Determinants of neonatal near misses among neonates admitted to Guji and Borena zones selected public hospitals, Southern Ethiopia, 2021: A facility based unmatched case control study design

There is little available evidence that quantifies the determinats of NNM in Ethiopia despite an increasing magnitude of neonatal mortality. Therefore, this study was designed to provide concrte evidence about the determinats of NNMS among neonates admitted to Guji and Borena Zones Public Hospitals, Southern Ethiopia, 2021. A facility based unmatched case control study design was conducted on 402 (134 cases and 268 controls) selected neonates admitted to Bule Hora, Adola and Yabelo General Hospitals from February 1-March 31, 2021. Cases were consecutively selected. Whereas for each case, two controls were selected by systematic random sampling technique. The data collection included a pretested and structured face-to-face interviewer administered questionnaire with a supplementation of maternal and neonatal medical records with checklists. Then the data were coded and entered in to Epi data version 3.1 and then exported to the Statistical Package for Social Science IBM version 25 for analysis. The descriptive statistics run and the results of the data were presented using frequencies, and tables. Bivariable and multi variable logistic regression was used for the analsysis of the data. Finally, Adjusted Odds Ratio together with 95% Confidence Intervals and p value <0.05 was used to declare the significance of all statistic. A total of 134 cases (neonatal near misses) and 268 controls (normal neonate) were participated in this study to make a response rate of 100% for both cases, and controls. In this study rural residence (AOR = 0.51, 95% CI: 0.27, 0.96), previous history of neonatal death (AOR = 4.85, 95%CI: 2.24,10.49), birth interval ≤ 2 years (AOR = 1.83, 95% CI: 1.04, 3.11) and history of abortion (both induced and miscarriage) (AOR = 1.97, 95%CI: 1.17, 3.31) were found to be statistically significant at a p-value of <0.05. History of prior abortion history of prior neonatal death and short birth interval (≤ 2 years) were identified to be the determinats of NNMs. High quality antenatal and intrapartum continuum of care should be provided for women and neonates. Additionally, contraceptive utilization should be encouraged for a women to space the births of their children.

Association of Antenatal Corticosteroid Administration-to-delivery Interval With Neonatal Respiratory Distress Syndrome and Respiratory Support in Preterm Infants

Background: Administration of antenatal corticosteroids (ACS) is an effective strategy for the management of preterm infants, which can improve neonatal respiratory distress syndrome (NRDS) and attenuate the risk of neonatal mortality. However, many preterm infants do not expose to a complete course of ACS administration, and the effects of different ACS-to-delivery intervals on NRDS and respiratory support remain unclear.we explore the relationships of ACS administration-to-birth intervals with NRDS and respiratory support in preterm infants in this study.Methods: In this retrospective cohort study, the preterm infants born between 240/7 and 316/7 wk of gestation were recruited from Jan 2015 to Jul 2021. All participants were categorized based on the time interval from the first ACS dose to delivery: <24 h, 1-2 d, 2-7 d, and more >7 d. Multivariable logistic regression analysis was conducted to examine the relationships between ACS-to-birth interval and primary or secondary outcome, while adjusting for potential confounders.Results: Of the 706 eligible neonates, 264, 83, 292 and 67 received ACS-to-delivery intervals of <24 h, 1-2 d, 2-7 d and >7 d, respectively. After adjusting these confounding factors, multivariable logistic analysis showed a significant increased risk of NRDS (aOR: 1.8, 95% CI: 1.2-2.7), neonatal mortality (aOR: 2.8, 95% CI: 1.1-6.8), the need for surfactant use (aOR: 2.7, 95% CI: 1.7-4.4), endotracheal intubation in delivery room (aOR: 1.9, 95% CI: 1.0-3.7), mechanical ventilation (aOR: 1.9, 95% CI: 1.1-3.4) in the ACS-to-delivery interval of <24 h group when compared with the ACS-to-birth interval of 2-7 d group. Similar findings were observed in the subgroup analysis of the ACS interval of <6 h and 6-12 h groups (incidence of death and surfactant use), but no obvious differences were found in the ACS intervals of 12-24 h, 1-2 d and >7 d groups compared with the ACS-to-birth interval of 2-7 d group.Conclusions: Neonatal outcomes such as NRDS, neonatal mortality, the need for surfactant use, intubation in delivery room, mechanical ventilation are at a higher risk when the neonates exposed to ACS interval for less than 12 h before delivery.

