Factors of The Neonatal Mortality Rate In Puntland.

CHAPTER ONE 1

1.1 Introduction 1

1.2. Background 1

1.3. Statement of the problem 3

1.4. Objectives of the study: 4

1.3.1. General objective 4

1.3.2. Specific objectives. 4

1.7. Research questions 4

1.6. Hypothesis of the study 4

1.6.1. Null hypothesis 4

1.6.2. Alternative hypothesis 5

1.8. Scope of the study. 5

1.5. Significance of the study 5

1.9. The conceptual frame work of the study 6

1.10. Operational definitions

CHAPTER ONE

Introduction

In this chapter will presents the background of the study, problem statement, Objectives of the study,
the significance of the study and scope of the research.

1.2. Background

The neonatal mortality rate (NMR), defined as the annual number of deaths less than 28 days of
age per 1000 live births, is an important indicator of health (Abdulghani 2012;4(9):597–600). It is also
considered as a key indicator of population health, being associated with socio-economic conditions,
quality of and access to medical care (Dallolio L, Lenzi J2013;39(1):19). It has a close relation to infant
mortality rate (IMR), which is used as major indicator of the quality of life of a population and can be
broken down into two components: neonatal and post neonatal mortality (Korbin Liu SD. 1991;13(4):5–
6).

Neonatal mortality includes all deaths occurring before the 28th day of life, whereas postneonatal
mortality encompasses all deaths occurring between the 28th day of life and the day before the child’s
first birthday. This could be further subdivided into early (occurring before the seventh day of life) or
late neonatal mortality (occurring thereafter). The subdivision is necessary, because the causes of early
and late neonatal mortality are distinct. The extent to which the neonatal component contributes to
overall infant mortality is proportional to the development status of each country, as improved social
and environmental conditions lead to reductions in post neonatal mortality (Livia Maria..
2011;29(2):224–30).

The majority of the developing countries in the world have been given highest priority for reducing child
mortality in the first few years of life(less than five years child) (Quamrul HC, 2010;2(2):132–8). Every
Newborn Action Plan, launched in June 2014, provides a stimulus to accelerate progress by
implementing effective cause-specific interventions that can rapidly reduce neonatal mortality (Oza S,
Lawn 2000-2013. 2013; ). More over the Sustainable Development Goals (SDGs) are intended to be
universal in the sense of embodying a universally shared common global vision of progress towards
every aspects of life for all human beings to thrive on the planet and planned to be fully implemented by
2030 GC. All of the SDGs are relevant and apply in general terms to all countries including developed
countries. Accordingly, Goal 3 ensure healthy lives and promote well-being for all at all ages especially
neonatal age group contributing to more death (9Derek Osborn, 2015).

In Somalia,neonatalMortalityrate; (per 1;000 live births) in Somalia was reported at 39.7 in 2015,
according to the World Bank collection of development indicators, compiled from officially recognized
sources. Neonatal mortality rate of Somalia fell gradually from 44.2 deaths per 1,000 live births in 1996
to 39.7 deaths per 1,000 live births in 2015 as reported World Data Atlas.

According to estimates by the Inter‐Agency Group for Child Mortality Estimation (IGME), under ‐5
mortality rates (U5MR) in Somalia have remained constant since 1985. U5MR is among the highest in
the world (180 deaths per 1 000 live births). According to the MICS survey carried out in Somalia in
2006, the under‐5 mortality rate was very high in all the three zones surveyed, with small differential
between urban and rural areas and poorer (60%) and richer (40%) households. Disparities are more
marked between geographical areas; in SCS, mortality was 27% higher than in NWS. In Somalia, 29% of
under‐5 deaths occur in the neonatal period and 71% in the post‐neonatal period.

1.3. Statement of the problem

Globally, about 6.6 million children die before their 5th birthday each year, 5 million of thisoccurs in the
first year of life and nearly 3 million dies within the first 28 days of birth. Thisindicates that about 44% of
under-five deaths and 60% of infant deaths account for theneonatal mortality. Moreover, the share of
neonatal mortality from the under-five death rosefrom 37% in 1990 to 44% in 209. Among the four
million neonatal deaths across theworld; 3 million of these deaths occur in the early neonatal period i.e.,
in the first week of life. Every minute 37 newborns die worldwide, representing 37% all infant mortality.

