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      A retrospective follow up study on maternal age and infant mortality in two Sicilian districts

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          Abstract

          Background

          Infant mortality rate (IMR) is a key public health indicator. Maternal age is a well-known determinant of pregnancy and delivery complications and of infant morbidity and mortality. In Italy the Infant Mortality Rate was 3.7/1000 during 2005, lower than the average IMR for the European Union (4.94/1000). Sicily is the Italian region with the highest IMR, 5/1000, and neonatal mortality rate (NMR), 3.8/1000, with substantial variation among its nine districts.

          The present study compared a high IMR/NMR district (Messina) with a low IMR/NMR district (Palermo) during the period 2004-2006 to evaluate potential determinants of the IMRs' differences between the two districts and specifically the impact of maternal age.

          Methods

          The Death Causes Registers identified all deaths during the first year of life recorded among infants born to residents of the two districts in 2004-2006. For every case, available hospital charts records were abstracted using a standardized form designed to capture information on potential determinants of infant death. For each district and for each year, IMRs and NMRs were computed. Chi-squared statistics tested the significance of differences between district-specific IMRs. A Poisson regression model was used to analyze the relationship between maternal age, district of residence and IMR.

          Results

          The 246 death registry-confirmed cases included 143 (58.1%) males and 103 (41.2%) females, with mean age at death of 33.3 days (SD: 64.5, median: 5.5). The average IMR for 2004-2006 was significantly higher for the Messina district than for the Palermo district (p = 0.0001). The IMR ratio was 1.6 (95%CI: 1.2 - 2.1). The IMRs declined from 2004 to 2006. A significant interaction (p = 0.04) between maternal age and district of residence was documented.

          Conclusion

          The association between advanced maternal age and infant deaths in the Messina district was due in part to the excess of newborns from advanced age mothers, but also to increased risk of death among such newborns. The significant interaction between district of residence and maternal age indicated that the IMR excess in the Messina district cannot be explained by disproportionately high live birth rates among older mothers and suggested the hypothesis that health care facilities in the Messina district could be less well prepared to provide assistance to the excess of high risk pregnancies and deliveries, as compared to Palermo district.

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          Most cited references16

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          WHO estimates of the causes of death in children.

          Child survival efforts can be effective only if they are based on accurate information about causes of deaths. Here, we report on a 4-year effort by WHO to improve the accuracy of this information. WHO established the external Child Health Epidemiology Reference Group (CHERG) in 2001 to develop estimates of the proportion of deaths in children younger than age 5 years attributable to pneumonia, diarrhoea, malaria, measles, and the major causes of death in the first 28 days of life. Various methods, including single-cause and multi-cause proportionate mortality models, were used. The role of undernutrition as an underlying cause of death was estimated in collaboration with CHERG. In 2000-03, six causes accounted for 73% of the 10.6 million yearly deaths in children younger than age 5 years: pneumonia (19%), diarrhoea (18%), malaria (8%), neonatal pneumonia or sepsis (10%), preterm delivery (10%), and asphyxia at birth (8%). The four communicable disease categories account for more than half (54%) of all child deaths. The greatest communicable disease killers are similar in all WHO regions with the exception of malaria; 94% of global deaths attributable to this disease occur in the Africa region. Undernutrition is an underlying cause of 53% of all deaths in children younger than age 5 years. Achievement of the millennium development goal of reducing child mortality by two-thirds from the 1990 rate will depend on renewed efforts to prevent and control pneumonia, diarrhoea, and undernutrition in all WHO regions, and malaria in the Africa region. In all regions, deaths in the neonatal period, primarily due to preterm delivery, sepsis or pneumonia, and birth asphyxia should also be addressed. These estimates of the causes of child deaths should be used to guide public-health policies and programmes.
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            Trends in the occurrence, determinants, and consequences of multiple births.

            After a substantial decrease in the middle of the 20th century, multiple pregnancy rates have increased in many Western countries. Between the mid-1970s and 1998, the rate of twin pregnancies increased by 50% to 60% in England and Wales, France, and the United States. The rates of triplet or higher-order multiple pregnancies increased by 310% in France, 430% in England and Wales, and 696% in the United States. One fourth to one third of the increase in twin or triplet pregnancies are attributable to a contemporaneous increase in maternal age. Furthermore, in countries with high occurrence of multiple births, 30% to 50% of twin pregnancies and at least 75% of triplet pregnancies occur after infertility treatment. The impact of the increase in multiple births on preterm delivery rates in the overall population is mainly attributable to twin pregnancies. In Canada, France, and the United States, an increase in preterm births among multiples contributed almost as much as the increase in occurrence of multiple births to the increase or stabilization of the overall rates of preterm delivery observed in these countries.
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              Selecting an indicator set for monitoring and evaluating perinatal health in Europe: criteria, methods and results from the PERISTAT project.

              The PERISTAT project was charged with developing an indicator set for monitoring and describing perinatal health in Europe as part of the European Commission's Health Monitoring Programme, run by the Directorate General for Health and Consumer Protection (DG-SANCO), which is working towards the establishment of a comprehensive health monitoring system at the community level. To develop its recommendations, the PERISTAT project carried out an extensive review of existing perinatal health indicators and then implemented a DELPHI consensus process with its scientific advisory committee, a panel composed of clinicians, epidemiologists and statisticians, as well as with a panel of midwives. Consensus was achieved on 10 core and 23 recommended indicators using methods that drew on and consolidated previous work in this field. Twelve of these indicators were targeted for further development and the other 21 for immediate implementation. A feasibility study, reported in the rest of this issue, was put into place to assess these recommendations.
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                Author and article information

                Journal
                BMC Public Health
                BMC Public Health
                BioMed Central
                1471-2458
                2011
                19 October 2011
                : 11
                : 817
                Affiliations
                [1 ]Department of Health Promotion Sciences, University of Palermo, Palermo, Italy
                [2 ]Division of Biostatistics and Epidemiology, Cincinnati Children's Hospital Medical Center, Cincinnati, OH, USA
                [3 ]Provincial Health Agency Palermo, Palermo, Italy
                [4 ]Provincial Health Agency Messina, Messina, Italy
                [5 ]Epidemiological Observatory, Regional Health Authority, Palermo, Italy
                [6 ]Department of Maternal and Child Health, University of Palermo, Palermo, Italy
                [7 ]Department of Experimental Medicine - Clinical Medicine and Public Health Section, "Sapienza" University of Rome, Rome, Italy
                Article
                1471-2458-11-817
                10.1186/1471-2458-11-817
                3206483
                22011347
                4dbbc2d0-cbbb-4e1f-87ce-979520e8d4ff
                Copyright ©2011 Mazzucco et al; licensee BioMed Central Ltd.

                This is an Open Access article distributed under the terms of the Creative Commons Attribution License ( http://creativecommons.org/licenses/by/2.0), which permits unrestricted use, distribution, and reproduction in any medium, provided the original work is properly cited.

                History
                : 29 November 2010
                : 19 October 2011
                Categories
                Research Article

                Public health
                Public health

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