Distinct mortality patterns at 0-2 days versus the remaining neonatal period: results from population-based assessment in the Indian state of Bihar.

Publisher: BioMed Central Country of Publication: England NLM ID: 101190723 Publication Model: Electronic Cited Medium: Internet ISSN: 1741-7015 (Electronic) Linking ISSN: 17417015 NLM ISO Abbreviation: BMC Med Subsets: MEDLINE

Original Publication: [London] : BioMed Central, 2003-

Infant Mortality* ; Perinatal Death*; Live Birth/*epidemiology; Adolescent ; Adult ; Age Factors ; Autopsy ; Cause of Death ; Female ; Humans ; India/epidemiology ; Infant ; Infant, Newborn ; Infant, Newborn, Diseases/mortality ; Infant, Newborn, Diseases/pathology ; Logistic Models ; Male ; Middle Aged ; Pregnancy ; Premature Birth/diagnosis ; Premature Birth/mortality ; Premature Birth/pathology ; Risk Factors ; Surveys and Questionnaires ; Young Adult

Background: The objectives of this study were to understand the differences in mortality rate, risk factors for mortality, and cause of death distribution in three neonatal age sub-groups (0-2, 3-7, and 8-27 days) and assess the change in mortality rate with previous assessments to inform programmatic decision-making in the Indian state of Bihar, a large state with a high burden of newborn deaths.
Methods: Detailed interviews were conducted in a representative sample of 23,602 live births between January and December 2016 (96.2% participation) in Bihar state. We estimated the neonatal mortality rate (NMR) for the three age sub-groups and explored the association of these deaths with a variety of risk factors using a hierarchical logistic regression model approach. Verbal autopsies were conducted using the PHMRC questionnaire and the cause of death assigned using the SmartVA automated algorithm. Change in NMR from 2011 to 2016 was estimated by comparing it with a previous assessment.
Results: The NMR 0-2-day, 3-7-day, and 8-27-day mortality estimates in 2016 were 24.7 (95% CI 21.8-28.0), 13.2 (11.1 to 15.7), 5.8 (4.4 to 7.5), and 5.8 (4.5 to 7.5) per 1000 live births, respectively. A statistically significant reduction of 23.3% (95% CI 9.2% to 37.3) was seen in NMR from 2011 to 2016, driven by a reduction of 35.3% (95% CI 18.4% to 52.2) in 0-2-day mortality. In the final regression model, the highest odds for mortality in 0-2 days were related to the gestation period of ≤ 8 months (OR 16.5, 95% CI 11.9-22.9) followed by obstetric complications, no antiseptic cord care, and delivery at a private health facility or home. The 3-7- and 8-27-day mortality was driven by illness in the neonatal period (OR 10.33, 95% CI 6.31-16.90, and OR 4.88, 95% CI 3.13-7.61, respectively) and pregnancy with multiple foetuses (OR 5.15, 95% CI 2.39-11.10, and OR 11.77, 95% CI 6.43-21.53, respectively). Birth asphyxia (61.1%) and preterm delivery (22.1%) accounted for most of 0-2-day deaths; pneumonia (34.5%), preterm delivery (33.7%), and meningitis/sepsis (20.1%) accounted for the majority of 3-7-day deaths; meningitis/sepsis (30.6%), pneumonia (29.1%), and preterm delivery (26.2%) were the leading causes of death at 8-27 days.
Conclusions: To our knowledge, this is the first study to report a detailed neonatal epidemiology by age sub-groups for a major Indian state, which has highlighted the distinctly different mortality rate, risk factors, and causes of death at 0-2 days versus the rest of the neonatal period. Monitoring mortality at 0-2 and 3-7 days separately in the traditional early neonatal period of 0-7 days would enable more effective programming to reduce neonatal mortality.

