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nte
rna
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l J
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urna
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J
P
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S)
Vo
l.
15
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s
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Ca
uses
and risk
f
a
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neo
na
tal
mo
rtality
t
h
ro
ug
h t
he
AM
P
-
SR
f
ra
me
w
o
rk:
a
sco
ping
re
v
iew in
Indo
nesia
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licha
Nur
ha
y
a
t
i
1
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M
a
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ticle
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to
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y:
R
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eiv
ed
No
v
2
9
,
2
0
2
5
R
ev
is
ed
Feb
1
,
2
0
2
6
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ep
ted
Feb
1
6
,
2
0
2
6
Ne
o
n
a
tal
m
o
rtalit
y
in
I
n
d
o
n
e
sia
c
o
n
ti
n
u
e
s
to
in
c
re
a
se
,
e
sp
e
c
ially
d
u
ri
n
g
t
h
e
first
0
–
6
d
a
y
s o
f
l
ife,
in
d
ica
ti
n
g
p
e
rsiste
n
t
g
a
p
s in
t
h
e
q
u
a
li
t
y
o
f
m
a
tern
a
l
a
n
d
n
e
o
n
a
tal
c
a
re
.
Th
e
m
a
tern
a
l
p
e
rin
a
tal
su
rv
e
il
lan
c
e
a
n
d
re
sp
o
n
se
a
u
d
it
(AMP
-
S
R)
is
im
p
lem
e
n
ted
t
o
id
e
n
t
ify
c
a
u
se
s
o
f
d
e
a
th
a
n
d
g
u
i
d
e
p
re
v
e
n
ti
v
e
a
n
d
c
u
ra
ti
v
e
a
c
ti
o
n
s.
Th
is
sc
o
p
in
g
re
v
iew
a
ims
to
e
x
p
l
o
re
th
e
c
a
u
se
s
a
n
d
risk
fa
c
to
rs
o
f
n
e
o
n
a
tal
m
o
rtal
it
y
u
sin
g
th
e
A
M
P
-
S
R
fra
m
e
wo
rk
.
Articl
e
se
a
rc
h
e
s
we
re
c
o
n
d
u
c
ted
in
G
o
o
g
le S
c
h
o
la
r,
G
a
ru
d
a
,
a
n
d
P
u
b
M
e
d
u
sin
g
th
e
k
e
y
wo
r
d
s
(“
Ne
o
n
a
tal
De
a
th
”
OR
“
Ca
u
se
o
f
De
a
th
”
OR
“
Ke
m
a
ti
a
n
Ne
o
n
a
tal”
)
AN
D
(“
AMP
-
S
R”
OR
“
De
a
th
No
ti
fica
ti
o
n
”
).
In
c
l
u
sio
n
c
rit
e
ria
c
o
m
p
rise
d
p
rima
ry
stu
d
ies
p
u
b
li
sh
e
d
in
In
d
o
n
e
sia
n
o
r
E
n
g
l
ish
b
e
twe
e
n
2
0
2
1
a
n
d
2
0
2
5
t
h
a
t
e
x
a
m
in
e
d
n
e
o
n
a
tal
d
e
a
th
s
u
sin
g
t
h
e
AMP
-
S
R
a
p
p
ro
a
c
h
.
S
e
v
e
n
tee
n
a
rti
c
les
we
re
se
lec
ted
a
n
d
th
e
m
a
ti
c
a
ll
y
a
n
a
ly
z
e
d
f
o
ll
o
win
g
th
e
P
RIS
M
A
g
u
i
d
e
li
n
e
s.
Th
e
m
a
in
c
a
u
se
s
o
f
n
e
o
n
a
tal
d
e
a
th
we
re
c
li
n
ica
l
c
o
n
d
it
i
o
n
s,
in
c
lu
d
in
g
a
sp
h
y
x
ia,
p
re
m
a
tu
rit
y
,
se
p
sis,
h
y
p
o
th
e
rm
ia,
a
n
d
c
o
n
g
e
n
it
a
l
a
b
n
o
rm
a
li
ti
e
s.
Id
e
n
ti
fied
risk
fa
c
to
rs
e
n
c
o
m
p
a
ss
e
d
m
a
tern
a
l
a
g
e
,
p
re
g
n
a
n
c
y
c
o
m
p
li
c
a
ti
o
n
s,
re
fe
rra
l
d
e
lay
s,
in
a
d
e
q
u
a
te
q
u
a
li
ty
o
f
c
a
re
,
a
n
d
li
m
it
e
d
h
e
a
lt
h
wo
r
k
e
r
c
o
m
p
e
ten
c
e
.
M
o
st
n
e
o
n
a
tal
d
e
a
th
s
o
c
c
u
rre
d
wit
h
in
th
e
first
7
2
h
o
u
rs
o
f
li
fe
,
p
re
d
o
m
i
n
a
n
tl
y
a
m
o
n
g
m
a
le
in
fa
n
ts
with
lo
w
b
irt
h
we
ig
h
t
o
r
g
e
sta
ti
o
n
a
l
a
g
e
u
n
d
e
r
3
7
we
e
k
s.
Th
e
se
fin
d
i
n
g
s
d
e
m
o
n
stra
te
th
a
t
n
e
o
n
a
tal
m
o
rtalit
y
re
su
lt
s
fro
m
in
terc
o
n
n
e
c
ted
m
e
d
ica
l,
m
a
tern
a
l,
a
n
d
h
e
a
lt
h
sy
ste
m
fa
c
to
rs
th
a
t
c
a
n
b
e
sy
ste
m
a
ti
c
a
ll
y
id
e
n
t
ifi
e
d
th
r
o
u
g
h
AMP
-
S
R.
F
ro
m
a
p
o
li
c
y
a
n
d
p
ra
c
ti
c
e
p
e
rsp
e
c
ti
v
e
,
stre
n
g
th
e
n
in
g
t
h
e
ro
u
ti
n
e
u
se
o
f
AMP
-
S
R
fin
d
in
g
s
t
o
in
fo
rm
targ
e
ted
q
u
a
li
ty
imp
r
o
v
e
m
e
n
t,
re
fe
rra
l
sy
ste
m
stre
n
g
th
e
n
in
g
,
a
n
d
wo
rk
fo
rc
e
c
a
p
a
c
it
y
-
b
u
il
d
i
n
g
is
e
ss
e
n
ti
a
l
t
o
re
d
u
c
e
p
re
v
e
n
tab
le
n
e
o
n
a
tal
d
e
a
th
s
in
In
d
o
n
e
sia
.
K
ey
w
o
r
d
s
:
AM
P
-
SR
As
p
h
y
x
ia
C
au
s
es o
f
d
ea
th
Neo
n
atal
m
o
r
tality
Sco
p
in
g
r
e
v
iew
T
h
is i
s
a
n
o
p
e
n
a
c
c
e
ss
a
rticle
u
n
d
e
r th
e
CC B
Y
-
SA
li
c
e
n
se
.
C
o
r
r
e
s
p
o
nd
ing
A
uth
o
r
:
Su
lich
a
Nu
r
h
ay
ati
Ma
s
ter
’
s
Pro
g
r
am
in
Pu
b
lic
H
ea
lth
,
Facu
lty
o
f
Pu
b
lic
Hea
lth
,
Dip
o
n
eg
o
r
o
U
n
iv
er
s
ity
Sem
ar
an
g
,
I
n
d
o
n
esia
E
m
ail:
lik
an
u
r
h
a
y
ati8
@
g
m
ail.
co
m
1.
I
NT
RO
D
UCT
I
O
N
Neo
n
atal
m
o
r
tality
co
n
tin
u
es
to
b
e
a
m
ajo
r
p
u
b
lic
h
ea
lth
ch
a
llen
g
e
g
lo
b
ally
[
1
]
–
[
3
]
.
W
o
r
ld
wid
e,
th
e
in
f
an
t
m
o
r
tality
r
ate
(
I
MR)
was
r
ec
o
r
d
ed
at
2
.
4
m
illi
o
n
d
e
ath
s
,
with
ap
p
r
o
x
im
ately
4
7
%
o
r
1
.
1
m
illi
o
n
d
ea
th
s
o
cc
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r
r
in
g
d
u
r
in
g
th
e
n
eo
n
atal
p
er
io
d
(
0
–
2
8
d
ay
s
o
f
life
)
[
4
]
.
B
etwe
en
2
0
2
1
a
n
d
2
0
2
3
,
th
e
g
lo
b
al
n
e
o
n
atal
mort
ality
r
ate
(
NM
R
)
r
an
g
ed
f
r
o
m
1
7
.
9
%
to
1
7
.
2
6
%,
with
th
e
h
ig
h
est
r
ates
i
n
Su
b
-
Sah
ar
an
Af
r
ica
(
2
7
.
6
–
2
6
.
7
%),
f
o
llo
wed
b
y
So
u
th
ea
s
t
Asi
a
(
1
2
.
3
–
1
1
.
8
%),
in
clu
d
i
n
g
co
u
n
tr
ies
s
u
ch
as
I
n
d
o
n
esia
[
5
]
.
I
n
I
n
d
o
n
esia,
d
ata
f
r
o
m
t
h
e
m
ater
n
al
p
er
in
atal
d
ea
th
n
o
tific
atio
n
(
MPDN)
s
y
s
tem
s
h
o
wed
a
1
.
4
3
%
in
cr
ea
s
e
in
in
f
an
t
m
o
r
tali
ty
in
2
0
2
3
(
2
9
,
9
4
5
d
ea
th
s
)
co
m
p
ar
ed
to
2
0
2
2
(
2
0
,
8
8
2
d
ea
th
s
)
.
T
h
e
m
ajo
r
ity
o
f
th
e
s
e
d
ea
th
s
o
cc
u
r
r
ed
d
u
r
in
g
th
e
n
eo
n
atal
p
er
io
d
(
1
8
,
2
8
1
ca
s
es),
with
7
5
.
5
%
h
ap
p
en
in
g
with
in
t
h
e
f
ir
s
t
0
–
7
d
ay
s
an
d
2
4
.
5
%
Evaluation Warning : The document was created with Spire.PDF for Python.
I
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Hea
lth
Sci
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N:
2252
-
8
8
0
6
C
a
u
s
es a
n
d
r
is
k
fa
cto
r
s
o
f n
eo
n
a
ta
l m
o
r
ta
lity th
r
o
u
g
h
th
e
A
MP
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S
R
fr
a
mewo
r
k:
…
(
S
u
lich
a
N
u
r
h
a
ya
ti
)
243
b
etwe
en
8
–
2
8
d
ay
s
[
6
]
.
I
n
C
en
tr
al
J
av
a
Pro
v
in
ce
,
th
e
NM
R
r
o
s
e
s
ig
n
if
ica
n
tly
in
2
0
2
3
to
7
.
3
5
p
er
1
,
0
0
0
liv
e
b
ir
th
s
,
an
in
cr
ea
s
e
o
f
5
1
.
2
3
%
f
r
o
m
th
e
p
r
ev
i
o
u
s
y
ea
r
[
7
]
.
Dem
a
k
R
eg
en
c
y
also
ex
p
er
ien
ce
d
a
s
p
ik
e
in
n
eo
n
atal
m
o
r
tality
,
r
ea
c
h
in
g
6
.
4
p
er
1
,
0
0
0
liv
e
b
ir
th
s
(
6
4
%)
in
2
0
2
4
,
u
p
f
r
o
m
3
.
2
(
3
2
%)
in
2
0
2
3
an
d
2
.
4
(
2
4
%)
in
2
0
2
2
.
Mo
s
t
n
eo
n
atal
d
ea
th
s
o
cc
u
r
r
e
d
with
in
th
e
f
i
r
s
t
0
–
6
d
ay
s
o
f
life
(
6
8
%),
h
i
g
h
lig
h
tin
g
th
e
h
ig
h
v
u
ln
er
ab
ilit
y
d
u
r
in
g
th
e
ea
r
ly
n
eo
n
atal
p
er
i
o
d
[
8
]
.
I
MR
an
d
NM
R
ar
e
k
ey
in
d
icato
r
s
in
ac
h
iev
in
g
th
e
Su
s
tain
a
b
le
Dev
elo
p
m
en
t
Go
als
(
SDGs
)
[
9
]
.
T
h
e
W
o
r
ld
Hea
lth
Or
g
an
izatio
n
(
W
HO)
h
as
s
et
a
tar
g
et
f
o
r
2
0
3
0
:
r
ed
u
cin
g
th
e
NM
R
to
1
2
p
er
1
,
0
0
0
liv
e
b
i
r
th
s
an
d
th
e
I
MR
to
2
5
p
er
1
,
0
0
0
liv
e
b
ir
th
s
[
1
0
]
.
Neo
n
atal
h
ea
lth
s
er
v
es
as
a
cr
itical
in
d
icato
r
o
f
p
u
b
lic
h
ea
lth
s
tatu
s
an
d
r
eq
u
ir
es
s
er
io
u
s
atten
tio
n
.
T
h
e
h
ig
h
r
ates
o
f
I
MR
an
d
NM
R
r
em
ain
a
s
ig
n
if
ican
t
ch
allen
g
e
;
th
er
ef
o
r
e,
im
p
r
o
v
in
g
th
e
eq
u
ity
an
d
q
u
ality
o
f
h
e
alth
s
er
v
ices,
p
ar
ticu
lar
ly
f
o
r
p
r
e
g
n
an
t
w
o
m
en
an
d
n
ewb
o
r
n
s
,
is
a
to
p
p
r
io
r
it
y
in
n
atio
n
al
h
ea
lth
d
ev
elo
p
m
en
t
[
1
1
]
,
[
1
2
]
.
T
h
e
r
is
e
in
n
eo
n
atal
m
o
r
tality
h
as d
r
awn
m
o
r
e
f
o
c
u
s
to
im
p
lem
en
tin
g
m
ater
n
al
p
er
in
atal
s
u
r
v
eillan
c
e
an
d
r
esp
o
n
s
e
(
AM
P
-
SR
)
,
s
p
ec
if
ically
in
h
o
s
p
itals
[
1
3
]
,
[
1
4
]
.
Ad
d
r
ess
in
g
n
eo
n
at
al
m
o
r
tality
is
s
u
es
r
eq
u
ir
es
a
n
in
-
d
ep
th
a
n
aly
s
is
th
r
o
u
g
h
AM
P
-
SR
[
1
5
]
.
T
h
is
p
r
o
g
r
a
m
en
ab
les
th
e
id
en
tific
atio
n
o
f
th
e
ca
u
s
es
o
f
n
e
o
n
ata
l
d
ea
th
as
an
in
itial
s
tep
to
p
r
ev
en
t
s
im
ilar
ca
s
es.
T
h
e
d
ev
elo
p
m
en
t
o
f
clin
ical
a
u
d
it in
s
tr
u
m
en
ts
s
u
p
p
o
r
ts
th
e
a
n
aly
s
is
o
f
th
e
ca
u
s
es o
f
n
e
o
n
at
al
d
ea
th
[
1
6
]
.
T
h
e
im
p
lem
e
n
tatio
n
o
f
AM
P
-
SR
r
ep
r
esen
ts
a
s
tr
ateg
ic
ad
v
a
n
ce
m
en
t
in
s
y
s
tem
atica
lly
d
o
c
u
m
en
tin
g
,
ass
es
s
in
g
,
an
d
an
aly
zin
g
e
v
er
y
m
ater
n
al
an
d
n
e
o
n
atal
d
ea
th
—
b
o
th
at
t
h
e
h
ea
lth
f
ac
ilit
y
lev
el
an
d
with
in
th
e
co
m
m
u
n
ity
[
1
7
]
.
AM
P
-
SR
p
r
o
v
id
es
u
n
iq
u
e,
co
n
tex
t
-
s
p
ec
if
ic,
an
d
d
ata
-
d
r
iv
en
in
s
ig
h
ts
in
to
th
e
u
n
d
er
ly
in
g
m
ed
ical
ca
u
s
es,
d
elay
s
i
n
c
ar
e,
an
d
s
o
cial
d
e
te
r
m
in
an
ts
co
n
tr
ib
u
tin
g
to
n
eo
n
atal
m
o
r
tality
[
18
]
.
T
hi
s
s
tr
u
ct
ur
e
d
s
ur
ve
il
l
a
n
c
e
s
y
s
t
e
m
i
s
e
s
s
en
ti
al
f
or
i
m
p
r
o
vi
n
g
h
e
al
t
h
s
er
vi
c
e
s
,
i
nf
or
m
i
n
g
p
ol
i
c
y
r
ef
or
m
s
,
a
n
d
ul
t
i
m
at
el
y
r
e
d
uc
in
g
pr
e
v
e
nt
a
bl
e
d
ea
t
h
s
in
I
n
d
o
ne
s
i
a
[
1
9]
,
[
2
0]
.
