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Silva ABDS, Costa LS, de Frias PG, Araújo ACDM, do Bonfim CV. Temporal analysis of mortality from preventable causes in the first 24 hours of life, 2000-2021. Rev Lat Am Enfermagem 2023; 31:e4079. [PMID: 38055593 PMCID: PMC10695294 DOI: 10.1590/1518-8345.6696.4079] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/06/2023] [Accepted: 09/06/2023] [Indexed: 12/08/2023] Open
Abstract
OBJECTIVE to analyze the temporal pattern and estimate mortality rates in the first 24 hours of life and from preventable causes in the state of Pernambuco from 2000 to 2021. METHOD an ecological study, using the quarter as the unit of analysis. The data source was made up of the Mortality Information System and the Live Birth Information System. The time series modeling was conducted according to the Autoregressive Integrated Moving Average Model. RESULTS 14,462 deaths were recorded in the first 24 hours of life, 11,110 (76.8%) of which being preventable. It is observed from the forecasts that the mortality rate in the first 24 hours of life ranged from 3.3 to 2.4 per 1,000 live births, and the mortality rate from preventable causes ranged from 2.3 to 1.8 per 1,000 live births. CONCLUSION the prediction suggested progress in reducing mortality in the first 24 hours of life in the state and from preventable causes. The ARIMA models presented satisfactory estimates for mortality rates and preventable causes in the first 24 hours of life.
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Affiliation(s)
- Aline Beatriz dos Santos Silva
- Universidade Federal de Pernambuco, Recife, PE, Brasil
- Instituto Aggeu Magalhães-Fiocruz, Recife, PE, Brasil
- Becaria de la Coordenação de Aperfeiçoamento de Pessoal de Nível Superior (CAPES), Brasil
| | | | | | - Ana Catarina de Melo Araújo
- Secretaria Estadual de Saúde de Pernambuco, Superintendência de Imunizações e Doenças Imunopreveníveis, Recife, PE, Brasil
| | - Cristine Vieira do Bonfim
- Universidade Federal de Pernambuco, Recife, PE, Brasil
- Fundação Joaquim Nabuco, Diretoria de Pesquisas Sociais, Recife, PE, Brasil
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Kale PL, Fonseca SC. Intrauterine growth restriction, prematurity, and low birth weight: risk phenotypes of neonatal death, Rio de Janeiro State, Brazil. CAD SAUDE PUBLICA 2023; 39:e00231022. [PMID: 37377302 PMCID: PMC10547104 DOI: 10.1590/0102-311xpt231022] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/03/2022] [Revised: 02/27/2023] [Accepted: 03/23/2023] [Indexed: 06/29/2023] Open
Abstract
Intrauterine growth restriction and prematurity determine low birth weight. The combination of the three conditions results in different neonatal phenotypes that interfere with child survival. Neonatal prevalence, survival and mortality were estimated according to neonatal phenotypes in the cohort of live births in 2021 in the state of Rio de Janeiro, Brazil. In this study, live births of multiple pregnancies, with congenital anomalies and inconsistencies in the information of weight and gestational age were excluded. The Intergrowth curve was used to classify weight adequacy. Mortality (< 24 hours, 1-6 and 7-27 days) and survival (Kaplan-Meier) were estimated. In total, 6.8%, 5.5%, and 9.5% of the 174,399 live births were low birth weight, small for gestational age (SGA), and premature, respectively. Considering low birth weight live births, 39.7% were SGA and 70% were premature. The neonatal phenotypes were heterogeneous according to maternal, delivery, pregnancy, and newborn characteristics. The mortality rate per 1,000 live births was high for low birth weight premature newborns, both SGA (78.1) and AGA (adequate for gestational age: 61.1), at all specific ages. Reductions in the survival rate were observed when comparing non-low birth weight and AGA term live births. The estimated prevalence values were lower than those of other studies, partly due to the exclusion criteria adopted. The neonatal phenotypes identified children who were more vulnerable and at higher risk of death. Prematurity contributed more to mortality than SGA, and its prevention is necessary to reduce neonatal mortality in the state of Rio de Janeiro.
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Affiliation(s)
- Pauline Lorena Kale
- Instituto de Estudos de Saúde Coletiva, Universidade Federal do Rio de Janeiro, Rio de Janeiro, Brasil
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3
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Pejovic NJ. Cost-effective interventions to save Africa's most vulnerable infants. Acta Paediatr 2022; 111:211-212. [PMID: 34928498 DOI: 10.1111/apa.16204] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 09/08/2021] [Revised: 11/25/2021] [Accepted: 11/29/2021] [Indexed: 11/28/2022]
Affiliation(s)
- Nicolas J. Pejovic
- Department of Global Public Health Karolinska Institutet Stockholm Sweden
- Department of Neonatology Sachs’ Children and Youth Hospital Stockholm Sweden
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Belsti Y, Nigussie ZM, Tsegaye GW. Derivation and Validation of a Risk Score to Predict Mortality of Early Neonates at Neonatal Intensive Care Unit: The END in NICU Score. Int J Gen Med 2021; 14:8121-8134. [PMID: 34795517 PMCID: PMC8594787 DOI: 10.2147/ijgm.s336888] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/24/2021] [Accepted: 11/02/2021] [Indexed: 12/17/2022] Open
Abstract
BACKGROUND Early neonatal death is death of infants in the first week of life. And 34% to 92% of neonatal deaths happen within 7 days of postnatal period. Thus, the early neonatal period is the most critical time for an infant, requiring different strategies to prevent mortality. Among strategies, deriving and implementing early warning scores is crucial to predict early neonatal mortality earlier upon hospital admission. OBJECTIVE To derive and validate a risk score to predict mortality of early neonates at Felege Hiwot Specialized Hospital neonatal intensive care unit, Bahir Dar, 2021. METHODS The document review was conducted from February 24, to April 08, 2021, on all early neonates admitted to neonatal intensive care unit from January 1, 2018 to December 31, 2020. The total number of early neonates included in the derivation study was 1100. Data were collected by using checklists prepared on EpiCollect5 software. After exporting the data to R version 4.0.5 software, variables with (p < 0.25) from the simple binary regression were entered into a multiple logistic regression model, and significant variables (p < 0.05) were kept in the model. The discrimination and calibration were assessed. The model was internally validated using bootstrapping technique. RESULTS Admission weight, birth Apgar score, perinatal asphyxia, respiratory distress syndrome, mode of delivery, sepsis, and gestational age at birth remained in the final multiple logistic regression prediction model. The area under curve of receiver operating characteristic curve for early neonatal mortality score was 90.7%. The model retained excellent discrimination under internal validation. The sensitivity, specificity, and positive predictive value, negative predictive value of the model was 89.4%, 82.5%, 55.5%, and 96.9%, respectively. CONCLUSION The derived score has an excellent discriminative ability and good prediction performance. This is an important tool for predicting early neonatal mortality in neonatal intensive care units at admission.
