scholarly journals Birth, stillbirth and death registration data completeness, quality and utility in population-based surveys: EN-INDEPTH study

2021 ◽  
Vol 19 (S1) ◽  
Author(s):  
Simon Kasasa ◽  
◽  
Davis Natukwatsa ◽  
Edward Galiwango ◽  
Tryphena Nareeba ◽  
...  
Keyword(s):  
Neonatal Death ◽  
Neonatal Period ◽  
Population Based ◽  
Descriptive Statistics ◽  
Reproductive Age ◽  
Birth Registration ◽  
Death Registration ◽  
Neonatal Deaths ◽  
Live Births ◽  
Factors Associated

Abstract Background Birth registration is a child’s first right. Registration of live births, stillbirths and deaths is foundational for national planning. Completeness of birth registration for live births in low- and middle-income countries is measured through population-based surveys which do not currently include completeness of stillbirth or death registration. Methods The EN-INDEPTH population-based survey of women of reproductive age was undertaken in five Health and Demographic Surveillance System sites in Bangladesh, Ethiopia, Ghana, Guinea-Bissau and Uganda (2017–2018). In four African sites, we included new/modified questions regarding registration for 1177 stillbirths and 11,881 livebirths (1333 neonatal deaths and 10,548 surviving the neonatal period). Questions were evaluated for completeness of responses, data quality, time to administer and estimates of registration completeness using descriptive statistics. Timing of birth registration, factors associated with non-registration and reported barriers were assessed using descriptive statistics and logistic regression. Results Almost all women, irrespective of their baby’s survival, responded to registration questions, taking an average of < 1 min. Reported completeness of birth registration was 30.7% (6.1-53.5%) for babies surviving the neonatal period, compared to 1.7% for neonatal deaths (0.4–5.7%). Women were able to report age at birth registration for 93.6% of babies. Non-registration of babies surviving the neonatal period was significantly higher for home-born children (aOR 1.43 (95% CI 1.27–1.60)) and in Dabat (Ethiopia) (aOR 4.11 (95% CI 3.37–5.01)). Other socio-demographic factors associated with non-registration included younger age of mother, more prior births, little or no education, and lower socio-economic status. Neonatal death registration questions were feasible (100% women responded; only 1% did not know), revealing extremely low completeness with only 1.2% of neonatal deaths reported as registered. Despite > 70% of stillbirths occurring in facilities, only 2.5% were reported as registered. Conclusions Questions on birth, stillbirth and death registration were feasible in a household survey. Completeness of birth registration is low in all four sites, but stillbirth and neonatal death registration was very low. Closing the registration gap amongst facility births could increase registration of both livebirths and facility deaths, including stillbirths, but will require co-ordination between civil registration systems and the often over-stretched health sector. Investment and innovation is required to capture birth and especially deaths in both facility and community systems.

Smallness at Birth and Neonatal Death: Reexamining the Current Indicator Using Sibling Data

2019 ◽  
Vol 38 (01) ◽  
pp. 076-081
Author(s):  
Maya Tabet ◽  
Louise H. Flick ◽  
Hong Xian ◽  
Chang Jen Jen
Keyword(s):  
United States ◽  
Gestational Age ◽  
Neonatal Death ◽  
Retrospective Cohort ◽  
Significant Interaction ◽  
Neonatal Period ◽  
The United States ◽  
Population Based ◽  
Live Births ◽  
Second Births

Abstract Objective The similarity in size among siblings has implications for neonatal death, but research in this area is lacking in the United States. We examined the association between small-for-gestational age (SGA), defined as a birthweight <10th percentile for gestational age, and neonatal death, defined as death within the first 28 days of life, among second births who had an elder sibling with SGA (“repeaters”) versus those whose elder sibling did not have SGA (“nonrepeaters”). Study Design We conducted a population-based retrospective cohort study including 179,436 women who had their first two nonanomalous singleton live births in Missouri (1989–2005). Logistic regression was used to evaluate the association between SGA and neonatal death among second births, stratified by whether the elder sibling was SGA. Results Out of 179,436 second births, 297 died in the neonatal period. There was a significant interaction between birthweight-for-gestational age of first and second births in relation to neonatal death (p = 0.001). Second births with SGA had increased odds of neonatal death by 2.15-fold if they were “repeaters,” and 4.44-fold if they were “nonrepeaters,” as compared with non-SGA second births. Conclusion Our findings suggest that referencing sibling birthweight may be warranted when evaluating infant size in relation to neonatal death.

