Bull World Health Organ. 2016 Oct 1;94(10):752-758B. Epub 2016 Aug 30.

Neonatal mortality within 24 hours of birth in six low- and lower-middle-income countries

Baqui AH¹, Mitra DK¹, Begum N¹, Hurt L², Soremekun S³, Edmond K⁴, Kirkwood B³, Bhandari N⁵, Taneja S⁵, Mazumder S⁵, Nisar MI⁶, Jehan F⁶, Ilyas M⁶, Ali M⁶, Ahmed I⁶, Ariff S⁶, Soofi SB⁶, Sazawal S¹, Dhingra U¹, Dutta A⁷, Ali SM⁸, Ame SM⁸, Semrau K⁹, Hamomba FM⁹, Grogan C⁹, Hamer DH¹⁰, Bahl R¹¹, Yoshida S¹¹, Manu A¹¹.

• ¹International Center for Maternal and Newborn Health, Johns Hopkins University, Baltimore, United States of America (USA).

• ²Division of Population Medicine, Cardiff University School of Medicine, Cardiff, Wales .
• ³Department of Population Health, London School of Hygiene and Tropical Medicine, London, England .
• ⁴School of Paediatrics and Child Health, University of Western Australia, Perth, Australia .
• ⁵Centre for Health Research and Development, Society for Applied Studies, New Delhi, India .
• ⁶Department of Paediatric and Child Health, The Aga Khan University, Karachi, Pakistan .
• ⁷Center for Public Health Kinetics, New Delhi, India .
• ⁸Public Health Laboratory Ivo de Carneri, Pemba, United Republic of Tanzania .
• ⁹BetterBirth Program, Ariadne Labs, Boston, USA .
• ¹⁰Center for Global Health and Development, Boston University, Boston, USA .
• ¹¹Department of Maternal, Newborn, Child and Adolescent Health, World Health Organization, avenue Appia 20, 1211 Geneva 27, Switzerland .

Abstract below; full text is at https://www.ncbi.nlm.nih.gov/pmc/articles/PMC5043199/

OBJECTIVE:

To estimate neonatal mortality, particularly within 24 hours of birth, in six low- and lower-middle-income countries.

METHODS:

We analysed epidemiological data on a total of 149 570 live births collected between 2007 and 2013 in six prospective randomized trials and a cohort study from predominantly rural areas of Bangladesh, Ghana, India, Pakistan, the United Republic of Tanzania and Zambia. The neonatal mortality rate and mortality within 24 hours of birth were estimated for all countries and mortality within 6 hours was estimated for four countries with available data. The findings were compared with published model-based estimates of neonatal mortality.

FINDINGS:

Overall, the neonatal mortality rate observed at study sites in the six countries was 30.5 per 1000 live births (range: 13.6 in Zambia to 47.4 in Pakistan). Mortality within 24 hours was 14.1 per 1000 live births overall (range: 5.1 in Zambia to 20.1 in India) and 46.3% of all neonatal deaths occurred within 24 hours (range: 36.2% in Pakistan to 65.5% in the United Republic of Tanzania). Mortality in the first 6 hours was 8.3 per 1000 live births, i.e. 31.9% of neonatal mortality.

CONCLUSION:

Neonatal mortality within 24 hours of birth in predominantly rural areas of six low- and lower-middle-income countries was higher than model-based estimates for these countries. A little under half of all neonatal deaths occurred within 24 hours of birth and around one third occurred within 6 hours. Implementation of high-quality, effective obstetric and early newborn care should be a priority in these settings.