identify and close inter-jurisdictional gaps. The objective of this article is to describe the trend in infant mortality rate in Argentina and interjurisdictional gaps, infant mortality magnitude and causes, in compliance with the Millennium Development Goals. Population and methods. A descriptive study on infant mortality was conducted in Argentina in 1990 and between 2000 and 2013, based on vital statistics data published by the Health Statistics and Information Department of the Ministry of Health of Argentina. Results. The following reductions were confirmed: 57.8% in IMR, 52.6% in neonatal mortality rate and 63.8% in post-neonatal mortality rate. The inter-provincial Gini coefficient for IMR decreased by 27%. The population attributable risk decreased by 16.6% for IMR, 38.8% for neonatal mortality rate and 51.5% for post-neonatal mortality rate in 2013 versus 1990. Conclusion. A significant reduction in infant mortality and its components has been shown, but not enough to meet the Millennium Development Goals. The reduction in IMR gaps reached the set goal; however, inequalities still persist.

Análise da relação entre gasto público per capita em saúde e a taxa de mortalidade infantil nas 4 macrorregiões do estado de Pernambuco no período de 2008 a 2012 / Analysis of the relationship between public expenditure per capita in health and the infant mortality rate in the four macroregions of the state of Pernambuco in the period from 2008 to 2012

Um dos principais desafios em pauta para o SUS é o seu financiamento, que envolve tanto a insuficiência dos recursos disponíveis frente às necessidades da população, como a precária qualidade da gestão e ineficiência do gasto em saúde. Este trabalho objetivou analisar a relação entre a despesa per capita em saúde e o impacto na Taxa de Mortalidade Infantil-TMI nas quatro Macrorregiões do Estado Pernambuco no período de 2008 a 2012. Estudo quantitativo, descritivo com dados secundários. Foram analisados as informações referentes aos 184 municípios de PE, sendo esses agrupados em 4 Macrorregionais de Saúde, de acordo com a divisão política administrativa de saúde do Estado de PE. Os dados foram analisados através do método de Pearson e do modelo econométrico de regressão múltipla, utilizando o método de dados em painel. Verificou-se que a despesa com saúde per capita nas quatro Macrorregiões de Pernambuco mostrou tendência ascendente no período de 2008 a 2012. Observou-se também que a Taxa de Mortalidade InfantilTMI nas quatro Macrorregiões, assim como no Estado de Pernambuco e no Brasil, apresentaram uma tendência de redução. Contudo, há importantes diferenças na redução da TMI entre as Macrorregiões. Na análise da correlação bivariada entre a despesa per capita em saúde e a TMI nas quatro Macrorregiões de saúde, os dados mostraram que as variáveis estão correlacionadas em todas as quatro Macrorregiões, com destaque para a Macrorregião II (p = 0,011 e de r2 = 0,91) , que apresentou a correlação mais significante entre as Macrorregionais de saúde. Na montagem do modelo econométrico, os resultados mostraram que mesmo com a introdução de outras variáveis que também influenciam a TMI, o efeito da despesa per capita/ano na TMI continua significativo, conferindo a despesa per capita com saúde um grau de robustez.(AU)

One of the major challenges on the agenda for the NHS is its funding, which involves both the inadequacy of available resources across the population's needs, as the poor quality of management and inefficiency of spending on health. This study aimed to analyze the relationship between per capita health expenditure and the impact on Mortality Rate Child-TMI in the four Macroregions of Pernambuco State in the period 2008 to 2012. quantitative, descriptive study using secondary data. We analyzed the information regarding the 184 municipalities of PE, these being grouped into 4 macro-regional Health, according to the administrative political division of health PE status. Data were analyzed using the method of Pearson and econometric multiple regression model using panel data method. It was found that expenditure on health per capita in the four Macroregions of Pernambuco showed upward trend in the period 2008 to 2012. It was also observed that the mortality rate Child-TMI in the four Macroregions, as well as in the state of Pernambuco and Brazil , showed a downward trend. However, there are important differences in the reduction of IMR between Macroregions. In the analysis of the bivariate correlation between the per capita expenditure on health and IMR in four health Macroregions, the data showed that the variables are correlated in all four Macroregions, with emphasis on the macroregion II (p = 0.011 and r2 = 0 , 91), which had the most significant correlation between health macro-regional. In the assembly of the econometric model, the results showed that even with the introduction of other variables also influence the IMR, the effect of expenditure per capita / year in IMR remains significant, giving the per capita expenditure on health a degree of robustness.(AU)

