Fighting Infant Mortality


Over the past few months, medical professionals on Chicago’s South Side have been trying a new tactic to bring down the area’s infant mortality rate: find women of childbearing age and ask them about everything.

Really, everything.

“In the last 12 months, have you had any problems with any bug infestations, rodents, or mold?” Kathy Tossas-Milligan, MS, an epidemiologist, asked Yolanda Flowers during a recent visit to her home, in Chicago’s Englewood neighborhood. “Have you ever had teeth removed or crowned because of a cavity?”

Though they seem to have little to do with motherhood, these questions are borrowed from the playbook of the Chicagoans’ new mentors — doctors from the Cuban Ministry of Public Health. As Tossas-Milligan administered her survey, two Cuban doctors sat nearby, observing.

Cuba, a poor country where many of the cars on the road are half a century old, may seem an unlikely role model for American healthcare. But Cuba’s infant mortality rate, at 4.3 per 1,000, is lower than the United States’ 5.7 per 1,000, according to the World Health Organization’s 2015 data. And Cuba’s rate is much better than the infant mortality rates in some of the poorest parts of the U.S. In the Englewood neighborhood, for instance, 14.5 babies per 1,000 do not reach their first birthday. That’s a rate comparable to in war-torn Syria.

“Cuba is not a rich country,” said Jose Armando Arronte-Villamarin, MD, one of the Cuban doctors. “[So] we have to develop the human resources, at the primary healthcare level.”

Now University of Illinois at Chicago health workers are bringing Cuban-style surveys and home visits to Englewood.

“Sometimes the answers are in the most unexpected places,” Tossas-Milligan said. “Sometimes it’s hard for us to face the reality that, as much as we spend, we have somehow not been successful at keeping our babies alive.”

The home visits came out of a partnership between the Cuban Ministry of Public Health and the University of Illinois Cancer Center. Three Cuban doctors and a nurse are embedded in Chicago from August to December, joining their American counterparts in visiting the homes of 50 women of reproductive age in Englewood.

In exchange for a $50 stipend, the women answer dozens of questions, on topics ranging from the state of their home to their emotional well-being.

The project is funded by a $1 million grant from the W.K. Kellogg Foundation, which has also paid for some American healthcare workers to visit Cuba.

In Chicago, researchers plan to use the data they gather to classify women into four risk groups. Those deemed at higher risk will be recommended for additional home visits. The idea, Tossas-Milligan said, is to address these women’s medical issues at an early stage and at home as much as possible, to avoid costly hospital bills.

“What we are hoping to discover is issues in Englewood that truly impact health, that are not being collected — that the doctors cannot see when they come and see [a] woman, and prescribe her one pill,” Tossas-Milligan said.

One question the team has been asking women, for example, is when they last saw a dentist. Gum disease, while unlikely to come up during an expectant mother’s hospital visit, has been linked to premature birth.

In her interview, Yolanda Flowers said that she hadn’t been to a dentist “since 1999 or 2000,” which she attributed to a lack of insurance and a longtime fear of the dentist. And at 47, Flowers has had a difficult obstetric history: three miscarriages and one premature birth. Her baby did not survive.

Flowers, who said she had “bare-bones insurance” or had been on Medicaid for much of her adult life, first attempted a planned pregnancy in 2003, with her then-fiancé. She visited a doctor who, Flowers recalled, suspected an ovarian cyst. But before they went further, Flowers’ fiancé died in an accident. In 2009, she tried to get pregnant again and visited a different doctor for help. That doctor, offered under a different health insurance plan, was not aware of her history, Flowers said, “because you only get a limited amount of time with the doctors, and there is only so much that I remembered.”

Tossas-Milligan and Arronte-Villamarin said that even if Flowers does not attempt another pregnancy, simply having that information, and having it in one place, could help them head off problems facing other potential mothers in the neighborhood.

The American healthcare workers would like to scale up this system to address other key health problems in underserved parts of the city.

Experts who have studied the Cuban health system say that is an idea worth exploring, but it would require much more than just home visits and health surveys.

“When a doctor or team [in Cuba] finds problems in the home … and they think it has any bearing on her pregnancy, she gets help,” said Mary Anne Mercer, MPH, DrPH, a senior lecturer emeritus at the University of Washington in Seattle.

Mercer noted that Cuba, despite being very poor, guarantees resources for at-risk women.

By contrast, the Chicago effort may identify women in Englewood as needing food or different housing, but they would have to find a way to fill those needs on their own.

“Thinking about a very poor, low-income, disadvantaged setting in the U.S., I don’t think we’ve got those resources,” Mercer said. “So it’s nice to say, ‘Yeah, we could do it, if we were willing to expend those resources,’ but I am not convinced we could.”

Would,” Mercer corrected. “I’m not convinced we would.”

