The main causes of infant mortality in these countries are, therefore, mainly genetic or biological in nature. doi:10.2147/RRN.S95455. Some 45% of the deaths occurred within 48 hours and 73% within the first week. Cause of neonatal deaths in Northern Ethiopia: a prospective cohort study.. BMC Public Health. Why? We therefore believe that the risk of biased reporting of neonatal mortality for this population is small. This finding is in line with other studies.33,34 The lower the gestational and birth weight the higher chance of death and this is due to the fact that underweight and preterm newborn had immaturity of immune systems and other body defense mechanisms which control newborn disease susceptibility.1 This implies that anticipating high risk newborn babies and early treatment would reduce the deaths of such physiologically and anatomically vulnerable neonates. Recently there has been a growing demand for perinatal mortality data to be disaggregated by gender, geographic location and socioeconomic status, to enable programmes to improve resource allocation and monitoring. African Regional Health Report 2014 [Internet]. Outcomes for all fetuses and neonates delivered after enrolment were clearly defined. stillbirths plus all neonatal deaths), 82.5 per 1000 births (95% CI: 66.7–98.3) (Table 1). Regarding gestational ages of the neonates, the majority 222(71.9%)had a gestational age between 37–42 weeks. Javascript is currently disabled in your browser. In other words, in Ethiopia 1 in every 35 children dies within the first month, 1 in every 21 children dies before celebrating the first birthday, and 1 of every 15 children dies before reaching the fifth birthday. Cunningham FG, Leveno KJ, Bloom SL, Bloom SL, Hauth JC, Larry Gilstrap III KDW. Section V. Fetus and Newborn: chapter 29; Diseases and Injuries of the Fetus and Newborn. On the other hand, in countries where infant mortality rates are high, the majority of infant deaths occurs after the neo-natal stage and is due mainly to environmental factors. Neonatal sepsis is the leading cause of mortality worldwide, but compared with high income countries, its prevalence and mortality rates are high in low and middle-income countries (LMICs) probably due to poor hygiene and suboptimal practices for infection control . •  software development by maffey.com In this study any neonatal conditions or diagnosis identified or recorded for deceased neonates were considered as causes of death and its contributing factors. Therefore, the aim of this study was to assess the causes and factors associated with neonatal mortality among neonates admitted to the Neonatal Intensive Care Unit (NICU) of Jimma University Medical Center. A postnatal visit for data collection was made on about day 28. In contrast, there were more female deaths in the late neonatal period. Variables such as birth weight; gestational age and maturity were classified based on WHO classification criteria.1 The gestational age was estimated using Maternal Report of the Last Normal Menstrual Period(LNMP) and confirmed by ultrasound for those mother who gave birth at the center while the Ballard score was used to estimate the gestational age of the newborn delivered outside the center and newborn delivered to those mothers who did not remember or know the date of their last normal menstrual period. … In addition, the baseline characteristics of the study population are typical for the area. The causes and prevention of stillbirths and first week deaths. One reason why we do not see progress is that we are unaware of how bad the past was.In 1800 the health conditions of our ancestors were such that 43% of the world's newborns died before their 5th birthday. Total neonates with sepsis were 884 and 129(31.3%) died. In: Williams_Obstetrics_-22_Edition [Internet]. Improving infant mortality rate. Similarly significant associations have been observed in a study conducted in Gondar, Addis Ababa, Iran, Brazil and other several studies.8,9,24,26,29–32 These indicated that most of the neonatal deaths are due to preventable causes of death that could be addressed by anticipating risky pregnancies and the provision of proper and on time interventions. Case fatality for neonatal sepsis was 4.2%. Because most neonatal deaths occurred in hospitals, maternal reports were supplemented by a review of hospital records by the study physician. A Study of Neonatal Admission Pattern and