Journal articles on the topic 'Underreporting of births'
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Huang, T., H. C. Watt, N. J. Wald, J. K. Morris, D. Mutton, and E. Alberman Emeritus. "Reliability of Statistics on Down's Syndrome Notifications." Journal of Medical Screening 4, no. 2 (June 1997): 95–97. http://dx.doi.org/10.1177/096914139700400205.
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Objectives— To evaluate the completeness of notifications of Down's syndrome live births and terminations to the Office for National Statistics (ONS) using data from the National Down Syndrome Cytogenetic Register (NDSCR). To examine the agreement of observed birth prevalence of Down's syndrome with the expected birth prevalence derived from published maternal age specific rates. Methods— The number of live births (adjusted to allow for the estimated under-ascertainment) and the number of terminations due to fetal Down's syndrome from NDSCR were compared with those figures reported to the ONS. Subsequently, using the NDSCR figures, the live birth prevalence of Down's syndrome that would have occurred in the absence of antenatal diagnosis and selective termination was calculated in England and Wales in the years 1990–1993. These figures were compared with those derived by applying published age specific prevalences to the maternal age distribution in England and Wales. Results— It is estimated that only 48% and 46% respectively of Down's syndrome live births and terminations of pregnancy were notified to ONS between 1990 and 1993. The annual expected birth prevalences of Down's syndrome obtained by applying maternal age specific prevalences to the maternal age distribution were in close agreement with observed rates from NDSCR. Conclusions— There is considerable underreporting of Down's syndrome births and terminations to ONS. The NDSCR data are more complete and therefore the effects of screening should be monitored using data from this source, or using estimates derived from the age specific rates of Down's syndrome.
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Merli, M. Giovanna. "Underreporting of Births and Infant Deaths in Rural China: Evidence from Field Research in One County of Northern China." China Quarterly 155 (September 1998): 637–55. http://dx.doi.org/10.1017/s0305741000050025.
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Between the beginning of the 1950s and the early 1970s, China, like many other countries in Asia, Africa and Latin America, experienced rapid population growth. This was due mainly to a dramatic mortality decline not offset by any decline in the birth rate. In 1970, China had a crude birth rate of 33.43 (per 1,000), a crude death rate of 7.60 (per 1,000) and a rate of natural increase of 25.83. “Population growth” was identified as a fundamental obstacle to economic development, and the stage was set for large-scale state interventions in the process of human reproduction. The apotheosis of this intervention was the introduction, in 1979, of the One Child Policy, which was successfully implemented in the urban areas. In rural areas, policies promoting later marriage, one child – maximum two – per couple, and greater spacing of those births that are permitted contributed to the swift fertility decline witnessed over the last three decades. In 1996 China's birth and death rates were reported at 16.98 per 1,000 and 6.56 per 1,000 respectively and the population was growing at 10.42 per 1,000.
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Luquetti, Daniela Varela, and Rosalina Jorge Koifman. "Quality of reporting on birth defects in birth certificates: case study from a Brazilian reference hospital." Cadernos de Saúde Pública 25, no. 8 (August 2009): 1721–31. http://dx.doi.org/10.1590/s0102-311x2009000800008.
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The aim of this study was to evaluate the coverage, validity and reliability of Brazil's Information System on Live Births (SINASC) for birth defects in a hospital in the city of Campinas (São Paulo State). The study population consisted of 2,823 newborn infants delivered in 2004 at the Women's Integrated Health Care Center (CAISM). A birth defect registry (ECLAMC) was used as the gold-standard. All birth defect cases reported at CAISM in 2004 (92 cases) were selected from SINASC data files. All 168 birth defect cases from the same city and year registered at ECLAMC were also retrieved. An underreporting of 46.8% was observed for all birth defects, and 36.4% when considering only the major birth defects. The ascertained sensitivity and specificity were, respectively, 54.2% and 99.8%. The reliability of three and four-digit ICD-10 coding for birth defects was 0.77 and 0.55 respectively (kappa statistic). These results suggest that information provided by birth certificates in Campinas still presents limitations when seeking to ascertain accurate estimates of the prevalence of birth defects, hence indicating the need for improvements in the SINASC database to enable it to portray birth defect prevalence at birth in this city.
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Rodin, Urelija, Boris Filipović-Grčić, Josip Đelmiš, Tatjana Glivetić, Josip Juras, Željka Mustapić, and Ruža Grizelj. "Perinatal Health Statistics as the Basis for Perinatal Quality Assessment in Croatia." BioMed Research International 2015 (2015): 1–9. http://dx.doi.org/10.1155/2015/537318.
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Context. Perinatal mortality indicators are considered the most important measures of perinatal outcome. The indicators reliability depends on births and deaths reporting and recording. Many publications focus on perinatal deaths underreporting and misclassification, disabling proper international comparisons.Objective. Description of perinatal health care quality assessment key indicators in Croatia.Methods. Retrospective review of reports from all maternities from 2001 to 2014.Results. According to reporting criteria for birth weight ≥500 g, perinatal mortality (PNM) was reduced by 31%, fetal mortality (FM) by 32%, and early neonatal mortality (ENM) by 29%. According to reporting criteria for ≥1000 g, PNM was reduced by 43%, FM by 36%, and ENM by 54%. PNM in ≥22 weeks’ (wks) gestational age (GA) was reduced by 28%, FM by 30%, and ENM by 26%. The proportion of FM at 32–36 wks GA and at term was the highest between all GA subgroups, as opposed to ENM with the highest proportion in 22–27 wks GA. Through the period, the maternal mortality ratio varied from 2.4 to 14.3/100,000 live births. The process indicators have been increased in number by more than half since 2001, the caesarean deliveries from 11.9% in 2001 to 19.6% in 2014.Conclusions. The comprehensive perinatal health monitoring represents the basis for the perinatal quality assessment.
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Desai, Sheila, Laura D. Lindberg, Isaac Maddow-Zimet, and Kathryn Kost. "The Impact of Abortion Underreporting on Pregnancy Data and Related Research." Maternal and Child Health Journal 25, no. 8 (April 30, 2021): 1187–92. http://dx.doi.org/10.1007/s10995-021-03157-9.
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Abstract Introduction The impact on research findings that use pregnancy data from surveys with underreported abortions is not well-established. We estimate the percent of all pregnancies missing from women’s self-reported pregnancy histories because of abortion underreporting. Methods We obtained abortion and fetal loss data from the 2006–2015 National Survey of Family Growth (NSFG), annual counts of births from US vital statistics, and external abortion counts from the Guttmacher Institute. We estimated the completeness of abortion reporting in the NSFG as compared to the external counts, the proportion of pregnancies resolving in abortion, and the proportion of pregnancies missing in the NSFG due to missing abortions. Each measure was examined overall and by age, race/ethnicity, union status, and survey period. Results Fewer than half of abortions (40%, 95% CI 36–44) that occurred in the five calendar years preceding respondents’ interviews were reported in the NSFG. In 2006–2015, 18% of pregnancies resolved in abortion, with significant variation across demographic groups. Nearly 11% of pregnancies (95% CI 10–11) were missing from the 2006–2015 NSFG due to abortion underreporting. The extent of missing pregnancies varied across demographic groups and was highest among Black women and unmarried women (18% each); differences reflect both the patterns of abortion underreporting and the share of pregnancies ending in abortion. Discussion Incomplete reporting of pregnancy remains a fundamental shortcoming to the study of US fertility-related experiences. Efforts to improve abortion reporting are needed to strengthen the quality of pregnancy data to support maternal, child, and reproductive health research.
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Silva, Antônio Augusto Moura da, Leopoldo Muniz da Silva, Marco Antonio Barbieri, Heloísa Bettiol, Luciana Mendes de Carvalho, Valdinar Sousa Ribeiro, and Marcelo Zubaran Goldani. "The epidemiologic paradox of low birth weight in Brazil." Revista de Saúde Pública 44, no. 5 (October 2010): 767–75. http://dx.doi.org/10.1590/s0034-89102010005000033.
