Factors associated with perinatal mortality in Nepal: evidence from Nepal demographic and health survey 2001–2016

Ghimire, Pramesh Raj; Agho, Kingsley; Renzaho, Andre Μ Ν; Nisha, Monjura Khatun; Dibley, Michael J.; Raynes‐Greenow, Camille

doi:10.1186/s12884-019-2234-6

Cited by 26 publications

(39 citation statements)

References 34 publications

(34 reference statements)

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“…Whereas earlier studies have linked socioeconomic status to perinatal death [ 9–11 , 23 ], our findings are similar to other studies that found no significant association between perinatal death and maternal education status [ 13 , 24 , 30 , 48 ], household wealth index [ 13 , 30 ] and marital status [ 13 , 30 ]. This could be due to the rural setting of the study, and that access to quality maternity care services is more important than other factors.…”

Section: Discussionsupporting

confidence: 90%

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Perinatal death in Northern Uganda: incidence and risk factors in a community-based prospective cohort study

Arach

Tumwine

Nakasujja

et al. 2021

Global Health Action

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Background : Perinatal mortality in Uganda remains high at 38 deaths/1,000 births, an estimate greater than the every newborn action plan (ENAP) target of ≤24/1,000 births by 2030. To improve perinatal survival, there is a need to understand the persisting risk factors for death. Objective : We determined the incidence, risk factors, and causes of perinatal death in Lira district, Northern Uganda. Methods : This was a community-based prospective cohort study among pregnant women in Lira district, Northern Uganda. Female community volunteers identified pregnant women in each household who were recruited at ≥28 weeks of gestation and followed until 50 days postpartum. Information on perinatal survival was gathered from participants within 24 hours after childbirth and at 7 days postpartum. The cause of death was ascertained using verbal autopsies. We used generalized estimating equations of the Poisson family to determine the risk factors for perinatal death. Results : Of the 1,877 women enrolled, the majority were ≤30 years old (79.8%), married or cohabiting (91.3%), and had attained only a primary education (77.7%). There were 81 perinatal deaths among them, giving a perinatal mortality rate of 43/1,000 births [95% confidence interval (95% CI: 35, 53)], of these 37 were stillbirths (20 deaths/1,000 total births) and 44 were early neonatal deaths (23 deaths/1,000 live births). Birth asphyxia, respiratory failure, infections and intra-partum events were the major probable contributors to perinatal death. The risk factors for perinatal death were nulliparity at enrolment (adjusted IRR 2.7, [95% CI: 1.3, 5.6]) and maternal age >30 years (adjusted IRR 2.5, [95% CI: 1.1, 5.8]). Conclusion : The incidence of perinatal death in this region was higher than had previously been reported in Uganda. Risk factors for perinatal mortality were nulliparity and maternal age >30 years. Pregnant women in this region need improved access to care during pregnancy and childbirth.

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Section: Discussionsupporting

confidence: 90%

“…Hence, there is an urgent need for reduction in perinatal mortality in this region. The realization of a perinatal mortality reduction, however, is a complex issue that does not only involve improvement of the accessibility and quality health care [ 3 ] but also on improving nutrition, sanitation and education [ 23 , 24 ].…”

Section: Introductionmentioning

confidence: 99%

Perinatal death in Northern Uganda: incidence and risk factors in a community-based prospective cohort study

Arach

Tumwine

Nakasujja

et al. 2021

Global Health Action

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“…For adjusting the cluster effect, the sample size is adjusted by the design effect. The design effect is chosen as a proxy of 1.71 based on Nepal’s Demographic Health Survey 2016 [37]. This design effect is updated based on our average cluster size.…”

