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Amini E, Heidarzadeh M, Sohbati S, Behseresht M, Amiresmaili M. Exploring causes of neonatal mortality in south east of Iran: A qualitative study. Int J Health Plann Manage 2024; 39:22-35. [PMID: 37717258 DOI: 10.1002/hpm.3708] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/01/2022] [Revised: 07/25/2023] [Accepted: 09/01/2023] [Indexed: 09/19/2023] Open
Abstract
AIM Neonatal mortality (NM) is a significant global challenge that has a profound impact on families, particularly mothers. To address this challenge, the first step is to identify its underlying causes. Accordingly, this study aimed to explore the phenomenon by consulting with stakeholders, including mothers and experts. STUDY DESIGN This study utilized a qualitative design, conducting in-depth interviews with 16 mothers and 15 healthcare experts to gather information. A conventional content analysis approach was employed to analyze the data. RESULTS NM is influenced by personal, systemic, and socioeconomic factors. Personal factors can be further divided into those related to the neonate and those related to the mother. Systemic factors are primarily related to the healthcare system, while socioeconomic factors include low literacy, low income, lack of access to healthcare, and consanguineous marriage. CONCLUSION NM is influenced by a wide range of factors that require separate and targeted interventions to reduce its incidence. In the short term, priority should be given to preventable factors that can be addressed through simple interventions, such as screening mothers for urinary tract infections, educating mothers, and preparing them for pregnancy with necessary lab tests and supplements. In the long term, preventing premature birth, addressing maternal addiction, family poverty, and shortages in healthcare equipment and personnel must be thoroughly addressed.
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Affiliation(s)
- Elham Amini
- Health in Disaster and Emergencies Research Center, Institute for Futures Studies in Health, Kerman University of Medical Sciences, Kerman, Iran
| | | | - Samira Sohbati
- Department of Obstetrics and Gynecology, Clinical Research Development Unit, Afzalipour Hospital, Kerman University of Medical Sciences, Kerman, Iran
| | - Maryam Behseresht
- Social Determinants of Health Research Center, Institute for Futures Studies in Health, Kerman University of Medical Sciences, Kerman, Iran
| | - Mohammadreza Amiresmaili
- Health in Disaster and Emergencies Research Center, Institute for Futures Studies in Health, Kerman University of Medical Sciences, Kerman, Iran
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Singh A, Chakrabarty M, Chandra R, Chowdhury S, Singh S. Intra-urban differentials in the exclusive use of hygienic methods during menstruation among young women in India. PLOS GLOBAL PUBLIC HEALTH 2023; 3:e0002047. [PMID: 37310954 DOI: 10.1371/journal.pgph.0002047] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Subscribe] [Scholar Register] [Received: 06/28/2022] [Accepted: 05/15/2023] [Indexed: 06/15/2023]
Abstract
Menstrual hygiene among women is a critical public health issue in urban India, but it remains understudied and under-researched. However, to our knowledge, no national level study in India has yet examined the differentials in the exclusive use of hygienic methods among young women (aged 15-24) in urban India. This study attempts to fill this gap by analysing biodemographic, socioeconomic, and geographic differentials in the exclusive use of hygienic methods among these women. We analysed data on 54561 urban women aged 15-24 from National Family Health Survey-5, 2019-21. We used binary logistic regression to examine differentials in the exclusive use of hygienic methods. To examine spatial variation, we mapped exclusive use of hygienic methods across Indian states and districts. The study found that two-thirds of young women in urban India reported exclusive use of hygienic methods. However, there was significant geographic heterogeneity observed at both state and district levels. In states such as Mizoram and Tamil Nadu, the use of hygienic methods was over 90%, while in Uttar Pradesh, Bihar, Chhattisgarh, and Manipur, it was less than 50%. The district-level variation in exclusive use of hygienic methods was even more striking. In many states, districts with extremely low exclusive use (less than 30%) were located in close proximity to districts with high exclusive use. Being poor, uneducated, Muslim, having no mass media exposure, living in the north and central regions, not having a mobile phone, getting married before 18, and having an early experience of menarche were associated with lower exclusive use of hygienic methods. In conclusion, substantial biodemographic, socioeconomic, and geographic differentials in the exclusive use of hygienic methods suggest the need for context-specific behavioural interventions. Mass media campaigns and targeted distribution of subsidized hygienic methods could help reduce the existing inequities in the exclusive use of hygienic methods.
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Affiliation(s)
- Aditya Singh
- Banaras Hindu University, Varanasi, India
- Girl Innovation, Research, and Learning Centre, Population Council, New York, NY, United States of America
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Singh A, Chakrabarty M, Singh S, Chandra R, Chowdhury S, Singh A. Menstrual hygiene practices among adolescent women in rural India: a cross-sectional study. BMC Public Health 2022; 22:2126. [PMCID: PMC9675161 DOI: 10.1186/s12889-022-14622-7] [Citation(s) in RCA: 6] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/05/2022] [Accepted: 11/14/2022] [Indexed: 11/21/2022] Open
Abstract
Background Exclusive use of hygienic methods (sanitary napkins, locally prepared napkins, tampons, and menstrual cups) to prevent the visibility of bloodstains during menstruation is still considerably low among adolescent women in rural India. However, no prior research has explored the prevalence and determinants of exclusive hygienic methods among rural Indian adolescent women. To address this gap, this study examines the factors affecting adolescent women’s exclusive use of hygienic methods in rural India. Additionally, this study explores state- and district-level geographical disparities in the exclusive use of hygienic methods among adolescent women in rural India. Methods Information on 95,551 adolescent women from rural India from the latest round of National Family Health Survey (NFHS-5) was analyzed. Bivariate statistics and multilevel logistic regression analysis were used to assess the Individual- and community-level factors associated with exclusive use of hygienic methods among adolescent women in rural India. Choropleth maps were used to discern the geographical disparities in the exclusive use of hygienic methods. Results In rural India, only 42% of adolescent women exclusively used hygienic methods, with substantial geographic disparities at the state and district levels. At the state level, the exclusive use of hygienic methods varied from 23% in Uttar Pradesh to 85% in Tamil Nadu. Even greater variation was observed at the district level. There was a clear north-south divide in the exclusive use of hygienic methods among adolescent women in rural India. The results of multilevel logistic regression indicated a considerable amount of variation in the exclusive use of hygienic methods at community level which further reduced when controlled for individual and community-level factors. Rural Indian adolescent women with higher education (AOR:3.20, 95% CI: 2.81–3.64), from general category (AOR: 1.14, 95% CI: 1.07–1.21), with medium mass media exposure (AOR: 1.43, 95% CI: 1.35–1.51), and from richest wealth quintile (AOR: 3.98, 95% CI: 3.69–4.30) were more likely to use hygienic methods exclusively. Conclusion Wide differential across biodemographic and socioeconomic groups, and substantial geographic disparities at state- and district-level in the exclusive use of hygienic methods suggests a need to adopt context-specific interventions for adolescent women in rural India. Distribution of subsidized or free menstrual hygiene methods to disadvantaged adolescent women, and in the low-prevalence districts may increase the level of exclusive use of hygienic methods remarkably. Supplementary Information The online version contains supplementary material available at 10.1186/s12889-022-14622-7.
