Facility neonatal mortality rate

The percent of neonates (children within the first 28 completed days of life) who die in the facility, in a specific year or period.

Neonatal deaths (deaths among live births during the first 28 completed days of life) may be subdivided into early neonatal deaths, occurring during the first 7 days of life, and late neonatal deaths, occurring after the 7th day but before the 28th completed day of life.

Number of children who died during the first 28 days of life.

Total number of live births in the health facility.

Age in days/weeks, birth weight (i.e. >4000 g, 2500–3999 g, 2000–2499 g, 1500–1999 g, <1500 g), place of residence, sex, socioeconomic status.

Data from routine health information systems: Routine health information systems may collect data for this indicator to obtain estimates of the facility neonatal mortality rate. Facility data are not recommended for estimating the neonatal mortality rate for the general population, because in many settings, many neonatal deaths and live
births occur outside the health system, which will cause substantial selection bias.

Data from household surveys: Calculations are based on full birth history, whereby women are asked for the date of birth of each of their children, whether each child is still alive and if not the age at death.

To ensure consistency with mortality rates in children younger than 5 years (under-five mortality rate) produced by the UN-IGME and to account for variation in survey-to-survey measurement errors, country data points for the under-five and neonatal mortality rates were rescaled for all years to match the latest time series estimates of the under-five mortality rate produced by UN-IGME. This rescaling assumes that the proportionate measurement error in neonatal and under-five mortality rates is equal for each data point.

The following multilevel statistical model was then applied to estimate neonatal mortality rates: log (neonatal mortality rate/1000) = α0 + β1*log(under-five mortality rate/1000) + β2*[log(under-five mortality rate/1000)] 2 ) with random effects parameters or both level and trend regression parameters, and random effects parameters influenced by the country itself.

For countries with high-quality civil registration data for neonatal deaths – defined as (i) 100% complete for adults and only civil registration data is used for child mortality, (ii) population greater than 800 000, (iii) and with at least three civil registration data points for the periods 1990−1994, 1995−1999, 2000−2004 and 2005 onwards – we used the same basic equation, but with random effects parameters for both level and trend regression parameters, and random effects parameters influenced by the country itself.

Predominant type of statistics: adjusted and predicted.

These neonatal rates are estimates, derived from the estimated UN-IGME neonatal rate infant population for World population prospects to calculate the live births; hence they are not necessarily the same as the official national statistics.

See also: Neonatal mortality rate (NMR)Perinatal mortality rate (PMR)  and Birth weight specific mortality rate (BWSMR)

Hospital records and registers, outcome forms and death case reviews.

Household surveys, population census.

This is a key outcome indicator for newborn care and directly reflects prenatal, intrapartum, and neonatal care. When collected at the facility level, the indicator can be used to monitor the outcome of delivery and newborn care in health facilities. Reliable estimates for individual facilities can only be obtained for very large facilities if there are large numbers of deliveries and neonatal admissions.

Comparisons of facility-based estimates of the neonatal mortality rate should be interpreted carefully because facility neonatal mortality rate is very sensitive to the case mix of deliveries and neonatal admissions. A higher rate in one facility may not suggest poorer quality of neonatal care in that facility because the neonatal mortality rate may rise or fall with changes in the case-mix. Also, improvements in prenatal and intrapartum care and advances in medical technology may increase the NMR because babies who may otherwise have been stillbirths may survive delivery only to die in the neonatal period.

For these reasons, it is reommended that evaluators break down facility-based estimates of the neonatal mortality rate by birth weight and by admission status (direct admission or transfer-in) as a proxy for case mix.

Neonatal care, Pediatric care, Newborn health, Child health, Mortality

World Health Organization (WHO). 2015 Global Reference List of 100 Core Health Indicators.; 2015. http://apps.who.int/iris/bitstream/10665/173589/1/WHO_HIS_HSI_2015.3_eng.pdf

World Health Organization (WHO). Consultation on Improving Measurement of the Quality of Maternal, Newborn and Child Care in Health Facilities.; 2013. http://apps.who.int/iris/bitstream/10665/128206/1/9789241507417_eng.pdf

Gage AJ, Ali D, Suzuki C. A Guide for Monitoring and Evaluating Child Health Programs. MEASURE Evaluation. Carolina Population Center, University of North Carolina at Chapel Hill.; 2005. http://www.coregroup.org/storage/documents/Workingpapers/ms-05-15.pdf


Further information and related links

Every newborn: an action plan to end preventable deaths. Geneva: World Health Organization; 2014 (Retrieved from http://www.everynewborn.org/Documents/Full-action-plan-EN.pdf).

Framework of actions for the follow-up to the Programme of Action of the International Conference on Population and Development beyond 2014. Report of the Secretary-General. New York (NY): United Nations; 2014 (Retrieved from https://www.unfpa.org/webdav/site/global/shared/documents/ICPD/Framework%20of%20action%20for%20the%20follow-up%20to%20the%20PoA%20of%20the%20ICPD.pdf).

World population prospects. New York (NY): United Nations; 2012 (Retrieved from http://esa.un.org/wpp/).

Filed under: Child health , Mortality , Neonatal care , Newborn health , Pediatric care