The challenge of reducing neonatal mortality in middle-income countries: findings from three Brazilian birth cohorts in 1982, 1993, and 2004
The challenge of reducing neonatal mortality in middle-income countries: findings from three Brazilian birth cohorts in 1982, 1993, and 2004
复制标题
DOI：
10.1016/s0140-6736(05)71042-4
复制
发表时间：
2005-03-05
期刊：
影响因子：
168.9
通讯作者：
Vaughan, JP
中科院分区：
文献类型：
--
作者：
Barros, FC;Victora, CG;Vaughan, JP
中等收入国家需要大幅降低新生儿死亡率，以实现儿童生存的千年发展目标。产前和围产期保健指标在巴西城市的Pelanmar从1982年至2004年的演变提供了一个有用的案例研究潜在的challenges.Methods我们前瞻性地研究了三个出生队列，代表所有的城市出生在1982年，1993年，2004年1月至7月。结果尽管产妇的特征有所改善，早产的患病率从1982年的6.3%（294 4665）增加到2004年的16.2%（342 2112），相当于平均出生体重减少47克。2004年，产前检查的平均次数为每名妇女8.3次，但护理质量仍然不够- 97%的妇女做了超声波扫描，但只有1 830名（77%）妇女做了阴道检查，1 748名未接种疫苗的妇女中有559名没有接种破伤风类毒素。剖腹产率大幅上升，从1982年的28%（5 914例中的1 632例）上升到2004年的43%（2 403例中的1 039例），2004年达到456例中的374例（82%）。早产率的增加似乎主要是剖腹产或引产的结果。新生儿护理得到改善，自1982年以来，特定妊娠年龄的死亡率下降了约50%。因此，新生儿死亡率自1990年以来一直保持稳定，尽管早产率有所增加。解释过度的药物治疗，包括引产，剖腹产，不准确的超声波扫描，由一个不受监管的私营部门与公共部门的溢出效应，可能会抵消改善孕产妇健康和新生儿生存带来的收益。努力实现儿童生存千年发展目标的中等收入国家必须面对这些挑战。
Background Middle-income countries will need to drastically reduce neonatal deaths to achieve the Millennium Development Goal for child survival. The evolution of antenatal and perinatal care indicators in the Brazilian city of Pelotas from 1982 to 2004 provides a useful case study of potential challenges.Methods We prospectively studied three birth cohorts representing all urban births in 1982, 1993, and from January to July, 2004. The same methods were used in all three studies.Findings Despite improvements in maternal characteristics, prevalence of preterm births increased from 6.3% (294 of 4665) in 1982 to 16.2% (342 of 2112) in 2004, corresponding to a 47 g reduction in mean birthweight. Average number of antenatal visits in 2004 was 8.3 per woman, but quality of care was still inadequate - 97% of women had an ultrasound scan, but only 1830 (77%) had a vaginal examination and 559 of 1748 non-immunised women did not receive tetanus toxoid. Rate of Caesarean sections increased greatly, from 28% (1632 of 5914) in 1982 to 43% (1039 of 2403) in 2004, reaching 374 of 456 (82%) of all private deliveries in 2004. The increased rate of preterm births seemed to result largely from Caesarean sections or inductions. Newborn care improved, and gestational-age-specific mortality rates had fallen by about 50% since 1982. As a result, neonatal mortality rates had been stable since 1990, despite the increase in preterm deliveries.Interpretation Excessive medicalisation-including labour induction, Caesarean sections, and inaccurate ultrasound scans-led by an unregulated private sector with spill-over effects to the public sector, might offset the gains resulting from improved maternal health and newborn survival. These challenges will have to be faced by middle-income countries striving to achieve the child survival Millennium Development Goal.