Postneonatal Mortality Research Articles

Sudden Infant Death Syndrome: Risk Factors and Newer Risk Reduction Strategies.

Sudden infant death syndrome (SIDS) continues to be one of the top causes of infant death in the U.S. Despite significant public health initiatives focused on high-risk populations to enhance sleep environments and techniques. The SIDS rate has remained stable in recent years. Risk factors and newer risk reduction strategies for SIDS are the focus of this review article. We conducted a comprehensive literature search on Medline, Cochrane, Embase, and Google Scholar until July 2022. The following search strings and Medical Subject Heading (MeSH) terms were used: "SIDS," "Sudden Infant Death" and "SUID". We explored the literature on SIDS for its epidemiology, pathophysiology, the role of various etiologies and their influence, associated complications leading to SIDS, and preventive and treatment modalities. Despite a more than 50% drop-in rates since the start of the "Back to Sleep" campaign in 1994, sudden infant death syndrome (SIDS) continues to be the top cause of post-neonatal mortality in the United States, despite continued educational initiatives that support safe sleep and other risk reduction strategies. The new American Academy of Pediatrics guidelines for lowering the risk of SIDS include a lot of emphasis on sleeping habits, bedding, and environment but also include elements that are frequently ignored (i.e., prenatal care, smoking, alcohol and drug use, and childhood vaccinations). This study highlights these less-frequently discussed aspects and identifies treatments that have produced beneficial behavioral shifts that benefit newborns as well as their mothers' health and wellbeing.

Altered 5-HT2A/C receptor binding in the medulla oblongata in the sudden infant death syndrome (SIDS): Part I. Tissue-based evidence for serotonin receptor signaling abnormalities in cardiorespiratory- and arousal-related circuits.

The sudden infant death syndrome (SIDS), the leading cause of postneonatal infant mortality in the United States, is typically associated with a sleep period. Previously, we showed evidence of serotonergic abnormalities in the medulla (e.g. altered serotonin (5-HT)1A receptor binding), in SIDS cases. In rodents, 5-HT2A/C receptor signaling contributes to arousal and autoresuscitation, protecting brain oxygen status during sleep. Nonetheless, the role of 5-HT2A/C receptors in the pathophysiology of SIDS is unclear. We hypothesize that in SIDS, 5-HT2A/C receptor binding is altered in medullary nuclei that are key for arousal and autoresuscitation. Here, we report altered 5-HT2A/C binding in several key medullary nuclei in SIDS cases (n = 58) compared to controls (n = 12). In some nuclei the reduced 5-HT2A/C and 5-HT1A binding overlapped, suggesting abnormal 5-HT receptor interactions. The data presented here (Part 1) suggest that a subset of SIDS is due in part to abnormal 5-HT2A/C and 5-HT1A signaling across multiple medullary nuclei vital for arousal and autoresuscitation. In Part II to follow, we highlight 8 medullary subnetworks with altered 5-HT receptor binding in SIDS. We propose the existence of an integrative brainstem network that fails to facilitate arousal and/or autoresuscitation in SIDS cases.

Maternal Opioid Use Disorder and the Risk of Postneonatal Infant Mortality

The risk of serious long-term outcomes for infants born to individuals with opioid use disorder (OUD) is not fully characterized, nor is it well understood whether risks are modified by infant diagnosis of neonatal opioid withdrawal syndrome (NOWS). To characterize the risk of postneonatal infant mortality among infants with a NOWS diagnosis or born to individuals with OUD. The study team conducted a retrospective cohort study of 390 075 infants born from 2007 through 2018 to mothers who were enrolled in Tennessee Medicaid from 183 days prior to delivery through 28 days post partum (baseline). Maternal and infant baseline characteristics were measured using administrative claims and birth certificates, and infants were followed up from day 29 post partum through day 365 or death. Deaths were identified using linked death certificates through 2019. These data were analyzed from February 10, 2022, through March 3, 2023. Infant exposures included birth to an individual with OUD or postnatal diagnosis of NOWS. The study team defined a pregnant individual's OUD status (maternal OUD) as having OUD diagnosis or a maintenance medication prescription fill during baseline; this study defined NOWS as having NOWS diagnosis up to day 28. Groups were categorized by exposures as maternal OUD with NOWS (OUD positive/NOWS positive), maternal OUD without NOWS (OUD positive/NOWS negative), no documented maternal OUD with NOWS (OUD negative/NOWS positive), and no documented maternal OUD or NOWS (OUD negative/NOWS negative, unexposed). The outcome was postneonatal infant death, confirmed by death certificates. Cox proportional hazards models were used, adjusting for baseline maternal and infant characteristics, to estimate adjusted hazard ratios (aHRs) and 95% CIs for the association between maternal OUD or NOWS diagnosis with postneonatal death. Pregnant individuals in the cohort had a mean (SD) age of 24.5 (5.2) years; 51% of infants were male. The study team observed 1317 postneonatal infant deaths and incidence rates of 3.47 (OUD negative/NOWS negative, 375 718), 8.41 (OUD positive/NOWS positive, 4922); 8.95 (OUD positive/NOWS negative, 7196), and 9.25 (OUD negative/NOWS positive, 2239) per 1000 person-years. After adjustment, the risk of postneonatal death was elevated for all groups, relative to the unexposed: OUD positive/NOWS positive (aHR, 1.54; 95% CI, 1.07-2.21), OUD positive/NOWS negative (aHR, 1.62; 95% CI, 1.21-2.17), and OUD negative/NOWS positive (aHR, 1.64; 95% CI, 1.02-2.65). Infants born to individuals with OUD or with a NOWS diagnosis had an increased risk of postneonatal infant mortality. Future work is necessary to create and evaluate supportive interventions for individuals with OUD during and after pregnancy to reduce adverse outcomes.

