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Children are not born equal in their likelihood of survival. The risk of mortality is highest during and shortly after birth. In the immediate postnatal period and beyond, perinatal events, nutrition, infections, family and environmental exposures, and health services largely determine the risk of death. We argue that current public health programmes do not fully acknowledge this spectrum of risk or respond accordingly. As a result, opportunities to improve the care, survival, and development of children in resource-poor settings are overlooked. Children at high risk of mortality are underidentified and commonly treated using guidelines that do not differentiate care according to the magnitude or drivers of those risks. Children at low risk of mortality are often provided with more intensive care than needed, disproportionately using limited health-care resources with minimal or no benefits. Declines in newborn, infant, and child mortality rates globally are slowing, and further reductions are likely to be incrementally more difficult to achieve once simple, high impact interventions have been universally implemented. Currently, 63 countries have rates of neonatal mortality that are off track to meet the Sustainable Development Goal 2030 target of 12 deaths per 1000 livebirths or less, and 54 countries have rates of mortality in children younger than 5 years that are off track to meet the target of 25 deaths per 1000 livebirths or less. If these targets are to be met, a change of approach is needed to address infant and child mortality and for health-care systems to more efficiently address residual mortality. [ABSTRACT FROM AUTHOR]

Child mortality is very important to be considered by policymakers, especially for developing countries, like Indonesia. Child mortality rates reflect the level of health development of a country and the quality of life of its people. The Government of Indonesia through the 2015-2019 National Medium-Term Development Plan (RPJMN) has set a target of achieving a reduction in infant mortality of 24 per 1000 births in 2019. Achievement targets that have been made, are intended to follow the major goals of the Sustainable development goals (SDGs) in health and welfare. The government has issued a policy to reduce child mortality through programs such as Healthy Indonesia with a family approach through Permenkes no.39 of 2016. Based on data obtained by the Indonesian Central Statistics Agency (BPS), it was found that neonatal mortality, infant mortality, and infant mortality from 1991 to 2017 there was a decline which meant that there was progress in efforts to reduce child mortality. The success of the Government of Indonesia in reducing child mortality can not be separated from the use of expert theory well. the theories used as references are those of Mosley and Chen, and Filmer who states that children's survival is influenced by social, economic, and biomedical factors. [ABSTRACT FROM AUTHOR]

Objective: Child mortality and stillbirth rates (SBR) remain high in low‐income countries but may be underestimated due to incomplete reporting of child deaths in retrospective pregnancy/birth histories. The aim of this study is to compare stillbirth and mortality estimates derived using two different methods: the method assuming full information and the prospective method. Methods: Bandim Health Project's Health and Demographic Surveillance Systems (HDSS) follows women of reproductive age and children under five through routine home visits every 1, 2 or 6 months. Between 2012 and 2020, we estimated and compared early neonatal (ENMR, <7 days), neonatal (NMR, <28 days), and infant mortality (IMR, <1 year) per 1000 live births and SBR per 1000 births. Risk time for children born to registered women was calculated from birth (the method assuming full information) versus date of first observation in the HDSS (the prospective method), either at birth (for pregnancy registration) or registration. Rates were calculated using the Kaplan–Meier estimator and compared in generalised linear models allowing for within‐child correlation obtaining relative risks (RR). Results: We registered and followed 29,413 infants (1380 deaths; 1459 stillbirths) prospectively. An additional 164 infant deaths and 129 stillbirths were registered retrospectively and included in the method assuming full information. The ENMR was 24.5 (95%CI: 22.6–26.4) for the method assuming full information and 25.8 (23.7–27.8) for the prospective method, RR = 0.96 (0.93–0.99). Differences were smaller for the NMRs and IMRs. For SBRs, the estimates were 53.5 (50.9–56.0) and 58.6 (55.7–61.5); RR = 0.91 (0.90–0.93). The difference between methods became more pronounced when the analysis was limited to areas visited every 6 months: RR for ENMR: 0.91 (0.86–0.96) and RR for SBR: 0.85 (0.83–0.87). Conclusions: Assuming full information underestimates SBR and ENMR. Accounting for omissions of stillbirths and early neonatal deaths may lead to more accurate estimates and improved ability to monitor mortality. [ABSTRACT FROM AUTHOR]