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OBJECTIVE: To examine whether the low birth weight (LBW) paradox exists in Brazil. METHODS: LBW and cesarean section rates between 1995 and 2007 were estimated based on data from SINASC (Brazilian Live Births Database). Infant mortality rates (IMRs) were obtained using an indirect method that correct for underreporting. Schooling information was obtained from census data. Trends in LBW rate were assessed using joinpoint regression models. The correlations between LBW rate and other indicators were graphically assessed by lowess regression and tested using Spearman's rank correlation. RESULTS: In Brazil, LBW rate trends were non-linear and non-significant: the rate dropped from 7.9% in 1995 to 7.7% in 2000, then increased to 8.2% in 2003 and remained nearly steady thereafter at 8.2% in 2007. However, trends varied among Brazilian regions: there were significant increases in the North from 1999 to 2003 (2.7% per year), and in the South (1.0% per year) and Central-West regions (0.6% per year) from 1995 to 2007. For the entire period studied, higher LBW and lower IMRs were seen in more developed compared to less developed regions. In Brazilian States, in 2005, the higher the IMR rate, the lower the LBW rate (p=0.009); the lower the low schooling rate, the lower the LBW rate (p=0.007); the higher the number of neonatal intensive care beds per 1,000 live births, the higher the LBW rate (p=0.036). CONCLUSIONS: The low birth weight paradox was seen in Brazil. LBW rate is increasing in some Brazilian regions. Regional differences in LBW rate seem to be more associated to availability of perinatal care services than underlying social conditions.
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Rau, Manoj Kumar, and Ananta Basudev Sahub. "Sdg 3 monitoring at sub-national level with data from the civil registration system in rajasthan state, india : 2001-14." Journal of Management and Science 7, no. 3 (December 30, 2017): 410–25. http://dx.doi.org/10.26524/jms.2017.65.
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In India, Civil registration was initiated under the registration of births and deaths act,1969 to give reliable estimates of fertility and mortality situation for the nation up to the lowest administrative levels, but due to its inadequate and underreporting, still the Sample Registration System is used to generate reliable indicators of fertility and mortality. In this paper, an attempt is made to compute certain indicators from the civil registration system for the period of 2001-14 in the State of Rajasthan, India. The major SDG indicators of goal 3 of ensuring healthy lives and promoting well-being for all at all ages; targets 3.1 (By 2030, reduce the global maternal mortality ratio to less than 70 per 100,000 live births) and 3.2 (By 2030, end preventable deaths of newborns and children under 5 years of age, with all countries aiming to reduce neonatal mortality to at least as low as 12 per 1,000 live births and under-5 mortality to at least as low as 25 per 1,000 live births) with indicators of Under-five Mortality Rate (indicator 3.2.1) and Maternal Mortality Ratio (indicator 3.1.1) and other fertility and mortality indicators can be computed, if certain denominator bases are available every year. As the civil registration data has not been classified by the place of residence, it is not strictly comparable to SRS figures. But it has been presented here so as to serve as an indication and for the improvement of the system for generation of reliable vital rates at subnational levels using civil registration data, which is the need of the day for planning purposes for programme managers and policy makers.
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Salih, Shahla O., Stefania Moramarco, Daniele Di Giovanni, Sivar A. Qadir, Haveen H. Alsilefanee, Faiq B. Basa, and Leonardo Emberti Gialloreti. "Ten-Year Mortality Trends and Natural Causes of Death in the Iraqi Kurdistan." Open Public Health Journal 14, no. 1 (July 13, 2021): 264–71. http://dx.doi.org/10.2174/1874944502114010264.
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Background: Mortality and causes of death are among the most important statistics used in assessing the effectiveness of a country’s health system. Several countries do not have information systems for collecting these data, and they must therefore be estimated from surveys. Objective: This study analyzes mortality data retrieved from official government databases in Iraqi Kurdistan to describe ten-year trends in natural causes of death. Methods: Data for natural causes of death, reported from 2009 to 2018, were extracted from the databases of the Registration Bureau of Births and Deaths and of the Forensic Medicine of the Province of Sulaymaniyah. A sample of 16,433 causes of death was analyzed. Results: Causes of death were coded according to the ICD-10 classification. Overall, cardiovascular diseases were the leading cause of mortality (52.6%), followed by neoplasms (17.7%), infectious and parasitic diseases (8.9%), and genitourinary diseases (6.3%). Neonatal conditions, congenital anomalies, and neurological conditions each accounted for less than 1% each. Numbers of natural deaths by cause and cause-specific mortality rates have been estimated for the entire Region of Iraqi Kurdistan. Comparisons with other sources suggest that there is a substantial amount of underreporting, especially in relation to deaths of infants and under-five children. Conclusion: Our findings confirm that the region is facing a burden of non-communicable diseases, coupled with high proportions of infectious diseases. However, the lack of effective vital statistics with combined under-reported data collection highlights the need for implementation of health monitoring systems. Advancements in generating high-quality data are essential in improving health and reducing preventable deaths. The establishment of a novel Health Information System is discussed.
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Nogueira Mendes Neto, Nilson, Jessika T. da S. Maia, Marcelo Zacarkim, Igor T. Queiroz, Gleyson Rosa, A. Desiree Labeaud, and David Aronoff. "1671. Impact of Zika Syndrome on Brazilian Infant Mortality Rate." Open Forum Infectious Diseases 6, Supplement_2 (October 2019): S611—S612. http://dx.doi.org/10.1093/ofid/ofz360.1535.
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Abstract Background Infant mortality in Brazil has increased for the first time in 26 years. This study aimed to define the Zika Syndrome (ZS) perinatal case fatality rate (PCF) since the 2015 Zika outbreak in a Brazilian northeast state highly impacted by the virus. Methods Cross-sectional study conducted using data obtained through the State Health Department for cases of microcephaly (MCP) and congenital abnormalities (CA) in Rio Grande do Norte State (RN) from April 2015 to March 2, 2019. Perinatal period: commencing at 22 completed weeks (154 days) of gestation until 7 days after birth. PCF was defined as the number of deaths as a fraction of the number of sick persons with the specific disease (×100). Results There were 535 reported cases of MCP and others CA notified in RN during this period: 4 in 2014, 337 in 2015, 157 in 2016, 21 in 2017, 14 in 2018, and 2 in 2019. Of these, 151 were confirmed and 135 remain under investigation. The remaining 247 cases were ruled out by normal physical exams or due to noninfectious cause of MCP. Of the total confirmed cases, 35.8% (54/151) died after birth or during pregnancy. Zika virus infection during pregnancy was confirmed in 55.5% (30/54) of deaths and 1.8% (01/54) had a positive TORCH blood test. The odds ratio for the Zika PCF was found to be 1.57 (95% CI: 0.7940–3.1398; P = 0.1928). Deaths related to Zika were confirmed using a combination of clinical and epidemiological findings paired with either radiological information or molecular/serological data (RT–PCR and/or IgM/IgG antibodies against Zika). Twelve cases remain under investigation and 7 were ruled out as MCP. The highest number of confirmed MCP cases occurred between August 2015 and February 2016. The prevalence increased in September, with a peak in November 2015 (20.1 cases per 1,000 live births). Conclusion Before the recent Brazilian Zika outbreak, the incidence of MCP in RN between 2010 and 2014 was 1.8 cases/year. The real incidence and prevalence might be higher due to the underreporting and lack of resources for confirmatory diagnostic tests (laboratory and imaging). This study indicates that Zika virus accounted for a substantial proportion of MCP cases seen during the years studied, and suggests that ZS contributed to an increase in infant mortality in Brazil. Disclosures All authors: No reported disclosures.
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van der Veen, F. J. C., J. M. van Hagen, J. Berkhof, and J. P. W. Don Griot. "Regional Underreporting of Associated Congenital Anomalies in Cleft Patients in the Netherlands." Cleft Palate-Craniofacial Journal 43, no. 6 (November 2006): 710–14. http://dx.doi.org/10.1597/05-179.
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Objective: The Dutch Cleft Palate Association (DCPA) registers all patients with cleft lip or palate and associated congenital anomalies in the Netherlands. The aim of this study was to assess if early registration of cleft patients leads to underreporting of associated congenital anomalies and, if so, whether reregistration is necessary. Methods: The DCPA registration of the birth cohort 1997 to 2001 was compared with the medical files of these cleft patients for prevalence, type, and moment of registration of associated congenital anomalies. To assess possible long-term underregistration, a second birth cohort of 1990 to 1991 was analyzed. Results: The percentage of cleft patients with associated congenital anomalies was 26% in the DCPA database and 33% in the retrospective medical file review. A syndrome, sequence, or association was recognized in 8% of the cleft patients by the DCPA compared with 13% in our medical file review. Of all associated congenital anomalies diagnosed during a follow-up of 12 years, 53% were diagnosed in the first year of life. The cumulative percentage was 59% after 2 years, 62% after 3 years, 80% after 6 years, and 97% after 10 years. Conclusion: Early registration of cleft patients leads to underreporting of other associated anomalies. For a complete registration of associated congenital anomalies in cleft patients, reregistration at a later age is necessary.
