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Nogueira-Pileggi V, Oladapo OT, Souza JP, Cavenague de Souza HC, Pileggi-Castro C, Oyeneyin LO, Oliveira-Ciabati L, Barbosa F, Camelo JS. Unveiling the strong positive relationship: Maternal characteristics and neonatal outcomes in the Better Outcomes in Labour Difficulty (BOLD) study - a secondary analysis validating neonatal near miss classification. J Glob Health 2024; 14:04024. [PMID: 38236696 PMCID: PMC10802829 DOI: 10.7189/jogh.14.04024] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/23/2024] Open
Abstract
Background The near miss concept, denoting near collisions between aircraft, originated in aeronautics, but has recently been transferred to the neonatal context as a way of evaluating the quality of health services for newborns, especially in settings with reduced child mortality. However, there is yet no consensus regarding the underlying criteria. The most common indicators used to assess health care quality include mortality (maternal and neonatal) and life-threatening conditions. Using the World Health Organization (WHO) Better Outcomes in Labour Difficulty (BOLD) prospective cohort study data set, we conducted a secondary analysis to validate the near miss concept and explore the association between maternal and neonatal outcomes. Methods We studied 10 203 singleton mothers treated between December 2014 and November 2015 in nine Nigerian and four Ugandan hospitals. We validated the near miss concept by testing the diagnostic accuracy (sensitivity, specificity, positive likelihood ratio, negative likelihood ratio, and odds ratio (OR)) using death as the reference variable and calculating the maternal and neonatal case fatality rates. We performed ordinal and binomial logistic regression, with the independent variables being those that had P < 0.1 in the univariate analyses. We considered the significance level of 5%. Results We validated the neonatal near miss concept using the BOLD study data. We observed maternal and neonatal case fatality rates of 70.2% and 6.5%, with an increasing severity relationship between maternal and neonatal outcomes (P < 0.05). Ordinal logistic regression showed that gestational age <37 or >41 weeks and <8 antenatal consultations were related to a higher risk of neonatal severe outcomes, while maternal age between 30 and 34 years functioned as a protective factor against severe neonatal outcomes (SNO). Binomial logistic regression showed gestational age <37(OR = 1.46; 95% confidence interval (CI) = 1.07-1.94) or >41 weeks (OR = 2.26; 95% CI = 1.55-3.20), low educational level (OR = 1.76; 95% CI = 1.12-2.69), overweight/obesity (OR = 1.23; 95% CI = 1.02-1.47), one previous cesarean section (OR = 1.90; 95% CI = 1.36-2.61), one previous abortion (OR = 1.25; 95% CI = 1.00-1.56), and previous chronic condition (OR = 1.83; 95% CI = 1.37-2.41) were risk factors for SNO. Conclusions The neonatal near miss concept could be used as a parameter for analysis in different health systems, to ensure that measuring of neonatal severity is comparable across health care units. In this analysis, we observed a progressive association between maternal severity and the severity of the newborns' outcomes.