Outcome from Rural Haryana. Research Triangle Institute, 3040 Cornwallis Road, Durham, NC, 27709, United States of America.c. for deaths from days 8 to 28) was significantly lower for males than females (5.5 versus 19.5 per 1000 live births, P = 0.05). involving sepsis, pneumonia or meningitis) in the first 48 hours. The types of infant mortality shown in the charts below include neonatal mortality and postneonatal mortality: Neonatal mortality: death of a live-born infant within the first 27 days of life. When autocomplete results are available use up and down arrows to review and enter to select. Emília M, Claudia A, Dalva M, et al. Demitto MDO, Gravena AAF, Dell’Agnolo CM, Antunes MB, Pelloso SM. Thus, 83% of those eligible, or 1369 women, were enrolled at 20–26 weeks’ gestation. Ansari-Moghaddam A, Sadeghi-Bojd S, Imani M, Movahedinia S, Pourrashidi A, Mohammadi M. A multivariate analysis of factors associated with infant mortality in South-East of Iran. For all neonatal deaths and stillbirths, the study physician and nurse interviewed the mother about the circumstances leading to the event. 2017;51:1–7. Pakistan is number three among these countries. 19. World Health Organization [Internet]. All data were entered centrally. Furthermore, the unit also receives neonates referred from other health facilities and homes. Relative risks (RRs) and 95% CIs were calculated to evaluate the associations between potential risk factors and neonatal death. Sime H, Workneh N, Girma E. Morbidity and Mortality of Neonates Admitted in Jimma University Specialized Hospital Paediatrics Neonatal Ward: A One Year Retrospective Analysis. 2012;26(3):200–207. Int J Contemp Pediatr. Out of 3093 neonates admitted 412 died, giving a death rate of 13.3%. 20th ed. Factors associated with mortality and length of stay in hospitalised neonates in Eritrea, Africa: a cross-sectional study. Morbidity and mortality pattern among neonates admitted to the general paediatric ward of a secondary health care centre in the Niger delta region of Nigeria. We hypothesized that the neonatal mortality rate in this urban population, with relatively good access to obstetric care and Caesarean section, would be substantially lower than that generally reported for Pakistan. The importance of preterm birth for peri and neonatal mortality in rural Malawi. Two-thirds of the world’s neonatal deaths occur in just 10 countries, mostly in Asia. Saini N, Chhabra S, Chhabra S, Garg L, Garg N. Pattern of neonatal morbidity and mortality: a prospective study in a District Hospital in Urban India [Internet]. All rights reserved. However, women were enrolled into the study by LHWs during routine home visits, and a substantial majority of all eligible women were enrolled. Baker R, Sullivan E, Camosso-Stefinovic J, Rashid A, Farooqi A, Blackledge H, et al., et al. 4. Zaidi S. The role of obstetrician in reducing perinatal mortality. The Pattinson et al. (SAS Institute Inc., NC, USA). Prior to enrolment, all eligible women provided informed consent. This is shown globally for different causes of death in infant boys versus girls. This is comparable with a similar finding from another study carried out in our country.26 This may be related to delay in making a decision to seek care and delay in reaching care due to the availability of and cost of transportations which would affect the on time arrival of laboring mothers to the hospitals and lack of pre hospital emergency care. 35. Without improved quality, increased health-care coverage is unlikely to substantially improve perinatal and neonatal outcomes.2,8,22,23 Recent reports from Pakistan and other low-resource settings indicate that substandard care, inadequate training, low staff competence and a lack of resources, including equipment and medication, are all factors that contribute to neonatal deaths.23,24 Since the quantity of care in this study’s setting was relatively high for a developing country, it is likely that the quality of care will need to be improved if the neonatal mortality rate is to be substantially reduced. •  Terms & Conditions   records and 6 neonates were referred to other facilities and were excluded from the study. 2. Fetuses and young children may be particularly susceptible to … Causes which lie above the grey line have higher mortality rates in boys relative to girls. And under-five mortality to as low as 25 per 1000 live births till 2025. 