Risk factors for neonatal mortality: an observational cohort study in Sarlahi district of rural southern Nepal

Authors

Tingting Yan, Department of International Health, Johns Hopkins University Bloomberg School of Public Health, Baltimore, Maryland, USA.
Luke C. Mullany, Department of International Health, Johns Hopkins University Bloomberg School of Public Health, Baltimore, Maryland, USA.
Seema Subedi, Department of International Health, Johns Hopkins University Bloomberg School of Public Health, Baltimore, Maryland, USA.
Elizabeth A. Hazel, Department of International Health, Johns Hopkins University Bloomberg School of Public Health, Baltimore, Maryland, USA.
Subarna K. Khatry, Department of International Health, Johns Hopkins University Bloomberg School of Public Health, Baltimore, Maryland, USA.
Diwakar Mohan, Department of International Health, Johns Hopkins University Bloomberg School of Public Health, Baltimore, Maryland, USA.
Scott Zeger, Department of Biostatistics, Johns Hopkins University Bloomberg School of Public Health, Baltimore, Maryland, USA.
James M. Tielsch, Department of Global Health, George Washington University School of Public Health and Health Services, Washington, DC, USA.
Steven C. LeClerq, Department of International Health, Johns Hopkins University Bloomberg School of Public Health, Baltimore, Maryland, USA.
Joanne Katz, Department of International Health, Johns Hopkins University Bloomberg School of Public Health, Baltimore, Maryland, USA jkatz1@jhu.edu.

Document Type

Journal Article

Publication Date

9-14-2023

Journal

BMJ open

Volume

13

Issue

9

DOI

10.1136/bmjopen-2022-066931

Keywords

Epidemiology; Factor Analysis, Statistical; NEONATOLOGY; Primary Prevention; Public health; Risk Factors

Abstract

OBJECTIVES: To assess the association between maternal characteristics, adverse birth outcomes (small-for-gestational-age (SGA) and/or preterm) and neonatal mortality in rural Nepal. DESIGN: This is a secondary observational analysis to identify risk factors for neonatal mortality, using data from a randomised trial to assess the impact of newborn massage with different oils on neonatal mortality in Sarlahi district, Nepal. SETTING: Rural Sarlahi district, Nepal. PARTICIPANTS: 40 119 pregnant women enrolled from 9 September 2010 to 16 January 2017. MAIN OUTCOME: The outcome variable is neonatal death. Cox regression was used to estimate adjusted Hazard Ratios (aHRs) to assess the association between adverse birth outcomes and neonatal mortality. RESULTS: There were 32 004 live births and 998 neonatal deaths. SGA and/or preterm birth was strongly associated with increased neonatal mortality: SGA and preterm (aHR: 7.09, 95% CI: (4.44 to 11.31)), SGA and term/post-term (aHR: 2.12, 95% CI: (1.58 to 2.86)), appropriate-for-gestational-age/large-for-gestational-age and preterm (aHR: 3.23, 95% CI: (2.30 to 4.54)). Neonatal mortality was increased with a history of prior child deaths (aHR: 1.53, 95% CI: (1.24 to 1.87)), being a twin or triplet (aHR: 5.64, 95% CI: (4.25 to 7.48)), births at health posts/clinics or in hospital (aHR: 1.34, 95% CI: (1.13 to 1.58)) and on the way to facilities or outdoors (aHR: 2.26, 95% CI: (1.57 to 3.26)). Risk was lower with increasing maternal height from <145 cm to 145-150 cm (aHR: 0.78, 95% CI: (0.65 to 0.94)) to ≥150 cm (aHR: 0.57, 95% CI: (0.47 to 0.68)), four or more antenatal care (ANC) visits (aHR: 0.67, 95% CI: (0.53 to 0.86)) and education >5 years (aHR: 0.75, 95% CI: (0.62 to 0.92)). CONCLUSION: SGA and/or preterm birth are strongly associated with increased neonatal mortality. To reduce neonatal mortality, interventions that prevent SGA and preterm births by promoting ANC and facility delivery, and care of high-risk infants after birth should be tested. TRIAL REGISTRATION NUMBER: NCT01177111.

APA Citation

Yan, Tingting; Mullany, Luke C.; Subedi, Seema; Hazel, Elizabeth A.; Khatry, Subarna K.; Mohan, Diwakar; Zeger, Scott; Tielsch, James M.; LeClerq, Steven C.; and Katz, Joanne, "Risk factors for neonatal mortality: an observational cohort study in Sarlahi district of rural southern Nepal" (2023). GW Authored Works. Paper 3406.
https://hsrc.himmelfarb.gwu.edu/gwhpubs/3406

Department

Global Health