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Objectif : L'infection néonatale bactérienne précoce (INBP) demeure une préoccupation du pédiatre en raison des difficultés diagnostiques et sa morbi-mortalité accrue. Aucun travail antérieur au Mali n'avait étudié l'INBP, d'où l'initiation de ce travail afin d'étudier le profil épidémio-clinique, biologique et bactériologique de l'INBP. Méthode : Etude longitudinale (27 juin-03 septembre 2016) qui a concerné tous les nouveau-nés de 72 heures au plus hospitalisés pour suspicion d'INBP dans le service de néonatologie du CHU Gabriel Touré. L'INBP était définie par la présence de facteurs de risque infectieux maternels et néonataux avec un germe à l'hémoculture. Résultats : Au total, 324 nouveau-nés étaient inclus. La sex-ratio était de 1,6 avec 63,5% de prématurité et 77,8% d'out-born. Les principaux signes cliniques étaient la dysthermie et la détresse respiratoire. Cinquante-deux hémocultures étaient positives sur les 324 réalisées (fréquence hospitalière d'INBP à 11,04%). Les principales bactéries isolées étaient les cocci Gram positifs (Staphylococcus aureus à 55,77% et Streptococccus agalactiae à 03,84%) et les bacilles Gram négatifs (Klebsiella pneumoniae à 13,46 % et E.coli à 07,69%, Pseudomonas aéruginosa à 03,84% et Acinetobacter baumannii à 03,84%) avec une résistance élevée à l'association ceftriaxone + gentamicine (12,5%-100%) et pour une bonne sensibilité à l'association ciprofloxacine + amikacine (100%). La mortalité était de 50% et 19,2% de sortie contre l'avis médical. Conclusion : L'IBNP est une cause majeure de morbi-mortalité néonatale due principalement aux staphylocoques et entérobactéries. Le dépistage et le traitement adéquat de toute infection génitale basse chez la femme enceinte à partir du deuxième trimestre réduirait cette morbi-mortalité.

Objective: Over time, we have seen a major evolution of measurement initiatives, indicators and methods, such that today a wide range of maternal and perinatal indicators are monitored and new indicators are under development. Monitoring global progress in maternal and newborn health outcomes and development has been dominated in recent decades by efforts to set, measure and achieve global goals and targets: the Millennium Development Goals followed by the Sustainable Development Goals. This paper aims to review, reflect and learn on accelerated progress towards global goals and events, including universal health coverage, and better tracking of maternal and newborn health outcomes.Methods: We searched for literature of key events and global initiatives over recent decades related to maternal and newborn health. The searches were conducted using PubMed/MEDLINE and the World Health Organization Global Index Medicus.Results: This paper describes global key events and initiatives over recent decades showing how maternal and neonatal mortality and morbidity, and stillbirths, have been viewed, when they have achieved higher priority on the global agenda, and how they have been measured, monitored and reported. Despite substantial improvements, the enormous maternal and newborn health disparities that persist within and between countries indicate the urgent need to renew the focus on reducing inequities.Conclusion: The review has featured the long story of the progress in monitoring improving maternal and newborn health outcomes, but has also underlined current gaps and significant inequities. The many global initiatives described in this paper have highlighted the magnitude of the problems and have built the political momentum over the years for effectively addressing maternal and newborn health and well-being, with particular focus on improved measurement and monitoring. [ABSTRACT FROM AUTHOR]

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Copyright of African Journal of Reproductive Health is the property of Women's Health & Action Research Centre and its content may not be copied or emailed to multiple sites or posted to a listserv without the copyright holder's express written permission. However, users may print, download, or email articles for individual use. This abstract may be abridged. No warranty is given about the accuracy of the copy. Users should refer to the original published version of the material for the full abstract. (Copyright applies to all Abstracts.)

