Reduction In Neonatal Mortality Research Articles

Caesarean delivery and neonatal mortality: evidence from selected slums in and around Dhaka city, Bangladesh- A prospective cohort study

BackgroundThis study examined the neonatal mortality for newborn of women who delivered by caesarean section or vaginally using a prospective cohort.MethodsA total of 6,989 live births registered from 2016 to 2018, were followed for neonatal survival from the selected slums of Dhaka (North and South) and Gazipur city corporations, where icddr,b maintained the Health and Demographic Surveillance System (HDSS). Neonatal mortality was compared by maternal and newborn characteristics and mode of delivery using z-test. Logistic regression model performed for neonatal mortality by mode of delivery controlling selected covariates and reported adjusted odd ratios (aOR) with 95% confidence interval (CI).ResultsOut of 6,989 live births registered, 27.7% were caesarean and the rest were vaginal delivery; of these births, 265 neonatal deaths occurred during the follow-up. The neonatal mortality rate was 2.7 times higher (46 vs. 17 per 1,000 births) for vaginal than caesarean delivered. Until 3rd day of life, the mortality rate was very high for both vaginal and caesarean delivered newborn; however, the rate was 24.8 for vaginal and 6.3 per 1,000 live births for caesarean delivered on the 1st day of life. After adjusting the covariates, the odds of neonatal mortality were higher for vaginal than caesarean delivered (aOR: 2.63; 95% CI: 1.82, 3.85). Additionally, the odds were higher for adolescent than elderly adult mother (aOR: 1.60; 95% CI: 1.03, 2.48), for multiple than singleton birth (aOR: 5.40; 95% CI: 2.82, 10.33), for very/moderate (aOR: 5.13; 95% CI: 3.68, 7.15), and late preterm birth (aOR: 1.48; 95% CI: 1.05, 2.08) than term birth; while the odds were lower for girl than boy (aOR: 0.74; 95% CI: 0.58, 0.96), and for 5th wealth quintile than 1st quintile (aOR: 0.59, 95% CI: 0.38, 0.91).ConclusionOur study found that caesarean delivered babies had significantly lower neonatal mortality than vaginal delivered. Therefore, a comprehensive delivery and postnatal care for vaginal births needed a special attention for the slum mothers to ensure the reduction of neonatal mortality.

Health reforms, facility-based delivery, and newborn's health: evidence from Rwanda

Abstract Since 2006, Rwanda has experienced a substantial rise in the facility-based delivery (FBD) rate, attributed to various health initiatives. This paper investigates the impact of multiple health reforms on maternal service utilization and neonatal mortality rates. Employing a difference-in-differences framework utilizing geographical variation in the baseline FBD rate, our estimates indicate a 10–17 percentage point increase in FBD and a 0.15–0.18 times increase in the number of antenatal care visits. While our analysis indicates some evidence of a reduction in neonatal mortality rates, the findings are inconclusive. Nevertheless, our results suggest that the effect of the reforms on neonatal mortality rates was weakly intensified for those residing near district hospitals providing care for complicated pregnancies.

Effective multi-sectoral approach for rapid reduction in maternal and neonatal mortality: the exceptional case of Bangladesh

BackgroundBangladesh experienced impressive reductions in maternal and neonatal mortality over the past several decades with annual rates of decline surpassing 4% since 2000. We comprehensively assessed health system and non-health...

Impact of scaling up of kangaroo mother care on neonatal mortality among babies born with birth weight

ObjectiveTo assess the impact of scaling up of kangaroo mother care (KMC) on neonatal mortality among babies born with birth weight <2000 g across an entire district in southern India.Design,...

Morbidity and Mortality among Premature New-borns Admitted in the Nursery Unit of Al-Kuwait University Hospital in Sanaa-Yemen

