Author Interviews, Pediatrics, Race/Ethnic Diversity / 19.08.2020 Interview with: Anura Ratnasiri PhD Senior Research Scientist (Epidemiology and Biostatistics) Benefits Division Department of Health Care Services Sacramento, CA 95899-7417 What is the background for this study? Response: Infant mortality rate (IMR) is a widely-reported indicator of population health and is used as a standardized measurement of deaths in the first year of life per thousand live births. While IMR has been steadily declining in the United States, it remains relatively high compared with other developed countries. Even though significant improvements have been made in the quality and access to neonatal and infant care during the past decade, large educational, socioeconomic, racial, ethnic, geographic and behavioral disparities persist, and appear to be responsible for significant differences in IMR among different subgroups. Certain maternal and infant characteristics have important associations with IMR, and this study attempted to quantify major maternal and infant predictors, and trace associated mortality trends during the study period. There were no recent studies on infant mortality using a large data set such as California State. Moreover, gestational age based on obstetric estimates from fetal ultrasound, prepregnancy obesity, and smoking during pregnancy were not available in prior population-based studies in California. (more…)
Author Interviews, Global Health, Pediatrics, PLoS, Social Issues / 21.08.2019 Interview with: Jayanta Kumar Bora Guest Researcher IIASA|Laxenburg, Austria & Ph.D. Scholar Indian Institute of Dalit Studies New Delhi, India What is the background for this study? Response: Although under-five mortality rate (U5MR) is declining in India, it is still high in a few selected states and among the scheduled caste (SC) and scheduled tribe (ST) population of the country. We examined the disparities in under-five mortality in high focus states of India. The high-focus states in India were designated as such by the Indian government because of their persistently high child mortality and relatively poor socio-economic and health indicators. This study re-examines the association between castes and under-five mortality in high focus Indian states using the most recent Indian Demographic Health Survey data conducted in 2015-16. The study also aims to quantify the relative contribution of socioeconomic determinants to under-five deaths by explaining the gap between socially disadvantaged (SC and ST) and non-disadvantaged castes in high focus states. Identifying disadvantaged groups in high focus states can help to reduce the absolute and relative burden of under-five deaths in India. (more…)
Author Interviews, Global Health, Health Care Systems, Lancet, Pediatrics / 29.01.2019 Interview with: "By @plumavioleta "Atardecer en #caracas... #avebolivar # ccs #venezuela." via @PhotoRepost_app" by Pedro Fanega is licensed under CC BY 2.0. To view a copy of this license, visit: Jenny García, PhD candidate Institut National d’Études Démographiques INED Institut de Démographie de l'université Paris 1 Panthéon Sorbonne IDUP Paris, France Prof Gerardo Correa, MSc Instituto de Investigaciones Económicas y Sociales IIES Universidad Católica Andrés Bello UCAB Caracas, Venezuela Prof Brenda Rousset, PhD Departamento de Estadística, Escuela de Sociología (FaCES) Universidad Central de Venezuela UCV Caracas, Venezuela What is the background for this study? What are the main findings?  Response: Venezuela, as many countries in Latin America, showed substantial improvements in infant mortality rates during the last 60 years. However, the decreasing pattern might be reversing. Recent socioeconomic and political events have led to a collapse in living standards, along with a breakdown of the health system. At the same time, a strict secrecy policy has ruled public institutions, and since 2013 the Venezuelan government stopped publishing mortality statistics. This study attempts to fill this gap and estimate infant mortality using hospital and census data after 2013. The main finding is that infant mortality rates in Venezuela may have stopped decreasing and started increasing in 2009 – around the time funding for the Venezuelan health system started to be substantially reduced. By 2016, the infant mortality rate was 21.1 deaths per 1000 live births, which is 1.4 times the rate in 2008 (15.0 deaths per 1000 live births), and equivalent to the rate recorded in the late 1990s, meaning 18 years of progress may have been lost.  (more…)
Abuse and Neglect, Accidents & Violence, Brigham & Women's - Harvard, Pediatrics, PLoS / 21.03.2018 Interview with: Neha Bairoliya, Ph.D. Harvard Center for Population and Development Studies Cambridge, MA 02138 What is the background for this study? What are the main findings?  Response: While the high prevalence of preterm births and its impact on infant mortality in the US have been widely acknowledged, recent data suggest that even full-term births in the US face substantially higher mortality risks compared to European countries with low infant mortality rates. In this paper, we use the most recent birth records in the US to more closely analyze the primary causes underlying mortality rates among full-term births. We show that infants born full-term in the US face 50%-200% higher risks of infant mortality compared to leading European countries. The two main drivers of these high relative risks are increased risk of mortality due to congenital malformations, which patients cannot really do much about other than ensuring adequate screening during pregnancy, and high risk of sudden unexpected deaths in infancy, which should largely be preventable through appropriate sleeping arrangements. While we do not have data on actual sleeping arrangements from our study, other data sources suggest that a substantial number of babies continue to sleep on their tummy; we also found a shockingly large number of babies dying from suffocation, which suggests that parents either use covers that are not safe, or let children sleep in their own beds. (more…)
