Trends and population-attributable risk estimates for predictors of early neonatal mortality in Nigeria, 2003-2013: a cross-sectional analysis

Burden of early neonatal mortality in Sub-Saharan Africa. A systematic review and meta-analysis

BACKGROUND

Globally, with a neonatal mortality rate of 27/1000 live births, Sub-Saharan Africa has the highest rate in the world and is responsible for 43% of all infant fatalities. In the first week of life, almost three-fourths of neonatal deaths occur and about one million babies died on their first day of life. Previous studies lack conclusive evidence regarding the overall estimate of early neonatal mortality in Sub-Saharan Africa. Therefore, this review aimed to pool findings reported in the literature on magnitude of early neonatal mortality in Sub-Saharan Africa.

METHODS

This review's output is the aggregate of magnitude of early neonatal mortality in sub-Saharan Africa. Up until June 8, 2023, we performed a comprehensive search of the databases PubMed/Medline, PubMed Central, Hinary, Google, Cochrane Library, African Journals Online, Web of Science, and Google Scholar. The studies were evaluated using the JBI appraisal check list. STATA 17 was employed for the analysis. Measures of study heterogeneity and publication bias were conducted using the I2 test and the Eggers and Beggs tests, respectively. The Der Simonian and Laird random-effect model was used to calculate the combined magnitude of early neonatal mortality. Besides, subgroup analysis, sensitivity analysis, and meta regression were carried out to identify the source of heterogeneity.

RESULTS

Fourteen studies were included from a total of 311 articles identified by the search with a total of 278,173 participants. The pooled magnitude of early neonatal mortality in sub-Saharan Africa was 80.3 (95% CI 66 to 94.6) per 1000 livebirths. Ethiopia had the highest pooled estimate of early neonatal mortality rate, at 20.1%, and Cameroon had the lowest rate, at 0.5%. Among the included studies, both the Cochrane Q test statistic (χ2 = 6432.46, P <0.001) and I2 test statistic (I2 = 99.80%, p <0.001) revealed statistically significant heterogeneity. Egger's weighted regression (p <0.001) and funnel plot show evidence of publication bias in this meta-analysis.

CONCLUSION

This review demonstrated that the pooled magnitude of early neonatal mortality in sub-Saharan Africa is substantial. Therefore, governmental and nongovernmental agencies, international organizations, healthcare providers and institutions and academic and research institutions should give a due attention and design strategies to reduce early neonatal mortality in Sub-Saharan Africa.

Association between high-risk fertility behaviors and neonatal mortality in Ethiopia: A multilevel mixed-effects logit models from 2019 Ethiopian mini demographic and health survey

Objectives

This study aimed to explore the association between high-risk fertility behaviors and neonatal mortality in Ethiopia.

Study design

A community-based cross-sectional study was conducted using data from the 2019 Ethiopian Mini-Demographic and Health Survey.

Methods

Mixed-effects logit regression models were fitted to 5527 children nested within 305 clusters. The definition of high-risk fertility behavior was adopted from the 2019 EMDHS. The fixed effects (the association between the outcome variable and the explanatory variables) were expressed as adjusted odds ratios (ORs) with 95 % confidence intervals and measures of variation explained by intra-class correlation coefficients, median odds ratio, and proportional change invariance.

Results

The presence of births with any multiple high-risk fertility behaviors was associated with a 70 % higher risk of neonatal mortality (AOR = 1.7, (95 % CI: 1.2, 2.3) than those with no high-risk fertility behavior. From the combined risks of high-risk fertility behaviors, the combination of preceding birth interval <24 months and birth order four or higher had an 80 % increased risk of neonatal mortality (AOR = 1.8, (95 % CI, 1.2, 2.7) as compared to those who did not have either of the two. The 3-way risks (combination of preceding birth interval <24 months, birth order 4+, and mother's age at birth 34+) were associated with approximately four times increased odds of neonatal mortality (AOR (95 % CI:3.9 (2.1, 7.4)].

Conclusions

High-risk fertility behavior is a critical predictor of neonatal mortality in Ethiopia, with three-way high-risk fertility behaviors increasing the risk of neonatal mortality fourfold. In addition, antenatal follow-up was the only non-high fertility behavioral factor significantly associated with the risk of neonatal mortality in Ethiopia.

Hierarchical Predictors of Mortality in Neonatal Sepsis at Jimma Medical Center, Ethiopia: A Case-Control Study

Background

Neonatal sepsis made the neonatal period the most perilous time for child survival, and it continued to cause preventable mortalities worldwide. These mortalities stem from the interaction of several factors that have not been sufficiently studied and, in some cases, remain overlooked. Thus, the study aims to investigate the predictors of mortality that arise from the interaction of these factors and quantitatively determine their etiologic fraction.

