scholarly journals Cause of death in under 5 children in a demographic surveillance site in Pakistan

2017 ◽  
Vol 9 (1) ◽  
Author(s):  
Muhammad Imran Nisar ◽  
Muhammad Ilyas ◽  
Komal Naeem ◽  
Urooj Fatima ◽  
Fyezah Jehan
Keyword(s):  
Cause Of Death ◽  
Diarrheal Disease ◽  
Perinatal Asphyxia ◽  
Health Facilities ◽  
Childhood Mortality ◽  
Neonatal Deaths ◽  
Surveillance Site ◽  
Birth Complication ◽  
Specific Mortality ◽  
Cause Of Deaths

ObjectiveTo identify Cause of deaths among children below age of 5yearsfrom a prospective cohort of women in one urban and four peri-urbansettings of Karachi, PakistanIntroductionPakistan ranks 26th in Childhood mortality rates, globally. Pakistan,with other 4 countries is responsible for about half of the deaths ofchildren age under 5. Despite such burden vital registration systemis not well established, health facilities are not easily accessible andmostly deaths occur at home, making identification of cause of death(COD) difficultMethodsFrom Jan 2007-Dec 2012 under-5 mortality was identifiedby CHWs during their 3-monthly visits. A Research Assistantconducted Verbal Autopsies (VA). Each VA form was analyzed by2 physicians, independently, and assigned a cause. VA is analyzedby a third physician in case two physicians do not agree on a cause.Cause Specific Mortality Fractions (CSMF) were calculated for eachidentified COD.Results833(58%) neonatal deaths and 591(42%) Under-5 deaths (excludingneonates) were identified. Among neonates most common CODswere perinatal asphyxia(30.4%), neonatal sepsis/meningitis(28%),pre-term birth complication(11%) and neonatal pneumonia(6%).For Post-neonatal deaths most common CODs were sepsis (19%),diarrheal disease (17%), Pneumonia (17%) and meningitis (8%).ConclusionsWe describe the CSMF for different CODs among neonated andchildren under 5. Strategies for prevention of most common causesand making health facilities easily accessible will decrease thisburden.

scholarly journals Evaluation of neonatal mortality data completeness and accuracy in Ghana

PLoS ONE ◽  
2021 ◽  
Vol 16 (3) ◽  
pp. e0239049
Author(s):  
Dora Dadzie ◽  
Richard Okyere Boadu ◽  
Cyril Mark Engmann ◽  
Nana Amma Yeboaa Twum-Danso
Keyword(s):  
Public Sector ◽  
Data Quality ◽  
Neonatal Mortality ◽  
Cause Of Death ◽  
Health Facilities ◽  
Mortality Data ◽  
Death Certificates ◽  
Neonatal Deaths ◽  
Specific Mortality ◽  
Brong Ahafo

Background Cause-specific mortality data are required to set interventions to reduce neonatal mortality. However, in many developing countries, these data are either lacking or of low quality. We assessed the completeness and accuracy of cause of death (COD) data for neonates in Ghana to assess their usability for monitoring the effectiveness of health system interventions aimed at improving neonatal survival. Methods A lot quality assurance sampling survey was conducted in 20 hospitals in the public sector across four regions of Ghana. Institutional neonatal deaths (IND) occurring from 2014 through 2017 were divided into lots, defined as neonatal deaths occurring in a selected facility in a calendar year. A total of 52 eligible lots were selected: 10 from Ashanti region, and 14 each from Brong Ahafo, Eastern and Volta region. Nine lots were from 2014, 11 from 2015 and 16 each were from 2016 and 2017. The cause of death (COD) of 20 IND per lot were abstracted from admission and discharge (A&D) registers and validated against the COD recorded in death certificates, clinician’s notes or neonatal death audit reports for consistency. With the error threshold set at 5%, ≥ 17 correctly matched diagnoses in a sample of 20 deaths would make the lot accurate for COD diagnosis. Completeness of COD data was measured by calculating the proportion of IND that had death certificates completed. Results Nineteen out of 52 eligible (36.5%) lots had accurate COD diagnoses recorded in their A&D registers. The regional distribution of lots with accurate COD data is as follows: Ashanti (4, 21.2%), Brong Ahafo (7, 36.8%), Eastern (4, 21.1%) and Volta (4, 21.1%). Majority (9, 47.4%) of lots with accurate data were from 2016, followed by 2015 and 2017 with four (21.1%) lots. Two (10.5%) lots had accurate COD data in 2014. Only 22% (239/1040) of sampled IND had completed death certificates. Conclusion Death certificates were not reliably completed for IND in a sample of health facilities in Ghana from 2014 through 2017. The accuracy of cause-specific mortality data recorded in A&D registers was also below the desired target. Thus, recorded IND data in public sector health facilities in Ghana are not valid enough for decision-making or planning. Periodic data quality assessments can determine the magnitude of the data quality concerns and guide site-specific improvements in mortality data management.

