scholarly journals Gender variations in neonatal and early infant mortality in India and Pakistan: a secondary analysis from the Global Network Maternal Newborn Health Registry

2020 ◽  
Vol 17 (S3) ◽  
Author(s):  
Zubair H. Aghai ◽  
Shivaprasad S. Goudar ◽  
Archana Patel ◽  
Sarah Saleem ◽  
Sangappa M. Dhaded ◽  
...  
Keyword(s):  
Neonatal Mortality ◽  
Secondary Analysis ◽  
Newborn Health ◽  
Global Network ◽  
Live Births ◽  
Early Neonatal Mortality ◽  
Specific Mortality ◽  
Health Registry ◽  
Gender Variations ◽  
The Impact

Abstract Background To determine the gender differences in neonatal mortality, stillbirths, and perinatal mortality in south Asia using the Global Network data from the Maternal Newborn Health Registry. Methods This study is a secondary analysis of prospectively collected data from the three south Asian sites of the Global Network. The maternal and neonatal demographic, clinical characteristics, rates of stillbirths, early neonatal mortality (1–7 days), late neonatal mortality (8–28 days), mortality between 29–42 days and the number of infants hospitalized after birth were compared between the male and female infants. Results Between 2010 and 2018, 297,509 births [154,790 males (52.03%) and 142,719 females (47.97%)] from two Indian sites and one Pakistani site were included in the analysis [288,859 live births (97.1%) and 8,648 stillbirths (2.9%)]. The neonatal mortality rate was significantly higher in male infants (33.2/1,000 live births) compared to their female counterparts (27.4/1,000, p < 0.001). The rates of stillbirths (31.0 vs. 26.9/1000 births) and early neonatal mortality (27.1 vs 21.6/1000 live births) were also higher in males. However, there were no significant differences in late neonatal mortality (6.3 vs. 5.9/1000 live births) and mortality between 29–42 days (2.1 vs. 1.9/1000 live births) between the two groups. More male infants were hospitalized within 42 days after birth (1.8/1000 vs. 1.3/1000 live births, p < 0.001) than females. Conclusion The risks of stillbirths, and early neonatal mortality were higher among male infants than their female counterparts. However, there was no gender difference in mortality after 7 days of age. Our results highlight the importance of stratifying neonatal mortality into early and late neonatal period to better understand the impact of gender on neonatal mortality. The information from this study will help in developing strategies and identifying measures that can reduce differences in sex-specific mortality.

scholarly journals Institutional deliveries and stillbirth and neonatal mortality in the Global Network's Maternal and Newborn Health Registry

2020 ◽  
Vol 17 (S3) ◽  
Author(s):  
Shivaprasad S. Goudar ◽  
Norman Goco ◽  
Manjunath S. Somannavar ◽  
Avinash Kavi ◽  
Sunil S. Vernekar ◽  
...  
Keyword(s):  
Neonatal Mortality ◽  
Institutional Delivery ◽  
Newborn Health ◽  
Mortality Rates ◽  
Trial Registration ◽  
Live Births ◽  
Link Type ◽  
Institutional Deliveries ◽  
Health Registry ◽  
The Relationship

Abstract Background Few studies have shown how the move toward institutional delivery in low and middle-income countries (LMIC) impacts stillbirth and newborn mortality. Objectives The study evaluated trends in institutional delivery in research sites in Belagavi and Nagpur India, Guatemala, Kenya, Pakistan, and Zambia from 2010 to 2018 and compared them to changes in the rates of neonatal mortality and stillbirth. Methods We analyzed data from a nine-year interval captured in the Global Network (GN) Maternal Newborn Health Registry (MNHR). Mortality rates were estimated from generalized estimating equations controlling for within-cluster correlation. Cluster-level analyses were performed to assess the association between institutional delivery and mortality rates. Results From 2010 to 2018, a total of 413,377 deliveries in 80 clusters across 6 sites in 5 countries were included in these analyses. An increase in the proportion of institutional deliveries occurred in all sites, with a range in 2018 from 57.7 to 99.8%. In 2010, the stillbirth rates ranged from 19.3 per 1000 births in the Kenyan site to 46.2 per 1000 births in the Pakistani site and by 2018, ranged from 9.7 per 1000 births in the Belagavi, India site to 40.8 per 1000 births in the Pakistani site. The 2010 neonatal mortality rates ranged from 19.0 per 1000 live births in the Kenyan site to 51.3 per 1000 live births in the Pakistani site with the 2018 neonatal mortality rates ranging from 9.2 per 1000 live births in the Zambian site to 50.2 per 1000 live births in the Pakistani site. In multivariate modeling, in some but not all sites, the reductions in stillbirth and neonatal death were significantly associated with an increase in the institutional deliveries. Conclusions There was an increase in institutional delivery rates in all sites and a reduction in stillbirth and neonatal mortality rates in some of the GN sites over the past decade. The relationship between institutional delivery and a decrease in mortality was significant in some but not all sites. However, the stillbirth and neonatal mortality rates remain at high levels. Understanding the relationship between institutional delivery and stillbirth and neonatal deaths in resource-limited environments will enable development of targeted interventions for reducing the mortality burden. Trial registration The study is registered at clinicaltrials.gov. ClinicalTrial.gov Trial Registration: NCT01073475.

