scholarly journals Preterm neonatal mortality in China during 2009–2018: A retrospective study

PLoS ONE ◽  
2021 ◽  
Vol 16 (12) ◽  
pp. e0260611
Author(s):  
Xue Yu ◽  
Chunhua He ◽  
Yanping Wang ◽  
Leni Kang ◽  
Lei Miao ◽  
...  
Keyword(s):  
Neonatal Mortality ◽  
Gestational Age ◽  
Child Survival ◽  
Trend Test ◽  
Eastern Region ◽  
Neonatal Deaths ◽  
Medical Institutions ◽  
Central Regions ◽  
Policies And Programs ◽  
Mortality Surveillance

In this retrospective analysis, we aimed to analyze the epidemic characteristics of neonatal mortality due to preterm birth at 28–36 weeks gestation in different regions from 2009 to 2018. Data were obtained from China’s Under-5 Child Mortality Surveillance System (U5CMSS). The χ2 trend test, Poisson regression and the Cochran-Mantel-Haenszel method were used in this study. We found that 51.3%, 42.0% and 44.5% of neonate deaths were preterm infants, and immaturity was mainly attributed to 60.1%, 64.1% and 69.5% of these deaths, in the eastern, central and western regions, respectively. The preterm neonatal mortality rate due to immaturity dropped from 149.2, 216.5 and 339.5 in 2009 to 47.4, 83.8 and 170.1 per 100 000 live births in 2018, giving an average annual decline rate of 12.1%, 11.6% and 6.3% in the eastern, central and western regions, respectively, during the studying period. The relative risk of preterm neonatal mortality due to immaturity were 1.3 and 2.3 for the central regions and western regions in 2009–2010, ascending to 2.2 and 3.9 in 2017–2018. The proportion of preterm neonatal deaths with a gestational age <32 weeks was highest among the eastern region. There were significantly more preterm neonatal infants who were not delivered at medical institutions in the western region than in the eastern and central regions. The preterm infant, especially with gestational age <32 weeks, should receive the most attention through enhanced policies and programs to improve child survival. Priority interventions should be region-specific, depending on the availability of economic and healthcare resources.

scholarly journals Fetal, neonatal, and post-neonatal mortality in the 2015 Pelotas (Brazil) birth cohort and associated factors

2019 ◽  
Vol 35 (7) ◽  
Author(s):  
Andrea Ramirez Varela ◽  
Bruna Celestino Schneider ◽  
Susana Bubach ◽  
Mariangela Freitas Silveira ◽  
Andréa Dâmaso Bertoldi ◽  
...  
Keyword(s):  
Neonatal Mortality ◽  
Birth Cohort ◽  
Gestational Age ◽  
Associated Factors ◽  
Reference Group ◽  
Multinomial Logistic Regression ◽  
First Year ◽  
Chi Square ◽  
Neonatal Deaths ◽  
First Year Of Life

This study aimed to describe fetal, neonatal, and post-neonatal mortality and associated factors in participants of the 2015 Pelotas (Brazil) birth cohort. The child mortality sub-study followed up all deaths in the first year of life. Data were collected on intrauterine fetal deaths (weight ≥ 500g and/or gestational age ≥ 20 weeks), neonatal deaths (< 28 days of life), and post-neonatal deaths (from 28 days to the end of the first year of life). Descriptive analyses using the Pearson chi-square test and a multinomial logistic regression to estimate the risk of fetal, neonatal, and post-neonatal deaths compared to live infants in the cohort (reference group) were performed. Data from 4,329 eligible births were collected, of which 54 died during the fetal period. Of the 4,275 eligible live births, 59 died in the first year of life. An association between fetal, neonatal, and post-neonatal deaths (OR = 15.60, 7.63, and 5.51 respectively) was found, as well as less than six prenatal consultations. Compared to live infants, fetal deaths were more likely to occur in non-white mothers, and neonatal deaths were 14.09 times more likely to occur in a preterm gestational age (< 37 weeks). Compared to live infants, infants that were born in a C-section delivery had 3.71 increased odds of post-neonatal death. Additionally, neonatal deaths were 102.37 times more likely to have a low Apgar score on the fifth minute after birth. These findings show the need for early interventions during pregnancy, ensuring access to adequate prenatal care.

scholarly journals The effect of an mhealth clinical decision-making support system on neonatal mortality in Ghana

