Understanding differential patterns in perinatal mortality epidemiology to facilitate actions to reduce stillbirths and early neonatal deaths in India
R. Dandona (1), G.A. Kumar (1), M. Akbar (1), Y. Atmavilas (2), D. Bhattacharya (2), P. Nanda (2), L. Dandona (3)
(1) Public Health Foundation of India, Institute for Health Metrics and Evaluation, University of Washington, (2) Bill and Melinda Gates Foundation, (3) Public Health Foundation of India, Institute for Health Metrics and Evaluation, University of Washington
1) Background: The objectives of this study were to understand perinatal mortality (PM) by exploring the differences in risk factors for PM in subgroups of stillbirths, and 0-2 and 3-7 day neonatal deaths, and in cause of death distribution in the two neonatal age groups to inform programmatic decision-making in the Indian state of Bihar, a large state with a high burden of perinatal mortality.
2) Methods: Detailed interviews were conducted in a representative sample of 23,940 births from 189,800 households in Bihar in 2016. We estimated rates for PM, stillbirth, and 0-2 and 3-7 days deaths per 1,000 births, and explored the associations with a variety of risk factors using a hierarchical logistic regression model approach. Verbal autopsy was conducted and cause of death assigned for neonatal deaths using the SmartVA automated algorithm.
3) Results: The PMR in 2016 was 34 (95% CI 30.8-37.5) for Bihar state. Stillbirths (15.4) accounted for 45.2% of PM. The 0-2 day mortality rate (13.0) was 2.3 times higher than the 3-7 days rate (5.6). Gestation period of <8 months, pregnancies with multiple foetuses, breech presentation of baby, forceful push/pull during the delivery by health provider, and birth in private facilities or at home were significantly associated with the risk for overall PM and all the sub-groups. Previous history of stillbirth and not receiving tetanus injections during pregnancy was associated with overall PM but not with any subgroup. Being a boy baby was significantly associated with overall PM and 0-2 day deaths. Deferred deliveries and primi births were associated with overall PM and stillbirths. Birth asphyxia (61.1%) and preterm delivery (22.1%) accounted for most of 0-2 day deaths; pneumonia (34.5%), preterm delivery (33.7%), and meningitis/sepsis (20.1%) for the majority of 3-7 day deaths.
4) Conclusions: These data on perinatal mortality epidemiology by sub-groups can inform more effective programming to reduce perinatal deaths in India.
Ethics statement: This research was approved by the Ethics Committee of Public Health Foundation of India (approval number TRC-IEC-327/17).International Stillbirth Alliance, Annual Conference on Perinatal Mortality and Bereavement Care, Madrid, Spain. October 5-6th, 2019.