Decrease in infant mortality in New York City after 1989.

To estimate the trend of maternal racial and ethnic differences in mortality for early-term (37 0/7 to 38 6/7 weeks of gestation) compared with full-term births (39 0/7 to 41 6/7 weeks of gestation). We analyzed 46,329,018 singleton live births using the National Center for Health Statistics U.S. period-linked birth and infant death data from 1995 to 2006. Infant mortality rates, neonatal mortality rates, and postneonatal mortality rates were calculated according to gestational age, race and ethnicity, and cause of death. Overall, infant mortality rates have decreased for early-term and full-term births between 1995 and 2006. At 37 weeks of gestation, Hispanics had the greatest decline in infant mortality rates (35.4%; 4.8 per 1,000 to 3.1 per 1,000) followed by 22.4% for whites (4.9 per 1,000 to 3.8 per 1,000); blacks had the smallest decline (6.8%; 5.9 per 1,000 to 5.5 per 1,000) as a result of a stagnant neonatal mortality rate. At 37 weeks compared with 40 weeks of gestation, neonatal mortality rates increase. For Hispanics, the relative risk is 2.6 (95% confidence interval [CI] 2.0-3.3); for whites, the relative risk is 2.6 (95% CI 2.2-3.1); and for blacks, the relative risk is 2.9 (95% CI 2.2-3.8). Neonatal mortality rates are still increased at 38 weeks of gestation. At both early- and full-term gestations, neonatal mortality rates for blacks are 40% higher than for whites and postneonatal mortality rates 80% higher, whereas Hispanics have a reduced postneonatal mortality rate when compared with whites. Early-term births are associated with higher neonatal, postneonatal, and infant mortality rates compared with full-term births with concerning racial and ethnic disparity in rates and trends.

The period between the Franco-Prussian War (1871) and the beginning of World War I (1914), rich in scientific discoveries and filled with artistic creation, opened a new era in medicine. A high infant mortality rate, which was fueled by lack of basic hygiene, curtailed population growth in various European countries. Governments were worried, especially in France, (1)(2)(3) where industrialization and colonization were in progress. The “European Empires” needed men for industry, the military, and the colonies. Influential political men such as Dr Bourneville, a senator of the French Republic, (4) turned to obstetricians to solve the acute problem of infant mortality and address the depopulation issue. This powerful physician facilitated the creation of modern maternity units managed by certified obstetricians instead of surgeons. Maternal mortality had decreased markedly, starting in 1890, thanks to the introduction of antisepsis. A participant in this effort was the young doctor Pierre Budin, a senior resident of Stephane Tarnier, the leader of French obstetrics. (5) In 1874, he was sent to study with Joseph Lister in Edinburgh (6) to learn the preventive treatment of surgical infections. Puerperal fever had decimated maternity units to such an extent that some were closed intermittently. This serious issue absorbed so much of Dr Tarnier's energy that he was forced to take a leave of absence to prevent his health from deteriorating. A friend of Budin, Lucas Championniere, (7) a young surgeon, had preceded him on this path by working for a few months with Lister at the Royal Infirmary in Edinburgh. In Paris, he already was applying the antiseptic method of Lister with extremely good results. (7) Shortly after Championniere, Budin made the trip to Scotland and learned all the details of the antiseptic method. He also benefited from the teaching of Duncan, the chief …

This paper examines the determinants of infant and child mortality variations in Jordan Yemen Egypt and Tunisia using data from WFS surveys. The analysis considers biological correlates of mortality--mothers age birth order birth interval and previous infant loss--and several social factors--mothers and fathers education mothers residence fathers occupation and mothers work experience since marriage. The estimates for the 4 countries show large variations in the mortality rates and an expected pattern of declining infant and child mortality during the period of 20 years prior to the survey. Further the proportionate decline in child mortality in each country was generally greater than the proportionate decline in infant mortality. A persistent pattern of higher child mortality for females than for males is found suggesting preferential care and treatment of male offspring. The higher mortality risk is found for infants born to very young and very old mothers with short previous birth intervals of higher birth orders and where the previous infant had died. Among the socioeconomic characteristics the education of the mother and rural-urban residence are found to affect infant survival. In childhood among the demographic factors only birth interval shows a significant effect on mortality. The risk of child mortality decreases considerably with the increase in the birth interval. The analysis of the effect of breastfeeding on mortality although based on limited information clearly shows the beneficial effect of breastfeeding on the infants survival especially during the early months of life. For all countries the mortality rate for the non-breastfeeders is substantially higher than for the breastfeeders even when the effect of the other covariates is controlled.