2019 ◽  
Vol 29 (Supplement_4) ◽  
Author(s):  
H B Amoakoh ◽  
K Klipstein-Grobusch ◽  
I A Agyepong ◽  
P Zuithoff ◽  
M Amoakoh-Coleman ◽  
...  
Keyword(s):  
Decision Making ◽  
Neonatal Mortality ◽  
Neonatal Death ◽  
Clinical Decision Making ◽  
Clinical Decision ◽  
Mortality Data ◽  
Eastern Region ◽  
Intervention Period ◽  
Neonatal Deaths ◽  
Decision Making Support

Abstract Background Mhealth interventions promise to bridge gaps in clinical care but documentation of their effectiveness is limited. We evaluated the utilization and effect of an mhealth clinical decision-making support intervention that aimed to improve neonatal mortality in Ghana by providing access to emergency neonatal protocols for frontline health workers. Methods In the Eastern Region of Ghana, sixteen districts were randomized into two study arms (8 intervention and 8 control clusters) in a cluster-randomized controlled trial. Institutional neonatal mortality data were extracted from the District Health Information System-2 during an 18-month intervention period. We performed an intention-to-treat analysis and estimated the effect of the intervention on institutional neonatal mortality (primary outcome measure) using grouped binomial logistic regression with a random intercept per cluster. This trial is registered at ClinicalTrials.gov (NCT02468310). Results There were 65,831 institutional deliveries and 348 institutional neonatal deaths during the study period. Overall, 47·3% of deliveries and 56·9% of neonatal deaths occurred in the intervention arm. During the intervention period, neonatal deaths increased from 4·5 to 6·4 deaths and, from 3·9 to 4·3 deaths per 1,000 deliveries in the intervention arm and control arm respectively. The odds of neonatal death was non-significantly higher in the intervention arm compared to the control arm (odds ratio 2·10; 95% CI (0·77;5·77); p = 0·15). The correlation between the number of protocol requests and the number of deliveries per intervention cluster was 0·71 (p = 0·05). Conclusions Non-significant higher risk of neonatal death observed in intervention clusters may be due to problems with birth and death registration, unmeasured and unadjusted confounding, and unintended use of the intervention. The findings underpin the need for careful and rigorous evaluation of mhealth intervention implementation and effects. Key messages Supposedly effective interventions must be evaluated in context before they are scaled-up. Mechanisms influencing outcomes in context must be considered in the design and evaluation of interventions.

scholarly journals Trends for Neonatal Deaths in Nepal (2001–2016) to Project Progress Towards the SDG Target in 2030, and Risk Factor Analyses to Focus Action

2019 ◽  
Vol 24 (S1) ◽  
pp. 5-14 ◽  
Author(s):  
Ashish Kc ◽  
Anjani Kumar Jha ◽  
Mahendra Prasad Shrestha ◽  
Hong Zhou ◽  
Abhishek Gurung ◽  
...  
Keyword(s):  
Mortality Rate ◽  
Neonatal Mortality ◽  
Action Plan ◽  
Child Survival ◽  
Current Trend ◽  
Wealth Quintile ◽  
Demographic And Health Surveys ◽  
Neonatal Mortality Rate ◽  
Neonatal Deaths ◽  
Factors Associated

Abstract Introduction Nepal has made considerable progress on improving child survival during the Millennium Development Goal period, however, further progress will require accelerated reduction in neonatal mortality. Neonatal survival is one of the priorities for Sustainable Development Goals 2030. This paper examines the trends, equity gaps and factors associated with neonatal mortality between 2001 and 2016 to assess the likelihood of Every Newborn Action Plan (ENAP) target being reached in Nepal by 2030. Methods This study used data from the 2001, 2006, 2011 and 2016 Nepal Demographic and Health Surveys. We examined neonatal mortality rate (NMR) across the socioeconomic strata and the annual rate of reduction (ARR) between 2001 and 2016. We assessed association of socio-demographic, maternal, obstetric and neonatal factors associated with neonatal mortality. Based on the ARR among the wealth quintile between 2001 and 2016, we made projection of NMR to achieve the ENAP target. Using the Lorenz curve, we calculated the inequity distribution among the wealth quintiles between 2001 and 2016. Results In NDHS of 2001, 2006, 2011 and 2016, a total of 8400, 8600, 13,485 and 13,089 women were interviewed respectively. There were significant disparities between wealth quintiles that widened over the 15 years. The ARR for NMR declined with an average of 4.0% between 2001 and 2016. Multivariate analysis of the 2016 data showed that women who had not been vaccinated against tetanus had the highest risk of neonatal mortality (adjusted odds ratio [AOR] 3.38; 95% confidence interval [CI] 1.20–9.55), followed by women who had no education (AOR 1.87; 95% CI 1.62–2.16). Further factors significantly associated with neonatal mortality were the mother giving birth before the age of 20 (AOR 1.76; CI 95% 1.17–2.59), household air pollution (AOR 1.37; CI 95% 1.59–1.62), belonging to a poorest quintile (AOR 1.37; CI 95% 1.21–1.54), residing in a rural area (AOR 1.28; CI 95% 1.13–1.44), and having no toilet at home (AOR 1.21; CI 95% 1.06–1.40). If the trend of neonatal mortality rate of 2016 continues, it is projected that the poorest family will reach the ENAP target in 2067. Conclusions Although neonatal mortality is declining in Nepal, if the current trend continues it will take another 50 years for families in the poorest group to attain the 2030 ENAP target. There are different factors associated with neonatal mortality, reducing the disparities for maternal and neonatal care will reduce mortality among the poorest families.

