Cause and risk factors of delay related to neonatal death in Afghan immigrant neonates living in Tehran province, Iran

Document Type : Original Article


1 Department of Reproductive Health &Midwifery and Reproductive Sciences and Technology Research Center, Iran University of Medical Sciences, Tehran, Iran.

2 Health Management Research Center, Baqiyatallah University of Medical Sciences, Tehran, Iran

3 School of Nursing and Midwifery, Iran University Medical and Sciences, Tehran, Iran

4 MD, Professor of Iran University of Medical Sciences, Department of Obstetrics & Gynecology, Akbarabadi Teaching Hospital, Tehran, Iran.

5 Nephrology and Urology Research Center, Clinical Science Institute, Baqiyatallah University of Medical Sciences, Tehran, Iran.

6 MD, MPH: Professor of Iran University of Medical Sciences, Department of Community and Family Medicine, Tehran, Iran.

7 Master of Midwifery Degree, Department of Reproductive Health &Midwifery, Iran University of Medical Sciences, Tehran, Iran.



Background: The aim of current study was to assess the factors contributing to early neonatal mortality, focusing on Afghan immigrant neonates, utilizing hospital information systems and medical records to identify potential determinants.

Methods: Over the course of a 21-month study period from 2017 to 2018, data was collected from 576 neonates, comprising 441 cases of neonatal near-miss (NNM) and 135 neonates who died, admitted to the neonatal intensive care unit across six selected hospitals. Data collection methods included thorough reviews of hospital systems and medical records, as well as conducting telephone or face-to-face interviews using checklists and questionnaires. Statistical analysis was performed using SPSS version 20 for Windows, with a significance level set at P<0.05 and confidence intervals at 95%.

Results: Our data demonstrated that age of 20–35 (AOR = 1.394, 95% CI 1.209, 3.743; p = 0.005), mother's illiteracy [AOR 2.544, (95% CI, 1.316–6.498; p = 0.03)], newborn insurance [AOR 2.544, (95% CI, 2.387–10.656; p = 0.03)], risk factors of pregnancy [AOR 1.351, (95% CI, 1.833–5.978; p = 0.003)], number of pregnancies ≥ 5 [AOR 3.273, (95% CI, 2.083–10.84; p = 0.002)], 2-4 pregnancies [AOR 2.539, (95% CI,2.342–6.848; p = 0.007)], antenatal care [AOR 5.103, (95% CI,3.17- 056.901; p = 0.001)] , gestational age [AOR 2.385, (95% CI, 2.322–9.652; p = 0.004)] and delay [AOR 3.178, (95% CI, 3.084–9.376; p = 0.001)] were linked to an increased risk of neonatal mortality. According to our findings, the first delay (delay in decision making for care) was the most important delay factor involved in neonatal death, followed by third delay (delay in receiving services) and second delay (access to services).

Conclusion: The elevated neonatal mortality rate (NMR) observed among Afghan neonates in Iran underscores their heightened vulnerability when compared to their Iranian counterparts.