A 7-Month Review of Clinical and Demographic Predictors of Childhood Mortality in a Tertiary Children Hospital in Freetown, Sierra Leone.

BACKGROUND: Sierra Leone ranks among nations with unacceptably high infant and under-5 mortality rates. Understanding the clinical and demographic dynamics that underpin paediatric mortalities is not only essential but fundamental to the formulation and implementation of effective healthcare interventions that would enhance child survival. SUBJECTS AND MATERIAL: This was a 7-month review of all mortalities from May 24th 2021 to December 31st 2021 at Ola During Children's Hospital in Freetown, Sierra Leone. Information on biodata, presenting complaints, illness duration, diagnoses, treatment given inclusive of point-of-care investigations, and duration of hospital stay retrieved from all mortalities were entered into Excel spreadsheets and were analyzed using SPSS version 25.0 for IBM. Multivariable regression analysis was done to determine factors independently associated with mortalities within 24 hours of admission. All associations were considered significant if p < 0.05. RESULTS: There were 840 deaths out of 5920 children admitted during the period giving a mortality of 14.2% with a male-to-female ratio of 1:1. Three hundred and four (36.2%) of these deaths occurred in the neonatal age group while 63.8% occurred in the post neonatal age group. Perinatal asphyxia was the leading cause of neonatal deaths while acute respiratory infections and severe malaria were the leading causes of post neonatal deaths. The majority (64.8%) of the mortalities occurred within the first 24 hours of admission. In a multivariable regression, only transfusion status and use of respiratory support were independently associated with mortality within 24 hours of admission (P<0.05). CONCLUSION: Paediatric mortality in Sierra Leone is high and is caused mainly by preventable morbidities such as perinatal asphyxia and infections. Most of the deaths occurred within 24 hours of admission. It is recommended that patients should be brought to the hospital early and preventive measures be instituted to address these causes.

CONTEXTE: La Sierra Leone se classe parmi les nations ayant des taux de mortalité infantile et des moins de cinq ans inacceptables. Comprendre la dynamique clinique et démographique qui sous-tend les mortalités pédiatriques est non seulement essentiel mais fondamental pour la formulation et la mise en œuvre d'interventions efficaces en matière de santé qui amélioreraient la survie des enfants. SUJETS ET MATÉRIEL: Il s'agissait d'une revue de sept mois de toutes les mortalités du 24 mai 2021 au 31 décembre 2021 à l'Hôpital Ola During Children's à Freetown, Sierra Leone. Les informations sur les données biométriques, les plaintes de présentation, la durée de la maladie, les diagnostics, les traitements administrés, y compris les investigations sur le lieu de soins, et la durée du séjour à l'hôpital ont été saisies dans des feuilles de calcul Excel et analysées à l'aide de SPSS version 25.0 pour IBM. Une analyse de régression multivariée a été effectuée pour déterminer les facteurs indépendamment associés aux mortalités dans les 24 heures suivant l'admission. Toutes les associations étaient considérées comme significatives si p < 0,05. RÉSULTATS: Il y a eu 840 décès sur 5920 enfants admis pendant la période, ce qui donne une mortalité de 14,2 % avec un rapport hommefemme de 1:1. Trois cent quatre (36,2 %) de ces décès sont survenus dans le groupe d'âge néonatal, tandis que 63,8 % sont survenus dans le groupe d'âge post-néonatal. L'asphyxie périnatale était la principale cause de décès néonatal, tandis que les infections respiratoires aiguës et le paludisme grave étaient les principales causes de décès post-néonatal. La majorité (64,8 %) des mortalités sont survenues dans les premières 24 heures suivant l'admission. Dans une régression multivariée, seul le statut transfusionnel et l'utilisation d'un support respiratoire étaient indépendamment associés à la mortalité dans les 24 heures suivant l'admission (P<0,05). CONCLUSION: La mortalité pédiatrique en Sierra Leone est élevée et est principalement causée par des morbidités évitables telles que l'asphyxie périnatale et les infections. La plupart des décès surviennent dans les 24 heures suivant l'admission. Il est recommandé que les patients soient amenés à l'hôpital tôt et que des mesures préventives soient mises en place pour traiter ces causes. MOTS CLÉS: Mortalité pédiatrique, Profil clinique, Déterminants, Freetown.

