Outcome of delivery and cause-specific mortality and severe morbidity in early infancy: a Kenyan District Hospital birth cohort.

It has proven very difficult to determine the causes of early infant mortality and morbidity in Africa. We undertook a two-year, prospective birth cohort study in a rural Kenyan District Hospital to estimate cause-specific mortality and severe morbidity in infants too young to gain benefit from routine immunization approaches. A total of 2,359 infants eligible for the cohort were delivered. Of these, 136 (6%) were stillborn and 77 (3.5%) subsequently died. Prematurity (34%), birth asphyxia (27%), and infection (18.5%) were the predominant causes of death in the first 98 days of life, although infection accounted for 36% of all life-threatening illness episodes in the same period. The data suggest that health system constraints are likely to impede programmatic efforts to reduce early infant mortality and morbidity, and that infection prevention measures offer some promise for mortality reduction. Assessing the cost effectiveness of the latter, particularly for very specific interventions such as further maternal vaccination, will require very large trials.