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Ali IA, Inchon P, Suwannaporn S, Achalapong J. Neonatal mortality and associated factors among newborns in Mogadishu, Somalia: a multicenter hospital-based cross-sectional study. BMC Public Health 2024; 24:1635. [PMID: 38898456 PMCID: PMC11186222 DOI: 10.1186/s12889-024-19149-7] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/25/2023] [Accepted: 06/14/2024] [Indexed: 06/21/2024] Open
Abstract
INTRODUCTION Neonatal mortality is a significant public health problem in Sub-Saharan Africa, particularly in Somalia, where limited data exists about this. Mogadishu, the densely populated capital, faces a high rate of neonatal mortality, but this has not been widely studied on a national level. Healthcare providers and policymakers are working to reduce newborn deaths, but a comprehensive understanding of the contributing factors is crucial for effective strategies. Therefore, this study aims to determine the magnitude of neonatal death and identify factors associated with it in Mogadishu, Somalia. METHOD A multicenter hospital-based cross-sectional study was conducted to collect data from participants at 5 purposively selected hospitals in Mogadishu, Somalia. A well-structured, reliable, self-developed, validated questionnaire containing socio-demographic, maternal, and neonatal characteristics was used as a research tool. Descriptive statistics were used for categorical and continuous variables presented. Chi-square and logistic regression were used to identify factors associated with neonatal mortality at a significant level of α = 0.05. RESULTS A total of 513 participants were recruited for the study. The prevalence of neonatal mortality was 26.5% [95%CI = 22.6-30.2]. In a multivariable model, 9 variables were found: female newborns (AOR = 1.98, 95%CI = 1.22-3.19), those their mothers who did not attend ANC visits (AOR = 2.59, 95%CI = 1.05-6.45), those their mothers who did not take tetanus toxoid vaccination (AOR = 1.82, 95%CI = 1.01-3.28), those their mothers who delivered in instrumental assistant mode (AOR = 3.01, 95%CI = 1.38-6.56), those who had neonatal sepsis (AOR = 2.24, (95%CI = 1.26-3.98), neonatal tetanus (AOR = 16.03, 95%CI = 3.69-69.49), and pneumonia (AOR = 4.06, 95%CI = 1.60-10.31) diseases during hospitalization, premature (AOR = 1.99, 95%CI = 1.00-3.94) and postmature (AOR = 4.82, 95%CI = 1.64-14.16) neonates, those with a birth weight of less than 2500 gr (AOR = 4.82, 95%CI = 2.34-9.95), those who needed resuscitation after delivery (AOR = 2.78, 95%CI = 1.51-5.13), and those who did not initiate early breastfeeding (AOR = 2.28, 95%CI = 1.12-4.66), were significantly associated with neonatal mortality compared to their counterparts. CONCLUSION In this study, neonatal mortality was high prevalence. Therefore, the intervention efforts should focus on strategies to reduce maternal and neonatal factors related to neonatal mortality. Healthcare workers and health institutions should provide appropriate antenatal, postnatal, and newborn care.
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Affiliation(s)
- Ikran Abdulkadir Ali
- Department of Public Health, School of Health Science, Mae Fah Luang University, Chiang Rai Province, Thailand
- Department of Neonatal Intensive Care Unit, Yardimeli Hospital, Mogadishu, Somalia
| | - Pamornsri Inchon
- Department of Public Health, School of Health Science, Mae Fah Luang University, Chiang Rai Province, Thailand.
| | - Sirinan Suwannaporn
- Department of Public Health, School of Health Science, Mae Fah Luang University, Chiang Rai Province, Thailand
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Tikmani SS, Saleem S, Sadia A, M. Bann C, Bozdar MH, Raza J, Dhaded SM, Goudar SS, Gowdar G, Yasmin H, McClure EM, Goldenberg RL. Predictors of Preterm Neonatal Mortality in India and Pakistan: A Secondary Analysis of Data from PURPOSe Study. Glob Pediatr Health 2024; 11:2333794X241236617. [PMID: 38487208 PMCID: PMC10938607 DOI: 10.1177/2333794x241236617] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/21/2023] [Revised: 02/02/2024] [Accepted: 02/15/2024] [Indexed: 03/17/2024] Open
Abstract
Objective. To create a prediction model for preterm neonatal mortality. Methods. A secondary analysis was conducted using data from a prospective cohort study, the Project to Understand and Research Preterm Pregnancy Outcome South Asia. The Cox proportional hazard model was used and adjusted hazard ratios (AHR) with 95% confidence intervals (95% CI) were reported. Results. Overall, 3446 preterm neonates were included. The mean age of preterm neonates was 0.65 (1.25) hours and 52% were female. The preterm neonatal mortality rate was 23.3%. The maternal factors predicting preterm neonatal death was any antepartum hemorrhage, AHR 1.99 (1.60-2.47), while neonatal predictors were preterm who received positive pressure ventilation AHR 1.30 (1.08-1.57), temperature <35.5°C AHR 1.18 (1.00-1.39), and congenital malformations AHR 3.31 (2.64-4.16). Conclusion. This study identified key maternal and neonatal predictors of preterm neonatal mortality, emphasizing the need for targeted interventions and collaborative public health efforts to address disparities and regional variations.
