TY - JOUR
T1 - Causes and age of neonatal death and associations with maternal and newborn care characteristics in Nepal
T2 - a verbal autopsy study
AU - Erchick, Daniel J.
AU - Lackner, Johanna B.
AU - Mullany, Luke C.
AU - Bhandari, Nitin N.
AU - Shedain, Purusotam R.
AU - Khanal, Sirjana
AU - Dhakwa, Jyoti R.
AU - Katz, Joanne
N1 - Funding Information:
This work was supported by the United States Agency for International Development (USAID).
Funding Information:
Thank you to Dr. Binod Man Shrestha and Dr. Bal Krishna Kalakheti for meticulously reviewing the neonatal verbal autopsy forms. We would also like to acknowledge the support provided by the Child Health Division, Ministry of Health and Population, Nepal; United States Agency for International Development; Save the Children, Saving Newborn Lives; H4L Nepalgunj; and One Heart World in Dolpa.
Publisher Copyright:
© 2022, The Author(s).
PY - 2022/12
Y1 - 2022/12
N2 - Background: In Nepal, neonatal mortality fell substantially between 2000 and 2018, decreasing 50% from 40 to 20 deaths per 1,000 live births. Nepal’s success has been attributed to a decreasing total fertility rate, improvements in female education, increases in coverage of skilled care at birth, and community-based child survival interventions. Methods: A verbal autopsy study, led by the Integrated Rural Health Development Training Centre (IRHDTC), conducted interviews for 338 neonatal deaths across six districts in Nepal between April 2012 and April 2013. We conducted a secondary analysis of verbal autopsy data to understand how cause and age of neonatal death are related to health behaviors, care seeking practices, and coverage of essential services in Nepal. Results: Sepsis was the leading cause of neonatal death (n=159/338, 47.0%), followed by birth asphyxia (n=56/338, 16.6%), preterm birth (n=45/338, 13.3%), and low birth weight (n=17/338, 5.0%). Neonatal deaths occurred primarily on the first day of life (27.2%) and between days 1 and 6 (64.8%) of life. Risk of death due birth asphyxia relative to sepsis was higher among mothers who were nulligravida, had <4 antenatal care visits, and had a multiple birth; risk of death due to prematurity relative to sepsis was lower for women who made ≥1 delivery preparation and higher for women with a multiple birth. Conclusions: Our findings suggest cause and age of death distributions typically associated with high mortality settings. Increased coverage of preventive antenatal care interventions and counseling are critically needed. Delays in care seeking for newborn illness and quality of care around the time of delivery and for sick newborns are important points of intervention with potential to reduce deaths, particularly for birth asphyxia and sepsis, which remain common in this population.
AB - Background: In Nepal, neonatal mortality fell substantially between 2000 and 2018, decreasing 50% from 40 to 20 deaths per 1,000 live births. Nepal’s success has been attributed to a decreasing total fertility rate, improvements in female education, increases in coverage of skilled care at birth, and community-based child survival interventions. Methods: A verbal autopsy study, led by the Integrated Rural Health Development Training Centre (IRHDTC), conducted interviews for 338 neonatal deaths across six districts in Nepal between April 2012 and April 2013. We conducted a secondary analysis of verbal autopsy data to understand how cause and age of neonatal death are related to health behaviors, care seeking practices, and coverage of essential services in Nepal. Results: Sepsis was the leading cause of neonatal death (n=159/338, 47.0%), followed by birth asphyxia (n=56/338, 16.6%), preterm birth (n=45/338, 13.3%), and low birth weight (n=17/338, 5.0%). Neonatal deaths occurred primarily on the first day of life (27.2%) and between days 1 and 6 (64.8%) of life. Risk of death due birth asphyxia relative to sepsis was higher among mothers who were nulligravida, had <4 antenatal care visits, and had a multiple birth; risk of death due to prematurity relative to sepsis was lower for women who made ≥1 delivery preparation and higher for women with a multiple birth. Conclusions: Our findings suggest cause and age of death distributions typically associated with high mortality settings. Increased coverage of preventive antenatal care interventions and counseling are critically needed. Delays in care seeking for newborn illness and quality of care around the time of delivery and for sick newborns are important points of intervention with potential to reduce deaths, particularly for birth asphyxia and sepsis, which remain common in this population.
KW - Mortality
KW - Neonatal
KW - Nepal
KW - Newborn
KW - Verbal autopsy
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UR - http://www.scopus.com/inward/citedby.url?scp=85122445395&partnerID=8YFLogxK
U2 - 10.1186/s13690-021-00771-5
DO - 10.1186/s13690-021-00771-5
M3 - Article
C2 - 35012655
AN - SCOPUS:85122445395
SN - 0778-7367
VL - 80
JO - Archives of Public Health
JF - Archives of Public Health
IS - 1
M1 - 26
ER -