scholarly journals Biases in Survey Estimates of Neonatal Mortality: Results from a Validation Study in Urban Areas of Guinea-Bissau

2020 ◽  
Author(s):  
Stephane Helleringer ◽  
Li Liu ◽  
Yue Chu ◽  
Amabelia Rodrigues ◽  
Ane Baerent Fisker
Keyword(s):  
Neonatal Mortality ◽  
Survey Data ◽  
Validation Study ◽  
Urban Areas ◽  
Child Survival ◽  
Middle Income ◽  
Neonatal Deaths ◽  
Guinea Bissau ◽  
Stratified Sample ◽  
Survey Estimates

Neonatal deaths (i.e., those occurring within 28 days of birth) account for close to half of all deaths among children under age 5 worldwide. In most low and middle-income countries, data on neonatal deaths come primarily from household surveys. We conducted a validation study of survey data on neonatal mortality in Guinea-Bissau (West Africa). We used records from an urban health and demographic surveillancesystem (HDSS) that monitors child survival prospectively, as our reference dataset. We selected a stratified sample of 599 women aged 15-49 years old among residents of theHDSS, and collected the birth histories of 422 participants. We cross-tabulated survey and HDSS data. We used a mathematical model to investigate biases in survey estimates of neonatal mortality. Reporting errors in survey data might lead to estimates of the neonatal mortality rate that are too high. This may limit our ability to track progress towards global health objectives.

scholarly journals Neonatal mortality associated with perinatal asphyxia: a population-based study in a middle-income country

2021 ◽  
Vol 21 (1) ◽  
Author(s):  
Mandira D. Kawakami ◽  
Adriana Sanudo ◽  
Mônica L. P. Teixeira ◽  
Solange Andreoni ◽  
Josiane Q. X. de Castro ◽  
...  
Keyword(s):  
Neonatal Mortality ◽  
Gestational Age ◽  
Perinatal Asphyxia ◽  
Population Based ◽  
Sao Paulo ◽  
São Paulo ◽  
Middle Income ◽  
Neonatal Deaths ◽  
Paulo State ◽  
São Paulo State

Abstract Background It is challenging to decrease neonatal mortality in middle-income countries, where perinatal asphyxia is an important cause of death. This study aims to analyze the annual trend of neonatal mortality with perinatal asphyxia according to gestational age in São Paulo State, Brazil, during a 10-year period and to verify demographic, maternal and neonatal characteristics associated with these deaths. Methods Population-based study of neonatal deaths associated with perinatal asphyxia from 0 to 27 days in São Paulo State, Brazil, from 2004 to 2013. Perinatal asphyxia was considered as associated to death if intrauterine hypoxia, birth asphyxia or neonatal aspiration of meconium were noted in any line of the Death Certificate according to ICD-10. Poisson Regression was applied to analyze the annual trend of neonatal mortality rate according to gestational age. Kaplan-Meier curve was used to assess age at death during the 10-year study period. Hazard ratio of death during the neonatal period according to gestational age was analyzed by Cox regression adjusted by year of birth and selected epidemiological factors. Results Among 74,002 infant deaths in São Paulo State, 6648 (9%) neonatal deaths with perinatal asphyxia were studied. Neonatal mortality rate with perinatal asphyxia fell from 1.38‰ in 2004 to 0.95‰ in 2013 (p = 0.002). Reduction started in 2008 for neonates with 32–41 weeks, in 2009 for 28–31 weeks, and in 2011 for 22–27 weeks. Median time until 50% of deaths occurred was 25.3 h (95%CI: 24.0; 27.2). Variables independently associated with higher risk of death were < 7 prenatal visits, 1st minute Apgar score 0–3, and death at the same place of birth. Cesarean delivery compared to vaginal was protective against death with perinatal asphyxia for infants at 28–36 weeks. Conclusions There was an expressive reduction in neonatal mortality rates associated with perinatal asphyxia during this 10-year period in São Paulo State, Brazil. Variables associated with these deaths highlight the need of public health policies to improve quality of regionalized perinatal care.

