Abstract
BackgroundAlmost all (99%) neonatal deaths arise in low-income and middle-income countries. Approximately 450 new-born children die every hour, which is mainly from preventable causes. There has been increased recognition of the need for these countries to implement public health interventions that specifically target neonatal deaths. The purpose of this paper is to identify the predictors of neonatal death in Type 4 rural (poorest) counties in Shaanxi Province of northwestern China.MethodsA cross-sectional study was conducted in Shaanxi Province, China. A single-stage survey design was identified to estimate standard errors. Because of concern about the complex sample design, the data were analysed using multivariate logistic regression analysis. Socioeconomic and maternal health service utilization factors were added into the model.ResultsDuring the study period, a total of 4750 women who delivered in the past three years were randomly selected for interview in the five counties. There were 4880 live births and 54 neonatal deaths identified. In the multiple logistic regression, the odds of neonatal death was significantly higher for multiparous women (OR = 2.77; 95% CI: 1.34, 5.70) and women who did not receive antennal health care in the first trimester of pregnancy (OR = 2.49; 95% CI: 1.41, 4.40). Women who gave birth in a county-level hospital (OR = 0.18; 95% CI: 0.04, 0.86) and had junior high school or higher education level (OR = 0.20; 95% CI: 0.05, 0.84) were significantly protected from neonatal death.ConclusionsPublic health interventions directed at reducing neonatal death should address the socioeconomic factors and maternal health service utilization, which significantly influence neonatal mortality in rural China. Multipara, low educational level of the women, availability of prenatal visits in the first trimester of pregnancy and hospital delivery should be considered when planning the interventions to reduce the neonatal mortality in rural areas.
Highlights
Almost all (99%) neonatal deaths arise in low-income and middle-income countries
The purpose of this paper is to identify the socioeconomic status and utilization of maternal health service predictors of neonatal death in Type 4 rural counties in Shaanxi Province of northwestern China
Considering there were 13 neonatal deaths within 24 h that would not be included in the analyses, the breastfeeding covariate was not Results During the study period, a total of 4750 women who delivered in the past three years were randomly selected for interview in the five counties
Summary
Almost all (99%) neonatal deaths arise in low-income and middle-income countries. Approximately 450 new-born children die every hour, which is mainly from preventable causes. In the past two decades, the proportion of deaths that occur in the neonatal period increased due to the important worldwide reductions in the mortality of children under the age of 5 [3]. Chinese rural populations have a shorter life expectancy and disproportionally higher rates of overall mortality, which are associated with a broad range of health problems. These inequalities are due to the following three synergistic factors: the social determinants of health have become more inequitable, imbalances in the roles of the market and government have developed, and concerns among the public have grown about fairness in health [6,7]. In 2004 and 2010, the rural NMR was 2.06 and 2.44 times higher than the urban rate [8]
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