Introduction: The incidence of preterm births is increasing worldwide, and Asia and Africa are the major contributors to the global preterm burden. Preterm babies have increased the risk of morbidity and mortality which is inversely related to both gestational age and birth weight. Objectives: To determine the common morbidities and mortalities of premature new-borns admitted to the nursery unit at Al-Kuwait hospital, Sana'a. Materials and Methods: This is a retrospective descriptive study of Morbidities and mortalities of premature new-borns admitted to Al-Kuwait hospital Sana'a, Yemen from January 2014 to December 2015. Results: Preterm babies contribute 35.3 % of the total admissions. Among the 244 preterm babies admitted, 74 (30.3%) babies were admitted due to low birth weight only, 57 (23.4) babies were IUGR, 59(24.2%) babies were admitted with respiratory problems and only 23 (9.4%) babies were admitted with infection Among the preterm babies admitted, (62.7%) were improved and discharged, (29.5%) were dead, (6.9%) were lift against medical advice (LAMA) and only (0.9%) babies were referred to another hospital. Out of 72 preterm babies who died, 44 babies were delivered low birth weight contributing 65.2% of the total preterm babies’ death and the second cause of death was a respiratory problem with 14 that contributing 19.4 % of the total preterm babies’ death, but only 5 preterm babies dead from an infection that contributing 6.9 % of the total preterm babies’ death. Conclusions: Preterm babies contribute a significant percentage of the total new-born admissions in the nursery unit at AlKuwait hospital, Sana'a. Without improving the preterm care reduction of neonatal mortality rate and thereby IMR will be a dream unaccomplished.

Umbilical cord milking and delayed cord clamping for the prevention of neonatal hypoglycaemia: a systematic review and meta-analysis.

Placental management strategies such as umbilical cord milking and delayed cord clamping may provide a range of benefits for the newborn. The aim of this review was to assess the effectiveness of umbilical cord milking and delayed cord clamping for the prevention of neonatal hypoglycaemia. Three databases and five clinical trial registries were systematically reviewed to identify randomised controlled trials comparing umbilical cord milking or delayed cord clamping with control in term and preterm infants. The primary outcome was neonatal hypoglycaemia (study defined). Two independent reviewers conducted screening, data extraction and quality assessment. Quality of the included studies was assessed using the Cochrane Risk of Bias tool (RoB-2). Certainty of evidence was assessed using the Grading of Recommendations, Assessment, Development and Evaluation (GRADE) approach. Meta-analysis using a random effect model was done using Review Manager 5.4. The review was registered prospectively on PROSPERO (CRD42022356553). Data from 71 studies and 14 268 infants were included in this review; 22 (2 537 infants) compared umbilical cord milking with control, and 50 studies (11 731 infants) compared delayed with early cord clamping. For umbilical cord milking there were no data on neonatal hypoglycaemia, and no differences between groups for any of the secondary outcomes. We found no evidence that delayed cord clamping reduced the incidence of hypoglycaemia (6 studies, 444 infants, RR = 0.87, CI: 0.58 to 1.30, p = 0.49, I2 = 0%). Delayed cord clamping was associated with a 27% reduction in neonatal mortality (15 studies, 3 041 infants, RR = 0.73, CI: 0.55 to 0.98, p = 0.03, I2 = 0%). We found no evidence for the effect of delayed cord clamping for any of the other outcomes. The certainty of evidence was low for all outcomes. We found no data for the effectiveness of umbilical cord milking on neonatal hypoglycaemia, and no evidence that delayed cord clamping reduced the incidence of hypoglycaemia, but the certainty of the evidence was low.

Predictors of neonatal mortality in Ethiopia: Cross sectional study using 2005, 2010 and 2016 Ethiopian demographic health survey datasets.

Ethiopia is among the countries that have highest neonatal mortality in the world. Despite efforts to reduce neonatal mortality, the country has faced challenges in achieving national and global targets. The study aims to determine the trends and predictors of change in neonatal mortality in Ethiopia for the past 15 years. The study used Ethiopian Demographic Health Survey Datasets (EDHS) from 2005, 2011, and 2016. All live births of reproductive-age women in Ethiopia were included in the study. Multivariate decomposition analysis for the nonlinear response variable (MVDCMP) based on the logit link function was employed to determine the relative contribution of each independent variable to the change in neonatal mortality over the last 15 years. The neonatal mortality rate has decreased by 11 per 1,000 live births, with an annual reduction rate of 2.8% during the survey period. The mortality rate increased in the pastoralist regions of the country from 31 per 1,000 live births to 36 per 1,000 live births, compared to the city and agrarian regions. Maternal ANC visits in 2005 and 2016 (AOR [95%CI] = 0.10 [0.01, 0.81]; 0.01 [0.02, 0.60]) were significantly associated with decreased neonatal mortality. In addition, the decomposition analysis revealed that increased birth interval of more than 24 months and early breastfeeding initiation contributed to the reduction of neonatal mortality by 26% and 10%, respectively, during the survey period. The study found that neonatal mortality is a public health problem in the country, particularly in pastoralist communities. Tailor made maternal and child healthcare interventions that promote early breastfeeding initiation, increased birth intervals and ANC utilization should be implemented to reduce neonatal mortality, particularly in pastoralist communities.

