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Paediatr Perinat Epidemiol. 2014 Mar;28(2):127-37. doi: 10.1111/ppe.12098. Epub 2013 Dec 20.

Need to focus beyond the medical causes: a systematic review of the social factors affecting neonatal deaths.

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Department of Community Medicine, Vardhman Mahavir Medical College and Safdarjung Hospital, New Delhi, India.



Reducing the global total of 3.3 million neonatal deaths is crucial to meeting the fourth Millennium Development Goal. Until recently, attention has been on the medical causes of the neonatal deaths, while the social factors contextualising these deaths have largely remained unaddressed. The current review aimed to quantify the role of these factors in neonatal deaths.


A systematic search was performed through PubMed, Google scholar, Cochrane library, Medline, IndMed, Embase, World Health Organization and Biomed central databases. Studies published from 1995 to 2011 were included. Random effects meta-analysis was performed to derive at an estimate of the burden of delays, as defined by the 'three delays model' by Thadeus and Maine.


A total of 17 studies were reviewed. The majority of them (n = 10) were from the African continent. Level 3 delay, i.e. delay in receiving appropriate treatment upon reaching a health facility (38.7%, 95% CI, 21.7%-57.3%) and delay in deciding to seek care for the illness (Level 1 delay) (28%, 95% CI, 16%-43%) were the major contributors to neonatal deaths. Level 2 delay, i.e. delay in reaching a health facility (18.3%, 95% CI, 2.6-43.8%) contributed least to the neonatal deaths.


Creating awareness among caregivers regarding early recognition and treatment seeking for neonatal illness along with improving the quality of neonatal care provided at the health facilities is essential to reduce neonatal mortality.


neonatal deaths; social factors; systematic review; three delays model

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