Infant Mortality Rate as a Measure of a Country's Health: A Robust Method to Improve Reliability and Comparability

Progress towards universal health coverage and inequalities in infant mortality: an analysis of 4·1 million births from 60 low-income and middle-income countries between 2000 and 2019

BACKGROUND

Expanding universal health coverage (UHC) might not be inherently beneficial to poorer populations without the explicit targeting and prioritising of low-income populations. This study examines whether the expansion of UHC between 2000 and 2019 is associated with reduced socioeconomic inequalities in infant mortality in low-income and middle-income countries (LMICs).

METHODS

We did a retrospective analysis of birth data compiled from Demographic and Health Surveys (DHSs). We analysed all births between 2000 and 2019 from all DHSs available for this period. The primary outcome was infant mortality, defined as death within 1 year of birth. Logistic regression models with country and year fixed effects assessed associations between country-level progress to UHC (using WHO's UHC service coverage index) and infant mortality (overall and by wealth quintile), adjusting for infant-level, mother-level, and country-level variables.

FINDINGS

A total of 4 065 868 births to 1 833 011 mothers were analysed from 177 DHSs covering 60 LMICs between 2000 and 2019. A one unit increase in the UHC index was associated with a 1·2% reduction in the risk of infant death (AOR 0·988, 95% CI 0·981-0·995; absolute measure of association, 0·57 deaths per 1000 livebirths). An estimated 15·5 million infant deaths were averted between 2000 and 2019 because of increases in UHC. However, richer wealth quintiles had larger associated reductions in infant mortality from UHC (quintile 5 AOR 0·983, 95% CI 0·973-0·993) than poorer quintiles (quintile 1 0·991, 0·985-0·998). In the early stages of UHC, UHC expansion was generally beneficial to poorer populations (ie, larger reductions in infant mortality for poorer households [infant deaths per 1000 per one unit increase in UHC coverage: quintile 1 0·84 vs quintile 5 0·59]), but became less so as overall coverage increased (quintile 1 0·64 vs quintile 5 0·57).

INTERPRETATION

Since UHC expansion in LMICs appears to become less beneficial to poorer populations as coverage increases, UHC policies should be explicitly designed to ensure lower income groups continue to benefit as coverage expands.

FUNDING

UK National Institute for Health and Care Research.

Unveiling the health consequences of air pollution in the world's most polluted nations

Air pollution poses a persuasive threat to global health, demonstrating widespread detrimental effects on populations worldwide. Exposure to pollutants, notably particulate matter with a diameter of 2.5 µm (PM2.5), has been unequivocally linked to a spectrum of adverse health outcomes. A nuanced understanding of the relationship between them is crucial for implementing effective policies. This study employs a comprehensive investigation, utilizing the extended health production function framework alongside the system generalized method of moments (SGMM) technique, to scrutinize the interplay between air pollution and health outcomes. Focusing on a panel of the top twenty polluted nations from 2000 to 2021, the findings yield substantial insights. Notably, PM2.5 concentration emerges as a significant factor, correlating with a reduction in life expectancy by 3.69 years and an increase in infant mortality rates by 0.294%. Urbanization is found to increase life expectancy by 0.083 years while concurrently decreasing infant mortality rates by 0.00022%. An increase in real per capita gross domestic product corresponds with an improvement in life expectancy by 0.21 years and a decrease in infant mortality rates by 0.00065%. Similarly, an elevated school enrollment rate is associated with a rise in life expectancy by 0.17 years and a decline in infant mortality rates by 0.00032%. However, a higher population growth rate is found to modestly decrease life expectancy by 0.019 years and slightly elevate infant mortality rates by 0.000016%. The analysis reveals that per capita greenhouse gas emissions exert a negative impact, diminishing life expectancy by 0.486 years and elevating infant mortality rates by 0.00061%, while per capita energy consumption marginally reduces life expectancy by 0.026 years and increases infant mortality rates by 0.00004%. Additionally, economic volatility shock presents a notable decrement in life expectancy by 0.041 years and an increase in infant mortality rates by 0.000045%, with inflationary shock further exacerbating adverse health outcomes by lowering life expectancy by 0.70 years and elevating infant mortality rates by 0.00025%. Moreover, the study scrutinizes the role of institutional quality, revealing a constructive impact on health outcomes. Specifically, the institutional quality index is associated with an increase in life expectancy by 0.66% and a decrease in infant mortality rates by 0.0006%. Extending the analysis to examine the nuanced dimensions of institutional quality, the findings discern that economic institutions wield a notably stronger positive influence on health outcomes compared to political and institutional governance indices. Finally, the results underscore the pivotal moderating role of institutional quality in mitigating the deleterious impact of PM2.5 concentration on health outcomes, counterbalancing the influence of external shocks, and improving the relationships between explanatory variables and health outcome indicators. These findings offer critical insights for guiding evidence-based policy implications, with a focus on fostering resilient, sustainable, and health-conscious societies.

