Infant Mortality Rate Research

The provided research assignment aims to investigate the factors affecting infant mortality rates among GCC nationals. The study will examine the impact of various variables such as obesity, smoking, young age, and educational level on infant mortality rates. The researcher may face difficulties in collecting data due to lack of registries and database for women's pregnancies, as well as strict government policies that create barriers to research. However, there are opportunities to conduct this research in UAE or GCC nationals by increasing awareness regarding various factors that increase infant mortality rate in these countries. The study can assist the government in tackling these issues by implementing effective policies and increasing awareness to reduce the rate of infant mortality in the country.

RUNNING HEAD: PUBLIC HEALTH
Public health

Public Health 1
Assessment Task 1
Question 1
Answer: Cervical cancer is the third leading disease among the women, caused by HPV, after
breast and colorectal cancer. In 2012, 527,624 new cases of cervical cancer and 265,653
deaths were estimated because of this disease. The mortality and incidence rate has been
declined at a rate of 1.6% across the world. This decrease is because of the improvement in
treatment, reduction in risk factors, and access to the health services. However, in LMIC,
there are more than 80 percent of the cases of cervical cancer and 88 percent of the deaths
due to the same. Increase in the rate is been reported in some areas of the world, including
economies of Europe and Central Asia (Denny et al. n.d).
Regionally, Africa has the highest rates of cervical cancer; in Giunea and Malawai, the
incidence rate is over 50 per 100,000. On the contrast, countries in North Africa and Middle
East, rates are below 10 per 100,000 women (Denny et al. n.d).
Question 2
Answer: The screening programs in cervical method in high resource settings helps in
identifying cancer and treating it at an early stage. These programs are based on methodology
of cytology screening. The “gold standard” cervical screening method used in developed
countries is Pap smears (Papanicolaou test). It was developed and named after the Greek
doctor Georgios Papanikalaou. This screening method is simple, safe and effective to apply
for discovery of cancer cells. The cells are collected by opening the vaginal canal and then
these cells are examined for detecting any abnormalities. This approach has led to a dramatic
decline of deaths by cervical cancer (Boone, Erickson & Huh, 2012).
Question 3

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Answer: The alternatives or techniques used in low resource settings are cytology (Pap), VIA
and a HPV DNA test. VIA was comparatively much better than cytology in aspects of
sensitivity in disease. Two types of HPV test were developed by a new initiative taken by
PATH named as Screening Technologies to Advance Rapid Testing. This is also a low cost
test, simple to use, provide accurate results and is affordable for poor women also. By the
efforts of PATH and QIAGEN, the test became portable and does not require refrigeration. It
provides results in two and a half hours or less which stimulates quick treatment of the
disease.
Question 4
Answer: The advantages of VIA were:
 Much better in terms of sensitivity, when compare to cytology.
 Requires less specialized personnel and fewer equipment.
 Screening through it can be done in remote areas and the clinics having less
equipment.
 It gives instant results, which makes it possible to treat and screen women on the same
visit.
 The speedy treatment on single visit reduces the number of women who lost their
treatment because of the inconvenience.
Advantages of HPV DNA test:
 Performs much better than cytology and VIA.
 A test having low cost, developed for low resource settings.
 Portable, powered with batteries, provide quick results and facilitate instant
treatment.
Question 5

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Answer: One of the major requirement of HPV-DNA test was its acceptability by the women
and their families, as it was simple, accurate and easily affordable. In order to ensure this,
PATH established partnerships with QIAGEN and the WHO. The role played by
organization was to develop the technologies and to assess the new test for the purpose of
international procurement by UN agencies. Apart from them, PATH also partners with
Jhpiego, a nonprofit agency, having an affiliation with The Johns Hopkins University, with
an aim to lay the basis for the future outline of new test. The PATH and QIAGEN, in early
2007, developed a portable HPV DNA test which provides instant results in the same visit.
This is how the requirement of the new test was met and addressed.
Question 6
Answer: Certain conditions were placed for the use of screening technologies. Following are:
 There should be an adequate supply of HPV and cervical cancer tools at reasonable
prices.
 In order to support access to the new tools, partnership should be there between the
components of civil society, medical associations, donors, researchers, health
institutions and government.
 A financial commitment for effectively treating, screening and vaccinating women
and girls. Also establishing a sustained political leadership.
Question 7
Answer: The three initiatives have same goals but the challenges faced by them are separate.
They differ on the basis of nature of work and nature of partnership.
 Alliance for Cervical Cancer Protection: the main challenge faced was the absence of
attention in the work which resulted in friction in the early days. Moreover, the