Evaluation of statistical process control charts for infant mortality monitoring in Brazilian cities with different population sizes.

OBJECTIVES: The control chart is a classic statistical technique in epidemiology for identifying trends, patterns, or alerts. One meaningful use is monitoring and tracking Infant Mortality Rates, which is a priority both domestically and for the World Health Organization, as it reflects the effectiveness of public policies and the progress of nations. This study aims to evaluate the applicability and performance of this technique in Brazilian cities with different population sizes using infant mortality data. RESULTS: In this article, we evaluate the effectiveness of the statistical process control chart in the context of Brazilian cities. We present three categories of city groups, divided based on population size and classified according to the quality of the analyses when subjected to the control method: consistent, interpretable, and inconsistent. In cities with a large population, the data in these contexts show a lower noise level and reliable results. However, in intermediate and small-sized cities, the technique becomes limited in detecting deviations from expected behaviors, resulting in reduced reliability of the generated patterns and alerts.

Factors associated with under-five mortality in Scheduled Tribes in India: An analysis of national family health survey-5 (2019-2021).

Background & objectives Under-five mortality is high among the Scheduled Tribes (ST) in India compared with the general population. This study examined the association of different maternal, child, socio demographic, and household factors associated with under-five mortality among Scheduled Tribes in India. Methods Data from the National Family and Health Survey (NFHS)-5 (2019-2021) for the ST, across all Indian States and Union Territories were used for analyses. Binary and multivariate logistic regression were performed to identify the association of maternal, child, socio-demographic, and household factors with under-five mortality among the ST population. Results Different maternal, child, socio demographic, and household factors were significantly associated with under-five mortality. The odds of under-five mortality were highest among women who gave birth to their children at home [Adjusted odds ratio (AOR): 1.42; 95% confidence interval (CI): 1.268-1.59] as compared with women who gave birth at institution. Literate women have lesser odds of under-five mortality than women with no formal education (AOR: 0.666; 95% CI: 0.501-0.885). The risk of under-five mortality was higher among four or more birth order children (AOR: 1.422; 95% CI: 1.246-1.624) compared with the first to third birth order children. The odds of under-five mortality decreased among children with a rich wealth index (AOR: 0.742; 95% CI: 0.592-0.93) compared to children with a poor wealth index. Interpretation & conclusions Analyses of under-five mortality among ST in India showed a significant association between different maternal, child, sociodemographic, and household factors. Grass-roots-level interventions such as promoting female education, addressing vast wealth differentials, and providing family planning services with a focus on reducing under-five mortality are essential in improving the survival of under-five children among the ST population in India.

State Variations In Progress Toward Eliminating Disparities In Infant Mortality, 2007-19.

Progress toward eliminating the Black-White disparity in US infant mortality rates has been slow and highly variable by state. Among thirty-two eligible states, eight had an increase (worsening), and twenty-four had a reduction (improvement) in their Black-White infant mortality rate ratios from 2008 to 2018. These findings necessitate dynamic, multilevel initiatives aimed at preventing Black infant deaths.

U.S. Children Die at Higher Rates Overall Than Children in Other Wealthy Countries.

Infant mortality and teen deaths from firearms drive the disparity.

Risk Factors Associated with Under Five Children Mortality in Northeast Nigeria; A Retrospective Analysis of National Demographic and Health Survey Data.