Evaluation and Estimation of the Provincial Infant Mortality Rate in China's Sixth Census / 生物医学与环境科学（英文）

<p><b>OBJECTIVE</b>To assess the data quality and estimate the provincial infant mortality rate (1q0) from China's sixth census.</p><p><b>METHODS</b>A log-quadratic model is applied to under-fifteen data. We analyze and compare the average relative errors (AREs) for 1q0 between the estimated and reported values using the leave-one-out cross-validation method.</p><p><b>RESULTS</b>For the sixth census, the AREs are more than 100% for almost all provinces. The estimated average 1q0 level for 31 provinces is 12.3‰ for males and 10.7‰ for females.</p><p><b>CONCLUSION</b>The data for the provincial 1q0 from China's sixth census have a serious data quality problem. The actual levels of 1q0 for each province are significantly higher than the reported values.</p>

Differentials and Correlates of Infants Mortality in Nigeria: A Comparative Survival Analysis between North East and South West Nigeria.

Aims: Infant mortality rate (IMR) is not only used as a demographic measure, but also as an important health indicator of a society as well as a measure of its living standard worldwide. The Nigeria Demographic and Household Survey (NDHS) declared a wide difference in the IMR among geographical zones in Nigeria with widest gap between the North East (NE) and South West (SW). This study assessed the differences in IMR viz-a-viz socio-demographic, sexual and reproductive factors and also determined factors affecting the IMR in the two zones. Place of Study: Rural and Urbanlocations across the NE and SW Nigeria Study Design: We used a nationally representative cross sectional data from the NDHS 2008 survey.Our analysis was based on the 23,995 and 11,546 births during five years preceding data collection from women aged 15-49 years in NE and SW Nigeria respectively. Methods: We censored the children who have not had their first birthday as of the day of interview and estimated the IMR with Life tables using West Models. Other analysis were carried out with descriptive statistics, bivariate and multivariate cox regression models at 5% significance level. Results: About 3 of every four NE children are from rural areas compared with 47.4% in SW, while nearly 78% of NE children are from mothers without formal education the rate was 20.9% in the SW. The IMR among children from teenager mothers was 121 and 82 per 1000 live births in NE and SW respectively, 87 for urban NE, 52 for urban SW, 115 for rural NE, and 66 for rural SW. In the NE, children from rural areas were about 30% times more likely than children from urban areas to die before their first birthday (HR=1.3 95% CI:1.1-1.6)while in the SW they were 40% times more likely to die (HR=1.6 95% CI:1.1-2.4). Children from wealthiest homes in the NE had lower IMR than children from wealthiest homes in the SW (37 vs 55) but wealth quintiles were not significant to IMR in the SW. Conclusion: The prevailing trend of early marriage, non-education, delayed initiation of breastfeeding, unsafe drinking water, unemployment and poverty among others should be averted so as to improve child survival in the Nigeria especially in the North East.

How reproductive history of married women influencing the mortality rate of their children under 5 years in rural areas of Shaanxi province / 中华流行病学杂志

Objective To investigate the current status of reproductive history among married women and the mortality rate of children under 5 years.Influence of reproductive history among married women on mortality rate of their children under 5 years in rural areas in Shaanxi province was also studied.Methods A cross-sectional survey was conducted on reproductive history and mortality rate of their children under 5 years of age in five Fourth National-Level Poverty-Stricken counties in Shaanxi province.Sample under study was chosen according to the three-stage stratified random sampling technique.Results A total number of 4 732 married women were studied,with the average age of first birth as 23.65 years,the average parity as 1.49,the average spacing between first and second child birth as 6.96 years and the average spacing between second and third child birth as 3.98years.In children under 5 years of age among the surveyed women in 2007-2010,32.19％ of the deaths in children under 5 years of age occurred during infancy while 70.21％ of the infant deaths occurred during neonatal period.The mortality rates (1/1000) for newborns,infants and children under 5 years were 6.71‰,9.55‰,29.67‰ respectively.Infant mortality rate of mother with multiple births was higher than the singletons (x2=6.057,P=0.014).Parity differences in mortality rate of children under 5 years were significant (x2=17.469,P＜0.001) and interval differences of births on infant mortality rate were also significant (x2=13.137,P=0.001).Conclusion Fertility of rural women in Shaanxi was in good condition.The proportion that infant death was accounted for the total deaths of children under 5 years had declined,but the neonatal deaths still accounted for a big proportion of infant deaths.Infant mortality rate and mortality rate of children under 5 years old had declined,when compared to the national level in 2000,however,it was still higher than the city level.In terms of the fertility characteristics in women as multiple births,more parity and short spacing of births etc,were important factors of death of their children under 5 years of age.

