Neonatal deaths in rural Karnataka, India 2014-2018: a prospective population-based observational study in a low-resource setting

Sangappa M Dhaded, Manjunath S Somannavar, Janet L Moore, Elizabeth M McClure, Sunil S Vernekar, S Yogeshkumar, Avinash Kavi, Umesh Y Ramadurg, Tracy L Nolen, Robert L Goldenberg, Richard J Derman, Shivaprasad S Goudar, Sangappa M Dhaded, Manjunath S Somannavar, Janet L Moore, Elizabeth M McClure, Sunil S Vernekar, S Yogeshkumar, Avinash Kavi, Umesh Y Ramadurg, Tracy L Nolen, Robert L Goldenberg, Richard J Derman, Shivaprasad S Goudar

Abstract

Background: Neonatal mortality causes a substantial proportion of the under-5 mortality in low and middle-income countries (LMIC).

Methods: We undertook a prospective, population-based research study of pregnant women residing in defined geographic areas in the Karnataka State of India, a research site of the Global Network for Women's and Children's Health Research. Study staff collected demographic and health care characteristics on eligible women enrolled with neonatal outcomes obtained at delivery and day 28. Cause of neonatal mortality at day 28 was assigned by algorithm using prospectively defined variables.

Results: From 2014 to 2018, the neonatal mortality rate was 24.5 per 1,000 live births. The cause of the 28-day neonatal deaths was attributed to prematurity (27.9%), birth asphyxia (25.1%), infection (23.7%) and congenital anomalies (18.4%). Four or more antenatal care (ANC) visits was associated with a lower risk of neonatal death compared to fewer ANC visits. In the adjusted model, compared to liveborn infants ≥ 2500 g, infants born weighing < 1000 g RR for mortality was 25.6 (95%CI 18.3, 36.0), for 1000-1499 g infants the RR was 19.8 (95% CI 14.2, 27.5) and for 1500-2499 g infants the RR was 3.1 (95% CI 2.7, 3.6). However, more than one-third (36.8%) of the deaths occurred among infants with a birthweight ≥ 2500 g. Infants born preterm (< 37 weeks) were also at higher risk for 28-day mortality (RR 7.9, 95% CI 6.9, 9.0) compared to infants ≥ 37 weeks. A one-week decrease in gestational age at delivery was associated with a higher risk of mortality with a RR of 1.3 (95% CI 1.3, 1.3). More than 70% of all the deliveries occurred at a hospital. Among infants who died, 50.3% of the infants had received bag/mask ventilation, 47.3% received antibiotics, and 55.6% received oxygen.

Conclusions: Consistent with prior research, the study found that infants who were preterm and low-birth weight remained at highest risk for 28-day neonatal mortality in India. Although most of births now occur within health facilities, a substantial proportion are not receiving basic life-saving interventions. Further efforts to understand the impact of care on infant outcomes are needed. Study registration The trial is registered at clinicaltrials.gov. ClinicalTrial.gov Trial Registration: NCT01073475.

Keywords: Cause of death; India; Neonatal death.

Conflict of interest statement

The authors declare that they have no competing interests.

Figures

Fig. 1
Fig. 1
Enrollment diagram
Fig. 2
Fig. 2
Cause of 28-day neonatal mortality in Belagavi, India 2014–2018
Fig. 3
Fig. 3
Predictive model for 28-day neonatal mortality

