Manandhar S R, Ojha A, Manandhar D S, Shrestha B, Shrestha D, Saville N, Costello A M, Osrin D
Department of Paediatrics, Kathmandu Medical College, Sinamangal, Nepal.
Kathmandu Univ Med J (KUMJ). 2010 Jan-Mar;8(29):62-72. doi: 10.3126/kumj.v8i1.3224.
Perinatal (stillbirths and first week neonatal deaths) and neonatal (deaths in the first 4 weeks) mortality rates remain high in developing countries like Nepal. As most births and deaths occur in the community, an option to ascertain causes of death is to conduct verbal autopsy.
The objective of this study was to classify and review the causes of stillbirths and neonatal deaths in Dhanusha district, Nepal.
Births and neonatal deaths were identified prospectively in 60 village development committees of Dhanusha district. Families were interviewed at six weeks after delivery, using a structured questionnaire. Cause of death was assigned independently by two pediatricians according to a predefined algorithm; disagreement was resolved in discussion with a consultant neonatologist.
There were 25,982 deliveries in the 2 years from September 2006 to August 2008. Verbal autopsies were available for 601/813 stillbirths and 671/954 neonatal deaths. The perinatal mortality rate was 60 per 1000 births and the neonatal mortality rate 38 per 1000 live births. 84% of stillbirths were fresh and obstetric complications were the leading cause (67%). The three leading causes of neonatal death were birth asphyxia (37%), severe infection (30%) and prematurity or low birth weight (15%). Most infants were delivered at home (65%), 28% by relatives. Half of women received an injection (presumably an oxytocic) during home delivery to augment labour. Description of symptoms commensurate with birth asphyxia was commoner in the group of infants who died (41%) than in the surviving group (14%).
The current high rates of stillbirth and neonatal death in Dhanusha suggest that the quality of care provided during pregnancy and delivery remains sub-optimal. The high rates of stillbirth and asphyxial mortality imply that, while efforts to improve hygiene need to continue, intrapartum care is a priority. A second area for consideration is the need to reduce the uncontrolled use of oxytocic for augmentation of labour.
在尼泊尔这样的发展中国家，围产期（死产和出生后第一周新生儿死亡）及新生儿（出生后前4周死亡）死亡率仍然很高。由于大多数出生和死亡发生在社区，一种确定死亡原因的方法是进行口头尸检。
本研究的目的是对尼泊尔达努沙区的死产和新生儿死亡原因进行分类和回顾。
在达努沙区的60个乡村发展委员会中前瞻性地确定出生和新生儿死亡情况。在分娩后六周使用结构化问卷对家庭进行访谈。由两名儿科医生根据预定义算法独立确定死亡原因；如有分歧，则与新生儿科顾问医生讨论解决。
在2006年9月至2008年8月的两年间，共有25982例分娩。601/813例死产和671/954例新生儿死亡有口头尸检报告。围产期死亡率为每1000例出生60例，新生儿死亡率为每1000例活产38例。84%的死产为新鲜死产，产科并发症是主要原因（67%）。新生儿死亡的三大主要原因是出生窒息（37%）、严重感染（30%）和早产或低出生体重（15%）。大多数婴儿在家中分娩（65%），28%由亲属接生。一半的妇女在家庭分娩期间接受了注射（可能是催产素）以加强宫缩。与出生窒息相符的症状描述在死亡婴儿组（41%）中比在存活婴儿组（14%）中更为常见。
达努沙区目前较高的死产和新生儿死亡率表明，孕期和分娩期间提供的护理质量仍未达到最佳水平。高死产率和窒息死亡率意味着，在继续努力改善卫生状况的同时，产时护理是当务之急。另一个需要考虑的方面是减少催产素在加强宫缩方面的无节制使用。
