Thirteen newborn deaths occurred. Eight of those deaths (61.54%) occurred within the control group. Ten out of all 13 deaths (76.92%) were early neonatal deaths, two (15.38%) were late neonatal deaths, and one was a stillbirth. The largest single contributor to neonatal death in the sample, per cause of death assigned by consulting pediatricians, was neonatal sepsis. Six out of 13 deaths (46.15%) were attributed to some form of sepsis. Twenty-three percent of the deaths were attributed to asphyxia. Other causes of death included stillbirth and prematurity.
The majority of the newborns (76.92%) were male, and their mothers’ ages ranged from 19 to 35, whom were married between the ages of 17 and 27. The mothers had an average of 6.7 years of schooling and their average household size was 6.4 people per home.
The number of mothers’ antenatal care visits ranged from two to nine, with an average of five. At those visits, only six women were informed of any danger signs to be aware of during pregnancy or where to go if experiencing any of those signs.
All 13 newborns were born in a health facility, and five (38.46%) died at the same facility in which they were born. Of the eight babies who went home after birth, four (50%) were referred to a hospital upon discharge of the facility where they were born; all four died in the hospital after referral. Of those mother/baby pairs who went home after birth, none of them reported being visited by a community health worker at home.
Twelve out of 13 (92.31%) deliveries were vaginal, with the exception being the stillbirth, where cesarean section was used to deliver the baby. Of the 12 vaginal deliveries, three (25%) were with forceps. Four of the 13 babies (23.08%) were ever breastfed, and seven of 13 (53.85%) were fed either a pre-mixed formula or powdered formula mixed with a liquid. Three out of 13 mothers (23.08%) received counselling upon discharge of the birth facility that did not include referral to a hospital; two of those three were in the intervention group.
Ten out of the 13 recorded deaths (76.92%) were within the first week of life, five of which (38.46%) occurred between zero and one day. Four out of the 10 early neonatal deaths (40%) were within the intervention group. The largest contributors to early neonatal death in our sample were neonatal sepsis and asphyxia. Three of the 10 early neonatal deaths (30%) were due to neonatal sepsis and three more of the 10 (30%) were due to asphyxia. Other causes of early neonatal death recorded were other/unspecified, pneumonia, and prematurity. Two of the 13 recorded deaths (15.38%) occurred between the 7th and 28th day of life—one from the control group and one from the intervention group. Neonatal sepsis was the cause of death in both cases.
We report on the causes of deaths of 13 neonates following verbal autopsy interviews with family members of the deceased. Five of the deaths reported (38.46%) were linked to intrapartum events, including four of the five deaths that occurred within the intervention group. Severe infection was the most common cause of death, followed by asphyxia.
Verbal autopsy analyses conducted in other countries indicate that sepsis and asphyxia are often among the top three causes of neonatal deaths. When conducting verbal autopsies in Morang, Nepal, Khanal et al. found that infection (41%), birth asphyxia (37%), and prematurity or low birth weight (18.4%) were the most common causes of neonatal death . An analysis of verbal autopsies in Nigeria found that sepsis (31.5%), birth injury/asphyxia (22.3%), and pneumonia (19.9%) were the largest contributors to death . A verbal and social autopsy (VASA) investigation conducted by the World Health Organization and UNICEF to estimate the causes of neonatal and child deaths in several high priority countries found that severe neonatal infection and asphyxia were the leading causes of neonatal death in Niger in 2010 .
One study identified an important linkage to mother’s age—more than half of recorded stillbirths in that study were to women under 21 years old, and babies born to mothers under 25 years old were less likely to survive compared to older mothers . Research in Bangladesh and Malawi found delays in care-seeking to be an underlying cause of neonatal deaths [15, 16]. In the current study, only one verbal autopsy reported pre-term delivery and there was limited information on care-seeking, likely related to the small sample size.
Prompt initation and exclusive breastfeeding, which are known to protect against neonatal illness including sepsis [17, 18] were not widely practiced among study particpants, with only five families reporting breastfeeding of baby before death.
Additionally, the VA interviews highlight several important gaps regarding referral and postnatal care. First, no respondent who left the facility where she gave birth reported being visited by a community health worker at home, pointing to a lack of care coordination between health center staff and village health volunteers. Second, while seven mothers received some form of counselling upon discharge, four of those women were referred to a hospital, and of the three mothers who received counselling other than a hospital referral, only two received information regarding danger signs of newborn illness.