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Affiliation(s)
- Yitayeh Belsti
- Department of Physiology, School of Medicine, College of Medicine and Health Science, University of Gondar, Gondar, Ethiopia
| | - Zelalem Mehari Nigussie
- Department of Epidemiology and Biostatistics, School of Public Health, College of Medicine and Health Science, Bahir Dar University, Bahir Dar, Ethiopia
| | - Gebeyaw Wudie Tsegaye
- Department of Epidemiology and Biostatistics, School of Public Health, College of Medicine and Health Science, Bahir Dar University, Bahir Dar, Ethiopia
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Bezerra IMP, Ramos JLS, Pianissola MC, Adami F, da Rocha JBF, Ribeiro MAL, de Castro MR, Bezerra JDF, Smiderle FRN, Sousa LVDA, Siqueira CE, de Abreu LC. Perinatal Mortality Analysis in Espírito Santo, Brazil, 2008 to 2017. Int J Environ Res Public Health 2021; 18:11671. [PMID: 34770185 PMCID: PMC8583128 DOI: 10.3390/ijerph182111671] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 09/01/2021] [Revised: 10/26/2021] [Accepted: 11/02/2021] [Indexed: 12/17/2022]
Abstract
This is an ecological and time-series study using secondary data on perinatal mortality and its components from 2008 to 2017 in Espírito Santo, Brazil. The data were collected from the Mortality Information System (SIM) and Live Births Information System (SINASC) of the Unified Health System Informatics Department (DATASUS) in June 2019. The perinatal mortality rate (×1000 total births) was calculated. Time series were constructed from the perinatal mortality rate for the regions and Espírito Santo. To analyze the trend, the Prais-Winsten model was used. From 2008 to 2017 there were 8132 perinatal deaths (4939 fetal and 3193 early neonatal) out of a total of 542,802 births, a perinatal mortality rate of 15.0/1000 total births. The fetal/early neonatal ratio was 1.5:1, with a strong positive correlation early neonatal mortality rate, perinatal mortality rate, r (9) = 0.8893, with a significance level of p = 0.000574. The presence of differences in trends by health region was observed. Risk factors that stood out were as follows: mother's age ranging between 10 and 19 or 40 and 49 years old, with no education, a gestational age between 22 and 36 weeks, triple and double pregnancy, and a birth weight below 2499 g. Among the causes of death, 49.70% of deaths were concentrated in category of the tenth edition of the International Classification of Diseases, fetuses and newborns affected by maternal factors and complications of pregnancy, labor, and delivery (P00-P04), and 11.03% were in the category of intrauterine hypoxia and birth asphyxia (P20-P21), both related to proper care during pregnancy and childbirth. We observed a slow reduction in the perinatal mortality rate in the state of Espírito Santo from 2008 to 2017.
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Affiliation(s)
- Italla Maria Pinheiro Bezerra
- Departamento de Pós-Graduação em Políticas Públicas e Desenvolvimento Local, Escola Superior de Ciências da Santa Casa de Misericórdia de Vitória (EMESCAM), Vitória 29027502, Brazil
- Departamento de Enfermagem, Laboratório de Escrita Científica, Escola Superior de Ciências da Santa Casa de Misericórdia de Vitória (EMESCAM), Vitória 29027502, Brazil; (J.L.S.R.); (M.C.P.); (F.R.N.S.)
| | - José Lucas Souza Ramos
- Departamento de Enfermagem, Laboratório de Escrita Científica, Escola Superior de Ciências da Santa Casa de Misericórdia de Vitória (EMESCAM), Vitória 29027502, Brazil; (J.L.S.R.); (M.C.P.); (F.R.N.S.)
| | - Micael Colodetti Pianissola
- Departamento de Enfermagem, Laboratório de Escrita Científica, Escola Superior de Ciências da Santa Casa de Misericórdia de Vitória (EMESCAM), Vitória 29027502, Brazil; (J.L.S.R.); (M.C.P.); (F.R.N.S.)
| | - Fernando Adami
- Laboratório de Epidemiologia do Centro Universitário ABC (FMABC), Santo André 09060590, Brazil;
| | - João Batista Francalino da Rocha
- Ciências da Saúde no Centro Universitário ABC (FMABC), Santo André 09060870, Brazil; (J.B.F.d.R.); (M.A.L.R.)
- Centro de Ciências da Saúde e do Desporto (CCSD), Universidade Federal do Acre (UFAC), Rio Branco 69920900, Brazil
| | - Mariane Albuquerque Lima Ribeiro
- Ciências da Saúde no Centro Universitário ABC (FMABC), Santo André 09060870, Brazil; (J.B.F.d.R.); (M.A.L.R.)
