Causes of stillbirths and early neonatal deaths: data from 7993 pregnancies in six developing countries

Ngoc, Nhu Thi Nguyen; Merialdi, Mario; Abdel‐Aleem, Hany; Carroli, Guillermo; Purwar, Manorama; Zavaleta, Nelly; Campodónico, Liana; Ali, Mohamed M.; Hofmeyr, G Justus; Mathai, Matthews; Lincetto, Ornella; Villar, José

doi:10.2471/blt.05.027300

Cited by 236 publications

(103 citation statements)

References 10 publications

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“…Our study confirms results from others indicating that stillbirths may constitute up to 70%-80% of perinatal deaths and underlines the importance of access to good quality antenatal and delivery care [22]. Being one of the main causes of early neonatal death it is a concern that we found higher incidences of prematurity than otherwise reported from the region [23,24]. The gestational age at delivery is however based on provider estimates and should be interpreted with caution.…”

Section: Discussionsupporting

confidence: 89%

Mobile Phone Intervention Reduces Perinatal Mortality in Zanzibar: Secondary Outcomes of a Cluster Randomized Controlled Trial

Lund¹,

Rasch²,

Hemed³

et al. 2014

JMIR Mhealth Uhealth

119

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BackgroundMobile phones are increasingly used in health systems in developing countries and innovative technical solutions have great potential to overcome barriers of access to reproductive and child health care. However, despite widespread support for the use of mobile health technologies, evidence for its role in health care is sparse.ObjectiveWe aimed to evaluate the association between a mobile phone intervention and perinatal mortality in a resource-limited setting.MethodsThis study was a pragmatic, cluster-randomized, controlled trial with primary health care facilities in Zanzibar as the unit of randomization. At their first antenatal care visit, 2550 pregnant women (1311 interventions and 1239 controls) who attended antenatal care at selected primary health care facilities were included in this study and followed until 42 days after delivery. Twenty-four primary health care facilities in six districts were randomized to either mobile phone intervention or standard care. The intervention consisted of a mobile phone text message and voucher component. Secondary outcome measures included stillbirth, perinatal mortality, and death of a child within 42 days after birth as a proxy of neonatal mortality.ResultsWithin the first 42 days of life, 2482 children were born alive, 54 were stillborn, and 36 died. The overall perinatal mortality rate in the study was 27 per 1000 total births. The rate was lower in the intervention clusters, 19 per 1000 births, than in the control clusters, 36 per 1000 births. The intervention was associated with a significant reduction in perinatal mortality with an odds ratio (OR) of 0.50 (95% CI 0.27-0.93). Other secondary outcomes showed an insignificant reduction in stillbirth (OR 0.65, 95% CI 0.34-1.24) and an insignificant reduction in death within the first 42 days of life (OR 0.79, 95% CI 0.36-1.74).ConclusionsMobile phone applications may contribute to improved health of the newborn and should be considered by policy makers in resource-limited settings.Trial RegistrationClinicalTrials.gov NCT01821222; http://www.clinicaltrials.gov/ct2/show/NCT01821222 (Archived by WebCite at http://www.webcitation.org/6NqxnxYn0).

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Section: Discussionsupporting

confidence: 89%

Mobile Phone Intervention Reduces Perinatal Mortality in Zanzibar: Secondary Outcomes of a Cluster Randomized Controlled Trial

Lund¹,

Rasch²,

Hemed³

et al. 2014

JMIR Mhealth Uhealth

119

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“…In low-middle income countries, most early neonatal deaths are caused by prematurity [8, 12, 16, 34]. Gestational age is an important factor of neonatal mortality, but the relation to hospital death in our study was not statistically significant in the multivariate analysis.…”

Section: Discussioncontrasting

confidence: 71%

Low Neonatal Mortality and High Incidence of Infectious Diseases in a Vietnamese Province Hospital

Kruse

et al. 2016

BioMed Research International

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Background. Neonatal deaths constitute the majority of child mortality in Vietnam, but studies are scarce and focus on community settings. Methods. During a 12-month period, all sick neonates admitted to a pediatric department in a province hospital were studied. Potential risk factors of death covering sociodemographic factors, pregnancy history, previous neonatal period, and status on admission were registered. The neonates were followed up until discharge or death or until 28 completed days of age if still hospitalized or until withdrawal of life support. The main outcome was neonatal death. Results. The neonatal mortality was 4.6% (50/1094). In a multivariate analysis, four associated risk factors of death were extremely low birth weight (OR = 22.9 (2.3–233.4)), no cry at birth (OR = 3.5 (1.3–9.4)), and cyanosis (OR = 3.3 (1.2–8.7)) and shock (OR = 12.3 (2.5–61.5)) on admission. The major discharge diagnoses were infection, prematurity, congenital malformations, and asphyxia in 88.5% (936/1058), 21.3% (225/1058), 5.0% (53/1058), and 4.6% (49/1058), respectively. In 36, a discharge diagnosis was not registered. Conclusion. Infection was the main cause of neonatal morbidity. Asphyxia and congenital malformations were diagnosed less frequently. The neonatal mortality was 4.6%. No sociodemographic factors were associated with death. Extreme low birth weight, no cry at birth, and cyanosis or shock at admission were associated with death.

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“…Interventions are hampered by insufficient data [2] and inconsistency in the definition of stillbirths for reporting purposes [3, 4]. There are also multiple medical causes of stillbirth which are characteristically different in developed versus developing nations [5, 6], and indirect causal pathways.…”

Section: Introductionmentioning

confidence: 99%

Social and Cultural Factors Associated with Perinatal Grief in Chhattisgarh, India

Roberts¹,

Montgomery

Lee

et al. 2011

J Community Health

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Stillbirth is a globally significant public health problem with many medical causes. There are also indirect causal pathways including social and cultural factors which are particularly salient in India's traditional society. The purpose of this study was to explore women's perceptions of stillbirth and to determine how issues of gender and power, social support, coping efforts, and religious beliefs influence perinatal grief outcomes among poor women in rural Chhattisgarh, India. Structured interviews were done face-to-face in 21 randomly selected villages among women of reproductive age (N = 355) who had experienced stillbirth (n = 178) and compared to those who had not (n = 177), in the Christian Hospital, Mungeli catchment area. Perinatal grief was significantly higher among women with a history of stillbirth. Greater perinatal grief was associated with lack of support, maternal agreement with social norms, and younger maternal age. These predictors must be understood in light of an additional finding—distorted sex ratios, which reflect gender discrimination in the context of Indian society. The findings of this study will allow the development of a culturally appropriate health education program which should be designed to increase social support and address social norms, thereby reducing psychological distress to prevent complicated perinatal grief. Perinatal grief is a significant social burden which impacts the health women.

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Causes of stillbirths and early neonatal deaths: data from 7993 pregnancies in six developing countries

Abstract: Advancements in the care of premature infants and prevention of spontaneous preterm labour and hypertensive disorders of pregnancy could lead to a substantial decrease in perinatal mortality in hospital settings in developing countries.

Cited by 236 publications

References 10 publications

Mobile Phone Intervention Reduces Perinatal Mortality in Zanzibar: Secondary Outcomes of a Cluster Randomized Controlled Trial

Mobile Phone Intervention Reduces Perinatal Mortality in Zanzibar: Secondary Outcomes of a Cluster Randomized Controlled Trial

Low Neonatal Mortality and High Incidence of Infectious Diseases in a Vietnamese Province Hospital

Social and Cultural Factors Associated with Perinatal Grief in Chhattisgarh, India

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