Patel Kaajal, Say Sopheakneary, Leng Daly, Khut Sophanou, Duong Sothearith, Ly Chou, Riedel Arthur, Lo Koung, Carrara Verena, Turner Claudia
Saving Babies' Lives Programme, Angkor Hospital for Children, PO Box 50, Siem Reap, Cambodia.
Cambodia Oxford Medical Research Unit, Angkor Hospital for Children, PO Box 50, Siem Reap, Cambodia.
Lancet Reg Health West Pac. 2025 Jul 15;60:101626. doi: 10.1016/j.lanwpc.2025.101626. eCollection 2025 Jul.
Perinatal mortality remains a significant global health challenge, particularly in low- and middle-income countries (LMICs). Accurate cause-of-death data are essential to inform effective interventions but are often scarce. This study aimed to identify causes of stillbirths and neonatal deaths in rural Cambodia using verbal autopsy (VA) and the WHO International Classification of Diseases to Perinatal Mortality (ICD-PM).
A four-year prospective study (2018-2022) in Preah Vihear province, Cambodia, established a community health worker-based pregnancy surveillance system. Verbal autopsy was conducted on stillbirths and neonatal deaths, with dual physician analysis to interpret VA data. To classify causes of death, ICD-PM was applied with adaptations made for stillbirths with unknown timing of death.
A total of 522 deaths (229 stillbirths, 293 neonatal deaths) were recorded, and 79.1% (413) had a VA. Applying ICD-PM, primary causes of death were identified for 36.6% of stillbirths and 95.0% of neonatal deaths. The leading cause of death was hypoxia for intrapartum stillbirths (78.3%), low birth weight and prematurity for early neonatal deaths (40.9%), and infection for late neonatal deaths (51.4%). Complications during labour and delivery were the leading maternal contributing condition for intrapartum stillbirths (63.3%) and early neonatal deaths (42.4%). Unknown timing of death was assigned to 12.0% of stillbirths.
Application of ICD-PM with VA-derived data provides valuable insights into causes of stillbirths and neonatal deaths. However, adaptations are necessary to address ICD-PM's limitations, particularly to classify unknown timing of death. Our findings can contribute to global efforts to improve the reporting of perinatal mortality data.
This study is nested in the Saving Babies' Lives study, which was supported by funding from Angkor Hospital for Children, Civil Society in Development, Fu Tak Iam Foundation, Manan Trust, T&J Meyer Family Foundation, Vitol Foundation, IF Foundation, and Wellcome Trust [220211]. This research was funded in part by the Wellcome Trust [220211/Z/20/Z].
围产期死亡率仍然是一项重大的全球卫生挑战，在低收入和中等收入国家（LMICs）尤其如此。准确的死亡原因数据对于制定有效的干预措施至关重要，但往往十分匮乏。本研究旨在利用死因推断（VA）和世界卫生组织围产期死亡率国际疾病分类（ICD-PM）确定柬埔寨农村地区死产和新生儿死亡的原因。
在柬埔寨柏威夏省进行了一项为期四年的前瞻性研究（2018 - 2022年），建立了一个基于社区卫生工作者的妊娠监测系统。对死产和新生儿死亡进行死因推断，并由两名医生进行分析以解读VA数据。为了对死亡原因进行分类，应用了ICD-PM，并针对死亡时间不明的死产进行了调整。
共记录了522例死亡（229例死产，293例新生儿死亡），其中79.1%（413例）进行了死因推断。应用ICD-PM，确定了36.6%的死产和95.0%的新生儿死亡的主要死因。产时死产的主要死因是缺氧（78.3%），早期新生儿死亡的主要死因是低出生体重和早产（40.9%），晚期新生儿死亡的主要死因是感染（51.4%）。分娩期间的并发症是产时死产（63.3%）和早期新生儿死亡（42.4%）的主要母体相关情况。12.0%的死产被判定为死亡时间不明。
将ICD-PM应用于VA获得的数据，为死产和新生儿死亡的原因提供了有价值的见解。然而，有必要进行调整以解决ICD-PM的局限性，特别是对死亡时间不明的情况进行分类。我们的研究结果有助于全球改善围产期死亡率数据报告的工作。
本研究嵌套于“拯救婴儿生命”研究中，该研究得到了吴哥儿童医院、发展中的民间社会、傅德荫基金会、马南信托、T&J迈耶家族基金会、维多尔基金会、IF基金会和惠康信托基金[220211]的资助。本研究部分由惠康信托基金[220211/Z/20/Z]资助。