Comparison of Neonatal and Infant Mortality Rates between Infants Born in South Korea and Those Born in the United States

PURPOSE: The neonatal (NMR) or infant mortality rate (IMR) in South Korea is lower than that in the United States. We aimed to investigate the contributing factors to this difference in mortality rates. METHODS: The study populations consisted of five groups, namely group A, comprising live births in South Korea during 2009-2011 (n=1,383,806), and groups B (live births to Korean parents, n=107,309), C (Caucasian births, n=31,588,183), D (African-origin, n=4,381,664), and E (all live births, n=49,384,187) comprising various US live births during 2000-2011. Maternal characteristics, birth outcomes, and mortality rates in these five groups were compared according to birth weight (BW) and gestational age (GA). RESULTS: Maternal characteristics such as BW distribution and very low and low BW rates among infants in South Korea and those in the United States were quite similar. Both rates were significantly lower among the Korean live births than among Caucasian and African-origin live births in the United States. However, the mortality rates of these small birth weight groups were significantly higher in the Korean infants born in South Korea than in those born in the United States, or in Caucasian and African-origin infants born in the United States. Similar results were noted when analyzed according to gestational age. CONCLUSIONS: The NMR or IMR in South Korea is lower than that in the United States, primarily due to the overwhelming favorable BW and GA distribution, despite the lower BW- and GA-specific survival rates in the live births in South Korea than in the United States.

Brechas regionales de la mortalidad infantil en Colombia / Regional disparities in infant mortality in Colombia

Objetivos. Estudiar las variaciones de la tasa de mortalidad infantil (TMI) en los departamentos de Colombia durante el período 2003-2009, examinar la persistencia de las variaciones entre los departamentos sobre el tiempo y relacionarlas con el impacto de las condiciones socioeconómicas y la disponibilidad de servicios de salud, sobre la mortalidad infantil. Materiales y métodos. Utilizando estadísticas vitales y relacionando datos socioeconómicos y de servicios de salud, se analizaron tres aspectos: la variación de la TMI departamental (2003-2009), la relación entre la TMI departamental y determinantes claves en el tiempo, y las líneas de causalidad e impacto relativo de los diferentes factores. Se emplearan ecuaciones estructurales. Resultados. Se encontró una razón de 4,7 entre la mayor y menor TMI departamental (2009), esta podría estar subestimada principalmente por el subregistros en departamentos de bajos ingresos. Hay una relación negativa entre la TMI departamental con el tiempo y variables altamente correlacionadas, como educación de la madre, ingreso per cápita, cobertura de aseguramiento y acceso a servicios. Conclusiones. El efecto del aseguramiento, disponibilidad de camas privadas y atención médica, es superior al impacto de mejores condiciones socioeconómicas sobre la TMI. La oferta de servicios no parece estar influenciada por una política racional, los recursos no se asignan de acuerdo con las necesidades, sino con el desarrollo general. Las camas privadas se hacen disponibles donde hay mejor aseguramiento en salud y menor TMI.

Objectives. To study the variations in infant mortality rate (IMR) across Colombia’s 33 administrative departments over the period 2003-2009, examine persistency of variations across departments over time, and relate those variations to the impact of socio-economic conditions and availability of care on IMR. Materials and methods. Using vital statistics and related socio-economic data we establish three types of analysis according to: (a) the variation of the departmental IMR (2003-2009), (b) the association between the departmental IMR and its key determinants over time, and (c) the lines of causality and relative impact of different factors, by using structural equations. Results. The 4.7 fold ratio between the highest and lowest departmental IMR (2009) may be underestimated considering underreporting, especially in low-income departments. There is a negative association between the departmental IMR with time and a set of highly correlated variables, such as the mother education, income per capita, health insurance level and access to services. Conclusions. The effect of better insurance, availability of private beds, and having doctors attending mothers, eclipse the impact of better socioeconomic conditions. The range of services does not appear to be influenced by a rational policy; resources are not allocated according to the need, but with the general development. Private beds are made available where there is better health insurance.

