Using annual time series data on neonatal deaths in Zimbabwe from 1966 to 2018, we model and forecast number of neonatal deaths over the next 25 years using the Box – Jenkins ARIMA technique. Diagnostic tests such as the ADF tests show that Neonatal Deaths (ND) series is I (2). Based on the AIC, the study presents the ARIMA (8, 2, 0) model as the optimal model. The diagnostic tests further indicate that the presented model is stable and its residuals are stationary in levels. The results of the study reveal that the numbers of neonatal deaths per year are expected to decline sharply in the next 25 years. In order to keep on reducing neonatal deaths in Zimbabwe, the study offered a four-fold policy prescription. by Dr. Smartson. P. Nyoni and Mr. Thabani NyonI 2020. Analyzing neonatal deaths in Zimbabwe using box-jenkins arima models. International Journal on Integrated Education. 3, 7 (Jul. 2020), 39-50. DOI:https://doi.org/10.31149/ijie.v3i7.462. https://journals.researchparks.org/index.php/IJIE/article/view/462/441 https://journals.researchparks.org/index.php/IJIE/article/view/462
Three studies found that infant mortality rates increased with decreasing gestational age and birth weight. Infants born preterm, very preterm, or with very low birth weight had substantially higher mortality rates compared to term or normal birth weight infants. Two additional studies found higher rates of neonatal mortality and morbidity for late preterm infants compared to term infants. Three studies reported higher rates of stillbirth, perinatal mortality, and infant mortality with increasing maternal obesity, including a dose-dependent relationship between higher BMI and increased mortality. One study also found higher rates of miscarriage with obesity.
Hospital based study on perinatal mortality in RIMS,Manipuriosrjce
IOSR Journal of Dental and Medical Sciences is one of the speciality Journal in Dental Science and Medical Science published by International Organization of Scientific Research (IOSR). The Journal publishes papers of the highest scientific merit and widest possible scope work in all areas related to medical and dental science. The Journal welcome review articles, leading medical and clinical research articles, technical notes, case reports and others.
This study evaluated risk factors for nosocomial infections in the neonatal intensive care unit (NICU) using surveillance data from 871 babies in 7 Japanese medical institutions. The results showed that the risk of nosocomial infection was significantly related to lower birth weight, male gender, and the insertion of a central venous catheter. The risk increased with decreasing birth weight, from 3.7% for babies over 1500g to 25.2% for babies under 1000g. Methicillin-resistant Staphylococcus aureus (MRSA) infections also increased with lower birth weight, from 0.3% over 1500g to 11.1% under 1000g. Device use other than central venous catheters did not significantly increase infection
AN ANALYSIS OF OUTCOMES IN TWIN PREGNANCIES WITH ACTIVE FETAL SURVEILLANCE AN...Apollo Hospitals
The incidence of multiple gestations is increasing with
increasing maternal age and use of assisted reproduction
techniques. Selective fetal reduction of multifetal pregnancies is now widely practiced to reduce the higher order multiples to twins based on evidence from nonrandomised studies which suggests that this will improve the perinatal outcome. The proportion of twin pregnancies with unique fetal and maternal problems is therefore increasing. Optimising maternal, fetal and perinatal outcomes in twin pregnancies continues to be a formidable challenge in the present day clinical practice.
Preterm Premature Rupture of Membranes and Neonatal and Maternal Outcomesremedypublications2
The management of Preterm Premature Rupture of Membranes (PPROM) remains
controversial. PPROM may lead significant maternal and neonatal complications.
Methods: Retrospective data of PPROM cases managed in Suleymaniye Maternity Research and
Training Hospital between 2008 and 2012 were collected and analyzed using SPSS.
This study examined trends in the incidence of ectopic pregnancy in England and Wales from 1966 to 1996 using official hospitalization statistics. The results showed that the recorded incidence of ectopic pregnancy increased approximately 4.5 times over this period, from 3.45 to 15.5 per 1000 maternities. The rate of increase was not uniform, approximately doubling between 1966-1985, then again nearly doubling by 1989. The incidence has remained stable in recent years. The trends were similar across different age groups. The increasing incidence is likely due to both improved diagnostic tests and an actual increase possibly related to a sexually transmitted infection.
INTERNATIONAL PUBLICATION International journal of gynecology & obstetri...Dr Muhammad Mustansar
This document summarizes a 5-year study of maternal mortality in Faisalabad City, Pakistan from 1989-1993. The study found 215 maternal deaths during this period, giving a maternal mortality rate of 0.77 deaths per 1,000 live births. The main causes of death were postpartum hemorrhage (23.3%), pregnancy induced hypertension/eclampsia (15.8%), and non-obstetric causes (15.8%). Efforts like traditional birth attendant training, community education, antenatal checkups, and improved obstetric care were found to help reduce the maternal mortality rate in the region over this time period.
Three studies found that infant mortality rates increased with decreasing gestational age and birth weight. Infants born preterm, very preterm, or with very low birth weight had substantially higher mortality rates compared to term or normal birth weight infants. Two additional studies found higher rates of neonatal mortality and morbidity for late preterm infants compared to term infants. Three studies reported higher rates of stillbirth, perinatal mortality, and infant mortality with increasing maternal obesity, including a dose-dependent relationship between higher BMI and increased mortality. One study also found higher rates of miscarriage with obesity.
Hospital based study on perinatal mortality in RIMS,Manipuriosrjce
IOSR Journal of Dental and Medical Sciences is one of the speciality Journal in Dental Science and Medical Science published by International Organization of Scientific Research (IOSR). The Journal publishes papers of the highest scientific merit and widest possible scope work in all areas related to medical and dental science. The Journal welcome review articles, leading medical and clinical research articles, technical notes, case reports and others.
This study evaluated risk factors for nosocomial infections in the neonatal intensive care unit (NICU) using surveillance data from 871 babies in 7 Japanese medical institutions. The results showed that the risk of nosocomial infection was significantly related to lower birth weight, male gender, and the insertion of a central venous catheter. The risk increased with decreasing birth weight, from 3.7% for babies over 1500g to 25.2% for babies under 1000g. Methicillin-resistant Staphylococcus aureus (MRSA) infections also increased with lower birth weight, from 0.3% over 1500g to 11.1% under 1000g. Device use other than central venous catheters did not significantly increase infection
AN ANALYSIS OF OUTCOMES IN TWIN PREGNANCIES WITH ACTIVE FETAL SURVEILLANCE AN...Apollo Hospitals
The incidence of multiple gestations is increasing with
increasing maternal age and use of assisted reproduction
techniques. Selective fetal reduction of multifetal pregnancies is now widely practiced to reduce the higher order multiples to twins based on evidence from nonrandomised studies which suggests that this will improve the perinatal outcome. The proportion of twin pregnancies with unique fetal and maternal problems is therefore increasing. Optimising maternal, fetal and perinatal outcomes in twin pregnancies continues to be a formidable challenge in the present day clinical practice.
Preterm Premature Rupture of Membranes and Neonatal and Maternal Outcomesremedypublications2
The management of Preterm Premature Rupture of Membranes (PPROM) remains
controversial. PPROM may lead significant maternal and neonatal complications.
Methods: Retrospective data of PPROM cases managed in Suleymaniye Maternity Research and
Training Hospital between 2008 and 2012 were collected and analyzed using SPSS.
This study examined trends in the incidence of ectopic pregnancy in England and Wales from 1966 to 1996 using official hospitalization statistics. The results showed that the recorded incidence of ectopic pregnancy increased approximately 4.5 times over this period, from 3.45 to 15.5 per 1000 maternities. The rate of increase was not uniform, approximately doubling between 1966-1985, then again nearly doubling by 1989. The incidence has remained stable in recent years. The trends were similar across different age groups. The increasing incidence is likely due to both improved diagnostic tests and an actual increase possibly related to a sexually transmitted infection.