Objective: To describe the spatio-temporal distribution of infant mortality and its components in the city of Rio de Janeiro, Brazil, in 2010 and 2019. Methods: Infant mortality rate and the neonatal and postneonatal components were estimated. The standardized mortality rate was calculated to detect excess child mortality in the planning areas. Poisson regression was performed to estimate the effect of these planning areas on the years 2010 and 2019. Spatial analysis per neighborhoods was performed to identify the spatial autocorrelation rates, using the Moran's Index and local indicator of spatial association (LISA). Results: The planning areas are very heterogeneous, depending on the history and evolution of occupation. There is an excess of mortality in planning areas with greater social vulnerability. In the Poisson model, it was observed that in all components, the planning area (PA) of residence was statistically significant as well as the year. Moran's index did not show global spatial autocorrelation. However, when applying the LISA method, autocorrelation was observed at the local level and spatial clusters in the municipality of Rio de Janeiro. Conclusions: The spatial heterogeneity of the infant mortality rate in Rio de Janeiro suggests that local health policy strategies of each region consist in an efficient measure for reducing this rate. [ABSTRACT FROM AUTHOR]

The article discusses a study which investigated the levels and trends in child mortality in 187 countries from 1970 to 2010. Study authors utilized a database containing 16,174 measurements of mortality in children younger than five years and used Gaussian process regression to generate estimates. They found that the worldwide mortality of children younger than five years decreased from 11.9 million in 1990 to 7.7 million in 2010. Global decline in neonatal mortality was 2.1 percent, 2.3 percent in postneonatal mortality and 2.2 percent in childhood mortality. Study authors also concluded that the declining rates of child mortality should be given more policy attention.

Background: There has been a considerable decline in fetal and neonatal mortality in the Western world. The authors hypothesized that this decline has been largest for boys, since boys have a higher risk of fetal and neonatal death. Methods: The authors used data from the Medical Birth Registry about all births in Norway to study changes during 1967-2005 in mortality for boys and girls from the 23rd week of pregnancy until one month after birth. Absolute and relative yearly changes in fetal and neonatal death rates were estimated separately for boys and girls. Results: From 1967 to 2005, the average annual reduction in the overall death rate was greater for boys: 0.47 per 1000 boys (95% CI: 0.45, 0.48) and 0.37 per 1000 girls (95% CI: 0.35, 0.39). These estimates were not affected by adjustments made for changes over time in maternal characteristics. The convergence in death rates by sex was strongest for the first week after birth: average annual reduction in the early neonatal death rate was 0.24 per 1000 boys (95% CI: 0.23, 0.25) and 0.17 per 1000 girls (95% CI: 0.16, 0.18). The death rates for boys and girls also converged during pregnancy and from one week to one month after birth. The relative reduction in death rates was quite similar for boys and girls: the overall death rate fell annually by 4.4% (95% CI: 4.3, 4.6%) for boys and by 4.2% (95% CI: 4.0, 4.4%) for girls. Conclusions: During the period 1967-2005, the absolute reduction in fetal and neonatal death rates was greatest for boys. The relative reduction in mortality was about the same for both sexes, but the absolute reduction was greatest for boys since the mortality for boys began at a higher level. The convergence of death rates was not due to changes in the composition of mothers, suggesting that convergence has been caused by technological progress. [ABSTRACT FROM AUTHOR]

