Risk factors for neonatal mortality: an observational cohort study in Sarlahi district of rural southern Nepal

To assess the association between maternal characteristics, adverse birth outcomes (small-for-gestational-age (SGA) and/or preterm) and neonatal mortality in rural Nepal. This is a secondary observational analysis to identify risk factors for neonatal mortality, using data from a randomised trial to...

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Veröffentlicht in:BMJ open Jg. 13; H. 9; S. e066931
Hauptverfasser: Yan, Tingting, Mullany, Luke C, Subedi, Seema, Hazel, Elizabeth A, Khatry, Subarna K, Mohan, Diwakar, Zeger, Scott, Tielsch, James M, LeClerq, Steven C, Katz, Joanne
Format: Journal Article
Sprache:Englisch
Veröffentlicht: England BMJ Publishing Group LTD 14.09.2023
BMJ Publishing Group
Schriftenreihe:Original research
Schlagworte:
Alcohol use
Babies
Birth weight
Child
Cohort analysis
Cohort Studies
Female
Gestational age
Humans
Immunization
Infant
Infant Mortality
Infant, Newborn
Menstruation
Miscarriage
Multiple births
Nepal - epidemiology
Newborn babies
Observational studies
Perinatal Death
Pregnancy
Premature birth
Premature Birth - epidemiology
Public Health
Risk Factors
Rural areas
Socioeconomic factors
Stillbirth
Tetanus
Womens health
Nepal
Primary Prevention
Factor Analysis, Statistical
Epidemiology
Risk Factors
Public health
NEONATOLOGY
ISSN:2044-6055, 2044-6055
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Zusammenfassung:To assess the association between maternal characteristics, adverse birth outcomes (small-for-gestational-age (SGA) and/or preterm) and neonatal mortality in rural Nepal. This is a secondary observational analysis to identify risk factors for neonatal mortality, using data from a randomised trial to assess the impact of newborn massage with different oils on neonatal mortality in Sarlahi district, Nepal. Rural Sarlahi district, Nepal. 40 119 pregnant women enrolled from 9 September 2010 to 16 January 2017. The outcome variable is neonatal death. Cox regression was used to estimate adjusted Hazard Ratios (aHRs) to assess the association between adverse birth outcomes and neonatal mortality. There were 32 004 live births and 998 neonatal deaths. SGA and/or preterm birth was strongly associated with increased neonatal mortality: SGA and preterm (aHR: 7.09, 95% CI: (4.44 to 11.31)), SGA and term/post-term (aHR: 2.12, 95% CI: (1.58 to 2.86)), appropriate-for-gestational-age/large-for-gestational-age and preterm (aHR: 3.23, 95% CI: (2.30 to 4.54)). Neonatal mortality was increased with a history of prior child deaths (aHR: 1.53, 95% CI: (1.24 to 1.87)), being a twin or triplet (aHR: 5.64, 95% CI: (4.25 to 7.48)), births at health posts/clinics or in hospital (aHR: 1.34, 95% CI: (1.13 to 1.58)) and on the way to facilities or outdoors (aHR: 2.26, 95% CI: (1.57 to 3.26)). Risk was lower with increasing maternal height from <145 cm to 145-150 cm (aHR: 0.78, 95% CI: (0.65 to 0.94)) to ≥150 cm (aHR: 0.57, 95% CI: (0.47 to 0.68)), four or more antenatal care (ANC) visits (aHR: 0.67, 95% CI: (0.53 to 0.86)) and education >5 years (aHR: 0.75, 95% CI: (0.62 to 0.92)). SGA and/or preterm birth are strongly associated with increased neonatal mortality. To reduce neonatal mortality, interventions that prevent SGA and preterm births by promoting ANC and facility delivery, and care of high-risk infants after birth should be tested. NCT01177111.
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ISSN:2044-6055
2044-6055
DOI:10.1136/bmjopen-2022-066931