scholarly journals DETERMINANTS OF NEONATAL MORTALITY IN THE LARGEST INTERNATIONAL BORDER OF BRAZIL: A CASE CONTROL STUDY

2019 ◽  
Author(s):  
Suzana de Souza ◽  
Etienne Larissa Duim ◽  
Fernando Kenji Nampo
Keyword(s):  
Neonatal Mortality ◽  
Neonatal Death ◽  
Case Control Study ◽  
Case Control ◽  
Sociodemographic Characteristics ◽  
Neonatal Deaths ◽  
Live Births ◽  
Factors Associated ◽  
International Border ◽  
Control Study

Abstract BACKGROUND: Neonatal deaths correspond to 44% of the deaths in children under five globally. The most populous international border of Brazil includes Foz do Iguassu (Brazil), Puerto Iguazu (Argentina) and Ciudad del Este (Paraguay). Similarly to any other Brazilian city, the public health services located in Foz do Iguassu provide medical care to foreigners, including pregnant women who go to Brazil to deliver. Although the international importance of Foz do Iguassu in terms of healthcare, neonatal mortality in the city (15.3/1,000 live births) is higher than Brazil’s average (13.8/1,000 live births) and corresponds to 61% of all deaths in children under five. Unfortunately, the causes of the neonatal deaths in Foz do Iguassu remain unclear, which make it more difficult to manage the problem. The current study aimed to identify the determinants of neonatal mortality in Foz do Iguassu. METHODS: In this case-control study, we analyzed all neonatal deaths occurred in Foz do Iguassu from 2012 to 2016. Birth and mortality data were extracted from two national governmental databases (SINASC and SIM). We extracted data on (i) maternal sociodemographic characteristics, (ii) pregnancy care, and (iii) newborn characteristics. Multiple logistic regression with the conceptual framework was applied to examine the factors associated with neonatal mortality. RESULTS: Most of the deaths occurred in the early neonatal period (65.9%). The factors associated with neonatal death were fetal congenital anomaly (OR 22.4; CI 95% 7.41-67.76; p = <0.001); low birth weight (OR 17.4; CI 95% 8.70-35.17; p = <0.001), first minute Apgar score under 7 (OR 15.4; CI 95% 8.11- 29.24; p = <0.001); zero to 3 prenatal appointments (OR 3.3; CI 95% 1.28-8.70; p = 0.014) and prematurity (OR 3.5; CI 95% 1.79 6.92; p = <0.001). CONCLUSION: The high rate of neonatal death in Foz do Iguassu is strongly associated with newborn characteristics and not associated with maternal sociodemographic characteristics. Thus, the health services in the Brazilian side of this international borders should be aware of the quality of the prenatal care and childbirth attention provided.

scholarly journals Stillbirth outcome capture and classification in population-based surveys: EN-INDEPTH study

2021 ◽  
Vol 19 (S1) ◽  
Author(s):  
Hannah Blencowe ◽  
◽  
Matteo Bottecchia ◽  
Doris Kwesiga ◽  
Joseph Akuze ◽  
...  
Keyword(s):  
Gestational Age ◽  
A Priori ◽  
Healthcare Providers ◽  
Population Based ◽  
Reproductive Age ◽  
Group Discussions ◽  
Cross Sectional ◽  
Vital Status ◽  
Neonatal Deaths ◽  
Adverse Pregnancy

