Prevalence of neonatal near miss and associated factors in Nepal: a cross-sectional study

Abstract

Background The rate of neonatal mortality has declined but lesser than the infant mortality rate and remains a major public health challenge in low- and middle-income countries. There is an urgent need to focus on newborn care, especially during the first 24 h after birth and the early neonatal period. Neonatal near miss (NNM) is an emerging concept similar to that of maternal near miss. NNM events occur three to eight times more often than neonatal deaths. The objective of this study was to establish the prevalence of NNM and identify its associated factors. Methods A hospital-based cross-sectional study was conducted in Koshi Hospital, Morang district, Nepal. Neonates and their mothers of unspecified maternal age and gestational age were enrolled. Key inclusion criteria were pragmatic and management markers of NNM and admission of newborn infants to the neonatal intensive care unit (NICU) in Koshi Hospital. Non-Nepali citizens were excluded. Consecutive sampling was used until the required sample size of 1,000 newborn infants was reached. Simple and multiple logistic regression was performed using SPSS® version 24.0. Results One thousand respondents were recruited. The prevalence of NNM was 79 per 1,000 live births. Severe maternal morbidity (adjusted odds ratio (aOR) 4.52; 95% confidence interval (CI) 2.07–9.84) and no formal education (aOR 2.16; 95% CI 1.12–4.14) had a positive association with NNM, while multiparity (aOR 0.52; 95% CI 0.32–0.86) and caesarean section (aOR 0.44; 95% CI 0.19–0.99) had negative associations with NNM. Conclusions Maternal characteristics and complications were associated with NNM. Healthcare providers should be aware of the impact of obstetric factors on newborn health and provide earlier interventions to pregnant women, thus increasing survival chances of newborns.

Effect of fetal malposition, primiparous, and premature rupture of membrane on Neonatal Near miss mediated by grade three meconium-stained amniotic fluids and duration of the active first stage of labor: Mediation analysis

“…The NNM proportion of 28.6% in our study was, however, lower when compared to other studies conducted in health facilities in Brazil [42], central Gujarat India [6], Nepal [7], Central Uganda [8], Hawasa Ethiopia [43], South Ethiopia [14], and Debre Tabor hospital, northwest Ethiopia [13]. Participants in these other studies in Brazil, central Gujarat India, and Uganda, were neonates born to women hospitalized with severe obstetric problems.This could be one of the contributing factors to the disparity.…”

“…Neonatal Near Miss has a varied magnitude around the world. The proportion was 22% in northwestern Brazil [4], 17.2% in Australia [5], 86% in central Gujarat, India [6], and 79% in Nepal [7] in facility based studies. In three Africa countries like Benin, Burkina Faso, and Morocco, it was 27.1%, 19.1%, and 30.4%, respectively [3], and 36.7% in central Uganda [8].…”

Magnitude of neonatal near miss in public hospitals in Eastern Ethiopia: A cross-sectional study

“…Our finding is in line with findings in Ethiopia [Hawassa (33.4%) 15 and Debre Tabor (32.9%) 16 ] and Brazilian university hospitals (30.3%). 18 However, it is higher than some other studies in Ethiopia [Jimma (26.7%) 14 and Injibara (23.3%) 19 ], Nepal (7.9%), 20 Brazil [(8.7%), 21 (22.2%), 22 (3.3%) 23 ], and the WHOMCS (7.3%). 6 This might be related with differences in sociodemographic conditions and mothers’ ability of early recognition of complications and health-seeking behavior, study settings, and NNM identification criteria.…”

The Prevalence of Neonatal Near Misses in Rabat, Morocco

“…An association between maternal education and neonatal mortality, particularly in low-income countries, has been documented in other studies [17,18]. In addition, educated mothers are more likely to have a higher socioeconomic status, have better knowledge of healthy behaviors, and use health care appropriately [19].…”