Association of breast feeding and birth interval with child mortality in Pakistan: a cross-sectional study using nationally representative Demographic and Health Survey data

ObjectivesThis study analysed the association between breast feeding (BF) and birth interval (BI) (both succeeding and preceding) with neonatal mortality (NM), infant mortality (IM) and under-5 mortality (U5M).DesignThis cross-sectional study used data from the Pakistan Demographic and Health Survey 2017–2018.SettingsAll provinces, Islamabad and Federally Administered Tribal Areas were included in the analysis.ParticipantsA total of 12 769 children born to ever-married multiparous women aged 30–49 years who gave live birth within 5 years preceding the interview. Multiple births are not included.Data analysisMultivariate logistic regression analysis was used.ResultsWe found that BF was associated with nearly 98% lower risk of NM (OR 0.015; 95% CI: 0.01 to 0.03; p<0.001), 96% lower risk of IM (OR 0.038; 95% CI: 0.02 to 0.06; p<0.001) and 94% lower risk of U5M (OR 0.050; 95% CI: 0.03 to 0.08; p<0.001). Compared with optimal preceding birth interval (PBI) (36+ months), short PBI (<18 months) was associated with around six times higher risk of NM (OR 5.661; 95% CI: 2.78 to 11.53; p<0.001), over five times risk of IM (OR 4.704; 95% CI: 2.70 to 8.19; p<0.001) and over five times risk of U5M (OR 4.745; 95% CI: 2.79 to 8.07; p<0.001). Disaggregating the data by child’s gender, place of residence and mother’s occupational status showed that being ever breast fed was associated with a smaller risk of NM, IM and U5M in all three disaggregations. However, the risk of smaller PBI <18 months was generally more pronounced in female children (NM and U5M) or when the children lived in rural areas (NM, IM and U5M). PBI <18 months was associated with greater risk of NM and IM, and smaller risk of U5M when mothers did a paid job.ConclusionThis study’s significance lies in the fact that it has found BF and BI to be consistent protective factors against NM, IM and U5M. Given Pakistan’s economic constraints, optimal BF and BI are the most cost-effective interventions to reduce child mortality.

Frequency of Maternal Factors in Patients of Stillbirth in Pakhtoon Families Visiting Public Hospitals of Peshawar

Aim: To determine the frequency of maternal factors in patients of still birth in Pakhtoon families visiting hospitals of Peshawar. Study design: Cross-sectional study Place and duration of study: Department of Community & Preventive Medicine, Kabir Medical College Gandhara University Peshawar from 1stJanuary 2020 to 31stDecember 2020 Methodology: Five hundred pregnant women were enrolled. All multiparous pregnant women of Pakhtoon families with still birth admitted in Gynaecology wards in public hospitals of Peshawar were included. All multiparous pregnant women of Pakhtoon families with still births with renal diseases, accidental trauma, respiratory diseases and history of physical violence visiting public hospitals of Peshawar were excluded. Results: 65% of respondents were from 31-45 years. Maternal risk factors were education below matric 64.4%, 7% respondents were working, 78% respondents with total income less than 30 thousand. 59.8% with last birth interval less than 2 years. 44% respondents had haemoglobin less than 7g/dl. 40.2% respondents had comorbidity with stillbirth i.e. hypertension. Conclusion: Maternal risk factors were low socioeconomic status, birth interval less than 2 years, severe anemia and hypertension in current study. Keywords: Still birth, Socioeconomic, Ante-partum hemorrhage

Prevalence of Vitamin A Deficiency And Associated Factors Among Children Aged 6-59 Months In Dera District, Northwest Ethiopia: A Cross-Sectional Study

Background: Vitamin A is a fat-soluble vitamin. It comes retinol from animal sources or beta-carotene from plant source. Vitamin A contains breast milk after the post-weaning period and their increased nutrient demand of children from 6-59 months, they are considered highly affected segments of the community. Hence, study assesses vitamin A deficiency and associated factors among children aged 6-59 months in Dera district, Northwest Ethiopia. Methods: Cross-sectional study design was conducted via multistage sampling techniques. Data were coded and entered into Epi-data version 3.1 and exported to Statistical Package for the Social Sciences (SPSS) version 20 for analysis. The bivariate and multiple variable logistic regression analyses were fitted. Results: Total response rate 94.7%. Prevalence of vitamin A deficiency among children age from 6-59 months was 7.8% (95% CI: 4.7, 11.3). Anti natal care (ANC) follow-up (AOR =0.446:95 % CI; 0.155, 0.980), and birth interval (AOR= 0.392: 95 % CI; 0.107, 0.839), reduces the odds of developing vitamin A deficiency; whereas age group of 36–47 months (AOR= 1.911: 95 % CI; 1.305, 11.969) increases the odds of its deficiency. Conclusion: Age of children, birth interval, ANC follow-up, Post natal care (PNC) follow-up, and place of residence were associated factors for vitamin A deficiency. Therefore more efforts should be encouraged to produce and purchase a variety of foods rich in vitamin A.

