Decline In Neonatal Mortality Research Articles

Research on the Demographic Variables associated with Diabetes and Fetal Death in the United States

Infant mortality has declined significantly worldwide from the last century to the present. Over the past few decades, however, the decline in neonatal mortality has far outpaced that of fetal mortality. Fetal death accounts for almost 50% of all perinatal deaths, and with intrauterine fetal death ranking in the top five causes worldwide, fetal death remains an important and understudied problem. Diabetes is one of the main reasons and increases fetal mortality risk fivefold. In the United States, from 2014 to 2016, this study compares the disparities in fetal fatalities among women of all races who had gestational diabetes or did not. With a total of 1300 patients reporting a diagnosis of gestational diabetes, statistical significance was shown for the variables of mother education of high school or equivalent, pre-pregnancy body mass index of overweight, and area of fetal birth of the South. The rate of fetal mortality was 16% higher in patients with gestational diabetes than in non-patients without gestational diabetes, according to a negative binomial regression model.

Mothers experience on neonatal danger signs and associated factors in northwest Ethiopia: a community based cross-sectional study.

Introductioneven though there is a significant decline in neonatal mortality globally, it remained unacceptably high in Ethiopia. The estimated experience of neonatal danger signs affects the outcome more than the perceived knowledge. The main aim of this study was to estimate the experience of mothers on neonatal danger signs and its associated factors in Northwest Ethiopia.Methodsa community-based cross-sectional study was conducted from April 6-16, 2019. All the women who have delivered live birth in the past six months in three districts of Northwest Ethiopia were the source populations. A total of 2424 mothers were selected using two-stage stratified cluster random sampling technique. A pretested and semi-structured interviewer-administered questionnaire was used to collect data from eligible mothers. A multivariable logistic regression model was used to identify independent factors that affected mother´s experiences about neonatal danger signs at a p-value of 5%.Resultsin this study, 2335 (96.3%) mothers completed the interview and 1509 (64.6%) of them have mentioned at least one danger sign. However, only 160 (11.0%) mothers have experienced danger signs in their babies. Of these, about 54 (49.1%) mothers have noticed within 24 hours of delivery and 37 (33.6%) have noticed after 48 hours of delivery. Fifty (45.5%) mothers have noticed the danger signs at home after birth, and 48 (43.6%) have noticed during birth. The frequently reported danger signs were; baby feels hot 106 (66.3%), fast breathing 67(41.9%), and difficulty of breathing 61(38.1%). Mothers who are living in urban, AOR=1.8(95%CI: 1.04,3.0), having multiple pregnancy, AOR=9.8 (95%CI: 2.3,42.0), absence of obstetric danger signs or complication, AOR=0.4 (95%CI: 0.2,0.6), post-term gestational age, AOR=6.5 (95%CI: 2.1,19.5), preterm gestational age, AOR=3.3 (95%CI: 0.8,13.4), assessment by hospital staff during delivery, AOR=2.1 (95% CI: 1.01,4.3), and poor mothers knowledge on neonatal danger signs, AOR=0.7 (95% CI: 0.5,0.9) were the predictors of mothers experience on neonatal danger signs.Conclusioneven though the knowledge of mothers on neonatal danger signs is high, the practice or experience in using their knowledge is very low. We recommend an implementation study to be conducted to bridge this “know-do” gap.

Assessing neo-natal mortality trends in Pakistan: an insight using equity lens

BackgroundAlmost 2.5 million neonates died in the first year of life in the year 2017. These account for almost half of the total deaths of children under the age of 5 years. Overall, child mortality has declined over the past two decades. Comparatively, the pace of decline in neonatal mortality has remained much slow. Significant inequalities in health across several dimensions – including wealth, ethnicity, and geography – continue to exist both between and within countries, and these contribute to neonatal mortality. This study aims to quantify the magnitude of inequalities in neonatal mortality trends by wealth quintile and place of residence with province wise segregation.MethodsThe study was done using raw data from the last three Pakistan Demographic & Health Surveys (2017–18, 2012–13 and 2006–07). The concentration curves were drawn in Microsoft Excel 365 using scatter plot as graph type while the frequencies were calculated using SPSS 24.ResultsThe situation of inequity across provinces and in rural vs urban areas has slightly declined, however, gross inequities continue to exist.ConclusionsPresentation of outcomes data, such as neonatal mortality in various wealth quintiles is an effective way to highlight the inequities amongst income groups as it highlights the vulnerable and at-risk groups. In other countries, rural-urban distribution, or ethnic groups may also reflect similar differences and help in identifying high-risk groups.

