From single-case analysis of neonatal deaths toward a further reduction of the neonatal mortality rate

2018 ◽  
Vol 47 (1) ◽  
pp. 125-133 ◽  
Author(s):  
André Sander ◽  
Roland Wauer

Abstract Background The infant mortality rate (IMR), a key indicator of the quality of a healthcare system, has remained at approximately 3.5‰ for the past 10 years in Germany. Generic quality indicators (QIs), as used in Germany since 2010, greatly help in ensuring such a good value but do not seem to be able to further reduce the IMR. The neonatal mortality rate (NMR) contributes to 65–70% of the IMR. We therefore propose single-case analysis of neonatal deaths as an additional method and show an efficient way to implement this approach. Methods We used the Nordic-Baltic classification (NBC) to detect avoidable neonatal deaths. We applied this classification to a sample of 1968 neonatal death records, which represent over 90% of all neonatal deaths in East Berlin from 1973 to 1989. All cases were analyzed as to their preventability based on the complete perinatal and clinical data by a special commission of different experts. The NBC was automatically applied through natural language processing and an ontology-based terminology server. Results The NBC was used to select the group of cases that had a high potential of avoidance. The selected group represented 6.0% of all cases, and 60.4% of the cases within that group were judged avoidable or conditionally avoidable. The automatic detection of malformations showed an F1 score of 0.94. Conclusion The results show that our method can be applied automatically and is a powerful and highly specific tool for selecting potentially avoidable neonatal deaths and thus for supporting efficient single-case analysis.

2004 ◽  
Vol 38 (6) ◽  
pp. 773-779 ◽  
Author(s):  
Valdinar S Ribeiro ◽  
Antônio A M Silva ◽  
Marco A Barbieri ◽  
Heloisa Bettiol ◽  
Vânia M F Aragão ◽  
...  

OBJECTIVE: To obtain population estimates and profile risk factors for infant mortality in two birth cohorts and compare them among cities of different regions in Brazil. METHODS: In Ribeirão Preto, southeast Brazil, infant mortality was determined in a third of hospital live births (2,846 singleton deliveries) in 1994. In São Luís, northeast Brazil, data were obtained using systematic sampling of births stratified by maternity unit (2,443 singleton deliveries) in 1997-1998. Mothers answered standardized questionnaires shortly after delivery and information on infant deaths was retrieved from hospitals, registries and the States Health Secretarys' Office. The relative risk (RR) was estimated by Poisson regression. RESULTS: In São Luís, the infant mortality rate was 26.6/1,000 live births, the neonatal mortality rate was 18.4/1,000 and the post-neonatal mortality rate was 8.2/1,000, all higher than those observed in Ribeirão Preto (16.9, 10.9 and 6.0 per 1,000, respectively). Adjusted analysis revealed that previous stillbirths (RR=3.67 vs 4.13) and maternal age <18 years (RR=2.62 vs 2.59) were risk factors for infant mortality in the two cities. Inadequate prenatal care (RR=2.00) and male sex (RR=1.79) were risk factors in São Luís only, and a dwelling with 5 or more residents was a protective factor (RR=0.53). In Ribeirão Preto, maternal smoking was associated with infant mortality (RR=2.64). CONCLUSIONS: In addition to socioeconomic inequalities, differences in access to and quality of medical care between cities had an impact on infant mortality rates.


Author(s):  
Fevi Novkaniza ◽  
Khairil Anwar Notodiputro ◽  
I Wayan Mangku ◽  
Kusman Sadik

This article is concerned with the density estimation of Neonatal Mortality Rate (NMR) in Central Java Province, Indonesia. Neonatal deaths contribute to 73% of infant deaths in Central Java Province. The number of neonatal deaths for 35 districts/municipalities in Central Java Province is considered as Poisson distributed surrogate with NMR as the rate of Poisson distribution. It is assumed that each number of neonatal deaths by district/municipality in Central Java Province were realizations of unobserved NMR, which come from unknown prior density. We applied the Empirical Bayes Deconvolution (EBD) method for estimating the unknown prior density of NMR based on Poisson distributed surrogate. We used secondary data from the Health Profiles of Central Java Province, Indonesia, in 2018. The density estimation of NMR by the EBD method showed that the resulting prior estimate is relatively close to the Gamma distribution based on Poisson surrogate. This is implying that the suitability of the obtained prior density estimation as a conjugate prior for Poisson distribution.


