Enrique Donoso Siña

Reducción de la mortalidad materna en Chile de 1990 a 2000

OBJETIVO: Determinar si Chile alcanzo el objetivo de reducir en 50% la mortalidad materna entre 1990 y 2000, conforme a lo establecido en el Plan de Accion Regional para la Reduccion de la Mortalidad Materna en las Americas. METODOS: Se diseno un estudio observacional y descriptivo que permitiera analizar la tendencia de la mortalidad materna en el pais durante 19902000. Las variables evaluadas fueron la razon de mortalidad materna, las causas de muerte y la edad de las madres fallecidas. Las causas se clasificaron de acuerdo con la novena revision de la Clasificacion internacional de enfermedades,traumatismos y causas de defuncion (CIE-9), y los datos brutos se obtuvieron de los anuarios del Instituto Nacional de Estadisticas de Chile. La fluctuacion de las variables se estimo segun el porcentaje de cambio acumulado, y la tendencia, mediante analisis de correlacion de Pearson. RESULTADOS: El estudio demostro una reduccion de la mortalidad materna de 60,3% de 1990 a 2000; la razon de mortalidad materna mas baja, de 18,7/100 000 nacidos vivos, se registro en el ano 2000. El analisis indica que las cinco causas mas importantes de muerte materna fueron: hipertension arterial, aborto, enfermedades maternas concurrentes (pregestacionales), sepsis puerperal y hemorragia posparto. Se observo una tendencia descendente significativa de la mortalidad materna por hipertension arterial (r= 0,712; P= 0,014), aborto (r= 0,810; P = 0,003) y sepsis puerperal (r= 0,718; P= 0,013), pero no se encontraron cambios estadisticamente significativos en la mortalidad por enfermedades maternas concurrentes ni por hemorragia posparto. La cifra mas alta de mortalidad materna correspondio a las mujeres de 40 anos de edad y mayores (100,2/100 000 nacidos vivos), y la mas baja a las adolescentes de 15 a 19 anos (18,7/100 000 nacidos vivos). CONCLUSIONES: Chile cumplio el objetivo del Plan de Accion Regional para la Reduccion de la Mortalidad Materna en las Americas, habiendo logrado un descenso de mas de 50% de dicha mortalidad en el periodo 19902000. Tal reduccion se debe principalmente al descenso de la mortalidad materna por hipertension arterial, aborto y sepsis puerperal.

Birth rates and reproductive risk in adolescents in Chile, 1990­1999

OBJETIVOS: Evaluar en madres adolescentes chilenas menores de 15 anos y de 15 a 19 anos las tendencias de la natalidad y del riesgo reproductivo en el periodo de 19901999. METODOS: Sobre la base de datos extraidos de los Anuarios de demografia publicados por el Instituto Nacional de Estadisticas de Chile para 19901999, se calcularon las tendencias mostradas por el numero de nacidos vivos y las tasas de mortalidad materna, fetal tardia, neonatal e infantil entre madres adolescentes menores de 15 anos y de 15 a 19 anos de edad. Se calculo el riesgo (razon de posibilidades, RP) de ambos grupos en comparacion con el de mujeres de 20 a 34 anos de edad. La comparacion entre grupos se efectuo mediante la prueba de Fisher o de ji2, segun el caso, y el analisis de tendencias en el periodo estudiado se realizo mediante la correlacion de Pearson con un nivel alfa de 0,05. RESULTADOS: En el periodo estudiado, las tasas de mortalidad materna, fetal tardia, neonatal e infantil en madres adolescentes menores de 15 anos fueron, respectivamente, de 41,9 (por 100 000 nacidos vivos [NV]), 5,1 (por 1 000 NV), 15,2 (por 1 000 NV) y 27,4 (por 1 000 NV); en adolescentes de 15 a 19 anos, de 19,3, 4,1, 8,1 por 1 000 y 16,6, respectivamente, mientras que en adultas de 20 a 34 anos dichas tasas fueron de 26,8, 5,0, 6,7 y 12,1, respectivamente. En las adolescentes menores de 15 anos el mayor riesgo de muerte materna (RP = 1,56; IC95%: 0,50 a 4,31; P = 0,372) y de muerte fetal (RP = 1,02; IC95%: 0,76 a 1,36; P = 0,890) no fue estadisticamente significativo; en cambio, si se detecto un riesgo significativamente mayor de muerte neonatal (RP = 2,27; IC95%: 1,92 a 2,68; P <0,0001) y el de