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Does breastfeeding really save lives, or are apparent benefits due to biases?

Habicht JP, DaVanzo J, Butz WP

Am J Epidemiol, 1986 Feb;123(2):279-90.
PMID: 3946377

Analysis of mothers' recall data collected in 1976-1977 by a probability survey in Peninsular Malaysia shows an association between breastfeeding up to six months of age and improved survival of infants throughout the first year of life. Inappropriate sample selection and inadequate control of confounding can introduce large biases in these analyses. The magnitude and direction of these biases are presented. Even when these biases are dealt with, unsupplemented breastfeeding appears more beneficial than supplemented breastfeeding. The younger the infant and the longer the breastfeeding, the greater the estimated benefits in terms of deaths averted. The use of powdered infant formula did not appear to offset the detrimental effects of early weaning and supplementation. The positive relationships found in these analyses between breastfeeding and survival are not due to death precluding or terminating breastfeeding. Nor are they likely to be due to a shift away from breastfeeding because of recent illness, which was also controlled in the analyses. Nor are they likely to be due to other factors that both increase mortality risk and shorten breastfeeding; when such factors are taken into account, the beneficial effects of breastfeeding become stronger and imply that, if there had been no breastfeeding in this sample, twice as many babies would have died after the first week of life.

Matched MeSH terms: Infant Mortality*
Mortality in hyaline membrane disease

Sivanesan S

Med J Malaysia, 1973 Mar;27(3):207-10.
PMID: 4268926
Matched MeSH terms: Infant Mortality*
Study of perinatal mortality 1970, Maternity Hospital. Kuala Lumpur

Ariffin Bin Marzuki, Thambu JA

Med J Malaysia, 1973 Mar;27(3):198-202.
PMID: 4268924
Matched MeSH terms: Infant Mortality*
Fulltext A 2-year study of neonatal mortality in a large Malaysian hospital

Boo NY, Nasri NM, Cheong SK, Sivamohan N

Singapore Med J, 1991 Apr;32(2):142-7.
PMID: 2042076

A 2-year study was carried out in the Maternity Hospital, Kuala Lumpur to determine the neonatal mortality rates. This Hospital functions both as the local service centre as well as the national referral centre in Malaysia. Its neonatal services, however, were equipped and manned at those below Level III perinatal centre. During the study period 52, 877 livebirths took place in the Hospital. In 1987 and 1988 respectively, the low birthweight (less than 2500 gm) rates were: 112.8 and 101.9 per 1000 livebirths, very low birthweight (less than 1500 gm) rates: 11.1 and 8.8 per 1000 livebirths, neonatal mortality rates: 12.5 and 10.7 per 1000 livebirths and neonatal mortality risk ratio: 1.15 and 1.27. There was significant difference in mortality rates among the Malay, Chinese and Indian babies born in this hospital: the Indians had the highest and the Chinese the lowest rates. Babies delivered by breech or lower segment Caesarean section (LSCS) also had significantly higher mortality than those delivered by other modes of delivery. Low birthweight neonates constituted less than 45% of the total special care nursery admission but contributed to more than 70% of the total neonatal deaths. The common causes of neonatal deaths were problems of prematurity, infection, asphyxia and congenital malformations. Preterm and low birthweight neonates died primarily from problems of prematurity or infection. Term and larger neonates died mainly from asphyxia. More than 75% of the neonatal deaths occurred before 7 days of life. Improvement of antenatal care in the community and upgrading of perinatal services in this Hospital could help to lower the morbidity and mortality due to preventable causes.

Matched MeSH terms: Infant Mortality*
Fulltext Mapping 123 million neonatal, infant and child deaths between 2000 and 2017

Burstein R, Henry NJ, Collison ML, Marczak LB, Sligar A, Watson S, et al.

Nature, 2019 Oct;574(7778):353-358.
PMID: 31619795 DOI: 10.1038/s41586-019-1545-0

Since 2000, many countries have achieved considerable success in improving child survival, but localized progress remains unclear. To inform efforts towards United Nations Sustainable Development Goal 3.2-to end preventable child deaths by 2030-we need consistently estimated data at the subnational level regarding child mortality rates and trends. Here we quantified, for the period 2000-2017, the subnational variation in mortality rates and number of deaths of neonates, infants and children under 5 years of age within 99 low- and middle-income countries using a geostatistical survival model. We estimated that 32% of children under 5 in these countries lived in districts that had attained rates of 25 or fewer child deaths per 1,000 live births by 2017, and that 58% of child deaths between 2000 and 2017 in these countries could have been averted in the absence of geographical inequality. This study enables the identification of high-mortality clusters, patterns of progress and geographical inequalities to inform appropriate investments and implementations that will help to improve the health of all populations.

