Stillbirths and newborn deaths in slum settlements in Mumbai, India: a prospective verbal autopsy study
TLDR
Delays in receiving care after arrival at a health facility dominated and were mostly the result of referral from one institution to another, and most delays in seeking care were attributed to a failure to recognise symptoms of complications or their severity.Abstract:
Three million babies are stillborn each year and 3.6 million die in the first month of life. In India, early neonatal deaths make up four-fifths of neonatal deaths and infant mortality three-quarters of under-five mortality. Information is scarce on cause-specific perinatal and neonatal mortality in urban settings in low-income countries. We conducted verbal autopsies for stillbirths and neonatal deaths in Mumbai slum settlements. Our objectives were to classify deaths according to international cause-specific criteria and to identify major causes of delay in seeking and receiving health care for maternal and newborn health problems. Over two years, 2005–2007, births and newborn deaths in 48 slum areas were identified prospectively by local informants. Verbal autopsies were collected by trained field researchers, cause of death was classified by clinicians, and family narratives were analysed to investigate delays on the pathway to mortality. Of 105 stillbirths, 65 were fresh (62%) and obstetric complications dominated the cause classification. Of 116 neonatal deaths, 87 were early and the major causes were intrapartum-related (28%), prematurity (23%), and severe infection (22%). Bereavement was associated with socioeconomic quintile, previous stillbirth, and number of antenatal care visits. We identified 201 individual delays in 121/187 birth narratives (65%). Overall, delays in receiving care after arrival at a health facility dominated and were mostly the result of referral from one institution to another. Most delays in seeking care were attributed to a failure to recognise symptoms of complications or their severity. In Mumbai’s slum settlements, early neonatal deaths made up 75% of neonatal deaths and intrapartum-related complications were the greatest cause of mortality. Delays were identified in two-thirds of narratives, were predominantly related to the provision of care, and were often attributable to referrals between health providers. There is a need for clear protocols for care and transfer at each level of the health system, and an emphasis on rapid identification of problems and communication between health facilities. ISRCTN96256793read more
Citations
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Journal ArticleDOI
Stillbirths: rates, risk factors, and acceleration towards 2030
Joy E Lawn,Joy E Lawn,Hannah Blencowe,Hannah Blencowe,Peter Waiswa,Agbessi Amouzou,Colin Mathers,Daniel R Hogan,Vicki Flenady,J. Frederik Frøen,J. Frederik Frøen,Zeshan Qureshi,Claire Calderwood,Suhail Shiekh,Fiorella Bianchi Jassir,Danzhen You,Elizabeth M. McClure,Matthews Mathai,Simon Cousens +18 more
TL;DR: Improved care at birth is essential to prevent 1.3 million intrapartum stillbirths, end preventable maternal and neonatal deaths, and improve child development, and provide a way to target interventions to reach more than 7000 women every day worldwide who experience the reality of stillbirth.
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Causes of and factors associated with stillbirth in low- and middle-income countries: a systematic literature review.
TL;DR: It is necessary to understand causes and contributing factors to understand why stillbirths occur worldwide and in developing countries, and how to reduce the number of still births in these countries.
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When do newborns die? A systematic review of timing of overall and cause-specific neonatal deaths in developing countries.
Mari Jeeva Sankar,Chandra Kumar Natarajan,Rashmi Ranjan Das,Ramesh Agarwal,Aparna Chandrasekaran,Vinod K. Paul +5 more
TL;DR: The distribution of both overall and cause-specific mortality did not differ greatly between Asia and Africa, and the first week of life accounts for most of asphyxia-, prematurity- and malformation-related mortality and one-half of sepsis-related deaths.
Journal ArticleDOI
Making stillbirths visible: A systematic review of globally reported causes of stillbirth
Hanna E. Reinebrant,Susannah Hopkins Leisher,Michael Coory,Sarah Henry,Aleena M. Wojcieszek,Glenn Gardener,Rohan Lourie,Rohan Lourie,David Ellwood,Z. Teoh,Z. Teoh,Emma R. Allanson,Emma R. Allanson,Hannah Blencowe,Elizabeth S Draper,Jan Jaap H. M. Erwich,J. F. Froen,J. F. Froen,Jason Gardosi,Katherine J. Gold,Sanne J. Gordijn,Adrienne Gordon,Alexander E. P. Heazell,Alexander E. P. Heazell,T. Y. Khong,Fleurisca J. Korteweg,Joy E Lawn,Elizabeth M. McClure,Jeremy Oats,Robert Clive Pattinson,Karin Pettersson,Dimitrios Siassakos,Robert M. Silver,Gordon C. S. Smith,Ö Tunçalp,Vicki Flenady +35 more
TL;DR: The World Health Organization (WHO) application of the International Classification of Diseases for perinatal mortality (ICD‐PM) aims to improve data on stillbirth to enable prevention.
Journal ArticleDOI
Subnational mapping of under-5 and neonatal mortality trends in India: the Global Burden of Disease Study 2000–17
Rakhi Dandona,G Anil Kumar,Nathaniel J Henry,Vasna Joshua,Siddarth Ramji,Subodh S Gupta,Deepti Agrawal,Rashmi Kumar,Rakesh Lodha,Matthews Mathai,Nicholas J Kassebaum,Anamika Pandey,Haidong Wang,Anju Sinha,Rajkumar Hemalatha,Rizwan Suliankatchi Abdulkader,Vivek Agarwal,Sandra Albert,Atanu Biswas,Roy Burstein,Joy K Chakma,D J Christopher,Michael Collison,Aditya Prasad Dash,Sagnik Dey,Daniel Dicker,William M. Gardner,Scott D Glenn,Mahaveer Golechha,Yihua He,Suparna Ghosh Jerath,Rajni Kant,Anita Kar,Ajay Khera,Sanjay Kinra,Parvaiz A Koul,Varsha Krish,Rinu P Krishnankutty,Anura V Kurpad,Hmwe H Kyu,Avula Laxmaiah,Jagadish Mahanta,Padukudru Anand Mahesh,Ridhima Malhotra,Raja Sriswan Mamidi,Helena Manguerra,Joseph L. Mathew,Manu Raj Mathur,Ravi Mehrotra,Satinath Mukhopadhyay,Gudlavalleti V S Murthy,Parul Mutreja,Balakrishna Nagalla,Grant Nguyen,Anu Mary Oommen,Ashalata Pati,Sanghamitra Pati,Samantha Perkins,Sanjay Prakash,Manorama Purwar,Rajesh Sagar,Mari Jeeva Sankar,Deepika Saraf,D K Shukla,Sharvari Rahul Shukla,Narinder Pal Singh,Vishnubhatla Sreenivas,Babasaheb V. Tandale,Kavumpurathu Raman Thankappan,Manjari Tripathi,Suryakant Tripathi,Srikanth Tripathy,Christopher Troeger,Chris M Varghese,Santosh Varughese,Stefanie Watson,Geetika Yadav,Sanjay Zodpey,K. Srinath Reddy,G S Toteja,Mohsen Naghavi,Stephen S Lim,Theo Vos,Hendrik J Bekedam,Soumya Swaminathan,Christopher J L Murray,Simon I. Hay,R S Sharma,Lalit Dandona +88 more
TL;DR: A detailed analysis of subnational trends of child mortality to inform efforts aimed at meeting the India National Health Policy (NHP) and Sustainable Development Goal (SDG) targets for child mortality is presented.
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