BACKGROUND: Under-five children mortality rate (U5MR) remains a crucial indicator of a nation's child healthcare and socioeconomic development. This study aims to identify and quantify significant maternal, child, family, and environmental risk factors contributing to under-five mortalities in the Northeast geopolitical zone of Nigeria. METHODS: Retrospective analysis of secondary data from the 2018 National Demographic and Health Survey (NDHS) in six northeastern Nigerian states. Maternal factors (age, education, health-seeking behavior), child variables (weight, sex, vaccination status), family factors, and environmental factors (water source, residence, wealth index) were analyzed to determine their association with the under-five mortality rate (U5MR). Logistic regression models and population-attributable risk estimates were used to identify key contributors to U5MR in the region. RESULTS: A total of 26,293 mothers were surveyed, of which the majority (93.6%) were married, employed (70.7%), and had no insurance (99%). Most of the mothers were above 35 years of age, uneducated and with first birth between ages 15-19. Adjusted odds ratios show unmarried mothers 1.67 (P=0.015), small birth size 1.37 (P=0.022), never breastfeeding 1.83 (P=0.000), short birth intervals 1.50 (0.005), higher parity 1.5 (P=0.005), lack of any family planning method 1.43(P=0.040), twin siblings 3.95 (P=0.000) and place of residence 1.21 (P=0.000) were associated with higher U5MR odds ratios. Maternal age 21-25 years showed a protective effect AOR 0.59 (95% CI: 0.36-0.98, P=0.040) and age > 31 years AOR 0.44 (95% CI: 0.24-0.81, P=0.009). CONCLUSION: This study provides crucial insights into the multifaceted determinants of under-5 mortality in Northeast Nigeria. The findings underscore the importance of tailored interventions addressing maternal, child, and family factors to improve child health outcomes in the region.

CONTEXTE: Le taux de mortalité des enfants de moins de cinq ans (U5MR) reste un indicateur crucial des soins de santé pour les enfants et du développement socio-économique d'une nation. Cette étude vise à identifier et à quantifier les facteurs de risque significatifs liés à la mère, à l'enfant, à la famille et à l'environnement, contribuant à la mortalité des enfants de moins de cinq ans dans la zone géopolitique du nord-est du Nigéria. MÉTHODES: Analyse rétrospective des données secondaires de l'Enquête Démographique et de Santé Nationale (EDSN) de 2018 dans six États du nordest du Nigéria. Les facteurs maternels (âge, éducation, comportement de recherche de soins), les variables de l'enfant (poids, sexe, statut vaccinal), les facteurs familiaux et les facteurs environnementaux (source d'eau, résidence, indice de richesse) ont été analysés pour déterminer leur association avec le taux de mortalité des enfants de moins de cinq ans (U5MR). Des modèles de régression logistique et des estimations du risque attribuable à la population ont été utilisés pour identifier les principaux contributeurs à l'U5MR dans la région. RÉSULTATS: Un total de 26 293 mères ont été interrogées, dont la majorité (93,6%) étaient mariées, employées (70,7%) et n'avaient pas d'assurance (99%). La plupart des mères avaient plus de 35 ans, n'étaient pas éduquées et avaient eu leur premier enfant entre 15 et 19 ans. Les ratios de cotes ajustés montrent que les mères non mariées (1,67, P=0,015), la petite taille à la naissance (1,37, P=0,022), l'absence d'allaitement (1,83, P=0,000), les intervalles de naissance courts (1,50, P=0,005), une parité élevée (1,5, P=0,005), l'absence de méthode de planification familiale (1,43, P=0,040), les jumeaux (3,95, P=0,000) et le lieu de résidence (1,21, P=0,000) étaient associés à des ratios de cotes plus élevés de l'U5MR. L'âge maternel de 21 à 25 ans a montré un effet protecteur AOR 0,59 (95% CI : 0,36-0,98, P=0,040) et l'âge > 31 ans AOR 0,44 (95% CI : 0,24-0,81, P=0,009). CONCLUSION: Cette étude fournit des informations cruciales sur les déterminants multifactoriels de la mortalité des enfants de moins de cinq ans dans le nord-est du Nigéria. Les résultats soulignent l'importance d'interventions adaptées abordant les facteurs liés à la mère, à l'enfant et à la famille pour améliorer les résultats de santé des enfants dans la région. MOTS-CLÉS: Mortalité des enfants de moins de cinq ans, Facteurs de risque,Nord-Est du Nigéria, Santé des enfants.

Intersectional configuration of infant mortality due to malnutrition in Colombia: a mini-review.