Neonatal Mortality in Rural Area in Senegal

Most newborn deaths occur in two regions of the world, South Asia and sub-Saharan Africa. In Senegal, much progress has been made over the past two decades with a reduction in overall infant mortality by 38%. However, the decline in neonatal mortality has been slower during the same period. The objective of this study is to assess neonatal mortality, to determine the different causes and to make recommendations for improving care in rural areas. This is a retrospective study with a descriptive and analytical aim carried out in the pediatrics department of the Diourbel regional hospital, 130 km from Dakar, the Senegalese capital, over a 12-month period from January 1 to January 31, December 2018. All newborns hospitalized in the pediatric ward during the study period were included. Overall mortality was 30.6%, newborns between 0 and 7 days accounted for 90.6% of deaths, INBORNs accounted for 62.3% of deaths. Newborns whose mother’s age was between 20 and 35 years of age accounted for 69.3% of deaths. Newborns of first-time mothers accounted for 40.2% of deaths and those of multiparous mothers 31%. Newborns who did not reach term accounted for 58.9% of deaths. Newborns admitted for respiratory distress represented the majority of deaths 45.5% (n = 93) followed by those with low birth weight 32.5 (n = 65) followed by those with neurological manifestations 30.5 (n = 62). Conclusion: Neonatal mortality is very high in the Diourbel region and the main cause is the lack of human resources and a very insufficient technical platform. The fight against this mortality involves improving the technical platform and recruiting sufficient and well-trained staff.

An assessment of admission pattern and treatment outcomes of neonates admitted in centers under facility-based newborn care program in Maharashtra, India.

Newborn period is the most vulnerable period of life. As the rate of decline in neonatal mortality was slow compared to infant mortality rate, improved neonatal health-care services were started in existing facilities under facility-based newborn care program. A total of six special newborn care units at the district hospitals and 12 newborn stabilization units at the subdistrict/rural hospitals were included in the study. The outcome parameters were analyzed in the admitted babies using statistical tests. The mortality pattern was higher among low-birth-weight and preterm babies. The lower health-care centers had less neonatal deaths, as the neonates were referred. The common causes of admission were neonatal jaundice, respiratory distress syndrome, birth asphyxia, and so on. The focus on the high-risk babies needs to be strengthened, as these babies are at a high risk for neonatal mortality.

Determinants of Neonatal Mortality in Kenya: Evidence from the Kenya Demographic and Health Survey 2014.

Background:Globally, there has been a marked decline in neonatal mortality and overall child mortality indicators from 1990 to date. In Kenya, neonatal deaths remain unacceptably high, contributing to 40% of under-five mortality rates (U5MR) making it an important health priority. The objective of this study was to identify the determinants of neonatal mortality in Kenya. An understanding of the determinants of neonatal mortality will provide evidence for better interventions to reduce these deaths.Methods:Neonatal deaths from singleton live-born infants were extracted from women’s dataset collected for the 5-year period preceding the study published in the Kenya Demographic and Health Survey (KDHS), 2014. Data were obtained from 18,951 births. There were 356 neonatal deaths recorded. Data were weighted using an individual weighting factor to adjust for the study design and reduce sample variability. Data were analyzed using SPSS version 20.0. Logistic regression was conducted to adjust for confounding factors.Results:Neonatal mortality rate was established at 19/1000 (95% CI: 16.8-20.7). Mothers with no education had higher odds of experiencing deaths of neonates with adjusted Odds Ratio (aOR)=2.201, 95% CI: 1.43-4.15,p=0.049) compared to mothers with higher education. Low Birth Weight (LBW) neonates were 3.2 times likely to die in the first 28 days (aOR=3.206, 95% CI: 1.85-12.08, p=0.006) compared to neonates with >3.5 kilograms at birth. Mothers who did not attend ANC during pregnancy and those who attended between 1-3 ANC visits had higher odds of losing their infants (aOR=3.348, 95% CI: 1.616-8.53, p=0.041, and aOR=2.316, 95% CI: 1.10-4.88, p=0.027) respectively, compared to mothers who attended >4 ANC visits.Conclusion and Global Health Implications:Improving maternal health and nutrition during pregnancy should be enhanced to ensure adequate weight gain and reduce instances of low birth weight. Community referrals and follow-up for expectant women to take up the requisite 4 ANC visits should be encouraged. Girls’ education should be emphasized to reduce the proportion of illiterate mothers.

