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30-10-2011 | Legal medicine | Article

China has improved neonatal mortality rates, but still high in rural areas


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MedWire News: China has substantially reduced its neonatal mortality rates in recent years, by 62%, study findings show.

However, data from China's National Maternal and Child Mortality Surveillance System (MCMS) show greater improvements in faculty- as opposed to community-based care, where the most under-developed rural areas still have high annual neonatal death rates.

"Although intrapartum risk factors are probably the greatest threat to neonatal survival and facility-based birth care by a skilled provider can prevent many neonatal deaths, an institutional strategy for intrapartum care might not be considered as an immediate option for poor countries," explain Yan Guo (Peking University, Beijing, China) and colleagues.

"Therefore, attention in these countries has focused mainly on the effectiveness of community and outreach interventions in reducing neonatal mortality," they add in The Lancet.

The team examined trends in neonatal mortality using data from the MCMS between 1996 and 2008, noting that in 2000, community-based midwifery began to be discouraged, and improvements in the demand for and quality of hospital services have been made.

The MCMS comprises 37 urban districts and 79 rural counties, and each city is categorized according to size and development on a scale of 1-4 where type 4 is the least developed.

All 1,490,710 live births and 16,772 neonatal deaths during the study period were included in analysis, and the research team compared these rates between at-home and in-hospital deliveries during 2002 through 2008.

Birth asphyxia was the most common cause of neonatal mortality (29.7%) followed by preterm complications (27.5%), the majority of which (82.0%) occurred within the first week of life.

Between 1996 and 2008, the neonatal mortality rate fell from 24.7 per 1000 live births to 9.3 per 1000, and the rate of decline was highest in the semi-urbanized rural region type 1, at 8.5% per year. The rate of decline was lowest in rural region type 4, at 5.9%.

In 2007-2008, 82.6% of neonatal deaths in urban areas were in hospitals, note Guo et al, compared with 47.3% in rural region type 4.

Among babies born in hospital, 86.3% of deaths were in hospital compared with 51.9% of deaths that occurred in rural region type 4. Of babies born at home, 70.4% and just 14.0% of neonatal deaths among those living in urban and rural regions type 4, respectively, were in hospitals.

Guo and team found a significant association between increasing levels of neonatal mortality and decreasing levels of development; babies born in hospitals in rural region type 4 were almost four-times more likely to die than their counterparts who were born in urban hospitals.

"Scarce resources and personnel in such areas could threaten the quality of care even for basic neonatal resuscitation," remark the researchers.

They conclude that China, and other countries, should ensure that "family, community, and hospital connections are strengthened technically, administratively, and financially for these most vulnerable people."

By Sarah Guy

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