Abstract Background Household surveys remain important sources of stillbirth data, but omission and misclassification are common. Classifying adverse pregnancy outcomes as stillbirths requires accurate reporting of vital status at birth and gestational age or birthweight for every pregnancy. Further categorisation, e.g. by sex, or timing (intrapartum/antepartum) improves data to understand and prevent stillbirth. Methods We undertook a cross-sectional population-based survey of women of reproductive age in five health and demographic surveillance system sites in Bangladesh, Ethiopia, Ghana, Guinea-Bissau and Uganda (2017–2018). All women answered a full birth history with pregnancy loss questions (FBH+) or a full pregnancy history (FPH). A sub-sample across both groups were asked additional stillbirth questions. Questions were evaluated using descriptive measures. Using an interpretative paradigm and phenomenology methodology, focus group discussions with women exploring barriers to reporting birthweight for stillbirths were conducted. Thematic analysis was guided by an a priori codebook. Results Overall 69,176 women reported 98,483 livebirths (FBH+) and 102,873 pregnancies (FPH). Additional questions were asked for 1453 stillbirths, 1528 neonatal deaths and 12,620 surviving children born in the 5 years prior to the survey. Completeness was high (> 99%) for existing FBH+/FPH questions on signs of life at birth and gestational age (months). Discordant responses in signs of life at birth between different questions were common; nearly one-quarter classified as stillbirths on FBH+/FPH were reported born alive on additional questions. Availability of information on gestational age (weeks) (58.1%) and birthweight (13.2%) was low amongst stillbirths, and heaping was common. Most women (93.9%) were able to report the sex of their stillborn baby. Response completeness for stillbirth timing (18.3–95.1%) and estimated proportion intrapartum (15.6–90.0%) varied by question and site. Congenital malformations were reported in 3.1% stillbirths. Perceived value in weighing a stillborn baby varied and barriers to weighing at birth a nd knowing birthweight were common. Conclusions Improving stillbirth data in surveys will require investment in improving the measurement of vital status, gestational age and birthweight by healthcare providers, communication of these with women, and overcoming reporting barriers. Given the large burden and effect on families, improved data must be made available to end preventable stillbirths.

scholarly journals Geospatial analysis of determinants of neonatal mortality in Ghana

2021 ◽  
Vol 21 (1) ◽  
Author(s):  
Duah Dwomoh
Keyword(s):  
Risk Factors ◽  
Birth Weight ◽  
Low Birth Weight ◽  
Neonatal Mortality ◽  
Neonatal Death ◽  
Reproductive Age ◽  
Multiple Births ◽  
Demographic And Health Surveys ◽  
Neonatal Deaths ◽  
The Impact

Abstract Background Ghana did not meet the Millennium Development Goal 4 of reducing child mortality by two-thirds and may not meet SDG (2030). There is a need to direct scarce resources to mitigate the impact of the most important risk factors influencing high neonatal deaths. This study applied both spatial and non-spatial regression models to explore the differential impact of environmental, maternal, and child associated risk factors on neonatal deaths in Ghana. Methods The study relied on data from the Ghana Demographic and Health Surveys (GDHS) and the Ghana Maternal Health Survey (GMHS) conducted between 1998 and 2017 among 49,908 women of reproductive age and 31,367 children under five (GDHS-1998 = 3298, GDHS-2003 = 3844, GDHS-2008 = 2992, GDHS-2014 = 5884, GMHS-2017 = 15,349). Spatial Autoregressive Models that account for spatial autocorrelation in the data at the cluster-level and non-spatial statistical models with appropriate sampling weight adjustment were used to study factors associated with neonatal deaths, and a p-value less than 0.05 was considered statistically significant. Results Population density, multiple births, smaller household sizes, high parity, and low birth weight significantly increased the risk of neonatal deaths over the years. Among mothers who had multiple births, the risk of having neonatal deaths was approximately four times as high as the risk of neonatal deaths among mothers who had only single birth [aRR = 3.42, 95% CI: 1.63–7.17, p < 0.05]. Neonates who were perceived by their mothers to be small were at a higher risk of neonatal death compared to very large neonates [aRR = 2.08, 95% CI: 1.19–3.63, p < 0.05]. A unit increase in the number of children born to a woman of reproductive age was associated with a 49% increased risk in neonatal deaths [aRR = 1.49, 95% CI: 1.30–1.69, p < 0.05]. Conclusion Neonatal mortality in Ghana remains relatively high, and the factors that predisposed children to neonatal death were birth size that were perceived to be small, low birth weight, higher parity, and multiple births. Improving pregnant women’s nutritional patterns and providing special support to women who have multiple deliveries will reduce neonatal mortality in Ghana.