scholarly journals Evaluating the effect of care around labor and delivery practices on early neonatal mortality in the Global Network’s Maternal and Newborn Health Registry

2020 ◽  
Vol 17 (S2) ◽  
Author(s):  
Archana B. Patel ◽  
Elizabeth M. Simmons ◽  
Sowmya R. Rao ◽  
Janet Moore ◽  
Tracy L. Nolen ◽  
...  
Keyword(s):  
Quality Of Care ◽  
Neonatal Mortality ◽  
Composite Index ◽  
Newborn Health ◽  
World Health ◽  
Essential Newborn Care ◽  
Neonatal Deaths ◽  
Early Neonatal Mortality ◽  
Health Registry

Abstract Background Neonatal deaths in first 28-days of life represent 47% of all deaths under the age of five years globally and are a focus of the United Nation’s (UN’s) Sustainable Development Goals. Pregnant women are delivering in facilities but that does not indicate quality of care during delivery and the postpartum period. The World Health Organization’s Essential Newborn Care (ENC) package reduces neonatal mortality, but lacks a simple and valid composite index that measures its effectiveness. Methods Data on 5 intra-partum and 3 post-partum practices (indicators) recommended as part of ENC, routinely collected in NICHD’s Global Network’s (GN) Maternal Newborn Health Registry (MNHR) between 2010 and 2013, were included. We evaluated if all 8 practices (Care around Delivery – CAD), combined as an index was associated with reduced early neonatal mortality rates (days 0–6 of life). Results A total of 150,848 live births were included in the analysis. The individual indicators varied across sites. All components were present in 19.9% births (range 0.4 to 31% across sites). Present indicators (8 components) were associated with reduced early neonatal mortality [adjusted RR (95% CI):0.81 (0.77, 0.85); p < 0.0001]. Despite an overall association between CAD and early neonatal mortality (RR < 1.0 for all early mortality): delivery by skilled birth attendant; presence of fetal heart and delayed bathing were associated with increased early neonatal mortality. Conclusions Present indicators (8 practices) of CAD were associated with a 19% reduction in the risk of neonatal death in the diverse health facilities where delivery occurred within the GN MNHR. These indicators could be monitored to identify facilities that need to improve compliance with ENC practices to reduce preventable neonatal deaths. Three of the 8 indicators were associated with increased neonatal mortality, due to baby being sick at birth. Although promising, this composite index needs refinement before use to monitor facility-based quality of care in association with early neonatal mortality. Trial registration The identifier of the Maternal Newborn Health Registry at ClinicalTrials.gov is NCT01073475.

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 Essential Medicine and Equipment for Emergency Obstetric and Newborn Care in Zanzibar: Situation at a Glance

2019 ◽  
pp. 1-7
Author(s):  
Andrea B. Pembe ◽  
Bruno Sunguya ◽  
Stella Mushy ◽  
Sebalda Leshabari ◽  
George Kiwango ◽  
...  
Keyword(s):  
Neonatal Mortality ◽  
Essential Medicine ◽  
Newborn Care ◽  
Newborn Health ◽  
Structure Interview ◽  
Essential Medicines ◽  
Maternal And Newborn Health ◽  
Cross Sectional ◽  
Live Births ◽  
Delivery Services