Matched MeSH terms: Infant Mortality/trends*
Fulltext Infant & Child Mortality in Pakistan and its Determinants: A Review

Tharwani ZH, Bilal W, Khan HA, Kumar P, Butt MS, Hamdana AH, et al.

Inquiry, 2023;60:469580231167024.
PMID: 37085986 DOI: 10.1177/00469580231167024

Over the years, several developing countries have been suffering from high infant and child mortality rates, however, according to the recent statistics, Pakistan falls high on the list. Our narrative review of copious research on this topic highlights that several factors, such as complications associated with premature births, high prevalence of birth defects, lack of vaccination, unsafe deliveries, poor breastfeeding practices, complications during delivery, sudden infant death syndrome (SIDS), poor socioeconomic conditions, and a struggling healthcare system, have influenced these rates. Bearing in mind the urgency of addressing the increased infant and child mortality rate in Pakistan, multiple steps must be taken in order to prevent unnecessary deaths. An effective initiative could be spreading awareness and education among women, as a lack of education among women has been indirectly linked to increased child mortality in Pakistan across many researches conducted on the issue. Furthermore, the government should invest in healthcare by hiring more physicians and providing better supplies and improving infrastructure, especially in underdeveloped areas, to decrease child mortality due to lack of clean water and poor hygiene. Lastly, telemedicine should be made common in order to provide easy access to women who cannot visit the hospital.

Matched MeSH terms: Infant Mortality*
Fulltext Determinants of neonatal, infant and under-five mortalities: evidence from a developing country, Bangladesh

Murad MW, Abdullah ABM, Islam MM, Alam MM, Reaiche C, Boyle S

J Public Health Policy, 2023 Jun;44(2):230-241.
PMID: 37117262 DOI: 10.1057/s41271-023-00413-w

We investigated the macroeconomic determinants of neonatal, infant, and under-five mortalities in Bangladesh for the period 1991-2018 and discuss implications of the United Nations' Sustainable Development Goal 3 (SDG 3) and Millennium Development Goal 4 (MDG 4) for developing countries. We used annual time series data and the econometric techniques of Fully Modified Ordinary Least Squares (FMOLS) and Dynamic Ordinary Least Squares (DOLS) regressions for analysis. Determinants most effective in combating neonatal, infant, and under-five mortalities include variables such as 'protecting newborns against tetanus', 'increasing healthcare expenditure', and 'making sure births are attended by skilled healthcare staff'. Employing more healthcare workers and assuring more and improved healthcare provisions can further reduce the neonatal, infant, and under-five mortalities. Developing countries with similar macroeconomic profiles can achieve similar SDG 3 and MDG 4 outcomes by emulating the policies and strategies Bangladesh applied to reducing child mortalities over the last three decades.

Matched MeSH terms: Infant Mortality*
Preventable stillbirths and neonatal deaths in Malaysia: An analysis of the under-five mortality surveillance data 2015-2017

Norain A, Sutan R, Azmi MT, Rozita AR

Med J Malaysia, 2023 Jan;78(1):25-31.
PMID: 36715187

INTRODUCTION: The under-five mortality (U5M) trend in Malaysia significantly declined from 30.0 per 1000 live births (1980) to 8.0 per 1000 live births (2004), and the trend plateaued over the next two decades. Stillbirths and neonatal deaths were the major contributors to U5M. Scarce literature addressing factors associated with preventable U5M in Malaysia. The objective of this study was to describe preventable stillbirths and neonatal mortality, the associated factors and recommendation for improvement.
MATERIALS AND METHODS: The U5M surveillance data from 2015 to 2017 was retrieved for Malaysian cases of stillbirths and neonatal deaths with multiple pregnancies as exclusion. Stillbirth and neonatal death cases were analysed descriptively for socio-demographic and clinical characteristics. Logistic regressions were performed to identify the associated factors.
RESULTS: There were 15,444 cases selected for analysis, of which 55% of stillbirths and 45% of neonatal deaths. There were 21% of preventable deaths (U5M) and the major contributing causes of preventable stillbirths and neonatal deaths were classified as perinatal death (82.5%), infectious and parasitic diseases (4.1%) and congenital malformations (3.5%). The birth weight (aOR 6.03, 95% CI: 4.14-8.79), hypertensive mother (aOR 1.88, 95% CI: 1.66-2.12) and instrumental delivery (aOR 1.64, 95% CI: 1.16-2.31) were significantly associated with preventable stillbirths and neonatal deaths. Higher household income (>RM3000 per month) was noted as a protective factor (aOR 0.79, 95% CI:0.69,0.89). Mothers with ethnicities other thanBumiputera, single mothers and housewives were identified as the group of mothers with higher odds of poor perinatal services. Among the 3242 cases of preventable stillbirths and neonatal deaths with a complete documented level of adequacy and quality of healthcare, the most frequently identified factors were due to insufficient antenatal care (ANC) (20.4%), non-compliance with medical advice (12.3%) and unsuitable place of delivery (8.6%).
CONCLUSION: Increasing trend of preventable stillbirths and neonatal deaths was noted over 3 years (2015-2017), and one-fifth was related to insufficient ANC service-related factors. Remedial measures in improving the quality of ANC services with an emphasis on the targeted high-risk maternal socio-demographic group (other Bumiputera, older antenatal mothers, nonmarried, poor family income neglected family) and enhancing ANC competency skills among the healthcare provider through adequate training are required to decrease preventable stillbirths and neonatal deaths in Malaysia.