This mini review delves into the complex issue of mortality linked to malnutrition, highlighting its multifaceted nature beyond just biomedical factors, presenting it as an intricate intersectional phenomenon. Method: The mini-review methodology involved a systematic literature search across databases like PubMed and Scielo, focusing on malnutrition and infant mortality in Colombia. We used specific keywords and Boolean operators to identify relevant studies, emphasizing socio-economic, gender, and ethnic factors, while excluding non-peer-reviewed and outdated publications. Results: The relationship between gender and food/nutrition has deep historical and cultural roots. Patriarchal norms influence dietary habits based on gender roles, often placing undue responsibility on mothers for children's nutritional health, reflecting profound social intersections. Mortality due to malnutrition is most prevalent among indigenous and Afro-descendant children in rural, conflict-affected areas with limited access to healthcare. Unpaid domestic work restricts women's economic independence, intensifying challenges for single-parent households. Conclusion: A comprehensive understanding can shift institutional attitudes toward mothers, leading to more coherent policy strategies and effective interventions.

An analysis of cause-specific under-5 mortality in Bangladesh using the demographic and health survey 2011 and 2017-2018.

BACKGROUND: As the Sustainable Development Goal 3.2.1 deadline (2030) approaches, rapidly reducing under-5 mortality (U5M) gains more prominence. However, initiatives or interventions that aided Bangladesh in achieving Millennium Development Goal 4 showed varied effectiveness in reducing certain cause-specific U5M. Therefore, this study aimed to examine the predictors of the key cause-specific mortalities. METHODS: This cross-sectional study was conducted using the Bangladesh Demographic and Health Survey 2011 and 2017-18 data. Cause-specific U5M was examined using multilevel multinomial mixed-effects analyses, and overall/all-cause U5M was examined using multilevel mixed-effects analyses. The respective estimates were compared. RESULTS: The cause-specific analysis revealed that pneumonia and prematurity-related U5M were significantly associated with antenatal care and postnatal care, respectively. However, analysis of overall/all-cause U5M did not reveal any significant association with health services. Twins or multiples had a greater risk of mortality from preterm-related conditions (adjusted Relative Risk Ratio (aRRR): 38.01, 95% CI: 19.08-75.7, p < .001), birth asphyxia (aRRR: 6.52, 95% CI: 2.51-16.91, p < .001), and possible serious infections (aRRR: 11.12, 95% CI: 4.52-27.36, p < .001) than singletons. Children born to mothers 18 years or younger also exhibited a greater risk of mortality from these three causes than children born to older mothers. This study also revealed an increase in the predicted risk of prematurity-related mortality in the 2017-18 survey among children born to mothers 18 years or younger, children born to mothers without any formal education, twins or multiples and children who did not receive postnatal care. CONCLUSIONS: This research provides valuable insights into accelerating U5M reduction; a higher risk of preterm-related death among twins underscores the importance of careful monitoring of mothers pregnant with twins or multiples through the continuum of care; elevated risk of death among children who did not receive postnatal care, or whose mothers did not receive antenatal care stresses the need to strengthen the coverage and quality of maternal and neonatal health care; furthermore, higher risks of preterm-related deaths among the children of mothers with low formal education or children born to mothers 18 years or younger highlight the importance of more comprehensive initiatives to promote maternal education and prevent adolescent pregnancy.

Neonatologist staffing is related to the inter-hospital variation of risk-adjusted mortality of very low birth weight infants in Korea.

This study investigated whether hospital factors, including patient volume, unit level, and neonatologist staffing, were associated with variations in standardized mortality ratios (SMR) adjusted for patient factors in very-low-birth-weight infants (VLBWIs). A total of 15,766 VLBWIs born in 63 hospitals between 2013 and 2020 were analyzed using data from the Korean Neonatal Network cohort. SMRs were evaluated after adjusting for patient factors. High and low SMR groups were defined as hospitals outside the 95% confidence limits on the SMR funnel plot. The mortality rate of VLBWIs was 12.7%. The average case-mix SMR was 1.1; calculated by adjusting for six significant patient factors: antenatal steroid, gestational age, birth weight, sex, 5-min Apgar score, and congenital anomalies. Hospital factors of the low SMR group (N = 10) had higher unit levels, more annual volumes of VLBWIs, more number of neonatologists, and fewer neonatal intensive care beds per neonatologist than the high SMR group (N = 13). Multi-level risk adjustment revealed that only the number of neonatologists showed a significant fixed-effect on mortality besides fixed patient risk effect and a random hospital effect. Adjusting for the number of neonatologists decreased the variance partition coefficient and random-effects variance between hospitals by 11.36%. The number of neonatologists was independently associated with center-to-center differences in VLBWI mortality in Korea after adjustment for patient risks and hospital factors.

