Risk factors for early infant mortality in Sarlahi district, Nepal.
OBJECTIVE
Early infant mortality has not declined as rapidly as child mortality in many countries. Identification of risk factors for early infant mortality may help inform the design of intervention strategies.


METHODS
Over the period 1994-97, 15,469 live-born, singleton infants in rural Nepal were followed to 24 weeks of age to identify risk factors for mortality within 0-7 days, 8-28 days, and 4-24 weeks after the birth.


RESULTS
In multivariate models, maternal and paternal education reduced mortality between 4 and 24 weeks only: odds ratios (OR) 0.28 (95% confidence interval (CI) = 0.12-0.66) and 0.63 (95% CI = 0.44-0.88), respectively. Miscarriage in the previous pregnancy predicted mortality in the first week of life (OR = 1.98, 95% CI = 1.37-2.87), whereas prior child deaths increased the risk of post-neonatal death (OR = 1.85, 95% CI 1.24-2.75). A larger maternal mid-upper arm circumference reduced the risk of infant death during the first week of life (OR = 0.88, 95% CI = 0.81-0.95). Infants of women who did not receive any tetanus vaccinations during pregnancy or who had severe illness during the third trimester were more likely to die in the neonatal period. Maternal mortality was strongly associated with infant mortality (OR = 6.43, 95% CI = 2.35-17.56 at 0-7 days; OR = 11.73, 95% CI = 3.82-36.00 at 8-28 days; and OR = 51.68, 95% CI = 20.26-131.80 at 4-24 weeks).


CONCLUSIONS
Risk factors for early infant mortality varied with the age of the infant. Factors amenable to intervention included efforts aimed at maternal morbidity and mortality and increased arm circumference during pregnancy.
Katz
Joanne
J
Division of Disease Prevention and Control, Center for Human Nutrition, Sight & Life Research Institute, Department of International Health, Johns Hopkins Bloomberg School of Public Health, Baltimore, MD 21205, USA. jkatz@jhsph.edu
West
Keith P
KP
Khatry
Subarna K
SK
Christian
Parul
P
LeClerq
Steven C
SC
Pradhan
Elizabeth Kimbrough
EK
Shrestha
Sharada Ram
SR
D000293:Adolescent; D000328:Adult; D000367:Age Factors; D019587:Dietary Supplements / Q000600:supply & distribution*; D005260:Female; D006801:Humans; D007226:Infant Mortality; D007231:Infant, Newborn; D016015:Logistic Models; D008297:Male; D008428:Maternal Mortality; D039382:Maternal Nutritional Physiological Phenomena; D009390:Nepal / Q000453:epidemiology; D011247:Pregnancy; D011248:Pregnancy Complications / Q000453:epidemiology*; D012307:Risk Factors; D012959:Socioeconomic Factors; D014801:Vitamin A / Q000008:administration & dosage*
D014801:Vitamin A