INTERNATIONAL PUBLICATION International journal of gynecology & obstetri...Dr Muhammad Mustansar
This document summarizes a 5-year study of maternal mortality in Faisalabad City, Pakistan from 1989-1993. The study found 215 maternal deaths during this period, giving a maternal mortality rate of 0.77 deaths per 1,000 live births. The main causes of death were postpartum hemorrhage (23.3%), pregnancy induced hypertension/eclampsia (15.8%), and non-obstetric causes (15.8%). Efforts like traditional birth attendant training, community education, antenatal checkups, and improved obstetric care were found to help reduce the maternal mortality rate in the region over this time period.
This document compares two methods for estimating fetal weight near term - Johnson's formula based on symphysiofundal height measurements and Hadlock's formula based on ultrasound measurements. A study of 100 pregnancies found that Johnson's formula overestimated fetal weight in all cases, while Hadlock's formula both overestimated and underestimated depending on actual birth weight. Hadlock's formula produced a more accurate estimation of fetal weight within 100g in 68% of cases compared to 30% for Johnson's formula. Although ultrasound using Hadlock's formula was more accurate, Johnson's formula provides a low-cost alternative that is still reasonably accurate when ultrasound is unavailable.
The document summarizes a study on women's awareness of initiating and continuing breastfeeding after cesarean section in Baghdad, Iraq. The study involved surveying 30 women who had cesarean sections using a questionnaire. The results showed that 43.3% initiated breastfeeding within 24 hours of their c-section. 76.7% continued breastfeeding, though only 26% practiced exclusive breastfeeding. The study aimed to identify factors influencing breastfeeding initiation and continuation after c-sections. It recommended promoting breastfeeding through baby-friendly hospital initiatives and counseling women during pregnancy and after birth.
Breastfeeding Practices of Postnatal Mothers: Exclusivity, Frequency and Dura...IJEAB
This study examined breastfeeding practices of 299 postnatal mothers in southeast Nigeria in terms of exclusivity, frequency, and duration. The results showed that most mothers exclusively breastfed for a short period, with 22.3% exclusively breastfeeding for 1 month and 31.5% for 4-6 months. The majority (80.7%) breastfed infants on demand day and night, while 40.5% reported infants suckling for over 20 minutes. Breastfeeding patterns were found to differ across primary, secondary, and tertiary health institutions, though not significantly. The study concluded that efforts are needed to motivate mothers to exclusively breastfeed for the recommended 6 months.
Pregnancy Outcome Comparison in Elderly and Non Elderly Primigravida attending at Mahila Chikitsalay, Jaipur (Rajasthan) India-Pregnancy and child birth are normal physiological processes and outcomes of most of the pregnancies are good but sometimes because of some reasons it has bad outcomes; out of that one is supposed to be elderly primi. But nowadays it becomes essential to delay the pregnancy in changing social and economic trend. Simultaneously higher advanced technique and better supported maternal and neonatal care also exist. So to have an idea of balance between these this case-control study was done on 120 elderly and 120 non-elderly primigravida to compare the pregnancy outcomes. To find out the association Chi-Square and Unpaired‘t’ test was used. It was observed in this study that although there was no significant difference in antenatal maternal pregnancy outcomes but PPH, induction of labor, cervix dystocia were significantly more in elderly. Likewise time taken to start with breast feeding was also more in elderly. In case of newborn mean APGAR score and mean birth weight was significantly lesser in elderly than non-elderly.
Current point of view in preterm labor management in albania (2)Alexander Decker
This study examined the use of maintenance tocolysis therapy to prevent preterm labor in Albania. The study included 325 pregnant women between 28-32 weeks gestation hospitalized for preterm labor. Women received tocolysis therapy for over one month. Those between 28-30 weeks (n=200) had greater benefits, with pregnancy prolonged by 6-8 weeks on average. The authors conclude maintenance tocolysis therapy can considerably prolong pregnancy for women diagnosed with preterm labor between 28-32 weeks gestation, though larger studies are still needed.
Unsafe abortion is a significant public health issue in Indonesia. An estimated 3.21 million abortions occur annually in Indonesia, the majority of which are unsafe. Unsafe abortions are performed outside of health care facilities by unskilled providers and in unsanitary conditions, leading to complications and an unknown number of deaths each year. Expanding access to contraception and safe abortion services performed by skilled clinicians is necessary to reduce the health risks of unsafe abortion in Indonesia.
The study analyzed records of 17,787 Holstein cows from 1999 to 2004 to investigate the effects of environmental factors on abortion rates and offspring sex ratios. The overall abortion mean was 5.80% and was significantly affected by season and year of calving, with higher rates in spring and summer. The overall offspring sex ratio mean was 51.05% male. Year of conception and calving interval significantly affected sex ratio, with ratios skewed in some years and intervals. The document provides background on abortion and sex ratio in cattle before presenting results of the statistical analysis of the data, which found some environmental factors had significant impacts on the two traits studied.
This document compares the use of intravaginal misoprostol tablets and intracervical dinoprostone gel for cervical ripening and labor induction. A study of 200 women found that dinoprostone gel resulted in a shorter mean induction to delivery interval, more spontaneous vaginal births, and fewer C-sections and instrument-assisted deliveries than misoprostol. Neonatal outcomes were similar between the two groups, with most babies experiencing no complications. The study concluded that dinoprostone gel is more effective than misoprostol for cervical ripening and labor induction in nulliparous and primiparous women at term with an unfavorable cervix.
Effectiveness of Early Ambulation on Post Operative Recovery among the Women ...ijtsrd
The document discusses a study that assessed the effectiveness of early ambulation on post-operative recovery among women who had undergone cesarean section (CS). The study involved 60 women, randomly assigned to either an experimental group that received early ambulation intervention or a control group. The experimental group showed gradual improvement in post-operative recovery from day 1 to day 3, while the control group also improved but to a lesser extent. The study concluded that early ambulation was effective in improving activities of daily living for post-CS women compared to the control group.
Nuclear TK1 expression is an independent prognostic factor for survival in pr...Enrique Moreno Gonzalez
TK1 expression was determined by immunohistochemistry in cervical lesions (cervical intraepithelial neoplasia (CIN), n = 216; invasive cervical carcinoma, n = 84). TK1 and Ki-67
expressions and pathological/FIGO stages and age were correlated with 5-year survival by Kaplan-Meier, log rank and COX hazard uni- and multivariate analyses.
Indications and Outcomes of Emergency Caesarean Section at St Paul’s Hospital...Crimsonpublishers-IGRWH
Cesarean Section (CS) rates and their indications vary all over the World. Audit of indications and factors affecting infant and maternal outcome remain an important activity in rationalizing the use of this major procedure in obstetrics practice. Cesarean section (CS) carries a higher maternal morbidity and mortality compared to vaginal delivery. Noresearches have been done on this area.
This document discusses new concepts in oral contraceptive intake, specifically the 24/4 regimen. It begins by providing background on different generations of combined oral contraceptives. It then introduces the 24/4 regimen, which contains ethinylestradiol and drospirenone over 24 days followed by 4 hormone-free days. Studies show this regimen more effectively inhibits follicular development compared to the traditional 21/7 regimen. The 24/4 regimen provides 3 extra days of anti-mineralocorticoid and antiandrogenic effects, and may reduce hormone-withdrawal symptoms. A large observational study found the 24/4 regimen with drospirenone, specifically Yaz, had the lowest contraceptive failure rates including in
Placental Elastography in Intrauterine Growth Restriction: A Case–control Studyasclepiuspdfs
Background: Intrauterine growth restriction (IUGR) is related to poor fetal outcome. Though, various tools are available for evaluation of IUGR they are notreliable inearly diagnosis of IUGR. Shear wave elastography (SWE) can be used to study the change in mechanical properties of various disease which can be a potential technique for early diagnosis of IUGR. Objective: The objective of the study was to compare the differences in SWE values of placentas between IUGR and normal pregnancies. Methodology: Normal second- and third-trimester pregnancies and IUGR pregnancies between 24 and 42 weeks period of gestation (POG), meeting the inclusion criteria were matched for age group and POG. SWE of placenta was performed in supine position during quiet respiration. The SWE of placenta was measured by placing the region of interest in relatively homogeneous area. The placental elasticity values obtained in pregnancies complicated by IUGR were compared with that of normal controls. Umbilical artery (UA) and fetal middle cerebral artery (MCA) Doppler findings were correlated with placental elasticity value of IUGR pregnancies.
