Victora GV (Department of Social Medicine, Universidade Federal de Pelotas, CP 464, 96100 Pelotas... more Victora GV (Department of Social Medicine, Universidade Federal de Pelotas, CP 464, 96100 Pelotas, RS, Brazil), Barros FC, Vaughan JP and Teixeira AMB. Birthweight and infant mortality: a longitudinal study of 5914 Brazilian children. Internationa/Journal of ...
This paper describes the main methodological aspects of a cohort study, with emphasis on its rece... more This paper describes the main methodological aspects of a cohort study, with emphasis on its recent phases, which may be relevant to investigators planning to carry out similar studies. In 1993, a population based study was launched in Pelotas, Southern Brazil. All 5,249 newborns delivered in the city's hospitals were enrolled, and sub-samples were visited at the ages of one, three and six months and of one and four years. In 2004-5 it was possible to trace 87.5% of the cohort at the age of 10-12 years. Sub-studies are addressing issues related to oral health, psychological development and mental health, body composition, and ethnography. Birth cohort studies are essential for investigating the early determinants of adult disease and nutritional status, yet few such studies are available from low and middle-income countries where these determinants may differ from those documented in more developed settings.
Caesarean sections in Brazil rose from 15 per cent of all births in 1970 to over 30 per cent in 1... more Caesarean sections in Brazil rose from 15 per cent of all births in 1970 to over 30 per cent in 1980. A new policy was introduced by the largest medical care provider (INAMPS) which made the reimbursement fee payable to doctors the same for both vaginal and caesarean section deliveries. However, the caesarean rate has continued to rise. This study analysed the antenatal care and deliveries of over 7000 births which occurred during 1982 in the city of Pelotas in southern Brazil. The organization of health care is discussed in relation to the findings on the utilization of the different antenatal and delivery services available. Utilization is then related to the gestational risk and socio-economic status of the mothers. There were marked differentials between the low and high risk mothers and between those from high and low income families. Doctors clearly concentrated their efforts on the low risk and high income mothers, with 50 per cent of private patients having an operative delivery compared to 13 per cent of uninsured mothers. There was a large demand for tubal ligations to be carried out at the same time as the caesareans. The non-medical and financial reasons for these high rates are discussed and the high extra cost that is being incurred by patients and the insurance schemes is emphasized.
Brazilian infant and child mortality levels are not compatible with the country's economi... more Brazilian infant and child mortality levels are not compatible with the country's economic potential. In this paper, we provide a description of levels and trends in infant mortality due to perinatal causes and malformations and assess the likely impact of changing intermediate-level determinants, many of which are amenable to direct interventions through the health or related sectors. Review paper. Two main sources of mortality data were used: indirect mortality estimates based on censuses and surveys, and rates based on registered deaths. The latter were corrected for under-registration. Combination of the two sources of data allowed the estimation of cause-specific mortality rates. Data on current coverage of preventive and curative interventions were mostly obtained from the 1996 Demographic and Health Survey. Other national household surveys and Ministry of Health Statistics were also used. A thorough review of the Brazilian literature on levels, trends and determinants of infant mortality led to the identification of a large number of papers and books. These provided the background for the analyses of risk factors and potential interventions. The indirect infant mortality rate estimate for 1995-97 is of 37.5 deaths per thousand live births, about six times higher than in the lowest mortality countries in the world. Perinatal causes account for 57 % of all infant deaths, and congenital malformations are responsible for 11.2 % of these deaths. Mortality levels are highest in the Northeast and North, and lowest in the South and Southeast; the Center-West falls in between. Since surveys of the North region do not cover rural areas, mortality for this region may be underestimated. A first priority for the further reduction in infant mortality in Brazil is to improve equality among regions, since the North and Northeast, and particularly rural areas, still show very high death rates. Further reductions in infant mortality will largely depend on decreasing deaths due to perinatal causes. Improvements in the coverage and particularly in the quality of antenatal and delivery care are urgently needed. Another intervention with a potential important impact on infant mortality is the promotion of family planning. Improving birth weight might lead to an 8 % reduction in infant mortality but the efficacy of available interventions is low.