References

    1. Lawn JE, Blencowe H, Oza S, You D, Lee AC, Waiswa P, et al. Lancet Every Newborn Study Group. Every Newborn: progress, priorities, and potential beyond survival. Lancet. 2014;384:189–205. doi: 10.1016/S0140-6736(14)60496-7.
    1. Wang H, Liddell CA, Coates MM, Mooney MD, Levitz CE, Schumacher AE, et al. Global, regional, and national levels of neonatal, infant, and under-5 mortality during 1990–2013: a systematic analysis for the Global Burden of Disease Study 2013. Lancet. 2014;384:957–979. doi: 10.1016/S0140-6736(14)60497-9.
    1. Liu L, Chu Y, Oza S, Hogan D, Perin J, Bassani DG, et al. National, regional, and state-level all-cause and cause-specific under-5 mortality in India in 2000–15: a systematic analysis with implications for the Sustainable Development Goals. Lancet Glob Health. 2019;7:e721–e734. doi: 10.1016/S2214-109X(19)30080-4.
    1. Lawn JE, Osrin D, Adler A, Cousens S. Four million neonatal deaths: counting and attribution of cause of death. Paediatr Perinat Epidemiol. 2008;22:410–416. doi: 10.1111/j.1365-3016.2008.00960.x.
    1. Sankar MJ, Neogi SB, Sharma J, Chauhan M, Srivastava R, Prabhakar PK, et al. State of newborn health in India. J Perinatol. 2016;36:S3–S8. doi: 10.1038/jp.2016.183.
    1. Million Death Study Collaborators Changes in cause-specific neonatal and 1–59-month child mortality in India from 2000 to 2015: a nationally representative survey. Lancet. 2017;390:1972–1980. doi: 10.1016/S0140-6736(17)32162-1.
    1. Goldenberg RL, Muhe L, Saleem S, Dhaded S, Goudar SS, Patterson J, et al. Criteria for assigning cause of death for stillbirths and neonatal deaths in research studies in low-middle income countries. J Matern Fetal Neonatal Med. 2019;32(11):1915–1923. doi: 10.1080/14767058.2017.1419177.
    1. McClure EM, Garces A, Saleem S, Moore JL, Bose CL, Esamai F, et al. Global Network for Women's and Children's Health Research: probable causes of stillbirth in low- and middle-income countries using a prospectively defined classification system. BJOG. 2018;125:131–138. doi: 10.1111/1471-0528.14493.
    1. Garces AL, McClure EM, Pérez W, Hambidge KM, Krebs NF, Figueroa L, et al. The Global Network Neonatal Cause of Death algorithm for low-resource settings. Acta Paediatr. 2017;106(6):904–11. doi: 10.1111/apa.13805.
    1. Gupta M, Rao C, Lakshmi P, Prinja S, Kumar R. Estimating mortality using data from civil registration: a cross-sectional study in India. Bull World Health Organ. 2016;94:10–21. doi: 10.2471/BLT.15.153585.
    1. Baqui AH, Darmstadt GL, Williams EK, Kumar V, Kiran TU, Panwar D, et al. Rates, timing and causes of neonatal deaths in rural India: implications for neonatal health programmes. Bull World Health Organ. 2006;84:706–713. doi: 10.2471/BLT.05.026443.
    1. Dogra V, Khanna R, Jain A, Kumar AM, Shewade HD, Majumdar SS. Neonatal mortality in India’s rural poor: findings of a household survey and verbal autopsy study in Rajasthan. Bihar and Odisha J Trop Pediatr. 2015;61:210–214. doi: 10.1093/tropej/fmv013.
    1. Goudar SS, Carlo WA, McClure EM, Pasha O, Patel A, Esamai F, et al. The Maternal and Newborn Health Registry Study of the Global Network for Women's and Children's Health Research. Int J Gynaecol Obstet. 2012;118:190–193. doi: 10.1016/j.ijgo.2012.04.022.
    1. Koso-Thomas M, McClure EM; Global Network for Women's and Children's Health Research Investigators. The Global Network for Women's and Children's Health Research: A model of capacity-building research. Semin Fetal Neonatal Med 2015;20:293–9.
    1. Bose CL, Bauserman M, Goldenberg RL, Goudar SS, McClure EM, Pasha O, et al. The Global Network Maternal Newborn Health Registry: a multi-national, community-based registry of pregnancy outcomes. Reprod Health. 2015;12(Suppl 2):S1. doi: 10.1186/1742-4755-12-S2-S1.
    1. SAS Proceedings 2009 .

Source: PubMed

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