scholarly journals Improving quality of medical certification of causes of death in health facilities in Tanzania 2014–2019

2021 ◽  
Vol 21 (S1) ◽  
Author(s):  
Trust Nyondo ◽  
Gisbert Msigwa ◽  
Daniel Cobos ◽  
Gregory Kabadi ◽  
Tumaniel Macha ◽  
...  
Keyword(s):  
Quality Improvement ◽  
Health Policy ◽  
Cause Of Death ◽  
Causes Of Death ◽  
Health Facilities ◽  
Mortality Data ◽  
Medical Certification ◽  
Specific Mortality ◽  
Icd 10

Abstract Background Monitoring medically certified causes of death is essential to shape national health policies, track progress to Sustainable Development Goals, and gauge responses to epidemic and pandemic disease. The combination of electronic health information systems with new methods for data quality monitoring can facilitate quality assessments and help target quality improvement. Since 2015, Tanzania has been upgrading its Civil Registration and Vital Statistics system including efforts to improve the availability and quality of mortality data. Methods We used a computer application (ANACONDA v4.01) to assess the quality of medical certification of cause of death (MCCD) and ICD-10 coding for the underlying cause of death for 155,461 deaths from health facilities from 2014 to 2018. From 2018 to 2019, we continued quality analysis for 2690 deaths in one large administrative region 9 months before, and 9 months following MCCD quality improvement interventions. Interventions addressed governance, training, process, and practice. We assessed changes in the levels, distributions, and nature of unusable and insufficiently specified codes, and how these influenced estimates of the leading causes of death. Results 9.7% of expected annual deaths in Tanzania obtained a medically certified cause of death. Of these, 52% of MCCD ICD-10 codes were usable for health policy and planning, with no significant improvement over 5 years. Of certified deaths, 25% had unusable codes, 17% had insufficiently specified codes, and 6% were undetermined causes. Comparing the before and after intervention periods in one Region, codes usable for public health policy purposes improved from 48 to 65% within 1 year and the resulting distortions in the top twenty cause-specific mortality fractions due to unusable causes reduced from 27.4 to 13.5%. Conclusion Data from less than 5% of annual deaths in Tanzania are usable for informing policy. For deaths with medical certification, errors were prevalent in almost half. This constrains capacity to monitor the 15 SDG indicators that require cause-specific mortality. Sustainable quality assurance mechanisms and interventions can result in rapid improvements in the quality of medically certified causes of death. ANACONDA provides an effective means for evaluation of such changes and helps target interventions to remaining weaknesses.

scholarly journals Monitoring progress with national and subnational health goals by integrating verbal autopsy and medically certified cause of death data

2021 ◽  
Vol 6 (5) ◽  
pp. e005387
Author(s):  
Tim Adair ◽  
Sonja Firth ◽  
Tint Pa Pa Phyo ◽  
Khin Sandar Bo ◽  
Alan D Lopez
Keyword(s):  
Cause Of Death ◽  
Verbal Autopsy ◽  
Integration Method ◽  
Mortality Rates ◽  
Vital Statistics ◽  
Death Registration ◽  
Chronic Respiratory Diseases ◽  
Health Goals ◽  
Specific Mortality ◽  
Four Causes

