Newborn survival: a multi-country analysis of a decade of change

Abstract

Neonatal deaths account for 40% of global under-five mortality and are ever more important if we are to achieve the Millennium Development Goal 4 (MDG 4) on child survival. We applied a results framework to evaluate global and national changes for neonatal mortality rates (NMR), healthy behaviours, intervention coverage, health system change, and inputs including funding, while considering contextual changes. The average annual rate of reduction of NMR globally accelerated between 2000 and 2010 (2.1% per year) compared with the 1990s, but was slower than the reduction in mortality of children aged 1-59 months (2.9% per year) and maternal mortality (4.2% per year). Regional variation of NMR change ranged from 3.0% per year in developed countries to 1.5% per year in sub-Saharan Africa. Some countries have made remarkable progress despite major challenges. Our statistical analysis identifies inter-country predictors of NMR reduction including high baseline NMR, and changes in income or fertility. Changes in intervention or package coverage did not appear to be important predictors in any region, but coverage data are lacking for several neonatal-specific interventions. Mortality due to neonatal infection deaths, notably tetanus, decreased, and deaths from complications of preterm birth are increasingly important. Official development assistance for maternal, newborn and child health doubled from 2003 to 2008, yet by 2008 only 6% of this aid mentioned newborns, and a mere 0.1% (US$4.56m) exclusively targeted newborn care. The amount of newborn survival data and the evidence based increased, as did recognition in donor funding. Over this decade, NMR reduction seems more related to change in context, such as socio-economic factors, than to increasing intervention coverage. High impact cost-effective interventions hold great potential to save newborn lives especially in the highest burden countries. Accelerating progress requires data-driven investments and addressing context-specific implementation realities.

Causes of pediatric mortality and case-fatality rates in eight Médecins Sans Frontières-supported hospitals in Africa

“…However, despite this and despite various calls for action, 7,8 neonatal care still appears to be a neglected area for: 1) policy makers in African countries, although substantial efforts have been made in Malawi and Uganda; 9,10 2) donors; 11,12 and 3) non-governmental organizations such as MSF (among the MSF hospitals only one offered special care for neonates). Low-cost and implementable or adaptable care packages have been proposed in the literature, 12,13 suggesting that there should be no resource barriers for implementation.…”

Neonatal Deaths and Autopsy Rates in a Nigerian Tertiary Hospital: A 10-Year Trend Analysis in University of Calabar Teaching Hospital, Calabar, Nigeria

“…The NMR of 49.6 per 1000 live births in the study is high when compared to that in India where a quarter of global neonatal deaths occur with a national neonatal mortality of 43 per 1000 live births is documented [12]. This rate is higher than that of Northern Nigeria with the highest estimates observed in Zamfara and Katsina at 30 deaths per 1000 live births and the lowest in Yobe at 20 deaths per 1000 live births [13]. Since 2000, China, India, Nigeria, and Pakistan are among the world's most populous countries with the most annual births and have consistently experienced the greatest number of neonatal deaths [13].…”

“…This rate is higher than that of Northern Nigeria with the highest estimates observed in Zamfara and Katsina at 30 deaths per 1000 live births and the lowest in Yobe at 20 deaths per 1000 live births [13]. Since 2000, China, India, Nigeria, and Pakistan are among the world's most populous countries with the most annual births and have consistently experienced the greatest number of neonatal deaths [13]. It is notable that Nigeria and Pakistan now have more neonatal deaths than China, owing to China's decreasing NMR and fertility rate [13].…”

“…Since 2000, China, India, Nigeria, and Pakistan are among the world's most populous countries with the most annual births and have consistently experienced the greatest number of neonatal deaths [13]. It is notable that Nigeria and Pakistan now have more neonatal deaths than China, owing to China's decreasing NMR and fertility rate [13]. The average rate of reduction of NMR has been very low at approximately 1% per year for sub-Saharan African Countries [12].…”

The Challenge of Reducing Neonatal Mortality in Low- and Middle-Income Countries

“…However, until then, there were few data regarding cause of death in countries and regions with a high NMR, with neonatal deaths classified either as "perinatal cause" or included in other categories. 6 The classification of neonatal deaths as listed in the UNICEF reports has allowed a much more targeted approach to these causes whereby more effective policies and programs can be developed to meet specific local circumstances.…”