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. 2015 Sep;100(5):F439-47.
doi: 10.1136/archdischild-2014-307636. Epub 2015 May 13.

Cause-specific neonatal mortality: analysis of 3772 neonatal deaths in Nepal, Bangladesh, Malawi and India

Edward Fottrell  1 , David Osrin  1 , Glyn Alcock  1 , Kishwar Azad  2 , Ujwala Bapat  3 , James Beard  1 , Austin Bondo  4 , Tim Colbourn  1 , Sushmita Das  3 , Carina King  1 , Dharma Manandhar  5 , Sunil Manandhar  5 , Joanna Morrison  1 , Charles Mwansambo  6 , Nirmala Nair  7 , Bejoy Nambiar  1 , Melissa Neuman  1 , Tambosi Phiri  8 , Naomi Saville  1 , Aman Sen  5 , Nadine Seward  1 , Neena Shah Moore  3 , Bhim Prasad Shrestha  5 , Bright Singini  8 , Kirti Man Tumbahangphe  5 , Anthony Costello  1 , Audrey Prost  1
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Cause-specific neonatal mortality: analysis of 3772 neonatal deaths in Nepal, Bangladesh, Malawi and India

Edward Fottrell et al. Arch Dis Child Fetal Neonatal Ed. 2015 Sep.

Abstract

Objective: Understanding the causes of death is key to tackling the burden of three million annual neonatal deaths. Resource-poor settings lack effective vital registration systems for births, deaths and causes of death. We set out to describe cause-specific neonatal mortality in rural areas of Malawi, Bangladesh, Nepal and rural and urban India using verbal autopsy (VA) data.

Design: We prospectively recorded births, neonatal deaths and stillbirths in seven population surveillance sites. VAs were carried out to ascertain cause of death. We applied descriptive epidemiological techniques and the InterVA method to characterise the burden, timing and causes of neonatal mortality at each site.

Results: Analysis included 3772 neonatal deaths and 3256 stillbirths. Between 63% and 82% of neonatal deaths occurred in the first week of life, and males were more likely to die than females. Prematurity, birth asphyxia and infections accounted for most neonatal deaths, but important subnational and regional differences were observed. More than one-third of deaths in urban India were attributed to asphyxia, making it the leading cause of death in this setting.

Conclusions: Population-based VA methods can fill information gaps on the burden and causes of neonatal mortality in resource-poor and data-poor settings. Local data should be used to inform and monitor the implementation of interventions to improve newborn health. High rates of home births demand a particular focus on community interventions to improve hygienic delivery and essential newborn care.

Keywords: Data Collection; Epidemiology; Measurement; Mortality; Neonatology.

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Figures

Figure 1
Figure 1
Total and cause-specific neonatal mortality rates by study site ordered left to right by decreasing neonatal mortality rate. Superimposed numbers represent cause-specific mortality fractions (CSMFs) (%) for each site. PCP, Perinatal Care Project; SNEHA, Society for Nutrition, Education and Health Action.
Figure 2
Figure 2
Cause-specific mortality fractions (CSMFs) by day of death and study site ordered left to right by decreasing neonatal mortality rate. PCP, Perinatal Care Project; SNEHA, Society for Nutrition, Education and Health Action.
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