A cohort of 1711 children born in Tari, Southern Highlands Province, Papua New Guinea was followed to determine the effect of birthweight on total and cause-specific mortality at varying ages during infancy. Mean birthweight was 3.04 kg, males were significantly heavier than females and first offspring significantly lighter than other offspring. Children weighing < or = 2.5 kg at birth accounted for 15% of all births and 32% of all deaths and were 2.7 times more likely to die in infancy than heavier children. Infant mortality was negatively associated with birthweight (p < 0.001). Mortality was very high among children with birthweight < or = 2 kg and was lowest in the 3.1-3.5 kg birthweight category. Pneumonia mortality declined with increasing birthweight in the 1-5 month age group, but in the 6-11 month age group the risk of death from pneumonia was the same among children with birthweight > 3.5 kg as those with birthweight < or = 2.5 kg. While control of infectious diseases will have a marked impact on infant mortality in the short term, longer-term interventions aimed at improving socioeconomic status are needed to improve nutritional status of both adults and children (including birthweight) and hence sustain the lower mortality levels achieved in young children. PIP: Birth weight is an important determinant of infant mortality in both developed and developing countries, with low birth weight associated with a high risk of neonatal death and an increased risk of death during the postneonatal period. 1711 children born in Tari, Southern Highlands Province, Papua New Guinea, were followed to assess the effect of birth weight upon total and cause-specific mortality at varying ages during infancy. The infants were of mean birth weight 3.04 kg, with males significantly heavier than females and first offspring significantly lighter than other offspring. Children weighing 2.5 kg or less at birth accounted for 15% of all births and 32% of all deaths, and were 2.7 times more likely to die in infancy than heavier children. Infant mortality was negatively associated with birth weight. For example, mortality was very high among children with birth weight of 2 kg or less and lowest among those of birth weight 3.1-3.5 kg. Pneumonia mortality declined with increasing birth weight at ages 1-5 months. However, in the 6-11 month age group, the risk of death from pneumonia was the same among children with birth weight of greater than 3.5 kg as it was among those with birth weight of 2.5 kg or less. Controlling infectious diseases will have a major impact upon infant mortality in the short-term, but longer-term interventions designed to improve socioeconomic status are needed to improve the nutritional status of both adults and children and thereby sustain the lower mortality levels achieved in young children.
Cause of Death ; Cohort Studies ; Female ; Humans ; Infant ; Male ; Papua New Guinea - epidemiology ; Pneumonia - mortality ; Proportional Hazards Models ; Rural Population

This cross-sectional study of women was conducted in a deprived area of Papua New Guinea with an estimated infant mortality rate of 133/1000 live births. Mortality patterns derived from birth histories showed that neonatal deaths contribute proportionally more to infant mortality than postneonatal deaths, emphasizing the need for better care at delivery. To examine possible mechanisms for intervention, pregnant women were interviewed to determine patterns of antenatal clinic use, antimalarial drugs and micronutrient supplements given, and how much the women smoked. The results showed that the health system was failing to implement current routine supplementation and prophylaxis regimens, and that there was a need to revise national guidelines. A large proportion of pregnant women smoked during pregnancy, and this behaviour could be a target for future public health campaigns and health worker promotion advice to women. PIP: A cross-sectional study conducted in 20 randomly selected villages in the impoverished Wosera Subdistrict, East Sepik Province, Papua New Guinea, in 1989 assessed infant mortality, antenatal attendance, and smoking during pregnancy in 1008 women. 60% of respondents had never attended school. The total fertility rate was 5.7/woman. The infant mortality rate was 133/1000 live births. Of the 3074 births reported by respondents, 52 were stillbirths (rate, 17/1000 births). The perinatal mortality rate was 80/1000, the neonatal mortality rate 88/1000, and the postneonatal mortality rate 45/1000. The finding that neonatal deaths contributed proportionately more to infant mortality than postneonatal deaths indicates a need for better care at delivery. Bacterial sepsis related to umbilical infection was common. Of the 109 women pregnant at the time of the survey, only 33 (30%) had been seen at the antenatal clinic. Few of these women were complying with chloroquine treatment (given every 6 weeks). 69% of pregnant women were current smokers of locally cultivated sun-dried tobacco and 68% chewed betel nut during pregnancy. Overall, these findings indicate a need for major changes, including improved implementation of routine supplementation and prophylaxis regimens during pregnancy, health education around the dangers of smoking during pregnancy, improved attendance at antenatal care, and attention to the major causes of infant mortality.