Objective: Improving civil registration and vital statistics (CRVS) systems is essential to monitoring health objectives locally and globally. The barriers to birth and particularly death registration in low- and middle-income countries are however poorly understood.Methods: We conducted a survey among women of reproductive age in Bissau, the capital of Guinea-Bissau. We asked women with a birth in the past two years whether their child had been registered and had obtained a birth certificate. We elicited the sources of information about birth registration and asked respondents to list their reasons for (not) registering a birth. If their child had died, we asked similar questions about death registration.Results: Most women (86%) had received messages about birth registration, but few women whose child had died had heard about the need to register deaths (22%). The primary sources of information about birth registration were messages broadcast on the radio or displayed at health facilities. Information about death registration was primarily obtained through informal social networks. Only 16% of births, and 2% of deaths, had been registered. The main barriers to birth registration were administrative pre-requisites and paternal absence. The main reasons for not registering a death were lack of knowledge about death registration and lack of perceived benefits.Conclusion: Strengthening CRVS systems requires addressing the specific barriers preventing birth and death registration. In Bissau, interventions to improve knowledge about death registration are needed. Simplifying registration procedures, as well as providing additional incentives, might help improve the coverage of birth registration. [ABSTRACT FROM AUTHOR]

Objective: Although distance has been identified as an important barrier to care, evidence for an effect of distance to care on child mortality is inconsistent. We investigated the association of distance to care with self-reported care seeking behaviours, neonatal and post-neonatal under-five child mortality in rural areas of Burkina Faso.Methods: We performed a cross-sectional survey in 14 rural areas from November 2014 to March 2015. About 100 000 women were interviewed on their pregnancy history and about 5000 mothers were interviewed on their care seeking behaviours. Euclidean distances to the closest facility were calculated. Mixed-effects logistic and Poisson regressions were used respectively to compute odds ratios for care seeking behaviours and rate ratios for child mortality during the 5 years prior to the survey.Results: Thirty per cent of the children lived more than 7 km from a facility. After controlling for confounding factors, there was a strong evidence of a decreasing trend in care seeking with increasing distance to care (P ≤ 0.005). There was evidence for an increasing trend in early neonatal mortality with increasing distance to care (P = 0.028), but not for late neonatal mortality (P = 0.479) and post-neonatal under-five child mortality (P = 0.488). In their first week of life, neonates living 7 km or more from a facility had an 18% higher mortality rate than neonates living within 2 km of a facility (RR = 1.18; 95%CI 1.00, 1.39; P = 0.056). In the late neonatal period, despite the lack of evidence for an association of mortality with distance, it is noteworthy that rate ratios were consistent with a trend and similar to or larger than estimates in early neonatal mortality. In this period, neonates living 7 km or more from a facility had an 18% higher mortality rate than neonates living within 2 km of a facility (RR = 1.18; 95%CI 0.92, 1.52; P = 0.202). Thus, the lack of evidence may reflect lower power due to fewer deaths rather than a weaker association.Conclusion: While better geographic access to care is strongly associated with increased care seeking in rural Burkina Faso, the impact on child mortality appears to be marginal. This suggests that, in addition to improving access to services, attention needs to be paid to quality of those services. [ABSTRACT FROM AUTHOR]

Objective: Lesotho has one of the highest maternal mortality rates in the world. While at primary health care (PHC) level maternity care is free, at hospital level co-payments are required from patients. We describe service utilisation and delivery outcomes before and after removal of user fees and quality of delivery care, and associated costs, at St Joseph's Hospital (SJH) in Roma, Lesotho.Methods: We compared utilisation of delivery services, stillbirths and maternal and neonatal mortality for the periods before (1 July 2012 to 31 December 2013) and after (1 January 2014 to 30 June 2015) user fee removal through a retrospective chart review and estimated additional costs attributed to user fee removal from provider (hospital) and patient perspectives.Results: Of 4715 deliveries 3855 were at SJH and 860 at PHC centres. Of women delivering at SJH 684 (18.5%) were ≤19 years and 894 (23.6%) were HIV positive. After user fee removal hospital deliveries increased by 49% - from 1547 to 2308 - and neonatal mortality decreased from 4.8 to 1.3 per 1000 live births (P = 0.033). Extrapolating costs to the entire country, 1 USD per capita per year would allow user fee removal at hospital level, the provision of free transport to/from and accommodation at hospital.Conclusion: Removing user fees for hospital delivery care in Lesotho is feasible and affordable, and has the potential to improve maternal and neonatal outcomes by removing financial barriers to skilled birth attendants and increasing coverage of institutional deliveries. [ABSTRACT FROM AUTHOR]

Copyright of African Journal of Reproductive Health is the property of Women's Health & Action Research Centre and its content may not be copied or emailed to multiple sites or posted to a listserv without the copyright holder's express written permission. However, users may print, download, or email articles for individual use. This abstract may be abridged. No warranty is given about the accuracy of the copy. Users should refer to the original published version of the material for the full abstract. (Copyright applies to all Abstracts.)