- The study analyzed data on egg production (in grams per day) by birds aged 18-87 weeks to determine the optimal age for production.
- Polynomial regression found that a cubic model best described the relationship, with maximum production at 44.36 weeks of 12.14 grams per day.
- Birds were found to be most productive between 34.5-54.5 weeks, producing at least 7.11 grams daily.
- The study recommends not keeping birds beyond 54.5 weeks for optimal egg production.
This study assessed the acceptability and feasibility of menstrual regulation with medication (MRM) among early pregnant women in Bangladesh. 294 women underwent MRM using mifepristone followed by misoprostol. 91% had successful termination, with most complaining of moderate bleeding and pain. 87% found the side effects acceptable. 90% were satisfied with MRM and said they would recommend it. The study concluded MRM is a safe, effective and acceptable method for early termination in Bangladesh that could help reduce unsafe abortions.
Neonatal and Obstetric Risk Assessment (NORA) Pregnancy Cohort Study in Singa...Premier Publishers
The Neonatal and Obstetric Risk Assessment (NORA) pregnancy cohort study was set up to assess clinical, biochemical and biophysical markers for risk assessment and prediction of the outcomes early in pregnancy. A total of 3271 patients who were in KK Women’s and Children’s Hospital between September 2010 and October 2014 were screened and 1013 patients consented to participate in the study. Women were followed at 18 to 22 weeks, 28 to 32 weeks and 34 weeks and above, till their postnatal discharge from the hospital. Finally, 926 patients remained for studying the outcome. In NORA study, we established locally derived and gestational age-specific reference intervals for the five thyroid hormone parameters. Higher serum progesterone levels at 28–32 weeks of pregnancy were observed in women who had preterm deliveries compared with women with term deliveries in the cohort. We also found that extracellular vesicle (EV) biomarkers enhanced the predictive robustness of an existing pre-eclampsia (PE) biomarker sufficiently to justify PE screening in a low-risk general obstetric population. We plan to further conduct a range of serial assessments from the biosamples which will provide a comprehensive and valuable information of the dynamics of maternal conditions and fetal development during pregnancy.
This document is a curriculum vitae for Dr. Kaberi Banerjee. It summarizes her educational background, qualifications, work experience, publications, presentations, memberships, and awards. She received her medical degree and MD from AIIMS in New Delhi. Her work experience includes positions at AIIMS, Guy's Hospital in London, and as Medical Director of her own fertility center. She has numerous publications and has presented her research internationally and in India.
Epidemiological Determinants affecting Caesarean Section in a Rural Block of ...iosrjce
IOSR Journal of Dental and Medical Sciences is one of the speciality Journal in Dental Science and Medical Science published by International Organization of Scientific Research (IOSR). The Journal publishes papers of the highest scientific merit and widest possible scope work in all areas related to medical and dental science. The Journal welcome review articles, leading medical and clinical research articles, technical notes, case reports and others.
The Breast Cancer Epidemic: Modeling and Forecasts Based on Abortion and Othe...Mario Guillermo Simonovich
Using data on breast cancer incidence and abortion rates from eight European countries, the document examines trends and forecasts future trends. It finds that induced abortion is the best predictor of breast cancer incidence, while fertility is also a useful predictor. A linear regression model including abortion and fertility rates as explanatory variables accurately predicted observed breast cancer incidence in subsequent years in England and Wales. The model forecasts a 50.9% increase in breast cancer incidence in England and Wales by 2025, corresponding to an annual 1.7% compound increase.
This document summarizes a study that evaluated the effects of various maternal, fetal, and technical factors on the accuracy of sonographic fetal weight estimation (SFWE). The study analyzed over 9,000 SFWEs performed within a week of delivery. It found that several maternal factors, including higher weight, height, BMI, older age, diabetes, and multiparity were associated with underestimation of fetal weight. Fetal factors like male sex were also linked to underestimation, while breech presentation slightly improved accuracy. Experience level of the sonographer had little effect. Overall, the models assessed explained less than 10% of errors, suggesting most inaccuracy comes from limitations of SFWE formulas themselves.
A box-jenkins sarima analysis of dysentery cases in children aged below five ...SubmissionResearchpa
This piece of work uses monthly time series data on new dysentery cases at Gweru Provincial Hospital (GPH) from Janaury 2010 to December 2018, to predict dysentery cases over the period January 2019 to December 2020. As confirmed by unit root tests, the series under consideration is basically an I (1) variable. The study applied the Box-Jenkins “catch all” model. Residual analysis of this model indicates that the model is stable and thus suitable for predicting dysentery cases at GPH over the out-of-sample period. The results of the study reveal that dysentery cases will be on the rise at GPH over the out-of-sample period; characterized by seasonal repeats in December each year. The study offers a two-fold policy recommendation in order to help policy makers in the fight against dysentery in children under five years of age within the GPH catchment area. by Dr. Smartson. P. Nyon and Mr. Thabani Nyoni 2020. A box-jenkins sarima analysis of dysentery cases in children aged below five at a provincial hospital in Zimbabwe. International Journal on Integrated Education. 3, 7 (Jul. 2020), 33-38. DOI:https://doi.org/10.31149/ijie.v3i7.461. https://journals.researchparks.org/index.php/IJIE/article/view/461/440 https://journals.researchparks.org/index.php/IJIE/article/view/461
This document discusses fitting probability distributions to maternal mortality rate (MMR) data in Nigeria. Four distributions were fitted to the MMR data: gamma, lognormal, Weibull, and exponential. The Akaike information criterion (AIC) and Bayesian information criterion (BIC) were used to select the best fitting distribution. The exponential distribution had the lowest AIC and BIC values, indicating it was the best fitting distribution. The estimated rate parameter for the exponential distribution was 0.5853659, with this model providing the best fit for analyzing MMR in Nigeria.
This document compares two methods for estimating fetal weight near term - Johnson's formula based on symphysiofundal height measurements and Hadlock's formula based on ultrasound measurements. A study of 100 pregnancies found that Johnson's formula overestimated fetal weight in all cases, while Hadlock's formula both overestimated and underestimated depending on actual birth weight. Hadlock's formula produced a more accurate estimation of fetal weight within 100g in 68% of cases compared to 30% for Johnson's formula. Although ultrasound using Hadlock's formula was more accurate, Johnson's formula provides a low-cost alternative that is still reasonably accurate when ultrasound is unavailable.
The document summarizes a study on women's awareness of initiating and continuing breastfeeding after cesarean section in Baghdad, Iraq. The study involved surveying 30 women who had cesarean sections using a questionnaire. The results showed that 43.3% initiated breastfeeding within 24 hours of their c-section. 76.7% continued breastfeeding, though only 26% practiced exclusive breastfeeding. The study aimed to identify factors influencing breastfeeding initiation and continuation after c-sections. It recommended promoting breastfeeding through baby-friendly hospital initiatives and counseling women during pregnancy and after birth.
Breastfeeding Practices of Postnatal Mothers: Exclusivity, Frequency and Dura...IJEAB
This study examined breastfeeding practices of 299 postnatal mothers in southeast Nigeria in terms of exclusivity, frequency, and duration. The results showed that most mothers exclusively breastfed for a short period, with 22.3% exclusively breastfeeding for 1 month and 31.5% for 4-6 months. The majority (80.7%) breastfed infants on demand day and night, while 40.5% reported infants suckling for over 20 minutes. Breastfeeding patterns were found to differ across primary, secondary, and tertiary health institutions, though not significantly. The study concluded that efforts are needed to motivate mothers to exclusively breastfeed for the recommended 6 months.
