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Abstract：
BACKGROUND: Recent modelled estimates suggest that Niger made progress in maternal mortality since 2000. However, neonatal mortality has not declined since 2012 and maternal mortality estimates were based on limited data. We researched the drivers of progress and challenges.
METHODS: We reviewed two decades of health policies, analysed mortality trends from United Nations data and six national household surveys between 1998 and 2021 and assessed coverage and inequalities of maternal and newborn health indicators. Quality of care was evaluated from health facility surveys in 2015 and 2019 and emergency obstetric assessments in 2011 and 2017. We determined the impact of intervention coverage on maternal and neonatal lives saved between 2000 and 2020. We interviewed 31 key informants to understand the factors underpinning policy implementation.
RESULTS: Empirical maternal mortality ratio declined from 709 to 520 per 100 000 live births during 2000-2011, while neonatal mortality rate declined from 46 to 23 per 1000 live births during 2000-2012 then increased to 43 in 2018. Inequalities in neonatal mortality were reduced across socioeconomic and demographic strata. Key maternal and newborn health indicators improved over 2000-2012, except for caesarean sections, although the overall levels were low. Interventions delivered during childbirth saved most maternal and newborn lives. Progress came from health centre expansion, emergency care and the 2006 fee exemptions policy. During the past decade, challenges included expansion of emergency care, continued high fertility, security issues, financing and health workforce. Social determinants saw minimal change.
CONCLUSIONS: Niger reduced maternal and neonatal mortality during 2000-2012, but progress has stalled. Further reductions require strategies targeting comprehensive care, referrals, quality of care, fertility reduction, social determinants and improved security nationwide.
METHODS: We reviewed two decades of health policies, analysed mortality trends from United Nations data and six national household surveys between 1998 and 2021 and assessed coverage and inequalities of maternal and newborn health indicators. Quality of care was evaluated from health facility surveys in 2015 and 2019 and emergency obstetric assessments in 2011 and 2017. We determined the impact of intervention coverage on maternal and neonatal lives saved between 2000 and 2020. We interviewed 31 key informants to understand the factors underpinning policy implementation.
RESULTS: Empirical maternal mortality ratio declined from 709 to 520 per 100 000 live births during 2000-2011, while neonatal mortality rate declined from 46 to 23 per 1000 live births during 2000-2012 then increased to 43 in 2018. Inequalities in neonatal mortality were reduced across socioeconomic and demographic strata. Key maternal and newborn health indicators improved over 2000-2012, except for caesarean sections, although the overall levels were low. Interventions delivered during childbirth saved most maternal and newborn lives. Progress came from health centre expansion, emergency care and the 2006 fee exemptions policy. During the past decade, challenges included expansion of emergency care, continued high fertility, security issues, financing and health workforce. Social determinants saw minimal change.
CONCLUSIONS: Niger reduced maternal and neonatal mortality during 2000-2012, but progress has stalled. Further reductions require strategies targeting comprehensive care, referrals, quality of care, fertility reduction, social determinants and improved security nationwide.
摘要：
背景：最近的模型估计表明，尼日尔自2000年以来在孕产妇死亡率方面取得了进展。然而,新生儿死亡率自2012年以来没有下降,孕产妇死亡率估计是基于有限的数据.我们研究了进步和挑战的驱动因素。
方法：我们回顾了二十年来的卫生政策，分析了1998年至2021年期间联合国数据和六次全国住户调查的死亡率趋势，并评估了孕产妇和新生儿健康指标的覆盖面和不平等。从2015年和2019年的医疗机构调查以及2011年和2017年的产科急诊评估中评估了护理质量。我们确定了干预覆盖率对2000年至2020年间挽救的孕产妇和新生儿生命的影响。我们采访了31名主要线人，以了解支持政策执行的因素。
结果：在2000-2011年期间，经验孕产妇死亡率从每10万活产的709下降到520，而新生儿死亡率在2000-2012年期间从每1000活产的46下降到23，然后在2018年上升到43。在社会经济和人口阶层中，新生儿死亡率的不平等现象有所减少。除了剖腹产外，主要孕产妇和新生儿健康指标在2000-2012年间有所改善，虽然总体水平较低。分娩期间的干预措施挽救了大多数产妇和新生儿的生命。医疗中心的扩建取得了进展，紧急护理和2006年费用豁免政策。在过去的十年里，挑战包括扩大急诊护理，持续的高生育率，安全问题,筹资和卫生劳动力。社会决定因素的变化很小。
结论：尼日尔在2000-2012年期间降低了孕产妇和新生儿死亡率，但进展停滞不前。进一步减少需要针对全面护理的战略，转介,护理质量,生育率降低,社会决定因素和全国范围内改善的安全。
方法：我们回顾了二十年来的卫生政策，分析了1998年至2021年期间联合国数据和六次全国住户调查的死亡率趋势，并评估了孕产妇和新生儿健康指标的覆盖面和不平等。从2015年和2019年的医疗机构调查以及2011年和2017年的产科急诊评估中评估了护理质量。我们确定了干预覆盖率对2000年至2020年间挽救的孕产妇和新生儿生命的影响。我们采访了31名主要线人，以了解支持政策执行的因素。
结果：在2000-2011年期间，经验孕产妇死亡率从每10万活产的709下降到520，而新生儿死亡率在2000-2012年期间从每1000活产的46下降到23，然后在2018年上升到43。在社会经济和人口阶层中，新生儿死亡率的不平等现象有所减少。除了剖腹产外，主要孕产妇和新生儿健康指标在2000-2012年间有所改善，虽然总体水平较低。分娩期间的干预措施挽救了大多数产妇和新生儿的生命。医疗中心的扩建取得了进展，紧急护理和2006年费用豁免政策。在过去的十年里，挑战包括扩大急诊护理，持续的高生育率，安全问题,筹资和卫生劳动力。社会决定因素的变化很小。
结论：尼日尔在2000-2012年期间降低了孕产妇和新生儿死亡率，但进展停滞不前。进一步减少需要针对全面护理的战略，转介,护理质量,生育率降低,社会决定因素和全国范围内改善的安全。
