mild preterm births (between 32 and 36 weeks) have been shown to increase the risk of infant mortality . Most of the decrease in early infant deaths that has occurred in developed countries has been due to weight-specific mor- tality rates . Several studies have shown that fetal losses and neonatal mortality can be reduced further, as high- lighted in a report  which concluded that in 20% of perinatal deaths at least one avoidable factor could be identified that might have altered the outcome. Others have also shown that factors such as maternal height, twin pregnancy, hypertension, antenatal care and ethnic back- ground can also influence the outcome [5-7]. This high- lighted a need for an analytical study of possible causes associated with stillbirths and neonatal deaths in LSLHA. Within LSLHA there were three hospital trusts delivering maternity care, each having its own maternity informa- tion system used mainly to provide routine data on provi- sion of services. There was interest from LSLHA and the three hospital trusts in using the routinely collected infor- mation to identify the risk factors associated with still- births and early neonatal deaths (ENND). The quality of the data collected by National Health Service (NHS) maternity units has been considered sub-optimal . Thus we were interested in ascertaining whether the infor- mation collected by the three NHS hospital trusts would allow us to carry out two case-control studies, one for still- births and another for ENND using data available for the 1996–1998 period. The expectation was that these analy- ses would shed some light on the relatively high fetal losses and ENND in LSLHA and also that it would provide clues for further improvement of the information systems in place.
Quality service provision through focused antenatal care is important in minimizing adverse pregnancy outcomes , especially if they can predict high risk deliveries. First: Our study recorded a 12.5% (n = 80) non-ANC booking. Quality ANC is essential in identification and management of infections such as malaria and syphilis, conditions like pregnancy induced hypertension and dia- betes which can result in adverse outcomes. A study by Guzha et al. , showed a high primipara booking of 94.1% and a reduced maternal mortality in the group. However, Dodzo and Mhloyi  showed that perceptions of poor services, and high costs at health facility result in community deliveries. Zimbabwe hospitals require facility specific efforts to ensure provision of quality services. Sec- ondly, of those that access ANC 36.25% had less than 4 visits while 51.25% had 4 or more visits. Focused ANC is a known strategy to improve maternity outcomes. The hos- pital should come up with strategies to improve focused ANC services. Lastly, high syphilis infection and HIV rates in our study needs monitoring. Mutare districts should ex- plore methods that improve booking rates and quality of care throughout the continuum of care to reduce high prevalence of stillbirths and early neonatal deaths. Quality focused ANC though not a factor in our study, if im- proved will indirectly impact adverse outcomes by im- proving early identification of complications, resulting in appropriate intervention (method of delivery) and post-partum care.
The independent risk factors associated with early neo- natal death observed in this study included some com- monly reported variables such as the absence of antenatal corticosteroid use , multiple gestation [14-17], male gender [14,15,18], five minute Apgar <7 [7,19,20], birth weight <1000 g [14,15,21] and gestational age <28 weeks [7,14,16,22,23]. The contribution of these variables to early neonatal deaths indicates that the biological characteristics related to the vulnerability of the preterm infant (birth weight, gestational age, gender and twinning) and vitality at birth (5 minute Apgar score <7), and characteristics reflecting the care of pregnant women in the peripartum period and the training of pediatric staff who attend the newborn in resuscitation and life support, are key deter- minants of the success of neonatal care in the first days of life. In the present study, the gestational age at which sur- vival beyond 6th day of life exceeded 50% was 26 weeks, indicating that it is necessary to invest in perinatal health in the analyzed region to rectify the inequality in viability for premature infants born in this area.
Doctor attendance at birth and during emergencies is im- portant and can help to ensure that the newborn survives beyond the first week of their life. There is a need to in- crease the availability of resuscitation equipment, train personnel in newborn care and develop and implement protocols and checklists to promote efficiencies in medical record information gathering and documentation. Accurate complete maternal and neonatal records are important for the delivery of care to both the mother and baby. Combin- ing maternal and neonatal records is one way of assisting clinical management and also providing data for research.
