Causes of stillbirth, neonatal death and early childhood death in rural Zambia by verbal autopsy assessments

Abstract

Summary OBJECTIVES To describe specific causes of the high rates of stillbirth, neonatal death and early child childhood death in Zambia. METHODS We conducted a household-based survey in rural Zambia. Socio-demographic and delivery characteristics were recorded, alongside a maternal HIV test. Verbal autopsy questionnaires were administered to elicit mortality-related information and independently reviewed by three experienced paediatricians who assigned a cause and contributing factor to death. For this secondary analysis, deaths were categorized into: stillbirths (foetal death ≥28 weeks of gestation), neonatal deaths (≤28 days) and early childhood deaths (>28 days to <2 years). RESULTS Among 1679 households, information was collected on 148 deaths: 34% stillbirths, 26% neonatal and 40% early childhood deaths. Leading identifiable causes of stillbirth were intrauterine infection (26%) and birth asphyxia (18%). Of 32 neonatal deaths, 38 (84%) occurred within the first week of life, primarily because of infections (37%) and prematurity (34%). The majority of early childhood deaths were caused by suspected bacterial infections (82%). HIV prevalence was significantly higher in mothers who reported an early childhood death (44%) than mothers who did not (17%; P < 0.01). Factors significantly associated with mortality were lower socio-economic status (P < 0.01), inadequate water or sanitation facilities (P < 0.01), home delivery (P = 0.04) and absence of a trained delivery attendant (P < 0.01). CONCLUSION We provide community-level data about the causes of death among children under 2 years of age. Infectious etiologies for mortality ranked highest. At a public health level, such information may have an important role in guiding prevention and treatment strategies to address perinatal and early childhood mortality.

Risk of stillbirth among Zambian women with a prior cesarean delivery

“…20,21 By contrast, 63% of all stillbirths in our cohort likely occurred during labor or near the time of delivery. This estimate is similar to that from a recent study from rural Zambia, which showed a rate of 72% of non-macerated stillbirths, 22 and a multi-country study from the Global Network, which reported that 67% of all stillbirths in Zambia were non-macerated, suggesting an intrapartum stillbirth. 20 In our cohort of women with a prior CD, intrapartum stillbirths were more likely to occur than antepartum stillbirths.…”

Verbal Autopsy of Stillbirths and Neonatal Deaths in a Rural Area of Burkina Faso

“…This study has identified preterm birth (19.4%) as the second cause of neonatal death. Sombie [18] in the West of Burkina Faso, Edmond et al [13] in Ghana, and Turnbull et al [12] in Zambia had made the same observation, with the respective preterm death rates of 15%, 19.7%, and 34%. Poverty, hardship of field work and chores, the long walks on foot to look for firewood and water are situations experienced daily by women in the area of this study, which encourage preterm deliveries.…”

Causes of and factors associated with stillbirth in low‐ and middle‐income countries: a systematic literature review

“…The percentage attribution ranged from 8 to 50% of stillbirths. Maternal conditions as causes of stillbirth such as diabetes, HIV, syphilis and hypertensive disorders were the most commonly reported …”