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Affiliation(s)
- Vicky Nogueira-Pileggi
- Department of Paediatrics – Ribeirão Preto Medical School, University of São Paulo, São Paulo, Brazil
| | - Olufemi T Oladapo
- UNDP, UNFPA, UNICEF, WHO, World Bank Special Programme of Research, Development and Research Training in Human Reproduction (HRP), Department of Reproductive Health and Research, Geneva, Switzerland
| | - João Paulo Souza
- Department of Social Medicine – Ribeirão Preto Medical School, University of São Paulo, São Paulo, Brazil
| | | | - Cynthia Pileggi-Castro
- Department of Paediatrics – Ribeirão Preto Medical School, University of São Paulo, São Paulo, Brazil
| | - Lawal O Oyeneyin
- Department of Obstetrics and Gynaecology, University of Medical Sciences Teaching Hospital, Ondo State, Nigeria
| | - Livia Oliveira-Ciabati
- UNDP, UNFPA, UNICEF, WHO, World Bank Special Programme of Research, Development and Research Training in Human Reproduction (HRP), Department of Reproductive Health and Research, Geneva, Switzerland
| | - Francisco Barbosa
- UNDP, UNFPA, UNICEF, WHO, World Bank Special Programme of Research, Development and Research Training in Human Reproduction (HRP), Department of Reproductive Health and Research, Geneva, Switzerland
| | - José Simon Camelo
- Department of Paediatrics – Ribeirão Preto Medical School, University of São Paulo, São Paulo, Brazil
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Berg V, Kuja-Halkola R, Khemiri L, Larsson H, Lichtenstein P, Latvala A. Parental alcohol and drug abuse and offspring mortality by age 10: a population-based register study. Eur J Public Health 2022; 32:933-938. [PMID: 36172920 DOI: 10.1093/eurpub/ckac142] [Citation(s) in RCA: 2] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/13/2022] Open
Abstract
BACKGROUND Parental substance abuse (SA) of alcohol and drugs is associated with offspring mortality, including sudden infant death syndrome (SIDS), in infancy, but research on cause-specific mortality and mortality in later childhood is scarce. METHODS Using population-based register data on all births in Sweden in 1973-2013 (N = 4.2 million) and Cox regressions, we examined the associations of mother's and father's SA registered between 2 years before and 12 years after the child birth with offspring all-cause and cause-specific mortality in infancy and childhood. RESULTS Parental SA was associated with increased offspring all-cause and natural-cause mortality in infancy, but not in the neonatal period, and with external-cause mortality in ages 1-9. Risk of SIDS was 130-280% higher in infants with parental SA compared to infants with no parental SA. Adjusting for parental socioeconomic and immigrant status and severe psychiatric disorders, paternal SA was associated with 66% higher mortality due to communicable diseases and infections in infancy, and both maternal and paternal SA were associated with 40-174% higher mortality due to accidents in infancy and in ages 1-9. The associations between parental SA and offspring mortality were similar for male and female offspring. CONCLUSIONS Child mortality is rare in contemporary Sweden, and parental SA has variable associations with elevated offspring mortality throughout the first 10 years of life, excluding the neonatal period, which is indicative of insufficient recognition of children at risk. Preventive measures should be long-term and targeted to both parental and offspring behaviour.
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Affiliation(s)
- Venla Berg
- Institute for Molecular Medicine Finland, University of Helsinki, Helsinki, Finland.,Department of Medical Epidemiology and Biostatistics, Karolinska Institutet, Solna, Sweden.,Institute of Criminology and Legal Policy, University of Helsinki, Helsinki, Finland.,Population Research Institute, Väestöliitto, Helsinki, Finland
| | - Ralf Kuja-Halkola
- Department of Medical Epidemiology and Biostatistics, Karolinska Institutet, Solna, Sweden
| | - Lotfi Khemiri
- Department of Medical Epidemiology and Biostatistics, Karolinska Institutet, Solna, Sweden
| | - Henrik Larsson
- Department of Medical Epidemiology and Biostatistics, Karolinska Institutet, Solna, Sweden.,School of Medical Sciences, Örebro University, Örebro, Sweden
| | - Paul Lichtenstein
- Department of Medical Epidemiology and Biostatistics, Karolinska Institutet, Solna, Sweden
| | - Antti Latvala
- Institute for Molecular Medicine Finland, University of Helsinki, Helsinki, Finland.,Department of Medical Epidemiology and Biostatistics, Karolinska Institutet, Solna, Sweden.,Institute of Criminology and Legal Policy, University of Helsinki, Helsinki, Finland