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Affiliation(s)
- Aditya Singh
- grid.411507.60000 0001 2287 8816Banaras Hindu University, Varanasi, Uttar Pradesh India
| | | | - Shivani Singh
- grid.429013.d0000 0004 6789 6219India Health Action Trust, Lucknow, Uttar Pradesh India
| | - Rakesh Chandra
- grid.419871.20000 0004 1937 0757Tata Institute of Social Science, Mumbai, Maharashtra India
| | | | - Anshika Singh
- grid.411507.60000 0001 2287 8816Banaras Hindu University, Varanasi, Uttar Pradesh India
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O'Dair MA, Demetri A, Clayton GL, Caldwell D, Barnard K, Burden C, Fraser A, Merriel A. Does provision of antenatal care in Southern Asia improve neonatal survival? A systematic review and meta-analysis. AJOG GLOBAL REPORTS 2022; 2:100128. [PMID: 36478662 PMCID: PMC9720596 DOI: 10.1016/j.xagr.2022.100128] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/09/2022] Open
Abstract
BACKGROUND Southern Asia has one of the highest burdens of neonatal mortality worldwide (26/1000 live births). Ensuring that women receive antenatal care from a skilled provider may play an important role in reducing this burden. OBJECTIVE This study aimed to determine whether antenatal care received from a skilled provider could reduce neonatal mortality in Southern Asia by systematically reviewing existing evidence. STUDY DESIGN Seven databases were searched (MEDLINE, Embase, Cochrane Library, CINAHL, PubMed, PsycINFO, and International Bibliography of the Social Sciences [IBSS]). The key words included: "neonatal mortality," "antenatal care," and "Southern Asia." Nonrandomized comparative studies conducted in Southern Asia reporting on neonatal mortality in women who received antenatal care compared with those who did not were included. Two authors carried out the screening and data extraction. The Risk of Bias Assessment tool for Non-randomized Studies (RoBANS) was used to assess quality of studies. Results were reported using a random-effects model based on odds ratios with 95% confidence intervals. RESULTS Four studies were included in a meta-analysis of adjusted results. The pooled odds ratio was 0.46 (95% confidence interval, 0.24 to 0.86) for neonatal deaths among women having at least 1 antenatal care visit during pregnancy compared with women having none. In the final meta-analysis, 16 studies could not be included because of lack of adjustment for confounders, highlighting the need for further higher-quality studies to evaluate the true impact. CONCLUSION This review suggests that in Southern Asia, neonates born to women who received antenatal care have a lower risk of death in the neonatal period compared with neonates born to women who did not receive antenatal care. This should encourage health policy to strengthen antenatal care programs in Southern Asia.
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Affiliation(s)
- Millie A. O'Dair
- Academic Women's Health Unit, Bristol Medical School, University of Bristol, Bristol, United Kingdom (O'Dair, Demetri, Barnard, Burden, Merriel)
| | - Andrew Demetri
- Academic Women's Health Unit, Bristol Medical School, University of Bristol, Bristol, United Kingdom (O'Dair, Demetri, Barnard, Burden, Merriel)
| | - Gemma L. Clayton
- Medical Research Council Integrative Epidemiology Unit, University of Bristol, Bristol, United Kingdom (Clayton)
| | - Deborah Caldwell
- Population Health Sciences, Bristol Medical School, University of Bristol, Bristol, United Kingdom (Caldwell, Fraser)
| | - Katie Barnard
- Academic Women's Health Unit, Bristol Medical School, University of Bristol, Bristol, United Kingdom (O'Dair, Demetri, Barnard, Burden, Merriel)
| | - Christy Burden
- Academic Women's Health Unit, Bristol Medical School, University of Bristol, Bristol, United Kingdom (O'Dair, Demetri, Barnard, Burden, Merriel)
- North Bristol National Health Service Trust, Bristol, United Kingdom (Burden)
- National Institute for Health and Care Research Biomedical Research Centre, Bristol Medical School, University of Bristol, Bristol, United Kingdom (Burden, Fraser, Merriel)
| | - Abigail Fraser
- Population Health Sciences, Bristol Medical School, University of Bristol, Bristol, United Kingdom (Caldwell, Fraser)
- National Institute for Health and Care Research Biomedical Research Centre, Bristol Medical School, University of Bristol, Bristol, United Kingdom (Burden, Fraser, Merriel)
| | - Abi Merriel
- Academic Women's Health Unit, Bristol Medical School, University of Bristol, Bristol, United Kingdom (O'Dair, Demetri, Barnard, Burden, Merriel)
- National Institute for Health and Care Research Biomedical Research Centre, Bristol Medical School, University of Bristol, Bristol, United Kingdom (Burden, Fraser, Merriel)
- Centre for Women's Health Research, Institute of Life Course and Medical Sciences, Faculty of Health & Life Sciences, University of Liverpool, Liverpool, United Kingdom (Merriel)
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Islam MA, Biswas B. Socio-economic factors associated with increased neonatal mortality: A mixed-method study of Bangladesh and 20 other developing countries based on demographic and health survey data. CLINICAL EPIDEMIOLOGY AND GLOBAL HEALTH 2021. [DOI: 10.1016/j.cegh.2021.100801] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/16/2022] Open
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Neonatal mortality clustering in the central districts of Ghana. PLoS One 2021; 16:e0253573. [PMID: 34170957 PMCID: PMC8232428 DOI: 10.1371/journal.pone.0253573] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/09/2020] [Accepted: 06/09/2021] [Indexed: 11/19/2022] Open
Abstract
INTRODUCTION Identifying high risk geographical clusters for neonatal mortality is important for guiding policy and targeted interventions. However, limited studies have been conducted in Ghana to identify such clusters. OBJECTIVE This study aimed to identify high-risk clusters for all-cause and cause-specific neonatal mortality in the Kintampo Districts. MATERIALS AND METHODS Secondary data, comprising of 30,132 singleton neonates between January 2005 and December 2014, from the Kintampo Health and Demographic Surveillance System (KHDSS) database were used. Verbal autopsies were used to determine probable causes of neonatal deaths. Purely spatial analysis was ran to scan for high-risk clusters using Poisson and Bernoulli models for all-cause and cause-specific neonatal mortality in the Kintampo Districts respectively with village as the unit of analysis. RESULTS The study revealed significantly high risk of village-clusters for neonatal deaths due to asphyxia (RR = 1.98, p = 0.012) and prematurity (RR = 5.47, p = 0.025) in the southern part of Kintampo Districts. Clusters (emerging clusters) which have the potential to be significant in future, for all-cause neonatal mortality was also identified in the south-western part of the Kintampo Districts. CONCLUSIONS Study findings showed cause-specific neonatal mortality clustering in the southern part of the Kintampo Districts. Emerging cluster was also identified for all-cause neonatal mortality. More attention is needed on prematurity and asphyxia in the identified cause-specific neonatal mortality clusters. The emerging cluster for all-cause neonatal mortality also needs more attention to forestall any formation of significant mortality cluster in the future. Further research is also required to understand the high concentration of prematurity and asphyxiated deaths in the identified clusters.
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The Effects of Maternal Age on Neonatal and Post-neonatal Mortality in India: Roles of Socioeconomic and Biodemographic Factors. CANADIAN STUDIES IN POPULATION 2021. [DOI: 10.1007/s42650-021-00041-3] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/21/2022]
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Sidi-Yakhlef A, Boukhelif M, Aouar Metri A. Socio-demographic determinants of neonatal mortality in Algeria according to MICS4 data (2012-2013). Afr Health Sci 2021; 21:357-361. [PMID: 34394317 PMCID: PMC8356605 DOI: 10.4314/ahs.v21i1.45] [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: 12/02/2022] Open
Abstract
Background Neonatal mortality remains a public health problem in developing countries, including Algeria. Information on this indicator makes it possible to assess government efforts to improve the living conditions of target populations. Objectives This study aims to identify some determinants associated with this mortality from data of multiple indicator cluster survey conducted in Algeria in 2012–2013 (mics 4). Methods A retrospective case-control study including 1047 cases and 1041 controls. From a logistic regression model, we appreciated the role of different factors, socio-demographic, economic and geographic (Mother's age, level of education, wealth index, area of residence) in newborn survival. Results The main factors associated with neonatal mortality were rural residence (p<0.01; OR= 1.3; CI 1.08–1.54), South geographical area (p<0.05; OR=1.5; CI 1.18–1.84), low education level of mother (p<0.01; OR= 2.10; CI 1.35– 3.29), early age of maternal procreation (p<0.001; OR=4.34; CI 2.19– 14.40), the birth rank “7 and over” (<0.01; OR = 1.57; CI 1.13 – 2.44) and the two lowest wealth indices (p <0.001; OR = 2; 1.45–2.62 and p <0.01; OR = 1.66; CI 1.23–2.26). Conclusion In addition to the various reproductive health strategies already adopted by the authorities for health promotion and family planning, action should be taken to evaluate their implementation with sustained assistance for disadvantaged people and in risk areas.