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discussions of ACCP were argumentative and it seems difficult to maintain the
partnership on several occasions.
 START and START-UP: One of the key challenge was faced by QIAGEN, is to
prepare a business model that takes into account, the marketing of two types of HPV
DNA test. The initiative also faces challenges from medical communities.
 Cervical Cancer Action: Challenges faced includes rising price of HPV vaccine and
the lack of global success in the implementation of cervical cancer screening at large
scale, in low resource setting.
Question 8
Answer: As it is clear from the case study that, HPV DNA test is more effective than Pap test
in the treatment of the disease. In 2016 update of NCBI, it was reported that the test was
applied to 23,211 women and a positivity rate of 7.0% was noticed which was higher than
HPV DNA programs (Maggino et al. 2016). Moreover, in the update of 2017, it was noticed
that HPV- Cryo test was least costly and it reduces the cancer risk by 29.5%, more than HPV-
VIA, HPV-Pap and Pap only. The test is very cost effective and has the best strategies
(Campos et al. 2017).
Assessment Task 2
Question 1
Answer: The seven confounders in the study include age, education level, and year of
delivery, parity, height, smoking and country of birth. Women who give first birth between
the ages of 12 and 35 have a risk of poor child health than compared to women between ages
of 27 and 29 (Finlay, Ozaltin & Canning, 2011). Smoking increases the chances of too early
pregnancy or weight loss of the child. Women who have only completed secondary level
schooling are more likely to get pregnant in their teenage years than compared with women

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who complete post-secondary education. Infant rate is higher outside Sweden which proves
the importance of country of birth. Shorter mothers have shorter pregnancies which
negatively affect child’s health. Parity-related factors increase the risk of Pelvic girdle pain in
pregnancy. Year of delivery is crucial since the rate of infant mortality has reduced due to
progressive medical science.
Question 2
Answer: Birth spacing is defined as a practice of waiting between two pregnancies. A
woman’s body is required to rest properly before getting pregnant again. After pregnancy,
women should wait for 18 months for next pregnancy which is called birth spacing.
According to the research of Fotso, Cleland, Mberu, Mutua & Elungata (2013), an inter-
pregnancy interval of fewer than 18 months has a two-fold increase in infant mortality rate.
Women who give birth without waiting for more than 18 months have twice the chance of
infant mortality than compared to women who wait for more than 18 months. Therefore, the
researchers should have included birth spacing in the adjusted model.
Question 3
Answer: A large number of women in European countries smoke during their pregnancy
which negatively affects the health of the child, and it contributes to increasing in infant
mortality rate. For example, one in every five women in France smokes. Smoking is one of
the major factors which increase the rate of infant mortality by negatively affecting women
and children health. In this study, the data regarding smoking habits of pregnant women were
collected at the first antenatal visit (Johansson et al. 2014). The validity of the data estimation
is not clear since the data was only collected from the first antenatal visit. The researchers
should have collected data from more antenatal visits of pregnant women which would have
increased the validity of the data.

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Question 4
Answer: Though, I believe that due to information biases, there has been an increase in the
association between maternal overweight and infant mortality. But, I believe that the data is
not substantially affected by the information biases. The strong association between these two
has been proved by many studies conducted in the similar field. The health of mother and
child is negatively affected by the obesity of the pregnant women which contributes to
increased infant mortality rate. Therefore, the strength of the association between infant
mortality and maternal overweight/obesity has not been affected by the information biases in
the study.
Question 5
Answer: The advance in medical science is a key factor which assists in reducing infant,
neonatal and post-neonatal mortality rate since it prevents the deaths which occur due to
premature births, infections, perinatal asphyxia, birth injuries and complications during
delivery. Another contributing factor which reduces the mortality rate is reduction in women
smokers during the pregnancy stage because the awareness regarding its side effects has
grown substantially. Another factor is increase in the number of literate women as the
education level grows. These factors have assisted in reducing the number of infant, neonatal
and post-neonatal mortality rate but they did not have a significant impact on factors such as
obesity have increased the rate of infant mortality. The table clearly shows a decline in the
number of infant mortality, but factors such as obesity are still affecting women and infants’
health which results in increasing infant mortality rates.
Question 6
Answer: The reported PAF is considerably high which negatively affect people’s health.
Increasing obesity is a contributing factor in infant mortality rate among European women as

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provided in the study. Smoking is another factor which increases infant mortality rate since it
increases the risk of preterm birth and low weight. In public health significance, obesity and
smoking have a negative effect on people’s health since it increases the risk of health disease,
bone and joint disease, early menopause, type 2 diabetes, anxiety and irritability, infertility,
high cholesterol, cervical cancer and many others. The study has also proved the negative
impact of obesity and smoking on public health significance.
Question 7
Answer: Residual confounding is defined as a frequent explanation which is used for unusual
research findings. It occurs when a confounding variable in a study is measured with some
error or imperfectly and the adjustment of this imperfect measure is not entirely removed the
impact of confounding variable. For example, a study conducted in 1999 provided that
smoking during pregnancy reduces the risk of Down syndrome birth. But, as it turns out the
relationship between age and smoking during pregnancy has affected the finding of the
research since young women indulge more in smoking, and they are less likely to give birth
to a child with Down syndrome (Chen, Gilbert & Daling, 1999). In the context of this study,
potential residual confounding is lack of within-siblings study. Another residual confounding
is non-adjustment birth spacing in the adjusted model. Obese women who smoke generally
faces problems during breastfeeding.
Question 8
Answer: The Sibling Study analysis incorporates both quantitative and qualitative data
regarding young people that represent a unique body of information through adolescence
(Donovan & Susser, 2011). It can be used in this study to examine the influence of maternal
obesity on the health of adolescence children. A within-siblings study would have resulted in
decreasing the residual confounding in the study by use of characteristics that remain fixed