The Role of Infant Health Problems in Constraining Interneighborhood Mobility: Implications for Citywide Employment Networks

Infant health problems are a persistent concern across the United States, disproportionally affecting socioeconomically vulnerable communities. We investigate how inequalities in infant health contribute to differences in interneighborhood commuting mobility and shape neighborhoods' embeddedness in the citywide structure of employment networks in Chicago over a 14-year period. We use the Census Bureau's Longitudinal Employer-Household Dynamics' Origin-Destination Employment Statistics to analyze commuting networks between 2002 and 2015. Results from longitudinal network analyses indicate two main patterns. First, after the Great Recession, a community's infant health problems began to significantly predict isolation from the citywide employment network. Second, pairwise dissimilarity in infant health problems predicts a lower likelihood of mobility ties between communities throughout the entire study period. The findings suggest that infant health problems present a fundamental barrier for communities in equally accessing the full range of jobs and opportunities across the city-compounding existing inequalities.

Uncovering the rural-urban gap in determinants of infant mortality in Punjab-Pakistan

OBJECTIVE

The main objective of this research is to observe the various socio-economic, demographic, health-seeking, and environmental factors influencing infant mortality and the rural-urban division in Punjab, Pakistan.

METHODS

The study used the data of 38,405 households from the Multiple Indicator Cluster Survey that was conducted by the Bureau of Statistics Punjab during 2017-18. This survey assessed 125 indicators i.e., health, education, etc. created by UNICEF to assess the well-being of mothers and children in Punjab, Pakistan.

RESULTS AND CONCLUSION

The mother, the child, and the family are the three main risk factors for infant death, according to our research in Pakistan. The socioeconomic position of the household, social practices, environment, and usage of medical services are the key factors that help in reducing infant death. Women's education, birth spacing, and household economic position all played a significant role in the decline in infant mortality. The health of infants born in rural Punjab is at risk due to a large rural-urban gap in the determinants of infant mortality. Uncovering and addressing this disparity has become a pressing health priority in Pakistan.

Trends and Factors Associated With Mortality Rates of Leading Causes of Infant Death: A CDC Wide-Ranging Online Data for Epidemiologic Research (CDC WONDER) Database Analysis

BACKGROUND

Infant mortality is a critical indicator of a nation's healthcare system and social well-being. This study explores trends and factors associated with mortality rates for three leading causes of infant death: congenital malformations, deformations, and chromosomal abnormalities; disorders related to short gestation and low birth weight, not elsewhere classified; and sudden infant death syndrome (SIDS).

METHODS

Utilizing the CDC WONDER (CDC Wide-Ranging Online Data for Epidemiologic Research) database, we conducted a retrospective observational analysis of infant mortality rates and associated factors. Data encompassed multiple years, allowing for trend analysis and exploration of influencing variables. Study variables included demographic, maternal, prenatal, and leading cause as factors.

RESULT

Trends in infant mortality rates varied across causes. The overall mortality rate was 2.69 per 1,000 (p=0.000) people during 2007-2020. The highest rates were observed in 2007 (3.05), 2008 (3.01), and 2009 (2.93) per 1,000 infants. For congenital malformations, deformations, and chromosomal abnormalities, the rate ranged from 1.35 to 1.12 (2007-2020). Gender-based mortality differences were subtle (male rate 2.88 per 1,000 infants, p=0.000; female infants 2.50 per 1,000 infants, p=0.000). The examination of infant mortality trends also explored maternal variables, including maternal age, education, and delivery method. The analysis revealed disparities across variables. Teenage maternal age correlated with higher mortality rates, while maternal education was associated with lower rates. Vaginal delivery (2.61 per 1,000 infants, p=0.199) showed slightly lower rates compared to cesarean section (2.86 per 1,000 infants, p=0.076).

CONCLUSION

This study utilizes the CDC WONDER database and offers evidence of changing trends in infant mortality rates for the selected causes. Factors such as maternal age (30-34 years and 35-39 years), race/ethnicity (Black or African-American and White), birthplace (in hospital), and mother's education (master's degree) were identified as influencing mortality rates. These findings contribute to informed policymaking and interventions aimed at mitigating infant mortality and improving the well-being of infants and their families. Further research is needed to fully understand the underlying dynamics of these trends and factors.

Healthcare System Impact on Deceased Organ Donation and Transplantation: A Comparison Between the Top 10 Organ Donor Countries With 4 Countries in Southeast Asia

The need for organ donation is constantly increasing. Some countries have made improvements, while others, such as countries in Southeast Asia (SEA), have some of the lowest rates of deceased donors (pmp). This review aims to compare 14 countries with regards to many variables related to healthcare systems. Countries leading in deceased organ donation spend more on health and education, which is associated with increased potential for deceased organ donation. Out-of-pocket expenditure, is also associated with a decrease in deceased organ donation. Countries in SEA are lacking in healthcare resources such as workforce and materials, which are both necessary for a successful transplant program. Most countries in SEA have an excellent foundation for successful organ donation systems, including proper legislation, government support, and brain death laws along with an overall acceptance of brain death diagnosis. Priorities should include improving coordination, donor identification, and healthcare worker education. Countries in SEA have a lot of potential to increase deceased organ donation, especially by investing in healthcare and education. There is no one size fits all for organ donation programs and countries in SEA should focus on their strengths and take cultural differences into consideration when planning interventions.

