Abstract
BackgroundNeonatal deaths in first 28-days of life represent 47% of all deaths under the age of five years globally and are a focus of the United Nation’s (UN’s) Sustainable Development Goals. Pregnant women are delivering in facilities but that does not indicate quality of care during delivery and the postpartum period. The World Health Organization’s Essential Newborn Care (ENC) package reduces neonatal mortality, but lacks a simple and valid composite index that measures its effectiveness.MethodsData on 5 intra-partum and 3 post-partum practices (indicators) recommended as part of ENC, routinely collected in NICHD’s Global Network’s (GN) Maternal Newborn Health Registry (MNHR) between 2010 and 2013, were included. We evaluated if all 8 practices (Care around Delivery – CAD), combined as an index was associated with reduced early neonatal mortality rates (days 0–6 of life).ResultsA total of 150,848 live births were included in the analysis. The individual indicators varied across sites. All components were present in 19.9% births (range 0.4 to 31% across sites). Present indicators (8 components) were associated with reduced early neonatal mortality [adjusted RR (95% CI):0.81 (0.77, 0.85); p < 0.0001]. Despite an overall association between CAD and early neonatal mortality (RR < 1.0 for all early mortality): delivery by skilled birth attendant; presence of fetal heart and delayed bathing were associated with increased early neonatal mortality.ConclusionsPresent indicators (8 practices) of CAD were associated with a 19% reduction in the risk of neonatal death in the diverse health facilities where delivery occurred within the GN MNHR. These indicators could be monitored to identify facilities that need to improve compliance with ENC practices to reduce preventable neonatal deaths. Three of the 8 indicators were associated with increased neonatal mortality, due to baby being sick at birth. Although promising, this composite index needs refinement before use to monitor facility-based quality of care in association with early neonatal mortality.Trial registration The identifier of the Maternal Newborn Health Registry at ClinicalTrials.gov is NCT01073475.
Highlights
Neonatal deaths in first 28-days of life represent 47% of all deaths under the age of five years globally and are a focus of the United Nation’s (UN’s) Sustainable Development Goals
Since presence of Essential Newborn Care (ENC) and immediate neonatal care practices are associated with reduced early neonatal mortality [20, 21], we evaluated whether occurrence of all of these 8 indicators of ENC that were available in the Maternal Newborn Health Registry (MNHR) would be associated with reduced early neonatal mortality
The enrollment target in all participating communities is at least 95% of pregnant women. Outcomes for these women are tracked throughout their pregnancy, delivery and during the post-partum period with follow-up data collected within 7 days of delivery and around 42 days post-partum
Summary
Neonatal deaths in first 28-days of life represent 47% of all deaths under the age of five years globally and are a focus of the United Nation’s (UN’s) Sustainable Development Goals. The focus on reducing maternal, childhood and neonatal mortality continues to be a part of the UN’s Sustainable Development Goal 3 with new targets for 2030 [5]. High quality of care during pregnancy, labor and delivery, and immediately post-partum is critical to reducing maternal, perinatal and neonatal mortality [1, 6, 7]. This need is being partly addressed by an increase in access to institutional deliveries and presence of a skilled birth attendant at delivery, but access to health care providers does not guarantee that recommended interventions will be provided.
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