muerte infantil (RP = 2,39; IC95%: 2,04 a 2,62; P <0,0001). Entre las madres adolescentes de 15 a 19 anos, el riesgo de muerte materna (RP = 0,72; IC95%: 0,56 a 0,92; P <0,008) y el de muerte fetal (RP = 0,81; IC95%: 0,77 a 0,86; P <0,0001) fueron inferiores en grado significativo en comparacion con los del grupo testigo, mientras que el riesgo de muerte neonatal (RP = 1,20; IC95%: 1,16 a 1,25; P <0,0001) y el de muerte infantil (RP = 1,38; IC95%: 1,35 a 1,42; P <0,0001) fueron significativamente superiores. Tanto en las madres adolescentes mayores como en las del grupo testigo se observo una tendencia descendente significativa de la mortalidad materna, fetal, neonatal e infantil en el periodo estudiado; en las adolescentes menores solo la mortalidad neonatal y la mortalidad infantil descendieron significativamente. Tambien se observo una tendencia ascendente del numero de nacidos vivos entre los dos grupos de madres adolescentes, pero dicha tendencia fue significativa solamente entre las menores de 15 anos, mientras que en el grupo testigo se observo una tendencia descendente estadisticamente significativa. CONCLUSIONES: Los resultados confirman que, en el periodo estudiado, las madres adolescentes chilenas tuvieron riesgos reproductivos elevados en comparacion con las mujeres de 20 a 34 anos y que el numero de nacidos vivos de madres adolescentes mostro una tendencia ascendente durante el periodo, pero de un modo significativo solamente en las menores de 15 anos. Los resultados apuntan a la necesidad de crear programas que permitan mejorar la educacion sexual y la regulacion de la fecundidad desde la adolescencia temprana.Objectives: To evaluate trends related to childbirth and reproductive risks among adolescent Chilean mothers under 15 years old and from 15 to 19 years of age in the period 1990-1999. Methods: Using the data base extracted from the Demographic Yearbooks published by the National Statistics Institute of Chile for 1990-1999 the trends in the number of live births and the rates of infant neonatal fetal and maternal mortality among adolescent mothers younger than 15 years old and from 15 to 19 years of age were calculated. The risk (probability ratio PR) of both groups was calculated in comparison with women from 20 to 34 years of age. The comparison between groups was carried out using the Fisher test or the £q 2 depending on the case and the analysis of trends in the period studied were carried out using the Pearsons correlationship with an alfa level of 0.05. Results: In the period studied the rates of maternal fetal neonatal and infant mortality in adolescent mothers under 15 were respectively 41.9 (per 100000 live births [LB]) 5.1 (per 1000 LB) 15.2 (per 1000 LB) and 27.4 (per 1000 LB); in adolescents from 15 to 19 years of age the figures were 19.3 4.1 8.1 per 1000 and 16.6 respectively; and in adults from 20 to 34 the rates were 26.8 5.0 6.7 12.1 respectively. In adolescents under 15 the greatest risk of maternal death (PR= 156; 95% confidence: 0.50 a 4.31; P = 0.372) and fetal death (PR = 1.02; 95% confidence: 0.76 to 1.36; P = 0.890) was not statistically significant; in contrast the study detected a significantly greater risk of neonatal death (PR = 2.27; 95% confidence: 1.92 to 2.68; P < 0.0001) and infant death (PR = 2.39; 95% confidence: 2.04 to 2.62; P < 0.0001). Among adolescent mothers from 15 to 19 years of age the risk of maternal death (PR = 0.72; 95% confidence: 0.56 to 0.92; P < 0.008) and fetal death (PR = 0.81; 95% confidence: 0.77 to 0.86; P < 0.0001) were significantly lower than the control group while the risk of neonatal death (PR = 1.20; 95% confidence: 1.16 to 1.25; P < 0.0001) and infant death (PR = 1.38; 95% confidence: 1.35 to 1.42; P < 0.0001) were significantly higher. Both the older adolescent mothers and the control group exhibited a significant downward trend in maternal fetal neonatal and infant mortality in the period studied; among the younger adolescents only neonatal mortality and infant