Methods

A case-control study with hierarchical data input was conducted at Jimma Medical Center (JMC) in Oromia, Ethiopia, spanning from May 2022 to July 2023. It employed logistic regression to calculate adjusted odds ratios (AORs) and their corresponding 95% confidence intervals (CI) at a significance level of p ≤ 0.05. The model adjusted odds ratios (ORs) for variables within each level and farther levels and presented an etiologic fraction (EF), indicating the proportion of neonatal mortality attributable to specific factors.

Results

The analysis of 67 cases and 268 controls unveiled significant predictors of mortality in sepsis that emerged from distal, intermediate, and proximal levels. In the final model, thus, rural residence [AOR 3.1; 95% CI (1.5, 6.3), p ≤ 0.01], prolonged labor [AOR 4.5; 95% CI (2.2, 9.3), p ≤ 0.01], prematurity [AOR 3.9; 95% CI (1.9, 7.9), P ≤ 0.0], gram-negative bacteremia [AOR 3.8; 95% CI (1.9, 7.6); P ≤ 0.01], convulsion [AOR 3.2; 95% CI (1.6, 6.4); P ≤ 0.03], low birth weight [AOR 2.7; 95% CI (1.3, 5.4); P≤0.01], and delayed breastfeeding [AOR 2.5; 95% CI (1.2, 4.9); P ≤ 0.01] attributed a variable percentage of mortality.

Conclusion

Factors emerging and interacting at distal (residence), intermediate (prolonged labor), and proximal (prematurity, birth weight, convulsion, bacterial etiology, and feeding) levels influence neonatal mortality in sepsis at JMC. Therefore, concurrently improving rural family characteristics, managing labor duration, strengthening diagnostic stewardship, and promoting essential newborn care can actively prevent and reduce these mortalities.

Factors associated with infant mortality in Nigeria: A scoping review

BACKGROUND

Infant mortality persists as a global public health concern, particularly in lower-middle-income countries (LIMCs) such as Nigeria. The risk of an infant dying before one year of age is estimated to be six times higher in Africa than in Europe. Nigeria recorded an infant mortality rate of 72.2 deaths per 1,000 live births in 2020, in contrast to the global estimate of 27.4 per 1,000 live births. Several studies have been undertaken to determine the factors influencing infant mortality.

OBJECTIVE

This scoping review sought to identify and summarise the breadth of evidence available on factors associated with infant mortality in Nigeria.

METHODS

This review followed the five-stage principles of Arksey and O'Malley's framework. Four electronic databases were searched with no limit to publication date or study type: Ovid MEDLINE, PubMed, CINAHL Complete, and Web of Science. Selected studies were imported into Endnote software and then exported to Rayyan software where duplicates were removed. Included articles were thematically analysed and synthesised using the socioecological model.

RESULTS

A total of 8,139 references were compiled and screened. Forty-eight articles were included in the final review. At the individual level, maternal- and child-related factors were revealed to influence infant mortality; socioeconomic and sociocultural factors at the interpersonal level; provision and utilisation of health services, health workforce, hospital resources and access to health services at the organisational level; housing/neighbourhood and environmental factors at the community level; and lastly, governmental factors were found to affect infant mortality at the public policy level.

CONCLUSION

Factors related to the individual, interpersonal, organisational, community and public policy levels were associated with infant mortality in Nigeria.

The association between plasma osmolality and in-hospital mortality in the first 24 h after neonatal intensive care unit admission

Background

Perturbation of osmolality is associated with increased mortality in adults and children in critically ill conditions. However, it is still unclear whether osmolality imbalance impacts the prognosis of critically ill infants. This study aimed to investigate the relationship between plasma osmolality and prognosis in critically ill infants within 24 h of admission.

Methods

This retrospective study enrolled 1,042 infants who had plasma osmolality data from 2010 to 2018. The initial plasma osmolality (within 24 h after admission) was extracted from the pediatric intensive care database (PIC V1.1). The locally weighted scatter-plot smoothing (LOWESS) and restricted cubic splines (RCS) methods were used to explore the approximate relationship between plasma osmolality and in-hospital mortality. Univariate and multivariate logistic regression analyses were used to further analyse this relationship. Kaplan-Meier analysis was applied to estimate the probability of hospital mortality within 90 days of admission. Subgroup analysis was employed to assess the impact of potential confounders (including postnatal days, gender, and gestational age).

