Paper detail

Cause-of-death estimates for the early and late neonatal periods for 194 countries from 2000-2013

Objective: Cause-of-death distributions are important for prioritising interventions. We estimated proportions, risks, and numbers of deaths (with uncertainty) for programme-relevant causes of neonatal death for 194 countries for 2000-2013, differentiating between the early (days 0-6) and late (days 7-27) neonatal periods. Methods: For 65 high-quality VR countries, we used the observed early and late neonatal proportional cause distributions. For the remaining 129 countries, we used multinomial logistic models to estimate the early and late proportional cause distributions. We used separate models, with different inputs, for low and high neonatal mortality countries. We applied these cause-specific proportions to neonatal death estimates from the United Nations by country/year to estimate cause-specific risks and numbers of deaths. Findings: Of the 2.76 million neonatal deaths in 2013, 0.99 (uncertainty: 0.70-1.31) million (35.7%) were estimated to be from preterm complications, 0.64 (uncertainty: 0.46-0.84) million (23.4%) from intrapartum-related complications, and 0.43 (0.22-0.66) million (15.6%) from sepsis. Preterm (40.8%) and intrapartum-related (27.0%) complications accounted for the majority of early neonatal deaths while infections caused nearly half of late neonatal deaths. In every region, preterm was the leading cause of neonatal death, with the highest risks in Southern Asia (11.9 per 1000 livebirths) and Sub-Saharan Africa (9.5). Conclusion: The neonatal cause-of-death distribution differs between the early and late periods, and varies with NMR level and over time. To reduce neonatal deaths, this knowledge must be incorporated into policy decisions. The Every Newborn Action Plan provides stimulus for countries to update national strategies and include high-impact interventions to address these causes.