What was Killing Babies in Trondheim? An Investigation of Infant Mortality Using Individual Level Causes of Death, 1830–1907

This paper examines infant mortality amongst newborns in Trondheim city, 1830–1907, working specifically with individual level cause of death data. Findings show that infant mortality in the city started to drop from 1895, primarily as a result of a decline in post-neonatal mortality. At the start of the decline air-borne diseases accounted for nearly half of the deaths, and water-food borne for around one third. The drop was predominantly driven by a decline in these two causal groups, and seasonal fluctuations became less pronounced. Because of the fall in post-neonatal mortality, the relative risk of dying amongst neonates rose towards the end of the period. Although 'convulsions' accounted for 50–70% of all infant deaths between 1830 and 1860, this cause had faded away to near insignificance by the beginning of the 1900s. Here we aim to assess the extent to which this particular aspect of decline can be explained by alterations to official instructions regarding registration and in registration practice itself. This article proposes that the decline in deaths from 'convulsions' can be explained by a relabelling of such deaths into 'congenital and birth disorders' amongst neonates, and a mix of 'water-food borne' and 'air-borne diseases' amongst post-neonates. This argument is supported by the fact that the timing of the decline corresponds with the introduction of cause of death certificates issued by medical practitioners, and which most likely resulted in fewer causes of death being reported by lay informants who could only offer vague symptoms rather than informed diagnoses.

Health risk assessment for particulate matter: application of AirQ+ model in the northern Caribbean region of Colombia

Air pollution is considered the world’s most important environmental and public health risk. The annual exposure for particulate matter (PM) in the northern Caribbean region of Colombia between 2011 and 2019 was determined using PM records from 25 monitoring stations located within the area. The impact of exposure to particulate matter was assessed through the updated Global Burden of Disease health risk functions using the AirQ+ model for mortality attributable to acute lower respiratory disease (in children ≤ 4 years); mortality in adults aged > 18 years old attributable to chronic obstructive pulmonary disease, ischaemic heart disease, lung cancer, and stroke; and all-cause post-neonatal infant mortality. The proportions of the prevalence of bronchitis in children and the incidence of chronic bronchitis in adults attributable to PM exposure were also estimated for the population at risk. Weather Research and Forecasting-California PUFF (WRF-CALPUFF) modeling systems were used to estimate the spatiotemporal trends and calculate mortality relative risk due to prolonged PM2.5 exposure. Proportions of mortality attributable to long-term exposure to PM2.5 were estimated to be around 11.6% of ALRI deaths in children ≤ 4 years of age, 16.1% for COPD, and 26.6% for IHD in adults. For LC and stroke, annual proportions attributable to PM exposure were estimated to be 9.1% and 18.9%, respectively. An estimated 738 deaths per year are directly attributed to particulate matter pollution. The highest number of deaths per year is recorded in the adult population over 18 years old with a mean of 401 events. The mean risk in terms of the prevalence of bronchitis attributable to air pollution in children was determined to be 109 per 100,000 inhabitants per year. The maximum RR values for mortality (up 1.95%) from long-term PM2.5 exposure were predicted to correspond to regions downwind to the industrial zone.