Results

An approximately"U"-shaped relationship between plasma osmolality and mortality was detected. In the logistic regression model, plasma osmolality <270 mmol/L (low osmolality group) was significantly associated with in-hospital mortality (P < 0.05; OR 2.52; 95% CI, 1.15-5.06). Plasma osmolality >300 mmol/L (high osmolality group) was also significantly associated with mortality (P < 0.05; OR 3.52; 95% CI, 1.16-8.83). This association remained even after multivariable adjustments. The 90-day survival rate was lower in the abnormal plasma osmolality group (including high or low osmolality groups) than in the intermediate group (log-rank test, P < 0.05). The abnormal plasma osmolality group had a significantly higher incidence of all-cause mortality in the 0-7 postnatal days subgroup (high osmolality group, P < 0.05; OR 5.25; low osmolality group, P < 0.05; OR 3.01). Infants with abnormal osmolality had a significantly higher mortality rate in the female group (P < 0.05). High osmolality was associated with a higher mortality rate in the preterm group (P < 0.05).

Conclusions

Both hypoosmolality and hyperosmolality were shown to be independently associated with increased risk of in-hospital infant mortality in NICUs.

Prevalence of neonatal near miss in Africa: a systematic review and meta-analysis

BACKGROUND

Neonatal near miss (NNM) applies to cases where newborns almost died during the first 28 d of life but survived life-threatening conditions following birth. The most vulnerable time for infant survival is the neonatal stage, corresponding to almost 50% of deaths occurring at <5 y of age. No study indicates the overall pooled prevalence of NNM in Africa. Thus this review aimed to estimate the overall pooled prevalence of NNMs in Africa.

METHODS

Articles were retrieved through a comprehensive search strategy using PubMed/MEDLINE, Embase, Health InterNetwork Access to Research Initiative, Cochrane Library and Google Search. Data extraction was done independently by all authors. Forest plots and tables were used to represent the original data. The statistical heterogeneity was evaluated using I2 statistics. There was heterogeneity between the included articles. Therefore the authors used a meta-analysis of random effects to estimate the aggregate pooled prevalence of NNM in Africa. Funnel plot and Egger regression test methods were used to assess possible publication bias. R software version 3.5.3 and R studio version 1.2.5003 were used to analyse the data. The guideline of the Preferred Reporting Items for Systematic Reviews and Meta-Analyses was used to publish this article. The review was registered on the International Prospective Register of Systematic Reviews (registration ID: CRD42021290223).

RESULTS

Through an exhaustive search, we found 835 articles. However, we considered only eight full-text articles to be included in this meta-analysis. The analysis of included studies showed that the overall pooled prevalence of NNM in Africa was 30% (95% confidence interval [CI] 16 to 44). The subgroup analysis by study year showed that the prevalence of NNM from 2012-2015 and 2018-2019 was 36% (95% CI 23 to 49) and 20% (95% CI 1 to 39), respectively.

CONCLUSION

This finding suggests that the pooled prevalence of NNM is high in Africa as compared with other studies. Therefore the government and other stakeholders working on maternal and child health should assist in the design of interventions and strategies for improving the quality of neonatal care.

Cause and risk factors of early neonatal death in Ethiopia

Background

Globally, three fourth of neonatal deaths occur during the early neonatal period, this makes it a critical time to reduce the burden of neonatal death. The survival status of a newborn is determined by the individual (neonatal and maternal), and facility-level factors. Several studies were conducted in Ethiopia to assess early neonatal death; however, most of the studies had limited participants and did not well address the two main determinant factors covered in this study. In response to this gap, this study attempted to examine factors related to early neonatal death based on perinatal death surveillance data in consideration of all the possible determinants of early neonatal death.

Methods

The national perinatal death surveillance data were used for this study. A total of 3814 reviewed perinatal deaths were included in the study. Bayesian multilevel parametric survival analysis was employed to identify factors affecting the survival of newborns during the early neonatal period. Adjusted time ratio (ATR) with 95% Bayesian credible intervals (CrI) was reported and log-likelihood was used for model comparison. Statistical significance was declared based on the non-inclusion of 1.0 in the 95% CrI.

Result

More than half (52.4%) of early neonatal deaths occurred within the first two days of birth. Per the final model, as gestational age increases by a week the risk of dying during the early neonatal period is reduced by 6% [ATR = 0.94,95%CrI:(0.93–0.96)]. There was an increased risk of death during the early neonatal period among neonates deceased due to birth injury as compared to neonates who died due to infection [ATR = 2.05,95%CrI:(1.30–3.32)]; however, perinates who died due to complication of an intrapartum event had a lower risk of death than perinates who died due to infection [ATR = 0.87,95%CrI:(0.83–0.90)]. As the score of delay one and delay three increases by one unit, the newborn’s likelihood of surviving during the early neonatal period is reduced by 4% [ATR = 1.04,95%CrI:(1.01–1.07)] and 21% [ATR = 1.21,95%CrI:(1.15–1.27)] respectively. Neonates born from mothers living in a rural area had a higher risk of dying during the early neonatal period than their counterparts living in an urban area [ATR = 3.53,95%CrI:(3.34–3.69)]. As compared to neonates treated in a primary health facility, being treated in secondary [ATR = 1.14,95%CrI:(1.02–1.27)] and tertiary level of care [ATR = 1.15,95%CrI:(1.04–1.25)] results in a higher risk of death during the early neonatal period.