The Impact of Sociodemographic, Macroeconomic, and Health Status and Resources on Infant Mortality Rates in Oman: Evidence from 1980 to 2022

BACKGROUND

The infant mortality rate (IMR) is an important reflection of the well-being of infants and the overall health of the population. This study aims to examine the macroeconomic (ME), sociodemographic (SD), and health status and resources (HSR) effects on IMR, as well as how they may interact with each other.

METHODS

A retrospective time-series study using yearly data for Oman from 1980 to 2022. Partial Least Squares-Structural Equation Modelling (PLS-SEM) was utilized to develop the exploratory model of the determinants of IMR.

RESULTS

The model indicates that HSR determinants directly, but negatively, affect IMR (β = -0.617, p < 0.001). SD directly and positively affects IMR (β = 0.447, p < 0.001). ME only indirectly affects IMR (β = -0.854, p < 0.001). ME determinants also exert some direct influences on both HSR (β = 0.722, p < 0.001) and SD (β = -0.916, p < 0.001) determinants.

CONCLUSIONS

This study has indicated that IMR is a multi-faceted issue. It also highlighted the interplay of numerous variables and their influence on IMR, particularly the role that social status, the health sector, and the wealth of the country and its population play in reducing IMR. These findings indicate that an integrated policy that addresses socioeconomic and health-related factors and the overall ME environment is necessary for the health and well-being of the children and the population overall in Oman.

Infant Mortality Trends and Determinants in Kazakhstan

Infant mortality rate (IMR) is a crucial indicator of healthcare performance and a reflection of a country's socioeconomic development. We analyzed the trends of IMR in Central Asia (CA) countries and its determinants in Kazakhstan, which is a middle-income country. Linear regression was used for IMR trend analysis in CA countries from 2000 to 2020 and for exploring associations between IMR and socioeconomic factors, health service-related factors, and population health indicators-related factors. A gamma generalized linear model was applied to define associations with various determinants. Our analysis revealed that IMR has decreased in all CA countries, with Kazakhstan having the lowest rate in 2000 and 2020. Our results suggest that socioeconomic indicators, such as total unemployment, Gini index, current health expenditure, gross domestic product (GDP), proportion of people living in poverty, and births by 15-19-year-old mothers, were associated with increased infant mortality rates. Improving socioeconomic conditions, investing in healthcare systems, reducing poverty and income inequality, and improving access to education, are all potential issues for further development. Addressing these factors may be critical for improving maternal and child health outcomes in the region.

Geographical disparities and determinants of infant mortality in Ethiopia: mapping and spatial analysis using EDHS data

BACKGROUND

Infant mortality remains a public health challenge in Ethiopia. Exploring infant mortality will aid in tracking the progress toward achieving sustainable development goals.

OBJECTIVE

The study aimed to explore the geographical variations and associated factors of infant mortality in Ethiopia.

METHOD

A total of 11,023 infants from the 2016 Ethiopian Demographic and Health Survey (EDHS) data were extracted and included in the analysis. EDHS used a two-stage cluster sampling design with a census enumeration area as the primary sampling unit and households as the secondary sampling unit. Arc GIS software was used for spatial analysis using clusters for exploring geographical variations in infant mortality. A binary logistic regression was employed using R software to identify the significant determinants of infant mortality.

RESULTS

The study revealed that the spatial distribution of infant mortality was non-random in the country. Infants whose mothers not receiving ANC (AOR = 1.45; 95%CI: 1.17, 1.79), not breastfed status (AOR = 3.94; 95%CI: 3.19, 4.81), poor wealth index (AOR = 1.36; 95%CI: 1.04, 1.77), male infants (AOR = 1.59; 95%CI: 1.29, 1.95), birth order of six or above (AOR = 3.11; 95%CI: 2.08, 4.62), small birth size (AOR = 1.27; 95%CI: 1.26, 1.60), birth spacing [(≤ 24 months (AOR = 2.29; 95%CI: 1.79, 2.92), 25-36 months (AOR = 1.16; 95%CI: 1.12, 1.49)], multiple births (AOR = 6.82; 95%CI: 4.76, 10.81), rural residence (AOR = 1.63; 95%CI: 1.05, 2.77) and regions [Afar (AOR = 1.54; 95%CI: 1.01, 2.36), Harari (AOR = 1.56; 95%CI: 1.04, 2.56), and Somali (AOR = 1.52; 95%CI: 1.03, 2.39)] were the determinants of infant death in Ethiopia.

CONCLUSIONS

There is a great geographical disparity in infant mortality rates across regions. Afar, Harari, and Somali regions were verified as hot spot areas. ANC usage, breastfed status, wealth index, sex of the infant, birth order, birth size, birth spacing, birth type, residence, and region were the determinants of infant death in Ethiopia. Therefore, appropriate interventions need to be implemented in the hot spots to alleviate the risk factors for infant mortality.

