Article

Neonatal Death in Low- to Middle-Income Countries: A Global Network Study

Institute for Clinical Effectiveness, Buenos Aires, Argentina.
American Journal of Perinatology (Impact Factor: 1.6). 05/2012; 29(8):649-56. DOI: 10.1055/s-0032-1314885
Source: PubMed

ABSTRACT To determine population-based neonatal mortality rates in low- and middle-income countries and to examine gestational age, birth weight, and timing of death to assess the potentially preventable neonatal deaths.
A prospective observational study was conducted in communities in five low-income countries (Kenya, Zambia, Guatemala, India, and Pakistan) and one middle-income country (Argentina). Over a 2-year period, all pregnant women in the study communities were enrolled by trained study staff and their infants followed to 28 days of age.
Between October 2009 and March 2011, 153,728 babies were delivered and followed through day 28. Neonatal death rates ranged from 41 per 1000 births in Pakistan to 8 per 1000 in Argentina; 54% of the neonatal deaths were >37 weeks and 46% weighed 2500 g or more. Half the deaths occurred within 24 hours of delivery.
In our population-based low- and middle-income country registries, the majority of neonatal deaths occurred in babies >37 weeks' gestation and almost half weighed at least 2500 g. Most deaths occurred shortly after birth. With access to better medical care and hospitalization, especially in the intrapartum and early neonatal period, many of these neonatal deaths might be prevented.