Conclusion

The survival of a newborn during the early neonatal period is determined by both individual (gestational age, cause of death, and delay one) and facility (residence, type of health facility and delay three) level factors. Thus, to have a positive early neonatal outcome, a tailored intervention is needed for the three major causes of death (i.e Infection, birth injury, and complications of the intrapartum period). Furthermore, promoting maternal health, improving the health-seeking behaviour of mothers, strengthening facility readiness, and narrowing down inequalities in service provision are recommended to improve the newborn’s outcomes during the early neonatal period.

Trends and Factors Associated with Under-5 Mortality in Northwest Nigeria (2008-2018)

Background:

The Nigeria Demographic and Health Survey (NDHS) revealed that the under-five mortality rate (U5MR) in the northwest geopolitical zone (NWGZ), Nigeria, increased by 1.1% from 185 to 187 deaths per 1,000 live births between 2013 and 2018, indicating a setback to the previously reported modest improvement in U5MR.

Objectives:

This study sought to examine trends and factors related to under-5 mortality (U5M) in NWGZ from 2008 to 2018.

Methods:

A combined NWGZ dataset extracted from the 2008, 2013 and 2018 NDHSs, with a sample of 32,015 singleton live births, including 3,745 under-5 deaths, was used. The U5MRs for each survey year and potential independent factors were obtained using the STATA “syncrmrates” command, and then the trends were examined. A logistic regression generalised linear latent and mixed model was used to explore the potential factors associated with U5M in NWGZ.

Findings:

In NWGZ, the U5MR declined by only 8.2% (from 195 to 179 per 1,000 live births between 2008 and 2018, respectively), with a similar trend observed among its seven states. Multivariable analyses indicated that maternal education (no formal or primary education), maternal non-use of contraception, a mother’s perception of the baby being small or very small, birth order (second to fourth or higher) with a shorter birth interval (≤2 years), younger or older maternal age (<20 years or ≥40 years old) and rural residence were significantly associated with U5M in NWGZ.

Conclusion:

Interventional initiatives including educating mothers on the benefits of contraceptive use, child spacing, kangaroo mother care of small-sized babies and promoting regular check-ups for older mothers will substantially reduce U5M in NWGZ.

Trends of under-five mortality and associated risk factors in Zambia: a multi survey analysis between 2007 and 2018

BACKGROUND

Mortality at a young age is key to public health measures. This study aims to describe the burden, trend, and associated factors of under-five mortality rate (U5MR) in Zambia from 2007-to-2018.

METHOD

A sample of 29,274 children under-five were analyzed from the Zambia demographic and health survey (ZDHS). Univariate and bivariate analysis were used to identify factors influencing U5M.

RESULT

Pooled prevalence of U5MR in Zambia was 84.4/ 1000 live-births. Over 15 years, U5M has declined by 49% (from 118.7 to 60.5/1000 live-births). Compared to children of teenage (≤19 years) mothers the likelihood of U5M was lower by 24 to 37% among children of 20 to 34 years old mothers. The likelihood of U5M was lower by 23% (AOR, 0.77 95%CI, 0.58-1.04) for poorest, 27% (AOR, 0.73 95%CI, 0.55-0.98) for poorer, and 19% (AOR, 0.81 95%CI, 0.62-1.07) for middle as compared to the richest households. The likelihood of U5M was 21% (AOR, 0.79 95%CI, 0.67-0.93) lower among rural residents. Multiple-born children died 2.54 times (95%CI, 1.95-3.98) higher than the single-born. Male children (AOR, 1.28, 95% CI, 1.23-1.46), smaller than average birth size (AOR, 1.78; 95% CI, 1.52-2.09), and no ANC visit (AOR, 3.17, 95% CI, 2.74-3.67) were associated with U5M. The likelihoods of U5M were significantly higher in the Eastern, Luapula, and Muchinga regions than in the Central.

CONCLUSION

This study revealed that Zambia has made a gain on child survival. Further efforts targeting mothers, children, and provinces are needed to scale up the decline and achieve the SDG3.

