Academic journal article Bulletin of the World Health Organization

Neonatal Mortality of Low-Birth-Weight Infants in Bangladesh

Academic journal article Bulletin of the World Health Organization

Neonatal Mortality of Low-Birth-Weight Infants in Bangladesh

Article excerpt

Voir page 613 le resurme en francais. En la pagina 613 figura un resumen en espanol.

Introduction

Perinatal and neonatal mortality are increasingly important public health issues in many developing countries, as postneonatal mortality rates fall (1). In Bangladesh, for example, the infant mortality rate appears to have fallen this century from over 200 deaths per thousand live births to approximately 80 deaths per thousand live births (2-4). By contrast, neonatal deaths now account for about two-thirds of the 8 million infant deaths that occur globally each year (5), and the neonatal mortality rate (NMR) in Bangladesh was recently estimated to be 65 deaths per thousand live births (6). However, the NMRs can differ by rural, urban and other locations (2, 7), even within large demographic surveys (8).

Low birth weight (LBW) is defined as a birth weight of less than 2500 g and is a well-documented risk factor for neonatal mortality (9, 10). In Bangladesh, for example, the LBW prevalence varies between 23% and 60% (11-13) and this has presumptive effects on stillbirth and neonatal death rates. Despite the apparent importance of LBW as an indicator, there have been few prospective studies of outcome for LBW infants in developing countries, largely because of the difficulties inherent in community-based data collection. The definition of LBW also fails to distinguish between LBW neonates who are premature and those who are merely small for their gestational age. As a result, there is a lack of information about infant mortality in the first four weeks of life, and this has hindered the development of appropriate neonatal interventions. In this paper we report the findings of a prospective cohort study of LBW infants in Dhaka, Bangladesh, and have modelled the effects of essential newborn care.

Materials and methods

Study area

Bangladesh has a population of 126 million and a growth rate of 2.0%. Per capita income is US$ 370 per annum. The literacy rate is 63% for men and 48% for women. The average household size is 5.6 people and 16% of households do not own land (3). Up to 90% of women in Bangladesh marry by 18 years of age and most conceive in their teens (14). Health care for mothers and children is minimal: community-based support during pregnancy is available from family welfare assistants, but the responsibilities of the assistants are often unfeasibly broad. For example, they bear the burden of referring the estimated 600 000 high-risk pregnancies in visitors to family welfare centres each year.

The study cohort was recruited via the maternity service at Mitford Hospital, a government-run centre which hosts about 4000 deliveries per year. Although services are free in principle, attendance involves both explicit and implicit costs (15). The hospital is adjacent to the Buriganga river in the old part of Dhaka and draws clients from urban, suburban and rural areas. Seventy-five per cent of service users are classified as living in poverty. The high uptake of services at the hospital is probably explained by the low cost of the services and by the difficulties of delivering home services in the nearby congested slums. After presentation at the hospital, the majority of births take place within two days. The subsequent hospital stay is usually six hours, unless the mother or infant experiences problems. It is recommended that mothers stay in hospital for 10 days after caesarean section, or for as long as infants require specialized care. Specialized care is provided in a neonatal unit in the form of incubator care, antimicrobials and nasogastric or intravenous hydration. Hospital records suggest an LBW prevalence of 30%, and there is usually more than one infant per incubator.

Study design

The cohort of infants was recruited at the time of birth in the hospital and consisted solely of LBW infants, who were to be followed up at home. The objective was to quantify mortality in this high-risk population over the course of the first month of extrauterine life. …

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