T
h
e
an
al
y
s
i
s
of
n
e
on
a
ta
l
d
e
at
h
c
au
s
e
s
id
e
nt
if
ie
s
a
nd
ca
t
eg
or
i
z
e
s
c
o
nt
r
i
b
ut
in
g
f
a
c
to
r
s
i
nt
o
s
o
ci
o
e
c
on
o
m
i
c
f
a
ct
or
s
(
m
a
te
r
n
al
e
m
pl
o
y
m
en
t,
w
e
al
t
h
s
t
at
u
s
)
,
m
at
er
n
al
f
a
ct
or
s
(
m
at
er
n
al
a
g
e,
p
a
r
it
y,
bi
r
t
h
s
p
a
ci
ng
,
c
o
m
p
li
c
at
i
o
n
s
d
ur
i
n
g
de
li
ve
r
y)
,
i
nf
a
nt
f
a
ct
or
s
(
l
o
w
bi
r
th
w
ei
g
ht
or
L
B
W
)
,
a
n
d
h
e
al
t
h
s
er
vi
c
e
f
a
ct
or
s
(
a
nt
en
a
ta
l
c
ar
e/
A
N
C
a
n
d
b
ir
t
h
a
tt
e
nd
a
nt
s
)
,
w
i
t
h
L
B
W
b
e
in
g
t
h
e
m
o
s
t
i
n
f
lu
e
nt
i
al
v
ar
i
a
bl
e
i
n
ne
o
n
at
al
m
or
t
al
it
y
i
n
I
n
d
o
ne
s
i
a
[
2
1]
–
[
2
7]
.
Key
r
is
k
f
ac
to
r
s
f
o
r
p
e
r
in
atal
an
d
n
eo
n
atal
m
o
r
tality
in
clu
d
e
m
ater
n
al
ag
e,
p
ar
ity
,
an
d
c
o
m
o
r
b
id
ities
,
all
o
f
wh
ich
s
h
o
wed
s
tatis
tical
s
ig
n
if
ican
ce
(
p
=
0
.
0
0
)
,
wh
er
ea
s
ed
u
ca
tio
n
lev
el
w
as
n
o
t
s
ig
n
if
ican
tly
ass
o
ciate
d
(
p
=
0
.
7
5
0
)
.
Pre
m
a
tu
r
e
p
r
e
g
n
an
c
y
was
also
f
o
u
n
d
to
b
e
ass
o
ciate
d
with
n
eo
n
at
al
d
ea
th
.
A
s
tu
d
y
at
a
h
o
s
p
ital
in
Den
p
asar
id
en
tifie
d
lo
w
b
ir
th
weig
h
t
(
p
=
0
.
0
1
;
R
P
2
.
0
2
;
9
5
%
C
I
:
1
.
1
8
–
3
.
0
7
)
,
asp
h
y
x
ia
(
p
=
0
.
0
0
;
R
P
2
.
5
6
;
9
5
%
C
I
:
1
.
7
–
3
.
8
5
)
,
an
d
p
r
eter
m
g
estatio
n
al
ag
e
(
p
=
0
.
0
0
;
R
P
2
.
5
2
;
9
5
%
C
I
:
1
.
6
8
–
3
.
8
9
)
a
s
s
ig
n
if
ican
t
co
n
tr
ib
u
tin
g
f
ac
to
r
s
,
wh
ile
co
n
g
en
ital
ab
n
o
r
m
alities
an
d
in
f
ec
tio
n
s
wer
e
n
o
t
s
tatis
t
ically
s
ig
n
if
ican
t
(
p
=
0
.
1
an
d
p
=
0
.
5
)
.
R
esear
ch
in
Pid
ie
J
ay
a
Dis
tr
ict
f
o
u
n
d
th
at
lo
w
b
ir
th
weig
h
t
was
th
e
d
o
m
in
an
t
f
ac
to
r
,
f
o
llo
wed
b
y
lo
w
ed
u
ca
tio
n
,
h
ig
h
-
r
is
k
p
ar
ity
,
co
m
o
r
b
i
d
ities
,
asp
h
y
x
ia,
an
d
c
o
n
g
e
n
ital
ab
n
o
r
m
alities
.
Oth
er
s
tu
d
ies
h
ig
h
lig
h
ted
m
ater
n
al
a
g
e
an
d
n
u
tr
itio
n
al
s
tatu
s
as
s
ig
n
if
ica
n
t
f
ac
to
r
s
,
wh
e
r
ea
s
in
f
an
t
g
en
d
er
,
in
c
o
m
e,
an
d
v
il
lag
e
cl
ass
if
icatio
n
s
h
o
wed
n
o
s
ig
n
if
ican
t
ass
o
ciatio
n
.
I
n
ad
eq
u
ate
an
ten
atal
ca
r
e
(
ANC)
an
d
p
ass
iv
e
ex
p
o
s
u
r
e
to
cig
ar
ette
s
m
o
k
e
wer
e
also
lin
k
ed
to
in
cr
ea
s
ed
r
is
k
o
f
lo
w
b
ir
th
weig
h
t
an
d
n
eo
n
atal
m
o
r
tality
[
2
8
]
.
M
o
r
e
o
v
er
,
lim
ited
u
tili
za
tio
n
o
f
m
a
ter
n
al
an
d
n
ewb
o
r
n
h
ea
lth
s
er
v
ices,
s
u
ch
as
ANC
(
9
0
.
9
%),
I
NC
(
7
9
.
4
%),
an
d
PNC
(
6
8
.
9
%),
co
n
tr
ib
u
tes to
n
e
o
n
atal
m
o
r
tality
[
2
9
]
.
Neo
n
atal
m
o
r
tality
i
n
I
n
d
o
n
e
s
ia
r
em
ain
s
p
er
s
is
ten
tly
h
ig
h
,
with
th
e
m
ajo
r
ity
o
f
d
ea
t
h
s
o
cc
u
r
r
in
g
with
in
th
e
f
ir
s
t
7
2
h
o
u
r
s
o
f
life
.
Desp
ite
t
h
e
im
p
lem
en
t
atio
n
o
f
AM
P
-
SR
,
p
r
e
v
en
tab
le
n
eo
n
atal
d
ea
th
s
co
n
tin
u
e
t
o
o
cc
u
r
d
u
e
to
g
ap
s
in
th
e
id
e
n
tif
icatio
n
o
f
clin
ical
ca
u
s
es,
m
ater
n
al
r
is
k
f
ac
to
r
s
,
an
d
wea
k
n
ess
es
in
h
ea
lth
s
y
s
tem
p
er
f
o
r
m
a
n
ce
.
E
x
is
tin
g
ev
id
en
ce
is
s
ca
tter
ed
ac
r
o
s
s
d
if
f
er
en
t
r
eg
io
n
s
a
n
d
s
tu
d
y
d
esig
n
s
,
r
esu
ltin
g
in
a
lim
ited
u
n
d
e
r
s
tan
d
in
g
o
f
th
e
d
o
m
in
an
t
ca
u
s
es
an
d
r
is
k
p
atter
n
s
o
f
n
e
o
n
a
tal
m
o
r
tality
wh
en
v
iewe
d
co
m
p
r
eh
e
n
s
iv
ely
th
r
o
u
g
h
t
h
e
AM
P
-
SR
f
r
am
ewo
r
k
.
T
h
er
ef
o
r
e,
a
s
y
n
th
esized
a
n
d
s
y
s
tem
atic
o
v
er
v
iew
o
f
n
e
o
n
atal
m
o
r
tality
d
eter
m
in
an
ts
is
u
r
g
e
n
tly
n
ee
d
ed
to
s
tr
en
g
th
en
th
e
e
v
id
en
ce
b
ase
f
o
r
p
o
licy
,
s
er
v
ice
im
p
r
o
v
em
e
n
t,
an
d
tar
g
eted
in
t
er
v
en
tio
n
s
.
B
ased
o
n
th
e
af
o
r
em
e
n
tio
n
ed
b
ac
k
g
r
o
u
n
d
,
a
s
y
s
tem
atic
liter
atu
r
e
r
e
v
iew
u
s
in
g
a
s
co
p
i
n
g
r
e
v
iew
ap
p
r
o
ac
h
is
n
ec
ess
ar
y
to
s
u
m
m
ar
ize
th
e
f
ac
t
o
r
s
co
n
t
r
ib
u
tin
g
to
n
eo
n
atal
m
o
r
tality
b
ased
o
n
AM
P
-
SR
d
ata,
s
er
v
in
g
as a
f
o
u
n
d
atio
n
f
o
r
h
e
alth
s
er
v
ice
p
o
licy
f
o
r
m
u
latio
n
an
d
in
ter
v
en
tio
n
.
T
h
is
s
tu
d
y
aim
s
to
id
en
tify
an
d
ex
p
lain
th
e
r
is
k
f
ac
to
r
s
an
d
ca
u
s
es o
f
n
eo
n
atal
m
o
r
tality
b
as
ed
o
n
t
h
e
AM
P
-
SR
.
Desp
ite
th
e
g
r
o
win
g
b
o
d
y
o
f
liter
atu
r
e
o
n
n
e
o
n
atal
m
o
r
tal
ity
,
ex
is
tin
g
s
tu
d
ies
r
em
ain
f
r
ag
m
en
ted
,
co
n
tex
t
-
s
p
ec
if
ic,
an
d
p
r
ed
o
m
i
n
an
tly
d
escr
ip
tiv
e,
o
f
ten
f
o
c
u
s
in
g
o
n
s
in
g
le
f
ac
ilit
ies
o
r
p
r
o
v
in
ce
s
.
T
o
d
ate,
n
o
co
m
p
r
eh
e
n
s
iv
e
s
y
n
th
esis
h
as
s
y
s
tem
atica
lly
m
ap
p
ed
th
e
ca
u
s
es
an
d
r
is
k
f
ac
to
r
s
o
f
n
eo
n
atal
m
o
r
tality
s
p
ec
if
ically
th
r
o
u
g
h
th
e
AM
P
-
SR
f
r
am
ewo
r
k
.
T
h
is
s
co
p
in
g
r
ev
iew
o
f
f
er
s
a
n
o
v
el
co
n
tr
ib
u
tio
n
b
y
in
te
g
r
atin
g
ev
id
en
ce
f
r
o
m
d
iv
er
s
e
s
ettin
g
s
to
ex
am
in
e
n
eo
n
atal
m
o
r
t
ality
n
o
t
m
er
ely
as
a
clin
ical
o
u
tco
m
e,
b
u
t
as
a
m
u
ltid
im
en
s
io
n
al
p
h
e
n
o
m
en
o
n
s
h
ap
ed
b
y
m
ater
n
al,
n
e
o
n
atal,
an
d
h
ea
lth
s
y
s
tem
d
eter
m
in
an
ts
with
in
an
au
d
i
t
-
b
ased
s
u
r
v
eillan
ce
–
r
esp
o
n
s
e
ap
p
r
o
ac
h
.
B
y
p
o
s
itio
n
in
g
AM
P
-
SR
as
an
an
aly
tical
len
s
r
ath
er
th
a
n
a
r
ep
o
r
tin
g
to
o
l,
th
is
s
tu
d
y
ad
v
an
ce
s
ex
is
tin
g
k
n
o
wled
g
e
an
d
p
r
o
v
i
d
es
a
m
o
r
e
ac
tio
n
ab
l
e
u
n
d
er
s
tan
d
in
g
o
f
p
r
ev
en
tab
le
n
eo
n
atal
d
ea
th
s
.
Evaluation Warning : The document was created with Spire.PDF for Python.
I
SS
N
:
2
2
5
2
-
8
8
0
6
I
n
t J Pu
b
lic
Hea
lth
Sci
,
Vo
l.
15
,
No
.
1
,
M
ar
ch
20
26
:
2
4
2
-
255
244
2.
M
E
T
H
O
D
2
.
1
.
Study
d
esig
n
T
h
is
s
tu
d
y
em
p
lo
y
ed
a
s
co
p
in
g
r
e
v
iew
d
esig
n
to
s
y
s
te
m
atica
lly
m
ap
a
n
d
s
y
n
t
h
esize
ex
is
tin
g
ev
id
en
ce
o
n
t
h
e
ca
u
s
es
an
d
r
is
k
f
ac
to
r
s
o
f
n
e
o
n
atal
m
o
r
ta
lity
with
in
th
e
AM
P
-
SR
f
r
a
m
ewo
r
k
.
A
s
co
p
in
g
r
ev
iew
ap
p
r
o
ac
h
was
s
elec
ted
b
ec
au
s
e
th
e
av
ailab
le
liter
a
tu
r
e
is
h
eter
o
g
en
e
o
u
s
in
ter
m
s
o
f
s
tu
d
y
d
esig
n
,
p
o
p
u
latio
n
ch
ar
ac
ter
is
tics
,
an
d
o
u
tco
m
e
m
ea
s
u
r
e
m
en
ts
.
Mo
r
eo
v
e
r
,
th
is
d
esig
n
is
p
ar
ticu
lar
ly
s
u
itab
le
f
o
r
ex
p
lo
r
in
g
b
r
o
ad
r
esear
ch
q
u
e
s
tio
n
s
,
id
en
tify
in
g
k
ey
co
n
ce
p
ts
,
m
ap
p
in
g
ev
id
e
n
ce
g
a
p
s
,
an
d
clar
if
y
in
g
h
o
w
n
eo
n
atal
m
o
r
tality
h
as
b
ee
n
an
aly
ze
d
th
r
o
u
g
h
t
h
e
AM
P
-
SR
len
s
.
B
y
ad
o
p
tin
g
th
is
ap
p
r
o
ac
h
,
th
e
s
tu
d
y
aim
s
t
o
p
r
o
v
id
e
a
co
m
p
r
eh
e
n
s
iv
e
o
v
er
v
iew
r
ath
er
th
a
n
a
n
ar
r
o
w
q
u
a
n
titativ
e
s
y
n
th
esis
[
3
0
]
.
Sco
p
in
g
r
ev
iews
ar
e
esp
ec
ially
ap
p
r
o
p
r
iate
wh
en
ex
a
m
in
in
g
em
er
g
in
g
o
r
co
n
tex
t
-
s
p
ec
if
ic
f
r
am
ewo
r
k
s
s
u
ch
as
AM
P
-
SR
,
wh
er
e
m
eth
o
d
o
lo
g
ical
d
iv
er
s
i
ty
is
co
m
m
o
n
,
an
d
ev
id
e
n
ce
is
d
is
tr
ib
u
ted
ac
r
o
s
s
d
if
f
er
en
t
r
eg
io
n
s
an
d
h
ea
lth
ca
r
e
s
ettin
g
s
.
Un
lik
e
s
y
s
tem
atic
r
ev
iews
th
at
ty
p
ically
f
o
c
u
s
o
n
n
ar
r
o
wly
d
ef
i
n
ed
cl
in
ical
q
u
esti
o
n
s
,
th
is
s
tu
d
y
s
ee
k
s
to
ex
p
lo
r
e
h
o
w
n
eo
n
atal
m
o
r
tality
d
eter
m
i
n
an
ts
a
r
e
co
n
ce
p
tu
alize
d
,
ca
teg
o
r
ized
,
a
n
d
in
ter
p
r
eted
with
in
an
au
d
it
-
b
ased
s
u
r
v
eill
an
ce
s
y
s
tem
.
T
h
er
ef
o
r
e,
th
e
s
co
p
in
g
m
eth
o
d
o
lo
g
y
en
ab
les
th
e
in
teg
r
atio
n
o
f
c
lin
ical,
m
ater
n
al,
an
d
h
ea
lth
s
y
s
tem
p
er
s
p
ec
tiv
es
in
to
a
u
n
if
ied
an
aly
tical
f
r
am
ewo
r
k
.
T
h
is
ap
p
r
o
ac
h
s
tr
en
g
th
en
s
th
e
s
tu
d
y
’
s
o
b
jectiv
e
to
r
ep
o
s
itio
n
AM
P
-
SR
n
o
t
o
n
ly
as
a
r
ep
o
r
tin
g
m
ec
h
an
is
m
b
u
t a
ls
o
as a
s
tr
ate
g
ic
an
aly
tical
to
o
l.
2
.
2
.
F
r
a
m
ewo
r
k
a
nd
re
po
rt
ing
s
t
a
nd
a
rd
T
h
e
r
ev
iew
was
co
n
d
u
cte
d
f
o
llo
win
g
th
e
m
et
h
o
d
o
lo
g
ical
f
r
am
ewo
r
k
in
th
e
s
tu
d
y
b
y
W
estp
h
aln
et
a
l.
[
3
0
]
p
r
o
p
o
s
e
d
b
y
Ar
k
s
ey
an
d
O’
Ma
lley
a
n
d
f
u
r
th
er
r
ef
in
ed
b
y
T
r
icco
e
t
a
l.