Risk factors associated with neonatal mortality among neonates admitted to neonatal intensive care unit of the University Teaching Hospital in Lusaka

Globally, several children die shortly after birth and many more of them within the first 28 days of life. Sub-Sharan Africa accounts for almost half (43%) of the global neonatal death with slow progress in reduction. These neonatal deaths are associated with lack of quality care at or immediately after birth and in the first 28 days of life. This study aimed to determine the trends and risk factors of facility-based neonatal mortality in a major referral hospital in Lusaka, Zambia. We conducted retrospective analysis involving all neonates admitted in the University Teaching Hospital Neonatal Intensive Care Unit (UTH-NICU) in Lusaka from January 2018 to December 2019 (N = 2340). We determined the trends and assessed the factors associated with facility-based neonatal mortality using Generalized Linear Models (GLM) with a Poisson distribution and log link function. Overall, the facility-based neonatal mortality was 40.2% (95% CI 38.0–42.0) per 1000 live births for the 2-year period with a slight decline in mortality rate from 42.9% (95% CI 40.0–46.0) in 2018 to 37.3% (95% CI 35.0–40.0) in 2019. In a final multivariable model, home delivery (ARR: 1.70, 95% CI 1.46–1.96), preterm birth (ARR: 1.59, 95% CI 1.36–1.85), congenital anomalies (ARR: 1.59, 95% CI 1.34–1.88), low birthweight (ARR: 1.57, 95% CI 1.37–1.79), and health centre delivery (ARR: 1.48, 95% CI 1.25–1.75) were independently associated with increase in facility-based neonatal mortality. Conversely, hypothermia (ARR: 0.36, 95% CI 0.22–0.60), antenatal attendance (ARR: 0.76, 95% CI 0.68–0.85), and 1-day increase in neonatal age (ARR: 0.96, 95% CI 0.95–0.97) were independently associated with reduction in facility-based neonatal mortality. In this hospital-based study, neonatal mortality was high compared to the national and global targets. The improvement in neonatal survival observed in this study may be due to interventions including Kangaroo mother care already being implemented. Early identification and interventions to reduce the impact of risks factors of neonatal mortality in Zambia are important.

FIGO Preconception Checklist: Preconception care for mother and baby.

The preconception period is a unique and opportunistic time in a woman's life when she is motivated to adopt healthy behaviors that will benefit her and her child, making this time period a critical "window of opportunity" to improve short- and long-term health. Improving preconception health can ultimately improve both fetal and maternal outcomes. Promoting health before conception has several beneficial effects, including an increase in seeking antenatal care and a reduction in neonatal mortality. Preconception health is a broad concept that encompasses the management of chronic diseases, including optimal nutrition, adequate consumption of folic acid, control of body weight, adoption of healthy lifestyles, and receipt of appropriate vaccinations. Use of the FIGO Preconception Checklist, which includes the key elements of optimal preconception care, will empower women and their healthcare providers to better prepare women and their families for pregnancy.

Factors associated with perinatal and neonatal deaths in Sao Tome & Principe: a prospective cohort study.

