Sabanur ÇAVDAR, Ayşe Zülal TOKAÇ FARIMAZ, Hüseyin KÜÇÜKALİ, Ayşe Seval PALTEKİ, Ömer ATAÇ, Osman HAYRAN

Evaluation of infant mortality before and during COVID-19 pandemic in a district of Istanbul

Objective: The aim of this study is to evaluate infant mortality in 2019 and 2020 years at the local level, considering the beginning of the pandemic period. Methods: The population of this cross-sectional study are infants registered in a district of Istanbul in 2019 and 2020. Infant mortality rates before and during the COVID-19 pandemic were calculated. Antenatal healthcare and delivery practices in addition to the underlying risk factors for infant deaths were identified and compared by the year of mortality. Results: Infant mortality rates were calculated as 4.8 and 5.1; neonatal mortality rates were 3.9 and 2.7; postneonatal mortality rates were 0.9 and 2.4 per thousand live births, respectively by the years. No statistically significant difference was found between maternal and infant characteristics of the two years. The number of pregnancy follow-up records was significantly higher for the infants that died in 2020 compared to 2019. Yet, there wasn’t any difference in number of prenatal physician visits. Conclusion: Increase in the infant mortality rate during the pandemic compared to the pre-pandemic period is due to postneonatal mortality. The increase in postneonatal mortality is related to deaths caused by infections. This should be investigated with the characteristics of infants and healthcare accessibility features. No disruption was identified in access to antenatal care in cases of infant mortality during the research period. This continuity in health services must be preserved. Our experience during the study revealed a room for improvement in data access on always-important public health indicators for evidence-based decision-making.

Keywords:

infant mortality, COVID-19, Prenatal Care, Maternal-Child Health Services, Routinely Collected Health Data,

