{"status":"ok","message-type":"work","message-version":"1.0.0","message":{"indexed":{"date-parts":[[2026,9,19]],"date-time":"2026-09-19T14:11:56Z","timestamp":1789827116735,"version":"4.0.1"},"reference-count":24,"publisher":"SAGE Publications","license":[{"start":{"date-parts":[[2026,9,16]],"date-time":"2026-09-16T00:00:00Z","timestamp":1789516800000},"content-version":"tdm","delay-in-days":0,"URL":"https:\/\/journals.sagepub.com\/page\/policies\/text-and-data-mining-license"}],"content-domain":{"domain":["journals.sagepub.com"],"crossmark-restriction":true},"short-container-title":["Journal of Neonatal-Perinatal Medicine"],"abstract":"<jats:sec>\n                    <jats:title>Background<\/jats:title>\n                    <jats:p>Individual-level death audits can identify modifiable failures that routine mortality statistics miss. We analyzed 5\u00a0years of neonatal death audits from the Zaatari and Azraq refugee camps to characterize health-system delays, contributing factors, and preventability.<\/jats:p>\n                  <\/jats:sec>\n                  <jats:sec>\n                    <jats:title>Methods<\/jats:title>\n                    <jats:p>This individual-level analysis included 177 audited neonatal deaths from January 1, 2021, through December 31, 2025. Structured audits used caregiver interviews, maternal and neonatal records, antenatal care (ANC) cards, and provider discussions, followed by sequential independent clinical review and UNHCR validation. Contributing factors were organized using an adapted Three Delays operational taxonomy, and preventability was assigned through the audit review and adjudication process.<\/jats:p>\n                  <\/jats:sec>\n                  <jats:sec>\n                    <jats:title>Results<\/jats:title>\n                    <jats:p>Concurrent Delay 1 and Delay 3 factors were recorded in 164 deaths (92.7%). Although 99.4% of mothers received ANC, suboptimal ANC was documented in 70.6% of audited deaths, poor management of high-risk pregnancy in 57.6%, and clinician non-adherence to standards in 46.3%. Term neonates accounted for 30.1% of deaths and normal-birth-weight neonates for 30.4%. Seventy-four deaths (41.8%) were classified as definitely preventable, 60 (33.9%) as probably preventable, and 43 (24.3%) as possibly preventable; no deaths were classified as unlikely or not preventable.<\/jats:p>\n                  <\/jats:sec>\n                  <jats:sec>\n                    <jats:title>Conclusions<\/jats:title>\n                    <jats:p>Near-universal ANC attendance coexisted with frequent audit-identified deficiencies in ANC and high-risk pregnancy management, highlighting an access-quality gap. Three-quarters of audited deaths were classified as definitely or probably preventable through the audit process. These findings identify priorities for quality improvement but do not establish causal effects or the comparative impact of quality versus service coverage.<\/jats:p>\n                  <\/jats:sec>","DOI":"10.1177\/19345798261489879","type":"journal-article","created":{"date-parts":[[2026,9,16]],"date-time":"2026-09-16T23:22:16Z","timestamp":1789600936000},"update-policy":"https:\/\/doi.org\/10.1177\/sage-journals-update-policy","source":"Crossref","is-referenced-by-count":0,"title":["Preventability and contributing factors in neonatal deaths in protracted refugee camp settings: A five-year audit among Syrian refugees in Jordan"],"prefix":"10.1177","author":[{"ORCID":"https:\/\/orcid.org\/0009-0004-7400-2401","authenticated-orcid":false,"given":"Iyad","family":"Shtaiyat","sequence":"first","affiliation":[{"name":"United Nations High Commissioner for Refugees (UNHCR)"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"ORCID":"https:\/\/orcid.org\/0000-0002-7830-6857","authenticated-orcid":false,"given":"Yousef","family":"Khader","sequence":"additional","affiliation":[{"name":"Jordan University of Science and Technology"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Muhammad","family":"Fawad","sequence":"additional","affiliation":[{"name":"United Nations High Commissioner for Refugees (UNHCR)"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Mohannad","family":"Al Nsour","sequence":"additional","affiliation":[{"name":"Center of Excellence for Applied Epidemiology, Eastern Mediterranean Public Health Network (EMPHNET)"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Mohammad","family":"Abu Khadair","sequence":"additional","affiliation":[{"name":"Center of Excellence for Applied Epidemiology, Eastern Mediterranean Public Health Network (EMPHNET)"}],"role":[{"vocabulary":"crossref","role":"author"}]}],"member":"179","published-online":{"date-parts":[[2026,9,16]]},"reference":[{"key":"e_1_3_6_2_2","volume-title":"Improving newborn and neonatal care in refugee settings","author":"UNHCR","year":"2016","unstructured":"UNHCR. Improving newborn and neonatal care in refugee settings. UNHCR, 2016."