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

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.

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

1970 ◽  
Vol 8 (1) ◽  
pp. 62-72 ◽  
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

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

2011 ◽  
Vol 31 (1) ◽  
pp. 44-48 ◽  
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

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

2022 ◽  
Vol 80 (1) ◽  
Author(s):  
Daniel J. Erchick ◽  
Johanna B. Lackner ◽  
Luke C. Mullany ◽  
Nitin N. Bhandari ◽  
Purusotam R. Shedain ◽  
...  
Keyword(s):  
Antenatal Care ◽  
Verbal Autopsy ◽  
Neonatal Death ◽  
Birth Asphyxia ◽  
Multiple Birth ◽  
Care Seeking ◽  
Autopsy Study ◽  
Training Centre ◽  
Neonatal Deaths ◽  
Risk Of Death

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.

scholarly journals Verbal autopsy to ascertain causes of neonatal deaths in a community setting: A study from Morang, Nepal

2011 ◽  
Vol 51 (181) ◽  
Author(s):  
S Khanal ◽  
VS GC ◽  
P Dawson ◽  
R Houston
Keyword(s):  
Cause Of Death ◽  
Verbal Autopsy ◽  
Causes Of Death ◽  
Health Planning ◽  
Birth Asphyxia ◽  
Community Setting ◽  
District Level ◽  
Quality Data ◽  
Neonatal Deaths ◽  
Institutional Deliveries

Introduction: Clinical registration of the cause of death is available for less than one-third of the global newborn deaths, but the need for good quality data on causes of death for public health planning has renewed the interest in the Verbal Autopsy (VA). We aimed to determine the cause of neonatal deaths by VA in Morang district of Nepal. Methods: Caretakers of the deceased were interviewed using a semi-structured VA questionnaire by female community health volunteers. The cause of death was assigned by two senior pediatricians independently and disagreements in ascertaining the proximate cause of death were resolved by consensus. Results: The proximate causes of deaths were infections (41 %), birth asphyxia (37.2 %), prematurity (11.5 %), and low birth weight related causes (6.9 %). There was no signifi cant statistical difference in deaths due to infection seen in non-institutional deliveries (43.5 %) than institutional deliveries (34.6 %). More than half of the deaths (58.5 %) occurred within the fi rst three days of life where the predominant cause of death was birth asphyxia (60.7 %). Conclusions: Analysis of verbal autopsies demonstrates that the major causes of death still are infections and birth asphyxia. The timing of deaths suggests that neonatal interventions should be aimed at the fi rst week of life. There is no comparative advantage between institutional deliveries at below district level institutions and non-institutional deliveries to prevent neonatal infection. Thus, further study on the quality of care at institutes below the district level should be conducted. Disparities still occur in deaths, with most deaths in Morang occurring in non-institutional deliveries and in disadvantaged groups. Keywords: neonatal deaths, Nepal, newborn, verbal autopsy.

ANALYSIS OF FETAL AND NEONATAL DEATHS IN 4117 CONSECUTIVE BIRTHS

PEDIATRICS ◽  
1950 ◽  
Vol 5 (2) ◽  
pp. 184-192
Author(s):  
HERBERT C. MILLER
Keyword(s):  
Cause Of Death ◽  
Premature Infants ◽  
Neonatal Death ◽  
Causes Of Death ◽  
Neonatal Period ◽  
Full Term ◽  
Maternal Complications ◽  
Term Infants ◽  
Neonatal Deaths ◽  
Postmortem Examinations

An analysis of the significant causes of death in 4117 consecutive births was made; there were 66 fetal deaths and 85 neonatal deaths. A significant cause of death was determined in 51 fetuses and 56 live-born infants. Eighty-five per cent of the live-born infants who weighed over 1000 gm. at birth and had postmortem examinations had causes of death which were considered to be significant. Almost half of the live-born premature infants with birth weights between 1000 and 2500 gm. were considered to have had more than one significant cause of death. The so-called significant causes of death among live-born infants differed from those determined for fetuses dying before birth. Among the former, pathologic conditions in the infants were determined four times more frequently than in those dying before birth and, in the latter, maternal complications of pregnancy and labor were diagnosed as significant causes of death five times more frequently than in infants dying in the neonatal period. Hyaline-like material in the lung was considered to be the most frequent significant cause of death in live-born premature infants; congenital malformation and anoxia resulting from complications of labor were the most frequently determined significant causes of death in live-born full term infants. No differences were found in the significant causes of death in premature and full term fetuses. Anoxia resulting from accidental and unexpected interruption of the blood flow in the placenta and umbilical cord and from dystocia was the most frequently determined significant cause of death in both groups. A plea has been made for the adoption by obstetricians, pathologists and pediatricians of a formal uniform plan of classifying the causes of fetal and neonatal death which would divest current efforts to determine the cause of death of as much vague terminology and arbitrary opinion as possible.