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Girma D, Abita Z, Fetene G, Birie B. Individual and community-level factors of perinatal mortality in the high mortality regions of Ethiopia: a multilevel mixed-effect analysis. BMC Public Health 2022; 22:247. [PMID: 35130852 PMCID: PMC8819877 DOI: 10.1186/s12889-022-12695-y] [Citation(s) in RCA: 5] [Impact Index Per Article: 2.5] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/04/2021] [Accepted: 01/31/2022] [Indexed: 12/01/2022] Open
Abstract
BACKGROUND Even though perinatal mortality has declined globally; it is still the major public health concern in sub-Saharan Africa countries. Ethiopia is one of the sub-Saharan countries which contribute the highest-burden of perinatal mortality with a devastating rate in some of the regions. Therefore, this study aimed to identify the determinants of perinatal mortality in the high mortality regions of Ethiopia. METHOD A secondary data analysis was done using the 2016 Ethiopian Demographic and Health Survey data. The outcomes of 4120 pregnancies reaching ≥ 7 months of gestational age were considered for the analysis. A multilevel mixed logistic regression model was fitted to identify the predictors of perinatal mortality. Finally, a statistically significant association was declared at a p-value of ≤ 0.05. RESULT The study found that birth interval < 2 years (AOR = 3.71, 95%CI:2.27, 6.07),having no antenatal care (AOR = 2.43,95%CI:1.15,5.38), initiating breastfeeding after 1 h(AOR = 4.01,95%CI:2.49,6.51), being distant from health institutions (AOR = 1.99, 95%CI: 1.24, 3.22), having previous terminated pregnancy (AOR = 4.68, 95%CI:2.76,7.86), being mothers not autonomous(AOR = 1.96, 95%CI:1.19,3.20),being no media exposure (AOR = 2.78, 95%CI:1.48,5.59),being households ≤ 4 family sizes (AOR = 4.12, 95%CI:2.19,7.79), having ≥ 6 parity (AOR = 2.48, 95%CI:1.21, 5.22) were associated with a high odds of perinatal mortality. CONCLUSION The study concludes that birth interval, antenatal care, time for breastfeeding initiation, distance from health institutions, previous history of terminated pregnancy, maternal autonomy, media exposure, family size, and parity were predictors of prenatal mortality. Therefore, programmatic emphases to maternal waiting service utilization for mothers distant from health institutions and media advertising regarding the complications related to pregnancy, childbirth and on its respective direction that the mothers should follow could reduce perinatal mortality in high mortality regions of Ethiopia.
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Affiliation(s)
- Desalegn Girma
- Department of Midwifery, College of Health Science, Mizan-Tepi University, Mizan, Ethiopia.
| | - Zinie Abita
- Department of Reproductive Health, School of Public Health, College of Health Science, Mizan-Tepi University, Mizan, Ethiopia
| | - Gossa Fetene
- Department of Midwifery, College of Health Science, Mizan-Tepi University, Mizan, Ethiopia
| | - Bamlaku Birie
- Department of Midwifery, College of Health Science, Mizan-Tepi University, Mizan, Ethiopia
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4
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Liu Y, Li Q, Wang T, Zhang S, Chen L, Li Y, Diao J, Li J, Song X, Sun M, Wei J, Shu J, Yang T, Qin J. Determinants for Perinatal Mortality in South China: A Prospective Cohort Study. Front Pediatr 2022; 10:756444. [PMID: 35372159 PMCID: PMC8975146 DOI: 10.3389/fped.2022.756444] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 12/13/2021] [Accepted: 02/08/2022] [Indexed: 11/21/2022] Open
Abstract
OBJECTIVE To estimate the association of selected maternal and fetal characteristics with the risk of perinatal mortality in South China. METHODS A prospective cohort study was conducted from March 2013 to December 2019. The exposures of interest were maternal sociodemographic characteristics, lifestyle and habits during early pregnancy, and complications of pregnancy. Their effects on the development of perinatal death were analyzed in our study. RESULTS A total of 44,048 eligible pregnant women were included in the analysis. Of these, 596 fetuses were perinatal deaths (perinatal mortality was 13.5 per 1,000 births). After adjustment, maternal obesity, being employed, history of gestational hypertension, taking antidepressants during early pregnancy, history of gestational diabetes mellitus, gestational diabetes mellitus, infertility drug treatment and assisted reproductive techniques, history of neonatal death, preterm birth, and congenital malformations all significantly increased the risk of perinatal death. Ethnic minority, income > 5,000, multiparous women, and cesarean section associated with reduced risk of perinatal death. CONCLUSION Some factors of maternal sociodemographic characteristics, abnormal pregnancy history, lifestyle and habits during early pregnancy, and complications of pregnancy were associated with the risk of perinatal death.