Author(s):  
Godwin Oligbu ◽  
Leila Ahmed ◽  
Laura Ferraras-Antolin ◽  
Shamez Ladhani

ObjectiveTo estimate the overall and infection-related neonatal mortality rate and the pathogens responsible using electronic death registrations.DesignRetrospective analysis of national electronic death registrations data.SettingEngland and Wales.PatientsNeonates aged <28 days.Main outcome measuresOverall and infection-related mortality rate per 1000 live births in term, preterm (28–36 weeks) and extremely preterm (<28 weeks) neonates; the contribution of infections and specific pathogens; comparison with mortality rates in 2003–2005.ResultsThe neonatal mortality rate during 2013–2015 (2.4/1000 live births; 5095 deaths) was 31% lower than in 2003–2005 (3.5/1000; 6700 deaths). Infection-related neonatal mortality rate in 2013–2015 (0.32/1000; n=669) was 20% lower compared with 2003–2015 (0.40/1000; n=768), respectively. Infections were responsible for 13.1% (669/5095) of neonatal deaths during 2013–2015 and 11.5% (768/6700) during 2003–2005. Of the infection-related deaths, 44.2% (296/669) were in term, 19.9% (133/669) preterm and 35.9% (240/669) extremely preterm neonates. Compared with term infants (0.15/1000 live births), infection-related mortality rate was 5.9-fold (95% CI 4.7 to 7.2) higher in preterm (0.90/1000) and 188-fold (95% CI 157 to 223) higher in extremely preterm infants (28.7/1000) during 2013–2015. A pathogen was recorded in 448 (67%) registrations: 400 (89.3%) were bacterial, 37 (8.3%) viral and 11 (2.4%) fungal. Group B streptococcus (GBS) was reported in 30.4% (49/161) of records that specified a bacterial infection and 7.3% (49/669) of infection-related deaths.ConclusionsOverall and infection-related neonatal mortality rates have declined, but the contribution of infection and of specific pathogens has not changed. Further preventive measures, including antenatal GBS vaccine may be required to prevent the single most common cause of infection-related deaths in neonates.