Association of maternal snuff use and smoking with Sudden Infant Death Syndrome: a national register study

BackgroundThe aim was to study whether non-combustible nicotine (Swedish snuff) use in pregnancy is associated with elevated risk of post neonatal mortality, Sudden Infant Death Syndrome (SIDS), and Sudden Unexpected Infant Death (SUID) and to study how cessation before the antenatal booking influenced these risks.MethodsThis was a population-based register study of all infants with information on tobacco exposure in early pregnancy born in Sweden 1999–2019, n = 2,061,514. Self-reported tobacco use in early pregnancy was categorized as nonuse, snuff use, and moderate and heavy smoking. Multiple logistic regression models were used to estimate crude and adjusted odds ratios (aORs) with 95% confidence intervals (CIs).ResultsMaternal snuff use was associated with increased risks of post neonatal mortality, SIDS, and SUID. The risks of snuff use and moderate smoking were of similar magnitude. Heavy smoking was associated with the highest risks. Cessation of smoking and snuff use before the antenatal booking was associated with lower risks of SIDS and SUID compared to that of continuous usage.ConclusionsMaternal snuff use was associated with increased risks of post neonatal mortality, SIDS, and SUID. Nicotine is the common substance in cigarette smoke and snuff. These findings support the hypothesis that nicotine contributes to an elevated risk of SIDS.ImpactMaternal snuff use and smoking in early pregnancy were associated with increased risks of post neonatal mortality, SIDS, and SUID.Cessation of smoking and snuff use before the first antenatal visit was associated with reduced risks of SIDS and SUID.The common substance in cigarette smoke and snuff is nicotine. Our findings suggest that nicotine contributes to an elevated risk of SIDS and SUID.The implication of our findings is that all forms of nicotine should be avoided in pregnancy.

Contextual, maternal, and infant factors in preventable infant deaths: a statewide ecological and cross-sectional study in Rio Grande do SUL, Brazil

BackgroundEnding preventable deaths of newborns and children under five by 2030 is among the United Nations Sustainable Development Goals. This study aimed to describe infant mortality rate due to preventable causes in Rio Grande do Sul (RS), the Southernmost state in Brazil. With 11,329,605 inhabitants and 141,568 live births in 2017, RS was the fifth most populous state in the country.MethodAn ecological and cross-sectional statewide study, with data extracted from records of the Mortality Information System, Death Certificates, and Live Birth Certificates for the year 2017. Preventability was estimated by applying the List of Causes of Deaths Preventable through Intervention of SUS (acronym for Sistema Unico de Saude - Brazilian Unified Health System) Intervention. Rates of preventable infant mortality (PIMR), preventable early neonatal mortality (PENMR), preventable late neonatal mortality (PLNMR), and preventable post-neonatal mortality (PPNMR) per 1000 live births (LB) were quantified. Incidence ratios, according to contextual characteristics (human development index of the health region and of the municipality; Gini index of the municipality), maternal characteristics at the time of delivery (age, education, self-reported skin color, presence of a partner, number of antenatal care consultations, and type of delivery), and characteristics of the child at the time of birth (gestational age, weight, and pregnancy type) were calculated.ResultsIn 2017, there were 141,568 live births and 1425 deaths of infants younger than 1 year old, of which 1119 were preventable (PIMR = 7.9:1000 LB). The PENMR, PLNMR, and PPNMR were 4.1:1000 LB; 1.5:1000 LB; and 2.3:1000 LB, respectively. More than 60% of deaths in the first week and 57.5% in the late neonatal period could be reduced through adequate care of the woman during pregnancy. The most frequent preventable neonatal causes were related to prematurity, mainly acute respiratory syndrome, and non-specified bacterial septicemia. In the post-neonatal period, 31.8% of deaths could be prevented through adequate diagnostic and treatment.ConclusionsThe strategies needed to reduce preventable infant deaths should preferably focus on preventing prematurity, through adequate care of the woman during pregnancy.

Repercussions of Consanguinity on Metrical Traits At Different Phases of Growth

Introduction: Consanguinity is associated with increase in the likelihood of receiving two copies of deleterious gene from parents, which brings the hidden recessive disorders. This further increases the risk of neonatal and post neonatal mortality. Some of which may also have negative effect on metrical traits of the children, thereby affecting their development and reducing their cognitive abilities. Aim: To examine the effect of parental consanguinity on various metrical traits like linear, circumferential and weight measurements among the Muslim males. Materials and Methods: A cross-sectional study was conducted amongst the Muslim males living in the different river islands of Barpeta district in Assam. The study consisted 1438 males (587 inbred and 851 non-inbred). A total of 936 boys (3 years to 18 years) were measured at an interval of one year. The rest (502 adult men) from 19 to 60 years were in age cohorts of five-years age interval. They were measured for stature, sitting height, lower extremity length, body weight, waist circumference, abdominal circumference and hip circumference. Inbreeding depression on trait was calculated using average coefficient of inbreeding and % of depression in a trait. Wright’s path coefficient method was used for the calculation of inbreeding coefficient. Results: The average coefficient of inbreeding was found to be 0.01637931154. A significant increase in the difference of mean values in all the linear, circumferential and weight measurements has been observed at many ages with the increase in the inbreeding coefficient during childhood and adolescence phase of life. But the difference in mean variance in the adult body parameters between the inbred and non-inbred was statistically insignificant at almost all ages (p>0.05). Conclusion: Consanguinity has not affected any of the adult body measurements. A significant positive association between consanguinity and diminution of body measurements found during the growing period needs to be correlated with the other socio demographic variables because the growing period is always more dependent on environmental variables.

