Academic journal article Bulletin of the World Health Organization

Rates, Timing and Causes of Neonatal Deaths in Rural India: Implications for Neonatal Health programmes/Taux, Repartition Dans le Temps et Causes Des Deces Neonataux Dans l'Inde Rurale: Implications Pour Les Programmes De Sante neonatale/Tasas, Momento Y Causas De la Mortalidad Neonatal En la India Rural: Implicaciones Para Los Programas De Salud Neonatal

Academic journal article Bulletin of the World Health Organization

Rates, Timing and Causes of Neonatal Deaths in Rural India: Implications for Neonatal Health programmes/Taux, Repartition Dans le Temps et Causes Des Deces Neonataux Dans l'Inde Rurale: Implications Pour Les Programmes De Sante neonatale/Tasas, Momento Y Causas De la Mortalidad Neonatal En la India Rural: Implicaciones Para Los Programas De Salud Neonatal

Article excerpt

Introduction

Every year, there are an estimated 4 million neonatal deaths, accounting for almost 40% of deaths in children younger than 5 years. (l,2) About a quarter of global neonatal deaths occur in India, which has a neonatal mortality of 43 per 1000 live births. (1,3) Therefore, interventions to address neonatal mortality are crucial if child mortality is to be reduced globally and in India. (2,4-6)

Globally, the main causes of neonatal deaths are thought to be preterm birth (28%), sepsis or pneumonia (26%), and birth asphyxia (23%). (1,2) In the South-East Asia Region, WHO has attributed 30% of neonatal deaths to preterm birth, 27% to sepsis or pneumonia, 23% to birth asphyxia, 6% to congenital abnormalities, 4% to tetanus, 3% to diarrhoea and 7% to other causes. (7) However, most stillbirths or neonatal deaths occur at home and vital registration systems are incomplete, (3,4,8) and as such current estimates have been generated from a limited set of data. (2,9,10)

Verbal autopsies, which are interviews with caregivers, (11,12) have been used to establish causes of neonatal deaths. (8,13-21) Data on timing and causes of neonatal deaths are very important for the design of interventions to reduce mortality, yet only one study with a small sample size (n = 40) has previously described causes of neonatal deaths by day. (13)

Here, we describe the rates, causes and timing of 1048 neonatal deaths and stillbirths in a rural population in Uttar Pradesh, India, where the neonatal mortality rate has been estimated at 57 deaths per 1000 live births. (3) The findings of this study have important implications for community-based research and programmes to improve maternal and neonatal health and survival not only in rural north India, but also in other similar developing world settings.

Methods

Sample group

Data were collected to establish baseline rates and causes of neonatal mortality. Then, we randomly selected 17 rural sectors in two districts of Uttar Pradesh, Barabanki and Unnao.

We obtained informed consent from all participants. Institutional review boards of the Johns Hopkins Bloomberg School of Public Health, Baltimore MD, USA, and King George Medical University, India, reviewed the study protocol and study conduct for ethical considerations.

Verbal autopsy

The verbal autopsy questionnaire was adapted by an expert panel (see Acknowledgements) from the instrument used in a WHO three-country verbal autopsy validation study, (22) with added questions about pregnancy, childbirth, common causes of death in newborn babies, and a new module to distinguish between stillbirths and early neonatal deaths. The instrument was further adapted to the local context and culture. The verbal autopsy started with open-ended questions to elicit a narrative about the neonate's death, followed by close-ended questions. The instrument was translated from English into Hindi, and local terms for specific illnesses were used when appropriate.

Data collection

All data collectors received 2 weeks of training that included classroom lectures, field practice sessions, and observations at a children's hospital. Whenever possible, efforts were made to interview the mother. If the mother was absent, an adult relative who had the closest contact with the child during the terminal illness was the primary respondent. Data collectors conducted the interviews in Hindi using local vocabulary and the surveys lasted for about an hour.

All questionnaires and data forms were reviewed by the research team for accuracy, consistency and completeness, and if necessary, data collectors made additional field visits to clarify data entries. One week after data collection, quality control teams randomly selected and re-interviewed 5% of the sample. These data were compared with the original interview data to check for consistency. After editing, the data were entered in databases designed with use of Visual FoxPro (Microsoft, Redmond, Washington, USA). …

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