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Melberg, Andrea, Lidiya Teklemariam, Karen Marie Moland, Henriette Sinding Aasen, and Mitike Molla Sisay. "Juridification of maternal deaths in Ethiopia: a study of the Maternal and Perinatal Death Surveillance and Response (MPDSR) system." Health Policy and Planning 35, no. 8 (June 28, 2020): 900–905. http://dx.doi.org/10.1093/heapol/czaa043.
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Abstract Juridification of maternal health care is on the rise globally, but little is known about its manifestations in resource constrained settings in sub-Saharan Africa. The Maternal and Perinatal Death Surveillance and Response (MPDSR) system is implemented in Ethiopia to record and review all maternal and perinatal deaths, but underreporting of deaths remains a major implementation challenge. Fear of blame and malpractice litigation among health workers are important factors in underreporting, suggestive of an increased juridification of birth care. By taking MPDSR implementation as an entry point, this article aims to explore the manifestations of juridification of birth care in Ethiopia. Based on multi-sited fieldwork involving interviews, document analysis and observations at different levels of the Ethiopian health system, we explore responses to maternal deaths at various levels of the health system. We found an increasing public notion of maternal deaths being caused by malpractice, and a tendency to perceive the juridical system as the only channel to claim accountability for maternal deaths. Conflicts over legal responsibility for deaths influenced birth care provision. Both health workers and health bureaucrats strived to balance conflicting concerns related to the MPDSR system: reporting all deaths vs revealing failures in service provision. This dilemma encouraged the development of strategies to avoid personalized accountability for deaths. In this context, increased juridification impacted both care and reporting practices. Our study demonstrates the need to create a system that secures legal protection of health professionals reporting maternal deaths as prescribed and provides the public with mechanisms to claim accountability and high-quality birth care services.
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Nhoncanse, Geiza Cesar, Carla Maria R. Germano, Lucimar Retto da S. de Avo, and Debora Gusmao Melo. "Maternal and perinatal aspects of birth defects: a case-control study." Revista Paulista de Pediatria 32, no. 1 (March 2014): 24–31. http://dx.doi.org/10.1590/s0103-05822014000100005.
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Objective: To assess the prevalence of congenital defects and to investigate their maternal and perinatal associated aspects by reviewing Birth Certificates. Methods: Among all born alive infants from January 2003 to December 2007 in Maternidade da Santa Casa de Misericórdia of São Carlos, Southeast Brazil (12,199 infants), cases were identified as the newborns whose Birth Certificates registered any congenital defect. The same sex neonate born immediately after the case was chosen as a control. In total, 13 variables were analyzed: six were maternal related, three represented labor and delivery conditions and four were linked to fetal status. The chi-square and Fisher's exact tests were used to compare the variables, being significant p<0.05. Results: The prevalence of congenital defects was 0.38% and the association of two or more defects represented 32% of all cases. The number of mothers whose education level was equal or less than eight years was significantly higher among the group with birth defects (p=0.047). A higher frequency of prematurity (p<0.001) and cesarean delivery (p=0.004) was observed among children with birth defects. This group also showed lower birth weight and Apgar scores in the 1st and the 5th minute (p<0.001). Conclusions: The prevalence of congenital defect of 0.38% is possibly due to underreporting. The defects notified in the Birth Certificates were only the most visible ones, regardless of their severity. There is a need of adequate epidemiological monitoring of birth defects in order to create and expand prevention and treatment programs.
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Kustec, Tanja, Darja Keše, and Irena Klavs. "Under-reporting of sexually transmitted infection with chlamydia trachomatis - a revision of surveillance system is required." Slovenian Journal of Public Health 55, no. 3 (September 1, 2016): 174–78. http://dx.doi.org/10.1515/sjph-2016-0022.
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Abstract Introduction To consider whether a revision of the national chlamydia surveillance system is needed, the objectives were to estimate the proportion of laboratory confirmed cases at the Institute of Microbiology and Immunology (IMI) not reported to the National Institute of Public Health (NIPH), and to assess the completeness of reporting for individual data items. Methods The dataset with information about the cases diagnosed at the IMI during 2007-2010, and the national chlamydia surveillance data at the NIPH, were linked using SOUNDEX code and the date of birth as unique identifier. The proportion of unreported cases was calculated. The proportions of records with missing data for individual variables were estimated for all reported cases during the same period. Chlamydia testing and reported rates for the period 2002-2010 were presented. Results Of 576 laboratory confirmed chlamydia cases at the IMI during 2007-2010, 201 were reported to the NIPH, corresponding to 65.1% of the overall underreporting (50.4% among dermatovenerologists, 90.1% among gynaecologist and 100% among other specialists). Item response was above 99% for demographic variables and from 69% to 81% for sexual behaviour variables. Higher testing rates corresponded to higher diagnosed rates. Conclusions Surveillance data underestimated diagnosed chlamydia infection rates. Mandatory reporting of cases by laboratories with less variables, including unique identifier, gender, date of diagnosis, and reporting physician specialty, together with numbers of tests performed (for estimating testing and positivity rates) would simplify the surveillance system and eliminate underreporting of laboratory confirmed cases, while still providing necessary information for public health policies.
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Wallon, Martine, and François Peyron. "Congenital Toxoplasmosis: A Plea for a Neglected Disease." Pathogens 7, no. 1 (February 23, 2018): 25. http://dx.doi.org/10.3390/pathogens7010025.
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Maternal infection by Toxoplasma gondii during pregnancy may have serious consequences for the fetus, ranging from miscarriage, central nervous system involvement, retinochoroiditis, or subclinical infection at birth with a risk of late onset of ocular diseases. As infection in pregnant women is usually symptomless, the diagnosis relies only on serological tests. Some countries like France and Austria have organized a regular serological testing of pregnant women, some others have no prenatal program of surveillance. Reasons for these discrepant attitudes are many and debatable. Among them are the efficacy of antenatal treatment and cost-effectiveness of such a program. A significant body of data demonstrated that rapid onset of treatment after maternal infection reduces the risk and severity of fetal infection. Recent cost-effectiveness studies support regular screening. This lack of consensus put both pregnant women and care providers in a difficult situation. Another reason why congenital toxoplasmosis is disregarded in some countries is the lack of precise information about its impact on the population. Precise estimations on the burden of the disease can be achieved by systematic screening that will avoid bias or underreporting of cases and provide a clear view of its outcome.
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Queiroz, Igor Thiago, Jessika Thais Da Silva Maia, Gleysson Rosa, Tatyana Vidal Mendes, S. Jayne Alves Vidal, Maria Goretti Lins, Marcelo Rodrigues Zacarkim, David Aronoff, A. Desiree Labeaud, and Nilson N. Mendes Neto. "Perinatal Case Fatality Rate Related to Congenital Zika Syndrome in Brazil: a Cross-Sectional Study." Open Forum Infectious Diseases 4, suppl_1 (2017): S22. http://dx.doi.org/10.1093/ofid/ofx162.054.
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Abstract Background Many studies have demonstrated a causal link between Zika virus (ZIKV) infection, microcephaly (MCP), and other congenital abnormalities (CA). This study aimed to determine perinatal case fatality rate in cases of Congenital Zika Syndrome (CZS) in the Rio Grande do Norte State (RN), a Brazilian Northeast State highly impacted by the Zika virus outbreak. Methods A cross-sectional study was conducted using data obtained through the State Health Department (SHD) for cases of MCP and CA in Rio Grande do Norte from April 2015 to February 5, 2016. Definition of perinatal period: commences at 22 completed weeks (154 days) of gestation and ends seven completed days after birth. Results During the study period, there were 486 cases of MCP and others CA notified in RN, of which 142 were confirmed and 108 remain under investigation. The remaining 236 cases have been ruled out by presenting normal examinations or due to presenting microcephaly by noninfectious causes. Of the total confirmed cases, 26.7% (38/142) died after birth or during pregnancy. 15.78% (06/38) of confirmed deaths had ZIKV infection during pregnancy and 2.63% (01/38) had a positive TORCH blood test. The six cases related to ZIKV were confirmed by RT–PCR and/or IgM/IgG antibodies against ZIKV. The remaining cases of deaths remain either under investigation or have been ruled out. Conclusion This study highlights a high rate of perinatal lethality (15.78%) in cases of CZS. Despite the growing number of CZS cases, the real incidence and prevalence might be higher due to the underreporting and lack of resources for confirmatory diagnostic tests (laboratory and imaging). Due to the high rate of lethality and the ongoing uncontrolled ZIKV outbreak, this study predicts an increase in the infant mortality rate in Brazil and highlights the need for developing public health programs to control the ZIKV outbreak. Disclosures All authors: No reported disclosures.