},{"key":"e_1_3_6_3_2","volume-title":"Newborn mortality. Fact sheet","author":"World Health Organization","year":"2024","unstructured":"World Health Organization. Newborn mortality. Fact sheet. WHO, 2024."},{"key":"e_1_3_6_4_2","volume-title":"Levels and trends in child mortality: report 2023","author":"UNICEF","year":"2023","unstructured":"UNICEF. Levels and trends in child mortality: report 2023. UNICEF, 2023."},{"key":"e_1_3_6_5_2","doi-asserted-by":"publisher","DOI":"10.1016\/S2214-109X(18)30386-3"},{"key":"e_1_3_6_6_2","doi-asserted-by":"publisher","DOI":"10.1016\/S2214-109X(18)30389-9"},{"key":"e_1_3_6_7_2","doi-asserted-by":"publisher","DOI":"10.1007\/s10995-015-1892-x"},{"key":"e_1_3_6_8_2","volume-title":"World development indicators","author":"World Bank","year":"2023","unstructured":"World Bank. Mortality rate, neonatal (per 1,000 live births) \u2014 Jordan. In: World development indicators. World Bank, 2023."},{"key":"e_1_3_6_9_2","doi-asserted-by":"publisher","DOI":"10.3389\/ijph.2023.1605645"},{"key":"e_1_3_6_10_2","volume-title":"Neonatal mortality and stillbirths audits: Zaatari and Azraq camps. Annual report 2023","author":"GHD\/EMPHNET, UNHCR","year":"2024","unstructured":"GHD\/EMPHNET, UNHCR. Neonatal mortality and stillbirths audits: Zaatari and Azraq camps. Annual report 2023. GHD\/EMPHNET, 2024."},{"key":"e_1_3_6_11_2","doi-asserted-by":"publisher","DOI":"10.1186\/1471-2393-15-S2-S9"},{"key":"e_1_3_6_12_2","doi-asserted-by":"publisher","DOI":"10.1016\/j.ijgo.2009.07.011"},{"key":"e_1_3_6_13_2","first-page":"04133","article-title":"Implementation of MPDSR in humanitarian settings: a scoping review","volume":"14","author":"Neal S","year":"2024","unstructured":"Neal S, Ahmed T, Moran AC, et al. Implementation of MPDSR in humanitarian settings: a scoping review. J Glob Health 2024; 14: 04133.","journal-title":"J Glob Health"},{"key":"e_1_3_6_14_2","doi-asserted-by":"publisher","DOI":"10.1016\/0277-9536(94)90226-7"},{"issue":"2","key":"e_1_3_6_15_2","doi-asserted-by":"crossref","first-page":"e0002494","DOI":"10.1371\/journal.pgph.0002494","article-title":"Identifying delays in healthcare: the three delays and mortality among infants","volume":"4","author":"Blanchet K","year":"2024","unstructured":"Blanchet K, Duncombe G, Fl\u00e9chet A, et al. Identifying delays in healthcare: the three delays and mortality among infants. PLOS Glob Public Health 2024; 4(2): e0002494.","journal-title":"PLOS Glob Public Health"},{"key":"e_1_3_6_16_2","doi-asserted-by":"publisher","DOI":"10.7189\/jogh.14.04022"},{"key":"e_1_3_6_17_2","doi-asserted-by":"publisher","DOI":"10.1136\/archdischild-2013-305555"},{"key":"e_1_3_6_18_2","volume-title":"Shrinking health services put mothers and newborns at risk in Za\u2019atari camp","author":"International Rescue Committee","year":"2025","unstructured":"International Rescue Committee. Shrinking health services put mothers and newborns at risk in Za\u2019atari camp. Press release, 2025."},{"key":"e_1_3_6_19_2","doi-asserted-by":"publisher","DOI":"10.9745\/GHSP-D-13-00176"},{"key":"e_1_3_6_20_2","doi-asserted-by":"publisher","DOI":"10.7189\/jogh.07.020501"},{"key":"e_1_3_6_21_2","volume-title":"WHO recommendations on antenatal care for a positive pregnancy experience","author":"World Health Organization","year":"2016","unstructured":"World Health Organization. WHO recommendations on antenatal care for a positive pregnancy experience. WHO, 2016."},{"key":"e_1_3_6_22_2","volume-title":"Standards for improving quality of maternal and newborn care in health facilities","author":"World Health Organization","year":"2016","unstructured":"World Health Organization. Standards for improving quality of maternal and newborn care in health facilities. WHO, 2016."},{"key":"e_1_3_6_23_2","volume-title":"WHO recommendations on home-based records for maternal, newborn and child health","author":"World Health Organization","year":"2018","unstructured":"World Health Organization. WHO recommendations on home-based records for maternal, newborn and child health. WHO, 2018."},{"issue":"3","key":"e_1_3_6_24_2","first-page":"CD007754","article-title":"Community-based intervention packages for reducing maternal and neonatal morbidity and mortality and improving neonatal outcomes","author":"Lassi ZS","year":"2015","unstructured":"Lassi ZS, Bhutta ZA. Community-based intervention packages for reducing maternal and neonatal morbidity and mortality and improving neonatal outcomes. 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