Neonatal Mortality

The indicator measures the number of newborns dying during the first 28 days of life per 1,000 live births. It is a key impact indicator for newborn care interventions.

Neonatal mortality rate (NMR) is calculated either by using official health statistics or by conducting household surveys. If health statistics are not available or are of questionable reliability, use the following guidance to measure NMR based on household surveys:

1) Design a representative sample of households which represent the population for which you want to assess NMR.

2) Conduct individual interviews with the target households’ female representatives, asking:

Q1: How many girls have you given birth to?

A1: [enter the number]

Q2: How many boys have you given birth to?

A2: [enter the number]

Q3: Have you ever given birth to a boy or girl who was born alive but later died?

A3: yes / no

If the answer is NO, probe:

Q4: Have you delivered a baby who cried or showed signs of life but did not survive?

A4: yes / no

(ask the following questions only if one of the previous two answers is YES)

Q5: How many of the girls you delivered died?

A5: [enter number]

Q6: How old was the girl(s) who died?

A6:

1) 1st girl who died: …….    days    ……. months    ……. years

2) 2nd girl who died: …….     days…….     months…….     years (cross out this answer if only one girl died)

Q7: How many of the boys you delivered died?

A7: [enter number]

Q8: How old was the boy(s) who died?

A8:

1) 1st boy who died: ……. days   ……. months    ……. years

2) 2nd boy who died: ……. days    ……. months    ……. years (cross out this answer if only one boy died)

3) Calculate the total number of children born. Calculate the total number of children who died within the first 28 days of life (i.e. the neonatal deaths).

4) To calculate the indicator’s value, multiply the number of children who died within the first 28 days by 1,000 and divide the result by the total number of children born.

Disaggregate the data by gender, place of delivery (home, health centre, hospital), location (rural/ urban) and wealth category.

1) NMR can also be measured for a specific reference period, for example, the past five years (the period could, for example, reflect the duration of your intervention to reduce NMR). If you decide to do so, ensure that all questions and answers reflect the given time period only. When determining the child’s age, always ask for official documentation specifying the child’s age (e.g. birth certificate) or if not available, use a Local Events Calendar (see guidance on its use in the document below).

2) This indicator relies on accurate age assessment. Since people often do not remember the exact dates of their children’s birth, the data collectors should never solely rely on the information provided by caregivers and always verify the child’s age. This can be done by reviewing the child’s birth certificate or other documents; however, since many caregivers do not have such documents, it is essential that your data collectors are able to determine the child’s age by using local events calendars. Read FAO’s Guidelines (see below) to learn how to prepare local events calendars and how to train data collectors on their correct use.

3) Asking about child’s death is a sensitive topic – discuss and agree with the data collectors on what they will do to gain the required information in as sensitive a manner as possible.