Determinants of early neonatal mortality in Afghanistan: an analysis of the Demographic and Health Survey 2015

Abstract

Background: Neonatal mortality is declining slowly compared to under-five mortality in many developing countries including Afghanistan. About three-fourths of these deaths occur in the early neonatal period (i.e., the first week of life). Although a number of studies investigated determinants of early neonatal mortality in other countries, there is a lack of evidence regarding this in Afghanistan. This study investigated determinants of early neonatal mortality in Afghanistan.

Methods: Data from the Afghanistan Demographic and Health Survey 2015 (AfDHS 2015) were analyzed. After reporting the weighted frequency distributions of selected factors, a multilevel logistic regression model revealed adjusted associations of factors with early neonatal mortality.

Results: A total of 19,801 weighted live-births were included in our analysis; 266 (1.4%) of the newborns died in this period. Multivariable analysis found that multiple gestations (adjusted odds ratio (AOR): 9.3; 95% confidence interval (CI): 5.7-15.0), larger (AOR: 2.9; 95% CI: 2.2-3.8) and smaller (AOR: 1.8; 95% CI: 1.2-2.6) than average birth size, maternal age ≤ 18 years (AOR: 1.8; 95% CI: 1.1-3.2) and ≥ 35 years (AOR: 1.7; 95% CI: 1.3-2.3), and birth interval of < 2 years (AOR: 2.6; 95% CI: 1.4-4.9) had higher odds of early neonatal mortality. On the other hand, antenatal care by a skilled provider (AOR: 0.7; 95% CI: 0.5-0.9), facility delivery (AOR: 0.7; 955 CI: 0.5-0.9), paternal higher education level (AOR: 0.7; 95% CI: 0.5-1.0), living in north-western (AOR: 0.3; 95% CI: 0.1-0.6), central-western regions (AOR: 0.5; 95% CI: 0.3-0.9) and in a community with higher maternal education level (AOR: 0.4; 95% CI: 0.2-0.9) had negative association.

Conclusions: Several individual, maternal and community level factors influence early neonatal deaths in Afghanistan; significance of the elements of multiple levels indicates that neonatal survival programs should follow a multifaceted approach to incorporate these associated factors. Programs should focus on birth interval prolongation with the promotion of family planning services, utilization of antenatal care and institutional delivery services along with management of preterm and sick infants to prevent this large number of deaths in this period.

Keywords: Afghanistan; Demographic and health survey; Determinants; Early neonatal mortality.

Fig. 1

Conceptual Framework for determinants of early neonatal mortality. Adapted from Mosley and Chen’s framework for child survival in developing countries [14]