Neonatal mortality reduction is a global goal, but its factors are seldom studied in most resource-constrained settings. This is the first study conducted to identify the factors affecting perinatal and neonatal deaths in Sao Tome & Principe (STP), the smallest Central Africa country. Institution-based prospective cohort study conducted at Hospital Dr. Ayres Menezes. Maternal-neonate dyads enrolled were followed up after the 28th day of life (n = 194) for identification of neonatal death-outcome (n = 22) and alive-outcome groups (n = 172). Data were collected from pregnancy cards, hospital records and face-to-face interviews. After the 28th day of birth, a phone call was made to evaluate the newborn's health status. Crude odds ratios and corresponding 95% confidence intervals were obtained. A p value <0.05 was considered statistically significant. The mean gestational age of the death-outcome and alive-outcome groups was 36 (SD = 4.8) and 39 (SD = 1.4) weeks, respectively. Death-outcome group (n = 22) included sixteen stillbirths, four early and two late neonatal deaths. High-risk pregnancy score [cOR 2.91, 95% CI: 1.18-7.22], meconium-stained fluid [cOR 4.38, 95% CI: 1.74-10.98], prolonged rupture of membranes [cOR 4.84, 95% CI: 1.47-15.93], transfer from another unit [cOR 6.08, 95% CI:1.95-18.90], and instrumental vaginal delivery [cOR 8.90, 95% CI: 1.68-47.21], were factors significantly associated with deaths. The odds of experiencing death were higher for newborns with infectious risk, IUGR, resuscitation maneuvers, fetal distress at birth, birth asphyxia, and unit care admission. Female newborn [cOR 0.37, 95% CI: 0.14-1.00] and birth weight of more than 2,500 g [cOR 0.017, 95% CI: 0.002-0.162] were found to be protective factors. Factors such as having a high-risk pregnancy score, meconium-stained amniotic fluid, prolonged rupture of membranes, being transferred from another unit, and an instrumental-assisted vaginal delivery increased 4- to 9-fold the risk of stillbirth and neonatal deaths. Thus, avoiding delays in prompt intrapartum care is a key strategy to implement in Sao Tome & Principe.

Nomogram to predict risk of neonatal mortality among preterm neonates admitted with sepsis at University of Gondar Comprehensive Specialized Hospital: risk prediction model development and validation

BackgroundMortality in premature neonates is a global public health problem. In developing countries, nearly 50% of preterm births ends with death. Sepsis is one of the major causes of death in preterm neonates. Risk prediction model for mortality in preterm septic neonates helps for directing the decision making process made by clinicians.ObjectiveWe aimed to develop and validate nomogram for the prediction of neonatal mortality. Nomograms are tools which assist the clinical decision making process through early estimation of risks prompting early interventions.MethodsA three year retrospective follow up study was conducted at University of Gondar Comprehensive Specialized Hospital and a total of 603 preterm neonates with sepsis were included. Data was collected using KoboCollect and analyzed using STATA version 16 and R version 4.2.1. Lasso regression was used to select the most potent predictors and to minimize the problem of overfitting. Nomogram was developed using multivariable binary logistic regression analysis. Model performance was evaluated using discrimination and calibration. Internal model validation was done using bootstrapping. Net benefit of the nomogram was assessed through decision curve analysis (DCA) to assess the clinical relevance of the model.ResultThe nomogram was developed using nine predictors: gestational age, maternal history of premature rupture of membrane, hypoglycemia, respiratory distress syndrome, perinatal asphyxia, necrotizing enterocolitis, total bilirubin, platelet count and kangaroo-mother care. The model had discriminatory power of 96.7% (95% CI: 95.6, 97.9) and P-value of 0.165 in the calibration test before and after internal validation with brier score of 0.07. Based on the net benefit analysis the nomogram was found better than treat all and treat none conditions.ConclusionThe developed nomogram can be used for individualized mortality risk prediction with excellent performance, better net benefit and have been found to be useful in clinical practice with contribution in preterm neonatal mortality reduction by giving better emphasis for those at high risk.

Incidence and Predictors of Successful Vaginal Birth Among Women With a History of Cesarean Section in Public Health Facilities of Southern Ethiopia in 2021

BACKGROUND:Even though a cesarean section (CS) performed greater than 15% has no significant association with a reduction in maternal and neonatal mortality, repeat elective CS continues to play a major role in unnecessary CS worldwide. Trial of labor after cesarean (TOLAC) is one of the strategies to reduce the rate of unnecessary CS. However, the selection of candidates for a TOLAC is not an easy task without evidence. This study was conducted to determine the incidence of successful vaginal birth after one CS and the associated factors in public health facilities in southern Ethiopia.METHODS:An institutional-based cross-sectional study was conducted from June 10, 2020, to December 10, 2021, on laboring women, and the data were collected using a pretested interviewer-administered questionnaire and a data extraction sheet. A binary logistic regression model was used to assess the factors associated with successful vaginal birth after cesarean (VBAC) section using SPSS version 25. Bivariate and multivariate analyses were performed, and independent variables withp&lt; .05 along with an odd ratio and 95% confidence interval (CI) declare the associated factors.RESULTS:A total of 417 women participated in this study making a response rate of 98.8%. The incidence of vaginal births after cesarean was 51.1% (CI, 46%–56%). The likelihood of successful VBAC was observed in women with a history of vaginal delivery before CS (AOR, 3.7, CI = 1.06, 13.19), favorable Bishop score at admission (AOR, 19.1, CI = 2.69, 134.98), greater than 4-cm cervical dilation at admission (AOR, 171.3, CI = 1.8, 16,722), and clear color of amniotic fluid (AOR, .096, CI = .02, .38).CONCLUSION:The incidence of VBAC in this study is promising and should be practiced. In choosing a woman for the TOLAC, health professionals might need to pay attention to intrapartum variables, such as cervical dilation, Bishop score, and color of the amniotic fluid.