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Affiliation(s)
| | | | | | - Carla M. Bann
- Research Triangle Institute (RTI) International, Durham, NC, USA
| | | | - Jamal Raza
- National Institute of Child Health, Napier Quarter, Karachi, Pakistan
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Razzaque A, Rahman A, Chowdhury R, Mustafa AHMG, Naima S, Begum F, Shafique S, Sarker BK, Islam MZ, Kim M, Jahangir MA, Matin Z, Ferdous J, Vandenent M, Reidpath DD. Preterm birth and neonatal mortality in selected slums in and around Dhaka City of Bangladesh: A cohort study. PLoS One 2024; 19:e0284005. [PMID: 38241263 PMCID: PMC10798464 DOI: 10.1371/journal.pone.0284005] [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] [Received: 03/29/2023] [Accepted: 12/26/2023] [Indexed: 01/21/2024] Open
Abstract
BACKGROUND Although under-five mortality has declined appreciably in Bangladesh over the last few decades, neonatal mortality still remains high. The objective of the study is to assess the level and determinants of preterm birth and the contribution of preterm birth to neonatal mortality. METHODS Data for this study came from selected slums in and around Dhaka city, where; since 2015, icddr,b has been maintaining the Health and Demographic Surveillance System (HDSS). The HDSS data were collected by female Field Workers by visiting each household every three months; however, during the visit, data on the Last Menstrual Period (LMP) were also collected by asking each eligible woman to ascertain the date of conception. Gestational age was estimated in complete weeks by subtracting LMP from the date of the pregnancy outcome. In this study, 6,989 livebirths were recorded by HDSS during 2016-2018, and these births were followed for neonatal survival; both bivariate and multivariate analyses were performed. RESULTS Out of total births, 21.7% were born preterm (before 37 weeks of gestation), and sub-categories were: 2.19% for very preterm (28 to 31 weeks), 3.81% for moderate preterm (32 to 33 weeks), and 15.71% for late preterm (34 to 36 weeks). The study revealed that preterm babies contributed to 39.6% of neonatal deaths; however, the probability of death was very high on the 1st day of birth (0.124 for very preterm, 0.048 for moderate preterm, 0.024 for late preterm, and 0.013 for term birth), and continued until the 3rd day. In the regression analysis, compared to the term neonates, the odds of neonatal mortality were 8.66 (CI: 5.63, 13.32, p<0.01), 4.13 (CI: 2.69, 6.34, p<0.01) and 1.48 (CI: 1.05, 2.08, p<0.05) respectively for very, moderate, and late preterm birth categories. The population attributable fraction for neonatal mortality was 23%, and sub-categories were 14% for very preterm, 10% for moderate preterm, and 6% for late preterm. CONCLUSIONS Although urban slums are in proximity to many health facilities, a substantial proportion of preterm births contribute to neonatal deaths. So, pregnant women should be targeted, to ensure timely care during pregnancy, delivery, and post-partum periods to improve the survival of new-borns in general and preterm birth in particular.
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Affiliation(s)
- Abdur Razzaque
- International Centre for Diarrheal Disease Research, Bangladesh (icddr,b), Dhaka, Bangladesh
| | - Anisur Rahman
- International Centre for Diarrheal Disease Research, Bangladesh (icddr,b), Dhaka, Bangladesh
| | - Razib Chowdhury
- International Centre for Diarrheal Disease Research, Bangladesh (icddr,b), Dhaka, Bangladesh
| | - A. H. M. Golam Mustafa
- International Centre for Diarrheal Disease Research, Bangladesh (icddr,b), Dhaka, Bangladesh
| | - Shakera Naima
- International Centre for Diarrheal Disease Research, Bangladesh (icddr,b), Dhaka, Bangladesh
| | - Farzana Begum
- International Centre for Diarrheal Disease Research, Bangladesh (icddr,b), Dhaka, Bangladesh
| | - Sohana Shafique
- International Centre for Diarrheal Disease Research, Bangladesh (icddr,b), Dhaka, Bangladesh
| | - Bidhan Krishna Sarker
- International Centre for Diarrheal Disease Research, Bangladesh (icddr,b), Dhaka, Bangladesh
| | | | - Minjoon Kim
- Maternal Newborn Health, UNICEF New York, New York, New York, United States of America
| | | | - Ziaul Matin
- Health Section, UNICEF India, New Delhi, India
| | | | | | - Daniel D. Reidpath
- International Centre for Diarrheal Disease Research, Bangladesh (icddr,b), Dhaka, Bangladesh
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Gupta A, Choorakuttil RM, Nirmalan PK. The Association of Abnormal Doppler and Abnormal Amniotic Fluid Volume in the Third Trimester of Pregnancy with Preterm Birth in Pregnant Women in Agra, India. Indian J Radiol Imaging 2023; 33:315-320. [PMID: 37362367 PMCID: PMC10289862 DOI: 10.1055/s-0043-1764465] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 06/28/2023] Open
Abstract
Aim This article determines the association and diagnostic effectiveness of abnormal Doppler and abnormal amniotic fluid volume (AFV) in the third trimester of pregnancy with preterm births. Methods The third trimester screening protocol of the Samrakshan program of the Indian Radiological and Imaging Association utilizes trimester-specific fetal Doppler studies and ultrasound assessments, estimation of the risk for preterm preeclampsia (PE), assessment of the fetal environment, growth, and structure, and staging of fetal growth restriction. A multivariate logistic regression model was used to explore associations of abnormal Doppler and AFV with preterm birth. The diagnostic effectiveness of Doppler and amniotic fluid measurements for preterm births was assessed. Results One hundred and sixty-one (25.6%) of the 630 women had a preterm birth before 37 gestational weeks. Eighty (21.1%) of the 379 women with normal AFV and normal fetal Doppler studies in the third trimester had a preterm birth. The proportion of preterm birth declined from 35.14% in 2019 to 19.53% in 2022 (chi-square test p = 0.009). Preterm birth was associated with preterm PE (adjusted odds ratio: 3.66, 95% confidence interval: 1.42, 9.44) in a multivariate logistic regression model. Both abnormal fetal Doppler and AFV did not have a good discriminatory ability for preterm births. Conclusion Integration of fetal Doppler studies helped reduce the preterm birth rate by providing an objective measure of fetal well-being, contrary to a common belief that the use of color Doppler in the third trimester may result in iatrogenic increased preterm birth. Preterm births are associated with preterm PE and early identification of high-risk women and early initiation of low-dose aspirin may have an added benefit on preterm birth rates.