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Neto, Nilson N. Mendes, Jessika Maia, Igor Thiago Queiroz, Marcelo Rodrigues Zacarkim, Maria Goretti Lins, A. Desiree Labeaud, and David Aronoff. "693. Congenital Zika Syndrome: Assessing the Fatality Rate Since the 2015 Zika Outbreak." Open Forum Infectious Diseases 5, suppl_1 (November 2018): S250. http://dx.doi.org/10.1093/ofid/ofy210.700.
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Abstract Background Many studies have demonstrated a causal link between Zika virus (ZIKV) infection, microcephaly (MCP) and other congenital abnormalities (CA). This study aimed to determine the perinatal case fatality rate in cases of Congenital Zika Syndrome (CZS) in the Rio Grande do Norte State (RN), a Brazilian Northeast State highly impacted by the Zika virus outbreak. Methods A cross-sectional study was conducted using data obtained through the State Health Department (SHD) for cases of MCP and CA in Rio Grande do Norte from April 2015 to December 31, 2017. Definition of perinatal period: commences at 22 completed weeks (154 days) of gestation and ends seven completed days after birth. Perinatal case fatality rate is defined as the number of deaths as a fraction of the number of sick persons with a specific disease (×100). Results During the study period, there were 519 cases of MCP and others CA notified in RN, of which 150 were confirmed and 126 remain under investigation. The remaining 243 cases have been ruled out by presenting normal exams or due to presenting microcephaly by non-infectious causes. Of the total confirmed cases, 30.0% (45/150) died after birth or during pregnancy. 64.4% (29/45) of confirmed deaths had ZIKV infection during pregnancy and 4.4% (02/45) had a positive TORCH blood test. The deaths related to Zika were confirmed using either clinical/epidemiological/radiological (the presence of typical and indicative alterations of congenital ZIKV infection) or clinical/epidemiological/serological (RT-PCR and/or IgM/IgG antibodies against ZIKV). Eleven cases remain under investigation and five were ruled out. Conclusion This study highlights a high rate of perinatal lethality (64.4%) in cases of CZS. Despite the growing number of CZS cases, the real incidence and prevalence might be higher due to the underreporting and lack of resources for confirmatory diagnostic tests (laboratory and imaging). Due to the high rate of lethality, our findings predict an increase in the infant mortality rate in areas endemic for arboviruses. Because the severe neurological complications caused by CZS, it is likely to pose a substantial burden on public spending on healthcare. This study may be used to better describe the congenital Zika syndrome, its prognosis and natural history. Disclosures All authors: No reported disclosures.
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Miltz, Ada, Fiona Lampe, Sheena McCormack, David Dunn, Ellen White, Alison Rodger, Andrew Phillips, et al. "Prevalence and correlates of depressive symptoms among gay, bisexual and other men who have sex with men in the PROUD randomised clinical trial of HIV pre-exposure prophylaxis." BMJ Open 9, no. 12 (December 2019): e031085. http://dx.doi.org/10.1136/bmjopen-2019-031085.
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ObjectivesThe aim of this analysis is to: (i) assess the prevalence of clinically significant depressive symptoms at baseline and follow-up for participants in the PROUD trial of HIV pre-exposure prophylaxis (PrEP), examining changes in prevalence over time and (ii) investigate the association of socioeconomic and psychosocial factors with depression.MethodsPROUD was an open label randomised trial evaluating the benefit of PrEP for 544 HIV-negative gay, bisexual and other men who have sex with men (GBMSM) in England. Enrolment was between 2012 and 2014, with at least 2 years follow-up. Prevalence of depression (score ≥10 on Patient Health Questionnaire-9) was assessed and compared across time-points (using McNemar’s χ2tests) and between trial arms (using χ2tests). Cross-sectional associations with socioeconomic and psychosocial factors were examined using baseline data in modified Poisson regression models and combined 12 and 24 month follow-up data in generalised estimating equations (GEEs). Prevalence ratios (PRs) were presented as unadjusted PR and adjusted PR (aPR) for age, UK birth, sexual identity, university education, London study clinic site and calendar time (and follow-up time-point in GEEs).ResultsDepression increased significantly from baseline (9.1%; 49/540) to the 12 month (14.4%; 59/410) and 24 month (14.4%; 48/333) follow-ups, possibly explained by underreporting at baseline. The prevalence of depression did not differ by study trial arm, at any time-point. In the baseline analysis, younger age, unemployment and crystal methamphetamine use, was associated with depression. In combined analysis of 12 and 24 month data, measures of intimate partner violence (IPV) (lifetime IPV victimisation aPR 2.57 (95% CI: 1.71 to 3.86)), internalised homophobia (aPR 1.91 (95% CI: 1.29 to 2.83)) and concealment of sexual identity (aPR 1.75 (95% CI: 1.16 to 2.65)), were strongly associated with depression.ConclusionsThere is a high concomitant burden of psychosocial factors with depression among GBMSM.Trial registration numberISRCTN (ISRCTN94465371) and ClinicalTrials.gov (NCT02065986).
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Johnson, Amy Kristen, Runa Bhaumik, Irina Tabidze, and Supriya D. Mehta. "Nowcasting Sexually Transmitted Infections in Chicago: Predictive Modeling and Evaluation Study Using Google Trends." JMIR Public Health and Surveillance 6, no. 4 (November 5, 2020): e20588. http://dx.doi.org/10.2196/20588.
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Background Sexually transmitted infections (STIs) pose a significant public health challenge in the United States. Traditional surveillance systems are adversely affected by data quality issues, underreporting of cases, and reporting delays, resulting in missed prevention opportunities to respond to trends in disease prevalence. Search engine data can potentially facilitate an efficient and economical enhancement to surveillance reporting systems established for STIs. Objective We aimed to develop and train a predictive model using reported STI case data from Chicago, Illinois, and to investigate the model’s predictive capacity, timeliness, and ability to target interventions to subpopulations using Google Trends data. Methods Deidentified STI case data for chlamydia, gonorrhea, and primary and secondary syphilis from 2011-2017 were obtained from the Chicago Department of Public Health. The data set included race/ethnicity, age, and birth sex. Google Correlate was used to identify the top 100 correlated search terms with “STD symptoms,” and an autocrawler was established using Google Health Application Programming Interface to collect the search volume for each term. Elastic net regression was used to evaluate prediction accuracy, and cross-correlation analysis was used to identify timeliness of prediction. Subgroup elastic net regression analysis was performed for race, sex, and age. Results For gonorrhea and chlamydia, actual and predicted STI values correlated moderately in 2011 (chlamydia: r=0.65; gonorrhea: r=0.72) but correlated highly (chlamydia: r=0.90; gonorrhea: r=0.94) from 2012 to 2017. However, for primary and secondary syphilis, the high correlation was observed only for 2012 (r=0.79), 2013 (r=0.77), 2016 (0.80), and 2017 (r=0.84), with 2011, 2014, and 2015 showing moderate correlations (r=0.55-0.70). Model performance was the most accurate (highest correlation and lowest mean absolute error) for gonorrhea. Subgroup analyses improved model fit across disease and year. Regression models using search terms selected from the cross-correlation analysis improved the prediction accuracy and timeliness across diseases and years. Conclusions Integrating nowcasting with Google Trends in surveillance activities can potentially enhance the prediction and timeliness of outbreak detection and response as well as target interventions to subpopulations. Future studies should prospectively examine the utility of Google Trends applied to STI surveillance and response.
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Demakakos, Panayotes, Eleni Linara-Demakakou, and Gita D. Mishra. "Adverse childhood experiences are associated with increased risk of miscarriage in a national population-based cohort study in England." Human Reproduction 35, no. 6 (June 1, 2020): 1451–60. http://dx.doi.org/10.1093/humrep/deaa113.
