Despite the large number of stillbirths worldwide, the topic of stillbirths in developing countries has received very little research, programmatic or policy attention. Better access to appropriate obstetric care, especially during labor, should reduce developing country stillbirth rates dramatically.

Summary OBJECTIVES To describe specific causes of the high rates of stillbirth, neonatal death and early child childhood death in Zambia. METHODS We conducted a household-based survey in rural Zambia. Socio-demographic and delivery characteristics were recorded, alongside a maternal HIV test. Verbal autopsy questionnaires were administered to elicit mortality-related information and independently reviewed by three experienced paediatricians who assigned a cause and contributing factor to death. For this secondary analysis, deaths were categorized into: stillbirths (foetal death ≥28 weeks of gestation), neonatal deaths (≤28 days) and early childhood deaths (>28 days to <2 years). RESULTS Among 1679 households, information was collected on 148 deaths: 34% stillbirths, 26% neonatal and 40% early childhood deaths. Leading identifiable causes of stillbirth were intrauterine infection (26%) and birth asphyxia (18%). Of 32 neonatal deaths, 38 (84%) occurred within the first week of life, primarily because of infections (37%) and prematurity (34%). The majority of early childhood deaths were caused by suspected bacterial infections (82%). HIV prevalence was significantly higher in mothers who reported an early childhood death (44%) than mothers who did not (17%; P < 0.01). Factors significantly associated with mortality were lower socio-economic status (P < 0.01), inadequate water or sanitation facilities (P < 0.01), home delivery (P = 0.04) and absence of a trained delivery attendant (P < 0.01). CONCLUSION We provide community-level data about the causes of death among children under 2 years of age. Infectious etiologies for mortality ranked highest. At a public health level, such information may have an important role in guiding prevention and treatment strategies to address perinatal and early childhood mortality.

Objectives To describe the pattern of incident illness in children after initiation of antiretroviral therapy (ART) in a large public health sector in Lusaka, Zambia. Methods A systematic review was performed to extract data from medical records of children (i.e., under 16 years) initiating ART in the Lusaka, Zambia HIV care and treatment program. Incident conditions were listed separately and then grouped according to broad categories. Predictors for incident diagnoses were determined using univariate and multivariable analysis. Results Between May 2004 and July 2006, 1,940 HIV-infected children initiated ART. Of these, 1,391 (71.1%) had their medical records reviewed. Median age at ART initiation was 77 months and 631 (45.4%) were females. 859 (62%) children had an incident condition during this period, with a median time of occurrence of 63 days from ART initiation. 28 different incident conditions were documented. When categorized, the most common were mucocutaneous conditions (incidence rate [IR]: 101.1 per 100 child-years, 95%CI: 92.3-110.5) and upper respiratory tract infection (IR: 100.6 per 100 child-years; 95% CI 91.9-110.0). Children with severe immunosuppression (i.e., CD4 < 10%) were more likely to develop lower respiratory tract infection (15.4% vs. 8.4%; p = 0.0002), mucocutaneous conditions (41.3% vs. 29.5%; p < 0.0001) and gastrointestinal conditions (19.8% vs. 14.5%; p = 0.02), when compared to those with CD4 ≥ 10%. Conclusion There is a high incidence of new illness following ART initiation, emphasizing the importance of close monitoring during this period.