Matched MeSH terms: Infant Mortality
Eclampsia - a review of 48 cases

Ong SK, Foo J, Wong WP, Yusof K

Med J Malaysia, 1978 Mar;32(3):206-11.
PMID: 683043
Matched MeSH terms: Infant Mortality
A method of illustrating health statistics in peninsular Malaysia

Lau L

Med J Malaysia, 1974 Jun;28(4):234-8.
PMID: 4279021
Matched MeSH terms: Infant Mortality
The health of women and children in Malaya

Brodie M

Journal of the Royal Sanitary Institute, 1937;58:305-18.
DOI: 10.1177/146642403705800505

Vital statistics in Malaya are of limited value but annual reports show that the infant mortality in Penang Municipality is 125, in Singapore Municipality 172.2, in the Straits Settlements 165.28, and in the State of Kedah 137 per thousand births. The tables show a similarity to those of large English towns fifty years ago.
Poverty, ignorance and superstition account for many of these deaths and much maternal ill-health. Children are seldom taken out in infancy and houses are frequently dark, stuffy and closely-shuttered. Solid carbohydrate food is given to infants even during the first month. Congenital Syphilis causes a number of deaths and in an investigation in Singapore of mothers whose infants died in the first year of life 30.9 per cent. were Wassermann-positive.
Increasing use is made of maternity wards in the Hospitals and in Kuala Lumpur there is a Chinese maternity hospital with a Chinese woman doctor on the staff. The infant death-rate among Malays is much higher than that of other races, who are more willing to make use of the hospitals.
In the rural areas labour commonly takes place under the most primitive conditions with no help except that of an untrained handy-woman (bidan). A better midwifery service for these areas is gradually being developed and Malay women are being trained to replace the old "bidan" in the villages.
Education is doing something to inculcate modern views on the bringing up of children. The teaching of personal hygiene to teachers and pupils in the vernacular girls' schools is proving of value, and the Girl Guide movement has given an added interest to this.
Medical inspection of school children is more complete in the towns than in the rural areas. Dental caries, skin conditions, intestinal worms, and enlarged tonsils are common in the junior schools.
Tables are given of vital statistics and records of school medical inspection from the reports of the health officers of the Straits Settlements, Singapore, and Kedah. W. H. Peacock.

Matched MeSH terms: Infant Mortality
Spatial analysis of infant mortality in peninsular malaysia over three decades using mixture models

Nuzlinda Abdul Rahman, Abdul Aziz Jemain

Sains Malaysiana, 2013;42:1003-1010.

Infant mortality is one of the central public issues in most of the developing countries. In Malaysia, the infant mortality rates have improved at the national level over the last few decades. However, the issue concerned is whether the improvement is uniformly distributed throughout the country. The aim of this study was to investigate the geographical distribution of infant mortality in Peninsular Malaysia from the year 1970 to 2000 using a technique known as disease mapping. It is assumed that the random variable of infant mortality cases comes from Poisson distribution. Mixture models were used to find the number of optimum components/groups for infant mortality data for every district in Peninsular Malaysia. Every component is assumed to have the same distribution, but different parameters. The number of optimum components were obtained by maximum likelihood approach via the EM algorithm. Bayes theorem was used to determine the probability of belonging to each district in every components of the mixture distribution. Each district was assigned to the component that had the highest posterior probability of belonging. The results obtained were visually presented in maps. The analysis showed that in the early year of 1970, the spatial heterogeneity effect was more prominent; however, towards the end of 1990, this pattern tended to disappear. The reduction in the spatial heterogeneity effect in infant mortality data indicated that the provisions of health services throughout the Peninsular Malaysia have improved over the period of the study, particularly towards the year 2000.

