Differentials in neonatal mortality in two adjacent rural areas of Bangladesh: Lessons for neonatal health interventions

The neonatal mortality rate in India is amongst the highest in the world and skewed towards rural areas. Nonavailability of trained manpower along with poor healthcare infrastructure is one of the major hurdles in ensuring quality neonatal care. We reviewed case studies and relevant literature from low and middle income countries and documented alternative strategies that have proved to be favourable in improving neonatal health. The authors reiterate the fact that recruiting and retaining trained manpower in rural areas by all means is essential to improve the quality of neonatal care services. Besides this, other strategies such as training of local rural healthcare providers and traditional midwives, promoting home-based newborn care, and creating community awareness and mobilization also hold enough potential to influence the neonatal health positively and efforts should be made to implement them on a larger scale. More research is demanded for innovations such as “m-health” and public-private partnerships as they have been shown to offer potential in terms of improving the standards of care. The above proposed strategy is likely to reduce morbidity among neonatal survivors as well.

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Effect of basic public health service project on neonatal health services and neonatal mortality in China: a longitudinal time-series study

BMJ Open ◽

10.1136/bmjopen-2019-034427 ◽

2020 ◽

Vol 10 (7) ◽

pp. e034427

Author(s):

Pengyu Zhao ◽

Xueyan Han ◽

Lili You ◽

Yu Zhao ◽

Li Yang ◽

...

Keyword(s):

Public Health ◽

Health Services ◽

Neonatal Mortality ◽

Rural Areas ◽

Public Health Service ◽

Health Management ◽

Neonatal Health ◽

Visit Rate ◽

Before And After ◽

Urban And Rural Areas

ObjectiveTo analyse the trend change and level change of neonatal health services and neonatal mortality before and after the introduction of the Basic Public Health Service (BPHS) project in 2009.Design and settingA national longitudinal study on neonatal mortality from 1991 to 2017 and neonatal health services from 2000 to 2017 was conducted based on data extracted from the National Neonatal Mortality Surveillance System and National Health Statistic Yearbook. The segmented linear regression model was used to assess the level changes and trend changes of the outcome variables before and after the introduction of BPHS project. Pearson correlation analysis as conducted to measure association between neonatal mortality rates (NMRs) and maternal health management rates (MMRs), neonatal visit rates, respectively.Primary and secondary outcome measuresThe outcome variables were national NMR, the gap of NMR between urban and rural areas, maternal health management rate and neonatal visit rate.ResultsThe annual trend change coefficient of national NMR and the gap of NMR between urban and rural areas were −0.57 (p<0.01) and −0.49 (p<0.01) after the introduction of BPHS project, while the annual trend coefficient of the MMR and the neonatal visit rate were 1.21 (p<0.01) and 0.85 (p<0.01), respectively. The negative correlations were found between NMR and MMR (r=−0.79, p<0.01) and neonatal visit rate (r=−0.76, p<0.01).ConclusionThe BPHS project was found to be associated with increased volume of neonatal health services and reduced NMR. The design and implementation of this project may provide references to other low-income and middle-income countries.

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Neonatal health in Nepal: analysis of absolute and relative inequalities and impact of current efforts to reduce neonatal mortality

BMC Public Health ◽

10.1186/1471-2458-13-1239 ◽

2013 ◽

Vol 13 (1) ◽

Cited By ~ 19

Author(s):

Deepak Paudel ◽

Ishwar B Shrestha ◽

Matthias Siebeck ◽

Eva A Rehfuess

Keyword(s):

Neonatal Mortality ◽

Neonatal Health ◽

Absolute And Relative Inequalities

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THE EFFECT OF WOMEN’S STATUS ON INFANT AND CHILD MORTALITY IN FOUR RURAL AREAS OF BANGLADESH

Journal of Biosocial Science ◽

10.1017/s002193200600143x ◽

2007 ◽

Vol 39 (3) ◽

pp. 355-366 ◽

Cited By ~ 23

Author(s):

MIAN B. HOSSAIN ◽

JAMES F. PHILLIPS ◽

BRIAN PENCE

Keyword(s):

Neonatal Mortality ◽

Child Mortality ◽

Rural Areas ◽

Family Health ◽

Women's Status ◽

Proportional Hazard ◽

Women’S Status ◽

Health And Nutrition ◽

Simulation Based ◽

Care Family

Summary.In South Asia women are often the primary decision-makers regarding child health care, family health and nutrition. This paper examines the proposition that constraints on women’s status adversely affect the survival of their children. Survey data are used to construct indices of women’s household autonomy and authority, which are then linked to longitudinal data on survival of their children. Proportional hazard models indicate that enhanced autonomy significantly decreases post-neonatal mortality. Enhanced household authority significantly decreases child mortality. A simulation based on estimated effects of eliminating gender inequality suggests that achieving complete gender equality could reduce child mortality by nearly fifty per cent and post-neonatal mortality by one-third.

