Academic journal article Bulletin of the World Health Organization

Risk Factors for Early Infant Mortality in Sarlahi District, Nepal

Academic journal article Bulletin of the World Health Organization

Risk Factors for Early Infant Mortality in Sarlahi District, Nepal

Article excerpt

Objectives Early infant mortality has not declined as rapidly as child mortality in many countries. Identification of risk factors for early infant mortality may help inform the design of intervention strategies.

Methods Over the period 1994-97, 15 469 live-born, singleton infants in rural Nepal were followed to 24 weeks of age to identify risk factors for mortality within 0-7 days, 8-28 days, and 4-24 weeks after the birth.

Findings In multivariate models, maternal and paternal education reduced mortality between 4 and 24 weeks only: odds ratios (OR) 0.28 (95% confidence interval (CI) = 0. 12-0.66) and 0.63 (95% CI = 0.44-0.88), respectively. Miscarriage in the previous pregnancy predicted mortality in the first week of life (OR =1.98, 95% CI = 1.37-2.87), whereas prior child deaths increased the risk of post-neonatal death (OR =1.85, 95% CI 1.24-2.75). A larger maternal mid-upper arm circumference reduced the risk of infant death during the first week of life (OR = 0.88, 95% CI = 0.81-0.95). Infants of women who did not receive any tetanus vaccinations during pregnancy or who had severe illness during the third trimester were more likely to die in the neonatal period. Maternal mortality was strongly associated with infant mortality (OR = 6.43, 95% CI = 2.35-17.56 at 0-7 days; OR =11.73, 95% CI = 3.82-36.00 at 8-28 days; and OR = 51.68, 95% CI = 20.26-131.80 at 4-24 weeks).

Conclusion Risk factors for early infant mortality varied with the age of the infant. Factors amenable to intervention included efforts aimed at maternal morbidity and mortality and increased arm circumference during pregnancy.

Keywords Infant mortality; Infant, Newborn; Risk factors; Socioeconomic factors; Age factors; Maternal mortality; Health status; Tetanus toxoid/pharmacology; Smoking/adverse effects; Alcohol drinking/adverse effects; Randomized controlled trials; Nepal (source: MeSH, NLM).

Mots cles Mortalite nourrisson; Nouveau-ne; Facteurs risque; Facteurs socio-economiques; Facteurs age; Mortalite maternelle; Etat sanitaire; Anatoxine tetanique/pharmacologie; Tabagisme/effets indesirables; Consommation alcool//effets indesirables; Essai clinique randomise; Nepal (source: MeSH, INSERM).

Palabras clave Mortalidad infantil; Recien nacido; Factores de riesgo; Factores socioeconomicos; Factores de edad; Mortalidad materna; Estado de salud; Toxoide tetanico/farmacologia; Tabaquismo/efectos adversos; Consumo de bebidas alcoholicas/efectos adversos; Ensayos controlados aleatorios; Nepal (fuente DeCS, BIREME).


Bulletin of the World Health Organization 2003;81:717-725

Voir page 723 le resume en francais En la pagina 723 figura un resumen En espanol.


Facteurs de risque de la mortalite infantile precoce dans le district de Sarlahi (Nepal)

Objectif Dans de nombreux pays, la mortalite infantile (enfants de moins de 1 an) precoce n'a pas baisse aussi rapidement que la mortalite juvenile (enfants de moins de 5 ans). L'identification des facteurs de risque de la mortalite infantile precoce aiderait a concevoir les strategies d'intervention necessaires.

Methodes Au cours de la periode 1994-1997, 15 469 naissances vivantes d'enfants uniques dans les zones rurales au Nepal ont fait l'objet d'un suivi pendant 24 semaines afin d'identifier les facteurs de risque de la mortalite entre 0 et 7 jours, 8 et 28 jours, et 4 et 24 semaines apres la naissance.

Resultats Les modeles multivaries ont revele que le niveau d'instruction de la mere et du pere reduisait la mortalite entre 4 et 24 semaines seulement : odds ratio (OR) = 0,28 (intervalle de confiance (IC) a 95% : 0,12-0,66) et OR = 0,63 (IC 95% : 0,44-0,88), respectivement. Des antecedents d'avortement spontane lors de la grossesse precedente etaient un facteur predictif de mortalite au cours de la premiere semaine de vie (OR = 1,98, IC 95 % : 1,37-2,87), tandis que le deces anterieur d'un enfant augmentait le risque de deces postneonatal (OR = 1,85, IC 95% : 1,24-2,75). …

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