Impact of the COVID-19 pandemic on neonatal admissions in a tertiary children's hospital in southwest China: An interrupted time-series study

Background

The unprecedented coronavirus disease 2019 (COVID-19) pandemic has caused millions of infections worldwide and represents a significant challenge facing modern health care systems. This study was conducted to investigate the impact of lockdown measures in a tertiary Children’s Hospital in southwest China, which might be used to predict long-term effects related to health-seeking behavior of parents/caregivers.

Methods

This study included newborns enrolled over a span of 86 weeks between January 4, 2019, and August 27, 2020. We designated two time periods for analysis purposes: a stable pre-COVID period(55 weeks between January 4, 2019, and January 23, 2020) and a COVID-impacted period (31 weeks between January 24, 2020, and August 27, 2020). An interrupted time-series analysis was employed to compare changes and trends in hospital admissions and disease spectra before and after the period of nonpharmaceutical interventions (NPIs). Furthermore, this study was conducted to evaluate whether the health-seeking behavior of parents/caregivers was influenced by pandemic factors.

Results

Overall, 16,640 infants were admitted to the neonatology department during the pre-COVID period (n = 12,082) and the COVID-impacted period (n = 4,558). The per week neonatal admissions consistently decreased following the first days of NPIs (January 24, 2020). The average weekly admission rates of 220/week pre-COVID period and 147/week COVID-impacted period. There was an evident decrease in the volume of admissions for all disease spectra after the intervention, whereas the decrease of patients complaining about pathological jaundice-related conditions was statistically significant (p<0.05). In the COVID-impacted period, the percentage of patients who suffered from respiratory system diseases, neonatal encephalopathy, and infectious diseases decreased, while the percentage of pathological jaundice-related conditions and gastrointestinal system diseases increased. The neonatal mortality rates (NMRs) increased by 8.7% during the COVID-impacted period compared with the pre-COVID period.

Conclusions

In summary, there was a significant decline in neonatal admissions in a tertiary care hospital during the COVID-19 Pandemic and the associated NPIs. Additionally, this situation had a remarkable impact on disease spectra and health-seeking behavior of parents/caregivers. We, therefore, advise continuing follow-ups and monitoring the main health indicators in vulnerable populations affected by this Pandemic over time.

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

OBJECTIVES

This 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).

DESIGN

This cross-sectional study used data from the Pakistan Demographic and Health Survey 2017-2018.

SETTINGS

All provinces, Islamabad and Federally Administered Tribal Areas were included in the analysis.

PARTICIPANTS

A 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 ANALYSIS

Multivariate logistic regression analysis was used.

RESULTS

We 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.

CONCLUSION

This 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.

Under-5 Mortality and Its Associated Factors in Northern Nigeria: Evidence from 22,455 Singleton Live Births (2013-2018)

The northern geopolitical zones (NGZs) continue to report the highest under-5 mortality rates (U5MRs) among Nigeria's six geopolitical zones. This study was designed to identify factors related to under-5 mortality (U5M) in the NGZs. The NGZ populations extracted from the 2018 Nigeria Demographic and Health Survey were explored to assess the factors associated with U5M using logistic regression, generalised linear latent, and mixed models. Between 2013 and 2018, the northwest geopolitical zone reported the highest U5MR (179 deaths per 1000 live births; 95% confidence interval [CI]: 163-194). The adjusted model showed that geopolitical zone, poor household, paternal occupation, perceived children's body size at birth, caesarean delivery, and mothers and fathers' education were highly associated with increased odds of U5M. Other significant factors that influenced U5M included children of fourth or higher birth order with shorter interval ≤ 2 years (adjusted odds ratio [aOR] = 1.68; CI: 1.42-1.90) and mothers who did not use contraceptives (aOR = 1.41, CI: 1.13-1.70). Interventions are needed and should primarily spotlight children residing in low-socioeconomic households. Educating mothers on the benefits of contraceptive use, child spacing, timely and safe caesarean delivery and adequate care for small-sized babies may also reduce U5M in Nigeria, particularly in the NGZs.

Impact of high-risk fertility behaviours on underfive mortality in Asia and Africa: evidence from Demographic and Health Surveys

Background

Maternal age < 18 or > 34 years, short inter-pregnancy birth interval, and higher birth order are considered to be high-risk fertility behaviours (HRFB). Underfive mortality being disproportionately concentrated in Asia and Africa, this study analyses the association between HRFB and underfive mortality in selected Asian and African countries.

