Publication: The proportion and associated factors of prematurity among neonatal death in Kelantan 2020-2023
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Date
2025-06
Authors
Ghazali, Mohd Faiz Mohd
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Abstract
Background: Neonatal deaths accounted for nearly 47% of all under-five child deaths globally in 2022, with prematurity being a major contributor. Although the neonatal mortality rate in Kelantan has remained below the Sustainable Development Goal (SDG) target, the trend in Kelantan has shown a progressive increase since years 2020 that warrants attention. The neonatal mortality rate in Kelantan increased from 2.79 to 4.88 per 1,000 live births between 2020 and 2023. This study aims to determine the proportion of prematurity and its associated factors among neonatal death cases in Kelantan, from 2020 to 2023.
Methodology: This cross-sectional study was conducted from December 2024 to May 2025 based on a retrospective review of neonatal death data reported to the Kelantan State Health Department from 2020 to 2023. Secondary data for this study were obtained from Under-5 Mortality Notification System and the Neonatal Death Investigation Form. A total of 475 neonatal death cases were selected using simple random sampling with SPSS. Sociodemographic, maternal, fetal and intrapartum factors were extracted from the records and analysed using descriptive analysis, simple logistic regression, and multiple logistic regression to identify factors associated with prematurity.
Results: among 475 neonatal deaths reviewed, the proportion of prematurity was 32.0%. Prematurity was significantly associated with several maternal and fetal risk factors, including hypertension (aOR = 4.72, 95% CI: 1.08, 20.53), prolonged rupture of membranes (aOR = 3.89, 95% CI: 1.86, 8.11), and fetal congenital anomaly (aOR = 2.66, 95% CI: 1.58, 4.47). The odds of premature birth increased markedly with decreasing birth weight, with extremely low birth weight (<1000g) showing the highest association (aOR = 20.54, 95% CI: 10.08, 41.83).
Conclusion: Prematurity accounted for a significant proportion of neonatal deaths in Kelantan. Maternal and neonatal factors such as hypertension, prolonged rupture of membranes, birth weight and fetal congenital anomaly were significantly associated with prematurity among neonatal death. Identification of these contributing factors may support the improvement of future strategies and interventions, including enhancing antenatal care, optimising intrapartum management, and strengthening the capacity of neonatal and maternal healthcare services. This could improve the quality of services and contribute to the reduction of neonatal deaths due to prematurity birth in the Kelantan.
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Keywords
Neonatal mortality , prematurity