Pregnancy Outcome Comparison in Elderly and Non Elderly Primigravida attending at Mahila Chikitsalay, Jaipur (Rajasthan) India-Pregnancy and child birth are normal physiological processes and outcomes of most of the pregnancies are good but sometimes because of some reasons it has bad outcomes; out of that one is supposed to be elderly primi. But nowadays it becomes essential to delay the pregnancy in changing social and economic trend. Simultaneously higher advanced technique and better supported maternal and neonatal care also exist. So to have an idea of balance between these this case-control study was done on 120 elderly and 120 non-elderly primigravida to compare the pregnancy outcomes. To find out the association Chi-Square and Unpaired‘t’ test was used. It was observed in this study that although there was no significant difference in antenatal maternal pregnancy outcomes but PPH, induction of labor, cervix dystocia were significantly more in elderly. Likewise time taken to start with breast feeding was also more in elderly. In case of newborn mean APGAR score and mean birth weight was significantly lesser in elderly than non-elderly.
Current point of view in preterm labor management in albania (2)Alexander Decker
This study examined the use of maintenance tocolysis therapy to prevent preterm labor in Albania. The study included 325 pregnant women between 28-32 weeks gestation hospitalized for preterm labor. Women received tocolysis therapy for over one month. Those between 28-30 weeks (n=200) had greater benefits, with pregnancy prolonged by 6-8 weeks on average. The authors conclude maintenance tocolysis therapy can considerably prolong pregnancy for women diagnosed with preterm labor between 28-32 weeks gestation, though larger studies are still needed.
Unsafe abortion is a significant public health issue in Indonesia. An estimated 3.21 million abortions occur annually in Indonesia, the majority of which are unsafe. Unsafe abortions are performed outside of health care facilities by unskilled providers and in unsanitary conditions, leading to complications and an unknown number of deaths each year. Expanding access to contraception and safe abortion services performed by skilled clinicians is necessary to reduce the health risks of unsafe abortion in Indonesia.
The study analyzed records of 17,787 Holstein cows from 1999 to 2004 to investigate the effects of environmental factors on abortion rates and offspring sex ratios. The overall abortion mean was 5.80% and was significantly affected by season and year of calving, with higher rates in spring and summer. The overall offspring sex ratio mean was 51.05% male. Year of conception and calving interval significantly affected sex ratio, with ratios skewed in some years and intervals. The document provides background on abortion and sex ratio in cattle before presenting results of the statistical analysis of the data, which found some environmental factors had significant impacts on the two traits studied.
This document compares the use of intravaginal misoprostol tablets and intracervical dinoprostone gel for cervical ripening and labor induction. A study of 200 women found that dinoprostone gel resulted in a shorter mean induction to delivery interval, more spontaneous vaginal births, and fewer C-sections and instrument-assisted deliveries than misoprostol. Neonatal outcomes were similar between the two groups, with most babies experiencing no complications. The study concluded that dinoprostone gel is more effective than misoprostol for cervical ripening and labor induction in nulliparous and primiparous women at term with an unfavorable cervix.
Effectiveness of Early Ambulation on Post Operative Recovery among the Women ...ijtsrd
The document discusses a study that assessed the effectiveness of early ambulation on post-operative recovery among women who had undergone cesarean section (CS). The study involved 60 women, randomly assigned to either an experimental group that received early ambulation intervention or a control group. The experimental group showed gradual improvement in post-operative recovery from day 1 to day 3, while the control group also improved but to a lesser extent. The study concluded that early ambulation was effective in improving activities of daily living for post-CS women compared to the control group.
Nuclear TK1 expression is an independent prognostic factor for survival in pr...Enrique Moreno Gonzalez
TK1 expression was determined by immunohistochemistry in cervical lesions (cervical intraepithelial neoplasia (CIN), n = 216; invasive cervical carcinoma, n = 84). TK1 and Ki-67
expressions and pathological/FIGO stages and age were correlated with 5-year survival by Kaplan-Meier, log rank and COX hazard uni- and multivariate analyses.
Indications and Outcomes of Emergency Caesarean Section at St Paul’s Hospital...Crimsonpublishers-IGRWH
Cesarean Section (CS) rates and their indications vary all over the World. Audit of indications and factors affecting infant and maternal outcome remain an important activity in rationalizing the use of this major procedure in obstetrics practice. Cesarean section (CS) carries a higher maternal morbidity and mortality compared to vaginal delivery. Noresearches have been done on this area.
This document discusses new concepts in oral contraceptive intake, specifically the 24/4 regimen. It begins by providing background on different generations of combined oral contraceptives. It then introduces the 24/4 regimen, which contains ethinylestradiol and drospirenone over 24 days followed by 4 hormone-free days. Studies show this regimen more effectively inhibits follicular development compared to the traditional 21/7 regimen. The 24/4 regimen provides 3 extra days of anti-mineralocorticoid and antiandrogenic effects, and may reduce hormone-withdrawal symptoms. A large observational study found the 24/4 regimen with drospirenone, specifically Yaz, had the lowest contraceptive failure rates including in
Placental Elastography in Intrauterine Growth Restriction: A Case–control Studyasclepiuspdfs
Background: Intrauterine growth restriction (IUGR) is related to poor fetal outcome. Though, various tools are available for evaluation of IUGR they are notreliable inearly diagnosis of IUGR. Shear wave elastography (SWE) can be used to study the change in mechanical properties of various disease which can be a potential technique for early diagnosis of IUGR. Objective: The objective of the study was to compare the differences in SWE values of placentas between IUGR and normal pregnancies. Methodology: Normal second- and third-trimester pregnancies and IUGR pregnancies between 24 and 42 weeks period of gestation (POG), meeting the inclusion criteria were matched for age group and POG. SWE of placenta was performed in supine position during quiet respiration. The SWE of placenta was measured by placing the region of interest in relatively homogeneous area. The placental elasticity values obtained in pregnancies complicated by IUGR were compared with that of normal controls. Umbilical artery (UA) and fetal middle cerebral artery (MCA) Doppler findings were correlated with placental elasticity value of IUGR pregnancies.
- The study analyzed data on egg production (in grams per day) by birds aged 18-87 weeks to determine the optimal age for production.
- Polynomial regression found that a cubic model best described the relationship, with maximum production at 44.36 weeks of 12.14 grams per day.
- Birds were found to be most productive between 34.5-54.5 weeks, producing at least 7.11 grams daily.
- The study recommends not keeping birds beyond 54.5 weeks for optimal egg production.
This study assessed the acceptability and feasibility of menstrual regulation with medication (MRM) among early pregnant women in Bangladesh. 294 women underwent MRM using mifepristone followed by misoprostol. 91% had successful termination, with most complaining of moderate bleeding and pain. 87% found the side effects acceptable. 90% were satisfied with MRM and said they would recommend it. The study concluded MRM is a safe, effective and acceptable method for early termination in Bangladesh that could help reduce unsafe abortions.
Neonatal and Obstetric Risk Assessment (NORA) Pregnancy Cohort Study in Singa...Premier Publishers
The Neonatal and Obstetric Risk Assessment (NORA) pregnancy cohort study was set up to assess clinical, biochemical and biophysical markers for risk assessment and prediction of the outcomes early in pregnancy. A total of 3271 patients who were in KK Women’s and Children’s Hospital between September 2010 and October 2014 were screened and 1013 patients consented to participate in the study. Women were followed at 18 to 22 weeks, 28 to 32 weeks and 34 weeks and above, till their postnatal discharge from the hospital. Finally, 926 patients remained for studying the outcome. In NORA study, we established locally derived and gestational age-specific reference intervals for the five thyroid hormone parameters. Higher serum progesterone levels at 28–32 weeks of pregnancy were observed in women who had preterm deliveries compared with women with term deliveries in the cohort. We also found that extracellular vesicle (EV) biomarkers enhanced the predictive robustness of an existing pre-eclampsia (PE) biomarker sufficiently to justify PE screening in a low-risk general obstetric population. We plan to further conduct a range of serial assessments from the biosamples which will provide a comprehensive and valuable information of the dynamics of maternal conditions and fetal development during pregnancy.
This document is a curriculum vitae for Dr. Kaberi Banerjee. It summarizes her educational background, qualifications, work experience, publications, presentations, memberships, and awards. She received her medical degree and MD from AIIMS in New Delhi. Her work experience includes positions at AIIMS, Guy's Hospital in London, and as Medical Director of her own fertility center. She has numerous publications and has presented her research internationally and in India.
