title: Perinatal Mortality Magnitude, Determinants and Causes in West Gojam: Population-Based Nested Case-Control Study.
abstract: BACKGROUND
  In Ethiopia, even if a significant reduction in child mortality is recorded recently, perinatal mortality rate is still very high. This study assessed the magnitude, determinants and causes of perinatal death in West Gojam zone, Ethiopia.
  
  
  METHODS
  A nested case control study was conducted on 102 cases (mothers who lost their newborns for perinatal death) and 204 controls (mothers who had live infants in the same year) among a cohort of 4097 pregnant mothers in three districts of the West Gojam zone, from Feb 2011 to Mar 2012. Logistic regression models were used to identify the independent determinant factors for perinatal mortality. The World Health Organization verbal autopsy instrument for neonatal death was used to collect mortality data and cause of death was assigned by a pediatrician and a neonatologist.
  
  
  RESULTS
  Perinatal mortality rate was 25.1(95% CI 20.3, 29.9) per 1000 live and stillbirths. Primiparous mothers had a higher risk of losing their newborn babies for perinatal death than mothers who gave birth to five or more children (AOR = 3.15, 95% CI 1.03-9.60). Babies who were born to women who had a previous history of losing their baby to perinatal death during their last pregnancy showed higher odds of perinatal death than their counterparts (AOR = 9.55, 95% CI 4.67-19.54). Preterm newborns were more at risk for perinatal death (AOR = 9.44, 95%CI 1.81-49.22) than term babies. Newborns who were born among a household of more than two had a lesser risk of dying during the perinatal period as compared to those who were born among a member of only two. Paradoxically, home delivery was found to protect against perinatal death (AOR = 0.07 95% CI, 0.02-0.24) in comparison to institutional delivery. Bacterial sepsis, birth asphyxia and obstructed labour were among the leading causes of perinatal death.
  
  
  CONCLUSIONS
  Perinatal mortality rate remains considerably high, but proper maternal and child health care services can significantly decrease the burden.
authors.affiliation: Department of Reproductive Health and Health Service Management, School of Public Health, College of Health Sciences, Addis Ababa University, Addis Ababa, Ethiopia.
authors.forename: Robel
authors.initials: R
authors.lastname: Yirgu
authors.affiliation: Department of Reproductive Health and Health Service Management, School of Public Health, College of Health Sciences, Addis Ababa University, Addis Ababa, Ethiopia.
authors.forename: Mitike
authors.initials: M
authors.lastname: Molla
authors.affiliation: Nell Hodgson Woodruff School of Nursing and Rollins School of Public Health, Emory University, Atlanta, Georgia, United States of America.
authors.forename: Lynn
authors.initials: L
authors.lastname: Sibley
authors.affiliation: Maternal and Newborn Health in Ethiopia Partnership project, Emory University, Addis Ababa, Ethiopia.
authors.forename: Abebe
authors.initials: A
authors.lastname: Gebremariam
mesh_terms: D000293:Adolescent; D000328:Adult; D016022:Case-Control Studies; D005002:Ethiopia; D005260:Female; D006801:Humans; D007231:Infant, Newborn; D054238:Perinatal Mortality; D011247:Pregnancy; D055815:Young Adult