Causes and age of neonatal death and associations with maternal and newborn care characteristics in Nepal: a verbal autopsy study

Abstract Background In Nepal, neonatal mortality fell substantially between 2000 and 2018, decreasing 50% from 40 to 20 deaths per 1,000 live births. Nepal’s success has been attributed to a decreasing total fertility rate, improvements in female education, increases in coverage of skilled care at birth, and community-based child survival interventions. Methods A verbal autopsy study, led by the Integrated Rural Health Development Training Centre (IRHDTC), conducted interviews for 338 neonatal deaths across six districts in Nepal between April 2012 and April 2013. We conducted a secondary analysis of verbal autopsy data to understand how cause and age of neonatal death are related to health behaviors, care seeking practices, and coverage of essential services in Nepal. Results Sepsis was the leading cause of neonatal death (n=159/338, 47.0%), followed by birth asphyxia (n=56/338, 16.6%), preterm birth (n=45/338, 13.3%), and low birth weight (n=17/338, 5.0%). Neonatal deaths occurred primarily on the first day of life (27.2%) and between days 1 and 6 (64.8%) of life. Risk of death due birth asphyxia relative to sepsis was higher among mothers who were nulligravida, had <4 antenatal care visits, and had a multiple birth; risk of death due to prematurity relative to sepsis was lower for women who made ≥1 delivery preparation and higher for women with a multiple birth. Conclusions Our findings suggest cause and age of death distributions typically associated with high mortality settings. Increased coverage of preventive antenatal care interventions and counseling are critically needed. Delays in care seeking for newborn illness and quality of care around the time of delivery and for sick newborns are important points of intervention with potential to reduce deaths, particularly for birth asphyxia and sepsis, which remain common in this population.

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Causes of stillbirths and neonatal deaths in Dhanusha district, Nepal: A verbal autopsy study

Kathmandu University Medical Journal ◽

10.3126/kumj.v8i1.3224 ◽

1970 ◽

Vol 8 (1) ◽

pp. 62-72 ◽

Cited By ~ 9

Author(s):

SR Manandhar ◽

A Ojha ◽

DS Manandhar ◽

B Shrestha ◽

D Shrestha ◽

...

Keyword(s):

Mortality Rate ◽

Verbal Autopsy ◽

Neonatal Death ◽

Birth Asphyxia ◽

Severe Infection ◽

Home Delivery ◽

Group 14 ◽

Autopsy Study ◽

Neonatal Deaths ◽

Pregnancy And Delivery

Background: Perinatal (stillbirths and first week neonatal deaths) and neonatal (deaths in the first 4 weeks) mortality rates remain high in developing countries like Nepal. As most births and deaths occur in the community, an option to ascertain causes of death is to conduct verbal autopsy. Objective: The objective of this study was to classify and review the causes of stillbirths and neonatal deaths in Dhanusha district, Nepal. Materials and Methods: Births and neonatal deaths were identified prospectively in 60 village development committees of Dhanusha district. Families were interviewed at six weeks after delivery, using a structured questionnaire. Cause of death was assigned independently by two pediatricians according to a predefined algorithm; disagreement was resolved in discussion with a consultant neonatologist. Results: There were 25,982 deliveries in the 2 years from September 2006 to August 2008. Verbal autopsies were available for 601/813 stillbirths and 671/954 neonatal deaths. The perinatal mortality rate was 60 per 1000 births and the neonatal mortality rate 38 per 1000 live births. 84% of stillbirths were fresh and obstetric complications were the leading cause (67%). The three leading causes of neonatal death were birth asphyxia (37%), severe infection (30%) and prematurity or low birth weight (15%). Most infants were delivered at home (65%), 28% by relatives. Half of women received an injection (presumably an oxytocic) during home delivery to augment labour. Description of symptoms commensurate with birth asphyxia was commoner in the group of infants who died (41%) than in the surviving group (14%). Conclusion: The current high rates of stillbirth and neonatal death in Dhanusha suggest that the quality of care provided during pregnancy and delivery remains sub-optimal. The high rates of stillbirth and asphyxial mortality imply that, while efforts to improve hygiene need to continue, intrapartum care is a priority. A second area for consideration is the need to reduce the uncontrolled use of oxytocic for augmentation of labour. Key words: Stillbirth; neonatal death; verbal autopsy; Nepal. DOI: 10.3126/kumj.v8i1.3224 Kathmandu University Medical Journal (2010), Vol. 8, No. 1, Issue 29, 62-72