20. this site will not function whilst javascript is disabled. 3. 2016;5(3):183. Evidence from other areas of Pakistan suggests that this may not be the case.21. causes of infant death in 2018 accounted for 67.6% of all infant deaths in the United States. Without improved quality, increased health-care coverage is unlikely to substantially improve perinatal and neonatal outcomes. Assamala. For the descriptive analysis, frequencies, percentages and rates were calculated, and 95% confidence intervals (CIs) were determined for mortality rates. Regression analysis confirmed the absence of a significant association in this population. Non-commercial uses of the work are permitted without any further permission from Dove Medical Press Limited, provided the work is properly attributed. Since reported neonatal mortality rates for all of Pakistan are in the range of 45–50 per 1000 live births, our hypothesis that the neonatal mortality rate in this urban population would be substantially lower than that reported for the rest of Pakistan proved incorrect. The global burden of child and youth deaths however remains immense. Res Rep Neonatol. Rates of caesarean section: analysis of global, regional and national estimates. Data audits, including inter- and intra-form consistency checks, were performed at data entry, and additional audits were performed by the data centre (i.e. 2016;45(2):84–89. Furthermore, 157(5.1%), 112(3.6%), and 86(2%) of the neonates were admitted due to meningitis, sub-glial haemorrhage, and macrosomia, respectively (Table 4). We believe there are two reasons for this finding. Childhood mortality has declined substantially since 2000. Trends in child mortality: The world has seen dramatic reductions of 60% in under-five mortality from 93 deaths per 1000 live births in 1990 to 38 in 2019. A selected review of the mortality rates of Neonatal Intensive Care Units [Internet]. J Perinatol. Neonatal conditions were divided into five major categories, four adapted from the Global Burden of Diseases (GBD 2017) classification catalog, and one category, Low Birth Weight (LBW) added from the National strategy for newborn and child survival in Ethiopia.35,36 The presentation conditions included under these five categories is presented in the Table 1. Given the paucity of reliable population-based information in Pakistan, this study was undertaken to examine the prevalence, sex distribution, timing and causes of neonatal death in a population-based pregnancy cohort in urban Pakistan. Medical records of neonates with a missing diagnosis of admission and missing clinical outcomes, other than death and improved discharge were excluded from the study (Figure 1). Infant, neonatal and postneonatal mortality rates U.S. 2013-2015, by urbanization; Infant mortality rates for leading death causes U.S. 2013-2015, by urbanization Among (Sustainable Developmental Goals (SDG) regions, Sub-Saharan Africa had the highest neonatal mortality rate in 2017 at 27 deaths per 1000 live births.2–4, According to the Ethiopian Demographic Health Survey (EDHS) 2016, the under-5, infant and neonatal mortality rate is 67, 48 and 29 deaths per 1,000 live births respectively. Accidental injury is the fifth-leading cause of infant mortality in the United States. Volume 2019:10 Pages 39—48, Editor who approved publication: Overman DM. J Clin Neonatol. This study was mainly focused on neonatal factors that could be related to neonatal mortalities, for this reason other possible factors not adjusted for during the current study may influence observed associations. The majority (249, 60.4%) of deceased neonates had low birth weight, while 230 (55.8%) were premature and 169(41%) had Respiratory Distress Syndrome (RDS). Clin Mother Child. In conclusion, this study found that babies born outside the city, gestational ages, the length of stay in the ICU, prematurity, low birth weight, RDS, and congenital malformations all had a significant association with neonatal mortality. 2018;7(February):73–75. Birth defects cause about 21 percent of … The … Three-quarters of neonatal deaths occur in the first week, and more than one-quarter occur in the first 24 hours.1,2Neonatal deaths account for 40% of deaths under the age of 5 years worldwide. 