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Abstract STUDY QUESTION Is there an association between adverse childhood experiences (ACE) and the risk of miscarriage in the general population? SUMMARY ANSWER Specific ACE as well as the summary ACE score were associated with an increased risk of single and recurrent miscarriages. WHAT IS KNOWN ALREADY There is scarce evidence on the association between ACE and miscarriage risk. STUDY DESIGN, SIZE, DURATION We conducted a retrospective national cohort study. The sample consisted of 2795 women aged 55–89 years from the English Longitudinal Study of Ageing (ELSA). PARTICIPANTS/MATERIALS, SETTING, METHODS Our study was population-based and included women who participated in the ELSA Life History Interview in 2007. We estimated multinomial logistic regression models of the associations of the summary ACE score and eight individual ACE variables (pertaining to physical and sexual abuse, family dysfunction and experiences of living in residential care or with foster parents) with self-reported miscarriage (0, 1, ≥2 miscarriages). MAIN RESULTS AND THE ROLE OF CHANCE Five hundred and fifty-three women (19.8% of our sample) had experienced at least one miscarriage in their lifetime. Compared with women with no ACE, women with ≥3 ACE were two times more likely to experience a single miscarriage in their lifetime (relative risk ratio 2.00, 95% CI 1.25–3.22) and more than three times more likely to experience recurrent miscarriages (≥2 miscarriages) (relative risk ratio 3.10, 95% CI 1.63, 5.89) after adjustment for birth cohort, age at menarche and childhood socioeconomic position. Childhood experiences of physical and sexual abuse were individually associated with increased risk of miscarriage. LIMITATIONS, REASONS FOR CAUTION Given the magnitude of the observed associations, their biological plausibility, temporal order and consistency with evidence suggesting a positive association between ACE and adverse reproductive outcomes, it is unlikely that our findings are spurious. Nevertheless, the observed associations should not be interpreted as causal as our study was observational and potentially susceptible to bias arising from unaccounted confounders. Non-response and ensuing selection bias may have also biased our findings. Retrospectively measured ACE are known to be susceptible to underreporting. Our study may have misclassified cases of ACE and possibly underestimated the magnitude of the association between ACE and the risk of miscarriage. WIDER IMPLICATIONS OF THE FINDINGS Our study highlights experiences of psychosocial adversity in childhood as a potential risk factor for single and recurrent miscarriages. Our findings contribute to a better understanding of the role of childhood trauma in miscarriage and add an important life course dimension to the study of miscarriage. STUDY FUNDING/COMPETING INTEREST(S) ELSA is currently funded by the National Institute on Aging in USA (R01AG017644) and a consortium of UK government departments coordinated by the National Institute for Health Research. The funders had no role in the study design, data collection and analysis, decision to publish or preparation of the article. The authors have no actual or potential competing financial interests to disclose.
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De Geyter, Ch, C. Wyns, C. Calhaz-Jorge, J. de Mouzon, A. P. Ferraretti, M. Kupka, A. Nyboe Andersen, K. G. Nygren, and V. Goossens. "20 years of the European IVF-monitoring Consortium registry: what have we learned? A comparison with registries from two other regions." Human Reproduction 35, no. 12 (November 14, 2020): 2832–49. http://dx.doi.org/10.1093/humrep/deaa250.
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Abstract STUDY QUESTION How has the performance of the European regional register of the European IVF-monitoring Consortium (EIM)/European Society of Human Reproduction and Embryology (ESHRE) evolved from 1997 to 2016, as compared to the register of the Centres for Disease Control and Prevention (CDC) of the USA and the Australia and New Zealand Assisted Reproduction Database (ANZARD)? SUMMARY ANSWER It was found that coherent and analogous changes are recorded in the three regional registers over time, with a different intensity and pace, that new technologies are taken up with considerable delay and that incidental complications and adverse events are only recorded sporadically. WHAT IS KNOWN ALREADY European data on ART have been collected since 1997 by EIM. Data collection on ART in Europe is particularly difficult due to its fragmented political and legal landscape. In 1997, approximately 78.1% of all known institutions offering ART services in 23 European countries submitted data and in 2016 this number rose to 91.8% in 40 countries. STUDY DESIGN, SIZE, DURATION We compared the changes in European ART data as published in the EIM reports (2001–2020) with those of the USA, as published by CDC, and with those of Australia and New Zealand, as published by ANZARD. PARTICIPANTS/MATERIALS, SETTING, METHODS We performed a retrospective analysis of the published EIM data sets spanning the 20 years observance period from 1997 to 2016, together with the published data sets of the USA as well as of Australia and New Zealand. By comparing the data sets in these three large registers, we analysed differences in the completeness of the recordings together with differences in the time intervals on the occurrence of important trends in each of them. Effects of suspected over- and under-reporting were also compared between the three registers. X2 log-rank analysis was used to assess differences in the data sets. MAIN RESULTS AND THE ROLE OF CHANCE During the period 1997–2016, the numbers of recorded ART treatments increased considerably (5.3-fold in Europe, 4.6-fold in the USA, 3.0-fold in Australia and New Zealand), while the number of registered treatment modalities rose from 3 to 7 in Europe, from 4 to 10 in the USA and from 5 to 8 in Australia and New Zealand, as published by EIM, CDC and ANZARD, respectively. The uptake of new treatment modalities over time has been very different in the three registers. There is a considerable degree of underreporting of the number of initiated treatment cycles in Europe. The relationship between IVF and ICSI and between fresh and thawing cycles evolved similarly in the three geographical areas. The freeze-all strategy is increasingly being adopted by all areas, but in Europe with much delay. Fewer cycles with the transfer of two or more embryos were reported in all three geographical areas. The delivery rate per embryo transfer in thawing cycles bypassed that in fresh cycles in the USA in 2012, in Australia and New Zealand in 2013, but not yet in Europe. As a result of these changing approaches, fewer multiple deliveries have been reported. Since 2012, the most documented adverse event of ART in all three registers has been premature birth (<37 weeks). Some adverse events, such as maternal death, ovarian hyperstimulation syndrome, haemorrhage and infections, were only recorded by EIM and ANZARD. LIMITATIONS, REASONS FOR CAUTION The methods of data collection and reporting were very different among European countries, but also among the three registers. The better the legal background on ART surveillance, the more complete are the data sets. Until the legal obligation to report is installed in all European countries together with an appropriate quality control of the submitted data the reported numbers and incidences should be interpreted with caution. WIDER IMPLICATIONS OF THE FINDINGS The growing number of reported treatments in ART, the higher variability in treatment modalities and the rising contribution to the birth rates over the last 20 years point towards the increasing impact of ART. High levels of completeness in data reporting have been reached, but inconsistencies and inaccuracies still remain and need to be identified and quantified. The current trend towards a higher diversity in treatment modalities and the rising impact of cryostorage, resulting in improved safety during and after ART treatment, require changes in the organization of surveillance in ART. The present comparison must stimulate all stakeholders in ART to optimize surveillance and data quality assurance in ART. STUDY FUNDING/COMPETING INTEREST(S) This study has no external funding and all costs are covered by ESHRE. There are no competing interests. TRIAL REGISTRATION NUMBER N/A.
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Gava, Caroline, Andrey Moreira Cardoso, and Paulo Cesar Basta. "Infant mortality by color or race from Rondônia, Brazilian Amazon." Revista de Saúde Pública 51 (2017). http://dx.doi.org/10.1590/s1518-8787.2017051006411.
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ABSTRACT OBJECTIVE To analyze the quality of records for live births and infant deaths and to estimate the infant mortality rate for skin color or race, in order to explore possible racial inequalities in health. METHODS Descriptive study that analyzed the quality of records of the Live Births Information System and Mortality Information System in Rondônia, Brazilian Amazonian, between 2006-2009. The infant mortality rates were estimated for skin color or race with the direct method and corrected by: (1) proportional distribution of deaths with missing data related to skin color or race; and (2) application of correction factors. We also calculated proportional mortality by causes and age groups. RESULTS The capture of live births and deaths improved in relation to 2006-2007, which required lower correction factors to estimate infant mortality rate. The risk of death of indigenous infant (31.3/1,000 live births) was higher than that noted for the other skin color or race groups, exceeding by 60% the infant mortality rate in Rondônia (19.9/1,000 live births). Black children had the highest neonatal infant mortality rate, while the indigenous had the highest post-neonatal infant mortality rate. Among the indigenous deaths, 15.2% were due to ill-defined causes, while the other groups did not exceed 5.4%. The proportional infant mortality due to infectious and parasitic diseases was higher among indigenous children (12.1%), while among black children it occurred due to external causes (8.7%). CONCLUSIONS Expressive inequalities in infant mortality were noted between skin color or race categories, more unfavorable for indigenous infants. Correction factors proposed in the literature lack to consider differences in underreporting of deaths for skin color or race. The specific correction among the color or race categories would likely result in exacerbation of the observed inequalities.
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Soumokil, Pieter J. "SUATU PENDEKATAN ANALISIS MULTIVARIAT TENTANG TINGKAT KELAHIRAN PADA BEBERAPA KELOMPOK DAN ETNIS WANITA PERNAH KAWIN DI IRIAN JAYA." Populasi 3, no. 1 (May 14, 2016). http://dx.doi.org/10.22146/jp.10809.
