Why do neonates die in rural Gadchiroli, India? (Part II): estimating population attributable risks and contribution of multiple morbidities for identifying a strategy to prevent deaths.
Why do neonates die in rural Gadchiroli, India? (Part II): estimating population attributable risks and contribution of multiple morbidities for identifying a strategy to prevent deaths.
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DOI：
10.1038/sj.jp.7211270
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发表时间：
2005-03-01
期刊：
影响因子：
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通讯作者：
Deshmukh, Mahesh D
中科院分区：
文献类型：
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作者：
Bang, Abhay T;Reddy, Hanimi M;Deshmukh, Mahesh D
结论：对发展中国家农村地区新生儿死亡原因的理解有限。在第一年（1995年至1996年）的现场试验，以家庭为基础的新生儿护理在农村Gadchiroli，印度，我们前瞻性地观察了一组新生儿在39个村庄。在本文的第一部分，我们介绍了主要的死亡原因。对资料进行进一步分析：估计新生儿主要死因的人群归因危险度（PAR）。评估多种发病率的影响，并确定哪些发病率组合导致新生儿死亡。研究设计：我们通过逻辑回归分析了观察数据，以估计六种主要疾病的死亡PAR。估计每名新生儿的发病数对病死率（CF）的影响。然后，我们确定了主要的发病率组合作为导致死亡的组成原因。我们估计的超额死亡归因于败血症。结果：这个队列包括763名新生儿，其中40名新生儿死亡。六种主要疾病与以下死亡比例相关：早产，62.5%;败血症，60%;宫内生长受限（IUGR），27.5%;窒息，25%;体温过低，22.5%和喂养问题，15%。估计的PAR为：早产，0.74; IUGR，0.55;败血症，0.55;窒息，0.35;体温过低，0.08，喂养问题，0.04。与每例新生儿发病数相关的CF为：无发病率0.3%，1例发病率2.1%，2例发病率15.3%，3例或3例以上发病率41.4%（p
OBJECTIVES: The understanding about why neonates die in rural areas in developing countries is limited. In the first year (1995 to 1996) of the field trial of home-based neonatal care in rural Gadchiroli, India, we prospectively observed a cohort of neonates in 39 villages. In Part I of this article, we presented the primary causes of death. The data were further analyzed: To estimate the population attributable risk (PAR) of death for the main causes of neonatal mortality. To evaluate the effect of a multiplicity of morbidities and to identify which morbidity combinations cause neonatal deaths. To develop a hypothesis about how best to reduce neonatal mortality.STUDY DESIGN: We analyzed the observational data by logistic regression to estimate the PAR of death for six major morbidities. The effect of the number of morbidities per neonate on case fatality (CF) was estimated. Then we identified the main combinations of morbidities as the component causes leading to death. We estimated the excess deaths attributable to sepsis.RESULTS: This cohort included 763 neonates among whom 40 neonatal deaths occurred. Six major morbidities were associated with the following proportion of deaths: preterm, 62.5%; sepsis, 60%; intrauterine growth restriction (IUGR), 27.5%; asphyxia, 25%; hypothermia, 22.5%, and feeding problems, 15%. The estimated PARs were: preterm, 0.74; IUGR, 0.55; sepsis, 0.55; asphyxia, 0.35; hypothermia, 0.08, and feeding problems, 0.04. The CF associated with the number of morbidities per neonate was: with no morbidity, 0.3%; one morbidity, 2.1%; two morbidities, 15.3%; three or more morbidities, 41.4% (p