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Multicenter Study
. 2012 Aug;32(8):585-92.
doi: 10.1038/jp.2011.154. Epub 2011 Nov 10.

Causes of community stillbirths and early neonatal deaths in low-income countries using verbal autopsy: an International, Multicenter Study

C Engmann  1 , A Garces, I Jehan, J Ditekemena, M Phiri, M Mazariegos, E Chomba, O Pasha, A Tshefu, E M McClure, V Thorsten, H Chakraborty, R L Goldenberg, C Bose, W A Carlo, L L Wright
Affiliations
Multicenter Study

Causes of community stillbirths and early neonatal deaths in low-income countries using verbal autopsy: an International, Multicenter Study

C Engmann et al. J Perinatol. 2012 Aug.

Abstract

Objective: Six million stillbirths (SB) and early neonatal deaths (END) occur annually worldwide, mostly in rural settings distant from health facilities. We used verbal autopsy (VA), to understand causes of non-hospital, community-based SB and END from four low-income countries.

Study design: This prospective observational study utilized the train-the-trainer method. VA interviewers conducted standardized interviews; in each country data were reviewed by two local physicians who assigned an underlying causes of deaths (COD).

Result: There were 252 perinatal deaths (118 END; 134 SB) studied from pooled data. Almost half (45%) the END occurred on postnatal day 1, 19% on the second day and 16% the third day. Major early neonatal COD were infections (49%), birth asphyxia (26%), prematurity (17%) and congenital malformations (3%). Major causes of SB were infection (37%), prolonged labor (11%), antepartum hemorrhage (10%), preterm delivery (7%), cord complications (6%) and accidents (5%).

Conclusion: Many of these SB and END were from easily preventable causes. Over 80% of END occurred during the first 3 days of postnatal life, and >90% were due to infection, birth asphyxia and prematurity. The causes of SB were more varied, and maternal infections were the most common cause. Increased attention should be targeting at interventions that reduce maternal and neonatal infections and prevent END, particularly during the first 3 days of life.

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Figures

Figure 1
Figure 1
The Verbal Autopsy Process
Figure 2
Figure 2
Operational definitions
Figure 3
Figure 3
Flowchart of recruitment
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Figure 4
Causes of early neonatal death
Figure 5
Figure 5
Timing and cumulative probability of early neonatal death
Figure 6
Figure 6
Underlying cause of early neonatal death determined by physician consensus by age at death
Figure 7
Figure 7
Causes of stillbirth
See this image and copyright information in PMC

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