Gravidezes subseqüentes: quem as tem e quem as quer? Observações em um centro urbano da região Sul do Brasil

Em um estudo de coorte de base populacional, foram estudados todos os 6.011 nascimentos hospitalares ocorridos na cidade de Pelotas, RS, em 1982. As parturientes foram entrevistadas logo após o parto, e 80% delas foram novamente contactadas em suas residências no início de 1986, em média 43 meses mais tarde. Dessas mulheres, 39% haviam engravidado novamente. Esta proporção variou inversamente em relação à idade materna, anos de escolaridade e renda familiar. Quanto à paridade, a proporção de gravidezes subsqüentes foi maior para primíparas e para multíparas. Mães cujos filhos nasceram através de cesareana também apresentaram menor fecundidade, mesmo após exclusão daquelas que, por ocasião da operação cesárea, sofreram ligadura de trompas. Análise através de regressão logística mostrou que esses fatores permaneceram significativamente associados à fecundidade mesmo após o ajuste estatístico para as demais variáveis. Das mães que engravidaram após 1982, 60% informaram que não a desejaram. A proporção das gravidezes indesejadas foi mais elevada em mulheres de maior paridade, sendo esta tendência mais marcada em mulheres de famílias de alta renda.Subsequent pregnancies in mothers of a birth cohort from Pelotas, Southern Brazil, were studied in relation to maternal and socio-economic factors. Within about 3 1/2 years of the cohort child's birth, 39% of mothers had experienced at least one further pregnancy. This proportion decreased with increasing maternal age, years of schooling and family income. A U-shaped trend was observed with respect to parity. Mothers who had delivered the cohort child by caesarean section were also less likely to have another pregnancy within that time. Logistic regression analysis showed that each of these factors remained significantly associated with further pregnancies after controlling for the remaining variables. Analysis of the first subsequent pregnancy showed that a high proportion of mothers had not wanted the pregnancy. Unwanted pregnancies were also significantly associated with older women, low educational status, higher parity and low family income

Issues in the construction of wealth indices for the measurement of socio-economic position in low-income countries

BACKGROUND: Epidemiological studies often require measures of socio-economic position (SEP). The application of principal components analysis (PCA) to data on asset-ownership is one popular approach to household SEP measurement. Proponents suggest that the approach provides a rational method for weighting asset data in a single indicator, captures the most important aspect of SEP for health studies, and is based on data that are readily available and/or simple to collect. However, the use of PCA on asset data may not be the best approach to SEP measurement. There remains concern that this approach can obscure the meaning of the final index and is statistically inappropriate for use with discrete data. In addition, the choice of assets to include and the level of agreement between wealth indices and more conventional measures of SEP such as consumption expenditure remain unclear. We discuss these issues, illustrating our examples with data from the Malawi Integrated Household Survey 2004-5. METHODS: Wealth indices were constructed using the assets on which data are collected within Demographic and Health Surveys. Indices were constructed using five weighting methods: PCA, PCA using dichotomised versions of categorical variables, equal weights, weights equal to the inverse of the proportion of households owning the item, and Multiple Correspondence Analysis. Agreement between indices was assessed. Indices were compared with per capita consumption expenditure, and the difference in agreement assessed when different methods were used to adjust consumption expenditure for household size and composition. RESULTS: All indices demonstrated similarly modest agreement with consumption expenditure. The indices constructed using dichotomised data showed strong agreement with each other, as did the indices constructed using categorical data. Agreement was lower between indices using data coded in different ways. The level of agreement between wealth indices and consumption expenditure did not differ when different consumption equivalence scales were applied. CONCLUSION: This study questions the appropriateness of wealth indices as proxies for consumption expenditure. The choice of data included had a greater influence on the wealth index than the method used to weight the data. Despite the limitations of PCA, alternative methods also all had disadvantages

Young Lives

This paper presents a case study to illustrate the range of decisions involved in designing a sampling strategy for a complex, long-term research study. It is based on experience from the Young Lives project and identifies the approaches used to sample children for long-term follow-up in four countries. The rationale for decisions made and the resulting benefits, and limitations, of the approaches adopted are discussed. It is particularly important to choose samples which will yield data to enable useful analysis. Examples are presented of how this informed the design of the Young Lives sampling strategy

