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  • Title: Perinatal mortality and morbidity in rural West-Java, Indonesia. Part II: The results of a longitudinal survey on pregnant women.
    Author: Alisjahbana A, Soeroto-Hamzah E, Peeters R, Meheus A.
    Journal: Paediatr Indones; 1990; 30(7-8):179-90. PubMed ID: 2075019.
    Abstract:
    The main objective of this prospective survey is to obtain more information on the natural history of pregnancy and its outcome, including low birth weights, and of the factors closely associated with it. During the survey period the birth rate was 40 per thousand and the perinatal death rate 48 per thousand. The main causes of neonatal deaths are infections (predominantly tetanus) and hypoxia/birth asphyxia. Perinatal mortality is significantly associated with the following risk factors: age of mother less than 20 years; birth interval shorter than 18 months, twins, and breech presentation. The incidence of low birth weight is 14.7%. Statistically significant associations have been found between low birth weight and several risk factors. Traditional birth attendants made 5 home visits to each pregnant woman in Ujung-Berung area of rural West Java in Indonesia between September 1978-February 1980 to determine the natural history of pregnancy and its outcome and the factors associated with the different outcomes. They performed 87% of the deliveries. 4 mothers died (1.7% of all live births). The birth rate was 40% and 2335 infants were born. The perinatal mortality rate stood at 44.5. The percentage of fetal deaths was 13.7% (32) and of early neonatal deaths was 31.2% (72). The leading cause of early neonatal death was infection (50.2%) and tetanus neonatorum contributed to mortality in 79% of these cases (case fatality rate 100%). In the early neonatal period, the tetanus specific perinatal mortality was 17%. Further it stood at a high of 9.5/1000 live births due to low tetanus immunization coverage. Intrauterine hypoxia and birth asphyxia contributed the most to perinatal deaths (57.8%) followed by infections (23.6%). Twin births posed 4.14 times the risk of perinatal mortality than did singleton births (p.05). The single most significant risk factor for perinatal mortality, however, was breech delivery (relative risk [RR] 5.7; p.05). Mother's age 20 years (RR 1.28) and birth interval between 6-17 months (2.76) comprised the only other 2 significant risk factors (p.05). 14.7% of the infants weighed 2500 g. For low birth weight (LBW) infants, twin births posed the greatest risk to mortality (RR 5.65) followed by complications before delivery (RR 3.7), breech birth (RR 2.3), and 1st birth (RR 2.06) [all significant at p.05]. LBW infants had a high percentage of illnesses during the neonatal period (30.2%). Overall morbidity during this time stood at 16.9%.
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