Each year, an estimated six million perinatal deaths occur worldwide,
and 98% of these deaths occur in low- and middle-income countries.
These estimates are based on surveys in both urban and rural areas, and
they may underrepresent the problem in rural areas. This study was
conducted to quantify perinatal mortality, to identify the associated
risk factors, and to determine the most common causes of early neonatal
death in a rural area of the Democratic Republic of the Congo (DRC).
Data were collected on 1,892 births. Risk factors associated with
perinatal deaths were identified using multivariate analysis with
logistic regression models. Causes of early neonatal deaths were
determined by physician-review of information describing death. The
perinatal mortality rate was 61 per 1,000 births; the stillbirth rate
was 30 per 1,000 births; and the early neonatal death rate was 32 per
1,000 livebirths. Clinically-relevant factors independently associated
with perinatal death included: low birthweight [odds ratio (OR)=13.51,
95% confidence interval (CI) 7.82-23.35], breech presentation
(OR)=12.41; 95% CI 4.62-33.33), lack of prenatal care (OR=2.70, 95% CI
1.81-4.02), and parity greater than 4 (OR=1.93 95% CI 1.11-3.37). Over
one-half of early neonatal deaths (n=37) occurred during the first two
postnatal days, and the most common causes were low
birthweight/prematurity (47%), asphyxia (34%), and infection (8%). The
high perinatal mortality rate in rural communities in the DRC,
approximately one-half of which is attributable to early neonatal
death, may be modifiable. Specifically, deaths due to breech
presentation, the second most common risk factor, may be reduced by
making available emergency obstetric care. Most neonatal deaths occur
soon after birth, and nearly three-quarters are caused by low
birthweight/prematurity or asphyxia. Neonatal mortality might be
reduced by targeting interventions to improve neonatal resuscitation
and care of larger preterm infants