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Neonatal Deaths in Rural Southern Tanzania: Care-Seeking and Causes of Death

ISRN Pediatrics ◽

10.5402/2012/953401 ◽

2012 ◽

Vol 2012 ◽

pp. 1-8 ◽

Cited By ~ 9

Author(s):

Mwifadhi Mrisho ◽

David Schellenberg ◽

Fatuma Manzi ◽

Marcel Tanner ◽

Hassan Mshinda ◽

...

Keyword(s):

Verbal Autopsy ◽

Birth Asphyxia ◽

Household Survey ◽

Care Seeking ◽

Neonatal Deaths ◽

Rural Districts ◽

Common Causes ◽

Large Household ◽

Quantitative Results ◽

At Home

Introduction. We report cause of death and care-seeking prior to death in neonates based on interviews with relatives using a Verbal Autopsy questionnaire. Materials and Methods. We identified neonatal deaths between 2004 and 2007 through a large household survey in 2007 in five rural districts of southern Tanzania. Results. Of the 300 reported deaths that were sampled, the Verbal Autopsy (VA) interview suggested that 11 were 28 days or older at death and 65 were stillbirths. Data was missing for 5 of the reported deaths. Of the remaining 219 confirmed neonatal deaths, the most common causes were prematurity (33%), birth asphyxia (22%) and infections (10%). Amongst the deaths, 41% (90/219) were on the first day and a further 20% (43/219) on day 2 and 3. The quantitative results matched the qualitative findings. The majority of births were at home and attended by unskilled assistants. Conclusion. Caregivers of neonates born in health facility were more likely to seek care for problems than caregivers of neonates born at home. Efforts to increase awareness of the importance of early care-seeking for a premature or sick neonate are likely to be important for improving neonatal health.

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Use of Verbal Autopsy as a Proxy to Determine the Possible Cause of Neonatal Deaths

Journal of Nepal Paediatric Society ◽

10.3126/jnps.v31i1.2942 ◽

2011 ◽

Vol 31 (1) ◽

pp. 44-48 ◽

Cited By ~ 1

Author(s):

B Baghel ◽

AK Bansal

Keyword(s):

Verbal Autopsy ◽

Neonatal Death ◽

Birth Asphyxia ◽

Field Research ◽

Cost Effective ◽

Good Method ◽

Next Of Kin ◽

Neonatal Deaths ◽

Care Givers ◽

Total Death

Introduction: Information on causes of death is extremely important for policy making, planning, monitoring, field research, future management statergies and epidemic awareness. The best method of finding the cause of death is by post mortem examination but since this is difficult, post death analysis by verbal autopsy is a good method to determine the same. Objective: To asses the role of verbal autopsy method in the investigation of neonatal death and to determine the probable, causes of neonatal death. Materials and Methods: A pre-tested questionnaire in Hindi was administered to 50 mothers and/or next of kin or other care givers of the deceased residing in villages around 200 Kms. of Bhopal and in urban slums of Municipal Corporation, Bhopal. Results: 84 % of the total death occurred with in seven days of birth, 88 % of death occurred in villages where health facilities were available. As per verbal autopsy 36 % and 20 % of the infants died because of Birth asphyxia and Respiratory Distress Syndrome respectively and further 2%, 4% and 6% because of neonatal tetanus, hypothermia and other causes respectively. Conclusion: Verbal autopsy could be one of the possible cost effective and a reliable tool for determining the causes of neonatal deaths at present. Key words: Verbal Autopsy; Neonatal death; Reliable respondents and category of villages. DOI: 10.3126/jnps.v31i1.2942J Nep Paedtr Soc 2010;31(1):44-48

