title: Level, Causes and Risk Factors of Neonatal Mortality, in Jordan: Results of a National Prospective Study.
abstract: OBJECTIVE
  The present study aimed at assessment of the magnitude of neonatal mortality in Jordan, and its causes and associated factors.
  
  
  METHODS
  Through a multistage sampling technique, a total of 21,928 deliveries with a gestational period ≥20 weeks from 18 hospitals were included in the study. The status of their babies 28 days after birth, whether dead or alive, was ascertained. Extensive data were collected about mothers and their newborns at admission and after 28 days of birth. Causes of death were classified according to the neonatal and intrauterine death classification according to etiology. Preventability of death was classified according to Herman's classification into preventable, partially preventable, and not preventable.
  
  
  RESULTS
  Neonatal mortality rate, overall and for subgroups of the study was obtained. Risk factors for neonatal mortality were first examined in bivariate analyses and finally by multivariate logistic regression models to account for potential confounders. A total of 327 babies ≥20 weeks of gestation died in the neonatal period (14.9/1000 LB). Excluding babies <1000 g and <28 weeks of gestation to be consistent with the WHO and UNICEF's annual neonatal mortality reports, the NNMR decreased to 10.5/1000 LB. About 79 % of all neonatal deaths occurred in the first week after birth with over 42 % occurring in the first day after birth. According to NICE hierarchical classification, most neonatal deaths were due to congenital anomalies (27.2 %), multiple births (26.0 %), or unexplained immaturity (21.7 %). Other important causes included maternal disease (6.7 %), specific infant conditions (6.4 %), and unexplained asphyxia (4.9 %). According to Herman's classification, 37 % of neonatal deaths were preventable and 59 % possibly preventable. An experts' panel determined that 37.3 % of neonatal deaths received optimal medical care while the medical care provided to the rest was less than optimal. After adjusting for socio-demographic characteristics, type of the hospital, and clinical and medical history of women, the following variables were significantly associated with neonatal mortality: male gender, congenital defects, inadequate antenatal visits, multiple pregnancy, presentation at delivery, and gestational age.
  
  
  CONCLUSIONS
  The present study showed the level, causes, and risk factors of NNM in Jordan. It showed also that a large proportion of NNDs are preventable or possibly preventable. Providing optimal intrapartum, and immediate postpartum care is likely to result in avoidance of a large proportion of NNDs.
authors.affiliation: Department of Epidemiology and Public Health, Faculty of Medicine, Jordan University of Science and Technology, Irbid, 22110, Jordan. batieha@just.edu.jo.
authors.forename: Anwar M
authors.initials: AM
authors.lastname: Batieha
authors.affiliation: Department of Epidemiology and Public Health, Faculty of Allied Health Sciences, Jordan University of Science and Technology, Irbid, Jordan.
authors.forename: Yousef S
authors.initials: YS
authors.lastname: Khader
authors.affiliation: International Division, John Snow, Inc., 44 Farnsworth Street, Boston, MA, 02210, USA.
authors.forename: Nino
authors.initials: N
authors.lastname: Berdzuli
authors.affiliation: International Division, John Snow, Inc., 44 Farnsworth Street, Boston, MA, 02210, USA.
authors.forename: Chuanpit
authors.initials: C
authors.lastname: Chua-Oon
authors.affiliation: Department of Pediatrics, Faculty of Medicine, University of Jordan, Amman, Jordan.
authors.forename: Eman F
authors.initials: EF
authors.lastname: Badran
authors.affiliation: Jordan University of Science and Technology, Irbid, Jordan.
authors.forename: Nihaya A
authors.initials: NA
authors.lastname: Al-Sheyab
authors.affiliation: Department of Obstetrics and Gynecology, Faculty of Medicine, Jordan University, Amman, Jordan.
authors.forename: Asma S
authors.initials: AS
authors.lastname: Basha
authors.affiliation: Princess Rahma Hospital, Irbid, Jordan.
authors.forename: Ahmad
authors.initials: A
authors.lastname: Obaidat
authors.affiliation: Department of Maternal and Child Health, Jordan University, Amman, Jordan.
authors.forename: Ra'eda J
authors.initials: RJ
authors.lastname: Al-Qutob
mesh_terms: D000328:Adult; D002423:Cause of Death; D000013:Congenital Abnormalities / Q000401:mortality; D005260:Female; D005313:Fetal Death / Q000209:etiology*; D006801:Humans; D007223:Infant; D007226:Infant Mortality; D007231:Infant, Newborn; D007597:Jordan / Q000453:epidemiology; D008297:Male; D007752:Obstetric Labor, Premature / Q000453:epidemiology; D011247:Pregnancy; D011295:Prenatal Care; D011446:Prospective Studies; D012307:Risk Factors; D050497:Stillbirth / Q000453:epidemiology*; D055815:Young Adult
keywords: Antenatal; Gestation; Maternal; Mortality; Newborn; Prematurity