Causes and Differentials of Infant Mortality in the Pediatrics Wards in Fallujah General Hospital.

The aim of this study was to estimate the IMR in Fallujah General Hospital, Fallujah city/ Al –Anbar governorate/ Iraq, during the years 2007, 2008, 2009, 2010 and 2011 and to study the factors affecting it. This is a review of patient's records involving all live births and deaths occurring from the beginning of January 2007 to the end of December 2011 in FGH. The data were collected from the hospital records, the files of the patients admitted to the neonatal and children hospital wards during the mentioned years, and from birth and death certificates recorded in the hospital. Data collected included name, age, sex, residence, socioeconomic status and date of death .The IMR was 75/1000 live births in 2007, 53.8/1000 live births in 2008, 57.6/1000 live births in 2009 , 49.5/1000 live births in 2010 and 48.27/1000 live births in 2011. About 83.8% of deaths occur during the neonatal period & 16.2% in the post neonatal period. The average IMR was 57/1000 during the studied years, with an average male IMR=68.7/1000 and a female IMR= 44.37/1000. The studied dead infants were 52.8% in the rural and 47.2% in the urban areas. The 1st most common cause of death was the prematurity and RDS in the neonatal period and congenital malformation in the Post neonatal period. IMR was very high during the year 2007 and it didn't show much difference during the years 2008 and 2009, this may reflect the bad social, health, economic services in addition to the security situation during those years.

Inequalities in infant mortality among municipalities in Brazil according to the Family Development Index, 2006-2008 / Desigualdades en la mortalidad de menores de un año entre los municipios del Brasil, según el índice de desarrollo familiar de 2006 a 2008

OBJECTIVE: To describe inequalities in the infant mortality rate (IMR) according to socioeconomic indicators among geographic areas and municipalities in Brazil. METHODS: This was an exploratory ecological study of space aggregates that described IMR in 2006-2008 according to municipalities, states, and the Family Development Index (FDI), a socioeconomic indicator that ranges from 0 to 1. All the municipalities in Brazil were categorized according to four strata as defined by FDI quartiles, where stratum 4 included those with better FDI conditions, and stratum 1, worse conditions. The selected inequality measures were: Concentration Index, Attributable Risk Percent, Population Attributable Risk Percent, Rate Ratio, and number of avoidable events (number of infant deaths). RESULTS: The average IMR (per 1 000 live births) according to the FDI strata were: stratum 1 (FDI = 0.41-0.52) = 18.8; stratum 2 (FDI = 0.53-0.55) = 17.9; stratum 3 (FDI = 0.56-0.58) = 15.0; and stratum 4 (FDI = 0.59-0.73) = 13.4. Overall, the Concentration Index was 0.02. Moreover, stratum 1, with a proportion of 17% of all live births in the population, had a concentration of 20% of infant deaths. Additionally, the profile of causes and ages of infant mortality also differed qualitatively when stratum 1 was compared to stratum 4. CONCLUSIONS: The results suggest an association between the socioeconomic indicators, specifically the FDI, and the risk of infant death. These results call attention to the specific population groups in Brazil that are most vulnerable to infant mortality and demonstrate that the FDI can be used to identify these populations.

