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Title: [Newborn babies' health in Rwanda: evolution of factors associated with neonatal mortality trends] La sante des nouveau-nes au Rwanda. Evolution des facteurs associes aux tendances
Author: Beck L
Source: Sante Publique. 2009 Mar-Apr;21(2):159-72.
Abstract: In spite of increasing attention for maternal and child health, neonatal mortality (before the age of one month) represents a significant part of infant mortality in sub-Saharan Africa. Several demographic and health surveys show the lack of any major improvement since the 1980s in Rwanda, and despite some indication of minor improvement, any real progress has been countered by periods of aggravation of the situation. However, a noticeable decrease in neonatal mortality seems to have begun since the year 2000. This study describes the evolution of the determinants of neonatal mortality between 1980 and 2000 and the obstacles that hinder its sustainable decline. Regressive logistical analyses conducted with data on several different generations of newborns showed the persistence of some unfavourable factors and conditions, such as the short period of time between births of babies carried to term and premature births. Nevertheless, although the conditions for pregnancy and delivery are still insufficient, the quality of pre-natal and newborn care seems to be improving.
Language: French
Keywords:
RWANDA | RESEARCH REPORT | DEMOGRAPHIC AND HEALTH SURVEYS | NEONATAL MORTALITY | DEATH RATE | MORTALITY DETERMINANTS | MATERNAL-CHILD HEALTH SERVICES | NEEDS | QUALITY OF HEALTH CARE | Africa, Central | Africa, Sub Saharan | Africa | Developing Countries | Demographic Surveys | Population Dynamics | Demographic Factors | Population | Infant Mortality | Mortality | Primary Health Care | Health Services | Delivery of Health Care | Health | Economic Factors | Health Services Evaluation | Program Evaluation | Programs | Organization and Administration
Document Number: 342436

Title: Stillbirth and early neonatal mortality in rural Central Africa.
Author: Engmann C; Matendo R; Kinoshita R; Ditekemena J; Moore J; Goldenberg RL; Tshefu A; Carlo WA; McClure EM; Bose C; Wright LL
Source: International Journal of Gynaecology and Obstetrics. 2009 May;105(2):112-7.
Abstract: OBJECTIVE: To develop a prospective perinatal registry that characterizes all deliveries, differentiates between stillbirths and early neonatal deaths (ENDs), and determines the ratio of fresh to macerated stillbirths in the northwest Democratic Republic of Congo. METHOD: Birth outcomes were obtained from 4 rural health districts. RESULTS: A total of 8230 women consented, END rate was 32 deaths per 1000 live births, and stillbirth rate was 33 deaths per 1000 deliveries. The majority (75%) of ENDs and stillbirths occurred in neonates weighing 1500 g or more. Odds of stillbirth and END increased in mothers who were single or who did not receive prenatal care, and among premature, low birth weight, or male infants. The ratio of fresh to macerated stillbirths was 4:1. CONCLUSION: Neonates weighing 1500 g or more at birth represent a group with a high likelihood of survival in remote areas, making them potentially amenable to targeted intervention packages. The ratio of fresh to macerated stillbirths was approximately 10-fold higher than expected, suggesting a more prominent role for improved intrapartum obstetric interventions.
Language: English
Keywords:
AFRICA, CENTRAL | RESEARCH REPORT | LOW INCOME POPULATION | RURAL AREAS | NEONATAL MORTALITY | FETAL DEATH | Africa, Sub Saharan | Africa | Developing Countries | Social Class | Socioeconomic Status | Socioeconomic Factors | Economic Factors | Geographic Factors | Population | Infant Mortality | Mortality | Population Dynamics | Demographic Factors
Document Number: 341378

4.
Peer Reviewed

Title: Potential role of traditional birth attendants in neonatal healthcare in rural southern Nepal.
Author: Falle TY; Mullany LC; Thatte N; Khatry SK; LeClerq SC; Darmstadt GL; Katz J; Tielsch JM
Source: Journal of Health, Population, and Nutrition. 2009 Feb;27(1):53-61.
Abstract: The potential for traditional birth attendants (TBAs) to improve neonatal health outcomes has largely been overlooked during the current debate regarding the role of TBAs in improving maternal health. Randomly-selected TBAs (n=93) were interviewed to gain a more thorough understanding of their knowledge, attitudes, and practices regarding maternal and newborn care. Practices, such as using a clean cord-cutting instrument (89%) and hand-washing before delivery (74%), were common. Other beneficial practices, such as thermal care, were low. Trained TBAs were more likely to wash hands with soap before delivery, use a clean delivery-kit, and advise feeding colostrum. Although mustard oil massage was a universal practice, 52% of the TBAs indicated their willingness to consider alternative oils. Low-cost, evidence-based interventions for improving neonatal outcomes might be implemented by TBAs in this setting where most births take place in the home and neonatal mortality risk is high. Continuing efforts to define the role of TBAs may benefit from an emphasis on their potential as active promoters of essential newborn care.
Language: English
Keywords:
NEPAL | RESEARCH REPORT | RURAL AREAS | TRADITIONAL BIRTH ATTENDANTS | COMMUNITY WORKERS | KNOWLEDGE | ATTITUDES | NEONATAL MORTALITY | PERCEPTION | CHILDBIRTH | INTERVENTIONS | DELIVERY OF HEALTH CARE | Developing Countries | Asia, Southern | Asia | Geographic Factors | Population | Health Personnel | Health | Sociocultural Factors | Psychological Factors | Behavior | Infant Mortality | Mortality | Population Dynamics | Demographic Factors | Pregnancy Outcomes | Pregnancy | Reproduction | Programs | Organization and Administration
Document Number: 331129

Title: Reducing neonatal mortality in developing countries: low-cost interventions are the key determinants [letter]
Author: Garg P; Gogia S
Source: Journal of Perinatology. 2009 Jan;29(1):74-5; author reply 75.
Abstract: We read with great interest the recent editorial and the original article published in the May issue of the journal. Dr Gadzinowski, even though realizing that the results of the article will be challenging to the neonatologists outside North America, asserts that 'Improvements in the survival of newborns on the threshold of viability contributes to improved Neonatal mortality rates (NMRs) on an international scale'. However, 98% of neonatal deaths occur in developing countries. NMR are the highest in the Sub-Saharan regions of western, middle and eastern Africa and South-Central Asia with rates between 42 and 49 per 1000 live births. More than two-thirds of the causes of neonatal deaths in these countries are due to causes not attributable to prematurity, and an even much smaller proportion can be attributed to extreme prematurity. For example, in India extremely low birth weight neonates contribute only 14.5% of neonatal deaths (3680), in live births at 18 network institutions across all regions of India. Though, many of us are now saving very and extremely low birth weight preterm neonates in developing countries, the advancement of neonatal care is hampered by marked heterogeneity within and between states, rural and urban gaps and within urban differences. Social exclusion, caste, maternal literacy, negative parental attitudes arising from social environment, gender bias, ability to pay, and lack of basic prenatal, natal and postnatal care are the main determinants of newborn survival in developing countries. Global scientific communities have increasingly realized the importance of cost-effective interventions for reducing neonatal mortality in developing countries. Sri Lanka is a shining example in South Asia with NMR of 11 per 1000 live births without hi-tech neonatal intensive care infrastructure.3 In India also the effectiveness of community- and home-based neonatal care has been shown in field trials. It is estimated that 16 low-cost effective interventions can save 0.59-1.08 million lives in South Asia and 0.45-0.8 million lives in sub-Saharan Africa. It is important for developing countries like India to keep their focus on providing essential and level II newborn care (low-cost) services for the majority of population, which would have a far greater chance for improvement on newborn survival rather than getting swayed by providing high-tech services to few babies at thresholds of viability. (full-text)
Language: English
Keywords:
DEVELOPING COUNTRIES | RESEARCH REPORT | NEONATAL MORTALITY | INTERVENTIONS | PREVENTION AND CONTROL | PROGRAM EVALUATION | Infant Mortality | Mortality | Population Dynamics | Demographic Factors | Population | Programs | Organization and Administration | Diseases
Document Number: 331177

