Department of Paediatrics and Child Health, School of Medicine, College of Health Sciences, Makerere University, Kampala, Uganda.
PLoS One. 2011 May 9;6(5):e19674. doi: 10.1371/journal.pone.0019674.
To achieve a child mortality reduction according to millennium development goal 4, it is necessary to considerably reduce neonatal mortality. We report stillbirth and early neonatal mortality risks as well as determinants of perinatal mortality in Eastern Uganda.
A community-based prospective cohort study was conducted between 2006 and 2008. A total of 835 pregnant women were followed up for pregnancy outcome and survival of their children until 7 days after delivery. Mother's residence, age, parity, bed net use and whether delivery took place at home were included in multivariable regression analyses to identify risk factors for perinatal death.
The stillbirth risk was 19 per 1,000 pregnancies and the early neonatal death risk 22 per 1,000 live births. Overall, the perinatal mortality risk was 41 [95%CI: 27, 54] per 1,000 pregnancies. Of the deaths, 47% followed complicated deliveries and 24% preterm births. Perinatal mortality was 63/1,000 pregnancies among teenage mothers, 76/1,000 pregnancies among nulliparous women and 61/1,000 pregnancies among women delivering at home who, after controlling for potential confounders, had a 3.7 (95%CI: 1.8, 7.4) times higher perinatal mortality than women who gave birth in a health facility. This association was considerably stronger among nulliparous women [RR 8.0 (95%CI: 2.9, 21.6)] than among women with a previous live birth [RR 1.8 (95%CI: 0.7, 4.5)]. All perinatal deaths occurred among women who did not sleep under a mosquito net. Women living in urban slums had a higher risk of losing their babies than those in rural areas [RR: 2.7 (95%CI: 1.4, 5.3)].
Our findings strengthen arguments for ensuring that pregnant women have access to and use adequate delivery facilities and bed nets.
为了实现千年发展目标 4 规定的儿童死亡率降低目标，必须大幅降低新生儿死亡率。我们报告乌干达东部地区的死产和早期新生儿死亡率风险以及围产儿死亡的决定因素。
这是一项在 2006 年至 2008 年间进行的社区为基础的前瞻性队列研究。总共对 835 名孕妇进行了随访，以了解妊娠结局和其子女的存活情况，直至分娩后 7 天。多变量回归分析中包含了母亲的居住地、年龄、产次、蚊帐使用情况以及分娩是否在家中进行等因素，以确定围产儿死亡的危险因素。
死产风险为每 1000 例妊娠 19 例，早期新生儿死亡风险为每 1000 例活产 22 例。总的来说，围产儿死亡率为每 1000 例妊娠 41 例（95%CI：27，54）。在所有死亡病例中，47%是由于分娩过程复杂，24%是由于早产。在青少年母亲中，围产儿死亡率为 63/1000 例，在未产妇中为 76/1000 例，在在家中分娩的妇女中为 61/1000 例。这些妇女在控制了潜在混杂因素后，围产儿死亡率比在医疗机构分娩的妇女高 3.7 倍（95%CI：1.8，7.4）。在未产妇中，这种关联更为强烈[RR 8.0（95%CI：2.9，21.6）]，而在有活产史的妇女中，这种关联较弱[RR 1.8（95%CI：0.7，4.5）]。所有围产儿死亡均发生在未使用蚊帐的妇女中。与农村地区相比，居住在城市贫民窟的妇女失去婴儿的风险更高[RR：2.7（95%CI：1.4，5.3）]。
我们的研究结果进一步证明了确保孕妇获得和使用适当的分娩设施和蚊帐的重要性。