Copyright of African Journal of Reproductive Health is the property of Women's Health & Action Research Centre and its content may not be copied or emailed to multiple sites or posted to a listserv without the copyright holder's express written permission. However, users may print, download, or email articles for individual use. This abstract may be abridged. No warranty is given about the accuracy of the copy. Users should refer to the original published version of the material for the full abstract. (Copyright applies to all Abstracts.)

Copyright of Antropo is the property of Antropo and its content may not be copied or emailed to multiple sites or posted to a listserv without the copyright holder's express written permission. However, users may print, download, or email articles for individual use. This abstract may be abridged. No warranty is given about the accuracy of the copy. Users should refer to the original published version of the material for the full abstract. (Copyright applies to all Abstracts.)

INTRODUCTION: il s'est agit ici de déterminer la fréquence et les facteurs de risques de mortalité néonatale au service néonatologie de l'Etablissement Hospitalier Spécialisé Gynécologie Obstétrique de la wilaya de Sidi Bel Abbés (Ouest Algérien). METHODES: il s'agit d'une étude rétrospective a visée descriptive et analytique porté sur tous les décès de 2011-2012 survenus au service de néonatologie de Sidi Bel Abbes. RESULTATS: au total 1209 cas de mortalité néonatale ont été enregistré durant les deux années (2011-2012), soit une fréquence de 5.3%. Il s'agissait dans 96,85% des cas de mortalité précoce. La mortalité néonatale étant multifactorielle, l'analyse statistique a pu incriminer de façon majoritaire: l'âge maternel avancé (35) (OR = 3.1; IC 95 % (2.30 -4.40); p = 0.001); la multiparité (OR = 8.15; IC 95% (2.85-10.05); p = 0.001); l'infection génitale(OR = 5.3; IC 95% (2.5-6.7); p = 0.001) ; la prématurité (OR = 10.08; IC 95% (3.45-12.02); p = 0.001); le faible poids de naissance (OR = 4.5; IC 95% (1.6-10.5); p = 0.001); l'ictère (OR = 4.8; IC 95% (1.26-6.02; p = 0.001) et la souffrance fétale aigue (OR = 3.4; IC 95% (0.89-5.14); p = 0.001). CONCLUSION: une prise en charge efficace de la grossesse et du nouveau-né dans sa première semaine de vie, devraient amélioraient le pronostic néonatal.

INTRODUCTION: cette étude avait pour but d'étudier la mortalité néonatale hospitalière et les facteurs associés, dans un hôpital de référence de la ville de Douala au Cameroun. METHODES: il s'agit d'une étude de cohorte prospective qui s'est déroulée du 1er janvier au 31 avril 2014 dans l'unité de néonatologie de l'hôpital Laquintinie de Douala. Les nouveau-nés de 0 à 28 jours étaient concernés. Les données sociodémographiques, cliniques et l'évolution hospitalière ont été enregistrées. La durée moyenne d'hospitalisation était de 9,9, 6,9. Les tests du Chi2, de Student et une analyse bivariée ont permis de mesurer les associations entre variables. A l'aide de la régression multivariée les facteurs associés à la mortalité ont été déterminés. Le taux de significativité était de 0,05. RESULTATS: au total,350 nouveau-nés ont été inclus, avec un taux de mortalité de 20,3%. L'hyperthermie était le principal motif de consultation avec 102 (29%) patients. Les principales affections associées au décès étaient: les infections 39 (54,9%) (p = 0,0001), la prématurité 31 (43,6%) (p = 0,05), les troubles de l'adaptation 23 (32,4 %) (p = 0,005), les encéphalopathies 5 (7%) (p = 0,005) et le paludisme 5 (7 %) (p = 0,03). L'on notait comme facteurs associés à cette mortalité, la naissance hors de l'hôpital 51(71,8%) (p= 0,005), la présentation de siège (p = 0,02), l'âge gestationnel =32 semaines (p = 0,005), l'âge =7 jours (p = 0,03) et le poids de naissance = 1500g (p = 0,005). CONCLUSION: le contrôle des facteurs associés à la mortalité peut conduire à une réduction de la mortalité néonatale.

Copyright of African Journal of Reproductive Health is the property of Women's Health & Action Research Centre and its content may not be copied or emailed to multiple sites or posted to a listserv without the copyright holder's express written permission. However, users may print, download, or email articles for individual use. This abstract may be abridged. No warranty is given about the accuracy of the copy. Users should refer to the original published version of the material for the full abstract. (Copyright applies to all Abstracts.)