6.
Peer Reviewed

Title: Neonatal mortality, risk factors and causes: a prospective population-based cohort study in urban Pakistan.
Author: Jehan I; Harris H; Salat S; Zeb A; Mobeen N; Pasha O; McClure EM; Moore J; Wright LL; Goldenberg RL
Source: Bulletin of the World Health Organization. 2009 Feb;87(2):130-8.
Abstract: OBJECTIVE: To evaluate the prevalence, sex distribution and causes of neonatal mortality, as well as its risk factors, in an urban Pakistani population with access to obstetric and neonatal care. METHODS: Study area women were enrolled at 20-26 weeks' gestation in a prospective population-based cohort study that was conducted from 2003 to 2005. Physical examinations, antenatal laboratory tests and anthropometric measures were performed, and gestational age was determined by ultrasound to confirm eligibility. Demographic and health data were also collected on pretested study forms by trained female research staff. The women and neonates were seen again within 48 hours postpartum and at day 28 after the birth. All neonatal deaths were reviewed using the Pattinson et al. system to assign obstetric and final causes of death; the circumstances of the death were determined by asking the mother or family and by reviewing hospital records. Frequencies and rates were calculated, and 95% confidence intervals were determined for mortality rates. Relative risks were calculated to evaluate the associations between potential risk factors and neonatal death. Logistic regression models were used to compute adjusted odds ratios. FINDINGS: Birth outcomes were ascertained for 1280 (94%) of the 1369 women enrolled. The 28-day neonatal mortality rate was 47.3 per 1000 live births. Preterm birth, Caesarean section and intrapartum complications were associated with neonatal death. Some 45% of the deaths occurred within 48 hours and 73% within the first week. The primary obstetric causes of death were preterm labour (34%) and intrapartum asphyxia (21%). Final causes were classified as immaturity-related (26%), birth asphyxia or hypoxia (26%) and infection (23%). Neither delivery in a health facility nor by health professionals was associated with fewer neonatal deaths. The Caesarean section rate was 19%. Almost all (88%) neonates who died received treatment and 75% died in the hospital. CONCLUSION: In an urban population with good access to professional care, we found a high neonatal mortality rate, often due to preventable conditions. These results suggest that, to decrease neonatal mortality, improved health service quality is crucial.
Language: English
Keywords:
PAKISTAN | RESEARCH REPORT | PROSPECTIVE STUDIES | URBAN POPULATION | NEONATAL MORTALITY | RISK FACTORS | PREVALENCE | PREMATURE LABOR | CESAREAN SECTION | CAUSES OF DEATH | MATERNAL-CHILD HEALTH SERVICES | Developing Countries | Asia, Southern | Asia | Studies | Research Methodology | Population Characteristics | Demographic Factors | Population | Infant Mortality | Mortality | Population Dynamics | Health | Measurement | Pregnancy Outcomes | Pregnancy | Reproduction | Obstetrical Surgery | Surgery | Treatment | Medical Procedures | Medicine | Health Services | Delivery of Health Care | Primary Health Care
Document Number: 341787

Peer Reviewed

Title: Intrapartum antibiotic exposure and early neonatal, morbidity, and mortality in Africa.
Author: Kafulafula G; Mwatha A; Chen YQ; Aboud S; Martinson F; Hoffman I; Fawzi W; Read JS; Valentine M; Mwinga K; Goldenberg R; Taha TE
Source: Pediatrics. 2009 Jul;124(1):e137-44.
Abstract: BACKGROUND: Infants born to women who receive intrapartum antibiotics may have higher rates of infectious morbidity and mortality than unexposed infants. OBJECTIVE: Our goal was to determine the association of maternal intrapartum antibiotics and early neonatal morbidity and mortality. METHODS: We performed secondary analysis of data from a multisite randomized, placebo-controlled clinical trial of antibiotics to prevent chorioamnionitis-associated mother-to-child transmission of HIV-1 and preterm birth in sub-Saharan Africa. Early neonatal morbidity and mortality were analyzed. In an intention-to-treat (ITT) analysis, infants born to women randomly assigned to antibiotics or placebo were compared. In addition, non-ITT analysis was performed because some women received nonstudy antibiotics for various clinical indications. RESULTS: Overall, 2659 pregnant women were randomly assigned. Of these, 2466 HIV-1-infected and HIV-1-uninfected women delivered 2413 live born and 84 stillborn infants. In the ITT analysis, there were no significant associations between exposure to antibiotics and early neonatal outcomes. Non-ITT analyses showed more illness at birth (11.2% vs 8.6%, P = .03) and more admissions to the special care infant unit (12.6% vs 9.8%, P = .04) among infants exposed to maternal intrapartum antibiotics than among unexposed infants. Additional analyses revealed greater early neonatal morbidity and mortality among infants of mothers who received nonstudy antibiotics than of mothers who received study antibiotics. CONCLUSIONS: There is no association between intrapartum exposure to antibiotics and early neonatal morbidity or mortality. The associations observed in non-ITT analyses are most likely the result of women with peripartum illnesses being more likely to receive nonstudy antibiotics.
Language: English
Keywords:
AFRICA, SUB SAHARAN | RESEARCH REPORT | DATA ANALYSIS | CLINICAL TRIALS | PREGNANT WOMEN | PREMATURE BIRTH | NEONATAL DISEASES AND ABNORMALITIES | ANTIBIOTICS | MORBIDITY | NEONATAL MORTALITY | Africa | Developing Countries | Research Methodology | Clinical Research | Population Characteristics | Demographic Factors | Population | Pregnancy Outcomes | Pregnancy | Reproduction | Diseases | Drugs | Treatment | Medical Procedures | Medicine | Health Services | Delivery of Health Care | Health | Infant Mortality | Mortality | Population Dynamics
Document Number: 342887

Title: Burden of neonatal infections in developing countries: a review of evidence from community-based studies.
Author: Thaver D; Zaidi AK
Source: Pediatric Infectious Disease Journal. 2009 Jan;28(1 Suppl):S3-9.
Abstract: INTRODUCTION: Infections are a major contributor to newborn deaths in developing countries. Majority of these deaths occur at home without coming to medical attention. The Millennium Development Goal for child survival cannot be achieved without substantial reductions in infection-specific neonatal mortality. We describe the burden of neonatal infections in developing countries and discuss the need for community-based management approaches to improve survival from neonatal infections in these countries. METHODS: We reviewed community-based studies published since 1990 from developing countries to estimate the rates of neonatal and young infant infections and infection-specific neonatal mortality. RESULTS: Thirty-two studies reviewed suggest that infections may be responsible for 8% to 80% of all neonatal deaths and as many as 42% of deaths in the first week of life. Eleven reports provided data on incidence of infections in neonates and infants up to 60 days of life. Rates of neonatal sepsis were as high as 170/1000 live births (clinically diagnosed) and 5.5/1000 live births (blood culture-confirmed). CONCLUSIONS: Considerable heterogeneity exists among included studies, and more accurate data and standardized methodologies are required. However, data indicate that a significant proportion of neonatal deaths in developing countries are due to infections. Current recommendations of hospitalization and parenteral therapy for managing neonatal infections are inadequately followed in developing countries. Approaches for detecting and managing serious infections within the community, at home or first-level health facilities, may be more effective options in settings where delays and reluctance to seek care, health system inefficiencies, socioeconomic and cultural, as well as logistic constraints exist.
Language: English
Keywords:
DEVELOPING COUNTRIES | LITERATURE REVIEW | EPIDEMIOLOGIC METHODS | CLINICAL RESEARCH | STUDY DESIGN | COMMUNITY | INFANT | NEONATAL DISEASES AND ABNORMALITIES | INFECTIONS | NEONATAL MORTALITY | PREVALENCE | CAUSES OF DEATH | STANDARDIZATION | Research Methodology | Residence Characteristics | Population Distribution | Geographic Factors | Population | Youth | Age Factors | Population Characteristics | Demographic Factors | Diseases | Infant Mortality | Mortality | Population Dynamics | Measurement | Data Adjustment
Document Number: 330050

