Causes and risk factors for deaths in young infants in South Asia: the ANISA prospective population-based observational cohort study

IntroductionStrategies for reducing infant mortality require accurate, local, population-level data. We conducted a population-based observational study in three countries in South Asia to describe risk factors, causes and rates of mortality in young infants.MethodsPregnancies, births and pregnancy...

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Vydáno v:	BMJ global health Ročník 10; číslo 11; s. e018433
Hlavní autoři:	Darmstadt, Gary L, Abdalla, Safa, Islam, Mohammad Shahidul, El Arifeen, Shams, Arvay, Melissa L., Baqui, Abdullah H, Bhutta, Zulfiqar A, Bose, Anuradha, Connor, Nicholas E, Hossain, Belal, Isaac, Rita, Mahmud, Arif, Mitra, Dipak K., Mullany, Luke C, Nisar, Imran, Panigrahi, Kalpana, Panigrahi, Pinaki, Rahman, Qazi Sadeq-ur, Saha, Senjuti, Soofi, Sajid B., Solomon, Nardos, Santosham, Mathuram, Schrag, Stephanie J, Qazi, Shamim A., Saha, Samir K
Médium:	Journal Article
Jazyk:	angličtina
Vydáno:	England BMJ Publishing Group Ltd 03.11.2025 BMJ Publishing Group LTD BMJ Publishing Group
Témata:	Adult Age groups Antibiotics Asia - epidemiology Asia, Southern Autopsies Babies Bacterial infections Birth weight Breast feeding Cause of Death Child health Childbirth & labor Cohort analysis Community health care Congenital defects Environmental factors Epidemiology Estimates Etiology Female Global Health Households Humans Infant Infant Mortality Infant, Newborn Infants Male Mortality Newborn babies Observational studies Original research Paediatrics Postpartum period Pregnancy Pregnancy Outcome - epidemiology Premature birth Prospective Studies Public Health Risk Factors Sepsis Stillbirth Stillbirth - epidemiology Surveillance Trainers Viral infections Young Adult Asia Asia, Southern Bangladesh Pakistan Africa India South Asia Public Health Global Health Epidemiology Paediatrics Child health
ISSN:	2059-7908, 2059-7908
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Abstract	IntroductionStrategies for reducing infant mortality require accurate, local, population-level data. We conducted a population-based observational study in three countries in South Asia to describe risk factors, causes and rates of mortality in young infants.MethodsPregnancies, births and pregnancy outcomes were determined through household surveillance, and cause of deaths was ascertained by verbal autopsy. Cox regression was used to identify risk factors for deaths during days 0–<3, 3–<7 and 7–<60.ResultsAmong 73 622 pregnancy outcomes, 4638 deaths were identified, including 1669 stillbirths (36.0%), 1347 (29.0%) deaths among non-registered liveborn infants who died before the first home visit by community health workers (CHWs), and 1622 (35.0%) deaths that occurred during days 0–<60 among liveborn registered infants. Most deaths among liveborn infants (59.3%, 1757 of 2965) took place within 3 days of birth. The most common causes of death over the young infant period were infections/sepsis (32.5%, n=963 of 2,965), birth asphyxia (29.0%, n=859) and preterm birth/low birth weight (14.1%, n=418). Risk factors for mortality included early morbidity (need for resuscitation, intrapartum infection/antibiotics, multiple gestation, congenital anomalies), environmental factors (smoke exposure, maternal betel chewing) and poor maternal access to quality care (history of a prior neonatal death, lack of care seeking for labour complications). Protective factors included biology (female sex, higher birth weight), essential newborn care (immediate breastfeeding, clean cord care) and access to quality maternal and newborn care (antenatal care, facility birth, skilled birth attendant, maternal education, household wealth).ConclusionsOur population-based data highlight the importance of addressing deaths due to birth asphyxia and infections, while recognising that the relative burden of deaths due to preterm birth and congenital anomalies is increasing globally. Access to quality community-based and facility-based maternal and newborn care is critical to efforts to reduce mortality in young infants in high-mortality settings such as rural South Asia.