- Centro de Ciências da Saúde e do Desporto (CCSD), Universidade Federal do Acre (UFAC), Rio Branco 69920900, Brazil
| | - Magda Ribeiro de Castro
- Departamento de Enfermagem da Universidade Federal do Espírito Santo (UFES), Vitória 29075910, Brazil;
| | - Juliana da Fonsêca Bezerra
- Departamento de Enfermagem Materno Infantil (DEMI) da Universidade Federal do Rio de Janeiro (UFRJ), Rio de Janeiro 21941901, Brazil;
| | - Fabiana Rosa Neves Smiderle
- Departamento de Enfermagem, Laboratório de Escrita Científica, Escola Superior de Ciências da Santa Casa de Misericórdia de Vitória (EMESCAM), Vitória 29027502, Brazil; (J.L.S.R.); (M.C.P.); (F.R.N.S.)
| | | | - Carlos Eduardo Siqueira
- Environment and Public Health, School for the Environment, Transnational Brazilian Project, The Mauricio Gastón Institute for Latino Community Development and Public Policy, UMass Boston, Boston, MA 02125, USA;
| | - Luiz Carlos de Abreu
- Departamento de Educação Integrada em Saúde na Universidade Federal do Espírito Santo (UFES), Vitória 29027502, Brazil;
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Berglundh S, Benova L, Olisaekee G, Hanson C. Caesarean section rate in Nigeria between 2013 and 2018 by obstetric risk and socio-economic status. Trop Med Int Health 2021; 26:775-788. [PMID: 33780090 DOI: 10.1111/tmi.13579] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/27/2022]
Abstract
OBJECTIVES Caesarean section (CS) can be life-saving for both mother and child, but in Nigeria the CS rate remains low, at 2.7% of births. We aimed to estimate the rate of CS and early neonatal mortality in Nigeria according to obstetric risk and socio-economic background and to identify factors associated with CS. METHODS We used the 2018 Nigeria Demographic and Health Survey, encompassing 33 924 live births within the last 5 years, to estimate the CS rate and early neonatal mortality rate (ENMR) by obstetric risk group, informed by the Robson classification. The CS rate and ENMR were assessed within each Robson group and stratified by socio-economic background. Logistic regression analyses were used to explore determinants of CS. RESULTS Almost three-quarters (72.4%) of all births were to multiparous women, with a singleton baby of normal birthweight, thus a low-risk group similar to Robson 3, and with a CS rate of 1.0%. CS rates in the two high-risk groups (multiple pregnancy and preterm/low birthweight) were low, 7.1% (95% CI: 5.2-9.7) and 1.8 % (95% CI: 1.4-2.4), respectively. The ENMR was particularly high for multiple pregnancy (175 per 1000 live births; 95% CI: 131-230). Greater number of antenatal visits, unwanted pregnancy, multiple pregnancy, household wealth, maternal education, Christians/Others versus Muslims and referral during childbirth were positively associated with CS. CONCLUSION Inequitable access to CS is not limited to socio-economic determinants, but also related to obstetric risk factors, calling for increased efforts to improve access to CS for high-risk pregnancies.
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Affiliation(s)
- Sofia Berglundh
- Department of Global Public Health, Karolinska Institutet, Stockholm, Sweden
| | - Lenka Benova
- Institute of Tropical Medicine, Antwerp, Belgium.,London School of Hygiene and Tropical Medicine, London, UK
| | | | - Claudia Hanson
- Department of Global Public Health, Karolinska Institutet, Stockholm, Sweden.,London School of Hygiene and Tropical Medicine, London, UK
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Abstract
Intrauterine infections - infectious diseases in which infection of the fetus occurred in the ante- or intrapartum period, accompanied by clinical manifestations. The purpose of this study was to study the information content and diagnostic significance of the microbiological research method for the etiological diagnosis of intrauterine infections of a bacterial nature. A retrospective (2011-2014) and prospective (2015-2019) analysis of the results of microbiological studies of biomaterials from puerperas and their newborns was carried out in 63 cases of early neonatal mortality with established diagnoses of intrauterine infections. In the study of the separated cervical canal, placenta samples, and amniotic fluid, seeding of coagulase-negative staphylococci was most frequently observed, among which the species Staphylococcus epidermidis dominated, Staphylococcus hominis, Staphylococcus haemolyticus, Staphylococcus warneri also met. Frequent isolation of group B streptococci from the placenta and amniotic fluid was revealed in comparison with the material from the cervical canal.The information content of the microbiological study of materials from the puerpera and the newborn in terms of confirmation of the pathogen and the fact of its transmission from mother to fetus/newborn does not exceed 30%. Even with high contamination of the genital tract of the puerpera, placenta or amniotic fluid, examination of the materials from the newborn immediately after birth often does not allow to identify the causative agent, probably due to the low degree of contamination at the initial stage of development of the infectious process. An increase in the diagnostic value of microbiological research can be facilitated by an increase in the frequency of examinations, the number of samples taken; the use of techniques to increase the sensitivity of cultural research at the stage of analysis; the use of molecular genetic methods, especially in the study of materials from newborns.
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Affiliation(s)
- Elena Vitalevna Naumkina
- Federal State Budgetary Educational Institution of Higher Education «Omsk State Medical University».,Budgetary Healthcare Institution of the Omsk Region «City Clinical Perinatal Center»
| | - L V Kuklina
- Federal State Budgetary Educational Institution of Higher Education «Omsk State Medical University»
| | - E N Kravchenko
- Federal State Budgetary Educational Institution of Higher Education «Omsk State Medical University»
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Manjavidze T, Rylander C, Skjeldestad FE, Kazakhashvili N, Anda EE. Unattended Pregnancies and Perinatal Mortality in Georgia. Risk Manag Healthc Policy 2020; 13:313-321. [PMID: 32346317 PMCID: PMC7169472 DOI: 10.2147/rmhp.s243207] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/20/2019] [Accepted: 03/07/2020] [Indexed: 11/23/2022] Open
Abstract
Introduction The majority of pregnant women in Georgia attend the free-of-charge, national antenatal care (ANC) programme, but over 5% of pregnancies in the country are unattended. Moreover, Georgia has one of the highest perinatal mortality (PM) rates in Europe (11.7/1000 births). Purpose To assess the association between unattended pregnancies and the risk of PM. Methods Data were extracted from the Georgian Birth Registry (GBR) and the national vital registration system. All mothers who had singleton births and delivered in medical facilities in Georgia in 2017–2018 were included in the study and categorised into attended pregnancies (at least one ANC visit during pregnancy) and unattended pregnancies (no ANC visits during pregnancy). After exclusions, the study sample included 101,663 women and their newborns, of which 1186 were either stillborn or died within 7 days. Logistic regression analysis was used to assess the effect of unattended pregnancies on PM. Results During the study period, the PM rate was 12.9/1000 births. In total, 5.6% of women had unattended pregnancies. The odds of PM among women with unattended pregnancies were more than double those among women with attended pregnancies (odds ratio=2.21, [95% confidence interval: 1.81–2.70]). Multiparous women with higher education and who resided/delivered outside of Tbilisi were significantly less likely to experience PM. Conclusion The risk of PM doubled among women with unattended pregnancies. Six percent of PM cases were attributable to unattended pregnancies. Targeting women with previous unattended pregnancies will likely reduce the PM rate in Georgia.