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    • "The most recent systematic evaluation of direct causes of neonatal deaths estimated that in 2010, the major causes of neonatal deaths globally were direct complications from preterm birth (35%), intrapartum-related events (often previously referred to as birth asphyxia) (23%), with infections, including sepsis, pneumonia, diarrhoea , meningitis and tetanus, responsible for a combined 27% of neonatal deaths (Liu et al. 2012) (Figure 2). The role of preterm birth is even greater than suggested by this figure because preterm birth is not only a direct cause of death, but also an important contributory factor to deaths due to other causes such that over half of all neonatal deaths globally occur in preterm babies (Belizan et al. 2012). Recent initiatives have therefore sought to highlight the importance of preterm birth and to promote "
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    ABSTRACT: Reducing neonatal mortality remains a challenge with an estimated 3.0 million neonatal deaths in 2011, three-quarters of these in sub-Saharan Africa and Southern Asia. The leading causes of neonatal death globally are complications of preterm birth, intrapartum-related causes and infections. While post-neonatal, under-5 deaths fell by 47% between 1990 and 2011, neonatal deaths only fell by 32% and they now account for 43% of all under-5 child deaths. This article reviews the progress in reducing neonatal deaths in high-burden countries and presents an overview of known effective interventions to reduce neonatal mortality and the challenges faced in implementing these in high-burden settings. Effective action is possible to reduce neonatal mortality, but innovative approaches to implementation will be required if these preventable deaths are to be avoided. La réduction de la mortalité néonatale reste un défi, avec une estimation de 3,0 millions de décès néonatals en 2011, les trois quarts de ceux-ci survenant en Afrique subsaharienne et en Asie du sud. Les principales causes des décès néonataux sont globalement les suivantes: complications des naissances prématurées, causes de l'intrapartum et les infections associées. Alors que les décès post-néonataux, des moins de 5 ans ont diminué de 47% entre 1990 et 2011, les décès néonataux n'ont baissé que de 32% et représentent désormais 43% de tous les décès d'enfants de moins de 5 ans. Cet article passe en revue les progrès réalisés dans la réduction de la mortalité néonatale dans les pays fortement touchés et donne un aperçu des interventions efficaces connues pour réduire la mortalité néonatale et les défis rencontrés dans l'implémentation de celles-ci dans les milieux fortement touchés. Une action efficace pour réduire la mortalité néonatale est possible, mais des approches innovantes pour l'implémentation restent nécessaires si ces décès évitables sont à éviter. Reducir la mortalidad neonatal continúa siendo un reto con aproximadamente 3.0 millones de muertes neonatales acontecidas en el 2011 y tres cuartas partes de ellas sucediendo en África subsahariana y el sudeste asiático. Las principales causas de muerte neonatal a nivel global son: complicaciones por un nacimiento prematuro, causas relacionadas con el parto e infecciones. Mientras que las muertes post-neonatales de menores de 5 años disminuyeron en un 47% entre 1990 y 2011, las muertes neonatales solo disminuyeron en un 32% y ahora son responsables de un 43% de todas las muertes de menores de 5 años. En este artículo se hace una revisión del progreso en la reducción de las muertes en países con una alta carga y presenta una visión general de las intervenciones efectivas conocidas para reducir la mortalidad neonatal así como de los retos a los que hay que enfrentarse para implementarlos en emplazamientos con una alta incidencia. Las acciones efectivas pueden reducir la mortalidad neonatal, pero se requieren aproximaciones innovadoras a la hora de implementarlas si se quiere evitar estas muertes prevenibles.
    Tropical Medicine & International Health 01/2013; 18(3). DOI:10.1111/tmi.12048 · 2.30 Impact Factor
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    • "The World Health Organization estimates that 4 million children under 1 month of age die each year [1,2] and more than 90% of these deaths occur in developing countries [3,4]. Neonatal mortality rates have remained high despite a decline of infant mortality rates [5]. "
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    ABSTRACT: Background While child mortality is declining in Africa there has been no evidence of a comparable reduction in neonatal mortality. The quality of inpatient neonatal care is likely a contributing factor but data from resource limited settings are few. The objective of this study was to assess the quality of neonatal care in the district hospitals of the Kilimanjaro region of Tanzania. Methods Clinical records were reviewed for ill or premature neonates admitted to 13 inpatient health facilities in the Kilimanjaro region; staffing and equipment levels were also assessed. Results Among the 82 neonates reviewed, key health information was missing from a substantial proportion of records: on maternal antenatal cards, blood group was recorded for 52 (63.4%) mothers, Rhesus (Rh) factor for 39 (47.6%), VDRL for 59 (71.9%) and HIV status for 77 (93.1%). From neonatal clinical records, heart rate was recorded for3 (3.7%) neonates, respiratory rate in 14, (17.1%) and temperature in 33 (40.2%). None of 13 facilities had a functioning premature unit despite calculated gestational age <36 weeks in 45.6% of evaluated neonates. Intravenous fluids and oxygen were available in 9 out of 13 of facilities, while antibiotics and essential basic equipment were available in more than two thirds. Medication dosing errors were common; under-dosage for ampicillin, gentamicin and cloxacillin was found in 44.0%, 37.9% and 50% of cases, respectively, while over-dosage was found in 20.0%, 24.2% and 19.9%, respectively. Physician or assistant physician staffing levels by the WHO indicator levels (WISN) were generally low. Conclusion Key aspects of neonatal care were found to be poorly documented or incorrectly implemented in this appraisal of neonatal care in Kilimanjaro. Efforts towards quality assurance and enhanced motivation of staff may improve outcomes for this vulnerable group.
    BMC Pediatrics 11/2012; 12(1):182. DOI:10.1186/1471-2431-12-182 · 1.92 Impact Factor
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    • "These interventions include the Global Network Emergency Obstetric and Neonatal Care (EmONC) study [1]. Birth weights of all newborns therefore need to be obtained and documented [2,4]. In the initial phase of the study, actual rather than estimated newborn weights had been obtained in only 30% of Kenyan births, nearly all from those infants born in health facilities where weighing scales are available. "
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    ABSTRACT: Identifying every pregnancy, regardless of home or health facility delivery, is crucial to accurately estimating maternal and neonatal mortality. Furthermore, obtaining birth weights and other anthropometric measurements in rural settings in resource limited countries is a difficult challenge. Unfortunately for the majority of infants born outside of a health care facility, pregnancies are often not recorded and birth weights are not accurately known. Data from the initial 6 months of the Maternal and Neonatal Health (MNH) Registry Study of the Global Network for Women and Children's Health study area in Kenya revealed that up to 70% of newborns did not have exact weights measured and recorded by the end of the first week of life; nearly all of these infants were born outside health facilities. To more completely obtain accurate birth weights for all infants, regardless of delivery site, village elders were engaged to assist in case finding for pregnancies and births. All elders were provided with weighing scales and mobile phones as tools to assist in subject enrollment and data recording. Subjects were instructed to bring the newborn infant to the home of the elder as soon as possible after birth for weight measurement.The proportion of pregnancies identified before delivery and the proportion of births with weights measured were compared before and after provision of weighing scales and mobile phones to village elders. Primary outcomes were the percent of infants with a measured birth weight (recorded within 7 days of birth) and the percent of women enrolled before delivery. The recorded birth weight increased from 43 ± 5.7% to 97 ± 1.1. The birth weight distributions between infants born and weighed in a health facility and those born at home and weighed by village elders were similar. In addition, a significant increase in the percent of subjects enrolled before delivery was found. Pregnancy case finding and acquisition of birth weight information can be successfully shifted to the community level.
    BMC Pregnancy and Childbirth 03/2012; 12:15. DOI:10.1186/1471-2393-12-15 · 2.15 Impact Factor
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