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Centers of Disease Control and Prevention. CDC-Reproductive Health, 2020, Dec 12 [online]. Available at https://www.cdc.gov/reproductivehealth/maternalinfanthealth/infantmortality.htm Accessed March 27, 2023.
World Health Organization. Newborn Mortality: Factsheets, 2022, Jan 22 [online]. Available at https://www.who.int/news-room/fact-sheets/detail/levels-and-trends-in-child-mortalityreport-2021 Accessed March 27, 2023.
World Health Organization. WHO recommendations on antenatal care for a positive pregnancy experience, 2016, Nov 28 [online]. Available at https://www.who.int/publications/i/item/9789241549912 Accessed March 27, 2023.
Çağlar M, Oskay Ü. Pregnancy and Birth Management in COVID-19 Pandemic Process. Sağlık Bilimleri Üniversitesi Hemşirelik Dergisi, 2020;2(2):99-104.
World Health Organization. Coronavirus disease (COVID-19): Pregnancy and childbirth, 2020, Dec 12 [online]. Available at https://www.who. int/news-room/q-a-detail/coronavirus-diseasecovid-19-pregnancy-and-childbirth AccessedMarch 27, 2023.
Jacob CM, Briana DD, Di Renzo GC, et al. Building resilient societies after COVID-19: the case for investing in maternal, neonatal, and child health. The Lancet. Public health, 2020;5(11): e624–e627.
Bora Başara B, Soytutan Çağlar İ, Aygün A, et al. The Ministry of Health of Turkey Health Statistics Yearbook 2019, General Directorate of Health Information Systems, Ministry of Health, Ankara, 2021 [online]. Available at https://sbsgm.saglik.gov.tr/Eklenti/40566/0/health-statisticsyearbook-2019pdf.pdf Accessed March 27, 2023.
Demirbilek Y, Pehlivantürk G, Özgüler ZÖ, Alp Meşe E. COVID-19 outbreak control, example of ministry of health of Turkey. Turk J Med Sci. 2020;50(SI-1):489-494.
[Republic of Türkiye Ministry of Industry and Technology. Research on the socioeconomic development order of districts SEGE-2022.] T.C. Sanayi ve Teknoloji Bakanlığı. İlçelerin Sosyo-Ekonomik Gelişmişlik Sıralaması Araştırması SEGE-2022. Kalkınma Ajansları Genel Müdürlüğü Yayını, Sayı: 35, Araştırma Raporu Sayı: 8, Şubat 2022, Ankara, ISBN: 978-605-7679-34-5.
World Health Organization. Neonatal and perinatal mortality: country, regional and global estimates. World Health Organization, 2006 [online]. Available at https://apps.who.int/iris/handle/10665/43444 Accessed March 27, 2023.
Bora Başara B, Soytutan Çağlar İ, Aygün A, et al. Ministry of Health of Turkey Health Statistics Yearbook 2020, General Directorate of Health Information Systems, Ministry of Health, Ankara, 2022 [online]. Available at https://sbsgm.saglik.gov.tr/Eklenti/43400/0/siy2020-eng-26052022pdf.pdf Accessed March 27, 2023.
Turkish Statistical Institute - TURKSTAT “İstatistiki Bölge Birimleri Sınıflamasına Göre Bebek Ölüm Hızı” in: 23.02.2023, Ölüm ve Ölüm Nedeni İstatistikleri, 2023 [online]. Available at https://data.tuik.gov.tr/Bulten/Index?p=Olum-ve-Olum-Nedeni-Istatistikleri-2021- Accessed March 27, 2023.
Wise, P. Infant Mortality/Neonatal Disease In: Quah SR, editor. International encyclopedia of public health. Academic Press, 2016.
Çatak B, Öner C, Bekis Bozkurt H. Social Çavdar S., et al. Turk J Public Health 2023;21(3) 360 Determinants of Health Affect Postneonatal Infant Mortality: A Case–Control Field Study. The Anatolian Journal of Family Medicine, 2022;5(2):85–91.
Öz E, Küçükkelepçe O, Almış H, Parlak M, Kurt O. Evaluation of infant deaths during Covid-19 pandemic in Adıyaman, a southeastern province of Turkey. Adıyaman Üniversitesi Sağlık Bilimleri Dergisi, 2023;9(1):1-9.
Akova İ, Güneş Bal Ş, Arslaner S et al. Investigation of Infant Mortality and Causes in Sivas, Turkey. ESTÜDAM Halk Sağlığı Dergisi. 2022;7(3):436-443.
GBD 2019 Under-5 Mortality Collaborators. Global, regional, and national progress towards Sustainable Development Goal 3.2 for neonatal and child health: all-cause and cause-specific mortality findings from the Global Burden of Disease Study 2019. Lancet (London, England), 2021;398(10303):870–905.
Chmielewska B, Barratt I, Townsend R, et al. Effects of the COVID-19 pandemic on maternal and perinatal outcomes: a systematic review and metaanalysis. The Lancet. Global health, 2021;9(6):e759–e772.
Yang J, D’Souza R, Kharrat A, Fell DB, Snelgrove JW, Shah PS. COVID-19 pandemic and populationlevel pregnancy and neonatal outcomes in general population: A living systematic review and meta-analysis (Update#2: November 20, 2021). Acta obstetricia et gynecologica Scandinavica, 2022;101(3):273–292.
Heron M. Deaths: Leading Causes for 2019. National vital statistics reports: from the Centers for Disease Control and Prevention, National Center for Health Statistics, National Vital Statistics System, 2021;70(9):1–114 [online]. Available at https://www.cdc.gov/nchs/data/nvsr/nvsr70/nvsr70-09-508.pdf Accessed March 27, 2023.
Hekimoğlu B, Acar FA. Effects of COVID-19 pandemic period on neonatal mortality and morbidity. Pediatrics & Neonatology, 2022;63(1):78-83.
Townsend R, Chmielewska B, Barratt I, et al. Global changes in maternity care provision during the COVID-19 pandemic: A systematic review and metaanalysis. EClinicalMedicine, 2021;37:100947.
Montagnoli C, Zanconato G, Ruggeri S, Cinelli G, Tozzi AE. Restructuring maternal services during the covid-19 pandemic: Early results of a scoping review for non-infected women. Midwifery, 2021;94:102916.
Kotlar B, Gerson E, Petrillo S, Langer A, Tiemeier H. The impact of the COVID-19 pandemic on maternal and perinatal health: a scoping review. Reproductive health, 2021;18(1):10.
Coxon K, Turienzo CF, Kweekel L, et al. The impact of the coronavirus (COVID-19) pandemic on maternity care in Europe. Midwifery, 2020;88:102779.
Ashish KC, Gurung R, Kinney MV, et al. Effect of the COVID-19 pandemic response on intrapartum care, stillbirth, and neonatal mortality outcomes in Nepal: a prospective observational study. The Lancet. Global health, 2020;8(10): e1273–e1281.
Mor M, Kugler N, Jauniaux E, et al. Impact of the COVID-19 Pandemic on Excess Perinatal Mortality and Morbidity in Israel. American journal of perinatology, 2021;38(4):398–403.
Güler S, Topuz İ, Ulusoy F. The experiences of family health center workers in the Covid-19 pandemic. Halk Sağlığı Hemşireliği Dergisi, 2020;2(3):143-151.
Jackson D, Katwan E, Boehm C, Diaz T. Use of routine health information systems to monitor disruptions of coverage of maternal, newborn, and child health services during COVID-19: A scoping review. Journal of global health, 2023;13:06002. ISSN 2047-2978.