Tendência temporal da mortalidade infantil em Pernambuco, 2001-2019: um estudo ecológico de base populacional

Abstract Objectives: to analyze the temporal trend and spatial distribution of infant mortality in Pernambuco from 2001 to 2019. Methods: an ecological study involving all deaths in children under one year of age living in the state. Data were collected from the Mortality Information System and the Live Birth Information System. Four mortality rates were calculated and the temporal analysis was performed by applying the regression model by inflection points of the rates at different spatial levels. Results: 47,949 deaths were recorded, of which 51.0% (n=24,447) occurred in the first six days of life. A statistically significant downward trend was observed in all the rates analyzed (-4.5%/year in overall mortality, -3.6%/year in early neonatal mortality, -1.9%/year in the late neonatal component, and -6.3%/year in the post-neonatal component). Additionally, 64.3% of the municipalities (n=119) showed a declining trend in the overall infant mortality rate. Less than 50% of the municipalities showed a downward trend in early neonatal and late neonatal mortality (41.08%; n=76 and 43.2%; n=80, respectively). In post-neonatal mortality, 57.3% (n=106) showed decreasing trends. Conclusions: there was a temporal trend of decline in overall infant mortality, although there is an important portion of municipalities with a stationary trend, justifying the need to reduce social inequalities and geographical asymmetries.

THE CONTRIBUTION OF THE GEOGRAPHICAL AREA OF RESIDENCE ON RURAL-URBAN DIFFERENTIALS IN INFANT MORTALITY IN KAKAMEGA CENTRAL SUB-COUNTY, KAKAMEGA COUNTY, KENYA

Background: Infant mortality remains an indaba in Sub-Saharan Africa, a region currently producing over half of global infant deaths. Kakamega Central Sub-County, a region within Sub-Saharan Africa, has an infant mortality rate of 37. This study examined the contribution of the geographical area of residence on rural-urban differentials in infant mortality in Kakamega Central Sub-County, Kakamega County, Kenya. Methods: A cross-sectional research design was adopted. Primary data were collected from mothers between the childbearing ages of 15 to 49 years who had an experience of childbirth between 2013 and 2022. Secondary data were obtained from the 2019 Kenya population and housing census. Cross-tabulation and multinomial logistic regression analyses were conducted on the statistical package of the social sciences version 25 computer software program. Results: Rural areas with mud roads had higher odds of neonatal (aOR – 2.067) and infant (aOR - 3.867) mortalities when compared to those with tarmacked roads. Areas with 3 to 4 health facilities had 8.248 and 2.651 higher adjusted odds ratios of post-neonatal and infant mortality when compared to areas with at least 5 health facilities in rural and urban areas, respectively. Residing in good housing was associated with lower odds ratios of rural neonatal (aOR – 0.016), urban post-neonatal (aOR – 0.265), and infant (aOR – 0.312) mortalities when compared to residing in durable housing. Conclusion: There is a need for concerted efforts towards road improvement in rural areas; increased access to functional and well-equipped health to ensure an acceptable density of health facilities; and enlightening people on the importance of proper hygiene in the household environments and on good, affordable, dietary practices.

Risk of Postneonatal Infant Mortality Associated With Prior Founded Allegations of Child Abuse.