THE IMPACT OF BIRTH WEIGHT ON INFANT MORTALITY IN KAZAKHSTAN.

INTRODUCTION: Recognizing the importance of birth weight is fundamental to addressing public health challenges associated with maternal and child health. Birth weight serves as a critical indicator, offering insights into mortality, stunting, and the development of chronic diseases later in life. This study delves into fertility and infant mortality trends in Kazakhstan, with a specific focus on understanding urban-rural disparities and gender variations in mortality rates. OBJECTIVES: The primary objective of this study is to evaluate the influence of birth weight on infant mortality in Kazakhstan, considering demographic and regional nuances. Through comprehensive analysis, we aim to discern patterns and factors contributing to infant mortality, thereby informing targeted interventions and policies aimed at improving maternal and child health outcomes across the country. MATERIALS AND METHODS: The analysis was conducted using the data provided by the Republican State Enterprise on the PCV of the "Republican Centre for Electronic Health Care" of the Ministry of Health of Kazakhstan. RESULTS: In Kazakhstan, birth rates reached their zenith in 2021 (total 446,491 births). However, this figure experienced a downturn in 2022, declining to 403,893 births. Notably, urban regions consistently reported higher birth rates compared to rural areas. The year 2022 witnessed a decline in birth rates across both urban and rural populations, with decreases of 9.5% and 11.7%, respectively, compared to the previous year. Analysis using linear regression techniques on infant mortality rates spanning from 2017 to 2022 revealed no statistically significant time trend (slope=51.29, correlation coefficient=0.42, p=0.41). Gender-specific disparities in mortality rates were starkly evident, with boys exhibiting higher mortality rates compared to girls across all population subsets. Geographical analysis conducted in 2022 exposed significant divergences in mortality rates across various regions. CONCLUSIONS: The study highlights significant urban-rural disparities and gender differences in birth rates and infant mortality within Kazakhstan. It also confirms the protective effect of higher birth weight on infant mortality. Regional disparities suggest targeted public health interventions are necessary to address these variations effectively.

Efficiency of health systems in middle-income countries and determinants of efficiency in Latin America and the Caribbean.

We estimate the efficiency of health spending in 145 middle and high-income and the potential gains from improving efficiency for a range of health system outputs using Robust Data Envelopment Analysis for 2010-2014 and 2015-2019 and examine associations with health system characteristics. Focusing on Latin American and Caribbean countries, we find large variability in efficiency and overall substantial potential gains in the later period, despite improvements over time. Our results suggest that, for example, improving spending efficiency could increase life expectancy at birth by 3.5 years (4.6%), or slightly more than the 3.4-year improvement in average life expectancy in the region between 2000 and 2015. Similarly, improved efficiency could reduce neonatal mortality by 6.7 per 1,000 live births (62%), increase service coverage by 6 percentage points (8.7%), and reduce the rich-poor gap in birth attendance by 10 percentage points (12.6%). We find that governance quality is positively associated with efficiency. Overall, the findings indicate an urgent need to improve efficiency in the region and substantial scope for realizing the potential gains of such improvements.

Temporal Trends of Infant Mortality Secondary to Congenital Heart Disease: National CDC Cohort Analysis (1999-2020).