Considering evidence in the management of fetal growth restriction.

Considering evidence in the management of fetal growth restriction.

Original Article Risk Factors for Neonatal Mortality in Neonatal Intensive Care Unit in Benha Children Hospital

Though promising progress has been made towards achieving the Millennium Development Goal [MDG] through substantial reduction in under-five mortality, the decline in neonatal mortality remains stagnant, mainly in the middle and low-income countries. The present study aimed to: assess the incidence of neonatal mortality in neonatal intensive care units in Benha Children Hospital. Assess risk factors for neonatal mortality in neonatal intensive care units in Benha Children Hospital. Methods: This study was a prospective cohort study, which was done on 943 neonates [who were admitted in the neonatal intensive care unit at BenhaChildern Hospital].Data were obtained from: neonatal records and also maternal interview using a predesigned questionnaire. neonatal mortality among the studied cases was 18.3%.There might have been a Factual critical connection the middle of the gestational agdistis toward conception What's more neonatal mortality; there might have been statistically noteworthy expand being used about mv around kicked the bucket over made due situations. There might have been statistically noteworthy expand done crp Furthermore WBC around passed on over made due situations. Neonatal mortality On neonatal seriousness will be essential state funded wellbeing issues in creating nations. Neonatal mortality might have been 18. 3%. Amount from claiming danger figures seemed on make fundamentally connected with neonatal mortality like, easier gestational age, low conception weight, easier maternal age, neonatal sepsis Furthermore utilization of mechanical ventilation.

Potential contributions of an on-site nurse mentoring program on neonatal mortality reductions in rural Karnataka state, South India: evidence from repeat community cross-sectional surveys

BackgroundWe assessed the effects of a nurse mentoring program on neonatal mortality in eight districts in India.MethodsFrom 2012 to 2015, nurse mentors supported improvements in critical MNCH-related practices among health providers at primary health centres (PHCs) in northern Karnataka, South India. Baseline (n = 5240) and endline (n = 5154) surveys of randomly selected ever-married women were conducted. Neonatal mortality rates (NMR) among the last live-born children in the three years prior to each survey delivered in NM and non-NM-supported facilities were calculated and compared using survival analysis and cumulative hazard function. Mortality rates on days 1, 2–7 and 8–28 post-partum were compared. Cox survival regression analysis measured the adjusted effect on neonatal mortality of delivering in a nurse mentor supported facility.ResultsOverall, neonatal mortality rate in the three years preceding the baseline and endline surveys was 30.5 (95% CI 24.3–38.4) and 21.6 (95% CI 16.3–28.7) respectively. There was a substantial decline in neonatal mortality between the survey rounds among children delivered in PHCs supported by NM: 29.4 (95% CI 18.1–47.5) vs. 9.3 (95% CI 3.9–22.3) (p = 0.09). No significant declines in neonatal mortality rate were observed among children delivered in other facilities or at home. In regression analysis, among children born in nurse mentor supported facilities, the estimated hazard ratio at endline was significantly lower compared with baseline (HR: 0.23, 95% CI: 0.06–0.82, p = 0.02).ConclusionThe nurse mentoring program was associated with a substantial reduction in neonatal mortality. Further research is warranted to delineate whether this may be an effective strategy for reducing NMR in resource-poor settings.

Service utilization patterns for childbirth and neonatal mortality in the occupied Palestinian territory during conflict.