Context: There are ∼7500 postneonatal deaths (28 days to under 1 year) in the US annually, of which a majority are preventable. Previous studies have reported a child's prior encounter with child protective services (CPS) as a risk factor for preventable death but few studies have evaluated this in relation to subsequent postneonatal deaths. Objective: To measure the association between prior reports of child abuse and subsequent postneonatal death. Study Design/Analysis: Secondary data analysis from the case-control Chicago Infant Mortality Study (CIMS). Conditional logistic regression modeling determined the odds of postneonatal death when there was a founded prior allegation. Setting and Population Studied: CIMS included all sudden, unexplained infant deaths up to 1 year in Chicago (November 1993-April 1996) (n=469), and matched living controls (n=472). Information on prior child abuse reports and outcomes was obtained through the Illinois Department of Children and Family Services (DCFS) State Central Registry for each case and control. Instrument: Cause of death was determined by Cook County Medical Examiners based on autopsy, death scene investigation and review of the medical history. DCFS database was searched on infant's name, mother's name, screening number and other identifiers. Only "founded" allegations that occurred prior to the date of death (cases) and date of interview (controls) were included Outcome measures: Founded allegations for cases by cause of death. Odds of death by prior allegations and other socio-demographic factors. Results: DCFS founded allegations were identified in 119 cases (25%) and/or their families and in 35 controls (7%; OR = 4.25, 95% CI, 2.86, 6.35). There were no clear patterns when frequency of allegations was analyzed by cause of death. Families with founded allegations were almost 4 times more likely to experience a postneonatal death (aOR =3.79, 95% CI, 1.56, 9.10). Lower maternal education, age, inadequate prenatal care and infant-parent bedsharing were also associated with higher odds of postneonatal death. Conclusions: Child protective services involvement is an opportunity for education to help reduce the incidence of potentially preventable infant deaths. Families should have access to appropriate acute and preventive care and receive ongoing education about child abuse prevention, infant safety, reducing the risk of preventable deaths such as SIDS, and when to seek medical attention.

Padrões espaciais de mortalidade em recém-nascidos de baixo peso a termo e seus determinantes no Estado de São Paulo, Brasil

ABSTRACT Objective: Low birth weight (LBW) is a public health problem strongly associated with infant mortality. This study aimed to identify the spatial distribution of infant mortality in newborns with LBW (750–2,500 g) at term (≥37 weeks of gestation), due to their being small for gestational age, analyzing its association with mother-related determinants, as well as to identify priority areas of mortality in the State of São Paulo, 2010–2019. Methods: Infant mortality rate was analyzed in the division of neonatal mortality and postneonatal mortality of newborns with LBW at term. The empirical Bayesian method smoothed the rates, the univariate Moran index was used to measure the degree of spatial association between the municipalities, and the bivariate Moran index was employed to identify the existence of a spatial association between the rates and the selected determinants. Thematic maps of excess risk and local Moran were prepared to identify spatial clusters, adopting 5% as a significance level. Results: The excess risk map showed that more than 30% of the municipalities had rates above the state rate. High-risk clusters were identified in the southwest, southeast, and east regions, mainly among more developed municipalities. The determinants of adolescent mothers, mothers over 34 years of age, low education, human development index, social vulnerability index, gross domestic product, physicians, and pediatric beds showed a significant association with the rates evaluated. Conclusions: Priority areas and significant determinants associated with reduced mortality in newborns with LBW were identified, suggesting the need for intervention measures to achieve the Sustainable Development Goal.

Environmental Risk Assessment from 2018 To 2022 for Kota, Rajasthan (India)

Particulate matter pollution in the metropolis has become an international concern because of its dangerous short and long-term effects on humans and the environment. This research aims to quantify particulate matter's severe impact on inhabitants and identify the ecological environment risk category of Kota city, Rajasthan (India), throughout the selected study period from 2018 to 2022 for four years. Human health risk assessment has been assessed through AirQ+ software (WHO invented), while ecological hazard risk categories were recognised through risk quotient (RQ). The present scenario of particulate matter concentration is compared with standards given by different regulating agencies (WHO, USEPA, and Indian NAAQS) to verify particulate matter pollution. The current particulate matter concentration levels of Kota city are also compared with different regional cities of Rajasthan (India), namely, Jaipur, Udaipur, Ajmer, Pali, Alwar, and Jodhpur. The dust ratio (PM2.5/PM10) is computed for Kota and regional cities to validate the increasing levels of fine particulates than the larger ones. The four-year average concentration of PM10 and PM2.5 were 121 and 58 µg/m3, respectively, with a dust ratio of 0.48. Particulate matter concentrations (PM10 and PM2.5) are violating the standards set by environmental agencies during the study period. The mean risk quotient (RQ) is 2.02 for PM10 and 1.43 for PM2.5, which implies a high-risk hazard category (RQ > 1) in the ecological environment of Kota city. The mortality cases evaluated from AirQ+ software were 5024 for all natural causes, 885 for lung cancer, 272 for acute lower respiratory infection, 464 for COPD, 2060 for IHD, and 1880 for stroke. The number of hospital admissions was 1485 for respiratory disease, 58 for cardiovascular disease, and 784 for adult mortality (30+ years) to PM2.5. Chronic bronchitis incidence in adults was 14469, postneonatal infant mortality was 355816, and the prevalence of bronchitis in children was 767 due to PM10 exposure for a long time, while asthma symptoms in asthmatic children were 349 due to exposure for a short time. The results of this study are terrifying, and it is an earlier sign to government representatives and stakeholders to implement the new policies and technologies to curb the pollution level originating from particulate matter; otherwise, impacts on the environment become more acute.

