A novel maternal and newborn health composite indicator using national health surveys from low- and middle-income countries: Validation and association with infant mortality

OBJECTIVES: To create a composite indicator to measure maternal and newborn health (MNH) interventions using national surveys from low- and middle-income countries (LMICs) and assess its relationship with neonatal and post-neonatal mortality. STUDY DESIGN: Cross-sectional, multi-country study using nationally representative household survey data. METHODS: The Maternal and Newborn Health composite indicator (MNHci) was created based on three essential interventions: four or more antenatal care visits, institutional delivery, and postnatal care for the woman or baby within two days of delivery. One point was assigned per intervention received, ranging from zero to three. We analyzed national distributions and stratified results by wealth and residence. Spearman coefficients were used to assess the correlation between MNHci and neonatal and post-neonatal mortality. Multilevel Poisson regression using DHS data examined the relationship between MNHci and neonatal mortality. RESULTS: MNHci was estimated for 97 LMICs using data from 2010 to 2022. In 29 countries, over 80% of woman-baby dyads received all interventions; in 15 countries, more than 20% received none. Inequalities were evident: 83% of dyads in the wealthiest decile received all interventions compared to 44% in the poorest. Data from 80 countries showed a strong inverse correlation with neonatal (-0.64; 95% CI: -0.77, -0.50) and post-neonatal (-0.67; 95% CI: -0.81, -0.54) mortality. Adjusted Poisson regression indicated a 43% lower neonatal mortality incidence ratio (IR: 0.57; 95% CI: 0.38-0.83) for dyads receiving all interventions compared to none. CONCLUSIONS: The MNHci is a simple, standardized, and meaningful tool for tracking MNH coverage across LMICs, supporting efforts to reduce neonatal mortality and health inequalities.