mortality decreased significantly. An increase in the number of live births was also observed among the two groups of adolescent mothers but this trend was significant only among those under 15 while a statistically significant downward trend was observed in the control group. Conclusions: The results confirm that in the period studied adolescent Chilean mothers had high reproductive risks relative to women between 20 and 34 years of age while and that the number of live births by adolescent mothers showed a upward trend during the period but was only significant in the under-15 age group. The results highlight the need to create programs for the improvement of sexual education and the regulation of fertility in the early years of adolescence. (authors)OBJECTIVE For Chilean teenage mothers under 15 years old and from 15 to 19 years old, to evaluate the trends in birth rates and reproductive risk for the period of 1990-1999. METHODS A database was constructed using data from the Demography Yearbook (Anuario de demografia) volumes published by Chiles National Institute of Statistics (Instituto Nacional de Estadisticas) for 1990-1999. From that database we calculated the trends in the number of live births and in the rates of maternal mortality, late fetal mortality, neonatal mortality, and infant mortality among the teenage mothers under 15 and from 15 to 19 years old. We calculated the risk odds ratio (OR) for both of those age groups in comparison with women from 20 to 34 years old. The groups were compared using Fishers exact test or the chi-square test, and the analysis of trends in the period studied was carried out with Pearsons correlation, with an alpha level of 0.05. RESULTS In the period studied, for the teenage mothers under age 15, the respective rates for maternal mortality, late fetal mortality, neonatal mortality, and infant mortality were 41.9 per 100 000 live births, 5.1 per 1 000 live births, 15.2 per 1 000 live births, and 27.4 per 1 000 live births. For the adolescents from 15 to 19 years, the corresponding rates were 19.3, 4.1, 8.1, and 16.6; for the women 20-34 years old, they were 26.8, 5.0, 6.7, and 12.1. The adolescents under 15 had higher risks of maternal mortality (OR = 1.56; 95% confidence interval (CI): 0.50 to 4.31; P = 0.372) and of fetal mortality (OR = 1.02; 95% CI: 0.76 to 1.36; P = 0.890), but those differences were not statistically significant. However, the younger adolescents did have significantly higher risks of neonatal mortality (OR = 2.27; 95% CI: 1.92-2.68; P < 0.0001) and of infant mortality (OR = 2.39; 95% CI: 2.04 to 2.62; P < 0.0001). In comparison to the women 20-34 years old, the teenage mothers from 15 to 19 years old had significantly lower risks of maternal mortality (OR = 0.72; 95% CI: 0.56 to 0.92; P < 0.008) and of fetal mortality (OR = 0.81; 95% CI: 0.77 to 0.86; P < 0.0001) but significantly higher risks of neonatal mortality (OR = 1.20; 95% CI: 1.16 to 1.25; P < 0.0001) and of infant mortality (OR = 1.38; 95% CI: 1.35 to 1.42; P < 0.0001). Among both the older teenage mothers and the mothers 20-34 years old there was a significant downward trend in maternal, fetal, neonatal, and infant mortality rates in the period studied; in the younger adolescents only neonatal mortality and infant mortality declined significantly. There was a rising trend in the number of live births among the two groups of teenage mothers, but that trend was statistically significant only for the mothers under 15; among mothers 20-34 years old there was a statistically significant downward trend. CONCLUSIONS In the period studied, the Chilean teenage mothers faced greater reproductive risk than did the women 20-34 years old. The number of live births among teenage mothers tended to rise during the 1990-1999 period, but the change was significant only for the mothers under age 15. These results point to the need to develop programs that improve both sex education and birth control practices starting in early adolescence.