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Affiliation(s)
- Yiping Liu
- Department of Epidemiology and Health Statistics, Xiangya School of Public Health, Central South University, Changsha, China
| | - Qiongxuan Li
- Department of Epidemiology and Health Statistics, Xiangya School of Public Health, Central South University, Changsha, China
| | - Tingting Wang
- Department of Epidemiology and Health Statistics, Xiangya School of Public Health, Central South University, Changsha, China.,National Health Committee (NHC) Key Laboratory of Birth Defect for Research and Prevention, Hunan Provincial Maternal and Child Health Care Hospital, Changsha, China
| | - Senmao Zhang
- Department of Epidemiology and Health Statistics, Xiangya School of Public Health, Central South University, Changsha, China
| | - Letao Chen
- Department of Epidemiology and Health Statistics, Xiangya School of Public Health, Central South University, Changsha, China
| | - Yihuan Li
- Department of Epidemiology and Health Statistics, Xiangya School of Public Health, Central South University, Changsha, China
| | - Jingyi Diao
- Department of Epidemiology and Health Statistics, Xiangya School of Public Health, Central South University, Changsha, China
| | - Jinqi Li
- Department of Epidemiology and Health Statistics, Xiangya School of Public Health, Central South University, Changsha, China
| | - Xinli Song
- Department of Epidemiology and Health Statistics, Xiangya School of Public Health, Central South University, Changsha, China
| | - Mengting Sun
- Department of Epidemiology and Health Statistics, Xiangya School of Public Health, Central South University, Changsha, China
| | - Jianhui Wei
- Department of Epidemiology and Health Statistics, Xiangya School of Public Health, Central South University, Changsha, China
| | - Jing Shu
- Department of Epidemiology and Health Statistics, Xiangya School of Public Health, Central South University, Changsha, China
| | - Tubao Yang
- Department of Epidemiology and Health Statistics, Xiangya School of Public Health, Central South University, Changsha, China.,Hunan Provincial Key Laboratory of Clinical Epidemiology, Changsha, China
| | - Jiabi Qin
- Department of Epidemiology and Health Statistics, Xiangya School of Public Health, Central South University, Changsha, China.,National Health Committee (NHC) Key Laboratory of Birth Defect for Research and Prevention, Hunan Provincial Maternal and Child Health Care Hospital, Changsha, China.,Hunan Provincial Key Laboratory of Clinical Epidemiology, Changsha, China.,Guangdong Cardiovascular Institute, Guangdong Provincial People's Hospital, Guangdong Academy of Medical Sciences, Guangzhou, China
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5
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Bezerra IMP, Ramos JLS, Pianissola MC, Adami F, da Rocha JBF, Ribeiro MAL, de Castro MR, Bezerra JDF, Smiderle FRN, Sousa LVDA, Siqueira CE, de Abreu LC. Perinatal Mortality Analysis in Espírito Santo, Brazil, 2008 to 2017. INTERNATIONAL JOURNAL OF ENVIRONMENTAL RESEARCH AND PUBLIC HEALTH 2021; 18:11671. [PMID: 34770185 PMCID: PMC8583128 DOI: 10.3390/ijerph182111671] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 09/01/2021] [Revised: 10/26/2021] [Accepted: 11/02/2021] [Indexed: 12/17/2022]
