Causes and age of neonatal death and associations with maternal and newborn care characteristics in Nepal: a verbal autopsy study

Erchick, Daniel J; Lackner, Johanna B; Mullany, Luke C.; Bhandari, Nitin; Shedain, Purusotam Raj; Khanal, Sirjana; Dhakwa, Jyoti R; Katz, Joanne

doi:10.1186/s13690-021-00771-5

Cited by 13 publications

(20 citation statements)

References 28 publications

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“…Per the study findings, more than half of the early neonatal deaths occur during the first two days after birth. This finding was parallel with studies conducted in Ethiopia [ 60 ] and Nepal [ 61 ]. This implies that the measures taken in the first two days after birth could substantially reduce early neonatal death.…”

Section: Discussionsupporting

confidence: 89%

Cause and risk factors of early neonatal death in Ethiopia

et al. 2022

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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.

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Section: Discussionsupporting

confidence: 89%

Cause and risk factors of early neonatal death in Ethiopia

et al. 2022

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“…This reflects the most to least common causes of neonatal mortality in 2017 in Nepal as determined by the WHO and Maternal and Child Epidemiology Estimation Group (MCEE) [19]. This is in contrast to the study results of Erchick et al, which examined causes of neonatal deaths across six districts in Nepal from 2012-2013 [20]. Among the 338 neonatal deaths, sepsis was the leading cause of death (47%), followed by birth asphyxia (16.6%) and prematurity (13.3%).…”

Section: Location Of Birth (N %)mentioning

confidence: 80%

“…Physicians bring a more holistic approach to the assignment of cause of death, but have interobserver reliability issues that are removed by the use of an algorithm. Algorithms are reproducible by definition but are not necessarily more valid [20]. Of infants born preterm <37 weeks gestation, 2/3 were assigned prematurity as a COD.…”

Section: Location Of Birth (N %)mentioning

confidence: 99%

Causes of neonatal mortality using verbal autopsies in rural Southern Nepal, 2010–2017

Saya

Katz

Khatry

et al. 2022

PLOS Glob Public Health

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The burden of neonatal mortality remains high worldwide, particularly in South Asia. Verbal Autopsy is a method used to identify cause of death (COD) where vital registration capabilities are lacking. This study examines the causes of neonatal mortality in a large study population in rural Southern Nepal. The data used is from a larger cluster-randomized community-based trial. The study includes 984 neonatal deaths with complete verbal autopsy information which occurred between 2010 and 2017. The InterVA-5 software was used to identify COD. COD included severe infection (sepsis, pneumonia, meningitis/encephalitis), intrapartum related events (identified as birth asphyxia), congenital malformations, and other. The neonatal mortality rate was 31.2 neonatal deaths per 1000 live births. The causes of neonatal mortality were identified as prematurity (40%), intrapartum related events (35%), severe infection (19%), congenital abnormalities (4%), and other (2%). A high proportion, 42.5% of neonatal deaths occurred in the first 24 hours after birth. Over half (56.4%) of deaths occurred at home. This large prospective study identifies population level neonatal causes of death in rural Southern Nepal, which can contribute to national and regional COD estimates. Interventions to decrease neonatal mortality should focus on preventative measures and ensuring the delivery of high risk infants at a healthcare facility in the presence of a skilled birth attendant.

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“…More efforts are therefore necessary for low- and middle-income countries to achieve the United Nations Sustainable Development Goal 3 target 3.2 which aims to end all preventable deaths of newborns and children aged under 5 years of age by 2030 ( 3 – 5 ). Nepal remained with the 20 th highest rate of PTB in the world in 2010 ( 6 ), and prematurity has often been reported as one of the major causes of neonatal deaths in Nepal ( 7 – 9 ).…”

Section: Introductionmentioning

confidence: 99%