[
3
1
]
r
ep
o
r
tin
g
ad
h
er
ed
to
t
h
e
Pre
f
er
r
ed
R
ep
o
r
tin
g
I
tem
s
f
o
r
Sy
s
tem
atic
R
ev
iews
an
d
Me
ta
-
An
aly
s
es
ex
ten
s
io
n
f
o
r
Sco
p
i
n
g
R
ev
iews (
P
R
I
SMA
-
Sc
R
)
.
2
.
3
.
Sea
rc
h
s
t
ra
t
eg
y
A
s
y
s
t
em
ati
c
li
te
r
at
u
r
e
s
ea
r
c
h
was
c
o
n
d
u
cte
d
i
n
th
r
e
e
ele
ct
r
o
n
ic
d
ata
b
ases
:
Pu
b
M
ed
,
G
o
o
g
l
e
Sc
h
o
la
r
,
an
d
Gar
u
d
a.
T
h
e
s
ea
r
ch
s
tr
ateg
y
was
ad
ap
te
d
to
ea
ch
d
atab
ase
u
s
in
g
a
c
o
m
b
in
atio
n
o
f
Me
d
ical
Su
b
ject
Hea
d
in
g
s
(
Me
SH)
an
d
f
r
ee
-
te
x
t
ter
m
s
.
T
h
e
co
r
e
s
ea
r
ch
s
tr
in
g
u
s
ed
in
Pu
b
Me
d
was:
(
“n
eo
n
atal
m
o
r
tality
”
OR
“n
eo
n
atal
d
ea
th
”)
AND
(
“
Ma
ter
n
al
Per
in
atal
Au
d
it”
OR
“Su
r
v
eillan
ce
R
esp
o
n
s
e”
OR
“AM
P
-
SR
”)
.
E
q
u
iv
alen
t Bo
o
lean
o
p
e
r
ato
r
s
an
d
k
ey
wo
r
d
s
wer
e
m
o
d
if
ied
t
o
s
u
it th
e
s
y
n
tax
r
eq
u
ir
em
en
ts
o
f
Go
o
g
le
Sch
o
lar
an
d
Gar
u
d
a.
Ma
n
u
al
s
ea
r
c
h
in
g
o
f
r
ef
e
r
en
ce
lis
ts
was a
ls
o
p
er
f
o
r
m
ed
to
id
en
tif
y
ad
d
itio
n
al
r
elev
an
t stu
d
ies.
2
.
4
.
T
im
e
f
ra
me
j
us
t
if
ica
t
io
n
Stu
d
ies
p
u
b
lis
h
ed
b
etwe
en
2
0
2
1
an
d
2
0
2
5
wer
e
i
n
clu
d
e
d
to
ca
p
tu
r
e
th
e
m
o
s
t
r
e
ce
n
t
ev
id
en
ce
r
ef
lectin
g
cu
r
r
en
t
n
e
o
n
atal
ca
r
e
p
r
ac
tices
an
d
th
e
e
v
o
lv
in
g
im
p
lem
en
tatio
n
o
f
th
e
AM
P
-
SR
f
r
am
ewo
r
k
in
I
n
d
o
n
esia a
n
d
co
m
p
ar
ab
le
s
ett
in
g
s
.
2
.
5
.
E
lig
ibi
lity
c
rit
er
ia
E
lig
ib
ilit
y
cr
iter
ia
wer
e
d
ef
in
e
d
u
s
in
g
th
e
p
o
p
u
latio
n
–
c
o
n
ce
p
t
–
co
n
te
x
t (
PC
C
)
f
r
am
ewo
r
k
:
−
Po
p
u
latio
n
: N
eo
n
ates (
0
–
2
8
d
ay
s
o
f
life
)
−
C
o
n
ce
p
t:
C
au
s
es
an
d
r
is
k
f
ac
to
r
s
o
f
n
eo
n
atal
m
o
r
tality
ass
e
s
s
ed
th
r
o
u
g
h
AM
P
-
SR
o
r
co
m
p
ar
ab
le
m
ater
n
a
l
–
p
er
i
n
atal
au
d
it sy
s
tem
s
−
C
o
n
tex
t:
Ho
s
p
ital
-
b
ased
o
r
p
o
p
u
latio
n
-
b
ased
s
ettin
g
s
in
I
n
d
o
n
esia
an
d
co
m
p
a
r
ab
le
lo
w
-
an
d
m
id
d
le
-
in
co
m
e
co
u
n
tr
ies
I
n
clu
s
io
n
cr
iter
ia
c
o
m
p
r
is
ed
p
ee
r
-
r
ev
iewe
d
o
r
ig
i
n
al
r
esear
ch
ar
ticles
p
u
b
lis
h
ed
i
n
E
n
g
lis
h
o
r
I
n
d
o
n
esian
.
E
x
clu
s
io
n
cr
iter
ia
i
n
clu
d
ed
e
d
ito
r
ials
,
co
m
m
en
tar
ies,
c
o
n
f
er
en
ce
ab
s
tr
ac
ts
,
an
d
s
tu
d
ies
lack
in
g
s
u
f
f
icien
t
m
eth
o
d
o
l
o
g
ical
d
etail.
2
.
6
.
Study
s
elec
t
io
n
All
id
en
tifie
d
r
ec
o
r
d
s
wer
e
s
cr
ee
n
ed
in
two
s
tag
es:
titl
e
–
ab
s
tr
ac
t
s
cr
ee
n
in
g
an
d
f
u
ll
-
te
x
t
r
ev
iew.
Scr
ee
n
in
g
was
c
o
n
d
u
cted
in
d
ep
en
d
en
tly
b
y
two
r
ev
iewe
r
s
.
Dis
cr
ep
an
cies
wer
e
r
eso
lv
ed
th
r
o
u
g
h
d
is
cu
s
s
io
n
u
n
til co
n
s
en
s
u
s
was r
ea
ch
ed
.
2
.
7
.
Da
t
a
e
x
t
ra
ct
i
o
n
Data
wer
e
ex
tr
ac
ted
u
s
in
g
a
s
tan
d
ar
d
ized
ex
tr
ac
tio
n
f
o
r
m
ca
p
tu
r
in
g
au
th
o
r
,
y
ea
r
,
co
u
n
tr
y
,
s
tu
d
y
d
esig
n
,
s
am
p
le
ch
ar
ac
te
r
is
tics
,
ca
u
s
es o
f
n
eo
n
atal
m
o
r
tality
,
i
d
en
tifie
d
r
is
k
f
ac
t
o
r
s
,
an
d
k
ey
f
in
d
in
g
s
.
2
.
8
.
Q
ua
lit
y
a
pp
ra
is
a
l
A
l
t
h
o
u
g
h
s
c
o
p
i
n
g
r
e
v
i
ew
s
d
o
n
o
t
t
y
p
i
c
a
ll
y
e
x
c
l
u
d
e
s
t
u
d
ie
s
b
as
e
d
o
n
q
u
a
l
i
t
y
,
a
n
a
p
p
r
a
i
s
a
l
w
as
c
o
n
d
u
c
t
e
d
t
o
a
s
s
es
s
t
h
e
m
et
h
o
d
o
l
o
g
i
c
a
l
r
i
g
o
r
o
f
i
n
c
l
u
d
e
d
s
t
u
d
i
e
s
.
T
h
e
J
o
a
n
n
a
B
r
i
g
g
s
I
n
s
t
i
t
u
t
e
(
J
B
I
)
c
r
it
i
c
al
Evaluation Warning : The document was created with Spire.PDF for Python.
I
n
t J Pu
b
lic
Hea
lth
Sci
I
SS
N:
2252
-
8
8
0
6
C
a
u
s
es a
n
d
r
is
k
fa
cto
r
s
o
f n
eo
n
a
ta
l m
o
r
ta
lity th
r
o
u
g
h
th
e
A
MP
-
S
R
fr
a
mewo
r
k:
…
(
S
u
lich
a
N
u
r
h
a
ya
ti
)
245
a
p
p
r
a
i
s
a
l
c
h
ec
k
l
is
t
wa
s
u
s
e
d
,
an
d
r
e
s
u
l
t
s
w
e
r
e
s
u
m
m
a
r
i
z
e
d
n
ar
r
a
t
i
v
e
l
y
t
o
i
n
f
o
r
m
t
h
e
i
n
t
e
r
p
r
e
ta
t
i
o
n
o
f
f
i
n
d
i
n
g
s
.
2
.
9
.
Da
t
a
s
y
nthesis
E
x
tr
ac
ted
d
ata
wer
e
s
y
n
th
esized
u
s
in
g
th
em
atic
a
n
aly
s
is
.
C
au
s
es
an
d
r
is
k
f
ac
to
r
s
wer
e
g
r
o
u
p
ed
i
n
to
clin
ical,
m
ater
n
al,
an
d
h
ea
lt
h
s
y
s
tem
–
r
elate
d
th
em
es.
T
h
em
atic
co
d
in
g
was
co
n
d
u
ct
ed
iter
ativ
ely
,
an
d
p
atter
n
s
an
d
c
o
n
tr
ad
ictio
n
s
ac
r
o
s
s
s
tu
d
ies we
r
e
id
en
tifie
d
an
d
an
aly
ze
d
n
ar
r
ativ
ely
.
E
th
ical
ap
p
r
o
v
al
w
as
n
o
t
r
e
q
u
ir
ed
b
ec
au
s
e
th
is
s
tu
d
y
s
y
n
t
h
esized
d
ata
f
r
o
m
p
r
e
v
io
u
s
ly
p
u
b
lis
h
ed
liter
atu
r
e.
T
h
e
s
tu
d
y
s
elec
tio
n
p
r
o
ce
s
s
is
s
u
m
m
ar
ized
in
Fig
u
r
e
1
,
wh
ich
p
r
esen
ts
th
e
PR
I
SMA
-
ScR
f
lo
w
d
iag
r
am
o
u
tlin
in
g
th
e
id
en
tific
atio
n
,
s
cr
ee
n
in
g
,
elig
ib
ilit
y
ass
ess
m
en
t,
an
d
f
in
al
in
clu
s
io
n
o
f
s
tu
d
ies,
in
clu
d
in
g
th
e
n
u
m
b
er
o
f
r
ec
o
r
d
s
r
etr
iev
e
d
,
s
cr
ee
n
ed
,
ex
clu
d
e
d
,
an
d
in
c
lu
d
ed
in
t
h
e
an
aly
s
is
.
As
s
h
o
wn
in
Fig
u
r
e
1
,
1
,
2
5
3
r
ec
o
r
d
s
wer
e
in
itially
id
en
tifie
d
f
r
o
m
Sco
p
u
s
,
Pu
b
Me
d
,
a
n
d
W
eb
o
f
Scien
ce
.
Af
ter
d
u
p
licate
r
em
o
v
al,
1
,
0
1
3
r
ec
o
r
d
s
wer
e
s
cr
ee
n
ed
,
1
7
7
f
u
ll
-
tex
t
a
r
ticles
wer
e
ass
ess
ed
f
o
r
elig
ib
ilit
y
,
an
d
1
7
s
tu
d
ies
m
et
th
e
in
clu
s
io
n
cr
iter
ia
f
o
r
f
in
a
l
s
y
n
th
esis
,
en
s
u
r
in
g
a
tr
an
s
p
ar
en
t
an
d
r
ig
o
r
o
u
s
s
elec
tio
n
p
r
o
ce
s
s
.
Fig
u
r
e
1
.
PR
I
SMA
f
lo
wch
ar
t
3.
RE
SU
L
T
S AN
D
D
I
SCU
SS
I
O
N
T
h
e
r
ev
iew
id
en
tifie
d
1
7
eli
g
ib
le
s
tu
d
ies
an
d
p
r
o
d
u
ce
d
a
co
m
p
r
eh
e
n
s
iv
e
s
y
n
th
esis
o
f
n
eo
n
atal
m
o
r
tality
d
eter
m
i
n
an
ts
.
Fin
d
in
g
s
s
h
o
w
th
at
th
e
p
r
e
d
o
m
in
an
t
ca
u
s
es
o
f
n
eo
n
atal
d
ea
th
ar
e
clin
ical
co
n
d
itio
n
s
—
p
ar
ticu
lar
ly
asp
h
y
x
ia,
lo
w
b
ir
th
weig
h
t,
p
r
e
m
a
tu
r
ity
,
a
n
d
s
ep
s
is
—
wh
ile
k
ey
r
is
k
f
ac
to
r
s
in
clu
d
e
h
ig
h
-
r
is
k
m
ater
n
al
ag
e,
p
r
eg
n
an
cy
co
m
p
licatio
n
s
,
p
o
o
r
r
ec
o
g
n
itio
n
o
f
n
eo
n
atal
d
an
g
er
s
ig
n
s
,
an
d
s
u
b
o
p
tim
al
h
ea
lth
s
er
v
ice
q
u
ality
.
T
h
is
s
tu
d
y
p
r
o
v
id
es n
ew
v
alu
e
b
y
in
te
g
r
atin
g
n
atio
n
al
an
d
in
ter
n
atio
n
al
ev
id
en
ce
in
t
o
a
s
in
g
le
an
aly
tical
f
r
am
ewo
r
k
g
r
o
u
n
d
ed
in
AM
P
-
SR
.
Un
lik
e
p
r
ev
io
u
s
f
r
ag
m
e
n
ted
s
tu
d
ies,
th
is
r
ev
iew
clea
r
ly
d
em
o
n
s
tr
ates
h
o
w
m
ed
ical,
m
ater
n
al,
an
d
s
y
s
tem
ic
f
ac
to
r
s
in
ter
ac
t
to
p
r
o
d
u
ce
p
r
ev
en
ta
b
le
n
eo
n
atal
d
ea
th
s
.
T
h
e
s
tu
d
y
also
o
f
f
er
s
n
o
v
el
in
s
ig
h
t
in
to
g
ap
s
in
AM
P
-
SR
im
p
lem
en
tatio
n
,
s
u
ch
as
wea
k
r
ef
er
r
al
s
y
s
tem
s
,
in
co
n
s
is
ten
t
ca
s
e
an
aly
s
is
,
a
n
d
lim
ited
u
s
e
o
f
au
d
it
f
in
d
i
n
g
s
in
p
o
licy
ac
tio
n
.
T
h
ese
r
esu
lts
co
llectiv
ely
s
tr
en
g
th
en
th
e
ev
id
e
n
ce
b
ase
f
o
r
im
p
r
o
v
in
g
AM
P
-
SR
an
d
d
ev
elo
p
in
g
tar
g
eted
s
tr
ateg
ies
to
r
e
d
u
ce
n
eo
n
atal
m
o
r
tality
in
I
n
d
o
n
esia.
T
h
e
g
e
n
er
al
ch
a
r
ac
ter
is
tics
o
f
th
e
in
clu
d
e
d
s
tu
d
ies
ar
e
s
u
m
m
ar
ized
in
T
ab
le
1
(
s
ee
Ap
p
e
n
d
ix
)
[
3
2
]
-
[
4
8
]
.
T
h
is
tab
le
p
r
esen
ts
k
ey
in
f
o
r
m
atio
n
f
o
r
ea
c
h
s
tu
d
y
,
in
c
lu
d
in
g
th
e
au
th
o
r
s
,
y
ea
r
o
f
p
u
b
licatio
n
,
co
u
n
tr
y
o
r
s
tu
d
y
s
ettin
g
,
s
tu
d
y
d
esig
n
,
s
am
p
le
ch
ar
ac
ter
is
tics
,
an
d
m
ain
f
in
d
i
n
g
s
r
elate
d
to
n
e
o
n
atal
m
o
r
tality
.
B
y
o
r
g
an
izin
g
th
ese
co
r
e
attr
ib
u
te
s
s
y
s
tem
atica
lly
,
T
ab
le
1
p
r
o
v
id
es
an
o
v
e
r
v
iew
o
f
th
e
m
eth
o
d
o
lo
g
ical
d
iv
er
s
ity
an
d
g
e
o
g
r
ap
h
ical
d
is
tr
ib
u
tio
n
o
f
th
e
s
elec
ted
s
tu
d
ies.
[
3
2
]
–
[
4
1
]
[
4
2
]
–
[
4
8
]
.
T
h
e
id
en
tifie
d
ca
u
s
es
an
d
r
i
s
k
f
ac
to
r
s
o
f
n
eo
n
atal
m
o
r
t
ality
,
ca
teg
o
r
ized
with
in
th
e
AM
P
-
SR
fr
am
ewo
r
k
,
ar
e
p
r
esen
ted
in
T
ab
le
2
.
T
h
is
tab
le
s
y
n
th
esizes
th
e
f
in
d
in
g
s
o
f
th
e
in
clu
d
ed
s
t
u
d
ies
b
y
g
r
o
u
p
i
n
g
d
eter
m
in
an
ts
in
to
r
elev
an
t
d
o
m
ain
s
,
s
u
ch
as
m
ater
n
al
f
ac
t
o
r
s
,
n
eo
n
atal
f
ac
to
r
s
,
an
d
h
e
alth
s
y
s
tem
–
r
elate
d
f
ac
to
r
s
.
