Gender variations in neonatal and early infant mortality in India and Pakistan: a secondary analysis from the Global Network Maternal Newborn Health Registry

Zubair H Aghai,Parth Lalakia,Pooja Iyer,Shivaprasad S Goudar,Robert L Goldenberg,Avinash Kavi,Richard J Derman,Archana Patel,Sangappa M Dhaded,Farnaz Naqvi,Tracy L Nolen,Patricia L Hibberd,Elizabeth M Mcclure,Sarah Saleem

doi:10.1186/s12978-020-01028-0

Abstract

BackgroundTo determine the gender differences in neonatal mortality, stillbirths, and perinatal mortality in south Asia using the Global Network data from the Maternal Newborn Health Registry.MethodsThis study is a secondary analysis of prospectively collected data from the three south Asian sites of the Global Network. The maternal and neonatal demographic, clinical characteristics, rates of stillbirths, early neonatal mortality (1–7 days), late neonatal mortality (8–28 days), mortality between 29–42 days and the number of infants hospitalized after birth were compared between the male and female infants.ResultsBetween 2010 and 2018, 297,509 births [154,790 males (52.03%) and 142,719 females (47.97%)] from two Indian sites and one Pakistani site were included in the analysis [288,859 live births (97.1%) and 8,648 stillbirths (2.9%)]. The neonatal mortality rate was significantly higher in male infants (33.2/1,000 live births) compared to their female counterparts (27.4/1,000, p < 0.001). The rates of stillbirths (31.0 vs. 26.9/1000 births) and early neonatal mortality (27.1 vs 21.6/1000 live births) were also higher in males. However, there were no significant differences in late neonatal mortality (6.3 vs. 5.9/1000 live births) and mortality between 29–42 days (2.1 vs. 1.9/1000 live births) between the two groups. More male infants were hospitalized within 42 days after birth (1.8/1000 vs. 1.3/1000 live births, p < 0.001) than females.ConclusionThe risks of stillbirths, and early neonatal mortality were higher among male infants than their female counterparts. However, there was no gender difference in mortality after 7 days of age. Our results highlight the importance of stratifying neonatal mortality into early and late neonatal period to better understand the impact of gender on neonatal mortality. The information from this study will help in developing strategies and identifying measures that can reduce differences in sex-specific mortality.

Highlights

To determine the gender differences in neonatal mortality, stillbirths, and perinatal mortality in south Asia using the Global Network data from the Maternal Newborn Health Registry
The information on gender difference in stillbirths and mortality in different periods of infancy is important for developing strategies and identifying measures directed at reducing sex-specific mortality [12]
Our analysis shows the rates of stillbirth, early and late neonatal mortality and mortality between 29 and 42 days are higher for the Pakistani site compared to the two Indian sites

Summary

Introduction

To determine the gender differences in neonatal mortality, stillbirths, and perinatal mortality in south Asia using the Global Network data from the Maternal Newborn Health Registry. Several recent studies have reported higher neonatal and infant mortality in females compared to males in south Asia [10,11,12]. A few studies from south Asia reported that girls experience a higher risk of late neonatal mortality (between 8 and 28 days) [6, 12, 13]. The objective of the current study was to determine the gender differences in stillbirths, early and late neonatal mortality, and 29–42 day mortality in south Asia using Global Network data from the Maternal Newborn Health Registry (MNHR).

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Conclusion