Neonatal mortality (NM) until nowadays is still the highest mortality in human life, amongthese deaths
around 50-60% occur during the first week of life is associated with preventablecauses.
Somalia is the one of the highest number of neonatal death in worldwide because (per 1;000 live births)
in Somalia was reported at 39.7 die for the first the 28 days of their life according to the World Bank
collection of development indicators, compiled from officially recognized sources.

Children and women face more health challenges in Somalia than in almost any other of the world’s
countries. The under-five mortality rate (U5MR) of 137 per 1,000 live births is presently the third worst
in the world after Angola and Chad and one in seven Somali children dies before their fifth birthday.
Neonatal deaths (those in the first 28 days of life) occur at a higher rate in Somalia than in any other
country apart from Angola and Central African Republic this reported from UNICEF Somalia.

The infant mortality rate (IMR) in Puntland as per the MICS3(Multiple Cluster Indicator Survey) Somalia
2006 UNICEF survey is 80 per 1,000 live births while under-five mortality is 122 deaths per 1,000 live
births for the same period. This means that one in every 12 Somali children in NEZ (Northeast Zone) dies
before reaching age one, while one in every 8 does not survive to the fifth birthday. Most of all deaths
occur within the first weeks of life, due to complications related to pregnancy and/or delivery and the
lack of health care facilities. Infant mortality is also directly linked to maternal health. This situation is
further compounded by the). In rural areas, there is also lack of access to vaccines and immunization
services against childhood killer diseases.

There is no enough data about neonatal mortality in Puntland because there is no neonatal centers, the
first Neonatology in Puntland were established 2015 in Garowe Hospital.

This the why I have chosen the assessment of neonatal mortality among the Puntland Hospitals.

1.4. Objectives of the study:

1.3.1. General objective

Assessments on the associating factors of the neonatal mortality rate in Puntland, a case in hospitals,
2017.

1.3.2. Specific objectives.

To assess factors contributing neonatal Mortality in Puntland Somalia.

To identify the level of Magnitude of neonatal mortality In Puntland Somalia.

To analyze the relationship between low social-economic status and neonatal mortality in Puntland
Somalia.

1.7. Research questions

What are the factors contributing of neonatal mortality in Puntland hospitals?

What is the Magnitude of neonatal mortality in Puntland, Somalia?

Does the low socio-economic status affect the increase of neonatal mortality in Puntland?

1.6. Hypothesis of the study

1.6.1. Null hypothesis

Relationship between the poor roads and unskilled healthcare professionals cannot necessary effect the
increase of neonatal mortality

Socio-economic and cultural factors are not necessary effect the increase of neonatal mortality

1.6.2. Alternative hypothesis

Poor healthcare can increase the neonatal mortality

Relationship between the poor roads and unskilled healthcare professionals can necessary effect the
increase of neonatal mortality

Socio-economic and cultural factors are necessary effect the increase of neonatal mortality

1.8. Scope of the study.

The geographical scope of the study will have limited three hospitals in Puntland (Garowe hospital,
Galkio Hospital and Bosaso Hospital. Only records of neonates who were delivered in the hospital and
those who were admitted from home and died within 28 days after birth were assessed from June to
Augusto 2017. Neonates who died at home were excluded from the study

1.5. Significance of the study

Little is known about factors affecting neonatal mortality in Somalia among those admitted to hospitals.
Therefore, this study has positive impact in decreasing the neonatal mortality by providing information
helpful for programming and policy improvement in identifying associated factors determinants to
neonatal mortality.

Accordingly, study has identified the specific factors namely, sepsis and hypothermia having significant
association with neonatal mortality. This helps the health professionals to take special consideration on
general preventive mechanisms of these factors. Similarly, finding is helpful for policy makers in filling
the gap of preventing these specified factors aside from being a base line data for NGOs and other
researchers interested in the area.

1.9. The conceptual frame work of the study