scholarly journals The Jordan Stillbirth and Neonatal Mortality Surveillance (JSANDS) System: Evaluation Study (Preprint)

2021 ◽  
Author(s):  
Yousef Khader ◽  
Mohammad Alyahya ◽  
Ziad El-Khatib ◽  
Anwar Batieha ◽  
Nihaya Al-Sheyab ◽  
...  
Keyword(s):  
Neonatal Mortality ◽  
Health Care Professionals ◽  
Missing Values ◽  
Evaluation Study ◽  
Average Score ◽  
Surveillance Systems ◽  
Percentage Score ◽  
Neonatal Deaths ◽  
Maternity Hospitals ◽  
Mortality Surveillance

BACKGROUND The Jordan Stillbirth and Neonatal Mortality Surveillance (JSANDS) is an electronic surveillance system that automatically transfers the data on births, stillbirths, and neonatal deaths to the concerned authorities in the Ministry of Health. JSANDS was implemented and tested in 5 maternity hospitals during the period spanning May 2019 through December 2020. OBJECTIVE This study aimed to evaluate the usefulness and performance of JSANDS to register births, stillbirths, and neonatal deaths, and determine their causes. Specifically, this study examined the JSANDS attributes of acceptability, simplicity, flexibility, stability, representativeness, sustainability, penetration, data quality, sensitivity, and adoption. METHODS An evaluation study was conducted after 18 months of the JSANDS implementation using the Updated Guidelines for Evaluating Public Health Surveillance Systems. The evaluation focused on how well the system operated to meet its purpose and objectives. The indicators assessing the system attributes were scored on a Likert scale. Each indicator and overall attribute percentage score was represented as score rank and interpreted as excellent (score ≥80%), good (score ≥60 and &lt;80%), average (score ≥40 and &lt;60%), and poor (score &lt;40%). RESULTS A total of 270 health care professionals participated in this study and evaluated the system performance. The system users rated the usefulness of JSANDS as excellent (percentage score=85.6%). The overall acceptability (percentage score=82.3%), flexibility (percentage score=80.2%), stability (percentage score=80.0%), and representativeness (percentage score=86.6%) were also rated excellent. The overall simplicity was scored good (percentage score=75.4%). All participants were trained on JSANDS and used it in the past 12 months. Of the 270 respondents, 219 (86.2%) reported that they intend to continue using the JSANDS system to register neonatal deaths and stillbirths in the future. All variables in JSANDS had complete data with no missing values. CONCLUSIONS The performance of JSANDS in registering all stillbirths and neonatal deaths as well as their causes was excellent. Almost all attributes and indicators of JSANDS functionality were rated excellent. JSANDS can be scaled up to cover all maternity hospitals in Jordan. The potential for scaling up the system is very high for many reasons, including its usefulness, simplified stillbirth and neonatal death review tools, and ease of the reporting process.

How tourism industry agglomeration improves tourism economic efficiency?

2021 ◽  
pp. 135481662110091
Author(s):  
Zhoufei Li ◽  
Huiyue Liu
Keyword(s):  
Positive Impact ◽  
Regional Analysis ◽  
Tourism Industry ◽  
Scale Efficiency ◽  
Eastern Region ◽  
Location Quotient ◽  
Industry Agglomeration ◽  
Central Regions ◽  
National Perspective ◽  
The Impact

The agglomeration of the tourism industry has important effects on its efficiency. This article used panel data on the Chinese provincial tourism industry for the 2011–2016 period, applied the location quotient index and three-stage data envelopment analysis method to, respectively, measure the degree of agglomeration and efficiency, and explained the impact of agglomeration on tourism efficiency. The empirical results of this study indicate the following. (1) China’s tourism industry shows a trend towards agglomeration, revealing gradient differences where the highest degree of agglomeration is in the eastern region, followed by the western and central regions. (2) After eliminating random and environmental factors, the adjusted efficiencies are lower than the unadjusted efficiencies. The average overall tourism efficiency is higher in the eastern region than in the central and western regions. (3) From the national perspective, industrial agglomeration can significantly improve the overall efficiency (TE), pure technical efficiency (PTE), and scale efficiency of the tourism industry. (4) Based on regional analysis, the agglomeration of the eastern tourism industry can significantly enhance its TE and PTE. Agglomeration for the western area has a significant positive impact on PTE. There is no significant relationship between agglomeration and efficiency in the central region.

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.

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