2019 ◽  
Vol 2 (1) ◽  
pp. 6-10
Author(s):  
Hapi Apriasih ◽  
Tupriliany Danefi

Seiring dengan  perkembangan zaman, masalah remaja makin bertambah di mana-mana khususnya di Indonesia.  Masa remaja adalah masa peralihan dari masa anak-anak ke masa dewasa. Masalah remaja di zaman ini bukanlah baru terjadi, tapi dari tahun sebelum-sebelumnya sudah sering terjadi, dimana masalah pada remaja yaitu pergaulan bebas,  tawuran, memakai narkoba, menonton film porno, meminum minuman alkohol, pesta pora dan masih banyak lagi masalah yang terjadi pada remaja.  Dan sekarang ini ada juga anak-anak yang masih duduk di bangku sekolah seperti SD, maupun SMP dan SMA sudah ada yang merokok, pergaulan bebas, meminum alkohol, menonton film porno, dan bahkan ada yang sudah hamil di luar nikah. Ini semua terjadi karena kurang adanya pengawasan dari orangtua atau keluarga, guru, dan pemerintah.  Masalah remaja tentunya  tak jarang lagi mendengar atau menonton dan bahkan melihat yang terjadi disekitar kita. Berdasarkan hasil Survei Kesehatan berbasis Sekolah di Indonesia tahun 2015 (GSHS) dapat terlihat gambaran faktor risiko kesehatan pada pelajar uisa 12-18 tahun secara nasional sebanyak 41,8 % laki-laki dan 4,1 % perempuan mengaku pernah merokok, 32,82 % doantara merokok pertama kali pada umur < 13 tahun. Gambaran faktor resiko kesehatan lainnya adalah perilaku seksual dimana didapatkan 8,26 % pelajara laki-laki dan 4,17 pelajara perempuan usia 12-18 tahun pernah melakukan hubungan seksual. Perilaku seks pranikah tentunya memberikan dampak yang luas pada remaja terutama berkaitan dengan penularan penyakit dan kehamilan yang tidak diinginkan serta aborsi. Kehamilan pada remaja tidak hanya berpengaruh terhadap kondisi fisik, mental dan sosial remaja tetapi juga meningkatkan resiko kematian bayi dan balita, seperti yang ditunjukkan SDKI 2012 dimana kehamilan dan persalinan pada ibu dibawah umur 20 tahun memiliki kontribusi dalam tingginya Neonatal Mortality Rate (34/1000 KH), Postnatal Mortality Rate (16/1000 KH), Infant Mortality Rate (50/1000 KH) dan under -5 Mortality Rate (61/1000 KH). Laporan triwulan Direktorat Jenderal Pengendalian Penyakit dan Penyehatan Lingkungan (Ditjen P2PL) mulai 1987 sampai dengan Maret 2017 menunjukkan bahwa tingginya angka kejadian AIDS di kelompok usia 20-29 tahun mengindikasikan kelompok tersebut pertama kali terkena HIV pada usia remaja. Di Desa Cikunir merupakan desa di wilayah Puskesmas Singaparna yang terdiri dari 3 dusun yaitu Gunung Kawung, Pameungpeuk, dan Anggaraja. Melalui kegiatan praktik kerja nyata mahasiswa Program Studi Kebidanan STIKes Respati Tasikmalaya melalui focus grup discucion (FGD) diperoleh informasi dari 35 responden remaja sebagai berikut 48,7 % belum mengetahui kesehatan reproduksi khususnya terkait infeksi menular seksual, 45,71 % sudah mempunyai pcar, 51,43 % tidak mengetahui tentang HIV/AIDS, 22,86% tidak mengetahui dampai pernikahan dini, dan 11,43 % setuju dengan pernikahan dini. Berdasarkan data tersebut diketahui bahwa pengetahuan remaja tentang kesehatan reproduksi remaja masih kurang dan akan berdampak pada permasalahan yang serius maka menjadi hal yang sangat penting untuk adanya upaya dalam hal peningkatan pengetahuan remaja , oleh karena diselenggarakan kegiatan penyuluhan tentang personal higyene dan masa pubertas pada remaja.