T
h
r
o
u
g
h
th
is
s
tr
u
ctu
r
ed
ca
teg
o
r
iza
tio
n
,
T
ab
le
2
cla
r
if
ies
h
o
w
v
ar
io
u
s
r
is
k
f
ac
to
r
s
ar
e
in
ter
co
n
n
ec
ted
an
d
h
o
w
t
h
ey
alig
n
with
th
e
s
u
r
v
eillan
ce
–
r
esp
o
n
s
e
ap
p
r
o
ac
h
.
Fin
d
in
g
s
f
r
o
m
th
is
s
tu
d
y
in
d
icate
th
at
th
e
m
ain
ca
u
s
es
o
f
n
e
o
n
atal
m
o
r
tality
a
r
e
p
r
im
a
r
ily
r
elate
d
to
clin
ical
n
eo
n
atal
co
n
d
itio
n
s
,
with
th
e
m
o
s
t
d
o
m
in
an
t
b
ein
g
n
eo
n
atal
asp
h
y
x
ia,
lo
w
b
ir
th
weig
h
t
(
L
B
W
)
,
p
r
em
atu
r
ity
,
a
n
d
in
f
ec
tio
n
/s
ep
s
is
.
R
i
s
k
f
ac
to
r
s
f
o
r
n
eo
n
at
al
d
ea
th
in
clu
d
e
m
ater
n
al
h
e
alth
an
d
p
r
eg
n
an
cy
co
n
d
itio
n
s
,
as
well
as
h
ea
lth
ca
r
e
s
er
v
ice
f
ac
to
r
s
.
Ma
ter
n
al
f
ac
to
r
s
in
clu
d
e
ex
tr
em
e
m
ater
n
al
ag
e
(
<2
5
o
r
>3
5
y
ea
r
s
)
,
h
ig
h
p
ar
ity
,
lo
w
ed
u
ca
tio
n
lev
el,
p
r
e
g
n
an
c
y
c
o
m
p
lic
atio
n
s
,
an
d
th
e
u
s
e
o
f
co
n
tr
ac
ep
tiv
e
m
eth
o
d
s
.
I
n
ad
d
itio
n
,
p
r
em
atu
r
e
r
u
p
tu
r
e
o
f
m
em
b
r
a
n
es
(
PR
OM
)
at
ter
m
g
estatio
n
al
ag
e
also
in
cr
ea
s
es th
e
r
is
k
o
f
asp
h
y
x
ia
an
d
m
o
r
tality
.
Hea
lth
ca
r
e
s
er
v
ice
-
r
elate
d
r
is
k
f
ac
to
r
s
i
n
clu
d
e
u
n
s
af
e
d
eliv
er
y
s
ettin
g
s
,
d
ela
y
ed
r
ec
o
g
n
itio
n
o
f
d
an
g
er
s
ig
n
s
,
s
u
b
o
p
tim
al
r
e
f
er
r
al
s
y
s
tem
s
,
an
d
in
ad
eq
u
ate
q
u
ality
o
f
an
ten
atal
a
n
d
p
e
r
in
atal
ca
r
e.
Evaluation Warning : The document was created with Spire.PDF for Python.
I
SS
N
:
2
2
5
2
-
8
8
0
6
I
n
t J Pu
b
lic
Hea
lth
Sci
,
Vo
l.
15
,
No
.
1
,
M
ar
ch
20
26
:
2
4
2
-
255
246
T
ab
le
2
.
Ma
tr
ix
s
y
n
th
esis
th
em
atic
N
o
.
M
a
i
n
c
a
u
s
e
s
R
i
s
k
f
a
c
t
o
r
s
C
l
i
n
i
c
a
l
n
e
o
n
a
t
a
l
c
o
n
d
i
t
i
o
n
s
M
a
t
e
r
n
a
l
a
n
d
p
r
e
g
n
a
n
c
y
f
a
c
t
o
r
s
H
e
a
l
t
h
c
a
r
e
ser
v
i
c
e
f
a
c
t
o
r
s
1.
A
sp
h
y
x
i
a
[
35
]
,
[
48
]
M
a
t
e
r
n
a
l
a
g
e
<
2
5
o
r
>
3
5
y
e
a
r
s
[
33
],
[
41
]
P
l
a
c
e
o
f
d
e
l
i
v
e
r
y
(
h
o
me
v
s
.
h
e
a
l
t
h
f
a
c
i
l
i
t
y
)
2.
Lo
w
b
i
r
t
h
w
e
i
g
h
t
(
L
B
W
)
[
42
]
,
[
45
]
H
i
g
h
p
a
r
i
t
y
[
41
]
D
e
l
a
y
i
n
r
e
c
o
g
n
i
z
i
n
g
d
a
n
g
e
r
s
i
g
n
s [
33
]
3.
P
r
e
mat
u
r
i
t
y
[
45
]
I
n
f
a
n
t
c
a
r
e
g
i
v
e
r
(
w
h
o
c
a
r
e
s f
o
r
t
h
e
b
a
b
y
)
I
n
a
d
e
q
u
a
t
e
r
e
f
e
r
r
a
l
s
y
st
e
m [
42
]
4.
S
e
p
s
i
s,
i
n
f
e
c
t
i
o
n
[
47
]
,
[
48
]
Lo
w
e
d
u
c
a
t
i
o
n
[
41
]
Q
u
a
l
i
t
y
o
f
a
n
t
e
n
a
t
a
l
/
p
e
r
i
n
a
t
a
l
c
a
r
e
[
45
],
[
46
]
5.
A
n
t
i
b
i
o
t
i
c
-
r
e
si
s
t
a
n
t
K
l
e
b
si
e
l
l
a
p
n
e
u
m
o
n
i
a
e
i
n
f
e
c
t
i
o
n
[
47
]
P
r
e
g
n
a
n
c
y
c
o
m
p
l
i
c
a
t
i
o
n
s [
42
]
K
a
n
g
a
r
o
o
mo
t
h
e
r
c
a
r
e
(
K
M
C
)
[
46
]
6.
H
y
p
o
t
h
e
r
m
i
a
P
r
e
mat
u
r
e
r
u
p
t
u
r
e
o
f
me
mb
r
a
n
e
s
(
P
R
O
M
)
a
t
t
e
r
m
g
e
s
t
a
t
i
o
n
[
35
]
Th
e
c
a
e
sar
e
a
n
se
c
t
i
o
n
met
h
o
d
w
a
s
m
o
r
e
p
r
o
t
e
c
t
i
v
e
a
g
a
i
n
s
t
a
sp
h
y
x
i
a
a
n
d
n
e
o
n
a
t
a
l
d
e
a
t
h
7.
C
o
n
g
e
n
i
t
a
l
a
n
o
ma
l
i
e
s
[
48
]
3
.
1
.
Dis
cus
s
io
n
T
h
is
s
tu
d
y
ad
d
s
th
r
ee
k
ey
c
o
n
tr
ib
u
tio
n
s
to
th
e
liter
atu
r
e
.
First,
it
s
y
n
th
esizes
n
eo
n
atal
m
o
r
tality
ev
id
en
ce
ex
p
licitly
with
in
th
e
AM
P
-
SR
f
r
am
ewo
r
k
,
h
ig
h
l
ig
h
tin
g
h
o
w
au
d
it
-
b
ased
s
u
r
v
eillan
ce
ca
n
r
ev
ea
l
p
r
ev
en
tab
le
p
at
h
way
s
o
f
d
ea
t
h
b
ey
o
n
d
is
o
lated
clin
ical
ca
u
s
es.
Seco
n
d
,
it
m
ap
s
th
e
r
elati
v
e
p
r
o
m
in
e
n
c
e
an
d
co
n
tex
tu
al
v
ar
iatio
n
o
f
clin
ical,
m
ater
n
al,
an
d
s
y
s
tem
-
r
elate
d
r
is
k
f
ac
t
o
r
s
ac
r
o
s
s
m
u
ltip
le
r
eg
io
n
s
,
id
e
n
tify
in
g
p
atter
n
s
o
f
ten
o
v
er
lo
o
k
ed
i
n
s
in
g
le
-
s
ite
s
tu
d
ies.
T
h
ir
d
,
it tr
an
s
lates a
u
d
it f
in
d
in
g
s
in
to
p
o
licy
-
r
elev
an
t i
n
s
ig
h
ts
,
o
f
f
er
in
g
a
s
tr
u
ctu
r
e
d
b
asis
f
o
r
o
p
er
atio
n
alizin
g
AM
P
-
SR
d
ata
to
s
tr
en
g
th
en
r
ef
er
r
al
s
y
s
tem
s
,
an
ten
atal
ca
r
e,
an
d
tar
g
eted
n
eo
n
atal
in
ter
v
en
tio
n
s
in
I
n
d
o
n
esia.
Un
lik
e
p
r
ev
io
u
s
r
ev
iews
th
at
p
r
im
ar
ily
ca
talo
g
ca
u
s
es
o
f
n
eo
n
atal
m
o
r
tality
,
th
is
s
co
p
in
g
r
ev
iew
d
em
o
n
s
tr
ates
h
o
w
th
e
AM
P
-
SR
f
r
am
ewo
r
k
en
ab
les
a
m
o
r
e
in
teg
r
ativ
e
in
ter
p
r
etatio
n
o
f
n
eo
n
atal
d
ea
th
s
as
o
u
tco
m
es
o
f
in
ter
s
ec
tin
g
clin
ical
an
d
s
y
s
tem
ic
f
ailu
r
es.
T
h
e
f
in
d
in
g
s
s
u
g
g
est
th
at
p
r
ev
en
tab
le
n
eo
n
atal
m
o
r
tality
is
n
o
t
s
o
lely
d
r
iv
e
n
b
y
b
io
lo
g
ical
v
u
ln
er
a
b
ilit
y
b
u
t
is
s
tr
o
n
g
ly
m
ed
iated
b
y
d
elay
s
in
r
ef
er
r
al,
s
u
b
o
p
tim
al
an
ten
atal
ca
r
e,
an
d
u
n
ev
en
h
ea
lth
s
y
s
tem
ca
p
ac
ity
.
T
h
is
r
ein
f
o
r
ce
s
th
e
s
tr
ateg
ic
v
alu
e
o
f
AM
P
-
SR
as
a
d
ec
is
io
n
-
s
u
p
p
o
r
t
m
ec
h
an
i
s
m
f
o
r
p
r
i
o
r
itizin
g
in
ter
v
en
ti
o
n
s
at
b
o
th
f
ac
ilit
y
an
d
p
o
licy
l
ev
els.
T
h
e
an
aly
s
is
o
f
th
e
f
in
d
in
g
s
f
r
o
m
1
7
r
e
v
iewe
d
ar
ticles
r
ev
ea
led
v
ar
io
u
s
ca
u
s
es
o
f
n
eo
n
atal
d
ea
th
as
ex
am
in
ed
th
r
o
u
g
h
th
e
AM
P
-
SR
p
r
o
g
r
am
.
T
h
e
a
n
aly
s
is
an
d
d
is
cu
s
s
io
n
o
f
th
ese
f
in
d
in
g
s
ar
e
p
r
esen
ted
as f
o
llo
ws:
3
.
1
.
1
.
Cha
ra
ct
er
is
t
ics o
f
neo
na
t
a
l dea
t
h
Neo
n
atal
m
o
r
tality
r
em
ain
s
a
s
ig
n
if
ican
t
p
u
b
lic
h
ea
lth
is
s
u
e
in
b
o
th
I
n
d
o
n
esia
an
d
g
lo
b
ally
,
with
v
ar
y
in
g
c
h
ar
ac
ter
is
tics
in
f
lu
en
ce
d
b
y
b
i
o
lo
g
ical,
s
o
cial,
an
d
h
ea
lth
ca
r
e
s
er
v
ice
f
a
cto
r
s
.
A
co
m
m
o
n
ch
ar
ac
ter
is
tic
o
f
n
eo
n
atal
d
ea
th
s
is
th
eir
o
cc
u
r
r
en
ce
d
u
r
in
g
th
e
ea
r
ly
n
eo
n
atal
p
er
io
d
(
0
–
7
d
ay
s
)
.
Sev
er
al
s
tu
d
ies,
s
u
ch
as
th
o
s
e
b
y
R
u
k
m
o
n
o
et
a
l.
[
3
2
]
an
d
Utam
i
et
a
l.
[
3
7
]
,
r
e
p
o
r
ted
th
at
th
e
m
ajo
r
ity
o
f
d
ea
th
s
o
cc
u
r
with
in
th
e
f
ir
s
t
7
2
h
o
u
r
s
o
f
life
,
wh
ich
is
th
e
m
o
s
t
cr
itical
p
er
io
d
f
o
r
n
ewb
o
r
n
s
u
r
v
iv
al
[
4
9
]
.
Dem
o
g
r
a
p
h
ic
ch
ar
ac
ter
is
tics
also
s
h
o
w
th
a
t
m
ale
in
f
an
ts
ar
e
m
o
r
e
lik
e
ly
to
d
ie
(
6
0
.
5
%),
lik
ely
d
u
e
to
h
o
r
m
o
n
al
an
d
p
h
y
s
io
lo
g
ical
d
if
f
er
e
n
ce
s
th
at
in
cr
ea
s
e
th
eir
v
u
ln
er
a
b
ilit
y
[
35
]
.
Oth
e
r
k
e
y
ch
a
r
ac
ter
is
tics
in
clu
d
e
l
o
w
b
ir
t
h
weig
h
t
(
L
B
W
)
,
p
r
em
atu
r
ity
,
a
n
d
n
e
o
n
atal
asp
h
y
x
ia.
I
n
f
an
ts
b
o
r
n
weig
h
in
g
u
n
d
er
2
,
5
0
0
g
r
am
s
o
r
at
less
th
an
3
7
wee
k
s
o
f
g
estatio
n
al
ag
e
ar
e
h
ig
h
ly
s
u
s
ce
p
tib
le
to
co
m
p
licatio
n
s
s
u
ch
as
asp
h
y
x
ia,
h
y
p
o
th
e
r
m
ia,
h
y
p
o
g
ly
ce
m
ia,
an
d
in
f
ec
tio
n
.
A
s
tu
d
y
b
y
I
h
s
an
i
a
n
d
Hen
d
r
a
ti
[
3
9
]
in
E
ast
J
av
a
r
e
p
o
r
ted
t
h
at
p
r
eter
m
in
f
a
n
ts
h
av
e
a
two
to
th
r
ee
tim
es h
ig
h
er
lik
elih
o
o
d
o
f
d
ea
th
co
m
p
ar
e
d
to
f
u
ll
-
ter
m
in
f
a
n
ts
.
An
an
aly
s
is
o
f
n
eo
n
atal
d
ea
th
s
in
I
n
d
o
n
esia
f
r
o
m
2
0
1
9
–
2
0
2
0
s
h
o
wed
th
at
C
en
tr
al
J
av
a
Pr
o
v
in
ce
h
a
d
th
e
h
ig
h
est
n
eo
n
atal
m
o
r
tality
r
ate,
with
W
est
J
av
a
an
d
C
en
tr
al
J
av
a
also
r
ec
o
r
d
in
g
th
e
h
ig
h
est
p
r
ev
ale
n
ce
o
f
lo
w
-
b
ir
th
-
weig
h
t
ca
s
es.
Su
r
r
o
u
n
d
in
g
p
r
o
v
i
n
ce
s
with
h
ig
h
r
is
k
also
s
h
o
wed
s
im
ila
r
tr
en
d
s
,
s
u
g
g
esti
n
g
th
e
p
r
esen
ce
o
f
s
p
atial
clu
s
ter
s
.
Sp
atial
an
aly
s
is
u
s
in
g
Mo
r
an
's
I
an
d
Gea
r
y
’
s
C
m
eth
o
d
s
c
o
n
f
ir
m
e
d
a
p
o
s
itiv
e
s
p
atial
au
to
co
r
r
elatio
n
in
C
en
tr
al
J
av
a,
E
ast
J
av
a,
an
d
W
est
J
av
a,
in
d
icatin
g
th
at
n
eo
n
atal
d
ea
th
s
ar
e
n
o
t
r
an
d
o
m
l
y
d
is
tr
ib
u
t
ed
b
u
t
r
ath
e
r
clu
s
ter
ed
.
T
h
ese
p
atter
n
s
ar
e
b
eliev
ed
to
b
e
in
f
lu
e
n
ce
d
b
y
g
eo
g
r
a
p
h
ic
f
ac
to
r
s
,
av
ailab
ilit
y
o
f
h
ea
lth
ca
r
e
s
er
v
i
ce
s
,
an
d
s
o
cio
ec
o
n
o
m
ic
co
n
d
it
io
n
s
[
5
0
]
.
