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

1. Factors associated with perinatal deaths in women delivering in a health facility in Malawi Lily C. Kumbani, Johanne Sundby and Jon Øyvind Odland

2. Outline • Introduction • Study Purpose • Methodology • Results • Implications

3. Introduction • Newborn deaths account for 40% of under- five mortality (MDG- 4). • Reducing early neonatal mortality is necessary to achieve MDG- 4.

4. 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.

5. 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.

6. Objectives • To establish an estimate of perinatal mortality at Chiradzulu District Hospital. • To identify associated risk factors, and to determine causes of perinatal deaths.

7. 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.

8. 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.

9. 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

10. Results

11. Results- Mothers’ characteristics

12. Results- Mothers’ characteristics ctd…

13. Results - Frequency of perinatal deaths

14. Results - Frequency of perinatal deaths ctd…

15. Distribution of perinatal deaths

16. Causes of early neonatal deaths

17. Results- univariate analysis (Pregnancy) Maternal age, parity, HIV, syphilis, preeclampsia, anemia, malaria and APH had no effect on perinatal deaths (p >0.05).

18. Results- univariate analysis (Labor/Delivery)

19. Results- univariate analysis (Labor/Delivery) ctd…

20. Results- univariate analysis (Labor/Delivery) ctd… 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).

21. Results- univariate analysis (Postpartum)

22. Results- univariate analysis (Postpartum) ctd.. Meconium aspiration and hypothermia were not associated with perinatal deaths (p >0.05).

23. 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.

24. 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.

25. Thank you for your attention