Background:Maternal and neonatal mortality are unacceptably high in Zanzibar. Maternal mortality and neonatal mortality ratio stand at 350 per 100,000 live births and 29 per 1,000 live births respectively as of 2018. Addressing challenges facing maternal and newborn health requires among others, the assurance of essential medicine and equipment to deliver evidence based interventions. This paper reports evidence gathered on the availability of essential medicines and equipment in providing Emergency Obstetric and Newborn Care (EmoNC) services in Zanzibar. Methods:A cross-sectional mixed methods study design was used to collect information on the availability of drugs and equipment from all health facilities providing delivery services in Zanzibar. Semi-structure interview guide was used to carry in-depth interviews (IDIs) with health facility in-charges while observation on availability of essential medicine and equipment for EmONC was carried using standard observation guide as adopted from Averting Maternal Death and Disability program.

scholarly journals The Maternal and Newborn Health Registry Study of the Global Network for Women's and Children's Health Research

2012 ◽  
Vol 118 (3) ◽  
pp. 190-193 ◽  
Author(s):  
Shivaprasad S. Goudar ◽  
Waldemar A. Carlo ◽  
Elizabeth M. McClure ◽  
Omrana Pasha ◽  
Archana Patel ◽  
...  
Keyword(s):  
Health Research ◽  
Newborn Health ◽  
Children's Health ◽  
Global Network ◽  
Children’S Health ◽  
Maternal And Newborn Health ◽  
Registry Study ◽  
Health Registry ◽  
Maternal And Newborn

scholarly journals U-Shaped Association between Maternal Hemoglobin and Low Birth Weight in Rural Bangladesh

2021 ◽  
Author(s):  
Rebecca Carpenter ◽  
Masum Billah ◽  
Genevieve Lyons ◽  
Md Shahjahan Siraj ◽  
Qazi Rahman ◽  
...  
Keyword(s):  
Birth Weight ◽  
Low Birth Weight ◽  
Pregnant Women ◽  
Newborn Health ◽  
Global Network ◽  
World Health ◽  
Placental Disease ◽  
The Mean ◽  
Health Registry ◽  
Disease Understanding

Low birth weight (LBW) is associated with a higher risk of neonatal mortality and the development of adult-onset chronic disease. Understanding the ongoing contribution of maternal hemoglobin (Hgb) levels to the incidence of LBW in South Asia is crucial to achieve the World Health Assembly global nutrition target of a 30% reduction in LBW by 2025. We enrolled pregnant women from the rural Tangail District of Bangladesh in a Maternal Newborn Health Registry established under The Global Network for Women’s and Children’s Health Research. We measured the Hgb of pregnant women at enrollment and birth weights of all infants born after 20 weeks gestation. Using logistic regression to adjust for multiple potential confounders, we estimated the association between maternal Hgb and the risk of LBW. We obtained Hgb measurements and birth weights from 1,665 mother–child dyads between July 2019 and April 2020. Using trimester-specific cutoffs for anemia, 48.3% of the women were anemic and the mean (±SD) Hgb level was 10.6 (±1.24) g/dL. We identified a U-shaped relationship where the highest risk of LBW was seen at very low (< 7.0 g/dL, OR = 2.00, 95% CI = 0.43–7.01, P = 0.31) and high (> 13.0 g/dL, OR = 2.17, 95% CI = 1.01–4.38, P = 0.036) Hgb levels. The mechanisms underlying this U-shaped association may include decreased plasma expansion during pregnancy and/or iron dysregulation resulting in placental disease. Further research is needed to explain the observed U-shaped relationship, to guide iron supplementation in pregnancy and to minimize the risk of LBW outcomes.

scholarly journals STATUS OF MEDICAL CARE FOR NEWBORNS IN UKRAINE

2020 ◽  
Vol 10 (4(38)) ◽  
pp. 5-24
Author(s):  
Y. Antypkin ◽  
T. Znamenska ◽  
R. Marushko ◽  
E. Dudina ◽  
V. Lapshin ◽  
...  
Keyword(s):  
Birth Weight ◽  
Low Birth Weight ◽  
Medical Care ◽  
Neonatal Mortality ◽  
Perinatal Care ◽  
Neonatal Care ◽  
Postpartum Woman ◽  
Ministry Of Health ◽  
Live Births ◽  
Early Neonatal Mortality

