Caesarean delivery rates continue to increase worldwide. Our aim was to assess the association between caesarean delivery and pregnancy outcome at the institutional level, adjusting for the pregnant ...population and institutional characteristics.
For the 2005 WHO global survey on maternal and perinatal health, we assessed a multistage stratified sample, comprising 24 geographic regions in eight countries in Latin America. We obtained individual data for all women admitted for delivery over 3 months to 120 institutions randomly selected from of 410 identified institutions. We also obtained institutional-level data.
We obtained data for 97 095 of 106 546 deliveries (91% coverage). The median rate of caesarean delivery was 33% (quartile range 24–43), with the highest rates of caesarean delivery noted in private hospitals (51%, 43–57). Institution-specific rates of caesarean delivery were affected by primiparity, previous caesarean delivery, and institutional complexity. Rate of caesarean delivery was positively associated with postpartum antibiotic treatment and severe maternal morbidity and mortality, even after adjustment for risk factors. Increase in the rate of caesarean delivery was associated with an increase in fetal mortality rates and higher numbers of babies admitted to intensive care for 7 days or longer even after adjustment for preterm delivery. Rates of preterm delivery and neonatal mortality both rose at rates of caesarean delivery of between 10% and 20%.
High rates of caesarean delivery do not necessarily indicate better perinatal care and can be associated with harm.
Objective: Our objective was to examine whether improvement in maternal zinc status during pregnancy is positively associated with fetal neurobehavioral development in a Peruvian population.
Study ...Design: We electronically monitored, at 32 and 36 weeks’ gestation, 55 fetuses whose mothers were randomly assigned to receive, during pregnancy, a daily supplement containing 60 mg iron and 250 μg folate, with or without 15 mg zinc. Fetal heart rate and movement patterns were quantified in 55 and 34 fetuses, respectively, as indexes of neurobehavioral development.
Results: Fetuses of mothers who received zinc supplementation showed fewer episodes of minimal fetal heart rate variability, increased fetal heart rate range, an increased number of accelerations, an increased number of movement bouts, an increased amount of time spent moving, and an increased number of large movements. Differences by supplementation type increased with gestational age and were statistically significant at 36 weeks’ gestation (
P < .05).
Conclusion: Improving maternal zinc status through prenatal supplementation may improve fetal neurobehavioral development. (Am J Obstet Gynecol 1998;180:483-90.)
Anemia in children younger than 3 years is a public health problem in Peru and worldwide. It is believed that one of the primary causes of anemia is iron deficiency. Numerous studies and reviews have ...reported that iron deficiency limited psychomotor development in children and that, despite the correction of anemia, children with iron deficiency experienced poorer long-term performance in cognitive, social, and emotional functioning. These outcomes were reported in observational studies, follow-up studies, and experimental studies with a control group. Anemia can decrease school performance, productivity in adult life, quality of life, and the general income of affected individuals. Here we describe possible mechanisms underlying the effect of iron deficiency, with or without anemia, on childhood development. The high rate of anemia in this age group is a cause for concern. Moreover, anemia should be prevented in the first year of life to avoid long-term negative effects on individual development.
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To characterize the nutritional status and cardio‐metabolic indicators of two groups of adolescents 14 yrs old, born from prenatal supplemented mothers. Methods: We evaluated a group of ...86 adolescents from mothers that received iron and folic acid (group A), and 75 from mothers that received iron, folic acid and zinc (Group B).
Results
In group A, 16 (18.6%) were overweight and 24.4% were obese; in group B, 15 (20%) were overweight and 16% were obese (NS). Among the overweight and obese children (n=64), mean Hb in group A was 13.5 g/dl and 12.8 g/dl in group B (p=0.007), there were no differences on mean serum zinc, ferritin, PCR, triglycerides, HD cholesterol, glucose, fasting insulin, blood pressure, waist circumference. In group A, 16 (43.2 %), 15 (40.5%) and 5 children (13.5%); in Group B, 13 (48.1%), 8 (29.6%) and 3 children (11.1%) had 1, 2 and 3 or more abnormal cardio metabolic indicators (NS). In 53 (82.8%) children had PCR > 5mg/L, in 56 (87.5%) had HDL cholesterol < 40 mg/dl (NS between groups). Results have shown a high prevalence of overweight and obesity in this population, cardio‐metabolic indicators shown a trend to develop metabolic syndrome. Differences were not associated to group of maternal supplementation. Supported by Nestle Foundation.
