[8315.3] Perinatal Outcomes in India: A Community-Based Study
S.S. Goudar, V.D. Patil, E.M. McClure, S.M. Dhaded, LL Wright, W.A. Carlo. Global Network for Women's and Children's Health Research, Bethesda, MD.
BACKGROUND: India has the largest number of stillbirths worldwide and a quarter of all global neonatal deaths. Although improvements have been made, mortality remains high, and due to unreliable vital registration, the burden of stillbirths and early neonatal deaths is likely to be under-reported. Reliable population-based estimates, including the timing of perinatal deaths, are essential to develop effective interventions to reduce the perinatal mortality.
OBJECTIVE: To develop a system to track the outcomes of all pregnancies 24 weeks in a geographic area in rural India.
DESIGN/METHODS: An 18-month prospective, observational study was undertaken, using trained coordinators to track all pregnancies in a geographic area; the system included innovative methods (registering all eligible couples and informal reporters such as postal personnel, milk vendors, taxi drivers) to register all pregnant women with the assistance of Auxiliary Nurse Midwives and Anganwadi Workers. The outcomes of all registered pregnancies were captured irrespective of whether the women delivered within the study catchment area. For those delivering within the study area, the women were visited following delivery. Cause of death was assigned by the community coordinator, a trained physician.
RESULTS: We registered all women living in the catchment area by 24 weeks or women who moved into the area and delivered during the study period at 24 weeks (n=9982). An additional 2496 were registered but delivered outside the catchment area; these outcomes are not included in the analyses. 62% of the deliveries were by skilled birth attendants (physician or nurse) and 52% were in a hospital/clinic. The remaining occurred in home settings with traditional birth attendants. 3% were delivered by c-section. The stillbirth rate was 23/1000 with 28% having signs of maceration. The 7-day mortality rate was 27/1000. Of the neonatal deaths, 38% occurred within 6 hours of delivery. The primary cause of death was asphyxia (43%) followed by low-birth-weight (27%).
CONCLUSIONS: This innovative system was successful in registering and tracking pregnancy outcomes of all women in a defined catchment area. The majority of the deaths were fresh stillbirths or early (<6 hr) neonatal deaths, with birth asphyxia identified as the primary cause of the latter deaths. Perinatal interventions are needed to impact the high mortality at this time.