Neonatal (NMR), infant (IMR) and under-five (U5M) mortality rates remain high in Nigeria. Evidence-based knowledge of trends and drivers of child mortality will aid proper interventions needed to combat the menace. Therefore, this study assessed the trends and drivers of NMR, IMR, and U5M over a decade in Nigeria. A nationally representative data from three consecutive Nigeria Demographic and Household Surveys (NDHS) was used. A total of 66,158 live births within the five years preceding the 2003 (6029), 2008 (28647) and 2013 (31482) NDHS were included in the analyses. NMR was computed using proportions while IMR and U5 were computed using life table techniques embedded in Stata version 12. Probit regression model and its associated marginal effects were used to identify the predisposing factors to NMR, IMR, and U5M. The NMR, IMR, and U5M per 1000 live births in 2003, 2008 and 2013 were 52, 41, 39; 100, 75, 69; and 201, 157, 128 respectively. The NMR, IMR, and U5M were consistently lower among children whose mothers were younger, living in rural areas and from richer households. Generally, the probability of neonate death in 2003, 2008 and 2013 were 0.049, 0.039 and 0.038 respectively, the probability of infant death was 0.093, 0.071 and 0.064 while the probability of under-five death was 0.140, 0.112 and 0.092 for the respective survey years. While adjusting for other variables, the likelihood of infant and under-five deaths was significantly reduced across the survey years. Maternal age, mothers’ education, place of residence, child’s sex, birth interval, weight at birth, skill of birth attendant, delivery by caesarean operation or not significantly influenced NMR, IMR, and U5M. The NMR, IMR, and U5M in Nigeria reduced over the studied period. Multi-sectoral interventions targeted towards the identified drivers should be instituted to improve child survival. [ABSTRACT FROM AUTHOR]

Objective: The current study assessed intake of iron-and-folic-acid (IFA) tablet/syrup (grouped into none, < 100 d of IFA consumption or < 100 IFA and ≥ 100 d of IFA consumption or ≥ 100 IFA) among prospective mothers and its association with various stages of low-birth weight (ELBW, extremely low-birth weight; VLBW, very low-birth weight and LBW, low-birth weight) and neonatal mortality (death during day 0-1, 2-6, 7-27 and 0-27) in India.Design: The cross-sectional, nationally representative, 2015-2016 National Family Health Survey (NFHS-4) data were used. Weighted descriptive analysis and multiple binary logistic regression modelling were used.Setting: NFHS-4 covered 640 districts from thirty-seven states and union territories of India.Participants: A total of 120 374 and 143 675 index children aged 0-59 months were included to analyse LBW and neonatal mortality, respectively.Results: Overall, 30·7 % mothers consumed ≥ 100 IFA in 2015-2016, and this estimate ranged from 0·0 % in Zunheboto district of Nagaland state to 89·5 % in Mahe district of Puducherry of India. Multiple regression analysis revealed that children of mothers who consumed ≥ 100 IFA had lower odds of ELBW, VLBW, LBW and neonatal mortality during day 0-1, as compared with mothers who did not buy/receive any IFA. Consumption of IFA (< 100 IFA and ≥ 100 IFA) had a protective association with neonatal death during day 7-27 and 0-27. Consumption of IFA was not associated with neonatal death during day 2-6.Conclusions: While ≥ 100 IFA consumption during pregnancy was found to be associated with preventing select types of LBW and neonatal mortality, a large variation in coverage of ≥ 100 IFA consumption across 640 districts is concerning. [ABSTRACT FROM AUTHOR]

This paper employs individual level cause of death data from the port city of Hermoupolis on the Greek island of Syros, in order to test the newly-constructed ICD10h coding system. By constructing cause specific death rates for infants from the late 19th century to early 20th century, the paper contributes to a comparative approach, which aims to show how causes of death differ across several locations within Europe and how they develop over time. Given the scarcity of cause of death data both at the individual and aggregate level in Greece roughly prior to the 1920s, the availability of such data in the draft death registers (for sporadic runs of years in the second half of the 19th and early 20th century) and the civil registration (from 1916 onwards) in Hermoupolis provides a deeper understanding of the history of cause-of-death reporting in the country. Infant mortality in Hermoupolis was relatively high throughout the study period, with water-food borne diseases accounting for the highest number of infant deaths, especially during the hot and dry summer months. While the prominent winter peak of neonatal mortality but also congenital-birth disorders could be partially associated with birth seasonality and/or low temperatures over the winter months. Finally, certain vague terms such as 'atrophy' and 'athrepsy', but especially 'drakos' require further investigation until they are firmly understood. [ABSTRACT FROM AUTHOR]