Determinants of Neonatal and Post-neonatal Mortality in Pakistan

Ensuring the survival and well being of children is a concern of families, communities and nations throughout the world. Since the turn of the 20th century infant and child mortality in more developed countries has steadily declined and, currently, has been reduced to almost minimal levels. In contrast, although infant and child mortality has declined in the past three decades in most less developed countries, the pace of change and the magnitude of improvement vary considerably from one country to another. The inverse relationship between socio-economic variables of the parents and infant and child mortality is well established by several studies [Muhuri (1995); Forste (1994); Hobcraft, et al. (1984); Caldwell (1979); Sathar (1985, 1987)] and it holds true irrespective of the overall level of mortality in the national populations [Ruzicka (1989)]. The influence of parental education on infant and child health and mortality has proved to be universally significant [Bicego and Boerma (1993); Caldwell, et al. (1990)]. The father’s education, mother’s education and their work status each have independent effects upon child survival in developing countries [Sandiford, et al. (1995); Forste (1994); Caldwell, et al. (1983)]. Economic conditions of the household also help in explaining the variation in infant and child mortality. The nature of housing, diet, access to and availability of water and sanitary conditions as well as medical attention all depend on the economic conditions of the household. For example, poor families may reside in crowded, unhygienic housing and, thus, suffer from infectious disease associated with inadequate and contaminated water supplies and with poor sanitation [Esrey and Habicht (1986)].

Racial differentials in American Indian- White American Postneonatal Mortality in the United States: evidence from cohort linked birth/infant death records

PurposePostneonatal mortality (PNM), which differs from infant and perinatal mortality, has been observed in the past 25 years with respect to the health outcomes of children. While infant and perinatal mortality have been well-evaluated regarding racial differentials, there are no substantial data on PNM in this perspective. The purpose of this study was to assess whether or not social determinants of health adversely affect racial/ethnic PNM differentials in the USA.Design/methodology/approachA cross-sectional, nonexperimental epidemiologic study design was used to assess race as an exposure function of PNM using Cohort Linked Birth/Infant Death Data (2013). The outcome variable assessed PNM, while the main independent variables were race, social demographic variables (i.e. sex and age) and social determinants of health (i.e. marital status and maternal education). The chi-square statistic was used to assess the independence of variables by race, while the logistic regression model was used to assess the odds of PNM by race and other confounding variables.FindingsDuring 2013, there were 4,451 children with PNM experience. The cumulative incidence of PNM was 23.6% (n = 2,795) among white infants, 24.3% (n = 1,298) among Black/African-Americans (AA) and 39.5% (n = 88) were American-Indian infants (AI), while 21.3% (n = 270) were multiracial, χ2 (3) = 35.7, p < 0.001. Racial differentials in PNM were observed. Relative to White infants, PNM was two times as likely among AI, odds ratio (OR) 2.11 (95% confidence interval [CI] 1.61, 2.78). After controlling for the confounding variables, the burden of PNM persisted among AI, although slightly marginalized, adjusted odds ratio (aOR) 1.70, (99% CI 1.10, 2.65).Originality/valueIn a representative sample of US children, there were racial disparities in PNM infants who are AI compared to their white counterparts, illustrating excess mortality. These findings suggest the need to allocate social and health resources in transforming health equity in this direction.

Interpregnancy Interval and Child Health Outcomes in India: Evidence from Three Recent Rounds of National Family Health Survey

