DETERMINANTS OF NEONATAL-MORTALITY IN CENTRAL SUDAN

A follow-up study was conducted in six community health centres during the period April 1989 to March 1990 to determine the risk factors whi ch influence neonatal survival in central Sudan. The estimated neonata l mortality rate ranged between 20.0 and 36.0 per 1000 live births per year, and the major cause of death was tetanus neonatorum (29% of neo natal deaths). The mortality rate was lowest when tetanus toxoid was r eceived during pregnancy and the umbilical cord was cleaned by a modem hygienic method (mortality rate of 11 per 1000). In contrast, the mor tality rate was highest when no tetanus toxoid was received and no or traditional cord cleaning was used (mortality rate of 62 per 1000; rel ative risk (RR) = 5.6, 95% confidence interval (CI) 2.0-14.9). The maj or predictors of neonatal mortality were tetanus, short birth-to-conce ption interval, multiparity, reported malaria during pregnancy, low bi rthweight, low maternal weight and low socio-economic status. The popu lation attributable risks were high, and the preventable factors colle ctively accounted for 93.5% of neonatal mortality. Safe deliveries and wider immunization coverage are needed to control neonatal tetanus in this community. Other interventions to lower neonatal mortality in ce ntral Sudan should include accessible family planning programmes and m easures to lower the incidence of low birthweight.