oa Qatar achieves its target of neonatal survival required by United Nations Millennium Development Goal 4: A PEARL study analysis

Background and Objectives: Neonatal mortality, a component of United Nations Millennium Development Goal 4 (MDG-4) (two thirds reduction in childhood mortality by 2015), has been a focus of all global health improvement strategies and plans of action since 1990. Our study aims to prospectively ascertain Qatar's neonatal mortality rate (NMR) during 2011, analyze trends between 1975 and 2011, and compare with recent data from high income countries. Methods: A PEARL study (perinatal neonatal outcomes research study in the Arabian Gulf), a joint collaborative research project between Hamad Medical Corporation (HMC), Qatar and University of Gloucestershire, United Kingdom, is Qatar's prospective national perinatal epidemiologic study funded by Qatar National Research Fund. The study quantifies maternal, neonatal and perinatal mortality, morbidities and their correlates by establishing a national neonatal perinatal registry for Qatar called Q-Peri-Reg. Data on live births and neonatal mortality was collected from all public and private maternity facilities in Qatar during 2011 and compared with historical neonatal mortality data (1975-2011) ascertained from the database of maternity and neonatal units of the Women's Hospital and annual reports of HMC. Inter-country comparisons were made using World Health statistics 2011 and the European perinatal health report 2008. Results: Total live births during the study period were 20,583 and neonatal deaths 102. NMR was 4.9, early neonatal mortality rate (ENMR) 2.7, late neonatal mortality rate (LNMR) 2.2 and corrected neonatal mortality rate (cNMR) 3.26. Between 1975 and 2011, relative risk of NMR decreased by 87% (RR 0.13, 95% CI 0.10-0.18, p <0.001), ENMR by 91% (RR 0.09, 95% CI 0.06-0.12, p <0.001) and LNMR by 58% (RR 0.42, 95% CI 0.23-0.74, p= 0.002) though the population increased by 10 fold and number of deliveries by 7.2 folds. The comparable NMR from selected high income countries are between 3 and 5. Conclusion: Qatar has achieved its target MDG-4 by 2011. The improvement has been more marked in ENMR than LNMR. The current NMR, ENMR, LNMR and cNMR are comparable with selected high income counties. Further in-depth analysis of correlates and determinants of neonatal survival in Qatar may form the basis of a strategic global neonatal mortality improvement plan.