title: Intrapartum-related stillbirths and neonatal deaths in rural bangladesh: a prospective, community-based cohort study.
abstract: OBJECTIVE
  Using a low-cost community surveillance system, we aimed to estimate intrapartum stillbirth and intrapartum-related neonatal death rates for a low-income community setting.
  
  
  METHODS
  From 2005 to 2008, information on all deliveries in 18 unions of 3 districts of Bangladesh was ascertained by using traditional birth attendants as key informants. Outcomes were measured using a structured interview with families 6 weeks after delivery.
  
  
  RESULTS
  We ascertained information on 31 967 deliveries, of which 26 173 (82%) occurred at home. For home deliveries, the mean cluster-adjusted stillbirth rate was 26 (95% confidence interval [CI[: 24-28) per 1000 births, and the perinatal mortality rate was 51 per 1000 births (95% CI: 47-55). The NMR was 33 per 1000 live births (95% CI: 30-37). There were 3186 (12.5%) home-born infants who did not breathe immediately. Of these, 53% underwent some form of resuscitation. Of 1435 infants who were in poor condition at 5 minutes (5% of all deliveries), 286 (20%) died; 35% of all causes of neonatal mortality. Of 201 fresh stillbirths, 40 (14%) of the infants had major congenital abnormalities. Our estimate of the intrapartum-related crude mortality rate among home-born infants is 17 in 1000 (95% CI: 16-19), 6 in 1000 stillborn and 11 in 1000 neonatal deaths after difficulties at birth.
  
  
  CONCLUSIONS
  Difficulty initiating respiration among infants born at home in rural Bangladesh is common, and resuscitation is frequently attempted. Newborns who remain in poor condition at 5 minutes have a 20% mortality rate. Evaluation of resuscitation methods, early intervention trials including antibiotic regimes, and follow-up studies of survivors of community-based resuscitation are needed.
authors.affiliation: Perinatal Care Project, Bangladesh Diabetic Samity, BIRDEM, 122 Kazi Nazrul Islam Ave, Shahbagh, Dhaka-1000, Bangladesh.
authors.forename: Matthew
authors.initials: M
authors.lastname: Ellis
authors.forename: Kishwar
authors.initials: K
authors.lastname: Azad
authors.forename: Biplob
authors.initials: B
authors.lastname: Banerjee
authors.forename: Sanjit Kumer
authors.initials: SK
authors.lastname: Shaha
authors.forename: Audrey
authors.initials: A
authors.lastname: Prost
authors.forename: Arati Roselyn
authors.initials: AR
authors.lastname: Rego
authors.forename: Shampa
authors.initials: S
authors.lastname: Barua
authors.forename: Anthony
authors.initials: A
authors.lastname: Costello
authors.forename: Sarah
authors.initials: S
authors.lastname: Barnett
mesh_terms: D001459:Bangladesh / Q000453:epidemiology; D002423:Cause of Death; D015331:Cohort Studies; D016001:Confidence Intervals; D003906:Developing Countries; D005260:Female; D005313:Fetal Death / Q000453:epidemiology*; D006700:Home Childbirth / Q000009:adverse effects / Q000401:mortality*; D006801:Humans; D015994:Incidence; D007226:Infant Mortality / Q000639:trends; D007231:Infant, Newborn; D008297:Male; D020380:Needs Assessment; D054238:Perinatal Mortality / Q000639:trends*; D011203:Poverty; D011247:Pregnancy; D011248:Pregnancy Complications / Q000175:diagnosis / Q000453:epidemiology; D011446:Prospective Studies; D018570:Risk Assessment; D050497:Stillbirth / Q000453:epidemiology*