Determinants of Neonatal Mortality in Ethiopia: A Case Control Study, 2013

Desalegn Tsegaw Hibstu¹, Tadesse Awoke Ayele², Zelalem Birhanu Mengesha³

¹Department of Mid Wife, Hossana College of Health Sciences, Hossana, Ethiopia.
²Department of Epidemiology and Biostatistics, Institute of Public Health, University of Gondar, Gondar, Ethiopia.
³Department of Reproductive Health, Institute of Public Health, University of Gondar, Gondar, Ethiopia.

DOI: 10.4236/oalib.1100880                

Abstract

Introduction: Neonatal mortality is an obstacle to the continued step down of under-five mortality and the attainment of the Millennium Development Goal four. In Ethiopia, the neonatal mortality rate is decreased from 49 in 2000 to 39 deaths per 1000 live births in 2005, remaining stable at 37 deaths per 1000 live births in 2011 accounting for about 42% of under-five mortality. The aim of the study was to identify determinants of neonatal mortality in Ethiopia. Methods: Unmatched case-control study design was used to identify determinants of neonatal mortality in Ethiopia from February to June 2013 using the 2011 EDHS data. Cases were all died neonates and controls were all survived live births born within the last five years prior to 2011 EDHS. The total sample size was 11,195 with 2239 cases and 8956 controls. Logistic regression was used to identify determinants of neonatal mortality. Odds ratios with 95% CI and p-value was computed to measure the associations between the outcome variable and the independent variables. A p-value of less than 0.05 was considered as a significant result. Result: A total of 2239 (20%) cases and 8956 (80%) controls were included in this study. Mothers with no education (AOR = 1.89, CI: 1.32 - 2.72), short birth interval (AOR = 2.85, CI: 2.28 - 3.56), age of mother at birth (AOR = 0.18, CI: 0.04 - 0.86), multiple birth (AOR = 5.89, CI: 4.23 - 8.20), unemployed mothers (AOR = 1.39, CI: 1.07 - 1.67), unemployed fathers (AOR = 5.50, CI: 3.20 - 9.44) and place of residence (AOR = 1.63, CI: 1.42 - 1.87) were found to be determinants of neonatal mortality. Conclusion: The major determinants of neonatal mortality were maternal education, birth interval, multiple birth, and age at birth, maternal and paternal employment and place of residence. Emphasis needs to be given on women’s education, access to family planning, health education on consequences of early marriage and child bearing, and creating job opportunities to improve neonatal survival.

Keywords

Neonatal Mortality, Determinants, Ethiopia

Conflicts of Interest

The authors declare no conflicts of interest.