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Affiliation(s)
- Tinatin Manjavidze
- Department of Community Medicine, Faculty of Health Sciences, University of Tromsø - The Arctic University of Norway, Tromsø 9037, Norway
| | - Charlotta Rylander
- Department of Community Medicine, Faculty of Health Sciences, University of Tromsø - The Arctic University of Norway, Tromsø 9037, Norway
| | - Finn Egil Skjeldestad
- Department of Community Medicine, Faculty of Health Sciences, University of Tromsø - The Arctic University of Norway, Tromsø 9037, Norway
| | - Nata Kazakhashvili
- Department of Public Health, Faculty of Medicine, Ivane Javakhishvili Tbilisi State University, Tbilisi 0179, Georgia
| | - Erik Eik Anda
- Department of Community Medicine, Faculty of Health Sciences, University of Tromsø - The Arctic University of Norway, Tromsø 9037, Norway
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Hoffmann CBPC, Schultz LF, Vaichulonis CG, do Nascimento IB, João CG, Borges DC, Silva JC. Perinatal mortality: epidemiological profile, causes and avoidable factors at a reference public maternity hospital in the State of Santa Catarina, Brazil, 2011-2015. J Perinat Med 2020; 48:162-167. [PMID: 31874101 DOI: 10.1515/jpm-2018-0353] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 09/14/2018] [Accepted: 11/17/2019] [Indexed: 11/15/2022]
Abstract
Background This study aimed to identify the perinatal mortality coefficient, the epidemiological profile, causes and avoidable factors at a reference public maternity hospital in southern Brazil. Methods In this cross-sectional study, 334 medical records of postpartum women and newborns were evaluated between January 1st, 2011 and December 31st, 2015. The Expanded Wigglesworth Classification was used to assess the causes of perinatal mortality and the International Statistical Classification of Diseases and Related Health Problems (ICD-10/SEADE Foundation) was used for the preventable perinatal mortality analysis. Absolute numbers and percentages were used for data analysis. The perinatal mortality formula was used to calculate the perinatal mortality rate. Results The perinatal mortality rate was 13.2/1000 total births, with a predominance of white race/color; mothers were 21-30 years of age, had experienced their first pregnancy and had completed their high school education. Conclusion The main factors associated with perinatal death were antepartum fetal death in 182 (54.49%) cases, and avoidable death through appropriate prenatal care in 234 (70.05%) cases.
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Affiliation(s)
- Carla Beatriz Pimentel Cesar Hoffmann
- Nurse Management, Darcy Vargas Maternity Hospital, Rua Aubé 1417, house 1409 - Boa Vista, Joinville 89205-000, SC, Brazil.,Health and Environment, University of the Joinville Region (UNIVILLE), Street Paulo Malschitzki, 10, Joinville 89219-710, SC, Brazil
| | - Lidiane Ferreira Schultz
- Health and Environment, University of the Joinville Region, Street Paulo Malschitzki, 10, Joinville 89219-710, SC, Brazil
| | - Carla Gisele Vaichulonis
- Health and Environment, Darcy Vargas Maternity Hospital, Street Paulo Malschitzki, 10, Joinville 89219-710, SC, Brazil
| | | | | | | | - Jean Carl Silva
- Darcy Vargas Maternity Hospital, Medical Sciences, O.B.-G.Y.N, Joinville, Brazil.,University of the Joinville Region, Joinville, Brazil
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Nisha MK, Alam A, Raynes-Greenow C. Variations in perinatal mortality associated with different polluting fuel types and kitchen location in Bangladesh. Int J Occup Environ Health 2018; 24:47-54. [PMID: 30156135 DOI: 10.1080/10773525.2018.1507868] [Citation(s) in RCA: 11] [Impact Index Per Article: 1.8] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 10/28/2022]
Abstract
This study examines the association between household air pollution from use of polluting cooking fuels and perinatal mortality in Bangladesh. We analysed the data from the Bangladesh Demographic and Health Surveys (BDHS) 2004, 2007, 2011, and 2014. The two outcome variables were stillbirth and early neonatal mortality. The exposure variable was type of primary cooking fuel used in the household (clean vs. polluting). Bivariate and multivariable analyses were conducted to obtain the crude and adjusted odds ratio (aOR), respectively. In the adjusted model, the exposure to polluting fuels was associated with early neonatal mortality (aOR: 1.46, 95% confidence interval [CI]: 1.01-2.10), but not with stillbirth (aOR: 1.25, 95% CI: 0.85-1.84). The effect of cooking with agricultural crop waste was greater for stillbirth (aOR: 1.76, 95% CI: 1.10-2.80) and for early neonatal mortality (aOR: 1.78, 95% CI: 1.13-2.80) which was also associated with wood as the main fuel (aOR: 1.52, 95% CI: 1.04-2.21). Using polluting fuels in an indoor kitchen was associated with an increased odds of stillbirth (aOR: 4.12, 95% CI: 1.49-11.41). Cooking with polluting fuels is associated with perinatal mortality. The combined association of polluting cooking fuels and indoor kitchen location was greater for stillbirth. This effect and the effect of different fuel types need further investigation. Although this is a large sample, there are some limitations with the BDHS data in both recording the exposure and the outcomes. A large prospective trial is needed to determine the precise effect size.