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A comparative analysis of the InterVA model versus physician review in determining causes of neonatal deaths using verbal autopsy data from Nepal

10.21203/rs.3.rs-151220/v1 ◽

2021 ◽

Author(s):

Dinesh Dharel ◽

Penny Dawson ◽

Daniel Adeyinka ◽

Nazeem Muhajarine ◽

Dinesh Neupane

Keyword(s):

Cause Of Death ◽

Verbal Autopsy ◽

Neonatal Sepsis ◽

Neonatal Death ◽

Birth Asphyxia ◽

Neonatal Infection ◽

Proximate Cause ◽

Neonatal Deaths ◽

Physician Review ◽

Autopsy Data

Abstract Background: Verbal autopsy is a common method of ascertaining the cause of neonatal death in low resource settings where majority of causes of deaths remain unregistered. We aimed to compare the causes of neonatal deaths assigned by computer algorithm-based model, InterVA (Interpreting Verbal Autopsy) with the usual standard of Physician Review of Verbal Autopsy (PRVA) using the verbal autopsy data collected by Morang Innovative Neonatal Intervention (MINI) study in Nepal. Methods: MINI was a prospective community intervention study aimed at managing newborn illnesses at household level. Trained field staff conducted a verbal autopsy of all neonatal deaths during the study period. The cause of death was assigned by two pediatricians, and by using InterVA version 5. Cohen's kappa coefficient was calculated to compare the agreement between InterVA and PRVA assigned proximate cause of death, using STATATM software version 16.1. Results: Among 381 verbal autopsies for neonatal deaths, only 311 (81.6%) were assigned one of birth asphyxia, neonatal infection, congenital anomalies or preterm-related complications as the proximate cause of death by both InterVA and PRVA, while the remaining 70 (18.4%) were assigned other or non-specific causes. The overall agreement between InterVA and PRVA-assigned cause of death categories was moderate (66.5% agreement, kappa=0.47). Moderate agreement was observed for neonatal infection (kappa=0.48) and congenital malformations (kappa=0.49), while it was fair for birth asphyxia (kappa=0.39), and preterm-related complications (kappa=0.31); but there was only slight agreement for neonatal sepsis (kappa=0.19) and neonatal pneumonia (kappa=0.16) as specific causes of death within neonatal infections. Conclusions: We observed moderate overall agreement for major categories of causes of neonatal death assigned by InterVA and PRVA. The moderate agreement was sustained for the classification of neonatal infection but poor for neonatal sepsis and neonatal pneumonia as distinct categories of neonatal infection. Further studies should investigate the comparative effectiveness of an updated version of InterVA with the current standard of assigning the cause of neonatal death through longitudinal and experimental designs.

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Trends, patterns and cause-specific neonatal mortality in Tanzania: a hospital-based retrospective survey

International Health ◽

10.1093/inthealth/ihaa070 ◽

2020 ◽

Author(s):

Chacha D Mangu ◽

Susan F Rumisha ◽

Emanuel P Lyimo ◽

Irene R Mremi ◽

Isolide S Massawe ◽

...

Keyword(s):

Respiratory Distress ◽

Neonatal Mortality ◽

Neonatal Death ◽

Birth Asphyxia ◽

International Classification Of Diseases ◽

Mortality Rates ◽

Data Availability ◽

Mortality Data ◽

Neonatal Deaths ◽

Over Time

Abstract Background Globally, large numbers of children die shortly after birth and many of them within the first 4 wk of life. This study aimed to determine the trends, patterns and causes of neonatal mortality in hospitals in Tanzania during 2006–2015. Methods This retrospective study involved 35 hospitals. Mortality data were extracted from inpatient registers, death registers and International Classification of Diseases-10 report forms. Annual specific hospital-based neonatal mortality rates were calculated and discussed. Two periods of 2006–2010 and 2011–2015 were assessed separately to account for data availability and interventions. Results A total of 235 689 deaths were recorded and neonatal deaths accounted for 11.3% (n=26 630) of the deaths. The majority of neonatal deaths (87.5%) occurred in the first week of life. Overall hospital-based neonatal mortality rates increased from 2.6 in 2006 to 10.4 deaths per 1000 live births in 2015, with the early neonates contributing 90% to this rate constantly over time. The neonatal mortality rate was 3.7/1000 during 2006–2010 and 10.4/1000 during 2011–2015, both periods indicating a stagnant trend in the years between. The leading causes of early neonatal death were birth asphyxia (22.3%) and respiratory distress (20.8%), while those of late neonatal death were sepsis (29.1%) and respiratory distress (20.0%). Conclusion The majority of neonatal deaths in Tanzania occur among the early newborns and the trend over time indicates a slow improvement. Most neonatal deaths are preventable, hence there are opportunities to reduce mortality rates with improvements in service delivery during the first 7 d and maternal care.