Epidemiological Determinants affecting Caesarean Section in a Rural Block of ...iosrjce
IOSR Journal of Dental and Medical Sciences is one of the speciality Journal in Dental Science and Medical Science published by International Organization of Scientific Research (IOSR). The Journal publishes papers of the highest scientific merit and widest possible scope work in all areas related to medical and dental science. The Journal welcome review articles, leading medical and clinical research articles, technical notes, case reports and others.
The Breast Cancer Epidemic: Modeling and Forecasts Based on Abortion and Othe...Mario Guillermo Simonovich
Using data on breast cancer incidence and abortion rates from eight European countries, the document examines trends and forecasts future trends. It finds that induced abortion is the best predictor of breast cancer incidence, while fertility is also a useful predictor. A linear regression model including abortion and fertility rates as explanatory variables accurately predicted observed breast cancer incidence in subsequent years in England and Wales. The model forecasts a 50.9% increase in breast cancer incidence in England and Wales by 2025, corresponding to an annual 1.7% compound increase.
This document summarizes a study that evaluated the effects of various maternal, fetal, and technical factors on the accuracy of sonographic fetal weight estimation (SFWE). The study analyzed over 9,000 SFWEs performed within a week of delivery. It found that several maternal factors, including higher weight, height, BMI, older age, diabetes, and multiparity were associated with underestimation of fetal weight. Fetal factors like male sex were also linked to underestimation, while breech presentation slightly improved accuracy. Experience level of the sonographer had little effect. Overall, the models assessed explained less than 10% of errors, suggesting most inaccuracy comes from limitations of SFWE formulas themselves.
A box-jenkins sarima analysis of dysentery cases in children aged below five ...SubmissionResearchpa
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This document discusses neonatal mortality measurement and summarizes recent developments. It covers:
1) Neonatal mortality rates can now be estimated annually through improved surveys, though data reliability remains a concern. Pregnancy history modules may better capture neonatal deaths.
2) Estimates of neonatal causes of death have been improved through increased country data, especially for large countries like India and China. Rates of infections and tetanus appear to be declining in some areas.
3) Surveys can be improved by modifying questions to better capture neonatal mortality and stillbirths, and through follow up verbal autopsies to obtain cause of death data for over 75% of neonatal deaths dependent on surveys.
This document discusses neonatal mortality measurement and summarizes recent developments. It covers:
1) Neonatal mortality rates can now be estimated annually through improved surveys, though data reliability remains a concern. Pregnancy history modules may better capture neonatal deaths.
2) Estimates of neonatal causes of death have been improved through increased country data, especially for large countries like India and China. Rates of infections and tetanus appear to be declining in some areas.
3) Surveys can be improved by modifying questions to better capture neonatal mortality and stillbirths, and through follow up verbal autopsies to obtain cause of death data for over 75% of neonatal deaths dependent on surveys.
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Maternal and neonatal mortality remains a public health burden around the globe most especially in developing countries. A well utilized antenatal care ANC is however among the identified interventions to reduce this burden of maternal and neonatal mortality rates. A lot of factors therefore predispose, enable and cause mothers to identify the need to utilize this service ANC .This study employed descriptive cross sectional survey design. A semi structured questionnaire consisting of demographic profile of the respondents, their knowledge about ANC services and the level of ANC utilization. Logistic regression analysis techniques and chi square were used for the categorical variables to examine the associations between the dependent and independent variables. Data analysis was done using the Statistical Package for Social Science software SPSS version 22. Majority 87 of postpartum mothers in the Sunyani municipality attended ANC at least once during their last pregnancy of which 95.6 had four or more visits and 77.1 initiated their ANC attendance within their first trimester. It was further observed that 97.3 of the mothers had good knowledge about ANC. Marital status and ANC knowledge were found to be significantly associated with ANC attendance. Stephen Owusu Sekyere | Kodua Freda "Factors Associated with Antenatal Care Service Utilization among Women with Children under Five Years in Sunyani Municipality, Ghana" Published in International Journal of Trend in Scientific Research and Development (ijtsrd), ISSN: 2456-6470, Volume-5 | Issue-3 , April 2021, URL: https://www.ijtsrd.com/papers/ijtsrd39882.pdf Paper URL: https://www.ijtsrd.com/other-scientific-research-area/other/39882/factors-associated-with-antenatal-care-service-utilization-among-women-with-children-under-five-years-in-sunyani-municipality-ghana/stephen-owusu-sekyere
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Developing Predictive Model for Infant Mortality Based on Maternal Determinants and
Nutrition Status of 0-59 Month Older Children using a Deep Learning Approach in Ethiopia
Childbirth practices in the akpabuyo rural health and demographic surveillanc...Alexander Decker
This document discusses a study on childbirth practices in rural communities in Akpabuyo, Nigeria. The study found that:
1) The majority (84.6%) of births occurred outside formal health facilities and were attended by traditional birth attendants. Only 15.4% of births occurred in hospitals or health centers.
2) Common objects used to cut the umbilical cord included knives (46.2%) and new razor blades (30.8%), with knives being most common. Methylated spirits (63.1%) and "western medicine" (23.8%) were most commonly used to treat the umbilical cord after birth.
3) While 39.5% of women sought
Varying work schedules are suspected of increasing risks to pregnant women and to fetal well being. In particular, maternal hormonal disturbance arising from sleep deprivation, circadian rhythm disruption might impair fetal growth or lead to complications. This review was based on few high quality studies.
IRJET - Cervical Cancer Prognosis using MARS and ClassificationIRJET Journal
This document describes a study that used data mining techniques like MARS and C5.0 classification to analyze cervical cancer prognosis and recurrence. The study used a dataset of 168 cervical cancer patients with 12 variables from a hospital tumor registry. MARS and C5.0 models were developed using a training set of 118 patients and tested on 50 patients. The C5.0 model had a higher average correct classification rate of 96% compared to 86% for MARS. The C5.0 model also identified the most important prognostic factors as pStage, pT, cell type and RT target Summary. The study demonstrated that data mining can help identify specific risk factors for recurrent cervical cancer.
International Journal of Mathematics and Statistics Invention (IJMSI) is an international journal intended for professionals and researchers in all fields of computer science and electronics. IJMSI publishes research articles and reviews within the whole field Mathematics and Statistics, new teaching methods, assessment, validation and the impact of new technologies and it will continue to provide information on the latest trends and developments in this ever-expanding subject. The publications of papers are selected through double peer reviewed to ensure originality, relevance, and readability. The articles published in our journal can be accessed online.
This document presents a sequential probit model analysis of infant mortality in Nigeria using 2003 Nigeria Demographic and Health Survey data. The analysis examined factors affecting an infant's survival (stage 1) and age at death (stage 2). For stage 1, results showed infant mortality was positively affected by birth order and breastfeeding duration, and negatively affected by mother's education, number of total children born, and place of delivery. For stage 2, only place of delivery significantly affected infant's age at death. The error terms between stages were found to be significantly correlated.
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Error detection in census data age reportingcimran15
Age is an important demographic variable that must be carefully considered in all demographic survey. The objective of this study is to conduct a comprehensive assessment of the age reporting in Census data. The study gave an estimate of age misrepresentation in the Nigeria 2006 Population and Housing Census Data.
The data used in this study was obtained from the 2006 Population and Housing Census Priority Table, Volume(III)published by the National Population Commission, Abuja, Nigeria, in April
2010.
Age heaping and digit preference were measured using modified Whipple's index and Myers index. Age Sex accuracy was also measured using the United Nation's age-sex accuracy index.
The reported Whipple's index for both sexes was 251 indicating presence of age heaping and it also showed age heaping at terminal digit 0 and 5 as 268 and 233 respectively. The Myers index had an overall index of 50.9, 49 for male and 52.82 for female population.
The evaluation of Nigeria 2006 Population and Housing Census Data based on the technique applied in this study indicates that the data is of poor quality as a result of the presence of age heaping and digit preference in recorded ages. Therefore modern methods such as a systematic data management system, compulsion to register birth, and standard smoothing techniques are thereby recommended for future data collection.