Methods

This study used Integrated Public Microdata Series-Demographic and Health Surveys (IPUMS-DHS) data from 32 countries in sub-Saharan Africa, Middle East, North Africa and South Asia from 1986 to 2017 (N = 1,467,728). Previous evidence hints at four markers of HRFB: women’s age at birth of index child < 18 or > 34 years, preceding birth interval < 24 months and child’s birth order > 3. Using logistic regression, we analysed change in the odds of underfive mortality as a result of i) exposure to HRFB individually, ii) exposure to any single HRFB risk factor, iii) exposure to multiple HRFB risk factors, and iv) exposure to specific combinations of HRFB risk factors.

Results

Mother’s age at birth of index child < 18 years and preceding birth interval (PBI) < 24 months were significant risk factors of underfive mortality, while a child’s birth order > 3 was a protective factor. Presence of any single HRFB was associated with 7% higher risk of underfive mortality (OR 1.07; 95% CI 1.04–1.09). Presence of multiple HRFBs was associated with 39% higher risk of underfive mortality (OR 1.39; 95% CI 1.36–1.43). Some specific combinations of HRFB such as maternal age < 18 years and preceding birth interval < 24 month significantly increased the odds of underfive mortality (OR 2.07; 95% CI 1.88–2.28).

Conclusion

Maternal age < 18 years and short preceding birth interval significantly increase the risk of underfive mortality. This highlights the need for an effective legislation to curb child marriages and increased public investment in reproductive healthcare with a focus on higher contraceptive use for optimal birth spacing.

Supplementary Information

The online version contains supplementary material available at 10.1186/s12884-021-03780-y.

Predictive model and determinants of odds of neonates dying within 28 days of life in Ghana

BACKGROUND

One of the priorities and important current problem in public health research globally is modeling of neonatal mortality and its risk factors in using the appropriate statistical methods. It is believed that multiple risk factors interplay to increase the risk of neonatal mortality. To understand the risk factors of neonatal mortality in Ghana, the current study carefully evaluated and compared the predictive accuracy and performance of two classification models.

METHODS

This study reviewed the birth history data collected on 5884 children born in the 5 years preceding the 2014 Ghana Demographic and Health Survey (GDHS). The 2014 GDHS is a cross-sectional nationally representative household sample survey. The relevant variables were selected using leaps-and-bounds method, and the area under curves were compared to evaluate the predictive accuracy of unweighted penalized and weighted single-level multivariable logistic regression models for predicting neonatal mortality using the 2014 GDHS data.

RESULTS

The study found neonatal mortality prevalence of 2.8%. A sample of 4514 children born in the 5 years preceding the 2014 GDHS was included in the inferential analysis. The results of the current study show that for the unweighted penalized single-level multivariable logistic model, there is an increased risk of neonatal death among babies born to mothers who received prenatal care from non-skilled worker [OR: 3.79 (95% CI: 2.52, 5.72)], multiple births [OR: 3.10 (95% CI: 1.89, 15.27)], babies delivered through caesarian section [OR: 2.24 (95% CI: 1.30, 3.85)], and household with 1 to 4 members [OR: 5.74 (95% CI: 3.16, 10.43)], respectively. The predictive accuracy of the unweighted penalized and weighted single-level multivariable logistic regression models was 82% and 80%, respectively.

CONCLUSION

The study advocates that prudent and holistic interventions should be institutionalized and implemented to address the risk factors identified in order to reduce neonatal death and, by large, improve child and maternal health outcomes to achieve the SDG target 3.2.

Neonatal near Miss and Its Predictors among Neonates Delivered at Debretabor General Hospital, Northern Ethiopia; A Retrospective Analysis

Background

In many low-resource countries, the progress of neonatal mortality reduction is very slow. The scenario is notably true in sub-Saharan Africa including Ethiopia. For every neonatal death, there are lots of near missed neonates. Generating evidences on the extent and predictors of neonatal near miss is a key step in neonatal mortality reduction efforts. However, there is limited evidence in this aspect in Ethiopia.

Objective

This study is aimed at assessing the proportion of neonatal near miss and associated factors among neonates delivered at Debretabor General Hospital, Northern Ethiopia, 2019.

Methods

An institution-based cross-sectional study was conducted on 422 neonates delivered at Debretabor General Hospital from July 1^st, 2018, to June 30^th, 2019. Both pragmatic and management criteria of definition of neonatal near miss were utilized. A systematic random sampling technique was used to select the cards of the study participants. Data were extracted with structured and pretested checklist, entered in the EpiData, and then exported to SPSS version 20. Both descriptive and analytical procedures have been done. Descriptive statistics such as frequencies and cross tabulations were carried out. The binary logistic regression model was fitted and variables with p value < 0.20 were entered in the multivariable logistic regression model. Both crude and adjusted odds ratios with the corresponding 95% CI were computed. The level of significance has been claimed based on the adjusted odds ratio with 95% CI and its p value of ≤0.05.

