Khanal S, Gc V S, Dawson P, Houston R
Morang Innovative Neonatal Intervention/John Snow Inc. Research and Training Institute, Kathmandu, Nepal.
JNMA J Nepal Med Assoc. 2011 Jan-Mar;51(181):21-7.
Clinical registration of the cause of death is available for less than one-third of the global newborn deaths, but the need for good quality data on causes of death for public health planning has renewed the interest in the Verbal Autopsy (VA). We aimed to determine the cause of neonatal deaths by VA in Morang district of Nepal.
Caretakers of the deceased were interviewed using a semi-structured VA questionnaire by female community health volunteers. The cause of death was assigned by two senior pediatricians independently and disagreements in ascertaining the proximate cause of death were resolved by consensus.
The proximate causes of deaths were infections (41%), birth asphyxia (37.2%), prematurity (11.5%), and low birth weight related causes (6.9%). There was no significant statistical difference in deaths due to infection seen in non-institutional deliveries (43.5%) than institutional deliveries (34.6%). More than half of the deaths (58.5%) occurred within the first three days of life where the predominant cause of death was birth asphyxia (60.7%).
Analysis of verbal autopsies demonstrates that the major causes of death still are infections and birth asphyxia. The timing of deaths suggests that neonatal interventions should be aimed at the first week of life. There is no comparative advantage between institutional deliveries at below district level institutions and non-institutional deliveries to prevent neonatal infection. Thus, further study on the quality of care at institutes below the district level should be conducted. Disparities still occur in deaths, with most deaths in Morang occurring in non-institutional deliveries and in disadvantaged groups.
全球新生儿死亡原因的临床登记数据不足三分之一，但公共卫生规划需要高质量的死亡原因数据，这重新引发了对死因推断（VA）的兴趣。我们旨在通过死因推断确定尼泊尔莫朗地区新生儿死亡的原因。
女性社区卫生志愿者使用半结构化的死因推断问卷对死者的看护人进行访谈。由两名资深儿科医生独立确定死亡原因，对于确定直接死因的分歧通过协商解决。
直接死因包括感染（41%）、出生窒息（37.2%）、早产（11.5%）和低出生体重相关原因（6.9%）。非机构分娩中因感染导致的死亡（43.5%）与机构分娩中因感染导致的死亡（34.6%）相比，无显著统计学差异。超过一半的死亡（58.5%）发生在出生后的头三天，其中主要死因是出生窒息（60.7%）。
死因推断分析表明，主要死亡原因仍然是感染和出生窒息。死亡时间表明，新生儿干预措施应针对出生后的第一周。在区级以下机构进行的机构分娩与非机构分娩在预防新生儿感染方面没有比较优势。因此，应进一步研究区级以下机构的护理质量。死亡情况仍然存在差异，莫朗地区的大多数死亡发生在非机构分娩和弱势群体中。