The global incidence of man-made crises has increased in the last decade. Evidence on deviations in service uptake during conflict is needed to better understand the link between conflict and adverse neonatal outcomes. We assessed the association between conflict intensity in the occupied Palestinian territory (oPt) at time of birth and (i) utilization patterns for childbirth across different providers; and (ii) neonatal mortality. We combined data on conflict intensity with four demographic and health surveys (2004, 2006, 2010 and 2014) that included nationally representative samples of women of childbearing age. Our exposure variable was casualties per 100000 population in defined sub-regions of the oPt. Our outcome specifications were a binary variable for neonatal deaths and a categorical variable for childbirth location. We used multivariate logistic and multinomial regressions to assess the associations. High conflict intensity was associated with fewer childbirths in the private sector (RR=0.97, P=0.04), and non-governmental organizations (RR=0.95, P=0.03) compared to public facilities. Conflict intensity was not associated with higher neonatal mortality beyond 2004. Policy implications include better preparedness in the public sector for childbirth during conflict and exploring reasons for the slow decline in neonatal mortality in the territory beyond conflict at time of birth.

A study on obstetric profile of antenatal mothers in a community: Cross sectional study

In most developed countries, pregnancies are planned, complications are few and outcomes are generally favourable for both mother and infant. Adverse outcomes are far more frequent in the developing world. The most severe adverse outcome of pregnancy is the death of the mother or her offspring. The adverse pregnancy outcome means those pregnancies which terminate causing high risk to the mother and child’s health and life. Worldwide the number of neonatal deaths decreased from 5.1 million in 1990 to 2.5 million in 2017. However, the decline in neonatal mortality from 2000 to 2017 has been slower (41%) than that in post-neonatal mortality (60%) globally. This survey was carried out in the Kudathini Village, which is the rural field practice area situated 16 kms from VIMS Ballari. Ballari is a district in the southern part of Karnataka. There are 19.2% of study subjects who got married below the age of 18 years and the remaining 80.7% were married after 18 years of age. The percentage of consanguinity in marriage is 5.6% and rest 94.3% are non-consanguineous marriage. The duration of married life of most of the study subjects’ i.e, 48.6% belonged to 1-5 years duration followed by more than 5 years i.e, 28.2% and rest of 4.2% were married for less than a year.

What Explains the Decline in Neonatal Mortality in India in the Last Three Decades? Evidence from Three Rounds of NFHS Surveys.

Identifying the factors that have contributed to recent declines in neonatal mortality in India may help determine which policies and programs are most likely to facilitate further reductions. We use data from the 1992-93, 2005-06, and 2015-16 National Family Health Surveys (NFHS) to examine trends in neonatal mortality in India. We use multivariable decomposition to estimate the contribution of different factors to the change in neonatal mortality in India in the last three decades. When limited to most recent births in the 1-47 months preceding the surveys, 70 percent of the decline in neonatal mortality from 1992-2016 is due to changes in utilization of maternal- and child-care program factors and distribution of household, mother's, and child's characteristics. Improvement in "mother's schooling" and increase in utilization of "at least two tetanus toxoid injections" contributed the most followed by the increase in use of "at least three antenatal-care visits" and "clean fuel for cooking." The change in distribution of "birth order" also contributed significantly to the decline in neonatal mortality. Change in the benefits of "access to improved water," "delivery in a medical facility," and "mother's schooling" has led to a decline of 3 points, 2 points, and 1 point, respectively. More investments in maternal- and child-health programs (including family planning) and providing clean fuel for cooking are likely to pay higher dividends.

How fast did newborns die in Nigeria from 2009-2013: a time-to-death analysis using Verbal /Social Autopsy data.

BackgroundThe slow decline in neonatal mortality as compared to post-neonatal mortality in Nigeria calls for attention and efforts to reverse this trend. This paper examines how socioeconomic, cultural, behavioral, and contextual factors interact to influence survival time among deceased newborns in Nigeria.MethodsUsing the neonatal deaths data from the 2014 Nigeria Verbal/ Social Autopsy survey, we examined the temporal distribution of overall and cause-specific mortality of a sample of 723 neonatal deaths. We fitted an extended Cox regression model that also allowed a time-dependent set of risk factors on time-to-neonatal death from all causes, and then separately, from birth injury/birth asphyxia (BIBA) and neonatal infections, while adjusting for possible confounding variables.ResultsApproximately 26% of all neonatal deaths occurred during the first day, 52.8% during the first three days, and 73.9% during the first week of life. Almost all deaths (94.4%) due to BIBA and about 64% from neonatal infections occurred in the first week of life. The expected all-cause mortality hazard was 6.23 times higher on any particular illness day for the deceased newborns who had a severe illness at onset compared to those who did not. While the all-cause mortality hazard ratio of poor vs wealthier households was 0.77 (95% confidence interval (CI) = 0.648-0.922), the BIBA mortality hazard ratio of households with no electricity was 1.79 times higher compared to households with electricity (95% CI = 1.180-2.715).ConclusionsThe findings suggest the need for continued improvement of the coverage and quality of maternal and neonatal health interventions at birth and in the immediate postnatal period. They may also require confirmation in real-world cohorts with detailed, time-varying information on neonatal mortality.