Peer Reviewed

Title: The impact on neonatal mortality of shifting childbirth services among levels of hospitals: Taiwan's experience.
Author: Wang SY; Hsu SH; Chen LK
Source: BMC Health Services Research. 2009;9:94.
Abstract: BACKGROUND: There is considerable discussion surrounding whether advanced hospitals provide better childbirth care than local community hospitals. This study examines the effect of shifting childbirth services from advanced hospitals (i.e., medical centers and regional hospitals) to local community hospitals (i.e., clinics and district hospitals). The sample population was tracked over a seven-year period, which includes the four months of the 2003 severe acute respiratory syndrome (SARS) epidemic in Taiwan. During the SARS epidemic, pregnant women avoided using maternity services in advanced hospitals. Concerns have been raised about maintaining the quality of maternity care with increased demands on childbirth services in local community hospitals. In this study, we analyzed the impact of shifting maternity services among hospitals of different levels on neonatal mortality and maternal deaths. METHODS: A population-based study was conducted using data from Taiwan's National Health Insurance annual statistics of monthly county neonatal morality rates. Based on a pre-SARS sample from January 1998 to December 2002, we estimated a linear regression model which included "trend," a continuous variable representing the effect of yearly changes, and two binary variables, "month" and "county," controlling for seasonal and county-specific effects. With the estimated coefficients, we obtained predicted neonatal mortality rates for each county-month. We compared the differences between observed mortality rates of the SARS period and predicted rates to examine whether the shifting in maternity services during the SARS epidemic significantly affected neonatal mortality rates. RESULTS: With an analysis of a total of 1,848 observations between 1998 and 2004, an insignificantly negative mean of standardized predicted errors during the SARS period was found. The result of a sub-sample containing areas with advanced hospitals showed a significant negative mean of standardized predicted errors during the SARS period. These findings indicate that despite increased use of local community hospitals, neonatal mortality during the SARS epidemic did not increase, and even decreased in areas with advanced hospitals. CONCLUSION: An increased use of maternity services in local community hospitals occurred during the SARS epidemic in Taiwan. However, we observed no increase in neonatal and maternity mortality associated with these increased demands on local community hospitals.
Language: English
Keywords:
TAIWAN | RESEARCH REPORT | HOSPITALS | NEONATAL MORTALITY | MATERNAL-CHILD HEALTH SERVICES | DEATH RATE | ERROR SOURCES | IMPACT | PROGRAM EVALUATION | Asia, Eastern | Asia | Developed Countries | Health Facilities | Delivery of Health Care | Health | Infant Mortality | Mortality | Population Dynamics | Demographic Factors | Population | Primary Health Care | Health Services | Measurement | Research Methodology | Communication | Programs | Organization and Administration
Document Number: 342433

10.

Title: Developing community-based intervention strategies to save newborn lives: lessons learned from formative research in five countries.
Author: Neonatal Mortality Formative Research Working Group
Source: Journal of Perinatology. 2008 Dec;28 Suppl 2:S2-8.
Abstract: This paper summarizes lessons learned from formative research conducted in Bangladesh, Ghana, India, Mali and Nepal to inform the development of newborn health interventions, mostly in the context of field trials. Current practices, constraints to the adoption of optimal practices and implications for implementing inventions to improve newborn survival are discussed for: optimal care during pregnancy; skilled care at birth; optimal delivery and newborn care practices; special care of low birth weight babies; and timely and appropriate care seeking for newborn illness. General lessons concerning target audiences and intervention strategy are also drawn. In brief, interventions to reduce neonatal mortality need to start during pregnancy not only to promote birth preparedness and institutional delivery, but also to start the process of change concerning early newborn care practices. Their target audience should not only be pregnant or recently delivered women, but also include the main gatekeepers, particularly traditional birth attendants, grandmothers and other family members. Health providers' opinions also matter as care practices are less likely to change if families receive conflicting messages from different sources. Interventions are more likely to succeed if they are not simply message based, but include problem solving approaches, and a behavior change component to address community norms. Although antenatal care (ANC) is theoretically a good channel for newborn interventions, capitalising on its potential is not straightforward, and will require considerable investment and intervention development in its own right in order to improve ANC counselling, which will need to extend beyond training and tackle the many working day constraints encountered by ANC providers. Removing or subsidising the cost of deliveries may be a necessary action to increase institutional deliveries, but it is unlikely to be sufficient; measures will need to be put in place to ensure the basic quality of institutional deliveries and newborn care, and to change staff attitudes and practices. Post-natal visits should include observation of the baby, referral and counselling of the mother concerning danger signs in addition to promoting optimal care practices. The lessons learned should guide the development of interventions in other contexts, and ensure that key essential elements are not overlooked. They do not, however, mean that formative research will not be needed in other contexts, although the list of questions to address should be considerably reduced; successful intervention strategies require adaptation to make them local, context-specific if they are to be effective, and ongoing process monitoring to ensure the quality of intervention delivery, to check that it is having its intended effect, and to respond to any concerns from its implementers, recipients or the community. Finally, major gaps in evidence are highlighted. These include: establishing levels of recognition of asphyxiated babies and effectiveness of local solutions for resuscitation; clarifying the extent of the overlap between community perceptions of 'at risk' babies and low birthweight babies; developing and evaluating effective interventions to enable ANC services to deliver effective behaviour change counselling for pregnant and newborn health; evaluating effectiveness of delivering community-based newborn interventions at scale through routine services.
Language: English
Keywords:
MALI | INDIA | BANGLADESH | NEPAL | GHANA | RESEARCH REPORT | FORMATIVE RESEARCH | INFANT | CHILD SURVIVAL | PREGNANCY | CHILDBIRTH | BIRTH WEIGHT | NEONATAL MORTALITY | INFANT HEALTH | PRIMARY HEALTH CARE | PREVENTION AND CONTROL | PROGRAM EVALUATION | Developing Countries | Africa, Western | Africa, Sub Saharan | Africa | Asia, Southern | Asia | Research Methodology | Youth | Age Factors | Population Characteristics | Demographic Factors | Population | Survivorship | Length of Life | Mortality | Population Dynamics | Reproduction | Pregnancy Outcomes | Body Weight | Physiology | Biology | Infant Mortality | Child Health | Health | Health Services | Delivery of Health Care | Diseases | Programs | Organization and Administration
Document Number: 331049

11.

Title: Validation of neonatal tetanus elimination in Bangladesh by lot quality-assurance cluster sampling. Validation de l'elimination du tetanos neonatal au Bangladesh a l'aide d'un sondage en grappes pour le controle de la qualite des lots.
Author: World Health Organization [WHO]
Source: Weekly Epidemiological Record / Releve Epidemiologique Hebdomadaire. 2008 Aug 22;83(34):301-307.
Abstract: In the 1980s, Bangladesh, a country of 146 million inhabitants and more than 4 million births annually, had one of the highest neonatal tetanus (NT) mortality rates in the world. Community-based surveys showed that before widespread introduction of immunization, mortality rates from NT were 20-40/1000 live births in some parts of the country. According to these surveys, NT was responsible for 21-56% of all neonatal deaths. After the introduction of vaccination in 1979, NT rates fell sharply: surveys showed that NT rates had fallen from 6 cases/1000 live births in 1994 to 2.3/1000 live births in 2000. In May 2008, the Ministry of Health and Family Welfare, in collaboration with WHO and UNICEF, carried out an evaluation to determine whether NT had been eliminated in Bangladesh. Two community-based surveys were performed in the 2 districts where children were considered to be at the highest risk from NT. (excerpt)
Language: EnglishFrench
Keywords:
BANGLADESH | RESEARCH REPORT | EVALUATION REPORT | COMMUNITY SURVEYS | INFANT | NEONATAL MORTALITY | TETANUS | IMMUNIZATION | INTERVENTIONS | PROGRAM EVALUATION | PROGRAM EFFECTIVENESS | Developing Countries | Asia, Southern | Asia | Evaluation | Surveys | Sampling Studies | Studies | Research Methodology | Youth | Age Factors | Population Characteristics | Demographic Factors | Population | Infant Mortality | Mortality | Population Dynamics | Infections | Diseases | Primary Health Care | Health Services | Delivery of Health Care | Health | Programs | Organization and Administration
Document Number: 327997

