First-day Neonatal Mortality in the Developing world: A Neglected Crisis?

We examined the Demographic and Health Surveys (DHS) data from 31 countries over the last 20 years to estimate the levels and trends of first-day mortality rates considering potential differences in socioeconomic and healthcare factors. The trends in first-day mortality rates and 95% confidence intervals were estimated adjusting for potential clustering effects, comparing three successive DHS held across countries covering sub-Saharan Africa, South and Southeast Asia and Latin America. The findings show that first-day mortality rates varied widely from 21 deaths per 1000 live births in Mali and Ethiopia to about 17 per 1000 in Kenya and Nepal to less than 10 per 1000 in Dominican Republic, Philippines, Jordan and Egypt. The absolute change in the rates between DHS2 and DHS3 were not significant in about 24 countries and the levels were stagnantly high or increased in about 8 countries. First-day mortality increased consistently in Zimbabwe, Zambia, Senegal, Cambodia and Philippines. A negative linear relationship was found between skilled birth attendance, per-capita income and first-day mortality rates whereas a negative curvilinear relationship was observed between years of maternal schooling and first-day mortality rates. In countries where there is high medical intervention in births had relatively low first-day mortality.