Abstract
This is an ecological and time-series study using secondary data on perinatal mortality and its components from 2008 to 2017 in Espírito Santo, Brazil. The data were collected from the Mortality Information System (SIM) and Live Births Information System (SINASC) of the Unified Health System Informatics Department (DATASUS) in June 2019. The perinatal mortality rate (×1000 total births) was calculated. Time series were constructed from the perinatal mortality rate for the regions and Espírito Santo. To analyze the trend, the Prais-Winsten model was used. From 2008 to 2017 there were 8132 perinatal deaths (4939 fetal and 3193 early neonatal) out of a total of 542,802 births, a perinatal mortality rate of 15.0/1000 total births. The fetal/early neonatal ratio was 1.5:1, with a strong positive correlation early neonatal mortality rate, perinatal mortality rate, r (9) = 0.8893, with a significance level of p = 0.000574. The presence of differences in trends by health region was observed. Risk factors that stood out were as follows: mother's age ranging between 10 and 19 or 40 and 49 years old, with no education, a gestational age between 22 and 36 weeks, triple and double pregnancy, and a birth weight below 2499 g. Among the causes of death, 49.70% of deaths were concentrated in category of the tenth edition of the International Classification of Diseases, fetuses and newborns affected by maternal factors and complications of pregnancy, labor, and delivery (P00-P04), and 11.03% were in the category of intrauterine hypoxia and birth asphyxia (P20-P21), both related to proper care during pregnancy and childbirth. We observed a slow reduction in the perinatal mortality rate in the state of Espírito Santo from 2008 to 2017.
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Affiliation(s)
- Italla Maria Pinheiro Bezerra
- Departamento de Pós-Graduação em Políticas Públicas e Desenvolvimento Local, Escola Superior de Ciências da Santa Casa de Misericórdia de Vitória (EMESCAM), Vitória 29027502, Brazil
- Departamento de Enfermagem, Laboratório de Escrita Científica, Escola Superior de Ciências da Santa Casa de Misericórdia de Vitória (EMESCAM), Vitória 29027502, Brazil; (J.L.S.R.); (M.C.P.); (F.R.N.S.)
| | - José Lucas Souza Ramos
- Departamento de Enfermagem, Laboratório de Escrita Científica, Escola Superior de Ciências da Santa Casa de Misericórdia de Vitória (EMESCAM), Vitória 29027502, Brazil; (J.L.S.R.); (M.C.P.); (F.R.N.S.)
| | - Micael Colodetti Pianissola
- Departamento de Enfermagem, Laboratório de Escrita Científica, Escola Superior de Ciências da Santa Casa de Misericórdia de Vitória (EMESCAM), Vitória 29027502, Brazil; (J.L.S.R.); (M.C.P.); (F.R.N.S.)
| | - Fernando Adami
- Laboratório de Epidemiologia do Centro Universitário ABC (FMABC), Santo André 09060590, Brazil;
| | - João Batista Francalino da Rocha
- Ciências da Saúde no Centro Universitário ABC (FMABC), Santo André 09060870, Brazil; (J.B.F.d.R.); (M.A.L.R.)
- Centro de Ciências da Saúde e do Desporto (CCSD), Universidade Federal do Acre (UFAC), Rio Branco 69920900, Brazil
| | - Mariane Albuquerque Lima Ribeiro
- Ciências da Saúde no Centro Universitário ABC (FMABC), Santo André 09060870, Brazil; (J.B.F.d.R.); (M.A.L.R.)