UNICEF study reveals two-thirds of rural Indian children who die below the age of five are lost to treatable conditions like premature birth, infection, and diarrhoea


Despite the government’s efforts to curb child mortality, children under the age of five continue to die due to medical negligence and lack of timely medical aid.

A study, funded by the Ministry of Health and Family Welfare, USAID and UNICEF, conducted in rural areas of 16 districts from eight states across India, revealed that even today newborns suffer from infections, acute respiratory infection (ARI) and diarrhoea, which accounts for approximately 63 per cent of deaths in children under the age of five.

The study conducted by the Department of Biostatistics, All India Institutes of Medical Sciences (AIIMS), along with the INCLEN Trust International, was published in the latest issue of Indian Journal of Community Medicine.

Children under the age of five continue to die of diseases such as acute respiratory infection and diarrhoea

Children under the age of five continue to die of diseases such as acute respiratory infection and diarrhoea

The survey conducted in around 216,794 households revealed that more than 1,656 children under the age of five die due to various reasons.

The autopsies were analysed to learn the specific causes of deaths. In newborns, these were shown to be birth asphyxia, premature birth, and infection.

All this contributed to more than 67.5 per cent of the neonatal deaths, while in children aged 29 days to 59 months, ARI and diarrhea accounted for 54.3 per cent of deaths.

Shockingly, the families of 52.6 per cent of newborns and 21.7 per cent of infants and children under the age of five, did not seek any medical care.

The study said that substantial delays in seeking medical attention led to deaths either at home or during transit.

Little girls continue to be ignored in the Indian households, as the study revealed that baby girls born at home, or born in a health center run by unskilled health workers and caregivers with less than primary education were at a higher risk.

States such as Bihar, Madhya Pradesh, Rajasthan, Uttar Pradesh and Andhra Pradesh have recorded high mortality rates in children below five, and these were dubbed high-burden states in India.

Low birth weight and premature birth were the leading causes of neonatal mortality in Karnataka, Maharashtra, and Odisha. In Uttar Pradesh and Haryana, children largely died in the post-neonatal period due to diarrhoea.

“The majority of these deaths could have been prevented with the interventions offered in primary and secondary care,” the study revealed.

The study has indicated that arranging for transportation and social support for accompanying and deciding health care needs are interlinked and these were reported to be the major difficulties faced by families living in remote villages.

A contrary report was released by the National Family Health Survey (NFHS).

This survey was conducted in four of the 15 states and union territories, and it concluded that fewer children were dying in infancy and early childhood.

The Health Ministry recently said after the last round of NFHS in 2005-06, the infant mortality has declined in all the states/union territories.

The Ministry also said that all the 15 states/union territories have low death which is 51 deaths per 1,000 children born each day. It also added that there is a considerable variation among the states and the union territories.

 

Curbing Premature Birth May Hinge on a Single Molecule


Blocking a molecule in the uterus could delay or even halt premature birth, the leading cause of death and disability of newborns worldwide, according to a new study in rodents.

Normal pregnancies last between 38 and 42 weeks. However, more than 10 percent of all infants are born prematurely, after less than 37 weeks of pregnancy. As many as 3 percent are born quite prematurely, after less than 31 weeks of pregnancy, said study co-senior author Dr. David Cornfield, a pediatric pulmonary medicine physician and scientist at Stanford University in California.

Premature birth can lead to major problems because many organs, including the brain, lungs, and liver, need the final weeks of pregnancy to fully develop.

“There is a huge burden — financial, emotional, psychological, developmental — that premature infants and families must bear,” Cornfield said. “The societal costs are similarly huge.”

During pregnancy, the womb shelters a growing fetus. When a woman goes into labor, the uterus experiences powerful contractions to push out the baby. It remains poorly understood as to what makes the womb begin the labor process. As such, there is currently no effective treatment for premature labor.

Previous research suggested that calcium levels of muscle cells within the walls of the uterus help control womb contractions. As a result, Cornfield and his colleagues focused on a molecule found in the mouse uterus known as TRPV4, which helps control the flow of calcium into cells.

The scientists found that uterine tissue from pregnant women possessed higher levels of TRPV4 than non-pregnant women. Similarly, as pregnancy advanced in mice and rats, TRPV4 became increasingly abundant in the uterine wall muscle cells of these rodents.

Previous research discovered molecules that could activate TRPV4 so that it would permit calcium to flow into cells. In experiments, these compounds increased uterine contractions in mice, the researchers found.

Prior studies also identified molecules that could block TRPV4, preventing it from allowing calcium to enter cells. In experiments where mice were given drugs known to set off premature labor, these inhibitor compounds significantly prolonged pregnancy and prevented premature labor.

“This advance can to be used to develop treatments to stop preterm labor, and perhaps to increase the efficacy of uterine contractions so as to decrease the need for cesarean sections,” Cornfield told Live Science.

Future research will need to investigate if this approach can safely work on humans, Cornfield said.