Child mortality and more particularly infant mortality is often used as an indicator of the socioeconomic development of a country since children (infants), more than any other age-group of a population, depend heavily on the socioeconomic conditions of their environment for survival. Thus, the level of child mortality would present a measure of how well a society meets the needs of its people (Bicego and Ahmad, 1996). Looking into the history of the decline in mortality in India, it can be noted that in the country as a whole the level of infant mortality which was very high before 1951, fell substantially during the later half of the last century, although its level is still very high. As per the recent SRS estimates, the infant mortality rate (IMR) is 58 per 1000 live `births in 2005. It has also been a cause of concern that the pace of decline in infant mortality in the country has slowed during the last decade, particularly during its later half. Yet, there is surprisingly little evidence to suggest that planners and policy makers feel seriously concerned about this problem. In India, the programmes to reduce infant mortality had been guided by health professionals who were convinced that available low-cost technology was adequate to achieve the set goals.

Substantial declines in infant and under-5 mortality have taken place in recent years in many countries in Sub-Saharan Africa. Kenya's infant mortality rate has fallen by 7.6 percent per year, the fastest rate of decline among the 20 countries in the region for which recent Demographic and Health Survey data is available. Kenya's rate of postneonatal deaths per 1,000 live births fell by more than half over a five-year period, dropping from 47 to 22, as measured using data from the 2003 and 2008-09 Demographic and Health Surveys. Among the possible causes of the decline are various targeted new public health initiatives and improved access to water and sanitation. A Oaxaca-Blinder decomposition using Demographic and Health Survey data shows that the increased ownership of insecticide-treated bednets in endemic malaria zones explains 39 percent of the decline in postneonatal mortality and 58 percent of the decline in infant mortality. Changes in other observable candidate factors do not explain substantial portions of the decline. The portion of the decline not explained may be associated with generalized trends such as the overall improvement in living standards that has taken place with economic growth. The widespread ownership of insecticide-treated bednets in areas of Kenya where malaria is rare suggests that better targeting of insecticide-treated bednet provision programs could improve the cost-effectiveness of such programs.

Between the 1950s and 2000, Venezuela showed one of the most substantial improvements in infant mortality rates in Latin America. However, the recent economic crisis alongside an increase in infectious and parasitic diseases might be reversing previous patterns. Because no official updated mortality statistics have been published since 2013, the effect of these recent events has been difficult to assess accurately. We therefore aimed to estimate infant mortality rate trends and report the effect of the crisis. We estimated infant mortality rates using direct methods (ie, death counts from Venezuelan Ministry of Health via yearbooks and notifiable diseases bulletins, and birth records published by the UN Economic Commission for Latin America and the Caribbean and the Venezuelan National Institute of Statistics) and indirect methods (using census data and a Living Conditions Survey ENCOVI 2016). We shaped yearly estimations using a semiparametric regression model, specifically a P-Spline model with a cubic thin plate base. The primary objective was to estimate infant mortality rate trends from 1985 to 2016. Around 2009, the long-term decline in infant mortality rate stopped, and a new pattern of increase was observed. The infant mortality rate reached 21·1 deaths per 1000 livebirths (90% CI -17·8 to 24·3) in 2016, almost 1·4 times the rate of 2008 (15·0, -14·0 to 16·1). This increase represents a huge setback on previous achievements in reducing infant mortality. Our conservative estimation indicates that Venezuela is in the throes of a humanitarian crisis. The increase in infant mortality rate in 2016 compared with 2008 takes the country back to the level observed at the end of the 1990s, wiping out 18 years of expected progress, and leaves the Venezuelan Government far from achieving the target of nine deaths per 1000 livebirths stated in the UN Millennium Development Goals. None.

The decline of infant and maternal mortality represents one of the greatest public health achievements of the 20th century. From 1900 through 2000, infant mortality in the United States declined dramatically from estimated 10,000–15,000 deaths to 690 deaths per 100,000 births; similarly, maternal mortality declined from an estimated 600–900 deaths to under ten deaths per 100,000 births. Reductions in both morbidity and mortality have improved the lives of parents and children and have altered expectations for women. Public health actions to improve sanitation, maternal hygiene, nutrition, and prenatal care played a central role in the transformation of reproductive health in the 20th century. This chapter describes decade by decade the evolving concepts and debates about the causes of infant and maternal mortality, the initiatives to ameliorate them, the institutionalization of the major public health advances, and the resulting epidemiologic transformations in the United States.

