Pokhrel Khem Narayan, Khatri Resham, Sapkota Suman, Pokhrel Kalpana Gaulee, Pradhan Gauri, Thapa Tulsi Ram, Chapain Kamal Prasad, Pullum Thomas, Greenwell Fern
Development and Research Service International Nepal, Kathmandu, Nepal.
School of Public Health, University of Queensland, Brisbane, Queensland, Australia.
PLoS One. 2025 Aug 22;20(8):e0330734. doi: 10.1371/journal.pone.0330734. eCollection 2025.
Nepal has made significant progress in reducing the Neonatal Mortality Rate (NMR) over the past two decades. However, since 2016, NMR has stagnated at 21 deaths per 1,000 live births, indicating stalled improvements in neonatal survival. Past studies highlighted the disparities, with socioeconomically disadvantaged groups experiencing a higher rate of neonatal deaths. However, limited evidence exists on NMR trends and determinants in Nepal that examined the factors with the trend. This study analyzed NMR trends and key determinants using data from the two most recent Nepal Demographic and Health Surveys (NDHS).
NDHS 2016 and NDHS 2022 data were used to calculate NMR. Both surveys received ethical approval from the Nepal Health Research Council. The study included 106 neonatal deaths out of 5,087 live births in 2016 and 105 out of 5,192 in 2022. Independent variables included household characteristics, parental factors, pregnancy-related factors, maternal and newborn care, women's empowerment, and health system factors. NMRs were constructed using births within completed months from 1 to 61. A general linear model assessed NMR trends, while logit regression identified key determinants.
While national NMR remained unchanged since 2016, an increasing trend was observed among disadvantaged groups and mothers who did not utilize maternal/newborn health services. NMR rose from 27.3 to 27.8 per 1,000 live births (p = 0.001) among poor and poorest households. Similarly, women with no education experienced higher NMR at 29.3% in 2022 compared to 25.7% in 2016 (p = 0.002). Maithili-speaking mothers had higher NMR (27.4 in 2022 vs. 23.4 in 2016, p < 0.001). Women lacking decision-making power in healthcare had higher NMRs of 25.9 in 2022 vs. 23.4 in 2016 (p = 0.021). Women who were not assisted by skilled birth attendants (SBA). had significantly higher NMR compared to those, who were assisted by SBA (p = 0.010).
Targeted health system interventions are needed for disadvantaged groups covering those who had low education, from poor households, low health care decision making and lack access to SBA assisted delivery. While determinants have been explored, further targeted studies are warranted to uncover the causes of neonatal deaths in Nepal.
在过去二十年里，尼泊尔在降低新生儿死亡率（NMR）方面取得了重大进展。然而，自2016年以来，新生儿死亡率一直停滞在每1000例活产中有21例死亡，这表明新生儿存活率的改善陷入停滞。过去的研究强调了差异，社会经济弱势群体的新生儿死亡率较高。然而，关于尼泊尔新生儿死亡率趋势及其决定因素的研究证据有限，这些研究未探讨影响趋势的因素。本研究利用尼泊尔最近两次人口与健康调查（NDHS）的数据，分析了新生儿死亡率趋势及其关键决定因素。
使用2016年和2022年的尼泊尔人口与健康调查数据来计算新生儿死亡率。两项调查均获得了尼泊尔卫生研究委员会的伦理批准。该研究包括2016年5087例活产中的106例新生儿死亡和2022年5192例活产中的105例。自变量包括家庭特征、父母因素、与怀孕相关的因素、孕产妇和新生儿护理、妇女赋权以及卫生系统因素。新生儿死亡率是根据1至61个完整月内的出生情况构建的。采用一般线性模型评估新生儿死亡率趋势，同时使用逻辑回归确定关键决定因素。
自2016年以来，全国新生儿死亡率保持不变，但弱势群体和未使用孕产妇/新生儿保健服务的母亲中呈现出上升趋势。贫困和最贫困家庭的新生儿死亡率从每1000例活产中的27.3例上升至27.8例（p = 0.001）。同样，未受过教育的妇女的新生儿死亡率在2022年为29.3%，高于2016年的25.7%（p = 0.002）。说迈蒂利语的母亲的新生儿死亡率更高（2022年为27.4，2016年为23.4，p < 0.001）。在医疗保健方面缺乏决策权的妇女的新生儿死亡率在2022年为25.9，高于2016年的23.4（p = 0.021）。未得到熟练助产士（SBA）协助的妇女的新生儿死亡率显著高于得到熟练助产士协助的妇女（p = 0.010）。
需要针对弱势群体开展有针对性的卫生系统干预措施，这些群体包括教育程度低、来自贫困家庭、医疗保健决策能力低且无法获得熟练助产士协助分娩的人群。虽然已经探讨了决定因素，但仍有必要开展进一步的针对性研究，以揭示尼泊尔新生儿死亡的原因。
