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Searching for the definition of macrosomia through an outcome-based approach in low- and middle-income countries: a secondary analysis of the WHO Global Survey in Africa, Asia and Latin America.
BMC Pregnancy and Childbirth. 2015; 15(1):324.BACKGROUND: No consensus definition of macrosomia currently exists among researchers and obstetricians. We aimed to identify a definition of macrosomia that is more predictive of maternal and perinatal mortality and morbidity in low- and middle-income countries. METHODS: We conducted a secondary data analysis using WHO Global Survey on Maternal and Perinatal Health data on Africa and Latin America from 2004 to 2005 and Asia from 2007 to 2008. We compared adverse outcomes, which were assessed by the composite maternal mortality and morbidity index (MMMI) and perinatal mortality and morbidity index (PMMI) in subgroups with birthweight (3000-3499 g [reference group], 3500-3999 g, 4000-4099 g, 4100-4199 g, 4200-4299 g, 4300-4399 g, 4400-4499 g, 4500-4999 g) or country-specific birthweight percentile for gestational age (50(th)-74(th) percentile [reference group], 75(th)-89(th), 90(th)-94(th), 95(th)-96(th), and >/=97(th) percentile). Two-level logistic regression models were used to estimate odds ratios of MMMI and PMMI. RESULTS: A total of 246,659 singleton term births from 363 facilities in 23 low- and middle-income countries were included. Adjusted odds ratios (aORs) for intrapartum caesarean sections exceeded 2.0 when birthweight was greater than 4000 g (2 . 00 [95 % CI: 1 . 68, 2 . 39], 2 . 42 [95 % CI: 2 . 02, 2 . 89], 2 . 01 [95 % CI: 1 . 74, 2 . 33] in Africa, Asia and Latin America, respectively). aORs of MMMI reached 2.0 when birthweight was greater than 4000 g, 4500 g in Asia and Africa, respectively. aORs of PMMI approached to 2.0 (1 . 78 [95 % CI: 1 . 16, 2 . 74]) when birthweight was greater than 4500 g in Latin America. When birthweight was at the 90(th) percentile or higher, aORs of MMMI and PMMI increased, but none exceeded 2.0. CONCLUSIONS: The population-specific definition of macrosomia using birthweight cut-off points irrespective of gestational age (4500 g in Africa and Latin America, 4000 g in Asia) is more predictive of maternal and perinatal adverse outcomes, and simpler to apply compared to the definition based on birthweight percentile for a given gestational age.
Are universal standards for optimal infant growth appropriate? Evidence from a Hong Kong Chinese birth cohort.
Archives of Disease in Childhood. 2008 Jul; 93(7):561-5.OBJECTIVE: In 2006 the World Health Organization (WHO) published new optimal growth standards for all healthy infants worldwide. To assess their general applicability to a recently transitioned Chinese population, we compared them with infant growth patterns in a representative sample of Hong Kong infants. Design and settings: Weight at birth and at 1, 3, 9, 12, 18 and 36 months, length at 3 and 9 months and height at 36 months were obtained for over 80% of all infants born in April and May 1997 (3880 boys and 3536 girls). Age and sex specific z scores were calculated relative to the WHO growth standards for term singletons. RESULTS: Weight for age was close to the 50th percentile of the WHO growth standards for both boys (mean z score: 0.00) and girls (0.04) at most time points before 3 years of age. However, our participants were shorter at 3 years, where the z scores in height were -0.34 and -0.38 for boys and girls, respectively. Restricting the analysis to a subset matching the WHO criteria for healthy infants without restrictions on growth gave similar results. CONCLUSIONS: Although the WHO study group concluded there was a striking similarity in length/height among different populations, Hong Kong Chinese toddlers are, on average, shorter. Epigenetic constraints on growth coupled with the rapid epidemiological transition in Hong Kong may not have allowed sufficient generations for infants and children to reach their full genetic height potential, and with it the WHO standards. A universal infant growth standard may not be appropriate across all populations.