12.
Title: Importance of optimal infant and young child feeding (IYCF) in achieving millennium development goals.
Author: Agarwal RK
Source: Indian Pediatrics. 2008 Sep;45(9):719-21.
Abstract: Millennium Development Goals (MDGs) represent the widest commitment in history to addressing global poverty and ill health. The fourth goal (MDG-4) commits the international community to reducing mortality in children aged younger than 5 years by two-thirds between 1990 and 2015. The first goal (MDG-1) pertaining to eradicate extreme hunger and poverty includes prevalence of underweight children less than five years of age as one of the indicator to gauge for achieving this goal(1). Undernutrition is a largely preventable cause of over one third (35 million) of about 10 million child deaths annually(2). Deaths associated with inappropriate feeding practices mostly occur during the first year of life. By the time children reach their second birthday, if undernourished, they could suffer irreversible physical and cognitive damage, impacting their future health, economic well-being, and welfare. The consequences of insufficient nourishment continue into adulthood and are passed on to the next generation as undernourished girls and women, giving birth to babies with low birth weight(3). To achieve optimal health, development and survival of infants and young children, all infants should be exclusively breastfed for the first six months followed by introduction of appropriate complementary feeding along with continued breastfeeding for two years or beyond(4). (excerpt)
Language: English
Keywords:
DEVELOPING COUNTRIES | CRITIQUE | RECOMMENDATIONS | CLINICAL RESEARCH | INFANT | CHILDREN | CHILD SURVIVAL | CHILD NUTRITION | INFANT NUTRITION | BODY WEIGHT | MALNUTRITION | CHILD DEVELOPMENT | CAUSES OF DEATH | NEONATAL MORTALITY | RISK ASSESSMENT | Research Methodology | Youth | Age Factors | Population Characteristics | Demographic Factors | Population | Survivorship | Length of Life | Mortality | Population Dynamics | Nutrition | Health | Physiology | Biology | Nutrition Disorders | Diseases | Infant Mortality | Evaluation
Document Number: 329157

13.

Title: Perinatal factors associated with early deaths of preterm infants born in Brazilian Network on Neonatal Research centers.
Author: Almeida MF; Guinsburg R; Martinez FE; Procianoy RS; Leone CR; Marba ST; Rugolo LM; Luz JH; Lopes JM
Source: Jornal De Pediatria. 2008 Jul-Aug;84(4):300-7.
Abstract: OBJECTIVE: To evaluate perinatal factors associated with early neonatal death in preterm infants with birth weights (BW) of 400-1,500 g. METHODS: A multicenter prospective cohort study of all infants with BW of 400-1,500 g and 23-33 weeks of gestational age (GA), without malformations, who were born alive at eight public university tertiary hospitals in Brazil between June of 2004 and May of 2005. Infants who died within their first 6 days of life were compared with those who did not regarding maternal and neonatal characteristics and morbidity during the first 72 hours of life. Variables associated with the early deaths were identified by stepwise logistic regression. RESULTS: A total of 579 live births met the inclusion criteria. Early deaths occurred in 92 (16%) cases, varying between centers from 5 to 31%, and these differences persisted after controlling for newborn illness severity and mortality risk score (SNAPPE-II). According to the multivariate analysis, the following factors were associated with early intrahospital neonatal deaths: gestational age of 23-27 weeks (odds ratio - OR = 5.0; 95%CI 2.7-9.4), absence of maternal hypertension (OR = 1.9; 95%CI 1.0-3.7), 5th minute Apgar 0-6 (OR = 2.8; 95%CI 1.4-5.4), presence of respiratory distress syndrome (OR = 3.1; 95%CI 1.4-6.6), and network center of birth. CONCLUSION: Important perinatal factors that are associated with early neonatal deaths in very low birth weight preterm infants can be modified by interventions such as improving fetal vitality at birth and reducing the incidence and severity of respiratory distress syndrome. The heterogeneity of early neonatal rates across the different centers studied indicates that best clinical practices should be identified and disseminated throughout the country.
Language: English
Keywords:
BRAZIL | RESEARCH REPORT | COHORT ANALYSIS | INFANT | NEONATAL MORTALITY | LOW BIRTH WEIGHT | PREMATURE BIRTH | CAUSES OF DEATH | South America, Eastern | South America | Latin America | Americas | Developing Countries | Research Methodology | Youth | Age Factors | Population Characteristics | Demographic Factors | Population | Infant Mortality | Mortality | Population Dynamics | Birth Weight | Body Weight | Physiology | Biology | Pregnancy Outcomes | Pregnancy | Reproduction
Document Number: 341040

14.

Title: Factors associated with bed sharing and sleep position in Thai neonates.
Author: Anuntaseree W; Mo-suwan L; Vasiknanonte P; Kuasirikul S; Ma-a-lee A
Source: Child: Care, Health and Development. 2008;:[9] p.
Abstract: Sleep in a supine position and in a bed separate from but proximate to adults is recommended, in several Western countries, to prevent Sudden Infant Death Syndrome (SIDS). Cultural differences and a lower rate of SIDS in Asian populations may affect concern with this problem and thus infant sleeping arrangements. The objective was to study bed sharing and sleep position in Thai neonates and the relationship to infant and maternal characteristics. Methods A cross-sectional survey based on interviews with parents of infants aged 21 days old, was conducted under the Prospective Cohort Study of Thai Children. Of the total sample, 2236/3692 (60.6%) infants shared a bed with their parents. Sixty per cent of the parents placed their infants to sleep in a supine position, 32.2% on their side and 4.9% in a prone position. Bed sharing was associated with older maternal age, higher education, Muslim mother, and with work status of professional career or unemployed. Placing the infants to sleep in a prone position was associated with infant birth weight of greater than 2500 g, older maternal age, higher education, Buddhist mother, mother with professional career and middle-class household economic status. Infant bed sharing is a common practice in the Thai culture, as in other Asian countries. The prone sleep position is less common than in Western populations. The main factor associated with both bed sharing and putting infants to sleep in the prone position was a higher maternal socioeconomic status (SES), in contrast to previous studies in some Western countries in which both practices were associated with low maternal SES. Cultural differences may play an important role in these different findings. (author's)
Language: English
Keywords:
THAILAND | RESEARCH REPORT | CROSS SECTIONAL ANALYSIS | SURVEYS | INFANT | SUDDEN INFANT DEATH SYNDROME | SLEEPING | BEHAVIOR | SOCIOECONOMIC STATUS | CULTURE | Asia, Southeastern | Asia | Developing Countries | Research Methodology | Sampling Studies | Studies | Youth | Age Factors | Population Characteristics | Demographic Factors | Population | Infant Mortality | Mortality | Population Dynamics | Socioeconomic Factors | Economic Factors | Sociocultural Factors
Document Number: 326846

15.
Peer Reviewed

Title: Impact of an integrated nutrition and health programme on neonatal mortality in rural northern India.
Author: Baqui A; Williams EK; Rosecrans AM; Agrawal PK; Ahmed S; Darmstadt GL; Kumar V; Kiran U; Panwar D; Ahuja RC; Srivastava VK; Black RE; Santosham M
Source: Bulletin of the World Health Organization. 2008 Oct;86(10):796-804, A.
Abstract: OBJECTIVE: To assess the impact of the newborn health component of a large-scale community-based integrated nutrition and health programme. METHODS: Using a quasi-experimental design, we evaluated a programme facilitated by a nongovernmental organization that was implemented by the Indian government within existing infrastructure in two rural districts of Uttar Pradesh, northern India. Mothers who had given birth in the 2 years preceding the surveys were interviewed during the baseline (n = 14 952) and endline (n = 13 826) surveys. The primary outcome measure was reduction of neonatal mortality. FINDINGS: In the intervention district, the frequency of home visits by community-based workers increased during both antenatal (from 16% to 56%) and postnatal (from 3% to 39%) periods, as did frequency of maternal and newborn care practices. In the comparison district, no improvement in home visits was observed and the only notable behaviour change was that women had saved money for emergency medical treatment. Neonatal mortality rates remained unchanged in both districts when only an antenatal visit was received. However, neonates who received a postnatal home visit within 28 days of birth had 34% lower neonatal mortality (35.7 deaths per 1000 live births, 95% confidence interval, CI: 29.2-42.1) than those who received no postnatal visit (53.8 deaths per 1000 live births, 95% CI: 48.9-58.8), after adjusting for sociodemographic variables. Three-quarters of the mortality reduction was seen in those who were visited within the first 3 days after birth. The effect on mortality remained statistically significant when excluding babies who died on the day of birth. CONCLUSION: The limited programme coverage did not enable an effect on neonatal mortality to be observed at the population level. A reduction in neonatal mortality rates in those receiving postnatal home visits shows potential for the programme to have an effect on neonatal deaths.
Language: English
Keywords:
INDIA | RESEARCH REPORT | RURAL POPULATION | MOTHERS | ANTENATAL CARE | NEONATAL MORTALITY | NUTRITION PROGRAMS | INTEGRATED PROGRAMS | IMPACT | Developing Countries | Asia, Southern | Asia | Population Characteristics | Demographic Factors | Population | Parents | Family Relationships | Family Characteristics | Family and Household | Sociocultural Factors | Maternal Health Services | Maternal-Child Health Services | Primary Health Care | Health Services | Delivery of Health Care | Health | Infant Mortality | Mortality | Population Dynamics | Programs | Organization and Administration | Communication
Document Number: 330115

16.

