Neonatal Mortality and Maternal Health Care in Nepal: Searching for Patterns of Association

Shakya, Kushum; McMurray, Christine

doi:10.1017/s0021932001000876

Cited by 29 publications

(31 citation statements)

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“…Our results are in agreement with other studies that showed males had a higher odds of dying than females during the first month of life [36-39]. This increased hazard for newborn males may also be due to the large proportions of neonatal deaths occurring in the first week of life, which is the time when gender differences in neonatal mortality are most pronounced [36]. Biological factors that have been implicated with this increased risk of neonatal death in male infants include immunodeficiency [38] increasing the risks of infectious diseases in males, late maturity [36] resulting in a high prevalence of respiratory diseases in males, and congenital malformations of the urogenital system.…”

Section: Discussionsupporting

confidence: 94%

The effect of mother’s age and other related factors on neonatal survival associated with first and second birth in rural, Tanzania: evidence from Ifakara health and demographic surveillance system in rural Tanzania

Selemani

Mwanyangala

Mrema

et al. 2014

BMC Pregnancy Childbirth

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BackgroundWith a view to improve neonatal survival, data on birth outcomes are critical for planning maternal and child health care services. We present information on neonatal survival from Ifakara Health and Demographic Surveillance System (HDSS) in Tanzania, regarding the influence of mother’s age and other related factors on neonatal survival of first and second births.MethodsThe study conducted analysis using longitudinal health and demographic data collected from Ifakara HDSS in parts of Kilombero and Ulanga districts in Morogoro region. The analysis included first and second live births that occurred within six years (2004–2009) and the unit of observation was a live birth. A logistic regression model was used to assess the influence of socio-demographic factors on neonates’ survival.ResultsA total of 18,139 first and second live births were analyzed. We found neonatal mortality rate of 32 per 1000 live births (95% CI: 29/1000-34/1000). Results from logistic regression model indicated increase in risk of neonatal mortality among neonates those born to young mothers aged 13–19 years compared with those whose mother‘s aged 20–34 years (aOR = 1.64, 95% CI = 1.34-2.02). We also found that neonates in second birth order were more likely to die than those in first birth order (aOR = 1.85: 95% CI = 1.52-2.26). The risk of neonatal mortality among offspring of women who had a partner co-resident was 18% times lower as compared with offspring of mothers without a partner co-resident in the household (aOR = 0.82: 95% CI = 0.66-0.98). Short birth interval (<33 months) was associated with increased risk of neonatal mortality (aOR = 1.50, 95% CI =1.16-1.96) compared with long birth interval (> = 33 months). Male born neonates were found to have an increased risk (aOR = 1.34, 95% CI =1.13- 1.58) of neonatal mortality as compared to their female counterparts.ConclusionsDelaying the age at first birth may be a valuable strategy to promote and improve neonatal health and survival. Moreover, birth order, birth interval, mother’s partner co-residence and sex of the neonate appeared as important markers for neonatal survival.

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Section: Discussionsupporting

confidence: 94%

The effect of mother’s age and other related factors on neonatal survival associated with first and second birth in rural, Tanzania: evidence from Ifakara health and demographic surveillance system in rural Tanzania

Selemani

Mwanyangala

Mrema

et al. 2014

BMC Pregnancy Childbirth

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“…Previous studies confirm this, but with varying excess odds [19,23-27]. Contributing factors include immunodeficiency, higher prevalence of respiratory and other infectious diseases, and congenital malformations of the urogenital system [28,29].…”

