INFANT MORTALITY. Gavilán 94 - C - Capital Federal - Buenos Aires Argentina Tel.: (5411) /70 -

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1 INFANT MORTALITY Gavilán 94 - C - Capital Federal - Buenos Aires Argentina Tel.: (5411) /70 -

2 Period: Years File Name 2

3 INFANT MORTALITY Expresses the extent to which death occurs in a population at a given time. 1 Death and Dying 2 Mortality 1- Loss of individual biological life. 2- Category strictly nature population. Consequently, mortality expresses the dynamics of the deaths occurring in populations over time and space, and only allows comparisons at this level of analysis.

4 INFANT MORTALITY General Mortality Volume of deaths from all causes of disease in all age groups and for both sexes. The crude mortality expresses the relationship between the volume of deaths in a given period and the size of the population in which they were presented ; The adjusted (or standardized) mortality expresses this relationship but considers the possible differences in the age structure, sex, etc. of the populations analyzed, allowing comparisons between them.

5 INFANT MORTALITY Specific Mortality When there is reason to assume that mortality can vary among different subgroups of the population it is divided for study. For example, mortality rates by age, sex, causespecific, and so on. Rates adjusted or standardized.

6 INFANT MORTALITY Specific Mortality In some cases combinations can be calculated several fractions population, and when so, the considered groups are specified ( for example, female mortality in reproductive age ). Specific mortality rates by age and sex are calculated as follows:

7 INFANT MORTALITY Classification: Infant mortality rate (IMR): Number of deaths of children less than one year of age per 1000 live births. The rate for a given region is the number of children dying under one year of age, divided by the number of live births during the year, multiplied by 1,000.

8 INFANT MORTALITY Classification: Forms of infant mortality: Perinatal mortality is late fetal death (22 weeks gestation to birth), or death of a newborn up to one week postpartum. Neonatal mortality is newborn death occurring within 28 days postpartum. Neonatal death is often attributed to inadequate access to basic medical care, during pregnancy and after delivery. This accounts for 40 60% of infant mortality in developing countries.

9 INFANT MORTALITY Classification: Postneonatal mortality is the death of children aged 29 days to one year. The major contributors to postneonatal death are malnutrition, infectious disease, and problems with the home environment.

10 INFANT MORTALITY Classification: 1st W 2nd W 3thW 4thst W Birth preterm > w22 Birth term W month 12 month Perinatal period Neonatal period Postneonatal period

11 INFANT MORTALITY Under Five Mortality Rates (U5MR) Under-five mortality is also one of the major determinants of life expectancy across the globe. File Name 11

12 INFANT MORTALITY These indicators have important comparative advantages for evaluating the impact of actions on the welfare and survival of children. It is also an indicator of preventive care and outcomes (eg, immunization, clean water, maternal health, nutrition). How we can compare them??? File Name 12

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17 INFANT MORTALITY Vital Statistics Information on vital events. birthd, marrieges, deaths and fetal deaths for the whole country and jurisdiction. Vital Statistics are part of the Health Statistical System (SES ) File Name 17

18 INFANT MORTALITY Conceptual framework of determinants influencing infant mortality File Name 18

19 INFANT MORTALITY Conceptual framework of determinants influencing infant mortality File Name 19

20 INFANT MORTALITY Conceptual framework of Social determinants influencing infant mortality File Name 20

21 Millennium Development Goals File Name 21

22 Millennium Development Goals GOAL 4: REDUCE CHILD MORTALITY Target 4.A: Reduce by two thirds, between 1990 and 2015, the under-five mortality rate Between 1990 and 2015, the global under-five mortality rate has declined by more than half, dropping from 90 to 43 deaths per 1000 live births. Between 1990 and 2015, the number of deaths in children under five worldwide declined from 12.7 million in 1990 to almost 6 million in

23 Millennium Development Goals GOAL 4: REDUCE CHILD MORTALITY Target 4.A: Reduce by two thirds, between 1990 and 2015, the under-five mortality rate Children of mothers with secondary or higher education are almost three times as likely to survive as children of mothers with no education. While Sub-Saharan Africa has the world s highest child mortality rate, the absolute decline in child mortality has been the largest over the past two decades. Every day in 2015, 16,000 children under five continue to die, mostly from preventable causes. Child survival must remain a focus of the new sustainable development agenda. 23