Results: Thirteen newborn deaths of infants born in health facilities participating in a community based, behavioral intervention were reported during February 2015–November 2016. Ten deaths (76.92%) were early neonatal deaths, two (15.38%) were late neonatal deaths, and one was a stillbirth. Five out of 13 deaths (38.46%) occurred within the first day of life. The largest single contributor to mortality was neonatal sepsis; six of 13 deaths (46.15%) were attrib- uted to some form of sepsis. Twenty-three percent of deaths were attributed to asphyxia. The study highlights the continuing need to improve quality of care and infection prevention and control, and to fully address causes of sepsis, in order to effectively reduce mortality in the newborn period.
In 2006, 65,810 births were notified to the NPRS, an increase of 6.5 per cent since 2005 and 8.1 per cent since 2002. The significant growth in births reflects the increase in singleton live births between 2005 and 2006 (reported at 59,621 and 63,555 respectively). In 2006 there were 308 stillbirths, giving a stillbirth rate of 4.7 per 1,000 live births and stillbirths in 2006. The stillbirth rate was slightly higher in previous years: 5.0 per 1,000 live births and stillbirths in 2005 and 5.6 per 1,000 live births and stillbirths in 2002. There were 152 early neonatal deaths resulting in an early neonatal death rate of 2.3 per 1,000 live births in 2006. This rate is the same as the rate per 1,000 live births in 2005, but lower than that reported in 2002 (2.8 per 1,000 live births) and still lower than that reported in earlier years. The perinatal mortality rate was 7.0 per 1,000 live births and stillbirths in 2006, a decrease of 0.2 per 1,000 from 2005. The 2006 perinatal mortality rate was also lower than that reported in 2002 (8.4 per 1,000 live births and stillbirths), and is at its lowest since this series of reports started in 1999. The average birthweight of babies born in 2006 was estimated at just over 3,473 grams, marginally higher than that reported in 2005. The average gestational age at delivery in 2006 of 39.4 weeks has remained fairly constant since 2002. Low birthweight babies (weighing less than 2,500 grams) accounted for 5.0 per cent of total births in 2006. The twinning rate for 2006 was 14.8 per 1,000 maternities, and comprised 958 sets of twin births, 17 sets of triplet births, and 1 set of quadruplet births.
152 Read more
Among the 41 PNDs, 26 were stillbirths and 15 were early neonatal deaths. In Arghakhanchi district hospital, within 10 months period (July 2012 to April 2013), there were 1,147 births, out of which 26 babies were SBs and 15 babies died within 7 days of birth (ENNDs). The perinatal mortality rate (PMR) of Arghakhanchi district hospital was 32.2 per 1,000 births and neonatal mortality rate (NMR) was 9.8 per 1,000 live births. Out of 41 perinatal deaths, 54% (22) were male and 46% (19) were female. Most of the perinatal deaths (46%) were between 37 to 42 weeks of gestation, shown in Figure 1. Most of the perinatal deaths (46%) were between 1500 to 2500 grams, depicted in Figure 2.
Early neonatal mortality as global concern (mother, family, society and medical personnel as well) it is of great importance that some health personnel get interested in order to understand the magnitude and the reasons to why this situation and prevent it whenever possible. It is worthy mentioning that problem is rarely investigated in our country (there are not many publications on the subject available in our country) and to our knowledge there is no study that has been conducted on the subject at Gitwe hospital.
16 Read more
Table 2 shows the possible maternal and neonatal deaths averted in both study sites. One hundred forty- six of the 460 pregnant volunteers (31.7%) had abnormal scans. There was a statistically significant difference in the number of abnormal scans between the urban Para- ñaque study site and the rural Tagum study site with the former having a higher prevalence of abnormal ultra- sound results (37.6% vs. 24.8%, p-value <0.01). The dis- tribution of abnormal scans included abnormal AFV (0.6%), twin pregnancy (1.3%), PIAs (3.7%) and fetal mal- presentation (26.7%). The most common fetal malpre- sentation was breech (24.1%) followed by transverse lie (2.6%). The total maternal and neonatal deaths possibly averted at the time of the scanning from both study sites were estimated to be 6.3% and 26.1%, respectively using the predetermined definition. Furthermore, higher per- centages of deaths possibly averted were observed in urban Parañaque compared to rural Tagum for both ma- ternal (8.8% vs. 3.4%, p-value = 0.02) and neonatal (30% vs. 21.4%, p -value = 0.02) deaths. At the time of delivery, 40% of the 111 breech presentations turned to cephalic which decreased the neonatal deaths possibly averted to approximately 14.6% (67/460).
