Perinatal and Neonatal Mortality in Jordan

Abstract

Despite the extraordinary improvements in child survival over the past 25 years, little progress has been made in reducing neonatal mortality (NNM) in many developing countries. According to the Jordan Perinatal and Neonatal Mortality study, stillbirth, neonatal, and perinatal mortality rates were 11.6/1,000 total births, 14.9/1,000 live births, and 23.7/1,000 total births, respectively. Maternal age (<20 years old), history of preterm or low birth weight delivery, history of neonatal death or stillbirth, preeclampsia, mother’s hospitalization during the current pregnancy, primiparity, breach presentation, and male offspring are significantly associated with increased risk of neonatal mortality in Jordan. Newborns who have congenital defects, multiple births, and babies born to women who do not use antenatal care services are at higher risk of neonatal mortality. Preterm babies and low birth weight babies are almost 20 times more likely to die during the neonatal period compared to full-term babies and normal birth weight babies, respectively. Most neonatal deaths in Jordan are due to congenital anomalies (27.2%), multiple births (26.0%), or unexplained immaturity (21.7%). Other important causes include maternal disease (6.7%), specific infant conditions (6.4%), and unexplained asphyxia (4.9%). The main causes of stillbirths are maternal diseases (19.5%), unexplained immaturity (18.8%), congenital anomalies (17.6%), unexplained antepartum stillbirths (17.6%), obstetric complications (8.4%), placental abruption (5.7%), and multiple births (5%). Previous research in Jordan reported that about 30% of all neonatal deaths are preventable and that 44.3% are possibly preventable with optimal care. An efficient referral system which directs high-risk pregnancies to institutions with optimum facilities and equipment, personnel technical skills, and specialization of neonatal intensive care units (e.g., through regionalization) is needed to improve perinatal outcomes. Moreover, interventions that reduce mortality and morbidity in preterm babies need immediate attention. Improved survival for the majority of moderate to late preterm (32 to <37 weeks) and early preterm neonates (28 to <32 weeks) can be attained by improving essential newborn care and utilizing a range of low-cost and evidence-based interventions. Such interventions include the prevention and management of hypothermia, hypoglycemia, and infection, and providing adequate respiratory and feeding support.