Neonatal mortality and coverage of essential newborn interventions 2010 - 2013: a prospective, population-based study from low-middle income countries

Sangappa M Dhaded, Manjunath S Somannavar, Sunil S Vernekar, Shivaprasad S Goudar, Musaku Mwenche, Richard Derman, Janet L Moore, Archana Patel, Omrana Pasha, Fabian Esamai, Ana Garces, Fernando Althabe, Elwyn Chomba, Edward A Liechty, K Hambidge, Nancy F Krebs, Mabel Berrueta, Alvaro Ciganda, Patricia L Hibberd, Robert L Goldenberg, Elizabeth M McClure, Marion Koso-Thomas, Albert Manasyan, Waldemar A Carlo, Sangappa M Dhaded, Manjunath S Somannavar, Sunil S Vernekar, Shivaprasad S Goudar, Musaku Mwenche, Richard Derman, Janet L Moore, Archana Patel, Omrana Pasha, Fabian Esamai, Ana Garces, Fernando Althabe, Elwyn Chomba, Edward A Liechty, K Hambidge, Nancy F Krebs, Mabel Berrueta, Alvaro Ciganda, Patricia L Hibberd, Robert L Goldenberg, Elizabeth M McClure, Marion Koso-Thomas, Albert Manasyan, Waldemar A Carlo

Abstract

Background: Approximately 3 million neonatal deaths occur each year worldwide. Simple interventions have been tested and found to be effective in reducing the neonatal mortality. In order to effectively implement public health interventions, it is important to know the rates of neonatal mortality and understand the contributing risk factors. Hence, this prospective, population-based, observational study was carried out to inform these needs.

Methods: The Global Network's Maternal Newborn Health Registry was initiated in the seven sites in 2008. Registry administrators (RAs) attempt to identify and enroll all eligible women by 20 weeks gestation and collect basic health data, and outcomes after delivery and at 6 weeks post-partum. All study data were collected, reviewed, and edited by staff at each study site. The study was reviewed and approved by each sites' ethics review committee.

Results: Overall, the 7-day neonatal mortality rate (NMR) was 20.6 per 1000 live births and the 28-day NMR was 25.7 per 1000 live births. Higher neonatal mortality was associated with maternal age > 35 and <20 years relative to women 20-35 years of age. Preterm births were at increased risk of both early and 28-day neonatal mortality (RR 8.1, 95% CI 7.5-8.8 and 7.5, 95% CI 6.9-8.1) compared to term as were those with low birth weight (<2500g). Neonatal resuscitation rates were 4.8% for hospital deliveries compared to 0.9% for home births. In the hospital, 26.5% of deliveries were by cesarean section with an overall cesarean section rate of 12.5%. Neonatal mortality rates were highest in the Pakistan site and lowest in Argentina.

Conclusions: Using prospectively collected data with high follow up rates (99%), we documented characteristics associated with neonatal mortality. Low birth weight and prematurity are among the strongest predictors of neonatal mortality. Other risk factors for neonatal deaths included male gender, multiple gestation and major congenital anomalies. Breech presentation/transverse lie, and no antenatal care were also significant risk factors for neonatal death. Coverage of interventions varied by setting of delivery, with the overall population rate of most evidence-based interventions low. This study informs about risk factors for neonatal mortality which can serve to design strategies/interventions to reduce risk of neonatal mortality.

Trial registration: The trial is registered at clinicaltrials.gov. ClinicalTrial.gov

Trial registration: NCT01073475.

Figures

Figure 1
Figure 1
CONSORT Diagram for neonatal study, 2010 - 2013
Figure 2
Figure 2
Early and 28-day neonatal mortality by study site, 2010-2013