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Neonatal mortality and leading causes of deaths: a descriptive study in China, 2014–2018

BMJ Open ◽

10.1136/bmjopen-2020-042654 ◽

2021 ◽

Vol 11 (2) ◽

pp. e042654

Author(s):

Yuxi Liu ◽

Leni Kang ◽

Chunhua He ◽

Lei Miao ◽

Xiaoqiong Qiu ◽

...

Keyword(s):

Mortality Rate ◽

Neonatal Mortality ◽

Low Income ◽

Rural Areas ◽

Urban Areas ◽

Middle Income ◽

Government Interventions ◽

Neonatal Deaths ◽

Live Births ◽

Urban And Rural Areas

ObjectiveThe present study estimated the national and urban–rural levels and causes of neonatal deaths in China annually between 2014 and 2018 to provide data support for the further end of preventable neonatal deaths for China and other low-income and middle-income countries.MethodsThe study was based on data from the National Maternal and Child Health Surveillance System. All neonates of surveillance districts (gestational week: ≥28 weeks) who died after delivery have been involved in the study. The mortality rate and the leading causes of death for neonates were analysed.ResultsThe neonatal mortality rate (NMR) of China has steadily decreased from 5.9 deaths per 1000 live births in 2014 to 3.9 deaths per 1000 live births in 2018. The NMR in 2018 of urban and rural areas was 2.2 deaths per 1000 live births and 4.7 deaths per 1000 live births, respectively. The leading preventable causes of neonatal deaths are the same in the urban and rural areas were same, which were preterm birth, intrapartum complications and pneumonia. Mortality rates of these three causes fell significantly between 2014 and 2018 but contributed to a higher proportion of deaths in rural areas than urban areas. The proportion of preventable deaths accounted for 74.6% in 2018.ConclusionsThe NMR of China has decreased steadily from 2014 to 2018. However, the inequality between urban and rural areas still exists. The goal of government interventions should be to reduce the health inequality of neonates and further take targeted measures to eliminate preventable neonatal death.

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Community-level impacts of sanitation coverage on maternal and neonatal health: a retrospective cohort of survey data

BMJ Global Health ◽

10.1136/bmjgh-2021-005674 ◽

2021 ◽

Vol 6 (10) ◽

pp. e005674

Author(s):

Brittany L Kmush ◽

Bhavneet Walia ◽

Anushruta Neupane ◽

Carolina Frances ◽

Idris Ahmed Mohamed ◽

...

Keyword(s):

Neonatal Mortality ◽

Logit Model ◽

Retrospective Cohort ◽

Community Level ◽

The Other ◽

Demographic And Health Surveys ◽

Birth Size ◽

Neonatal Health ◽

Live Births ◽

Maternal And Neonatal Health

IntroductionAccess to sanitation facilities (toilets or latrines) greatly improves human health. Low community sanitation coverage may lead to increased exposure to pathogens for households both with and without a sanitation facility.MethodsWe created a retrospective cohort using Demographic and Health Surveys from 1990 through 2018. Using regression with matched women as a random intercept, we assessed the association between community-level sanitation coverage and neonatal mortality (Poisson model, n=1 254 862 live births, 187 datasets), small birth size (logit model, n=1 058 843 live births, 187 datasets) and anaemia (logit model, n=1 304 626 women, 75 datasets).ResultsAmong women with household sanitation, the incidence of neonatal death (incidence rate ratio: 0.85, 95% CI 0.77 to 0.93), the odds of small birth size (OR: 0.81, 95% CI 0.76 to 0.87) and anaemia (OR: 0.82, 95% CI 0.79 to 0.85) were lower for women in communities with 100% sanitation coverage compared with 1%–30% (p≤0.001 for all). There was no difference in neonatal deaths between women in communities with 31%–99% sanitation coverage compared with 1%–30% (p≥0.05). Among women without household sanitation, there were no differences in neonatal mortality by community sanitation (p≥0.05). The odds of small birth size were decreased (OR: 0.91, 95% CI 0.87 to 0.97, p=0.003) for women in communities with 61%–99% sanitation coverage compared with 1%–30%; there was no association with the other community sanitation categories (p≥0.05). The odds of anaemia were increased (OR: 1.08, 95% CI 1.06 to 1.11, p<0.001) for women living in communities with 0% sanitation coverage compared with 1%–30%, but no association with the other community sanitation categories (p≥0.05).ConclusionCommunity sanitation coverage is associated with improved maternal and neonatal outcomes, particularly among women with household sanitation. This suggests that the impact of sanitation coverage on maternal and neonatal health is underestimated unless the community-level effects are considered.