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Adjei G, Darteh EKM, Nettey OEA, Doku DT. Neonatal mortality in the central districts of Ghana: analysis of community and composition factors. BMC Public Health 2021; 21:173. [PMID: 33478435 PMCID: PMC7819257 DOI: 10.1186/s12889-021-10156-6] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/19/2020] [Accepted: 01/01/2021] [Indexed: 11/30/2022] Open
Abstract
BACKGROUND Communities and their composition have an impact on neonatal mortality. However, considering the smallest health administrative units as communities and investigating the impact of these communities and their composition on neonatal mortality in Ghana have not been studied. Therefore, this study aimed to investigate the effect of community-, household- and individual-level factors on the risk of neonatal mortality in two districts in Ghana. METHODS This was a longitudinal study that used the Kintampo Health and Demographic Surveillance System as a platform to select 30,132 neonatal singletons with 634 deaths. Multilevel cox frailty model was used to examine the effect of community-, household- and individual-level factors on the risk of neonatal mortality. RESULTS Regarding individual-level factors, neonates born to mothers with previous adverse pregnancy (aHR = 1.38, 95% CI: 1.05-1.83), neonates whose mothers did not receive tetanus toxoid vaccine (aHR = 1.32, 95% CI: 1.08-1.60) and neonates of mothers with Middle, Junior High School or Junior Secondary School education (aHR = 1.30, 95% CI: 1.02-1.65) compared to mothers without formal education, had a higher risk of neonatal mortality. However, female neonates (aHR = 0.61, 95% CI: 0.51-0.73) and neonates whose mother had secondary education or higher (aHR = 0.37, 95% CI: 0.18-0.75) compared to those with no formal education had a lower risk of mortality. Neonates with longer gestation period (aHR = 0.95, 95% CI: 0.94-0.97) and those who were delivered at home (aHR = 0.56, 95% CI: 0.45-0.70), private maternity home (aHR = 0.45, 95% CI: 0.30-0.68) or health centre/clinic (aHR = 0.40, 95% CI: 0.26-0.60) compared to hospital delivery had lower risk of mortality. Regarding the household-level, neonates belonging to third quintile of the household wealth (aHR = 0.70, 95% CI: 0.52-0.94) and neonates belonging to households with crowded sleeping rooms (aHR = 0.91, 95% CI: 0.85-0.97) had lower risk of mortality. CONCLUSION The findings of the study suggest the risk of neonatal mortality at the individual- and household-levels in the Kintampo Districts. Interventions and strategies should be tailored towards the high-risk groups identified in the study.
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Affiliation(s)
- George Adjei
- Department of Community Medicine, University of Cape Coast, Cape Coast, Ghana
| | - Eugene K. M. Darteh
- Department of Population and Health, University of Cape Coast, Cape Coast, Ghana
| | - Obed Ernest A. Nettey
- University of Ghana, Regional Institute for Population Studies, Accra, Ghana
- Kintampo Health Research Centre, P.O. Box 200, Kintampo, Ghana
| | - David Teye Doku
- Department of Population and Health, University of Cape Coast, Cape Coast, Ghana
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Basha GW, Woya AA, Tekile AK. Determinants of neonatal mortality in Ethiopia: an analysis of the 2016 Ethiopia Demographic and Health Survey. Afr Health Sci 2020; 20:715-723. [PMID: 33163036 PMCID: PMC7609081 DOI: 10.4314/ahs.v20i2.23] [Citation(s) in RCA: 20] [Impact Index Per Article: 5.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/17/2022] Open
Abstract
Background The first 28 days of life, the neonatal period, are the most vulnerable time for a child’s survival. Neonatal mortality accounts for about 38% of under-five deaths in low and middle income countries. This study aimed to identify the determinants of neonatal mortality in Ethiopia. Methods The study used data from the nationally representative 2016 Ethiopia Demographic and Health Survey (EDHS). Once the data were extracted; editing, coding and cleaning were done by using SAS 9.4.Sampling weights was applied to ensure the representativeness of the sample in this study. Both bivariate and multivariable logistic regression statistical analysis was used to identify determinants of neonatal mortality in Ethiopia. Results A total of 11,023 weighted live-born neonates born within five years preceding the 2016 EDHS were included this in this study. Multiple logistic regression analysis showed that multiple birth neonates (Adjusted Odds Ratio (AOR)=6.38;95%-Confidence Interval (CI):4.42-9.21), large birth size (AOR=1.35; 95% CI: 0.28-1.62), neonates born to mothers who did not utilize ANC (AOR=1.41; 95% CI: 1.11-1.81), neonates from rural area (AOR=1.88; 95% CI: 1.15-3.05) and neonates born in Harari region (AOR=1.45; 95% CI: 0.61-3.45)had higher odds of neonatal mortality. On the other hand, female neonates (AOR=0.60; 95% CI: 0.47-0.75), neonates born within the interval of more than 36 months of the preceding birth (AOR=0.56; 95% CI: 0.43-0.75), neonates born to fathers with secondary and higher education level (AOR=0.51; 95%CI: 0.22-0.88) had lower odds of neonatal mortality in Ethiopia. Conclusion To reduce neonatal mortality in Ethiopia, there is a need to implement sex specific public health intervention mainly focusing on male neonate during pregnancy, child birth and postnatal period. A relatively simple and cost-effective public health intervention should be implemented to make sure that all pregnant women are screened for multiple pregnancy and if positive, extra care should be given during pregnancy, child birth and postnatal.
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Affiliation(s)
- Garoma Wakjira Basha
- Department of Statistics, College of Science, Bahir Dar University
- Corresponding author: Garoma Wakjira Basha, Department of Statistics, College of Science, Bahir Dar University.
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Banadakoppa Manjappa R, Kar A, Jayanna K, Hallad JS, Cunningham T, Potty R, Mohan HL, Crockett M, Bradley J, Fischer E, Sudarshan H, Blanchard JF, Moses S, Avery L. Potential contributions of an on-site nurse mentoring program on neonatal mortality reductions in rural Karnataka state, South India: evidence from repeat community cross-sectional surveys. BMC Pregnancy Childbirth 2020; 20:242. [PMID: 32326902 PMCID: PMC7181530 DOI: 10.1186/s12884-020-02942-8] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/22/2019] [Accepted: 04/13/2020] [Indexed: 11/10/2022] Open
Abstract
BACKGROUND We assessed the effects of a nurse mentoring program on neonatal mortality in eight districts in India. METHODS From 2012 to 2015, nurse mentors supported improvements in critical MNCH-related practices among health providers at primary health centres (PHCs) in northern Karnataka, South India. Baseline (n = 5240) and endline (n = 5154) surveys of randomly selected ever-married women were conducted. Neonatal mortality rates (NMR) among the last live-born children in the three years prior to each survey delivered in NM and non-NM-supported facilities were calculated and compared using survival analysis and cumulative hazard function. Mortality rates on days 1, 2-7 and 8-28 post-partum were compared. Cox survival regression analysis measured the adjusted effect on neonatal mortality of delivering in a nurse mentor supported facility. RESULTS Overall, neonatal mortality rate in the three years preceding the baseline and endline surveys was 30.5 (95% CI 24.3-38.4) and 21.6 (95% CI 16.3-28.7) respectively. There was a substantial decline in neonatal mortality between the survey rounds among children delivered in PHCs supported by NM: 29.4 (95% CI 18.1-47.5) vs. 9.3 (95% CI 3.9-22.3) (p = 0.09). No significant declines in neonatal mortality rate were observed among children delivered in other facilities or at home. In regression analysis, among children born in nurse mentor supported facilities, the estimated hazard ratio at endline was significantly lower compared with baseline (HR: 0.23, 95% CI: 0.06-0.82, p = 0.02). CONCLUSION The nurse mentoring program was associated with a substantial reduction in neonatal mortality. Further research is warranted to delineate whether this may be an effective strategy for reducing NMR in resource-poor settings.
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Affiliation(s)
- Ramesh Banadakoppa Manjappa
- Centre for Global Public Health, Department of Community Health Sciences, University of Manitoba, R070 Med Rehab Bldg, 771 McDermot Avenue, Winnipeg, Manitoba, R3E 0T6, Canada.