Feces, flies, and fetor: findings from a Peruvian shantytown

Sanitary disposal of feces is vital to combat childhood diarrhea, and its promotion is key to improving health in developing countries. Knowledge of prevailing feces disposal practices is a prerequisite to formulation of effective intervention strategies. Two studies were conducted in a shantytown area of Lima, Peru. First, information was gathered through in-depth interviews with mothers and structured observations (4 hours) of young children and their caretakers. Data on beliefs and practices related to feces disposal behaviors were obtained. Excreta were deposited by animals or humans in or near the house in 82% of households observed. Beliefs about feces depended on their source and were reflected in how likely the feces were to be cleared. While 22% of children aged > or = 18 months were observed to use a potty for defecation, 48% defecated on the ground where the stools often remained. Although almost all children were cleaned after defecation, 30% retained some fecal matter on their body or clothes. Handwashing after the child's defecation was extremely rare for both children (5%) and caretakers (20%). The hygienic disposal of feces poses problems in this type of community. Nevertheless existing practices were found that show promise for promotion on a wider scale, including greater use of potties

Maternal education in relation to early and late child health outcomes: Findings from a Brazilian cohort study

In a population-based cohort of approximately 6000 Brazilian children, the associations between maternal education and a number of child health outcomes were studied while controlling for potentially confounding variables such as family income and education of the husband. In the crude analyses, maternal education was associated with perinatal and infant mortality, hospital admissions in the first 20 months of life and the three nutritional indicators (length-for-age, weight-for-age and weight-for-length) at mean age 20 months. After adjustment for confounding, the apparent associations with outcomes in early infancy--birthweight and perinatal mortality--were no longer present, while that with infant mortality persisted despite being reduced. Strong associations remained with later outcomes including hospital admissions, length-for-age and weight-for-age at mean age 20 months. Among infants born to women with little or no schooling, deaths due to diarrhoea, pneumonia and other infectious diseases were particularly common. These findings support the hypothesis that maternal education has an effect on child health which is partly independent from that of other socioeconomic factors; they also suggest that maternal care is more important than the biological characteristics of the mothers since stronger effects were observed for the late (postneonatal mortality, hospital admissions and nutritional status) than for the early (birthweight, perinatal mortality) outcomes.infant mortality mother's education birth weight malnutrition morbidity diarrhoea acute respiratory infections

Training peer counselors to promote and support exclusive breastfeeding in Bangladesh.

Exclusive breastfeeding is rare in Bangladesh. About 90% of women have home deliveries, so the Baby-Friendly Hospital Initiative has no mechanism to reach them. Mother support groups do not exist, and community health workers do not have time to promote and support exclusive breastfeeding. To provide this kind of support at the community level, an area in Dhaka was selected for a peer-counseling intervention program. Using certain selection criteria, 1 woman from each community was trained as a peer counselor. The training was based on the World Health Organization/United Nations International Children's Emergency Fund 40-hour breastfeeding counseling course and related books. Counseling skills were taught using demonstrations and role play, followed by practical training in the project area. The intervention was very successful, as 70% of the mothers in the project area breastfed their infants exclusively for 5 months compared to only 6% in the control area. The authors describe the peer counseling training, strategies used for peer counseling visits, and lessons learned

Subsequent pregnancies: who has them and who wants them? Observations from an urban center in Southern Brazil Gravidezes subseqüentes: quem as tem e quem as quer? Observações em um centro urbano da região Sul do Brasil

Subsequent pregnancies in mothers of a birth cohort from Pelotas, Southern Brazil, were studied in relation to maternal and socio-economic factors. Within about 3 1/2 years of the cohort child's birth, 39% of mothers had experienced at least one further pregnancy. This proportion decreased with increasing maternal age, years of schooling and family income. A U-shaped trend was observed with respect to parity. Mothers who had delivered the cohort child by caesarean section were also less likely to have another pregnancy within that time. Logistic regression analysis showed that each of these factors remained significantly associated with further pregnancies after controlling for the remaining variables. Analysis of the first subsequent pregnancy showed that a high proportion of mothers had not wanted the pregnancy. Unwanted pregnancies were also significantly associated with older women, low educational status, higher parity and low family income.<br>Em um estudo de coorte de base populacional, foram estudados todos os 6.011 nascimentos hospitalares ocorridos na cidade de Pelotas, RS, em 1982. As parturientes foram entrevistadas logo após o parto, e 80% delas foram novamente contactadas em suas residências no início de 1986, em média 43 meses mais tarde. Dessas mulheres, 39% haviam engravidado novamente. Esta proporção variou inversamente em relação à idade materna, anos de escolaridade e renda familiar. Quanto à paridade, a proporção de gravidezes subsqüentes foi maior para primíparas e para multíparas. Mães cujos filhos nasceram através de cesareana também apresentaram menor fecundidade, mesmo após exclusão daquelas que, por ocasião da operação cesárea, sofreram ligadura de trompas. Análise através de regressão logística mostrou que esses fatores permaneceram significativamente associados à fecundidade mesmo após o ajuste estatístico para as demais variáveis. Das mães que engravidaram após 1982, 60% informaram que não a desejaram. A proporção das gravidezes indesejadas foi mais elevada em mulheres de maior paridade, sendo esta tendência mais marcada em mulheres de famílias de alta renda

Subjective measures of socio-economic position and the wealth index: a comparative analysis.

