Trajectory of cause of death among brought dead neonates in tertiary care public facilities of Pakistan: A multicenter study
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Considering the fact that Pakistan is amongst the countries with very high neonatal mortality rates, we conducted a research study to determine the possible causes and characteristics of neonates presenting dead to the emergency department of tertiary public health care facilities of Pakistan using verbal autopsies.
A descriptive case series study was conducted in emergency department/pediatrics ward/neonatal ward/nursery unit of ten tertiary care public health facilities, situated in seven major cities of Pakistan from November, 2011 to June, 2013. Precoded verbal autopsy proforma was used to collect information regarding cause of death, family narratives and other associated risks accountable for pathway to mortality.
We identified 431 neonates presenting dead to the emergency department (238 males and 193 females). Sepsis (26.7%), birth asphyxia (18.8%) and persistent pulmonary arrest (17.2%) were main primary causes of brought death. Around 72% brought dead neonates were referred from doctors/health care facilities and more than 28% caregivers mentioned that they were not informed about the diagnosis/ailment of their deceased newborn.
Findings of our study suggest that infectious disease remains the main primary cause of neonatal mortality. Underweight in newborns (64%) was estimated as a leading associated risk. Delays in referrals to respective health care facility enlightened the concern of sub-standard prerequisites of neonatal care that could be one of the major contributing risk factor of high mortality rates.
Key wordsautopsy child health services early childhood emergency department use neonatal mortality
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All the authors are thankful to PMRC for providing funds. The project was Conducted under PMRC grant no.4-17-1/09/RDC/Multicenter/Verbal Autopsy/NICH.
- 4.College of Physicians and Surgeons, Pakistan. CPSP Reproductive health, a manual for physician. Karachi: CPSP, 2002.Google Scholar
- 5.World Health Organization. Health action in crises: Pakistan, The present context. 2008. http://www.who.int/hac/crises/pak/Pakistan_Aug08.pdf (accessed December 30, 2014).Google Scholar
- 6.Mahmood A, Sultan M. Child Health. Pakistan Demographic and Health Survey 2006-07. Islamabad, Pakistan: National Institute of Population Studies and Macro International Inc., 2008: 123–145.Google Scholar
- 7.Bhutta ZA, Hyder AA, Ali N. Defining a new challenge for health systems: Perinatal health in Pakistan. In: Bhutta ZA, eds. Perinatal and newborn care in South Asia: Priorities and action. Pakistan: Oxford University Press, 2007: 1–30.Google Scholar
- 10.Save the Children USA. Saving Newborns Lives Initiative. State of the World’s Newborns. Save the Children USA: Washington, DC, 2001.Google Scholar
- 13.World Health Organization. World population data sheet. 2004. http://www.prb.org/pdf04/04worlddatasheet_eng.pdf (Accessed September 23, 2014).Google Scholar
- 14.Black RE, Coldham C, Kalter H, Quigley MA, Ross D, Snow RW. A standard verbal autopsy method for investigating causes of death in infants and children. Geneva: World Health Organization, 1999.Google Scholar
- 16.World Health Organization. Technical consultation on verbal autopsy tools. Geneva: World Health Organization, 2005.Google Scholar
- 19.Bhutta ZA. Epidemiology of neonatal sepsis in Pakistan: an analysis of available evidence and implications for care. J Coll Physicians Surg Pak 1996;6:12–17.Google Scholar
- 23.UNDP. Infants with low birth weight. http://hdrstats.undp.org/indicators/67.html (accessed December 17, 2014).Google Scholar
- 25.Naheed I, Yasin A. Determinants of low birth weight babies (A prospective study of associated factors and outcome). Ann King Edward Med Coll 2000;6:361.Google Scholar