| | - Arin Kar
- Karnataka Health Promotion Trust, Bangalore, India
| | - Krishnamurthy Jayanna
- Centre for Global Public Health, Department of Community Health Sciences, University of Manitoba, R070 Med Rehab Bldg, 771 McDermot Avenue, Winnipeg, Manitoba, R3E 0T6, Canada
| | | | | | | | - H L Mohan
- Centre for Global Public Health, Department of Community Health Sciences, University of Manitoba, R070 Med Rehab Bldg, 771 McDermot Avenue, Winnipeg, Manitoba, R3E 0T6, Canada
| | - Maryanne Crockett
- Centre for Global Public Health, Department of Community Health Sciences, University of Manitoba, R070 Med Rehab Bldg, 771 McDermot Avenue, Winnipeg, Manitoba, R3E 0T6, Canada
| | - Janet Bradley
- Centre for Global Public Health, Department of Community Health Sciences, University of Manitoba, R070 Med Rehab Bldg, 771 McDermot Avenue, Winnipeg, Manitoba, R3E 0T6, Canada
| | | | | | - James F Blanchard
- Centre for Global Public Health, Department of Community Health Sciences, University of Manitoba, R070 Med Rehab Bldg, 771 McDermot Avenue, Winnipeg, Manitoba, R3E 0T6, Canada
| | - Stephen Moses
- Centre for Global Public Health, Department of Community Health Sciences, University of Manitoba, R070 Med Rehab Bldg, 771 McDermot Avenue, Winnipeg, Manitoba, R3E 0T6, Canada
| | - Lisa Avery
- Centre for Global Public Health, Department of Community Health Sciences, University of Manitoba, R070 Med Rehab Bldg, 771 McDermot Avenue, Winnipeg, Manitoba, R3E 0T6, Canada
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Alebel A, Wagnew F, Petrucka P, Tesema C, Moges NA, Ketema DB, Yismaw L, Melkamu MW, Hibstie YT, Temesgen B, Bitew ZW, Tadesse AA, Kibret GD. Neonatal mortality in the neonatal intensive care unit of Debre Markos referral hospital, Northwest Ethiopia: a prospective cohort study. BMC Pediatr 2020; 20:72. [PMID: 32061260 PMCID: PMC7023807 DOI: 10.1186/s12887-020-1963-z] [Citation(s) in RCA: 27] [Impact Index Per Article: 6.8] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 04/08/2019] [Accepted: 02/07/2020] [Indexed: 11/10/2022] Open
Abstract
BACKGROUND Neonatal mortality remains a serious global public health problem, but Sub-Saharan Africa (SSA), in particular, is largely affected. Current evidence on neonatal mortality is essential to inform programs and policies, yet there is a scarcity of information concerning neonatal mortality in our study area. Therefore, we conducted this prospective cohort study to determine the incidence and predictors of neonatal mortality at Debre Markos Referral Hospital, Northwest Ethiopia. METHODS This institutionally-based prospective cohort study was undertaken among 513 neonates admitted to the neonatal intensive care unit of Debre Markos Referral Hospital between December 1st, 2017 and May 30th, 2018. All newborns consecutively admitted to the neonatal intensive care unit during the study period were included. An interviewer administered a questionnaire with the respective mothers. Data were entered using Epi-data™ Version 3.1 and analyzed using STATA™ Version 14. The neonatal survival time was estimated using the Kaplan-Meier survival curve, and the survival time between different categorical variables were compared using the log rank test. Both bi-variable and multivariable Cox-proportional hazard regression models were fitted to identify independent predictors of neonatal mortality. RESULTS Among a cohort of 513 neonates at Debre Markos Referral Hospital, 109 (21.3%) died during the follow-up time. The overall neonatal mortality rate was 25.8 deaths per 1, 000 neonate-days (95% CI: 21.4, 31.1). In this study, most (83.5%) of the neonatal deaths occurred in the early phase of neonatal period (< 7 days post-partum). Using the multivariable Cox-regression analysis, being unemployed (AHR: 1.6, 95% CI: 1.01, 2.6), not attending ANC (AHR: 1.9, 95% CI: 1.01, 3.5), not initiating exclusive breastfeeding (AHR: 1.7, 95% CI: 1.02, 2.7), neonatal admission due to respiratory distress syndrome (AHR: 2.0, 95% CI: 1.3, 3.1), and first minute Apgar score classification of severe (AHR: 2.1, 95% CI: 1.1, 3.9) significantly increased the risk of neonatal mortality. CONCLUSION In this study, we found a high rate of early neonatal mortality. Factors significantly linked with increased risk of neonatal mortality included: unemployed mothers, not attending ANC, not initiating exclusive breastfeeding, neonates admitted due to respiratory distress syndrome, and first minute Apgar score classified as severe.
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Affiliation(s)
- Animut Alebel
- College of Health Science, Debre Markos University, P.O. Box 269, Debre Markos, Ethiopia
- Faculty of Health, University of Technology Sydney, Ultimo, NSW Australia
| | - Fasil Wagnew
- College of Health Science, Debre Markos University, P.O. Box 269, Debre Markos, Ethiopia
| | - Pammla Petrucka
- College of Nursing, University of Saskatchewan, Saskatoon, Canada
- School of Life Sciences and Bioengineering, Nelson Mandela African Institute of Science and Technology, Arusha, Tanzania
| | - Cheru Tesema
- College of Health Science, Debre Markos University, P.O. Box 269, Debre Markos, Ethiopia
- Faculty of Health, University of Technology Sydney, Ultimo, NSW Australia
| | - Nurilign Abebe Moges
- College of Health Science, Debre Markos University, P.O. Box 269, Debre Markos, Ethiopia
| | - Daniel Bekele Ketema
- College of Health Science, Debre Markos University, P.O. Box 269, Debre Markos, Ethiopia
| | - lieltework Yismaw
- College of Health Science, Debre Markos University, P.O. Box 269, Debre Markos, Ethiopia
| | | | | | | | - Zebenay Workneh Bitew
- Department of Nursing, St. Paul’s Hospital Millennium Medical College, Addis Ababa, Ethiopia
| | - Animen Ayehu Tadesse
- Department of Medical Parasitology, College of Medicine and Health Sciences, Bahir Dar University, Bahir Dar, Ethiopia
| | - Getiye Dejenu Kibret
- College of Health Science, Debre Markos University, P.O. Box 269, Debre Markos, Ethiopia
- Faculty of Health, University of Technology Sydney, Ultimo, NSW Australia
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Zakaria M, Tariq S, Ul Husnain MI. Socio-economic, macroeconomic, demographic, and environmental variables as determinants of child mortality in South Asia. ENVIRONMENTAL SCIENCE AND POLLUTION RESEARCH INTERNATIONAL 2020; 27:954-964. [PMID: 31820247 DOI: 10.1007/s11356-019-06988-w] [Citation(s) in RCA: 10] [Impact Index Per Article: 2.5] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 06/18/2019] [Accepted: 11/06/2019] [Indexed: 06/10/2023]
Abstract
The study empirically examines the effects of socio-economic (human capital), macroeconomic (per capita GDP), demographic (fertility rate, urbanization), and environmental variables (carbon emissions) on child mortality in South Asia. For empirical analysis, panel cointegration technique is used by using data for five South Asian countries for the period 1973 to 2015. First, it is found that the variables have unit roots at levels but are stationary at first differences, which indicates the possibility of cointegration. Cointegration test results show that long-run cointegrating relationship holds among variables. Fully Modified OLS (FMOLS) and Dynamic OLS (DOLS) methods are applied to find the parameter estimates. The results of long-run estimates show that human capital, per capita income, and urbanization reduce child mortality while high fertility rate and environmental degradation increase child mortality in the region. It is also found that trade openness, immunization, food security, and high life expectancy also decrease child mortality and that population density increases child mortality.
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Affiliation(s)
- Muhammad Zakaria
- Department of Economics, COMSATS University Islamabad, Islamabad, Pakistan.
| | - Samia Tariq
- Department of Economics, COMSATS University Islamabad, Islamabad, Pakistan
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Singh A, Kumar K, Singh A. What Explains the Decline in Neonatal Mortality in India in the Last Three Decades? Evidence from Three Rounds of NFHS Surveys. Stud Fam Plann 2019; 50:337-355. [PMID: 31713878 DOI: 10.1111/sifp.12105] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/28/2022]
Abstract
Identifying the factors that have contributed to recent declines in neonatal mortality in India may help determine which policies and programs are most likely to facilitate further reductions. We use data from the 1992-93, 2005-06, and 2015-16 National Family Health Surveys (NFHS) to examine trends in neonatal mortality in India. We use multivariable decomposition to estimate the contribution of different factors to the change in neonatal mortality in India in the last three decades. When limited to most recent births in the 1-47 months preceding the surveys, 70 percent of the decline in neonatal mortality from 1992-2016 is due to changes in utilization of maternal- and child-care program factors and distribution of household, mother's, and child's characteristics. Improvement in "mother's schooling" and increase in utilization of "at least two tetanus toxoid injections" contributed the most followed by the increase in use of "at least three antenatal-care visits" and "clean fuel for cooking." The change in distribution of "birth order" also contributed significantly to the decline in neonatal mortality. Change in the benefits of "access to improved water," "delivery in a medical facility," and "mother's schooling" has led to a decline of 3 points, 2 points, and 1 point, respectively. More investments in maternal- and child-health programs (including family planning) and providing clean fuel for cooking are likely to pay higher dividends.