The deaths of children aged 1-4 years were studied in a cohort of 5914 Brazilian liveborns. A tot... more The deaths of children aged 1-4 years were studied in a cohort of 5914 Brazilian liveborns. A total of 29 early childhood deaths were recorded (cumulative mortality risk of approximately 6 per 1000), 17 of which (59%) were due to infectious diseases. The death rate was highest in the second year. Deaths were highly concentrated in children from low income (< US $50/month) families, where the cumulative risk of early childhood death was about 10 per 1000; on the other hand, there were no deaths among the 616 children from families with a monthly income of US $300 or more. Birthweight was also associated with mortality: the cumulative risk of children weighing less than 2000 g at birth was 21 per 1000, compared to 4 per 1000 among those with birthweights of 3500 g or more. Simultaneous adjustment for income and birthweight did not substantially change these differentials. These findings confirm the strong association between early childhood mortality and socioeconomic conditions, but also make evident the long-term effects of low birthweight.
To investigate the relationship between social and biological conditions experienced in very earl... more To investigate the relationship between social and biological conditions experienced in very early life and dental caries in children aged 6 years. The design was a dental caries cross-sectional study nested in a birth cohort study started in Pelotas, Brazil, in 1993. The cross-sectional study was carried out in 1999. A random sample of 400 6-year-old children was selected from among 5249 live births in 1993. The World Health Organization (1997) criteria were used to diagnose dental caries. Results from the oral health study were linked to the data concerning perinatal and childhood health and illnesses and family social conditions collected at birth, 1, 3, 6 and 12 months, and in the sixth year of life. Dental caries was the outcome measured at two levels of severity (very low: dmft < or = 1; high: dmft > or = 4). Unconditional univariate and multiple logistic regression analysis were performed. Self-employed and employees/unemployed, fathers with <8 years of education at time child was born, child's height deficit for age at 12 months; child who did not attend day care centre in sixth year of life; brushing teeth less than once a day, and children with sweet consumption of at least once a day at 6 years were risk factors for high dental caries after controlling for possible confounders. Harmful social and biological risk factors accumulated in early life contributed to the development of a high level of dental caries in childhood.
Victora GV (Department of Social Medicine, Universidade Federal de Pelotas, CP 464, 96100 Pelotas... more Victora GV (Department of Social Medicine, Universidade Federal de Pelotas, CP 464, 96100 Pelotas, RS, Brazil), Barros FC, Vaughan JP and Teixeira AMB. Birthweight and infant mortality: a longitudinal study of 5914 Brazilian children. Internationa/Journal of ...
This paper describes the main methodological aspects of a cohort study, with emphasis on its rece... more This paper describes the main methodological aspects of a cohort study, with emphasis on its recent phases, which may be relevant to investigators planning to carry out similar studies. In 1993, a population based study was launched in Pelotas, Southern Brazil. All 5,249 newborns delivered in the city's hospitals were enrolled, and sub-samples were visited at the ages of one, three and six months and of one and four years. In 2004-5 it was possible to trace 87.5% of the cohort at the age of 10-12 years. Sub-studies are addressing issues related to oral health, psychological development and mental health, body composition, and ethnography. Birth cohort studies are essential for investigating the early determinants of adult disease and nutritional status, yet few such studies are available from low and middle-income countries where these determinants may differ from those documented in more developed settings.
Caesarean sections in Brazil rose from 15 per cent of all births in 1970 to over 30 per cent in 1... more Caesarean sections in Brazil rose from 15 per cent of all births in 1970 to over 30 per cent in 1980. A new policy was introduced by the largest medical care provider (INAMPS) which made the reimbursement fee payable to doctors the same for both vaginal and caesarean section deliveries. However, the caesarean rate has continued to rise. This study analysed the antenatal care and deliveries of over 7000 births which occurred during 1982 in the city of Pelotas in southern Brazil. The organization of health care is discussed in relation to the findings on the utilization of the different antenatal and delivery services available. Utilization is then related to the gestational risk and socio-economic status of the mothers. There were marked differentials between the low and high risk mothers and between those from high and low income families. Doctors clearly concentrated their efforts on the low risk and high income mothers, with 50 per cent of private patients having an operative delivery compared to 13 per cent of uninsured mothers. There was a large demand for tubal ligations to be carried out at the same time as the caesareans. The non-medical and financial reasons for these high rates are discussed and the high extra cost that is being incurred by patients and the insurance schemes is emphasized.
