Factors associated with perinatal deaths in women delivering in a health facility in Malawi

Lily C. Kumbani, Johanne Sundby and Jon Øyvind Odland

Outline

• Introduction

• Study Purpose

• Methodology

• Results

• Implications

1

Introduction

• Newborn deaths account for 40% of under- five mortality (MDG- 4).

• Reducing early neonatal mortality is necessary to achieve MDG- 4.

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Introduction ctd…

• Two-thirds of child deaths occur in the first month of life. Of these, more than two-thirds die in their first week. Among those in the first week, two-thirds die in the first 24 hours of life.

• Unless neonatal mortality is greatly reduced it is not possible to achieve millennium development goal 4.

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Introduction ctd…

• In Malawi, an increase in perinatal mortality estimated at 40/1000 (MDHS 2010)

• Few studies done.

• These data are essential to effectively plan how to reduce perinatal mortality.

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Objectives

• To establish an estimate of perinatal mortality at Chiradzulu District Hospital.

• To identify associated risk factors, and to determine causes of perinatal deaths.

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Methodology

• Design: A cross sectional prospective review of records.

• Setting: Chiradzulu district hospital, labor ward and postnatal ward.

• Inclusion criteria: Records of mothers who received antenatal care at any health facility but delivered at the district hospital from 28 weeks to term.

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Methodology ctd…

Data collection: • A data record form: was used to collect

maternal and neonatal information

Data analysis• Stata version 11.0 was used• Univariate analysis was computed to

determine the association between outcome (perinatal death) and independent variables.

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Methodology ctd…

Ethical consideration:

• Study approval - Norway Regional Committee for Medical Research Ethics & College of Medicine Research and Ethics Committee, Malawi.

• Written permission from the District Health Officer - Chiradzulu District Hospital

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Results

No. of records - 606 n Percentage

Type of deliveries

SVD 419 69

C/S 165 27.2

VE/ Breech 21 3.5

Term Gestation 534 89

Skilled attendant 581 95.9

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Results- Mothers’ characteristics

n Percentage

Age group

14- 18 115 19

19- 35 437 72.3

36- 46 53 8.8

Parity

1 211 34.8

2- 4 310 51.2

≥ 5 85 1410

Results- Mothers’ characteristics ctd…

n Percentage

No. of antenatal visits

1 34 5.7

2 119 19.8

3-4 389 64.8

≥ 5 58 9.7

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Results - Frequency of perinatal deaths

n Percentage

Total Deliveries 685

Number of fresh still births

18 2.6

Number of macerated still births

7 1

Number of early neonatal deaths

16 2.4

Perinatal deaths 41 5.912

Results - Frequency of perinatal deaths ctd…

Rate

Perinatal mortality rate 59.9/ 1000 births

Still birth rate 36/ 1000 births

Early neonatal death rate

24/1000 live births

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Distribution of perinatal deaths

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Causes of early neonatal deaths

Percentage

Birth asphyxia 75

Severe prematurity (28- 30 weeks)

12.5

Severe prematurity & sepsis

12.5

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Results- univariate analysis (Pregnancy)

Characteristic Perinatal deaths No Yes

P-value †

No. of antenatal visits

n % n % <0.001

1 24 70.6 10 29.4

2 110 92 9 8

3 197 97 6 3

4 177 95 9 5

≥5 51 88 7 12

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Maternal age, parity, HIV, syphilis, preeclampsia, anemia, malaria and APH had no effect on perinatal deaths (p >0.05).

Results- univariate analysis (Labor/Delivery)

Characteristic Perinatal deaths No Yes

P-value †

Gestation n % n % <0.001 ≤31 10 53 9 4732-36 140 93 11 7≥37 405 95 21 5Labor &Delivery complication <0.001 No 351 97 10 3Yes 206 88 27 12Preterm labour 0.029No 165 90 19 10Yes 11 69 5 31 17

Results- univariate analysis (Labor/Delivery) ctd…

Characteristic Perinatal deaths No Yes

P-value †

Presentation n % n % <0.001 Cephalic 533 94 33 6Breech 23 79 6 21Compound 4 67 2 33Prolonged 2nd stage of labor <0.001 No 525 95 30 5Yes 39 78 11 22

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Results- univariate analysis (Labor/Delivery) ctd…

Characteristic Perinatal deaths No Yes

P-value †

Delivery type n % n % 0.012SVD 396 95 23 5C/S 152 92 13 7.8VE/Breech/ Breech extraction

16 76 5 24

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Anemia, obstetric complications (preeclampsia, eclampsia, rupture of membranes > 24 hours, fetal distress, CPD, obstructed labor), and skilled attendant were not associated with perinatal deaths (p >0.05).

Results- univariate analysis (Postpartum)

Characteristic Perinatal deaths No Yes

P-value †

Asphyxia n % n % <0.001No 502 99 5 1Yes 63 85 11 15Apgar score <0.0011-3 7 54 6 464-6 60 91 6 97-10 498 99.2 4 0.8Preterm <0.001No 514 96 20 4Yes 50 76 16 24 20

Results- univariate analysis (Postpartum) ctd.. Characteristic Perinatal deaths

No Yes

P-value †

Birth weight n % n % <0.001

700g-1499g 7 39 11 611500g-2499g 93 91 9 9≥2500g 463 96 20 4Sepsis 0.009No 444 99.6 2 0.4Yes 17 89.5 2 10.5

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Meconium aspiration and hypothermia were not associated with perinatal deaths (p >0.05).

Implications• Reinforce and improve health workers’ abilities

to properly monitor women in labor at all levels of care for early identification and management of complications.

• Encourage women to start antenatal care early for them to adhere to the four recommended antenatal visits.

• Improve health workers ability in basic resuscitation, as well as care of low birth weight babies.

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Implications ctd…

• Referral of women with very preterm labor (28 to 32 weeks) to deliver in a facility with neonatal intensive care.

• Pregnant women and communities should have sufficient information on obstetric complications to seek health care in time.

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