Yirgu Robel, Molla Mitike, Sibley Lynn
Department of Reproductive Health and Health Service Management, School of Public Health, College of Health Sciences, Addis Ababa University, Addis Ababa, Ethiopia.
Department of Preventive Medicine, School of Public Health, College of Health Sciences, Addis Ababa University, Addis Ababa, Ethiopia.
PLoS One. 2017 Apr 18;12(4):e0172875. doi: 10.1371/journal.pone.0172875. eCollection 2017.
In low income and middle income countries, neonatal mortality remains high despite the gradual reduction in under five mortality. Newborn death contributes for about 38% of all under five deaths. This study has identified the magnitude and independent predictors of neonatal mortality in rural Ethiopia.
This population based nested case control study was conducted in rural West Gojam zone, Northern Ethiopia, among a cohort of pregnant women who gave birth between March 2011 and Feb 2012. The cohort was established by Maternal and Newborn Health in Ethiopia Partnership (MaNHEP) project in 2010 by recruiting mothers in their third trimester, as identified by trained community volunteers. Once identified, women stayed in the cohort throughout their pregnancy period receiving Community Maternal and Newborn Health (CMNH) training by health extension workers and community volunteers till the end of the first 48 hours postpartum. Cases were 75 mothers who lost their newborns to neonatal death and controls were 150 randomly selected mothers with neonates who survived the neonatal period. Data to identify cause of death were collected using the WHO standard verbal autopsy questionnaire after the culturally appropriate 40 days of bereavement period. Binomial logistic regression model was used to identify independent contributors to neonatal mortality.
The neonatal mortality rate was AOR(95%CI) = 18.6 (14.8, 23.2) per 1000 live births. Neonatal mortality declined with an increase in family size, neonates who were born among a family of more than two had lesser odds of death in the neonatal period than those who were born in a family of two AOR (95% CI) = 0.13 (0.02, 0.71). Mothers who gave birth to 2-4 AOR(95%CI) = 0.15 (0.05, 0.48) and 5+ children AOR(95%CI) = 0.08 (0.02, 0.26) had lesser odds of losing their newborns to neonatal mortality. Previous history of losing a newborn to neonatal death also increased the odds of neonatal mortality during the last birth AOR (95%CI) = 0.25 (0.11, 0.53).
The neonatal mortality rate in our study was three times lower than the regional neonatal mortality rate estimate, indicating community based interventions could significantly decrease neonatal mortality. The identified determinants, which are amenable for change, emphasize the need to improve quality of care during pregnancy, labour and delivery to improve pregnancy outcome.
在低收入和中等收入国家，尽管五岁以下儿童死亡率逐渐下降，但新生儿死亡率仍然很高。新生儿死亡约占所有五岁以下儿童死亡的38%。本研究确定了埃塞俄比亚农村地区新生儿死亡率的规模和独立预测因素。
这项基于人群的巢式病例对照研究在埃塞俄比亚北部西戈贾姆地区农村进行，研究对象为2011年3月至2012年2月期间分娩的孕妇队列。该队列由埃塞俄比亚孕产妇和新生儿健康伙伴关系（MaNHEP）项目于2010年建立，通过受过培训的社区志愿者识别处于孕晚期的母亲。一旦被识别，妇女在整个孕期都留在队列中，接受卫生推广工作者和社区志愿者提供的社区孕产妇和新生儿健康（CMNH）培训，直至产后48小时结束。病例为75名因新生儿死亡而失去新生儿的母亲，对照组为150名随机选择的新生儿存活至新生儿期的母亲。在经过符合文化习俗的40天丧亲期后，使用世界卫生组织标准的口头尸检问卷收集确定死亡原因的数据。采用二项逻辑回归模型确定新生儿死亡率的独立影响因素。
新生儿死亡率为每1000例活产18.6（14.8，23.2）（调整后比值比及95%置信区间）。新生儿死亡率随着家庭规模的增加而下降，出生在两个以上孩子家庭的新生儿在新生儿期死亡的几率低于出生在两个孩子家庭的新生儿，调整后比值比（95%置信区间）=0.13（0.02，0.71）。生育2 - 4个孩子（调整后比值比（95%置信区间）=0.15（0.05，0.48））和生育5个及以上孩子（调整后比值比（95%置信区间）=0.08（0.02，0.26））的母亲，其新生儿因新生儿死亡而死亡的几率较低。既往有新生儿因新生儿死亡的病史也增加了上次分娩时新生儿死亡的几率，调整后比值比（95%置信区间）=0.25（0.11，0.53）。
我们研究中的新生儿死亡率比该地区新生儿死亡率估计值低三倍，表明基于社区的干预措施可显著降低新生儿死亡率。已确定的这些可改变的决定因素强调了改善孕期、分娩期护理质量以改善妊娠结局的必要性。