AbstractList	IntroductionStrategies for reducing infant mortality require accurate, local, population-level data. We conducted a population-based observational study in three countries in South Asia to describe risk factors, causes and rates of mortality in young infants.MethodsPregnancies, births and pregnancy outcomes were determined through household surveillance, and cause of deaths was ascertained by verbal autopsy. Cox regression was used to identify risk factors for deaths during days 0–<3, 3–<7 and 7–<60.ResultsAmong 73 622 pregnancy outcomes, 4638 deaths were identified, including 1669 stillbirths (36.0%), 1347 (29.0%) deaths among non-registered liveborn infants who died before the first home visit by community health workers (CHWs), and 1622 (35.0%) deaths that occurred during days 0–<60 among liveborn registered infants. Most deaths among liveborn infants (59.3%, 1757 of 2965) took place within 3 days of birth. The most common causes of death over the young infant period were infections/sepsis (32.5%, n=963 of 2,965), birth asphyxia (29.0%, n=859) and preterm birth/low birth weight (14.1%, n=418). Risk factors for mortality included early morbidity (need for resuscitation, intrapartum infection/antibiotics, multiple gestation, congenital anomalies), environmental factors (smoke exposure, maternal betel chewing) and poor maternal access to quality care (history of a prior neonatal death, lack of care seeking for labour complications). Protective factors included biology (female sex, higher birth weight), essential newborn care (immediate breastfeeding, clean cord care) and access to quality maternal and newborn care (antenatal care, facility birth, skilled birth attendant, maternal education, household wealth).ConclusionsOur population-based data highlight the importance of addressing deaths due to birth asphyxia and infections, while recognising that the relative burden of deaths due to preterm birth and congenital anomalies is increasing globally. Access to quality community-based and facility-based maternal and newborn care is critical to efforts to reduce mortality in young infants in high-mortality settings such as rural South Asia. Introduction Strategies for reducing infant mortality require accurate, local, population-level data. We conducted a population-based observational study in three countries in South Asia to describe risk factors, causes and rates of mortality in young infants.Methods Pregnancies, births and pregnancy outcomes were determined through household surveillance, and cause of deaths was ascertained by verbal autopsy. Cox regression was used to identify risk factors for deaths during days 0–<3, 3–<7 and 7–<60.Results Among 73 622 pregnancy outcomes, 4638 deaths were identified, including 1669 stillbirths (36.0%), 1347 (29.0%) deaths among non-registered liveborn infants who died before the first home visit by community health workers (CHWs), and 1622 (35.0%) deaths that occurred during days 0–<60 among liveborn registered infants. Most deaths among liveborn infants (59.3%, 1757 of 2965) took place within 3 days of birth. The most common causes of death over the young infant period were infections/sepsis (32.5%, n=963 of 2,965), birth asphyxia (29.0%, n=859) and preterm birth/low birth weight (14.1%, n=418). Risk factors for mortality included early morbidity (need for resuscitation, intrapartum infection/antibiotics, multiple gestation, congenital anomalies), environmental factors (smoke exposure, maternal betel chewing) and poor maternal access to quality care (history of a prior neonatal death, lack of care seeking for labour complications). Protective factors included biology (female sex, higher birth weight), essential newborn care (immediate breastfeeding, clean cord care) and access to quality maternal and newborn care (antenatal care, facility birth, skilled birth attendant, maternal education, household wealth).Conclusions Our population-based data highlight the importance of addressing deaths due to birth asphyxia and infections, while recognising that the relative burden of deaths due to preterm birth and congenital anomalies is increasing globally. Access to quality community-based and facility-based maternal and newborn care is critical to efforts to reduce mortality in young infants in high-mortality settings such as rural South Asia. Strategies for reducing infant mortality require accurate, local, population-level data. We conducted a population-based observational study in three countries in South Asia to describe risk factors, causes and rates of mortality in young infants. Pregnancies, births and pregnancy outcomes were determined through household surveillance, and cause of deaths was ascertained by verbal autopsy. Cox regression was used to identify risk factors for deaths during days 0-<3, 3-<7 and 7-<60. Among 73 622 pregnancy outcomes, 4638 deaths were identified, including 1669 stillbirths (36.0%), 1347 (29.0%) deaths among non-registered liveborn infants who died before the first home visit by community health workers (CHWs), and 1622 (35.0%) deaths that occurred during days 0-<60 among liveborn registered infants. Most deaths among liveborn infants (59.3%, 1757 of 2965) took place within 3 days of birth. The most common causes of death over the young infant period were infections/sepsis (32.5%, n=963 of 2,965), birth asphyxia (29.0%, n=859) and preterm birth/low birth weight (14.1%, n=418). Risk factors for mortality included early morbidity (need for resuscitation, intrapartum infection/antibiotics, multiple gestation, congenital anomalies), environmental factors (smoke exposure, maternal betel chewing) and poor maternal access to quality care (history of a prior neonatal death, lack of care seeking for labour complications). Protective factors included biology (female sex, higher birth weight), essential newborn care (immediate breastfeeding, clean cord care) and access to quality maternal and newborn care (antenatal care, facility birth, skilled birth attendant, maternal education, household wealth). Our population-based data highlight the importance of addressing deaths due to birth asphyxia and infections, while recognising that the relative burden of deaths due to preterm birth and congenital anomalies is increasing globally. Access to quality community-based and facility-based maternal and newborn care is