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While anemia can be the result of several micronutrient deficiencies, iron deficiency is frequently the cause. Children under the age of 2 are commonly affected by iron deficiency ...anemia, particularly in developing nations where repeated infection can exacerbate existing nutritional deficiency. Iron deficiency during childhood is associated with several negative outcomes, some of which persist beyond repletion. Here we investigated alterations in systemic metabolism and microbial diversity and functionality in a cross‐section of 6 mo and 12 mo anemic and non‐anemic Peruvian infants (n=200). Serum and fecal metabolomes were assessed using
1
H‐NMR and the fecal microbiome by 16S rRNA sequencing. Differences in microbial communities between the ages were as expected, with 6 mo old subjects exhibiting a greater abundance of
Bifidobacteria,
and lower abundance of
Bacteroidetes
and
Clostridia
, in comparison to the 12 mo old subjects. In 6 mo old subjects, we observed few differences in microbial communities and the fecal metabolome between anemic and non‐anemic subjects, though there were suggestions of impaired systemic energy metabolism as indicated by decreased levels of TCA cycle intermediates. In 12 mo old subjects, the structure of the microbial community did not exhibit many differences between anemic and non‐anemic infants. However, the fecal metabolomes suggested changes in community functionality with anemic infants having greater concentrations of both toxic and antioxidant compounds. While the concentrations of many of these compounds are too low to be quantified in blood, these differences have the potential to influence systemic metabolism. Additionally, 12 mo old anemic subjects exhibited expected decreases energy metabolism, and interesting male‐specific changes in amino acid levels were also observed. Considering that a greater proportion of anemia in the 12 mo old male subjects can be attributed to iron deficiency in comparison to the 12 mo old females, these patterns may begin to provide clues regarding why males are at a greater risk of developing IDA. Furthermore, these results highlight metabolic differences in anemia, and suggest how anemia negatively impacts long‐term development, potentially in a sex‐specific manner.
Support or Funding Information
Support for this project was provided by GAIN.
To develop an indicator of maternal near miss as a proxy for maternal death and to study its association with maternal factors and perinatal outcomes.
In a multicenter cross-sectional study, we ...collected maternal and perinatal data from the hospital records of a sample of women admitted for delivery over a period of two to three months in 120 hospitals located in eight Latin American countries. We followed a stratified multistage cluster random design. We assessed the intra-hospital occurrence of severe maternal morbidity and the latter's association with maternal characteristics and perinatal outcomes.
Of the 97,095 women studied, 2964 (34 per 1000) were at higher risk of dying in association with one or more of the following: being admitted to the intensive care unit (ICU), undergoing a hysterectomy, receiving a blood transfusion, suffering a cardiac or renal complication, or having eclampsia. Being older than 35 years, not having a partner, being a primipara or para > 3, and having had a Caesarean section in the previous pregnancy were factors independently associated with the occurrence of severe maternal morbidity. They were also positively associated with an increased occurrence of low and very low birth weight, stillbirth, early neonatal death, admission to the neonatal ICU, a prolonged maternal postpartum hospital stay and Caesarean section.
Women who survive the serious conditions described could be pragmatically considered cases of maternal near miss. Interventions to reduce maternal and perinatal mortality should target women in these high-risk categories.
ABSTRACT
Objective:
To compare glucose and rice‐based oral rehydration solution with rice‐based oral rehydration solution containing recombinant human lactoferrin and recombinant human lysozyme in ...diarrhea outcomes.
Patients and Methods:
We conducted a randomized, double‐blind controlled trial in children with acute diarrhea and dehydration. One hundred and forty children 5 to 33 months old were block randomized to receive low osmolarity WHO‐ORS (G‐ORS), rice‐based ORS (R‐ORS), or rice‐based ORS plus lactoferrin and lysozyme (Lf/Lz‐R‐ORS). Intake and output were monitored for 48 h in the ORU, with continued monitoring through home and clinic follow‐up for 14 d.