B
ased
o
n
th
is
d
is
cu
s
s
io
n
,
it
ca
n
b
e
co
n
clu
d
ed
th
at
n
eo
n
atal
d
ea
th
s
ty
p
ically
o
cc
u
r
with
in
t
h
e
f
ir
s
t
7
2
h
o
u
r
s
o
f
life
an
d
m
o
r
e
f
r
e
q
u
e
n
tly
af
f
ec
t
m
ale
in
f
a
n
ts
,
p
r
ete
r
m
in
f
a
n
ts
,
an
d
th
o
s
e
with
l
o
w
b
ir
th
weig
h
t.
T
h
e
ea
r
ly
n
eo
n
atal
p
er
i
o
d
is
th
u
s
a
cr
itical
f
o
c
u
s
f
o
r
n
eo
n
atal
d
ea
th
p
r
ev
en
tio
n
ef
f
o
r
ts
in
I
n
d
o
n
esia.
T
h
e
s
p
atial
d
is
tr
ib
u
tio
n
o
f
n
eo
n
atal
d
ea
th
s
s
h
o
ws
c
lu
s
ter
ed
p
atter
n
s
,
p
ar
ticu
lar
ly
in
C
en
tr
al
J
av
a,
E
ast
J
av
a,
an
d
W
e
s
t
J
av
a.
T
h
is
h
ig
h
lig
h
ts
th
e
n
ee
d
f
o
r
s
p
atially
tar
g
ete
d
in
ter
v
e
n
tio
n
s
an
d
r
is
k
m
ap
p
i
n
g
.
T
h
e
s
e
f
in
d
in
g
s
s
u
p
p
o
r
t
th
e
n
ec
ess
ity
f
o
r
n
e
o
n
atal
h
ea
l
th
ca
r
e
p
o
licies
th
at
f
o
c
u
s
o
n
t
h
e
cr
itical
ea
r
ly
n
e
o
n
atal
p
e
r
io
d
,
im
p
r
o
v
e
s
er
v
ices
f
o
r
h
ig
h
-
r
is
k
in
f
a
n
ts
,
an
d
i
m
p
lem
en
t
s
p
atial
in
ter
v
en
tio
n
s
in
h
ig
h
-
p
r
ev
alen
ce
r
eg
io
n
s
.
Ad
ap
tiv
e
p
o
licy
r
esp
o
n
s
es a
r
e
ess
en
tial to
r
ed
u
ce
n
eo
n
atal
m
o
r
tality
n
atio
n
wi
d
e.
3
.
1
.
2
.
M
a
in
ca
us
es o
f
neo
na
t
a
l dea
t
h (
neo
na
t
a
l c
lin
ica
l c
o
nd
it
io
ns
)
T
h
e
m
ain
ca
u
s
es
o
f
n
eo
n
at
al
d
ea
th
ar
e
clin
ical
co
n
d
itio
n
s
,
in
clu
d
in
g
asp
h
y
x
ia,
p
r
em
atu
r
ity
,
in
f
ec
tio
n
/s
ep
s
is
,
h
y
p
o
th
er
m
ia
,
an
d
c
o
n
g
e
n
ital
an
o
m
alies.
T
h
e
m
o
s
t
f
r
e
q
u
en
t
ca
u
s
e
o
f
n
eo
n
atal
d
ea
th
is
Evaluation Warning : The document was created with Spire.PDF for Python.
I
n
t J Pu
b
lic
Hea
lth
Sci
I
SS
N:
2252
-
8
8
0
6
C
a
u
s
es a
n
d
r
is
k
fa
cto
r
s
o
f n
eo
n
a
ta
l m
o
r
ta
lity th
r
o
u
g
h
th
e
A
MP
-
S
R
fr
a
mewo
r
k:
…
(
S
u
lich
a
N
u
r
h
a
ya
ti
)
247
r
esp
ir
ato
r
y
d
is
tr
ess
[
28
]
.
A
s
tu
d
y
b
y
R
u
k
m
o
n
o
et
a
l.
[
3
2
]
r
ev
ea
led
th
at
asp
h
y
x
ia
is
s
ig
n
if
ican
tly
ass
o
ciate
d
with
n
eo
n
atal
d
ea
th
(
p
0
.
0
2
7
<
0
.
0
5
)
,
as
af
f
ec
te
d
in
f
an
ts
e
x
p
er
ien
ce
r
esp
ir
ato
r
y
d
is
tr
ess
th
at
lim
its
o
x
y
g
e
n
s
u
p
p
ly
t
o
th
e
b
r
ain
a
n
d
v
ital
o
r
g
an
s
d
u
r
i
n
g
o
r
im
m
ed
iately
af
ter
b
ir
th
.
An
o
t
h
er
s
tu
d
y
r
e
p
o
r
ted
th
at
n
eo
n
atal
d
ea
th
s
an
d
th
e
m
ajo
r
ity
o
f
s
till
b
ir
th
s
wer
e
ca
u
s
ed
b
y
asp
h
y
x
ia/h
y
p
o
x
ia
(
5
3
%),
n
eo
n
atal
d
ea
th
s
b
y
s
ep
s
is
(
6
0
%
)
,
a
n
d
u
n
d
e
r
-
f
i
v
e
d
e
a
t
h
s
b
y
m
a
l
n
u
t
r
i
t
i
o
n
(
7
5
%
)
a
n
d
i
n
f
e
ct
i
o
n
s
[
48
]
.
A
s
p
h
y
x
i
a
i
n
c
r
e
as
es
t
h
e
r
i
s
k
o
f
d
e
a
t
h
b
y
1
5
.
4
7
t
i
m
e
s
,
l
o
w
b
i
r
t
h
we
i
g
h
t
(
L
B
W
)
i
n
f
a
n
t
s
a
r
e
8
.
2
ti
m
e
s
m
o
r
e
l
i
k
e
l
y
t
o
d
i
e
,
s
e
p
s
is
t
r
i
p
le
s
t
h
e
r
i
s
k
o
f
n
e
o
n
a
t
a
l
d
ea
th
,
an
d
p
r
eter
m
b
ir
th
in
c
r
e
ases
th
e
r
is
k
f
iv
ef
o
ld
(
p
0
.
0
0
0
1
;
R
R
5
.
0
0
;
9
5
%
C
I
:
2
.
1
5
–
1
1
.
5
9
)
.
3
0
Ho
we
v
er
,
an
o
th
er
s
tu
d
y
r
ep
o
r
ted
t
h
at
asp
h
y
x
ia
was n
o
t sig
n
if
ican
tly
a
s
s
o
ciate
d
with
n
eo
n
atal
d
ea
th
(
p
0
.
3
0
9
)
[
42
]
.
Utam
i
et
a
l.
[
3
7
]
in
a
s
tu
d
y
at
Pra
y
a
Gen
er
al
Ho
s
p
ital,
C
en
t
r
al
L
o
m
b
o
k
,
f
o
u
n
d
a
n
e
o
n
atal
m
o
r
tality
p
r
ev
alen
ce
o
f
2
1
.
9
%,
with
ca
u
s
es
in
clu
d
in
g
s
ep
s
is
/in
f
ec
ti
o
n
(
3
6
.
0
7
%),
h
y
p
o
th
e
r
m
ia
(
2
8
.
7
7
%),
asp
h
y
x
ia
(
1
9
.
1
8
%),
an
d
p
r
em
atu
r
ity
(
1
5
.
9
8
%).
Ve
r
an
i
et
a
l.
[
4
7
]
s
ta
ted
th
at
n
eo
n
atal
s
ep
s
is
is
a
s
ig
n
if
ican
t
ca
u
s
e
o
f
d
ea
th
.
K.
p
n
e
u
m
o
n
iae
in
f
ec
ti
o
n
was
m
o
r
e
c
o
m
m
o
n
in
h
ea
l
th
f
ac
ilit
y
d
ea
th
s
(
2
2
%)
co
m
p
ar
ed
to
c
o
m
m
u
n
ity
d
ea
th
s
(
1
4
%).
T
h
e
m
o
s
t
co
m
m
o
n
clin
ical
s
y
n
d
r
o
m
es
wer
e
s
ep
s
is
(
4
4
%),
s
ep
s
is
with
p
n
e
u
m
o
n
ia
(
1
9
%),
an
d
p
n
eu
m
o
n
ia
alo
n
e
(
1
6
%).
Ne
o
n
atal
s
ep
s
is
is
lin
k
ed
to
u
n
s
ter
ile
d
eliv
er
y
en
v
ir
o
n
m
en
ts
,
lack
o
f
m
ater
n
al
in
f
ec
tio
n
s
cr
ee
n
in
g
,
d
ela
y
ed
d
iag
n
o
s
is
,
an
d
an
tib
io
tic
r
esis
tan
ce
,
esp
ec
ially
to
K.
Pn
eu
m
o
n
iae
[
47
]
.
E
ar
ly
-
o
n
s
et
n
eo
n
atal
s
ep
s
is
(
E
OS)
h
ad
an
in
cid
e
n
ce
r
ate
o
f
9
.
6
%,
with
8
%
ca
u
s
ed
b
y
g
r
am
-
n
eg
ativ
e
b
ac
ter
ia
(
9
0
.
4
%).
Sep
s
is
is
a
d
ir
ec
t c
au
s
e
o
f
n
eo
n
atal
d
ea
th
as id
en
tifi
ed
b
y
t
h
e
AM
P
-
SR
p
r
o
g
r
am
[
5
1
]
.
Ast
r
ia
an
d
W
in
d
asar
i
[
3
8
]
f
o
u
n
d
th
at
n
eo
n
atal
d
ea
th
was
ass
o
ciate
d
with
asp
h
y
x
ia
(
p
0
.
0
0
0
1
;
R
R
1
5
.
4
7
;
9
5
%
C
I
:
5
.
9
3
–
4
0
.
3
9
)
,
p
r
eter
m
g
estatio
n
al
ag
e
(
p
0
.
0
0
0
1
;
R
R
5
.
0
0
;
9
5
%
C
I
:
2
.
1
5
-
1
1
.
5
9
)
,
L
B
W
(
p
0
.
0
0
0
1
; RR
8
.
2
0
; 9
5
% C
I
: 3
.
3
9
–
1
9
.
7
9
)
,
an
d
n
eo
n
atal
s
ep
s
is
(
p
0
.
0
0
5
; RR
3
.
2
3
; 9
5
% C
I
: 1
.
42
-
7
.
3
3
)
.
I
n
Ser
an
g
Dis
tr
ict,
ca
u
s
es
o
f
n
eo
n
atal
d
e
ath
wer
e
L
B
W
(
4
6
%),
asp
h
y
x
ia
(
2
7
.
9
%),
co
n
g
en
ital
an
o
m
al
ies
(
1
1
.
6
%),
o
t
h
er
ca
u
s
es
(
1
1
.
6
%),
n
eo
n
atal
tetan
u
s
(
1
.
4
%),
an
d
s
ep
s
is
(
1
.
4
%).
L
B
W
was
also
s
ig
n
if
ican
tly
ass
o
ciate
d
with
n
eo
n
atal
d
ea
th
(
p
=
0
.
0
0
5
)
[
42
]
.
Fetal
ch
ar
ac
ter
is
tics
ass
o
ci
ated
with
n
eo
n
atal
d
ea
th
in
cl
u
d
e
m
ale
s
ex
,
s
h
o
r
t
b
ir
th
in
ter
v
al
(
<2
4
m
o
n
th
s
)
,
a
n
d
s
m
all
s
ize.
Pre
m
atu
r
ity
co
n
tr
ib
u
tes
to
u
n
d
er
d
e
v
elo
p
e
d
o
r
g
an
s
,
esp
ec
ially
th
e
lu
n
g
s
an
d
im
m
u
n
e
s
y
s
tem
,
in
c
r
ea
s
in
g
th
e
r
is
k
o
f
r
esp
ir
ato
r
y
f
ail
u
r
e,
s
ep
s
is
,
an
d
tem
p
er
atu
r
e
r
eg
u
latio
n
is
s
u
es
[
5
2
]
.
Oth
e
r
s
tu
d
ies
f
o
u
n
d
n
o
s
ig
n
if
ican
t
ass
o
ciatio
n
b
etwe
en
L
B
W
an
d
n
eo
n
atal
d
ea
th
,
b
u
t
tr
en
d
s
s
till
p
o
in
ted
to
war
d
L
B
W
as a
co
n
tr
ib
u
tin
g
ca
u
s
e.
I
n
co
n
cl
u
s
io
n
,
n
e
o
n
atal
clin
i
ca
l
f
ac
to
r
s
s
u
ch
as
asp
h
y
x
ia,
p
r
em
atu
r
ity
,
L
B
W
,
an
d
s
ep
s
is
ar
e
th
e
lead
in
g
d
ir
ec
t
ca
u
s
es
o
f
n
e
o
n
atal
d
ea
th
.
Par
ticu
lar
atten
tio
n
s
h
o
u
ld
b
e
p
ai
d
to
s
ep
s
is
an
d
an
tib
io
tic
-
r
esis
tan
t
in
f
ec
tio
n
s
lik
e
K.
p
n
eu
m
o
n
iae
.
Alth
o
u
g
h
n
o
t
all
s
tu
d
ies
s
h
o
w
s
tatis
tically
s
ig
n
if
ican
t
ass
o
ciatio
n
s
,
th
e
o
v
er
all
p
atter
n
s
u
p
p
o
r
ts
th
e
im
p
o
r
tan
ce
o
f
ad
d
r
ess
in
g
n
eo
n
atal
clin
ical
co
n
d
itio
n
s
as
th
e
p
r
im
ar
y
f
o
cu
s
in
ef
f
o
r
ts
to
r
ed
u
ce
n
eo
n
atal
m
o
r
tality
in
I
n
d
o
n
esia.
T
h
ese
f
in
d
in
g
s
u
n
d
er
s
co
r
e
th
e
n
ee
d
to
im
p
r
o
v
e
ea
r
ly
d
etec
tio
n
an
d
m
an
ag
em
en
t
o
f
n
eo
n
atal
c
o
m
p
licatio
n
s
,
s
tr
en
g
th
en
N
I
C
U
ca
p
ac
ity
,
an
d
im
p
lem
en
t
s
tr
ict
in
f
ec
tio
n
c
o
n
tr
o
l
p
r
o
to
co
ls
in
all
n
eo
n
atal
ca
r
e
f
ac
ilit
ies ac
r
o
s
s
th
e
co
u
n
tr
y
.
3
.
1
.
3
.
Ris
k
f
a
c
t
o
rs f
o
r
neo
na
t
a
l
m
o
rt
a
lity
−
Ma
ter
n
al
an
d
p
r
eg
n
a
n
cy
-
r
elate
d
f
ac
to
r
s
Ma
ter
n
al
ch
ar
ac
ter
is
tics
ass
o
ciate
d
with
n
eo
n
atal
d
ea
t
h
in
cl
u
d
e
m
ater
n
al
ag
e
(
p
-
v
alu
e
=
0
.
0
2
4
)
a
n
d
p
ar
ity
(
p
-
v
alu
e
0
.
0
0
2
)
.
Ho
wev
er
,
th
er
e
wer
e
n
o
s
ig
n
if
ica
n
t a
s
s
o
ciatio
n
s
f
o
u
n
d
f
o
r
m
ater
n
al
ed
u
ca
tio
n
lev
el
(
p
-
v
alu
e
0
.
2
2
6
)
o
r
g
estatio
n
al
ag
e
(
p
-
v
alu
e
0
.
1
0
8
)
[
41
]
.
M
o
th
e
r
s
at
r
is
k
(
<2
5
y
ea
r
s
o
r
>3
5
y
ea
r
s
)
h
ad
a
3
.
4
9
6
tim
es
h
ig
h
er
lik
elih
o
o
d
o
f
n
eo
n
atal
m
o
r
tality
co
m
p
a
r
ed
to
t
h
o
s
e
in
th
e
s
af
e
ag
e
r
a
n
g
e
(
2
5
-
3
5
y
ea
r
s
)
(
p
-
v
alu
e
0
.
0
0
6
; O
R
3
.
4
9
6
;
9
5
% C
I
: 1
.
4
3
8
–
8
.
4
9
8
)
[
5
3
]
.
An
o
th
er
s
tu
d
y
in
d
icate
d
th
at
m
o
t
h
er
s
ag
ed
<
2
0
o
r
>
3
5
wer
e
2
.
8
tim
es
m
o
r
e
lik
ely
to
ex
p
e
r
ien
c
e
n
eo
n
atal
d
ea
th
(
p
0
.
0
4
8
;
OR
2
.
8
)
,
an
d
lo
w
ed
u
ca
tio
n
le
v
els
also
in
cr
ea
s
ed
th
e
r
is
k
(
p
0
.
0
0
0
;
OR
0
.