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Affiliation(s)
- Monjura Khatun Nisha
- a Sydney School of Public Health, The University of Sydney , Sydney , NSW , Australia
| | - Ashraful Alam
- a Sydney School of Public Health, The University of Sydney , Sydney , NSW , Australia
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Semrau KEA, Hirschhorn LR, Marx Delaney M, Singh VP, Saurastri R, Sharma N, Tuller DE, Firestone R, Lipsitz S, Dhingra-Kumar N, Kodkany BS, Kumar V, Gawande AA. Outcomes of a Coaching-Based WHO Safe Childbirth Checklist Program in India. N Engl J Med 2017; 377:2313-2324. [PMID: 29236628 PMCID: PMC5672590 DOI: 10.1056/nejmoa1701075] [Citation(s) in RCA: 159] [Impact Index Per Article: 22.7] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 12/27/2022]
Abstract
BACKGROUND The prevalence of facility-based childbirth in low-resource settings has increased dramatically during the past two decades, yet gaps in the quality of care persist and mortality remains high. The World Health Organization (WHO) Safe Childbirth Checklist, a quality-improvement tool, promotes systematic adherence to practices that have been associated with improved childbirth outcomes. METHODS We conducted a matched-pair, cluster-randomized, controlled trial in 60 pairs of facilities across 24 districts of Uttar Pradesh, India, testing the effect of the BetterBirth program, an 8-month coaching-based implementation of the Safe Childbirth Checklist, on a composite outcome of perinatal death, maternal death, or maternal severe complications within 7 days after delivery. Outcomes - assessed 8 to 42 days after delivery - were compared between the intervention group and the control group with adjustment for clustering and matching. We also compared birth attendants' adherence to 18 essential birth practices in 15 matched pairs of facilities at 2 and 12 months after the initiation of the intervention. RESULTS Of 161,107 eligible women, we enrolled 157,689 (97.9%) and determined 7-day outcomes for 157,145 (99.7%) mother-newborn dyads. Among 4888 observed births, birth attendants' mean practice adherence was significantly higher in the intervention group than in the control group (72.8% vs. 41.7% at 2 months; 61.7% vs. 43.9% at 12 months; P<0.001 for both comparisons). However, there was no significant difference between the trial groups either in the composite primary outcome (15.1% in the intervention group and 15.3% in the control group; relative risk, 0.99; 95% confidence interval, 0.83 to 1.18; P=0.90) or in secondary maternal or perinatal adverse outcomes. CONCLUSIONS Birth attendants' adherence to essential birth practices was higher in facilities that used the coaching-based WHO Safe Childbirth Checklist program than in those that did not, but maternal and perinatal mortality and maternal morbidity did not differ significantly between the two groups. (Funded by the Bill and Melinda Gates Foundation; Clinical Trials number, NCT02148952 .).
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Affiliation(s)
- Katherine E A Semrau
- From Ariadne Labs-Brigham and Women's Hospital, Harvard T.H. Chan School of Public Health (K.E.A.S., M.M.D., D.E.T., S.L., A.A.G.), the Divisions of Global Health Equity (K.E.A.S.) and General Internal Medicine (S.L.) and the Department of Surgery (A.A.G.), Brigham and Women's Hospital, the Department of Medicine, Harvard Medical School (K.E.A.S.), and the Department of Health Policy and Management, Harvard T.H. Chan School of Public Health (A.A.G.) - all in Boston; Feinberg School of Medicine, Northwestern University, Chicago (L.R.H.); Population Services International (V.P.S., R.S., N.S.) and the Community Empowerment Lab (V.K.), Lucknow, and Jawaharlal Nehru Medical College, Belgaum (B.S.K.) - all in India; Population Services International, Washington, DC (R.F.); and the World Health Organization, Geneva (N.D.-K.)
| | - Lisa R Hirschhorn
- From Ariadne Labs-Brigham and Women's Hospital, Harvard T.H. Chan School of Public Health (K.E.A.S., M.M.D., D.E.T., S.L., A.A.G.), the Divisions of Global Health Equity (K.E.A.S.) and General Internal Medicine (S.L.) and the Department of Surgery (A.A.G.), Brigham and Women's Hospital, the Department of Medicine, Harvard Medical School (K.E.A.S.), and the Department of Health Policy and Management, Harvard T.H. Chan School of Public Health (A.A.G.) - all in Boston; Feinberg School of Medicine, Northwestern University, Chicago (L.R.H.); Population Services International (V.P.S., R.S., N.S.) and the Community Empowerment Lab (V.K.), Lucknow, and Jawaharlal Nehru Medical College, Belgaum (B.S.K.) - all in India; Population Services International, Washington, DC (R.F.); and the World Health Organization, Geneva (N.D.-K.)
| | - Megan Marx Delaney
- From Ariadne Labs-Brigham and Women's Hospital, Harvard T.H. Chan School of Public Health (K.E.A.S., M.M.D., D.E.T., S.L., A.A.G.), the Divisions of Global Health Equity (K.E.A.S.) and General Internal Medicine (S.L.) and the Department of Surgery (A.A.G.), Brigham and Women's Hospital, the Department of Medicine, Harvard Medical School (K.E.A.S.), and the Department of Health Policy and Management, Harvard T.H. Chan School of Public Health (A.A.G.) - all in Boston; Feinberg School of Medicine, Northwestern University, Chicago (L.R.H.); Population Services International (V.P.S., R.S., N.S.) and the Community Empowerment Lab (V.K.), Lucknow, and Jawaharlal Nehru Medical College, Belgaum (B.S.K.) - all in India; Population Services International, Washington, DC (R.F.); and the World Health Organization, Geneva (N.D.-K.)
| | - Vinay P Singh
- From Ariadne Labs-Brigham and Women's Hospital, Harvard T.H. Chan School of Public Health (K.E.A.S., M.M.D., D.E.T., S.L., A.A.G.), the Divisions of Global Health Equity (K.E.A.S.) and General Internal Medicine (S.L.) and the Department of Surgery (A.A.G.), Brigham and Women's Hospital, the Department of Medicine, Harvard Medical School (K.E.A.S.), and the Department of Health Policy and Management, Harvard T.H. Chan School of Public Health (A.A.G.) - all in Boston; Feinberg School of Medicine, Northwestern University, Chicago (L.R.H.); Population Services International (V.P.S., R.S., N.S.) and the Community Empowerment Lab (V.K.), Lucknow, and Jawaharlal Nehru Medical College, Belgaum (B.S.K.) - all in India; Population Services International, Washington, DC (R.F.); and the World Health Organization, Geneva (N.D.-K.)