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Status of neonatal death in sick newborn care unit of a tertiary care hospital

International Journal of Contemporary Pediatrics ◽

10.18203/2349-3291.ijcp20173709 ◽

2017 ◽

Vol 4 (5) ◽

pp. 1638

Author(s):

Ashish Kumar Mishra ◽

Sadhu Charan Panda

Keyword(s):

Neonatal Death ◽

Tertiary Care Hospital ◽

Care Delivery ◽

Tertiary Care ◽

Birth Asphyxia ◽

Newborn Care ◽

Health Care Delivery System ◽

Care Hospital ◽

Neonatal Deaths ◽

Antenatal Visits

Background: In view of clusters of death in Sick New Born Care Units of tertiary care hospitals in recent past and few studies done so far in this field necessitates a research. The aim of the present study was to assess the factors associated with neonatal mortality and the infrastructure of the SNCU.Methods: All sick neonates admitted in the SNCU during June and July 2017 were followed up till they were discharged or declared dead. Data were collected by facility observation, interview of parents/attendants and from patient case sheet with a predesigned a pretested questionnaire and were analyzed applying appropriate statistical methods.Results: Prevalence neonatal death was 12 per cent among 250 sick neonates studied. Majority of neonatal deaths occurred among mothers having lower SE Status 25 (27.4), antenatal visits less than 4 times (22, 22%), undernourished neonates (24, 37.5%) all of which were significant. Majority of morbidity were of Prematurity, (110, 44%) followed by Birth Asphyxia (96, 38.4%) and Infections (35.2%) and leading cause of death was infection. There was a deficit of resources from 25% to 75% and no monitoring and supervision were done till date.Conclusions: Health care delivery system at block level and below needs to be strengthened in terms of antenatal visits, improvement of nutritional status of mother. The resource constraint of SNCU at tertiary care hospital and surveillance and monitoring mechanism requires prompt action to make SNCU more effective.

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Verbal autopsy of neonatal and infant deaths from Bhavnagar rural and comparison with recent data

International Journal of Community Medicine and Public Health ◽

10.18203/2394-6040.ijcmph20205721 ◽

2020 ◽

Vol 8 (1) ◽

pp. 351

Author(s):

Rajesh B. Patel ◽

Hinal A. Sinol ◽

Sonal V. Jindal ◽

Jayendra R. Gohil

Keyword(s):