BACKGROUND: Infant mortality continues to be a significant problem for patients with congenital heart disease (CHD). Limited data exist on the recent trends of mortality in infants with CHD. METHODS: The CDC WONDER (Centers for Disease Control and Prevention Wide-Ranging Online Data for Epidemiologic Research) was queried to identify deaths occurring within the United States with CHD listed as one of the causes of death between 1999 and 2020. Subsequently, trends were calculated using the Joinpoint regression program (version 4.9.1.0; National Cancer Institute). RESULTS: A total of 47,015 deaths occurred in infants due to CHD at the national level from the year 1999 to 2020. The overall proportional infant mortality (compared to all deaths) declined (47.3% to 37.1%, average annual percent change [AAPC]: -1.1 [95% CI -1.6 to -0.6, p < 0.001]). There was a significant decline in proportional mortality in both Black (45.3% to 34.3%, AAPC: -0.5 [-0.8 to -0.2, p = 0.002]) and White patients (55.6% to 48.6%, AAPC: -1.2 [-1.7 to -0.7, p = 0.001]), with a steeper decline among White than Black patients. A statistically significant decline in the proportional infant mortality in both non-Hispanic (43.3% to 33.0%, AAPC: -1.3% [95% CI -1.9 to -0.7, p < 0.001]) and Hispanic (67.6% to 57.7%, AAPC: -0.7 [95% CI -0.9 to -0.4, p < 0.001]) patients was observed, with a steeper decline among non-Hispanic infant population. The proportional infant mortality decreased in males (47.5% to 53.1%, AAPC: -1.4% [-1.9 to -0.9, p < 0.001]) and females (47.1% to 39.6%, AAPC: -0.9 [-1.9 to 0.0, p = 0.05]). A steady decline in for both females and males was noted. CONCLUSION: Our study showed a significant decrease in CHD-related mortality rate in infants and age-adjusted mortality rate (AAMR) between 1999 and 2020. However, sex-based, racial/ethnic disparities were noted, with female, Black, and Hispanic patients showing a lesser decline than male, White, and non-Hispanic patients.

Toilet construction under the Swachh Bharat Mission and infant mortality in India.

Improvement of water and sanitation conditions may reduce infant mortality, particularly in countries like India where open defecation is highly prevalent. We conducted a quasi-experimental study to investigate the association between the Swachh Bharat Mission (SBM)-a national sanitation program initiated in 2014-and infant (IMR) and under five mortality rates (U5MR) in India. We analyzed data from thirty-five Indian states and 640 districts spanning 10 years (2011-2020), with IMR and U5MR per thousand live births as the outcomes. Our main exposure was the district-level annual percentage of households that received a constructed toilet under SBM. We mapped changes in IMR and U5MR and toilet access at the district level over time. We fit two-way fixed effects regression models controlling for sociodemographic, wealth, and healthcare-related confounders at the district-level to estimate the association between toilets constructed and child mortality. Toilet access and child mortality have a historically robust inverse association in India. Toilets constructed increased dramatically across India following the implementation of SBM in 2014. Results from panel data regression models show that districts with > 30% toilets constructed under SBM corresponds with 5.3 lower IMR (p < 0.05), and 6.8 lower U5MR (p < 0.05). Placebo, falsification tests and robustness checks support our main findings. The post-SBM period in India exhibited accelerated reductions in infant and child mortality compared to the pre-SBM years. Based on our regression estimates, the provision of toilets at-scale may have contributed to averting approximately 60,000-70,000 infant deaths annually. Our findings show that the implementation of transformative sanitation programs can deliver population health benefits in low- and middle-income countries.

Linkages between consanguinity, pregnancy outcomes and offspring mortality in twenty-first century India.

We hypothesized that consanguineous marriage will remain a risk factor for pregnancy outcome and offspring mortality, but the development in demographic, socioeconomic conditions and increased utilization of maternal and child health care services during postglobalization era would work as a buffer in the reduction of child mortality rates. Data fromNational Family Health Surveys 4(2015-2016) and 5(2019-2021) were pooled and used for the analysis. Binary logistic regression and Cox proportional hazard regression models were used to examine the effects of close (CC) and distant (DC) consanguinity on spontaneous abortion, stillbirth, neonatal mortality, post-neonatal, and child mortality respectively compared to non-consanguinity (NC). The final model showed that the risk of spontaneous abortion (both CC and DC, p < 0.001) and neonatal mortality (DC, p < 0.001) were significantly higher compared to NC. No significant association was found between consanguinity and child mortality. We conclude that the endogenous effect of consanguinity still pose a serious challenge to the survival of fetus and new born; but exogenous effect reduces the risk of child death. We propose to incorporate socially entrenched practice of consanguinity explicitly into Mosley and Chen's (1984) framework for the aid in understanding child survival in developing countries.

Trends in under-five mortality rate in China, 1996-2020: a Joinpoint regression and correlation analysis.