Natalidad y riesgo reproductivo en adolescentes de Chile, 1990-1999

OBJETIVOS: Evaluar en madres adolescentes chilenas menores de 15 anos y de 15 a 19 anos las tendencias de la natalidad y del riesgo reproductivo en el periodo de 19901999. METODOS: Sobre la base de datos extraidos de los Anuarios de demografia publicados por el Instituto Nacional de Estadisticas de Chile para 19901999, se calcularon las tendencias mostradas por el numero de nacidos vivos y las tasas de mortalidad materna, fetal tardia, neonatal e infantil entre madres adolescentes menores de 15 anos y de 15 a 19 anos de edad. Se calculo el riesgo (razon de posibilidades, RP) de ambos grupos en comparacion con el de mujeres de 20 a 34 anos de edad. La comparacion entre grupos se efectuo mediante la prueba de Fisher o de ji2, segun el caso, y el analisis de tendencias en el periodo estudiado se realizo mediante la correlacion de Pearson con un nivel alfa de 0,05. RESULTADOS: En el periodo estudiado, las tasas de mortalidad materna, fetal tardia, neonatal e infantil en madres adolescentes menores de 15 anos fueron, respectivamente, de 41,9 (por 100 000 nacidos vivos [NV]), 5,1 (por 1 000 NV), 15,2 (por 1 000 NV) y 27,4 (por 1 000 NV); en adolescentes de 15 a 19 anos, de 19,3, 4,1, 8,1 por 1 000 y 16,6, respectivamente, mientras que en adultas de 20 a 34 anos dichas tasas fueron de 26,8, 5,0, 6,7 y 12,1, respectivamente. En las adolescentes menores de 15 anos el mayor riesgo de muerte materna (RP = 1,56; IC95%: 0,50 a 4,31; P = 0,372) y de muerte fetal (RP = 1,02; IC95%: 0,76 a 1,36; P = 0,890) no fue estadisticamente significativo; en cambio, si se detecto un riesgo significativamente mayor de muerte neonatal (RP = 2,27; IC95%: 1,92 a 2,68; P <0,0001) y el de muerte infantil (RP = 2,39; IC95%: 2,04 a 2,62; P <0,0001). Entre las madres adolescentes de 15 a 19 anos, el riesgo de muerte materna (RP = 0,72; IC95%: 0,56 a 0,92; P <0,008) y el de muerte fetal (RP = 0,81; IC95%: 0,77 a 0,86; P <0,0001) fueron inferiores en grado significativo en comparacion con los del grupo testigo, mientras que el riesgo de muerte neonatal (RP = 1,20; IC95%: 1,16 a 1,25; P <0,0001) y el de muerte infantil (RP = 1,38; IC95%: 1,35 a 1,42; P <0,0001) fueron significativamente superiores. Tanto en las madres adolescentes mayores como en las del grupo testigo se observo una tendencia descendente significativa de la mortalidad materna, fetal, neonatal e infantil en el periodo estudiado; en las adolescentes menores solo la mortalidad neonatal y la mortalidad infantil descendieron significativamente. Tambien se observo una tendencia ascendente del numero de nacidos vivos entre los dos grupos de madres adolescentes, pero dicha tendencia fue significativa solamente entre las menores de 15 anos, mientras que en el grupo testigo se observo una tendencia descendente estadisticamente significativa. CONCLUSIONES: Los resultados confirman que, en el periodo estudiado, las madres adolescentes chilenas tuvieron riesgos reproductivos elevados en comparacion con las mujeres de 20 a 34 anos y que el numero de nacidos vivos de madres adolescentes mostro una tendencia ascendente durante el periodo, pero de un modo significativo solamente en las menores de 15 anos. Los resultados apuntan a la necesidad de crear programas que permitan mejorar la educacion sexual y la regulacion de la fecundidad desde la adolescencia temprana.Objectives: To evaluate trends related to childbirth and reproductive risks among adolescent Chilean mothers under 15 years old and from 15 to 19 years of age in the period 1990-1999. Methods: Using the data base extracted from the Demographic Yearbooks published by the National Statistics Institute of Chile for 1990-1999 the trends in the number of live births and the rates of infant neonatal fetal and maternal mortality among adolescent mothers younger than 15 years old and from 15 to 19 years of age were calculated. The risk (probability ratio PR) of both groups was calculated in comparison with women from 20 to 34 years of age. The comparison between groups was carried out using the Fisher test or the £q 2 depending on the case and the analysis of trends in the period studied were carried out using the Pearsons correlationship with an alfa level of 0.05. Results: In the period studied the rates of maternal fetal neonatal and infant mortality in adolescent mothers under 15 were respectively 41.9 (per 100000 live births [LB]) 5.1 (per 1000 LB) 15.2 (per 1000 LB) and 27.4 (per 1000 LB); in adolescents from 15 to 19 years of age the figures were 19.3 4.1 8.1 per 1000 and 16.6 respectively; and in adults from 20 to 34 the rates were 26.8 5.0 6.7 12.1 respectively. In adolescents under 15 the greatest risk of maternal death (PR= 156; 95% confidence: 0.50 a 4.31; P = 0.372) and fetal death (PR = 1.02; 95% confidence: 0.76 to 1.36; P = 0.890) was not statistically