Neonatal mortality of Low birth-weight infants in Bangladesh Group 7 IMOUKHUEDE IZIEN Bobby Birhiray MOGAKA EDWIN DOMINIQUE FOH Ehsan keshani

Introduction Perinatal and neonatal mortality are increasingly important public health issues in many developing countries, as post neonatal mortality rates fall. Bangladesh: Infant mortality rate has fallen this century from 200 deaths per thousand live births to approximately 80 deaths per thousand live births. Neonatal deaths account for about 2/3rd of 8 million infant deaths globally each year. Neonatal mortality rate in Bangladesh was recently estimated to be 65 deaths/1000 live births. This rate can be different by location (rural, urban and other locations) Low birth weight (less than 2500 g) is a well documented risk factor for neonatal mortality. Bangladesh for example: LBW prevalence varies between 23% and 60% Despite the importance of LBW as a risk facto only a few prospective studies of outcome for LBW infants in developing countries have been done. Definition of LBW is not clear: LWB due to premature neonates vs. neonate who are just born small. As result there is a lack of information about infant mortality rate within he first 4 weeks. This has hindered the development of appropriate interventions

Objective: To ascertain he role of low birth weight in neonatal mortality in a periurban setting in Bangladesh

Methods and Materials The criteria Infants weighing 2.5kg and that they completed 28 gestational weeks. Their families lived within 80km of the study site. All mothers who qualified gave their verbal consent. All neonates that did not meet the criteria were ruled out. Still and live births were counted Soehnle 831000 scale Soehnle 7209 (0-130 kg weight range; 200g accuracy) Rollametre (plastic roll-up mat with 0.5cm accuracy) Plastic tape (1mm accuracy) Minimeter 183 (wall-hung plastic injection- moulded scale; 1mm accuracy) Intercooled STATA 5.0 for MacIntosh

Methods and Materials Design: One month induction period comprised a week of discussion, planning and questionnaire design, a week of anthropometric and clinical assessment training, a week of clinical practice, and a week of questionnaire pretesting modification and piloting. Cohort study that recruited maternity service at Mitford Hospital, a government run center which host about 4000 deliveries per year. It measured neonates who were recruited prospectively and followed up at one month of age. The neonates were recruited after delivery in a hospital in Dhaka, Bangladesh, and 776 were successfully followed up either at home or, in the event of early death in hospital

Methods and Materials method method Maternal post-delivery weight and height were measured using the Soehnle 7209 scale and the Minimeter 183. Mothers filled out questionnaires addressing past obstetric history, history of present pregnancy, and socieoeconomic factors. Data from the questionnaires was collected and reviewed until finally being compiled into an electronic database. STATA 5.0 was used to analyze the data and baseline characteristics were further analyzed using ANOVA and analogous nonparametric tests. Finally, mortality rates were computed. 6 days a week enrollment. (Excluding religious holiday and strike days) Every birth attended by study team member 4 Ped Medical Officers and 1 clerical assistant Study team prepared for 1 month Discussion, planning, and questionnaire design Anthropometric and clinical assessment training (1 week) In clinical practice (1 week) Questionnaire pre-testing, modification, and piloting (1 week) Shortly after birth, infant birth weight, length, circumference of head, mid-upper arm, and chest were measured using the Soehnle 831000 scale, Rollametre mat, and plastic tape respectively. Gestational age was assessed using the +.

Method Infants anthropometric data were recorded at the time of birth. Birth weight and birth length were measured. Circumference of head was measured as well. Maternal postdelivery weight was measured with women lightly clothed and weight range was 0- 130kg. Questionnaires were administered within a few hours of birth and covered areas that included past obstetric history, history of the present pregnancy and socioeconomic factor. LBW was defined as a birth weight of less than 2500g, regardless of gestational age. Preterm delivery implied a gestation at birth of less than 37 completed weeks, while term was defined as a gestational age of 37–42 completed weeks. Baseline characteristics were analysed with two- sample comparison of means, one-way ANOVA and analogous nonparametric tests. Mortality rates were computed arithmetically and confidence intervals estimated using binomial methods.

Results 78% were anemic. 23 % of the mothers received no neonatal care, 48% were primiparous, and 3% were delivering their 5th child The birth weights of the cohort infants were at the lower end of a normal distribution and were therefore nonparametrically distributed. 94% of infants with birth weights less than 1500 g were preterm, compared with only 25% of infants with birth weights between 2000 and 2500 g Of 937 live-born infants enrolled in the study , outcome data were available for 776, representing a loss to follow-up of 17%. The monthly income of most cohort families was under 3000 taka (US$ 66). Most of the mothers were Muslim (77%) and about 1/3 received no formal schooling, 1/2 had been educated at primary level. 27% married in their teens Maternal post-delivery weight was normally distributed about a mean of 47 kg with a standard deviation (SD) of 6.1 kg;

Socioeconomic & Demographic Findings Variable Average Maternal education Primary Paternal education Family income Under US$ 66 Maternal age at marriage Under 20 Maternal post-delivery weight 47 Kg – SD:6.1

Outcome There were 103 neonatal deaths, of which 43 occurred within 48 hours of birth, and 87 within the first six days; 81 of the deaths occurred in hospital, 22 at home. Birth asphyxia and infection were noted on the autopsies. The data show that the overall Neonatal Mortality Rate was 133, the Early Neonatal Mortality Rate was 112 and the L ate Neonatal Mortality Rate 21 per thousand live births . Preterm infants were five times as likely to die as term infants. Infants born at fewer than 32 weeks of gestation had a Neonatal Mortality Rate comparable to that of Very Low Birth Weight infants.

Discussion The study found that 84% of cohort deaths occurred in the first week of extrauterine life, half within the first 48 hours. This is generally consistent with previous findings from Bangladesh indicating that 21% of neonates die within the first three days ; comparable results have been reported for Brazil . By contrast though , another study done in Gambia suggested that early and late neonatal deaths were roughly equal , although early deaths may have been underreported.

Discussion The data also showed that VLBW is strongly associated with high mortality. VLBW infants made up only 7% of the LBW total, but accounted for a third of infant deaths and had a mortality rate of 780 per thousand live births. Like VLBW, lower gestational age at birth also carries a high mortality risk (769 per thousand live births at less than 32 weeks). 75% of all deaths occurred in preterm infants, even though they constituted only a third of all LBW infants.

Discussion & Conclusion The majority of LBW infants in developing countries were small-for-dates rather than preterm , and the high prevalence of LBW can be explained mainly on the basis of IUGR. Programmatic agendas should include both the prevention of preterm delivery and the prevention and reduction of IUGR Discussion & Conclusion It may not be possible to generalize the conclusions of this study because the cohort was recruited from a hospital, where service users tend to come from groups with higher socioeconomic status and lower exposure to risk. Loss to follow-up is also likely to be biased towards social groups at higher risk of mortality, so that late neonatal deaths may have been overrepresented in the dropout group There may also be a systematic downward bias in the assessment of gestational age, since the researchers relied, of necessity, on the method of Capurro. The group of preterm neonates was likely over-ascribed, since infants with intrauterine growth retardation (IUGR) may achieve lower scores on such profiles.

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