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Multicenter Study
. 2016 Aug 2;16(1):202.
doi: 10.1186/s12884-016-0994-9.

Survival of neonates and predictors of their mortality in Tigray region, Northern Ethiopia: prospective cohort study

Hayelom Gebrekirstos Mengesha  1   2 , Alem Desta Wuneh  3 , Wondwossen Terefe Lerebo  3 , Tesfay Hailu Tekle  3
Affiliations
Multicenter Study

Survival of neonates and predictors of their mortality in Tigray region, Northern Ethiopia: prospective cohort study

Hayelom Gebrekirstos Mengesha et al. BMC Pregnancy Childbirth. .

Abstract

Background: Neonatal mortality accounts for an estimated 2.8 million deaths worldwide, which constitutes 44 % of under-5-mortality and 60 % of infant mortality. Neonatal mortality predictors vary by country with the availability and quality of health care. Therefore, aim of this study was to estimate survival time and identify predictors of neonatal mortality in Tigray region, northern Ethiopia.

Method: A prospective cohort study design was carried out among a cohort of neonates delivered in seven hospitals of Tigray from April to July, 2014 and followed up for a total of 28 days. Data were collected by interviewing mothers using structured questionnaires and assessments of the neonate and mothers by midwives. Kaplan-Meier, Log rank test and Cox-proportional hazard regressions were used. STATA V-11 program was used for data entry, cleaning and analysis.

Results: From 1152 neonates, 68 died (neonatal mortality rate 62.5/1000 live births), 73.52 % of the neonates died within 7 days, 60 were lost to follow-up and the percentage of survival at 28 days was 93.96 % (95 % CI: 92.4, 95.2 %). Predictors of neonatal mortality were: normal birth weight (AHR: 0.45, 95 % CI: 0.24, 0.84), not initiating exclusive breastfeeding (AHR: 7.5, 95 % CI: 3.77, 15.05), neonatal complications (AHR: 0.14, 95 % CI 0.07, 0.29), maternal complications (AHR: 0.37, 95 % CI: 0.22, 0.63) and proximity (AHR: 2.5, 95 % CI: 1.29, 4.91).

Conclusion: Neonatal mortality is unacceptably very high. Managing complications and low birth weight, initiating exclusive breast feeding, improving quality of services and ensuring a continuum of care are recommended to increase survival of neonates.

Keywords: Ethiopia; Neonatal mortality; Survival analysis; Tigray region.

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Figures

Fig. 1
Fig. 1
Flow diagram of the overall recruitment and follow up process of mothers and neonates in Tigray region, northern Ethiopia, April–July, 2014. In this figure Health extension worker (HEW) means a female completed 10th grade education and received one year training in providing prevention services including breastfeeding, safe and clean delivery, basic antenatal and post-neonatal care. The topics include immunization, family planning, and management of childhood illnesses. The HEWs serves communities in which they reside
Fig. 2
Fig. 2
Summary of Kaplan Meir survival estimate on the survival time of neonates born in Tigray region, northern Ethiopia, April–July, 2014 (n = 1152). The graph shows the proportion of neonates who survived during the follow up time (birth, 7, 14, 21 and 28 days). Accordingly, as can be seen from the graph; during the first seven days the graph went down gradually which shows a higher proportion of neonates were dying and there was a lower probability of survival. While, over the next 7 days (7 and 14), the proportion of neonates survived has slightly increased and the graph fell down slowly up to the third follow up time (21 day). In the last follow up period the graph became straight which indicates the proportion of neonates survived remained stable indicating virtually no deaths
Fig. 3
Fig. 3
Cox-Snell residual Nelson -Alen cumulative hazard graph on neonates born in Tigray region, Northern Ethiopia, April -July 2014. This figure shows if the Cox regression model fits the data, these residuals should have a standard censored exponential distribution with hazard ratio. The hazard function follows the 45° line very closely
See this image and copyright information in PMC

References

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