Peer Reviewed

Title: Effect of community-based newborn-care intervention package implemented through two service-delivery strategies in Sylhet district, Bangladesh: A cluster-randomised controlled trial.
Author: Baqui AH; El-Arifeen S; Darmstadt GL; Ahmed S; Williams EK
Source: Lancet. 2008 Jun 7-13;371(9628):1936-1944.
Abstract: Neonatal mortality accounts for a high proportion of deaths in children under the age of 5 years in Bangladesh. Therefore the project for advancing the health of newborns and mothers (Projahnmo) implemented a community-based intervention package through government and non-government organisation infrastructures to reduce neonatal mortality. In Sylhet district, 24 clusters (with a population of about 20 000 each) were randomly assigned in equal numbers to one of two intervention arms or to the comparison arm. Because of the study design, masking was not feasible. All married women of reproductive age (15-49 years) were eligible to participate. In the home-care arm, female community health workers (one per 4000 population) identified pregnant women, made two antenatal home visits to promote birth and newborn-care preparedness, made postnatal home visits to assess newborns on the first, third, and seventh days of birth, and referred or treated sick neonates. In the community-care arm, birth and newborn-care preparedness and careseeking from qualified providers were promoted solely through group sessions held by female and male community mobilisers. The primary outcome was reduction in neonatal mortality. Analysis was by intention to treat. The study is registered with ClinicalTrials.gov, number 00198705. The number of clusters per arm was eight. The number of participants was 36059, 40159, and 37598 in the home-care, community-care, and comparison arms, respectively, with 14 769, 16 325, and 15 350 livebirths, respectively. In the last 6 months of the 30-month intervention, neonatal mortality rates were 29.2 per 1000, 45.2 per 1000, and 43.5 per 1000 in the home-care, community-care, and comparison arms, respectively. Neonatal mortality was reduced in the home-care arm by 34% (adjusted relative risk 0.66; 95% CI 0.47-0.93) during the last 6 months versus that in the comparison arm. No mortality reduction was noted in the community-care arm (0.95; 0.69-1.31). A home-care strategy to promote an integrated package of preventive and curative newborn care is effective in reducing neonatal mortality in communities with a weak health system, low health-care use, and high neonatal mortality. United States Agency for International Development and saving newborn lives programme by Save the Children (US) with a grant from Bill and Melinda Gates Foundation. (author's)
Language: English
Keywords:
BANGLADESH | RESEARCH REPORT | CLINICAL TRIALS | PROGRAM EVALUATION | MATERNAL HEALTH | MATERNAL HEALTH SERVICES | INFANT | INFANT HEALTH | INTERVENTIONS | ANTENATAL CARE | HOME VISITS | HOME CARE | NEONATAL MORTALITY | PROGRAM EFFECTIVENESS | Developing Countries | Asia, Southern | Asia | Clinical Research | Research Methodology | Programs | Organization and Administration | Health | Maternal-Child Health Services | Primary Health Care | Health Services | Delivery of Health Care | Youth | Age Factors | Population Characteristics | Demographic Factors | Population | Child Health | Communication | Care and Support | Infant Mortality | Mortality | Population Dynamics
Document Number: 327025

17.

Title: Predictors of mortality in very low birth weight neonates in India.
Author: Basu S; Rathore P; Bhatia BD
Source: Singapore Medical Journal. 2008 Jul;49(7):556-60.
Abstract: INTRODUCTION: Very low birth weight (VLBW) neonates constitute approximately 4-7 percent of all live births and their mortality is very high. The objective of the present study was to determine the predictors of mortality in VLBW neonates. METHODS: A retrospective cohort of VLBW neonates admitted over three years was studied. Exclusion criteria were: (1) neonates weighing less than 500 g and with gestational age less than 26 weeks; (2) presence of lethal congenital malformations; and (3) death in the delivery room or within 12 hours of life. The outcome measure was in-hospital death. Medical records were reviewed and data was analysed. Univariate analysis and logistic regression analysis were done to determine the predictors of mortality. RESULTS: A total of 260 cases were enrolled, of which a total of 96 (36.9 percent) babies died. The survival rate was found to increase with the increase in birth weight and gestational age. Univariate analysis showed maternal per vaginal bleeding, failure to administer steroid antenatally, Apgar score less than or equal to 5 at one minute, apnoea, gestational age, neonatal septicaemia and shock are the factors directly responsible for neonatal mortality. Logistic regression equation showed maternal bleed (1.326), apnoea (3.159), birth weight (0.037), gestational age (0.063), hypothermia (1.132) and shock (3.49) predicted 65 percent of mortality in VLBW babies. CONCLUSION: Common antenatal and perinatal predictors of mortality in VLBW infants in India include maternal bleed, failure to administer antenatal steroids, low Apgar score, apnoea, extreme prematurity, neonatal septicaemia and shock.
Language: English
Keywords:
INDIA | RESEARCH REPORT | EPIDEMIOLOGIC METHODS | CLINICAL RESEARCH | COHORT ANALYSIS | STATISTICAL REGRESSION | RETROSPECTIVE STUDIES | INFANT | PREVALENCE | RISK FACTORS | LOW BIRTH WEIGHT | PREGNANCY OUTCOMES | NEONATAL MORTALITY | GESTATIONAL AGE | TOXIC SHOCK SYNDROME | Developing Countries | Asia, Southern | Asia | Research Methodology | Data Analysis | Studies | Youth | Age Factors | Population Characteristics | Demographic Factors | Population | Measurement | Biology | Birth Weight | Body Weight | Physiology | Pregnancy | Reproduction | Infant Mortality | Mortality | Population Dynamics | Fetus | Infections | Diseases
Document Number: 328997

18.

Title: Birth-spacing, fertility and neonatal mortality in India: Dynamics, frailty, and fecundity.
Author: Bhalotra S; van Soest A
Source: Journal of Econometrics. 2008 Apr;143(2):274-290.
Abstract: Using microdata on 30,000 childbirths in India and dynamic panel data models, we analyse causal effects of birth spacing on subsequent neonatal mortality and of mortality on subsequent birth intervals, controlling for unobserved heterogeneity. Right censoring is accounted for by jointly estimating a fertility equation, identified by using data on sterilization. We find evidence of frailty, fecundity, and causal effects in both directions. Birth intervals explain only a limited share of the correlation between neonatal mortality of successive children in a family. We predict that for every neonatal death, 0.37 additional children are born, of whom 0.30 survive. (author's)
Language: English
Keywords:
INDIA | RESEARCH REPORT | THEORETICAL MODELS | CORRELATION STUDIES | BIRTH SPACING | FERTILITY DETERMINANTS | NEONATAL MORTALITY | ESTIMATION TECHNIQUES | Developing Countries | Asia, Southern | Asia | Research Methodology | Statistical Studies | Studies | Family Planning | Fertility | Population Dynamics | Demographic Factors | Population | Infant Mortality | Mortality
Document Number: 327065

19.

