Cause and risk factors of early neonatal death in Ethiopia

Abstract

Background Globally, three fourth of neonatal deaths occur during the early neonatal period, this makes it a critical time to reduce the burden of neonatal death. The survival status of a newborn is determined by the individual (neonatal and maternal), and facility-level factors. Several studies were conducted in Ethiopia to assess early neonatal death; however, most of the studies had limited participants and did not well address the two main determinant factors covered in this study. In response to this gap, this study attempted to examine factors related to early neonatal death based on perinatal death surveillance data in consideration of all the possible determinants of early neonatal death. Methods The national perinatal death surveillance data were used for this study. A total of 3814 reviewed perinatal deaths were included in the study. Bayesian multilevel parametric survival analysis was employed to identify factors affecting the survival of newborns during the early neonatal period. Adjusted time ratio (ATR) with 95% Bayesian credible intervals (CrI) was reported and log-likelihood was used for model comparison. Statistical significance was declared based on the non-inclusion of 1.0 in the 95% CrI. Result More than half (52.4%) of early neonatal deaths occurred within the first two days of birth. Per the final model, as gestational age increases by a week the risk of dying during the early neonatal period is reduced by 6% [ATR = 0.94,95%CrI:(0.93–0.96)]. There was an increased risk of death during the early neonatal period among neonates deceased due to birth injury as compared to neonates who died due to infection [ATR = 2.05,95%CrI:(1.30–3.32)]; however, perinates who died due to complication of an intrapartum event had a lower risk of death than perinates who died due to infection [ATR = 0.87,95%CrI:(0.83–0.90)]. As the score of delay one and delay three increases by one unit, the newborn’s likelihood of surviving during the early neonatal period is reduced by 4% [ATR = 1.04,95%CrI:(1.01–1.07)] and 21% [ATR = 1.21,95%CrI:(1.15–1.27)] respectively. Neonates born from mothers living in a rural area had a higher risk of dying during the early neonatal period than their counterparts living in an urban area [ATR = 3.53,95%CrI:(3.34–3.69)]. As compared to neonates treated in a primary health facility, being treated in secondary [ATR = 1.14,95%CrI:(1.02–1.27)] and tertiary level of care [ATR = 1.15,95%CrI:(1.04–1.25)] results in a higher risk of death during the early neonatal period. Conclusion The survival of a newborn during the early neonatal period is determined by both individual (gestational age, cause of death, and delay one) and facility (residence, type of health facility and delay three) level factors. Thus, to have a positive early neonatal outcome, a tailored intervention is needed for the three major causes of death (i.e Infection, birth injury, and complications of the intrapartum period). Furthermore, promoting maternal health, improving the health-seeking behaviour of mothers, strengthening facility readiness, and narrowing down inequalities in service provision are recommended to improve the newborn’s outcomes during the early neonatal period.

Hierarchical Predictors of Mortality in Neonatal Sepsis at Jimma Medical Center, Ethiopia: A Case–Control Study

“…It revealed that at the proximal level, rural residence contributes to a 9.5% of preventable neonatal mortality within the population under study, and it increasingly pronounced when adjusted to the proximal level factors, illustrating a stronger connection between rural residence and mortality resulting from neonatal sepsis. The association between rural residence and neonatal mortality observed in this study is consistent with findings reported in various locations, 29 and these results appear to be reasonable and justifiable. Global reports indicate that neonates living in rural settings often delay seeking healthcare until their condition worsens, or they are referred due to complications related to sepsis.…”

Assessing postnatal care for newborns in Sub-Saharan Africa: A multinational analysis

“…A child born in SSA or Southern Asia is 10 times more likely to die in the first month of life than a child born in a high-income nation. The majority of neonatal deaths in impoverished nations are caused by childbirth, intrapartum, and inadequate immediate infant care practices [ 2 , 4 , 5 ].…”

Effective coverage of antenatal care services in Ethiopia: A population-based cross- sectional study

“…Among other preventive interventions, providing two doses of tetanus vaccination is crucial to prevent neonatal tetanus. Low tetanus vaccination coverage increases the risk of neonatal tetanus and death in home deliveries with unhygienic conditions [7]. Similarly, inadequate coverage of iron-folate supplementation increases the risk of severe anemia and complications for mothers and newborns [8].…”