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

Journal of Perinatology volume 32, pages 585–592 (2012)Cite this article

Subjects

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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Acknowledgements

Funding was provided by grants from the National Institutes of Child Health and Human Development (U01 HD043475, U01 HD040636, U01 HD043464, U01 HD040607, U01 HD040657 and U01 HD043475-03S1).

Authors contribution

Cyril Engmann is the PI of the study and had significant intellectual input in the conception and design of this study, data acquisition and analyses, draft writing and the final approval of this study.

Ana Garces, Imtiaz Jehan, John Ditekemena, Mutinta Phiri, Manolo Mazariegos, Elwyn Chomba, Omrana Pasha, Antoinette Tsefu, Elizabeth McClure, Vanessa Thorsten and Hrishikesh Chakraborty had significant input in the design of this study, data acquisition and analyses, draft writing and the final approval of this study.

Robert Goldenberg, Carl Bose, Waldemar Carlo, Linda Wright had significant input in the conception and design of this study, data acquisition and analyses, draft writing and final approval of the study.

Author information

Authors and Affiliations

  1. Division of Neonatal-Perinatal Medicine, Department of Pediatric and Maternal Child Health, University of North Carolina Schools of Medicine and Public Health, Chapel Hill, NC, USA

    C Engmann & C Bose

  2. IMSALUD/San Carlos University, Guatemala City, Guatemala

    A Garces

  3. Department of Community Health Sciences, The Aga Khan University, Karachi, Karachi, Pakistan

    I Jehan & O Pasha

  4. Faculty of Medicine, Kinshasa School of Public Health, Kinshasa, Democratic Republic of Congo

    J Ditekemena & A Tshefu

  5. Department of Pediatrics and Child Health, University Teaching Hospital, Lusaka, Zambia

    M Phiri & E Chomba

  6. Institute of Nutrition for Central America and Panama (INCAP), Guatemala City, Guatemala

    M Mazariegos

  7. Research Triangle Institute, Durham, NC, USA

    E M McClure, V Thorsten & H Chakraborty

  8. College of Medicine, Drexel University, Philadelphia, PA, USA

    R L Goldenberg

  9. Department of Pediatrics, University of Alabama, Birmingham, AL, USA

    W A Carlo

  10. Eunice Kennedy Shriver National Institute of Child Health and Human Development, Bethesda, MD, USA

    L L Wright

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Correspondence to C Engmann.

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Engmann, C., Garces, A., Jehan, I. et al. Causes of community stillbirths and early neonatal deaths in low-income countries using verbal autopsy: an International, Multicenter Study. J Perinatol 32, 585–592 (2012). https://doi.org/10.1038/jp.2011.154

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  • DOI: https://doi.org/10.1038/jp.2011.154

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