4
)
.
Hig
h
p
ar
ity
also
in
cr
ea
s
ed
th
e
r
is
k
,
alb
eit
m
o
d
estl
y
(
p
0
.
0
4
9
;
OR
1
.
2
)
.
Mo
r
e
o
v
er
,
d
eliv
er
y
atten
d
ed
b
y
n
o
n
-
h
ea
l
th
wo
r
k
er
s
ca
r
r
ied
a
s
ig
n
if
ica
n
tly
h
ig
h
er
r
is
k
-
u
p
to
8
.
6
tim
es
-
if
ass
is
tan
ce
wa
s
in
ad
eq
u
ate
(
p
0
.
0
0
0
;
OR
8
.
6
)
.
Deliv
er
ies
th
at
o
cc
u
r
r
e
d
o
u
ts
id
e
h
ea
lth
f
ac
ilit
ies
also
h
ad
a
f
o
u
r
f
o
ld
i
n
cr
ea
s
ed
r
is
k
(
p
0
.
0
2
5
; O
R
4
.
0
0
)
[
5
4
]
.
R
eg
ar
d
in
g
g
estatio
n
al
ag
e,
a
s
tu
d
y
f
o
u
n
d
a
s
ig
n
if
ican
t
ass
o
ciatio
n
with
n
eo
n
atal
m
o
r
tality
(
p
0
.
0
0
2
)
,
wh
ile
p
ar
ity
was
n
o
t
s
ig
n
if
ic
an
tly
r
elat
ed
(
p
0
.
5
8
3
)
[
42
]
.
T
h
is
is
s
u
p
p
o
r
ted
b
y
an
o
th
er
s
tu
d
y
s
h
o
win
g
th
at
p
ar
ity
d
id
n
o
t
s
ig
n
if
ican
tly
c
o
r
r
elate
with
n
eo
n
atal
d
ea
th
(
p
0
.
5
5
1
;
R
R
=
1
.
2
8
;
9
5
%
C
I
:
0
.
5
8
–
2
.
8
4
)
.
Oth
er
m
ater
n
al
ch
ar
ac
te
r
is
tics
,
s
u
ch
as
p
o
s
t
-
ter
m
g
estatio
n
an
d
m
u
ltip
ar
ity
,
wer
e
f
o
u
n
d
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with
in
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o
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Ad
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ater
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r
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p
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an
cy
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p
licatio
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s
wer
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ass
o
ciate
d
with
h
ig
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er
n
eo
n
atal
m
o
r
tality
.
E
ar
ly
n
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ea
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was
also
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ciate
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co
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tr
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ev
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i
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ch
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4
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I
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5
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5
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Mo
th
er
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t u
s
in
g
co
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tr
ac
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ti
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ad
1
1
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4
tim
es h
ig
h
er
r
is
k
o
f
ea
r
ly
n
e
o
n
atal
d
ea
th
.
T
h
ese
f
in
d
in
g
s
em
p
h
asize
th
e
im
p
o
r
tan
ce
o
f
c
o
m
m
u
n
ity
h
ea
lth
wo
r
k
er
s
i
n
p
r
o
m
o
tin
g
f
am
ily
p
lan
n
in
g
p
ar
ticip
atio
n
am
o
n
g
co
u
p
les
o
f
r
ep
r
o
d
u
ctiv
e
ag
e
as a
s
tr
ateg
y
f
o
r
p
r
ev
en
tin
g
ea
r
ly
n
eo
n
atal
m
o
r
tality
[
5
5
]
.
Ma
ter
n
al
h
ea
lth
ca
r
e
s
er
v
ice
in
d
icato
r
s
in
clu
d
e
ANC
(
K4
)
co
v
er
ag
e
at
9
2
%,
s
k
illed
b
ir
th
at
ten
d
an
ce
at
9
9
.
4
%,
in
s
titu
tio
n
al
d
eliv
er
y
co
v
e
r
ag
e
at
8
9
.
3
%,
f
u
ll
n
e
o
n
atal
v
is
it
co
v
er
ag
e
at
9
9
.
6
%,
an
d
ea
r
l
y
in
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n
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m
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ail
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ater
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ly
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ates
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3
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5
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ig
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r
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k
o
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g
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An
o
t
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tu
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ig
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if
ican
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b
etwe
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d
n
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atal
d
ea
th
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b
u
t th
e
v
ar
iab
le
s
till
s
h
o
wed
a
r
el
ev
an
t tr
en
d
.
O
b
s
t
et
r
i
c
c
o
m
p
l
i
c
at
i
o
n
s
s
u
c
h
as
p
r
e
m
a
t
u
r
e
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u
p
t
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m
e
m
b
r
a
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e
s
(
P
R
O
M
)
a
t
t
e
r
m
i
n
c
r
e
as
ed
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h
e
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3
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I
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(
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I
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I
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p
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a
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i
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o
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,
n
o
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a
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a
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h
(
p
=
0
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7
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.
C
l
i
n
i
c
a
l
c
h
o
r
i
o
a
m
n
i
o
n
i
t
i
s
i
n
c
i
d
e
n
c
e
was
h
i
g
h
e
r
i
n
t
e
r
m
p
r
e
g
n
a
n
c
i
es
an
d
w
a
s
a
s
s
o
c
ia
t
e
d
w
it
h
a
d
d
i
t
i
o
n
a
l
r
i
s
k
f
a
c
t
o
r
s
s
u
c
h
a
s
i
n
f
e
ct
i
o
n
a
n
d
h
e
p
at
i
t
is
B
[
35
]
.
I
n
f
e
c
t
e
d
m
o
t
h
e
r
s
a
r
e
al
s
o
a
t
r
i
s
k
o
f
v
e
r
t
i
c
al
t
r
a
n
s
m
is
s
i
o
n
o
f
d
i
s
e
as
es
li
k
e
H
I
V
,
h
e
p
a
t
i
t
is
,
a
n
d
s
y
p
h
i
l
is
,
w
h
i
c
h
i
n
c
r
e
a
s
e
n
e
o
n
a
t
a
l
m
o
r
b
i
d
it
y
a
n
d
m
o
r
t
a
l
i
t
y
t
h
r
o
u
g
h
i
n
f
e
c
ti
o
n
s
a
n
d
s
e
p
s
is
[
5
6
]
.
P
r
e
g
n
a
n
c
y
c
o
m
p
l
i
c
a
t
i
o
n
s
a
ls
o
i
n
c
r
e
a
s
e
d
t
h
e
r
is
k
o
f
p
r
e
t
e
r
m
b
i
r
t
h
(
a
O
R
=
0
.
9
2
;
9
5
%
C
I
:
0
.
5
3
–
1
.
6
0
)
,
s
m
a
l
l
-
f
o
r
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g
e
s
t
a
ti
o
n
a
l
-
a
g
e
b
i
r
t
h
s
(
a
OR
=
1
.
1
9
;
9
5
%
C
I
:
0
.
6
2
–
2
.
2
6
)
,
l
o
w
5
-
m
i
n
u
t
e
A
p
g
a
r
s
c
o
r
e
s
(
a
OR
=
2
.
5
7
;
9
5
%
C
I
:
0
.
9
3
–
7
.
1
5
)
,
a
n
d
m
a
j
o
r
c
o
n
g
e
n
i
t
a
l
a
n
o
m
a
li
es
(
a
OR
=
0
.
9
3
;
9
5
%
C
I
:
0
.
4
8
–
1
.
8
3
)
[
5
7
]
.
H
o
w
e
v
e
r
,
a
n
o
t
h
e
r
s
t
u
d
y
f
o
u
n
d
n
o
s
i
g
n
i
f
i
c
a
n
t
a
s
s
o
c
i
at
i
o
n
b
e
t
w
e
e
n
p
r
e
g
n
a
n
c
y
c
o
m
p
l
i
c
at
i
o
n
s
a
n
d
n
e
o
n
a
t
a
l
d
ea
t
h
(
p
=
0
.
4
8
7
)
[
42
]
.
I
n
co
n
clu
s
io
n
,
m
ater
n
al
f
ac
t
o
r
s
s
u
ch
as
e
x
tr
em
e
m
ater
n
a
l
ag
e
(
<
2
0
a
n
d
>3
5
y
ea
r
s
)
,
p
r
eg
n
a
n
cy
co
m
p
licatio
n
s
(
e.
g
.
,
PR
OM
,
in
f
ec
tio
n
)
,
in
ad
e
q
u
ate
in
f
an
t
c
ar
e,
an
d
lack
o
f
c
o
n
tr
ac
ep
tiv
e
u
s
e
s
ig
n
if
ican
tl
y
in
cr
ea
s
e
th
e
r
is
k
o
f
n
eo
n
atal
m
o
r
tality
.
Alth
o
u
g
h
ANC
co
v
er
ag
e
is
h
ig
h
,
d
elay
e
d
r
ec
o
g
n
i
tio
n
o
f
d
an
g
er
s
ig
n
s
r
em
ain
s
a
cr
itical
i
s
s
u
e.
T
h
ese
f
in
d
in
g
s
s
u
p
p
o
r
t
n
atio
n
al
p
o
licy
r
ec
o
m
m
e
n
d
atio
n
s
to
s
tr
en
g
th
en
m
ater
n
al
s
u
p
p
o
r
t
s
y
s
tem
s
th
r
o
u
g
h
co
m
m
u
n
ity
h
ea
lth
wo
r
k
er
s
,
ed
u
ca
te
m
o
th
er
s
o
n
p
r
e
g
n
an
c
y
an
d
n
eo
n
atal
d
an
g
er
s
ig
n
s
,
an
d
im
p
r
o
v
e
th
e
q
u
ali
ty
o
f
an
ten
atal
ca
r
e
an
d
f
am
ily
p
lan
n
in
g
s
er
v
ices.
Pro
g
r
a
m
s
lik
e
P
o
s
ya
n
d
u
,
P
ON
E
D
,
P
ON
E
K
,
an
d
AM
P
-
SR
s
h
o
u
ld
b
e
s
y
n
er
g
ize
d
with
s
tr
en
g
t
h
en
ed
r
is
k
co
m
m
u
n
i
ca
tio
n
an
d
in
ten
s
iv
e
m
o
n
ito
r
in
g
o
f
h
ig
h
-
r
is
k
p
r
e
g
n
an
cies to
s
u
s
tain
ab
ly
r
ed
u
ce
n
eo
n
atal
m
o
r
tality
.
−
Hea
lth
s
er
v
ice
f
ac
to
r
s
R
esear
ch
f
in
d
in
g
s
in
d
icate
th
a
t
th
e
q
u
ality
o
f
p
r
en
atal,
in
tr
a
p
ar
tu
m
,
an
d
d
eliv
er
y
ca
r
e
p
lay
s
a
cr
u
cial
r
o
le
in
p
r
e
v
en
tin
g
a
v
o
id
ab
le
n
eo
n
atal
d
ea
th
s
.
Me
d
ical
s
er
v
ic
es
wer
e
s
ig
n
if
ican
tly
ass
o
ciate
d
with
in
f
an
t
d
ea
th
p
r
ev
en
tio
n
o
n
ly
th
r
o
u
g
h
th
e
c
o
llab
o
r
ativ
e
ef
f
o
r
t o
n
th
e
in
f
a
n
t m
o
r
tality
(
I
C
E
)
m
eth
o
d
[
45
]
.
Hea
lth
s
y
s
tem
an
d
s
er
v
ice
f
ac
to
r
s
a
r
e
clo
s
ely
lin
k
ed
to
th
e
b
ir
th
atten
d
a
n
t
a
n
d
p
lace
o
f
d
eliv
e
r
y
.
Deliv
er
ies
o
u
ts
id
e
h
ea
lt
h
f
ac
ilit
ies
wer
e
f
o
u
n
d
t
o
in
cr
ea
s
e
th
e
r
is
k
o
f
n
eo
n
atal
d
ea
th
b
y
u
p
to
f
o
u
r
tim
es
(
p
=
0
.
0
2
5
;
OR
=
4
.
0
)
.
T
h
u
s
,
ed
u
ca
tio
n
-
b
ased
in
ter
v
en
tio
n
s
,
im
p
r
o
v
ed
ac
ce
s
s
to
f
ac
ilit
y
-
b
ased
d
eliv
er
ies,
an
d
s
tr
o
n
g
er
p
o
s
tn
atal
ca
r
e
s
u
p
p
o
r
t
ar
e
ess
en
tial
f
o
r
r
ed
u
c
in
g
n
eo
n
atal
m
o
r
tality
.
Mo
r
eo
v
er
,
th
e
p
lace
o
f
d
eliv
er
y
is
a
s
tr
o
n
g
p
r
ed
ict
o
r
o
f
n
eo
n
atal
d
ea
t
h
(
p
-
v
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e
<
0
.
0
0
1
)
.
R
ef
er
r
al
s
y
s
tem
s
ar
e
al
s
o
a
m
ajo
r
c
o
n
tr
ib
u
to
r
t
o
n
e
o
n
atal
d
ea
th
s
(
p
=
0
.
0
0
5
)
,
p
ar
ticu
lar
l
y
d
u
e
to
r
ef
e
r
r
al
d
elay
s
,
wh
ich
o
f
ten
r
esu
lt
in
b
ab
ies ar
r
iv
in
g
in
cr
itical
co
n
d
itio
n
.
Ho
wev
er
,
th
e
m
o
d
e
o
f
d
eliv
e
r
y
was n
o
t s
ig
n
if
ican
tly
ass
o
ciate
d
with
n
e
o
n
atal
d
ea
th
(
p
=
0
.
3
7
1
)
[
42
]
.
T
h
at
s
aid
,
am
o
n
g
ea
r
ly
p
r
eter
m
g
r
o
u
p
s
,
m
o
d
e
o
f
d
eliv
e
r
y
was
s
ig
n
if
ican
tly
ass
o
ciate
d
(
p
<
0
.
0
5
)
with
o
u
tco
m
es
s
u
ch
as
b
ir
th
weig
h
t,
Ap
g
ar
s
co
r
e,
a
n
d
n
e
o
n
atal
d
ea
th
.
I
n
late
p
r
eter
m
g
r
o
u
p
s
,
s
ig
n
if
ican
t
ass
o
ciati
o
n
s
wer
e
f
o
u
n
d
o
n
ly
with
Ap
g
ar
s
co
r
es
an
d
n
eo
n
at
al
m
o
r
tality
(
p
<
0
.
0
5
)
,
n
o
t b
ir
th
weig
h
t.
C
esar
ea
n
s
ec
tio
n
d
eliv
er
ies
s
h
o
wed
a
s
ig
n
if
ican
tly
lo
wer
in
cid
en
ce
o
f
n
eo
n
atal
asp
h
y
x
ia
a
n
d
d
ea
th
in
b
o
th
g
r
o
u
p
s
co
m
p
ar
ed
to
o
th
e
r
d
eliv
er
y
m
eth
o
d
s
.
C
er
tain
d
eliv
er
y
p
r
ac
tices,
s
u
ch
as
la
b
o
r
in
d
u
ctio
n
a
n
d
ce
s
ar
ea
n
s
ec
tio
n
,
h
av
e
b
ee
n
lin
k
ed
with
a
r
is
in
g
tr
en
d
in
n
eo
n
atal
d
ea
th
s
.
Des
p
ite
r
elativ
ely
h
ig
h
s
er
v
ice
co
v
er
ag
e,
p
er
s
is
ten
tly
h
ig
h
n
eo
n
atal
m
o
r
tality
r
ates
s
u
g
g
est
o
n
g
o
in
g
is
s
u
es
in
s
er
v
ice
q
u
ality
an
d
in
ad
d
r
ess
in
g
m
ater
n
al,
n
eo
n
atal,
an
d
s
y
s
tem
ic
r
is
k
f
ac
to
r
s
.
Hen
ce
,
im
p
r
o
v
in
g
th
e
q
u
ality
o
f
m
ater
n
al
an
d
n
eo
n
atal
h
ea
lth
s
er
v
ices
—
esp
ec
iall
y
in
th
e
p
r
e
v
en
tio
n
o
f
lo
w
b
ir
th
weig
h
t (
L
B
W
)
an
d
tim
ely
asp
h
y
x
ia
m
a
n
ag
em
en
t
—
is
im
p
er
a
tiv
e.
Ser
v
ice
in
n
o
v
atio
n
also
p
la
y
s
a
r
o
le
in
r
e
d
u
cin
g
n
eo
n
atal
m
o
r
tality
.
Fo
r
in
s
tan
ce
,
i
n
ter
v
e
n
tio
n
s
lik
e
Kan
g
ar
o
o
Mo
th
er
C
ar
e
(
KM
C
)
f
o
r
p
r
e
m
atu
r
e
an
d
lo
w
b
ir
t
h
weig
h
t
in
f
an
ts
h
av
e
b
ee
n
i
d
en
tifie
d
as
s
ig
n
if
ican
t
p
r
ed
icto
r
s
o
f
d
ec
r
ea
s
ed
n
e
o
n
a
tal
d
ea
th
s
[
46
]
.
