School of Science and Health, Western Sydney University, Locked Bag1797, Penrith, NSW, 2571, Australia.
School of Social Sciences and Psychology, Western Sydney University, Locked Bag1797, Penrith, NSW, 2571, Australia.
BMC Pregnancy Childbirth. 2019 Mar 11;19(1):88. doi: 10.1186/s12884-019-2234-6.
Perinatal mortality is a devastating pregnancy outcome affecting millions of families in many low and middle-income countries including Nepal. This paper examined the more distant factors associated with perinatal mortality in Nepal.
A sample of 23,335 pregnancies > 28 weeks' gestation from the Nepal Demographic and Health Survey datasets for the period (2001-2016) was analysed. Perinatal Mortality (PM) is defined as the sum of stillbirth (fetal deaths in pregnancies > 28 weeks' gestation) and early neonatal mortality (deaths within the first week of life), while Extended Perinatal Mortality (EPM) is denoted as the sum of stillbirth and neonatal mortality (deaths within the first 28 days of life). Rates of PM and EPM were calculated. Logistic regression generalized linear latent and mixed models (GLLAMM) that adjusted for clustering and sampling weight was used to examine the factor associated with perinatal mortality.
Over the study period, the PMR was 42 [95% Confidence Interval (CI): 39, 44] per 1000 births for the five-year before each survey; while corresponding EPMR was 49 (95% CI, 46, 51) per 1000 births. Multivariable analyses revealed that women residing in the mountains, who did not use contraceptives, women aged 15-18 years or 19-24 years, and women having no education were associated with increased PM and EPM. The study also identified households using biomass as cooking fuel, and households who reported unimproved sanitation or open defecation were significantly more likely to experience PM and EPM.
Interventions aimed to improve use of contraceptives, and reduce biomass as a source of cooking fuel are needed to achieve the recommended target of < 12 perinatal deaths per 1000 births by 2030.
围产儿死亡率是一种毁灭性的妊娠结局，影响到包括尼泊尔在内的许多低收入和中等收入国家的数百万个家庭。本文研究了尼泊尔围产儿死亡的更长期因素。
对尼泊尔人口与健康调查数据集（2001-2016 年）中 23335 例>28 周妊娠的样本进行了分析。围产儿死亡率（PM）定义为死产（妊娠>28 周的胎儿死亡）和早期新生儿死亡（生命第一周内死亡）之和，而扩展围产儿死亡率（EPM）表示死产和新生儿死亡（生命头 28 天内死亡）之和。计算 PM 和 EPM 的发生率。使用调整了聚类和抽样权重的逻辑回归广义线性潜在和混合模型（GLLAMM）来检查与围产儿死亡率相关的因素。
在研究期间，五次调查前五年的 PMR 为每 1000 例活产 42 例（95%置信区间：39，44）；而相应的 EPMR 为每 1000 例活产 49 例（95%置信区间，46，51）。多变量分析显示，居住在山区、不使用避孕药具、年龄在 15-18 岁或 19-24 岁之间、没有受过教育的妇女与 PM 和 EPM 增加有关。该研究还发现，使用生物质作为烹饪燃料的家庭，以及报告卫生条件未改善或露天排便的家庭，发生 PM 和 EPM 的可能性显著增加。
需要采取干预措施，提高避孕药具的使用率，并减少生物质作为烹饪燃料的来源，以实现到 2030 年<12 例每千例围产儿死亡的建议目标。
