Neonatal mortality risk of vulnerable newborns: A descriptive analysis of subnational, population-based birth cohorts for 238 143 live births in low- and middle-income settings from 2000 to 2017

Elizabeth A. Hazel, International Health Department, Johns Hopkins Bloomberg School of Public Health, Baltimore, Maryland, USA.
Daniel J. Erchick, International Health Department, Johns Hopkins Bloomberg School of Public Health, Baltimore, Maryland, USA.
Joanne Katz, International Health Department, Johns Hopkins Bloomberg School of Public Health, Baltimore, Maryland, USA.
Anne C. Lee, Pediatric Newborn Medicine, Brigham and Women's Hospital, Harvard Medical School, Boston, Massachusetts, USA.
Michael Diaz, International Health Department, Johns Hopkins Bloomberg School of Public Health, Baltimore, Maryland, USA.
Lee S. Wu, International Health Department, Johns Hopkins Bloomberg School of Public Health, Baltimore, Maryland, USA.
Keith P. West, Department of International Health, Center for Human Nutrition, Johns Hopkins Bloomberg School of Public Health, Baltimore, Maryland, USA.
Abu Ahmed Shamim, BRAC JP Grant School of Public Health, Dhaka, Bangladesh.
Parul Christian, Department of International Health, Center for Human Nutrition, Johns Hopkins Bloomberg School of Public Health, Baltimore, Maryland, USA.
Hasmot Ali, JiVitA Maternal and Child Health Research Project, Rangpur, Bangladesh.
Abdullah H. Baqui, Department of International Health, Johns Hopkins Bloomberg School of Public Health, Baltimore, Maryland, USA.
Samir K. Saha, Child Health Research Foundation, Dhaka, Bangladesh.
Salahuddin Ahmed, Projahnmo Research Foundation, Dhaka, Bangladesh.
Arunangshu Dutta Roy, Projahnmo Research Foundation, Dhaka, Bangladesh.
Mariângela F. Silveira, Post-Graduate Program in Epidemiology - Federal University of Pelotas, Pelotas, Brazil.
Romina Buffarini, Post-Graduate Program in Epidemiology - Federal University of Pelotas, Pelotas, Brazil.
Roger Shapiro, Harvard T.H. Chan School of Public Health, Boston, Massachusetts, USA.
Rebecca Zash, Beth Israel Deaconess Medical Center, Boston, Massachusetts, USA.
Patrick Kolsteren, Department of Food Technology, Safety and Health, Ghent University, Ghent, Belgium.
Carl Lachat, Department of Food Technology, Safety and Health, Ghent University, Ghent, Belgium.
Lieven Huybregts, Department of Food Technology, Safety and Health, Ghent University, Ghent, Belgium.
Dominique Roberfroid, Namur University, Namur, Belgium.
Zhonghai Zhu, Department of Epidemiology and Biostatistics, School of Public Health, Xi'an Jiaotong University Health Science Centre, Xi'an, China.
Lingxia Zeng, Department of Epidemiology and Biostatistics, School of Public Health, Xi'an Jiaotong University Health Science Centre, Xi'an, China.
Seifu H. Gebreyesus, Department of Nutrition and Dietetics, School of Public Health, Addis Ababa University, Addis Ababa, Ethiopia.
Kokeb Tesfamariam, Department of Food Technology, Safety, and Health, Faculty of Bioscience Engineering, Ghent University, Ghent, Belgium.
Seth Adu-Afarwuah, Department of Nutrition and Food Science, University of Ghana, Accra, Ghana.
Kathryn G. Dewey, Department of Nutrition, Institute for Global Nutrition, University of California, Davis, California, USA.
Stephaney Gyaase, Kintampo Health Research Centre, Kintampo, Ghana.
Kwaku Poku-Asante, Kintampo Health Research Centre, Kintampo, Ghana.
Ellen Boamah Kaali, Kintampo Health Research Centre, Kintampo, Ghana.
Darby Jack, Columbia University's Mailman School of Public Health, New York, New York, USA.

Document Type

Journal Article

Publication Date

5-8-2023

Journal

BJOG : an international journal of obstetrics and gynaecology

DOI

10.1111/1471-0528.17518

Keywords

low-and middle-income countries, obstetrics and gynaecology; paediatrics: neonatal; preterm; small-for-gestational age

Abstract

OBJECTIVE: We aimed to understand the mortality risks of vulnerable newborns (defined as preterm and/or born weighing smaller or larger compared to a standard population), in low- and middle-income countries (LMICs). DESIGN: Descriptive multi-country, secondary analysis of individual-level study data of babies born since 2000. SETTING: Sixteen subnational, population-based studies from nine LMICs in sub-Saharan Africa, Southern and Eastern Asia, and Latin America. POPULATION: Live birth neonates. METHODS: We categorically defined five vulnerable newborn types based on size (large- or appropriate- or small-for-gestational age [LGA, AGA, SGA]), and term (T) and preterm (PT): T + LGA, T + SGA, PT + LGA, PT + AGA, and PT + SGA, with T + AGA (reference). A 10-type definition included low birthweight (LBW) and non-LBW, and a four-type definition collapsed AGA/LGA into one category. We performed imputation for missing birthweights in 13 of the studies. MAIN OUTCOME MEASURES: Median and interquartile ranges by study for the prevalence, mortality rates and relative mortality risks for the four, six and ten type classification. RESULTS: There were 238 143 live births with known neonatal status. Four of the six types had higher mortality risk: T + SGA (median relative risk [RR] 2.8, interquartile range [IQR] 2.0-3.2), PT + LGA (median RR 7.3, IQR 2.3-10.4), PT + AGA (median RR 6.0, IQR 4.4-13.2) and PT + SGA (median RR 10.4, IQR 8.6-13.9). T + SGA, PT + LGA and PT + AGA babies who were LBW, had higher risk compared with non-LBW babies. CONCLUSIONS: Small and/or preterm babies in LIMCs have a considerably increased mortality risk compared with babies born at term and larger. This classification system may advance the understanding of the social determinants and biomedical risk factors along with improved treatment that is critical for newborn health.

Department

Global Health

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