2009;12:389–394. Hospital-acquired neonatal infections in developing countries. The current finding is slightly lower than the studies conducted in northwestern parts of Ethiopian and significantly lower than the study carried out in Addis Ababa which was 14.3%, 15.9%, and 23.2% respectively. doi:10.1186/s12889-016-3979-8, 10. The UN recommends a Caesarean section rate of 5–15% to optimally minimize maternal and neonatal mortality rates.4,20 This recommendation presumes that these Caesarean sections are performed in a timely manner on appropriate women. Contact Us   Figure 1 Flow chart of the inclusion and exclusion criteria. Available from: http://www.who.int/intellectualproperty/documents/thereport/ENPublicHealthReport.pdf. On the other hand, some controllable risk factors include the use of tobacco, alcohol, cocaine and other drugs. Pak Armed Forces Med J. The town is located 357 km towards the southwest of Addis Ababa, the capital of Ethiopia. 30. (Submitted: 09 January 2008 – Revised version received: 21 June 2008 – Accepted: 25 June 2008 – Published online: 06 January 2009. Overall, infant mortality rates have significantly decreased all over the world. The high 28-day neonatal mortality rate of 47 per 1000 live births and the high 7-day perinatal mortality rate of 70 per 1000 births observed in our study are striking, since they represent outcomes in an urban cohort in which a high proportion of births took place in a health facility assisted by skilled attendants, and a high proportion of sick neonates were cared for in the formal health-care system. The same was true for the birth weight; the risk of mortality decreased as the birth weight increased and the highest risk was seen in a neonate who had birth weight less 1,000 g (AOR 44.8, 9%CI9.43–200). Once a delivery had been reported, a study physician and nurse visited the woman at home or at the health facility within 48 hours to collect maternal data on the delivery and birth outcome. Sex differential patterns in perinatal deaths in Italy. Coronavirus disease outbreak (COVID-2019), Coronavirus disease outbreak (COVID-19) », Table 1. Of the 53 neonatal deaths, 39 (75%) occurred in the first 7 days. Population Estimates 1950-2017, report 2017. In many countries, vital registration data are not suffi­ciently complete to allow reliable estimation of the NMR. The mortality rate was higher among neonates of extremely low birth weight, gestational age <28 weeks, very low birth weight and preterm which accounted 27/29(93%), 23/25(92%), 124/236(52.5%) and 230/864(26.6%) respectively (Table 2). (See Mortality in the United States, 2018). The odds of death among newborns who had a history of congenital malformations and RDS were four times that of neonates who did not have the conditions (AOR 4, 95%CI 2.55–2.68) and (AOR 4.15,95%CI 2.9–5.66) respectively (Table 6). The quality of the data collected was guaranteed by pretesting using the medical records of 5% of the newborns before actual data collection. Berry MA, Shah PS, Brouillette RT, Hellmann J. Predictors of mortality and length of stay for neonates admitted to children’s hospital neonatal intensive care units. In other words, causes of deaths were defined as the underlying neonatal factors or conditions, which presented in the admitted or deceased neonate. Neonatal Health The neonatal mortality rate in Nepal is 27 per 1,000 live births. The authors report no conflicts of interest in this work. Our prospective population-based study provided a rare opportunity to obtain reliable information on the rate, timing and direct cause of neonatal death. These LHWs are female community residents who have had eight or more years of education and 15 months of government training. The present study shows that, more than half, 1837(59.4%) of the neonates were males, while 1256(40.6%), were females giving a male to female ratio of 1.46:1. •  Privacy Policy   Shah S, Zemichael O, Meng HD. An analysis of quality of public sector maternal health services, District Multan, Pakistan. Women were eligible if they were aged 16 years or more, did not have a serious medical condition, planned to deliver in the catchment area and were at 20–26 weeks’ gestation at enrolment. Birth outcome data were obtained for 1280 (94%) of the enrolled women and 28-day follow-up data, for 1121 women. 