Risk factors for early infant mortality in Sarlahi district, Nepal

Joanne Katz, Keith P. West, Subarna Khatry, Parul Christian, Steven C. LeClerq, Elizabeth Kimbrough Pradhan, Sharada Ram Shrestha

Research output: Contribution to journalArticlepeer-review

58 Scopus citations


Objectives: Early infant mortality has not declined as rapidly as child mortality in many countries. Identification of risk factors for early infant mortality may help inform the design of intervention strategies. Methods: Over the period 1994-97, 15 469 live-born, singleton infants in rural Nepal were followed to 24 weeks of age to identify risk factors for mortality within 0-7 days, 8-28 days, and 4-24 weeks after the birth. Findings: In multivariate models, maternal and paternal education reduced mortality between 4 and 24 weeks only: odds ratios (OR) 0.28 (95% confidence interval (CI) = 0.12-0.66) and 0.63 (95% CI = 0.44-0.88), respectively. Miscarriage in the previous pregnancy predicted mortality in the first week of life (OR = 1.98, 95% CI = 1.37-2.87), whereas prior child deaths increased the risk of post-neonatal death (OR =1.85, 95% CI 1.24-2.75). A larger maternal mid-upper arm circumference reduced the risk of infant death during the first week of life (OR = 0.88, 95% CI = 0.81-0.95), Infants of women who did not receive any tetanus vaccinations during pregnancy or who had severe illness during the third trimester were more likely to die in the neonatal period. Maternal mortality was strongly associated with infant mortality (OR = 6.43, 95% CI = 2.35-17.56 at 0-7 days; OR = 11.73, 95% CI = 3.82-36.00 at 8-28 days; and OR = 51.68, 95% CI = 20.26-131.80 at 4-24 weeks). Conclusion: Risk factors for early infant mortality varied with the age of the infant. Factors amenable to intervention included efforts aimed at maternal morbidity and mortality and increased arm circumference during pregnancy.

Original languageEnglish (US)
Pages (from-to)717-725
Number of pages9
JournalBulletin of the World Health Organization
Issue number10
StatePublished - Nov 27 2003


  • Age factors
  • Alcohol drinking/adverse effects
  • Health status
  • Infant mortality
  • Infant, Newborn
  • Maternal mortality
  • Nepal
  • Randomized controlled trials
  • Risk factors
  • Smoking/adverse effects
  • Socioeconomic factors
  • Tetanus toxoid/pharmacology

ASJC Scopus subject areas

  • Public Health, Environmental and Occupational Health


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