Nutrition Research. 1999 Jun; 19(6):843-860.Child malnutrition measured by stunting, wasting, and under-weight is a serious problem in Botswana. There are conflicting reports from previous studies in developing countries on the effect of some of the known factors affecting child malnutrition. We used descriptive statistics, regression, and logistic regression methods to identify the determinants of malnutrition based on data from a national cross-sectional study. There is 29.6% stunting, 14.9% underweight, and 7.1% wasting among children. Ordered logistic regression analysis shows the significance of some of the factors not shown by association statistics, regression analysis, and ordinary logistic regression analysis. Hence it is a better tool in the search for determinants of child malnutrition. The determinants of malnutrition cover biological, social, cultural, economic, and morbidity factors: age, birth-weight, breast-feeding duration, gender of family head, residence, house type, toilet facility, education of mother and father, child caretaker; intake levels of milk and dairy products, staple foods and cereals, and beverages; and incidence of cough and diarrhea. The influence of these factors can be used in the development of strategies of intervention for reducing child malnutrition. (author's)
WHO Programme in Maternal and Child Health and Family Planning. Report of the second meeting of the WHO Programme Advisory Committee in Maternal and Child Health, Geneva, 21-25 November 1983.
[Unpublished] 1984. 95 p. (MCH/84.5)The objectives of the 2nd meeting of the Program Advisory Committee (PAC) for the World Health Organization's (WHO's) Program in Maternal and Child Health, including Family Planning (MCH/FP) were to 1) assess the MCH/FP program's achievements since the 1st PAC meeting in June, 1982, 2) determine the level of scientific and financial resources available for the program, and 3) to examine the role of traditional birth attendants (TBAs) in the delivery of MCH/FP services. The committee reviewed the activities and targets of the program's 4 major areas (pregnancy and perinatal care, child health, growth, and development, adolescent health, and family planning and infertility), and developed a series of recommendations for each of these areas. Specific recommendations were also made for each of the major program areas in reference to the analysis and dessimination of information and to the development and use of appropriate health technologies. Upon reviewing the role of TBAs in the delivery of MCH/FP services, PAC recommended that all barriers to TBA utilization be removed and that training for TBAs should be improved and expanded. PAC's examination of financial support for MCH/FP activities revealed that for a sample of 26 countries, the average annual amount allocated to MCH activities was less than US$3/child or woman. This low level of funding must be taken into account when setting program targets. International funding agencies did indicate their willingness to increase funding levels for MCH programs. The appendices included 1) a list of participants, 2) an annotated agenda, 3) detailed information on the proposed activities of the program's headquarters for 1986-87, and 4) a description of the the function, organizational structure, and technical management of the MCH/FP program. Also included in the appendices was an overview of the current status of MCH and a series of tables providing information on infant, child, and maternal health indicators. Specifically, the tables provided information by region and by country on maternal, child, and infant mortality; causes of child deaths; maternal health care coverage; contraceptive prevalence; infant and child malnutrition; the number of low weight births; adolescent health; teenage births; breast feeding prevalence and duration; and the proportion of women and children in the population.
Are the WHO (1980) criteria for the 75 g oral glucose tolerance test appropriate for pregnant women?
BRITISH JOURNAL OF OBSTETRICS AND GYNAECOLOGY. 1993 Jul; 100(7):645-8.To assess the normal response to the 75 gm oral glucose tolerance test (OGTT) in normal pregnant women, healthy Chinese and Malay women who had been referred to the antenatal clinic of the Department of Reproductive Medicine, Kandang Kerbau Hospital, Singapore, were evaluated. The women were selected on the basis of having none of the generally accepted risk factors for diabetes mellitus: their age was < 35 years, they weighed < 80 kg, they did not have a personal history of diabetes or a family history of diabetes or a family history of diabetes in first degree relatives, nor did they have a history of babies weighing > 4000 gm at birth, still-births, neonatal deaths, congenital malformations, or recurrent miscarriages. All OGTTs were performed after 28 weeks of gestation. The fasting blood sample was taken from the antecubital vein. Further samples were taken 1 and 2 hours after the glucose drink. A glucose analyzer using 5 mcl of plasma was employed. The analytical method was based on the glucose oxidase/peroxidase/aminophenazone process. There was no significant difference in mean glucose levels at corresponding points of the OGTT in Chinese and Malay women. correlation calculations confirmed the absence of any influence of gestational age after 28 weeks on glucose tolerance. Of the 64 women, 47 were Chinese and 17 Malays; 20 wee nulliparous, and 44 were parous. Their mean age was 27.2 years (range 18-35). The mean birthweight of the infants was 3140 gm (range 2094-4240 gm). There were 33 female and 31 male infants. The mean apgar scores at 1 and 5 min were 8.8 (range 7-9) and 9.0 (range 6-10). The mean values and the proposed upper limits of normality for the 75 gm OGTT were 3.9 and 4.9 mmol/1, respectively. 6 women had abnormal OGTT results according to the WHO criteria (fasting glucose > 6 mmol/1; 2 hour glucose > 8 mmol/1).