OBJETIVO: Describir las desigualdades en la tasa de mortalidad de menores de un año entre las zonas geográficas y los municipios del Brasil según los indicadores socioeconómicos. MÉTODOS: Se realizó un estudio exploratorio y ecológico de los grupos de espacios que definieron la tasa de mortalidad de menores de un año en el período de 2006 a 2008 según los municipios, los estados y el índice de desarrollo familiar (IDF), un indicador socioeconómico que va del 0 al 1. Todos los municipios del Brasil se clasificaron según 4 estratos, de conformidad con lo definido por los cuartiles del IDF; el estrato 4 incluyó a aquellas personas con mejores condiciones de IDF y el estrato 1 a aquellas con peores condiciones. Se eligieron las siguientes medidas de la desigualdad: el índice de concentración, el porcentaje de riesgo atribuible a la población, la razón de la tasa y el número de sucesos evitables (número de defunciones de menores de un año). RESULTADOS: La tasa promedio de mortalidad de menores de un año (por 1 000 nacidos vivos) según los estratos del IDF fueron: estrato 1 (IDF = 0,41-0,52) = 18,8; estrato 2 (IDF = 0,53-0,55) = 17,9; estrato 3 (IDF = 0,56-0,58) = 15,0; y estrato 4 (IDF = 0,59-0,73) = 13,4. En términos generales, el índice de concentración fue 0,02. Al estrato 1, que tuvo una proporción de 17% de todos los nacidos vivos en la población, correspondió una concentración de 20% de defunciones de menores de un año. Además, el perfil de las causas y las edades de la mortalidad de menores de un año también difirió cualitativamente cuando se compararon los estratos 1 y 4. CONCLUSIONES: Los resultados indican que hay una asociación entre los indicadores socioeconómicos, en concreto el IDF, y el riesgo de mortalidad de menores de un año. Estos resultados destacan los grupos de población específicos en el Brasil que son más vulnerables a la mortalidad de menores de un año y demuestran que el IDF puede utilizarse para identificarlos.

India’s progress towards the Millennium Development Goals 4 and 5 on infant and maternal mortality.

Background: India is in a race against time to achieve the Millennium Development Goals (MDGs) 4 and 5, to reduce Infant Mortality Rate (IMR) to ‘28’ and Maternal Mortality Ratio (MMR) to ‘109’, by 2015. This study estimates the percent net contribution of the states and the periods in shaping India’s IMR/MMR, and predicts future levels. Methods: A standardized decomposition technique was used to estimate each state’s and period’s percent share in shaping India’s decline in IMR/MMR between two time points. Linear and exponential regression curves were fitted for IMR/MMR values of the past two decades to predict IMR/MMR levels for 2015 for India and for the 15 most populous states. Results: Due to favourable maternal mortality reduction efforts in Bihar/Jharkhand (19%) and Madhya Pradesh/Chhattisgarh (11%), Uttar Pradesh (33%) - India is predicted to attain the MDG-5 target by 2016, assuming the pace of decline observed in MMR during 1997-2009 continues to follow a linear-trend, while the wait may continue until 2023-2024 if the decline follows an exponentialtrend. Attaining MDG-4 may take until 2023-2024, due to low acceleration in IMR drop in Bihar/ Jharkhand, Uttar Pradesh/Uttarakhand and Rajasthan. The maximum decline in MMR during 2004- 2009 coincided with the launch and uptake of the National Rural Health Mission (NRHM). Conclusions: Even though India as a nation is not predicted to attain all the MDG 4 and 5 targets, at least four of its 15 most populous states are predicted to do so. In the past two decades, MMR reduction efforts were more effective than IMR reduction efforts.

Defunciones en niños a principios de los siglos XX y XXI en Boyacá-Colombia / Deaths in children during the early twentieth and twenty-first century in Boyacá, Colombia

Objetivo Comparar y analizar las Tasas Brutas de Mortalidad (TBM), la Mortalidad en Menores (MN) de 5 años por mil Nacidos Vivos (NV) y la Mortalidad Infantil (MI) en el departamento de Boyacá-Colombia, a comienzos de los siglos XX y XXI. Métodos Estudio descriptivo comparativo con enfoque histórico epidemiológico. Se utilizaron dos fuentes de datos, para las defunciones: registros parroquiales de 1912-1927 y el Boletín epidemiológico de Boyacá 2007; para la población los censos DANE 1912-1918-1927 y 2005. Se almacenaron y analizaron en Mysql®. Se calcularon tasas brutas, específicas por edad e infantil, proporciones de mortalidad y mortalidad por causas. Resultados Entre 1912-1927 se registra una media de 7 958 muertes, en comparación con 5 813 en el siglo XXI; la TBM pasó de 150 muertes a 42 por 10 mil habitantes; la TMI se redujo considerablemente pasando de 231 a 17 por cada 1 000 NV; aunque se pueden comparar las tasas especificas en menores de 8 años con las de menores de 5, existe variabilidad en el rango y en la construcción de la TM especifica y la definida por OMS- UNICEF. Conclusiones Existe un impacto en la reducción de mortalidad, mayor en el siglo XXI, debido a las políticas nacionales e internacionales de control de enfermedades inmunoprevenibles y muerte materna. La pandemia de gripa de 1918-19 afectó considerablemente la mortalidad en todos los grupos de población; las causas violentas ocupan lugares importantes en la mortalidad infantil en el siglo XXI.

