Abstract
BackgroundNeonatal mortality causes a substantial proportion of the under-5 mortality in low and middle-income countries (LMIC).MethodsWe undertook a prospective, population-based research study of pregnant women residing in defined geographic areas in the Karnataka State of India, a research site of the Global Network for Women’s and Children’s Health Research. Study staff collected demographic and health care characteristics on eligible women enrolled with neonatal outcomes obtained at delivery and day 28. Cause of neonatal mortality at day 28 was assigned by algorithm using prospectively defined variables.ResultsFrom 2014 to 2018, the neonatal mortality rate was 24.5 per 1,000 live births. The cause of the 28-day neonatal deaths was attributed to prematurity (27.9%), birth asphyxia (25.1%), infection (23.7%) and congenital anomalies (18.4%). Four or more antenatal care (ANC) visits was associated with a lower risk of neonatal death compared to fewer ANC visits. In the adjusted model, compared to liveborn infants ≥ 2500 g, infants born weighing < 1000 g RR for mortality was 25.6 (95%CI 18.3, 36.0), for 1000-1499 g infants the RR was 19.8 (95% CI 14.2, 27.5) and for 1500–2499 g infants the RR was 3.1 (95% CI 2.7, 3.6). However, more than one-third (36.8%) of the deaths occurred among infants with a birthweight ≥ 2500 g. Infants born preterm (< 37 weeks) were also at higher risk for 28-day mortality (RR 7.9, 95% CI 6.9, 9.0) compared to infants ≥ 37 weeks. A one-week decrease in gestational age at delivery was associated with a higher risk of mortality with a RR of 1.3 (95% CI 1.3, 1.3). More than 70% of all the deliveries occurred at a hospital. Among infants who died, 50.3% of the infants had received bag/mask ventilation, 47.3% received antibiotics, and 55.6% received oxygen.ConclusionsConsistent with prior research, the study found that infants who were preterm and low-birth weight remained at highest risk for 28-day neonatal mortality in India. Although most of births now occur within health facilities, a substantial proportion are not receiving basic life-saving interventions. Further efforts to understand the impact of care on infant outcomes are needed.Study registration The trial is registered at clinicaltrials.gov. ClinicalTrial.gov Trial Registration: NCT01073475
Highlights
Neonatal mortality causes a substantial proportion of the under-5 mortality in low and middle-income countries (LMIC)
We have previously demonstrated that the Global Network Cause of Death Algorithm can be used to classify causes of neonatal deaths across low-resource settings such as India [8, 9]
This study was conducted as part of the Global Network for Women’s and Children’s Health Research (Global Network)’s Maternal Newborn Health Registry (MNHR), a population based, observational study conducted in six low-resource countries, including India [13, 14]
Summary
Neonatal mortality causes a substantial proportion of the under-5 mortality in low and middle-income countries (LMIC). In India alone, almost 0.7 million neonatal deaths were estimated to occur in 2015 [3]. Many of these neonatal deaths are believed to occur because of potentially preventable causes such as complications of preterm birth, infectious disease and asphyxia [4]. These three causes are estimated to be responsible for almost 84% of the deaths [5]. In low and middle-income countries (LMIC) such as India, the estimates may under-represent the true burden and be inaccurate [6]. There are limited data regarding representative rural, population-based Indian data of causes and risk factors of neonatal mortality. This study aimed to identify causes and risk factors of neonatal deaths in rural Belagavi from 2014 to 2018
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