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A growing disadvantage of being born in an urban area? Analysing urban–rural disparities in neonatal mortality in 21 African countries with a focus on Tanzania

BMJ Global Health ◽

10.1136/bmjgh-2021-007544 ◽

2022 ◽

Vol 7 (1) ◽

pp. e007544

Author(s):

Megan Norris ◽

Gonnie Klabbers ◽

Andrea B Pembe ◽

Claudia Hanson ◽

Ulrika Baker ◽

...

Keyword(s):

Neonatal Mortality ◽

Rural Areas ◽

Urban Areas ◽

Maternal Education ◽

Health Seeking ◽

African Countries ◽

Live Births ◽

Urban Rural ◽

Ssa Countries

IntroductionNeonatal mortality rate (NMR) has been declining in sub-Saharan African (SSA) countries, where historically rural areas had higher NMR compared with urban. The 2015–2016 Demographic and Health Survey (DHS) in Tanzania showed an exacerbation of an existing pattern with significantly higher NMR in urban areas. The objective of this study is to understand this disparity in SSA countries and examine the specific factors potentially underlying this association in Tanzania.MethodsWe assessed urban–rural NMR disparities among 21 SSA countries with four or more DHS, at least one of which was before 2000, using the DHS StatCompiler. For Tanzania DHS 2015–2016, descriptive statistics were carried out disaggregated by urban and rural areas, followed by bivariate and multivariable logistic regression modelling the association between urban/rural residence and neonatal mortality, adjusting for other risk factors.ResultsAmong 21 countries analysed, Tanzania was the only SSA country where urban NMR (38 per 1000 live births) was significantly higher than rural (20 per 1,000), with largest difference during first week of life. We analysed NMR on the 2015–2016 Tanzania DHS, including live births to 9736 women aged between 15 and 49 years. Several factors were significantly associated with higher NMR, including multiplicity of pregnancy, being the first child, higher maternal education, and male child sex. However, their inclusion did not attenuate the effect of urban–rural differences in NMR. In multivariable models, urban residence remained associated with double the odds of neonatal mortality compared with rural.ConclusionThere is an urgent need to understand the role of quality of facility-based care, including role of infections, and health-seeking behaviour in case of neonatal illness at home. However, additional factors might also be implicated and higher NMR within urban areas of Tanzania may signal a shift in the pattern of neonatal mortality across several other SSA countries.

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DETERMINANTS OF NEONATAL MORTALITY BASED ON THE 2017 INDONESIAN DEMOGRAPHIC AND HEALTH SURVEY (IDHS)

The Indonesian Journal of Public Health ◽

10.20473/ijph.v16i3.2021.363-374 ◽

2021 ◽

Vol 16 (3) ◽

pp. 363

Author(s):

Fidya Rumiati ◽

Asri C. Adisasmita

Keyword(s):

Birth Weight ◽

Low Birth Weight ◽

Neonatal Mortality ◽

Health Survey ◽

Neonatal Period ◽

Health Interventions ◽

Demographic And Health Survey ◽

Outcome Variable ◽

Childbearing Age ◽

Major Health Problem

ABSTRACTInfant mortality is still a major health problem in Indonesia as 63% of deaths occur in the neonatal period. The trend of the neonatal mortality rate in Indonesia has decreased from 15 (2017) to 13 deaths per 1,000 live births (2018), but this does not meet the Sustainable Development Goals (SDGs) target. Evidence-based health interventions are based on determinants that most influences neonatal mortality. The purpose of this study was to determine the most influential determinants of neonatal mortality in Indonesia. This research is an analytic observational study that uses the 2017 Indonesian Demographic and Health Survey (IDHS) data, with a cross-sectional design. This study’s population was the last baby of married women of childbearing age (15-49 years) and was recorded in the 2017 IDHS with a sample of 15,102 babies. The outcome variable in this study was neonatal mortality. The analysis was conducted in stages, namely univariate analysis, bivariate analysis using the chi-square statistical test (X2), and multivariate analysis using logistic regression. The results showed that 85.71% of deaths occurred in the early neonatal period. The most influential determinants of neonatal mortality were male sex (adj OR = 2.91: 95% CI 1.78-4.76), low birth weight (adj OR = 12.08: 95% CI 7.38-18.86) and parity status ≥ 4 (adj OR = 2.11: 95% CI 1.22-3.61). Public health interventions aimed at reducing neonatal mortality should be linked to newborn and maternal characteristics that significantly influence Indonesia's neonatal mortality. Therefore, health services must consider adequate postpartum neonatal care that is fully integrated with medical care. Moreover, further prevention of potential factors that cause low birth weight before conception should be implemented and further control of births would optimize the family planning program. Keywords: gender, low birth weight, parity status, determinant, neonatal mortality, Indonesia

