Factors associated with perinatal deaths in women delivering in a health facility in Malawi
Lily C. Kumbani, Johanne Sundby and Jon Øyvind Odland
Introduction
• Newborn deaths account for 40% of under- five mortality (MDG- 4).
• Reducing early neonatal mortality is necessary to achieve MDG- 4.
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Introduction ctd…
• Two-thirds of child deaths occur in the first month of life. Of these, more than two-thirds die in their first week. Among those in the first week, two-thirds die in the first 24 hours of life.
• Unless neonatal mortality is greatly reduced it is not possible to achieve millennium development goal 4.
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Introduction ctd…
• In Malawi, an increase in perinatal mortality estimated at 40/1000 (MDHS 2010)
• Few studies done.
• These data are essential to effectively plan how to reduce perinatal mortality.
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Objectives
• To establish an estimate of perinatal mortality at Chiradzulu District Hospital.
• To identify associated risk factors, and to determine causes of perinatal deaths.
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Methodology
• Design: A cross sectional prospective review of records.
• Setting: Chiradzulu district hospital, labor ward and postnatal ward.
• Inclusion criteria: Records of mothers who received antenatal care at any health facility but delivered at the district hospital from 28 weeks to term.
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Methodology ctd…
Data collection: • A data record form: was used to collect
maternal and neonatal information
Data analysis• Stata version 11.0 was used• Univariate analysis was computed to
determine the association between outcome (perinatal death) and independent variables.
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Methodology ctd…
Ethical consideration:
• Study approval - Norway Regional Committee for Medical Research Ethics & College of Medicine Research and Ethics Committee, Malawi.
• Written permission from the District Health Officer - Chiradzulu District Hospital
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Results
No. of records - 606 n Percentage
Type of deliveries
SVD 419 69
C/S 165 27.2
VE/ Breech 21 3.5
Term Gestation 534 89
Skilled attendant 581 95.9
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Results- Mothers’ characteristics
n Percentage
Age group
14- 18 115 19
19- 35 437 72.3
36- 46 53 8.8
Parity
1 211 34.8
2- 4 310 51.2
≥ 5 85 1410
Results- Mothers’ characteristics ctd…
n Percentage
No. of antenatal visits
1 34 5.7
2 119 19.8
3-4 389 64.8
≥ 5 58 9.7
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Results - Frequency of perinatal deaths
n Percentage
Total Deliveries 685
Number of fresh still births
18 2.6
Number of macerated still births
7 1
Number of early neonatal deaths
16 2.4
Perinatal deaths 41 5.912
Results - Frequency of perinatal deaths ctd…
Rate
Perinatal mortality rate 59.9/ 1000 births
Still birth rate 36/ 1000 births
Early neonatal death rate
24/1000 live births
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Causes of early neonatal deaths
Percentage
Birth asphyxia 75
Severe prematurity (28- 30 weeks)
12.5
Severe prematurity & sepsis
12.5
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Results- univariate analysis (Pregnancy)
Characteristic Perinatal deaths No Yes
P-value †
No. of antenatal visits
n % n % <0.001
1 24 70.6 10 29.4
2 110 92 9 8
3 197 97 6 3
4 177 95 9 5
≥5 51 88 7 12
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Maternal age, parity, HIV, syphilis, preeclampsia, anemia, malaria and APH had no effect on perinatal deaths (p >0.05).
Results- univariate analysis (Labor/Delivery)
Characteristic Perinatal deaths No Yes
P-value †
Gestation n % n % <0.001 ≤31 10 53 9 4732-36 140 93 11 7≥37 405 95 21 5Labor &Delivery complication <0.001 No 351 97 10 3Yes 206 88 27 12Preterm labour 0.029No 165 90 19 10Yes 11 69 5 31 17
Results- univariate analysis (Labor/Delivery) ctd…
Characteristic Perinatal deaths No Yes
P-value †
Presentation n % n % <0.001 Cephalic 533 94 33 6Breech 23 79 6 21Compound 4 67 2 33Prolonged 2nd stage of labor <0.001 No 525 95 30 5Yes 39 78 11 22
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Results- univariate analysis (Labor/Delivery) ctd…
Characteristic Perinatal deaths No Yes
P-value †
Delivery type n % n % 0.012SVD 396 95 23 5C/S 152 92 13 7.8VE/Breech/ Breech extraction
16 76 5 24
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Anemia, obstetric complications (preeclampsia, eclampsia, rupture of membranes > 24 hours, fetal distress, CPD, obstructed labor), and skilled attendant were not associated with perinatal deaths (p >0.05).
Results- univariate analysis (Postpartum)
Characteristic Perinatal deaths No Yes
P-value †
Asphyxia n % n % <0.001No 502 99 5 1Yes 63 85 11 15Apgar score <0.0011-3 7 54 6 464-6 60 91 6 97-10 498 99.2 4 0.8Preterm <0.001No 514 96 20 4Yes 50 76 16 24 20
Results- univariate analysis (Postpartum) ctd.. Characteristic Perinatal deaths
No Yes
P-value †
Birth weight n % n % <0.001
700g-1499g 7 39 11 611500g-2499g 93 91 9 9≥2500g 463 96 20 4Sepsis 0.009No 444 99.6 2 0.4Yes 17 89.5 2 10.5
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Meconium aspiration and hypothermia were not associated with perinatal deaths (p >0.05).
Implications• Reinforce and improve health workers’ abilities
to properly monitor women in labor at all levels of care for early identification and management of complications.
• Encourage women to start antenatal care early for them to adhere to the four recommended antenatal visits.
• Improve health workers ability in basic resuscitation, as well as care of low birth weight babies.
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Implications ctd…
• Referral of women with very preterm labor (28 to 32 weeks) to deliver in a facility with neonatal intensive care.
• Pregnant women and communities should have sufficient information on obstetric complications to seek health care in time.
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