PDF(Pubmed)
Abstract：
UNASSIGNED: Sub-Saharan Africa (SSA) has the highest burden of neonatal mortality in the world. Identifying the most critical modifiable risk factors is imperative for reducing neonatal mortality rates. This study is the first to calculate population-attributable fractions (PAFs) for modifiable risk factors of neonatal mortality in SSA.
UNASSIGNED: We analysed the most recent Demographic and Health Surveys data sets from 35 SSA countries conducted between 2010 and 2022. Generalized linear latent and mixed models were used to estimate odds ratios (ORs) along with 95% confidence intervals (CIs). PAFs adjusted for communality were calculated using ORs and prevalence estimates for key modifiable risk factors. Subregional analyses were conducted to examine variations in modifiable risk factors for neonatal mortality across Central, Eastern, Southern, and Western SSA regions.
UNASSIGNED: In this study, we included 255,891 live births in the five years before the survey. The highest PAFs of neonatal mortality among singleton children were attributed to delayed initiation of breastfeeding (>1 h after birth: PAF = 23.88%; 95% CI: 15.91, 24.86), uncleaned cooking fuel (PAF = 5.27%; 95% CI: 1.41, 8.73), mother\'s lacking formal education (PAF = 4.34%; 95% CI: 1.15, 6.31), mother\'s lacking tetanus vaccination (PAF = 3.54%; 95% CI: 1.55, 4.92), and infrequent antenatal care (ANC) visits (PAF = 2.45; 95% CI: 0.76, 3.63). Together, these five modifiable risk factors were associated with 39.49% (95% CI: 21.13, 48.44) of neonatal deaths among singleton children in SSA. Our subregional analyses revealed some variations in modifiable risk factors for neonatal mortality. Notably, delayed initiation of breastfeeding consistently contributed to the highest PAFs of neonatal mortality across all four regions of SSA: Central, Eastern, Southern, and Western SSA.
UNASSIGNED: The PAF estimates in the present study indicate that a considerable proportion of neonatal deaths in SSA are preventable. We identified five modifiable risk factors that accounted for approximately 40% of neonatal deaths in SSA. The findings have policy implications.
UNASSIGNED: None.
UNASSIGNED: We analysed the most recent Demographic and Health Surveys data sets from 35 SSA countries conducted between 2010 and 2022. Generalized linear latent and mixed models were used to estimate odds ratios (ORs) along with 95% confidence intervals (CIs). PAFs adjusted for communality were calculated using ORs and prevalence estimates for key modifiable risk factors. Subregional analyses were conducted to examine variations in modifiable risk factors for neonatal mortality across Central, Eastern, Southern, and Western SSA regions.
UNASSIGNED: In this study, we included 255,891 live births in the five years before the survey. The highest PAFs of neonatal mortality among singleton children were attributed to delayed initiation of breastfeeding (>1 h after birth: PAF = 23.88%; 95% CI: 15.91, 24.86), uncleaned cooking fuel (PAF = 5.27%; 95% CI: 1.41, 8.73), mother\'s lacking formal education (PAF = 4.34%; 95% CI: 1.15, 6.31), mother\'s lacking tetanus vaccination (PAF = 3.54%; 95% CI: 1.55, 4.92), and infrequent antenatal care (ANC) visits (PAF = 2.45; 95% CI: 0.76, 3.63). Together, these five modifiable risk factors were associated with 39.49% (95% CI: 21.13, 48.44) of neonatal deaths among singleton children in SSA. Our subregional analyses revealed some variations in modifiable risk factors for neonatal mortality. Notably, delayed initiation of breastfeeding consistently contributed to the highest PAFs of neonatal mortality across all four regions of SSA: Central, Eastern, Southern, and Western SSA.
UNASSIGNED: The PAF estimates in the present study indicate that a considerable proportion of neonatal deaths in SSA are preventable. We identified five modifiable risk factors that accounted for approximately 40% of neonatal deaths in SSA. The findings have policy implications.
UNASSIGNED: None.
摘要：
■撒哈拉以南非洲（SSA）是世界上新生儿死亡率最高的国家。确定最关键的可改变的危险因素对于降低新生儿死亡率至关重要。这项研究是第一个计算SSA中新生儿死亡率可改变危险因素的人口归因分数（PAF）的研究。
■我们分析了2010年至2022年期间来自35个SSA国家的最新人口和健康调查数据集。使用广义线性潜在和混合模型来估计优势比（OR）以及95％置信区间（CI）。根据社区调整后的PAF是使用OR和主要可改变风险因素的患病率估计值计算的。进行了次区域分析，以检查中部新生儿死亡率的可改变危险因素的变化，东方,南方,和西部SSA地区。
■在这项研究中，我们纳入了调查前五年的255,891例活产.单胎儿童中新生儿死亡率最高的PAF归因于母乳喂养的延迟开始（出生后>1小时：PAF=23.88％；95％CI：15.91，24.86），未清洗的烹饪燃料(PAF=5.27%；95%CI：1.41，8.73)，母亲缺乏正规教育(PAF=4.34%；95%CI：1.15，6.31)，母亲缺乏破伤风疫苗接种(PAF=3.54%；95%CI：1.55，4.92)，和不频繁的产前护理（ANC）就诊（PAF=2.45；95％CI：0.76，3.63）。一起,在SSA中,这5个可改变的危险因素与39.49%(95%CI:21.13,48.44)的单胎儿童新生儿死亡相关.我们的次区域分析显示，新生儿死亡率的可改变风险因素存在一些差异。值得注意的是,在SSA的所有四个地区，母乳喂养的延迟持续导致新生儿死亡率的最高PAF：中央，东方,南方,西方SSA
■本研究中的PAF估计表明，SSA中相当比例的新生儿死亡是可以预防的。我们确定了五个可改变的危险因素，这些因素约占SSA新生儿死亡的40％。这些发现具有政策含义。
■无。
■我们分析了2010年至2022年期间来自35个SSA国家的最新人口和健康调查数据集。使用广义线性潜在和混合模型来估计优势比（OR）以及95％置信区间（CI）。根据社区调整后的PAF是使用OR和主要可改变风险因素的患病率估计值计算的。进行了次区域分析，以检查中部新生儿死亡率的可改变危险因素的变化，东方,南方,和西部SSA地区。
■在这项研究中，我们纳入了调查前五年的255,891例活产.单胎儿童中新生儿死亡率最高的PAF归因于母乳喂养的延迟开始（出生后>1小时：PAF=23.88％；95％CI：15.91，24.86），未清洗的烹饪燃料(PAF=5.27%；95%CI：1.41，8.73)，母亲缺乏正规教育(PAF=4.34%；95%CI：1.15，6.31)，母亲缺乏破伤风疫苗接种(PAF=3.54%；95%CI：1.55，4.92)，和不频繁的产前护理（ANC）就诊（PAF=2.45；95％CI：0.76，3.63）。一起,在SSA中,这5个可改变的危险因素与39.49%(95%CI:21.13,48.44)的单胎儿童新生儿死亡相关.我们的次区域分析显示，新生儿死亡率的可改变风险因素存在一些差异。值得注意的是,在SSA的所有四个地区，母乳喂养的延迟持续导致新生儿死亡率的最高PAF：中央，东方,南方,西方SSA
■本研究中的PAF估计表明，SSA中相当比例的新生儿死亡是可以预防的。我们确定了五个可改变的危险因素，这些因素约占SSA新生儿死亡的40％。这些发现具有政策含义。
■无。
