title: Trajectory of cause of death among brought dead neonates in tertiary care public facilities of Pakistan: A multicenter study.
abstract: BACKGROUND
  Considering the fact that Pakistan is amongst the countries with very high neonatal mortality rates, we conducted a research study to determine the possible causes and characteristics of neonates presenting dead to the emergency department of tertiary public health care facilities of Pakistan using verbal autopsies.
  
  
  METHODS
  A descriptive case series study was conducted in emergency department/pediatrics ward/neonatal ward/nursery unit of ten tertiary care public health facilities, situated in seven major cities of Pakistan from November, 2011 to June, 2013. Precoded verbal autopsy proforma was used to collect information regarding cause of death, family narratives and other associated risks accountable for pathway to mortality.
  
  
  RESULTS
  We identified 431 neonates presenting dead to the emergency department (238 males and 193 females). Sepsis (26.7%), birth asphyxia (18.8%) and persistent pulmonary arrest (17.2%) were main primary causes of brought death. Around 72% brought dead neonates were referred from doctors/health care facilities and more than 28% caregivers mentioned that they were not informed about the diagnosis/ailment of their deceased newborn.
  
  
  CONCLUSIONS
  Findings of our study suggest that infectious disease remains the main primary cause of neonatal mortality. Underweight in newborns (64%) was estimated as a leading associated risk. Delays in referrals to respective health care facility enlightened the concern of sub-standard prerequisites of neonatal care that could be one of the major contributing risk factor of high mortality rates.
authors.affiliation: PMRC Specialized Research Center on Child Health, National Institute of Child Health, Karachi, Pakistan. ayazbukero@gmail.com.|5th Floor, PMRC Specialized Research Center on Child Health, National Institute of Child Health, Karachi, 75500, Pakistan. ayazbukero@gmail.com.
authors.forename: Muhammad Ayaz
authors.initials: MA
authors.lastname: Mustufa
authors.affiliation: PMRC Research Center, Liaquat University of Health and Medical Sciences, Jamshoro, Hyderabad, Pakistan.
authors.forename: Munir Ahmed
authors.initials: MA
authors.lastname: Sheikh
authors.affiliation: PMRC Research Center, Nishtar Medical College, Multan, Pakistan.
authors.forename: Ijaz-Ul-Haque
authors.initials: IU
authors.lastname: Taseer
authors.affiliation: PMRC Specialized Research Center on Child Health, National Institute of Child Health, Karachi, Pakistan.
authors.forename: Syed Jamal
authors.initials: SJ
authors.lastname: Raza
authors.affiliation: PMRC Research Center, Nishtar Medical College, Multan, Pakistan.
authors.forename: Muhammad Sohail
authors.initials: MS
authors.lastname: Arshad
authors.affiliation: PMRC Research Center, Khyber Medical College, Peshawar, Pakistan.
authors.forename: Tasleem
authors.initials: T
authors.lastname: Akhter
authors.affiliation: PMRC Research Center, Punjab Medical College, Faisalabad, Pakistan.
authors.forename: Ghazala Mohyuddin
authors.initials: GM
authors.lastname: Arain
authors.affiliation: PMRC Research Center, Dow University of Health Sciences, Karachi, Pakistan.
authors.forename: Sultana
authors.initials: S
authors.lastname: Habibullah
authors.affiliation: PMRC Research Center, Nishtar Medical College, Multan, Pakistan.
authors.forename: Sohail
authors.initials: S
authors.lastname: Safdar
authors.affiliation: PMRC Research Center, Bolan Medical College, Quetta, Pakistan.
authors.forename: Rukhsana
authors.initials: R
authors.lastname: Firdous
authors.affiliation: PMRC Research Center, FJMC, Lahore, Pakistan.
authors.forename: Muhammad
authors.initials: M
authors.lastname: Adnan
mesh_terms: D002423:Cause of Death; D002662:Child Health Services / Q000458:organization & administration; D015331:Cohort Studies; D003906:Developing Countries; D004522:Educational Status; D004636:Emergency Service, Hospital / Q000706:statistics & numerical data*; D005260:Female; D006801:Humans; D007223:Infant; D007226:Infant Mortality / Q000639:trends*; D007230:Infant, Low Birth Weight; D007231:Infant, Newborn; D008297:Male; D010154:Pakistan; D011633:Public Facilities / Q000458:organization & administration; D012189:Retrospective Studies; D018570:Risk Assessment; D012959:Socioeconomic Factors; D063128:Tertiary Health Care / Q000379:methods*
keywords: autopsy; child health services; early childhood; emergency department use; neonatal mortality