Causes of community stillbirths and early neonatal deaths in low-income countries using verbal autopsy: an International, Multicenter Study

Abstract

Objective Six million stillbirths (SB) and early neonatal deaths (END) occur annually worldwide, mostly in rural settings distant from health facilities. We used verbal autopsy (VA), to understand causes of non-hospital, community-based SB and END from four low-income countries. Study Design This prospective observational study utilized the train-the-trainer method. VA interviewers conducted standardized interviews; in each country data were reviewed by two local physicians who assigned an underlying causes of deaths (COD). Result There were 252 perinatal deaths (118 END; 134 SB) studied from pooled data. Almost half (45%) the END occurred on postnatal day 1, 19%on the second day and 16% the third day. Major early neonatal COD were infections (49%), birth asphyxia (26%), prematurity (17%) and congenital malformations (3%). Major causes of SB were infection (37%), prolonged labor (11%), antepartum hemorrhage (10%), preterm delivery (7%), cord complications (6%) and accidents (5%). Conclusion Many of these SB and END were from easily preventable causes. Over 80% of END occurred during the first 3 days of postnatal life, and >90% were due to infection, birth asphyxia and prematurity. The causes of SB were more varied, and maternal infections were the most common cause. Increased attention should be targeting at interventions that reduce maternal and neonatal infections and prevent END, particularly during the first 3 days of life.

Infant illness spanning the antenatal to early neonatal continuum in rural northern Ghana: local perceptions, beliefs and practices

“…[1][2][3] Despite these figures, perinatal health policies remain largely absent from global and national health agendas. 4,5 Over 99% of perinatal deaths occur in low-and middle-income countries and regional estimates suggest that west Africa has among the highest perinatal mortality rates in the world. 6,7 Additionally, many west African countries with high perinatal mortality rates have weak vital registration and health systems, resulting in poor quality perinatal morbidity and mortality data.…”

Multilevel Logistic Regression Analysis of the Determinants of Stillbirth in Ethiopia Using EDHS 2011 Data

“…7 A study conducted on four low and middle income countries revealed a stillbirth rate of 30/1000 deliveries. 8 …”

Optimising the International Classification of Diseases to identify the maternal condition in the case of perinatal death

“…This may come from an inability to investigate in great detail the cause of perinatal death, particularly but not exclusively in the settings where most of the deaths occur. 12,13 With the challenges of classifying perinatal death, 7 it is even more critical that maximal information is extracted from the classification of the maternal condition at the time of perinatal death. Assigning the underlying cause of death from the perinatal point of view can be challenging, given that many settings lack resources to fully investigate the cause of death and there is a lack of clarity around when to assign a particular cause of death.…”