A Tshefu

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

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.

Using verbal autopsy to ascertain perinatal cause of death: Are trained non-physicians adequate?

Objectivesu2002 To develop a standardized verbal autopsy (VA) training program and evaluate whether its implementation resulted in comparable knowledge required to classify perinatal cause of death (COD) by physicians and non‐physicians.

Birth attendants as perinatal verbal autopsy respondents in low-and middle-income countries: a viable alternative?

OBJECTIVEnTo assess the feasibility of using birth attendants instead of bereaved mothers as perinatal verbal autopsy respondents.nnnMETHODSnVerbal autopsy interviews for early neonatal deaths and stillbirths were conducted separately among mothers (reference standard) and birth attendants in 38 communities in four developing countries. Concordance between maternal and attendant responses was calculated for all questions, for categories of questions and for individual questions. The sensitivity and specificity of individual questions with the birth attendant as respondent were assessed.nnnFINDINGSnFor early neonatal deaths, concordance across all questions was 94%. Concordance was at least 95% for more than half the questions on maternal medical history, birth attendance and neonate characteristics. Concordance on any given question was never less than 80%. Sensitivity and specificity varied across individual questions, more than 80% of which had a sensitivity of at least 80% and a specificity of at least 90%. For stillbirths, concordance across all questions was 93%. Concordance was 95% or greater more than half the time for questions on birth attendance, site of delivery and stillborn characteristics. Sensitivity and specificity varied across individual questions. Over 60% of the questions had a sensitivity of at least 80% and over 80% of them had a specificity of at least 90%. Overall, the causes of death established through verbal autopsy were similar, regardless of respondent.nnnCONCLUSIONnBirth attendants can substitute for bereaved mothers as verbal autopsy respondents. The questions in existing harmonized verbal autopsy questionnaires need further refinement, as their sensitivity and specificity differ widely.

Global Network for Women's and Children's Health Research: probable causes of stillbirth in low‐ and middle‐income countries using a prospectively defined classification system

We sought to classify causes of stillbirth for six low‐middle‐income countries using a prospectively defined algorithm.

A prospective cause of death classification system for maternal deaths in low and middle-income countries: Results from the Global Network Maternal Newborn Health Registry

To describe the causes of maternal death in a population‐based cohort in six low‐ and middle‐income countries using a standardised, hierarchical, algorithmic cause of death (COD) methodology.

Effects of essential newborn care training on fresh stillbirths and early neonatal deaths by maternal education.

Background: Infants of women with lower education levels are at higher risk for perinatal mortality. Objectives: We explored the impact of training birth attendants and pregnant women in the Essential Newborn Care (ENC) Program on fresh stillbirths (FSBs) and early (7-day) neonatal deaths (END) by maternal education level in developing countries. Methods: A train-the-trainer model was used with local instructors in rural communities in six countries (Argentina, Democratic Republic of the Congo, Guatemala, India, Pakistan, and Zambia). Data were collected using a pre-/post-active baseline controlled study design. Results: A total of 57,643 infants/mothers were enrolled. The follow-up rate at 7 days of age was 99.2%. The risk for FSB and END was higher for mothers with 0-7 years of education than for those with ≥8 years of education during both the pre- and post-ENC periods in unadjusted models and in models adjusted for confounding. The effect of ENC differed as a function of maternal education for FSB (interaction p = 0.041) without evidence that the effect of ENC differed as a function of maternal education for END. The model-based estimate of FSB risk was reduced among mothers with 0-7 years of education (19.7/1,000 live births pre-ENC, CI: 16.3, 23.0 vs. 12.2/1,000 live births post-ENC, CI: 16.3, 23.0, p < 0.001), but was not significantly different for mothers with ≥8 years of education, respectively. Conclusion: A low level of maternal education was associated with higher risk for FSB and END. ENC training was more effective in reducing FSB among mothers with low education levels.

Preconception maternal nutrition: A multi-site randomized controlled trial

This chapter of the Yearbook on Nutrition and Growth reviews important articles published between July 2012 and July 2013 concerning the impact of maternal nutrition during pregnancy on intrauterine fetal growth. Along with human studies, several animal studies dealing with the effect of nutrition on the placenta are also included since this field is not sufficiently studied in humans. Finally, we included future studies that hopefully will help in understanding the goals and interventional options for healthier offspring.