Stillbirth and neonatal mortality in Jordan: findings from Jordan stillbirths and neonatal deaths surveillance system.

BACKGROUND

Stillbirth and neonatal mortality declined significantly in high- and some middle-income countries since 2000 because of the significant improvements in obstetric and neonatal care. Yet, stillbirth and neonatal mortality rates remain high in many low- and middle-income countries. The main reason for low progress in reducing such stillbirths and neonatal deaths in Jordan is the scarcity of data on causes and contributing factors leading to these deaths. This study aimed to determine the rates, causes, and risk factors of stillbirth and neonatal mortality in Jordan.

METHODS

An electronic stillbirth and neonatal deaths surveillance system was established in five large hospitals in Jordan. Anonymized data on all births, stillbirths, neonatal deaths, and their causes during the period May 2019-December 2020 were exported from the system and analyzed.

RESULTS

A total of 29,592 women gave birth to 31,106 babies during a period of 20 months in the selected hospitals. The stillbirth rate was 10.5 per 1000 total births, the neonatal death rate was 14.2 per 1000 live births, and the perinatal death rate was 21.4 per 1000 total births. Of all neonatal deaths, 29.4% died within the first day of life and 77.8% died during the first week of life. For neonatal deaths that occurred pre-discharge, the leading causes of death were respiratory and cardiovascular disorders (35.0%), low birth weight and prematurity (32.7%), and congenital malformations, deformations, and chromosomal abnormalities (19.5%). Almost one third of stillbirths had an unspecified cause of death (33.3% of antepartum stillbirths and 28.9% of intrapartum stillbirths). Intrauterine hypoxia was responsible for 27.4% of antepartum stillbirths and 13.2% of intrapartum stillbirths. Congenital malformations, deformations, and chromosomal abnormalities contributed to 18.1% of antepartum stillbirths and 34.2% of intrapartum stillbirths.

CONCLUSIONS

Several identified maternal and/or fetal conditions that contributed to stillbirths and/or neonatal deaths in Jordan are preventable. Focused care needs to be directed to high-risk pregnant women and neonates with low birthweight and respiratory problems.