| | - Rajiv Saurastri
- From Ariadne Labs-Brigham and Women's Hospital, Harvard T.H. Chan School of Public Health (K.E.A.S., M.M.D., D.E.T., S.L., A.A.G.), the Divisions of Global Health Equity (K.E.A.S.) and General Internal Medicine (S.L.) and the Department of Surgery (A.A.G.), Brigham and Women's Hospital, the Department of Medicine, Harvard Medical School (K.E.A.S.), and the Department of Health Policy and Management, Harvard T.H. Chan School of Public Health (A.A.G.) - all in Boston; Feinberg School of Medicine, Northwestern University, Chicago (L.R.H.); Population Services International (V.P.S., R.S., N.S.) and the Community Empowerment Lab (V.K.), Lucknow, and Jawaharlal Nehru Medical College, Belgaum (B.S.K.) - all in India; Population Services International, Washington, DC (R.F.); and the World Health Organization, Geneva (N.D.-K.)
| | - Narender Sharma
- From Ariadne Labs-Brigham and Women's Hospital, Harvard T.H. Chan School of Public Health (K.E.A.S., M.M.D., D.E.T., S.L., A.A.G.), the Divisions of Global Health Equity (K.E.A.S.) and General Internal Medicine (S.L.) and the Department of Surgery (A.A.G.), Brigham and Women's Hospital, the Department of Medicine, Harvard Medical School (K.E.A.S.), and the Department of Health Policy and Management, Harvard T.H. Chan School of Public Health (A.A.G.) - all in Boston; Feinberg School of Medicine, Northwestern University, Chicago (L.R.H.); Population Services International (V.P.S., R.S., N.S.) and the Community Empowerment Lab (V.K.), Lucknow, and Jawaharlal Nehru Medical College, Belgaum (B.S.K.) - all in India; Population Services International, Washington, DC (R.F.); and the World Health Organization, Geneva (N.D.-K.)
| | - Danielle E Tuller
- From Ariadne Labs-Brigham and Women's Hospital, Harvard T.H. Chan School of Public Health (K.E.A.S., M.M.D., D.E.T., S.L., A.A.G.), the Divisions of Global Health Equity (K.E.A.S.) and General Internal Medicine (S.L.) and the Department of Surgery (A.A.G.), Brigham and Women's Hospital, the Department of Medicine, Harvard Medical School (K.E.A.S.), and the Department of Health Policy and Management, Harvard T.H. Chan School of Public Health (A.A.G.) - all in Boston; Feinberg School of Medicine, Northwestern University, Chicago (L.R.H.); Population Services International (V.P.S., R.S., N.S.) and the Community Empowerment Lab (V.K.), Lucknow, and Jawaharlal Nehru Medical College, Belgaum (B.S.K.) - all in India; Population Services International, Washington, DC (R.F.); and the World Health Organization, Geneva (N.D.-K.)
| | - Rebecca Firestone
- From Ariadne Labs-Brigham and Women's Hospital, Harvard T.H. Chan School of Public Health (K.E.A.S., M.M.D., D.E.T., S.L., A.A.G.), the Divisions of Global Health Equity (K.E.A.S.) and General Internal Medicine (S.L.) and the Department of Surgery (A.A.G.), Brigham and Women's Hospital, the Department of Medicine, Harvard Medical School (K.E.A.S.), and the Department of Health Policy and Management, Harvard T.H. Chan School of Public Health (A.A.G.) - all in Boston; Feinberg School of Medicine, Northwestern University, Chicago (L.R.H.); Population Services International (V.P.S., R.S., N.S.) and the Community Empowerment Lab (V.K.), Lucknow, and Jawaharlal Nehru Medical College, Belgaum (B.S.K.) - all in India; Population Services International, Washington, DC (R.F.); and the World Health Organization, Geneva (N.D.-K.)
| | - Stuart Lipsitz
- From Ariadne Labs-Brigham and Women's Hospital, Harvard T.H. Chan School of Public Health (K.E.A.S., M.M.D., D.E.T., S.L., A.A.G.), the Divisions of Global Health Equity (K.E.A.S.) and General Internal Medicine (S.L.) and the Department of Surgery (A.A.G.), Brigham and Women's Hospital, the Department of Medicine, Harvard Medical School (K.E.A.S.), and the Department of Health Policy and Management, Harvard T.H. Chan School of Public Health (A.A.G.) - all in Boston; Feinberg School of Medicine, Northwestern University, Chicago (L.R.H.); Population Services International (V.P.S., R.S., N.S.) and the Community Empowerment Lab (V.K.), Lucknow, and Jawaharlal Nehru Medical College, Belgaum (B.S.K.) - all in India; Population Services International, Washington, DC (R.F.); and the World Health Organization, Geneva (N.D.-K.)
| | - Neelam Dhingra-Kumar
- From Ariadne Labs-Brigham and Women's Hospital, Harvard T.H. Chan School of Public Health (K.E.A.S., M.M.D., D.E.T., S.L., A.A.G.), the Divisions of Global Health Equity (K.E.A.S.) and General Internal Medicine (S.L.) and the Department of Surgery (A.A.G.), Brigham and Women's Hospital, the Department of Medicine, Harvard Medical School (K.E.A.S.), and the Department of Health Policy and Management, Harvard T.H. Chan School of Public Health (A.A.G.) - all in Boston; Feinberg School of Medicine, Northwestern University, Chicago (L.R.H.); Population Services International (V.P.S., R.S., N.S.) and the Community Empowerment Lab (V.K.), Lucknow, and Jawaharlal Nehru Medical College, Belgaum (B.S.K.) - all in India; Population Services International, Washington, DC (R.F.); and the World Health Organization, Geneva (N.D.-K.)