ANALYSIS OF FETAL AND NEONATAL DEATHS IN 4117 CONSECUTIVE BIRTHS

PEDIATRICS ◽  
1950 ◽  
Vol 5 (2) ◽  
pp. 184-192
Author(s):  
HERBERT C. MILLER
Keyword(s):  
Cause Of Death ◽  
Premature Infants ◽  
Neonatal Death ◽  
Causes Of Death ◽  
Neonatal Period ◽  
Full Term ◽  
Maternal Complications ◽  
Term Infants ◽  
Neonatal Deaths ◽  
Postmortem Examinations

An analysis of the significant causes of death in 4117 consecutive births was made; there were 66 fetal deaths and 85 neonatal deaths. A significant cause of death was determined in 51 fetuses and 56 live-born infants. Eighty-five per cent of the live-born infants who weighed over 1000 gm. at birth and had postmortem examinations had causes of death which were considered to be significant. Almost half of the live-born premature infants with birth weights between 1000 and 2500 gm. were considered to have had more than one significant cause of death. The so-called significant causes of death among live-born infants differed from those determined for fetuses dying before birth. Among the former, pathologic conditions in the infants were determined four times more frequently than in those dying before birth and, in the latter, maternal complications of pregnancy and labor were diagnosed as significant causes of death five times more frequently than in infants dying in the neonatal period. Hyaline-like material in the lung was considered to be the most frequent significant cause of death in live-born premature infants; congenital malformation and anoxia resulting from complications of labor were the most frequently determined significant causes of death in live-born full term infants. No differences were found in the significant causes of death in premature and full term fetuses. Anoxia resulting from accidental and unexpected interruption of the blood flow in the placenta and umbilical cord and from dystocia was the most frequently determined significant cause of death in both groups. A plea has been made for the adoption by obstetricians, pathologists and pediatricians of a formal uniform plan of classifying the causes of fetal and neonatal death which would divest current efforts to determine the cause of death of as much vague terminology and arbitrary opinion as possible.

The Difference in Sibling Birthweight and Neonatal Death: A Population-Based Cohort Study

2018 ◽  
Vol 36 (05) ◽  
pp. 498-504
Author(s):  
Maya Tabet ◽  
Louise Flick ◽  
Hong Xian ◽  
Jen Chang
Keyword(s):  
Logistic Regression ◽  
Cohort Study ◽  
Neonatal Death ◽  
Binary Logistic Regression ◽  
Population Based ◽  
Growth Potential ◽  
Live Births ◽  
The Difference ◽  
Second Births ◽  
Half Sibling

Background There has been a call for customized rather than population-based birthweight standards that would classify smallness based on an infant's own growth potential. Thus, this study aimed to examine the association between the difference in sibling birthweight and the likelihood of neonatal death among second births in a U.S. population. Study Design This was a population-based cohort study including 179,300 women who delivered their first two nonanomalous singleton live births in Missouri (1989–2005). We performed binary logistic regression to evaluate the association between being relatively smaller than the elder full- or half-sibling (i.e., smaller by at least 500 g) and neonatal death (i.e., deaths in the first 28 days of life) among second births after controlling for sociodemographic and pregnancy-related variables in the second pregnancy. Results The adjusted odds of neonatal death were 2.54-times higher among second births who were relatively smaller than their elder sibling. Among relatively small second births, every 100-g increase in the difference in sibling birthweight was associated with a 13% increase in the odds of neonatal death. Conclusion The deviation from the elder sibling's birthweight predicts neonatal death. Taking into consideration the elder sibling's birthweight may be warranted in clinical and research settings.

scholarly journals Comparing regional neonatal mortality rates: the influence of registration of births as live born for birth weight <500 g in Taiwan

2019 ◽  
Vol 3 (1) ◽  
pp. e000526
Author(s):  
Liang-Yi Wang ◽  
Yu-Shan Chang ◽  
Fu-Wen Liang ◽  
Yung-Chieh Lin ◽  
Yuh-Jyh Lin ◽  
...  
Keyword(s):  
Birth Weight ◽  
Neonatal Mortality ◽  
Ecological Study ◽  
Population Based ◽  
Cross Sectional ◽  
Neonatal Deaths ◽  
Live Births ◽  
Taipei City ◽  
The Impact ◽  
The City

