When, Where, and Why Are Babies Dying? Neonatal Death Surveillance and Review in Bangladesh
When, Where, and Why Are Babies Dying? Neonatal Death Surveillance and Review in Bangladesh
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DOI：
10.1371/journal.pone.0159388
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发表时间：
2016-08-01
期刊：
影响因子：
3.7
通讯作者：
van den Broek, Nynke
中科院分区：
文献类型：
--
作者：
Halim, Abdul;Dewez, Juan Emmanuel;van den Broek, Nynke
BackgroundBetter数据的原因，和因素，新生儿死亡，需要改善干预措施，旨在降低新生儿死亡率在低收入和中等收入countries.MethodsCommunity监测，以确定所有新生儿死亡在孟加拉国四个地区。每五个病例的口头尸检和InterVA-4用于指定可能的死亡原因。发现6748例新生儿死亡，新生儿死亡率为每1000例活产24.4例。其中，51.3%发生在社区，48.7%发生在卫生设施或前往卫生设施的途中。几乎一半（46.1%）发生在出生后24小时内，83.6%的死亡发生在出生后的头7天。出生窒息是死亡的主要原因（43%），其次是感染（29.3%）和早产（22.2%）。在68.3%的病例中，死亡前曾在医疗机构接受过治疗。在受过教育的母亲中，（RR 1.18，95% CI：1.04-1.35）或在卫生机构分娩的妇女（RR 1.48，95% CI 1.37-1.60），以前生育过2-4次的母亲中更低（RR 0.89，95%CI 0.82-0.96）、女婴（RR 0.87，95%CI 0.80-0.93）和低出生体重儿（RR 0.89，95%CI 0.82-0.96）。为了进一步降低新生儿死亡率，必须提高所提供护理的质量，特别是熟练的助产护理、产科急诊和出生后第一个月的新生儿护理，使其及时、安全和有效。
BackgroundBetter data on cause of, and factors contributing to, neonatal deaths are needed to improve interventions aimed at reducing neonatal mortality in low-and middle-income countries.MethodsCommunity surveillance to identify all neonatal deaths across four districts in Bangladesh. Verbal autopsy for every fifth case and InterVA-4 used to assign likely cause of death.Findings6748 neonatal deaths identified, giving a neonatal mortality rate of 24.4 per 1000 live births. Of these, 51.3% occurred in the community and 48.7% at or on the way to a health facility. Almost half (46.1%) occurred within 24 hours of birth with 83.6% of all deaths occurring in the first seven days of life. Birth asphyxia was the leading cause of death (43%), followed by infections (29.3%), and prematurity (22.2%). In 68.3% of cases, care had been provided at a health facility before death occurred. Care-seeking was significantly higher among mothers who were educated (RR 1.18, 95% CI: 1.04-1.35) or who delivered at a health facility (RR 1.48, 95% CI 1.37-1.60) and lower among mothers who had 2-4 previous births (RR 0.89, 95% CI 0.82-0.96), for baby girls (RR 0.87, 95% CI 0.80-0.93), and for low birth weight babies (RR 0.89, 95% CI 0.82-0.96).InterpretationMost parents of neonates who died had accessed and received care from a qualified health-care provider. To further reduce neonatal mortality, it is important that the quality of care provided, particularly skilled birth attendance, emergency obstetric care, and neonatal care during the first month of life is improved, such that it is timely, safe, and effective.