Abstract
BackgroundPeru has impressively reduced its neonatal mortality rate (NMR). We aimed, for the period 2000–2013, to: (a) describe national and district NMR variations over time; (b) assess NMR trends by wealth quintile and place of residence; (c) describe evolution of mortality causes; (d) assess completeness of registered mortality; (e) assess coverage and equity of NMR-related interventions; and (f) explore underlying driving factors.MethodsWe compared national NMR time trends from different sources. To describe NMR trends by wealth quintiles, place of residence and districts, we pooled data on births and deaths by calendar year for neonates born to women interviewed in multiple surveys. We disaggregated coverage of NMR-related interventions by wealth quintiles and place of residence. To identify success factors, we ran regression analyses and combined desk reviews with qualitative interviews and group discussions.ResultsNMR fell by 51 % from 2000 to 2013, second only to Brazil in Latin America. Reduction was higher in rural and poorest segments (52 and 58 %). District NMR change varied by source. Regarding cause-specific NMRs, prematurity decreased from 7.0 to 3.2 per 1,000 live births, intra-partum related events from 2.9 to 1.2, congenital abnormalities from 2.4 to 1.8, sepsis from 1.9 to 0.8, pneumonia from 0.9 to 0.4, and other conditions from 1.2 to 0.7. Under-registration of neonatal deaths decreased recently, more in districts with higher development index and lower rural population. Coverage of family planning, antenatal care and skilled birth attendance increased more in rural areas and in the poorest quintile. Regressions did not show consistent associations between mortality and predictors. During the study period social determinants improved substantially, and dramatic out-of-health-sector and health-sector changes occurred. Rural areas and the poorest quintile experienced greater NMR reduction. This progress was driven, within a context of economic growth and poverty reduction, by a combination of strong societal advocacy and political will, which translated into pro-poor implementation of evidence-based interventions with a rights-based approach.ConclusionsAlthough progress in Peru for reducing NMR has been remarkable, future challenges include closing remaining gaps for urban and rural populations and improving newborn health with qualified staff and intermediate- and intensive-level health facilities.Electronic supplementary materialThe online version of this article (doi:10.1186/s12889-016-3405-2) contains supplementary material, which is available to authorized users.
Highlights
Peru has impressively reduced its neonatal mortality rate (NMR)
To describe national time trends, we compared neonatal deaths and rates from different sources including the United Nations Inter-agency Group for Child Mortality Estimation (IGME) [8], the Institute of Health Metrics and Evaluation (IHME) [9], the Child Health Epidemiology Reference Group [10, 11], those estimated through pooled data on births and deaths by calendar year for newborns born to women interviewed in multiple Demographic and Health Surveys (DHS) [12], and official registered & corrected neonatal mortality data [13, 14]
Average annual rates for coverage and equity of interventions related to NMR and for NMR by wealth quintiles and by urban and rural residences were determined through variance-weighted regression of log-rates on year, using the whole time series from the Peruvian DHS [15]
Summary
Peru has impressively reduced its neonatal mortality rate (NMR). We aimed, for the period 2000–2013, to: (a) describe national and district NMR variations over time; (b) assess NMR trends by wealth quintile and place of residence; (c) describe evolution of mortality causes; (d) assess completeness of registered mortality; (e) assess coverage and equity of NMR-related interventions; and (f) explore underlying driving factors. Peru met the fourth Millennium Development Goal (MDG) of reduction of under-five mortality rate by two thirds between 1990 and 2015 [1, 2], and is on track to meet the fifth goal of reduction of maternal mortality by three quarters by 2015 [1, 2]. It has reduced dramatically under-five stunting and underweight prevalence, and has been ranked as the first country among all low and middle-income countries (LMIC) in reducing its neonatal mortality rate from 1990 onwards [3]. A recent multi-country review of healthsystems bottlenecks and success factors related to country progress of neonatal mortality has identified health workforce planning, financial protection measures and dynamic leadership as key facilitating strategies for reduction of neonatal mortality in eight of the 13 countries accounting for the highest burden of neonatal deaths [7].
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