The effect of household characteristics on child mortality in ghanaAlexander Decker
- The study examined the relationship between household characteristics and child mortality in Ghana using 2011 survey data.
- Key findings were that child mortality rates varied significantly by region, with the highest rates in the northern regions and the lowest in the eastern region. Mortality was also higher in rural areas, among mothers with lower education levels, and children who were not breastfed.
- Factors most strongly associated with increased child mortality were mothers' education levels, breastfeeding practices, number of children ever born, region of residence, and materials used for house floors. Household structure, water source, and toilet facilities were not related to child mortality.
Nurses' Knowledge Concerning Neuroblastoma in Children at Oncology Units in B...iosrjce
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Analyzing neonatal deaths in Zimbabwe using box-jenkins arima models
1. Volume 3, Issue VII, July 2020 | 39
e-ISSN : 2620 3502
p-ISSN : 2615 3785
International Journal on Integrated Education
Analyzing neonatal deaths in Zimbabwe using box-jenkins
arima models
Dr. Smartson P. Nyoni1
, Mr. Thabani Nyoni2
1
ZICHIRe Project, University of Zimbabwe, Harare, Zimbabwe
2
Department of Economics, University of Zimbabwe, Harare, Zimbabwe
Email: smartson_p@gmail.com
ABSTRACT
Using annual time series data on neonatal deaths in Zimbabwe from 1966 to 2018, we model and forecast
number of neonatal deaths over the next 25 years using the Box – Jenkins ARIMA technique. Diagnostic tests such
as the ADF tests show that Neonatal Deaths (ND) series is I (2). Based on the AIC, the study presents the ARIMA
(8, 2, 0) model as the optimal model. The diagnostic tests further indicate that the presented model is stable and its
residuals are stationary in levels. The results of the study reveal that the numbers of neonatal deaths per year are
expected to decline sharply in the next 25 years. In order to keep on reducing neonatal deaths in Zimbabwe, the
study offered a four-fold policy prescription.
Keywords: neonatal deaths, Zimbabwe, model.
1. INTRODUCTION
Neonatal death can be defined as the number of neonates dying before reaching 28 days of age (Usman et al.
2019). The first 2 days after birth account for over 50% neonatal deaths, while the first week of life accounts for
over 75% of all neonatal deaths (Carlo & Travers, 2016). Actually, the risk of neonatal death is highest in the first
24 hours of life (Nouri et al., 2013). In fact, 2.6 million children died in the first month of life in 2016 – nearly
7000 newborn deaths every day – most of which occurred in the first week, with about 1 million dying on the first
day and close to 1 million dying within the next 6 days (UNICEF, 2017). The major causes of neonatal deaths are
birth asphyxia, prematurity, sepsis as well as congenital malformation (Carlo & Travers, 2016). Thus, neonatal
deaths are an indicator of healthcare systems in a country (Babaei et al. 2018) in the sense that neonatal deaths
reveal the health of children and development of the economy and culture of a country or region (Chengye, 2012).
Interestingly, neonatal deaths are preventable (Tachiwenyika et al., 2011). In order to enhance the prevention of
neonatal deaths, modeling and forecasting neonatal deaths is critical, especially in developing countries such as
Zimbabwe where neonatal deaths are still prevalent in large numbers. Therefore, this paper, will go a long way in
uncovering the dynamics of neonatal deaths in Zimbabwe and consequently shed more light on health policy
formulation.
1.2 OBJECTIVES OF THE STUDY
i. To investigate the years during which neonatal deaths peaked in Zimbabwe.
ii. To forecast the number of neonatal deaths for the out-of sample period.
iii. To examine the pattern of neonatal deaths for the out-of-sample period.
1.3 RELEVANCE OF THE STUDY
Neonatal death is still a major public health problem worldwide and accounts for more than 60% of
newborn deaths before their first birthday (UNICEF, 2008). Of the world’s 7.7 million deaths in those aged
younger than 5 years, 3.1 million are neonatal deaths (Rajaratnam et al. 2010). Approximately 99% of these
neonatal deaths occur in low and middle – income countries, mostly in sub-Saharan Africa (Lawn et al. 2005)
including Zimbabwe which continues to bear a heavy burden of neonatal mortality (Ministry of Health and Child
Care, 2007). This study seeks to examine and forecast the number of neonatal deaths in Zimbabwe. In order to
reduce the numbers of neonatal deaths to zero, there is need for reliable forecasts that will act as a guiding tool
for policy makers in the health sector; hence, the need for this study.
2. LITERATURE REVIEW
Sarpong (2013) modeled and forecasted maternal mortality ratio (MMR) at the Okomfo Anokye
Teaching Hospital in Kumasi, Ghana, from the year 2000 to 2010; using ARIMA models and found out that the
ARIMA (1, 0, 2) model was optimal for forecasting quarterly MMR at Okomfo Anokye Teaching Hospital. Ezeh
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et al. (2014) analyzed the determinants of neonatal mortality in Nigeria using the Cox Regression model and found
out that a higher birth order of newborns with a short birth interval of less or equal to 2 years and newborns with
a higher birth order with a longer birth interval of greater than 2 years were significantly associated with neonatal
mortality.
Nyoni (2019) modeled and forecasted maternal deaths in Zimbabwe using annual time series data
covering the period 1990 – 2015 and applied the Box-Jenkins ARIMA models and basically found out that in the
next decade (2016-2025), maternal deaths will increase. In another Zimbabwean study, Chaibva et al. (2019)
analyzed stillbirths and neonatal deaths in Mutare district: the study conducted a retrospective review of 346
patient records, of women who delivered at Sakubva Hospital and those reffered for Mutare district facilities to
Mutare Provincial Hospital, between January and June 2014 and then used descriptive statistics to explore the
contributors to stillbirths and neonatal deaths in Mutare. Their results basically show that of the 346 women,
15.6% (i.e. 54) experienced an adverse pregnancy outcome (stillbirth or neonatal death). Their results also indicate
that contributing factors to adverse pregnancy outcomes included birthweight, gestational age, delivery
complications and delivery methods. In yet another, most recent Zimbabwean study, Nyoni & Nyoni (2020)
analyzed monthly time series data on neonatal death cases at Chitungwiza Central Hospital (CCH) from January
2013 to December 2018 using Box-Jenkins SARIMA models and found out that there will be a slow but steady
decrease in neonatal deaths at CCH over the out-of-sample period, that is, January 2019 to December 2020.
Mishra et al. (2019) forecasted Infant Mortality Rates (IMR) in India using ARIMA models. The forecast
of the sample period (1971-2016) indicated accuracy by the selected ARIMA (2, 1, 1) model. The post sample
forecast with the ARIMA (2, 1, 1) model revealed a decreasing trend of IMR (2017-2025). The forecast IMR for
2025 was found to be 15/1000 live births. Khan et al. (2019) modeled and forecasted IMR of Asian countries
using the log-log regression and ARIMA models and found out that there was a negative correlation between IMR
and GDP (PPP). Secondary data of IMR and GDP (PPP) from 1980 to 2015 was analyzed and forecast was done
from 2016 to 2025: the AR (1) model was found for all countries except Japan and Nepal for which the ARIMA
(1, 1, 1) model was found suitable. Usman et al. (2019) analyzed the incidence of the rate of neonatal mortality in
Nigeria using ARIMA models. Their trend plot of the incidence indicated that there was a steady decrease in the
incidence rate over the years. The ARIMA (1, 1, 1) model was found to be the optimal model. The time series
analysis also revealed that the neonatal mortality rate has reduced by 17.8% from 51.7% in the year 1990 to 33.9%
in the year 2017. This paper follows the leads of Usman et al. (2019) and is the first country-specific study which
has forecasted neonatal deaths in Zimbabwe.
