Stillbirth and Neonatal Mortality Among Rohingya Refugees in Bangladesh: A Prospective Surveillance from September 2017 Through December 2018

Background: We sought to evaluate the neonatal mortality and stillbirth rate among Rohingya refugees in Bangladesh and determine whether there is an association between nearness to a secondary health facility and neonatal mortality or stillbirth; and test the correlation between number of health facilities in a camp and neonatal mortality or stillbirth rate.

Methods: We carried out a prospective mortality surveillance in 29 out of 34 Rohingya refugee camps in Bangladesh from September 2017 to December 2018. The dataset covers approximately 811,543 Rohingya refugees in 29 camps with an estimated live birth of 19,477 during the study period. We linked the mortality surveillance data with publicly available information on camp population, number of functional health facilities by level of care, and geospatial coordinates of camp and health facility. We applied regression and spatial analysis to estimate the mortality rate and test for correlations and associations

Results: The overall neonatal mortality rate was 27.30 [95%CI: 22.30, 31.77] per 1000 livebirths and stillbirth rate 15.20 [95%CI: 10.82, 19.57] per 1000 total births. Majority of neonatal deaths 76.3% (n=405) and stillbirths 71.8% (n=201) occurred at home or in the community outside a health facility. By May 2018, 248 health facilities offered service to the population, of which 2.8% (n=7) were secondary health facilities and 6.9%(n=17) were labor room/sexual reproductive health units. There was positive correlation between number of health facilities and population size of camp (p-value <0.01) . There was no statistically significant correlation between neonatal mortality rate of camp and number of health facilities inside camp. Secondary health facilities were clustered near camps that had lower neonatal mortality rate and lower stillbirth rate (p-value <0.05). Labor room/sexual and reproductive health units were spread out and not associated with neonatal mortality rate or stillbirth rate.

Conclusion: The results of the prospective surveillance provide an insight to severe stillbirth and neonatal mortality rate among Rohingya population. Prospective mortality surveillance may be a feasible method to monitor and evaluate the severity of the situation and effectiveness of humanitarian response in improving neonatal survival and preventing stillbirth.