OBJECTIVES: To analyse annual trends of the under-five mortality rate (U5MR) and main cause-specific U5MR in China from 1996 to 2020 and to assess the potential correlation of the healthcare system and health expenditure with the U5MR in China. DESIGN: A retrospective observational study using national data from 1996 to 2020. Joinpoint regression was employed to model U5MR trends and Pearson correlation analysis was conducted to examine the relationship between healthcare system factors, health expenditure and U5MR. SETTING: Nationwide study covering both rural and urban populations across China over a 25-year period. RESULTS: The U5MR in China experienced a three-stage decline from 1996 to 2020 with an average annual percentage rate change (AAPC) of -7.27 (p<0.001). The AAPC of the rural U5MR (-7.07, p<0.001) was higher than that in urban areas (-5.57, p<0.001). Among the five main causes, the decrease in pneumonia-caused U5MR was the fastest while the decreases in congenital heart disease and accidental asphyxia were relatively slow. The rates of hospital delivery (r=-0.981, p<0.001), neonatal visits (r=-0.848, p<0.001) and systematic health management (r=-0.893, p<0.001) correlated negatively with U5MR. The proportion of government health expenditure in the total health expenditure (THE) correlated negatively with the national U5MR (r=-0.892, p<0.001) while the proportion of out-of-pocket health expenditure in THE correlated positively (r=0.902, p<0.001). CONCLUSION: China made significant advances in reducing U5MR from 1996 to 2020. The rural-urban gap in U5MR has narrowed, though rural areas remain a key concern. To further reduce U5MR, China should focus on rural areas, pay more attention to congenital heart disease and accidental asphyxia, further improve its health policies, and continue to increase the government health expenditure.

Factors associated with preventable infant mortality in 2020: a Brazilian population-based study.

OBJECTIVES: to identify factors associated with preventable infant deaths, classified as neonatal and post-neonatal. METHODS: this is an epidemiological and population-based study relating to 2020. Data from the Mortality Information System (MIS) and the preventability classification proposed in the Brazilian Health System List of Causes of Deaths Preventable by Interventions were used. RESULTS: prematurity, living in the North and Northeast regions and the occurrence of the event at home were associated with preventable neonatal deaths. To the avoidable post-neonatal component, death outside the hospital, low maternal education and children of brown or yellow color/race were associated. CONCLUSIONS: the main risk factor associated with preventable deaths was prematurity, in the case of neonatal death. Low maternal education and occurrence outside the hospital were associated with post-neonatal deaths.

Survival of Infants Born at 22 to 25 Weeks' Gestation Receiving Care in the NICU: 2020-2022.

OBJECTIVE: To provide contemporary data on infants inborn at 22 to 25 weeks' gestation and receiving care at level 3 and 4 neonatal intensive care units in the United States. METHODS: Vermont Oxford Network members submitted data on infants born at 22 to 25 weeks' gestation at a hospital with a level 3 or 4 NICU from 2020 to 2022. The primary outcome was survival to hospital discharge. Secondary outcomes included survival without severe complications, length of stay, and technology dependence. RESULTS: Overall, 22 953 infants at 636 US hospitals were included. Postnatal life support increased from 68.0% at 22 weeks to 99.8% at 25 weeks. The proportion of infants born at 22 weeks receiving postnatal life support increased from 61.6% in 2020 to 73.7% in 2022. For all infants, survival ranged from 24.9% at 22 weeks to 82.0% at 25 weeks. Among infants receiving postnatal life support, survival ranged from 35.4% at 22 weeks to 82.0% at 25 weeks. Survival without severe complications ranged from 6.3% at 22 weeks to 43.2% at 25 weeks. Median length of stay ranged from 160 days at 22 weeks to 110 days at 25 weeks. Among survivors, infants born at 22 weeks had higher rates of technology dependence at discharge home than infants born at later gestational ages. CONCLUSIONS: Survival ranged from 24.9% at 22 weeks to 82.1% at 25 weeks, with low proportions of infants surviving without complications, prolonged lengths of hospital stay, and frequent technology dependence at all gestational ages.

Magnitude of Neonatal Sepsis and Factors Associated with It among Neonates Admitted to the Intensive Care Units of Neonate in the Primary Hospital of Hawzen, Tigray, Ethiopia, 2020.

