title: Effect of Puerperal Infections on Early Neonatal Mortality: A Secondary Analysis of Six Demographic and Health Surveys.
abstract: BACKGROUND
  Around 1.5 million annual neonatal deaths occur in the first week of life, and infections represent one of the major causes in developing countries. Neonatal sepsis is often strictly connected to infection of the maternal genital tract during labour.
  
  
  METHODS
  The association between signs suggestive of puerperal infection and early neonatal mortality (<7 days of life) was performed using Demographic and Health Surveys (DHS) data of six countries, conducted between 2010 and 2013. The population attributable fraction (PAF) was generated using the estimates on early neonatal mortality of a 1990-2013 systematic analysis for the Global Burden of Disease Study.
  
  
  RESULTS
  Signs of puerperal infection ranged from 0.7% in the Philippines to 16.4% in Honduras. Infection was associated with a 2.1 adjusted Risk Ratio (95% CI: 1.4-3.2) of early neonatal mortality. Around five percent of all deaths in the first week of life were attributable to signs suggestive of puerperal infections and varied from 13.9% (95% CI: 1.0-26.6) in Honduras to 3.6% (95% CI: 1.0-8.5) in Indonesia.
  
  
  CONCLUSIONS
  Targeted interventions should be addressed to contain the burden of puerperal infections on early neonatal mortality. Consideration of the PAF will help in the discussion of the benefits of antenatal and perinatal measures.
authors.affiliation: World Health Organization, Department of Reproductive Health and Research, Geneva, Switzerland.
authors.forename: Saverio
authors.initials: S
authors.lastname: Bellizzi
authors.affiliation: ISGlobal, Barcelona Ctr. Int. Health Res. (CRESIB), Hospital Clínic-Universitat de Barcelona, Barcelona, Spain.|Centro de Investigação em Saúde de Manhiça (CISM), Maputo, Mozambique.|ICREA, Barcelona, Spain.
authors.forename: Quique
authors.initials: Q
authors.lastname: Bassat
authors.affiliation: World Health Organization, Department of Reproductive Health and Research, Geneva, Switzerland.
authors.forename: Mohamed M
authors.initials: MM
authors.lastname: Ali
authors.affiliation: World Health Organization, Western Pacific Regional Office, Manila, Philippines.
authors.forename: Howard L
authors.initials: HL
authors.lastname: Sobel
authors.affiliation: Department of Obstetrics and Gynaecology, Ghent University, Ghent, Belgium.
authors.forename: Marleen
authors.initials: M
authors.lastname: Temmerman
mesh_terms: D000293:Adolescent; D000328:Adult; D001459:Bangladesh / Q000453:epidemiology; D003105:Colombia / Q000453:epidemiology; D003906:Developing Countries; D005260:Female; D006306:Health Surveys; D006721:Honduras / Q000453:epidemiology; D006801:Humans; D007214:Indonesia / Q000453:epidemiology; D007223:Infant; D007226:Infant Mortality; D007231:Infant, Newborn; D008297:Male; D008423:Maternal Age; D008875:Middle Aged; D010568:Peru / Q000453:epidemiology; D010679:Philippines / Q000453:epidemiology; D011247:Pregnancy; D011645:Puerperal Infection / Q000401:mortality*; D012307:Risk Factors; D055815:Young Adult