- Centro de Ciências da Saúde e do Desporto (CCSD), Universidade Federal do Acre (UFAC), Rio Branco 69920900, Brazil
| | - Magda Ribeiro de Castro
- Departamento de Enfermagem da Universidade Federal do Espírito Santo (UFES), Vitória 29075910, Brazil;
| | - Juliana da Fonsêca Bezerra
- Departamento de Enfermagem Materno Infantil (DEMI) da Universidade Federal do Rio de Janeiro (UFRJ), Rio de Janeiro 21941901, Brazil;
| | - Fabiana Rosa Neves Smiderle
- Departamento de Enfermagem, Laboratório de Escrita Científica, Escola Superior de Ciências da Santa Casa de Misericórdia de Vitória (EMESCAM), Vitória 29027502, Brazil; (J.L.S.R.); (M.C.P.); (F.R.N.S.)
| | | | - Carlos Eduardo Siqueira
- Environment and Public Health, School for the Environment, Transnational Brazilian Project, The Mauricio Gastón Institute for Latino Community Development and Public Policy, UMass Boston, Boston, MA 02125, USA;
| | - Luiz Carlos de Abreu
- Departamento de Educação Integrada em Saúde na Universidade Federal do Espírito Santo (UFES), Vitória 29027502, Brazil;
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Levi R, Pariente G, Sheiner E, Wainstock T. Identifying risk factors for perinatal mortality from a preceding pregnancy without perinatal mortality. Int J Gynaecol Obstet 2021; 156:336-340. [PMID: 33735456 DOI: 10.1002/ijgo.13680] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/12/2021] [Revised: 03/10/2021] [Accepted: 03/16/2021] [Indexed: 11/09/2022]
Abstract
OBJECTIVE To identify risk factors in first pregnancy for perinatal mortality in the subsequent pregnancy. METHODS A retrospective population-based nested case-control study was conducted, including all women with two first singleton consecutive deliveries. Women with perinatal mortality in their first pregnancy were excluded, and cases with perinatal mortality in the second pregnancy were compared with controls who delivered a live birth. Characteristics and complications of the first pregnancy were compared between the groups using multivariable logistic models. RESULTS A total of 43 043 women were included in the study, 385 (0.9%) were cases. Cases, as compared with controls (live births), were younger (22.62 ± 4.0 vs 23.22 ± 4.0 years), with shorter inter-pregnancy interval (1.38 ± 1.55 vs 1.56 ± 1.53 years), and were more likely to have the following complications in their first pregnancy: severe pre-eclampsia (3.4% vs 1.7%), small for gestational age (12.5% vs 8.0%), preterm delivery (17.7% vs 7.8%), and congenital or chromosomal malformations (9.6% vs 5.9%). In multivariable analysis the risk for perinatal mortality was greater with each additional complication (adjused odds ratio [aOR] 1.64, 95% confidence interval [CI] 1.30-2.07, P < 0.001; aOR 2.55, 95% CI 1.61-4.04, P < 0.001; aOR 7.88, 95% CI 3.81-16.29, P < 0.001 for one, two, and three or more complications, compared with no complications, respectively). CONCLUSION Complications in first pregnancy ending with live birth are associated with increased risk for perinatal mortality in a subsequent pregnancy.