A concept analysis of immediate newborn care within 48 h of birth: A facility based

BackgroundImmediate newborn care interventions provided by midwives within 48 h of birth are invaluable in the reduction of neonatal morbidity and mortality. The purpose of this concept analysis is to clarify the meaning of immediate newborn care within 48 h of birth in relation to its attributes, antecedents, consequences and empirical referents. MethodsWalker and Avant’s (2019) framework was used to analyze the concept. The framework consist of the following steps: selecting a concept; determining the aims of the analysis; identifying all the uses of the concept; identifying the defining attributes; identifying and constructing model, borderline, related and contrary cases; identifying antecedents and consequences; and finally defining empirical referents. ResultsThe attributes of immediate newborn care are up to date knowledge, proficiency in skills, effective communication, willingness, responsibility, compassionate, honesty, commitment, resilience, touch and patience. The identified antecedents are availability of adequate midwives, pre-service and in-service training, availability of functioning equipment and supplies, regular supervision, follow up and mentorship. The consequences include: improved provider's performance, client/caretaker's satisfaction, provider's growth and satisfaction, and reduction in neonatal morbidity and mortality. ConclusionImmediate newborn care within 48 h helped in highlighting interventions that can be implemented immediately after child birth in order to reduce neonatal deaths.

Maternal Transport, What Do We Know: A Narrative Review.

This review examines the initial development of a transport system for neonates, followed by a subsequent evolution of a transportation system for the maternal/fetal unit, and then a maternal transport system (antepartum, intrapartum, and postpartum) to specifically address maternal morbidity/mortality. A literature search was undertaken using the electronic databases PubMed, Embase, and CINAHL. The search terms used were "maternal transport" AND "perinatal care" OR "labor" "obstetrics" OR "delivery". The years searched were 1960-2023. There were 260 abstracts identified and 52 of those are the basis of this review. The utilization of a transportation system with the regionalization of levels of care has resulted in a significant reduction in neonatal, perinatal, and maternal morbidity and mortality. Although preterm delivery remains a concern in women transported, the number of deliveries that have occurred during transport is relatively small. Reimbursement for transportation continues to be a problem in several states. A state-of-the-art transportation system has evolved that transfers neonates, maternal/fetal dyad, and pregnant women (antepartum, intrapartum, postpartum) to the appropriate level of care facility to ensure the best maternal/fetal/neonatal outcomes.

Descriptive Analysis of Neonatal Mortality during May 2023 at Holy Family Hospital Rawalpindi

Although child mortality has substantially been declined due to stringent efforts for achieving the set targets meant to attain health related Millenium Development Goals (MDGs) by 2015, yet the reduction in neonatal mortality has been noted at comparatively slower pace. Considerable neonatal deaths have also been reported in South Asan regions of the globe. Objective: To analyze neonatal mortality in terms of place of delivery, antenatal booking and maternal as well as medical causes of death. Methods: A cross-sectional descriptive study was done during May 2023 to determine various attributes of neonatal mortality like delivery site and antenatal visits. In addition to maternal factors contributing to neonatal mortality, post-delivery mortality reasons were also recorded. Data were entered and analyzed by using Microsoft Excel 2016. Results: Out of 100 neonatal mortalities about 88.5% were early neonatal deaths. 21% and 79% were home and hospital delivered neonates respectively. Of the 49 booked cases, 35% were delivered in private hospitals while 25.5% of the remaining non-booked cases were delivered in private healthcare facilities. Approximately 47% and 53% were preterm and full-term births respectively. 35.6% neonates died of bacterial sepsis while 22% and 19% neonates succumbed to respiratory distress syndrome and intrauterine hypoxia respectively. Conclusions: There were considerable early neonatal deaths and majority died of bacterial sepsis and respiratory distress syndrome.