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It has been argued by many demographers that socio economic development with its associated fundamental changes in the role of women and the value of children is the dominant factor in the transition from high to low fertility. Research in less developed countries has found lower fertility levels in urban population compared to rural population. It was therefore assumed that the modernizing role of urbanlife helped bring about a decline infertility levels.This study in Irian Jaya, however, convincingly shows that fertility of urban women in Irian Jaya is higher than that of rural women. This differential infertility in favour of urban women in Irian Jaya appears to be real and not a result of underreporting of total live births in rural areas.The reasons for lower fertility in the rural areas in IrianJaya remain unknown, and more research is therefore needed. However, this study strongly suggests that the traditional system of swidden agricultyure in Irian Jaya, which places a highvalue on the labour input of women, may play a major role in constraining fertility in rural area of this province. On the other hand, high fertility in urban areas takes place because urbanwomen have their first birth earlier thanwomen inthe rural areas.
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Glatthorn, H., M. Sauer, J. Brandt, and C. Ananth. "P–773 Infertility treatment and the risk of small for gestational age births: a population-based study in the United States." Human Reproduction 36, Supplement_1 (July 1, 2021). http://dx.doi.org/10.1093/humrep/deab130.772.
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Abstract Study question What is the association between infertility treatments and small for gestational age (SGA) births? Summary answer Women who conceived pregnancies with any infertility treatment had a decreased risk of SGA <10th, <5th and <3rd percentiles compared to naturally conceived pregnancies. What is known already Assisted reproductive technology (ART) and other infertility treatments have long been associated with an increased risk of SGA births, which confers a greater risk of perinatal morbidity and mortality compared to appropriate for gestational age births. Study design, size, duration This is a cross-sectional study of 16,836,228 births in the United States (US) between 2015–2019. The exposure group included women who underwent any infertility treatment, including ART and prescribed fertility enhancing medications. The comparison group included those who had naturally conceived pregnancies. The primary outcome was SGA birth, defined as sex-specific birthweight <10th percentile for gestational age. Secondary outcomes included SGA <5th and <3rd percentile births. Participants/materials, setting, methods Pregnant subjects (n = 16,836,228) in the US who delivered non-malformed, singleton live births between 24–44 weeks’ gestational age. We estimated risk of SGA births in relation to any infertility treatment from fitting log-linear Poisson regression models with robust variance. Risk ratios (RR) and 95% confidence intervals (CI) were estimated as the effect measure before and after adjusting for confounders. We also performed a sensitivity analysis to correct for potential non-differential exposure misclassification and unmeasured confounding biases. Main results and the role of chance During the study period, 1.4% (n = 231,177) of non-malformed singleton live births resulted from infertility treatments (0.8% ART and 0.6% fertility enhancing medications). Of these, 9.4% (n = 21,771) of pregnancies conceived with infertility treatment were complicated by SGA <10th percentile compared to 11.9% (n = 1,755,925) of naturally conceived pregnancies. For pregnancies conceived with infertility treatment versus naturally conceived pregnancies, the adjusted RR for SGA <10th percentile was 1.07 (95% CI 1.06, 1.08). However, after correction for misclassification bias and unmeasured confounding, infertility treatment was found to be protective for SGA and conferred a 27% reduced risk of SGA <10th percentile (bias-corrected RR 0.73, 95% CI 0.53, 0.85). These trends were similar for analyses stratified by exposure to ART and fertility enhancing medications and secondary SGA outcomes, including SGA <5th and <3rd percentile. Limitations, reasons for caution All information collected on infertility treatment relies on self-reporting by patients and recording by hospital staff at the time of delivery, which likely resulted in underreporting of infertility treatments. Additionally, we cannot determine the impact of interventions that were not recorded, such as intrauterine insemination (IUI). Wider implications of the findings: Compared to naturally conceived pregnancies, exposure to infertility treatment is associated with reduction in the risk of SGA births. These findings, which are contrary to some published reports, likely reflect changes in the modern practice of infertility care in the US, and importantly, robust analysis of the national data. Trial registration number Not applicable
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Farley, G., M. Sauer, J. Brandt, and C. Ananth. "P–776 Singleton pregnancies conceived with infertility treatments and the risk of neonatal and infant mortality." Human Reproduction 36, Supplement_1 (July 1, 2021). http://dx.doi.org/10.1093/humrep/deab130.775.
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Abstract Study question Is maternal infertility treatment associated with an increased risk of neonatal and infant mortality when compared to natural conception? Summary answer Infertility treatment is associated with a 70% increased adjusted risk of neonatal mortality. This association is strongly mediated by preterm delivery. What is known already The number of assisted reproduction technology (ART) cycles performed in the United States (US) increased by 39% from 142,435 cycles in 2007 to 197,737 in 2016. Within this growing experience, several studies described an increased risk of preterm delivery, low birth weight, congenital malformations, neonatal intensive care unit admission, stillbirth, and perinatal mortality among singletons conceived through ART compared to those conceived naturally. Experts have called for ART patients to be advised of potential increased risk for adverse perinatal outcomes and for obstetricians to manage these pregnancies as high risk. Study design, size, duration This is a cross-sectional study of 11,289,466 pregnancies in the United States (US) from 2015–2017 that resulted in a non-malformed singleton live birth. The exposure group includes births resulting from any infertility treatment method, including ART and fertility-enhancing drugs. The control group includes births resulting from natural conceptions. The primary outcomes measured were neonatal (within 1 month), post-neonatal (1 month to a year), and infant (up to 1 year) mortality. Participants/materials, setting, methods Pregnancies (n = 11,289,466) resulting in a non-malformed singleton live birth in the US from 2015–2017. Associations were estimated from log-linear Poisson regression models with robust variance. Risk ratio (RR) and 95% confidence interval (CI) were derived as the effect measure with adjustments for confounders. The impact of exposure misclassification and unmeasured confounding biases were assessed. A causal mediation analysis of the infertility treatment-mortality association with preterm delivery (<37 weeks) was performed. Main results and the role of chance Any infertility treatment was documented in 1.3% (n = 142,215) of singleton live births during the study period. Any infertility treatment was associated with a 70% increased adjusted risk of neonatal mortality (RR 1.70, 95% CI 1.54–1.88), with an even higher risk for early neonatal (RR 1.82, 95% CI 1.63–2.05) than late neonatal (RR 1.37, 95% CI 1.11–1.69) mortality. These risks were similar among pregnancies conceived through ART and treatment with fertility-enhancing drugs. The mediation analysis showed that 68% (95% CI 59–81) of the total effect of infertility treatment on neonatal mortality was mediated through preterm delivery. In a sensitivity analysis, following corrections for exposure misclassification and unmeasured confounding biases, these risks were higher for early neonatal (bias-corrected RR [RRbc] 2.94 95% CIbc 2.16–4.01), but not for late neonatal (RRbc 1.04, 95% CIbc 0.68–1.59) mortality. Limitations, reasons for caution Limitations of the study include the potential underreporting of infertility treatment on birth certificates and potential confounding from sociodemographic characteristics that were not accounted for in this study. Wider implications of the findings: Pregnancies conceived with infertility treatment are associated with increased neonatal mortality and this association is mediated by the increased risk of preterm delivery. Knowledge of this risk should be shared with prospective couples consulting for fertility care in order to best provide adequate informed consent. Trial registration number Not applicable
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Stevens, Antony, Roberta Maria Leite Costa, and Dacio de Lyra Rabello Neto. "Profile Matching of Brazilian Birth and Mortality Records where microcephaly is recorded." International Journal of Population Data Science 1, no. 1 (April 18, 2017). http://dx.doi.org/10.23889/ijpds.v1i1.112.
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ABSTRACT
BackgroundIn Profile Matching the term "Profile" means that the information available about an individual could be the same as that available for some other individuals.
Reduced versions of birth and mortality records are made publicly available by the Brazilian Ministry of Health and this study covers the years 1996 to 2013. Date of birth, sex and municipality of residence are available in both types of record, so their combination could be studied as a pseudo-identifier. The municipality could be different at the two events so the results outlined here must be seen as a first cut.
MethodThe ICD 10 code for microcephaly is Q02. Among the mortality records where Q02 was recorded either as a basic cause or in one of the other lines there were 1676 combinations of the three variables. All but three of them were unique and the remaining three each occcurred with only two records. For 1324 of these records the year of birth was between 1996 and 2013 so that we could reasonably expect these combinations of values among the birth records. However, there were only 204 birth records with combinations that matched and where Q02 was recorded. Possible reasons for the difference could include i) underreporting of births, ii) the failure to detect microcephaly at birth registration and iii) the possibility that microcephaly can only be securely identified sometime after a birth would normally be registered.