2018 ◽  
Vol 2 (1) ◽  
Author(s):  
Homsiatur Rohmatin ◽  
Agustina Widayati

 Abstrak Program Perencanaan Persalinan dan Pencegahan Komplikasi (P4K) merupakan program pemerintah dalam penurunan angka kematian ibu dan bayi baru lahir. Angka kematian bayi (AKB) di Indonesia masih tinggi dimana Kabupaten Probolinggo merupakan salah satu penyumbang tertinggi. P4K merupakan tanggung jawab bidan, ibu hamil, suami, dan keluarga. Masih tingginya kematian neonatal di Kabupaten Probolinggo, diduga karena kurangnya peran aktif ibu, suami, dan keluarga dalam penerapan P4K. Penelitian ini bertujuan menganalisis pengaruh penerapan P4K terhadap kematian neonatal di Kabupaten Probolinggo. Rancang bangun penelitian adalah crossectional dengan populasi seluruh ibu yang mempunyai bayi lahir hidup atau mati (usia 0-28 hari) yang mendapatkan stiker P4K. Teknik sampling menggunakan accidental sampling. Sampel penelitian ini adalah sebagian ibu yang mempunyai bayi lahir hidup atau mati (usia 0-28 hari) yang mendapatkan stiker P4K. Pengumpulan data menggunakan kuesioner dan wawancara. Uunivariat, bivariat dan multivariat digunakan dalam menganalisis data. Hasil penelitian menginformasikan sebagian besar ibu, suami, dan keluarga kurang berperan aktif. Sehingga ada pengaruh penerapan P4K terhadap kematian neonatal. Untuk itu, diperlukan peran aktif kader posyandu dalam memotivasi dan mendampingi ibu, suami dan keluarga dalam penerapan P4K sebagai upaya menurunkan kematian neonatal.  Kata kunci  : P4K, kematian neonatal, stiker  Abstract           The Maternity and Complication Prevention Planning Program (P4K) is a government program in reducing maternal and newborn mortality. The infant mortality rate (IMR) in Indonesia is still high where Probolinggo District is one of the highest contributors. P4K is the responsibility of midwives, pregnant women, husbands and families. The high neonatal mortality rate in Probolinggo Regency is allegedly due to the lack of active role of mothers, husbands, and families in implementing P4K. This study aimed to analyze the effect of P4K application on neonatal mortality in Probolinggo District. The research design was cross-sectional with the population of all mothers who had live or dead babies (aged 0-28 days) who received P4K stickers. The sampling technique used accidental sampling. The sample of this study was that some mothers who have babies born alive or dead (age 0-28 days) who got P4K stickers. Data collection used questionnaires and interviews. Univariate, bivariate and multivariate were used to analyze the data. The results of the study informed that most mothers, husbands, and families were less active. Therefore, there was an effect of applying P4K to neonatal mortality. It is suggested for posyandu cadres to have an active role in motivating and assisting mothers, husbands and families in implementing P4K as an effort to reduce neonatal mortality.Keywords    : P4K, neonatal mortality, sticker


Author(s):  
Kareem Abiodun John ◽  
Fasoranti Ifedayo Olabisi ◽  
Alonge Abel Olumuyiwa ◽  
Kareem Adesola Olawumi ◽  
Bewaji Temitayo Olubunmi ◽  
...  

Background: The neonatal mortality rate remains high in developing countries despite the significant reduction in under-five mortality globally. Therefore, periodic evaluations on the causes of mortality are an aspect of health status, which could be performed to improve the neonatal mortality rate. Objectives: The present study aimed to determine the pattern and causes of neonatal mortality in the Federal Medical Center in Owo, Ondo State, Southwest Nigeria. Methods: This retrospective study was conducted using the hospital records of the neonates admitted over a five-year period from 1st of January 2015 to 31st of December 2019. Results: In total, 2,065 neonates were admitted, including 208 cases of neonatal deaths. Mortality occurred in 127 males (61.1%) and 81 females (38.9%), with the male-to-female ratio of 1.6:1. Among the recorded deaths, 114 cases (54.8%) occurred within the first 24 hours of admission, while 94 neonates (45.2%) died after 24 hours of admission. In addition, the mortality rate was higher among outborn neonates (n = 120; 57.7%) compared to inborn neonates (n = 88; 42.3%). The major causes of neonatal deaths included birth asphyxia (46.6%), prematurity (23.1%), and sepsis (17.8%). The overall mortality rate over the five-year period was 10.1%, which is equivalent to 19 deaths per 1,000 live births. Conclusions: According to the results, preventable diseases such as birth asphyxia, prematurity, and sepsis remain the major causes of neonatal mortality, of which neonatal deaths occur mostly within 24 hours of admission.


Author(s):  
Krishan Kumar ◽  
Rajiv Srivastava ◽  
S. K. Mishra

Background: One of the most important indicator or index of socio-economic development of a country or region is infant mortality rate. The present study was undertaken to assess the quantum of childhood mortality and to find out the social factors associated with these deaths by verbal autopsies. Methods: This one year cross-sectional study was undertaken in a purposively selected community Development Block Sainyan, district Agra among children aged between 0-5 years using multistage random sampling technique. Suitable statistical methods were applied. Results: Out of total 8355 families surveyed, a total of 185 deaths were reported among children. Number of deaths was higher among those belonging to nuclear family and lower socioeconomic status. The neonatal mortality rate was estimated to be 33.55/1000 live births. The post neonatal mortality rate was found to be 40.78/1000 live births and infant mortality rate was 74.33/1000 live births. Mortality rate in 1-5 year age group children was 10.6/1000 same age group children, while 0-5 yrs. mortality was estimated to be 22.39/1000 children of same age group. Out of 185 children who died, 52.7% were unimmunized and another 35.67% were partially immunized. Conclusions: Female education and socioeconomic well-being should be strengthened. 