The Causes and Factors Associated with Infant Mortality Rate in Ethiopia: The Application of Structural Equation Modelling

Infant mortality rate is a proxy measure of population health. Previous studies on the infant mortality rate in Ethiopia did not consider measurement errors in the measured variables and had a one-directional effect; little emphasis was placed on testing multiple causal paths at the same time. We used structural equation modelling for a better understanding of the direct, indirect, and total effects among causal variables in a single model. A path analysis was part of an algorithm providing equations that were relating the variances and covariances of the indicators. From the results, the maternal mortality ratio (MMR) was significantly mediating the influence of out-of-pocket expenditure (OOP) on infant mortality rate (IMR), and the fertility rate (FR) was significantly mediating the influence of GDP to IMR (β = 1.168, p < 0.001). The GDP affects the IMR directly and indirectly while the OOP affects IMR indirectly. This study showed that there was a causal linkage between the World Bank Health and Population Variables for causing IMR in Ethiopia. The MMR and FR were found to be the intermediate indicators in this study. Through the indicators, FR had the highest standardised coefficients for increasing the IMR. We recommended that the existing interventions to reduce IMR be strengthened.

Emission of Industrial Air Pollution and Mortality Due to Respiratory Diseases: A Birth Cohort Study in Poland

BACKGROUND

Air pollution is a major risk factor for public health worldwide, but evidence linking this environmental problem with the mortality of children in Central Europe is limited.

OBJECTIVE

To investigate the relationship between air pollution due to the emission of industry-related particulate matter and mortality due to respiratory diseases under one year of age.

METHODS

A retrospective birth cohort analysis of the dataset including 2,277,585 children from all Polish counties was conducted, and the dataset was matched with 248 deaths from respiratory diseases under one year of age. Time to death during the first 365 days of life was used as a dependent variable. Harmful emission was described as total particle pollution (TPP) from industries. The survival analysis was performed using the Cox proportional hazards model for the emission of TPP at the place of residence of the mother and child, adjusted individual characteristics, demographic factors, and socioeconomic status related to the contextual level.

RESULTS

Infants born in areas with extremely high emission of TPP had a significantly higher risk of mortality due to respiratory diseases: hazard ratio (HR) = 1.781 [95% confidence interval (CI): 1.175, 2.697], p = 0.006, compared with those born in areas with the lowest emission levels. This effect was persistent when significant factors were adjusted at individual and contextual levels (HR = 1.959 [95% CI: 1.058, 3.628], p = 0.032). The increased risk of mortality was marked between the 50th and 150th days of life, coinciding with the highest exposure to TPP.

CONCLUSIONS

The emission of TPP from industries is associated with mortality due to respiratory diseases under one year of age. A considerable proportion of children's deaths could be prevented in Poland, especially in urban areas, if air pollution due to the emission of particle pollution is reduced.

Factors associated with post-neonatal mortality in Ethiopia: Using the 2019 Ethiopia mini demographic and health survey

Background

Post-neonatal mortality is the number of deaths of infants aged 28 days through 11 months and is expressed as post-neonatal deaths per 1000 live births per year. This study aimed to identify the factors that influence post-neonatal death using the 2019 Ethiopia mini demographic and health survey (EMDHS2019).

Methods

The study included 2126 post neonates born from mothers who had been interviewed about births in the five years before the survey. The survey gathering period was carried out from March 21, 2019, to June 28, 2019. The data were first analyzed with a chi-square test of association, and then relevant factors were evaluated with binary logistic regression models and the results were interpreted using adjusted odds ratio (AOR) and confidence interval(CI) of parameters.

Results

The prevalence of post neonatal death was 16% (95% CI: 15.46, 17.78). The study also showed that not vaccinated post-neonates (AOR = 2.325, 95% CI: 1.784, 3.029), mothers who were not receiving any tetanus injection (AOR = 2.891, 95% CI: 2.254, 3.708), mothers age group 15-24(AOR = 1.836, 95% CI: 1.168, 2.886), Afar (AOR = 2.868, 95% CI: 1.264, 6.506), Somali(AOR = 2.273, 95% CI: 1.029, 5.020), Southern Nations, Nationalities, and People’s Region(SNNP) (AOR = 2.619, 95% CI: 1.096, 6.257), 2–4 birth orders (AOR = 1.936, 95% CI: 1.225, 3.060), not attend antenatal care(ANC) visit (AOR = 6.491, 95% CI: 3.928, 10.726), and preceding birth interval less than 24 months (AOR = 1.755, 95% CI: 1.363,2.261) statistically associated with a higher risk of post neonatal death. Although not given anything other than breast milk (AOR = 0.604, 95% CI 0.462, 0.789), urban residents (AOR = 0.545, 95% CI: 0.338, 0.877), single births (AOR = 0.150, 95% CI: 0.096, 0.234), less than 3 children in a family (AOR = 0.665, 95% CI 0.470, 0.939) and the head of the male household (AOR = 0.442, 95% CI: 0.270, 0.724) were statistically associated with a lower risk of post-neonatal mortality.

Conclusions

It is highly suggested that maternal and child health care services (including antenatal care visits, postnatal care visits, and immunization) be strengthened and monitored during the early stages of infancy. Mothers from Somali, Afar, and SNNP regions, as well as multiple births, rural residents, and those giving birth to a child with a birth gap of fewer than 24 months, demand special care.