Peer Reviewed

Title: Implementing community-based perinatal care: Results from a pilot study in rural Pakistan.
Author: Bhutta ZA; Memon ZA; Soofi S; Salat MS; Cousens S
Source: Bulletin of the World Health Organization. 2008 Jun;86(6):452-459.
Abstract: This pilot study investigated the feasibility of delivering a package of community-based interventions for improving perinatal care using lady health workers (LHWs) and traditional birth attendants (Dais) in rural Pakistan. The intervention was implemented in four of eight village clusters (315 villages, total population 138 600), while four served as a comparison group. The LHWs in intervention clusters received additional training focused on essential maternal and newborn care, conducted community education group sessions, and were encouraged to link up with local Dais. The intervention was delivered within the regular government LHW programme and was supported by the creation of voluntary community health committees. In intervention villages, there were significant reductions from baseline in stillbirth (from 65.9 to 43.1 per 1000 births, P less than 0.001) and neonatal mortality rates (from 57.3 to 41.3 per 1000 live births, P less than 0.001). The proportion of deliveries conducted by skilledattendants at public sector facilities also increased, from 18% at baseline to 30%, while the proportion of home births decreased from 79% to 65%. A household survey indicated a higher frequency of key behaviours (e.g. early and exclusive breastfeeding, delayed bathing and cord care) in intervention villages. The improved stillbirth and neonatal mortality rates observed indicate that community health workers (i.e. LHWs and Dais) can be effective in implementing a community and outreach package that leads to improved home care practices by families, increased care-seeking behaviour and greater utilization of skilled care providers. These preliminary observations require confirmation in an adequately powered trial. (author's)
Language: English
Keywords:
PAKISTAN | RESEARCH REPORT | SURVEYS | INFANT | TRADITIONAL BIRTH ATTENDANTS | RURAL AREAS | NEONATAL MORTALITY | FETAL DEATH | COMMUNITY HEALTH SERVICES | HOME CARE | KNOWLEDGE | TRAINING PROGRAMS | Developing Countries | Asia, Southern | Asia | Sampling Studies | Studies | Research Methodology | Youth | Age Factors | Population Characteristics | Demographic Factors | Population | Health Personnel | Delivery of Health Care | Health | Geographic Factors | Infant Mortality | Mortality | Population Dynamics | Primary Health Care | Health Services | Care and Support | Sociocultural Factors | Education
Document Number: 327222

20.

21.

Title: Effect of WHO Newborn Care Training on neonatal mortality by education.
Author: Chomba E; McClure EM; Wright LL; Carlo WA; Chakraborty H
Source: Ambulatory Pediatrics. 2008 Sep-Oct;8(5):300-304.
Abstract: Background.-Ninety-nine percent of the 4 million neonatal deaths per year occur in developing countries. The World Health Organization (WHO) Essential Newborn Care (ENC) course sets the minimum accepted standard for training midwives on aspects of infant care (neonatal resuscitation, breastfeeding, kangaroo care, small baby care, and thermoregulation), many of which are provided by the mother. Objective.-The aim of this study was to determine the association of ENC with all-cause 7-day (early) neonatal mortality among infants of less educated mothers compared with those of mothers with more education. Methods.-Protocol- and ENC-certified research nurses trained all 123 college-educated midwives from 18 low-risk, first-level urban community health centers (Zambia) in data collection (1 week) and ENC (1 week) as part of a controlled study to test the clinical impact of ENC implementation. The mothers were categorized into 2 groups, those who had completed 7 years of school education (primary education) and those with 8 or more years of education. Results.-ENC training is associated with decreases in early neonatal mortality; rates decreased from 11.2 per 1000 live births pre- ENC to 6.2 per 1000 following ENC implementation (P <.001). Prenatal care, birth weight, race, and gender did not differ between the groups. Mortality for infants of mothers with 7 years of education decreased from 12.4 to 6.0 per 1000 (P < .0001) but did not change significantly for those with 8 or more years of education (8.7 to 6.3 per 1000, P �.14). Conclusions.-ENC training decreases early neonatal mortality, and the impact is larger in infants of mothers without secondary education. The impact of ENC may be optimized by training health care workers who treat women with less formal education.
Language: English
Keywords:
ZAMBIA | URBAN AREAS | RESEARCH REPORT | STATISTICAL STUDIES | NURSES AND NURSING | MIDWIVES AND MIDWIFERY | MOTHERS | EDUCATIONAL STATUS | NEONATAL MORTALITY | WHO | TRAINING PROGRAMS | TRAINING OF TRAINERS | PROGRAM EFFECTIVENESS | Developing Countries | Africa, Southern | Africa, Sub Saharan | Africa | Geographic Factors | Population | Studies | Research Methodology | Health Personnel | Delivery of Health Care | Health | Parents | Family Relationships | Family Characteristics | Family and Household | Sociocultural Factors | Socioeconomic Status | Socioeconomic Factors | Economic Factors | Infant Mortality | Mortality | Population Dynamics | Demographic Factors | UN | International Agencies | Organizations | Political Factors | Education | Program Evaluation | Programs | Organization and Administration
Document Number: 340233

22.

Peer Reviewed

Title: Effect of skin barrier therapy on neonatal mortality rates in preterm infants in Bangladesh: A randomized, controlled, clinical trial.
Author: Darmstadt GL; Saha SK; Ahmed AS; Ahmed S; Chowdhury MA
Source: Pediatrics. 2008 Mar;121(3):522-529.
Abstract: Skin barrier therapy during the neonatal period, when the skin barrier is most highly compromised and the risk of death is greatest, has been shown to have a number of potential benefits, including reduced risk of nosocomial sepsis. Topical application of emollients that augment skin barrier function was evaluated as a strategy for improving survival rates among hospitalized preterm infants in Bangladesh. A prospective, randomized, controlled, clinical trial was conducted in the special care nursery at Dhaka Shishu (Children) Hospital, the largest tertiary care children's hospital in Bangladesh. Preterm infants (gestational age: less than or equal to 33 weeks; N = 497) received daily topical applications of sunflower seed oil or Aquaphor ointment. Neonatal mortality rates were compared in an intent-to-treat analysis with a control group that did not receive emollient therapy. Treatment with sunflower seed oil resulted in a statistically significant 26% reduction in mortality rates, compared with infants not receiving topical emollient therapy. Aquaphor therapy also significantly reduced mortality rates, by 32%. Topical therapy with skin barrier-enhancing emollients improved survival rates among preterm hospitalized infants in Bangladesh. This study provides strong evidence for the implementation of topical therapy for high-risk preterm neonates in developing countries. (author's)
Language: English
Keywords:
BANGLADESH | RESEARCH REPORT | CLINICAL TRIALS | INFANT, PREMATURE | NEONATAL MORTALITY | DEATH RATE | DERMATOLOGICAL EFFECTS | INFECTION PREVENTION | Developing Countries | Asia, Southern | Asia | Clinical Research | Research Methodology | Infant | Youth | Age Factors | Population Characteristics | Demographic Factors | Population | Infant Mortality | Mortality | Population Dynamics | Physiology | Biology | Infections | Diseases
Document Number: 324975

23.

Peer Reviewed

Title: Extended-interval dosing of gentamicin for treatment of neonatal sepsis in developed and developing countries.
Author: Darmstadt GL; Miller-Bell M; Batra M; Law P; Law K
Source: Journal of Health, Population and Nutrition. 2008 Jun;26(2):163-182.
Abstract: Serious bacterial infections are the single most important cause of neonatal mortality in developing countries. Case-fatality rates for neonatal sepsis in developing countries are high, partly because of inadequate administration of necessary antibiotics. For the treatment of neonatal sepsis in resource-poor, high-mortality settings in developing countries where most neonatal deaths occur, simplified treatment regimens are needed. Recommended therapy for neonatal sepsis includes gentamicin, a parenteral aminoglycoside antibiotic, which has excellent activity against gram-negative bacteria, in combination with an antimicrobial with potent gram-positive activity. Traditionally, gentamicin has been administered 2-3 times daily. However, recent evidence suggests that extended-interval (i.e. > or = 24 hours) dosing may be applicable to neonates. This review examines the available data from randomized and non-randomized studies of extended- interval dosing of gentamicin in neonates from both developed and developing countries. Available data on the use of gentamicin among neonates suggest that extended dosing intervals and higher doses (>4 mg/kg) confer a favourable pharmacokinetic profile, the potential for enhanced clinical efficacy and decreased toxicity at reduced cost. In conclusion, the following simplified weight-based dosing regimen for the treatment of serious neonatal infections in developing countries is recommended: 13.5 mg (absolute dose) every 24 hours for neonates of > or = 2,500 g, 10 mg every 24 hours for neonates of 2,000-2,499 g, and 10 mg every 48 hours for neonates of <2,000 g. (author's)
Language: English
Keywords:
DEVELOPING COUNTRIES | DEVELOPED COUNTRIES | LITERATURE REVIEW | CLINICAL RESEARCH | INFANT | NEONATAL DISEASES AND ABNORMALITIES | BACTERIAL AND FUNGAL DISEASES | NEONATAL MORTALITY | ANTIBIOTICS | TREATMENT | ADMINISTRATION AND DOSAGE | TIME FACTORS | Research Methodology | Youth | Age Factors | Population Characteristics | Demographic Factors | Population | Diseases | Infections | Infant Mortality | Mortality | Population Dynamics | Drugs | Medical Procedures | Medicine | Health Services | Delivery of Health Care | Health
Document Number: 327783

24.