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AMINI-RARANI M, RASHIDIAN A, BAYATI M, KHEDMATI MORASAE E. Estimation of a Neonatal Health Production Function for Iran: Secondary Analysis of Iran's Multiple Indicator Demographic and Health Survey 2010. IRANIAN JOURNAL OF PUBLIC HEALTH 2019; 48:1488-1495. [PMID: 32292732 PMCID: PMC7145914] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Download PDF] [Subscribe] [Scholar Register] [Indexed: 11/13/2022]
Abstract
BACKGROUND Despite constant decrease in rate of neonatal mortality, the rate is still higher than that of other under-five children. One of the first steps towards reduction of neonatal mortality is to identify its determinants using health production function. The aim of the present study was to estimate neonatal health production function for Iran. METHODS In this cross-sectional study, Iranian Multiple Indicator Demographic and Health Survey (Ir-MIDHS) 2010 was used. Four categories of socioeconomic, mother, neonatal demographic and healthcare system factors were entered into the Binomial Logistic Regression model to estimate neonate health production function. Households' economic status was constructed using principal component analysis. RESULTS History of abortion/stillbirth had the highest significant positive impact on odds of neonatal mortality (odds ratio=1.98; 95 % CI=1.55-2.75), indicating that neonates of mothers with such a history had 1.98 times higher chance of death compared to other neonates. Moreover, odds ratio of neonatal death for the poorest quintiles was 1.70 (95 % CI=1.08-2.74), indicating that by moving from the poorest quintile to the richest one, the odds of being alive for neonates increased up to 70%. However, skilled birth attendant decreased the chance of death up to 58% (odds ratio=0.58; 95 % CI=0.36-0.93). CONCLUSION Considering the most significant inputs of neonatal health production function in Iran, improvement of economic status of households, provision of appropriate care services for mothers, and improvement of delivery care provided by trained personnel, could be priorities for health policymakers to act and reduce neonatal mortality in Iran.
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Affiliation(s)
- Mostafa AMINI-RARANI
- Social Determinants of Health Research Center, Isfahan University of Medical Sciences, Isfahan, Iran
| | - Arash RASHIDIAN
- Department of Health Management and Economics, School of Public Health, Tehran University of Medical Sciences, Tehran, Iran,Department of Information, Evidence and Research, World Health Organization, Eastern Mediterranean Region, Cairo, Egypt
| | - Mohsen BAYATI
- Health Human Resources Research Center, School of Management & Information Sciences, Shiraz University of Medical Sciences, Shiraz, Iran,Corresponding Author:
| | - Esmaeil KHEDMATI MORASAE
- Center for Systems Studies, Hull University Business School (HUBS), Hull York Medical School (HYMS), University of Hull, Hull, UK
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Khubchandani J, Soni A, Fahey N, Raithatha N, Prabhakaran A, Byatt N, Moore Simas TA, Phatak A, Rosal M, Nimbalkar S, Allison JJ. Caste matters: perceived discrimination among women in rural India. Arch Womens Ment Health 2018; 21:163-170. [PMID: 29034410 PMCID: PMC5857209 DOI: 10.1007/s00737-017-0790-1] [Citation(s) in RCA: 16] [Impact Index Per Article: 2.7] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 02/09/2017] [Accepted: 10/06/2017] [Indexed: 11/30/2022]
Abstract
The aim of this study is to examine the relationship of caste and class with perceived discrimination among pregnant women from rural western India. A cross-sectional survey was administered to 170 pregnant women in rural Gujarat, India, who were enrolled in a longitudinal cohort study. The Everyday Discrimination Scale and the Experiences of Discrimination questionnaires were used to assess perceived discrimination and response to discrimination. Based on self-report caste, women were classified into three categories with increasing historical disadvantage: General, Other Backward Castes (OBC), and Scheduled Caste or Tribes (SC/ST). Socioeconomic class was determined using the standardized Kuppuswamy scale. Regression models for count and binomial data were used to examine association of caste and class with experience of discrimination and response to discrimination. Sixty-eight percent of women experienced discrimination. After adjusting for confounders, there was a consistent trend and association of discrimination with caste but not class. In comparison to General Caste, lower caste (OBC, SC/ST) women were more likely to (1) experience discrimination (OBC OR: 2.2, SC/ST: 4.1; p trend: 0.01); (2) have a greater perceived discrimination score (OBC IRR: 1.3, SC/ST: 1.5; p trend: 0.07); (3) accept discrimination (OBC OR: 6.4, SC/ST: 7.6; p trend: < 0.01); and (4) keep to herself about discrimination (OBC OR: 2.7, SC/ST: 3.6; p trend: 0.04). The differential experience of discrimination by lower caste pregnant women in comparison to upper caste pregnant women and their response to such experiences highlight the importance of studying discrimination to understand the root causes of existing caste-based disparities.
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Affiliation(s)
- Jasmine Khubchandani
- University of Massachusetts Medical School, Albert Sherman Center, 55 Lake Avenue N, Worcester, MA, 01605, USA
| | - Apurv Soni
- University of Massachusetts Medical School, Albert Sherman Center, 55 Lake Avenue N, Worcester, MA, 01605, USA.
| | - Nisha Fahey
- University of Massachusetts Medical School, Albert Sherman Center, 55 Lake Avenue N, Worcester, MA, 01605, USA
| | | | | | - Nancy Byatt
- University of Massachusetts Medical School, Albert Sherman Center, 55 Lake Avenue N, Worcester, MA, 01605, USA
| | - Tiffany A Moore Simas
- University of Massachusetts Medical School, Albert Sherman Center, 55 Lake Avenue N, Worcester, MA, 01605, USA
| | - Ajay Phatak
- Pramukhswami Medical College, Karamsad, India
| | - Milagros Rosal
- University of Massachusetts Medical School, Albert Sherman Center, 55 Lake Avenue N, Worcester, MA, 01605, USA
| | | | - Jeroan J Allison
- University of Massachusetts Medical School, Albert Sherman Center, 55 Lake Avenue N, Worcester, MA, 01605, USA
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Byberg S, Østergaard MD, Rodrigues A, Martins C, Benn CS, Aaby P, Fisker AB. Analysis of risk factors for infant mortality in the 1992-3 and 2002-3 birth cohorts in rural Guinea-Bissau. PLoS One 2017; 12:e0177984. [PMID: 28542646 PMCID: PMC5436893 DOI: 10.1371/journal.pone.0177984] [Citation(s) in RCA: 14] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/03/2016] [Accepted: 05/05/2017] [Indexed: 11/18/2022] Open
Abstract
Introduction Though still high, the infant mortality rate in Guinea-Bissau has declined. We aimed to identify risk factors including vaccination coverage, for infant mortality in the rural population of Guinea-Bissau and assess whether these risk factors changed from 1992–3 to 2002–3. Methods The Bandim Health Project (BHP) continuously surveys children in rural Guinea-Bissau. We investigated the association between maternal and infant factors (especially DTP and measles coverage) and infant mortality. Hazard ratios (HR) were calculated using Cox regression. We tested for interactions with sex, age groups (defined by current vaccination schedule) and cohort to assess whether the risk factors were the same for boys and girls, in different age groups in 1992–3 and in 2002–3. Results The infant mortality rate declined from 148/1000 person years (PYRS) in 1992–3 to 124/1000 PYRS in 2002–3 (HR = 0.88;95%CI:0.77–0.99); this decline was significant for girls (0.77;0.64–0.94) but not for boys (0.97;0.82–1.15) (p = 0.10 for interaction). Risk factors did not differ significantly by cohort in either distribution or effect. Mortality decline was most marked among girls aged 9–11 months (0.56;0.37–0.83). There was no significant mortality decline for girls 1.5–8 months of age (0.93;0.68–1.28) (p = 0.05 for interaction). DTP and measles coverage increased from 1992–3 to 2002–3. Conclusions Risk factors did not change with the decline in mortality. Due to beneficial non-specific effects for girls, the increased coverage of measles vaccination may have contributed to the disproportional decline in mortality by sex and age group.
