Risk factors for neonatal mortality due to birth asphyxia in southern Nepal: A prospective, community-based cohort study

OBJECTIVE. Our goal was to identify antepartum, intrapartum, and infant risk factors for birth asphyxia mortality in a rural, low-resource, population-based cohort in southern Nepal. PATIENTS AND METHODS.Data were collected prospectively during a cluster-randomized, community-based trial evaluating the impact of newborn skin and umbilical cord cleansing on neonatal mortality and morbidity in Sarlahi, Nepal. A total of 23 662 newborn infants were enrolled between September 2002 and January 2006. Multi-variable regression modeling was performed to determine adjusted relative risk estimates of birth asphyxia mortality for antepartum, intrapartum, and infant risk factors. © 2008 by the American Academy of Pediatrics

Verbal autopsy methods to ascertain birth asphyxia deaths in a community-based setting in southern Nepal

OBJECTIVES. The goals of this study were to (1) develop an approach to ascertain birth asphyxia deaths by using verbal autopsy data from a community-based setting in Nepal, and (2) explore variations in birth asphyxia mortality fractions by using different birth asphyxia case definitions and hierarchical classifications. PATIENTS AND METHODS.Data were prospectively collected during a cluster-randomized, community-based trial of health interventions on neonatal mortality in Sarlahi, Nepal from 2002 to 2006. To assign cause of death, 4 computer-assigned, symptom-based asphyxia case definitions;Nepali physician classification;and our independent review of verbal autopsy open narratives were used. Various hierarchical classification approaches to assign cause of death were also explored. RESULTS.Birth asphyxia specific mortality ranged from 26% to 54%, depending on the computer case definition used. There was poor agreement between computer and physician classification of birth asphyxia. By comparing computer results, physician results, and our independent ascertainment of cause of death, we identified 246 cases of birth asphyxia (32% of neonatal deaths). Allowing for \u3e1 cause of death, 30% and 42% of asphyxia cases also met criteria for prematurity and serious infection,respectively. When a hierarchy was used to assign a single cause of death, the birth asphyxia proportionate mortality was reduced to 12% when identification of deaths because of congenital anomalies, prematurity, and serious infections preceded birth asphyxia. CONCLUSIONS. The use of various verbal autopsy definitions and hierarchical approaches to assign cause of death may substantially affect estimates of birth asphyxia-specific mortality and analyses of risk factors. Verbal autopsy methods need to be standardized and validated to generate accurate global estimates to direct policy and resource allocation in low-middl income countries. © 2008 by the American Academy of Pediatrics