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Assessment and Evaluation of the High Risk Neonate: The NICU Network Neurobehavioral Scale
Published on: August 25, 2014
Unraveling the complexity of selected adverse neonatal outcomes in India: a multilevel analysis using data from a
Anuj Kumar Pandey1,2, Benson M Thomas3, Diksha Gautam1,3
1Department of Health Systems and Implementation Research, International Institute of Health Management Research New Delhi, Dwarka, India.
Insights
Adverse neonatal outcomes (ANOs) increased in India, with higher education and antenatal care showing protective effects. Difficulty accessing medical help and poor wealth status are significant risk factors for these outcomes.
Area of Science:
- Public Health
- Neonatal Health
- Epidemiology
Background:
- Adverse neonatal outcomes (ANOs), including preterm birth (PTB), low birth weight (LBW), and early neonatal deaths, pose a significant global public health challenge, especially in developing nations.
- The study addresses the persistent burden of ANOs, highlighting the need for updated estimates and analysis of contributing factors.
Purpose of the Study:
- To estimate the prevalence of adverse birth outcomes in India.
- To examine individual, household, and community-level correlates of adverse neonatal outcomes using a multi-level model.
Main Methods:
- Utilized data from the National Family Health Survey (2019-21) for approximately 1.7 million pregnant women.
- Constructed a combined indicator for ANOs (PTB, LBW, early neonatal death).
- Employed a three-level logistic regression model to analyze the probability of ANOs.
Main Results:
- Adverse neonatal outcomes (ANOs) affected 26.5% of births, an increase from 20% in 2005-06.
- Higher education, antenatal checkups, and birth preparedness knowledge were associated with a reduced likelihood of ANOs.
- Difficulty seeking medical help, poor wealth status, and unintended pregnancies were identified as risk factors for ANOs.
Conclusions:
- The rising incidence of ANOs in India necessitates urgent attention and intervention.
- Strategies to empower women with knowledge about preventing unintended pregnancies and mitigating adverse outcomes are crucial.
Introduction:
The burden of adverse neonatal outcomes (ANOs), encompassing preterm birth(PTB), low birth weight(LBW), and early neonatal deaths, remain significant public health challenge globally, particularly in developing countries. The study aims to provide estimates of adverse birth outcomes and examine their correlates by using a multi-level model analysis at individual/household/community level.
Methodology:
The study has chosen three ANOs such as preterm birth(PTB), low birth weight(LBW), and early neonatal deaths (based on available data) for constructing a combined indicator which is calculated by the presence of any one of these variables. We used National-Family-Health-Survey India data(2019-21). Multilevel(three-level) logistic regression model was used to find the probability of binary adverse neonatal outcomes with the effects of individual/household/community level variables among the recently delivered women.
Result:
Between 2019-21, a total of 26.5% ANOs were reported from 1.7 million pregnant women surveyed, a rate that has increased since 2005-06 (20%). Final multilevel model asserts that women having higher education [OR 0.92, 95%CI 0.88, 0.96), and those registered for antenatal checkups (OR 0.95, 95%CI OR 0.9, 0.99) and know all components of birth-preparedness-and-complication-readiness (OR 0.88, 95%CI 0.84, 0.92) have a higher protective odd of having adverse outcomes. Difficulty in seeking medical help (OR 1.2, 95%CI 1.15, 1.25) and belonging to poor wealth status and no intention to become pregnant (OR 1.11 95% CI 1.05, 1.18) acts as a risk factor. Multilevel model with household, community and district level variables added to the null model showed a decline in the ICC values to 4.7%, 18.8% and 30.9% respectively across district, community, and household levels.
Conclusion:
The study underscores that specific ANOs in India has shown an increase, prompting significant concern. There is need to institute a mechanism for generating knowledge amongst women to protect them from unwanted pregnancies and later adverse outcomes.