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Affiliation(s)
- Stine Byberg
- Bandim Health Project, Indepth Network, Bissau, Guinea-Bissau
- Research Center for Vitamins and Vaccines (CVIVA), Bandim Health Project, Statens Serum Institut, Copenhagen, Denmark
- OPEN, Odense Patient data Explorative Network, Odense University Hospital/Institute of Clinical Research, University of Southern Denmark, Odense, Denmark
- * E-mail:
| | | | | | - Cesario Martins
- Bandim Health Project, Indepth Network, Bissau, Guinea-Bissau
| | - Christine S. Benn
- Bandim Health Project, Indepth Network, Bissau, Guinea-Bissau
- Research Center for Vitamins and Vaccines (CVIVA), Bandim Health Project, Statens Serum Institut, Copenhagen, Denmark
- OPEN, Odense Patient data Explorative Network, Odense University Hospital/Institute of Clinical Research, University of Southern Denmark, Odense, Denmark
| | - Peter Aaby
- Bandim Health Project, Indepth Network, Bissau, Guinea-Bissau
- Research Center for Vitamins and Vaccines (CVIVA), Bandim Health Project, Statens Serum Institut, Copenhagen, Denmark
| | - Ane B. Fisker
- Bandim Health Project, Indepth Network, Bissau, Guinea-Bissau
- Research Center for Vitamins and Vaccines (CVIVA), Bandim Health Project, Statens Serum Institut, Copenhagen, Denmark
- OPEN, Odense Patient data Explorative Network, Odense University Hospital/Institute of Clinical Research, University of Southern Denmark, Odense, Denmark
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Adewuyi EO, Zhao Y. Determinants of neonatal mortality in rural and urban Nigeria: Evidence from a population-based national survey. Pediatr Int 2017; 59:190-200. [PMID: 27378178 DOI: 10.1111/ped.13086] [Citation(s) in RCA: 16] [Impact Index Per Article: 2.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 04/19/2016] [Revised: 06/13/2016] [Accepted: 07/01/2016] [Indexed: 11/30/2022]
Abstract
BACKGROUND Significant reduction in the global burden of neonatal mortality was achieved through the millennium development goals. In Nigeria, however, only a marginal reduction was realized. This study assesses the rural-urban differences in neonatal mortality rate (NMR) and the associated risk factors in Nigeria. METHODS The dataset from the 2013 Nigeria demographic and health survey (NDHS), disaggregated by rural-urban residence (n = 20 449 and 9935, respectively), was explored using univariate, bivariate, and multivariable analysis. Complex samples analysis was applied to adjust for the unequal selection probabilities due to the multi-stage cluster sampling method used in the 2013 NDHS. The adjusted relationship between the outcome and predictor variables was assessed on multi-level logistic regression analysis. RESULTS NMR for rural and urban populations was 36 and 28 deaths per 1000 live births, respectively. Risk factors in urban residence were lack of electricity access (adjusted OR [AOR], 1.555; 95%CI: 1.089-2.220), small birth size (as a proxy for low birthweight; AOR, 3.048; 95%CI: 2.047-4.537), and male gender (AOR, 1.666; 95%CI: 1.215-2.284). Risk factors in rural residence were small birth size (a proxy for low birthweight; AOR, 2.118; 95%CI: 1.600-2.804), and birth interval <2 years (AOR, 2.149; 95%CI: 1.760-2.624). Cesarean delivery was a risk factor both in rural (AOR, 5.038; 95%CI: 2.617-9.700) and urban Nigeria (AOR, 2.632; 95%CI: 1.543-4.489). CONCLUSIONS Determinants of neonatal mortality were different in rural and urban Nigeria, and rural neonates had greater risk of mortality than their urban counterparts.
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Affiliation(s)
- Emmanuel O Adewuyi
- 2 Div Hospital, Adekunle Fajuyi Cantonment, Ibadan, Nigeria.,Department of Epidemiology and Biostatistics, School of Public Health, Faculty of Health Sciences, Curtin University, Perth, Western Australia, Australia
| | - Yun Zhao
- Department of Epidemiology and Biostatistics, School of Public Health, Faculty of Health Sciences, Curtin University, Perth, Western Australia, Australia
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Nass SS, Danawi H, Cain L, Sharma M. Predictors of Neonatal Tetanus Mortality in Katsina State, Northwestern Nigeria. Health Serv Res Manag Epidemiol 2017; 4:2333392817723970. [PMID: 35146071 PMCID: PMC8822446 DOI: 10.1177/2333392817723970] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/18/2017] [Revised: 07/11/2017] [Accepted: 07/11/2017] [Indexed: 11/15/2022] Open
Abstract
Background The mortality rate of neonatal tetanus (NNT) remains high in Nigeria. The study was guided by Mosley and Chen's model for the elements of child survival in developing countries. The goal of the study was to assess the associations between selected NNT risk factors, number of maternal tetanus toxoid injections, frequency of antenatal visits, place of delivery, and cord care with neonatal mortality as the outcome variable. Methods The study is a retrospective record review using data from 332 NNT records and analyzed using a logistic regression model. Findings Neonates whose mothers had 1 dose of tetanus toxoid vaccine were found to be 4% less prone to NNT mortality compared to neonates whose mothers did not have any dose of tetanus toxoid vaccine during pregnancy (P < .05, odds ratio = 4.12, 95% confidence interval = 1.04-16.29. Frequency of antenatal visits, place of delivery, and cord care were all not significant predictors of NNT mortality. Conclusion The study shows that there is association between NNT risk factors and neonatal mortality, hence the need to further strengthen the NNT surveillance system for early detection of potential risk factors. This would help develop specific public health interventions aimed at improving the outcome of NNT. Implications The identification and analysis of NNT mortality risk factors and promoting tetanus toxoid vaccination among pregnant women are effective strategies toward attaining NNT elimination goals in Nigeria.
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Affiliation(s)
| | - Hadi Danawi
- World Health Organization, Katsina State, Nigeria
| | - Loretta Cain
- World Health Organization, Katsina State, Nigeria
| | - Manoj Sharma
- World Health Organization, Katsina State, Nigeria
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20
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Kujala S, Waiswa P, Kadobera D, Akuze J, Pariyo G, Hanson C. Trends and risk factors of stillbirths and neonatal deaths in Eastern Uganda (1982-2011): a cross-sectional, population-based study. Trop Med Int Health 2016; 22:63-73. [PMID: 27910181 DOI: 10.1111/tmi.12807] [Citation(s) in RCA: 21] [Impact Index Per Article: 2.6] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/01/2022]
Abstract
OBJECTIVES To identify mortality trends and risk factors associated with stillbirths and neonatal deaths 1982-2011. METHODS Population-based cross-sectional study based on reported pregnancy history in Iganga-Mayuge Health and Demographic Surveillance Site (HDSS) in Uganda. A pregnancy history survey was conducted among women aged 15-49 years living in the HDSS during May-July 2011 (n = 10 540). Time trends were analysed with cubic splines and linear regression. Potential risk factors were examined with multilevel logistic regression with adjusted odds ratios (AOR) and 95% confidence intervals (CI). RESULTS 34 073 births from 1982 to 2011 were analysed. The annual rate of decrease was 0.9% for stillbirths and 1.8% for neonatal mortality. Stillbirths were associated with several risk factors: multiple births (AOR 2.57, CI 1.66-3.99), previous adverse outcome (AOR 6.16, CI 4.26-8.88) and grand multiparity among 35- to 49-year-olds (AOR 1.97, CI 1.32-2.89). Neonatal deaths were associated with multiple births (AOR 6.16, CI 4.80-7.92) and advanced maternal age linked with parity of 1-4 (AOR 2.34, CI 1.28-4.25) and grand multiparity (AOR 1.44, CI 1.09-1.90). Education, marital status and household wealth were not associated with the outcomes. CONCLUSIONS The slow decline in mortality rates and easily identifiable risk factors calls for improving quality of care at birth and a rethinking of how to address obstetric risks, potentially a revival of the risk approach in antenatal care.