2016 ◽  
Vol 12 (27) ◽  
pp. 55
Author(s):  
Esraa Abd Al-Muhsen Ali

Background: The neonatal mortality rate is a key outcome indicator for newborn care and directly reflects prenatal, natal, and postnatal care. Early neonatal deaths are more closely associated with pregnancy-related factors and maternal health, whereas late neonatal deaths are associated more with factors in the newborn‘s environment. Objectives: To estimate the neonatal mortality rate in Aseptic Neonatal Care Unit of Al-Sadder Teaching Hospital in Missan Province during period (2011-2014). To determine the most common causes of death in the neonatal period. Patients and methods: A hospital-based study was done depending on data collected from records of the Aseptic Neonatal Care Unit of Al-Sadder Teaching Hospital in Missan Province to calculate the number of deaths within the neonatal period (0-28 days) that was conducted from 2011 to 2014. The other line of data was collected from Obstetrical Ward by calculating number of live births for the same period. Then Neonatal Mortality Rate is calculated and conducted for each year according to the method recommended by WHO. Results: The neonatal mortality rates were 12.15, 13.51, 16.37 and16.11 in 2011 to 2014 respectively in which there was an increment in mortality rate. The main causes of death were respiratory distress syndrome, birth asphyxia and congenital anomalies. Conclusion: Neonatal mortality rate was high in the Aseptic Neonatal Care Unit of Al-Sadder Teaching Hospital, but it was less than the previous period in Iraq since 1990. These results suggest, that to decrease neonatal mortality, improved health service quality is crucial.


2001 ◽  
Vol 35 (3) ◽  
pp. 256-261 ◽  
Author(s):  
Marcelo Zubaran Goldani ◽  
Marco Antonio Barbieri ◽  
Heloisa Bettiol ◽  
Marisa Ramos Barbieri ◽  
Andrew Tomkins

OBJECTIVE: Data from municipal databases can be used to plan interventions aimed at reducing inequities in health care. The objective of the study was to determine the distribution of infant mortality according to an urban geoeconomic classification using routinely collected municipal data. METHODS: All live births (total of 42,381) and infant deaths (total of 731) that occurred between 1994 and 1998 in Ribeirão Preto, Brazil, were considered. Four different geoeconomic areas were defined according to the family head's income in each administrative urban zone. RESULTS: The trends for infant mortality rate and its different components, neonatal mortality rate and post-neonatal mortality rate, decreased in Ribeirão Preto from 1994 to 1998 (chi-square for trend, p<0.05). These rates were inversely correlated with the distribution of lower salaries in the geoeconomic areas (less than 5 minimum wages per family head), in particular the post-neonatal mortality rate (chi-square for trend, p<0.05). Finally, the poor area showed a steady increase in excess infant mortality. CONCLUSIONS: The results indicate that infant mortality rates are associated with social inequality and can be monitored using municipal databases. The findings also suggest an increase in the impact of social inequality on infant health in Ribeirão Preto, especially in the poor area. The monitoring of health inequalities using municipal databases may be an increasingly more useful tool given the continuous decentralization of health management at the municipal level in Brazil.


2019 ◽  
Vol 24 (S1) ◽  
pp. 5-14 ◽  
Author(s):  
Ashish Kc ◽  
Anjani Kumar Jha ◽  
Mahendra Prasad Shrestha ◽  
Hong Zhou ◽  
Abhishek Gurung ◽  
...  

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.


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