SEARCHCOHORTepidemiology, public health

cohort·epidemiology, public health, pediatrics, obstetrics and gynecology, observational study·PMC10503364

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

BMJ Open · 10 authors, 4 centres

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TL;DR

Cox regression was used to assess associations between maternal characteristics, adverse birth outcomes, and neonatal mortality.

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Cox regression was used to assess associations between maternal characteristics, adverse birth outcomes, and neonatal mortality. The findings suggest interventions targeting the prevention of SGA and preterm births and care of high-risk infants may reduce neonatal mortality.

STUDY TYPE

cohort

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epidemiology

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AI pipeline

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ORIGINAL PAPER

PMC10503364

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

BMJ Open

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ABSTRACT

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

CITATION EXPORT

Tingting Yan, Luke C Mullany, Seema Subedi et al.. Risk factors for neonatal mortality: an observational cohort study in Sarlahi district of rural southern Nepal. BMJ Open. (2023). https://doi.org/10.1136/bmjopen-2022-066931

AUTHORS

10 · 4 CENTRES

Tingting Yan, Luke C Mullany, Seema Subedi, Elizabeth A Hazel, Subarna K Khatry, Diwakar Mohan, Scott Zeger, James M Tielsch, Steven C LeClerq, Joanne Katz

1Department of International Health, Johns Hopkins University Bloomberg School of Public Health, Baltimore, Maryland, USA
2Nepal Nutrition Intervention Project - Sarlahi (NNIPS), Nepal Eye Hospital Complex, Tripureshwor, Kathmandu, Nepal
3Department of Biostatistics, Johns Hopkins University Bloomberg School of Public Health, Baltimore, Maryland, USA
4Department of Global Health, George Washington University School of Public Health and Health Services, Washington, DC, USA