Research Priorities for the Reduction of Perinatal and Neonatal Morbidity and Mortality in Developing Country Communities

Abstract

Despite global declines in under-five and infant mortality rates in recent decades, neonatal mortality rates have remained relatively unchanged.1 Mortality during the first 28 days of life now accounts for two-thirds of deaths in children less than 1 year of age, and nearly four-tenths of all deaths in children less than 5 years of age.2 -4 A recent analysis found that the loss of healthy life from newborn deaths represented 8.2% and 13.6% of the burden of disease in Sub-Saharan Africa and South Asia, respectively, or 27 and 53 million years of life lost in those two respective regions alone. 5 The analysis, however, highlighted the dearth of information available on neonatal outcomes in developing countries, particularly at the community level, and the potential for currently available figures to underestimate the magnitude of the problem. Thus, epidemiological research is needed to make available more accurate data on risk factors and causes of neonatal morbidity and mortality, and improved and validated neonatal verbal autopsy instruments are needed in order to collect accurate data.For every death during the neonatal period, it is estimated that another stillbirth has occurred; when combined with the two-thirds of neonatal deaths that occur during the first week of life, perinatal deaths nearly equal the number of deaths during the entire first year of life. 6,7 Estimates from the World Bank suggest that perinatal deaths account for approximately 7% of the global burden of disease, exceeding that due to malaria and vaccine-preventable infections combined. 8 Worldwide, 98% of all neonatal deaths occur in developing countries, most often at home, outside the formal health care system, and largely due to infections (32%), birth asphyxia and injuries (29%), and consequences of prematurity and congenital anomalies (34%).9 Infections may account for approximately half of newborn deaths at the community level.10 Low birth weight (LBW) is an overriding factor in the majority of the deaths. 1Conditions that affect the neonate, including LBW, impact not only neonatal mortality but also long-term morbidity through effects on neurological and cognitive development and associations with chronic diseases such as diabetes, cardiovascular disease and chronic lung disease.11 Thus, interventions that prevent morbidity during the neonatal period have the potential to be highly cost-effective and impact health far beyond the neonatal period.In this review, we present a conceptual framework for maternal and neonatal health care, and in this context, propose priority research activities to improve perinatal and neonatal health and survival in developing country communities. CONCEPTUAL FRAMEWORK AND CONTEXT OF NEONATAL HEALTH CARE AND RESEARCHImproving newborn health and survival depends in large measure on more effectively implementing what we already know works.Although post -neonatal and child mortality rates have declined dramatically in many developing countries in recent decades, neonatal mortality rates have remained relati...

Risk factors associated with the development of perinatal asphyxia in neonates at Hospital Universitario del Valle, Cali, Colombia, 2010-2011

“…After prematurity, perinatal asphyxia is considered to be the main cause of neonatal mortality (2,3). It is estimated that over one million newborns who survive asphyxia develop cerebral palsy, epilepsy, learning disabilities and other developmental problems, with longterm sequelae (2,4,5).…”

Maternal and Newborn Risk Factors associated With Neonatal Mortality in Gitwe District Hospital in Ruhango District, Rwanda

“…Estimations from the WHO showed 4 that although underfive mortality has fallen globally from 12.2 million deaths in 1990 to 7.6 million deaths in 2010, the fall in neonatal mortality is considerably less than that in the post-neonatal period. 5,6 Consequently, the proportion of deaths in the neonatal period rose from 38% (4 million) of total deaths in 2000 to about 41% (3.3 million) in 2009. 7 This may be attributable to the high emphasis on child survival programs such as nutrition, vaccination and health promotion interventions relative to hospital-related investments necessary for neonatal mortality reduction particularly in rural areas.…”

A Global View of Advancing Neonatal Health and Survival

“…The authors 10,11 correctly identify the area of sepsis as a research priority. This is of great clinical importance since sepsis is the major cause of death after birth asphyxia.…”

“…Overall, Marsh et al 10 and Moss et al 11 capture the major theme of the WHO/UNICEF recommendations to reduce the persisting high maternal and neonatal mortality in the developing countries. Using well-recognized milestones from pregnancy to parturition, these authors provide paradigms for recognition of danger signals and appropriate interventions.…”

“…In the previous issue, Moss et al 11 gave an overview of the global burden of neonatal/perinatal disease, then identified research priorities for the reduction of perinatal and neonatal morbidity in the developing countries. In the current issue, the article by Marsh et al 10 provides a conceptual framework to advance neonatal health and survival in the developing countries.…”