National, regional, and state-level all-cause and cause-specific under-5 mortality in India in 2000–15: a systematic analysis with implications for the Sustainable Development Goals

SummaryBackgroundIndia had the largest number of under-5 deaths of all countries in 2015, with substantial subnational disparities. We estimated national and subnational all-cause and cause-specific mortality among children younger than 5 years annually in 2000–15 in India to understand progress made and to consider implications for achieving the Sustainable Development Goal (SDG) child survival targets.MethodsWe used a multicause model to estimate cause-specific mortality proportions in neonates and children aged 1–59 months at the state level, with causes of death grouped into pneumonia, diarrhoea, meningitis, injury, measles, congenital abnormalities, preterm birth complications, intrapartum-related events, and other causes. AIDS and malaria were estimated separately. The model was based on verbal autopsy studies representing more than 100 000 neonatal deaths globally and 16 962 deaths among children aged 1–59 months at the subnational level in India. By applying these proportions to all-cause deaths by state, we estimated cause-specific numbers of deaths and mortality rates at the state, regional, and national levels.FindingsIn 2015, there were 25·121 million livebirths in India and 1·201 million under-5 deaths (under-5 mortality rate 47·81 per 1000 livebirths). 0·696 million (57·9%) of these deaths occurred in neonates. There were disparities in child mortality across states (from 9·7 deaths [Goa] to 73·1 deaths [Assam] per 1000 livebirths) and regions (from 29·7 deaths [the south] to 63·8 deaths [the northeast] per 1000 livebirths). Overall, the leading causes of under-5 deaths were preterm birth complications (0·330 million [95% uncertainty range 0·279–0·367]; 27·5% of under-5 deaths), pneumonia (0·191 million [0·168–0·219]; 15·9%), and intrapartum-related events (0·139 million [0·116–0·165]; 11·6%), with cause-of-death distributions varying across states and regions. In states with very high under-5 mortality, infectious-disease-related causes (pneumonia and diarrhoea) were among the three leading causes, whereas the three leading causes were all non-communicable in states with very low mortality. Most states had a slower decline in neonatal mortality than in mortality among children aged 1–59 months. Ten major states must accelerate progress to achieve the SDG under-5 mortality target, while 17 are not on track to meet the neonatal mortality target.InterpretationEfforts to reduce vaccine-preventable deaths and to reduce geographical disparities should continue to maintain progress achieved in 2000–15. Enhanced policies and programmes are needed to accelerate mortality reduction in high-burden states and among neonates to achieve the SDG child survival targets in India by 2030.FundingBill & Melinda Gates Foundation.

Neonatal Death with Relation to Institutional Delivery in North-Eastern States of India

Background: Millennium development goal sets target to achieve goal of reducing child mortality for all countries. However decline in neonatal mortality for developing countries was very slow. In India reduction in neonatal mortality was led by institutional delivery along with several other factors. As government of India has implemented various policies to promote institutional delivery. Objectives: This study provides information regarding impact of institutional delivery on neonatal death. Also explains underlying factors which affect institutional delivery. Methods: Present study analyse data from National Family Health Survey, 2015-16 (NFHS-IV). A total of 179752 births (last birth) and 3774 neonatal death were recorded in last 1 Year in Northeastern states of India. A Logistic regression is attempted to understand the correlates of Institutional delivery. Logistic regression model was used to assess the factors responsible for neonatal death in North-Eastern states of India. Results: In Sikkim almost all deliveries taken place at institutions whereas Nagaland is having the highest cases of non-institutional delivery. Highest neonatal death prevails in the state of Assam, Whereas Mizoram and Arunachal Pradesh is having few neonatal death. Conclusion: This study clearly indicates the roll of different socio-economic factors on institutional delivery as a part of to promote neonatal survival. And found that influence of institutional delivery is not much on neonatal death. This may be because there are several variables which affect the pattern of neonatal death of an area. But from the study it is found that delivery at home is still higher in some of the states like Nagaland. Funding Statement: None. Declaration of Interests: None. Ethics Approval Statement: The institutional review board of IIPS Mumbai has given ethical approval.

