Verbal Autopsy Program

IRHDTC has been awarded with the program to ascertain the causes of neonatal deaths in six CBNCP implemented districts – Dolpa, Jumla, Palpa, Salyan, Morang & Chitwan. It is a research based study funded by USAID with the time period of six months (August 2013 – January 2014). Standard verbal autopsy tool is being used to conduct interviews with the families of the deceased. Data collections in the respective districts are ongoing.

In addition, information related to the causes of deaths, delays in identification of illness and care seeking practice, place of death and review of asphyxia cases managed are also being studied.
IRHDTC has been awarded with the program to ascertain the causes of neonatal deaths in six CBNCP implemented districts – Dolpa, Jumla, Palpa, Salyan, Morang & Chitwan. It is a research based study funded by USAID with the time period of six months (August 2013 – January 2014). Standard verbal autopsy tool is being used to conduct interviews with the families of the deceased. Data collections in the respective districts are ongoing.

In addition, information related to the causes of deaths, delays in identification of illness and care seeking practice, place of death and review of asphyxia cases managed are also being studied.

Findings on neonatal deaths

Seventy-seven percent of respondents in the study were mothers and the remaining were relatives, non-relatives and fathers. A majority of respondents (84 percent) were with the sick newborn during the entire period i.e. from illness till death. Only two thirds (66 percent) of mothers were aware about messages of essential newborn care and only half received the message through FCHV (51 percent). Utilization of services was found to be very promising with 90 percent of mothers utilizing ANC services and with 50 percent making four or more Antenatal care visits.

A total of 551 deaths were recorded, among which 342 were live births and 209 stillbirths. The majority of deaths occurred at home (53 percent) and among males (58 percent). The three leading causes of neonatal mortality in our study were: neonatal sepsis (48 percent), birth asphyxia (16 percent) and prematurity related (13 percent). Mortality was observed to be high on the day of birth and most deaths were attributed to birth asphyxia, deaths due to neonatal sepsis was found to be particularly high on the third day of birth, and more common in the hilly region. The majority of neonatal deaths (39 percent) were among disadvantaged ethnic groups (Disadvantaged Janajatis). Thirty eight percent of total deaths were attributed to stillbirths, of which, 73 percent were fresh stillbirth, highlighting a strong need for interventions directed towards intra-partum stillbirths.

Findings on survived asphyxiated neonates

The study, in addition to verbal autopsy, tracked babies who had birth asphyxia and received care at home or at a health facility. The result shows the developmental outcomes in babies successfully managed by health workers (including FCHV) trained on resuscitation of asphyxiated newborns.

A total of 72 cases were tracked, among which 68 percent were males. Ninety percent of respondents were mothers and in average, all mothers reported experiencing some form of complications during their last pregnancy (blurring of vision, convulsions, abnormal delivery etc.). A majority, 92 percent of mothers reported that the baby did not cry at the time of birth and were provided with initial stimulation followed by the use of Dee Lee Suction tube, while only 85 percent of babies were provided with Bag and Mask ventilation. Intervention was carried out ‘immediately’ in 49 percent of the cases, whereas in 17 percent of the cases the health worker initiated the intervention ‘more than 20 minutes’ after birth.

The illness history of the survived baby as responded by the mother revealed that illness is common in survived children. Eighty-one percent of mothers responded that the child became ill at least once in the first month of life, with more than 50 percent of mothers giving a history of either chest in-drawing, fever or cough. More than half of mothers reported hearing either stridor or grunting or wheezing and flaring of nostrils at the time of illness.

Based on anthropometric measurements and developmental milestones, more than two-thirds (71 percent) were found to be developing normally, one-tenths (11 percent) were delayed development while the remaining (18 percent) needs further assessment to arrive at any conclusive opinion.