Suchergebnisse

Newborn infants are among those which generate the highest health care costs. For instance, the cost of hospital care until discharge was assessed at US $ 14,200 (Boyle et al., 1983) for babies weighing 1000–1499g at birth. The average hospital stay for a baby weighing less than 1500g at birth in 1981 was 100 days at an average daily cost of US$ 898 (Stahlman, 1984). Achievements in neonatal survival, especially of extremely low birth weight babies, have necessitated frequent revision of the definition of viability. However, modern neonatal intensive care cannot be regarded as appropriate for developing countries as it cannot be made accessible to all at an affordable cost.

Ensuring the survival and well being of children is a concern
of families, communities and nations throughout the world. Since the
turn of the 20th century infant and child mortality in more developed
countries has steadily declined and, currently, has been reduced to
almost minimal levels. In contrast, although infant and child mortality
has declined in the past three decades in most less developed countries,
the pace of change and the magnitude of improvement vary considerably
from one country to another. The inverse relationship between
socio-economic variables of the parents and infant and child mortality
is well established by several studies [Muhuri (1995); Forste (1994);
Hobcraft, et al. (1984); Caldwell (1979); Sathar (1985, 1987)] and it
holds true irrespective of the overall level of mortality in the
national populations [Ruzicka (1989)]. The influence of parental
education on infant and child health and mortality has proved to be
universally significant [Bicego and Boerma (1993); Caldwell, et al.
(1990)]. The father's education, mother's education and their work
status each have independent effects upon child survival in developing
countries [Sandiford, et al. (1995); Forste (1994); Caldwell, et al.
(1983)]. Economic conditions of the household also help in explaining
the variation in infant and child mortality. The nature of housing,
diet, access to and availability of water and sanitary conditions as
well as medical attention all depend on the economic conditions of the
household. For example, poor families may reside in crowded, unhygienic
housing and, thus, suffer from infectious disease associated with
inadequate and contaminated water supplies and with poor sanitation
[Esrey and Habicht (1986)].

Child mortality (the mortality of children less than five years old) declined considerably in the developing world in the 1990s, but infant mortality declined less. The reductions in neonatal mortality were not impressive and, as a consequence, there is an increasing percentage of infant deaths in the neonatal period. Any further reduction in child mortality, therefore, requires an understanding of the determinants of neonatal mortality. 209,628 birth and 2581 neonatal death records for the 1998 birth cohort from the city of São Paulo, Brazil, were probabilistically matched. Data were from SINASC and SIM, Information Systems on Live Births and Deaths of Brazil. Logistic regression was used to find the association between neonatal mortality and the following risk factors: birth weight, gestational age, Apgar scores at 1 and 5 minutes, delivery mode, plurality, sex, maternal education, maternal age, number of prior losses, prenatal care, race, parity and community development. Infants of older mothers were less likely to die in the neonatal period. Caesarean delivery was not found to be associated with neonatal mortality. Low birth weight, pre-term birth and low Apgar scores were associated with neonatal death. Having a mother who lives in the highest developed community decreased the odds of neonatal death, suggesting that factors not measured in this study are behind such association. This result may also indicate that other factors over and above biological and more proximate factors could affect neonatal death.

SummaryThis paper investigates variations in the strength and structure of familial association in neonatal mortality risks in four populations; Bolivia, Kenya, Peru, and Tanzania. Exploratory analyses of the structure of the familial association are presented for each population. Random effects logistic models are then used to estimate the strength of familial association in neonatal mortality risks using a standard set of control variables. The results suggest that the strength of familial association in neonatal mortality risks is quite similar in these four populations which would be consistent with a biological explanation for the association. However, some differences were found, particularly in the form of the association in Peru, which may suggest at least a small role of other factors.

In 2005, the Indian Government launched a conditional cash-incentive program to encourage institutional delivery. This paper studies the effects of the program on neonatal mortality using district-level household survey data. We model mortality using survival analysis, paying special attention to the substantial heaping present in the data. The main objective of this paper is to provide a set of sufficient conditions for identification and consistent estimation of the baseline hazard accounting for heaping and unobserved heterogeneity. Our identification strategy requires neither administrative data nor multiple measurements, but a correctly reported duration and the presence of some flat segments in the baseline hazard which includes this correctly reported duration point. We establish the asymptotic properties of the maximum likelihood estimator and provide a simple procedure to test whether the policy had (uniformly) reduced mortality. While our empirical findings do not confirm the latter, they do indicate that accounting for heaping matters for the estimation of the baseline hazard.

Background: A prospective study was conducted in the neonatal intensive care unit of department of Paediatrics, Holy Family Hospital, Rawalpindi, from 1st January, 2006 to 30th June, 2006. Methods: All neonates admitted were enrolled in this study. Sixteen hundred thirty one neonates were admitted. Results: The major cases admitted were 617 (37.82%) cases of neonatal sepsis, followed by prematurity 333 (20.41%), birth asphyxia, 299 (18.33%), neonatal jaundice 146 (8.95%) and 75 (4.59%) cases of meconium aspiration. The number of neonates who expired were 383 (23.48%), while 1190(72.96%), were discharged and 58(3.55%) left against medical advice. Among the neonates expired there were 236 (61.6%) males and 147 (38.4%) females. SVD was the predominant mode of delivery in 303 (79.0%) and LSCS in 80 (20.9%). Babies delivered at HFH were 156 (40.7%) with 102 (26.6%) home delivered, 79 (20.6%) from private hospitals while 46 (12%) were from Children Hospital and other government hospitals of Rawalpindi/Islamabad. Most neonates presented before 24 hrs of age 230 (60.1%), whereas 63 (16.4%) presented between 24 – 72 hrs and 90 (23.5%) presented between 72 hrs and 28 days. Most expiries occurred in less than 24 hrs after admission 167 (43.6%), followed by expiries in > than72 hrs and between 24 – 72 hrs of stay, 113 (29.6%) and 103 (26.8%) respectively. The major contributors to mortality were birth asphyxia 13 (43.8%), pre maturity 129 (38.7%), meconium aspiration 13 (7.3%), neonatal sepsis 75 (12.15%) and neo natal jaundice 1 (10.27%) Conclusion: Age of presentation is an important contributor to neonatal mortality. The importance of focusing on facility based clinical care, with involvement of out reach teams, family and community cannot be over emphasized .

The low priority that most low-income countries give to neonatal mortality, which now constitutes more than 40% of deaths to children younger than 5 years, is a stumbling block to the world achieving the child survival Millennium Development Goal. Bangladesh is an exception to this inattention. Between 2000 and 2011, newborn survival emerged from obscurity to relative prominence on the government's health policy agenda. Drawing on a public policy framework, we analyzed how this attention emerged. Critical factors included national advocacy, government commitment to the Millennium Development Goals, and donor resources. The emergence of policy attention involved interactions between global and national factors rather than either alone. The case offers guidance on generating priority for neglected health problems in low-income countries.