3. MATERIALS & METHODS
ARIMA Models
Autoregressive Integrated Moving Average (ARIMA) models deliver more accurate forecasts than
econometric techniques (Song et al., 2003b). In fact, ARIMA models perform better than multivariate models in
forecasting (du Preez & Witt, 2003). ARIMA models were developed by Box & Jenkins (1970) and their approach
of identification, estimation and diagnostics is based on the principle of parsimony (Asteriou & Hall, 2007). The
generalized ARIMA (p, d, q) model can be represented by a backward shift operator as:
∅(B)(1 − B)d
NDt = θ(B)μt … … … … … … … … … … … … … … … … … … … … … … . … … … … . . [1]
Where the autoregressive (AR) and moving average (MA) characteristic operators are:
∅(B) = (1 − ∅1B − ∅2B2
− ⋯ − ∅pBp
) … … … … … … … … … … … … … … … … … … … . … … … [2]
θ(B) = (1 − θ1B − θ2B2
− ⋯ − θqBq
) … … … … … … … … … … … … … … … … … … … … … … . . [3]
and
(1 − B)d
NDt = ∆d
NDt … … … … … … … … … … … … … … … … … … … … … … … … . … … … … . . [4]
Where ∅the parameter estimate of the autoregressive component is, θ is the parameter estimate of the
moving average component, ∆ is the difference operator, d is the difference, B is the backshift operator and μt is
the disturbance term.
The Box – Jenkins Methodology
The first step towards model selection is to difference the series in order to achieve stationarity. Once
this process is over, the researcher will then examine the correlogram in order to decide on the appropriate orders
of the AR and MA components. It is important to highlight the fact that this procedure (of choosing the AR and
MA components) is biased towards the use of personal judgement because there are no clear – cut rules on how
to decide on the appropriate AR and MA components. Therefore, experience plays a pivotal role in this regard.
The next step is the estimation of the tentative model, after which diagnostic testing shall follow. Diagnostic
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checking is usually done by generating the set of residuals and testing whether they satisfy the characteristics of
a white noise process. If not, there would be need for model re – specification and repetition of the same process;
this time from the second stage. The process may go on and on until an appropriate model is identified (Nyoni,
2018c).
Data Collection
This study is based on 53 observations of annual total Neonatal Deaths (ND) in Zimbabwe. All the data
was gathered from the World Bank online database.
Diagnostic Tests & Model Evaluation
Stationarity Tests: Graphical Analysis
Figure 1
Figure 1 above indicates that the ND series is not stationary since it follows a particular trend over the
period 1966 to 2018. This basically implies that the mean and varience of the ND series is changing over time.
Between 1966 and 1980, neonatal deaths were on the rise in Zimbabwe (then Rhodesia). This could be attributed
to the liberation war (between black majority and white minority) that was taking place in Rhodesia. Soon after
Zimbabwe’s independence, the country inherited a health system which was well functioning and given there was
political stability; neonatal deaths dropped significantly from as high as 10869 deaths in 1980 to as low as 8455
in 1993. The disastrous macroeconomic reforms over the period 1990 – 2000, largely contributed to poor
performance of the health sector and hence neonatal healthcare service delivery was worse off. The following
“lost decade”, that is; 2000 to 2010 was a completely lost decade, as noted by Kanyenze et al. (2017), as it was
characterized by gross macroeconomic mismanagement, hyperinflation and excessive unemployment. This period
was a huge blow to the health sector in Zimbabwe and this could be an explanation as to why neonatal deaths had
to sky-rocket over the period 2000 to 2010. Thereafter, the numbers of neonatal deaths started going down
gradually. This could be attributed to macroeconomic stability that was largely brought about by the introduction
of the United States Dollar (USD) as the official currency, following the rejection of the Zimbabwean dollar which
had lost value. When the economy is performing, the government and its partners are able to mobilize resources
for the health sector and this improves health service delivery. When the economy is not performing, health
workers migrate to greener pastures just like what happened during the lost decade. The government is usually
not able to capacitate and renovate existing healthcare facilities if the economy is not performing. In order to
determine the order of integration of the ND series shown above, the study will employ correlogram analyses
along with the Augmented-Dickey-Fuller (ADF) test.
7000
8000
9000
10000
11000
12000
13000
14000
1970 1980 1990 2000 2010
ND
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The Correlogram in Levels
Figure 2
The ADF Test
Table 1: Levels-intercept
Variable ADF Statistic Probability Critical Values Conclusion
ND -2.929920 0.0493 -3.574446 @1% Not stationary
-2.923780 @5% Stationary
2.599925 @10% Stationary
Table 2: Levels-trend & intercept
Variable ADF Statistic Probability Critical Values Conclusion
ND -3.631186 0.0375 -4.161144 @1% Not stationary
-3.506374 @5% Stationary
-3.183002 @10% Stationary
Table 3: without intercept and trend & intercept
Variable ADF Statistic Probability Critical Values Conclusion
ND 0.305604 0.7702 -2.613010 @1% Not stationary
-1.947665 @5% Not stationary
-1.612573 @10% Not stationary
-1
-0.5
0
0.5
1
0 2 4 6 8 10 12 14 16
lag
ACF for ND
+- 1.96/T^0.5
-1
-0.5
0
0.5
1
0 2 4 6 8 10 12 14 16
lag
PACF for ND
+- 1.96/T^0.5
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The Correlogram (at 1st
Differences)
Figure 3
Table 4: 1st
Difference-intercept
Variable ADF Statistic Probability Critical Values Conclusion
ND -3.084520 0.0343 -3.571310 @1% Not stationary
-2.922449 @5% Stationary
-2.599224 @10% Stationary
Table 5: 1st
Difference-trend & intercept
Variable ADF Statistic Probability Critical Values Conclusion
ND -3.135578 0.1097 -4.156734 @1% Not stationary
-3.504330 @5% Not stationary
-3.181826 @10% Not stationary
Table 6: 1st
Difference-without intercept and trend & intercept
Variable ADF Statistic Probability Critical Values Conclusion
ND -3.071985 0.0028 -2.613010 @1% Stationary
-1.947665 @5% Stationary
-1.612573 @10% Stationary
Figures above, that is; 2 and 3 and tables above, that is; 1 to 6 show that the ND series is not stationary in levels
and even after taking first differences.
-1
-0.5
0
0.5
1
0 2 4 6 8 10 12 14 16
lag
ACF for d_ND
+- 1.96/T^0.5
-1
-0.5
0
0.5
1
0 2 4 6 8 10 12 14 16
lag
PACF for d_ND
+- 1.96/T^0.5
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The Correlogram in (2nd
Differences)
Figure 4
Table 7: 2nd
Difference-intercept
Variable ADF Statistic Probability Critical Values Conclusion
ND -3.675517 0.0076 -3.574446 @1% Stationary
-2.923780 @5% Stationary
-2.599925 @10% Stationary
Table 8: 2nd
Difference-trend & intercept
Variable ADF Statistic Probability Critical Values Conclusion
ND -3.551269 0.0452 -4.161144 @1% Not stationary
-3.506374 @5% Stationary
-3.183002 @10% Stationary
Table 9: 2nd
Difference-without intercept and trend & intercept
Variable ADF Statistic Probability Critical Values Conclusion
ND -3.656290 0.0005 -2.614029 @1% Stationary
-1.947816 @5% Stationary
-1.612492 @10% Stationary
Figure 4 and tables 7 – 9 illustrate that the ND series is I (2).
