TY - JOUR
T1 - How fast did newborns die in Nigeria from 2009-2013
T2 - A time-to-death analysis using Verbal /Social Autopsy data
AU - Koffi, Alain K.
AU - Perin, Jamie
AU - Kalter, Henry D.
AU - Monehin, Joseph
AU - Adewemimo, Adeyinka
AU - Black, Robert E.
N1 - Funding Information:
We thank Ezenwa N. Loveth and Jalingo Inuwa for their contributions to the conduct of the study. We also thank the study participants and field staff for their efforts in implementing the survey. Ethical clearance: In line with national and international codes for health research ethics which requires that every survey is carried out with recourse to institutional guides, rules and regulations, the National Health Research Ethics Committee of the Federal Ministry of Health (FMOH) in Nigeria and the Institutional Review Board, Johns Hopkins Bloomberg School of Public Health Baltimore, Maryland, USA reviewed the VASA study proposal and provided approval to conduct the survey in 2014. The approval was reviewed and extended to September 2015 to allow enough time for analysis, report writing and dissemination. The VASA technical team that also doubled as the quality control team, as well as the data collectors received elaborate training on ethics for the collection of data from human subjectsFunding for the Verbal and Social Autopsy field work was provided by US Agency for International Development/Nigeria and the Office of Population and Reproductive Health, US Agency for International Development/Washington D.C., through a Leader with Associates (LWA) Cooperative Agreement under the terms of Award No GHS-A-00-09-00004-00 to Johns Hopkins University. Funding for technical assistance for the survey was provided through a grant to Maternal and Child Epidemiology Estimation (MCEE) that is supported by the Bill and Melinda Gates Foundation under Global Development Grant #OPP1096225 to Johns Hopkins University. The funders had no role in study design, data collection and analysis, decision to publish, or preparation of the manuscript.
Publisher Copyright:
© 2019 The Author(s).
PY - 2019/12
Y1 - 2019/12
N2 - Background The slow decline in neonatal mortality as compared to post-neonatal mortality in Nigeria calls for attention and efforts to reverse this trend. This paper examines how socioeconomic, cultural, behavioral, and contextual factors interact to influence survival time among deceased newborns in Nigeria. Methods Using the neonatal deaths data from the 2014 Nigeria Verbal/ Social Autopsy survey, we examined the temporal distribution of overall and cause-specific mortality of a sample of 723 neonatal deaths. We fitted an extended Cox regression model that also allowed a time-dependent set of risk factors on time-to-neonatal death from all causes, and then separately, from birth injury/birth asphyxia (BIBA) and neonatal infections, while adjusting for possible confounding variables. Results Approximately 26% of all neonatal deaths occurred during the first day, 52.8% during the first three days, and 73.9% during the first week of life. Almost all deaths (94.4%) due to BIBA and about 64% from neonatal infections occurred in the first week of life. The expected all-cause mortality hazard was 6.23 times higher on any particular illness day for the deceased newborns who had a severe illness at onset compared to those who did not. While the all-cause mortality hazard ratio of poor vs wealthier households was 0.77 (95% confidence interval (CI) = 0.648-0.922), the BIBA mortality hazard ratio of households with no electricity was 1.79 times higher compared to households with electricity (95% CI = 1.180-2.715). Conclusions The findings suggest the need for continued improvement of the coverage and quality of maternal and neonatal health interventions at birth and in the immediate postnatal period. They may also require confirmation in real- world cohorts with detailed, time-varying information on neonatal mortality.
AB - Background The slow decline in neonatal mortality as compared to post-neonatal mortality in Nigeria calls for attention and efforts to reverse this trend. This paper examines how socioeconomic, cultural, behavioral, and contextual factors interact to influence survival time among deceased newborns in Nigeria. Methods Using the neonatal deaths data from the 2014 Nigeria Verbal/ Social Autopsy survey, we examined the temporal distribution of overall and cause-specific mortality of a sample of 723 neonatal deaths. We fitted an extended Cox regression model that also allowed a time-dependent set of risk factors on time-to-neonatal death from all causes, and then separately, from birth injury/birth asphyxia (BIBA) and neonatal infections, while adjusting for possible confounding variables. Results Approximately 26% of all neonatal deaths occurred during the first day, 52.8% during the first three days, and 73.9% during the first week of life. Almost all deaths (94.4%) due to BIBA and about 64% from neonatal infections occurred in the first week of life. The expected all-cause mortality hazard was 6.23 times higher on any particular illness day for the deceased newborns who had a severe illness at onset compared to those who did not. While the all-cause mortality hazard ratio of poor vs wealthier households was 0.77 (95% confidence interval (CI) = 0.648-0.922), the BIBA mortality hazard ratio of households with no electricity was 1.79 times higher compared to households with electricity (95% CI = 1.180-2.715). Conclusions The findings suggest the need for continued improvement of the coverage and quality of maternal and neonatal health interventions at birth and in the immediate postnatal period. They may also require confirmation in real- world cohorts with detailed, time-varying information on neonatal mortality.
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U2 - 10.7189/jogh.09.020501
DO - 10.7189/jogh.09.020501
M3 - Article
C2 - 31360450
AN - SCOPUS:85070830628
SN - 2047-2978
VL - 9
JO - Journal of global health
JF - Journal of global health
IS - 2
M1 - 020501
ER -