IntroductionThe measurement of progress towards many Sustainable Development Goals (SDG) and other health goals requires accurate and timely all-cause and cause of death (COD) data. However, existing guidance to countries to calculate these indicators is inadequate for populations with incomplete death registration and poor-quality COD data. We introduce a replicable method to estimate national and subnational cause-specific mortality rates (and hence many such indicators) where death registration is incomplete by integrating data from Medical Certificates of Cause of Death (MCCOD) for hospital deaths with routine verbal autopsy (VA) for community deaths.MethodsThe integration method calculates population-level cause-specific mortality fractions (CSMFs) from the CSMFs of MCCODs and VAs weighted by estimated deaths in hospitals and the community. Estimated deaths are calculated by applying the empirical completeness method to incomplete death registration/reporting. The resultant cause-specific mortality rates are used to estimate SDG Indicator 23: mortality between ages 30 and 70 years from cardiovascular diseases, cancers, chronic respiratory diseases and diabetes. We demonstrate the method using nationally representative data in Myanmar, comprising over 42 000 VAs and 7600 MCCODs.ResultsIn Myanmar in 2019, 89% of deaths were estimated to occur in the community. VAs comprised an estimated 70% of community deaths. Both the proportion of deaths in the community and CSMFs for the four causes increased with older age. We estimated that the probability of dying from any of the four causes between 30 and 70 years was 0.265 for men and 0.216 for women. This indicator is 50% higher if based on CSMFs from the integration of data sources than on MCCOD data from hospitals.ConclusionThis integration method facilitates country authorities to use their data to monitor progress with national and subnational health goals, rather than rely on estimates made by external organisations. The method is particularly relevant given the increasing application of routine VA in country Civil Registration and Vital Statistics systems.

scholarly journals Early neonatal deaths associated with perinatal asphyxia in infants ≥2500 g in Brazil

2017 ◽  
Vol 93 (6) ◽  
pp. 576-584 ◽  
Author(s):  
Maria Fernanda Branco de Almeida ◽  
Mandira Daripa Kawakami ◽  
Lícia Maria Oliveira Moreira ◽  
Rosa Maria Vaz dos Santos ◽  
Lêni Márcia Anchieta ◽  
...  
Keyword(s):  
Perinatal Asphyxia ◽  
Neonatal Deaths ◽  
Early Neonatal Deaths

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.

Cross-sectional study of the quality of neonatal care services in Armenia

2019 ◽  
Vol 32 (8) ◽  
pp. 1145-1161
Author(s):  
Suren H. Galstyan ◽  
Hrant Z. Kalenteryan ◽  
Arshak S. Djerdjerian ◽  
Hovhannes S. Ghazaryan ◽  
Naira T. Gharakhanyan ◽  
...  
Keyword(s):  
Mortality Rate ◽  
Quality Assessment ◽  
Neonatal Care ◽  
Health Facilities ◽  
Cross Sectional ◽  
Content Type ◽  
Neonatal Deaths ◽  
Live Births ◽  
Care Services

Purpose The purpose of this paper is to report the assessment results of the quality of neonatal care services in Armenia and to describe the identified obstacles to improving the quality of care for newborn infants. Design/methodology/approach The study carried out a cross-sectional descriptive design. The data were collected in health facilities with different levels of neonatal care that were selected employing a multi-stage, stratified purposeful sampling design. The quality of neonatal services was assessed using the generic WHO tool. Data collection was performed using face-to-face semi-structured interviews, hospital statistics, medical records and direct observations. Findings In 31 study hospitals, 31,976 deliveries were performed resulting in 31,701 live births and 734 stillbirths. About 85 percent of all neonatal deaths was attributable to early neonatal deaths with over 48 percent occurring during the first 24 h of life. The proportion of neonatal deaths was highest in infants with low birth weight constituting 92.8 percent of all neonatal deaths. The total neonatal mortality rate was 3.50 per 1,000 live births, whereas stillbirth rate and perinatal mortality rate were 22.60 and 25.26 per 1,000 total births in 2015. Specific indicators with relatively lower mean scores included neonatal resuscitation, early breastfeeding, monitoring of newborn conditions, neonatal sepsis, feeding standards, total parenteral nutrition, and infection treatment. Originality/value Given the limited scope of research on quality assessment, this paper provides valuable information on the status of quality of neonatal care services in Armenian health facilities. This work also extends the existing studies focused on quality assessment through applying the model of Avedis Donabedian with the structure–process–outcomes approach as a theoretical basis.