References

    1. Lawn JE, Osrin D, Adler A, Cousens S. Four million neonatal deaths: counting and attribution of cause of death. Paediatr Perinat Epidemiol. 2008;22:410–6. doi: 10.1111/j.1365-3016.2008.00960.x.
    1. Jehan I, Harris H, Salat S, Zeb A, Mobeen N, Pasha O. et al.Neonatal mortality, risk factors and causes: a prospective population-based cohort study in urban Pakistan. Bull World Health Organ. 2009;87:130–8. doi: 10.2471/BLT.08.050963.
    1. Gizaw M, Molla M, Mekonnen W. Trends and risk factors for neonatal mortality in Butajira District, South Central Ethiopia, (1987-2008): a prospective cohort study. BMC Pregnancy Childbirth. 2014;14:64. doi: 10.1186/1471-2393-14-64.
    1. Lawn JE, Cousens S, Zupan J. 4 million neonatal deaths: When? Where? Why? Lancet. 2005;365:891–900. doi: 10.1016/S0140-6736(05)71048-5.
    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. Bhutta ZA, Das JK, Bahl R, Lawn JE, Salam RA, Paul VK. et al.Lancet Newborn Interventions Review Group; Lancet Every Newborn Study Group. Can available interventions end preventable deaths in mothers, newborn babies, and stillbirths, and at what cost? Lancet. 2014;384:347–70. doi: 10.1016/S0140-6736(14)60792-3.
    1. Dickson KE, Simen-Kapeu A, Kinney MV, Huicho L, Vesel L, Lackritz E. et al.Lancet Every Newborn Study Group. Every Newborn: health-systems bottlenecks and strategies to accelerate scale-up in countries. Lancet. 2014;384(9941):438–54. doi: 10.1016/S0140-6736(14)60582-1.
    1. Mason E, McDougall L, Lawn JE, Gupta A, Claeson M, Pillay Y. et al.Lancet Every Newborn Study Group; Every Newborn Steering Committee. From evidence to action to deliver a healthy start for the next generation. Lancet. 2014;384(9941):455–67. doi: 10.1016/S0140-6736(14)60750-9.
    1. Kamath-Rayne BD, Griffin JB, Moran K, Jones B, Downs A, McClure EM, Goldenberg RL, Rouse D, Jobe AH. Resuscitation and Obstetrical Care to Reduce Intrapartum-Related Neonatal Deaths: A MANDATE Study. Matern Child Health J. 2015. in press .
    1. Manasyan A, Saleem S, Koso-Thomas M, Althabe F, Pasha O, Chomba E. et al.EmONC Trial Group. Assessment of obstetric and neonatal health services in developing country health facilities. Am J Perinatol. 2013;30(9):787–94. doi: 10.1055/s-0032-1333409.
    1. Kumar GA, Dandona R, Chaman P, Singh P, Dandona L. A population-based study of neonatal mortality and maternal care utilization in the Indian state of Bihar. BMC Pregnancy Childbirth. 2014;14:357. doi: 10.1186/1471-2393-14-357.
    1. Moura S, Maestá I, Rugolo LM, Angulski LF, Caldeira AP, Peraçoli JC. et al.Risk factors for perinatal death in two different levels of care: a case–control study. Reproductive Health. 2014;11:11. doi: 10.1186/1742-4755-11-11.
    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;118:190–3. doi: 10.1016/j.ijgo.2012.04.022.
    1. Bose CL, Bauserman M, Goldenberg RL, Goudar SS, McClure EM, Pasha O. The Global Network Maternal Newborn Health Registry: a multi-national, community-based registry of pregnancy outcomes. Reproductive Health. in press .
    1. Belizán JM, McClure EM, Goudar SS, Pasha O, Esamai F, Patel A. et al.Neonatal death in low- to middle-income countries: a global network study. Am J Perinatol. 2012;29(8):649–56.
    1. Marete I, Tenge C, Pasha O, Goudar S, Chomba E, Patel A. et al.Perinatal outcomes of multiple-gestation pregnancies in Kenya, Zambia, Pakistan, India, Guatemala, and Argentina: a global network study. Am J Perinatol. 2014;31:125–132.
    1. Wang H, Liddell CA, Coates MM, Mooney MD, Levitz CE, Schumacher AE, 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. pp. 60497–9.
    1. Liu L, Oza S, Hogan D, Perin J, Rudan I, Lawn JE, Global, regional, and national causes of child mortality in 2000-13, with projections to inform post-2015 priorities: an updated systematic analysis. Lancet. 2014.
    1. Lee AC, Katz J, Blencowe H, Cousens S, Kozuki N, Vogel JP. et al.CHERG SGA-Preterm Birth Working Group. National and regional estimates of term and preterm babies born small for gestational age in 138 low-income and middle-income countries in 2010. Lancet Glob Health. 2013;1:e26–36. doi: 10.1016/S2214-109X(13)70006-8.
    1. Blencowe H, Cousens S, Chou D, Oestergaard M, Say L, Moller AB. et al.Born Too Soon Preterm Birth Action Group. Born too soon: the global epidemiology of 15 million preterm births. Reprod Health. 2013;10(Suppl 1):S2. doi: 10.1186/1742-4755-10-S1-S2.
    1. Goudar SS, Somannavar MS, Clark R, Lockyer JM, Revankar AP, Fidler HM. et al.Stillbirth and newborn mortality in India after helping babies breathe training. Pediatrics. 2013;131:e344–52. doi: 10.1542/peds.2012-2112.
    1. Goudar SS, Dhaded SM, McClure EM, Derman RJ, Patil VD, Mahantshetti NS, ENC training reduces perinatal mortality in Karnataka, India. J Maternal-Fetal and Neonatal Medicine. 2011. pp. 1–7.
    1. Mason E, McDougall L, Lawn JE, Gupta A, Claeson M, Pillay Y. et al.Lancet Every Newborn Study Group; Every Newborn Steering Committee. From evidence to action to deliver a healthy start for the next generation. Lancet. 2014;384:455–67. doi: 10.1016/S0140-6736(14)60750-9.
    1. Requejo J, Merialdi M, Althabe F, Keller M, Katz J, Menon R. Born too soon: care during pregnancy and childbirth to reduce preterm deliveries and improve health outcomes of the preterm baby. Reprod Health. 2013;10(Suppl 1):S4. doi: 10.1186/1742-4755-10-S1-S4.

Source: PubMed

스폰서 및 공동 작업자

건강 상태

약물 개입

3
구독하다