Epidemiological transitions in maternal and child health in Peru: 1990–2013

Background: Millennium Development Goal (MDG) 4 set the target of reducing the under-5 mortality rate by two-thirds between 1990 and 2015. MDG 5 set the target of reducing the maternal mortality ratio (MMR) by three-quarters over the same time period, and also achieve universal access to reproductive health. The objective of this study is to analyse the epidemiological transitions in maternal and child health in Peru from 1990 to 2013. Methods: We analysed the risk of child mortality by age, and MMR by cause, stage of pregnancy, and age from 1990–2013 in Peru using data from the Global Burden of Disease Study, 2013. Findings: From 1990 to 2013, child deaths per 1000 livebirths in Peru dropped from 16 to 8·0 during the early neonatal period, 8·3 to 2·7 in the late neonatal period, 29 to 6·5 in the post-neonatal period, and 21 to 4·9 in those aged 1–4 years. MMR for Peru was 130 per 100 000 livebirths in 1990, 76 per 100 000 in 2003, and 64 per 100 000 in 2013. MMR, by cause, from 1990 to 2013 fell from 20 to 9·7 for sepsis, 7·3 to 2·9 for obstructed labour, 20 to 15 for late maternal deaths (up to a year after delivery), 12 to 8·5 for hypertension, 33·2 to 9·4 for haemorrhage, 13 to 6·9 for abortive outcomes, 15 to 7·3 for direct deaths, and 9·5 to 4·3 for indirect deaths (during pregnancy and within 6 weeks of delivery). MMR, by time period of pregnancy, from 1990 to 2013 fell from 17 to 8·5 during the antepartum period, 32 to 16 during the intrapartum period, 62 to 24 during the postpartum period, and 20 to 15 during the late period. MMR, by age, in Peru from 1990 to 2013 changed from 0·8 to 0·2 for ages 10–14 years, 12·0 to 5·7 for ages 15–19 years, 25·0 to 11·0 for ages 20–24 years, 25·0 to 8·0 for ages 25–29 years, 26·0 to 12·0 for ages 30–34 years, 24·0 to 13·0 for ages 35–39 years, 14·0 to 8·6 for ages 40–44 years, and 4·7 to 6·1 for age ≥45 years. Interpretation: Peru has significantly improved child health, with a 70% decline in child mortality with an annualised rate of decline of 5.3% from 1990 to 2013. The ratios of maternal deaths due to haemorrhage and obstructed labour were reduced significantly by 72% and 60%, respectively, from 1990 to 2013. Deaths in pregnant women younger than 35 years dropped by more than 50%, but increased by 30% for women 45 years and older from 1990 to 2013. Postpartum deaths fell by 61% in the study period. The Peruvian government has prioritised access for pregnant women to health facilities and prenatal and postnatal care, including culturally adapted health services. UNICEF and the Ministry of Health in Peru partnered to establish the Mamawasi (mother's home in Quechua local language) project, to encourage women in rural areas who lack transportation to give birth in health centres. Furthermore, economic growth, diminishment of extreme poverty, focus on health initiatives, and political and social support have contributed to improvement of child health and achievement of the MDG 4 target. Although improvements in maternal health have been made, the MDG 5 target is unlikely to be met. Funding: None

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Cell culture The HUVEC cell line was cultured in DMEM:F12 supplemented with 7% heat-inactivated FBS along with 100 IU/mL penicillin G and 100 g/mL streptomycin. The culture was incubated at 37°C with humidi ed air that contained 5% CO 2 . Abstract Background: Agiogenesis is the development of new blood vessels from pre-existing vasculatures. Although essential in the physiological process, it becomes pathological in various diseases including cancer. Preventing the formation of new blood vessels causes reductions in tumor size and metastasis. This study has been undertaken to elucidate the anti-angiogenesis effects of ICD-85 (derived peptides from venom). Methods: We evaluated the ICD-85 anti-angiogenesis activity by the in vivo CAM assay and in vitro tube formation assay of human umbilical vein endothelial cells (HUVECs). The anti-proliferative activity of ICD-85 was also determined through MTT assay on HUVECs. Results: Results of this study revealed the anti-proliferative activity of ICD-85 on the HUVEC cell line with an IC50 of 12 g/mL. The in vivo CAM assay also clearly showed the prevention of new vascular formation when the chick embryos were exposed to 0.15 g/disc of ICD-85. In vitro tube formation assay of HUVECs also showed the complete prevention of capillary tube formation on 18 g/mL. Conclusion: Based on the results obtained in this study, ICD-85 has anti-angiogenesis activity as shown by the prevention of capillary tube formation and the CAM assay

Maternal and neonatal outcomes after caesarean delivery in the African Surgical Outcomes Study: a 7-day prospective observational cohort study.

BACKGROUND: Maternal and neonatal mortality is high in Africa, but few large, prospective studies have been done to investigate the risk factors associated with these poor maternal and neonatal outcomes. METHODS: A 7-day, international, prospective, observational cohort study was done in patients having caesarean delivery in 183 hospitals across 22 countries in Africa. The inclusion criteria were all consecutive patients (aged ≥18 years) admitted to participating centres having elective and non-elective caesarean delivery during the 7-day study cohort period. To ensure a representative sample, each hospital had to provide data for 90% of the eligible patients during the recruitment week. The primary outcome was in-hospital maternal mortality and complications, which were assessed by local investigators. The study was registered on the South African National Health Research Database, number KZ_2015RP7_22, and on ClinicalTrials.gov, number NCT03044899. FINDINGS: Between February, 2016, and May, 2016, 3792 patients were recruited from hospitals across Africa. 3685 were included in the postoperative complications analysis (107 missing data) and 3684 were included in the maternal mortality analysis (108 missing data). These hospitals had a combined number of specialist surgeons, obstetricians, and anaesthetists totalling 0·7 per 100 000 population (IQR 0·2-2·0). Maternal mortality was 20 (0·5%) of 3684 patients (95% CI 0·3-0·8). Complications occurred in 633 (17·4%) of 3636 mothers (16·2-18·6), which were predominantly severe intraoperative and postoperative bleeding (136 [3·8%] of 3612 mothers). Maternal mortality was independently associated with a preoperative presentation of placenta praevia, placental abruption, ruptured uterus, antepartum haemorrhage (odds ratio 4·47 [95% CI 1·46-13·65]), and perioperative severe obstetric haemorrhage (5·87 [1·99-17·34]) or anaesthesia complications (11·47 (1·20-109·20]). Neonatal mortality was 153 (4·4%) of 3506 infants (95% CI 3·7-5·0). INTERPRETATION: Maternal mortality after caesarean delivery in Africa is 50 times higher than that of high-income countries and is driven by peripartum haemorrhage and anaesthesia complications. Neonatal mortality is double the global average. Early identification and appropriate management of mothers at risk of peripartum haemorrhage might improve maternal and neonatal outcomes in Africa. FUNDING: Medical Research Council of South Africa.Medical Research Council of South Africa