Document Detail

Associations between social and environmental factors and perinatal mortality in Jamaica.
MedLine Citation:
PMID:  8072899     Owner:  NLM     Status:  MEDLINE    
Social and environmental factors in Jamaica were compared between 9919 mothers delivering in a 2-month period a singleton who survived the early neonatal period and 1847 mothers who were delivered of a singleton perinatal death in a contiguous 12-month period. Logistic regression showed independent positive statistically significant increased odds of having a perinatal death among mothers who lived in rural parishes, older mothers (aged 30 +), single parents, no other children in the household, large number of adults in the household, mother unemployed, the major wage earner of the household not being in a managerial, professional or skilled non-manual occupation, the household not having sole use of toilet facilities, smaller mothers and those classified as obese or undernourished. Variations were found for different categories of death. Intrapartum asphyxia deaths were not related to union (marital) status, occupation of major wage earner, number of adults nor to the use of the toilet. Antepartum fetal deaths did not vary significantly with occupation of major wage earner or maternal height, but did show a relationship with maternal education, mothers with lowest levels having reduced risk. Deaths from immaturity were significantly related only to occupation of major wage earner, number of children in the household, number of social amenities available (negative relationships) and maternal age (< 17 at highest risk). In conclusion there was little to indicate that social deprivation per se was related to perinatal death, although specific features of the environment showed strong relationships.
The Jamaican Perinatal Mortality Survey provided the data for this logistic regression analysis of factors related to perinatal mortality. The sample included 94% of all mothers delivering in September and October 1986 and clinical records of still births and infant mortality with 7 days of birth during September 1986 and August 1987. Causes were identified according to the Wigglesworth classification as antepartum fetal deaths (APFD), congenital malformations and immaturity (IMMAT), intrapartum asphyxia (IPA), and miscellaneous. The results showed the lowest risk among married mothers and the highest among women with a visiting partner, but the relationship was not strong. Expenditures on food per person was unrelated. Unemployed women had a higher risk for all causes except immaturity. There were reduced risks for all deaths and IPA among households with heads engaged in professional and nonmanual skilled occupations. There was a strong relationship with the number of children under 11 years old in the household. The risk was very high in households with no children and risk declined with number of children under 11 years old. Housing size or type of ownership were unrelated. The more crowded the sleeping conditions, the lower the risk of perinatal death for IPA and all perinatal deaths. Risk was increased with lack of access to a private water supply in the household and use of shared toilet facilities. Increased risk was also related to lack of access to urban facilities. Risk was lowest in the eastern area of the island and highest in the far western areas. Lowest risks for all deaths were in the urban areas of Kingston, St. Andrew, and St. James. A U-shaped pattern appeared for age, with high risk among those under 17 years and over 35 years old for all deaths and IPAs. APFDs and IMMAT were more likely among mothers under 17 years old. Women taller than 5 feet 6 inches had the lowest mortality. APFDs and total perinatal mortality were significantly related to increased weight. Risk was increased among mothers either malnourished or obese. The final logistic model showed increased risk among mothers who were unmarried or cohabiting, with no young children regardless of parity, with shared toilet facilities, with lower nutrition, and increased age.
J Golding; R Greenwood; A McCaw-Binns; P Thomas
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Publication Detail:
Type:  Comparative Study; Journal Article; Research Support, Non-U.S. Gov't    
Journal Detail:
Title:  Paediatric and perinatal epidemiology     Volume:  8 Suppl 1     ISSN:  0269-5022     ISO Abbreviation:  Paediatr Perinat Epidemiol     Publication Date:  1994 Apr 
Date Detail:
Created Date:  1994-09-29     Completed Date:  1994-09-29     Revised Date:  2006-11-15    
Medline Journal Info:
Nlm Unique ID:  8709766     Medline TA:  Paediatr Perinat Epidemiol     Country:  ENGLAND    
Other Details:
Languages:  eng     Pagination:  17-39     Citation Subset:  IM; J    
Institute of Child Health, Bristol UK.
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MeSH Terms
Asphyxia Neonatorum / epidemiology
Body Height
Body Weight
Cohort Studies
Fetal Death / epidemiology*
Infant Mortality*
Infant, Newborn
Infant, Premature
Jamaica / epidemiology
Maternal Age
Risk Factors
Socioeconomic Factors*

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