Verbal Autopsy ◽

Vaginal Discharge ◽

Neonatal Period ◽

Perinatal Care ◽

Neonatal Resuscitation ◽

Birth Asphyxia ◽

Hyaline Membrane Disease ◽

Neonatal Deaths ◽

Infant Deaths ◽

Hyaline Membrane

Background: Infant deaths from Bhavnagar rural areas were studied by using a verbal autopsy tool.Methods: Community visit based retrospective study of Bhavnagar rural by WHO verbal autopsy questionnaire.Results: Of the 92 deaths analyzed, 59 % (early), 12% (late), and 29% were during the post neonatal period. Male deaths were 55 (60%). The most common immediate causes were infection (39%), birth asphyxia (23%), and hyaline membrane disease (15%). Underlying causes were: maternal illness with feeding problem (45%), prematurity (26%), meconium aspiration syndrome (9%), and congenital/genetic anomalies (10%). Infant and neonatal deaths were seen more with illiteracy of mother, age of mother (25-29 years), third parity, anemia, and vaginal discharge; and non-breastfed, low birth weight and preterm. Birth asphyxia and hyaline membrane disease were during early, and meningitis and pneumonia were after the neonatal period. Verbal autopsy was accurate in 18/23 (78%) of the facility-based deaths where the cause of death was available. Ethics approval was obtained.Conclusions: Reproductive health education to adolescent girls and mothers, regarding the treatment of fever, vaginal discharge; and breastfeeding counselling with vitamin B12 should be used as more infant deaths are associated with anemia of mother. Health workers should be skilled in neonatal resuscitation, prematurity management, and referral, after stabilization, identification of congenital anomaly, antenatal screening by USG, and neonatal metabolic screen. Recent 2018 data obtained from Bhavnagar District Health Authority shows that over a period of eight years, institutional deliveries have increased and home deliveries, early neonatal deaths, HMD, and septicemia have decreased. Perinatal care should be check-list based, monitored, and mentored.

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A Study of Early Neonatal Deaths at Kathmandu Medical College Teaching Hospital

Journal of Nepal Paediatric Society ◽

10.3126/jnps.v27i2.1584 ◽

1970 ◽

Vol 27 (2) ◽

pp. 79-82

Author(s):

M Shrestha ◽

BL Bajracharya ◽

DS Manandhar

Keyword(s):

Birth Weight ◽

Neonatal Mortality ◽

Death Rate ◽

Neonatal Death ◽

Birth Asphyxia ◽

Early Neonatal Death ◽

Extreme Prematurity ◽

Neonatal Deaths ◽

Live Births ◽

Early Neonatal Deaths

Over 9 million deaths occur each year in the perinatal and neonatal periods globally. 98% of these deaths take place in the developing world. Nepal has a high neonatal mortality rate (NMR) of 38.6 per 1000 live births (2001). Two thirds of the newborn deaths usually occur in the first week of life (early neonatal death). Newborn survival has become an important issue to improve the overall health status and for achieving the millennium developmental goals of a developing country like Nepal. Aims and Objectives: This study was carried out to determine the causes of early neonatal deaths (ENND) at KMCTH in the two-year period from November 2003 to October2005 (Kartik 2060 B.S. to Ashoj 2062). Methodology: This is a prospective study of all the early neonatal deaths in KMCTH during the two-year study period. Details of each early neonatal death were filled in the standard perinatal death audit forms of the Department. Results: Out of the 1517 total births in the two-year period, there were 10 early neonatal deaths (ENND). Early neonatal death rate during the study period was 6.7 per 1000 live births and early neonatal death rate (excluding less than 1 kg) was 6.1 per 1000 live births The important causes of early neonatal deaths were extreme prematurity, birth asphyxia, congenital anomalies and septicaemia. During the study period, there was no survival of babies with a birth weight of less than 1 kg. Among the maternal characteristics, 80% of the mothers of early neonatal deaths were aged between 20-35 years. 50% of the mothers were primigravida. 50% of the mothers of ENNDs had delivered their babies by caesarean section.Discussion: Most of the early neonatal deaths were due to extreme prematurity. Birth asphyxia was the second most important cause of early neonatal deaths. 70% of ENNDs were among LBW babies. Prevention of premature delivery, proper management of very low birth weight babies and early detection and appropriate management of perinatal hypoxia have become important interventional strategies in reducing early neonatal deaths in KMCTH.Conclusion: Early neonatal mortality at KMCTH is fairly low. Good care during pregnancy, labour and after the birth of the baby has helped to achieve these results. Low cost locally made equipments were used to manage the sick newborns. Reduction of early neonatal deaths require more intensive care including use of ventilators, surfactant and parenteral nutrition and prevention of preterm births Key words: Early neonatal death (ENND), neonatal mortality doi:10.3126/jnps.v27i2.1584 J. Nepal Paediatr. Soc. Vol 27(2), p.79-82

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A study of early neonatal mortality in a tertiary hospital of Maharashtra, India

International Journal of Contemporary Pediatrics ◽

10.18203/2349-3291.ijcp20183522 ◽

2018 ◽

Vol 5 (5) ◽

pp. 1869

Author(s):

