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

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.

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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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ANALYSIS OF FETAL AND NEONATAL DEATHS IN 4117 CONSECUTIVE BIRTHS

PEDIATRICS ◽

10.1542/peds.5.2.184 ◽

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.

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Can verbal autopsy improve the diagnostic accuracy of Physicians in Shanghai? Application of SmartVA

10.21203/rs.3.rs-226018/v1 ◽

2021 ◽

Author(s):

Lei Chen ◽

Tian Xia ◽

Rasika Rampatige ◽

Hang Li ◽

Tim Adair ◽

...

Keyword(s):

Cause Of Death ◽

Verbal Autopsy ◽

Medical Records ◽

Community Health Centers ◽

Causes Of Death ◽

Practical Method ◽

Initial Diagnosis ◽

Hospital Death ◽

Routine Practice ◽

Record Review

Abstract Background Accurate data on causes of death are essential for policy makers and public health experts to plan appropriate health policies and interventions to improve population health. Whereas approximately 30% deaths of Shanghai either occur at home or are not medically attended; the recorded cause of death in these cases may be less reliable than for a hospital death. Verbal Autopsy is a practical method that can help determine causes of death in regions where medical records are insufficient or unavailable. In this research, the smart VA tool was adopted to assign the cause of death of home deaths and to validate the accuracy and efficiency of the tool, the results were compared with routine practice to ascertain the value, if any, of incorporating VA into the diagnostic practices of physician in Shanghai certifying the cause of home deaths. Methods This pilot study selected home deaths certified by 16 community health centers from 3 districts represent urban, suburb, and urban-suburb areas in Shanghai, from December 2017 to June 2018. The medical records for all deaths for which a VA was carried out in these 3 districts during same period were carefully evaluated an independent Medical Record Review (MRR) team. Causes of death from both the SmartVA sample and the UCOD from the MRR were transformed to the SmartVA cause list for comparison. The concordance between the initial diagnosis and MRR UCOD and post-VA diagnosis and MRR UCOD was assessed using Chance Corrected Concordance. Results Overall CSMF accuracy improved from 0.93, based on the initial diagnosis, to 0.96 after the application of SmartVA. The misclassification of the initial diagnosis compared to that from the MRR. 86.3% of the initial diagnoses assigned the correct CODs, after the VA investigation, 90.5% of the post-VA diagnosis assigned the correct CODs. Conclusions Although Shanghai has an established and well-functioning CRVS system, SmartVA for Physicians contributed to an improvement in the accuracy of death certification. In addition, SmartVA may be a useful tool for inferring some special causes of death, such as those CODs classified as undetermined.

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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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Causes of death among Syrian children using verbal autopsy

Eastern Mediterranean Health Journal ◽

10.26719/1996.2.3.440 ◽

2021 ◽

Vol 2 (3) ◽

pp. 440-448

Author(s):

N. Abou Rashid ◽

S. Al Jirf ◽

H. Bashour

Keyword(s):

Public Health ◽

Cause Of Death ◽

Verbal Autopsy ◽

Congenital Malformations ◽

Causes Of Death ◽

Public Health Importance ◽

Related Factors ◽

Children Under Five ◽

The Public ◽

Under Five

The causes of death in children under five years were studied using a structured verbal autopsy questionnaire. Possible determinants of death were also investigated. About 44% of deaths were among neonates [below 28 days of age] ; the major causes of death in neonates were prematurity [33%] and birth-related factors [30%]. In infants [1-11 months of age], the leading cause of death was congenital malformations [24%]. Accidents were responsible for one-third of deaths in children aged 1-4 years. Factors that might have contributed to death were investigated. The public health importance of causes of death was evaluated and its implications were discussed

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Causes and Predictors of Mortality among HIV-Exposed Infants in Rural North-Central Nigeria: Results of a Simple Verbal Autopsy Survey

10.21203/rs.2.21758/v1 ◽

2020 ◽

Author(s):

Chamberline E. Ozigbu ◽

Salome Erekaha ◽

Eric E. Chinaeke ◽

Tongdiyen L. Jasper ◽

Gift Nwanne ◽

...

Keyword(s):

