Saito Akiko, Kondo Masahide
Department of Health Care Policy and Health Economics, Institute of Medicine, University of Tsukuba, 1-1-1 Tennodai, Tsukuba, Ibaraki, 3058577, Japan.
Trop Med Health. 2024 Nov 26;52(1):87. doi: 10.1186/s41182-024-00658-5.
Neonatal mortality has decreased in Angola; however, it remains high. Quality maternal and child health (MCH) care is key to improving neonatal survival. In Angola, however, the association between neonatal mortality and MCH care has not yet been investigated. Therefore, this study aimed to identify the association between neonatal mortality and MCH services in Angola.
We used the Angola Demographic Health Survey 2015-16, which is the latest nationally representative dataset of Angola. The associations between early/late neonatal death and MCH care utilization were identified by a multivariable logistic regression analysis, adjusted by the sex of the child, type of residence, wealth index, caesarian section, size of the child at birth and delivery assisted by skilled birth attendant. The individual sample weight, sample strata for sampling errors/design, and cluster number were incorporated in a descriptive and logistic regression analysis to account for the unequal probability sampling in different strata.
The early and late neonatal mortality rates were 22 and 2 per 1000 live births, respectively. We found that having none, one, two or three tetanus injections before the last pregnancy compared to five or more injections, and no postnatal health check for children before discharge were associated with the occurrence of late neonatal death. During the first 2 days after childbirth, no observation of breastfeeding, no counseling on breastfeeding, no counseling on newborn danger signs, no measurement of child body temperature, and no examination of the cord as well as not checking child health before discharge were associated with early neonatal death.
Doses of maternal tetanus vaccination and postnatal child health check before discharge were modifiable factors associated to late neonatal death. Further studies to improve MCH care coverage are needed.
安哥拉的新生儿死亡率已有所下降；然而，该死亡率仍居高不下。优质的母婴健康（MCH）护理是提高新生儿存活率的关键。然而，在安哥拉，新生儿死亡率与母婴健康护理之间的关联尚未得到研究。因此，本研究旨在确定安哥拉新生儿死亡率与母婴健康服务之间的关联。
我们使用了《2015 - 2016年安哥拉人口与健康调查》，这是安哥拉最新的具有全国代表性的数据集。通过多变量逻辑回归分析确定早期/晚期新生儿死亡与母婴健康护理利用之间的关联，并根据儿童性别、居住类型、财富指数、剖宫产、出生时儿童大小以及由熟练助产士协助分娩等因素进行调整。在描述性和逻辑回归分析中纳入了个体样本权重、用于抽样误差/设计的样本分层以及聚类数量，以考虑不同分层中不等概率抽样的情况。
早期和晚期新生儿死亡率分别为每1000例活产22例和2例。我们发现，与五次或更多次注射相比，在最后一次怀孕前未进行破伤风注射、进行一次、两次或三次破伤风注射，以及儿童出院前未进行产后健康检查与晚期新生儿死亡的发生有关。在分娩后的头两天，未观察母乳喂养情况、未提供母乳喂养咨询、未提供新生儿危险信号咨询、未测量儿童体温、未检查脐带以及出院前未检查儿童健康状况与早期新生儿死亡有关。
产妇破伤风疫苗接种剂量和出院前产后儿童健康检查是与晚期新生儿死亡相关的可改变因素。需要进一步开展研究以提高母婴健康护理的覆盖率。