References

[1]	Lawn, J.E., et al. (2005) 4 Million Neonatal Deaths: When? Where? Why? Lancet, 365, 891-900. http://dx.doi.org/10.1016/S0140-6736(05)71048-5
[2]	The World Health Report (2005) Make Every Mother and Child Count. World Health Organization, Geneva.
[3]	Black, R.E., et al. (2010) Global, Regional, and National Causes of Child Mortality in 2008: A Systematic Analysis. Lancet, 375, 1969-1987. http://dx.doi.org/10.1016/S0140-6736(10)60549-1
[4]	Lawn, J.E., et al. (2009) Survival in Low Resource Settings—Are We Delivering? BJOG: An International Journal of Obstetrics & Gynaecology, 116, 49-59. http://dx.doi.org/10.1111/j.1471-0528.2009.02328.x
[5]	UNICEF (2012) Levels and Trends in Child Mortality: Estimates Developed by the UN Inter-Agency Group for Child Mortality Estimation. New York, USA.
[6]	Bayou G. and Berhan, Y. (2012) Perinatal Mortality and Associated Risk Factors: A Case Control Study. Ethiopian Journal of Health Sciences, 22, 153-162.
[7]	Central Statistical Agency (Ethiopia) and ICF International (2012) Ethiopia Demographic and Health Survey 2011. Central Statistical Agency and ICF International, Addis Ababa, Ethiopia and Calverton, Maryland, USA.
[8]	Mahmood, M.A. (2002) Determinants of Neonatal and Post-Neonatal Mortality in Pakistan. The Pakistan Development Review Journal, 41, 723-744.
[9]	Schell, C.M., et al. (2007) Socioeconomic Determinants of Infant Mortality: A Worldwide Study of 152 Low, Middle and High-Income Countries. Scandinavian Journal of Public Health, 35, 288-297. http://dx.doi.org/10.1080/14034940600979171
[10]	Titaley, C.R., et al. (2008) Determinants of Neonatal Mortality in INDONESIA. BMC Public Health, 8, 232. http://dx.doi.org/10.1186/1471-2458-8-232
[11]	Abuqamar, M.D., et al. (2011) The Impact of Parental Education on Infant Mortality in Gaza Strip, Palestine. Journal of Public Health and Epidemiology, 3, 28-33.
[12]	Bryce, J. and Requejo, J.H. (2008) Countdown to 2015. Tracking Progression on Maternal Newborn & Child Survival. The 2008 Report. UNICEF, New York.
[13]	(2013) http://www.un.org/millennium/declaration/accessed
[14]	(2013) http://www.unicef.org/specialsession/accessed
[15]	World Health Organization (2006) Neonatal and Perinatal Mortality: Country, Regional and Global Estimates. Geneva.
[16]	Mason, E. (2013) Newborns in Sub-Saharan Africa: How to Save These Fragile Lives. UN Chronicle. Dec 2007.
[17]	MacFarlane, A.J., Johnson, A. and Mugford, M. (2006) Epidemiology of Neonatal Mortality. In: Rennie, J.M. and Roberton, N.R.C., Eds., Textbook of Neonatology, Churchill Livingstone, Edinburgh, 3-33.
[18]	McKeown, T., Record, R. and Turner, R. (2007) An Interpretation of the Decline in Mortality in England and Wales during the Twentieth Century. Population Studies, 29, 391-422. http://dx.doi.org/10.1080/00324728.1975.10412707
[19]	Darmstadt, G.L., Bhutta, Z.A., Cousens, S., Adam, T., Walker, N. and de Bernis, L. (2005) Evidence-Based, Cost-Effective Interventions: How Many Newborn Babies Can We Save? The Lancet, 365, 977-988. http://dx.doi.org/10.1016/S0140-6736(05)71088-6
[20]	Haws, R.A., Thomas, A.L., Bhutta, Z.A. and Darmstadt, G.L. (2007) Impact of Packaged Interventions on Neonatal Health: A Review of the Evidence. Health Policy and Planning, 22, 193-215. http://dx.doi.org/10.1093/heapol/czm009
[21]	Oestergaard, M.Z., Inoue, M., Yoshida, S., Mahanani, W.R., Gore, F.M., Cousens, S., et al. (2011) Neonatal Mortality Levels and Trends for 193 Countries in 2009 with Trends since 1990: A Systematic Analysis of Progress, Projections, and Priorities. PLoS Medicine, 8, e1001080. http://dx.doi.org/10.1371/journal.pmed.1001080
[22]	Rajaratnam, J.K., Marcus, J.R., Flaxman, A.D., Wang, H., Levin-Rector, A., Dwyer, L., et al. (2010) Neonatal, Post Neonatal, Childhood, and under-5 Mortality for 187 Countries, 1970-2010: A Systematic Analysis of Progress towards the Millennium Development Goal 4. The Lancet, 375, 1988-2008. http://dx.doi.org/10.1007/s13312-012-0044-2
