BACKGROUND: Perinatal (stillbirths and first week neonatal deaths) and neonatal (deaths in the first 4 weeks) mortality rates remain high in developing countries like Nepal. As most births and deaths occur in the community, an option to ascertain causes of death is to conduct verbal autopsy. OBJECTIVE: The objective of this study was to classify and review the causes of stillbirths and neonatal deaths in Dhanusha district, Nepal. MATERIALS AND METHODS: Births and neonatal deaths were identified prospectively in 60 village development committees of Dhanusha district. Families were interviewed at six weeks after delivery, using a structured questionnaire. Cause of death was assigned independently by two pediatricians according to a predefined algorithm; disagreement was resolved in discussion with a consultant neonatologist. RESULTS: There were 25,982 deliveries in the 2 years from September 2006 to August 2008. Verbal autopsies were available for 601/813 stillbirths and 671/954 neonatal deaths. The perinatal mortality rate was 60 per 1000 births and the neonatal mortality rate 38 per 1000 live births. 84% of stillbirths were fresh and obstetric complications were the leading cause (67%). The three leading causes of neonatal death were birth asphyxia (37%), severe infection (30%) and prematurity or low birth weight (15%). Most infants were delivered at home (65%), 28% by relatives. Half of women received an injection (presumably an oxytocic) during home delivery to augment labour. Description of symptoms commensurate with birth asphyxia was commoner in the group of infants who died (41%) than in the surviving group (14%). CONCLUSION: The current high rates of stillbirth and neonatal death in Dhanusha suggest that the quality of care provided during pregnancy and delivery remains sub-optimal. The high rates of stillbirth and asphyxial mortality imply that, while efforts to improve hygiene need to continue, intrapartum care is a priority. A second area for consideration is the need to reduce the uncontrolled use of oxytocic for augmentation of labour.
BACKGROUND: Perinatal (stillbirths and first week neonatal deaths) and neonatal (deaths in the first 4 weeks) mortality rates remain high in developing countries like Nepal. As most births and deaths occur in the community, an option to ascertain causes of death is to conduct verbal autopsy. OBJECTIVE: The objective of this study was to classify and review the causes of stillbirths and neonatal deaths in Dhanusha district, Nepal. MATERIALS AND METHODS: Births and neonatal deaths were identified prospectively in 60 village development committees of Dhanusha district. Families were interviewed at six weeks after delivery, using a structured questionnaire. Cause of death was assigned independently by two pediatricians according to a predefined algorithm; disagreement was resolved in discussion with a consultant neonatologist. RESULTS: There were 25,982 deliveries in the 2 years from September 2006 to August 2008. Verbal autopsies were available for 601/813 stillbirths and 671/954 neonatal deaths. The perinatal mortality rate was 60 per 1000 births and the neonatal mortality rate 38 per 1000 live births. 84% of stillbirths were fresh and obstetric complications were the leading cause (67%). The three leading causes of neonatal death were birth asphyxia (37%), severe infection (30%) and prematurity or low birth weight (15%). Most infants were delivered at home (65%), 28% by relatives. Half of women received an injection (presumably an oxytocic) during home delivery to augment labour. Description of symptoms commensurate with birth asphyxia was commoner in the group of infants who died (41%) than in the surviving group (14%). CONCLUSION: The current high rates of stillbirth and neonatal death in Dhanusha suggest that the quality of care provided during pregnancy and delivery remains sub-optimal. The high rates of stillbirth and asphyxial mortality imply that, while efforts to improve hygiene need to continue, intrapartum care is a priority. A second area for consideration is the need to reduce the uncontrolled use of oxytocic for augmentation of labour.
Authors: Frank Baiden; Ayaga Bawah; Sidu Biai; Fred Binka; Ties Boerma; Peter Byass; Daniel Chandramohan; Somnath Chatterji; Cyril Engmann; Dieltiens Greet; Robert Jakob; Kathleen Kahn; Osamu Kunii; Alan D Lopez; Christopher J L Murray; Bernard Nahlen; Chalapati Rao; Osman Sankoh; Philip W Setel; Kenji Shibuya; Nadia Soleman; Linda Wright; Gonghuan Yang Journal: Bull World Health Organ Date: 2007-08 Impact factor: 9.408
Authors: Karen M Edmond; Maria A Quigley; Charles Zandoh; Samuel Danso; Chris Hurt; Seth Owusu Agyei; Betty R Kirkwood Journal: Paediatr Perinat Epidemiol Date: 2008-09 Impact factor: 3.980
Authors: Fatema Khatun; Sabrina Rasheed; Allisyn C Moran; Ashraful M Alam; Mohammad Sohel Shomik; Munira Sultana; Nuzhat Choudhury; Mohammad Iqbal; Abbas Bhuiya Journal: BMC Public Health Date: 2012-01-26 Impact factor: 3.295
Authors: Susannah Hopkins Leisher; Zheyi Teoh; Hanna Reinebrant; Emma Allanson; Hannah Blencowe; Jan Jaap Erwich; J Frederik Frøen; Jason Gardosi; Sanne Gordijn; A Metin Gülmezoglu; Alexander E P Heazell; Fleurisca Korteweg; Joy Lawn; Elizabeth M McClure; Robert Pattinson; Gordon C S Smith; Ӧzge Tunçalp; Aleena M Wojcieszek; Vicki Flenady Journal: BMC Pregnancy Childbirth Date: 2016-09-15 Impact factor: 3.007
Authors: Susannah Hopkins Leisher; Zheyi Teoh; Hanna Reinebrant; Emma Allanson; Hannah Blencowe; Jan Jaap Erwich; J Frederik Frøen; Jason Gardosi; Sanne Gordijn; A Metin Gülmezoglu; Alexander E P Heazell; Fleurisca Korteweg; Joy Lawn; Elizabeth M McClure; Robert Pattinson; Gordon C S Smith; Ӧzge Tunçalp; Aleena M Wojcieszek; Vicki Flenady Journal: BMC Pregnancy Childbirth Date: 2016-10-05 Impact factor: 3.007