Causes of Stillbirths and Early Neonatal Deaths: Data from 7993 Pregnancies in Six Developing countries/Causes De Mortinatalite et De Mortalite Neonatale Precoce: Donnees Portant Sur 7993 Grossesses Dans Six Pays En developpement/Causas De Mortinatalidad Y De Mortalidad Neonatal Precoz: Datos De 7993 Embarazos En Sels Paises En Desarrollo
Ngoc, Nhu Thi Nguyen, Merialdi, Mario, Abdel-Aleem, Hany, Carroli, Guillermo, Purwar, Manorama, Zavaleta, Nelly, Campodonico, Liana, Ali, Mohamed M., Hofmeyr, G. Justus, Mathai, Matthews, Lincetto, Ornella, Villar, Jose, Bulletin of the World Health Organization
A two-thirds reduction of mortality in children less than 5 years old by 2015 is one of the UN Millennium Development Goals. (1) Despite a decline in mortality in children in this age group in the last few decades, neonatal mortality numbers have not changed substantially. While infant mortality rates are expected to decrease as a result of the widespread implementation of effective interventions such as vaccines and oral rehydration therapy, the proportion of neonatal deaths is likely to increase. (2)
One of the most striking examples of inequity between countries is in the area of newborn health. Of the 4 million neonatal deaths that occur every year, 98% are in the poorest countries of the world. This figure seems even more catastrophic when seen in the light of the estimate that for every neonatal death there is one stillbirth. Perinatal deaths are responsible for about 7% of the total global burden of disease. (2) This percentage exceeds that caused by vaccine-preventable diseases and malaria together. The disparity between high-income and low-income countries in neonatal mortality is unacceptably large and continues to increase. (3)
Knowledge of the relative importance of the different causes of stillbirth and neonatal deaths in developing countries is still lacking. (2) Preterm birth, infection and birth asphyxia are thought to be the main causes of death in newborn babies worldwide. (4) However, Kulmala et al. (5) report that the importance of causes of death may vary according to whether the birth setting was a hospital or in the community) In hospital-based surveys, women who are at high risk of negative outcomes (e.g. referred cases) might be over-represented, while community based studies may be less reliable with respect to accurate diagnosis of the causes of deaths. Additionally, surveys--both hospital and community based--may not provide information on pregnancy complications or events prior to delivery that may have influenced the risk of death for the fetus or the newborn child. From an obstetric and neonatal care perspective, such information is crucial if the primary events that started the pathological process leading to the death of the fetus or the newborn child are to be understood. (6)
Here, we report primary obstetric causes of death and rates of early neonatal death (until 7 days postpartum) and stillbirth (fetal death after 28 weeks' gestation) in 7993 pregnancies of nulliparous women enrolled in a trial of calcium supplementation for the prevention of pre-eclampsia conducted in six developing countries. (7) Additionally, final neonatal causes of death are reported and we assess differences in mortality by centre and gestational age at delivery.
Between 2001 and 2004 WHO conducted a multicentre, randomized, placebo-controlled, double-blind trial of calcium supplementation for the prevention of pre-eclampsia in women with low calcium intake. (7) Seven centres in six countries participated in the trial: Rosario (Argentina), Assiut (Egypt), Nagpur and Vellore (India), Lima (Peru), East London (South Africa) and Ho Chi Minh City (Viet Nam).
Pregnant women receiving antenatal care between November 2001 and July 2003 at the participating centres were eligible for the trial if gestational age was less than 20 weeks, they were nulliparous and willing and able to give informed consent. Gestational age at trial entry was established with use of the "best obstetric estimate", including ultrasound examination (if required) by the attending obstetrician. Women were deemed ineligible if they had history of urolithiasis or symptoms suggestive of urolithiasis or any renal disease. Other exclusion criteria were: parathyroid disease; blood pressure [greater than or equal to] 140 mmHg systolic and/or [greater than or equal to] 90 mmHg diastolic; treatment with antihypertensives, diuretics, digoxin, phenytoin or tetracyclines; and a history of hypertension. …