Objective Comparing and analysing crude death (CDR), child mortality (CMR) 5-year per thousand live births (LBR) and infant mortality rates (IMR) in the Boyacá department, Colombia, during the early 20th and 21st centuries. Methods A descriptive epidemiological comparative historical approach was adopted. Two data sources were used for deaths: parish registers 1912-1927 and the Boyacá Epidemiological Bulletin 2007 population census for 1912-1918-1927 and 2005 (Colombian Statistics Bureau - DANE); data was stored and analysed in Mysql. Crude rates, age-specific and child mortality ratios and mortality were calculated by cause. Results 7,958 deaths were recorded from 1912-1927 compared to 5,813 in the 21st century. CDR dropped from 150 to 42 deaths per 10,000 inhabitants; the IMR became significantly reduced from 231 to 17 for every 1,000 LB. Although specific rates for children under 8 years of age could be compared to children under 5, there was variability in the range and construction of the specific MR and that defined by WHO-UNICEF. Conclusions There was a higher reduction in mortality in the 21st century due to national and international policies for controlling preventable diseases and maternal death. The 1918-19 flu pandemic significantly affected mortality in all population groups; violent causes were prominent in infant mortality in the 21st century.

Mortalidade infantil, segundo critérios de evitabilidade e componentes - Viçosa - MG, 1998-2010 / Infant mortality according to preventable causes and components - Viçosa - MG, 1998-2010

Objetivo: Analisar a evolução dos indicadores da mortalidade infantil, segundo seus componentes e por causas evitáveis, no município de Viçosa, Minas Gerais, comparando-os com o Estado de Minas Gerais e o Brasil. Métodos: Estudo ecológico e descritivo de séries temporais, realizado com dados secundários relativos à mortalidade infantil, segundo grupos de causas e componentes, no município de Viçosa, no período de 1998 a 2010. Os dados de óbitos infantis ocorridos no município de Viçosa, no período de estudo, foram categorizados de acordo com a Classificação Internacional de Doenças, 10ª revisão ou CID-10, nas categorias de dois dígitos, seus componentes ? neonatal precoce, neonatal tardio e pós-neonatal ? e também de acordo com os critérios de evitabilidade, por meio da Classificação de Óbitos Evitáveis da Fundação Sistema Estadual de Análise de Dados (Fundação SEADE) do governo do Estado de São Paulo ou Classificação de Ortiz (2000). Resultados: Apesar de um declínio ao longo dos anos do coeficiente de mortalidade infantil, mantém-se um predomínio do componente neonatal à custa dos óbitos neonatais precoces, sem redução das causas evitáveis (ou reduzíveis) de óbitos nos períodos neonatal e pós-neonatal, as quais vêm mantendo-se em percentuais superiores às causas de óbitos não evitáveis ou maldefinidas. Conclusões: Grande parte da mortalidade infantil poderia ser evitada ou reduzida por meio de adequado controle da gravidez, adequada atenção ao parto e por ações de prevenção, diagnóstico e tratamento precoces e parcerias com outros setores. Por outro lado, as causas maldefinidas ainda estão em valores bem elevados, ressaltando-se a necessidade de registros de óbitos de melhor qualidade.

Factor analysis on trend of infant mortality and maternal health management in Henan province from 2000 to 2010 / 中华流行病学杂志

