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Variation in neonatal mortality and its relation to country characteristics in sub-Saharan Africa: an ecological study.

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Kayode, Gbenga Ayodele, Grobbee, Diederick E, Amoakoh-Coleman, Mary, Ansah, Evelyn, Uthman, Olalekan A. and Klipstein-Grobusch, Kerstin (2017) 'Variation in neonatal mortality and its relation to country characteristics in sub-Saharan Africa: an ecological study.'. BMJ Global Health, Vol 2, Issue 4, e000209.

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Abstract

A substantial reduction in neonatal mortality is the main priority to reduce under-five mortality. A clear understanding of the variation in neonatal mortality and the underlying causes is important for targeted intervention. We aimed to explore variation in neonatal mortality and identify underlying causes of variation in neonatal mortality in sub-Saharan Africa (SSA). This ecological study used 2012 publicly available data from WHO, the US Agency for International Development and the World Bank. Variation in neonatal mortality across 49 SSA countries was examined using control chart and explanatory spatial data analysis. Associations between country-level characteristics and neonatal mortality were examined using linear regression analysis. The control chart showed that 28 (57%) SSA countries exhibited special-cause variation, 14 countries were below and 14 above the 99.8% control-limits. The remaining 21 (43%) SSA countries showed common-cause variation. No spatial clustering was observed for neonatal mortality (Global Moran's I statistic -0.10; p=0.74). Linear regression analysis showed HIV/AIDS prevalence among the population of reproductive age to be positively associated with neonatal mortality (β=0.463; 95% CI 0.135 to 0.790; p<0.01). Declining socioeconomic deprivation (β=-0.234; 95% CI -0.424 to -0.044; p<0.05) and high quality of healthcare governance (β=-1.327, 95% CI -2.073 to -0.580; p<0.01) were inversely associated with neonatal mortality. This study shows a wide variation in neonatal mortality in SSA. A substantial part of this variation can be explained by differences in the quality of healthcare governance, prevalence of HIV and socioeconomic deprivation. Future studies should validate our findings using more rigorous epidemiological study designs.

Item Type: Article
Subjects: WA Public Health > WA 30 Socioeconomic factors in public health (General)
WQ Obstetrics > Labor > WQ 330 Complications of labor
WS Pediatrics > By Age Groups > WS 420 Newborn infants. Neonatology
WS Pediatrics > By Age Groups > WS 430 Infancy
Faculty: Department: Clinical Sciences & International Health > International Public Health Department
Digital Object Identifer (DOI): https://doi.org/10.1136/bmjgh-2016-000209
SWORD Depositor: JISC Pubrouter
Depositing User: Stacy Murtagh
Date Deposited: 17 Nov 2017 16:49
Last Modified: 15 Feb 2018 11:39
URI: http://archive.lstmed.ac.uk/id/eprint/7831

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