| | - Bhalachandra S Kodkany
- From Ariadne Labs-Brigham and Women's Hospital, Harvard T.H. Chan School of Public Health (K.E.A.S., M.M.D., D.E.T., S.L., A.A.G.), the Divisions of Global Health Equity (K.E.A.S.) and General Internal Medicine (S.L.) and the Department of Surgery (A.A.G.), Brigham and Women's Hospital, the Department of Medicine, Harvard Medical School (K.E.A.S.), and the Department of Health Policy and Management, Harvard T.H. Chan School of Public Health (A.A.G.) - all in Boston; Feinberg School of Medicine, Northwestern University, Chicago (L.R.H.); Population Services International (V.P.S., R.S., N.S.) and the Community Empowerment Lab (V.K.), Lucknow, and Jawaharlal Nehru Medical College, Belgaum (B.S.K.) - all in India; Population Services International, Washington, DC (R.F.); and the World Health Organization, Geneva (N.D.-K.)
| | - Vishwajeet Kumar
- From Ariadne Labs-Brigham and Women's Hospital, Harvard T.H. Chan School of Public Health (K.E.A.S., M.M.D., D.E.T., S.L., A.A.G.), the Divisions of Global Health Equity (K.E.A.S.) and General Internal Medicine (S.L.) and the Department of Surgery (A.A.G.), Brigham and Women's Hospital, the Department of Medicine, Harvard Medical School (K.E.A.S.), and the Department of Health Policy and Management, Harvard T.H. Chan School of Public Health (A.A.G.) - all in Boston; Feinberg School of Medicine, Northwestern University, Chicago (L.R.H.); Population Services International (V.P.S., R.S., N.S.) and the Community Empowerment Lab (V.K.), Lucknow, and Jawaharlal Nehru Medical College, Belgaum (B.S.K.) - all in India; Population Services International, Washington, DC (R.F.); and the World Health Organization, Geneva (N.D.-K.)
| | - Atul A Gawande
- From Ariadne Labs-Brigham and Women's Hospital, Harvard T.H. Chan School of Public Health (K.E.A.S., M.M.D., D.E.T., S.L., A.A.G.), the Divisions of Global Health Equity (K.E.A.S.) and General Internal Medicine (S.L.) and the Department of Surgery (A.A.G.), Brigham and Women's Hospital, the Department of Medicine, Harvard Medical School (K.E.A.S.), and the Department of Health Policy and Management, Harvard T.H. Chan School of Public Health (A.A.G.) - all in Boston; Feinberg School of Medicine, Northwestern University, Chicago (L.R.H.); Population Services International (V.P.S., R.S., N.S.) and the Community Empowerment Lab (V.K.), Lucknow, and Jawaharlal Nehru Medical College, Belgaum (B.S.K.) - all in India; Population Services International, Washington, DC (R.F.); and the World Health Organization, Geneva (N.D.-K.)
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12
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Abstract
OBJECTIVES To assess trends in early neonatal mortality (ENM) and population-attributable risk (PAR) estimates for predictors of ENM in Nigeria. DESIGN, SETTING AND PARTICIPANTS A cross-sectional data on 63 844 singleton live births within the preceding 5 years from the 2003, 2008 and 2013 Nigeria Demographic and Health Surveys were used. Adjusted PARs were used to estimate the number of early neonatal deaths attributable to each predictor in the final multivariable Cox regression model. MAIN OUTCOME MEASURES ENM, defined as the death of a live-born singleton between birth and 6 days of life. RESULTS The ENM rate slightly declined from 30.5 (95% CI 26.1 to 34.9) to 26.1 (CI 24.3 to 27.9) during the study period. Approximately 36 746 (CI 14 656 to 56 920) and 37 752 (CI 23 433 to 51 126) early neonatal deaths were attributable to rural residence and male sex, respectively. Other significant predictors of ENM included small neonates (attributable number: 25 884, CI 19 172 to 31 953), maternal age <20 years (11 708, CI 8521 to 17 042), caesarean section (6312, CI 4260 to 8521) and birth order ≥4 with a short birth interval (≤2 years) (18 929, CI 12 781 to 25 563)). CONCLUSIONS To improve early neonatal survival in Nigeria, community-based interventions are needed for small neonates, and to promote delayed first pregnancy, child spacing and timely referral for sick male neonates and caesarean delivery.
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Affiliation(s)
- Osita Kingsley Ezeh
- School of Science and Health, Western Sydney University, Penrith, New South Wales, Australia
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13
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Bellizzi S, Sobel HL, Mathai M, Temmerman M. Does place and attendance at birth improve early neonatal mortality? Secondary analysis of nine Demographic and Health Surveys. BJOG 2016; 124:1558-1565. [PMID: 27862850 DOI: 10.1111/1471-0528.14422] [Citation(s) in RCA: 7] [Impact Index Per Article: 0.9] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 08/31/2016] [Indexed: 11/27/2022]
Abstract
OBJECTIVES To determine the relation between place and skilled birth attendance at birth and early neonatal mortality. DESIGN Retrospective analysis using data from Demographic and Health Surveys on obstetric complications. SETTING Nine low and middle income countries between 2006 and 2013. POPULATION 71 758 women aged 15-49 years. METHODS A secondary analysis was carried out to investigate the occurrence and effect of obstetric complications on early neonatal mortality and association with place and attendance at birth. Obstetric complications studied were prolonged labour, puerperal infection and eclampsia. MAIN OUTCOME MEASURES Association between early neonatal mortality and place and attendance at birth, unadjusted and adjusted for presence of severe obstetric complications. RESULTS Thirty-five percent of all births were at home: 70% of these were without skilled attendamts. Obstetric complications were reported in 17 079 women: 82% of these women gave birth in health facilities. Overall, no association was observed between place of birth or attendance at birth and early neonatal mortality. When adjusted for obstetric complications, the odds of early neonatal deaths for births at home without a skilled attendant were 1.3 (95% CI 1.1-1.5) compared with 1.2 (95% CI 1.0-1.5) with a skilled attendant and births in health facilities. CONCLUSIONS When adjusted for obstetric complications, births in health facilities were associated with reduced early neonatal mortality. However, reporting and referral bias account for at least part of the association. TWEETABLE ABSTRACT Births in health facilities are linked with fewer early newborn deaths when adjusted for obstetric complications.