Introduction: Il s'est agit ici de déterminer la fréquence et les facteurs de risques de mortalité néonatale au service néonatologie de l'Etablissement Hospitalier Spécialisé Gynécologie Obstétrique de la wilaya de Sidi Bel Abbés (Ouest Algérien). Méthodes: Il s'agit d'une étude rétrospective a visée descriptive et analytique porté sur tous les décès de 2011-2012 survenus au service de néonatologie de Sidi Bel Abbes. Résultats: Au total 1209 cas de mortalité néonatale ont été enregistré durant les deux années (2011-2012), soit une fréquence de 5.3%. Il s'agissait dans 96,85% des cas de mortalité précoce. La mortalité néonatale étant multifactorielle, l'analyse statistique a pu incriminer de façon majoritaire: l'âge maternel avancé (>35) (OR = 3.1; IC 95 % (2.30 -4.40); p = 0.001); la multiparité (OR = 8.15; IC 95% (2.85-10.05); p = 0.001); l'infection génitale(OR = 5.3; IC 95% (2.5-6.7); p = 0.001) ; la prématurité (OR = 10.08; IC 95% (3.45-12.02); p = 0.001); le faible poids de naissance (OR = 4.5; IC 95% (1.6-10.5); p = 0.001); l'ictère (OR = 4.8; IC 95% (1.26-6.02; p = 0.001) et la souffrance fœtale aigue (OR = 3.4; IC 95% (0.89-5.14); p = 0.001). Conclusion: Une prise en charge efficace de la grossesse et du nouveau-né dans sa première semaine de vie, devraient amélioraient le pronostic néonatal. [ABSTRACT FROM AUTHOR]

Introduction: cette étude avait pour but d'étudier la mortalité néonatale hospitalière et les facteurs associés, dans un hôpital de référence de la ville de Douala au Cameroun. Méthodes: il s'agit d'une étude de cohorte prospective qui s'est déroulée du 1er janvier au 31 avril 2014 dans l'unité de néonatologie de l'hôpital Laquintinie de Douala. Les nouveau-nés de 0 à 28 jours étaient concernés. Les données sociodémographiques, cliniques et l'évolution hospitalière ont été enregistrées. La durée moyenne d'hospitalisation était de 9,9± 6,9. Les tests du Chi2, de Student et une analyse bivariée ont permis de mesurer les associations entre variables. A l'aide de la régression multivariée les facteurs associés à la mortalité ont été déterminés. Le taux de significativité était de 0,05. Résultats: au total,350 nouveau-nés ont été inclus, avec un taux de mortalité de 20,3%. L'hyperthermie était le principal motif de consultation avec 102 (29%) patients. Les principales affections associées au décès étaient: les infections 39 (54,9%) (p = 0,0001), la prématurité 31 (43,6%) (p < 0,05), les troubles de l'adaptation 23 (32,4 %) (p < 0,005), les encéphalopathies 5 (7%) (p < 0,005) et le paludisme 5 (7 %) (p = 0,03). L'on notait comme facteurs associés à cette mortalité, la naissance hors de l'hôpital 51(71,8%) (p< 0,005), la présentation de siège (p = 0,02), l'âge gestationnel < 0,005), l'âge < 1500g (p < 0,005). Conclusion: le contrôle des facteurs associés à la mortalité peut conduire à une réduction de la mortalité néonatale. [ABSTRACT FROM AUTHOR]

INTRODUCTION: La mortalité néonatale demeure un problème majeur de santé publique dans les pays en développement. Notre étude avait pour but de déterminer la morbidité et la mortalité des nouveau-nés à Ouagadougou, Burkina Faso. METHODES: Une étude rétrospective sur 10 années a permis d'inclure tous les nouveau-nés admis dans l'Unité de Néonatologie de la Clinique El Fateh-Suka.