Infant and Child Mortality in Industrialized Countries

Limited data exist on population-level mortality outcomes related to extreme neonatal hyperbilirubinemia (EHB) and this study examines trends in annual infant mortality rate (IMR) attributed to hemolytic and perinatal jaundice among Germany, France, Italy, Portugal, Greece and Spain from 1990 to 2019. Data on annual incident cases and disability-adjusted life years were collected from the 2019 Global Burden of Disease study. Live birth cohort data were sourced from UN World Population Prospects. We quantified temporal trends, with relative percent changes. Average annual percent changes (AAPCs) were evaluated using the Joinpoint Regression Program. EHB-related infant mortality decreased from 21.4 (95%CI: 16.1, 27.1) in 1990 to 4.2 (95%CI: 1.9, 7.6) per million live births in 2019. Germany demonstrated lowest AAPC of -3.2% (95% CI: -3.8, -2.5), while Portugal had the highest AAPC of -8.6% (95% CI -11.9, -5.1) in reducing infant mortality due to EHB. There were distinct divergences in the trajectories of declining EHB mortality among the studied countries. This study highlights a significant decline in infant mortality due to extreme hyperbilirubinemia, emphasizing the need for national surveillance and tailored guidelines to prevent bilirubin induced neurological damage. This cross-sectional analysis revealed a marked decline in infant mortality rates attributed to extreme hyperbilirubinemia across the selected European countries. The rates of decline varied significantly between countries, demonstrating notable heterogeneity in mortality trends when stratified by age at death. Implementing data-driven surveillance systems can optimize the alignment of equitable healthcare services, strengthen accountability measures, and identify critical operational inefficiencies. In the European Union, country-specific hyperbilirubinemia guidelines should be reinforced to ensure effective screening and post-discharge follow-up protocols that are tailored to risk burden and available healthcare resources.

Over the past decades in Ukraine, the unfavorable indicators of population reproduction, the state of health of women and children, acquired in the previous period, have become persistent, one of the integrative indicators of which is the mortality of children under one year of age. The infant mortality rate is a sensitive indicator of the general sanitary and socio$economic well-being of the country, a strategic indicator of the health and survival of children, the level and quality of medical and social care, and the effectiveness of obstetric and pediatric services. Purpose — to study, analyze and determine the general and regional features of the state and dynamics of infant mortality and its components in Ukraine. Materials and methods. A retrospective analysis and assessment of the dynamics of infant mortality in Ukraine for the period 1990–2019 was carried out in the context of regions and separate states according to state and industry statistics, perinatal audit for the methodology of the WHO «MATRIX-BABIES». Methods of a systematic approach, statistical, graphic representation are applied. Results. The study found that the unfavorable demographic situation in Ukraine is accompanied by a still high, with a positive trend, the mortality rate of children in the first year of life — 12.8‰ in 1990, and 7.0‰ in 2019 (loss rate — 30.9%), a direct dependence of infant mortality rates on indicators of total fertility (r=0.340) and morbidity in children in the first year of life (r=0.888) was found with an excess of mortality under 1 year in boys compared with girls (OR with 95% CI 1.1 (1.0–1.2). Infant mortality rates are relatively low, below the average for Ukraine, in Vinnitsa, Volyn, Kyiv, Lviv, Poltava, Ternopil, Khmelnitsky regions and City Kyiv, and above average — in Dnepropetrovsk, Donetsk, Transcarpathian, Kharkiv regions. The decrease in the overall infant mortality rate was due to the positive dynamics of all its components — early neonatal (5.8‰ in 1990, 3.04‰ in 2019), neonatal (7.3‰, 4.57‰) and postneonatal mortality (5.7‰, 2.52‰, respectively) with a more intensive decrease in postneonatal mortality (rate of decline — 55.8%). However, there are doubts that the registered data on neonatal mortality, as well as on infant mortality in general, are real, since according to the perinatal audit data, the «MATRIX-BABIES» method revealed an underestimation of early neonatal mortality — an underestimation of its real level in general by 2.1–2.3 times. It is shown that the infant mortality rate has decreased from all the main causes of mortality with a more accelerated rate of decrease in infant losses from exogenous, manageable causes — respiratory diseases (rate of decline — 83.7%), infectious and parasitic diseases (rate of decline — 80.7%). At the same time, the key causes of mortality in children under 1 year of age throughout the entire observation period remain separate conditions that arise in the perinatal period (52.8–38.4 per 10,000 live births) and congenital malformations, deformities, and chromosomal abnormalities (38,6–17.2 per 10,000 live births). It was found that against the background of a decrease in infant losses in the structure of infant mortality by 43.2%, the part of mortality from certain conditions of the perinatal period increased with a significant decrease in the part of losses from exogenous causes of death — respiratory diseases by 66.7%, some infectious and parasitic diseases by 57.8%. Conclusions. In general, despite the positive dynamics of all components of infant mortality, its level characterizes a pronounced lag behind developed countries, and according to the rating of the countries of the world as of 2018, Ukraine ranks 61st among 193 countries of the world and administrative territories without state status. The research was carried out in accordance with the principles of the Helsinki Declaration. The study protocol was approved by the Local Ethics Committee of these Institutes. The informed consent of the patient was obtained for conducting the studies. No conflict of interest was declared by the authors. Key words: infant mortality, morbidity, newborns, children in the first year of life.