Sepsis is the organ dysfunction resulting from an infection associated with an unregulated host inflammatory response, which generates high mortality rates in Brazil. The aim of this stydy was to analyze the trend of early, late and post-neonatal mortality rates due to sepsis in Brazilian regions, from 2009 to 2018. This is an ecological study of time series. The trend of infant mortality from sepsis was analyzed using the International Classification of Diseases (ICD10) according to the place of residence (North, Northeast, Southeast, South and Midwest). Death Certificate data were collected from the Mortality Information System database. The temporal trend was analyzed using the Prais-Winsten estimate, interpreted as increasing, decreasing or stable, through the dependent variable (logarithm of mortality rates) and interdependent variables (years of the historical series). The Stata 14.0 statistical software was used. There were 39,867 infant deaths due to sepsis (78.67% for unspecified bacterial sepsis of the neonate). Most of the children were male, had mixed ethnicity (black and white), were born preterm with low birth weight and most mothers were 20-34 years old. There were decreasing trends in mortality rates from 2009 to 2018: early neonatal, in the Southeast (-3.57%), North (-3.33%) and South (-2.91%); late neonatal, in the South (-4.12%), Southeast (-4.53%), North (-4.55%) and Midwest (-6.21%); and post-neonatal, in the Northeast (-1.84%), North (-3.62%), Southeast (-3.83%) and Midwest (-5.81%). The Northeast showed a stable trend in early and late neonatal mortality rates. It was concluded that most regions showed a decreasing trend in mortality rates from sepsis in all age components, despite regional differences. [ABSTRACT FROM AUTHOR]

Background Birth before 28 weeks of gestation is associated with high mortality and morbidity. The purpose of this study was to examine characteristics associated with in-hospital mortality and morbidity among extremely low-birthweight neonates admitted to three tertiary care centers in Romania. Methods The study was conducted in three Romanian hospitals with level- III neonatal intensive care units. We studied singleton live births at the established Romanian limit of viability (i.e., 25-28 weeks' gestational age) born between January 2007 and December 2010 ( n = 227). Infants born in non-level-III facilities transferred to these three centers were included in our study ( n = 39). Descriptive and multivariate statistical analyses were used to describe the population and examine outcomes and risk factors. Results During the study period, 62 neonates (27.3%) were delivered at 25 weeks, 56 (24.7%) were delivered at 26 weeks, 56 (24.7%) at 27 weeks, and 53 (23.3%) at 28 weeks. Overall in-hospital mortality was 65% (from 85% at 25 weeks to 35% at 28 weeks). The rates for major morbidities were necrotizing enterocolitis 8.8%, bronchopulmonary dysplasia 12.5%, and retinopathy of prematurity (stage higher than 2) 26.2%. Conclusions During 2007-2010, in-hospital survival of infants admitted to three neonatal intensive care units in Romania was 35% and ranged from 14% at 25 weeks to 64% at 28 weeks. [ABSTRACT FROM AUTHOR]

To determine differential improvements in mortality rates according to age, and to discuss differences in neonatal and post-neonatal mortality rates, using longitudinal data from the past 50 years in three rural Gambian villages.All villagers whose date of birth was recorded were followed up until death or October 1997. A Lexis expansion was performed to categorize age: early neonatal, late neonatal, infant, 1–4 years, 5–14 years and 15 or more years. Calendar time was divided into three periods– prior to 1975, 1975–1984 and after 1985, representing different levels of clinical care. Cox regression and likelihood-ratio test were used to model the hazards ratios.There were 3981 subjects included in the analysis with a total of 59 002 person-years follow-up. There was a dramatic decrease in neonatal (44 to 15), infant (162 to 36) and under-five mortality rates (397–66 per 1000) from pre-1975 to the present. The disproportionate decrease in the mortality rates means that neonatal deaths accounted for a greater percentage of post-natal deaths in later years. There was a marked seasonality in mortality rates with significantly more deaths in the‘hungry’ season prior to 1975 (odds = 1.87; 95% CI = 1.62–2.17) and from 1975 to 1984 (odds = 1.84; 95% CI = 1.34–2.53). This seasonality of death has diminished in recent years (odds = 1.23; 95% CI = 0.85–1.76).Our analysis indicates a dramatic reduction in mortality rates and an attenuation in the seasonality of death. It is likely that the efficient implementation of basic currently available health measures was one of the key elements in achieving such a major reduction in mortality. [ABSTRACT FROM AUTHOR]