Nitin Mehkarkar ◽

Vijay Baburao Sonawane

Keyword(s):

Neonatal Mortality ◽

Neonatal Death ◽

Birth Asphyxia ◽

Tertiary Hospital ◽

Premature Delivery ◽

Early Neonatal Death ◽

Neonatal Deaths ◽

Live Births ◽

Early Neonatal Mortality ◽

Early Neonatal Deaths

Background: India has a high Neonatal Mortality Rate (NMR) of 31 per 1000 live births and rural being 34 whereas urban being 17 (2011). Two thirds of the newborn deaths usually occur in the first week of life. Newborn survival has become an important issue to improve the overall health care goals. This study is carried out to identify primary causes of early neonatal deaths and to ascertain the factors affecting early neonatal mortality.Methods: This is a prospective study of all the early neonatal deaths in tertiary hospital of Maharashtra over two years. Details of each early neonatal death were filled in the standard perinatal death proforma.Results: Out of the 2073 total births, there were 75 early neonatal deaths (END) which is nearly 36.18 per 1000 live births. The important causes of END were severe birth asphyxia, respiratory distress syndrome and septicemia. About 50% of deaths were observed in mothers with age < 20 years, 25% deaths observed in mothers of age group 20-29 years, and similar percentage is with age >30 years. Most of the early neonatal deaths were due to Birth asphyxia and RDS was the second most important cause of early neonatal deaths. 70% of ENDs were among LBW babies. Prevention of premature delivery, proper management of very low birth weight babies and early detection and appropriate management of perinatal hypoxia have become important interventional strategies in reducing early neonatal deaths.Conclusions: Early Neonatal Mortality (ENM) at Tertiary Hospital is fairly high. In present study, early neonatal death rate of 36.18 per 1000 live births is observed which significantly higher than reported in literature.

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Assessment of neonatal mortality major factors

Iraqi National Journal of Medicine ◽

10.37319/iqnjm.2.2.8 ◽

2019 ◽

pp. 124-130

Author(s):

Rasmiya Lafta ◽

Husam Habeeb

Keyword(s):

Respiratory Distress ◽

Neonatal Mortality ◽

Congenital Anomalies ◽

Neonatal Death ◽

Birth Asphyxia ◽

Health Resources ◽

Neonatal Care ◽

Hemorrhagic Disease ◽

Neonatal Deaths ◽

Major Factors

Background: Neonatal mortality accounts for nearly half of the deaths of children under the age of five, the main leading causes for which are respiratory distress, infection, and congenital anomalies. Action plans, which call for the elimination of preventable deaths of newborn babies, set specific targets to reduce neonatal mortality. This retrospective descriptive study was conducted in the Basra Teaching Hospital for maternity and childhood from January 2019 to February 2020, including all the neonates who were admitted in the first and second neonatal care units of the hospital. Aim: This study aims to study the main causes of neonatal deaths in newborn babies in the neonatal care units at the main maternity and pediatric hospital of the Basra government. Patients and methods: A total of 716 neonatal deaths were registered along with days of life before death and the cause of death; the cases were classified as early (1–6) days death and late (7–28) days death. Results: In this study, we found that the main causes of early neonatal death were respiratory distress syndrome (68.4%), congenital anomalies (11.4%), infection (10.9%), birth asphyxia (7.2%), and other neonatal conditions (inborn error of metabolism, hemorrhagic disease of newborn, severe anemia, and unspecified causes) (2.1%), while for late neonatal death, respiratory distress (27.2%), congenital problems (17.7%), infection (45.6%), birth asphyxia (6.1%), and other conditions (3.4%) were cited. Conclusions: It is important to direct the health resources towards preventable causes of neonatal deaths both before, during and after the delivery of a baby when the higher risk factors are preventable (prematurity, birth problems, and sepsis). Using all available resources to decrease preterm labors and mother education toward pregnancy and to improve the facilities and quality of neonatal care at the delivery room and neonatal care units. Keywords: neonate, prematurity, congenital problems, birth asphyxia

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