Results

The proportion of neonates experiencing near miss was obtained to be 32.2% with 95% CI (28, 36). Rural residence (AOR = 4.41; 95% CI: 2.57,7.55), incomplete ANC visit (AOR = 3.16; 95% CI: 1.90,5.25), primiparous (AOR = 2.55; 95% CI: 1.59,4.12), pregnancy-induced hypertension (AOR = 3.23; 95% CI: 1.19,8.78), premature rupture of membrane (AOR = 4.65; 95% CI: 1.70,12,73), cephalic-pelvic disproportion (AOR = 3.05; 95% CI: 1.32,7.01), and antepartum hemorrhage (AOR = 4.95; 95% CI: 1.89,12.96) were the independent predictors of neonatal near-miss. Conclusion and Recommendations. The proportion of neonatal near miss was found to be high in the study setting. Most of the determinants of near miss are modifiable obstetric-related factors. Hence, stakeholders need to consider the aforesaid factors while they design interventions.

Incidence and predictors of neonatal mortality among neonates admitted in Amhara regional state referral hospitals, Ethiopia: prospective follow up study

BACKGROUND

Globally, about 2.7 million neonates die annually and more than 99% of these deaths happened in developing countries. Although most neonatal deaths are preventable and attempts had been taken to tackle these deaths, an aggregate of 30 neonatal deaths per 1000 live births had been reported in Ethiopia. In this regard, identifying the predictors could be an important step. However, evidence on the incidence and predictors of neonatal mortality has been limited in Ethiopia, in the study area in particular. Even the available studies were limited in scope and were retrospective or cross section in nature. Thus, this study is aimed at assessing the incidence and predictors of neonatal mortality among neonates admitted in Amhara regional state referral hospitals, Ethiopia..

METHOD

A multi center prospective follow up study was conducted on 612 neonates admitted in Amhara region referral hospitals from July 01 to August 30, 2018. A simple random sampling technique was used to select three of all referral hospitals in the study settings and all neonates admitted in the selected hospitals were included. Data were entered into Epi info version 7.0 and exported to STATA 14.0 for analysis. Cox proportional hazard regression model was fitted to identify predictors of neonatal mortality. Crude and Adjusted hazard ratio with 95% confidence interval was computed and variables' statistical significance was declared based on its AHR with 95% CI and p-value ≤0.05.

RESULT

Overall, 144 (18.6%) neonates died with a total person-time of 4177.803 neonate-days which is equivalent to the neonatal mortality rate of 186 per 1000 admitted neonates with 95% CI (157,219). The incidence rate of neonatal mortality was 27 per 1000 admitted neonates with 95%CI (23, 33). Maternal age ≥ 35 years (AHR = 2.60; 95%CI: 1.44, 4.72), mothers unable to read and write (AHR = 1.40; 95%CI: 1.23, 2.44), multiple pregnancy (AHR = 3.96; 95%CI: 2.10, 7.43) and positive maternal HIV status (AHR = 6.57; 95%CI: 2.53, 17.06) were predictors of neonatal mortality.

CONCLUSION

In this study, the neonatal mortality rate was higher than the national figure. Its most predictors were found to be modifiable. Thus, the stakeholders would better consider the aforementioned predictors to decrease this higher burden.

Community-and proximate-level factors associated with perinatal mortality in Nigeria: evidence from a nationwide household survey

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.

Risk of adverse pregnancy outcomes associated with short and long birth intervals in Bangladesh: evidence from six Bangladesh Demographic and Health Surveys, 1996-2014

OBJECTIVE

To examine the effect of short (<36 months) and long (≥60 months) birth intervals on adverse pregnancy outcomes in Bangladesh.

DESIGN, SETTING AND PARTICIPANTS

We analysed data from six Bangladesh Demographic and Health Surveys (1996-1997, 1999-2000, 2004, 2007, 2011 and 2014). We included all singleton non-first live births, most recently born to mothers within 5 years preceding each survey (n=21 382). We defined birth interval according to previous research which suggests that a birth interval between 36 and 59 months is the most ideal interval. Bivariate and multivariable analyses were conducted to obtain the crude and adjusted ORs (aOR) respectively to assess the odds of first-day neonatal death, early neonatal death and small birth size for both short (<36 months) and long (≥60 months) spacing between births.

MAIN OUTCOME MEASURES

First-day neonatal death, early neonatal death and small birth size.

