Socio-economic factors associated with increased neonatal mortality: A mixed-method study of Bangladesh and 20 other developing countries based on demographic and health survey data

A biosocial analysis of perinatal and late neonatal mortality among Indigenous Maya Kaqchikel communities in Tecpán, Guatemala: a mixed-methods study

INTRODUCTION

Neonatal mortality is a global public health challenge. Guatemala has the fifth highest neonatal mortality rate in Latin America, and Indigenous communities are particularly impacted. This study aims to understand factors driving neonatal mortality rates among Maya Kaqchikel communities.

METHODS

We used sequential explanatory mixed methods. The quantitative phase was a secondary analysis of 2014-2016 data from the Global Maternal and Newborn Health Registry from Chimaltenango, Guatemala. Multivariate logistic regression models identified factors associated with perinatal and late neonatal mortality. A number of 33 in-depth interviews were conducted with mothers, traditional Maya midwives and local healthcare professionals to explain quantitative findings.

RESULTS

Of 33 759 observations, 351 were lost to follow-up. There were 32 559 live births, 670 stillbirths (20/1000 births), 1265 (38/1000 births) perinatal deaths and 409 (12/1000 live births) late neonatal deaths. Factors identified to have statistically significant associations with a higher risk of perinatal or late neonatal mortality include lack of maternal education, maternal height <140 cm, maternal age under 20 or above 35, attending less than four antenatal visits, delivering without a skilled attendant, delivering at a health facility, preterm birth, congenital anomalies and presence of other obstetrical complications. Qualitative participants linked severe mental and emotional distress and inadequate maternal nutrition to heightened neonatal vulnerability. They also highlighted that mistrust in the healthcare system-fueled by language barriers and healthcare workers' use of coercive authority-delayed hospital presentations. They provided examples of cooperative relationships between traditional midwives and healthcare staff that resulted in positive outcomes.

CONCLUSION

Structural social forces influence neonatal vulnerability in rural Guatemala. When coupled with healthcare system shortcomings, these forces increase mistrust and mortality. Collaborative relationships among healthcare staff, traditional midwives and families may disrupt this cycle.

Proximate and distant determinants of maternal and neonatal mortality in the postnatal period: A scoping review of data from low- and middle-income countries

Global maternal and neonatal mortality rates remain unacceptably high. The postnatal period, encompassing the first hour of life until 42 days, is critical for mother-baby dyads, yet postnatal care (PNC) coverage is low. Identifying mother-baby dyads at increased risk for adverse outcomes is critical. Yet few efforts have synthesized research on proximate and distant factors associated with maternal and neonatal mortality during the postnatal period. This scoping review identified proximate and distant factors associated with maternal and neonatal mortality during the postnatal period within low- and middle-income countries (LMICs). A rigorous, systematic search of four electronic databases was undertaken to identify studies published within the last 11 years containing data on risk factors among nationally representative samples. Results were synthesized narratively. Seventy-nine studies were included. Five papers examined maternal mortality, one focused on maternal and neonatal mortality, and the rest focused on neonatal mortality. Regarding proximate factors, maternal age, parity, birth interval, birth order/rank, neonate sex, birth weight, multiple-gestation, previous history of child death, and lack of or inadequate antenatal care visits were associated with increased neonatal mortality risk. Distant factors for neonatal mortality included low levels of parental education, parental employment, rural residence, low household income, solid fuel use, and lack of clean water. This review identified risk factors that could be applied to identify mother-baby dyads with increased mortality risk for targeted PNC. Given risks inherent in pregnancy and childbirth, adverse outcomes can occur among dyads without obvious risk factors; providing timely PNC to all is critical. Efforts to reduce the prevalence of risk factors could improve maternal and newborn outcomes. Few studies exploring maternal mortality risk factors were available; investments in population-based studies to identify factors associated with maternal mortality are needed. Harmonizing categorization of factors (e.g., age, education) is a gap for future research.

Exploring the Influencing Factors for Contraceptive Use among Women: A Meta-Analysis of Demographic and Health Survey Data from 18 Developing Countries

Background. The primary objective of this research was to investigate how socioeconomic and demographic factors influence the usage of contraceptives by women in 18 developing countries. Methods. The study used the latest DHS data from 18 developing countries in order to acquire a broad perspective of contraceptive methods. We applied meta-analysis techniques for 18 developing countries to find out the summary results. Results. The overall summary effect showed that the variable respondent education ( $\text{OR}=1.39$ ; 95% CI: 1.17 to 1.65), husband education ( $\text{OR}=1.60$ ; 95% CI: 1.32 to 1.93), type of place of residence ( $\text{OR}=0.88$ ; 95% CI 0.78 to 0.98), current working status ( $\text{OR}=1.47$ ; 95% CI 1.30 to 1.66), age of the respondent ( $\text{OR}=3.41$ ; 95% CI 2.35 to 4.93), breastfeeding status ( $\text{OR}=1.34$ ; 95% CI 1.11 to 1.62), and desire for more children ( $\text{OR}=0.53$ ; 95% CI 0.43 to 0.65) were the significant factors for contraceptive utilization in developing countries. Conclusions. According to the findings of this descriptive study, the respondent’s age, level of education, and work status were shown to be the most significant factors that influence the usage of contraceptives in developing countries. It is necessary to take reasonable steps in order to increase the rate of utilizing methods of contraception among women of reproductive age who are uneducated, living in rural areas, and unemployed.

Infant Mortality and Inflation in China: Based on the Mixed Frequency VAR Analyses

Reducing neonatal mortality is an important goal in the Sustainable Development Goals (SDGs), and with the outbreak of the new crown epidemic and severe global inflation, it is extremely important to explore the relationship between inflation and infant mortality. This paper investigates the causal relationship between inflation and infant mortality using a mixed frequency vector autoregressive model (MF-VAR) without any filtering procedure, along with impulse response analysis and forecast misspecification variance decomposition, and compares it with a low frequency vector autoregressive model (LF-VAR). We find that there is a causal relationship between inflation and infant mortality, specifically, that is inflation increases infant mortality. Moreover, the contribution of CPI to IMR is greater in the forecast error variance decomposition in the MF-VAR model compared to the LF-VAR model, indicating that CPI has stronger explanatory power for IMR in mixed-frequency data. The results of the study have important implications for China and other developing countries in reducing infant mortality and achieving the Sustainable Development Goals (SDGs). Policymakers should focus on inflation as a macroeconomic variable that reduces the potential negative impact of inflation on infant mortality. The results of the analysis further emphasize the importance of price stability in the context of global inflation caused by the outbreak of the coronavirus pandemic outbreak.