Recent historic increase of infant mortality in France: A time-series analysis, 2001 to 2019

Background

The infant mortality rate (IMR) serves as a key indicator of population health.

Methods

We used data from the French National Institute of Statistics and Economic Studies on births and deaths during the first year of life from 2001 to 2019 to calculate IMR aggregated by month. We ran joinpoint regressions to identify inflection points and assess the linear trend of each segment. Exploratory analyses were performed for overall IMR, as well as by age at death subgroups (early neonatal [D0-D6], late neonatal [D7-27], and post-neonatal [D28-364]), and by sex. We performed sensitivity analyses by excluding deaths at D0 and using other time-series modeling strategies.

Results

Over the 19-year study period, 53,077 infant deaths occurred, for an average IMR of 3·63/1000 (4·00 in male, 3·25 in female); 24·4% of these deaths occurred during the first day of life and 47·8% during the early neonatal period. Joinpoint analysis identified two inflection points in 2005 and 2012. The IMR decreased sharply from 2001 to 2005 (slope: -0·0167 deaths/1000 live births/month; 95%CI: -0·0219 to -0·0116) and then decreased slowly between 2005 and 2012 (slope: -0·0041; 95%CI: -0·0065 to -0·0016). From 2012 onwards, a significant increase in IMR was observed (slope: 0·0033; 95%CI: 0·0011 to 0·0056). Subgroup analyses indicated that these trends were driven notably by an increase in the early neonatal period. Sensitivity analyses provided consistent results.

Interpretation

The recent historic increase in IMR since 2012 in France should prompt urgent in-depth investigation to understand the causes and prepare corrective actions.

Funding

No financial relationships with any organizations that might have an interest in the submitted work in the previous three years, no other relationships or activities that could appear to have influenced the submitted work.

Effects of short birth interval on neonatal, infant and under-five child mortality in Ethiopia: a nationally representative observational study using inverse probability of treatment weighting

OBJECTIVE

To assess the effect of short birth interval (SBI) on neonatal, infant, and under-five mortality in Ethiopia.

DESIGN

A nationally representative cross-sectional survey.

SETTING

This study used data from the Ethiopia Demographic and Health Survey 2016.

PARTICIPANTS

A total of 8448 women who had at least two live births during the 5 years preceding the survey were included in the analysis.

OUTCOME MEASURES

Neonatal mortality (death of the child within 28 days of birth), infant mortality (death between birth and 11 months) and under-five mortality (death between birth and 59 months) were the outcome variables.

METHODS

Weighted logistic regression analysis based on inverse probability of treatment weights was used to estimate exposure effects adjusted for potential confounders.

RESULTS

The adjusted ORs (AORs) of neonatal mortality were about 85% higher among women with SBI (AOR=1.85, 95% CI=1.19 to 2.89) than those without. The odds of infant mortality were twofold higher (AOR=2.16, 95% CI=1.49 to 3.11) among women with SBI. The odds of under-five child mortality were also about two times (AOR=2.26, 95% CI=1.60 to 3.17) higher among women with SBI.

CONCLUSION

SBI has a significant effect on neonatal, infant and under-five mortality in Ethiopia. Interventions targeting SBI are warranted to reduce neonatal, infant and under-five mortality.

Risk Factors for Neonatal Sepsis in Secondary and Tertiary Care Hospitals of a District in Sri Lanka: A Case–Control Study

Objective The aim of this study was to determine the risk factors for neonatal sepsis.

Methods A case–control study was performed in secondary and tertiary care hospitals of a district in Sri Lanka. Neonates who diagnosed with sepsis based on clinical criteria or culture positivity were taken as the case group (n = 240) and neonates born during the same period who had not been diagnosed with sepsis were taken as the control group (n = 240). The controls were recruited from the community. The study instruments were, pretested interviewer administered questionnaire, a check list and record sheets. Multiple logistic regression analysis was performed. The results were expressed as odds ratios (OR) with the 95% confidence intervals (CI).

Results The independent risk factors for neonatal sepsis were history of abortions, still birth, and early neonatal deaths (OR: 6.78; 95% CI: 3.2–14.3), registration of pregnancy after 8 weeks of gestation (OR: 1.91; 95% CI: 1.07–3.4), total antenatal clinic visits ≤4 (OR: 7.18; 95% CI: 2.1–24.5), history of maternal fever prior to the week of delivery (OR: 2.74; 95% CI: 1.25–6.0) leaking amniotic fluid >18 hours (OR: 10.0; 95% CI: 2.1–47.4), performed >3 vaginal examinations before delivery (OR: 3.28; 95% CI: 2.1–24.5), meconium stained amniotic fluid (OR: 10.57; 95% CI: 3.7–29.7), mode of delivery by cesarean section, forceps or vacuum (OR: 2.33; 95% CI: 1.4–3.9), time of birth of the neonate being during on-call hours (OR: 2.12; 95% CI: 1.3–3.5), being a male baby (OR: 1.74; 95% CI: 1.1–2.8), and birth weight <2,500 g (OR: 5.17; 95% CI: 2.8–9.6) of neonates.

