title: Cause-specific neonatal mortality: analysis of 3772 neonatal deaths in Nepal, Bangladesh, Malawi and India.
abstract: OBJECTIVE
  Understanding the causes of death is key to tackling the burden of three million annual neonatal deaths. Resource-poor settings lack effective vital registration systems for births, deaths and causes of death. We set out to describe cause-specific neonatal mortality in rural areas of Malawi, Bangladesh, Nepal and rural and urban India using verbal autopsy (VA) data.
  
  
  METHODS
  We prospectively recorded births, neonatal deaths and stillbirths in seven population surveillance sites. VAs were carried out to ascertain cause of death. We applied descriptive epidemiological techniques and the InterVA method to characterise the burden, timing and causes of neonatal mortality at each site.
  
  
  RESULTS
  Analysis included 3772 neonatal deaths and 3256 stillbirths. Between 63% and 82% of neonatal deaths occurred in the first week of life, and males were more likely to die than females. Prematurity, birth asphyxia and infections accounted for most neonatal deaths, but important subnational and regional differences were observed. More than one-third of deaths in urban India were attributed to asphyxia, making it the leading cause of death in this setting.
  
  
  CONCLUSIONS
  Population-based VA methods can fill information gaps on the burden and causes of neonatal mortality in resource-poor and data-poor settings. Local data should be used to inform and monitor the implementation of interventions to improve newborn health. High rates of home births demand a particular focus on community interventions to improve hygienic delivery and essential newborn care.
authors.affiliation: University College London, Institute for Global Health, London, UK.
authors.forename: Edward
authors.initials: E
authors.lastname: Fottrell
authors.affiliation: University College London, Institute for Global Health, London, UK.
authors.forename: David
authors.initials: D
authors.lastname: Osrin
authors.affiliation: University College London, Institute for Global Health, London, UK.
authors.forename: Glyn
authors.initials: G
authors.lastname: Alcock
authors.affiliation: Diabetic Association of Bangladesh, Perinatal Care Project, Dhaka, Bangladesh.
authors.forename: Kishwar
authors.initials: K
authors.lastname: Azad
authors.affiliation: Society for Nutrition, Education and Health Action, Mumbai, India.
authors.forename: Ujwala
authors.initials: U
authors.lastname: Bapat
authors.affiliation: University College London, Institute for Global Health, London, UK.
authors.forename: James
authors.initials: J
authors.lastname: Beard
authors.affiliation: Parent and Child Health Initiative, Lilongwe, Malawi.
authors.forename: Austin
authors.initials: A
authors.lastname: Bondo
authors.affiliation: University College London, Institute for Global Health, London, UK.
authors.forename: Tim
authors.initials: T
authors.lastname: Colbourn
authors.affiliation: Society for Nutrition, Education and Health Action, Mumbai, India.
authors.forename: Sushmita
authors.initials: S
authors.lastname: Das
authors.affiliation: University College London, Institute for Global Health, London, UK.
authors.forename: Carina
authors.initials: C
authors.lastname: King
authors.affiliation: Mother and Infant Research Activities, Kathmandu, Nepal.
authors.forename: Dharma
authors.initials: D
authors.lastname: Manandhar
authors.affiliation: Mother and Infant Research Activities, Kathmandu, Nepal.
authors.forename: Sunil
authors.initials: S
authors.lastname: Manandhar
authors.affiliation: University College London, Institute for Global Health, London, UK.
authors.forename: Joanna
authors.initials: J
authors.lastname: Morrison
authors.affiliation: Ministry of Health, Government of Malawi, Lilongwe, Malawi.
authors.forename: Charles
authors.initials: C
authors.lastname: Mwansambo
authors.affiliation: Ekjut, Chakradharpur, India.
authors.forename: Nirmala
authors.initials: N
authors.lastname: Nair
authors.affiliation: University College London, Institute for Global Health, London, UK.
authors.forename: Bejoy
authors.initials: B
authors.lastname: Nambiar
authors.affiliation: University College London, Institute for Global Health, London, UK.
authors.forename: Melissa
authors.initials: M
authors.lastname: Neuman
authors.affiliation: MaiMwana Project, Mchinji, Malawi.
authors.forename: Tambosi
authors.initials: T
authors.lastname: Phiri
authors.affiliation: University College London, Institute for Global Health, London, UK.
authors.forename: Naomi
authors.initials: N
authors.lastname: Saville
authors.affiliation: Mother and Infant Research Activities, Kathmandu, Nepal.
authors.forename: Aman
authors.initials: A
authors.lastname: Sen
authors.affiliation: University College London, Institute for Global Health, London, UK.
authors.forename: Nadine
authors.initials: N
authors.lastname: Seward
authors.affiliation: Society for Nutrition, Education and Health Action, Mumbai, India.
authors.forename: Neena
authors.initials: N
authors.lastname: Shah Moore
authors.affiliation: Mother and Infant Research Activities, Kathmandu, Nepal.
authors.forename: Bhim Prasad
authors.initials: BP
authors.lastname: Shrestha
authors.affiliation: MaiMwana Project, Mchinji, Malawi.
authors.forename: Bright
authors.initials: B
authors.lastname: Singini
authors.affiliation: Mother and Infant Research Activities, Kathmandu, Nepal.
authors.forename: Kirti Man
authors.initials: KM
authors.lastname: Tumbahangphe
authors.affiliation: University College London, Institute for Global Health, London, UK.
authors.forename: Anthony
authors.initials: A
authors.lastname: Costello
authors.affiliation: University College London, Institute for Global Health, London, UK.
authors.forename: Audrey
authors.initials: A
authors.lastname: Prost
mesh_terms: D001344:Autopsy / Q000379:methods; D001459:Bangladesh / Q000453:epidemiology; D002423:Cause of Death; D005260:Female; D006801:Humans; D007194:India / Q000453:epidemiology; D007223:Infant; D007226:Infant Mortality; D008295:Malawi / Q000453:epidemiology; D008297:Male; D009390:Nepal / Q000453:epidemiology; D011159:Population Surveillance / Q000379:methods*; D011446:Prospective Studies; D017678:Sex Distribution
keywords: Data Collection; Epidemiology; Measurement; Mortality; Neonatology