Section: Methodsmentioning

confidence: 99%

Scaling Up Safer Birth Bundle Through Quality Improvement in Nepal (SUSTAIN)—a stepped wedge cluster randomized controlled trial in public hospitals

et al. 2019

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Background Each year, 2.2 million intrapartum-related deaths (intrapartum stillbirths and first day neonatal deaths) occur worldwide with 99% of them taking place in low- and middle-income countries. Despite the accelerated increase in the proportion of deliveries taking place in health facilities in these settings, the stillborn and neonatal mortality rates have not reduced proportionately. Poor quality of care in health facilities is attributed to two-thirds of these deaths. Improving quality of care during the intrapartum period needs investments in evidence-based interventions. We aim to evaluate the quality improvement package—Scaling Up Safer Bundle Through Quality Improvement in Nepal (SUSTAIN)—on intrapartum care and intrapartum-related mortality in public hospitals of Nepal. Methods We will conduct a stepped wedge cluster randomized controlled trial in eight public hospitals with each having least 3000 deliveries a year. Each hospital will represent a cluster with an intervention transition period of 2 months in each. With a level of significance of 95%, the statistical power of 90% and an intra-cluster correlation of 0.00015, a study period of 19 months should detect at least a 15% change in intrapartum-related mortality. Quality improvement training, mentoring, systematic feedback, and a continuous improvement cycle will be instituted based on bottleneck analyses in each hospital. All concerned health workers will be trained on standard basic neonatal resuscitation and essential newborn care. Portable fetal heart monitors (Moyo®) and neonatal heart rate monitors (Neobeat®) will be introduced in the hospitals to identify fetal distress during labor and to improve neonatal resuscitation. Independent research teams will collect data in each hospital on intervention inputs, processes, and outcomes by reviewing records and carrying out observations and interviews. The dose-response effect will be evaluated through process evaluations. Discussion With the global momentum to improve quality of intrapartum care, better understanding of QI package within a health facility context is important. The proposed package is based on experiences from a similar previous scale-up trial carried out in Nepal. The proposed evaluation will provide evidence on QI package and technology for implementation and scale up in similar settings. Trial registration number ISRCTN16741720 . Registered on 2 March 2019.

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“…Around 11.6% of cesarean sections had to be performed for obstructed labour, placenta previa, ruptured uterus. 3,13 . This was the first study conducted in Abbasi Shaheed Hospital.…”

Section: Table 1: Distribution Of Deliveries In Perinatal Mortality In One Year Periodmentioning

confidence: 99%

Audit of Neonatal Outcome in Tertiary Care Hospital.

Rashid¹,

Iqbal²,

Nadeem³

2021

Int. j. endorsing health sci. res.

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Background: Every year, 2.7 million stillbirths occur worldwide, mostly in developing countries. The United Nations Sustainable Development Goals (SDGs) include reducing childhood mortality under five years of age. Perinatal death audit is an intervention to reduce preventable neonatal mortality. The aim of this study was to determine the Perinatal Mortality Rate (PMR) and the factors responsible for perinatal deaths at a Tertiary Care Hospital in Karachi-Pakistan. Methodology: This was a prospective study of all the stillbirths and early neonatal deaths in Abbasi Shaheed Hospital Karachi, Gynecology Unit I. Details of each perinatal death were filled in the standard form. We used Aberdeen Obstetric classification to classify causes of perinatal deaths. Results: There were 1627 deliveries and 43 perinatal deaths during the study period. Our study's perinatal mortality rate was 27.14/1000 births, and the stillbirth rate was 13.25/1000 births. Antepartum hemorrhage (APH), pregnancy-induced hypertension (PIH) and anemia were the common causes of perinatal deaths. Conclusion: Antepartum hemorrhage, pregnancy-induced hypertension and anemia are the leading causes of perinatal deaths. Most of these complications can be reduced by educating women and providing effective antenatal care.

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Factors associated with perinatal mortality in Nepal: evidence from Nepal demographic and health survey 2001–2016

Cited by 26 publications

References 34 publications

Perinatal death in Northern Uganda: incidence and risk factors in a community-based prospective cohort study

Perinatal death in Northern Uganda: incidence and risk factors in a community-based prospective cohort study

Scaling Up Safer Birth Bundle Through Quality Improvement in Nepal (SUSTAIN)—a stepped wedge cluster randomized controlled trial in public hospitals

Audit of Neonatal Outcome in Tertiary Care Hospital.

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