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between pregnancies. The researchers should have used sibling control analysis to observe
the influence of obesity and other factors such as smoking, age, and height and education
level on the children till their adolescence which would have resulted in increasing the
validity of data of the research.
Question 9
Answer: The finding of the study provided that there is strong association between infant
mortality rate and maternal overweight and obesity. The study provided that there are various
other contributing factors as well such as smoking, education level, height, years of birth,
country of birth, age and parity. In UAE and GCC nationals, the number of female smokers is
substantially high which increases the risk of high infant mortality rates. According to
Sulaiman et al. (2017), the rate of obesity in women in UAE is increasing rapidly which can
result in increasing infant mortality rate. The educational level of women in UAE and GCC
nationals is low as well. To address these issues, preconception planning is necessary during
the first antenatal appointment, periconception period and throughout pregnancy. Pregnant
women should be given proper information regarding the negative effect of obesity and
smoking on their pregnancy in order to reduce infant mortality rates.
Question 10
Answer: There are numerous challenges of conducting this study in the UAE or GCC
country. For example, it is relatively difficult to collect the data from reliable sources since
most people prefer to keep their records confidential. The researchers will face difficulties in
collecting the data regarding women pregnancies since there is lack of registries and
database. Strict government policies also create barriers to the research. These factors
increase the number of confounding variables which negatively affects the validity of the
research. There are several opportunities of conducting this research in UAE or GCC

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nationals as well such as increase in awareness regarding various factors which increases
infant mortality rate in these countries such as obesity, smoking, young age, and educational
level. The study can assist the government in tacking these issues by implementing effective
policies and increasing awareness in order to reduce the rate of infant mortality in the
country.

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References
Boone, J., Erickson, B., & Huh, W. (2012). New insights into cervical cancer
screening. NCBI. Retrieved 28 February 2018, from
https://www.ncbi.nlm.nih.gov/pmc/articles/PMC3469864/
Campos, N., Mvundura, M., Jeronimo, J., Holme, F., Vodicka, E., & Kim, J. (2017). Cost-
effectiveness of HPV-based cervical cancer screening in the public health system in
Nicaragua. NCBI. Retrieved 27 February 2018, from
https://www.ncbi.nlm.nih.gov/pmc/articles/PMC5623348/
Chen, C. L., Gilbert, T. J., & Daling, J. R. (1999). Maternal smoking and Down syndrome:
the confounding effect of maternal age. American journal of epidemiology, 149(5),
442-446.
Denny, L., Herrero, R., Levin, C., & Kim, J. Cervical Cancer. (n.d). NCBI. Retrieved 27
February 2018, from https://www.ncbi.nlm.nih.gov/books/NBK343648/
Donovan, S. J., & Susser, E. (2011). Commentary: advent of sibling designs. International
journal of epidemiology, 40(2), 345.
Finlay, J. E., Özaltin, E., & Canning, D. (2011). The association of maternal age with infant
mortality, child anthropometric failure, diarrhoea and anaemia for first births:
evidence from 55 low-and middle-income countries. BMJ open, 1(2), e000226.
Fotso, J. C., Cleland, J., Mberu, B., Mutua, M., & Elungata, P. (2013). Birth spacing and
child mortality: an analysis of prospective data from the Nairobi urban health and
demographic surveillance system. Journal of biosocial science, 45(6), 779-798.

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Johansson, S., Villamor, E., Altman, M., Bonamy, A. K. E., Granath, F., & Cnattingius, S.
(2014). Maternal overweight and obesity in early pregnancy and risk of infant
mortality: a population based cohort study in Sweden. Bmj, 349, g6572.
Maggino, T., Sciarrone, R., Murer, B., Dei Rossi, M., Fedato, C., & Maran, M. et al.
(2016). Screening women for cervical cancer carcinoma with a HPV mRNA test: first
results from the Venice pilot program. NCBI. Retrieved 27 February 2018, from
https://www.ncbi.nlm.nih.gov/pmc/articles/PMC4997543/
Sulaiman, N., Elbadawi, S., Hussein, A., Abusnana, S., Madani, A., Mairghani, M., ... &
Shaw, J. (2017). Prevalence of overweight and obesity in United Arab Emirates
Expatriates: the UAE National Diabetes and Lifestyle Study. Diabetology &
metabolic syndrome, 9(1), 88.