Antibiotic resistance is now a global problem. Reports of multiresistant bacteria causing neonatal sepsis in developing countries are increasing, particularly in intensive care units. Studies show increasing resistance of organisms to commonly used antibiotics. Most Gram negative bacteria are now resistant to ampicillin and cloxacillin, and many are becoming resistant to gentamicin. However, reduced susceptibility to third generation cephalosporins and even to quinolones is emerging. In some countries, Staph aureus is the most common cause of neonatal sepsis and methicillin resistant strains (MRSA) are widespread. 5
Case studies revealed that some of the mothers per- ceived that their newborns were not provided with ade- quate care and attention by the health workers even in hospital. This finding highlights the third delay according to the three delay model . This is an alarming finding in Nepal where the newborn death is a major challenge  and care seeking is poor. Such perception of poor care in hospital may discourage mothers to seek treat- ment from hospitals . Such findings reiterate that those delays need to be the major focus while implement- ing any neonatal survival programs in Nepal. Addition- ally, providing complete information on the procedure that the newborns are getting in the intensive care unit and indoor care is essential. This approach requires a bet- ter communication skill of health care workers which the current medical education system is lacking.
Contributory factors to the common causes of death were analyzed. Analysis of asphyxial deaths revealed that delivery at level 1 care centre was associated with higher mortality (p <0.001 )compared to level 2 and 3 centres emphasizing the need to improve intrapartum monitoring and neonatal resuscitation skills in these centres. Higher birth weight and gestational age were associated with higher asphyxia deaths. (>2.5 kg -39 %,> 37wks- 37%).There was no significant association between mode of delivery and asphyxial death. Early Antenatal registration and regular antenatal visits (100%) did not reduce perinatal asphyxia . The mode of delivery did not show any significant relationship to asphyxial death .73% of asphyxia deaths occurred within 3 days suggesting severe intrauterine asphyxia in our study . So it is crucial to make sure that quality of care given during the intrapartum period is improved to decrease asphyxia deaths .
110 Read more
days of life (deaths within these windows of life are usually small and pooling of surveys becomes necessary). Information was collected from a combined number of 79,953 women aged 15-49 years old: 7,620 in 2003; 33,385 in 2008 and 38, 948 in 2013. Similarly, the combined number of live births for the three surveys is 244,836. In the 2013 survey there were 119,282 live births; in 2008 survey there were 101,977 live births and in 2003 there were 23,578 live births respectively. In this analysis, multiple pregnancies were included and live birth was restricted to the most recent within the five year- period before each survey. The organization, conduct, and other technical details in terms of sampling, questionnaire administration are described in the final reports of the each survey. Also, the ethical clearance for the conduct of these surveys were issued by the National Health Research Ethics Committee of the Federal Ministry of Health of Nigeria.