ObjectiveTo investigate regional variation in the registration of births (still+live) as live born for birth weight <500 g and the impact on the city/county ranking of neonatal mortality rate (NMR) in Taiwan.DesignPopulation-based cross-sectional ecological study.Setting20 cities/counties in Taiwan.ParticipantsRegistered births for birth weight <500 g and neonatal deaths in 2015–2016.Main outcome measuresCity/county percentage of births <500 g registered as live born and ranking of city/county NMR (deaths per 1000 live births) including and excluding live births <500 g.ResultsThe percentage of births <500 g registered as live born ranged from 0% in Keelung City (0/26) and Penghu County (0/4) to 20% in Taipei City (112/558), 24% in Hsinchu County (5/21) and 28% in Hualien County (9/32). The change in city/county ranking of NMR from including to excluding live births <500 g was most prominent in Taipei City (from the 15th to the 1st) followed by Kaohsiung City (from the 18th to the 14th).ConclusionsThe city/county NMR in Taiwan is influenced by variation in the registration of live born for births with uncertain viability. We recommend presenting city/county NMR using both criteria (with or without minimum threshold of gestation period or birth weight) for better interpretation of the findings of comparisons of city/county NMR.

scholarly journals Medicine package inserts from the users’ perspective: are they read and understood?

2019 ◽  
Vol 22 ◽  
Author(s):  
Tatiane da Silva Dal Pizzol ◽  
Cassia Garcia Moraes ◽  
Paulo Sérgio Dourado Arrais ◽  
Andréa Dâmaso Bertoldi ◽  
Luiz Roberto Ramos ◽  
...  
Keyword(s):  
Population Based ◽  
Education Level ◽  
Descriptive Statistics ◽  
Cross Sectional ◽  
Population Based Study ◽  
Package Inserts ◽  
Factors Associated ◽  
Written Information ◽  
Lower Education Level ◽  
Lower Education

ABSTRACT: Introduction: The written information on medicines has been acknowledged as an important tool for health education. Objective: To analyze the use and understanding of medicine package inserts by users and assess sociodemographic and medical factors associated with their comprehension. Method: Data in this analysis are part of the PNAUM National Survey - a cross-sectional population-based study conducted in Brazil. Descriptive statistics and the Pearson χ2 tests were performed to compare proportions between sociodemographic and medical characteristics, as well as use and understanding of medicine package inserts. Results: A total of 28.427 individuals responded to questions related to medicine package inserts. From these, 59.6% (95%CI 57.7 - 61.5) said they usually read the inserts, and 98.4% (95%CI 98.0 - 98.8) considered them necessary. Among people who read the medicine package inserts, more than half indicated difficulties with legibility (57.4%; 95%CI 55,2 - 59,6) and readability (54.1%; 95%CI 52.1 - 56.1). People from a lower education level reported greater difficulty in understanding them. Conclusion: The larger portion of the population usually read medicine package inserts. Nevertheless, people have difficulty in reading and understanding them.

scholarly journals Factors Associated with Urinary Iodine Concentration among Women of Reproductive Age, 20–49 Years Old, in Tanzania: A Population-Based Cross-Sectional Study

2020 ◽  
Vol 4 (5) ◽  
Author(s):  
Djibril M Ba ◽  
Paddy Ssentongo ◽  
Muzi Na ◽  
Kristen H Kjerulff ◽  
Guodong Liu ◽  
...  
Keyword(s):  
Urinary Iodine ◽  
Iodine Concentration ◽  
Population Based ◽  
Cross Sectional Study ◽  
Iodized Salt ◽  
Reproductive Age ◽  
Urinary Iodine Concentration ◽  
Women Of Reproductive Age ◽  
Cross Sectional ◽  
Factors Associated