ResultsAmong the birth records there were 2349 combinations where Q02 was mentioned as a birth anomaly. All but seven of them were unique and the remaining seven each occcurred with only two records. Corresponding to these combinations there were 1416 combinations found among the mortality records. These were found in 2149 records. However in only 541 of the mortality records was there a mention of Q02. It appears as the basic cause of death in 204 of these 541 records. It could be that such a small number of deaths attributed to Q02 is consistent with best medical opinion.
ConclusionIt is easy to dismiss these apparent discrepancies as poor recording. Some of it may be, but it could be that doctors were faithful to what they observed. The next step is have a clear picture of what was recorded, like other types of birth defect, when Q02 was not observed in both records of a match.
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Al-Harbi, Aziza Abdullah M., and Rajaa M. Al-Raddadi. "MATERNAL MORTALITY AND ITS RELATIONSHIP WITH HEALTHCARE WORKERS' KNOWLEDGE - AN EVALUATION OF HOSPITALS IN TABUK PROVINCE, KINGDOM OF SAUDI ARABIA." European Journal of Public Health Studies 4, no. 1 (June 21, 2021). http://dx.doi.org/10.46827/ejphs.v4i1.92.
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Recently, the Kingdom of Saudi Arabia, has witnessed a progressive decrease in maternal mortality rate. A study conducted by (Najimudeen, M. et al, 2018), reveal that, the reduction of maternal mortality rates in the community is envisaged through greater patient acceptance of medical advice, family spacing and proficient obstetric services. The main objective of the current study is to examine the trends of maternal mortality rate per 10,000 live births during a 10-years period (2005 – 2014), and to assess the reporting of maternal mortality trends at Tabuk region hospitals, in Saudi Arabia. Methods: The descriptive approach was used to collect data needed, using two questionnaire methods, RAMOS questionnaire with sample size (34) cases of maternal mortality. Descriptive and inferential statistics techniques used for data analysis by using (SPSS) version 20. Findings: The study concluded that the majority of deaths among reproductive women have happened for normal reasons, the study showed that around 88.0% of maternal deaths at the age category (25-44) years, and the MMR during the period (2005-to 2014) is reaching 12.2% for (106,326) of live birth. The results reveal that, there is a statistically significant positive association between maternal death registration reports and healthcare workers' knowledge in most hospitals. Conclusion: The study concluded that there is underreporting of maternal mortality index. The study recommended that it is necessary to improve the maternal mortality registration via supporting registration systems and biostatistics and use of customized calculators creating a system for maternal mortality registration to report about maternal mortality deaths and developing a committee to monitor and follow maternal mortality registration.
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Wingate, Heather, Lindsey Sizemore, Jennifer Black, Zachary Heth, and Carolyn Wester. "Retrospective Surveillance of Perinatal Hepatitis C Virus Exposure – Tennessee, 2013-2017." Online Journal of Public Health Informatics 11, no. 1 (May 30, 2019). http://dx.doi.org/10.5210/ojphi.v11i1.9889.
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Objective1. To quantify the burden of perinatal hepatitis C (HCV) exposure and examine the geographic variation in Tennessee (TN).2. Develop new surveillance strategies for retrospective tracking of perinatal HCV exposures.IntroductionHepatitis C virus (HCV) infections are increasing nationwide and are of particular concern in Tennessee, especially among individuals of reproductive age.1,2 Maternal HCV status reported on the birth certificate reveals that the rate of HCV among women giving birth in TN increased 163% from 2009-2014.3 Further, a 2017 TN Department of Health (TDH) study found that 30% of reproductive aged women with newly reported chronic HCV in TN were determined to be pregnant. While current treatment options are not recommended for children under 12, it is critical to identify an infant’s HCV status in order for him/her to receive proper care. Given the high rates of pregnancy reported among women with newly diagnosed HCV, we sought to expand viral hepatitis surveillance efforts to quantify the extent of the burden of HCV among women giving birth in TN, utilizing surveillance data in lieu of standalone birth certificate data.MethodsBirth certificate data, denoting all live births in TN from 2013 to 2017, were obtained from the TDH Birth Statistical File (n=404,694). Maternal HCV infection laboratory data were obtained from the TDH National Electronic Surveillance System (NEDSS) Based System (NBS). Maternal birth certificate and maternal HCV data were matched using a step-wise matching algorithm; records were required to match on one of the following criteria: (1) first name, last name, and date of birth (DOB); (2) first name, maiden name, and DOB; (3) phonetic first name, phonetic last name, DOB; (4) phonetic first name, phonetic maiden name, and DOB; or (5) social security number.For geographical variations, maternal county of residence was extracted from birth certificate data. As there is currently no case definition pertaining to HCV-positive pregnant women, laboratory data was used to determine perinatal exposure case status for each live birth as follows: (1) confirmed exposure, if a mother had at least 1 HCV RNA-positive lab during pregnancy, or in the absence of a pregnancy lab, at least one HCV RNA was conducted prior to pregnancy and the last HCV RNA prior to pregnancy was positive; (2) probable exposure, if a mother did not have an HCV RNA test, but had an HCV Ab-positive lab preceding or during pregnancy; or (3) no exposure, if a mother had a history of HCV, but only HCV RNA-negative labs during pregnancy, or in the absence of a pregnancy lab, at least one HCV RNA was conducted prior to pregnancy and the last RNA prior to pregnancy was negative. HCV infant exposure rates were calculated using the number of probable or confirmed HCV perinatal exposures divided by the total number of live births*1,000.ResultsFrom 2013 to 2017, there were 4,909 perinatal HCV exposures, with an average exposure rate of 12.1 per 1,000 live births. The exposure rate increased by 93.7%, from 7.9 in 2013 to 15.3 in 2017 (Table 1). Using an estimated 5.8% transmission rate, 285 infants acquired HCV infection perinatally over the past 5 years in TN.4Figure 1 depicts the rates of perinatal exposure per 1,000 live births in 2017, by county, and illustrates the large geographical variability of the perinatal HCV exposure rates. While the statewide average was 1.5%, this varied from 0% to 14.1% across TN. Eastern TN counties had higher rates; some signifying 5% to 14.1% of all infants born were vertically exposed to HCV.Limitations of our study included incomplete chronic HCV surveillance data, reporting bias, and external validity. Chronic HCV surveillance in TN was not routine until July 2015, and chronic HCV was not reportable until January 1, 2017. With respect to data included in our study prior to July 2015, only electronic laboratory reports were used, which could have resulted in under-reporting. Additionally, as pregnancy is not currently reportable in the context of HCV, we relied solely on birth certificate and NBS record matching to identify exposure. Lastly, our findings may not be generalizable to the rest of the US, as we only studied women of reproductive age in TN.Strengths to our study included the utilization of two reliable data sources, NBS and Birth Certificate data to determine perinatal HCV exposure. Analyzing data over a 5-year period allowed for a large sample size. Additionally, unlike previous studies, we analyzed laboratory data versus birth certificate data which is physician-reported and has been shown to underestimate the prevalence of maternal HCV infection.5ConclusionsHigh numbers of reported HCV cases among reproductive aged women translates into high rates of perinatal exposure to HCV among live born infants. As compared to maternal HCV status reported on birth certificates, matching birth records with HCV surveillance databases provides advantages to perinatal surveillance by: 1) detecting more cases, and 2) providing the ability to tease out current versus prior infection in mother and, therefore, actual exposure.This type of maternal surveillance provides unique opportunities to reach out and ensure that HCV infected mothers receive important information regarding appropriate infant testing, as indicated by the 2018 case definition, as well as disease prevention.6 Beginning in 2018, TDH has started to conduct surveillance on HCV exposed infants using these methods to track potential transmission in real-time, allowing us to evaluate testing outcomes among these exposed infants and determine if the infants are in appropriate care.References1. Zibbell JE, Asher AK, Patel RC, Kupronis B, Iqbal K, Ward JW, Holtzman D. Increases in Acute Hepatitis C Virus Infection Related to a Growing Opioid Epidemic and Associated Injection Drug Use, United States, 2004 to 2014. Am J Public Health. 2018 Feb; 108(2):175-181.2. Surveillance for Viral Hepatitis – United States, 2015. CDC.3. Patrick, Stephen W. et al. “Hepatitis C Virus Infection Among Women Giving Birth — Tennessee and United States, 2009–2014.” MMWR. Morbidity and Mortality Weekly Report 66.18 (2017): 470–473. PMC.4. Lenka Benova, Yousra A. Mohamoud, Clara Calvert, Laith J. Abu-Raddad; Vertical Transmission of Hepatitis C Virus: Systematic Review and Meta-analysis, Clinical Infectious Diseases, Volume 59, Issue 6, 15 September 2014, Pages 765–773.5. Snodgrass, Stephanie D., Tasha M. Poissant, and Ann R. Thomas. “Notes from the Field: Underreporting of Maternal Hepatitis C Virus Infection Status and the Need for Infant Testing — Oregon, 2015.” Morbidity and Mortality Weekly Report 67.6 (2018): 201–202. PMC.6. Hepatitis C, Perinatal Infection 2018 Case Definition. CDC.
