Cause-specific neonatal mortality: analysis of 3772 neonatal deaths in Nepal, Bangladesh, Malawi and India
Cause-specific neonatal mortality: analysis of 3772 neonatal deaths in Nepal, Bangladesh, Malawi and India
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DOI：
10.1136/archdischild-2014-307636
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发表时间：
2015-09-01
影响因子：
4.4
通讯作者：
Prost, Audrey
中科院分区：
文献类型：
--
作者：
Fottrell, Edward;Osrin, David;Prost, Audrey
了解死亡原因是解决每年300万新生儿死亡负担的关键。资源贫乏的环境缺乏有效的出生、死亡和死因人口动态登记系统。我们着手描述马拉维，孟加拉国，尼泊尔和农村和城市印度的死因特异性新生儿死亡率，使用死因推断（VA）data.Design我们前瞻性地记录出生，新生儿死亡和死胎在7个人口监测点。进行VA以确定死因。我们应用描述性流行病学技术和InterVA方法来描述每个地点新生儿死亡的负担、时间和原因。结果分析包括3772例新生儿死亡和3256例死产。63%至82%的新生儿死亡发生在出生后第一周，男性比女性更容易死亡。早产、出生窒息和感染是新生儿死亡的主要原因，但在国家以下一级和区域一级也存在重要差异。超过三分之一的死亡在印度城市归因于窒息，使其成为死亡的主要原因，在此setting.Conclusions人口为基础的VA方法可以填补信息空白的负担和新生儿死亡的原因，在资源贫乏和数据贫乏的设置。应利用当地数据为改善新生儿健康的干预措施提供信息并监测其实施情况。由于在家中分娩的比率很高，因此需要特别重视社区干预措施，以改善卫生分娩和新生儿基本护理。
Objective Understanding the causes of death is key to tackling the burden of three million annual neonatal deaths. Resource-poor settings lack effective vital registration systems for births, deaths and causes of death. We set out to describe cause-specific neonatal mortality in rural areas of Malawi, Bangladesh, Nepal and rural and urban India using verbal autopsy (VA) data.Design We prospectively recorded births, neonatal deaths and stillbirths in seven population surveillance sites. VAs were carried out to ascertain cause of death. We applied descriptive epidemiological techniques and the InterVA method to characterise the burden, timing and causes of neonatal mortality at each site.Results Analysis included 3772 neonatal deaths and 3256 stillbirths. Between 63% and 82% of neonatal deaths occurred in the first week of life, and males were more likely to die than females. Prematurity, birth asphyxia and infections accounted for most neonatal deaths, but important subnational and regional differences were observed. More than one-third of deaths in urban India were attributed to asphyxia, making it the leading cause of death in this setting.Conclusions Population-based VA methods can fill information gaps on the burden and causes of neonatal mortality in resource-poor and data-poor settings. Local data should be used to inform and monitor the implementation of interventions to improve newborn health. High rates of home births demand a particular focus on community interventions to improve hygienic delivery and essential newborn care.