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Title: Neonatal and post-neonatal mortality in the Galle district.
Author: Fonseka P, Wijewardene K, Harendra de Silva DG, Goonaratna C, Wijeyasiri WA.
Journal: Ceylon Med J; 1994 Jun; 39(2):82-5. PubMed ID: 7923456.
Abstract:
OBJECTIVE: To determine some factors associated with infant mortality. DESIGN: Descriptive study. SETTING: Galle district in Sri Lanka. SUBJECTS: 350 infant deaths of singleton births. MEASUREMENTS: Association between variables. RESULTS: Neonatal:post-neonatal death ratio was 3.2:1, and 62.3% (218) were early neonatal deaths. First day deaths comprised 28.6% (100); 67.8% (237) died at the Teaching Hospital. A high incidence (65.7%) of low birthweight (LBW) was noted. Mean birthweights of neonates and post-neonates were 1925 +/- 729 and 2520 +/- 620 gram respectively, and the difference between means was statistically significant (p < 0.001). LBW and related disorders were the major cause of death in 44% (154) of the total sample, and in 55.8% (149) of neonates. Infections were the commonest cause (55.8%) of death in post-neonates. Pediatric clinical assessment to differentiate small-for-dates (SFD) was not recorded in 90.3%. Statistically significant associations were found between the period of death (neonatal and post-neonatal) and the following variables: period of gestation (p < 0.001); birthweight (p < 0.001) and cause of death (p < 0.001). CONCLUSIONS: There was a high incidence of neonatal deaths and a high proportion of early neonatal deaths. About one-third of deaths occurred on the first day of life. Incidence of LBW was high. The major cause of death was LBW and related disorders in the total sample and in neonates. Assessment of SFD was not carried out in the vast majority of infants. Information was collected from hospitals, government medical centers, private hospitals, and death registrations in Galle district, Sri Lanka, in order to ascertain the factors associated with infant mortality. Deaths were grouped as low birth weight (LBW), birth trauma, infections, congenital anomalies, convulsions, and miscellaneous. The sample included 350 deaths (185 male and 165 female). 38.6% (135 deaths) were preterm at under 37 weeks. 93.3% of term (126 infants) and 65.5% of preterm (141 infants) died in the neonatal period. In the analysis of 336 infants, 65.7% (221 infants) were LBW, and 26.8% were very LBW at under 1500 grams. 85.9% of LBW babies and 57.4% of normal weight babies died during the neonatal period. 89 (40.3%) of the LBW babies were delivered at term, and 48.9% were LBW. 43.7% of the 335 infants were born in hospitals. 73.4% of infant deaths occurred at the hospital during the neonatal period. 14.3% of deaths took place at home. 44% of mortality was attributed to LBW, and LBW and related disorders accounted for 55.8% of neonatal mortality. 57.8% of postneonatal deaths were due to infections. 28.6% of neonatal deaths occurred within the first 24 hours, and 62.3% (218) occurred during the first week. There is a statistically significant association between time of death and period of gestation, birth weight, and cause of death. The importance of birth weight for child survival has been observed in other districts and other studies in Sri Lanka. The mean birth weight of infants dying in the neonatal period was 1925 +or- 729 g. In the postneonatal period, it was 2529 +or- 620 g.

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