Birthweight-specific neonatal mortality in developing countries and obstetric practices.

OBJECTIVES: To evaluate birthweight-specific neonatal mortality and perinatal interventions in major medical centers in developed and developing countries. METHODS: A survey was developed and electronically mailed to 13 medical centers participating in the Global Network for Perinatal and Reproductive Health (GNPRH). The ability of a center to provide requested data was assessed. The mortality rates and use of specific perinatal interventions in centers in developing countries were compared with developed countries. RESULTS: Nine centers in developing countries responded to the survey, and three centers in developed countries were used for comparison. Data collection was highly variable. Most developing country centers were able to provide data by birthweight but not by gestational age. The differences in mortality rates between developing and developed countries were more pronounced at lower gestational ages and birthweights. A difference was found in perinatal interventions between developing and developed countries. In the former, viability was generally considered 28 weeks, and the gestational age at which cesarean sections were usually performed for the sake of the fetus at preterm gestations varied from 26 to 37 weeks. Most centers did not routinely induce for pPROM; only five out of nine centers used antibiotics to prolong latency. Most centers used tocolysis beginning at 26-28 weeks through 32-37 weeks, and a variety of tocolytic agents were used. Most centers routinely used corticosteroids for preterm infants, and all centers employed repeat weekly steroid dosing if undelivered. CONCLUSIONS: Despite the fact that the GNPRH centers included in this study represent some of the best health care available in these countries, they lag far behind centers in developed countries in neonatal mortality rates and their use of various obstetric practices. Furthermore, incomplete and inconsistent data collection complicates the evaluation of the factors contributing to high neonatal mortality rates.

[Physicians denounce precariousness of reproductive health in the country and propose an addendum to the Brazilian document for the Cairo conference]. / Medicos denunciam precariedade da saude reprodutiva no Pais e propoem adendo ao documento brasileiro para Conferencia do Cairo.

PIP: On June 21, 1994, in Sao Paulo, a meeting took place of reproductive health professionals: service providers, university professors, representatives of nongovernmental organizations, secretaries of health of states and municipalities. They issued a manifesto on reproductive health in Brazil. In view of the preparations for the 3rd International Conference on Population and Development to take place in Cairo in September, 1994, it is hoped that these points will be incorporated into the official platform and in government action plans. Reproductive health is a basic human right. The growth of population decreased in Brazil in the 1980s, yet assistance in the area of reproductive health is still insufficient and unsatisfactory. The population decrease did not result in the improvement of health care and family planning. Maternal morbidity and mortality rates are still high in Brazil, especially in the north-northeastern regions, where it is 10 times higher than the national rate. There are 5 maternal deaths per 100,000 live births in Canada, 8 in the US, and 140 in Brazil. 90% of these deaths could be avoided by routine reproductive health measures. Important causes of infant mortality in Brazil are malnutrition and infectious diseases, which could be prevented by lifting the low socioeconomic level and through vaccination and birth spacing. Although fertility has been on the decline, the fertility of 10-19 year old adolescents has increased significantly, leading to high mortality rates for their infants. An estimated 1.4 million abortions occur per year in Brazil with frequent complications because of its illegal, clandestine nature. It is also estimated that 6-8 million women have been sterilized, which is the primary means of family planning because of the lack of other contraceptive options. The combination of cesarean-tubal ligation operations has been institutionalized in health services, which creates major distortions in the delivery of health care. Sexually transmitted diseases are on the rise, and HIV infections are contracted mainly from sexual intercourse and IV drug abuse. Furthermore, it is absolutely necessary for men to participate in family planning education in order to raise the status of women.^ieng