Brazilian infant and child mortality levels are not compatible with the country's economi... more Brazilian infant and child mortality levels are not compatible with the country's economic potential. In this paper, we provide a description of levels and trends in infant mortality due to perinatal causes and malformations and assess the likely impact of changing intermediate-level determinants, many of which are amenable to direct interventions through the health or related sectors. Review paper. Two main sources of mortality data were used: indirect mortality estimates based on censuses and surveys, and rates based on registered deaths. The latter were corrected for under-registration. Combination of the two sources of data allowed the estimation of cause-specific mortality rates. Data on current coverage of preventive and curative interventions were mostly obtained from the 1996 Demographic and Health Survey. Other national household surveys and Ministry of Health Statistics were also used. A thorough review of the Brazilian literature on levels, trends and determinants of infant mortality led to the identification of a large number of papers and books. These provided the background for the analyses of risk factors and potential interventions. The indirect infant mortality rate estimate for 1995-97 is of 37.5 deaths per thousand live births, about six times higher than in the lowest mortality countries in the world. Perinatal causes account for 57 % of all infant deaths, and congenital malformations are responsible for 11.2 % of these deaths. Mortality levels are highest in the Northeast and North, and lowest in the South and Southeast; the Center-West falls in between. Since surveys of the North region do not cover rural areas, mortality for this region may be underestimated. A first priority for the further reduction in infant mortality in Brazil is to improve equality among regions, since the North and Northeast, and particularly rural areas, still show very high death rates. Further reductions in infant mortality will largely depend on decreasing deaths due to perinatal causes. Improvements in the coverage and particularly in the quality of antenatal and delivery care are urgently needed. Another intervention with a potential important impact on infant mortality is the promotion of family planning. Improving birth weight might lead to an 8 % reduction in infant mortality but the efficacy of available interventions is low.
The deaths of children aged 1-4 years were studied in a cohort of 5914 Brazilian liveborns. A tot... more The deaths of children aged 1-4 years were studied in a cohort of 5914 Brazilian liveborns. A total of 29 early childhood deaths were recorded (cumulative mortality risk of approximately 6 per 1000), 17 of which (59%) were due to infectious diseases. The death rate was highest in the second year. Deaths were highly concentrated in children from low income (< US $50/month) families, where the cumulative risk of early childhood death was about 10 per 1000; on the other hand, there were no deaths among the 616 children from families with a monthly income of US $300 or more. Birthweight was also associated with mortality: the cumulative risk of children weighing less than 2000 g at birth was 21 per 1000, compared to 4 per 1000 among those with birthweights of 3500 g or more. Simultaneous adjustment for income and birthweight did not substantially change these differentials. These findings confirm the strong association between early childhood mortality and socioeconomic conditions, but also make evident the long-term effects of low birthweight.
To investigate the relationship between social and biological conditions experienced in very earl... more To investigate the relationship between social and biological conditions experienced in very early life and dental caries in children aged 6 years. The design was a dental caries cross-sectional study nested in a birth cohort study started in Pelotas, Brazil, in 1993. The cross-sectional study was carried out in 1999. A random sample of 400 6-year-old children was selected from among 5249 live births in 1993. The World Health Organization (1997) criteria were used to diagnose dental caries. Results from the oral health study were linked to the data concerning perinatal and childhood health and illnesses and family social conditions collected at birth, 1, 3, 6 and 12 months, and in the sixth year of life. Dental caries was the outcome measured at two levels of severity (very low: dmft < or = 1; high: dmft > or = 4). Unconditional univariate and multiple logistic regression analysis were performed. Self-employed and employees/unemployed, fathers with <8 years of education at time child was born, child's height deficit for age at 12 months; child who did not attend day care centre in sixth year of life; brushing teeth less than once a day, and children with sweet consumption of at least once a day at 6 years were risk factors for high dental caries after controlling for possible confounders. Harmful social and biological risk factors accumulated in early life contributed to the development of a high level of dental caries in childhood.
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