Investment case for small and sick newborn care in Tanzania: systematic analyses

BackgroundSmall and sick newborn care (SSNC) is critical for national neonatal mortality reduction targets by 2030. Investment cases could inform implementation planning and enable coordinated resource mobilisation. We outline development of an investment case for Tanzania to estimate additional financing for scaling up SSNC to 80% of districts as part of health sector strategies to meet the country’s targets.MethodsWe followed five steps: (1) reviewed national targets, policies and guidelines; (2) modelled potential health benefits by increased coverage of SSNC using the Lives Saved Tool; (3) estimated setup and running costs using the Neonatal Device Planning and Costing Tool, applying two scenarios: (A) all new neonatal units and devices with optimal staffing, and (B) half new and half modifying, upgrading, or adding resources to existing neonatal units; (4) calculated budget impact and return on investment (ROI) and (5) identified potential financing opportunities.ResultsNeonatal mortality rate was forecast to fall from 20 to 13 per 1000 live births with scale-up of SSNC, superseding the government 2025 target of 15, and close to the 2030 Sustainable Development Goal 3.2 target of <12. At 85% endline coverage, estimated cumulative lives saved were 36,600 by 2025 and 80,000 by 2030. Total incremental costs were estimated at US$166 million for scenario A (US$112 million set up and US$54 million for running costs) and US$90 million for scenario B (US$65 million setup and US$25 million for running costs). Setup costs were driven by infrastructure (83%) and running costs by human resources (60%). Cost per capita was US$0.93 and the ROI is estimated to be between US$8–12 for every dollar invested.ConclusionsROI for SSNC is higher compared to other health investments, noting many deaths averted followed by full lifespan. This is conservative since disability averted is not included. Budget impact analysis estimated a required 2.3% increase in total government health expenditure per capita from US$40.62 in 2020, which is considered affordable, and the government has already allocated additional funding. Our proposed five-step SSNC investment case has potential for other countries wanting to accelerate progress.

Determinants of Neonatal Mortality in Bhutan: A Case-Control Study.

More than half of Bhutan's under-five mortality is attributed to neonatal deaths. Despite this, there is a lack of local evidence on determinants of neonatal mortality. It is critical to generate new evidence to accelerate interventions to achieve sufficient reduction of neonatal mortality rate in line to sustainable development goal target 3.2. Thus, this study was aimed at exploring determinants of neonatal mortality in Bhutan. A case-control study was performed with reported neonatal deaths from hospitals and primary health centers between 2018 and 2019. A total of 181 neonatal deaths were included as cases along with three corresponding controls. Epidata and STATA were used for data management and analysis, respectively. A multivariable model was fitted to identify determinants of neonatal mortality. History of obstetric complications (odds ratio [OR] = 3.53; 95% confidence interval [CI] = 1.48-8.42), intrapartum complications (OR = 3.86; 95% CI = 1.71-8.74) gestational age (OR = 8.07; 95% CI = 2.89-22.52), and Apgar 1 minute (OR = 4.40; 95% CI =1.83-10.59) were associated with neonatal death. Therefore, quality of care during pregnancy and childbirth besides promoting supportive family environment is essential to reduce neonatal mortality.

Antenatal Care Reduces Neonatal Mortality in Ethiopia: A Systematic Review and Meta-Analysis of Observational Studies.

Neonatal deaths remain a serious public health concern in Ethiopia; being one of the top five countries contributing to half of the neonatal deaths worldwide. Although antenatal care (ANC) is assumed as one of the viable options that contribute to neonatal survival, findings from original studies indicated disparities in the effect of ANC on neonatal mortality. Thus, this review aimed to determine the pooled effect of ANC on neonatal mortality in Ethiopia. Databases such as PubMed, EMBASE, CINAHL, HINARI, and Cochrane Central Library were searched for articles using keywords. Selection of eligible articles and data extraction were conducted by an independent author. The risk of a bias assessment tool for non-randomized studies was used to assess the quality of the articles. Comprehensive meta-analysis version 2 software was used for meta-analysis. Heterogeneity and publication bias of included studies were assessed using I2 test statistic and Egger test, respectively. The random-effect model was employed; an outcome is reported using a risk ratio with a 95% confidence interval. Of 28 included studies, 20 showed receiving at least one ANC visit had a significant association with neonatal mortality. Accordingly, the estimated pooled risk ratio for neonatal mortality was 0.59 (95% CI 0.45, 0.77) among infants born to women who had at least one ANC visit compared to infants born to women who had no ANC visits. This finding indicated that neonatal mortality was decreased among infants born to women who had at least one ANC visit compared to infants born to women who had no ANC visit. Therefore, promoting and strengthening ANC service utilization during pregnancy would accelerate the reduction of neonatal mortality in Ethiopia.