scholarly journals Causes of Mortality in Older People With Intellectual Disability: Results From the HA-ID Study

2018 ◽  
Vol 123 (1) ◽  
pp. 61-71 ◽  
Author(s):  
Alyt Oppewal ◽  
Josje D. Schoufour ◽  
Hanne J.K. van der Maarl ◽  
Heleen M. Evenhuis ◽  
Thessa I.M. Hilgenkamp ◽  
...  
Keyword(s):  
Older Adults ◽  
Intellectual Disability ◽  
Cause Of Death ◽  
Causes Of Death ◽  
Circulatory System ◽  
Bacterial Diseases ◽  
Specific Mortality ◽  
Causes Of Mortality ◽  
Insight Into

Abstract We aim to provide insight into the cause-specific mortality of older adults with intellectual disability (ID), with and without Down syndrome (DS), and compare this to the general population. Immediate and primary cause of death were collected through medical files of 1,050 older adults with ID, 5 years after the start of the Healthy Ageing and Intellectual Disabilities (HA-ID) study. During the follow-up period, 207 (19.7%) participants died, of whom 54 (26.1%) had DS. Respiratory failure was the most common immediate cause of death (43.4%), followed by dehydration/malnutrition (20.8%), and cardiovascular diseases (9.4%). In adults with DS, the most common cause was respiratory disease (73.3%), infectious and bacterial diseases (4.4%), and diseases of the digestive system (4.4%). Diseases of the respiratory system also formed the largest group of primary causes of death (32.1%; 80.4% was due to pneumonia), followed by neoplasms (17.6%), and diseases of the circulatory system (8.2%). In adults with DS, the main primary cause was also respiratory diseases (51.1%), followed by dementia (22.2%).

Analysis of Causes of Neonatal Death in the United States with Specific Emphasis on Fatal Hyaline Membrane Disease

PEDIATRICS ◽  
1982 ◽  
Vol 70 (4) ◽  
pp. 570-575
Author(s):  
Robert H. Perelman ◽  
Philip M. Farrell
Keyword(s):  
Neonatal Mortality ◽  
Perinatal Asphyxia ◽  
Hyaline Membrane Disease ◽  
The United States ◽  
Mortality Statistics ◽  
Neonatal Deaths ◽  
Period 2 ◽  
National Mortality ◽  
Hyaline Membrane ◽  
Average Contribution

National mortality statistics for hyaline membrane disease (HMD) and the respiratory distress syndrome (RDS) and other major causalities were examined in this study for the years 1968 to 1978. A progressive reduction in total neonatal deaths began in 1971 such that only 56% as many newborn deaths occurred in 1978 as in 1968 (31,618 vs 66,456). In each of the 11 years surveyed, the majority of deaths occurred during the first four days of life, with more than half of the infants dying before 48 hours of age. HMD/RDS was the leading cause of death during nine of the 11 years analyzed, accounting for an average 19.5% of neonatal fatalities. Deaths associated with HMD/RDS increased for 1968 to 1971, plateaued, and progressively decreased in the ensuing years between 1974 and 1978. Thus, the percent of all neonatal deaths attributable to HMD/RDS increased from 14.7% in 1968 to a maximum of 21.3% in 1974, before declining to 17.5% in 1978. The average contribution of other major causes of death to overall neonatal mortality were: perinatal asphyxia, 13.4%; immaturity, 13.4%; and complications of pregnancy, 11.1%. These data indicate that: (1) despite the declining incidence of fatal HMD/RDS the disorder accounted for an increasing percent of total deaths through the later part of the 11-year period; (2) prevention and/or improved management of asphyxia made the most significant (29%) contribution to reduced neonatal mortality; (3) less change occurred in fatal complications of pregnancy, implying a continuing need for improved maternal/fetal care. Comparing national mortality statistics with those of Wisconsin suggests that further reduction in HMD/RDS death rates should be possible and could have a marked influence on national neonatal mortality statistics.

scholarly journals Immediate Outcome of Mechanically Ventilated Neonates: Experience from a Tertiary Care Hospital