Is the decline in neonatal mortality in northern Ghana, 1996–2012, associated with the decline in the age of BCG vaccination? An ecological study

ObjectiveTo examine the association between early Bacille Calmette-Guerin (BCG) vaccination and neonatal mortality in northern Ghana.MethodsThis ecological study used vaccination and mortality data from the Navrongo Health and Demographic Surveillance...

Association Between Temporal Changes in Neonatal Mortality and Spontaneous and Clinician-Initiated Deliveries in the United States, 2006-2013

Preterm and postterm deliveries have declined since 2005 in the United States, but the association between these changes and neonatal mortality remains unknown. To estimate changes in the gestational age distribution among spontaneous and clinician-initiated deliveries between 2006 and 2013 and associated changes in neonatal mortality. A retrospective cohort analysis was conducted of 22 million singleton live births without major malformations in the United States from 2006 to 2013. Data analysis was performed from August to October 2017. Changes in gestational age distribution among spontaneous and clinician-initiated deliveries at extremely preterm (20-27 weeks), very preterm (28-31 weeks), moderately preterm (32-33 weeks), late preterm (34-36 weeks), early term (37-38 weeks), term (39-40), late term (41 weeks), and postterm (42-44 weeks) gestations and changes in neonatal mortality rates at less than 28 days between 2006 and 2013. These changes were estimated from log-linear Poisson regression models with robust variance, adjusted for confounders. Among 22 million births, 12 493 531 (56.7%) were spontaneous and 9 557 815 (43.3%) were clinician-initiated deliveries. Among spontaneous deliveries, the proportion of births at 20 to 27, 28 to 31, 32 to 33, 34 to 36, and 37 to 38 weeks declined. Among clinician-initiated deliveries, the proportion of births at 34 to 36 and 37 to 38 weeks declined and the proportion at 39 to 40 weeks increased. Among spontaneous deliveries, overall neonatal mortality rates declined from 1.8 to 1.3 per 1000 live births, mainly at 20 to 27 weeks (adjusted annual decline, 1%; 95% CI, -2% to -1%) and 28 to 31 weeks (adjusted annual decline, 6%; 95% CI, -8% to -5%). Among clinician-initiated deliveries, overall mortality rates remained unchanged (2.1 to 2.2 per 1000 live births). However, mortality rates declined (0.6 to 0.5 per 1000 live births) at 39 to 40 weeks by 1% (95% CI, -3% to -0.4%) annually, adjusted for confounders. In the United States, there was a decline in spontaneous deliveries associated with an overall decline in neonatal mortality. Although clinician-initiated deliveries increased at 39 to 40 weeks, neonatal mortality at that gestation declined.

Quantifying nursing care delivered in Kenyan newborn units: protocol for a cross-sectional direct observational study

IntroductionIn many African countries, including Kenya, a major barrier to achieving child survival goals is the slow decline in neonatal mortality that now represents 45% of the under-5 mortality. In...

The unfinished health agenda: Neonatal mortality in Cambodia.