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Affiliation(s)
- Sanni Kujala
- Department of Public Health Sciences - Global Health, Karolinska Institutet, Stockholm, Sweden
| | - Peter Waiswa
- Department of Public Health Sciences - Global Health, Karolinska Institutet, Stockholm, Sweden.,Maternal and Newborn Centre of Excellence, Makerere University School of Public Health, Kampala, Uganda.,The INDEPTH Network Maternal and Newborn Working Group, Iganga-Mayuge Health and Demographic Surveillance Site, Iganga, Uganda
| | - Daniel Kadobera
- The INDEPTH Network Maternal and Newborn Working Group, Iganga-Mayuge Health and Demographic Surveillance Site, Iganga, Uganda.,Mental Health Program, Clinical Services Division, Ministry of Health, Kampala, Uganda
| | - Joseph Akuze
- Maternal and Newborn Centre of Excellence, Makerere University School of Public Health, Kampala, Uganda
| | - George Pariyo
- The INDEPTH Network Maternal and Newborn Working Group, Iganga-Mayuge Health and Demographic Surveillance Site, Iganga, Uganda.,Department of International Health, Johns Hopkins University, Baltimore, MD, USA
| | - Claudia Hanson
- Department of Public Health Sciences - Global Health, Karolinska Institutet, Stockholm, Sweden.,Faculty of Infectious & Tropical Disease, London School of Hygiene & Tropical Medicine, London, UK
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Sankar MJ, Neogi SB, Sharma J, Chauhan M, Srivastava R, Prabhakar PK, Khera A, Kumar R, Zodpey S, Paul VK. State of newborn health in India. J Perinatol 2016; 36:S3-S8. [PMID: 27924104 PMCID: PMC5144119 DOI: 10.1038/jp.2016.183] [Citation(s) in RCA: 112] [Impact Index Per Article: 14.0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/08/2022]
Abstract
About 0.75 million neonates die every year in India, the highest for any country in the world. The neonatal mortality rate (NMR) declined from 52 per 1000 live births in 1990 to 28 per 1000 live births in 2013, but the rate of decline has been slow and lags behind that of infant and under-five child mortality rates. The slower decline has led to increasing contribution of neonatal mortality to infant and under-five mortality. Among neonatal deaths, the rate of decline in early neonatal mortality rate (ENMR) is much lower than that of late NMR. The high level and slow decline in early NMR are also reflected in a high and stagnant perinatal mortality rate. The rate of decline in NMR, and to an extent ENMR, has accelerated with the introduction of National Rural Health Mission in mid-2005. Almost all states have witnessed this phenomenon, but there is still a huge disparity in NMR between and even within the states. The disparity is further compounded by rural-urban, poor-rich and gender differentials. There is an interplay of different demographic, educational, socioeconomic, biological and care-seeking factors, which are responsible for the differentials and the high burden of neonatal mortality. Addressing inequity in India is an important cross-cutting action that will reduce newborn mortality.
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Affiliation(s)
- M J Sankar
- Department of Pediatrics, All India Institute of Medical Sciences, New Delhi, India
| | - S B Neogi
- Indian Institute of Public Health (Delhi), Public Health Foundation of India, Delhi, India
| | - J Sharma
- Indian Institute of Public Health (Delhi), Public Health Foundation of India, Delhi, India
| | - M Chauhan
- Indian Institute of Public Health (Delhi), Public Health Foundation of India, Delhi, India
| | - R Srivastava
- Ministry of Health and Family Welfare, Government of India, New Delhi, India
| | - P K Prabhakar
- Ministry of Health and Family Welfare, Government of India, New Delhi, India
| | - A Khera
- Ministry of Health and Family Welfare, Government of India, New Delhi, India
| | - R Kumar
- Ministry of Health and Family Welfare, Government of India, New Delhi, India
| | - S Zodpey
- Indian Institute of Public Health (Delhi), Public Health Foundation of India, Delhi, India
| | - V K Paul
- Department of Pediatrics, All India Institute of Medical Sciences, New Delhi, India
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Determinants of Neonatal Mortality in North Shoa Zone, Amhara Regional State, Ethiopia. PLoS One 2016; 11:e0164472. [PMID: 27741284 PMCID: PMC5065191 DOI: 10.1371/journal.pone.0164472] [Citation(s) in RCA: 27] [Impact Index Per Article: 3.4] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/04/2016] [Accepted: 09/26/2016] [Indexed: 11/19/2022] Open
Abstract
In Ethiopia, neonatal mortality has been declined since the declaration of Millennium Developmental Goals, but the rate was slower since 2006. Thus, this study was designed to assess the determinants of neonatal mortality (NM) in North Shoa Zone. A community based case-control study was conducted on 84 cases and 252 controls. Cases were deceased new-borns within 28 days of birth while controls were infants survived beyond the first 28 days. Data were collected from mothers of the cases and controls using interviewer administered questionnaires. Multivariate analysis was done to examine determinants of NM. Variables significantly associated with NM in bivariate analysis were selected for multivariate analysis. Neonates whose mothers not attended antenatal care (AOR: 3.47; 95%CI: 1.44–8.32), delivered at home (AOR: 2.86; 95%CI: 1.56–5.26), and not received postnatal care services (AOR: 3.09; 95%CI: 1.73–5.51) were more likely to die. The odds of neonatal death was higher among neonates not breastfed within the first hour of delivery than those who breastfed within the first hour of delivery (AOR: 23.48; 95%CI: 8.43–65.37). Likewise, no-colostrum intake was positively associated with neonatal death. Neonates born to mothers who not received or received a single dose of tetanus toxoid injection (TTI) were more likely to experience death than those neonates born to mothers who received two or more doses of TTI (AOR: 2.05; 95%CI: 1.14–3.70). Furthermore, being small in size at birth (AOR: 2.66; 95%CI: 1.33–5.33) and male in sex (AOR: 1.85; 95% CI: 1.06–3.26) were risk factors for NM. In conclusion, neonatal mortality was significantly associated with factors that are modifiable through addressing the continuum-of-care approach in healthcare services in North Shoa. This implies that ensuring a continuity of health care services for maternal and new-borns from antenatal to postnatal care will improve neonatal survival.
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Saikia N, Shkolnikov VM, Jasilionis D. Trends and Sub-National Disparities in Neonatal Mortality in India from 1981 to 2011. ASIAN POPULATION STUDIES 2016. [DOI: 10.1080/17441730.2015.1130325] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/25/2022]
Affiliation(s)
| | - Vladimir M. Shkolnikov
- Department of Sociology, Max Planck Institute for Demographic Research, Rostock, Germany
- New Economic School, Moscow, Russian Federation
| | - Domantas Jasilionis
- Department of Sociology, Max Planck Institute for Demographic Research, Rostock, Germany
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Abdullah A, Hort K, Butu Y, Simpson L. Risk factors associated with neonatal deaths: a matched case-control study in Indonesia. Glob Health Action 2016; 9:30445. [PMID: 26895147 PMCID: PMC4759830 DOI: 10.3402/gha.v9.30445] [Citation(s) in RCA: 35] [Impact Index Per Article: 4.4] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/18/2015] [Revised: 01/05/2016] [Accepted: 01/21/2016] [Indexed: 11/14/2022] Open
Abstract
Background Similar to global trends, neonatal mortality has fallen only slightly in Indonesia over the period 1990–2010, with a high proportion of deaths in the first week of life. Objective This study aimed to identify risk factors associated with neonatal deaths of low and normal birthweight infants that were amenable to health service intervention at a community level in a relatively poor province of Indonesia. Design A matched case–control study of neonatal deaths reported from selected community health centres (puskesmas) was conducted over 10 months in 2013. Cases were singleton births, born by vaginal delivery, at home or in a health facility, matched with two controls satisfying the same criteria. Potential variables related to maternal and neonatal risk factors were collected from puskesmas medical records and through home visit interviews. A conditional logistic regression was performed to calculate odds ratios using the clogit procedure in Stata 11. Results Combining all significant variables related to maternal, neonatal, and delivery factors into a single multivariate model, six factors were found to be significantly associated with a higher risk of neonatal death. The factors identified were as follows: neonatal complications during birth; mother noting a health problem during the first 28 days; maternal lack of knowledge of danger signs for neonates; low Apgar score; delivery at home; and history of complications during pregnancy. Three risk factors (neonatal complication at delivery; neonatal health problem noted by mother; and low Apgar score) were significantly associated with early neonatal death at age 0–7 days. For normal birthweight neonates, three factors (complications during delivery; lack of early initiation of breastfeeding; and lack of maternal knowledge of neonatal danger signs) were found to be associated with a higher risk of neonatal death. Conclusion The study identified a number of factors amenable to health service intervention associated with neonatal deaths in normal and low birthweight infants. These factors include maternal knowledge of danger signs, response to health problems noted by parents in the first month, early initiation of breastfeeding, and delivery at home. Addressing these factors could reduce neonatal deaths in low resource settings.
