title: A community based case control study on determinants of perinatal mortality in a tribal population of southern India.
abstract: BACKGROUND
  Perinatal mortality rate has been regarded as an indicator of the quality of prenatal, obstetric and neonatal care in an area, which also reflects the maternal health and socioeconomic environment. The objective of the current study was to identify causes and risk factors for perinatal deaths among the tribal population in Jawadhi Hills, Tamil Nadu, southern India.
  
  
  METHODS
  A community-based case control study design was used, where a case was a perinatal death and controls were from a sampling frame of all children who were born alive in the same area ±7 days from the day of birth of the case. The WHO Standard International Verbal Autopsy form was used to arrive at the cause of death. Univariate and multivariate analyses for factors associated with perinatal deaths were done.
  
  
  RESULTS
  A total of40 cases, including 22 early neonatal deaths and 18 stillbirths, and 110 controls were included in the study. Among the perinatal deaths, 40% were born prematurely. Sepsis (17.5%) and birth asphyxias (12.5%) were the major causes of deaths. In the final logistic regression model, parity ≥4 (odds ratio [OR] 5.75 [95% confidence interval (CI) 1.88-17.54]), preterm births (OR 5.62 [95% CI 2.12-16.68]) and time to reach the nearest health facility more than two hours (OR 2.51 [95% CI 1.086.73]) were significantly associated with the perinatal deaths.
  
  
  CONCLUSIONS
  Prematurity, poor accessibility and a high parity were significantly associated with perinatal deaths in the tribal population of Jawadhi Hills.
authors.affiliation: Department of Community Medicine, Christian Medical College, Vellore, India. kumaran.viswanath@gmail.com.
authors.forename: Kumaran
authors.initials: K
authors.lastname: Viswanath
authors.affiliation: Department of Community Medicine, Christian Medical College, Vellore, India. rakeshrenjini@gmail.com.
authors.forename: Rakesh
authors.initials: R
authors.lastname: Ps
authors.affiliation: Department of Community Medicine, Christian Medical College, Vellore, India. dr.arupchakraborty@gmail.com.
authors.forename: Arup
authors.initials: A
authors.lastname: Chakraborty
authors.affiliation: Department of Community Medicine, Christian Medical College, Vellore, India. jasminep@cmcvellore.ac.in.
authors.forename: Jasmin H
authors.initials: JH
authors.lastname: Prasad
authors.affiliation: Department of Community Medicine, Christian Medical College, Vellore, India. minzshanti@gmail.com.
authors.forename: Shantidani
authors.initials: S
authors.lastname: Minz
authors.affiliation: Department of Community Medicine, Christian Medical College, Vellore, India. kurien@cmcvellore.ac.in.
authors.forename: Kuryan
authors.initials: K
authors.lastname: George
mesh_terms: D000328:Adult; D016022:Case-Control Studies; D002423:Cause of Death; D005260:Female; D006297:Health Services Accessibility / Q000706:statistics & numerical data; D006801:Humans; D007194:India / Q000453:epidemiology; D016015:Logistic Models; D016017:Odds Ratio; D010298:Parity; D054238:Perinatal Mortality; D047928:Premature Birth / Q000453:epidemiology; D012307:Risk Factors; D012959:Socioeconomic Factors; D050497:Stillbirth / Q000453:epidemiology
keywords: Asia; Determinants of Health; Evidence-based Care; Health Promotion; Health Service reform; Maternal and Child Health; Primary Health Care; Public Health; Women's Health