24 Millennium Development Goals GOAL 4: REDUCE CHILD MORTALITY Target 4.A: Reduce by two thirds, between 1990 and 2015, the under-five mortality rate Indicators Under-five mortality rate (UNICEF-WHO) Infant mortality rate (UNICEF-WHO) Proportion of 1 year-old children immunized against measles (UNICEF-WHO) File Name 24

25 September 2015 at the United Nations in New York to adopt the 2030 Agenda for Sustainable Development. File Name 25

26 CAUSE OF DEATH Vol 385 January 31, 2015File Name 26

27 Vol 385 January 31, 2015File Name 27

28 Vol 385 January 31, 2015File Name 28

29 Vol 385 January 31, 2015File Name 29

30 Respiratory Mortality File Name 30

31 Respiratory Mortality 56,560 children younger than age two years 12 tertiary care hospitals with >500 beds, ICUs, mechanical ventilation. Region hosts large low income districts.

32 Respiratory Mortality Ferolla FM. AJRCCM 13

33 Respiratory Mortality Ferolla FM. AJRCCM 13

34 Respiratory Mortality Who dies due to RSV disease? DYING FROM RSV DYING WITH RSV Biological susceptibility. Socioeconomic contribution: personal and systemic level. Secondary biological complication. HOSPITAL The ecosystem contributes to hurt you beyond its expected limitations. COMMUNITY Tire yourself to death (these deaths are lost to numerous stats).

35 Muertes infantiles hospitalarias, por mes, Muertes por todas las causas neonatales (línea verde), las muertes post-neonatal por todas las causas (línea roja), IRAB post- neonatal fatal durante la temporada de VSR ( línea de color negro ), RSV negativo IRAB ( barras de color naranja ; n = 17 ), IRAB por VSR positivo ( barras azules ; n = 20 ), no probado IRAB ( barras de color turquesa ; n = 8) File Name 35

36 Muertes infantiles comunitarias, por mes, Todas las causas de mortalidad neonatal ( línea azul ) y las muertes post-neonatal por todas las causas ( línea verde ). File Name 36

37 Community deaths Where (when) are these fatalities detected? How common is RSV as an agent of fatal ARI in the community when compared to hospital deaths? Can we extrapolate community deaths from hospital-based deaths? Are there subgroups within community deaths? Can you pair seamlessly community RSV deaths with RSV surveillance? What are the challenges for the program/ team?

38 Where are these fatalities detected? Deaths at home outside system Home Deaths brought to Hospital Home Deaths brought to Primary Care Clinics 15/26 (58%) 8/26 ER 7/26 morgue 4/26 (15%)

39 Maps SIG Lomas ( ) File Name 39

40 Maps SIG ( ) File Name 40

41 La Enfermedad respiratoria aguda baja ( IRAB ) por el virus sincitial respiratorio ( VRS) es la causa más frecuente de hospitalización en lactantes en el mundo 1. (1)Nair H, Nokes DJ, Gessner BD, et al. Global burden of acute lower respiratory infections due to respiratory syncytial virus in young children: a systematic review and meta-analysis. Lancet 2010; 375(9725):

42 Strategy Study of Home-based Infant Mortality VERBAL AUTOPSY (VA) They have developed different ways, with various analysis techniques. Gold Standard : Autopsy Diagnoses ( CDA ). Disadvantages VA. High porcetanje of misclassification. Causes underdiagnosed. Ability to syndromic diagnosis but not for specific causes. Last updated: May 27,

43 Estrategias Mortalidad Infantil Domiciliaria A) B) Posible causa respiratoria: <12 meses Todas las causas: 0-5 años 36hs: Swabs fallecido 72hs: Swabs convivientes 1-3 meses: VA 36hs: MITS fallecidos 1-3 meses: VA Sinergismo para determinar causa de muerte File Name 43

44 Swabs Secreciones Nasales PONER PROTOCOLO Estimaciones actuales de la mortalidad debida a enfermedad de las vías respiratorias inferiores relacionados con RSV - ( IRAB ) se basan en datos primarios limitada. File Name 44

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