TY - JOUR
T1 - Rates and determinants of neonatal mortality in two rural sub-districts of Sylhet, Bangladesh
AU - Projahnmo Study Group in Bangladesh
AU - Al Kibria, Gulam Muhammed
AU - Khanam, Rasheda
AU - Mitra, Dipak Kumar
AU - Mahmud, Arif
AU - Begum, Nazma
AU - Moin, Syed Mamun Ibne
AU - Saha, Samir Kumar
AU - Baqui, Abdullah
N1 - Publisher Copyright:
© 2018 Al Kibria et al. This is an open access article distributed under the terms of the Creative Commons Attribution License, which permits unrestricted use, distribution, and reproduction in any medium, provided the original author and source are credited.
PY - 2018/11
Y1 - 2018/11
N2 - Introduction Reducing neonatal mortality rate (NMR) is a challenge in many low- and middle-income countries including Bangladesh. In 2014, the estimated NMR in this country was 28 per 1,000 live births. This rate is higher in rural regions compared to the national average. Currently, Sylhet Division has the highest NMR in Bangladesh. Investigating rates and determinants of neonatal mortality in rural regions of this high-risk division is particularly important to implement evidence-based programs. This study examined rates and determinants of neonatal deaths in a large rural cohort in Sylhet Division. Methods We analyzed data from a multi-country cohort study, Aetiology of Neonatal Infections in South Asia. From November 2011 to December 2013, this study was conducted in two rural sub-districts in Sylhet Division. Community health workers followed 28,960 pregnant women and their newborns up to two months postpartum and collected data on pregnancy outcomes and newborns’ survival status. The NMR was obtained by dividing total number of neonatal deaths with all studied newborns. Logistic regression was employed to calculate adjusted odds ratios (AORs) and 95% confidence intervals (CIs) for factors associated with neonatal mortality. Stata 14.0 was used for data analysis. Results This study analyzed data of 21,227 newborns. The NMR was 43.4 (95% CI: 39.3–48.0) per 1,000 live births (N = 922). Multivariable analysis showed that the odds of neonatal mortality were significantly higher among male newborns (AOR: 1.5, 95% CI: 1.2–1.8), babies born before 34 weeks of gestation (AOR: 5.0, 95% CI: 4.1–6.1), those who were twins or triplets (AOR: 6.2, 95% CI: 3.6–10.9), and first-born child (AOR: 2.9, 95% CI: 1.6–5.3). Additionally, maternal age 30–35 years (AOR: 1.4, 95% CI: 1.-1.8), history of child death (AOR: 1.6, 95% CI: 1.2–2.2), and delivery complications (AOR: 2.1, 95% CI: 1.6–2.6) had positive associations with neonatal deaths. Conclusion Public health programs in Bangladesh need to adopt a comprehensive strategy to address the individual, maternal, and intrapartum factors associated with neonatal mortality in rural regions. Interventions should aim to prioritize managing pre-term deliveries, first-born child, and delivery complications among pregnant women.
AB - Introduction Reducing neonatal mortality rate (NMR) is a challenge in many low- and middle-income countries including Bangladesh. In 2014, the estimated NMR in this country was 28 per 1,000 live births. This rate is higher in rural regions compared to the national average. Currently, Sylhet Division has the highest NMR in Bangladesh. Investigating rates and determinants of neonatal mortality in rural regions of this high-risk division is particularly important to implement evidence-based programs. This study examined rates and determinants of neonatal deaths in a large rural cohort in Sylhet Division. Methods We analyzed data from a multi-country cohort study, Aetiology of Neonatal Infections in South Asia. From November 2011 to December 2013, this study was conducted in two rural sub-districts in Sylhet Division. Community health workers followed 28,960 pregnant women and their newborns up to two months postpartum and collected data on pregnancy outcomes and newborns’ survival status. The NMR was obtained by dividing total number of neonatal deaths with all studied newborns. Logistic regression was employed to calculate adjusted odds ratios (AORs) and 95% confidence intervals (CIs) for factors associated with neonatal mortality. Stata 14.0 was used for data analysis. Results This study analyzed data of 21,227 newborns. The NMR was 43.4 (95% CI: 39.3–48.0) per 1,000 live births (N = 922). Multivariable analysis showed that the odds of neonatal mortality were significantly higher among male newborns (AOR: 1.5, 95% CI: 1.2–1.8), babies born before 34 weeks of gestation (AOR: 5.0, 95% CI: 4.1–6.1), those who were twins or triplets (AOR: 6.2, 95% CI: 3.6–10.9), and first-born child (AOR: 2.9, 95% CI: 1.6–5.3). Additionally, maternal age 30–35 years (AOR: 1.4, 95% CI: 1.-1.8), history of child death (AOR: 1.6, 95% CI: 1.2–2.2), and delivery complications (AOR: 2.1, 95% CI: 1.6–2.6) had positive associations with neonatal deaths. Conclusion Public health programs in Bangladesh need to adopt a comprehensive strategy to address the individual, maternal, and intrapartum factors associated with neonatal mortality in rural regions. Interventions should aim to prioritize managing pre-term deliveries, first-born child, and delivery complications among pregnant women.
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U2 - 10.1371/journal.pone.0206795
DO - 10.1371/journal.pone.0206795
M3 - Article
C2 - 30462674
AN - SCOPUS:85056971192
SN - 1932-6203
VL - 13
JO - PloS one
JF - PloS one
IS - 11
M1 - e0206795
ER -