Objectives To assess the effect of distance to emergency obstetric and newborn care ( Em ONC) services on early neonatal mortality in rural Ethiopia and examine whether proximity to services contributes to socio-economic inequalities in early neonatal mortality. Methods We linked data from the 2011 Ethiopian Demographic and Health Survey with facility data from the 2008 Ethiopian National Em ONC Needs Assessment based on geographical coordinates collected in both surveys. Health facilities were classified based on the performance of nine Em ONC signal functions (e.g. neonatal resuscitation, Caesarean section). We used multivariable logistic regression to assess the relationship between distance to services and early neonatal mortality. A decomposition approach was used to quantify the relative contributions of distance to Em ONC services and other determinants to overall and socio-economic inequality in early neonatal mortality. Results In general, closer proximity to Em ONC services and higher level of care were associated with lower early neonatal mortality. Living more than 80 km from the nearest comprehensive Em ONC facility able to perform all nine signal functions compared to living within 10 km was associated with an increase of 14.4 early neonatal deaths per 1000 live births (95% CI: 0.1, 28.7). Closer proximity to a substandard Em ONC facility compared with no facility was not associated with lower early neonatal mortality. Distance to Em ONC services was an important determinant of early neonatal mortality, although it did not make a significant contribution to explaining socio-economic inequality. Conclusions Our results suggest that recent initiatives by the Ethiopian government to improve geographical access to Em ONC services have the potential to reduce early neonatal mortality but may not affect inequalities. [ABSTRACT FROM AUTHOR]

Copyright of African Population Studies is the property of Union for African Population Studies and its content may not be copied or emailed to multiple sites or posted to a listserv without the copyright holder's express written permission. However, users may print, download, or email articles for individual use. This abstract may be abridged. No warranty is given about the accuracy of the copy. Users should refer to the original published version of the material for the full abstract. (Copyright applies to all Abstracts.)

Introduction: La mortalité néonatale demeure un problème majeur de santé publique dans les pays en développement. Notre étude avait pour but de déterminer la morbidité et la mortalité des nouveau-nés à Ouagadougou, Burkina Faso. Méthodes: Une étude rétrospective sur 10 années a permis d'inclure tous les nouveau-nés admis dans l'Unité de Néonatologie de la Clinique El Fateh-Suka. Résultats: Au total, 697 nouveau-nés étaient hospitalisés sur la période d'étude. Les principaux diagnostics étaient les infections néonatales (23.5 %), les anomalies liées à la durée de la gestation et à la croissance du fœtus (17.9 %) et le paludisme congénital (15.1 %). Les 91 (13.1 %) décès étaient dus aux anomalies liées à la durée de la grossesse et à la croissance du fœtus (46.1 %), à l'hypoxie intra-utérine et à l'asphyxie obstétricale (20,9 %) et aux infections néonatales (17.6 %). Ces décès survenaient dans 81.3 % dans les 72 heures, dans 93.4 % des cas dans la première semaine d'hospitalisation. Le facteur de risque associé à ces décès était la voie basse d'accouchement (p = 0.02). Conclusion: Cette étude a identifié des pathologies évitables déjà décrites comme les principales causes d'hospitalisations et de décès néonatals. La voie basse d'accouchement était le facteur de risque associé à ces décès, ce qui n'avait pas encore été rapporté. Les efforts pour améliorer la qualité des services de soins périnatals doivent être intensifiés afin de réduire la mortalité néonatale dans les pays en développement. [ABSTRACT FROM AUTHOR]

Abstract: Most of the contemporary guidelines on newborn resuscitation are based on experience but lack scientific evidence. The use of 100% oxygen is one of the more evident. Today, these practices are questioned, particularly for the resuscitation of moderately depressed full-term or near-term newborns. Results of recent meta-analysis of trials that compared ventilation with room air versus pure oxygen at birth suggest current practices should be revisited. On the basis of these data, air can be the initial gas to use for these babies. Large-scale trials, including preterm and cause and/or severity of initial asphyxia, must now be undertaken before the publication of new guidelines for these populations. [Copyright &y& Elsevier]

Copyright of Ginecología y Obstetricia de México is the property of Federacion Mexicana de Ginecologia y Obstetricia and its content may not be copied or emailed to multiple sites or posted to a listserv without the copyright holder's express written permission. However, users may print, download, or email articles for individual use. This abstract may be abridged. No warranty is given about the accuracy of the copy. Users should refer to the original published version of the material for the full abstract. (Copyright applies to all Abstracts.)

Copyright of Ginecología y Obstetricia de México is the property of Federacion Mexicana de Ginecologia y Obstetricia and its content may not be copied or emailed to multiple sites or posted to a listserv without the copyright holder's express written permission. However, users may print, download, or email articles for individual use. This abstract may be abridged. No warranty is given about the accuracy of the copy. Users should refer to the original published version of the material for the full abstract. (Copyright applies to all Abstracts.)