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Affiliation(s)
- Asnawi Abdullah
- Faculty of Public Health, University Muhammadiyah Aceh, Banda Aceh, Indonesia.,Australia Indonesia Partnership for Maternal and Neonatal Health, Kupang, Indonesia.,Department of Epidemiology and Preventive Medicine, Monash University, Clayton, Australia;
| | - Krishna Hort
- Australia Indonesia Partnership for Maternal and Neonatal Health, Kupang, Indonesia.,Nossal Institute for Global Health, University of Melbourne, Parkville, Australia
| | - Yuli Butu
- Australia Indonesia Partnership for Maternal and Neonatal Health, Kupang, Indonesia
| | - Louise Simpson
- Australia Indonesia Partnership for Maternal and Neonatal Health, Kupang, Indonesia
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Huda TM, Tahsina T, El Arifeen S, Dibley MJ. The importance of intersectoral factors in promoting equity-oriented universal health coverage: a multilevel analysis of social determinants affecting neonatal infant and under-five mortality in Bangladesh. Glob Health Action 2016; 9:29741. [PMID: 26880153 PMCID: PMC4754013 DOI: 10.3402/gha.v9.29741] [Citation(s) in RCA: 23] [Impact Index Per Article: 2.9] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/12/2015] [Revised: 12/13/2015] [Accepted: 12/15/2015] [Indexed: 11/14/2022] Open
Abstract
INTRODUCTION Health is multidimensional and affected by a wide range of factors, many of which are outside the health sector. To improve population health and reduce health inequality, it is important that we take into account the complex interactions among social, environmental, behavioural, and biological factors and design our health interventions accordingly. OBJECTIVES This study examines mortality differentials in children of different age groups by key social determinants of health (SDH) including parental education and employment, mother's level of autonomy, age, asset index, living arrangements (utilities), and other geographical contextual factors (area of residence, road conditions). DESIGN We used data from the two rounds of Bangladesh Health and Demographic Survey, a nationally representative sample survey of the population residing in Bangladesh. Multilevel logistic models were used to study the impact of SDH on child mortality. RESULTS The study found that the mother's age, the education of both parents, the mother's autonomy to take decisions about matters linked to the health of her child, the household socio-economic conditions, the geographical region of residence, and the condition of the roads were significantly associated with higher risks of neonatal, infant, and under-five mortality in Bangladesh. CONCLUSION The study findings suggest there are complex relationships among different SDH. Thus larger intersectoral actions will be needed to reduce disparities in child health and mortality and achieve meaningful progress towards equity-oriented universal health coverage.
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Affiliation(s)
- Tanvir M Huda
- Sydney School of Public Health, The University of Sydney, Sydney, Australia
- Centre for Child and Adolescent Health, icddr,b, Dhaka, Bangladesh; ;
| | - Tazeen Tahsina
- Centre for Child and Adolescent Health, icddr,b, Dhaka, Bangladesh
| | - Shams El Arifeen
- Centre for Child and Adolescent Health, icddr,b, Dhaka, Bangladesh
| | - Michael J Dibley
- Sydney School of Public Health, The University of Sydney, Sydney, Australia
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Measures of Maternal Socioeconomic Status in Yemen and Association with Maternal and Child Health Outcomes. Matern Child Health J 2015; 20:386-97. [DOI: 10.1007/s10995-015-1837-4] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/22/2022]
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Singh A, Kumar A, Pranjali P. Utilization of maternal healthcare among adolescent mothers in urban India: evidence from DLHS-3. PeerJ 2014; 2:e592. [PMID: 25392750 PMCID: PMC4226640 DOI: 10.7717/peerj.592] [Citation(s) in RCA: 34] [Impact Index Per Article: 3.4] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/20/2013] [Accepted: 09/03/2014] [Indexed: 11/20/2022] Open
Abstract
Background. Low use of maternal healthcare services is one of the reasons why maternal mortality is still considerably high among adolescents mothers in India. To increase the utilization of these services, it is necessary to identify factors that affect service utilization. To our knowledge, no national level study in India has yet examined the issue in the context urban adolescent mothers. The present study is an attempt to fill this gap. Data and Methods. Using information from the third wave of District Level Household Survey (2007-08), we have examined factors associated with the utilization of maternal healthcare services among urban Indian married adolescent women (aged 13-19 years) who have given live/still births during last three years preceding the survey. The three outcome variables included in the analyses are 'full antenatal care (ANC)', 'safe delivery' and 'postnatal care within 42 days of delivery'. We have used Chi-square test to determine the difference in proportion and the binary logistic regression to understand the net effect of predictor variables on the utilization of maternity care. Results. About 22.9% of mothers have received full ANC, 65.1% of mothers have had at least one postnatal check-up within 42 days of pregnancy. The proportion of mother having a safe delivery, i.e., assisted by skilled personnel, is about 70.5%. Findings indicate that there is considerable amount of variation in use of maternity care by educational attainment, household wealth, religion, parity and region of residence. Receiving full antenatal care is significantly associated with mother's education, religion, caste, household wealth, parity, exposure to healthcare messages and region of residence. Mother's education, full antenatal care, parity, household wealth, religion and region of residence are also statistically significant in case of safe delivery. The use of postnatal care is associated with household wealth, woman's education, full antenatal care, safe delivery care and region of residence. Conclusion. Several socioeconomic and demographic factors affect the utilization of maternal healthcare services among urban adolescent women in India. Promoting the use of family planning, female education and higher age at marriage, targeting vulnerable groups such as poor, illiterate, high parity women, involving media and grass root level workers and collaboration between community leaders and health care system could be some important policy level interventions to address the unmet need of maternity services among urban adolescents.
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Affiliation(s)
- Aditya Singh
- Global Health and Social Care Unit, School of Health Sciences and Social Work, University of Portsmouth, Portsmouth, United Kingdom
| | - Abhishek Kumar
- International Institute for Population Sciences, Mumbai, India
| | - Pragya Pranjali
- Social Research Institute - IRMB International, New Delhi, India
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Damghanian M, Shariati M, Mirzaiinajmabadi K, Yunesian M, Emamian MH. Socioeconomic inequality and its determinants regarding infant mortality in iran. IRANIAN RED CRESCENT MEDICAL JOURNAL 2014; 16:e17602. [PMID: 25068048 PMCID: PMC4102981 DOI: 10.5812/ircmj.17602] [Citation(s) in RCA: 8] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Subscribe] [Scholar Register] [Received: 01/15/2014] [Revised: 03/19/2014] [Accepted: 04/01/2014] [Indexed: 11/16/2022]
Abstract
BACKGROUND Infant mortality rate is a useful indicator of health conditions in the society, the racial and socioeconomic inequality of which is from the most important measures of social inequality. OBJECTIVES The aim of this study was to determine the socioeconomic inequality and its determinants regarding infant mortality in an Iranian population. PATIENTS AND METHODS This cross-sectional study was performed on 3794 children born during 2010-2011 in Shahroud, Iran. Based on children's addresses and phone numbers, 3412 were available and finally 3297 participated in the study. A data collection form was filled out through interviewing the mothers as well as using health records. Using principal component analysis, the study population was divided to high and low socioeconomic groups based on the case's home asset, education and job of the household's head, marital status, and composition of the household members. Inequality between the groups with regard to infant mortality was investigated by Blinder-Oaxaca decomposition method. RESULTS The mortality rate was 15.1 per 1000 live births in the high socioeconomic group and 42.3 per 1000 in the low socioeconomic group. Mother's education, consanguinity of parents, and infant's nutrition type and birth weight constituted 44% of the gap contributing factors. Child's gender, high-risk pregnancy, and living area had no impact on the gap. CONCLUSIONS There was considerable socioeconomic inequality regarding infant mortality in Shahroud. Mother's education was the most contributing factor in this inequality.
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Affiliation(s)
- Maryam Damghanian
- Department of Reproductive Health, Shahroud University of Medical Sciences, Shahroud, IR Iran
| | - Mohammad Shariati
- Department of Community Medicine, School of Medicine, Tehran University of Medical Sciences, Tehran, IR Iran
| | - Khadigeh Mirzaiinajmabadi
- Department of Midwifery, School of Nursing and Midwifery, Mashhad University of Medical Sciences, Mashhad, IR Iran
| | - Masud Yunesian
- Department of Environmental Health Engineering, School of Public Health, Tehran University of Medical Sciences, Tehran, IR Iran
| | - Mohammad Hassan Emamian
- Center for Health Related Social and Behavioral Sciences Research, Shahroud University of Medical Sciences, Shahroud, IR Iran
- Corresponding Author: Mohammad Hassan Emamian, Center for Health Related Social and Behavioral Sciences Research, Shahroud University of Medical Sciences, Shahroud, IR Iran. Tel: +98-2332396714, Fax: +98-2332394852, E-mail:
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