Conclusion Most of the identified risk factors for neonatal sepsis were modifiable. Stringent implementation of guidelines and protocols would prevent neonatal sepsis.

Converging or diverging trajectories of mortality under one year of age in the Baltic States: a comparison with the European Union

BACKGROUND

Information about trends in perinatal and child health inequalities is scarce, especially in the Eastern Europe. We analyzed how mortality under 1 year of age has been changing in the Baltic States and the European Union (EU) over 25 years, and what associations occurred between changes in macroeconomic factors and mortality.

METHODS

Data on fetal, neonatal, infant mortality, and macroeconomic factors were extracted from WHO database. Joinpoint regression analysis was performed to analyze time trajectories of mortality over 1990-2014. We also investigated how the changes in health expenditures and Gross Domestic Product (GDP) contributed to the changes in mortality.

RESULTS

The reduction of fetal, neonatal and infant mortality in the Baltic countries led to convergence with the EU. In Estonia this process was the fastest, and then the rates tended to diverge. The strongest effect in reduction of neonatal mortality was related to the annual increase in health expenditure and GDP which had occurred in the same year, and a decrease in fetal mortality associated with an increase in health expenditure and GDP in the 4th and 5th year, respectively, following the initial change.

CONCLUSIONS

These findings outlined convergences and divergences in mortality under 1 year of age in the Baltic States compared with the patterns of the EU. Our data highlighted a need to define health policy directions aimed at the implementation of effective intervention modalities addressing reduction of risks in prenatal and early life.

Individual-, household- and community-level determinants of infant mortality in Ethiopia

INTRODUCTION

People living in the same area share similar determinants of infant mortality, such as access to healthcare. The community's prevailing norms and attitudes about health behaviours could also influence the health care decisions made by individuals. In diversified communities like Ethiopia, differences in child health outcomes might not be due to variation in individual and family characteristics alone, but also due to differences in the socioeconomic characteristics of the community where the child lives. While individual level characteristics have been examined to some extent, almost all studies into infant mortality conducted in Ethiopia have failed to consider the impact of community-level characteristics. Therefore, this study aims to identify individual and community level determinants of infant mortality in Ethiopia.

METHOD

Data from the Ethiopian Demographic and Health Survey in 2016 were used for this study. A total of 10641 live births were included in this analysis. A multi-level logistic regression analysis was used to examine both individual and community level determinants while accounting for the hierarchal structure of the data.

RESULTS

Individual-level characteristics such as infant sex have a statistically significant association with infant mortality. The odds of infant death before one year was 50% higher for males than females (AOR = 1.66; 95% CI: 1.25-2.20; p-value <0.001). At the community level, infants from pastoralist areas (Somali and Afar regions) were 1.4 more likely die compared with infants living in the Agrarian area such as Amhara, Tigray, and Oromia regions; AOR = 1.44; 95% CI; 1.02-2.06; p-value = 0.039).

CONCLUSION

Individual, household and community level characteristics have a statistically significant association with infant mortality. In addition to the individual based interventions already in place, household and community-based interventions such as focusing on socially and economically disadvantaged regions in Ethiopia could help to reduce infant mortality.

The comparing of infant mortality rate in different World Health Organization regions during 1990–2017

Background

Infant mortality rate is an important index of community health status and mortality rate. It is also one of the most prominent indexes showing the development of various societies. Regarding the importance of infant mortality rate (IMR), the purpose of current study was to compare and trend analysis of IMR in different areas of the WHO during 1990–2017. In current ecological study, IMR per 1000 live births in different WHO regions from 1990 to 2017 data were derived from the WHO website. The required information included the data about IMR per 1000 live births in different WHO regions from 1990 to 2017. The analysis was performed by using descriptive and analytical methods.

Results

The IMR during the study period had a significant decreasing trend in all the regions (p < 0.001) but the slope of decrease was greater in Africa than in other regions. The African and European regions had the highest (55.7%) and lowest (17.2%) annual decrease in the infant mortality rate (from 106.3 cases in 1990 to 50.6 in 2017, and from 24.9 in 1990 to 7.7 in 2017), respectively.

Conclusion

Our results showed that the trend of IMR had a decreasing trend in all WHO regions. It can be due to improving the public health situation in different areas. But the identification of effective factors on IMR needs individuals based studies.

Risk factors for mortality among neonates admitted to a special care unit in a low-resource setting

Background

Although under-5 mortality has decreased in the last two decades, neonatal mortality remains a global health challenge. Despite achieving notable progress, Ethiopia has still one of the highest neonatal mortality rates worldwide. We aimed to assess the risk factors for mortality among neonates admitted to a special care unit in a referral hospital in rural Ethiopia.

Methods

This was a retrospective observational study including all 4182 neonates admitted to the special care unit of the St. Luke Wolisso Hospital (Ethiopia) from January 2014 to December 2017. Data were retrieved from hospital charts and entered in an anonymized dataset. A logistic regression model was applied to identify predictors of mortality and effect sizes were expressed as odds ratios with 95% confidence intervals.