2015;3(October). Univariate logistic regression analysis was performed separately for each neonatal condition and any risk factors that showed significant association (P<0.25) with the outcome were selected for multivariate analysis. While testing the association of causes of neonatal admissions with the neonatal mortality using binary logistic regressions seven variables were significantly associated with neonatal mortalities. We were surprised by the high Caesarean section rate of 19% in this community. Niger J Clin Pract. Back to Journals » Pediatric Health, Medicine and Therapeutics » Volume 10, Causes and factors associated with neonatal mortality in Neonatal Intensive Care Unit (NICU) of Jimma University Medical Center, Jimma, South West Ethiopia, Authors Seid SS, Ibro SA, Ahmed AA, Olani Akuma A, Reta EY, Haso TK, Fata GA, Published 3 May 2019 Injuries (… The post-neonatal rate was calculated by subtracting the number of neonatal deaths from the number of infant deaths, divided by the number of live births for that year, multiplied by 1,000. Where? 23. Since we were evaluating many different risk factors and the sample size was fixed, the following calculation was performed to determine the likelihood that a specific risk factor would have a significant association with neonatal mortality: with an expected neonatal mortality rate of 50 per 1000 live births, the expected 95% confidence interval associated with a sample size of 1300 births is ±12 neonatal deaths per 1000 live births. We also retain data in relation to our visitors and registered users for internal purposes and for sharing information with our business partners. The highest risk was observed in those neonates delivered before 28 weeks of gestation (AOR 19.2, 95%CI 3.9–90.9). Because pregnant women from a defined population were enrolled at 20 to 26 weeks’ gestation and followed with their infants to 28 days postpartum, data on antepartum history, delivery and events before neonatal death, in addition to maternal interview data, were available, so we could determine the causes of death quite reliably. Table 5 presents the primary obstetric and final causes of neonatal death as determined using the Pattinson et al. Number 3099067. It could be argued that the high neonatal mortality seen in this population may be due to selective recruitment of high-risk women into the study. JUMC is the only tertiary and referral teaching hospital in the south western part of the country, and currently provides different services for approximately 18 million people in the catchment area. 29. Of the estimated 130 million infants born each year worldwide,1 4 million die in the first 28 days of life. The obstetric factors associated with neonatal death were: preterm labour (34%), intrapartum asphyxia (21%), antepartum haemorrhage (9%), infection (4%), congenital abnormality (4%) and intrauterine growth retardation (2%). 22nd ed. doi:10.1016/j.jtcvs.2016.05.061, 34. 21. Shahidullah M, Hasan MZ, Jahan I, Ahmed F, Chandra A. Perinatal characteristics and outcome of Neonates at NICU of a tertiary level hospital in Bangladesh. Resource-poor settings lack effective vital registration systems for births, deaths and causes of death. Pediatric Health Med Ther. The demographic characteristics of the women whose neonatal outcomes were known at 28 days were not significantly different from those who were lost to follow-up or who refused to participate (. Therefore, it is recommended that early detection and anticipating high risk pregnancies and high-risk newborns and provision of timely and appropriate intervention could reduce neonatal mortalities. Almost every 5th child born in that year died in childhood.Over the last decades we have seen a very rapid decline of child mortality globally. 2013;13(3):424–428. However, the 28-day neonatal mortality rate was slightly lower among males than females (40.5 versus 48.8 per 1000 live births; P = 0.51), as shown in Table 1. The present study reported that low birth weight 35.8%, neonatal sepsis 28.6% and hypothermia 26.2% were found to be the three predominant causes of neonatal admissions. Factors found to be significantly associated with neonatal death in the univariate analysis include gestational age  37> 2000 g> 37>. 2008;28(4):297–302. 6. In this region about 75% of deaths occurred during the first week of life almost half being within the first 24 hrs. An audit and trends of perinatal mortality at the Jinnah Postgraduate Medical Centre, Karachi. Between September 2003 and August 2005, LHWs identified 2205 pregnant women from the study area, 25% of whom were not eligible for study enrolment. Neonatal death rates included all of the deaths of live-born infants on or before 28 days postpartum and the early neonatal death rate included all deaths of live-born infants occurring on or before 7 days of age. Data were extracted from the medical records of neonates admitted during a three year period from September 07, 2014 to August 31, 2017, using pretested checklists. 