T
h
e
d
e
v
elo
p
m
en
t
o
f
n
eo
n
atal
h
ea
lth
p
r
o
t
o
co
ls
is
also
cr
u
cial
in
p
r
ev
en
tin
g
n
eo
n
atal
m
o
r
tality
[
5
8
]
.
Ho
wev
e
r
,
im
p
lem
en
tatio
n
o
f
th
e
AM
P
-
SR
p
r
o
ce
s
s
f
ac
es
ch
allen
g
es
s
u
ch
as
lim
ited
h
u
m
an
r
eso
u
r
ce
s
,
i
n
ad
eq
u
ate
b
u
d
g
ets,
ir
r
e
g
u
lar
c
alib
r
atio
n
o
f
m
e
d
ical
eq
u
ip
m
e
n
t,
an
d
s
u
b
o
p
tim
al
u
s
e
o
f
th
e
MPDN
ap
p
licatio
n
[
1
4
]
.
Oth
er
co
n
tr
i
b
u
tin
g
f
ac
to
r
s
in
clu
d
e
a
lac
k
o
f
h
e
alth
wo
r
k
er
s
k
ills
,
p
ar
ticu
lar
ly
in
m
an
ag
i
n
g
h
ig
h
-
r
is
k
d
eliv
er
ies
an
d
p
er
f
o
r
m
i
n
g
n
eo
n
atal
r
esu
s
citatio
n
,
as
well
as
th
e
lim
ited
av
ailab
ilit
y
o
f
h
ea
lth
ca
r
e
s
er
v
i
ce
s
in
r
em
o
te
o
r
r
u
r
al
ar
ea
s
.
T
h
ese
in
clu
d
e
s
h
o
r
ta
g
es
o
f
in
cu
b
ato
r
s
,
an
tib
i
o
tics
,
o
r
ev
en
s
tab
le
elec
tr
icity
,
an
d
th
e
p
r
ev
alen
ce
o
f
h
o
m
e
b
ir
t
h
s
—
esp
ec
ially
in
r
eg
io
n
s
with
s
tr
o
n
g
tr
ad
itio
n
al
b
elief
s
o
r
lim
ited
ac
ce
s
s
—
f
u
r
th
er
ex
ac
er
b
ates n
eo
n
atal
m
o
r
t
ality
[
5
9
]
.
I
n
c
o
n
c
l
u
s
i
o
n
,
t
h
e
h
e
a
l
t
h
s
y
s
t
em
f
a
c
t
o
r
s
—
s
u
c
h
a
s
p
l
ac
e
o
f
d
e
l
i
v
e
r
y
,
r
e
f
e
r
r
a
l
s
y
s
t
e
m
s
,
d
e
l
i
v
e
r
y
m
e
t
h
o
d
s
,
a
n
d
t
h
e
q
u
a
l
i
t
y
o
f
p
r
e
n
a
t
a
l
a
n
d
n
e
o
n
a
t
a
l
c
a
r
e
—
s
i
g
n
i
f
i
c
a
n
t
l
y
co
n
t
r
i
b
u
t
e
t
o
n
e
o
n
a
t
a
l
m
o
r
t
a
l
i
t
y
.
I
n
t
e
r
v
e
n
t
i
o
n
s
s
u
c
h
a
s
K
MC
a
n
d
h
e
al
t
h
w
o
r
k
e
r
c
ap
a
c
i
t
y
-
b
u
i
l
d
i
n
g
h
a
v
e
p
r
o
v
e
n
e
f
f
e
c
t
i
v
e
i
n
r
e
d
u
c
i
n
g
n
e
o
n
a
t
al
d
ea
t
h
s
,
p
a
r
ti
c
u
l
a
r
l
y
in
h
i
g
h
-
r
i
s
k
p
o
p
u
l
a
t
i
o
n
s
.
T
h
e
s
e
f
in
d
i
n
g
s
u
n
d
e
r
s
c
o
r
e
t
h
e
u
r
g
e
n
t
n
e
e
d
t
o
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r
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r
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p
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ll
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u
n
d
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r
d
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o
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e
d
r
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i
o
n
s
.
P
o
l
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c
y
m
a
k
e
r
s
p
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i
t
a
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r
o
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e
Evaluation Warning : The document was created with Spire.PDF for Python.
I
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t J Pu
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lic
Hea
lth
Sci
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SS
N:
2252
-
8
8
0
6
C
a
u
s
es a
n
d
r
is
k
fa
cto
r
s
o
f n
eo
n
a
ta
l m
o
r
ta
lity th
r
o
u
g
h
th
e
A
MP
-
S
R
fr
a
mewo
r
k:
…
(
S
u
lich
a
N
u
r
h
a
ya
ti
)
249
t
h
r
o
u
g
h
t
h
e
A
M
P
-
S
R
i
n
r
e
d
u
ci
n
g
m
a
t
e
r
n
a
l
a
n
d
n
e
o
n
a
t
al
m
o
r
t
a
l
i
t
y
.
R
e
al
-
t
i
m
e
,
t
e
c
h
-
b
as
e
d
r
e
f
e
r
r
a
l
s
y
s
t
e
m
s
f
o
r
h
i
g
h
-
r
i
s
k
m
o
t
h
e
r
s
a
n
d
n
e
o
n
at
e
s
,
e
n
h
a
n
c
e
d
t
r
ai
n
i
n
g
i
n
n
eo
n
a
t
a
l
r
es
u
s
ci
t
a
ti
o
n
a
n
d
h
i
g
h
-
r
i
s
k
c
a
r
e
,
n
a
t
i
o
n
al
i
m
p
l
e
m
e
n
t
a
ti
o
n
o
f
K
M
C
,
a
n
d
i
n
t
e
g
r
a
t
e
d
n
e
o
n
a
t
a
l
p
r
o
t
o
c
o
l
s
,
a
l
o
n
g
w
i
t
h
s
u
s
t
a
i
n
e
d
f
u
n
d
i
n
g
f
o
r
b
o
t
h
b
a
s
i
c
a
n
d
a
d
v
a
n
c
e
d
n
e
o
n
a
t
a
l
c
a
r
e
a
t
c
o
m
m
u
n
i
t
y
h
e
a
l
t
h
c
e
n
t
e
r
s
a
n
d
h
o
s
p
i
t
a
ls
,
a
r
e
es
s
e
n
t
i
a
l
s
t
e
p
s
f
o
r
w
a
r
d
.
3
.
1
.
4
.
Str
a
t
eg
ies
f
o
r
prev
ent
i
ng
neo
na
t
a
l a
nd
perina
t
a
l dea
t
hs
B
ased
o
n
th
e
r
ev
iew
f
in
d
in
g
s
,
th
e
p
r
ev
en
tio
n
o
f
n
eo
n
atal
d
ea
th
s
r
eq
u
ir
es
a
m
u
lti
-
lev
el
ap
p
r
o
ac
h
,
in
clu
d
in
g
i
n
d
iv
id
u
al,
f
am
ily
,
c
o
m
m
u
n
ity
,
an
d
h
ea
lth
ca
r
e
s
y
s
t
em
lev
els.
−
I
m
p
r
o
v
in
g
t
h
e
q
u
ality
o
f
h
ea
lt
h
s
er
v
ices
On
e
o
f
th
e
k
e
y
s
tr
ateg
ies in
p
r
ev
en
tin
g
n
e
o
n
atal
m
o
r
tality
is
en
h
an
cin
g
th
e
q
u
ality
o
f
h
ea
lt
h
s
er
v
ices.
I
m
p
r
o
v
in
g
b
o
th
th
e
co
v
e
r
ag
e
an
d
q
u
ality
o
f
An
te
n
atal
C
ar
e
(
ANC)
—
with
at
least
f
o
u
r
v
i
s
its
an
d
a
f
o
cu
s
o
n
ea
r
ly
d
etec
tio
n
o
f
c
o
m
p
licatio
n
s
—
h
as
b
ee
n
p
r
o
v
en
to
r
e
d
u
c
e
m
o
r
tality
r
ates
[
12
]
.
E
f
f
ec
ti
v
e
s
er
v
ices
m
u
s
t
b
e
s
u
p
p
o
r
ted
b
y
co
llab
o
r
atio
n
b
e
twee
n
h
ea
lth
o
f
f
ices,
h
ea
lth
ca
r
e
f
ac
ilit
ies,
an
d
m
id
wiv
es
in
p
r
o
v
id
i
n
g
m
ater
n
al
an
d
n
ewb
o
r
n
ca
r
e,
with
q
u
ali
ty
im
p
r
o
v
em
e
n
t
al
ig
n
ed
with
r
eg
u
latio
n
s
an
d
an
im
p
r
o
v
ed
in
teg
r
ated
r
ef
er
r
al
s
y
s
tem
to
r
ed
u
ce
th
e
t
r
en
d
o
f
n
eo
n
atal
d
ea
th
s
.
E
f
f
o
r
ts
m
u
s
t
also
in
clu
d
e
s
tr
en
g
th
en
in
g
m
ater
n
al
an
d
ch
ild
h
ea
lth
s
er
v
ices
th
r
o
u
g
h
ea
r
ly
d
e
tectio
n
o
f
h
ig
h
-
r
is
k
p
r
e
g
n
an
cies
v
ia
a
n
ten
atal
ca
r
e,
an
d
es
tab
lis
h
in
g
s
tr
u
ctu
r
ed
,
h
ier
ar
c
h
ical,
r
e
g
io
n
al,
an
d
in
te
g
r
ated
p
er
in
atal
n
etwo
r
k
s
[
45
]
.
Ad
d
itio
n
ally
,
h
ea
lth
wo
r
k
e
r
s
k
ills
—
p
ar
ticu
lar
ly
m
id
w
iv
es
—
n
ee
d
f
u
r
t
h
er
d
ev
elo
p
m
e
n
t,
p
a
r
ticu
lar
ly
in
ar
ea
s
s
u
ch
as
th
e
m
Hea
lth
in
Mid
wif
er
y
C
o
n
tin
u
ity
o
f
C
a
r
e
(
MCOC
)
m
o
d
el
,
wh
ich
in
clu
d
es e
ar
ly
r
is
k
d
ete
ctio
n
an
d
a
p
p
r
o
p
r
iate
tr
ea
tm
e
n
t
m
an
ag
em
en
t
[
6
0
]
.
−
Stre
n
g
th
en
in
g
h
ea
lth
s
y
s
tem
s
an
d
r
ef
e
r
r
al
n
etwo
r
k
s
An
ef
f
ec
tiv
e
an
d
in
teg
r
ated
h
e
alth
ca
r
e
s
y
s
tem
is
ess
en
tia
l
in
p
r
ev
en
tin
g
n
eo
n
atal
d
ea
th
s
.
I
n
f
o
r
m
atio
n
s
y
s
tem
s
f
o
r
r
ec
o
r
d
in
g
an
d
n
o
t
if
y
in
g
b
ir
th
s
an
d
d
ea
t
h
s
ar
e
c
r
itical
to
th
ese
p
r
ev
en
tio
n
ef
f
o
r
ts
[
6
1
]
.
A
d
ig
ital
an
d
in
teg
r
ativ
e
r
e
f
er
r
al
s
y
s
tem
,
s
u
ch
as
th
e
m
o
n
ito
r
in
g
p
er
in
atal
d
ea
th
n
o
tific
atio
n
(
MP
DN)
s
y
s
tem
,
en
ab
les
r
ap
id
r
ep
o
r
tin
g
an
d
ea
r
ly
in
te
r
v
en
tio
n
.
W
h
ile
d
ea
th
n
o
tific
atio
n
s
th
r
o
u
g
h
th
e
AM
P
-
SR
p
r
o
g
r
a
m
h
av
e
b
ee
n
im
p
lem
en
ted
f
air
ly
well,
im
p
r
o
v
em
en
ts
ar
e
s
till
n
ee
d
ed
to
o
p
tim
ize
ca
s
e
r
ep
o
r
tin
g
an
d
u
tili
za
tio
n
o
f
th
e
f
in
d
in
g
s
in
th
e
AM
P
-
SR
p
r
o
ce
s
s
[
6
2
]
.
R
eg
u
lar
au
d
its
o
f
p
e
r
in
atal
an
d
n
e
o
n
atal
d
ea
th
s
at
h
ea
lth
ca
r
e
f
ac
ilit
ies
ar
e
n
ee
d
ed
to
ev
alu
ate
ca
u
s
es
an
d
g
u
id
e
p
r
ev
e
n
tiv
e
ac
t
io
n
s
[
1
9
]
.
I
n
cr
ea
s
in
g
th
e
n
u
m
b
er
o
f
p
r
o
g
r
am
im
p
lem
en
ter
s
an
d
p
r
o
v
id
in
g
co
m
p
r
eh
e
n
s
iv
e
tr
ain
in
g
m
ater
i
als
ca
n
en
h
an
ce
th
e
ca
p
ac
ity
a
n
d
ef
f
ec
tiv
en
ess
o
f
AM
P
-
SR
im
p
lem
en
tatio
n
[
1
7
]
.
AM
P
-
SR
o
f
f
er
s
h
o
p
e
in
r
ed
u
cin
g
n
e
o
n
atal
m
o
r
tality
b
y
p
r
o
v
id
in
g
ea
r
ly
p
r
e
v
en
tio
n
an
d
d
ev
elo
p
in
g
r
ec
o
m
m
en
d
atio
n
s
to
av
o
i
d
r
e
p
ea
ted
d
ea
t
h
s
[1
4
]
.
Ad
d
itio
n
a
l
p
u
b
lic
h
ea
lth
e
f
f
o
r
ts
m
u
s
t
in
clu
d
e
s
tr
en
g
t
h
en
in
g
h
u
m
an
r
eso
u
r
ce
s
,
p
h
ar
m
ac
eu
ti
ca
l
av
ailab
ilit
y
,
p
r
o
d
u
ctio
n
an
d
d
is
tr
ib
u
tio
n
s
y
s
tem
s
,
m
ater
n
al
an
d
ch
ild
h
ea
lth
p
r
o
g
r
a
m
im
p
lem
en
tatio
n
,
an
d
co
m
m
u
n
ity
em
p
o
wer
m
e
n
t
[
6
3
]
.
Ser
v
ice
s
y
s
tem
in
n
o
v
atio
n
s
in
clu
d
e
d
ig
ital
n
o
tific
atio
n
s
y
s
tem
s
f
o
r
b
ir
th
an
d
n
eo
n
atal
d
ea
th
.
T
h
ese
s
y
s
tem
s
h
av
e
b
ee
n
s
h
o
wn
to
in
d
ep
en
d
e
n
tly
r
ec
o
r
d
o
v
er
h
alf
o
f
n
o
tific
atio
n
s
an
d
h
e
lp
p
r
ev
e
n
t
n
eo
n
atal
m
o
r
tality
[
1
8
],
[
61
]
.
I
n
n
o
v
ativ
e
s
tr
ateg
ies
f
o
r
co
m
p
ar
in
g
p
r
ev
alen
ce
an
d
r
is
k
s
o
f
s
till
b
ir
th
an
d
n
eo
n
atal
d
ea
th
—
p
ar
t
icu
lar
ly
am
o
n
g
s
m
all
f
o
r
g
estatio
n
al
ag
e
(
SGA)
in
f
an
ts
—
ar
e
cr
u
cial
f
o
r
r
is
k
m
itig
atio
n
[
58
]
.
Ad
d
itio
n
ally
,
ad
d
r
ess
in
g
in
f
ec
tio
n
-
r
elate
d
d
ea
th
s
r
eq
u
ir
es
m
o
r
e
ef
f
ec
tiv
e
a
n
d
tim
el
y
d
etec
tio
n
an
d
tr
ea
tm
e
n
t
s
tr
ateg
ies.
T
h
e
d
ev
elo
p
m
e
n
t
a
n
d
u
s
e
o
f
a
K.
p
n
eu
m
o
n
iae
v
ac
ci
n
e
co
u
ld
h
a
v
e
a
m
ajo
r
g
lo
b
al
im
p
ac
t in
r
ed
u
cin
g
in
f
a
n
t a
n
d
ch
il
d
m
o
r
tality
[
47
]
.
−
E
m
p
o
wer
m
e
n
t th
r
o
u
g
h
c
o
m
m
u
n
icatio
n
,
in
f
o
r
m
atio
n
,
an
d
ed
u
ca
tio
n
(
C
I
E
)
C
o
m
m
u
n
ity
em
p
o
wer
m
en
t
th
r
o
u
g
h
ed
u
ca
tio
n
a
n
d
in
f
o
r
m
at
io
n
is
k
ey
to
p
r
ev
e
n
tin
g
n
eo
n
atal
d
ea
th
,
esp
ec
ially
am
o
n
g
m
o
th
er
s
wit
h
h
ea
lth
p
r
o
b
lem
s
[
33
]
,
[
53
]
.
