Epidemiología de las muertes súbitas infantiles inesperadas en Argentina: tendencia secular y variación espacial / Epidemiology of sudden unexpected death in infancy in Argentina: secular trend and spatial variation

Introducción. La mortalidad infantil incluye defunciones de menores de un año. La proporción de muerte súbita inesperada infantil (MSII) varía entre países y según las causas de muerte consideradas. Objetivo. Describir la variación espacial y temporal de MSII en Argentina entre 1991 y 2014 utilizando la Clasificación Internacional de Enfermedades, décima revisión. Materiales y métodos. A partir de la información de defunciones infantiles (Dirección de Estadísticas e Información de Salud), se calculó el porcentaje de MSII sobre el total de muertes infantiles y la frecuencia de las causas que la componían a nivel nacional, regional y provincial. El riesgo de muerte y la tendencia secular se calcularon con regresión de Poisson. Para detectar agrupamientos departamentales con porcentajes de MSII significativamente diferentes a los nacionales, se utilizó el programa SaTScan v9.1.1. Resultados. En Argentina, entre 1991 y 2014, fallecieron 267 552 menores de un año; el 7 % fueron MSII; la tendencia secular de estas causas fue negativa y estadísticamente significativa; el riesgo de MSII fue de 0,86, y se observó una gran heterogeneidad espacial. A nivel nacional, la causa más frecuente fue síndrome de la muerte súbita del lactante, con diferencias interregionales. Nueve agrupamientos departamentales tuvieron riesgo de MSII entre 4,36 y 1,24, significativamente diferentes al resto del país. Conclusiones. La proporción de MSII y de las causas que la componen presenta heterogeneidad interregional con predominio de códigos relacionados con diagnósticos imprecisos en las regiones más desfavorecidas y de síndrome de muerte súbita del lactante en las más desarrolladas.

Introduction. Infant mortality comprises deaths among infants younger than one year old. The proportion of sudden unexpected death in infancy (SUDI) varies by country and based on the cause of death. Objective. To describe the spatial and temporal variation of SUDI in Argentina between 1991 and 2014 according to the International Classification of Diseases, tenth revision. Materials and methods. Based on infant death data (provided by the Health Statistics and Information Department), we estimated the percentage of SUDI over the total number of infant deaths and the frequency of causes of death at a provincial, regional, and national level. The risk for death and the secular trend were estimated using a Poisson regression. The SaTScan software, v9.1.1, was used to detect clusters of districts where the percentage of SUDI was significantly different from the national percentage. Results. In Argentina, between 1991 and 2014, 267 552 infants younger than 1 year died; 7 % corresponded to SUDI; the secular trend of causes was negative and statistically significant; the risk for SUDI was 0.86, and a great spatial heterogeneity was observed. At a national level, the most common cause was sudden infant death syndrome, with inter-regional differences. In nine district clusters, the risk for SUDI ranged between 4.36 and 1.24, which is significantly different from the rest of the country. Conclusions. The proportion of SUDI and its causes show inter-regional heterogeneity; codes related to inaccurate diagnoses predominated in more unfavorable regions, while sudden infant death syndrome was prevalent in the more developed regions.

Geographic altitude and prevalence of underweight, stunting and wasting in newborns with the INTERGROWTH-21st standard / Altitude geográfica e prevalência de recém-nascidos abaixo do peso, com baixa estatura e emaciação de acordo com o padrão INTERGROWTH-21st

Abstract Objective: To assess the prevalence and risks of underweight, stunting and wasting by gestational age in newborns of the Jujuy Province, Argentina at different altitude levels. Methods: Live newborns (n = 48,656) born from 2009-2014 in public facilities with a gestational age between 24+0 to 42+6 weeks. Phenotypes of underweight (<P3 weight/age), stunting (<P3 length/age) and wasting (<P3 body mass index/age) were calculated using Intergrowth-21st standards. Risk factors were maternal age, education, body mass index, parity, diabetes, hypertension, preeclampsia, tuberculosis, prematurity, and congenital malformations. Data were grouped by the geographic altitude: ≥2.000 or <2.000 m.a.s.l. Chi-squared test and a multivariate logistic regression analysis were performed to estimate the risk of the phenotypes associated with an altitudinal level ≥2.000 m.a.s.l. Results: The prevalence of underweight, stunting and wasting were 1.27%, 3.39% and 4.68%, respectively, and significantly higher at >2.000 m.a.s.l. Maternal age, body mass index >35 kg/m2, hypertension, congenital malformations, and prematurity were more strongly associated with underweight rather than stunting or wasting at ≥2.000 m.a.s.l. Conclusions: Underweight, stunting, and wasting risks were higher at a higher altitude, and were associated with recognized maternal and fetal conditions. The use of those three phenotypes will help prioritize preventive interventions and focus the management of fetal undernutrition.

