Estimating stillbirth and neonatal mortality rate among Rohingya refugees in Bangladesh, September 2017 to December 2018: a prospective surveillance

Abstract

IntroductionThere is limited literature on neonatal mortality in humanitarian emergencies. We estimated neonatal mortality and stillbirth rates; determined whether an association exists between proximity to a secondary health facility and neonatal mortality or stillbirth; and tested the correlation between the number of health facilities in a camp and neonatal mortality or stillbirth rates in Rohingya refugee camps in Bangladesh.MethodsWe conducted a prospective community-based mortality surveillance in 29 out of 34 Rohingya refugee camps between September 2017 and December 2018, covering approximately 811 543 Rohingya refugees with 19 477 estimated live births. We linked mortality surveillance data with publicly available information on camp population, number of functional health facilities and camp and health facility geospatial coordinates. Using descriptive statistics and spatial analyses, we estimated the mortality rate and tested for correlations.ResultsOverall, the estimated neonatal mortality rate was 27.0 (95% CI: 22.3 to 31.8) per 1000 live births, and the stillbirth rate was 15.2 (95% CI: 10.8 to 19.6) per 1000 total births. The majority of neonatal deaths (76.3%, n=405/531) and stillbirths (72.1%, n=202/280) occurred at home or in the community. A positive correlation existed between the camp population size and number of health facilities inside the camp (Spearman’s rho=0.56, p value<0.01). No statistically significant correlation existed between the camp neonatal mortality rate or stillbirth rate and number of health facilities inside the camp. Camps that were located closer to a secondary health facility as compared with a labour room/sexual and reproductive health unit had a lower neonatal mortality rate (p value<0.01).ConclusionsThe results provide insight into the neonatal mortality and stillbirth rates in Rohingya refugees camps in Bangladesh during 2017–2018. Prospective community-based mortality surveillance may be a feasible method to evaluate the effectiveness of humanitarian responses in improving neonatal survival and preventing stillbirths.

Implementation of maternal and perinatal death surveillance and response and related death review interventions in humanitarian settings: A scoping review

“…each relevant process documented in the literature). These programmes included the population mobility, mortality, and birth surveillance system in Democratic Republic of Congo (DRC) [ 15 ]; MNDSR in Afghanistan [ 57 ]; and two surveillance systems [ 27 , 51 ] and MDSR [ 62 , 64 ] in Cox’s Bazar (CXB), Bangladesh. Less than half (42%) of programmes described community-based death identification processes, most of which (n/N = 4/5) involved household visits by community health workers (CHWs), who were often then tasked with reporting deaths to their supervisor for verification and/or input into a surveillance database.…”

“…In particular, inaccessible information at referral facilities or health systems was reported as a data quality issue for three programmes: MPDSR in Burkina Faso, maternal death reviews in Palestine, and UNHCR death reviews across Africa [ 17 , 42 , 61 ]. Programmes also reported on missing or incomplete reporting on death review forms and tools [ 18 , 20 , 42 , 52 , 56 , 57 , 63 ] and misclassification of deaths [ 14 , 26 , 51 , 52 , 57 , 60 , 63 , 64 ]. Variation in stillbirth reporting was also highlighted by Russell et al [ 14 ] as an issue across identified humanitarian contexts.…”

Women's participation in childbearing decision-making and its effects on short-interval births in Rohingya refugee camps of Bangladesh

“…Covariates considered in this study were selected based on a review of relevant literature in refugee settings. 1 , 3 , 4 , 5 , 9 , 11 , 12 , 13 These included women's age (≤19 or ≥20), education (no education or at least some education), and work engagement outside the household (yes or no). Women's intentions regarding their most recent pregnancy, which occurred within two years of the survey and resulted in a live birth, were also included as an explanatory factor.…”

“… 2 , 3 Such higher rates of short interval births are linked to adverse maternal and child health outcomes, including stillbirth, neonatal mortality, and maternal mortality. 4 This persistent issue of the refugee settings is a global concern, contributing to nearly two-thirds of global maternal mortality and a significant proportion of the total under-five mortality. 5 Effectively addressing this issue requires reducing unintended pregnancies and increasing the spacing between births.…”

“…Existing research in the context of refugees primarily focuses on family planning, contraception, and maternal healthcare services, and their associated factors, as well as the gender-based violence. 1 , 3 , 4 , 5 , 9 , 11 , 12 , 13 , 14 , 15 , 16 , 17 , 18 This limited focus restricts policymakers' ability to develop evidence-based policies and programs aimed at enhancing women's participation in reproductive decision-making and reducing the incidence of short interval births. Therefore, this study aims to explore the extent of women's participation in decision-making with their partner regarding when to have a child, short interval births, and their associations.…”