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Brief Reports Indian Pediatrics 2001; 38: 1022-1025 |
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Verbal Autopsy Determined Causes of Neonatal Deaths |
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S.P. Shrivastava, Anjani Kumar, Arvind Kumar Ojha,
Neonatal mortality now accounts for about 60% of the total infant mortality. In Bihar, the neonatal mortality was 43.9 in 1993 accounting for 63% of the total infant mortality. In order to lower infant mortality, the focus should increasingly shift on neonatal deaths. It is, therefore, important to determine the causes of neonatal deaths. The exact cause of death can be known by postmortem autopsy. However, this is not feasible on a large scale, particularly in developing countries like India. In this difficult situation, a post death analysis by verbal autopsy is used as a proxy to determine the possible causes of death. Verbal autopsy consists of an interview directed to a care giver (usually the mother) close to the deceased subject and then the information about the cause of death is obtained. Verbal autopsy term was first used in 1931 but it was not until nineties that the technique has been more widely used(1-6). The present study was conducted to determine the causes of neonatal deaths utilizing this technique since there is paucity of such information from Bihar. Subjects and Methods The present study was undertaken on 1000 deaths which had occurred in and around Patna, within the first days of life in a span of two years (between 1994 to 1996). The neonatal deaths were randomly selected. Samples were selected from both urban and rural areas from different strata of society. Counsellors and Mukhiyas were contacted to obtain information and help about finding the neonatal deaths in their areas. A questionnaire was prepared with prestructured schedule and open ended questions. A single printed questionnaire was given to the care giver (usually the mother) of the child. The questions were explained by the interviewer to the care giver in Hindi, English and local languages. Sufficient time was given to recall the events during illness. It usually took 60 minutes for the completion of an interview. Care was especially taken for the interval between interview and the time since death of the child. At least 15 days were allowed to pass before the care giver was interviewed, so that they could be psycho-logically reconciled and the period was not too long to influence recall. The maximum time interval allowed was 24 months from the time of death. Interviews were conducted by boys and girls who had completed their education at least upto matriculation and were fully familiar with the local language spoken in that area. The questionnaire was the main source of data in the present study. Diagnosis was made on the basis of the answer given by the care giver to the questions asked in the questionnaire. Table I - Causes of Neonatal Mortality
Results Prematurity including low birth weight was the most important cause of neonatal deaths (25:4%; Table I). Other important causes of neonatal deaths were birth injury/asphyxia and neonatal sepsis. Deaths due to prematurity, congenital malformation, respiratory distress syndrome, neonatal pneumonia, post natal aspiration were more common during first seven days of life. Deaths due to birth injury/asphyxia, neonatal sepsis, neonatal tetanus and sudden deaths were more common during 8-28 days of life. Deaths due to diarrhea, dysentery and sudden death were recorded only in the late neonatal period. Discussion In the present study 1000 verbal autopsis were performed in and around Patna to evaluate the causes of neonatal death. This study re-affirmed the important causes/asso-ciates of neonatal deaths, namely, prematurity, low birth weight, birth asphyxia and neonatal sepsis. Similar observations have been made in earlier studies(3,6). Many of the documented causes are presentable. The ongoing and future programs for alleviating neonatal mortality should direct attention to these causes for the maximal benefit. Most of the neonatal deaths due to prematurity, neonatal pneumonia, respiratory distress syndrome and congenital malforma-tion were recorded during the first seven days of life whereas deaths due to diarrhea including dysentery and sudden deaths were recorded over the next three weeks of life. Deaths due to birth injury/asphyxia and sepsis were common during 2nd and 4th weeks of neonatal life. Singhal et al.(5) also reported that 42% of total neonatal deaths occurred during the first seven days of life. Thus, it appears that verbal autopsy could be one of the possible tools for determining the causes of neonatal deaths in our situation. Contributors: SPS conceived the idea, designed the study and drafted the manuscript; he will act as the guarantor for the paper. AK and AKO were involved in data collection and drafting of the manuscript. Funding: None.
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