Copyright of Ginecología y Obstetricia de México is the property of Federacion Mexicana de Ginecologia y Obstetricia and its content may not be copied or emailed to multiple sites or posted to a listserv without the copyright holder's express written permission. However, users may print, download, or email articles for individual use. This abstract may be abridged. No warranty is given about the accuracy of the copy. Users should refer to the original published version of the material for the full abstract. (Copyright applies to all Abstracts.)

Objective To examine the long-term effects of neonatal hypothermia (HT) on survival. Methods Using the longitudinal community and hospital surveillance system of the Bandim Health Project, we followed children born between 1997 and 2002 at the only maternity ward in the city. All children’s axillary temperature was measured within 12 h of birth. They were followed from birth to 6 months of life through regular home visits. Results We identified 2926 live births in the study area and 177 deaths before 6 months of age. Based on mortality risk, we defined a temperature below 34.5 °C as the cut-off point for HT. Two hundred and thirty-eight (8%) children had HT. Controlled for birth weight, HT was associated with a nearly fivefold increase in mortality during the first 7 days of life [mortality ratio (MR) = 4.81 (2.90–8.00)] and with increased mortality from 8 to 56 days of life [MR = 2.55 (1.29–5.04)]. Conclusion HT is associated with excess mortality beyond the perinatal period up to at least 2 months of age, especially among low-birth-weight children. Hence, failure to comply with the WHO guidelines for care of newborns in low-income countries may have long-term consequences for child survival which have not previously been assessed. The WHO definition of HT should be based on mortality data. [ABSTRACT FROM AUTHOR]

Objectives To assess newborn care-seeking practices in a rural area of Ghana where most births take place at home in order to inform potential strategies for reducing newborn mortality. Methods Qualitative, ethnographic study with quantitative data from a birth cohort collected as part of the surveillance system of an ongoing randomized controlled trial. Data collected comprised 84 h of participant observation (including following an ill newborn through a hospital visit), 14 in-depth interviews with key informants (older mothers and grandmothers), 45 semistructured interviews with mothers, 28 case histories from women who had recently given birth and 32 expert interviews with local health providers. Thirteen focus groups were held with men and women, and narrative histories of newborn deaths were taken from eight women. Birth cohort data came from 2878 singletons born alive in the study district within the year July 2003–June 2004. Results Significant delays in care seeking for ill newborns occur in Kintampo District, Ghana. 2.1% of 2878 newborns in the birth cohort had a serious illness during the first 4 weeks of life, but care was only sought outside the home for 61% of those and from a doctor or hospital for 39%. Barriers to prompt allopathic care seeking include sequential care-seeking practices, with often exclusive use of traditional medicine as first-line treatment for 7 days, previous negative experiences with health service facilities, financial constraints and remoteness from health facilities. Conclusions Improvements in care seeking are urgently needed. Families should be urged to seek medical care for any symptom of illness in a newborn; financial and socio-cultural barriers to care seeking for newborns must be addressed in order to improve neonatal survival. [ABSTRACT FROM AUTHOR]

To examine trends in incidence of multiple births (MB) and their survival in infancy, we used population-based, longitudinal data derived from the Health and Demographic Surveillance System in Matlab, Bangladesh, from 1975 to 2002. Logistic regression was applied to determine the impact of a number of variables on mortality among MB in the first year of life. MB averaged 2% of all live births, but contributed 10% to all infant deaths. Infant mortality among MB was more than five times higher than among singletons. Mortality among MB declined by 27% in 1975–2002, considerably less than the 51% mortality decline among singletons in the same period. Infant mortality among twins and triplets was particularly high among children who were born to young mothers (<20 years), who were the first live birth, who were born after a short birth interval (<24 months) and whose mothers were unschooled. Mortality of MB was lower in the area with easy access to high-quality maternal and child-care services. Thus, good maternity and newborn care will improve the survival of MB. [ABSTRACT FROM AUTHOR]