T
h
is
in
clu
d
es
r
aisi
n
g
awa
r
en
e
s
s
am
o
n
g
m
o
th
e
r
s
an
d
f
am
ilies
r
eg
ar
d
in
g
d
an
g
e
r
s
ig
n
s
in
p
r
e
g
n
an
c
y
an
d
n
eo
n
ates,
th
e
im
p
o
r
ta
n
ce
o
f
im
m
u
n
izatio
n
,
a
n
d
th
e
b
en
ef
its
o
f
h
o
m
e
v
is
its
b
y
h
ea
lth
wo
r
k
er
s
[
48
].
C
o
m
m
u
n
ity
-
b
ased
in
f
o
r
m
atio
n
d
is
s
em
in
atio
n
t
h
r
o
u
g
h
r
ev
italized
P
o
s
ya
n
d
u
an
d
h
e
alth
ca
d
r
es
is
cr
itical
to
s
u
p
p
o
r
tin
g
th
e
f
am
ily
p
lan
n
in
g
(
FP
)
p
r
o
g
r
am
a
n
d
r
ed
u
cin
g
ea
r
l
y
n
eo
n
atal
d
ea
th
s
.
E
d
u
ca
tio
n
is
also
n
ee
d
ed
f
o
r
b
ir
th
atten
d
an
ts
an
d
o
n
c
h
o
o
s
in
g
s
af
e
p
lac
es
f
o
r
d
eliv
er
y
,
b
o
th
o
f
wh
ich
ar
e
v
it
al
in
n
eo
n
atal
d
ea
th
p
r
ev
en
tio
n
.
−
Sp
ec
if
ic
in
t
er
v
en
tio
n
s
Sp
ec
if
ic
in
ter
v
en
tio
n
s
f
o
r
n
eo
n
atal
m
o
r
tality
p
r
ev
en
tio
n
in
cl
u
d
e
th
e
i
n
teg
r
atio
n
o
f
Kan
g
ar
o
o
Mo
th
e
r
C
ar
e
(
KM
C
)
in
to
th
e
h
ea
lth
c
ar
e
s
y
s
tem
.
T
h
is
in
ter
v
en
tio
n
p
r
o
v
i
d
es
im
p
o
r
tan
t
i
n
s
ig
h
ts
f
o
r
p
o
licy
m
ak
er
s
in
d
ev
elo
p
in
g
ef
f
ec
tiv
e
im
p
lem
e
n
tatio
n
an
d
s
ca
le
-
u
p
s
tr
ateg
ies
an
d
s
er
v
es
as
a
f
o
u
n
d
atio
n
f
o
r
f
u
tu
r
e
n
ewb
o
r
n
ca
r
e
p
r
o
g
r
am
s
[
46
]
.
I
n
co
n
cl
u
s
io
n
,
n
e
o
n
atal
d
ea
t
h
p
r
ev
en
tio
n
s
tr
ateg
ies
f
o
cu
s
o
n
im
p
r
o
v
i
n
g
ANC
an
d
p
er
in
ata
l
s
er
v
ices
th
r
o
u
g
h
tr
ain
in
g
h
ea
lth
wo
r
k
e
r
s
,
s
tr
en
g
th
en
in
g
in
f
o
r
m
atio
n
s
y
s
tem
s
an
d
r
ef
er
r
al
n
etwo
r
k
s
,
an
d
im
p
lem
en
ti
n
g
AM
P
-
SR
.
Dig
ital
in
n
o
v
atio
n
s
an
d
c
o
m
m
u
n
ity
em
p
o
wer
m
e
n
t
th
r
o
u
g
h
C
I
E
also
p
lay
k
ey
r
o
les
in
in
c
r
ea
s
in
g
awa
r
en
ess
o
f
p
r
eg
n
an
cy
r
is
k
s
,
s
u
p
p
o
r
te
d
b
y
ac
tiv
e
r
o
les
f
r
o
m
h
ea
lth
ca
d
r
es,
P
o
s
ya
n
d
u
,
an
d
f
am
ilies
.
KM
C
h
as
p
r
o
v
e
n
ef
f
ec
tiv
e
f
o
r
lo
w
b
ir
th
weig
h
t
an
d
p
r
em
at
u
r
e
in
f
a
n
ts
.
Po
licy
d
ir
ec
tio
n
s
h
o
u
ld
e
m
p
h
asize
Evaluation Warning : The document was created with Spire.PDF for Python.
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1
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ar
ch
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26
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4
2
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255
250
s
tan
d
ar
d
ized
s
er
v
ice
q
u
ality
,
tec
h
n
o
lo
g
y
-
b
ased
r
ef
er
r
al
r
ef
o
r
m
,
e
x
p
an
s
io
n
o
f
AM
P
-
SR
,
in
teg
r
atio
n
o
f
C
I
E
with
FP
an
d
ANC p
r
o
g
r
am
s
,
a
n
d
in
s
titu
tio
n
aliza
tio
n
o
f
KM
C
in
h
ea
lth
ca
r
e
s
er
v
ice
SOPs
.
4.
CO
NCLU
SI
O
N
T
h
is
s
co
p
in
g
r
ev
iew
p
r
o
v
i
d
es
a
co
m
p
r
eh
e
n
s
iv
e
s
y
n
th
esis
o
f
th
e
ca
u
s
es
an
d
r
is
k
f
ac
to
r
s
o
f
n
e
o
n
atal
m
o
r
tality
in
I
n
d
o
n
esia
u
s
in
g
th
e
Ma
ter
n
al
Per
in
atal
Su
r
v
eillan
ce
an
d
R
esp
o
n
s
e
(
AM
P
-
SR
)
f
r
am
ewo
r
k
as
an
an
aly
tical
len
s
.
B
y
in
teg
r
atin
g
ev
id
en
ce
f
r
o
m
1
7
s
tu
d
ies
ac
r
o
s
s
d
iv
er
s
e
s
ettin
g
s
,
th
is
s
tu
d
y
d
em
o
n
s
tr
ates
th
at
n
eo
n
atal
m
o
r
tality
is
d
r
iv
en
b
y
in
te
r
co
n
n
ec
ted
clin
ical,
m
ater
n
al,
an
d
h
ea
lth
s
y
s
tem
f
ac
to
r
s
th
at
ca
n
b
e
s
y
s
tem
atica
lly
id
en
tifie
d
th
r
o
u
g
h
au
d
it
-
b
ased
s
u
r
v
eillan
ce
.
T
h
e
m
ain
co
n
tr
i
b
u
tio
n
o
f
t
h
is
s
tu
d
y
lies
in
r
ep
o
s
itio
n
in
g
AM
P
-
SR
n
o
t
m
er
ely
as
a
r
ep
o
r
tin
g
m
ec
h
a
n
is
m
,
b
u
t
as
a
s
t
r
ateg
ic
to
o
l
f
o
r
u
n
d
er
s
tan
d
in
g
p
r
ev
en
tab
le
p
ath
way
s
o
f
n
eo
n
atal
d
ea
th
.
Neo
n
atal
m
o
r
tality
i
n
I
n
d
o
n
e
s
ia
r
em
ain
s
a
s
er
io
u
s
h
ea
lth
s
y
s
tem
ch
allen
g
e,
p
ar
ticu
lar
ly
d
u
r
in
g
th
e
ea
r
ly
n
eo
n
atal
p
er
io
d
(
0
–
7
d
ay
s
)
,
with
th
e
h
ig
h
est
r
is
k
o
c
cu
r
r
in
g
with
in
t
h
e
f
ir
s
t
7
2
h
o
u
r
s
o
f
life
.
Dea
th
s
p
r
ed
o
m
i
n
an
tly
af
f
ec
t
m
ale
in
f
an
ts
,
lo
w
b
ir
th
weig
h
t
(
L
B
W
)
an
d
p
r
eter
m
n
eo
n
ates,
with
lead
in
g
ca
u
s
es
in
clu
d
in
g
asp
h
y
x
ia,
s
ep
s
is
,
h
y
p
o
th
er
m
ia,
p
r
em
at
u
r
ity
,
an
d
co
n
g
en
ital
an
o
m
alies.
Key
r
is
k
f
ac
to
r
s
in
clu
d
e
h
ig
h
-
r
is
k
m
ater
n
al
a
g
e
(
<2
0
o
r
>3
5
y
ea
r
s
)
,
p
r
eg
n
an
cy
co
m
p
licatio
n
s
,
lo
w
ed
u
ca
tio
n
al
attain
m
en
t,
s
u
b
o
p
tim
al
an
ten
atal
ca
r
e,
d
ela
y
ed
r
ec
o
g
n
itio
n
o
f
d
a
n
g
er
s
ig
n
s
,
an
d
wea
k
n
ess
es in
r
ef
er
r
al
an
d
s
er
v
ice
d
eliv
er
y
s
y
s
tem
s
.
I
n
th
e
lo
n
g
ter
m
,
th
e
f
i
n
d
in
g
s
o
f
th
is
r
ev
iew
co
n
tr
ib
u
te
to
s
tr
en
g
th
en
in
g
th
e
e
v
id
en
c
e
b
ase
f
o
r
in
s
titu
tio
n
alizin
g
AM
P
-
SR
as
a
co
r
e
co
m
p
o
n
en
t
o
f
n
eo
n
atal
h
ea
lth
g
o
v
er
n
an
ce
in
I
n
d
o
n
esia.
B
y
s
y
s
tem
atica
lly
m
ap
p
in
g
p
r
e
v
en
tab
le
r
is
k
p
atter
n
s
,
th
is
s
tu
d
y
s
u
p
p
o
r
ts
th
e
u
s
e
o
f
AM
P
-
SR
d
ata
to
g
u
id
e
co
n
tin
u
o
u
s
q
u
ality
im
p
r
o
v
em
en
t,
i
n
f
o
r
m
tar
g
eted
p
o
licy
i
n
ter
v
en
tio
n
s
,
an
d
en
h
a
n
ce
ac
co
u
n
tab
ilit
y
with
in
m
ater
n
al
an
d
n
eo
n
atal
h
ea
lth
s
er
v
ices.
Ultim
ately
,
th
e
in
teg
r
atio
n
o
f
ev
id
e
n
ce
-
b
ased
AM
P
-
SR
f
in
d
in
g
s
in
to
r
o
u
tin
e
p
r
ac
tice
h
as
th
e
p
o
ten
tial
to
s
u
s
tain
ab
ly
r
ed
u
ce
p
r
e
v
en
tab
le
n
eo
n
atal
d
ea
th
s
an
d
ac
ce
ler
ate
p
r
o
g
r
ess
to
war
d
n
atio
n
al
a
n
d
g
lo
b
al
ch
i
ld
s
u
r
v
iv
al
tar
g
ets.
A
m
u
ltis
ec
to
r
al
an
d
s
u
s
tain
ed
ap
p
r
o
ac
h
is
u
r
g
e
n
tly
n
ee
d
ed
—
o
n
e
th
at
in
clu
d
es
s
tr
en
g
th
en
in
g
f
am
ily
p
lan
n
in
g
p
r
o
g
r
am
s
,
m
ater
n
a
l
ed
u
ca
tio
n
,
im
p
r
o
v
in
g
th
e
q
u
ality
o
f
ANC
an
d
n
eo
n
at
al
s
er
v
ices,
an
d
im
p
lem
en
tin
g
s
y
s
tem
atic
au
d
its
s
u
ch
as
th
e
Ma
ter
n
al
an
d
Per
in
atal
Dea
th
Su
r
v
eilla
n
ce
an
d
R
esp
o
n
s
e
(
MPDSR
/
AM
P
-
S
R
)
—
to
s
ig
n
i
f
ican
tly
r
ed
u
ce
n
eo
n
atal
m
o
r
ta
lity
in
I
n
d
o
n
esia.
5.
L
I
M
I
T
AT
I
O
N
T
h
i
s
s
c
o
p
i
n
g
r
e
v
i
ew
h
a
s
s
e
v
e
r
a
l
l
i
m
it
a
t
i
o
n
s
.
F
i
r
s
t
,
t
h
e
a
n
al
y
s
is
w
as
r
e
s
t
r
i
c
t
e
d
t
o
p
e
e
r
-
r
e
v
i
ewe
d
s
t
u
d
i
e
s
p
u
b
l
i
s
h
e
d
b
e
t
w
e
e
n
2
0
2
1
a
n
d
2
0
2
5
a
n
d
i
n
d
e
x
e
d
i
n
P
u
b
M
e
d
,
G
o
o
g
l
e
S
c
h
o
l
a
r
,
a
n
d
G
a
r
u
d
a
;
t
h
er
e
f
o
r
e
,
u
n
p
u
b
l
i
s
h
e
d
r
e
p
o
r
t
s
a
n
d
g
r
e
y
l
i
t
e
r
a
t
u
r
e
r
e
l
at
e
d
t
o
r
o
u
t
i
n
e
A
M
P
-
SR
i
m
p
l
em
e
n
t
a
t
i
o
n
m
a
y
n
o
t
b
e
f
u
l
l
y
c
a
p
t
u
r
e
d
.
S
e
c
o
n
d
,
t
h
e
i
n
c
l
u
d
e
d
s
t
u
d
i
es
w
e
r
e
p
r
e
d
o
m
i
n
a
n
t
l
y
o
b
s
e
r
v
a
t
i
o
n
al
a
n
d
d
e
s
c
r
i
p
ti
v
e
,
w
i
t
h
s
u
b
s
t
a
n
ti
a
l
h
et
e
r
o
g
e
n
e
i
t
y
i
n
s
t
u
d
y
d
e
s
i
g
n
,
d
a
t
a
s
o
u
r
c
e
s
,
a
n
d
o
u
t
c
o
m
e
r
e
p
o
r
t
i
n
g
,
w
h
i
c
h
l
i
m
i
ts
ca
u
s
a
l
i
n
f
e
r
e
n
ce
a
n
d
c
o
m
p
a
r
a
b
i
l
i
t
y
ac
r
o
s
s
s
t
u
d
ie
s
.
T
h
i
r
d
,
n
o
t
a
l
l
s
t
u
d
i
es
e
x
p
l
ic
i
tl
y
a
p
p
l
i
e
d
t
h
e
c
o
m
p
l
et
e
AM
P
-
SR
s
u
r
v
ei
l
l
a
n
c
e
–
r
es
p
o
n
s
e
c
y
c
l
e
,
r
e
s
u
l
ti
n
g
i
n
l
i
m
i
t
e
d
e
v
i
d
e
n
c
e
o
n
f
o
l
l
o
w
-
u
p
a
c
t
i
o
n
s
a
n
d
p
o
l
i
c
y
r
e
s
p
o
n
s
e
s
.
F
i
n
a
ll
y
,
m
o
s
t
e
v
i
d
e
n
c
e
w
a
s
d
e
r
i
v
e
d
f
r
o
m
f
a
c
i
l
i
t
y
-
b
a
s
e
d
s
e
t
ti
n
g
s
,
p
o
t
e
n
ti
a
l
l
y
u
n
d
e
r
r
e
p
r
es
e
n
t
i
n
g
n
e
o
n
a
t
al
d
e
a
t
h
s
o
cc
u
r
r
in
g
i
n
c
o
m
m
u
n
i
t
y
o
r
h
o
m
e
-
b
i
r
t
h
c
o
n
t
e
x
t
s
.
F
UNDING
I
NF
O
R
M
A
T
I
O
N
T
h
is
r
esear
ch
r
ec
eiv
ed
n
o
s
p
ec
if
ic
g
r
an
t f
r
o
m
a
n
y
f
u
n
d
in
g
ag
en
cy
.
AUTHO
R
CO
NT
RI
B
UT
I
O
NS ST
A
T
E
M
E
N
T
T
h
is
jo
u
r
n
al
u
s
es
th
e
C
o
n
tr
ib
u
to
r
R
o
les
T
ax
o
n
o
m
y
(
C
R
ed
iT)
to
r
ec
o
g
n
ize
in
d
iv
id
u
al
au
th
o
r
co
n
tr
ib
u
tio
n
s
,
r
ed
u
ce
au
th
o
r
s
h
ip
d
is
p
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tes,
an
d
f
ac
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ate
co
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o
r
atio
n
.
Na
m
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f
Aut
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r
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Va
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Vi
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8
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(
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251
CO
NF
L
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A
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ter
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DATA AV
AI
L
AB
I
L
I
T
Y
T
h
e
d
ata
th
at
s
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r
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th
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o
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[
SN]
,
upon
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ea
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eq
u
est.
RE
F
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NC
E
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[
1
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.
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.
J.
S
t
o
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l
,
“
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sep
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s:
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ma
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d
i
a
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o
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