PLoS One. 2015 Nov 23;10(11):e0143382. (PMID: 26599677)
BMC Pregnancy Childbirth. 2015 Feb 27;15:49. (PMID: 25884166)
Int J Epidemiol. 1997 Feb;26(1):224-7. (PMID: 9126524)
Lancet Glob Health. 2014 Sep;2(9):e521-e530. (PMID: 25304419)
BJOG. 2018 Aug;125(9):1145-1153. (PMID: 28029221)
PLoS One. 2014 May 01;9(5):e95704. (PMID: 24787692)
Bull World Health Organ. 2015 Jan 1;93(1):19-28. (PMID: 25558104)
Popul Health Metr. 2011 Aug 04;9:29. (PMID: 21816105)
Lancet. 2014 Aug 2;384(9941):438-54. (PMID: 24853600)
BMC Public Health. 2012 Jan 12;12:30. (PMID: 22240002)
PLoS One. 2017 Aug 24;12(8):e0183739. (PMID: 28837683)
BMC Med. 2015 Dec 08;13:291. (PMID: 26644140)
BMC Med. 2015 Dec 16;13:302. (PMID: 26670275)
BMC Med. 2019 Feb 7;17(1):28. (PMID: 30728016)
PLoS One. 2016 Aug 03;11(8):e0159793. (PMID: 27486745)
Am J Epidemiol. 2007 Mar 15;165(6):710-8. (PMID: 17182981)
Paediatr Int Child Health. 2015 Aug;35(3):174-86. (PMID: 26212573)
BMJ Open. 2017 Jan 25;7(1):e012436. (PMID: 28122828)
Lancet. 2012 Jun 9;379(9832):2162-72. (PMID: 22682464)
Lancet Glob Health. 2013 Dec;1(6):e328-30. (PMID: 25104592)
Lancet. 2007 Oct 13;370(9595):1358-69. (PMID: 17933651)
J Health Popul Nutr. 2009 Jun;27(3):332-8. (PMID: 19507748)
Lancet. 2017 Oct 28;390(10106):1972-1980. (PMID: 28939096)
J Perinatol. 2016 Dec;36(s3):S13-S17. (PMID: 27924109)
PLoS One. 2013 May 22;8(5):e64126. (PMID: 23717547)
Lancet. 2017 Sep 16;390(10100):1084-1150. (PMID: 28919115)
Midwifery. 2016 Mar;34:245-252. (PMID: 26628353)
Semin Perinatol. 2010 Dec;34(6):387-94. (PMID: 21094413)
BMC Pregnancy Childbirth. 2014 Oct 17;14:357. (PMID: 25326202)
BMC Pregnancy Childbirth. 2014 May 24;14:174. (PMID: 24885817)
BMC Health Serv Res. 2017 May 19;17(1):360. (PMID: 28526027)
Am J Obstet Gynecol. 2012 Feb;206(2):108-12. (PMID: 22118964)
Int J Equity Health. 2017 Mar 10;16(1):48. (PMID: 28283045)
PLoS One. 2014 May 08;9(5):e96773. (PMID: 24810416)
Lancet. 2014 Jul 12;384(9938):189-205. (PMID: 24853593)
BMC Pregnancy Childbirth. 2010 Feb 23;10 Suppl 1:S1. (PMID: 20233382)
Lancet. 2017 Dec 2;390(10111):2437-2460. (PMID: 29150201)
Lancet. 2005 Mar 12-18;365(9463):977-88. (PMID: 15767001)
BMC Health Serv Res. 2016 Jul 07;16:225. (PMID: 27387920)
Bull World Health Organ. 2010 Sep 1;88(9):658-666B. (PMID: 20865070)
J Trop Pediatr. 2005 Dec;51(6):366-76. (PMID: 15927948)
BMC Pregnancy Childbirth. 2017 Aug 23;17(1):266. (PMID: 28835213)
Lancet. 2011 Apr 30;377(9776):1523-38. (PMID: 21496906)
Popul Health Metr. 2011 Aug 04;9:35. (PMID: 21816098)
Paediatr Perinat Epidemiol. 2007 Sep;21 Suppl 2:86-96. (PMID: 17803622)
BMC Health Serv Res. 2018 Jan 25;18(1):40. (PMID: 29370798)
PLoS One. 2012;7(12):e49938. (PMID: 23236357)
Lancet. 2008 Jan 5;371(9606):75-84. (PMID: 18177778)

Keywords: Bihar; Birth asphyxia; Death; India; Meningitis; Neonatal mortality; Preterm; Risk factors; Sepsis; Verbal autopsy

Date Created: 20190720 Date Completed: 20200114 Latest Revision: 20200309

20240105

PMC6639919

10.1186/s12916-019-1372-z

31319860