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Affiliation(s)
- Rinat Levi
- Faculty of Health Sciences, Joyce and Irving Goldman Medical School, Ben Gurion University of the Negev, Beer-Sheva, Israel.,Department of Obstetrics and Gynecology, Soroka University Medical Center, Ben Gurion University of the Negev, Beer-Sheva, Israel
| | - Gali Pariente
- Department of Obstetrics and Gynecology, Soroka University Medical Center, Ben Gurion University of the Negev, Beer-Sheva, Israel
| | - Eyal Sheiner
- Department of Obstetrics and Gynecology, Soroka University Medical Center, Ben Gurion University of the Negev, Beer-Sheva, Israel
| | - Tamar Wainstock
- Department of Public Health, Faculty of Health Sciences, Ben Gurion University of the Negev, Beer-Sheva, Israel
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Yadeta TA, Mengistu B, Gobena T, Regassa LD. Spatial pattern of perinatal mortality and its determinants in Ethiopia: Data from Ethiopian Demographic and Health Survey 2016. PLoS One 2020; 15:e0242499. [PMID: 33227021 PMCID: PMC7682862 DOI: 10.1371/journal.pone.0242499] [Citation(s) in RCA: 9] [Impact Index Per Article: 2.3] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/14/2020] [Accepted: 11/03/2020] [Indexed: 12/17/2022] Open
Abstract
BACKGROUND The perinatal mortality rate in Ethiopia is among the highest in Sub Saharan Africa. The aim of this study was to identify the spatial patterns and determinants of perinatal mortality in the country using a national representative 2016 Ethiopia Demographic and Health Survey (EDHS) data. METHODS The analysis was completed utilizing data from 2016 Ethiopian Demographic and Health Survey. This data captured the information of 5 years preceding the survey period. A total of 7230 women who at delivered at seven or more months gestational age nested within 622 enumeration areas (EAs) were used. Statistical analysis was performed by using STATA version 14.1, by considering the hierarchical nature of the data. Multilevel logistic regression models were fitted to identify community and individual-level factors associated with perinatal mortality. ArcGIS version 10.1 was used for spatial analysis. Moran's, I statistics fitted to identify global autocorrelation and local autocorrelation was identified using SatSCan version 9.6. RESULTS The spatial distribution of perinatal mortality in Ethiopia revealed a clustering pattern. The global Moran's I value was 0.047 with p-value <0.001. Perinatal mortality was positively associated with the maternal age, being from rural residence, history of terminating a pregnancy, and place of delivery, while negatively associated with partners' educational level, higher wealth index, longer birth interval, female being head of household and the number of antenatal care (ANC) follow up. CONCLUSIONS In Ethiopia, the perinatal mortality is high and had spatial variations across the country. Strengthening partner's education, family planning for longer birth interval, ANC, and delivery services are essential to reduce perinatal mortality and achieve sustainable development goals in Ethiopia. Disparities in perinatal mortality rates should be addressed alongside efforts to address inequities in maternal and neonatal healthcare services all over the country.
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Affiliation(s)
- Tesfaye Assebe Yadeta
- School of Nursing and Midwifery, College of Health and Medical Sciences, Haramaya University, Harar, Ethiopia
| | - Bizatu Mengistu
- Department of Environmental Health, College of Health and Medical Sciences, Haramaya University, Harar, Ethiopia
| | - Tesfaye Gobena
- Department of Environmental Health, College of Health and Medical Sciences, Haramaya University, Harar, Ethiopia
| | - Lemma Demissie Regassa
- Department of Epidemiology and Biostatistics, School of Public Health, Haramaya University, Harar, Ethiopia
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8
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Manjavidze T, Rylander C, Skjeldestad FE, Kazakhashvili N, Anda EE. Unattended Pregnancies and Perinatal Mortality in Georgia. Risk Manag Healthc Policy 2020; 13:313-321. [PMID: 32346317 PMCID: PMC7169472 DOI: 10.2147/rmhp.s243207] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/20/2019] [Accepted: 03/07/2020] [Indexed: 11/23/2022] Open
Abstract
Introduction The majority of pregnant women in Georgia attend the free-of-charge, national antenatal care (ANC) programme, but over 5% of pregnancies in the country are unattended. Moreover, Georgia has one of the highest perinatal mortality (PM) rates in Europe (11.7/1000 births). Purpose To assess the association between unattended pregnancies and the risk of PM. Methods Data were extracted from the Georgian Birth Registry (GBR) and the national vital registration system. All mothers who had singleton births and delivered in medical facilities in Georgia in 2017–2018 were included in the study and categorised into attended pregnancies (at least one ANC visit during pregnancy) and unattended pregnancies (no ANC visits during pregnancy). After exclusions, the study sample included 101,663 women and their newborns, of which 1186 were either stillborn or died within 7 days. Logistic regression analysis was used to assess the effect of unattended pregnancies on PM. Results During the study period, the PM rate was 12.9/1000 births. In total, 5.6% of women had unattended pregnancies. The odds of PM among women with unattended pregnancies were more than double those among women with attended pregnancies (odds ratio=2.21, [95% confidence interval: 1.81–2.70]). Multiparous women with higher education and who resided/delivered outside of Tbilisi were significantly less likely to experience PM. Conclusion The risk of PM doubled among women with unattended pregnancies. Six percent of PM cases were attributable to unattended pregnancies. Targeting women with previous unattended pregnancies will likely reduce the PM rate in Georgia.