A comparative analysis of the influence of contraceptive use and fertility desire on the duration of second birth interval in four sub-Saharan African countries

Background Fertility decline characterised by inter-birth intervals remains rather slow or stall in many countries of sub-Saharan African (SSA). Non-adherence to optimal inter-birth intervals often occasioned by low prevalence of contraceptive use and high fertility desires often lead to poor maternal and child health outcomes. Additionally, information on the influence of contraception and fertility desire on interval between first and second births (SBI) is rarely available. This study therefore aimed to examine the influence of fertility desire and contraception on SBI among women in four SSA countries. Methods We analysed cross-sectional data on women aged 15–49 years who participated in the recent Demographic and Health Surveys in DR Congo, Ethiopia, Nigeria and South Africa. Semi-parametric Cox proportional hazards regression was employed for the analysis at 5% significance level. Results The median time to second birth was 34 months in DR Congo; 35 months, Nigeria; 42 months, Ethiopia; and 71 months, South Africa. About 70% of the women desired additional child(ren) and two-thirds have never used contraceptive in both Nigeria and DR Congo. The hazard of second birth was significantly lower among women who desired additional child(ren) compared to desired for no more child in DR Congo (aHR = 0.93; CI: 0.89–0.97), Ethiopia (aHR = 0.64; CI: 0.61–0.67) and South Africa (aHR = 0.51; CI: 0.47–0.55). Women who had never used contraceptive were 12%, 20% and 24% more likely to lengthen SBI than those who were current users in DR Congo, Nigeria and South Africa respectively. DR Congo and Nigerian women were about two times more likely to shorten SBI compared with their South African counterparts. Other significant determinants of SBI include ethnicity, rural residential, age and marital status at first birth, wealth and employment status. Conclusion Findings showed differentials in the linkage between second birth interval and the desired fertility and contraception by country, demonstrating the importance of context. The contribution of these factors to second birth interval requires country context-specific attention if further decline in fertility and poor health outcomes associated with sub-optimal inter-birth interval is to be attained in SSA.

Determinants of Anemia in The Third Trimester of Pregnancy in Mojokerto

Background: Anemia is a pregnancy complication that increases the morbidity and mortality of mother and baby during pregnancy and until puerperium. In 2015, the incidence of anemia in Indonesia was 23%. Purpose: The aim of this study was to determine factors that influence anemia in the third trimester of pregnancy. Methods: The study was conducted on pregnant women in Mojokerto. This study used a case-control design. The sample calculation results obtained 70 cases and 70 controls. The primary and secondary data were obtained from the MCH book and from interviews conducted according to questionnaire guidelines. Data were analyzed via chi-squared test and logistic regression test. Results: The factors that influence anemia in the third trimester of pregnancy were found to be age (p value = 0.04; OR 2.08; 95% CI = 1.04–4.16), occupation (p value = 0.02; OR = 2.27; 95% CI = 1.15–4.47), birth interval (p value = 0.03; OR = 2.25; 95% CI 1.08-4.69), nutritional status (p value = 0.02; OR = 2.33; 95% CI = 1.14- 4.82), knowledge [about anemia] (p value = 0.01; OR = 3.17; 95% CI = 1.41-7.09), income per month (p value = 0.03, OR = 2.25; 95% CI =1.08–4.69), smoking activity (p value = 0.04; OR = 2.00; 95% CI = 1.02–3.92), perception (p value = 0.02; OR = 2.20; 95% CI = 1.10–4.40) , and spousal support (p value = 0.01; OR = 2.63; 95% CI = 1.16 – 5.93) Conclusion: The most influential factors on anemia in the third trimester of pregnancy were birth interval, nutritional status, and knowledge.