-1
-0.5
0
0.5
1
0 2 4 6 8 10 12 14 16
lag
ACF for d_d_ND
+- 1.96/T^0.5
-1
-0.5
0
0.5
1
0 2 4 6 8 10 12 14 16
lag
PACF for d_d_ND
+- 1.96/T^0.5
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Evaluation of ARIMA models (without a constant)
Table 10: Evaluation of ARIMA Models
Model AIC U ME MAE RMSE MAPE
ARIMA (1, 2, 1) 508.8748 0.094273 0.13639 26.505 33.009 0.26106
ARIMA (1, 2, 0) 519.8532 0.10747 0.18166 30.387 37.611 0.29746
ARIMA (0, 2, 1) 548.4842 0.13613 -5.7155 36.803 49.579 0.35169
ARIMA (2, 2, 2) 498.1694 0.083948 -1.3455 24.151 28.506 0.23913
ARIMA (2, 2, 1) 497.0830 0.084895 -1.5782 23.865 28.766 0.2369
ARIMA (3, 2, 1) 498.5739 0.08457 -1.5579 24.048 28.622 0.23863
ARIMA (1, 2, 3) 499.0258 0.082422 -0.1567 23.625 28.741 0.23271
ARIMA (3, 2, 3) 497.6955 0.07881 -1.1237 22.872 27.254 0.22513
ARIMA (2, 2, 0) 499.6099 0.087145 -0.67409 23.98 30.075 0.23675
ARIMA (0, 2, 3) 503.4351 0.087326 -1.8571 23.997 30.595 0.23377
ARIMA (3, 2, 0) 496.7449 0.08461 -1.4581 24.097 28.669 0.23892
ARIMA (2, 2, 3) 498.0951 0.079599 -0.56861 23.234 27.871 0.227
ARIMA (3, 2, 2) 500.1682 0.083919 -1.3311 24.15 28.506 0.23909
ARIMA (4, 2, 0) 498.3876 0.084461 -1.6254 23.972 28.571 0.23801
ARIMA (5, 2, 0) 498.4799 0.082455 -1.3021 23.903 28.036 0.23686
ARIMA (6, 2, 0) 496.6646 0.080052 -1.3377 22.345 26.988 0.22224
ARIMA (7, 2, 0) 497.6298 0.079164 -1.4038 21.839 26.712 0.21697
ARIMA (8, 2, 0) 495.5793 0.074962 -1.2423 20.218 25.727 0.19847
ARIMA (9, 2, 0) 496.8071 0.073258 -1.136 20.158 25.514 0.19756
ARIMA (10, 2, 0) 496.9803 0.073258 -1.136 20.175 25.021 0.19801
ARIMA (8, 2, 1) 497.2608 0.07469 -1.2035 20.12 25.643 0.19726
ARIMA (6, 2, 1) 496.6081 0.078026 -1.4242 21.282 26.462 0.21073
A model with a lower AIC value is better than the one with a higher AIC value (Nyoni, 2018b) Similarly,
the U statistic can be used to find a better model in the sense that it must lie between 0 and 1, of which the closer
it is to 0, the better the forecast method (Nyoni, 2018a). In this paper, only the AIC is used to select the optimal
model. Therefore, the ARIMA (8, 2, 0) model is chosen.
Residual & Stability Tests
ADF Tests of the Residuals of the ARIMA (8, 2, 0) Model
Table 11: Levels-intercept
Variable ADF Statistic Probability Critical Values Conclusion
R -6.595173 0.0000 -3.596616 @1% Stationary
-2.933158 @5% Stationary
-2.604867 @10% Stationary
Table 12: Levels-trend & intercept
Variable ADF Statistic Probability Critical Values Conclusion
R -6.521314 0.0000 -4.192337 @1% Stationary
-3.520787 @5% Stationary
-3.191277 @10% Stationary
Table 13: without intercept and trend & intercept
Variable ADF Statistic Probability Critical Values Conclusion
R -6.651100 0.0000 -2.621185 @1% Stationary
-1.948886 @5% Stationary
-1.611932 @10% Stationary
Tables 11 – 13 indicate that the residuals of the chosen optimal model, the ARIMA (8, 2, 0) model; are stationary.
Correlogram of the Residuals of the ARIMA (8, 2, 0) Model
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Figure 5: Correlogram of the Residuals
Figure 5 indicates that the estimated model is adequate since ACF and PACF lags are quite short and
within the bands. This implies that the no autocorrelation assumption is not violated in this study.
Test for Normality of Residuals
Figure 6: Normality Test
Since the p-value, that is; [0.9024] is statistically insignificant, it implies that the residuals are normally
distributed, hence the validity of the normality assumption.
Stability Test of the ARIMA (8, 2, 0) Model
-0.4
-0.3
-0.2
-0.1
0
0.1
0.2
0.3
0.4
0 2 4 6 8 10 12 14 16
lag
Residual ACF
+- 1.96/T^0.5
-0.4
-0.3
-0.2
-0.1
0
0.1
0.2
0.3
0.4
0 2 4 6 8 10 12 14 16
lag
Residual PACF
+- 1.96/T^0.5
0
0.002
0.004
0.006
0.008
0.01
0.012
0.014
0.016
0.018
-80 -60 -40 -20 0 20 40 60 80
Density
uhat1
uhat1
N(-1.2423,27.985)
Test statistic for normality:
Chi-square(2) = 0.205 [0.9024]
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Figure 7: Inverse Roots
Since all the AR roots lie inside the unit circle, it implies that the estimated ARIMA process is
(covariance) stationary; thus confirming that the ARIMA (8, 2, 0) model is indeed stable and suitable for
forecasting annual neonatal deaths in Zimbabwe.
4. FINDINGS
Descriptive Statistics
Table 14: Descriptive Statistics
Description Statistic
Mean 9927
Median 9696
Minimum 7361
Maximum 13169
Standard deviation 1503.5
Skewness 0.51971
Excess kurtosis -0.48186
As shown above, the mean is positive, i.e. 9927. This means that the average number of neonatal deaths
over the study period is 9927 deaths per annum. The minimum number of neonatal deaths over the study period
is 7361 deaths and this was recorded in 1961 while the maximum number of neonatal deaths is 13169 deaths and
this was recorded in 2010. The skewness is 0.51971 and the most important characteristic is that it is positive,
meaning that the ND series is positively skewed and non-symmetric. Excess kurtosis is -0.48186; showing that
the ND series is not normally distributed.
Results Presentation
Table 15: Main Results
ARIMA (8, 2, 0) Model:
∆2
NDt = 1.3784∆2
NDt−1 − 0.410827∆2
NDt−2 − 0.00721141∆2
NDt−3 − 4.29788∆2
NDt−4
+ 0.556302∆2
NDt−5 − 0.628168∆2
NDt−6 + 0.648328∆2
NDt−7
− 0.350542∆2
NDt−8 … … … … … … … . . … … … … … . … . . [5]
Variable Coefficient Standard Error z p-value
∅1 1.37840 0.130935 10.53 0.0000***
∅2 -0.410827 0.222244 -1.849 0.0645*
∅3 -0.00721141 0.229988 -0.03136 0.9750
∅4 -0.429788 0.225863 -1.903 0.0571*
∅5 0.556302 0.217560 2.557 0.0106**
∅6 -0.628168 0.232070 -2.707 0.0068***
∅7 0.648328 0.261209 2.482 0.0131**
∅8 -0.350542 0.168886 -2.076 0.0379**
Forecast Graph
-1.5
-1.0
-0.5
0.0
0.5
1.0
1.5
-1.5 -1.0 -0.5 0.0 0.5 1.0 1.5
AR
roots
Inverse Roots of AR/MA Polynomial(s)
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Figure 9: Graphical Analysis of Out-of-Sample Forecasts
Table 15 shows the main results of the ARIMA (8, 2, 0) model. Figure 8 and 9 as well as table 18 are
out-of-sample forecasts of the ARIMA (8, 2, 0) model. As clearly shown in figure 9, the number of neonatal
deaths per year, over the out-of-sample period, show a sharply downwards trend. This is encouraging and
commendable, for a developing country like Zimbabwe. These results are consistent with Nyoni & Nyoni (2020).
Policy Implications
i. The government of Zimbabwe should continue to intensify training programs in resuscitation and in essential
newborn care in order to maintain low levels of and or eradicate neonatal deaths.
ii. The government of Zimbabwe should work towards improving access to healthcare services through out the
whole country.
iii. The government of Zimbabwe should also work toward capacity building in virtually all public health
institutions in the country to ensure that comprehensive neonatal care services are offered country-wide.
iv. The government of Zimbabwe should encourage and promote consistent home visits by community health
workers, for neonatal care.
5. CONCLUSION
The study shows that the ARIMA (8, 2, 0) model is not only stable but also the most suitable model to
forecast neonatal deaths in Zimbabwe for the next 25 years. The model predicts a sharp decrease in neonatal
deaths in Zimbabwe. Such a trend should be maintained and in this regard, a four-fold policy prescription has
been offered. These findings are essential for the government of Zimbabwe, especially when it comes to long-
term planning with regards to neonatal care in the country.
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Neonatal
Deaths
Year
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