Objective To understand the trends and influential factors on infant mortality in Henan province from 2000 to 2010.Methods Descriptive method,Cox-Stuart trend test and multiple linear regression were used to study the infant mortality trends and related influential factors in the regions with monitoring programs of Henan province,fiom 2000 to 2010.Results The total urban and rural infant mortality rates dropped significantly,from 30.91 per thousand,10.05 per thousand,33.99 por thousand in 2000 to 7.12 per thousand,5.51 per thousand,8.03 per thousand in 2010,respectively.The average annual rates of decrease were 13.65 percent,5.83 percent and 13.44 percent.The downward hrends were statistically significant (P＜0.05).The infant mortality rates dropped more significantly in rural areas (25.96％) than in the urban areas(4.54％).Difference between urban and rural areas reduced from 23.49％ to 2.52％.Rates on factors as setting up matemal record cards,carrying on postpartum visits,hospital delivery,or under help by new midwives and low birth weight rate etc.were remarkably influencing the rate on nfant mortality (F=229.738,P=0.004).In order,the inpact of strengths on those factors showed as:hospitalized delivery rate,low birth weight rate,the rate of ‘clean' delivery,setting up record cards on postpartum visits.Conclusion Total provincial,urban and rural infant mortality rates all showed downward trends.The infant mortality rates dropped more significantly in rural areas than in urban arcas.Difference between urban and rural areas was gradually getting small.Rates on setting up maternal record cards,carrying on postpartum visit,hospital delivery and tnder help by new midwives rate were important tactors that significantly impacting the infant mortality rate.Work on setting up record cards and hospital delivery should be further strengthened.

Fatores associados aos óbitos neonatais e pós-neonatais em Moçambique / Factores asociados a los óbitos neonatales e postneonatales en Mozambique / Factors related to neonatal and post-neonatal mortality in Mozambique

Este trabalho procura descrever e analisar os fatores associados aos óbitos neonatais e pós-neonatais em Moçambique, entre 1998 e 2003, com base nas informações da Demographic and Health Survey (DHS). Foram utilizadas as distribuições de frequência das características selecionadas, segundo os segmentos neonatal e pós-neonatal. Empregou-se, também, a regressão logística de resposta binária, múltipla, com entrada sequencial das variáveis, de forma a verificar a mudança na magnitude e a significância dos coeficientes. Entre alguns resultados obtidos, destacam-se os fatores que se relacionaram de forma inequívoca ao aumento da chance de mortalidade neonatal e pós-neonatal: ser o primeiro filho; tamanho pequeno ao nascimento; e residência na região Norte. A idade da mãe entre 30 e 34 anos revelou-se elemento protetor do óbito infantil nos dois segmentos, enquanto a faixa de 10 a 19 anos apresentou-se como fator de aumento da chance do óbito pós-neonatal. O tamanho grande ao nascimento mostrou-se protetor no caso do segmento pós-neonatal, assim como a residência na região Sul. Finalmente, o parto domiciliar revelou-se deletério ao óbito pósneonatal.

Este trabajo procura describir y analizar los factores asociados a los óbitos neonatales y postneonatales en Mozambique, entre 1998 y 2003, en base a la información de Demographic and Health Survey (DHS). Se utilizaron las distribuciones de frecuencia de las características seleccionadas, conforme el segmento neonatal y postneonatal. Se empleó, también, la regresión logística de respuesta binaria, múltiple, con entrada secuencial de las variables, de forma que se pudiese verificar el cambio en la magnitud y la relevancia de los coeficientes. Entre algunos de los resultados obtenidos, se destacan los factores que se relacionaron de forma inequívoca con el aumento de la probabilidad de mortalidad neonatal y postneonatal: ser el primer hijo; tamaño pequeño al nacer; y residir en la región Norte. La edad de la madre entre 30 y 34 años se reveló como un elemento protector del óbito infantil en los dos segmentos, mientras que para la franja de los 10 a 19 años se presentó como un factor de aumento de la probabilidad de óbito postneonatal. El tamaño grande en el nacimiento se mostró como protector en el caso del segmento postneonatal, así como residir en la región Sur. Finalmente, el parto en el domicilio se reveló deletéreo para el óbito postneonatal.

This article describes and analyzes factors related to neonatal and post-neonatal deaths in Mozambique between 1998 and 2003, based on information from the Demographic and Health Survey (DHS). Distributions in the frequency of the selected characteristics for the neonatal and post-neonatal segments were studied. Multiple logistic regression with binary responses, and sequential entrance of the variables were used in order to verify changes in the levels and significance of the coefficients. The most important findings are related to the unequivocal associated factors in the odds of neonatal and post-neonatal deaths, such as being the first child, small size at birth, and residence in the northern region of the country. Mothers' being between the ages of 30 and 34 was seen as a protective element against infant mortality in both segments. In contrast, mothers being in the age group between 10 and 19 was shown to be a factor that increased odds of post-neonatal death. Size at birth was also seen as a factor of protection for the post-neonatal segment, as was residence in the southern region of Mozambique. Finally, the death rate was lower among post-neonatal newborns who were given birth at home.