Abstract
ObjectivesWe compared pregnancy identification methods and outcome capture across 31 Health Demographic Surveillance System (HDSS) sites in 14 countries in sub-Saharan Africa and Asia.MethodsFrom 2009 to 2014, details on the sites and surveillance systems including frequency of update rounds, characteristics of enumerators and interviewers, acceptable respondents were collected and compared across sites.ResultsThe 31 HDSS had a combined population of over 2,905,602 with 165,820 births for the period. Stillbirth rate ranged from 1.9 to 42.6 deaths per 1000 total births and the neonatal mortality rate from 2.6 to 41.6 per 1000 live births. Three quarters (75.3%) of recorded neonatal deaths occurred in the first week of life. The proportion of infant deaths that occurred in the neonatal period ranged from 8 to 83%, with a median of 53%. Sites that registered pregnancies upon locating a live baby in the routine household surveillance round had lower recorded mortality rates.ConclusionsIncreased attention and standardization of pregnancy surveillance and the time of birth will improve data collection and provide platforms for evaluations and availability of data for decision-making with implications for national planning.
Highlights
At the end of the Millennium Development Goals (MDGs) era, the number of children dying each year before the age of five dropped by 54%, from an estimated 12.7 million in 1990 to fewer than six million in 2015
All INDEPTH member sites were invited to participate in the INDEPTH Network Maternal, Newborn and Child Health Working Group (MNCH_WG) activities within the INDEPTH Network because the network membership criteria require all sites to collect data on pregnancy and their outcomes and to conduct maternal and newborn causes of deaths using verbal autopsy
We found a wide range of stillbirth and neonatal mortality rates across the different sites, suggesting huge variations in site capacities for measuring birth outcomes
Summary
At the end of the Millennium Development Goals (MDGs) era, the number of children dying each year before the age of five dropped by 54%, from an estimated 12.7 million in 1990 to fewer than six million in 2015. Despite great progress in reducing child deaths during the MDGs, neonatal mortality had the least progress and accounts for 44% of these deaths globally (UNICEF et al 2015). Neonatal conditions accounted for 202 million disability-adjusted life years in 2010, or 8.1% of the worldwide total (Murray et al 2012). 36% of neonatal deaths occur on the first day and 73% in the first week after birth (Oza et al 2014). The progress in stillbirths was even less, with an estimated decline from 24.7 stillbirths per 1000 total births in 1990 to 18.4 stillbirths per 1000 total births in 2015, a 2% annual reduction rate (de Bernis et al 2016; Lawn et al 2016)
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