ABSTRACT Background Universal salt iodization (USI) is the most feasible and cost-effective, and equitable, approach to prevent iodine deficiency. Severe maternal iodine deficiency during pregnancy is associated with serious adverse gestational and birth outcomes. Objectives The aim was to assess iodine status and identify independent factors associated with urinary iodine concentration (UIC) among women of reproductive age in Tanzania. Methods This was a weighted, population-based, cross-sectional study in 2985 women of reproductive age (20–49 y) in Tanzania who participated in the Demographic and Health Surveys in 2015–2016 (DHS 2015–2016) and had measured UIC. Multivariable generalized linear regression was used to identify potential factors that were associated with UIC. Results The median UICs among women consuming inadequately iodized salt (93.6 μg/L; 25th and 75th percentiles: 43.1, 197.9 μg/L) and women in the lowest socioeconomic status (92.3 μg/L; 45.6, 194.4 μg/L) were below the WHO-recommended ranges (≥150 μg/L for pregnant women and ≥100 μg/L for nonpregnant women). The results of multivariable models indicated that pregnant women had 1.21 μg/L lower UIC than nonpregnant women (β = −1.21; 95% CI: −3.42, −0.12), breastfeeding women had 1.02 μg/L lower UIC than nonbreastfeeding women (β = −1.02; 95% CI: −2.25, −0.27), and women with no education had a 1.88 μg/L lower UIC compared with those with secondary/highest education (β = −1.88; 95% CI: −4.58, −0.36). Women consuming inadequately iodized salt had 6.55 μg/L lower UIC than those consuming adequately iodized salt (β = −6.55; 95% CI: −9.24, −4.33). The median UIC varied substantially across geographic zones, ranging from 83.2 μg/L (45.9, 165.3) in the Western region to 347.8 μg/L (185.0, 479.8) in the Eastern region. Conclusions Our findings indicated a great heterogeneity in median UIC across regions of Tanzania among women of reproductive age. Poverty, consuming inadequately iodized salt, and lack of education appeared to be the driving factors for lower UIC in Tanzania.

scholarly journals Burden of early-term birth on adverse infant outcomes: a population-based cohort study in Brazil

BMJ Open ◽  
2017 ◽  
Vol 7 (12) ◽  
pp. e017789 ◽  
Author(s):  
Maria do Carmo Leal ◽  
Ana Paula Esteves-Pereira ◽  
Marcos Nakamura-Pereira ◽  
Rosa Maria Soares Madeira Domingues ◽  
Marcos Augusto Bastos Dias ◽  
...  
Keyword(s):  
Cohort Study ◽  
Neonatal Death ◽  
Neonatal Intensive Care ◽  
Oxygen Therapy ◽  
Population Based ◽  
Medical Conditions ◽  
Infant Outcomes ◽  
Early Term ◽  
Live Births ◽  
National Rate

ObjectivesTo estimate the national rate of early-term live births in Brazil and to evaluate the effect of birth at 37 and 38 weeks’ gestation, as compared with 39 and 40 weeks’ gestation on infant outcomes according to precursors of birth and the existence of maternal/fetal medical conditions.DesignNational perinatal population-based cohort study.Setting266 maternity services located in the five Brazilian macroregions.Participants18 652 singleton live newborns from 37 0/7 to 40 6/7 weeks of gestation.Main outcome measuresResuscitation in delivery room, oxygen therapy, transient tachypnoea, admission to neonatal intensive care unit (NICU), hypoglycaemia, use of antibiotics, phototherapy, phototherapy after hospital discharge, neonatal death and breastfeeding.ResultsEarly terms accounted for 35% (95% CI 33.4% to 36.7%) of all live births. Among provider-initiated births in women without medical conditions, infants of 37 and 38 weeks’ gestation had higher odds of oxygen therapy (adjusted OR (AOR) 2.93, 95% CI 1.72 to 4.98 and AOR 1.92 95% CI 1.18 to 3.13), along with admission to NICU (AOR 2.01, 95% CI 1.18 to 3.41 and AOR 1.56, 95% CI 1.02 to 2.60), neonatal death (AOR 14.40, 95% CI 1.94 to 106.69 and AOR 13.76,95% CI 2.84 to 66.75), hypoglycaemia in the first 48 hours of life (AOR 7.86, 95% CI 1.95 to 31.71 and AOR 5.76, 95% CI 1.63 to 20.32), transient tachypnoea (AOR 2.98, 95% CI 1.57 to 5.65 and AOR 2.12, 95% CI 1.00 to 4.48) and the need for phototherapy within the first 72 hours of life (AOR 3.59, 95% CI 1.95 to 6.60 and AOR 2.29, 95% CI 1.49 to 3.53), yet lower odds of breastfeeding up to 1 hour after birth (AOR 0.67, 95% CI 0.53 to 0.86 and AOR 0.87, 95% CI 0.76 to 0.99) and exclusive breastfeeding during hospital stay (AOR 0.68, 95% CI 0.51 to 0.89 and AOR 0.84, 95% CI 0.71 to 0.99).ConclusionBirth at 37 and 38 weeks’ gestation increased the risk of most adverse infant outcomes analysed, especially among provider-initiated births and should be avoided before 39 weeks’ gestation in healthy pregnancies.

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