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Affiliation(s)
- Anjali Gupta
- Department of Clinical Radiology, Anjali Ultrasound and Colour Doppler Centre, Agra, Uttar Pradesh, India
| | - Rijo Mathew Choorakuttil
- Department of Clinical Radiology, AMMA Center for Diagnosis and Preventive Medicine, Kochi, Kerala, India
| | - Praveen K. Nirmalan
- Department of Research, Chief Research Mentor, AMMA Healthcare Research Gurukul, AMMA Center for Diagnosis and Preventive Medicine, Kochi, Kerala, India
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Summan A, Nandi A, Shet A, Laxminarayan R. The effect of the COVID-19 pandemic on routine childhood immunization coverage and timeliness in India: retrospective analysis of the National Family Health Survey of 2019-2021 data. THE LANCET REGIONAL HEALTH. SOUTHEAST ASIA 2023; 8:100099. [PMID: 36285007 PMCID: PMC9584865 DOI: 10.1016/j.lansea.2022.100099] [Citation(s) in RCA: 8] [Impact Index Per Article: 8.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Subscribe] [Scholar Register] [Received: 07/13/2022] [Revised: 09/27/2022] [Accepted: 10/11/2022] [Indexed: 11/09/2022]
Abstract
Background The COVID-19 pandemic has disrupted health systems globally. We estimated the effect of the pandemic on the coverage and timeliness of routine childhood immunization in India through April 2021. Methods We used data from India's National Family Health Survey 2019-2021 (NFHS-5), a cross-sectional survey which collected immunization information of under-five children from a nationally representative sample of households between June 2019 and April 2021. We used a mother fixed-effects regression model - accounting for secular trends and confounding factors - to compare COVID-affected children with their COVID-unaffected siblings (n = 59,144). Children who were eligible for a vaccine after January 30, 2020 (date of the first COVID case in India) were considered as the COVID-affected group and those eligible for a vaccine before this date were included in the COVID-unaffected group. Coverage of the following vaccine doses was considered-Bacillus Calmette-Guérin (BCG), hepatitis B birth dose (hepB0), DPT1 (diphtheria, pertussis, and tetanus, first dose), DPT2, DPT3, polio1, polio2, polio3, and measles first dose (MCV1). Indicators of vaccine coverage and vaccine timeliness (defined as receiving a dose within 45 days of minimum eligibility age) were separately examined. Findings Immunization coverage was lower in COVID-affected children as compared with unaffected children, ranging from 2% lower for BCG and hepB0 to 9% for DPT3 and 10% for polio3. There was no significant difference in MCV1 coverage. Coverage reduction was greater for vaccines doses given in later age groups. The rate of timely receipt of polio and DPT vaccine doses was 3%-5% lower among COVID-affected children relative to unaffected children. Among population subgroups, COVID-affected male children and those from rural areas experienced the highest reduction in vaccine coverage. Interpretation Children in India experienced lower routine immunization coverage and greater delays in immunization during the COVID-19 pandemic. Funding The Bill & Melinda Gates Foundation.
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Affiliation(s)
| | - Arindam Nandi
- One Health Trust, Washington, DC, USA,The Population Council, 1 Dag Hammarskjold Plaza, New York, NY, 10017, USA,Corresponding author. The Population Council, 1 Dag Hammarskjold Plaza, New York, NY, 10017, USA
| | - Anita Shet
- International Vaccine Access Center, Johns Hopkins Bloomberg School of Public Health, Baltimore, MD, USA
| | - Ramanan Laxminarayan
- One Health Trust, New Delhi, India,High Meadows Environmental Institute, Princeton University, NJ, USA
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