Globally 7.6 million children died in 2010 before reaching their fifth birthday and 40% of these deaths occur in the neonatal period. Pakistan has the third highest rate of neonatal mortality globally. To implement evidence-based interventions for the reduction of neonatal mortality, it is important to investigate factors associated with neonatal mortality. The aim of the current study was to identify determinants of neonatal mortality in Pakistan. Data was derived from the Pakistan Demographic and Health Survey 2006–07. All singleton live births between 2002 and 2006 were selected for the current analyses. Data was analysed by using STATA 13 and adjusted for the cluster sampling design. Multivariate Cox proportional hazard models were performed using step-wise backward elimination procedures to identify the determinants of neonatal mortality. A total of 5,702 singleton live births in the last five years preceding the survey were selected. Multivariate analyses showed that living in Punjab province (Adj HR = 2.10, p = 0.015), belonging to the poorest household wealth index quintile (Adj HR = 1.95, p = 0.035), male infants (Adj HR = 1.57, p = 0.014), first rank baby (Adj HR = 1.59, p = 0.049), smaller than average birth size (Adj HR = 1.61, p = 0.023) and mothers with delivery complications (Adj HR = 1.93, p = 0.001) had significantly higher hazards of neonatal death in Pakistan. To reduce neonatal mortality, there is a need to implement interventions focusing on antenatal care, effective referral system and retraining of healthcare providers to manage delivery complications and smaller than average birth size babies in resource poor communities of Pakistan.

/pdf/determinants-of-neonatal-mortality-in-pakistan-secondary-1zyj8ontla.pdf

Determinants of neonatal mortality in Pakistan: secondary analysis of Pakistan Demographic and Health Survey 2006–07

Objective The aim of this study was to identify factors associated with mortality in children under 5 years of age using a nationally representative sample of singleton births for the period of 2004–2011. Design, setting and participants Pooled 2004, 2007 and 2011 cross-sectional data sets of the Bangladesh Demographic and Health Surveys were analysed. The surveys used a stratified two-stage cluster sample of 16 722 singleton live-born infants of the most recent birth of a mother within a 3-year period. Main outcome measures Outcome measures were neonatal mortality (0–30 days), postneonatal mortality (1–11 months), infant mortality (0–11 months), child mortality (1–4 years) and under-5 mortality (0–4 years). Results Survival information for 16 722 singleton live-born infants and 522 deaths of children Conclusions Our study suggests that family planning is needed to further reduce the overall rate of under-5 deaths in Bangladesh. To reduce childhood mortality, public health interventions that focus on child spacing and contraceptive use by mothers may be most effective.

https://bmjopen.bmj.com/content/bmjopen/5/8/e006722.full.pdf

Risk factors for under-5 mortality: evidence from Bangladesh Demographic and Health Survey, 2004–2011

OBJECTIVE: To analyze neonatal mortality determinants using multilevel logistic regression and classic hierarchical models. METHODS: Cohort study including 138,407 live births with birth certi ﬁ cates and 1,134 neonatal deaths recorded in 2003, in the state of Rio Grande do Sul, Southern Brazil. The Information System on Live Births and mortality records were linked for gathering information on individual-level exposures. Sociodemographic data and information on the pregnancy, childbirth care and characteristics of the children at birth were collected. The associated factors were estimated and compared by traditional and multilevel logistic regression analysis. RESULTS: The neonatal mortality rate was 8.19 deaths per 1,000 live births. Low birth weight, 1- and 5-minute Apgar score below eight, congenital malformation, pre-term birth and previous fetal loss were associated with neonatal death in the traditional model. Elective cesarean section had a protective effect. Previous fetal loss did not remain signi ﬁ cant in the multilevel model, but the inclusion of a contextual variable (poverty rate) showed that 15% of neonatal mortality variation can be explained by varying poverty rates in the microregions.

/pdf/determinantes-contextuais-da-mortalidade-neonatal-no-rio-4nqg8g9pk1.pdf

Determinantes contextuais da mortalidade neonatal no Rio Grande do Sul por dois modelos de análise Contextual determinants of neonatal mortality using two analysis methods, Rio Grande do Sul, Brazil

Objective: analyze maternal perception about experiencing and learning to care for premature baby. Methodology:
qualitative research with 21 mothers at an ambulatory of neonatology of a General Hospital of Unified Health System-SUS in
Fortaleza. The data was collected through interviews and forms, analyzed by Thematic Content Analysis Technique and descriptive
statistics. Results: the experience of the mothers is marked by the trauma of premature birth. Conflicts and suffering
resulting from the lack of a “user embracement” and perinatal social support for these women. Absence of systematization
of reception and empowerment of mothers in their children’s care when admitted at the NICU opposing the humanized care
provided at the Kangaroo ward as well as difficulty in accessing specialized clinic after discharge. Conclusion: the need for
greater organization of mother and child assistance with incorporation of comprehensive and humanized care for family
and health professionals.