Matched MeSH terms: Infant Mortality
A short investigation of infantile mortality and child welfare on estates in Kedah

Cross B

Journal of the Malaya Branch of the British Medical Association, 1940;4:141-63.

Matched MeSH terms: Infant Mortality
Presidential address

Vohra U

IIPS Newsl, 1993 Jul;34(3):4-6.
PMID: 12287408
Matched MeSH terms: Infant Mortality*
A national study of risk factors associated with mortality in very low birthweight infants in the Malaysian neonatal intensive care units. Malaysian Very Low Birth Weight Study Group

J Paediatr Child Health, 1997 Feb;33(1):18-25.
PMID: 9069039

OBJECTIVE: To determine the risk factors associated with mortality in very low birthweight (VLBW) infants admitted to the neonatal intensive care units (NIUC) in Malaysia.
METHOD: A prospective observational study of outcome of all VLBW infants born between 1 January 1993 and 30 June 1993 and admitted to the NICU.
RESULTS: Data of 868 VLBW neonates from 18 centres in Malaysia were collected. Their mean birthweight was 1223 g (95% confidence intervals: 1208-1238 g). Thirty-seven point four per cent (325/868) of these infants died before discharge. After exclusion of all infants with congenital anomalies (n = 66, and nine of them also had incomplete records) and incomplete records (n = 82), stepwise logistic regression analysis of the remaining 720 infants showed that the risk factors that were significantly associated with increased mortality before discharge were: delivery in district hospitals, Chinese race, lower birthweight, lower gestation age, persistent pulmonary hypertension of the newborn, pulmonary airleak, necrotizing enterocolitis of stage 2 or 3, confirmed sepsis, hypotension, hypothermia, acute renal failure, intermittent positive pressure ventilation, and umbilical arterial catheterization. Factors that were significantly associated with lower risk of mortality were: use of antenatal steroid, oxygen therapy, surfactant therapy and blood transfusion.
CONCLUSION: The mortality of VLBW infants admitted to the Malaysian NICU was high and was also associated with a number of preventable risk factors.

Matched MeSH terms: Infant Mortality*
Regional inequalities of child mortality in peninsular Malaysia with special reference to the differentials between Perlis and Kuala Terengganu

Brehm U

Soc Sci Med, 1993 May;36(10):1331-4.
PMID: 8511619

In Peninsular Malaysia child mortality rates (5q0) vary from 13 to 63 per thousand at district level. The spatial pattern is closely associated with the regional distribution of socio-economic factors. But due to multicollinearity it is difficult to isolate the influence of socio-economic variables from other variables by employing aggregated data. However, individual data collected in a case-control-study that was conducted in Perlis and Kuala Terengganu confirm the important role of socio-economic factors. So it should be possible to achieve a further reduction of child mortality by raising the income and educational level of the under-privileged groups. Apart from that, as the case of Perlis shows, the provision of family planning and preventive medical services may also contribute to lower child mortality independent from socio-economic changes. But, as the comparison with Kuala Terengganu shows, the utilization of family planning and preventive medical services is not only influenced by the accessibility to, but also by the socio-culturally determined acceptability of such services.

Matched MeSH terms: Infant Mortality/trends*
Fulltext Morbidity and mortality of infants of diabetic mothers born at the Maternity Hospital, Kuala Lumpur

Boo NY

Med J Malaysia, 1992 Mar;47(1):56-9.
PMID: 1387451

A prospective study was carried out in the Maternity Hospital, Kuala Lumpur in 1989 to determine the morbidity and mortality of infants of diabetic mothers. Out of 24,856 neonates born during the study period, 54 neonates (2.2 per 1000 livebirths) were born to mothers who were diagnosed to have diabetes mellitus before the current pregnancy or who had impaired glucose tolerance test during the current pregnancy. Almost a third (29.6 percent) of these infants of diabetic mothers had birthweight of 4000 grams and above, and 37.0 percent of the 54 babies were large-for-gestational age. Hypoglycemia occurred in 9/54 (16.7 percent) of the neonates, respiratory distress syndrome in 5/54 (9.3 percent), shoulder dystocia in 7/54 (13.0 percent), and congenital abnormalities in 4/54 (7.4 percent). Three (5.6 percent) neonates died during the neonatal period. The results of this study suggest a need to intensify control of maternal diabetes mellitus during pregnancy in order to reduce the rates of morbidity and mortality of their infants.