Author Interviews, JAMA, OBGYNE, Pediatrics, Smoking / 19.09.2017 Interview with: Filippos Filippidis MD MPH PhD Lecturer in Public Health School of Public Health Imperial College London London What is the background for this study? What are the main findings? Response: Smoking kills millions of people every year. It is well established that increasing tobacco prices is the most effective way to reduce tobacco consumption and hence mitigate the devastating effects of tobacco on health. Taxation on tobacco products is high in the European Union, which makes cigarettes less affordable. However, transnational tobacco companies are known to manipulate prices, ensuring that cheap or ‘budget’ cigarettes are still available. This is particularly important for younger smokers and those of low socioeconomic status who are more sensitive in price increases. Smoking during pregnancy, as well as exposure of pregnant women and babies to cigarette smoke increase infant mortality. There is also evidence that increasing tobacco prices is associated with lower infant mortality. However, researchers typically use average or premium cigarette prices. We analysed 54 million births from 23 European Union countries to see if the differential between average priced and budget cigarettes (i.e. the availability of cigarettes much cheaper than average priced ones) is associated with infant mortality. We found that increasing average cigarette prices by 1 Euro per pack was associated with 0.23 fewer deaths per 1,000 live births in the same year and an additional 0.16 fewer deaths per 1,000 live births in the following year. A 10% increase in the price differential between budget and average priced cigarettes was associated with 0.07 more deaths per 1,000 live births the following year. This means that 3,195 infant deaths could potentially have been avoided in these 23 countries if there was no price difference between cigarette products over the 10-year study period. (more…)
Author Interviews, JAMA, OBGYNE / 28.12.2014

Keith P. West, Jr., Dr.P.H., R.D. Professor and Director Program and Center in Human Nutrition Department of International Health Bloomberg School of Public Health Johns Hopkins University Baltimore, Maryland Interview with: Keith P. West, Jr., Dr.P.H., R.D. Professor and Director Program and Center in Human Nutrition Department of International Health Bloomberg School of Public Health Johns Hopkins University Baltimore, Maryland 21205 Medical Research: What is the background for this study? What are the main findings? Dr. West: Deficiencies in vitamins and minerals (micronutrients) that must be provided by the diet, are a major public health concern in undernourished societies.  In rural South Asia, where some 35 million babies are born each year, maternal micronutrient deficiencies are common and may increase risk of adverse pregnancy outcomes such as preterm birth, low birth weight or stillbirth and infant mortality.  Further, a newborn of low birth weight faces higher risks of poor postnatal growth, infection and mortality.  Where prenatal care exists, iron-folic acid supplements are often prescribed as standard care to prevent iron deficiency anemia.  But it is likely that many micronutrient deficiencies emerge from an inadequate diet, raising the possibility that a supplement that provides each day a recommended dietary allowance of most essential vitamins and minerals  could measurably improve the health of the mother, fetus and infant.  Because prenatal multinutrient supplements are rarely taken in low income countries, it is important to assess their potential to  improve health before recommending this practice.  We did this be conducting a large prenatal supplementation trial in rural Bangladesh, randomizing  44,567 pregnant women in their 1st trimester to receive a supplement with 15 vitamins and minerals or only iron and folic acid, followed their pregnancies and survival of their 28,516 infants to 6 months of age. Medical Research: What are the main findings? Dr. West:  The multiple micronutrient supplement had the effect of extending the length of gestation compared to the iron-folic acid supplement, by about 2 days on average.  This was enough to lower risk of preterm birth, below 37 weeks,  by 15%.  The extra time in the womb also allowed the fetus to grow a little larger, increasing birth weight (by 54 grams or about 2 ounces) as well as length and other measures of size, leading to a 12% reduction in low birth weight.  In addition, there was an 11% reduction in risk of stillbirth.  These are all indications of a healthier pregnancy.  Although we observed a 14% lower mortality from all causes in girls, there was not a similar effect in boys, leading to no overall effect.  We are continuing to investigate possible reasons for this difference. (more…)
Author Interviews, BMJ, OBGYNE, Weight Research / 03.12.2014

Stefan Johansson, MD PhD consultant neonatologist Stockholm, Interview with: Stefan Johansson, MD PhD consultant neonatologist Stockholm, Sweden Medical Research: What is the background for this study? Dr. Johansson: Maternal obesity (BMI ≥ 30) has previously been linked to increased infant mortality. However, research has not produced consistent results. For example, there are disagreements whether infants to overweight mothers (BMI 25-29) are at increased risk, and research on BMI-related specific causes of death is scarce. (more…)
Author Interviews, JAMA, OBGYNE, Pediatrics / 08.07.2014 Interview with: David Olds, Ph.D. Professor of Pediatrics and Director Prevention Research Center for Family and Child Health University of Colorado Department of Pediatrics Aurora, Colorado Interview with: David Olds, Ph.D. Professor of Pediatrics and Director Prevention Research Center for Family and Child Health University of Colorado Department of Pediatrics Aurora, Colorado   80045 Medical Research: What are the main findings of the study? Dr. Olds: We’ve conducted a randomized controlled trial of a program of nurse home visiting for low-income women with no previous live firths during pregnancy and the first two years of the child’s life, with randomization of participants beginning in 1990. In our most recent follow-up of mothers and children in Memphis, those who received nurse-visitation were less likely to have died over a 2-decade period following the child’s birth than those in the control group.  Death among mothers and children in these age ranges in the US is rare and extraordinarily important for what it tells us about the health of the population studied in this trial. For children, the reduction in death was present for preventable causes, that is, sudden infant death syndrome, injuries, and homicide.  All of the child deaths for preventable causes were in the control group, for whom the rate was 1.6%.  None of the nurse-visited children died of preventable causes. The reductions in maternal mortality were found for two nurse-visited groups combined for this report: one received prenatal and newborn visitation and a second received visitation during pregnancy and through child age two.  Overall, mothers assigned to the control group were nearly 3 times more likely to die than those assigned to the two nurse-visited conditions.  The relative reduction in maternal mortality was particularly pronounced for deaths linked to maternal behaviors -- suicide, drug overdose, injuries, and homicide; for these external causes of death, 1.7% of the mothers in the control group had died, compared to 0.2% of those visited by nurses. (more…)