Peer Reviewed

Title: Neonatal tetanus in Turkey; what has changed in the last decade?
Author: Dikici B; Uzun H; Yilmaz-Keskin E; Tas T; Gunes A; Kocamaz H; Konca C; Tas MA
Source: BMC Infectious Diseases. 2008;8:112.
Abstract: BACKGROUND: Neonatal tetanus (NT) is still considered as one of the major causes of neonatal death in many developing countries. The aim of the present study was to assess the characteristics of sixty-seven infants with the diagnosis of neonatal tetanus followed-up in the Pediatric Infectious Diseases Ward of Dicle University Hospital, Diyarbakir, between 1991 and 2006, and to draw attention to factors that may contribute (or may have contributed) to the elimination of the disease in Diyarbakir. METHODS: The data of sixty-seven infants whose epidemiological and clinical findings were compatible with neonatal tetanus were reviewed. Patients were stratified into two groups according to whether they survived or not to assess the effect of certain factors in the prognosis. Factors having a contribution to the higher rate of tetanus among newborn infants were discussed. RESULTS: A total of 55 cases of NT had been hospitalized between 1991 and 1996 whereas only 12 patients admitted in the last decade. All of the infants had been delivered at home by untrained traditional birth attendants (TBA), and none of the mothers had been immunized with tetanus toxoid during her pregnancy. Twenty-eight (41.8%) of the infants died during their follow-up. Lower birth weight, younger age at onset of symptoms and at the time admission, the presence of opisthotonus, risus sardonicus and were associated with a higher mortality rate. CONCLUSION: Although the number of neonatal tetanus cases admitted to our clinic in recent years is lower than in the last decade efforts including appropriate health education of the masses, ensurement of access to antenatal sevices and increasing the rate of tetanus immunization among mothers still should be made in our region to achieve the goal of neonatal tetanus elimination.
Language: English
Keywords:
TURKEY | RESEARCH REPORT | EPIDEMIOLOGIC METHODS | CLINICAL RESEARCH | LONGITUDINAL STUDIES | INFANT | TRADITIONAL BIRTH ATTENDANTS | TETANUS | NEONATAL DISEASES AND ABNORMALITIES | NEONATAL MORTALITY | HOME CARE | RISK FACTORS | DEATH RATE | BIRTH WEIGHT | AGE FACTORS | Developing Countries | Europe, Southeastern | Europe | Research Methodology | Studies | Youth | Population Characteristics | Demographic Factors | Population | Health Personnel | Delivery of Health Care | Health | Infections | Diseases | Infant Mortality | Mortality | Population Dynamics | Care and Support | Health Services | Biology | Body Weight | Physiology
Document Number: 328604

25.

Title: Aetiology of stillbirths and neonatal deaths in rural Ghana: Implications for health programming in developing countries.
Author: Edmond KM; Quigley MA; Zandoh C; Danso S; Hurt C
Source: Paediatric and Perinatal Epidemiology. 2008 Sep;22(5):430-437.
Abstract: In developing countries many stillbirths and neonatal deaths occur at home and cause of death is not recorded by national health information systems. A community-level verbal autopsy tool was used to obtain data on the aetiology of stillbirths and neonatal deaths in rural Ghana. Objectives were to describe the timing and distribution of causes of stillbirths and neonatal deaths according to site of death (health facility or home). Data were collected from 1 January 2003 to 30 June 2004; 20 317 deliveries, 696 stillbirths and 623 neonatal deaths occurred over that time. Most deaths occurred in the antepartum period (28 weeks gestation to the onset of labour) (33.0%). However, the highest risk periods were during labour and delivery (intrapartum period) and the first day of life. Infections were a major cause of death in the antepartum (10.1%) and neonatal (40.3%) periods. The most important cause of intrapartum death was obstetric complications (59.3%). There were significantly fewer neonatal deaths resulting from birth asphyxia in the home than in the health facilities and more deaths from infection. Only 59 (20.7%) mothers of neonates who died at home reported that they sought care from an appropriate health care provider (doctor, nurse or health facility) during their baby's illness. The results from this study highlight the importance of studying community-level data in developing countries and the high risk of intrapartum stillbirths and infectious diseases in the rural African mother and neonate. Community-level interventions are urgently needed, especially interventions that reduce intrapartum deaths and infection rates in the mother and infant. (author's)
Language: English
Keywords:
GHANA | RESEARCH REPORT | NEONATAL MORTALITY | FETAL DEATH | DEATH RECORDS | AUTOPSY | COMMUNITY SURVEYS | CAUSES OF DEATH | MATERNAL HEALTH | MORBIDITY | COMMUNICABLE DISEASES | Developing Countries | Africa, Western | Africa, Sub Saharan | Africa | Infant Mortality | Mortality | Population Dynamics | Demographic Factors | Population | Vital Statistics | Population Statistics | Research Methodology | Examinations and Diagnoses | Medical Procedures | Medicine | Health Services | Delivery of Health Care | Health | Surveys | Sampling Studies | Studies | Diseases | Infections
Document Number: 327929

26.

Title: Diagnostic accuracy of verbal autopsies in ascertaining the causes of stillbirths and neonatal deaths in rural Ghana.
Author: Edmond KM; Quigley MA; Zandoh C; Danso S; Hurt C
Source: Paediatric and Perinatal Epidemiology. 2008 Sep;22(5):417-429.
Abstract: This study evaluated the diagnostic accuracy of a verbal autopsy (VA) tool in ascertaining the causes of stillbirths and neonatal deaths in rural Ghana and was nested within a community-based maternal vitamin A supplementation trial (ObaapaVitA trial). All stillbirths and neonatal deaths between 1 January 2003 and 30 June 2004 were prospectively included. Community VAs were carried out within 6 months of death and were classified with a primary cause of death by three experienced paediatricans. The reference standard diagnosis was obtained by the study paediatrician in 4 district hospitals in the study area. There were 20 317 deliveries, 661 stillbirths and 590 neonatal deaths with a VA diagnosis in the study population. A total of 311 stillbirths and 191 neonatal deaths had both a VA and a hospital reference standard diagnosis. The VA performed poorly for stillbirth diagnoses such as congenital abnormalities and maternal haemorrhage. Accuracy was higher for intrapartum obstetric complications and antepartum maternal disease. For neonatal deaths, sensitivity was >60% for all major causes; specificity was 76% for birth asphyxia but >85% for prematurity and infection. Overall, VA diagnostic accuracy was higher than expected in this rural African setting. Our classification system was based on the expected public health importance of the individual causes of death, differing implications for intervention and the ability to distinguish between the individual causes in low-resource settings. We believe this system was easier to use than traditional approaches and resulted in high precision and accuracy. However, further simplifications are needed to allow use of the World Health Organisation VA in routine child health programmes. The diagnostic accuracy of the VA tool should also be assessed in other regions and in multicentre studies.
Language: English
Keywords:
GHANA | RESEARCH REPORT | CLINICAL RESEARCH | RURAL POPULATION | WOMEN IN DEVELOPMENT | INFANT | POSTPARTUM WOMEN | AUTOPSY | FETAL DEATH | INTERVIEWS | EXAMINATIONS AND DIAGNOSES | NEONATAL MORTALITY | PREGNANCY COMPLICATIONS | RISK FACTORS | Developing Countries | Africa, Western | Africa, Sub Saharan | Africa | Research Methodology | Population Characteristics | Demographic Factors | Population | Economic Development | Economic Factors | Youth | Age Factors | Puerperium | Reproduction | Medical Procedures | Medicine | Health Services | Delivery of Health Care | Health | Mortality | Population Dynamics | Data Collection | Infant Mortality | Diseases | Biology
Document Number: 308033

27.