2016 ◽  
Vol 6 (1) ◽  
pp. 22-25
Author(s):  
Amrita Lal Halder ◽  
Md Abdul Baki ◽  
Nazmun Nahar ◽  
Tahmina Begum
Keyword(s):  
Mechanical Ventilation ◽  
Intensive Care ◽  
Respiratory Distress Syndrome ◽  
Respiratory Distress ◽  
Cause Of Death ◽  
Distress Syndrome ◽  
Perinatal Asphyxia ◽  
Common Reason ◽  
Fatality Rate ◽  
Common Complication

Background: A large number of neonates in intensive care unit require mechanical ventilation due to various disease conditions. There has been a dramatic fall in neonatal mortality in developed countries with the advent of mechanical ventilation and the concept of neonatal intensive care. But still fatality rate is very high in developing countries. So, this study or was done to identify the immediate hospital outcome of the neonates who required mechanical ventilation.Methods: This study was done in Special Care Baby Unit, BIRDEM General Hospital from July 2009 to June 2010. All neonates requiring mechanical ventilation during the study period were prospectively enrolled in this study. During the time of mechanical ventilation neonates were followed up to observe any complication till discharge or death.Results: Total 37 neonates were enrolled in the study. Among them 27 (73%) were preterm and 30 (81%) were low birth weight. Respiratory distress syndrome was the most common reason for ventilation accounting for 17 (45.9%) cases. The other indications were perinatal asphyxia (9, 24.3%), congenital pneumonia (5, 13.5%), septicemia (5, 13.5%) and meconium aspiration syndrome (1, 2.7%). The most common complication during the period of ventilation was septicemia (14, 37.8%). Other complication included pneumothorax (6, 16.2%), acute renal failure (5, 13.3%), pneumonia (5, 13.3%), pulmonary hemorrhage (3, 8.1%), intraventricular hemorrhage (2, 5.4%) and heart failure (2, 5.4%). The fatality rate was 38% and most of the infant died of perinatal asphyxia (5, 35.7%), septicemia (4, 28.5%), respiratory distress syndrome (3, 21.5%) and congenital pneumonia (2, 14.3%).Conclusion: Respiratory distress syndrome was the most common reason for mechanical ventilation followed by perinatal asphyxia and septicemia. Most common complication during mechanical ventilation was septicemia which was also a common cause of death. Another important cause of death was perinatal asphyxiaBirdem Med J 2016; 6(1): 22-25

scholarly journals Perinatal outcomes in adolescent pregnancy

2018 ◽  
Vol 8 (2) ◽  
pp. 27-31
Author(s):  
Yam Prasad Dwa ◽  
Sunita Bhandari ◽  
Devendra Shrestha ◽  
Ajaya Kumar Dhakal
Keyword(s):  
Adolescent Pregnancy ◽  
Perinatal Asphyxia ◽  
Mode Of Delivery ◽  
Perinatal Outcomes ◽  
Breech Presentation ◽  
Fetal Distress ◽  
Neonatal Deaths ◽  
Medical College ◽  
Adolescent Women ◽  
Pregnant Adolescent

Introduction: Adolescent pregnancy is prevalent in Nepal and bears significant consequences to both mother and newborn. Methods: All pregnant women aged 19 years or less who were admitted for delivery at KIST Medical College during 14th April 2017 to 15th July 2018 were included in this study. Maternal and immediate neonatal outcomes were analyzed retrospectively from their medical records. Results: There were 135 pregnant adolescent women out of 1300 deliveries. Preeclampsia was observed in 2 pregnancies. Vaginal delivery (99; 73.3%) was the predominant mode of delivery. Emergency LS CS was performed in 35 (25.9%) deliveries and most frequent indications for LS CS were nonprogress of labor (8/35), breech presentation (8/35) and fetal distress (6/35). 10 (7.4%) babies were born preterm. 23 (17%) babies were born low birth weight. 37 (27.4%) neonates were symptomatic and required neonatal admission. Respiratory distress was the most frequent neonatal problem (29; 21.5%), followed by neonatal sepsis (18; 13.3%) and perinatal asphyxia (9; 6.7%). There were 3 (2.2%) still birth and 2 (1.5%) early neonatal deaths. Conclusion: Adolescent pregnancy was common and associated with increased early neonatal problems.

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