207780 Exploring causes of and risk factors for perinatal mortality in rural Maharastra, India

Tuesday, November 10, 2009

Yue Monica Li, MHS , Global Health Center, Mount Sinai School of Medicine, New York, NY
Natasha Anandaraja, MD , Global Health Center, Mount Sinai School of Medicine, New York, NY
Shobha Arole, MBBS, DCBHD , Comprehensive Rural Health Project, Jamkhed, Dist. Ahmednagar, India
Ratna Kamle , Comprehensive Rural Health Project, Maharashtra, India
Ian Holzman, MD , Department of Pediatrics, Mount Sinai Hospital, New York, NY
Roy Brown, MD , Department of Population and Family Health, Columbia Mailman School of Public Health, New York, NY
The Comprehensive Rural Health Project (CRHP), a healthcare organization serving rural Maharashtra, India, made strides in reducing infant death over the past 30 years using community-based health interventions such as antenatal health visits. However, newborn deaths remain a significant cause of under-five mortality in project villages. This study aims to identify causes of and potential maternal risk factors for newborn mortality. Families that had experienced perinatal and neonatal deaths between April 1, 2007 and August 5, 2008 were identified from records of village health workers and government workers for 30 sentinel CRHP villages. A standardized verbal autopsy was administered, including questions on maternal health, socio-demographics, and health service utilization. Results of the verbal autopsies were applied to validated algorithms and reviewed by two pediatricians to identify causes of death. Of the 30 deaths (25 deaths /1000 live births), 20 (69%) were related to intrauterine or ante-partum events. These included cases of stillbirth (55%), intrauterine asphyxia (20%), premature labor (20%), and low birth weight (5%). A maternal history of hard physical labor up to the third trimester of pregnancy was present in 75% of cases and was the only notable common factor. The predominance of perinatal deaths associated with intrauterine events suggests that interventions promoting antenatal health at a household level and improving access to emergency obstetric care should be prioritized to reduced newborn mortality in CRHP, and similar, villages. Further research into maternal risk factors is warranted and will require larger, controlled studies.

Learning Objectives:
1. Identify the predominant causes of and risk factors for newborn death in rural villages with community-based healthcare. 2. Differentiate interventions needed to reduce perinatal versus late neonatal care. 3. Design informed research that will further elucidate risk factors for perinatal mortality in villages with community-based healthcare

Keywords: Maternal and Child Health, Community-Based Health Care

Presenting author's disclosure statement:

Qualified on the content I am responsible for because: I designed and implemented the research
Any relevant financial relationships? No

I agree to comply with the American Public Health Association Conflict of Interest and Commercial Support Guidelines, and to disclose to the participants any off-label or experimental uses of a commercial product or service discussed in my presentation.