Reducing Neonatal Mortality in India: Critical Role of Access to Emergency Obstetric Care

Background

Neonatal mortality currently accounts for 41% of all global deaths among children below five years. Despite recording a 33% decline in neonatal deaths between 2000 and 2009, about 900,000 neonates died in India in 2009. The decline in neonatal mortality is slower than in the post-neonatal period, and neonatal mortality rates have increased as a proportion of under-five mortality rates. Neonatal mortality rates are higher among rural dwellers of India, who make up at least two-thirds of India''s population. Identifying the factors influencing neonatal mortality will significantly improve child survival outcomes in India.

Methods

Our analysis is based on household data from the nationally representative 2008 Indian District Level Household Survey (DLHS-3). We use probit regression techniques to analyse the links between neonatal mortality at the household level and households'' access to health facilities. The probability of the child dying in the first month of birth is our dependent variable.

Results

We found that 80% of neonatal deaths occurred within the first week of birth, and that the probability of neonatal mortality is significantly lower when the child''s village is closer to the district hospital (DH), suggesting the critical importance of specialist hospital care in the prevention of newborn deaths. Neonatal deaths were lower in regions where emergency obstetric care was available at the District Hospitals. We also found that parental schooling and household wealth status improved neonatal survival outcomes.

Conclusions

Addressing the main causes of neonatal deaths in India – preterm deliveries, asphyxia, and sepsis – requires adequacy of specialised workforce and facilities for delivery and neonatal intensive care and easy access by mothers and neonates. The slow decline in neonatal death rates reflects a limited attention to factors which contribute to neonatal deaths. The suboptimal quality and coverage of Emergency Obstetric Care facilities in India require urgent attention.     

退耕还林(草)工程对中国北方农牧交错带生态系统健康的影响

生态系统健康是生态环境治理的目标,探究国家级生态修复项目退耕还林(草)工程对中国北方农牧交错带生态系统健康的影响,确定合理的生态环境恢复和资源管理策略,有助于加快生态环境建设、促进区域可持续发展。基于“压力-状态-响应”(PSR)模型,构建起一套包括自然、社会和经济等方面的综合指标体系,评估了2000年、2005年、2010年和2015年中国北方农牧交错带的生态系统健康水平,利用Moran′s I分析退耕还林(草)工程和区域生态系统健康的空间相关性,并从普通最小二乘法、地理加权回归模型、时间加权回归模型和时空地理加权回归模型中,选择最优回归模型,揭示退耕还林还草实施强度变化(△NDVI)对生态系统健康变化(△EHI)的影响机制。结果表明：(1)2000—2015年,中国北方农牧交错带的生态系统健康指数呈现“先下降后上升”的变化趋势,区域整体处于亚健康状态和一般健康状态,健康状况逐渐转好。(2)全局双变量Moran′s I结果显示,在2000—2010年工程的开始和发展阶段,退耕还林(草)工程对生态系统健康呈现正相关影响关系,而2010—2015年间,两者之间变为负相关关系。(3)多种回...