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Affiliation(s)
- Tinatin Manjavidze
- Department of Community Medicine, Faculty of Health Sciences, University of Tromsø - The Arctic University of Norway, Tromsø 9037, Norway
| | - Charlotta Rylander
- Department of Community Medicine, Faculty of Health Sciences, University of Tromsø - The Arctic University of Norway, Tromsø 9037, Norway
| | - Finn Egil Skjeldestad
- Department of Community Medicine, Faculty of Health Sciences, University of Tromsø - The Arctic University of Norway, Tromsø 9037, Norway
| | - Nata Kazakhashvili
- Department of Public Health, Faculty of Medicine, Ivane Javakhishvili Tbilisi State University, Tbilisi 0179, Georgia
| | - Erik Eik Anda
- Department of Community Medicine, Faculty of Health Sciences, University of Tromsø - The Arctic University of Norway, Tromsø 9037, Norway
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Ezeh OK, Uche-Nwachi EO, Abada UD, Agho KE. Community-and proximate-level factors associated with perinatal mortality in Nigeria: evidence from a nationwide household survey. BMC Public Health 2019; 19:811. [PMID: 31234805 PMCID: PMC6591945 DOI: 10.1186/s12889-019-7151-0] [Citation(s) in RCA: 7] [Impact Index Per Article: 1.4] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/28/2019] [Accepted: 06/11/2019] [Indexed: 11/10/2022] Open
Abstract
BACKGROUND The perinatal mortality rate (PMR) in Nigeria rose by approximately 5% from 39 to 41 deaths per 1000 total births between 2008 and 2013, indicating a reversal in earlier gains. This study sought to identify factors associated with increased PMR. METHODS Nationally representative data including 31,121 pregnancies of 7 months or longer obtained from the 2013 Nigeria Demographic and Health Survey were used to investigate the community-, socio-economic-, proximate- and environmental-level factors related to perinatal mortality (PM). Generalized linear latent and mixed models with the logit link and binomial family that adjusted for clustering and sampling weights was employed for the analyses. RESULTS Babies born to obese women (adjusted odds ratio [aOR] = 1.46, 95% confidence interval [CI]: 1.13-1.89) and babies whose mothers perceived their body size after birth to be smaller than the average size (aOR = 1.92, 95% CI: 1.61-2.30) showed greater odds of PM. Babies delivered through caesarean section were more likely to die (aOR = 2.85, 95% CI: 2.02-4.02) than those born through vaginal delivery. Other factors that significantly increased PM included age of the women (≥40 years), living in rural areas, gender (being male) and a fourth or higher birth order with a birth interval ≤ 2 years. CONCLUSIONS Newborn and maternal care interventions are needed, especially for rural communities, that aim at counselling women that are obese. Promoting well-timed caesarean delivery, Kangaroo mother care of small-for-gestational-age babies, child spacing, timely referral for ailing babies and adequate medical check-up for older pregnant women may substantially reduce PM in Nigeria.
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Affiliation(s)
- Osita K. Ezeh
- School of Science and Health, Western Sydney University, Locked Bag 1797, Penrith, NSW 2571 Australia
| | | | - Uchechukwu D. Abada
- Department of Banking and Finance, Madonna University Nigeria, Okija Campus, Okija, Anambra state Nigeria
| | - Kingsley E. Agho
- School of Science and Health, Western Sydney University, Locked Bag 1797, Penrith, NSW 2571 Australia
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