[23]	Mondal, N., Hossain, K. and Ali, K. (2009) Factors Influencing Infant and Child Mortality: A Case Study of Rajshahi District, Bangladesh. Journal of Human Ecology, 26, 31-39.
[24]	Upadhyay, R.P., Dwivedi, P.R., Rai, S.K., Misra, P., Kalaivani, M. and Krishnan, A. (2012) Determinants of Neonatal Mortality in Rural Haryana: Nested Case-Control Study. Indian Pediatrics, 49, 291-294. http://dx.doi.org/10.1007/s13312-012-0044-2
[25]	Tachiweyika, E., Gombe, N., Shambira, G., Chadambuka, A., Mufuta, T. and Zizhou, S. (2009) Determinants of Perinatal Mortality in Marondera District, Mashonaland East Province of Zimbabwe: A Case Control Study. Pan African Medical Journal, 8, 7.
[26]	Rutherford, M.E., Dockerty, J.D., Jasseh, M., Howie, S.R.C., Herbison, P., Jeffries, D.J., et al. (2009) Access to Health Care and Mortality of Children under 5 Years of Age in Gambia: A Case-Control Study. Bulletin of World Health Organization, 87, 216-224. http://dx.doi.org/10.2471/BLT.08.052175
[27]	Bashir, A.O., Ibrahim, G.H., Bashier, I.A. and Adam, I. (2013) Neonatal Mortality in Sudan: Analysis of the Sudan Household Survey, 2010. BMC Public Health, 13, 287. http://dx.doi.org/10.1186/1471-2458-13-287
[28]	Mendes, K.G., Olinto, M.T.A. and da Costa, J.S.D. (2006) Case-Control Study on Infant Mortality in Southern Brazil. Revista de Saúde Pública, 40, 240-248. http://dx.doi.org/10.1590/S0034-89102006000200009
[29]	Awour, I., Abed, Y. and Ashour, M. (2012) Determinants and Risk Factors of Neonatal Mortality in the Gaza Strip, Occupied Palestinian Territory: A Case-Control Study. The Lancet, 380, 25-26. http://dx.doi.org/10.1016/S0140-6736(13)60206-8
[30]	Hong, R., Ayad, M., Rutstein, S. and Ren, R. (2009) Childhood Mortality in Rwanda: Levels, Trends, and Differentials. Further Analysis of the Rwanda Demographic and Health Surveys 1992-2007/08. 66, 27.
[31]	Chaman, R., Naieni, K.H., Golestan, B., Nabavizadeh, H. and Yunesian, M. (2009) Neonatal Mortality Risk Factors in a Rural Part of Iran: A Nested Case-Control Study. Iranian Journal of Public Health, 38, 48-52.
[32]	Mahmood, M.A. (2002) Determinants of Neonatal and Post-Neonatal Mortality in Pakistan. The Pakistan Development Review, 41, 723-744.
[33]	Sharma, V., Katz, J., Mullany, L.C., Khatry, S.K., LeClerq, S.C., Shrestha, S.R., et al. (2008) Young Maternal Age and the Risk of Neonatal Mortality in Rural Nepal. Archives of Pediatrics & Adolescent Medicine, 162, 828-835. http://dx.doi.org/10.1001/archpedi.162.9.828
[34]	Kamal, S.M. (2011) What Is the Association between Maternal Age and Neonatal Mortality? Analysis of the 2007 Bangladesh Demographic and Health Survey. Asia-Pacific Journal of Public Health, Published Online. http://dx.doi.org/10.1177/1010539511428949
[35]	Kamal, S.M.M. (2012) Maternal Education as a Determinant of Neonatal Mortality in Bangladesh. Journal of Health Management, 14, 269-281. http://dx.doi.org/10.1177/0972063412457509
[36]	Maraga, A. and Emily, S. (2011) Risk Factors of Neonatal Mortality in Navrongo DSS in Ghana between 2001 and 2005.
[37]	Amoa, A.B. (2002) A Case-Control Study of Early Neonatal Deaths at the Port Moresby General Hospital in Papua New Guinea to Determine Associated Risk Factors. Papua New Guinea Medical Journal, 45, 185-196.
[38]	Susuman, A.S. (2012) Child Mortality Rate in Ethiopia. Iranian Journal of Public Health, 41, 9-19.
[39]	Mahy, M. (2003) Childhood Mortality in the Developing World: A Review of Evidence from the Demographic and Health Surveys, Comparative Report, No. 4. Macro International Inc., Irvine.
[40]	Upadhyay, U.D. and Setty-Venugopal, V. (2002) Birth Spacing: Three to Five Saves Lives. Johns Hopkins University Editor, Baltimore, 1-23.
[41]	Akin, Y., Cömert, S., Turan, C., Ünal, O., Piçak, A., Ger, L., et al. (2010) Increasing Low Birth Weight Rates: Deliveries in a Tertiary Hospital in Istanbul. Iran Journal of Pediatrics, 20, 284-290.