In: Mortality and health issues in Asia and the Pacific: report of a seminar held at Beijing in collaboration with the Institute of Population Research, People's University of China from 22 to 27 October 1986. New York, New York, United Nations, 1987. 133-50. (Asian Population Studies Series No. 78.; ST/ESCAP/485.)This paper draws up a tentative balance sheet of the attainability of the global Health For All By The Year 2000 targets in the Economic and Social Commission for Asia and the Pacific (ESCAP) region. Given a continuation of unflinching government commitments, the specific global health status and health care provision targets set for the year 2000 seem to be within reach for most countries in the ESCAP region. Exceptions are the targets for water supply and sanitation where the supply of the rural population in several countries is likely to create substantial difficulties. The attainment of equity in the distribution of health resources constitutes a serious challenge. There are some encouraging signs that throughout the ESCAP region health policies and resources are being reoriented towards the provision of health care to the vulnerable and disadvantaged. This optimistic assessment of the prospects owes a good deal to the "conservative" targets set by the World Health Organization as well as to the impressive advances made by the majority of countries on a broad range of economic and social development activities such as food production, industrial output, education, family planning, and welfare. The global strategy does not purport to portray a health scenario for the year 2000 from which to deduce regional or national priorities and tasks. The targets set are not a substitute for national analysis and health trend projection. Seen from a regional perspective, the value and relevance of the Health For All strategy lies in the political field with its emphasis on national and international equity. Basing itself on the moral authority of the world health community, the great social policy issues of health as a fundamental human right are set out and the health sector assigned its proper place in national development efforts for a better and more human life.
WORLD HEALTH. 1988 Jan-Feb; 10-11.In 1979 WHO invited its member states to participate in a global strategy for health and to monitor and evaluate its effectiveness using a minimum of 12 indicators. Members' 1982 implementation reports and 1985 evaluation reports form the basis for evaluating each measure. Indicators 1-6 have strong political and economic components in both developed and developing countries and are not complete. Indicator 7, for which rates of reply are satisfactory, asks whether at least 5 elements of primary health care are available to the whole population. The 8th gauge seeks information on the nutritional status of children, considering birth weight (a possible indicator of risk) and weight for age (a monitor of growth). Infant mortality rate and life expectancy at birth, indicators 9 and 10, are difficult to estimate in developing countries, and health services are not always kept informed of current estimates. Indicator 11 asks whether the literacy rate exceeds 70%; it can provide information on level of development and should emphasize literacy for women, for whom health information is critical. The last global measure yields information about the gross national product, which is not always the most recent, despite the trend of countries to publish their gross domestic product. Failure to make use of the best national sources, such as this, is one of several problems encountered by WHO's member states in collecting accurate data. Other problems include lack of universally acceptable definitions, different national accounting systems, disinterest of health authorities in economic matters, lack of staff, lack of financial resources in developing countries, and inadequately structured health system management. Each country must choose the most appropriate methods for collection of data. If an indicator cannot be calculated, the country is encouraged to seek and devise a substitute. WHO must produce more precise and reliable indicators. It must respond to requests for ways of improving or strengthening national systems.
In: World Health Organization. Manual of the international statistical classification of diseases, injuries, and causes of death. Vol. 1. Geneva, Switzerland, WHO, 1977. 761-8.This presentation defines live birth, fetal death, causes of death, underlying causes of death, birthweight and low birthweigth, gestational age, preterm, term, postterm, and maternal mortality. It makes recommendations regarding the following: responsibility for medical certification of cause of death; form of medical certificate of cause of death; confidentiality of medical information; selection of the cause for mortality tabulation; use of the International Classification of Diseases; perinatal mortality statistics; maternal mortality statistics, statistical tables; and tabulation of causes of death. Medical certification of cause of death should normally be the responsibility of the attending phsician. In the statistical use of the medical certificate of cause of death and other medical records, administrative procedures should provide such safeguards as are necessary to preserve the confidential nature of the information given by the position. It is recommended that national perinatal statistics should include all fetuses and infants delivered weight at least 500 gm (or, when birthweight is unavailable, the corresponding gestational age--22 weeks--or body length (25 cm crown heel), whether alive or dead). The maternal mortality rate, the direct obstetric death rate, and the indirect obstetric death rate should be expressed as rates per 1000 livebirths. The degree of detail in cross classification by cause, sex, age, and area of territory will depend partly on the purpose and range of the statistics and partly on the practical limits as regards the size of the tables. The patterns listed, designed to promote international comparability, consist of standard ways of expressing various characteristics.
Manila, World Health Organization, Nov. 1976. 72 p.Add to my documents.