Neonatal mortality—deaths in newborns, aged 3 weeks and under— has declined in all regions of the world over the past two decades but in 2009, more than half of all neonatal deaths occurred in five countries—India, Nigeria, Pakistan, China, and the Democratic Republic of Congo. Furthermore, over the past 20 years, more than 4% of all babies born live in India died during the first month of life.
These shocking findings come from a comprehensive and detailed analysis led by Mikkel Z Oestergaard, from the World Health Organization and partners published in this week's PLoS Medicine in which the authors used civil registration systems, household surveys, and other data sources to compile statistical models to estimate that in 2009, 3.3 million babies died during their first month of life compared to 4.6 million in 1990.
The authors also estimate that although the global neonatal mortality rate decreased from 33.2 to 23.9 deaths per 1000 live births (a decrease of 28%), neonatal mortality rate actually increased in eight countries, five of which were in Africa. Furthermore, in Africa as a whole, progress in improving neonatal mortality rates is slow and has only decreased by less than 1% per year, from 43.6 per 1000 live births in 1990 to 35.9 per 1000 live births in 2009.
Yet most neonatal deaths are preventable. The authors say: "The majority of neonatal deaths could be prevented with existing interventions including some that can be delivered at community level with potential to reduce neonatal deaths by one-third, such as improved hygiene at birth, breastfeeding, and simple approaches to keeping babies warm."
As there is currently no regular, reliable civil registration data from 92% of the world's births, the authors argue that regular annual reporting of neonatal mortality rates through the UN system should become routine, as is the case for under-five mortality rates. They say: "Many of the 79 million babies who died in the neonatal period since 1990 were born with little or no access to health services and in settings with little health information to drive health system improvement.
According to the authors, if Millennium Development Goal 4 target—to reduce the number of deaths in children aged five and under by two thirds from 1990 levels by 2015— is to be achieved, national governments and international donors and organisations must invest in providing improved care at birth and during the first few weeks of life and in improving methods for measuring neonatal deaths and stillbirths.
The authors say. "If… this needless loss of life prevented, it is essential that national governments, international agencies, and civil society increase attention to systematically preventing and tracking neonatal deaths."
Funding: The study was supported by funding from WHO and grants from the Bill & Melinda Gates Foundation to Save the Children's Saving Newborn Lives program (JEL), SC, and to CHERG. No funding bodies had any role in study design, data collection and analysis, decision to publish, or preparation of the manuscript.
Competing Interests: The authors have declared that no competing interests exist.
Citation: Oestergaard MZ, Inoue M, Yoshida S, Mahanani WR, Gore FM, et al. (2011) Neonatal Mortality Levels for 193 Countries in 2009 with Trends since 1990: A Systematic Analysis of Progress, Projections, and Priorities. PLoS Med 8(8): e1001080. doi:10.1371/journal.pmed.1001080
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