Determinants of neonatal mortality in rural Northern Ethiopia: A population based nested case control study

Abstract

IntroductionIn low income and middle income countries, neonatal mortality remains high despite the gradual reduction in under five mortality. Newborn death contributes for about 38% of all under five deaths. This study has identified the magnitude and independent predictors of neonatal mortality in rural Ethiopia.MethodsThis population based nested case control study was conducted in rural West Gojam zone, Northern Ethiopia, among a cohort of pregnant women who gave birth between March 2011 and Feb 2012. The cohort was established by Maternal and Newborn Health in Ethiopia Partnership (MaNHEP) project in 2010 by recruiting mothers in their third trimester, as identified by trained community volunteers. Once identified, women stayed in the cohort throughout their pregnancy period receiving Community Maternal and Newborn Health (CMNH) training by health extension workers and community volunteers till the end of the first 48 hours postpartum. Cases were 75 mothers who lost their newborns to neonatal death and controls were 150 randomly selected mothers with neonates who survived the neonatal period. Data to identify cause of death were collected using the WHO standard verbal autopsy questionnaire after the culturally appropriate 40 days of bereavement period. Binomial logistic regression model was used to identify independent contributors to neonatal mortality.ResultThe neonatal mortality rate was AOR(95%CI) = 18.6 (14.8, 23.2) per 1000 live births. Neonatal mortality declined with an increase in family size, neonates who were born among a family of more than two had lesser odds of death in the neonatal period than those who were born in a family of two AOR (95% CI) = 0.13 (0.02, 0.71). Mothers who gave birth to 2–4 AOR(95%CI) = 0.15 (0.05, 0.48) and 5+ children AOR(95%CI) = 0.08 (0.02, 0.26) had lesser odds of losing their newborns to neonatal mortality. Previous history of losing a newborn to neonatal death also increased the odds of neonatal mortality during the last birth AOR (95%CI) = 0.25 (0.11, 0.53).ConclusionThe neonatal mortality rate in our study was three times lower than the regional neonatal mortality rate estimate, indicating community based interventions could significantly decrease neonatal mortality. The identified determinants, which are amenable for change, emphasize the need to improve quality of care during pregnancy, labour and delivery to improve pregnancy outcome.

Survival Status and Predictors of Neonatal Mortality among Neonates Who were Admitted in Neonatal Intensive Care Unit at Arba Minch General Hospital, Southern Ethiopia

“…Neonates born from mothers who have a 2-4 history of birth have 5.4 times hazard of death as compared to those with first birth. In contrast to this, a study conducted in Rural northern Ethiopia revealed that mothers who gave birth 2-4 times have 85% lesser hazard of losing their newborn for a neonatal death [11]. Also, those Neonates born from mothers who have a history of more than 5 births had 12.1 times hazard of death.…”

Neonatal Mortality and Its Determinates in Public Hospitals of Gamo and Gofa Zones, Southern Ethiopia: Prospective Follow up Study

“…The incidence of neonatal mortality was lower than studies done in northern Ethiopia (18.6 per 1000 live births), Kersa Health and Demographic Surveillance system site in Ethiopia (27.5 per 1000 live births) and two studies in southwest Ethiopia (35.5 and 27 per 1000 live births). But, it was higher than one study done in South Central Ethiopia (4.8 per 1000 live births) [10,[12][13][14][15]. The reason for this is the study period difference along with advance in the health care system that people's attitudes and awareness about conditions that put the newborn for ill health and increase in healthseeking behavior from time to time.…”

“…Analysis of different studies in Ethiopia showed that the incidence of the neonatal mortality rate was ranged from 17.2 to 35.5 per 1000 live births [10][11][12][13][14][15]. The most determinate factors which were identified by previous studies were birth order, frequency of antenatal care, delivery place, twin delivery and size of neonate [10,16,17].…”

Intimate Partner Violence During Pregnancy and Neonatal Mortality in Eastern Ethiopia: A Population Based Matched Case-Control Study

“…In line with the Mosley and Chen conceptual framework [27], different confounders that have been conceptually linked to neonatal survival, such as women's age at birth [51,52], education level [30,31], working status [30], and alcohol consumption during index pregnancy [53] were also considered in this study. Moreover, obstetric and neonatal related variables such as utilization of antenatal and postnatal cares, number of previous pregnancies, parity, perceived weight of neonate at birth, place of birth and type of birth (singleton or multiple births) were considered as confounders in the association of IPVP and neonatal mortality [28,30,32,34].…”

“…Apart from IPV, socio-economic as well as obstetric and neonatal factors have been described by the Mosley and Chen conceptual framework on child survival [27]. Prior studies in Ethiopia documented risk factors such as young age at pregnancy or birth [28,29], living in rural area [29] and no or lower level of educational or employment status [30,31], which all relate to availability and use of limited resources in taking care of children that would indirectly contribute to the neonatal survival. Pregnancy and obstetric factors such as poor utilization of ANC, PNC or immunizations [28,32,33]; high gravidity and parity [28,30]; births occurring at home [32]; low birth weight [28,32,33] and multiple (as opposed to singleton) form of deliveries [28,33] have been extensively studied in the country.…”