Where is obstetric anesthesiology heading in the next decade? An Eastern European perspective

European countries of “Eastern Block” origin took different healthcare and economic development trajectories after the Berlin Wall fell. Despite decreased maternal and neonatal mortality in the last two decades, healthcare disparities exist between the various countries. Minimum standards for obstetric anesthesia are not available for every maternity patient. Lack of equity in access to healthcare for maternity patients is multifactorial and includes differences in systems of care and health economics, and shortages of medical personnel.The war in Ukraine generates additional challenges for healthcare systems in the region, resulting from a significant increase in the number of refugees, some of whom are pregnant and require maternity services, including obstetric anesthesia and analgesia and maternal critical care. The next decade's challenges comprise the implementation of evidence-based medicine advances in the field of obstetric anesthesia and analgesia, and of maternal critical care at national levels, including access to neuraxial opioids, the broad implementation of enhanced recovery after cesarean section protocols, and more frequent use of labor epidural analgesia. Further, there needs to be improvement in medical education provided in the national language, so that healthcare providers, patients, and their families can build and provide a safe environment for maternity patients. In addition, better provision of services and access to healthcare providers who have been well trained and are dedicated to dealing with obstetric patients.These measures will hopefully enhance the quality of care for maternity patients, focusing on further reduction of maternal and neonatal morbidity and mortality, which is a priority and a highly desirable long-term outcome.

Increase in birthweight coverage of neonatal deaths is needed to monitor low birthweight prevalence in India: lessons from the National Family Health Survey

BackgroundLow birthweight (LBW), defined as birthweight < 2500gms, is the largest contributor to the malnutrition disability-adjusted-live-years in India. We report on the inadequacy of birthweight data, which is a significant barrier in the understanding of LBW epidemiology, to address malnutrition in India.MethodsData from the recent round of the National Family Survey (NFHS-5) were utilised. Birthweight of livebirths in the last 5 years was documented in grams either from the health card or based on mother’s recall. We computed the coverage of birthweight measurement availability and the extent of heaping (values of 2500, 3000 and 3500gms) by the place of delivery and by the survival of newborn during the neonatal period. Heaping of > 55% was considered as poor-quality birthweight data. LBW prevalence per 100 livebirths was estimated and extrapolated for under-reporting of birthweight. Findings are reported for India and its 30 states.ResultsBirthweight measurement coverage irrespective of the place of delivery was (89·8%; 95% CI 89·7–90) for India, and varied by 2 times among the states with the highest coverage in Tamil Nadu (99·3%) and the lowest in Nagaland (49·7%). Home deliveries had the least coverage of birthweight measurement (49.6%; 95% CI 49.0–50.1) as compared with public health facility (96.3%; 95% CI 96.2–96.3) and private health facility (96%; 95% CI 95.8–96.1) deliveries. This coverage was 66·5% (95% CI 65·2–67·7) among neonatal deaths as compared with 90.4 (95% CI 90.3–90.6) for livebirths who survived the neonatal period for India. The proportion of health card as the data source increased for livebirths born in year 2015 to year 2020 but then dropped for livebirths born in year 2021 (p < 0.001). The proportion of heaping was 52·0% (95% CI 51·7–52·2) in the recorded birthweight for India, and heaping > 55% was seen in 10 states irrespective of the type data source; and 3 states in addition had heaping > 55% in mother’s recall. LBW prevalence was estimated at 17·4% (95% CI 17·3–17·6) for India, and ranged from 4.5% in Nagaland and Mizoram to 22.5% in Punjab for livebirths for whom birthweight was available. We estimated LBW at 77.8% for whom birthweight was not available, and the adjusted LBW prevalence for all livebirths was estimated at 23.5% (95% CI 23.3–23.8) for India.ConclusionsWithout measuring birthweight for every newborn irrespective of the survival and place of delivery, India may not able to address reduction in low birthweight and neonatal mortality effectively to meet global or national targets.