Results

Proportion of deaths was 17% (709/4182 neonates). Neonates referred from other health facilities or home (odds ratio 1.52, 95% confidence interval 1.21 to 1.91), moderate hypothermia at admission (odds ratio 1.53, 95% confidence interval 1.09 to 2.15) and diagnosis of late-onset sepsis (odds ratio 1.63, 95% confidence interval 1.12 to 2.36), low birthweight (odds ratio 2.48, 95% confidence interval 2.00 to 3.09), very low birthweight (odds ratio 11.71, 95% confidence interval 8.63 to 15.94), extremely low birthweight (odds ratio 76.04, 95% confidence interval 28.54 to 263.82), intrapartum-related complications (odds ratio 4.69, 95% confidence interval 3.55 to 6.20), meconium aspiration syndrome (odds ratio 2.34, 95% confidence interval 1.15 to 4.43), respiratory distress (odds ratio 2.25, 95% confidence interval 1.72 to 2.95), other infections (odds ratio 1.92, 95% confidence interval 1.31 to 2.81) or malformations (odds ratio 2.32, 95% confidence interval 1.49 to 3.57) were associated with increased mortality. Being admitted in 2017 vs. 2014 (odds ratio 0.71, 95% confidence interval 0.52 to 0.97), and older age at admission (odds ratio 0.95, 95% confidence interval 0.93 to 0.97) were associated with decreased likelihood of mortality.

Conclusions

The majority of neonatal deaths was associated with preventable and treatable conditions. Education on neonatal resuscitation and postnatal management, and the introduction of an on-call doctor for high-risk deliveries might have contributed to the reduction in neonatal mortality over time.

miRNA-23b as a biomarker of culture-positive neonatal sepsis

BACKGROUND

Neonatal sepsis remains an important cause of morbidity and mortality. The ability to quickly and accurately diagnose neonatal sepsis based on clinical assessments and laboratory blood tests remains difficult, where haemoculture is the gold standard for detecting bacterial sepsis in blood culture. It is also very difficult to study because neonatal samples are lacking.

METHODS

Forty-eight newborns suspected of sepsis admitted to the Neonatology Department of the Mother-Child Specialized Hospital of Tlemcen. From each newborn, a minimum of 1-2 ml of blood was drawn by standard sterile procedures for blood culture. The miRNA-23b level in haemoculture was evaluated by RT-qPCR.

RESULTS

miR-23b levels increased in premature and full-term newborns in early onset sepsis (p < 0.001 and p < 0.005 respectively), but lowered in late onset sepsis in full-term neonates (p < 0.05) compared to the respective negative controls. miR-23b levels also increased in late sepsis in the negative versus early sepsis negative controls (p < 0.05). miR-23b levels significantly lowered in the newborns who died from both sepsis types (p < 0.0001 and p < 0.05 respectively). In early sepsis, miR-23b and death strongly and negatively correlated (correlation coefficient = - 0.96, p = 0.0019). In late sepsis, miRNA-23b and number of survivors (correlation coefficient = 0.70, p = 0.506) positively correlated.

CONCLUSIONS

Lowering miR-23b levels is an important factor that favours sepsis development, which would confirm their vital protective role, and strongly suggest that they act as a good marker in molecular diagnosis and patient monitoring.

Understanding Trends in the Concentration of Infant Mortality Among Disadvantaged White and Black Mothers in the United States, 1983-2013: A Decomposition Analysis

The United States compares unfavorably with other high-income countries in infant mortality, which recent literature has attributed to the poor birth outcomes among disadvantaged (i.e., unmarried and less-educated) mothers. Describing and decomposing the trend of the concentration of infant mortality among disadvantaged mothers thus provides important clues for improving birth outcomes. We develop the infant mortality disadvantage index (IMDI) to measure such concentration. Using the 1983-2013 Birth Cohort Linked Birth and Infant Death data, we show that although the IMDI-as a measure of mortality inequality-was persistently higher for Blacks than Whites, the trends were different between the two groups. The IMDI declined for Black women; for White women, however, it increased in the 1980s, then plateaued until the early 2000s, and declined thereafter. We then use Das Gupta's decomposition method to assess the contribution of five demographic/social factors (age, education, marriage, fertility, and infant mortality) to the IMDI trend. Nonmarital fertility among women with less than 12 years of education contributed most to Whites' changing IMDI; for Blacks, a shrinking proportion of the less-educated group and declines in infant mortality among disadvantaged mothers contributed to their declining IMDI. These findings explicate links between population-level compositional changes and infant mortality inequality.

Where are they working? A case study of twenty Cuban-trained South African doctors

BACKGROUND

The year 2017 marked the 21st anniversary of the South African Cuban Medical Collaboration (SACMC) programme that offers disadvantaged South African (SA) students an opportunity for medical training in Cuba. Graduates are expected to return to practice at a primary care level in rural communities; however, little is known about the professional trajectories and career choices of graduates from the programme.

AIM

This study explored the reasons why students enrolled in the programme, their professional and career choices as graduates and their career intentions.

SETTING

The study setting was the whole of SA although participants were primarily drawn from KwaZulu-Natal.