Resumo Objetivo: Avaliar a prevalência e os riscos de recém-nascidos abaixo do peso, baixa estatura e emaciação por idade gestacional da Província de Jujuy, Argentina, em diferentes níveis de altitude. Métodos: Recém-nascidos vivos (n = 48.656) nascidos entre 2009 e 2014 em instalações públicas entre 24+0-42+6 semanas de idade gestacional. Os fenótipos de abaixo do peso (< P3 peso/idade), baixa estatura (< P3 comprimento/idade) e emaciação (< P3 índice de massa corporal/idade) foram calculados com os padrões do INTERGROWTH-21st. Os fatores de risco foram idade materna, escolaridade, índice de massa corporal, paridade, diabetes, hipertensão, pré-eclâmpsia, tuberculose, prematuridade e malformações congênitas. Os dados foram agrupados pela altitude geográfica: ≥ 2.000 ou < 2.000 m.a.s.l. O teste qui-quadrado e a análise de regressão logística multivariada foram feitos para estimar o risco dos fenótipos associados ao nível de altitude ≥ 2.000 m.a.s.l. Resultados: A prevalência de abaixo do peso, baixa estatura e emaciação foi de 1,27%, 3,39% e 4,68%, respectivamente, significativamente maiores em > 2.000 m.a.s.l. A idade materna, índice de massa corporal > 35 kg/m2, hipertensão, malformações congênitas e prematuridade foram mais fortemente associados a abaixo do peso e não a baixa estatura ou emaciação em ≥ 2.000 m.a.s.l. Conclusões: Os riscos de abaixo do peso, baixa estatura e emaciação foram maiores em altitude mais elevada e foram associados a condições maternas e fetais reconhecidas. O uso desses três fenótipos ajudará a priorizar as intervenções preventivas e focar no manejo da desnutrição fetal.

Prevalencias de bajo peso y pequeño para la edad gestacional en Argentina: comparación entre el estándar INTERGROWTH-21st y una referencia argentina / Prevalence of low weight and small for gestational age in Argentina: Comparison between the INTERGROWTH-21st standard and an Argentine reference

Introducción. Bajo peso al nacer (< 2500 g) incluye recién nacidos pretérmino y a término pequeños para la edad gestacional (PEG) (< P10). La Organización Mundial de la Salud define bajo peso (BP) como peso al nacer < P3 peso/edad. Internacionalmente, no existe consenso sobre estándares y/o referencias de peso al nacer por edad gestacional (EG) para evaluar PEG y BP en pretérminos. Se determinó la prevalencia de BP y PEG con el estándar INTERGROWTH-21st y la referencia poblacional argentina de Urquía, y se analizó la concordancia de las prevalencias entre ambas herramientas. Población y métodos. Estudio observacional, analítico y retrospectivo realizado sobre los nacimientos registrados en 2013 en el Ministerio de Salud de la Nación. Los criterios de exclusión fueron EG < 24+0 -> 42+6 semanas, embarazo gemelar y ausencia de datos de peso, EG y sexo. Se calcularon las prevalencias por sexo, regiones y categorías de prematurez de BP y PEG con el estándar y la referencia. La concordancia se evaluó con Kappa. Resultados. Las prevalencias de BP y PEG fueron más altas con el estándar en pretérmino; lo contrario se observó en recién nacidos a término. La significación estadística varió según categorías de EG, sexo y regiones. Las prevalencias más altas se presentaron en regiones del norte argentino y las concordancias entre prevalencias oscilaron entre débiles y muy buenas. Conclusiones. Las concordancias de prevalencias de BP y PEG obtenidas con el estándar y la referencia en pretérmino y a término fueron moderadas, y se observó variabilidad interregional. Los resultados plantean nuevas perspectivas auxológicas en la evaluación epidemiológica del retardo del crecimiento intrauterino en Argentina.

Introduction. The term "low birth weight" (< 2500 g) encompasses preterm newborns and term newborns small for gestational age (SGA) (< P10). The World Health Organization defines low weight (LW) as a birth weight < P3 of weight/age. There is no consensus at an international level about which standards and/or references related to birth weight for gestational age (GA) should be used to assess SGA and LW among preterm newborns. LW and SGA prevalence was determined using the INTERGROWTH-21st standard and Urquia's reference for the Argentine population, and agreement between the prevalence observed with both tools was analyzed. Population and methods. Observational, analytical, and retrospective study based on all births occurred in 2013 as reported by the Argentine National Ministry of Health. Exclusion criteria were GA < 24+0 - > 42+6 weeks, twin pregnancy, and missing data on weight, GA, and sex. Prevalence was estimated by sex, region, and prematurity category for LW and SGA according to the standard and the reference. Agreement was assessed using the Kappa index. Results. The prevalence of LW and SGA was higher according to the standard among preterm newborns; the contrary was observed among full-term newborns. Statistical significance varied based on GA category, sex, and region. A higher prevalence was observed in the northern regions of Argentina, and agreement among prevalence values ranged from weak to very good. Conclusions. Prevalence agreement of LW and SGA observed according to the standard and the reference among preterm and full-term newborn infants was moderate, with interregional variability. Results propose new auxological perspectives in the epidemiological assessment of intrauterine growth restriction in Argentina.