critical to efforts to reduce mortality in young infants in high-mortality settings such as rural South Asia. Strategies for reducing infant mortality require accurate, local, population-level data. We conducted a population-based observational study in three countries in South Asia to describe risk factors, causes and rates of mortality in young infants.INTRODUCTIONStrategies for reducing infant mortality require accurate, local, population-level data. We conducted a population-based observational study in three countries in South Asia to describe risk factors, causes and rates of mortality in young infants.Pregnancies, births and pregnancy outcomes were determined through household surveillance, and cause of deaths was ascertained by verbal autopsy. Cox regression was used to identify risk factors for deaths during days 0-<3, 3-<7 and 7-<60.METHODSPregnancies, births and pregnancy outcomes were determined through household surveillance, and cause of deaths was ascertained by verbal autopsy. Cox regression was used to identify risk factors for deaths during days 0-<3, 3-<7 and 7-<60.Among 73 622 pregnancy outcomes, 4638 deaths were identified, including 1669 stillbirths (36.0%), 1347 (29.0%) deaths among non-registered liveborn infants who died before the first home visit by community health workers (CHWs), and 1622 (35.0%) deaths that occurred during days 0-<60 among liveborn registered infants. Most deaths among liveborn infants (59.3%, 1757 of 2965) took place within 3 days of birth. The most common causes of death over the young infant period were infections/sepsis (32.5%, n=963 of 2,965), birth asphyxia (29.0%, n=859) and preterm birth/low birth weight (14.1%, n=418). Risk factors for mortality included early morbidity (need for resuscitation, intrapartum infection/antibiotics, multiple gestation, congenital anomalies), environmental factors (smoke exposure, maternal betel chewing) and poor maternal access to quality care (history of a prior neonatal death, lack of care seeking for labour complications). Protective factors included biology (female sex, higher birth weight), essential newborn care (immediate breastfeeding, clean cord care) and access to quality maternal and newborn care (antenatal care, facility birth, skilled birth attendant, maternal education, household wealth).RESULTSAmong 73 622 pregnancy outcomes, 4638 deaths were identified, including 1669 stillbirths (36.0%), 1347 (29.0%) deaths among non-registered liveborn infants who died before the first home visit by community health workers (CHWs), and 1622 (35.0%) deaths that occurred during days 0-<60 among liveborn registered infants. Most deaths among liveborn infants (59.3%, 1757 of 2965) took place within 3 days of birth. The most common causes of death over the young infant period were infections/sepsis (32.5%, n=963 of 2,965), birth asphyxia (29.0%, n=859) and preterm birth/low birth weight (14.1%, n=418). Risk factors for mortality included early morbidity (need for resuscitation, intrapartum infection/antibiotics, multiple gestation, congenital anomalies), environmental factors (smoke exposure, maternal betel chewing) and poor maternal access to quality care (history of a prior neonatal death, lack of care seeking for labour complications). Protective factors included biology (female sex, higher birth weight), essential newborn care (immediate breastfeeding, clean cord care) and access to quality maternal and newborn care (antenatal care, facility birth, skilled birth attendant, maternal education, household wealth).Our population-based data highlight the importance of addressing deaths due to birth asphyxia and infections, while recognising that the relative burden of deaths due to preterm birth and congenital anomalies is increasing globally. Access to quality community-based and facility-based maternal and newborn care is critical to efforts to reduce mortality in young infants in high-mortality settings such as rural South Asia.CONCLUSIONSOur population-based data highlight the importance of addressing deaths due to birth asphyxia and infections, while recognising that the relative burden of deaths due to preterm birth and congenital anomalies is increasing globally. Access to quality community-based and facility-based maternal and newborn care is critical to efforts to reduce mortality in young infants in high-mortality settings such as rural South Asia.
Author	Rahman, Qazi Sadeq-ur Abdalla, Safa Soofi, Sajid B. Isaac, Rita Baqui, Abdullah H Mullany, Luke C Connor, Nicholas E Saha, Samir K Darmstadt, Gary L Arvay, Melissa L. Solomon, Nardos El Arifeen, Shams Nisar, Imran Bose, Anuradha Panigrahi, Pinaki Mitra, Dipak K. Bhutta, Zulfiqar A Schrag, Stephanie J Panigrahi, Kalpana Saha, Senjuti Santosham, Mathuram Qazi, Shamim A. Mahmud, Arif Islam, Mohammad Shahidul Hossain, Belal
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Snippet	IntroductionStrategies for reducing infant mortality require accurate, local, population-level data. We conducted a population-based observational study in... Strategies for reducing infant mortality require accurate, local, population-level data. We conducted a population-based observational study in three countries... Introduction Strategies for reducing infant mortality require accurate, local, population-level data. We conducted a population-based observational study in...
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StartPage	e018433
SubjectTerms	Adult Age groups Antibiotics Asia - epidemiology Asia, Southern Autopsies Babies Bacterial infections Birth weight Breast feeding Cause of Death Child health Childbirth & labor Cohort analysis Community health care Congenital defects Environmental factors Epidemiology Estimates Etiology Female Global Health Households Humans Infant Infant Mortality Infant, Newborn Infants Male Mortality Newborn babies Observational studies Original research Paediatrics Postpartum period Pregnancy Pregnancy Outcome - epidemiology Premature birth Prospective Studies Public Health Risk Factors Sepsis Stillbirth Stillbirth - epidemiology Surveillance Trainers Viral infections Young Adult
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Title	Causes and risk factors for deaths in young infants in South Asia: the ANISA prospective population-based observational cohort study
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