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Determinants of neonatal mortality in a Tunisian population.

BACKGROUND
In Tunisia, perinatal mortality remains a public health problem, currently estimated at 28 per thousand, including 15 per thousand of still birth rate and 10 to 15 per thousand of early neonatal mortality rate. The recent investigations show that about half of the deaths at less than five-years-old are of perinatal origin and that neonatal mortality represents two thirds of infant mortality. Published data regarding neonatal mortality and the causes of death are sparse.


THE AIM
to evaluate the neonatal mortality rate over a 2 year period in our population study and to present data collected prospectively on the risk factors and the causes of all neonatal deaths.


METHODS
A prospective cohort compiling all live births reported between January 2007 and December 2008 at Charles Nicolle hospital (Tunis-Tunisia). All the neonatal deaths that occurred before or after discharge or transferred to other hospitals and subsequently died are included. Births from termination of pregnancy were excluded from all the analyses. Causes of deaths were assigned according the International Classification of Diseases, Tenth Revision (ICD10).


RESULTS
88 neonatal deaths were recorded over 7285 live births (LB) that is a NMR of 12 per thousand LB. Early neonatal death occurred in 79 cases (88.7%), that is an ENMR of 10.8 per thousand LB. Risk factors directly related to neonatal mortality were prematurity (aOR=6.03- 95%CI: [2-18.13] p=0.001), neonatal respiratory distress (aOR=16.12 - 95%CI: [5.67-45.78] p<10(-3)), perinatal asphyxia (aOR=11.49 - 95%CI: [3.68-35.92] p<10(-3)), nosocomial infection aOR=8.71- 95%CI: [1.77-42.70] p=0.008, and small for gestational age aOR=7.11 - 95%CI: [2.23-22.69] p=0.001. 80.6% of underlying causes and 88.6% of immediate causes of death are gathered in the chapter "Certain conditions originating in the perinatal period". Maternal hypertensive disorders and extreme immaturity due to spontaneous prematurity were respectively responsible for 13.6% and 10.2% of underlying causes of neonatal death.


CONCLUSION
Neonatal mortality remains high, dominated by the conditions originating in the perinatal period. The multitude of the risk factors implies the need for a multidisciplinary strategy of intervention, engaging the pre and perinatal prevention.