Peer Reviewed

Title: Child health and mortality.
Author: El Arifeen S
Source: Journal of Health, Population, and Nutrition. 2008 Sep;26(3):273-9.
Abstract: Bangladesh is currently one of the very few countries in the world, which is on target for achieving the Millennium Development Goal (MDG) 4 relating to child mortality. There have been very rapid reductions in mortality, especially in recent years and among children aged over one month. However, this rate of reduction may be difficult to sustain and may impede the achievement of MDG 4. Neonatal deaths now contribute substantially (57%) to overall mortality of children aged less than five years, and reductions in neonatal mortality are difficult to achieve and have been slow in Bangladesh. There are some interesting attributes of the mortality decline in Bangladesh. Mortality has declined faster among girls than among boys, but the poorest have not benefited from the reduction in mortality. There has also been a relative absence of a decline in mortality in urban areas. The age and cause of death pattern of under-five mortality indicate certain interventions that need to be scaled up rapidly and reach high coverage to achieve MDG 4 in Bangladesh. These include skilled attendance at delivery, postnatal care for the newborn, appropriate feeding of the young infant and child, and prevention and management of childhood infections. The latest (2007) Bangladesh Demographic and Health Survey shows that Bangladesh has made sustained and remarkable progress in many areas of child health. More than 80% of children are receiving all vaccines. The use of oral rehydration solution for diarrhoea is high, and the coverage of vitamin A among children aged 9-59 months has been consistently increasing. However, poor quality of care, misperceptions regarding the need for care, and other social barriers contribute to low levels of care-seeking for illnesses of the newborns and children. Improvements in the health system are essential for removing these barriers, as are effective strategies to reach families and communities with targeted messages and information. Finally, there are substantial health-system challenges relating to the design and implementation, at scale, of interventions to reduce neonatal mortality.
Language: English
Keywords:
BANGLADESH | PROGRESS REPORT | DEMOGRAPHIC AND HEALTH SURVEYS | CHILDREN | CHILD HEALTH | CHILD MORTALITY | GOALS | UN | NEONATAL MORTALITY | SEX FACTORS | CHILD SURVIVAL | IMMUNIZATION | DIARRHEA | UTILIZATION OF HEALTH CARE | CHILD HEALTH SERVICES | Developing Countries | Asia, Southern | Asia | Demographic Surveys | Population Dynamics | Demographic Factors | Population | Youth | Age Factors | Population Characteristics | Health | Mortality | Planning | Organization and Administration | International Agencies | Organizations | Political Factors | Sociocultural Factors | Infant Mortality | Survivorship | Length of Life | Primary Health Care | Health Services | Delivery of Health Care | Diseases | Maternal-Child Health Services
Document Number: 328891

28.

Peer Reviewed

Title: Using human rights to improve maternal and neonatal health: History, connections and a proposed practical approach.
Author: Gruskin S; Cottingham J; HIlber AM; Kismodi E; Lincetto O
Source: Bulletin of the World Health Organization. 2008 Aug;86(8):589-593.
Abstract: We describe the historical development of how maternal and neonatal mortality in the developing world came to be seen as a public-health concern, a human rights concern, and ultimately as both, leading to the development of approaches using human rights concepts and methods to advance maternal and neonatal health. We describe the different contributions of the international community, women's health advocates and human rights activists. We briefly present a recent effort, developed by WHO with the Harvard Program on International Health and Human Rights, that applies a human rights framework to reinforce current efforts to reduce maternal and neonatal mortality. (author's)
Language: English
Keywords:
DEVELOPING COUNTRIES | HISTORICAL REVIEW | MATERNAL HEALTH | NEONATAL MORTALITY | MATERNAL MORTALITY | HUMAN RIGHTS | Health | Infant Mortality | Mortality | Population Dynamics | Demographic Factors | Population | Political Factors | Sociocultural Factors
Document Number: 327981

29.
Title: [Perinatal mortality at Hospital de Ginecoobstetricia No. 23 of Monterrey, Nuevo Leon, 2002-2006 period] Mortalidad perinatal en el Hospital de Ginecoobstetricia num. 23 de Monterrey,
Author: Gutierrez Saucedo ME; Hernandez Herrera RJ; Luna Garcia SA; Flores Santos R; Alcala Galvan LG; Martinez Gaytan V
Source: Ginecologia y Obstetricia de Mexico. 2008 May;76(5):243-8.
Abstract: BACKGROUND: Perinatal period begins at 22 gestational weeks and ends seven days after birth. Perinatal mortality is an important quality indicator of the obstetric and pediatric care available, and representative of the population's health service. OBJECTIVE: To know fetal, early neonatal, and perinatal dead rates, and them main mortality causes. PATIENTS AND METHODS: Descriptive and retrospective study at IMSS's no. 32 UMAE (Monterrey, Nuevo Leon, Mexico), from January 2002 to December 2006. Mortality rates during fetal and perinatal, or neonatal periods, were estimated per 1,000 births or 1,000 live born, respectively. RESULTS: There were 1,681 deaths: 747 stillbirths and 934 neonatal. Two hundred and nineteen (29.3%) stillbirths had 22 to 27 gestational weeks, and 528 (70.6%) had 28. Three hundred and sixty neonatal deaths (38.5%) occurred before 27th gestational week, 320 (34.2%) between weeks 28th and 35th, and 254 (27.1%) after 36 weeks of pregnancy. Seven hundred and sixty four neonates died within 0 to 6 days of life, and 170 (18%) between seventh to 28th days of life. Fetal, neonatal, early neonatal, and late neonatal mortality rates were 7.2 in 1,000 births, 9.08 in 1,000 live born, 7.42 in 1,000 live born, and 1.65 in 1,000 births, respectively, and overall perinatal mortality rate was 14.58 in 1,000 births. CONCLUSIONS: Stillbirth, early neonatal, and perinatal mortality rates of this study were under national mean. Main mortality causes (70%) were congenital defects and prematurity.
Language: Spanish
Keywords:
MEXICO | RESEARCH REPORT | RETROSPECTIVE STUDIES | FETAL DEATH | NEONATAL MORTALITY | DEATH RATE | CAUSES OF DEATH | BIRTH DEFECTS | CONGENITAL ABNORMALITIES | North America | Americas | Developing Countries | Studies | Research Methodology | Mortality | Population Dynamics | Demographic Factors | Population | Infant Mortality | Neonatal Diseases and Abnormalities | Diseases
Document Number: 330576

30.

Peer Reviewed

Title: Child mortality inequalities and linkage with sanitation facilities in Bangladesh.
Author: Halder AM; Kabir M
Source: Journal of Health, Population and Nutrition. 2008 Mar;26(1):64-73.
Abstract: Principal component analysis (PCA) was applied to assets and other household data, collected as part of the Bangladesh Demographic and Health Survey (BDHS) in 2004, to rank individuals according to a household socioeconomic index and to investigate whether this predicts access to the sanitation system or outcomes. PCA was used for determining wealth indices for 11,440 women in 10,500 households in Bangladesh. The index was based on the presence or absence of items from a list of 13 specific household assets and three housing characteristics. PCA revealed 35 components, of which the first component accounted for 18% of the total variance. Ownership of assets and housing features contributed almost equally to the variance in the first component. In this study, ownership of latrines was examined as an example of sanitation- intervention access, and rates of mortality of neonates, infant, and children aged less than five years (under-five mortality) as examples of health outcomes. The analysis demonstrated significant gradients in both access and outcome measures across the wealth quintiles. The findings call for more attention to approaches for reducing health inequalities. These could include reforms in the health sector to provide more equitable allocation of resources, improvement in the quality of health services offered to the poor, and redesigning interventions and their delivery to ensure that they are more pro-poor. (author's)
Language: English
Keywords:
BANGLADESH | RESEARCH REPORT | DEMOGRAPHIC AND HEALTH SURVEYS | CHILDREN | WOMEN IN DEVELOPMENT | MOTHERS | CHILD MORTALITY | SANITATION | SOCIOECONOMIC STATUS | CHILD SURVIVAL | RESOURCE ALLOCATION | PERFORMANCE IMPROVEMENT | NEONATAL MORTALITY | PROGRAM ACCESSIBILITY | MATERNAL-CHILD HEALTH SERVICES | INEQUALITIES | Developing Countries | Asia, Southern | Asia | Demographic Surveys | Population Dynamics | Demographic Factors | Population | Youth | Age Factors | Population Characteristics | Economic Development | Economic Factors | Parents | Family Relationships | Family Characteristics | Family and Household | Sociocultural Factors | Mortality | Public Health | Health | Socioeconomic Factors | Survivorship | Length of Life | Financial Activities | Management | Organization and Administration | Infant Mortality | Program Evaluation | Programs | Primary Health Care | Health Services | Delivery of Health Care
Document Number: 308653


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