Reducing Neonatal Mortality in India: Critical Role of Access to Emergency Obstetric Care

Background
Neonatal mortality currently accounts for 41% of all global deaths among children below five years. Despite recording a 33% decline in neonatal deaths between 2000 and 2009, about 900,000 neonates died in India in 2009. The decline in neonatal mortality is slower than in the post-neonatal period, and neonatal mortality rates have increased as a proportion of under-five mortality rates. Neonatal mortality rates are higher among rural dwellers of India, who make up at least two-thirds of India's population. Identifying the factors influencing neonatal mortality will significantly improve child survival outcomes in India.
Methods
Our analysis is based on household data from the nationally representative 2008 Indian District Level Household Survey (DLHS-3). We use probit regression techniques to analyse the links between neonatal mortality at the household level and households' access to health facilities. The probability of the child dying in the first month of birth is our dependent variable.
Results
We found that 80% of neonatal deaths occurred within the first week of birth, and that the probability of neonatal mortality is significantly lower when the child's village is closer to the district hospital (DH), suggesting the critical importance of specialist hospital care in the prevention of newborn deaths. Neonatal deaths were lower in regions where emergency obstetric care was available at the District Hospitals. We also found that parental schooling and household wealth status improved neonatal survival outcomes.
Conclusions
Addressing the main causes of neonatal deaths in India – preterm deliveries, asphyxia, and sepsis – requires adequacy of specialised workforce and facilities for delivery and neonatal intensive care and easy access by mothers and neonates. The slow decline in neonatal death rates reflects a limited attention to factors which contribute to neonatal deaths. The suboptimal quality and coverage of Emergency Obstetric Care facilities in India require urgent attention.

背景
目前，新生儿死亡率占全球5岁以下儿童死亡总人数的41%。尽管2000年至2009年间全球新生儿死亡数下降了33%，但2009年印度仍有约90万新生儿死亡。新生儿死亡率的下降速度慢于新生儿后期（post-neonatal period）死亡率，且新生儿死亡率在5岁以下儿童死亡率中的占比有所上升。印度农村人口占全国总人口至少三分之二，而农村地区的新生儿死亡率更高。明确影响新生儿死亡率的相关因素，将显著改善印度的儿童生存结局。
方法
本研究的分析基于全国代表性的2008年印度地区层级家庭调查（District Level Household Survey, DLHS-3）的家庭数据。本研究采用概率单位回归（probit regression）技术，分析家庭层面新生儿死亡率与家庭获取医疗服务设施情况之间的关联。本研究的因变量为新生儿出生后第一个月内的死亡概率。
结果
本研究发现，80%的新生儿死亡发生在出生后第一周内；且新生儿所在村庄距离地区医院（District Hospital, DH）越近，新生儿死亡概率显著越低，这表明专科医疗护理在新生儿死亡预防中具有关键作用。地区医院提供急诊产科护理（Emergency Obstetric Care）的地区，新生儿死亡率更低。此外，父母受教育程度与家庭财富状况可改善新生儿生存结局。
结论
针对印度新生儿死亡的三大主要病因——早产、窒息与败血症——需配备充足的专科医护人员及助产、新生儿重症监护相关设施，并保障产妇与新生儿能够便捷获取这些资源。新生儿死亡率下降缓慢，反映出当前对新生儿死亡相关影响因素的关注不足。印度急诊产科护理设施的质量与覆盖范围未达最优水平，亟需得到重视与改善。