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Effect of the Iranian Health Sector Evolution Plan Implementation Focused on the Type of Delivery on Maternal and Neonatal Health Indicators in Selected Hospitals of East Azerbaijan Province

Health Technology Assessment in Action ◽

10.18502/htaa.v5i1.7382 ◽

2021 ◽

Author(s):

Hossein Jabbari Bayrami ◽

Mobin Sokhanvar ◽

Elahe Navvabi ◽

Salahaddin Asadi

Keyword(s):

Neonatal Mortality ◽

Data Extraction ◽

Health Sector ◽

Health Indicators ◽

Mortality Rates ◽

Neonatal Health ◽

Natural Childbirth ◽

Maternal And Neonatal Health ◽

East Azerbaijan ◽

Type Of Delivery

Background: Health systems are making reforms to ensure and promote public health. Measuring the effects of reform is one way to determine its effectiveness and consequences. Objectives: This study was aimed at investigating the effect of the Iranian Health Sector Evolution Plan (HSEP) implementation with a focus on the type of delivery on maternal and neonatal health indicators in East-Azerbaijan Province. Methods: This descriptive-analytical study was conducted in 2017. The data of 800 patients were randomly selected through the dataset of eight hospitals equally in the two time periods of before and after the HSEP implementation. A researcher-made checklist was used for data extraction. Data were analyzed by SPSS version 22 using descriptive statistics, t-test, and chi-square. Results: The mean age of the mothers in both periods was 27 years. Most of the participants did not have a previous delivery and had a diploma or a lower level of education. The rate of natural childbirth increased from 34.5% (before the HSEP) to 44.2% (after the HSEP) (P < 0.05). Maternal and neonatal mortality rates decreased from 0.3 and 0.8% to 0.0 and 0.5%, respectively. Maternal and neonatal mortality and stillbirth rates were not significantly different based on the study period and type of delivery (P > 0.05). Conclusions: The findings indicated a significant increase in the rate of natural childbirth after the HSEP implementation. Maternal and neonatal mortality rates had also decreased. These results can guide policymakers in deciding whether to continue or review the reform.

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Saving babies’ lives (SBL) – a programme to reduce neonatal mortality in rural Cambodia: study protocol for a stepped-wedge cluster-randomised trial

BMC Pediatrics ◽

10.1186/s12887-021-02833-7 ◽

2021 ◽

Vol 21 (1) ◽

Author(s):

Kaajal Patel ◽

Sopheakneary Say ◽

Daly Leng ◽

Manila Prak ◽

Koung Lo ◽

...

Keyword(s):

Data Collection ◽

Neonatal Mortality ◽

Rural Areas ◽

Health Workers ◽

Randomised Trial ◽

Scale Up ◽

Cluster Randomised Trial ◽

Stepped Wedge ◽

Cluster Randomised ◽

The Continuum

Abstract Background Neonatal mortality remains unacceptably high. Many studies successful at reducing neonatal mortality have failed to realise similar gains at scale. Effective implementation and scale-up of interventions designed to tackle neonatal mortality is a global health priority. Multifaceted programmes targeting the continuum of neonatal care, with sustainability and scalability built into the design, can provide practical insights to solve this challenge. Cambodia has amongst the highest neonatal mortality rates in South-East Asia, with rural areas particularly affected. The primary objective of this study is the design, implementation, and assessment of the Saving Babies’ Lives programme, a package of interventions designed to reduce neonatal mortality in rural Cambodia. Methods This study is a five-year stepped-wedge cluster-randomised trial conducted in a rural Cambodian province with an estimated annual delivery rate of 6615. The study is designed to implement and evaluate the Saving Babies’ Lives programme, which is the intervention. The Saving Babies’ Lives programme is an iterative package of neonatal interventions spanning the continuum of care and integrating into the existing health system. The Saving Babies’ Lives programme comprises two major components: participatory learning and action with community health workers, and capacity building of primary care facilities involving facility-based mentorship. Standard government service continues in control arms. Data collection covering the whole study area includes surveillance of all pregnancies, verbal and social autopsies, and quality of care surveys. Mixed methods data collection supports iteration of the complex intervention, and facilitates impact, outcome, process and economic evaluation. Discussion Our study uses a robust study design to evaluate and develop a holistic, innovative, contextually relevant and sustainable programme that can be scaled-up to reduce neonatal mortality. Trial registration ClinicalTrials.gov: NCT04663620. Registered on 11th December 2020, retrospectively registered.

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