METHODS

An exploratory, qualitative case study used a purposive sampling strategy to gather data through semi-structured interviews from participants.

RESULTS

Graduates (N = 20) of the SACMC programme were all practicing in local SA settings. Participants preferred the SACMC programme as it offered them a full scholarship for medical training. Nineteen doctors had fulfilled their obligation to work in rural areas. Thirteen doctors are engaged in primary healthcare practice, either as private practice generalists or as public service medical officers. Three doctors had completed specialty training: one doctor was training towards specialisation, one doctor was employed at national government and two doctors were employed as medical managers. At the time of the study, 11 doctors were practicing in rural locations and 19 had indicated a long-term intention to work and live within South Africa.

CONCLUSION

The participants of this study who graduated from the SACMC programme are fulfilling their obligations in rural communities. They all intend to contribute to the SA medical workforce in the long-term.

Neonatal mortality in Ethiopia: a protocol for systematic review and meta-analysis

BACKGROUND

A child's risk of dying is highest in the neonatal period, i.e. the first 28 days of life. Newborn death accounts for nearly half of under-five death. More than 80% of newborn deaths are the result of preventable and treatable conditions. Ethiopia has made significant progress towards reducing under-five mortality; however, the rate of neonatal mortality (NMR) still accounts for 41% of under-five deaths. With this systematic review and meta-analysis, we aim to determine the magnitude, causes, and determinants of neonatal mortality in Ethiopia.

METHODS

We will conduct a comprehensive search of the following electronic databases: PubMed, MEDLINE, EMBASE, CINAHL, Google Scholar, and maternity and infant care databases as well as grey literature. We will assess the quality of studies by using Newcastle-Ottawa Scale (NOS) checklist. Two reviewers will screen all retrieved articles, conduct data extraction, and then critically appraise all identified studies. We will analyse data by using STATA 11 statistical software. We will demonstrate pooled estimates and determinants of neonatal mortality with effect size and 95% confidence interval.

DISCUSSION

The result from this systematic review will inform and guide health policy planners and researchers on the burden, causes, and determinants of neonatal mortality in Ethiopia. To our knowledge, this is the first systematic review in Ethiopia. We will synthesise the findings to generate up-to-date knowledge on neonatal mortality in Ethiopia.

SYSTEMATIC REVIEW REGISTRATION

PROSPERO-CRD42018099663.

[Infant mortality in the European Union: A time trend analysis of the 1994-2015 period]

BACKGROUND

Infant mortality is an indicator of child health, and an explanatory variable to reflect the socioeconomic development of a country. We aimed to examine the changes and trends of infant mortality in the European Union (EU) and its 28 member states in the 1994-2015 period.

METHODS

We extracted data of deaths in children aged less than one year between 1994 and 2015 from the Eurostat database. We analysed secular variation in the EU overall, by country and by geographical region using joinpoint regression analysis. We conducted additional analyses to examine neonatal and early neonatal mortality trends.

RESULTS

Infant mortality in the EU has declined significantly from 8,3 to 3,6 per 1,000 live births (annual percent change=-3,8%; 95% confidence interval, -4,1 to -3,6). Among EU countries, we found the highest mortality rates throughout the study period in Romania and Bulgaria, and the lowest rates in Scandinavian countries (Finland, Sweden). There were significant decreasing trends in every country of the EU, which were most pronounced in former Soviet Baltic states and Eastern European countries, and least pronounced in Western European countries. Mortality rates have increased significantly in Greece in the last years, and plateaued in the United Kingdom and Ireland.

CONCLUSIONS

Our findings, which are based on official data, provide consistent evidence that infant mortality has declined steadily in the EU and its member states in the past decades, most markedly in Eastern European countries and former Soviet Baltic states. However, rates have risen or levelled off in some western countries in the past few years.

Impact of federal transfers upon US infant mortality rates: a secondary analysis using a fixed effects regression approach

OBJECTIVES

In order to improve health outcomes, the federal government allocates hundreds of billions of annual dollars to individual states in order to further the well-being of its citizens. This study examines the impact of such federal intergovernmental transfers on reducing state-level infant mortality rates.

SETTING

Annual data are collected from all 50 US states between 2004 and 2013.

PARTICIPANTS

Entire US population under the age of 1 year between 2004 and 2013.

PRIMARY AND SECONDARY OUTCOME MEASURES

State-level infant mortality rate, neonatal mortality rate and postneonatal mortality rate.

RESULTS

Using a fixed effects regression model to control for unmeasurable differences between states, the impact of federal transfers on state-level infant mortality rates is estimated. After controlling for differences across states, increases in per capita federal transfers are significantly associated with lower infant, neonatal and postneonatal mortality rates. Holding all other variables constant, a $200 increase in the amount of federal transfers per capita would save one child's life for every 10 000 live births.

CONCLUSIONS

Considerable debate exists regarding the role of federal transfers in improving the well-being of children and families. These findings indicate that increases in federal transfers are strongly associated with reductions in infant mortality rates. Such benefits should be carefully considered when state officials are deciding whether to accept or reject federal funds.