Department of International Health, Johns Hopkins Bloomberg School of Public Health, Baltimore, MD-21205, USA.
Department of Epidemiology, Johns Hopkins Bloomberg School of Public Health, Baltimore, MD-21205, USA.
Global Health. 2018 May 9;14(1):47. doi: 10.1186/s12992-018-0363-8.
Neonatal mortality is declining slowly compared to under-five mortality in many developing countries including Afghanistan. About three-fourths of these deaths occur in the early neonatal period (i.e., the first week of life). Although a number of studies investigated determinants of early neonatal mortality in other countries, there is a lack of evidence regarding this in Afghanistan. This study investigated determinants of early neonatal mortality in Afghanistan.
Data from the Afghanistan Demographic and Health Survey 2015 (AfDHS 2015) were analyzed. After reporting the weighted frequency distributions of selected factors, a multilevel logistic regression model revealed adjusted associations of factors with early neonatal mortality.
A total of 19,801 weighted live-births were included in our analysis; 266 (1.4%) of the newborns died in this period. Multivariable analysis found that multiple gestations (adjusted odds ratio (AOR): 9.3; 95% confidence interval (CI): 5.7-15.0), larger (AOR: 2.9; 95% CI: 2.2-3.8) and smaller (AOR: 1.8; 95% CI: 1.2-2.6) than average birth size, maternal age ≤ 18 years (AOR: 1.8; 95% CI: 1.1-3.2) and ≥ 35 years (AOR: 1.7; 95% CI: 1.3-2.3), and birth interval of < 2 years (AOR: 2.6; 95% CI: 1.4-4.9) had higher odds of early neonatal mortality. On the other hand, antenatal care by a skilled provider (AOR: 0.7; 95% CI: 0.5-0.9), facility delivery (AOR: 0.7; 955 CI: 0.5-0.9), paternal higher education level (AOR: 0.7; 95% CI: 0.5-1.0), living in north-western (AOR: 0.3; 95% CI: 0.1-0.6), central-western regions (AOR: 0.5; 95% CI: 0.3-0.9) and in a community with higher maternal education level (AOR: 0.4; 95% CI: 0.2-0.9) had negative association.
Several individual, maternal and community level factors influence early neonatal deaths in Afghanistan; significance of the elements of multiple levels indicates that neonatal survival programs should follow a multifaceted approach to incorporate these associated factors. Programs should focus on birth interval prolongation with the promotion of family planning services, utilization of antenatal care and institutional delivery services along with management of preterm and sick infants to prevent this large number of deaths in this period.
在包括阿富汗在内的许多发展中国家，与五岁以下儿童死亡率相比，新生儿死亡率下降缓慢。这些死亡人数中有四分之三发生在早期新生儿期（即生命的第一周）。尽管许多研究调查了其他国家早期新生儿死亡的决定因素，但在阿富汗缺乏这方面的证据。本研究调查了阿富汗早期新生儿死亡的决定因素。
对 2015 年阿富汗人口与健康调查（AfDHS 2015）的数据进行了分析。在报告选定因素的加权频率分布后，多水平逻辑回归模型揭示了因素与早期新生儿死亡率的调整关联。
共有 19801 名经加权的活产婴儿纳入我们的分析；在此期间，有 266 名（1.4%）新生儿死亡。多变量分析发现，多胎妊娠（调整后的优势比（AOR）：9.3；95%置信区间（CI）：5.7-15.0）、较大（AOR：2.9；95%CI：2.2-3.8）和较小（AOR：1.8；95%CI：1.2-2.6）的出生体重、母亲年龄≤18 岁（AOR：1.8；95%CI：1.1-3.2）和≥35 岁（AOR：1.7；95%CI：1.3-2.3），以及间隔时间<2 年（AOR：2.6；95%CI：1.4-4.9）的早期新生儿死亡风险更高。另一方面，由熟练提供者进行的产前护理（AOR：0.7；95%CI：0.5-0.9）、医疗机构分娩（AOR：0.7；955CI：0.5-0.9）、父亲接受较高教育水平（AOR：0.7；95%CI：0.5-1.0）、居住在西北部（AOR：0.3；95%CI：0.1-0.6）、中西部地区（AOR：0.5；95%CI：0.3-0.9）和母亲教育水平较高的社区（AOR：0.4；95%CI：0.2-0.9）呈负相关。
一些个体、产妇和社区层面的因素影响阿富汗的早期新生儿死亡；多层次要素的重要性表明，新生儿生存方案应采取多方面的方法，纳入这些相关因素。方案应注重延长生育间隔，同时促进计划生育服务、利用产前护理和机构分娩服务以及管理早产儿和患病婴儿，以防止在此期间发生大量死亡。
