title: Contribution of Congenital Anomalies to Neonatal Mortality Rates in Malta.
abstract: BACKGROUND
  Neonatal mortality is a public health concern, and congenital anomalies contribute significantly to this mortality. This paper describes trends in neonatal mortality in Malta separately for congenital anomaly and non-congenital anomaly causes.
  
  
  METHODS
  Data for neonatal deaths of 22-week gestation onwards registered between 1994-2013 were obtained from the National Mortality Register. Chi-square tests were used to analyse 5-year time trends and differences in proportions of causes of neonatal deaths. Neonatal mortality was compared with other European countries.
  
  
  RESULTS
  Between 1994 and 2013, 441 neonatal deaths and 84 821 livebirths were registered, giving a neonatal mortality of 5.2 per 1000 livebirths. Congenital anomalies accounted for 36.7% (n = 162) of the neonatal deaths, while the remaining 63.3% (n = 279) were attributed to non-congenital causes. During the 20-year period, neonatal mortality due to non-congenital causes decreased from 4.6 per 1000 livebirths in 1994-98 to 2.5 per 1000 in 2009-13, while that due to congenital anomalies remained stable (2.0 per 1000 livebirths in 1994-98 and 2.2 per 1000 in 2009-13). This has resulted in comparatively higher proportions of neonatal deaths attributed to congenital anomalies in recent years (45.9% in 2009-13 vs. 29.9% in 1994-98). Comparing neonatal mortality reported from European countries, Malta has a high rate most marked for deaths due to congenital anomalies.
  
  
  CONCLUSIONS
  During 1994-2013, neonatal mortality has decreased due to a decline of non-congenital causes of death, possibly related to improved health care. The proportionate neonatal mortality attributed to congenital anomalies has increased and is the highest reported from Europe. This may be explained by the fact that termination of pregnancy is illegal in Malta.
authors.affiliation: Directorate for Health Information and Research, Malta.
authors.forename: Miriam
authors.initials: M
authors.lastname: Gatt
authors.affiliation: Directorate for Health Information and Research, Malta.
authors.forename: Kathleen
authors.initials: K
authors.lastname: England
authors.affiliation: Academic Department of Paediatrics, Medical School, Mater Dei Hospital, Malta.
authors.forename: Victor
authors.initials: V
authors.lastname: Grech
authors.affiliation: Directorate for Health Information and Research, Malta.
authors.forename: Neville
authors.initials: N
authors.lastname: Calleja
mesh_terms: D000028:Abortion, Induced / Q000331:legislation & jurisprudence*; D002423:Cause of Death; D000013:Congenital Abnormalities / Q000401:mortality*; D005060:Europe / Q000453:epidemiology; D005260:Female; D006305:Health Status Indicators; D006801:Humans; D007231:Infant, Newborn; D008319:Malta / Q000453:epidemiology; D054238:Perinatal Mortality / Q000639:trends*; D011247:Pregnancy; D011634:Public Health; D012042:Registries; D050497:Stillbirth / Q000453:epidemiology*
keywords: anomalies; birth defects; neonatal mortality