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Mumford, Sunni, Kerry Flannagan, Jeannie Radoc, Torie Plowden, Keewan Kim, Alexandra Purdue-Smithe, Jessica Zolton, et al. "Preconception Marijuana Use and Pregnancy Outcomes (P18-033-19)." Current Developments in Nutrition 3, Supplement_1 (June 1, 2019). http://dx.doi.org/10.1093/cdn/nzz039.p18-033-19.
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Abstract Objectives Marijuana is the most widely used and fastest growing drug in the United States, with legislation currently broadening legalization for both medical and recreational use. However, there are limited data evaluating associations with fecundity and adverse pregnancy outcomes. A few studies evaluating self-reported use suggest marijuana may not be harmful for pregnancy, yet there is a concern for underreporting due to stigma as marijuana is not universally legalized. Our aim was to examine the association between preconception marijuana use, using both self-reported and urinary levels of tetrahydrocannabinol (THC), and fecundability, live birth, and pregnancy loss. Methods Women aged 18–40 years old (n = 1212) enrolled in the EAGeR trial were screened for urinary THC at up to 2 time points during preconception using a homogenous enzyme immunoassay from Randox Laboratories, and asked at baseline to report any marijuana use during the past year. Women were followed for up to 6 months while attempting pregnancy. Cox proportional hazard regression was used to calculate fecundability odds ratios (FOR), and log-binomial regression to estimate risk ratios (RR) for live birth and pregnancy loss adjusting for age, race, BMI, education, smoking, alcohol, and detectable levels of opioids. Results 33 (2.7%) women screened positive for THC during the preconception period, of which 14 also self-reported use during the past year. 62 women (5.1%) either screened positive or self-reported use. Women who screened positive for preconception THC had reduced fecundability (FOR 0.50; 95% CI 0.25, 1.00), as well as women who self-reported marijuana use (FOR 0.54; 95% CI 0.31, 0.94), or who were positive using either urinary or self-report (FOR 0.53, 95% CI 0.33, 0.86). No associations were observed between marijuana use and live birth (RR 0.71; 95% CI 0.41, 1.22) and pregnancy loss (RR 0.78; 95% CI 0.28, 2.18). Conclusions Women who screened positive for THC during preconception, or self-reported use during the past year had reduced fecundability, though no associations were observed with live birth or pregnancy loss. Further investigations are needed to determine what duration and dose of marijuana may negatively impact fecundability. Funding Sources Intramural Research Program, Division of Intramural Population Health Research, Eunice Kennedy Shriver National Institute of Child Health and Human Development.
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Hamroun, Aghilès, Luc Frimat, Maurice Laville, Marie Metzger, Christian Combe, Denis Fouque, Christian Jacquelinet, et al. "New Insights into Acute-on-Chronic Kidney Disease in Nephrology Patients: The CKD-REIN Study." Nephrology Dialysis Transplantation, September 2, 2021. http://dx.doi.org/10.1093/ndt/gfab249.
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Abstract Background Acute-on-chronic kidney disease (ACKD) is poorly understood and often overlooked. We studied its incidence, circumstances, determinants, and outcomes in patients with CKD. Methods We used the Kidney Disease Improving Global Outcomes criteria to identify all-stage acute kidney injury (AKI) events in 3033 nephrology outpatients with CKD stage 3-5 participating in the CKD-REIN cohort study (2013-2020), and cause-specific Cox models to estimate hazard ratios (HR, 95% confidence intervals [CI]) of AKI-associated risk factors. Results At baseline, 22% of the patients (mean age 67 years, 65% men, mean eGFR 32 ml/min/1.73m2) had a history of AKI. Over a 3-year follow-up, 443 had at least one AKI event: 27% were stage 2 or 3, and 11% required dialysis; 74% involved hospitalization including 47% acquired as hospital inpatients; a third were not reported in hospital discharge reports. Incidence rates were 10.1 and 4.8 per 100 person-years in patients with and without an AKI history, respectively. In 2375 patients without this history, male sex, diabetes, cardiovascular disease, cirrhosis, several drugs, low eGFR, and serum albumin levels were significantly associated with a higher risk of AKI, as were low birth weight (<2500 g) (adjusted HR, 1.98; 95%CI, 1.35 to 2.91) and hemoglobin level (HR 1.21; 1.12 to 1.32 per 1 g/dl decrease). Within one year, only 63% of the patients had recovered their previous kidney function, 13.7% had started kidney replacement therapy, and 12.7% had died. Conclusions The study highlights the high rate of hospital-acquired AKI events in patients with CKD, and their underreporting at hospital discharge. It also reveals low birth weight and anemia as possible new risk factors in CKD patients.
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Maruf, Farzana, Hannah Tappis, Jelle Stekelenburg, and Thomas van den Akker. "Quality of Maternal Death Documentation in Afghanistan: A Retrospective Health Facility Record Review." Frontiers in Global Women's Health 2 (March 17, 2021). http://dx.doi.org/10.3389/fgwh.2021.610578.
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Objectives: To assess the quality of health facility documentation related to maternal deaths at health facilities in Afghanistan.Methods: Analysis of a subset of findings from the 2016 National Maternal and Newborn Health Quality of Care Assessment in Afghanistan. At each facility, maternity registers were reviewed to obtain data related to maternity caseload, and number and causes of maternal deaths in the year preceding the survey. Detailed chart reviews were conducted for up to three maternal deaths per facility. Analyses included completeness of charts, quality of documentation, and cause of death using WHO application of International Statistical Classification of Disease to deaths during pregnancy, childbirth and the puerperium.Key findings: Only 129/226 (57%) of facilities had mortality registers available for review on the day of assessment and 41/226 (18%) had charts documenting maternal deaths during the previous year. We reviewed 68 maternal death cases from the 41 facilities. Cause of death was not recorded in nearly half of maternal death cases reviewed. Information regarding mode of birth was missing in over half of the charts, and one third did not capture gestational age at time of death. Hypertensive disorders of pregnancy and obstetric hemorrhage were the most common direct causes of death, followed by maternal sepsis and unanticipated complications of clinical management including anesthesia-related complications. Documented indirect causes of maternal deaths were anemia, cardiac arrest, kidney and hepatic failure. Charts revealed at least eight maternal deaths from indirect causes that were not captured in register books, indicating omission or misclassification of registered deaths.Conclusion: Considerable gaps in quality of recordkeeping exist in Afghanistan, including underreporting, misclassification and incompleteness. This hampers efforts to improve quality of maternal and newborn health data and priority setting.
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Jamieson, Lise, Denise Evans, Rebecca Berhanu, Nazir Ismail, Samantha Aucock, Kristina Wallengren, and Lawrence Long. "Data quality of drug-resistant tuberculosis and antiretroviral therapy electronic registers in South Africa." BMC Public Health 19, no. 1 (December 2019). http://dx.doi.org/10.1186/s12889-019-7965-9.
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Abstract Background To assess the quality and completeness of treatment and outcome data in the electronic tuberculosis (TB) and antiretroviral treatment (ART) registers in drug-resistant (DR-) TB patients at three treatment facilities in South Africa. Methods We did a retrospective cohort study using routinely-collected data from DR-TB registers of rifampicin resistant adults (≥18 years old), on ART, initiating DR-TB treatment between January 2012 and December 2013. We linked patient information from the DR-TB register to the ART register using patient identifiers and an algorithm based on string edit distance and date of birth. We describe data gaps and discrepancies found. Results Overall, 2852 DR-TB patients met our inclusion criteria based on the DR-TB register data, and of these, 1685 (59%) could be matched to the ART registers. An additional 253 patients from the DR-TB registers were found in the ART registers, having initiated ART, despite the DR-TB register indicating that they were not on ART (or this data was missing). 11% of matched patients did not have TB treatment status recorded in the ART register despite being recorded as being on TB treatment in the DR-TB register, and 78% did not have an ART start date recorded in DR-TB register despite being on ART treatment as per the ART register. 11% of matched patients had a death recorded in one register but not the other, and of those with death recorded in both, 15% of dates differed by > 1 month. Conclusions The underreporting of death and the lack of ART or TB status in the electronic DR-TB and ART registers could negatively impact monitoring efforts by downplaying the state of the TB/HIV epidemic. Improved recording of these data sources, and data integration across systems, could improve the accuracy of reporting for the national HIV/ART and TB programs.