A multicentre study of perinatal mortality in Nepal.

A prospective survey was carried out in two Kathmandu hospitals and two rural districts to establish urban and rural perinatal mortality rates (PNMRs) for these four centres in Nepal and to ascertain the causes of perinatal mortality. All perinatal deaths occurring over a 1-year period in the four centres were included (during which time there was a total of 14,967 births). Cause of death was established by contemporary review of hospital case records or by structured questionnaire ('verbal autopsy') in the rural areas. The PNMRs in the hospitals were 48.0 and 23.7 per thousand total births respectively, whilst those of the rural settings were 96.2 and 42.5 per thousand births. Perinatal asphyxia, low birthweight and infection were the most common causes but many of the deaths were unexplained. The high mortality rates were felt to reflect the difficult circumstances of childbirth in Nepal. It was concluded that a number of interventions would appear appropriate, but that these should be introduced in a scientific manner.