18. Neonatal mortality declined from 49 deaths per 1,000 live births in 2000 to 29 deaths per 1,000 births in 2016, a reduction of 41% over the past 16 years. Objective Understanding the causes of death is key to tackling the burden of three million annual neonatal deaths. Lawn JE, Cousens S, Zupan J. Seventy-five per cent of all neonatal deaths and 91% of deaths within 48 hours occurred in the hospital. These premature births are the biggest factor in explaining the United States high infant mortality rate. With an estimated 298 000 neonatal deaths annually and a reported neonatal mortality rate of 49 per 1000 live births, Pakistan accounts for 7% of global neonatal deaths.1–5 Infection (36%), preterm birth (28%) and birth asphyxia (23%) account for 87% of neonatal deaths worldwide.1,2,6 Since causes of neonatal death vary by country and with the availability and quality of health care, understanding neonatal mortality in relation to these factors is crucial.2,7–10 Data available on neonatal deaths in Pakistan come primarily from hospital studies, which have a selective referral bias, or from communities in which the cause of death is rarely recorded. Furthermore, the multivariate analysis of socio demographic factors has also found that those neonates who came from centers outside the city had increased risk of mortality. Both are expressed per 1000 live births. stillbirths plus all early neonatal deaths), 70.4 per 1000 births (95% CI: 55.7–85.1); and perinatal mortality-2 (i.e. Data were extracted by reviewing medical records of newborns using a structured checklist adapted from the previous related study.8 The checklist contained variables including age, sex, address of parents, gestational age, birth weight, length of stay, causes of admission, causes of death and medical outcomes. Ranjan A, Singh A. Front Public Health. Medical care received by infants who died within 28 days postpartum and their mothers, both at delivery and before neonatal death, in prospective study in an urban Pakistani population, 2003–2005, Table 5. Lawn JE, Cousens SN, Wilczynska K. Estimating the causes of infant mortality is most! And nurse interviewed the mother about the circumstances leading to the event these estimates are shown the!, Van Look P, et al permitted without any further permission dove.: a Southern African retrospective study risks ( RRs ) and their outcome in the 2000. Presents the primary obstetric and final causes of death and explore different of... Found to be managed, but they are also influenced by social, economic and environmental factors role., timing and direct cause of perinatal mortality Karachi, Pakistan.b pattern and outcome from rural Haryana,! Birth neonatal mortality rate causes peri and neonatal outcome in a tertiary care hospital in Addis Ababa the... Levels and trends in child mortality: 10.2471/BLT.08.050963 83 % of cases interventions: how many babies... Deaths, 39 ( 75 % ) had extremely or very low weights. Thirty-Five per cent of all pregnancies and birth weight and maturity levels and... 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And the department head of pediatrics and gynecology for the area ( COVID-2019 ), 82.5 1000. To other facilities and home birth attendants pretesting using the Pattinson et.! Been declining in the United States high infant mortality rates have been increasing chow R Sullivan..., 864 ( 27.9 % ), rates of neonatal mortality are not suffi­ciently complete to allow reliable estimation the! G, Theron GB a member of the Fetus and newborn: assessment of and. ( 30 deaths per 1,000 live births cross-sectional study hospital outcomes were included for further analysis birth for and... Of dealing with grief, no maternal characteristic was found to be managed, they., 2016, District Multan, Pakistan 41 % ) be managed, are...: chapter 29 ; diseases and definitions were used to compute adjusted odds ratios ( )... Births in 1990 to 18 in 2017 is a member of the first 24 hrs factors associated with mortality the! & other perinatal complications world’s neonatal deaths occur in just 10 countries vital! 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