Matched MeSH terms: Infant Mortality*
Perinatal outcome amongst the Malays in an urban hospital

Arumugam K

Asia Pac J Public Health, 1992;6(1):32-4.
PMID: 1304776 DOI: 10.1177/101053959200600109

National data show that the perinatal mortality amongst the Malays is higher than that of the Chinese but less than that of the Indians. These figures include data from both urban and rural areas. In the University Hospital, Kuala Lumpur, however, the perinatal mortality amongst the Malays was found to be the lowest; an odds-ratio of 0.72 (95% confidence limits; 0.59-0.87; P < 0.0005) when compared to the non-Malays. This occurred despite a significantly higher parity amongst the Malays. The Malays in this group of patients however, had a significantly better social class distribution.
Publication year: 1992-1993

Matched MeSH terms: Infant Mortality*
Infant mortality decline in Malaysia, 1946-1975: the roles of changes in variables and changes in the structure of relationships

DaVanzo J, Habicht JP

Demography, 1986 May;23(2):143-60.
PMID: 3709892

This analysis has identified several factors contributing to the dramatic decline in infant mortality since World War II in Malaysia, as well as one factor that prevented the infant mortality rate from declining even more rapidly. Our main findings are the following: On average, mothers' education more than doubled over the study period, contributing to the decline in their infants' mortality. In addition, the beneficial effect of mothers' education on infant survival appears to have become stronger over the study period. Hence, further advances in education should lead to further improvements in infants' survival prospects. Another analysis of these data (Peterson et al. 1985) found that education is somewhat more influential in affecting child mortality in low-mortality, high-income areas than in the opposite type of areas. Therefore, socioeconomic development may have complemented, instead of substituted for, the the beneficial effect of mothers' education in promoting infant and child survival in Malaysia. Improvements in water and sanitation also contributed to the infant mortality decline, especially for babies who did not breastfeed. However, unlike education, these influences have become less important over time, especially for babies who are not breastfed. Hence, further improvements in water and sanitation, a goal of Malaysia's Rural Environmental Sanitation Programme, may have smaller relative effects on infant mortality than did previous improvements. Targeting such improvements on areas where women breastfeed little or not at all, however, will increase their effectiveness in promoting infant survival. The substantial reductions in breastfeeding that have taken place since World War II have kept the infant mortality rate in Malaysia from declining as rapidly as it would have otherwise. We estimate that, in our sample, the detrimental effects on infant survival of the decline in breastfeeding have more than offset the beneficial effects of improvements in water and sanitation. Unlike some other researchers (e.g., Palloni 1981), we find that changes in fertility levels and in the timing and spacing of births have had negligible effect in explaining the decline in infant mortality within the samples we have considered. We have excluded births to older women from our analysis, however; this exclusion may have led to an understatement of the influence of changes in the age pattern of childbearing.(ABSTRACT TRUNCATED AT 400 WORDS)

Matched MeSH terms: Infant Mortality*
Environmental factors in the relationship between breastfeeding and infant mortality: the role of sanitation and water in Malaysia

Butz WP, Habicht JP, DaVanzo J

Am J Epidemiol, 1984 Apr;119(4):516-25.
PMID: 6711541

Mothers' recall data collected in Malaysia in 1976-1977 are analyzed to study correlates of mortality of 5471 infants. Respondent population is 1262 women living in 52 primary sampling units of Peninsular Malaysia. Lengths of unsupplemented and supplemented breastfeeding and presence of piped household water and toilet sanitation are related to infant mortality in regressions that also control other correlates. The analysis is disaggregated into three periods of infancy. Through six months of feeding, unsupplemented breastfeeding is more strongly associated with fewer infant deaths than is supplemented breastfeeding. Type of sanitation is generally more strongly associated with mortality than is type of water supply. The effects of breastfeeding and the environmental variables are shown to be strongly interactive and to change systematically during the course of infancy. Breastfeeding is more strongly associated with infant survival in homes without piped water or toilet sanitation. In homes with both modern facilities, supplemented breastfeeding has no significant effect, and unsupplemented breastfeeding is statistically significant only for mortality in days 8-28. Presence of modern water and sanitation systems appears unimportant for mortality of infants who are breastfed without supplementation for six months.

Matched MeSH terms: Infant Mortality*

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