Factors associated with perinatal deaths in women delivering in a

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Factors associated with perinatal
deaths in women delivering in a
health facility in Malawi
Lily C. Kumbani, Johanne Sundby
and Jon Øyvind Odland
Outline
• Introduction
• Study Purpose
• Methodology
• Results
• Implications
1
Introduction
• Newborn deaths
account for 40% of
under- five
mortality (MDG- 4).
• Reducing early
neonatal mortality
is necessary to
achieve MDG- 4.
2
Introduction ctd…
• Two-thirds of child deaths occur in the first
month of life. Of these, more than twothirds 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.
3
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.
4
Objectives
• To establish an
estimate of perinatal
mortality at Chiradzulu
District Hospital.
• To identify associated
risk factors, and to
determine causes of
perinatal deaths.
5
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.
6
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.
7
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
8
Results
No. of records - 606
n
Type of deliveries
SVD
C/S
VE/ Breech
Term Gestation
Skilled attendant
419
165
21
534
581
Percentage
69
27.2
3.5
89
95.9
9
Results- Mothers’ characteristics
n
Age group
14- 18
19- 35
36- 46
Parity
1
2- 4
≥5
Percentage
115
437
53
19
72.3
8.8
211
310
85
34.8
51.2
14
10
Results- Mothers’ characteristics ctd…
No. of antenatal visits
1
2
3-4
≥5
n
Percentage
34
119
389
58
5.7
19.8
64.8
9.7
11
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
5.9
12
Results - Frequency of perinatal
deaths ctd…
Perinatal mortality rate
Rate
59.9/ 1000 births
Still birth rate
36/ 1000 births
Early neonatal death
rate
24/1000 live births
13
Distribution of perinatal deaths
Perinatal deaths (N = 41)
Neonatal
death,
39%
Neonatal death outcomes
(N = 16)
Fresh
stillbirth;
44%
Died after
24 hours,
38%
Died
within 24
hours,
63%
Macerated
stillbirth;
17%
14
Causes of early neonatal deaths
Birth asphyxia
Severe prematurity (2830 weeks)
Severe prematurity &
sepsis
Percentage
75
12.5
12.5
15
Results- univariate analysis (Pregnancy)
Characteristic
Perinatal deaths
No
Yes
No. of antenatal n
visits
P-value †
%
n
%
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
<0.001
Maternal age, parity, HIV, syphilis, preeclampsia, anemia,
malaria and APH had no effect on perinatal deaths
(p >0.05).
16
Results- univariate analysis
(Labor/Delivery)
Characteristic
Gestation
≤31
32-36
≥37
Labor &Delivery
No
Perinatal deaths
No
Yes
n
10
%
53
140
93
405
95
complication
351
97
P-value †
n
9
%
47
11
21
7
5
<0.001
10
27
3
12
Yes
206
Preterm labour
No
165
88
90
19
10
Yes
69
5
31
11
<0.001
0.029
17
Results- univariate analysis
(Labor/Delivery) ctd…
Characteristic
Presentation
Cephalic
Perinatal deaths
No
Yes
n
533
%
94
Breech
23
79
Compound
4
67
Prolonged 2nd stage of labor
No
525
95
Yes
39
78
P-value †
n
33
%
6
6
2
21
33
<0.001
<0.001
30
11
5
22
18
Results- univariate analysis
(Labor/Delivery) ctd…
Characteristic
Delivery type
SVD
C/S
VE/Breech/
Breech extraction
Perinatal deaths
No
Yes
n
396
152
16
%
95
92
76
n
23
13
5
P-value †
%
5
7.8
24
0.012
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).
19
Results- univariate analysis (Postpartum)
Characteristic
P-value †
Perinatal deaths
No
Yes
Asphyxia
No
n
502
%
99
n
5
%
1
Yes
Apgar score
1-3
63
85
11
15
7
54
6
46
4-6
7-10
Preterm
No
60
498
91
99.2
6
4
9
0.8
Yes
<0.001
<0.001
<0.001
514
50
96
76
20
16
4
24
20
Results- univariate analysis (Postpartum)
ctd..
Characteristic
Birth weight
700g-1499g
1500g-2499g
≥2500g
Sepsis
No
Yes
Perinatal deaths
No
Yes
P-value †
n
%
n
%
7
93
463
39
91
96
11
9
20
61
9
4
<0.001
0.009
444
17
99.6
89.5
2
2
0.4
10.5
Meconium aspiration and hypothermia were not associated
with perinatal deaths (p >0.05).
21
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.
22
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.
23
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