Introduction. In the context of continuing depopulation, and low birth rate, the formation and preservation of newborn generations’ health is the most important medical and social task and one of the main activities of the Ministry of Health of Ukraine and local health care institutions. The aim of the study was to analyze and evaluate the effectiveness of medical care for newborns in Ukraine and its impact on the main indicators of newborns’ health. Materials and research methods. A retrospective analysis and assessment of the dynamics of neonatal care in Ukraine was carried out according to state and industry statistics, perinatal audit according to the method of WHO “MATRIX - BABIES” for the period 2001-2019, monitoring and evaluation of the regionalization of perinatal care (for 2014-2017). Methods of a systematic approach, bibliographic, statistical data processing, and graphic representation were applied. Results of the study: the study showed that during the period of the research a  number of newborns born in the facilities of the Ministry of Health of Ukraine decreased from 387900 in 2000 to 294100 in 2019, with a negative trend in the generalized objective criterion of the generation’s health and socio-economic well-being of the population - frequency of premature newborns with low birth weight  including those with extremely low birth weight. At the same time, the frequency of newborns with congenital diseases or those who got sick after birth, decreased from 280.8 per 1000 live births in 2000 to 172.14 in 2019 with the wave-like nature of its dynamics. The existing state system of three-level neonatal care integrated into the perinatal service makes it possible to provide basic, qualified and highly qualified specialized medical care for newborns at all stages of its provision. During the observation period, the provision of newborns with pediatrician-neonatologists increased from 4.58 per 1000 live births to 5.34, and with hospital beds for premature and sick newborns - from 5.62 to 6.91, respectively. A slight increasing trend of significant criterion of newborns’ health condition was achieved (99.36% in 2001 vs 99.7% in 2019) along with the activities of the neonatological service in survival of newborns in the first 168 hours of life mainly due to a 2.6-fold increase in the survival of newborns with a birth weight of 500-999g. Sufficient efficiency of medical care for newborns was confirmed by a positive trend in early neonatal mortality from 4.71 ‰ in 2000 to 3.04 ‰ in 2019 and neonatal mortality from 6.65 ‰ to 4.57 ‰, respectively. At the same time, the increase of newborns’ incidence with diseases that have a direct impact on the development of chronic and disabling diseases is a cause for concern: cases of congenital pneumonia increased from 3.18 ‰ in 2000 to 5.46 ‰ in 2019, of neonatal sepsis - from 0.09 ‰ to 0.74 ‰, respectively. Also other disorders of newborns’ cerebral status increased from 18.5 ‰ in 2010 to 28.5 ‰, and neonatal jaundice -  from 31.11 ‰ in 2015 to 43.65 ‰. An excess in 1.5 times of the standard recommended by the WHO of the proportional indicator of early neonatal mortality was revealed among infants weighing more than 1500 g. The excess of the real indicator of early neonatal mortality over the actual one was 2.2-2.3 times, which meant underestimation of the total rate of neonatal and infant mortality. Conclusions. Further improvement of the effectiveness of neonatal care and the decrease of early neonatal and neonatal mortality levels requires continued regionalization of perinatal care, completion of the perinatal care centers of the third level, revision and provision of patient routes, development and provision of state-guaranteed medical services/standards (such as a standard of child’s safety, safety of pregnant and postpartum woman), the reliability of determining body weight at birth, criteria for live birth and stillbirth, the introduction of follow-up monitoring of low-birth-weight newborns, the formation of a unified system for monitoring the activities of the maternal and child health services.

scholarly journals The Global Network Maternal Newborn Health Registry: a multi-national, community-based registry of pregnancy outcomes

2015 ◽  
Vol 12 (S2) ◽  
Author(s):  
Carl L Bose ◽  
Melissa Bauserman ◽  
Robert L Goldenberg ◽  
Shivaprasad S Goudar ◽  
Elizabeth M McClure ◽  
...  
Keyword(s):  
Pregnancy Outcomes ◽  
Newborn Health ◽  
Global Network ◽  
Community Based ◽  
National Community ◽  
Health Registry

scholarly journals The Global Network Maternal Newborn Health Registry: a multi-country, community-based registry of pregnancy outcomes

2020 ◽  
Vol 17 (S2) ◽  
Author(s):  
Elizabeth M. McClure ◽  
Ana L. Garces ◽  
Patricia L. Hibberd ◽  
Janet L. Moore ◽  
Shivaprasad S. Goudar ◽  
...  
Keyword(s):  
Health Care ◽  
Pregnant Women ◽  
Pregnancy Outcomes ◽  
Newborn Health ◽  
Population Based ◽  
Global Network ◽  
Resource Limited ◽  
Health Registry ◽  
Population Based Registry ◽  
Over Time