Determinants of Under-Five Mortality in Tach-Armachiho District, North Gondar, Ethiopia

Background: Under-five mortality rate, often known by its acronym U5MR, indicates the probability of dying between birth and five years of age, expressed per 1,000 live births. Globally, 16,000 children under-five still die every day. Especially in Sub-Saharan Africa every 1 child in 12, dying before his or her fifth birthday. This study aims to identify the determinants of under-five mortality among women in child bearing age group of Tach-Armachiho district using count regression models. Methods: For achieving the objective, a two stage random sampling technique (simple random sampling and systematic random sampling techniques in the first and second stages respectively) was used to select women respondents. The sample survey conducted in Tach-Armachiho district considered a total of 3815 households of women aged 15 to 49 years out of which the information was collected from 446 selected women through interviewer administrated questionnaire. Results: The descriptive statistics result showed that in the district 16.6% of mothers have faced the problem of at least one under-five death. In this study, Poisson regression, negative binomial, zero-inflated Poisson and zero-inflated negative binomial regression models were applied for data analysis. Each of these count models were compared by different statistical tests. So that, zero-inflated poisson regression model was found to be the best fit for the collected data. Results of the zero-inflated Poisson regression model showed that education of husband, source of water, mother occupation, kebele of mother, prenatal care, place of delivery, place of residence, wealth of house hold, average birth interval and average breast feeding were found to be statistically significant determinants of under-five mortality. Conclusions: In this study, it was found that the factors like average birth interval and average breast feeding were found to be statistically significant factors in both groups (not always zero category and always zero category) with under-five child death whereas education of husband, source of water, place of delivery, mother occupation and wealth index of the household have significant effect on under-five mortality under not always zero group. Place of residence, kebele of mother and prenatal care have a significant effect on under-five mortality in Tach-Armachiho district on inflated group.

Nutritional status and concomitant factors of stunting among pre-school children in Malda, India: A micro-level study using a multilevel approach

Background Malnutrition was the main cause of death among children below 5 years in every state of India in 2017. Despite several flagship programmes and schemes implemented by the Government of India, the latest edition of the Global Nutrition Report 2018 addressed that India tops in the number of stunted children, which is a matter of concern. Thus, a micro-level study was designed to know the level of nutritional status and to study this by various disaggregate levels, as well as to examine the risk factors of stunting among pre-school children aged 36–59 months in Malda. Method A primary cross-sectional quantitative survey was conducted using structured questionnaires following a multi-stage, stratified simple random sampling procedure in 2018. A sum of 731 mothers with at least one eligible child aged 36–59 months were the study participants. Anthropometric measures of children were collected following the WHO child growth standard. Children were classified as stunted, wasted, and underweight if their HAZ, WHZ, and WAZ scores, respectively, were less than −2SD. The random intercept multilevel logistic regression model has been employed to estimate the effects of possible risk factors on childhood stunting. Results The prevalence of stunting in the study area is 40% among children aged 36–59 months, which is a very high prevalence as per the WHO’s cut-off values (≥40%) for public health significance. Results of the multilevel analysis revealed that preceding birth interval, low birth weight, duration of breastfeeding, mother’s age at birth, mother’s education, and occupation are the associated risk factors of stunting. Among them, low birth weight (OR 2.22, 95% CI: 1.44–3.41) and bidi worker as mothers’ occupation (OR 1.92, 95% CI: 1.18–3.12) are the most influencing factors of stunting. Further, about 14 and 86% variation in stunting lie at community and child/household level, respectively. Conclusion Special attention needs to be placed on the modifiable risk factors of childhood stunting. Policy interventions should direct community health workers to encourage women as well as their male partners to increase birth interval using various family planning practices, provide extra care for low birth weight baby, that can help to reduce childhood stunting.

The Crucial Role of Mothers and Siblings in Child Survival: Evidence From 29 Health and Demographic Surveillance Systems in Sub-Saharan Africa

A considerable body of research has studied the effects of siblings on child mortality through birth intervals. This research has commonly focused on older siblings. We argue that birth intervals with younger siblings may have equal or stronger effects on child mortality, even during a mother's pregnancy. Moreover, we contend that birth interval effects need to be considered only when siblings are coresident. Using longitudinal data from 29 Health and Demographic Surveillance Systems across sub-Saharan Africa, covering more than 560,000 children, we examine the proximate role of siblings and mothers in child mortality. We find that a birth interval of 24 months or more is advantageous for both older and younger siblings. The effect of a younger sibling on child mortality is more pronounced than that of an older sibling and adds to the effect of an older sibling. Moreover, child mortality is particularly low during a mother's subsequent pregnancy, contrasting the shock resulting from a younger sibling's birth. Further, we find that a mother's or sibling's absence from the household results in a higher risk of mortality, and the death of either reduces child survival up to six months before the death.