Department of Statistics, Jahangirnagar University, Savar, Dhaka, Bangladesh; Centre for Non-Communicable Diseases and Nutrition, BRAC James P Grant School of Public Health, BRAC University, Dhaka, Bangladesh.
Department of Public Health, North South University, Dhaka, Bangladesh.
Public Health. 2023 Jul;220:112-119. doi: 10.1016/j.puhe.2023.05.004. Epub 2023 Jun 8.
This study aimed to identify significant antenatal and postnatal factors associated with neonatal death at 2-7 days and at 2-28 days in the Indian subcontinent. Results from this study may help guide strategies to improve antenatal and postnatal care services and reduce neonatal mortality.
Nationally representative recent Demographic and Health Survey data sets from five countries, including Bangladesh, India, Pakistan, Maldives and Nepal, were used.
Survey-weighted univariate distributions were used for study population characteristics and bivariate distributions, along with the chi-squared test for unadjusted associations. Finally, multilevel logistic regression models were performed to determine the association of antenatal care (ANC) and postnatal care (PNC) factors with neonatal deaths.
Among 200,499 live births, the highest neonatal death rate was observed in Pakistan, followed by Bangladesh, whereas the lowest rate was in Nepal. After adjusting for sociodemographic and maternal control variables, the multilevel analysis showed a significantly lower likelihood of neonatal death at 2-7 days and 2-28 days with ANC visits <12 weeks' gestation, at least four ANC visits during pregnancy, PNC visits within the first week after birth and breastfeeding. Delivery at home by a skilled birth attendant compared to unskilled birth attendant was significantly associated with lower neonatal death at 2-7 days. Multifoetal gestation was significantly associated with higher neonatal death at 2-7 days and at 2-28 days.
The findings suggest that strengthening ANC and PNC services will improve newborn health in the Indian subcontinent and decrease neonatal mortality.
本研究旨在确定与印度次大陆新生儿在 2-7 天和 2-28 天死亡相关的重要产前和产后因素。本研究的结果可能有助于指导策略，以改善产前和产后保健服务，降低新生儿死亡率。
使用了来自孟加拉国、印度、巴基斯坦、马尔代夫和尼泊尔五个国家的具有代表性的最新人口与健康调查数据集。
采用调查加权的单变量分布来描述研究人群的特征和双变量分布，并使用卡方检验进行未经调整的关联分析。最后，采用多水平逻辑回归模型来确定产前保健 (ANC) 和产后保健 (PNC) 因素与新生儿死亡的关联。
在 200499 例活产中，巴基斯坦的新生儿死亡率最高，其次是孟加拉国，而尼泊尔的新生儿死亡率最低。在调整了社会人口学和产妇控制变量后，多水平分析显示，在 2-7 天和 2-28 天内，ANC 就诊时间<12 周、孕期至少进行 4 次 ANC 就诊、产后第一周内进行 PNC 就诊以及母乳喂养的情况下，新生儿死亡的可能性显著降低。与非熟练接生员相比，由熟练接生员在家中接生与 2-7 天内新生儿死亡风险显著降低相关。多胎妊娠与 2-7 天和 2-28 天内新生儿死亡风险显著升高相关。
研究结果表明，加强 ANC 和 PNC 服务将改善印度次大陆新生儿的健康状况，并降低新生儿死亡率。