Results:
The G‐ORS and R‐ORS groups did not show any differences in diarrhea outcomes and were therefore combined as the control group. Intent‐to‐treat analysis showed a significant decrease in duration of diarrhea (3.67 d vs 5.21 d, P = 0.05) in the Lf/Lz‐R‐ORS group as compared with the control group and a significant increase in the number of children who achieved 48 h with solid stool, 85% vs 69% (P < 0.05). There were also decreases in volume of diarrhea and the percentage of children who had a new diarrhea episode after achieving the endpoint.
Conclusions:
Addition of recombinant human lactoferrin and lysozyme to a rice‐based oral rehydration solution had beneficial effects on children with acute diarrhea.
To describe the iron status profile and to propose hemoglobin adjustment factors for altitude for children aged 6 to 8 months in Lima, Arequipa, Cusco and Puno.
Cross-sectional study in children aged ...6 to 8 months from four cities. We measured hemoglobin and other iron biomarkers, C-reactive protein (CRP), among others. To estimate the adjustment equation, we applied an exponential regression. We excluded children with iron deficiency (ID) and/or inflammation.
The proportions of ID were higher in Puno and Arequipa, while inflammation did not exceed 19% in any of the cities. Hemoglobin showed an exponential increase at higher altitude. The adjustment equation was: 10.34249 x (1.00007 ^ Alt).
Children residing in Arequipa and Puno showed higher rates of ID and lower iron reserves; furthermore, the increase in hemoglobin by altitude was exponential, showing the need to adjust hemoglobin at altitude.
Background: To ensure multiple micronutrient powders (MNP) for children have their intended effect, it is important to understand caregivers’ experiences. Objective: We aimed to assess perceptions, ...practices, and preferences relating to the use of MNP among caregivers of children enrolled in a study to compare different MNP dosing schemes in Cajamarca, Peru. Methods: Infants age 6‐11 mo (n=400) were randomly assigned to 6 mo daily, 6 mo intermittent (every other day), 12 mo daily, or 12 mo intermittent MNP supplementation. MNP were provided monthly and field staff conducted home visits twice monthly. Unused MNP sachets were collected throughout and at endline (12 mo) all caregivers were asked about their experiences using MNP. Results: Most (94%) reported being very satisfied with MNP. One quarter (27%) reported difficulties remembering to give the MNP scheme as recommended. The most frequently reported strategies for remembering were keeping the MNP in the kitchen or bedroom. Most (98%) reported that giving their child MNP eventually became part of their regular routine; about half (59%) said that this took a week or less. Adherence was high; 85% of the MNP sachets were used and almost everyone (98%) reported giving all or most of the MNP to their child. Most (95%) reported noticing benefits after giving MNP to their child; increased appetite and increased hemoglobin (as informed by the study nurse) were most common. Caregivers assigned to the daily scheme were over 3 times more likely to say they would select their own scheme, compared to those in the intermittent group (OR: 3.6, 95%CI: 2.3‐5.7). Conclusions: MNP were acceptable and used with high adherence over the long term in this population; daily supplementation was preferred over intermittent.
Grant Funding Source: Supported by the Micronutrient Initiative
OBJECTIVE: To set up a global system for monitoring maternal and perinatal health in 54 countries worldwide. METHODS: The WHO Global Survey for Monitoring Maternal and Perinatal Health was ...implemented through a network of health institutions, selected using a stratified multistage cluster sampling design. Focused information on maternal and perinatal health was abstracted from hospital records and entered in a specially developed online data management system. Data were collected over a two- to three-month period in each institution. The project was coordinated by WHO and supported by WHO regional offices and country coordinators in Africa and the Americas. FINDINGS: The initial survey was implemented between September 2004 and March 2005 in the African and American regions. A total of 131 institutions in seven African countries and 119 institutions in eight Latin American countries participated. CONCLUSION: This project has created a technologically simple and scientifically sound system for large-scale data management, which can facilitate programme monitoring in countries.
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