Section: Discussionmentioning

confidence: 78%

Neonatal mortality in Ethiopia: trends and determinants

Mekonnen¹,

Tensou

Telake³

et al. 2013

BMC Public Health

211

171

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BackgroundThe Ethiopian neonatal mortality rate constitutes 42% of under-5 deaths. We aimed to examine the trends and determinants of Ethiopian neonatal mortality.MethodsWe analyzed the birth history information of live births from the 2000, 2005 and 2011 Ethiopia Demographic and Health Surveys (DHS). We used simple linear regression analyses to examine trends in neonatal mortality rates and a multivariate Cox proportional hazards regression model using a hierarchical approach to examine the associated factors.ResultsThe neonatal mortality rate declined by 1.9% per annum from 1995 to 2010, logarithmically. The early neonatal mortality rate declined by 0.9% per annum and was where 74% of the neonatal deaths occurred. Using multivariate analyses, increased neonatal mortality risk was associated with male sex (hazard ratio (HR) = 1.38; 95% confidence interval (CI), 1.23 − 1.55); neonates born to mothers aged < 18 years (HR = 1.41; 95% CI, 1.15 − 1.72); and those born within 2 years of the preceding birth (HR = 2.19; 95% CI, 1.89 − 2.51). Winter birth increased the risk of dying compared with spring births (HR = 1.28; 95% CI, 1.08 − 1.51). Giving two Tetanus Toxoid Injections (TTI) to the mothers before childbirth decreased neonatal mortality risk (HR = 0.44; 95% CI, 0.36 − 0.54). Neonates born to women with secondary or higher schooling vs. no education had a lower risk of dying (HR = 0.68; 95% CI, 0.49 − 0.95). Compared with neonates in Addis Ababa, neonates in Amhara (HR: 1.88; 95% CI: 1.26 − 2.83), Benishangul Gumuz (HR: 1.75; 95% CI: 1.15 − 2.67) and Tigray (HR: 1.54; 95% CI: 1.01 − 2.34) regions carried a significantly higher risk of death.ConclusionsNeonatal mortality must decline more rapidly to achieve the Millennium Development Goal (MDG) 4 target for under-5 mortality in Ethiopia. Strategies to address neonatal survival require a multifaceted approach that encompasses health-related and other measures. Addressing short birth interval and preventing early pregnancy must be considered as interventions. Programs must improve the coverage of TTI and prevention of hypothermia for winter births should be given greater emphasis. Strategies to improve neonatal survival must address inequalities in neonatal mortality by women's education and region.

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“…Traditionally in Nepalese culture women reside with their husband's family after marriage, and during pregnancy they depend entirely upon their mothers-in-law [9,44] since male involvement in maternity care is not common practice in Nepalese culture [45]. Mothers-in-law are given more responsibility and authority to allocate resources to their daughters-in-law in the belief that they understand women's issues, including health problems.…”

Section: Discussionmentioning

confidence: 99%

The role of mothers-in-law in antenatal care decision-making in Nepal: a qualitative study

Simkhada

Porter

Teijlingen

2010

BMC Pregnancy Childbirth

152

155

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BackgroundAntenatal care (ANC) has been recognised as a way to improve health outcomes for pregnant women and their babies. However, only 29% of pregnant women receive the recommended four antenatal visits in Nepal but reasons for such low utilisation are poorly understood. As in many countries of South Asia, mothers-in-law play a crucial role in the decisions around accessing health care facilities and providers. This paper aims to explore the mother-in-law's role in (a) her daughter-in-law's ANC uptake; and (b) the decision-making process about using ANC services in Nepal.MethodsIn-depth interviews were conducted with 30 purposively selected antenatal or postnatal mothers (half users, half non-users of ANC), 10 husbands and 10 mothers-in-law in two different (urban and rural) communities.ResultsOur findings suggest that mothers-in-law sometime have a positive influence, for example when encouraging women to seek ANC, but more often it is negative. Like many rural women of their generation, all mothers-in-law in this study were illiterate and most had not used ANC themselves. The main factors leading mothers-in-law not to support/encourage ANC check ups were expectations regarding pregnant women fulfilling their household duties, perceptions that ANC was not beneficial based largely on their own past experiences, the scarcity of resources under their control and power relations between mothers-in-law and daughters-in-law. Individual knowledge and social class of the mothers-in-law of users and non-users differed significantly, which is likely to have had an effect on their perceptions of the benefits of ANC.ConclusionMothers-in-law have a strong influence on the uptake of ANC in Nepal. Understanding their role is important if we are to design and target effective community-based health promotion interventions. Health promotion and educational interventions to improve the use of ANC should target women, husbands and family members, particularly mothers-in-law where they control access to family resources.

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Neonatal Mortality and Maternal Health Care in Nepal: Searching for Patterns of Association

Cited by 29 publications

References 0 publications

The effect of mother’s age and other related factors on neonatal survival associated with first and second birth in rural, Tanzania: evidence from Ifakara health and demographic surveillance system in rural Tanzania

The effect of mother’s age and other related factors on neonatal survival associated with first and second birth in rural, Tanzania: evidence from Ifakara health and demographic surveillance system in rural Tanzania

Neonatal mortality in Ethiopia: trends and determinants

The role of mothers-in-law in antenatal care decision-making in Nepal: a qualitative study

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