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.

Prevalencia de malnutrición en pacientes con discapacidad intelectual institucionalizados / Prevalence of malnutrition in institutionalized intellectually disabled patients

Los pacientes con discapacidad intelectual (DI) pueden presentar un riesgo elevado de padecer alteraciones nutricionales. Nuestro objetivo fue determinar la prevalencia de malnutrición en pacientes institucionalizados con DI, en la Colonia Nacional Montes de Oca, provincia de Buenos Aires, Argentina. Se realizó valoración antropométrica transversal mediante peso (kg) y talla (cm) en 614 individuos (352 varones y 262 mujeres). Se determinó IMC y la prevalencia de bajo peso, sobrepeso y obesidad por sexo y tipo de DI: leve, moderada y grave. Independientemente del sexo, las prevalencias de bajo peso, sobrepeso y obesidad fueron del 2.9%, 30% y 27.7% respectivamente. Sin considerar el grupo de DI, en mujeres se observó mayor prevalencia de obesidad (41.2%) y en varones de sobrepeso (34.7%). Teniendo en cuenta el grado de DI e independientemente del sexo se observó mayor prevalencia de bajo peso en DI grave y de sobrepeso y obesidad en DI leve. Ninguno de los pacientes con DI leve presentó bajo peso. Teniendo en cuenta el sexo y el grupo de DI las mayores prevalencias de bajo peso y sobrepeso se hallaron en varones con DI leve, (7% y 38.4% respectivamente) y de obesidad en mujeres con DI moderada (44%). Los resultados obtenidos indicarían la importancia del control del ingreso calórico y gasto energético de adultos con DI, prestando especial atención a las condiciones de vida y a los desordenes alimentarios en relación al grado de DI y a sus múltiples discapacidades asociadas.

As patients with intellectual and developmental disability (ID) may be more exposed to unfavorable factors, they are at higher risk of suffering nutritional alterations. Our objective was to determine prevalence of malnutrition in institutionalized patients with ID. An evaluation of the nutritional status through determination of transversal anthropometric parameters of weight (kg) and height (cm) was made on 614 individuals (352 men and 262 women) institutionalized at Colonia Nacional Montes de Oca, Buenos Aires Province, Argentina. Body mass index and prevalence of underweight, overweight and obesity cases by sex and ID type: mild, moderate and severe intellectual disability were determined. Regardless of sex, prevalence of underweight, overweight and obesity were of 2.9%, 30% and 27.7%, respectively. Regardless of degree of ID, greater prevalence of obesity (41.2%) was found amongst women, while overweight (34.7%) was more frequent amongst men. Taking the degree of ID and regardless of sex, greater prevalence of underweight was observed in severe ID, and overweight and obesity amongst mild ID. No any of the patients with mild ID presented underweight. Taking into account sex and ID, higher prevalence of underweight and overweight were observed amongst men with mild ID, (7% and 38.4%, respectively) and of obesity in women with moderate ID (44%). Results obtained would indicate the importance of caloric intake and energy consumption control in adults with ID, paying particular attention to life conditions and alimentary disorders in terms of the degree of ID and their multiple associated disabilities.

Valores del hematocrito y prevalencia de anemia en escolares jujenos / Hematocrit values and prevalence of anemia in schoolchildren of Jujuy

The hematocrit (Ht), as an indicator of anemia in individuals and populations, shows variations in relation to mesologic and genetic factors. Anemia is an endemic disease with insufficiently known prevalence in Argentina, in different age and risk groups and particularly in schoolchildren. The aim of this work was to study the variation of schoolchildren Ht in San Salvador of Jujuy city located at 1,200 m.a.s.l. in order to evaluate the prevalence of anemia and to relate these variations to the socio-economic characteristics of the population. The Ht data proceed from 17,580 schoolchildren of private and public schools. They were grouped by age, sex and socio-economic level. Were considered as anemic the children whose Ht was found: a) under a minimal value accepted for the 1200 m level; b) below 2 standard deviations. For the statistical analysis, ANOVA, chi 2 and correlation coefficient were employed. Independently of age, sex and socio-economic level, the average Ht values agree with those adjusted for the altitude. We observed: a) statistically significant intersex differences, males showing higher values than females; b) a trend to the Ht augmentation in relationship to the increase of the socio-economic level. Independently of the criterion used the prevalence of anemia was low in both sexes, age groups and in all socio-economic levels. Ht values: a) are representative of a schoolchildren population located at a moderate altitude; b) in spite of a trend to decrease in the low socio-economic level, this did not surpass, in most cases, the critical anemia level; c) are not indicative of malnutrition in the schoolchildren examined