Academic journal article Bulletin of the World Health Organization

Neonatal Mortality, Risk Factors and Causes: A Prospective Population-Based Cohort Study in Urban Pakistan/La Mortalite Neonatale, Ses Facteurs De Risque et Ses Causes: Etude De Cohorte Prospective En Population Dans Une Zone Rurale Du Pakistan/Mortalidad Neonatal, Factores De Riesgo Y Causas: Estudio De Cohortes Prospectivo Basado En la Poblacion En El Pakistan Urbano

Academic journal article Bulletin of the World Health Organization

Neonatal Mortality, Risk Factors and Causes: A Prospective Population-Based Cohort Study in Urban Pakistan/La Mortalite Neonatale, Ses Facteurs De Risque et Ses Causes: Etude De Cohorte Prospective En Population Dans Une Zone Rurale Du Pakistan/Mortalidad Neonatal, Factores De Riesgo Y Causas: Estudio De Cohortes Prospectivo Basado En la Poblacion En El Pakistan Urbano

Article excerpt

Introduction

Of the estimated 130 million infants born each year worldwide, (1,4) million die in the first 28 days of life. Three-quarters of neonatal deaths occur in the first week, and more than one-quarter occur in the first 24 hours. (1,2) Neonatal deaths account for 40% of deaths under the age of 5 years worldwide. Therefore, efforts to achieve the UN Millennium Development Goal 4 of reducing childhood mortality by two-thirds by 2015 are focused on reducing neonatal deaths in high-mortality countries.

Two-thirds of the world's neonatal deaths occur in just 10 countries, mostly in Asia. Pakistan is number three among these countries. With an estimated 298 000 neonatal deaths annually and a reported neonatal mortality rate of 49 per 1000 live births, Pakistan accounts for 7% of global neonatal deaths. (1-5) Infection (36%), preterm birth (28%) and birth asphyxia (23%) account for 87% of neonatal deaths worldwide. (1,2,6) Since causes of neonatal death vary by country and with the availability and quality of health care, understanding neonatal mortality in relation to these factors is crucial. (2,7-10) Data available on neonatal deaths in Pakistan come primarily from hospital studies, which have a selective referral bias, or from communities in which the cause of death is rarely recorded. Information on pregnancy complications and other events before delivery is limited. (4,5,11)

Given the paucity of reliable population-based information in Pakistan, this study was undertaken to examine the prevalence, sex distribution, timing and causes of neonatal death in a population-based pregnancy cohort in urban Pakistan. We hypothesized that the neonatal mortality rate in this urban population, with relatively good access to obstetric care and Caesarean section, would be substantially lower than that generally reported for Pakistan. This study therefore examines delivery outcomes in pregnant women with reasonably good access to professional health care who were enrolled at 20 to 26 weeks' gestation and followed with their infants to 28 days postpartum.

Methods

This prospective population-based study was conducted from September 2003 to August 2005 in four of 12 administrative units in the town of Latifabad, Hyderabad, Pakistan. These four units covered an area with a low-to-middle income population of about 90 000 individuals, or about 9000 households. Permanent residents who planned to give birth in the catchment area were screened by lady health workers (LHWs) of the Pakistan Ministry of Health. These LHWs are female community residents who have had eight or more years of education and 15 months of government training. They provide basic maternal care, including child health services, and maintain logs of all pregnancies and birth outcomes among their assigned households. In the four study units, approximately 90 LHWs were trained in the research protocols, study recruitment, communication skills and confidentiality. Study nurses supervised the LHWs in the required fieldwork. We therefore believe that our study team was aware of nearly every pregnancy in the catchment area.

During their routine home visits, LHWs provided study information to pregnant women who were screened as eligible for the study. Women were eligible ifthey were aged 16 years or more, did not have a serious medical condition, planned to deliver in the catchment area and were at 20-26 weeks' gestation at enrolment. Women who indicated interest were scheduled for an appointment at the research clinic closest to their home. At the research clinic visit, gestational age was determined by ultrasound to confirm eligibility, and a physical examination and anthropometric measurements were performed.

Various demographic and health data and routine antenatal laboratory test results were collected on pretested study forms by trained female research staff, which included two doctors, one dentist, two health visitors and one midwife. …

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