Neonatal mortality risk of vulnerable newborns: A descriptive analysis of subnational, population-based birth cohorts for 238 143 live births in low- and middle-income settings from 2000 to 2017

Research output: Contribution to journalJournal articlepeer-review

  • Elizabeth A. Hazel
  • Daniel J. Erchick
  • Joanne Katz
  • Anne C.C. Lee
  • Michael Diaz
  • Lee S.F. Wu
  • Keith P. West
  • Abu Ahmed Shamim
  • Parul Christian
  • Hasmot Ali
  • Abdullah H. Baqui
  • Samir K. Saha
  • Salahuddin Ahmed
  • Arunangshu Dutta Roy
  • Mariângela F. Silveira
  • Romina Buffarini
  • Roger Shapiro
  • Rebecca Zash
  • Patrick Kolsteren
  • Carl Lachat
  • Lieven Huybregts
  • Dominique Roberfroid
  • Zhonghai Zhu
  • Lingxia Zeng
  • Seifu H. Gebreyesus
  • Kokeb Tesfamariam
  • Seth Adu-Afarwuah
  • Kathryn G. Dewey
  • Stephaney Gyaase
  • Kwaku Poku-Asante
  • Ellen Boamah Kaali
  • Darby Jack
  • Thulasiraj Ravilla
  • James 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 W. Fawzi
  • Dongqing Wang
  • Daniel Minja
  • Omari Abdul Msemo
  • John P.A. 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 Humphrey
  • Robert E. Black
  • Rolf D.W. Klemm (Member of author collaboration)
  • Allan B. Massie (Member of author collaboration)
  • Maithilee Mitra (Member of author collaboration)
  • Sucheta Mehra (Member of author collaboration)
  • Kerry J. Schulze (Member of author collaboration)
  • Alfred Sommer (Member of author collaboration)
  • Md Barkat Ullah (Member of author collaboration)
  • Alain B. Labrique (Member of author collaboration)
  • Mabhubur Rashid (Member of author collaboration)
  • Saijuddin Shaikh (Member of author collaboration)
  • Nazma Begum (Member of author collaboration)
  • Nabidul Haque Chowdhury (Member of author collaboration)
  • Md Shafiqul Islam (Member of author collaboration)
  • Rasheda Khanam (Member of author collaboration)
  • Dipak Kumar Mitra (Member of author collaboration)
  • Abdul Quaiyum (Member of author collaboration)
  • Modiegi Diseko (Member of author collaboration)
  • Joseph Makhema (Member of author collaboration)
  • Yue Cheng (Member of author collaboration)
  • Meselech Roro (Member of author collaboration)
  • Bilal Shikur Endris (Member of author collaboration)
  • Charles D. Arnold (Member of author collaboration)
  • Rajiv Bahl (Member of author collaboration)
  • Nita Bhandari (Member of author collaboration)
  • Jose Martines (Member of author collaboration)
  • Sarmila Mazumder (Member of author collaboration)
  • Lotta Hallamaa (Member of author collaboration)
  • Juha Pyykkö (Member of author collaboration)
  • Willy Urassa (Member of author collaboration)
  • Phillippe Deloron (Member of author collaboration)
  • Sofie Lykke Moeller (Member of author collaboration)
  • Alfa Muhihi (Member of author collaboration)
  • Ramadhani Abdallah Noor (Member of author collaboration)
  • Moses R. Kamya (Member of author collaboration)
  • Miriam Nakalembe (Member of author collaboration)
  • Godfrey Biemba (Member of author collaboration)
  • Julie M. Herlihy (Member of author collaboration)
  • Reuben K. Mbewe (Member of author collaboration)
  • Fern Mweena (Member of author collaboration)
  • Kojo Yeboah-Antwi (Member of author collaboration)
  • Andrew Prendergast (Member of author collaboration)
  • Joy E. Lawn (Member of author collaboration)
  • Hannah Blencowe (Member of author collaboration)
  • Eric Ohuma (Member of author collaboration)
  • Yemi Okwaraji (Member of author collaboration)
  • Judith Yargawa (Member of author collaboration)
  • Ellen Bradley (Member of author collaboration)
  • Lorena Suarez Idueta (Member of author collaboration)

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 238 143 live births with known neonatal status. Four of the six types had higher mortality risk: T + SGA (median relative risk [RR] 2.8, interquartile range [IQR] 2.0–3.2), 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.

Original languageEnglish
JournalBJOG: An International Journal of Obstetrics and Gynaecology
ISSN1470-0328
DOIs
Publication statusAccepted/In press - 2023

Bibliographical note

Publisher Copyright:
© 2023 The Authors. BJOG: An International Journal of Obstetrics and Gynaecology published by John Wiley & Sons Ltd.

    Research areas

  • low-and middle-income countries, obstetrics and gynaecology, paediatrics: neonatal, preterm, small-for-gestational age

ID: 347696671