title: Causes of community stillbirths and early neonatal deaths in low-income countries using verbal autopsy: an International, Multicenter Study.
abstract: OBJECTIVE
  Six million stillbirths (SB) and early neonatal deaths (END) occur annually worldwide, mostly in rural settings distant from health facilities. We used verbal autopsy (VA), to understand causes of non-hospital, community-based SB and END from four low-income countries.
  
  
  METHODS
  This prospective observational study utilized the train-the-trainer method. VA interviewers conducted standardized interviews; in each country data were reviewed by two local physicians who assigned an underlying causes of deaths (COD).
  
  
  RESULTS
  There were 252 perinatal deaths (118 END; 134 SB) studied from pooled data. Almost half (45%) the END occurred on postnatal day 1, 19% on the second day and 16% the third day. Major early neonatal COD were infections (49%), birth asphyxia (26%), prematurity (17%) and congenital malformations (3%). Major causes of SB were infection (37%), prolonged labor (11%), antepartum hemorrhage (10%), preterm delivery (7%), cord complications (6%) and accidents (5%).
  
  
  CONCLUSIONS
  Many of these SB and END were from easily preventable causes. Over 80% of END occurred during the first 3 days of postnatal life, and >90% were due to infection, birth asphyxia and prematurity. The causes of SB were more varied, and maternal infections were the most common cause. Increased attention should be targeting at interventions that reduce maternal and neonatal infections and prevent END, particularly during the first 3 days of life.
authors.affiliation: Division of Neonatal-Perinatal Medicine, Department of Pediatric and Maternal Child Health, University of North Carolina Schools of Medicine and Public Health, Chapel Hill, NC 27599-7596, USA. cengmann@med.unc.edu
authors.forename: C
authors.initials: C
authors.lastname: Engmann
authors.forename: A
authors.initials: A
authors.lastname: Garces
authors.forename: I
authors.initials: I
authors.lastname: Jehan
authors.forename: J
authors.initials: J
authors.lastname: Ditekemena
authors.forename: M
authors.initials: M
authors.lastname: Phiri
authors.forename: M
authors.initials: M
authors.lastname: Mazariegos
authors.forename: E
authors.initials: E
authors.lastname: Chomba
authors.forename: O
authors.initials: O
authors.lastname: Pasha
authors.forename: A
authors.initials: A
authors.lastname: Tshefu
authors.forename: E M
authors.initials: EM
authors.lastname: McClure
authors.forename: V
authors.initials: V
authors.lastname: Thorsten
authors.forename: H
authors.initials: H
authors.lastname: Chakraborty
authors.forename: R L
authors.initials: RL
authors.lastname: Goldenberg
authors.forename: C
authors.initials: C
authors.lastname: Bose
authors.forename: W A
authors.initials: WA
authors.lastname: Carlo
authors.forename: L L
authors.initials: LL
authors.lastname: Wright
mesh_terms: D001344:Autopsy; D002423:Cause of Death; D003906:Developing Countries; D005260:Female; D006801:Humans; D007226:Infant Mortality; D007231:Infant, Newborn; D054238:Perinatal Mortality; D011203:Poverty / Q000706:statistics & numerical data*; D011247:Pregnancy; D011248:Pregnancy Complications; D011446:Prospective Studies; D012307:Risk Factors; D012959:Socioeconomic Factors; D050497:Stillbirth / Q000453:epidemiology
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