Trends and Determinants of Newborn Mortality in the Kyrgyz Republic: A Countdown Country Case Study

Background: The Kyrgyz Republic has made great progress in reducing neonatal mortality rate (NMR), compared to the region, despite its regional comparatively low GDP per capita. Given the availability of an established civil registration and vital statistics system, the country is uniquely positioned to undertake a comprehensive assessment of trends and determinants of newborn mortality. Methods: We used publicly available data repositories and the national birth registry data to examine trends and inequalities of reproductive, maternal and newborn health and mortality between 1990 and 2018 at a national and subnational level. Coverage of newborn and maternal health interventions were assessed and disaggregating by equity dimensions. Oaxaca-Blinder decomposition was done to determine the contextual factors associated with the observed decline in NMR. We undertook a comprehensive review of national policies and programs, as well as a prospective Lives Saved Tool (LiST) analysis to highlight interventions that will save the most lives. Findings: In the past two decades, with the help of investments and appropriate policies, the Kyrgyz Republic has reduced NMR by 54%, with the leading causes of death attributable to prematurity and asphyxia. Neonates born pre-term small-for-gestational age are over 80 times more likely to die in their first month of life, compared to those born full term, appropriate-for-gestational age. With the exception of contraceptive use, coverage of essential interventions is increasing and exceptionally high with limited sociodemographic inequities. By 2030, improved case management of premature babies will save the most neonatal lives. Interpretation: The Kyrgyz Republic has reduced NMR considerably, with the potential for further reduction given its remarkably high coverage and low inequities of preventative maternal and newborn health interventions. A particular focus is needed on scaling-up packages of interventions to care for small and sick babies, assuring quality of care in all healthcare facilities, and creating a linked national registry system for mothers and newborns. Funding Statement: US Fund for UNICEF under the Countdown to 2015 and UNICEF Kyrgyzstan Declaration of Interests: All authors declare no competing interests.