IntroductionShort interpregnancy interval (IPI) is a well-known risk factor for preterm births and low birth weights. However, research on the association between interpregnancy interval (IPI) and health outcomes in children under age 5 is limited in India. We examined the associations between IPI and five child health outcomes in India.MethodsWe used nationally representative cross-sectional data from three rounds of National Family Health Survey (NFHS) conducted in India during 2005-06, 2015-16 and 2019-21 to examine the associations between IPI [categorized as < 12 months, 12–17 months, 18–23 months (ref), 24–35 months, and 36–59 months] and five child health outcomes – neonatal mortality, postneonatal mortality, diarrhea and/or acute respiratory infections (ARI), stunting, and underweight, for the total sample and, secondarily, using sex-stratified analyses. We used multivariable and mother fixed-effects binary logistic regressions to examine the associations.Results3% and 2% of infants died during the neonatal and postneonatal period, respectively. Thirteen, 40, and 37% of children had diarrhea and/or ARI, were stunted, and were underweight, respectively. IPI < 12 months was associated with higher odds of diarrhea and/or ARI (OR: 1.11; 95% CI: 1.05–1.18), stunting (OR: 1.13; 95% CI: 1.08–1.18) and underweight (OR: 1.06; 95% CI: 1.01–1.11). Mother fixed-effects adjustments confirmed these associations and also found that births with IPI of 12–17 months and 36–59 months had higher odds of stunting, and IPI of 12–17 months was also associated with higher odds of underweight.DiscussionOur findings indicate that IPIs shorter than 12 months are a risk factor for diarrhea and/or ARI, and IPIs shorter than 12 months and 12–17 months are risk factors for stunting and underweight among children under 5 in India. Mother fixed-effects models allowed us to adjust our estimates for unobserved heterogeneity; this has rarely been done before. Increases in birth spacing may improve child health outcomes in India.

Effectiveness of adjunct telephone-based postnatal care on maternal and infant illness in the Greater Accra Region, Ghana: a randomized controlled trial

IntroductionGlobally, postnatal care (PNC) is fraught with challenges. Despite high PNC coverages in Ghana’s Greater Accra Region (GAR), maternal and newborn health outcomes are of great concern. In 2017, neonatal and post-neonatal mortality rates in GAR were 19 and 13 per 1000 live births respectively despite PNC coverages of 93% for at least one PNC and 87.5% for PNC within 48 hours post-delivery. Telephone follow-up has been used to improve health outcomes in some settings, however, its usefulness in improving maternal and infant health during the postnatal period is not well known in Ghana. We assessed effectiveness of telephone-based PNC on infant and maternal illness in selected hospitals in GAR.MethodsAn open-label, assessor-blinded, parallel-group, two-arm superiority randomized controlled trial with 1:1 allocation ratio was conducted from September 2020 to March 2021. Mother-baby pairs in intervention arm, in addition to usual PNC, received midwife-led telephone counselling within 48 hours post-discharge plus telephone access to midwife during postnatal period. In control arm, only usual PNC was provided. Descriptive and inferential data analyses were conducted to generate frequencies, relative frequencies, risk ratios and 95% confidence intervals. Primary analysis was by intention-to-treat (ITT), complemented by per-protocol (PP) analysis.ResultsOf 608 mother-baby pairs assessed for eligibility, 400 (65.8%) were enrolled. During 3 months follow-up, proportion of infants who fell ill was 62.5% in intervention arm and 77.5% in control arm (p = 0.001). Maternal illness occurred in 27.5% of intervention and 38.5% of control participants (p = 0.02). Risk of infant illness was 20% less in intervention than control arm in both ITT analysis [RR = 0.8 (95%CI = 0.71–0.92] and PP analysis [RR = 0.8 (95%CI = 0.67–0.89)]. Compared to controls, risk of maternal illness in intervention arm was 30% lower in both ITT [RR = 0.7 (95%CI = 0.54–95.00)] and PP analysis [RR = 0.7 (95%CI = 0.51–0.94)].ConclusionTelephone-based PNC significantly reduced risk of maternal and infant illness within first 3 months after delivery. This intervention merits consideration as a tool for adoption and scale up to improve infant and maternal health.Trial registrationThis trial was retrospectively registered with the International Standard Randomized Controlled Trial Number (ISRCTN) Registry with number ISRCTN46905855 on 09/04/2021.

Maternal height and child health and schooling in sub-Saharan Africa: Decomposition and heterogeneity

Maternal height is associated with mortality and anthropometry in low-and-middle-income countries. This paper explored residual associations and potential underlying mechanisms linking maternal height to several child outcomes using regression models with neighborhood and half-sibling fixed effects and Gelbach decomposition on 108 Demographic and Health Surveys from 37 sub-Saharan African countries. When adjusting for time of birth, twinning, sex, and survey, a single z-score (6.5 cm) increase in mother's height was associated with a 22% reduction in the average deficit in height-for-age among children under five (according to the WHO 2006 growth standard), 16% lower neonatal mortality (age <1 month) , 10% lower postneonatal mortality (age 1–11 months), 11% lower child mortality (age 12–59 months) , and 2% increase in school attendance among 7–16-year-olds. Adjusting further for maternal education, household living standards, maternal fertility and birth related factors, and neighborhood reduced the coefficients for maternal height by 22% for child height-for-age, 26% for neonatal mortality, 46% for postneonatal mortality, 56% for child mortality, and 90% for school attendance. The decomposition showed that adjusting for neighborhood had a substantial impact on the association of maternal height with all outcomes, especially child mortality. Adjusting for unobserved father and household factors also had a particularly large impact on the association with child mortality. The robustness of the relationship with neonatal mortality suggests that pregnancy and perinatal factors are an important link between maternal height and child outcomes. Adult living standards and socioeconomic and related behavioral factors likely play a small role. Genetics may also play a large role in linking maternal height and child height-for-age, especially for educated mothers, whose height was presumably impacted less by early life adversity.