Abstract Background The Global Network for Women's and Children’s Health Research (Global Network) conducts clinical trials in resource-limited countries through partnerships among U.S. investigators, international investigators based in in low and middle-income countries (LMICs) and a central data coordinating center. The Global Network’s objectives include evaluating low-cost, sustainable interventions to improve women’s and children’s health in LMICs. Accurate reporting of births, stillbirths, neonatal deaths, maternal mortality, and measures of obstetric and neonatal care is critical to determine strategies for improving pregnancy outcomes. In response to this need, the Global Network developed the Maternal Newborn Health Registry (MNHR), a prospective, population-based registry of pregnant women, fetuses and neonates receiving care in defined catchment areas at the Global Network sites. This publication describes the MNHR, including participating sites, data management and quality and changes over time. Methods Pregnant women who reside in or receive healthcare in select communities are enrolled in the MNHR of the Global Network. For each woman and her offspring, sociodemographic, health care, and the major outcomes through 42-days post-delivery are recorded. Study visits occur at enrollment during pregnancy, at delivery and at 42 days postpartum. Results From 2010 through 2018, the Global Network MNHR sites were located in Guatemala, Belagavi and Nagpur, India, Pakistan, Democratic Republic of Congo, Kenya, and Zambia. During this period at these sites, 579,140 pregnant women were consented and enrolled in the MNHR, nearly 99% of all eligible women. Delivery data were collected for 99% of enrolled women and 42-day follow-up data for 99% of those delivered. In this supplement, the trends over time and assessment of differences across geographic regions are analyzed in a series of 18 manuscripts utilizing the MNHR data. Conclusions Improving maternal, fetal and newborn health in countries with poor outcomes requires an understanding of the characteristics of the population, quality of health care and outcomes. Because the worst pregnancy outcomes typically occur in countries with limited health registration systems and vital records, alternative registration systems may prove to be highly valuable in providing data. The MNHR, an international, multicenter, population-based registry, assesses pregnancy outcomes over time in support of efforts to develop improved perinatal healthcare in resource-limited areas. Trial Registration The Maternal Newborn Health Registry is registered at Clinicaltrials.gov (ID# NCT01073475). Registered February 23, 2019. https://clinicaltrials.gov/ct2/show/NCT01073475

Reduction in Perinatal Mortality after Implementation of HBB Training at a District Hospital in Mali

2019 ◽  
Vol 66 (3) ◽  
pp. 315-321
Author(s):  
M Innerdal ◽  
I Simaga ◽  
H Diall ◽  
M Eielsen ◽  
S Niermeyer ◽  
...  
Keyword(s):  
Mortality Rate ◽  
Neonatal Mortality ◽  
Perinatal Mortality ◽  
District Hospital ◽  
Neonatal Mortality Rate ◽  
Neonatal Deaths ◽  
Live Births ◽  
Early Neonatal Mortality ◽  
Helping Babies Breathe ◽  
Before And After

Abstract Background Mali has a high neonatal mortality rate of 38/1000 live births; in addition the fresh stillbirth rate (FSR) is 23/1000 births and of these one-third are caused by intrapartum events. Objectives The aims are to evaluate the effect of helping babies breathe (HBB) on mortality rate at a district hospital in Kati district, Mali. Methods HBB first edition was implemented in April 2016. One year later the birth attendants were trained in HBB second edition and started frequent repetition training. This is a before and after study comparing the perinatal mortality during the period before HBB training with the period after HBB training, the period after HBB first edition and the period after HBB second edition. Perinatal mortality is defined as FSR plus neonatal deaths in the first 24 h of life. Results There was a significant reduction in perinatal mortality rate (PMR) between the period before and after HBB training, from 21.7/1000 births to 6.0/1000 live births; RR 0.27, (95% CI 0.19–0.41; p &lt; 0.0001). Very early neonatal mortality rate (24 h) decreased significantly from 6.3/1000 to 0.8/1000 live births; RR 0.12 (95% CI 0.05–0.33; p = 0.0006). FSR decreased from 15.7/1000 to 5.3/1000, RR 0.33 (95% CI 0.22–0.52; p &lt; 0.0001). No further reduction occurred after introducing the HBB second edition. Conclusion HBB may be effective in a local first-level referral hospital in Mali.

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