significant; in contrast the study detected a significantly greater risk of neonatal death (PR = 2.27; 95% confidence: 1.92 to 2.68; P < 0.0001) and infant death (PR = 2.39; 95% confidence: 2.04 to 2.62; P < 0.0001). Among adolescent mothers from 15 to 19 years of age the risk of maternal death (PR = 0.72; 95% confidence: 0.56 to 0.92; P < 0.008) and fetal death (PR = 0.81; 95% confidence: 0.77 to 0.86; P < 0.0001) were significantly lower than the control group while the risk of neonatal death (PR = 1.20; 95% confidence: 1.16 to 1.25; P < 0.0001) and infant death (PR = 1.38; 95% confidence: 1.35 to 1.42; P < 0.0001) were significantly higher. Both the older adolescent mothers and the control group exhibited a significant downward trend in maternal fetal neonatal and infant mortality in the period studied; among the younger adolescents only neonatal mortality and infant mortality decreased significantly. An increase in the number of live births was also observed among the two groups of adolescent mothers but this trend was significant only among those under 15 while a statistically significant downward trend was observed in the control group. Conclusions: The results confirm that in the period studied adolescent Chilean mothers had high reproductive risks relative to women between 20 and 34 years of age while and that the number of live births by adolescent mothers showed a upward trend during the period but was only significant in the under-15 age group. The results highlight the need to create programs for the improvement of sexual education and the regulation of fertility in the early years of adolescence. (authors)OBJECTIVE For Chilean teenage mothers under 15 years old and from 15 to 19 years old, to evaluate the trends in birth rates and reproductive risk for the period of 1990-1999. METHODS A database was constructed using data from the Demography Yearbook (Anuario de demografia) volumes published by Chiles National Institute of Statistics (Instituto Nacional de Estadisticas) for 1990-1999. From that database we calculated the trends in the number of live births and in the rates of maternal mortality, late fetal mortality, neonatal mortality, and infant mortality among the teenage mothers under 15 and from 15 to 19 years old. We calculated the risk odds ratio (OR) for both of those age groups in comparison with women from 20 to 34 years old. The groups were compared using Fishers exact test or the chi-square test, and the analysis of trends in the period studied was carried out with Pearsons correlation, with an alpha level of 0.05. RESULTS In the period studied, for the teenage mothers under age 15, the respective rates for maternal mortality, late fetal mortality, neonatal mortality, and infant mortality were 41.9 per 100 000 live births, 5.1 per 1 000 live births, 15.2 per 1 000 live births, and 27.4 per 1 000 live births. For the adolescents from 15 to 19 years, the corresponding rates were 19.3, 4.1, 8.1, and 16.6; for the women 20-34 years old, they were 26.8, 5.0, 6.7, and 12.1. The adolescents under 15 had higher risks of maternal mortality (OR = 1.56; 95% confidence interval (CI): 0.50 to 4.31; P = 0.372) and of fetal mortality (OR = 1.02; 95% CI: 0.76 to 1.36; P = 0.890), but those differences were not statistically significant. However, the younger adolescents did have significantly higher risks of neonatal mortality (OR = 2.27; 95% CI: 1.92-2.68; P < 0.0001) and of infant mortality (OR = 2.39; 95% CI: 2.04 to 2.62; P < 0.0001). In comparison to the women 20-34 years old, the teenage mothers from 15 to 19 years old had significantly lower risks of maternal mortality (OR = 0.72; 95% CI: 0.56 to 0.92; P < 0.008) and of fetal mortality (OR = 0.81; 95% CI: 0.77 to 0.86; P < 0.0001) but significantly higher risks of neonatal mortality (OR = 1.20; 95% CI: 1.16 to 1.25; P < 0.0001) and of infant mortality (OR = 1.38; 95% CI: 1.35 to 1.42; P < 0.0001). Among both the older teenage mothers and the mothers 20-34 years old there was a significant downward trend in maternal, fetal, neonatal, and infant mortality rates in the period studied; in the younger adolescents only neonatal mortality and infant mortality declined significantly. There was a rising trend in the number of live births among the two groups of teenage mothers, but that trend was statistically significant only for the mothers under 15; among mothers 20-34 years old there was a statistically significant downward trend. CONCLUSIONS In the period studied, the Chilean teenage mothers faced greater reproductive risk than did the women 20-34 years old. The number of live births among teenage mothers tended to rise during the 1990-1999 period, but the change was significant only for the mothers under age 15. These results point to the need to develop programs that improve both sex education and birth control practices starting in early adolescence.