RESULTS

In the multivariable analysis, compared with births spaced 36-59 months, infants with a birth interval of <36 months had increased odds of first-day neonatal death (aOR: 2.11, 95% CI: 1.17 to 3.78) and early neonatal death (aOR: 1.58, 95% CI: 1.13 to 2.22). Compared with births spaced 36-59 months, infants with a birth interval of ≥60 months had increased odds of first-day neonatal death (aOR: 2.02, 95% CI: 1.10 to 3.73) and small birth size (aOR: 1.17, 95% CI: 1.02 to 1.34). When there was a history of any previous pregnancy loss, there was an increase in the odds of first-day and early neonatal death for both short and long birth intervals, although it was not significant.

CONCLUSIONS

Birth intervals shorter than 36 months and longer than 59 months are associated with increased odds of adverse pregnancy outcomes. Care-providers, programme managers and policymakers could focus on promoting an optimal birth interval between 36 and 59 months in postpartum family planning.

Comparison of Micro-Census Results for Magarya Ward, Wurno Local Government Area of Sokoto State, Nigeria, with Other Sources of Denominator Data

Routine immunization coverage in Nigeria is suboptimal. In the northwestern state of Sokoto, an independent population-based survey for 2016 found immunization coverage with the third dose of Pentavalent vaccine to be 3%, whereas administrative coverage in 2016 was reported to be 69%. One possibility driving this large discrepancy is that administrative coverage is calculated using an under-estimated target population. Official population projections from the 2006 Census are based on state-specific standard population growth rates. Immunization target population estimates from other sources have not been independently validated. We conducted a micro-census in Magarya ward, Wurno Local Government Area of Sokoto state to obtain an accurate count of the total population living in the ward, and to compare these results with other sources of denominator data. We developed a precise micro-plan using satellite imagery, and used the navigation tool EpiSample v1 in the field to guide teams to each building, without duplications or omissions. The particular characteristics of the selected ward underscore the importance of using standardized shape files to draw precise boundaries for enumeration micro-plans. While the use of this methodology did not resolve the discrepancy between independent and administrative vaccination coverage rates, a simplified application can better define the target population for routine immunization services and estimate the number of children still unprotected from vaccine-preventable diseases.

Under five mortality patterns and associated maternal risk factors in sub-Saharan Africa: A multi-country analysis

BACKGROUND

Under-5 mortality rate in the sub-Saharan region has remained unabated. Worse still, information on the regional trend and associated determinants are not readily available. Knowledge of the trend and determinants of under-5 mortality are essential for effective design of intervention programmes that will enhance their survival. We aimed to examine the mortality patterns in under-5 children and maternal factors associated with under-5 deaths.

METHODS

Demographic and Health Survey (DHS) data from five sub-Sahara Africa countries; Chad, Democratic Republic of Congo, Mali, Niger and Zimbabwe were used in this study. The sample size consisted of 68,085 women aged 15-49 years with at least one history of childbirth. The outcome variable was under-five mortality rate. Relevant information on maternal factors were extracted for analysis. Multivariable Cox proportional hazards regression was used to model maternal factors associated with under-five mortality.

RESULTS

The current under-5 mortality rate (per 1,000 live births) was; 133 in Republic of Chad, 104 in Democratic Republic of Congo, 95 in Mali, 127 in Niger, and 69 in Zimbabwe. Several maternal and child level factors were found to be significantly associated with under-five mortality. Lack of spousal support (not currently married) resulted to increase in under-five mortality (Chad- Hazard Ratio [HR] = 1.11, 95%CI = 0.97-1.25; DR Congo- HR = 1.24, 95%CI = 1.11-1.40; Mali- HR = 2.43, 95%CI = 1.63-3.64; Niger- HR = 1.59, 95%CI = 1.24-2.03; Zimbabwe- HR = 1.33, 95%CI = 1.06-1.67). Delivery by caesarean section was significantly associated with under-five mortality (Chad- HR = 1.32, 95%CI = 1.00-1.77; DR Congo- HR = 1.20, 95%CI = 1.01-1.43; Mali- HR = 1.42, 95%CI = 1.08-1.85; Niger- HR = 1.43, 95%CI = 1.06-1.92; Zimbabwe- HR = 1.49, 95%CI = 1.03-2.15).

CONCLUSION

Despite concerted effort by government and several stakeholders in health to improve childhood survival, the rate of under-5 mortality is still high. Our findings provided evidence on the contribution of maternal age, place of residence, household wealth index, level of education, employment, marital status, religious background, birth type, birth order and interval, sex and size of child, place and mode of delivery, to Under-5 mortality rate in SSA. The position of prominent risk factors for under-five mortality should be addressed through effective design of timely and efficient intervention aimed at reducing childhood mortality.