BackgroundReduction of neonatal and under-five mortality rates remains a primary target in the achievement of universal health goals, as evident in renewed investments of Sustainable Development Goals. Various studies attribute declines in mortality to the combined effects of improvements in health care practices and changes in socio-economic factors. Since the early nineties, Cambodia has managed to evolve from a country devastated by war to a nation soon to enter the group of middle income countries. Cambodia's development efforts are reflected in some remarkable health outcomes such as a significant decline in child mortality rates and the early achievement of related Millennium Development Goals. An achievement acknowledged through the inclusion of Cambodia as one of the ten fast-track countries in the Partnership for Maternal, Newborn and Child Health. This study aims to highlight findings from the field so to provide evidence for future programming and policy efforts. It will be argued that to foster further advances in health, Cambodia will need to keep neonatal survival and health high on the agenda and tackle exacerbating inequities that arise from a pluralistic health system with considerable regional differences and socio-economic disparities.Methods/FindingsData was drawn from Demographic Health Surveys (2000, 2005, 2010, 2014). Information on a series of demographic and socio-economic household characteristics and on child anthropometry, feeding practices and child health were collected from nationally representative samples. To reach the required sample size, live-births that occurred over the past 10 years before the date of the interview were included. Demographic variables included: gender of the child, living area (urban or rural; four ecological regions (constructed by merging provinces and the capital), mother’s age at birth (<20, 20–35, 35+), birth interval (long, short) and birth order (1st, 2–3, 4–6, 7+). Socio-economic variables included: mother education level (none, primary, secondary+) and household wealth (asset-based index). Data on antenatal care, tetanus injection and skilled assistance at birth were used for the mother's last child.Between 2000 and 2014, Cambodia achieved a considerable reduction in neonatal mortality (46% reduction rate). By 2014, gender inequities became almost non-existent (for all measures of equality); inequity related to mother’s education decreased for all time periods; improvements were observed for differences in neonatal mortality by preceding birth interval; and a reduction in neonatal mortality rates could be noted among all the regional subgroups. Inequities increased between mothers who had limited antenatal care and those who received more than four antenatal care visits. In most scale indicators, the Slope Index of Inequality and Relative Index of Inequality estimates for all four rounds of the survey suggest inequity exacerbated in deprived communities. Also, wealth and residence (urban/rural divide) continued to be major determinants in neonatal mortality rates and related inequity trends.ConclusionAnalysis highlighted some of the complex patterns and determinants of neonatal mortality, in Cambodia. There has been a considerable decline in neonatal mortality which echoes global trends. Our analysis reveals that despite these advances, additional socio-economic and demographic characteristics considerably affected neonatal mortality rates and its inequities. There continue to be pockets of vulnerable groups that are lagging behind. This analysis highlights the determinants along the urban-rural and rich-poor divides in neonatal mortality inequities and how these affect access to and utilization of quality basic health services. This calls for future policy and programming efforts to be deliberate in their equity approach. Quality improvements in health services and targeted interventions for specific socio-economic groups will be required to further accelerate progress in reducing neonatal mortality and address Cambodia’s pressing unfinished agenda in health.

The Outcomes of Very Preterm Infants: Is It Time to Ask Different Questions?

* Abbreviations: CP — : cerebral palsy NDD — : neurodevelopmental disability VPT — : very preterm The birth of a very preterm (VPT, <32 weeks) infant is a medical emergency associated with life-threatening complications and high costs of care. Decision-making by providers and parents requires information on possible outcomes. Here we describe the evolution of outcomes assessments for VPT infants, their limitations, and alternative strategies. Much of the literature on the follow-up of very low birth weight (<1500 g) or VPT infants focuses on neurodevelopmental disability (NDD; ie, intelligence/developmental quotients generally <70); cerebral palsy [CP], and blindness/deafness). Characterizing the risk of these conditions followed adding birth weight to the US birth certificate in 1949. An early investigator, Lillienfeld,1 demonstrated higher rates of prematurity among children with CP, mental deficiency, and epilepsy than in children without these conditions. These findings were reinforced in the large, prospective Collaborative Perinatal Study.2 The large size and rigorous methods informed the assessment ages and content of subsequent follow-up studies, allowing later investigators to “benchmark” their results. Lilienfeld1 postulated that certain events in utero lead to an array of outcomes including spontaneous abortion, stillbirth, premature delivery, and infant morbidity. His intent was to underscore the diversity of potential outcomes—a spectrum of reproductive casualty. Later investigators hypothesized that this spectrum suggested a potential trade-off between survival and disability, that is, a relatively fixed quantum of adverse outcomes in which increased survival came at the expense of increased morbidity. The increased survival of premature infants that underlay the decline in neonatal mortality beginning in the late 1960s stimulated a steady … Address correspondence to Marie C. McCormick, MD, ScD, Sumner and Esther Feldberg Professor of Maternal and Child Health, Department of Social and Behavioral Sciences, The T.H. Chan Harvard School of Public Health, 677 Huntington Ave, Boston, MA 02115. E-mail: mmccormi{at}hsph.harvard.edu