Purpose: Neonatal sepsis contributes substantially to neonatal mortality and morbidity and is an ongoing major global public health problem particularly in developing countries. A significant proportion of mothers give birth in primary health care, but studies regarding neonatal sepsis and its associated factors among admitted neonates are limited to the hospital which may not be generalized to the primary health care unit. Therefore, this study aimed to assess the proportion of neonatal sepsis and associated factors in the study areas. Objective: To assess the magnitude of neonatal sepsis and its associated factors among neonates admitted to Neonatal Intensive Care Units (NICUs) of Hawzen Primary Hospital, Eastern Zone, Tigray, North Ethiopia, 2020. Methods: An institution-based cross-sectional study design was carried out among 290 study participants in Hawzen Primary Hospital in January-March/2020. A systematic random sampling method was applied to select the study participants, and pretested and structured questionnaires were used to collect data. The collected data were coded, entered, cleaned, and analyzed using SPSS version 20.0 software. Binary logistic regression analyses with a confidence interval of 95% were used to select determinant factors. Statistically significant factors were identified using the adjusted odds ratio (AOR). Statistical significance was determined at p value <0.05. Binary and multivariable logistic regression analyses were applied to see the association of the variables at a p < 0.05. Results: In this study, the overall proportion of neonatal sepsis was (60.2%) 95% CI (56, 68)]. Birth asphyxia [AOR = 2.04; 95%CI (1.07, 3.93)], maternal age of 15-19 [AOR = 2.00; 95% CI (1.81, 11.93)], duration of labor greater or equal to 24 hours [AOR = 3.00; 95% CI (2.67, 14.21)], history of oxygen administration [AOR = 2.37; 95% CI (1.18, 4.75)], neonatal age of greater or equal to seven days [AOR = 4.0595% CI (1.07, 3.93), and home delivery [AOR = 5.00; 95% CI (2.34, 18.92)] were the predictor variables for neonatal sepsis. Conclusion: In this study, neonatal sepsis was high. Birth asphyxia, intranasal oxygen administration, age of the mother, home delivery, and duration of labor were associated with neonatal sepsis.

Early neonatal mortality and determinants in Ethiopia: multilevel analysis of Ethiopian demographic and health survey, 2019.

INTRODUCTION: Despite remarkable achievements in improving maternal and child health, early neonatal deaths still persist, with a sluggish decline in Ethiopia. As a pressing public health issue, it requires frequent and current studies to make appropriate interventions. Therefore, by using the most recent Ethiopian Mini Demographic Health Survey Data of 2019, we aimed to assess the magnitude and factors associated with early neonatal mortality in Ethiopia. METHODS: Secondary data analysis was conducted based on the demographic and health survey data conducted in Ethiopia in 2019. A total weighted sample of 5,753 live births was included for this study. A multilevel logistic regression model was used to identify the determinants of early neonatal mortality. The adjusted odds ratio at 95% Cl was computed to assess the strength and significance of the association between explanatory and outcome variables. Factors with a p-value of < 0.05 are declared statistically significant. RESULTS: The prevalence of early neonatal mortality in Ethiopia was 26.5 (95% Cl; 22.5-31.08) per 1000 live births. Maternal age 20-35 (AOR, 0.38; 95% Cl, 0.38-0.69), richer wealth index (AOR, 0.47; 95% Cl, 0.23-0.96), having no antenatal care visit (AOR, 1.86; 95% Cl, 1.05-3.30), first birth order (AOR, 3.41; 95% Cl, 1.54-7.56), multiple pregnancy (AOR, 18.5; 95% Cl 8.8-38.9), presence of less than two number of under-five children (AOR, 5.83; 95% Cl, 1.71-19.79) and Somali region (AOR, 3.49; 95% Cl, 1.70-12.52) were significantly associated with early neonatal mortality. CONCLUSION: This study showed that, in comparison to other developing nations, the nation had a higher rate of early newborn mortality. Thus, programmers and policymakers should adjust their designs and policies in accordance with the needs of newborns and children's health. The Somali region, extreme maternal age, and ANC utilization among expectant moms should all be given special consideration.