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Published on: November 20, 2015
Effect of preterm birth on early neonatal, late neonatal, and postneonatal mortality in India
Ajit Kumar Kannaujiya1, Kaushalendra Kumar2, Ashish Kumar Upadhyay3
1International Institute for Population Sciences, Mumbai, India.
Insights
Preterm birth significantly increases the risk of infant mortality in India, including early neonatal, late neonatal, and postneonatal death. These findings highlight the urgent need for interventions to reduce preterm birth rates and improve infant survival.
Area of Science:
- Neonatal and Perinatal Health
- Public Health and Epidemiology
- Reproductive Health
Background:
- India faces a high burden of infant deaths and preterm births.
- Existing research has not adequately addressed unobserved heterogeneity in linking preterm birth to infant mortality.
- There is a critical need for studies quantifying the association between preterm birth and infant mortality in the Indian context.
Purpose of the Study:
- To examine the association between preterm birth and early neonatal death (ENND), late neonatal death (LNND), and postneonatal death (PNND) in India.
- To account for unobserved heterogeneity in the analysis of preterm birth and infant mortality.
- To provide evidence for programmatic and policy interventions addressing preterm birth in India.
Main Methods:
- Utilized data from the National Family Health Survey 2015-16 (NFHS-4) reproductive calendar.
- Identified preterm births within the five years preceding the survey.
- Employed multivariable logistic regression and mother fixed-effect logistic regression to analyze associations for all, most recent, second most recent, and third most recent births.
Main Results:
- Preterm births were significantly associated with increased risk of ENND, LNND, and PNND across different birth cohorts.
- Among all births, preterm births were 4.2, 3.8, and 1.7 times more likely to result in ENND, LNND, and PNND, respectively.
- Mother fixed-effect regressions confirmed the robust association between preterm birth and all three categories of infant mortality.
Conclusions:
- This study provides strong evidence for the association between preterm birth and increased risk of early neonatal, late neonatal, and postneonatal deaths in India.
- Findings are based on a large, representative sample of over 0.2 million births.
- Urgent programmatic and policy interventions are required to mitigate the substantial burden of preterm birth and its impact on infant mortality in India.
Abstract:
Despite India having a high burden of infant deaths and preterm birth, there is a clear lack of studies documenting association between preterm birth and infant mortality in India. Additionally, existing studies have failed to account for unobserved heterogeneity while linking preterm birth with infant mortality. Hence, the present study examines association of preterm birth with early neonatal death (ENND), late neonatal death (LNND), and postneonatal death (PNND) in India. We used the reproductive calendar canvassed in the cross-sectional National Family Health Survey 2015-16 (NFHS-4) to identify preterm births. We used multivariable logistic regression to examine the associations for all births, most-, second most-, and third most- recent births occurred in five years preceding NFHS-4. We use mother fixed-effect logistic regression to confirm the associations among all recent births. Among all births, preterm births were 4.2, 3.8, and 1.7 times as likely as full-term births to die during early neonatal, late neonatal, and postneonatal periods respectively. Among most recent births, preterm births were 4.4, 4.0, and 2.0 times as likely as full-term births to die during early neonatal, late neonatal, and postneonatal periods respectively. Preterm births were also associated with risk of only ENND, LNND, and PNND among the second most recent births. Preterm births were associated with risk of only ENND and LNND among the third most recent births. Preterm births were also associated with ENND, LNND, and PNND in the mother fixed-effects regressions. This study establishes associations of preterm birth with ENND, LNND, and PNND in India using over 0.2 million births that occurred in 5 years preceding one of the largest population-based representative household surveys conducted in any part of the world. Our findings call for programmatic and policy interventions to address the considerable burden of preterm birth in the country.
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