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

2012 ◽  
Vol 2012 ◽  
pp. 1-8 ◽  
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.

scholarly journals CAN WE MANAGE NEONATAL INFECTION IN THE COMMUNITY ?

2003 ◽  
Vol 42 (149) ◽  
pp. 302-5
Author(s):  
D S Manandhar ◽  
A M Costello ◽  
D Osrin
Keyword(s):  
Neonatal Sepsis ◽  
Health Workers ◽  
Oral Treatment ◽  
Birth Asphyxia ◽  
Care Facility ◽  
Neonatal Infection ◽  
Antibiotic Use ◽  
Community Management ◽  
Oral Antibiotic ◽  
Pilot Studies

As infant mortality rates have fallen in many developing countries, the problem of neonatal mortality hasbecome more obvious. The biggest causes of mortality in the first month of life are infection, birth asphyxia,and low birth weight. Infection is implicated in about a third of neonatal deaths in Nepal. Communitybaseddata are limited, but neonatal sepsis is likely to be the result of infection by Gram positive bacteriasuch as Staphylococci and Streptococci, and enteric Gram negatives.The appropriate management for neonatal sepsis is parenteral, hospital-based treatment with a penicillinand an aminoglycoside. However, about 90% of births in Nepal take place at home, and many infants neverreach hospital. For these infants, the next best management strategy is to give parenteral antibiotics at aprimary care facility. Before referral, it would be appropriate to give a dose of oral antibiotic such ascotrimoxazole, which is already incorporated into the acute respiratory infection programme. If referralfor parenteral treatment is not successful, we propose that community-based cadres be allowed to give a fullcourse of oral antibiotic in cases of neonatal sepsis.Community health workers should receive training and pictorial guidelines for the recognition of dangersigns for neonatal sepsis, and we recommend pilot studies to compare and evaluate oral treatment in thecommunity. For Nepal, a national policy on the community management of neonatal infection is an extremelyurgent priority.Key Words: Neonatal infection, community management, antibiotic use.

scholarly journals Factors Associated with Increased Neonatal Deaths at a Regional Hospital in Namibia

2020 ◽  
Vol 22 (1) ◽  
Author(s):  
Million Bimerew ◽  
Saara K. Hatupopi ◽  
Jennifer Chipps
Keyword(s):  
Respiratory Distress Syndrome ◽  
Respiratory Distress ◽  
Neonatal Sepsis ◽  
Distress Syndrome ◽  
Congenital Abnormalities ◽  
Survey Design ◽  
Birth Asphyxia ◽  
Regional Hospital ◽  
Record Keeping ◽  
Neonatal Deaths

The increased neonatal mortality rate in a regional hospital in Namibia is a concern. According to the 2013 records of the hospital, there were 333 neonatal deaths from 1 January to 31 December 2013. The aim of the study was to investigate the causes of the increased neonatal deaths at this regional hospital in Namibia. A retrospective descriptive survey design was employed to conduct the study. Data were collected from 231 record files of neonates that died from 1 January to 31 December 2013 while admitted at the regional hospital before 28 completed days of life. The results shows that 67.1 per cent (n = 155) neonates that died in the regional hospital were during the first 7 days of life, and 32.9 per cent (n = 76) died after 7 days of life but before 28 completed days of life. Five causes accounted for the early neonatal deaths: respiratory distress syndrome, congenital abnormalities, neonatal sepsis, birth asphyxia, and haemorrhagic diseases of newborns. The late neonatal deaths were mainly caused by neonatal sepsis, followed by respiratory distress syndrome, congenital abnormalities, and birth asphyxia. The results also indicated poor record-keeping as an associated factor in this regional hospital. The study finally concluded that the majority of neonatal deaths that occurred in 2013 at the regional hospital were associated with multiple factors such as respiratory distress syndrome, neonatal sepsis, asphyxia, and congenital abnormalities. However, the majority of these factors could have been avoided.

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

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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