https://www.arca.fiocruz.br/bitstream/icict/2780/1/v20n1a04.pdf

A percepção materna sobre vivência e aprendizado de cuidado de um bebê prematuro

This study aims to investigate the effect of maternal education on neonatal mortality in Bangladesh using data from the nationally representative 2007 Bangladesh Demographic and Health Survey. Both bivariate and multivariate statistical analyses were used to assess the relationship between neonatal mortality and contextual factors focusing on maternal education. The prevalence of neonatal mortality was 37/1,000. The statistical analyses yielded quantitatively important and reliable estimates of neonatal death. The sequential multivariate logistic regression analyses yielded strong significant negative association between maternal education and neonatal mortality. Maternal age, religion, birth order and antenatal care seeking are also important determinants of neonatal death. Programmes should be undertaken to improve female education in Bangladesh for a better chance of satisfying important factors that can improve infant survival, such as the quality of infant feeding, household sanitation and adequate u...

Maternal Education as a Determinant of Neonatal Mortality in Bangladesh

INTRODUCTION: Child Mortality (mortality of children less than five years) has declined considerably in the developing world in the 1990s, but the Infant Mortality has declined less. Therefore, to further reduce child mortality it is important to understand the determinants of neonatal and post-neonatal mortality. MATERIAL AND METHODS: We probabilistically matched 209628 live births and 3842 infant death records from the City of Sao Paulo, birth cohort of 1998. Data came from SINASC and SIM. We then used logistic regression to analyze the following risk factors of neonatal and post-neonatal mortality: birth weight, gestational age, Apgar scores at 1 and 5 minutes, delivery mode, plurality, sex, maternal education, maternal age, number of prior losses, prenatal care, race, parity and community development. RESULTS AND CONCLUSION: Infants of older mothers were less likely to die in the neonatal period; infants of adolescent mothers were more likely to die in both periods. Parities four or higher increased the likelihood of post-neonatal death. Cesarean delivery was not found to be associated with infant mortality. Low number of prenatal care visits, low birth weight, preterm birth and low Apgar scores were associated with neonatal death; Low number of prenatal care visits, low birth weight, and low Apgar scores were associated with post-neonatal death. Finally, having a mother live in a highest developed community decreased the likelihood of infant death, suggesting that unmeasured factors are behind such association.

/pdf/determinantes-da-mortalidade-neonatal-e-pos-neonatal-no-3z41ollfkk.pdf

Determinantes da mortalidade neonatal e pós-neonatal no Município de São Paulo

Introduction:Introduction: Child Mortality (mortality ofchildren less than five years) has declinedconsiderably in the developing world in the1990s, but the Infant Mortality has declinedless. Therefore, to further reduce childmortality it is important to understand thedeterminants of neonatal and post-neonatalmortality. Material and Methods: WeMaterial and Methods:probabilistically matched 209628 live birthsand 3842 infant death records from the Cityof Sao Paulo, birth cohort of 1998. Data camefrom SINASC and SIM. We then used logisticregression to analyze the following riskfactors of neonatal and post-neonatalmortality: birth weight, gestational age, Apgarscores at 1 and 5 minutes, delivery mode,plurality, sex, maternal education, maternalage, number of prior losses, prenatal care,race, parity and community development.Results and Conclusion:Results and Conclusion: Infants of oldermothers were less likely to die in the neonatalperiod; infants of adolescent mothers weremore likely to die in both periods. Paritiesfour or higher increased the likelihood ofpost-neonatal death. Cesarean delivery wasnot found to be associated with infantmortality. Low number of prenatal care visits,low birth weight, preterm birth and lowApgar scores were associated with neonataldeath; Low number of prenatal care visits,low birth weight, and low Apgar scores wereassociated with post-neonatal death. Finally,having a mother live in a highest developedcommunity decreased the likelihood ofinfant death, suggesting that unmeasuredfactors are behind such association.Key words: Neonatal mortality. Post-neonatal mortality. City of Sao Paulo. Riskfactors

Determinantes da mortalidade neonatal e pós-neonatal no Município de São Paulo* Determinants of neonatal and post- neonatal mortality in the City of São Paulo

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Determinantes da mortalidade neonatal e pós-neonatal no Município de São Paulo

Determinantes da mortalidade neonatal e pós-neonatal no Município de São Paulo* Determinants of neonatal and post- neonatal mortality in the City of São Paulo