Determinant of Neonatal Mortality in Palestine - 2012 (Northern West Bank)

Background: Although the world has recently achieved significant declines in under-five and infant mortality rates, progress in neonatal mortality is less marked, where neonatal mortality accounts for about 40% of the world under-five child mortality. In Palestine, high ratio of infant mortality (67%) is due to neonatal mortality, determinants of which are still not well studied. Objectives: The aim of this study is to determine the major risk factors contributing to neonatal mortality, and to describe the health reporting system regarding mortality of neonates and infants in the northern districts of the West Bank. Methods: A case-control design was adopted. Cases were obtained from all available officially reported cases of neonatal death that died after birth within 28 days after delivery in the northern West Bank in 2012. Control data were obtained through interviewed questionnaires of mothers of live neonates born in 2012. Cross tabulation, odds ratio, and multilevel, bivariate logistic regression was done to explore the risk factors associated with neonatal mortality. Results: First, this study explores defects in the health reporting system regarding NM in different aspects. Also, the lack of communication between primary health care units and the health information system was found, as well as the lack of a health information data base for the analysis and interpretation of those reported cases. Second, this study showed that a higher level of mother education (p-value= 0.042, odd=1.280, CI=1.098 - 1.642); numbers of antenatal visits more than 4 visits, (p-value=0.001, odd=2.980, CI=2.504 - 6.656); and the place of ANC in the private sector (p-value=0.007, odd=43.3, CI=2.82-665.13) were associated with fewer neonatal deaths. Breast feeding (p-value= <0.001, odd=1.18, CI=1.007-1.55) and early initiation of breast feeding immediately after birth (p-value= 0.027, odd=5.609, CI=5.25 - 125.911)were a protective factor for neonatal survival, whereas prematurity and low birth weight increased the risk of neonatal death. The main causes related to the death of neonates in this study were prematurity (36%); congenital malformation (31.5%), from which 17.1% was due to Congenital heart disease and 3.6 % as Chromosomal/Genetic disorders Conclusion: There is a need for the development of focused and evidence-based interventions to prevent neonatal deaths in Palestine. These interventions should be at all levels, and address risk factors of neonatal death. To strengthen reporting and the health information system is a major step in developing these strategies.