Effect of comprehensive smoke-free legislation on neonatal mortality and infant mortality across 106 middle-income countries: a synthetic control study

Background Following the adoption of the Millennium Development Goal 4 (MDG 4) in Ghana to reduce under-five mortality by two-thirds between 1990 and 2015, efforts were made towards its attainment. However, impacts and challenges of implemented intervention programs have not been examined to inform implementation of Sustainable Development Goal 3.2 (SDG 3.2) that seeks to end preventable deaths of newborns and children aged under-five. Thus, this study aimed to compare trends in neonatal, infant, and under-five mortality over two decades and to highlight the impacts and challenges of health policies and intervention programs implemented. Design Ghana Demographic and Health Survey data (1988–2008) were analyzed using trend analysis. Poisson regression analysis was applied to quantify the incidence rate ratio of the trends. Implemented health policies and intervention programs to reduce childhood mortality in Ghana were reviewed to identify their impact and challenges. Results Since 1988, the annual average rate of decline in neonatal, infant, and under-five mortality in Ghana was 0.6, 1.0, and 1.2%, respectively. From 1988 to 1989, neonatal, infant, and under-five mortality declined from 48 to 33 per 1,000, 72 to 58 per 1,000, and 108 to 83 per 1,000, respectively, whereas from 1989 to 2008, neonatal mortality increased by 2 per 1,000 while infant and under-five mortality further declined by 6 per 1,000 and 17 per 1,000, respectively. However, the observed declines were not statistically significant except for under-five mortality; thus, the proportion of infant and under-five mortality attributed to neonatal death has increased. Most intervention programs implemented to address childhood mortality seem not to have been implemented comprehensively. Conclusion Progress towards attaining MDG 4 in Ghana was below the targeted rate, particularly for neonatal mortality as most health policies and programs targeted infant and under-five mortality. Implementing neonatal-specific interventions and improving existing programs will be essential to attain SDG 3.2 in Ghana and beyond.

This study examines the rapid growth of Africa’s population in the post-World War II era. The study finds that Africa’s population increased by over 1 billion, from 228.7 million in 1950 to 1.341 billion in 2020: 431 million in Eastern Africa; 404 million in Western Africa; 247.5 million in Northern Africa; 193.5 million in Middle Africa; and 64.5 million in Southern Africa. There are four countries in Africa with populations of 100 million or more: 214 million in Nigeria; 108 million in Ethiopia; 104 million in Egypt; and 101.8 million in the Democratic Republic of Congo. Of the 1.341 billion people in Africa in 2020, 755.92 (56.4%) million are aged 24 and younger; and 533.5 (39.8%) million are under the age of 15. Some factors cited for this phenomenon are: high birth rates; high fertility rates; childbirth at a young age; low rates of contraceptive use; decline in infant mortality rates; decline in overall deaths rates; decline in maternal mortality rates; increase in life expectancy; and decline in HIV/AIDS related deaths. Some implications cited as a result of this phenomenon include increase in GDP and GDP per Capita in Africa; increase in the numbers of billionaires and millionaires in Africa; increase in political influence of African nations in the international community; and increase in the number of educated Africans, including those enrolled in college and college graduates. Finally, the study recommends that African nations should make the African Union a fully-fledged federal entity to be responsible for providing healthcare for the entire continent. The African Union should also represent all member states in the international community, including negotiating trade contracts or agreements.

This article examines the impact of development and population policies on fertility decline and regional variations in India during the 1970s. Indicators of development at the household level include female literacy and education, infant mortality, and poverty; at the village level they include availability of such social services as schools, medical facilities, and transportation and communication facilities. Multiple regression analysis of data aggregated at the state level demonstrates that conditions conducive to fertility decline include high adult female literacy and low infant mortality as indicators of social development, and high contraceptive use and, to a lesser extent, high female age at marriage as proximate determinants of fertility. There are reasons to believe that India's national family planning program contributed to the decline in fertility observed since the 1960s. The pace of fertility decline in the future will depend upon the pace of infant mortality decline, enhancement in female education, and improvements in family planning programs.

Infant and child survival in Shaanxi, China.