title: Causes of stillbirth, neonatal death and early childhood death in rural Zambia by verbal autopsy assessments.
abstract: OBJECTIVE
  To describe specific causes of the high rates of stillbirth, neonatal death and early child childhood death in Zambia.
  
  
  METHODS
  We conducted a household-based survey in rural Zambia. Socio-demographic and delivery characteristics were recorded, alongside a maternal HIV test. Verbal autopsy questionnaires were administered to elicit mortality-related information and independently reviewed by three experienced paediatricians who assigned a cause and contributing factor to death. For this secondary analysis, deaths were categorized into: stillbirths (foetal death ≥28 weeks of gestation), neonatal deaths (≤28 days) and early childhood deaths (>28 days to <2 years).
  
  
  RESULTS
  Among 1679 households, information was collected on 148 deaths: 34% stillbirths, 26% neonatal and 40% early childhood deaths. Leading identifiable causes of stillbirth were intrauterine infection (26%) and birth asphyxia (18%). Of 32 neonatal deaths, 38 (84%) occurred within the first week of life, primarily because of infections (37%) and prematurity (34%). The majority of early childhood deaths were caused by suspected bacterial infections (82%). HIV prevalence was significantly higher in mothers who reported an early childhood death (44%) than mothers who did not (17%; P < 0.01). Factors significantly associated with mortality were lower socio-economic status (P < 0.01), inadequate water or sanitation facilities (P < 0.01), home delivery (P = 0.04) and absence of a trained delivery attendant (P < 0.01).
  
  
  CONCLUSIONS
  We provide community-level data about the causes of death among children under 2 years of age. Infectious etiologies for mortality ranked highest. At a public health level, such information may have an important role in guiding prevention and treatment strategies to address perinatal and early childhood mortality.
authors.affiliation: Centre for Infectious Disease Research in Zambia, Lusaka, Zambia.
authors.forename: Eleanor
authors.initials: E
authors.lastname: Turnbull
authors.forename: Mwila K
authors.initials: MK
authors.lastname: Lembalemba
authors.forename: M Brad
authors.initials: MB
authors.lastname: Guffey
authors.forename: Carolyn
authors.initials: C
authors.lastname: Bolton-Moore
authors.forename: Mwangelwa
authors.initials: M
authors.lastname: Mubiana-Mbewe
authors.forename: Namwinga
authors.initials: N
authors.lastname: Chintu
authors.forename: Mark J
authors.initials: MJ
authors.lastname: Giganti
authors.forename: Mutinta
authors.initials: M
authors.lastname: Nalubamba-Phiri
authors.forename: Elizabeth M
authors.initials: EM
authors.lastname: Stringer
authors.forename: Jeffrey S A
authors.initials: JS
authors.lastname: Stringer
authors.forename: Benjamin H
authors.initials: BH
authors.lastname: Chi
mesh_terms: D001344:Autopsy; D002423:Cause of Death; D005260:Female; D005313:Fetal Death / Q000453:epidemiology*; D006801:Humans; D007223:Infant; D007226:Infant Mortality / Q000639:trends*; D007231:Infant, Newborn; D007239:Infections / Q000401:mortality; D008297:Male; D012424:Rural Population / Q000706:statistics & numerical data*; D050497:Stillbirth / Q000453:epidemiology*; D011795:Surveys and Questionnaires; D015024:Zambia / Q000453:epidemiology