Birth weight and infant mortality in a Western Cape metropolitan area
The nature of the environment, as well as an infant's weight at birth, constitute the major risk factors associated with infant death. It is for this reason that the infant mortality rate is universally recognized as an important indicator of the health status of children, the efficacy of the health services, and the level of social and economic progress. An infant's birth weight is regarded as the most important single indicator of growth and development during uterine life, and as such is frequently used to indicate maternal nutritional status. The greatest risks of mortality and morbidity exist for those infants who are born with a low birth weight ((2500 grams). Any analysis of infant mortality, therefore, requires a sound understanding of the influences of birth weight on mortality. In this study, birth weight and infant mortality data have been used to characterize maternal and infant health status within a Regional Health Scheme. The cross-linkage of birth and infant death certificates has permitted the identification of those maternal and infant characteristics associated with the greatest risks of death, as well as the calculation of one of the most important infant mortality statistics, namely birth weight-specific death rates. The cross-linkage process has facilitated the identification of certain factors which are affecting the levels of infant mortality. The development of a statistic (ratio) for better describing the birth weight distribution is presented. Such a statistic is shown to be of value for the geographical analysis of maternal health status. Linear regression analysis applied to the birth weight ratio, and infant mortality rate is able to compare the 'health status' of mothers and infants in separate geographic units within the region. Birth weight is shown to be an important intervening variable between the circumstances of pregnancy and infant death. This study provides an alternative perspective to the understanding and assessment of infant mortality and its spatial variation, as well as aiding the identification of possible points for future intervention. The technique presented forms a useful epidemiological basis for the implementation of more appropriate strategies for reducing infantile mortality and enhancing the evaluation of interventive programmes. Moreover, the application of medical geographical methods is shown to provide practical advantages to health administrators in that maternal and neonatal health priorities may now be more reliably defined, as well as for the determination of future services in the various geographical areas.
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Department of Public Health and Family Medicine