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A Comparison of Stillbirth (SB) and Early Neonatal Mortality Rates(ENMR) in Central Africa

Cyril M. Engmann, MD FAAP1, Rinko Kinoshita, RNM, MPH2, Richard Matendo, MD2, Nelly Dikamba Madiya, MD MPH3, Antoinette Tshefu, MD PhD3, Beth McClure, MSc4, Robert Ryder, MD MSc5, Linda L. Wright, MD FAAP6, and Waldemar Carlo, MD FAAP7. (1) Division of Neonatal-Perinatal Medicine, Department of Pediatrics, University of North Carolina School of Medicine, CB#7596, 4th Floor, UNC Hospitals, UNC-Chapel Hill, Chapel Hill, NC 27599-7596, 919-966-5063, cengmann@med.unc.edu, (2) Safe Pregnancy by Infectious Dsease Control, Hopital General de Kinshasa, 8502 (Pavillon 27) Gombe, Kinshasa, Congo-Kinshasa, (3) Kinshasa School of Public Health, BP 11850, Kinshasa, Congo-Kinshasa, (4) RTI International, 4426 South Miami Blvd, Durham, NC 27703, (5) Department of Epidemiology, University of North Carolina School of Public Health, McGavran-Greenberg Hall CB #7435, Chapel Hill, NC 27599, (6) Center for Research for Mothers and Children NICHD, NIH, 6100 Executive Blvd, Rm4B05J, Rockville, MD 20852, (7) Division of Neonatal-Perinatal Medicine, Department of Pediatrics, University of Alabama at Birmingham, 619 S. 20th Street,525 New Hillman Building, Birmingham, AL 35233

Introduction: There is a paucity of community-derived perinatal data from rural Central Africa.

Objective: To compare stillbirths to early neonatal mortality rates (death before 7 days of life/1000 live births) in remote, rural communities in Central Africa.

Methods: A nested, multi-site cohort study. The cohort included all stillbirths and all infants >1500 g born alive in 21 geographically scattered villages within 4 health districts of the province of Equateur, Democratic Republic of Congo. Enrollment was between June 20 and December 31, 2005 and subjects were followed through the first 7 days postpartum. Stillbirths were determined by ascultating/ palpating heart rate prior to and after delivery by trained birth attendants (nurses and traditional birth attendants).


Total number of subjects screened 2416. Number enrolled for study 2308. 7 day follow-up 2307. Stillbirth rate (all SB) 28.4/1000 total births/year. Early neonatal mortality rate (>1500g) 29.9/1000 live births/year. Ratio SB:ENMR 1:1.05. 65% of SBs were fresh.

Discussion: The Neonatal Mortality Rate (deaths before 28 days/1000 live births) calculated from our data (45/1000 live births) is close to WHO regional estimates(47/1000 live births). The SB: ENMR ratio of ~1:1 is similar to global estimates of 3.9 million SB: 4 million neonatal deaths. If our data are representative, the global neonatal mortality rate estimates may be low. In contrast, SBs may be overestimated because it is more acceptable to classify an Early Neonatal Death (END) as a SB. The high fresh SB rate suggests that additional training may increase survival. Rigorous training is imperative to ensure accurate assignment of SBs vs. ENMR.

Funded by U01-HD043475-03 (NICHD Global Network for Women's and Children's Health Research) and the Bill and Melinda Gates Foundation.

Learning Objectives:

Keywords: International MCH, Perinatal Health

Presenting author's disclosure statement:

Not Answered

Handout (.pdf format, 516.3 kb)

Child Health Issues and Innovations

The 134th Annual Meeting & Exposition (November 4-8, 2006) of APHA