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Affiliation(s)
- S Bellizzi
- World Health Organization, Western Pacific Regional Office, Manila, Philippines
| | - H L Sobel
- World Health Organization, Western Pacific Regional Office, Manila, Philippines
| | - M Mathai
- Centre for Maternal and Newborn Health, Liverpool School of Tropical Medicine, Liverpool, UK
| | - M Temmerman
- Department of Obstetrics and Gynaecology, Ghent University, Ghent, Belgium
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14
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Hudic I, Stray-Pedersen B, Skokic F, Fatusic Z, Zildzic-Moralic A, Skokic M, Fatusic J. LOW PRETERM BIRTH RATE WITH DECREASING EARLY NEONATAL MORTALITY IN BOSNIA AND HERZEGOVINA DURING 2007-2014. Mater Sociomed 2016; 28:32-5. [PMID: 27047264 PMCID: PMC4789633 DOI: 10.5455/msm.2016.28.32-35] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/10/2015] [Accepted: 11/15/2015] [Indexed: 11/03/2022] Open
Abstract
THE AIM of the study was to determine the situation of preterm births and early neonatal mortality during 2007-2014 in Tuzla Canton, Bosnia and Herzegovina. METHODS The study covers a 8-year period and is based on the protocols at the Tuzla Clinic for Gynecology and Obstetrics that covers all birth in Tuzla Canton area. We analyzed the gestational age of all newborns and recorded the number of neonatal deaths in the first week after birth. Demographics, pregnancy and birth characteristics were collected from the maternal records. RESULTS The total number of births in the period was 32738. Preterm birth was identified in 2401 (7.3%) cases with 12,5% occurring before 32 gestational weeks and 64% in 35-36 gestational weeks. The mothers of the 24-31 gws preterm group were significantly younger that those in the 32-36 group. In the 32-36 group there were significantly greater proportions of mothers with assisted reproductive technology and pre-eclampsia and 16.7% was medical induced preterm births versus 11.4 % in the 24-31 PTB group, p<0.05. The incidence of PTB did no vary significantly during the period, the lowest rate was found in 2010 (6.4%). A total of 221 children died giving a early mortality rate of 6.8 per 1000 live born over the 8 years. The majority 156 dying infants (70.6%) were preterm, only 5.7% died being born in the 35-36 gestational week (5.9 per 1000). Overall the preterm early mortality (7.3 per 1000) has shown a decreasing tendency during the latter years. CONCLUSION During the last 8 years there have been no significant decline in preterm birth in the Tuzla region while a decline in early neonatal death has been registered.
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Affiliation(s)
- Igor Hudic
- Clinic for Gynecology and Obstetrics, University Clinical Center, Tuzla, Bosnia and Herzegovina
| | - Babill Stray-Pedersen
- Division of Women and Children, Rikshospitalet, Oslo University Hospital and Faculty of Medicine, University of Oslo, Oslo, Norway
| | - Fahrija Skokic
- Children's Hospital, University Clinical Center Tuzla, Bosnia and Herzegovina
| | - Zlatan Fatusic
- Clinic for Gynecology and Obstetrics, University Clinical Center, Tuzla, Bosnia and Herzegovina
| | | | - Maida Skokic
- Children's Hospital, University Clinical Center Tuzla, Bosnia and Herzegovina
| | - Jasenko Fatusic
- Clinic for Gynecology and Obstetrics, University Clinical Center, Tuzla, Bosnia and Herzegovina
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15
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Rahman S, Al Rifai H, El Ansari W, Nimeri N, El Tinay S, Salameh K, Abbas T, Jarir RA, Said N, Taha S. A PEARL Study Analysis of National Neonatal, Early Neonatal, Late Neonatal, and Corrected Neonatal Mortality Rates in the State of Qatar during 2011: A Comparison with World Health Statistics 2011 and Qatar's Historic Data over a Period of 36 Years (1975-2011). J Clin Neonatol 2013; 1:195-201. [PMID: 24027726 PMCID: PMC3762056 DOI: 10.4103/2249-4847.105990] [Citation(s) in RCA: 6] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/17/2022] Open
Abstract
Objective: To prospectively ascertain Qatar's national Neonatal Mortality Rate (NMR), Early Neonatal Mortality Rate (ENMR), and Late Neonatal Mortality Rate (LNMR) during 2011, compare it with recent data from high-income countries, and analyze trends in Qatar's NMR's between 1975 and 2011 using historic data. Study Design: A National prospective cohort-study. Materials and Methods: National data on live births and neonatal mortality was collected from all public and private maternity facilities in Qatar (1st January-December 31st 2011) and compared with historical neonatal mortality data (1975-2010) ascertained from the database of maternity and neonatal units of Women's Hospital and annual reports of Hamad Medical Corporation. For inter country comparison, country data of 2009 was extracted from World Health Statistics 2011 (WHO) and the European Perinatal Health report (2008). Results: A total of 20583 live births were recorded during the study period. Qatar's national NMR during 2011 was 4.95, ENMR 2.7, LNMR 2.2, and cNMR 3.33. Between 1975 and 2011, Qatar's population increased by 10-fold, number of deliveries by 7.2 folds while relative risk of NMR decreased by 87% (RR 0.13, 95% CI 0.10-0.18, P<0.001), ENMR by 91% (RR 0.09, 95% CI 0.06-0.12, P<0.001) and LNMR by 58% (RR 0.42, 95% CI 0.23-0.74, P=0.002). The comparable ranges of neonatal mortality rates from selected high-income West European countries are: NMR: 2-5.7, ENMR 1.5-3.8, and LNMR 0.5-1.9. Conclusions: The neonatal survival in the State of Qatar has significantly improved between 1975 and 2011. The improvement has been more marked in ENMR than LNMR. Qatar's current neonatal mortality rates are comparable to most high-income West European countries. An in-depth research to assess the correlates and determinants of neonatal mortality in Qatar is indicated.
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Affiliation(s)
- Sajjad Rahman
- Department of Pediatrics, NICU, Women's Hospital, Hamad Medical Corporation, Doha, Qatar ; Department of Pediatrics, Weill Cornell Medical College, Doha, Qatar
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