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Improving Birth Outcomes: Meeting the Challenge in the Developing World
Reducing Neonatal Mortality and Morbidity
The greatest risk of childhood death occurs during the neonatal period, which extends from birth through the first month of life. About 60 percent of all deaths to children under age 5 and nearly two-thirds of infant deaths (birth to 12 months) occur during the neonatal period (Rutstein, 2000). About two-thirds of all neonatal deaths occur during the first week of life. Current estimates place the annual neonatal death toll at 4 million (Save the Children, 2001).
Approximately 98 percent of neonatal deaths occur in the developing world (World Health Organization, 1996b). The highest annual neonatal rates are in South Asia, where an estimated 51 deaths occur for every 1,000 live births. Each year in South Asia alone, 2 million children die within a month of their birth. By comparison, the rates per 1,000 live births are 42 in Africa, 25 in Latin America, and fewer than 10 in Europe and North America (World Health Organization, 1996b). The burden of neonatal morbidity in developing countries is unknown; however, a recent study of neonatal morbidity in rural India revealed that nearly half of the 763 infants observed developed high-risk morbidities (those with a case fatality greater than 10 percent), and nearly three-quarters suffered low-risk morbidities, some in addition to high-risk conditions (Bang et al., 2001).
CAUSES OF NEONATAL MORBIDITY AND MORTALITY
Most neonatal deaths occur at home, following unsupervised deliveries; thus little accurate information is available as to their causes (Stoll,