Effect of Puerperal Infections on Early Neonatal Mortality: A Secondary Analysis of Six Demographic and Health Surveys



Around 1.5 million annual neonatal deaths occur in the first week of life, and infections represent one of the major causes in developing countries. Neonatal sepsis is often strictly connected to infection of the maternal genital tract during labour.


The association between signs suggestive of puerperal infection and early neonatal mortality (<7 days of life) was performed using Demographic and Health Surveys (DHS) data of six countries, conducted between 2010 and 2013. The population attributable fraction (PAF) was generated using the estimates on early neonatal mortality of a 1990–2013 systematic analysis for the Global Burden of Disease Study.


Signs of puerperal infection ranged from 0.7% in the Philippines to 16.4% in Honduras. Infection was associated with a 2.1 adjusted Risk Ratio (95% CI: 1.4–3.2) of early neonatal mortality. Around five percent of all deaths in the first week of life were attributable to signs suggestive of puerperal infections and varied from 13.9% (95% CI: 1.0–26.6) in Honduras to 3.6% (95% CI: 1.0–8.5) in Indonesia.


Targeted interventions should be addressed to contain the burden of puerperal infections on early neonatal mortality. Consideration of the PAF will help in the discussion of the benefits of antenatal and perinatal measures.

Authors & affiliation: 
Saverio Bellizzi,1 Quique Bassat,2,3,4 Mohamed M. Ali,1,* Howard L. Sobel,5 and Marleen Temmerman6 Umberto Simeoni, Editor 1World Health Organization, Department of Reproductive Health and Research, Geneva, Switzerland 2ISGlobal, Barcelona Ctr. Int. Health Res. (CRESIB), Hospital Clínic—Universitat de Barcelona, Barcelona, Spain 3Centro de Investigação em Saúde de Manhiça (CISM), Maputo, Mozambique 4ICREA, Barcelona, Spain 5World Health Organization, Western Pacific Regional Office, Manila, Philippines 6Department of Obstetrics and Gynaecology, Ghent University, Ghent, Belgium Centre Hospitalier Universitaire Vaudois, FRANCE
Published In: 
PLoS One. 2017; 12(1): e0170856.
Publication date: 
Wednesday, January 25, 2017