12 Read more
An intriguing question is why there were signiﬁcantly poorer outcomes among institutional deliverers than home deliverers, even after adjusting for obvious confounders. One obvious expla- nation is that this was a high-risk group for which we could not eliminate all con- founders. Equally it might be that subop- timal institutional care contributes to poorer outcomes. Our earlier study of asphyxia in Nepal revealed an increased risk of neonatal encephalopathy after births routinely induced with syntoci- non, 29 and a recent World Health Organi-
11 Read more
The questionnaire had four parts and explored both qualitative and quantitative variables. It was filled up in a face-to-face interview setting. The questionnaire was also translated into Urdu, which is the native language. The first part of the questionnaire inquired about the individual's personal information such as age, employment status, educational status, household income. The second part inquired regarding the individual's past and present obstetrics history such as the trimester of the pregnancy in which she currently presented, number of previous pregnancies and previous cases of miscarriages or intra- uterine deaths. The third part of the questionnaire assessed if the candidates could identify any one of the 12 neonatal danger signs as identified in literature: 12 Spontaneous
For all children aged 1 to 19 years, the first and second leading causes of death in 2004 were uninten- tional injuries and homicide, respectively. Unintentional injuries accounted for 44.0% of all deaths, and homicide accounted for 10.4%. The death rate for both of these leading causes did not change between 2003 and 2004. Among the 10 leading causes of death for this age group, the only death rate that decreased significantly between 2003 and 2004 was that for influenza and pneumonia (40%). A significant increase was registered only for suicide (18.2%). Table 9 provides detailed information on the 5 leading causes of death according to rank in 2004 as well as the number of deaths, the percent of deaths, and the age-specific death rate for each of the leading causes for 2003 and 2004. Although the rates for some causes increased or decreased in specific age groups, the overall patterns of these death rates did not change significantly from 2003 to 2004.
18 Read more
An equally important point is that we urge the global community to pay full attention to the fact that there are tremendous inequalities between better-off and worst-off countries in child mortality due to infectious diseases, even though mortality caused by these condi- tions is relatively easy to avoid with existing inter- ventions. The rates of pneumonia-specific neonatal mortality and diarrhea-specific post-neonatal mortality among children living in the lowest-income countries are still close to or above 100 times of that among those in the highest--income countries. The situation is even worse for tetanus, measles, and AIDS. Child deaths due to these causes are almost or totally zero in the highest- income countries, while they are still causing numerous deaths of children in the lowest-income countries. All in all, these facts clearly show that there is still much room for improvement in child health in infectious diseases. A silver lining is that we may be able to accelerate progress in child mortality reduction because these diseases can be tackled with existing interventions. This study sheds light on the global movement surrounding the Count- down to 2030 Initiative to increase essential health coverage, particularly in the 81 countries with highest burden of maternal and child deaths. The integrated Global Action Plan for Pneumonia and Diarrhea (GAPPD) initiative of the World Health Organization to avoid pneumonia- and diarrhea-specific child deaths needs to receive careful, ongoing attention around the globe .
13 Read more
The data also indicate that a multifac- eted approach beyond BMV is neces- sary to achieve the greatest impact of reducing early neonatal mortality. Thus premature and LBW infants did not require much resuscitation in the de- livery room suggesting that other po- tential factors may have contributed to death including temperature insta- bility, hypoglycemia, and unrecog- nized or unanticipated infection. In the hospital setting in this report, the initial management of the neonate was by family members and labor staff with no speci ﬁ c education in appropriate care and treatment of newborns. This raises the need for simple neonatal protocols to observe and manage the “ seemingly stable ” premature or LBW infant. The lack of basic monitoring equipment and blood tests in this population might have con- tributed to an underestimation of early infection as a causative factor of death.
Babies delivered before the 37 th completed week of gestation are known to be highly vulnerable as a result of the complications of immaturity and the low birth weight  Therefore, the risk of mortality and chances of survival of such babies have been shown to be indirectly related to gestational age and birth weight . A recent global epidemiological report (2016) suggested that neonatal mortality contributes up to 46% of under-five mortality, especially in the developing parts of the world . By extension, preterm births and the associated complications contributed 1 million under-five deaths in 2015. .
The NPRS seeks to compile an accurate, complete and up-to-date database on perinatal events over a specified time period. A key issue in addressing the quality of data collected by the NPRS is differences arising between the vital statistics tables compiled by the CSO and the NPRS data. Differences in data reported by these two systems for perinatal events may arise for a variety of reasons. One reason for differences is that information is not always obtained from the same sources. This is particularly evident in the data for cause of death as the CSO and the NPRS have to use different sources for the compilation of these data. The CSO does not obtain information on maternal diseases or conditions affecting the foetus or infant while the NPRS does not have access to coroner’s certificates relating to neonatal deaths. The CSO also uses a separate notification form, the medical certificate of a stillbirth (Form 103), for collecting information on late foetal deaths.
152 Read more