INTRODUCTION: The wealth index is a commonly-used measure of socio-economic position (SEP) in low- and middle-income settings, but there is concern that it is strongly influenced by community-level as well as household-level factors. Subjective SEP indicators are infrequently used in health research. METHODS: We use data from 11 280 households included in the Malawi Integrated Household Survey 2004/5. We compare the wealth index with four subjective measures of SEP: perceived food consumption adequacy, perceived overall consumption adequacy, an economic ladder question, and perceived income sufficiency. The wealth index is compared with each subjective SEP measure in terms of: (i) agreement of classification of households, (ii) targeting accuracy with respect to US$1-a-day poverty based on consumption expenditure, and (iii) the socio-economic processes (household- and community-level) giving rise to the SEP scores. RESULTS: Each subjective SEP indicator resulted in considerable differential classification of households compared with the wealth index. Three measures of subjective SEP (perceived food consumption adequacy, economic ladder question, and perceived income sufficiency) identified a higher proportion of dollar-a-day poor households as poor than the wealth index. The wealth index was strongly influenced by community infrastructure, but all subjective SEP indicators were free from strong community-level influence. CONCLUSION: The strengths and limitations of any measure of SEP depend on the context and purpose for which it is being used. In these data, the wealth index was strongly influenced by community infrastructure, whereas the subjective SEP measures were not, perhaps allowing analyses using them to disentangle household and community influences. Several subjective measures also corresponded to dollar-a-day poverty more strongly than the wealth index. Subjective measures may therefore be preferable to the wealth index in some circumstances, although they have their own set of potential biases

Caffeine intake and pregnancy outcomes: a meta-analytic review Consumo de cafeína na gravidez e desfechos perinatais

Epidemiological publications on the relationship of caffeine to birth weight and duration of human pregnancy, from 1966 to 1995, were searched through Medline. Each study was treated as the stratification variable, and its weight in the weighted average was proportional to the inverse of its variance. Twenty-six studies were located. Among the twenty-two studies on birth weight, eleven were on mean birth weight, nine on low birth weight (LBW), and four on intrauterine growth retardation (IUGR). Combined analysis of mean birth weigh study results showed a significant decrease in birth weight of nearly 43g among newborns of the heaviest caffeine-consuming mothers. LBW, IUGR, and preterm delivery displayed significant homogeneity in the test results, indicating that a pooled estimate should not be taken as an adequate measure. The high heterogeneity of the available literature on the effects of caffeine on LBW, IUGR, and preterm delivery prevents estimation of reliable pooled estimates through meta-analysis. Further assessment of caffeine intake during pregnancy is needed in future research.<br>Foram rastreadas as publicações epidemiológicas de 1966 a 1995 sobre a associação entre cafeína e peso ao nascer e duração da gestação humana através de pesquisa em Medline. Cada estudo foi tratado como uma categoria de uma variável e seu peso foi proporcional ao inverso de sua variância. Foram localizados vinte e seis estudos. Entre os vinte e dois estudos sobre peso ao nascer, onze foram sobre peso médio ao nascer, nove sobre baixo peso ao nascer (BPN) e quatro sobre retardo do crescimento intra-uterino (RCIU). O efeito agregado sobre o peso médio ao nascer mostrou uma redução estatisticamente significativa de 43 gramas entre os recém-nascidos de mães que consumiam maiores quantidades de cafeína. A análise agregada do efeito sobre BPN, RCIU e nascimentos pré-termos apresentou teste de homegeneidade estatisticamente significativo, indicando que uma estimativa combinada não seria confiável. A grande heterogeneidade da literatura disponível quanto ao efeito da cafeína sobre o BPN, RCIU e partos pré-termo não permite o cálculo confiável de estimativas agrupadas através de meta-análise. Torna-se necessária uma avaliação mais cuidadosa do consumo de cafeína durante a gestação em estudos futuros