Infant Mortality ◽

Verbal Autopsy ◽

Causes Of Death ◽

Birth Asphyxia ◽

Monitoring And Evaluation ◽

Hiv Diagnosis ◽

North Central ◽

Predictors Of Mortality ◽

Hiv Exposed Infants ◽

Hiv Exposed

Abstract Background HIV-exposed infants (HEI) who die before diagnosis or treatment initiation, or who die in spite of being HIV-free constitute missed opportunities for reducing infant mortality. Verbal autopsy (VA) has been successfully applied in the collection of data to determine symptoms and circumstances surrounding death among infants, children and adults among populations that lack vital registration systems. There is little available data on rates and causes of death among HIV-exposed infants (HEI) in Nigeria. We used VA to characterize attributable causes and predictors of mortality among HEI in rural North-Central Nigeria.Methods Pregnant women living with HIV and HEI were enrolled at rural primary healthcare facilities and followed-up for 12 months, post-delivery. A simple 21-item VA instrument was used to collect infant mortality information from mothers, other family members, mentor mothers, and/or healthcare workers. Attributable causes of death were determined by physician coding. Multivariate logistic regression was performed to determine independent predictors of mortality.Results Data from 455 HIV-exposed infected and uninfected fetus/infant-mother pairs were analyzed. All mothers received anti-retroviral therapy. Seventy-five (16.5%) fetuses/infants died during gestation and within 12 months post-delivery. Forty (53.3%) deaths occurred in utero . The 12-month infant mortality risk among HEI in our study was 88.7/1,000. Among the 35 live-born infants, birth asphyxia (6/17, 35.3%) and sepsis (7/18, 38.9%) were the most common causes of death in the neonatal and post-neonatal periods, respectively. Unadjusted estimates showed that a greater proportion of deceased infants had mothers who did not deliver at a health facility (53.3 vs 31.8%, p=0.003), and who were newly HIV-diagnosed during pregnancy (69.3 vs 50.8%, p=0.029). Infants receiving nevirapine prophylaxis within 72 hours were less likely to have died (aOR = 0.40, 95% CI: 0.2-0.9).Conclusions Early HIV diagnosis and treatment among women of child-bearing age, maternal access to facility delivery and timely infant antiretroviral prophylaxis should be programmatically strengthened to reduce HEI mortality. Additionally, robust monitoring and evaluation systems are needed to track and record deaths among HEI.

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Mortality Cause in Goldsmith Workers of Bangladesh: Findings From Verbal Autopsy

10.21203/rs.3.rs-508983/v1 ◽

2021 ◽

Author(s):

Fahmida Afroz Khan ◽

Md. Khalequzzaman ◽

Mohammad Tanvir Islam ◽

Ataur Rahman ◽

Shahrin Emdad Rayna ◽

...

Keyword(s):

Life Expectancy ◽

Cause Of Death ◽

Verbal Autopsy ◽

Causes Of Death ◽

Heart Diseases ◽

Control Program ◽

Ischemic Heart ◽

World Health ◽

Average Life Expectancy ◽

Health Organization

Abstract Background: Information on the mortality causes of goldsmith workers in Bangladesh is very limited. This study was conducted to find out the causes of death in this group of population.Methods: The study subject was deceased goldsmith workers where face-to-face interviews were conducted with the family members who were present during the deceased's illness preceding death. A World Health Organization recommended questionnaire was adapted to conduct 20 deceased goldsmith workers' verbal autopsy. Causes of death were determined by reviewing the outcomes of the interviews by the expert physicians.Results: The mean age of the goldsmith workers at death was 59.2 ± 9.3 years. Among the deceased goldsmith workers, 70.0% were smokers, and 50.0% of them were alcohol consumers. Cardiovascular diseases (CVD) were the most common immediate and underlying cause of death (55.0% and 45.0%, respectively). Acute ischemic heart disease was the single most common (30.0%) immediate cause of death among the deceased goldsmith workers, whereas, for underlying causes of death, it was both acute and chronic ischemic heart diseases (35.0%).Conclusions: The life expectancy of goldsmith workers was much lower than the average life expectancy of Bangladesh, where CVD was the common cause of death. Smoking and alcohol consumption were prevalent among the majority of the deceased goldsmith workers. Awareness of healthy lifestyles should be prioritized for a successful CVD control program for this population. Trial registration: Not applicable.

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Neonatal Mortality Rate in Aseptic Neonatal Care Unit of Al-Sadder Teaching Hospital in Missan Province From 2011 to 2014

European Scientific Journal ESJ ◽

10.19044/esj.2016.v12n27p55 ◽

2016 ◽

Vol 12 (27) ◽

pp. 55

Author(s):

Esraa Abd Al-Muhsen Ali

Keyword(s):

Mortality Rate ◽

Neonatal Mortality ◽

Teaching Hospital ◽

Causes Of Death ◽

Neonatal Period ◽

Birth Asphyxia ◽

Neonatal Care ◽

Neonatal Mortality Rate ◽

Neonatal Deaths ◽

Neonatal Care Unit

Background: The neonatal mortality rate is a key outcome indicator for newborn care and directly reflects prenatal, natal, and postnatal care. Early neonatal deaths are more closely associated with pregnancy-related factors and maternal health, whereas late neonatal deaths are associated more with factors in the newborn‘s environment. Objectives: To estimate the neonatal mortality rate in Aseptic Neonatal Care Unit of Al-Sadder Teaching Hospital in Missan Province during period (2011-2014). To determine the most common causes of death in the neonatal period. Patients and methods: A hospital-based study was done depending on data collected from records of the Aseptic Neonatal Care Unit of Al-Sadder Teaching Hospital in Missan Province to calculate the number of deaths within the neonatal period (0-28 days) that was conducted from 2011 to 2014. The other line of data was collected from Obstetrical Ward by calculating number of live births for the same period. Then Neonatal Mortality Rate is calculated and conducted for each year according to the method recommended by WHO. Results: The neonatal mortality rates were 12.15, 13.51, 16.37 and16.11 in 2011 to 2014 respectively in which there was an increment in mortality rate. The main causes of death were respiratory distress syndrome, birth asphyxia and congenital anomalies. Conclusion: Neonatal mortality rate was high in the Aseptic Neonatal Care Unit of Al-Sadder Teaching Hospital, but it was less than the previous period in Iraq since 1990. These results suggest, that to decrease neonatal mortality, improved health service quality is crucial.

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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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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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