Abstract: According to WHO estimates, every year 4 millions of newborns die during the first four weeks of life. In Mali, neonatal mortality rate is 57.1‰ (DHS 2001). The aim of this work was to determine the importance as well as factors of neonatal mortality risk in rural area. The cross-sectional survey took place on September 1st to October 4th, 2004 in Kolokani located in the region of Koulikoro in Mali. The authors led an exhaustive investigation of women having delivered one year before the investigation. The rate of birth waited to Kolokani being 5%, they foresaw to interrogate 10,015 womens. The living births represented 97.1% (8242/8486) and stillborns 2.9% (244/8486). Neonatal mortality rate was 24‰ (199/8242) of which 17‰ (140/8486) for early neonatal death and 7‰ (59/8242) for late neonatal mortality. Perinatal mortality rate was 45‰ (384/8242). According to the logistic regression modal, twin pregnancy, mictional itching, low birth weight, feet edema and non cephalic presentation were the risks factors significantly associated with neonatal mortality. The neonatal mortality rate of 24‰ in Kolokani was lower than those reported by DHS 2001 (57.1‰). Factors identified for neonatal mortality were associated with the mother health, the conditions of pregnancy and the childbirth. The authors recommend setting up identification and monitoring system for pregnant women, to train the health staff and to organize the frame of reference between villages and health centers. [Copyright &y& Elsevier]

Abstract: A neonatal death certificate was introduced in France in 1997. It provides detailed data on the causes of death and the characteristics of newborn, birth and parents. Our aim was to describe the new results of this certificate. Method. – All deaths in 1999 in the first 27 days of life were included (N=2036). Certificates were analysed using the usual process, especially following the International Classification of Diseases. Results. – The neonatal death certificate was used for 87% of deaths. The proportion of documented items was 96% for gestational age and birthweight, 87% for maternal age and parity and 70% for maternal occupation. Almost three quarters of the deaths occurred in the first 6 days (36.9% in the first 24 hours and 35.1% between one and six days). 30.5% of the died infants were born before 27 weeks of gestation and 36.5% between 27 and 36 weeks. A shift in medical care was observed at 26 weeks, with an increase in caesarean sections before labour and newborn referrals. In all, 63.3% of neonatal deaths were due to perinatal conditions, and 27.9% to congenital anomalies. The proportion of deaths explained by congenital anomalies was higher for longer gestational age: 14% of deaths between 25 and 28 weeks of gestation vs 38 to 43% between 33 and 42 weeks. Conclusion. – The neonatal death certificate was well accepted; however the data on detailed causes of death and parent''s characteristics were insufficient. Analysis of the circumstances and the causes of death is facilitated with the neonatal death certificate and it will be developped in the future. [Copyright &y& Elsevier]

Objective. – The objective of this study is to answer the question: have we not been doing a lot of caesarean sections at University Teaching Hospital of Dakar?Patients and method. – This is an analytic study about caesarean section in 1992, 1996 and 2001; it was a prospective and longitudinal data collection from the epidemiological survey program carried through in Senegal about its obstetrical and surgical cover. For each year concerned, we have analysed caesarean section rate, maternal mortality rate and perinatal mortality rate. To eliminate the random part in observed variation, we used the comparison of proportions observed as a statistical test with a significant threshold less or equal to 5%.Results. – Caesarean section has gone from 12% in 1992 to 17.5 in 1996 and 25.2% in 2001. Operative indications are dominated by fœto-pelvic disproportion with an average of 31% and fœtal suffering with an average of 25%. The increasing trend has been statistically significant for information’s such as fœto-pelvic disproportion and maternal pathologies. The falling trend was statistically significant for indications in relation on relation to fœtal suffering and scarred uterus. Gathering information has shown a stabilisation of "obligatory" caesarean rate around 41%, a decrease in "caution" caesarean rate from 50 to 37.2% and an increase in caesarean by "necessity" from 8.6 to 22.4%. The maternal mortality rate among women delivered has fallen from 1.4% to 0.8%, but postoperative surgery morbidity rate was still high around 10%, essentially due to infections. Reading of caesarean section rate has not a significant impact in perinatal prognosis.Discussion and conclusion. – Today there is an inflation of caesarean section at University Teaching Hospital of Dakar, without any significant loss of the maternal and perinatal mortality rate. The high level of complications due to surgery incite to reverse trends in order to get reasonable rate around 10 to 15% of childbirths. [Copyright &y& Elsevier]

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Copyright of European Journal of Population is the property of Springer Nature and its content may not be copied or emailed to multiple sites or posted to a listserv without the copyright holder's express written permission. However, users may print, download, or email articles for individual use. This abstract may be abridged. No warranty is given about the accuracy of the copy. Users should refer to the original published version of the material for the full abstract. (Copyright applies to all Abstracts.)