Neonatal mortality risk of vulnerable newborns: A descriptive analysis of subnational, population‐based birth cohorts for 238 203 live births in low‐ and middle‐income settings from 2000 to 2017
Elizabeth Hazel, Daniel J. Erchick, Joanne Katz, Anne CC Lee, Michael J. Diaz, Lee Wu, Keith P. West, Abu Ahmed Shamim, Parul Christian, Hasmot Ali, Abdullah H Baqui, Samir K. Saha, Salahuddin Ahmed, Arunangshu Dutta Roy, Mariângela Freitas da Silveira, Romina Buffarini, Roger Shapiro, Rebecca Zash, Patrick Kolsteren, Carl Lachat, Lieven Huybregts, Dominique Roberfroid, Zhonghai Zhu, Lingxia Zeng, Seifu Hagos Gebreyesus, Kokeb Tesfamariam, Seth Adu‐Afarwuah, Kathryn G. Dewey, Stephaney Gyaase, Kwaku Poku‐Asante, Ellen Boamah Kaali, Darby Jack, Thulasiraj Ravilla, James M. Tielsch, Sunita Taneja, Ranadip Chowdhury, Per Ashorn, Kenneth Maleta, Ulla Ashorn, Charles Mangani, Luke C. Mullany, Subarna K. Khatry, Vundli Ramokolo, Wanga Zembe‐Mkabile, Wafaie Fawzi, Dongqing Wang, Christentze Schmiegelow, Daniel T. R. Minja, Omari Abdul Msemo, John Lusingu, Emily R. Smith, Honorati Masanja, Aroonsri Mongkolchati, Paniya Keentupthai, Abel Kakuru, Richard Kajubi, Katherine Semrau, Davidson H. Hamer, Albert Manasyan, Jake M. Pry, Bernard Chasekwa, Jean H. Humphrey, Robert E. Black, Subnational Collaborative Group for Vulnerable Newborn Mortality, Vulnerable Newborn Measurement Core Group
Abstract
OBJECTIVE: We aimed to understand the mortality risks of vulnerable newborns (defined as preterm and/or born weighing smaller or larger compared to a standard population), in low- and middle-income countries (LMICs). DESIGN: Descriptive multi-country, secondary analysis of individual-level study data of babies born since 2000. SETTING: Sixteen subnational, population-based studies from nine LMICs in sub-Saharan Africa, Southern and Eastern Asia, and Latin America. POPULATION: Live birth neonates. METHODS: We categorically defined five vulnerable newborn types based on size (large- or appropriate- or small-for-gestational age [LGA, AGA, SGA]), and term (T) and preterm (PT): T + LGA, T + SGA, PT + LGA, PT + AGA, and PT + SGA, with T + AGA (reference). A 10-type definition included low birthweight (LBW) and non-LBW, and a four-type definition collapsed AGA/LGA into one category. We performed imputation for missing birthweights in 13 of the studies. MAIN OUTCOME MEASURES: Median and interquartile ranges by study for the prevalence, mortality rates and relative mortality risks for the four, six and ten type classification. RESULTS: There were 238 203 live births with known neonatal status. Four of the six types had higher mortality risk: T + SGA (median relative risk [RR] 2.6, interquartile range [IQR] 2.0-2.9), PT + LGA (median RR 7.3, IQR 2.3-10.4), PT + AGA (median RR 6.0, IQR 4.4-13.2) and PT + SGA (median RR 10.4, IQR 8.6-13.9). T + SGA, PT + LGA and PT + AGA babies who were LBW, had higher risk compared with non-LBW babies. CONCLUSIONS: Small and/or preterm babies in LIMCs have a considerably increased mortality risk compared with babies born at term and larger. This classification system may advance the understanding of the social determinants and biomedical risk factors along with improved treatment that is critical for newborn health.