Inequalities in adverse birth outcomes and survival in early childhood: birth cohort in South Korea

Abstract Background Adverse birth outcomes (ABOs) are considered the most common factor of deaths in early childhood. Inequalities in child mortality occur due to interactions between intrinsic and socio-environmental factors related to socioeconomic disadvantage. There are, however, few studies investigating the impact of ABOs on mortality in terms of parental SEP. Methods Using the Under-5 Infant Birth-Death Cohort Data in Korea, a pooled retrospective birth cohort of all children born in 2012-2014 was built (N = 1,356,584). We analyzed neonatal, post-neonatal, and childhood mortality by ABOs and with the interaction of parental SEP using the Cox proportional hazard regression model for survival analyses. We further stratified the analysis both by parental SEP and child age. Multiple logistic regression was performed to confirm the social inequalities in ABO itself. Results After adjusting for covariates, children born with ABOs presented higher risk of mortality for all periods. For post-neonatal period, lower maternal education showed significant interaction effect with LBW (HR = 0.57; 95% CI = [0.39-0.85]), PTB (HR = 0.53; 95% CI = [0.33-0.86]), LBW &amp; PTB ([HR = 0.67; 95% CI = [0.54-0.83]) while lower paternal education (HR = 0.67; 95% CI = [0.54-0.82]) and maternal unemployment (HR = 0.80; 95% CI = [0.63-0.99]) showed significance for babies with LBW &amp; PTB. However, stratification analyses suggested that the impact of ABOs on mortality was greater for children born to lower parental SEP in neonatal period. Meanwhile apparent social inequalities in ABOs were suggested from regression analyses. Conclusions We confirmed social inequalities in the incidence of ABOs as well as mortalities from ABOs. However, the difference in mortality between babies with and without ABOs was greater for advantaged children. Policies to reduce the mortality of children with ABOs as well as those of healthy children among socioeconomically disadvantaged families are required. Key messages • Social inequalities in mortality from ABOs were apparent especially in the neonatal period while the incidence of ABOs itself was greater among children from disadvantaged families. • Disadvantaged children are more likely to die not only from ABOs but also from other socio-environmental determinants, especially in the post-neonatal period than their counterparts.

Newborn signal functions in Bangladesh: Identification through expert consultation and assessment of readiness among public health facilities

BackgroundThis study aimed to identify a set of newborn signal functions (NSFs) that can categorize health facilities and assist policymakers and health managers in appropriately planning and adequately monitoring the progress and performance of health facilities delivering newborn health care in Bangladesh and similar low-income settings.MethodsA modified Delphi method was used to identify a set of NSFs and a cross-sectional health facility assessment among the randomly selected facilities was conducted to test them in public health facilities in Bangladesh. In the modified Delphi approach, three main steps of listing, prioritizing, and testing were followed to identify the set of NSFs. Then, to finalize the set of NSFs and its variables, a total of five Delphi workshops and three rounds of Delphi surveys were conducted. Finally, 205 public health facilities located in 41 randomly selected districts were assessed for the availability and readiness of finalized NSFs using the updated tool of Bangladesh Health Facility Survey (BHFS) 2017.ResultsTwenty NSFs were identified and finalized, nine of which were categorized as primary NSFs, 13 as basic NSFs, 18 as comprehensive NSFs, and 20 as advanced NSFs. Almost all district hospitals (DHs), Upazila health complexes (UHCs,) and maternal and child welfare centres (MCWCs) performed the primary NSFs in the last three months. However, around one-third of the union health and family welfare centres (UH&FWCs) and very few community clinics (CCs) performed them during the same period. The basic, comprehensive, and advanced NSF readiness was inadequate and inappropriate across all types of facilities, including DHs and UHCs.ConclusionsIn the absence of internationally or nationally agreed-upon NSFs to measure a health facility's service availability and readiness for providing newborn care, this study becomes the first to identify and finalize a set of NSFs and to incorporate relevant variables in the health facility assessment tool which can be used to monitor the availability and readiness of a newborn care facility. The identified NSFs can also be adapted for the countries with similar contexts and can serve as a standard base to determine a global set of NSFs.