Table 2. Summary of studies that reported cause-specific mortality by day of life.
Study/country | Study design | Study population | Sample size | Methods | Results | Comments | |||||||||
---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|
Studies providing data for all the time points (included in initial as well as final analysis) | |||||||||||||||
Baqui et al.,7 India | Prospective | Data from two districts of Uttar Pradesh | Neonatal deaths: 618 | Data collected by data collectors Cause of death assigned by WHO VA algorithm | Cause | Days | Weeks | Deaths secondary to tetanus and diarrhea were included in sepsis deaths | |||||||
0 | 1 | 2 | 3 | 4 | 5 | 6 | 2 | 3–4 | |||||||
Birth asphyxia/injury (n=87) | 61 (70.1) | 6 (6.8) | 7 (8.0) | 3 (3.4) | 1 (1.1) | 4 (4.5) | 3 (3.4) | 2 (2.2) | 0 | ||||||
Prematurity (n=166) | 52 (31.3) | 18 (10.8) | 14 (8.4) | 14 (8.4) | 8 (4.8) | 7 (4.2) | 11 (6.6) | 18 (10.8) | 24 (14.4) | ||||||
Sepsis/pneumonia (n=149) | 16 (10.7) | 11 (7.3) | 14 (9.3) | 10 (6.7) | 8 (5.3) | 7 (4.6) | 10 (6.7) | 41 (27.5) | 32 (21.4) | ||||||
Tetanus (n=25) | 0 | 0 | 0 | 5 (20) | 2 (8) | 2 (8) | 0 | 10 (40) | 6 (24) | ||||||
Diarrhea (n=10) | 1 (10) | 0 | 0 | 0 | 0 | 0 | 2 (20) | 2 (20) | 5 (50) | ||||||
Congenital anomaly (n=40) | 19 (47.5) | 2 (5) | 1 (2.5) | 3 (7.5) | 2 (5) | 2 (5) | 1 (2.5) | 5 (12.5) | 5 (12.5) | ||||||
Not identified | 48 (36.6) | 11 (8.3) | 26 (19.8) | 11 (8.3) | 4 (3) | 6 (4.5) | 4 (3) | 14 (10.6) | 7 (5.3) | ||||||
Waiswa et al.,14 Uganda | Prospective; January 2005–December 2008 | Iganga/Mayug districts | Neonatal deaths: 64 | VA | Cause | Day 0 | Day 1 | Days 2–28 | Data were included in initial analysis for asphyxia and congenital anomalies; for prematurity and sepsis, data were extrapolated Deaths secondary to tetanus were included in sepsis deaths | ||||||
Birth asphyxia (n=19) | 12 (63.1) | 7 (36.8) | 0 | ||||||||||||
Prematurity (n=16) | 8 (50) | 0 | 8 (50) | ||||||||||||
Sepsis/pneumonia (n=20) | 6 (30) | 0 | 14 (70) | ||||||||||||
Tetanus (n=2) | 0 | 0 | 2 (100) | ||||||||||||
Congenital defects (n=1) | 0 | 1 (100) | 0 | ||||||||||||
Not identified (n=6) | 4 (66.6) | 0 | 2 (33.3) | ||||||||||||
Studies providing data for at least three time points (but not
all
time points; included in the final analysis) | |||||||||||||||
Bang et al.,12 India | Prospective; 1995–1996 | Rural India | Neonatal deaths: 40 | Cause of death assigned by neonatologist based on maternal and neonatal records | Cause | Days 0–3 | Days 4–7 | Week 2 | Weeks 3–4 | ||||||
Birth asphyxia (n=8) | 7 (87.5) | 1 (12.5) | 0 | 0 | |||||||||||
Prematurity (n=6) | 6 (100) | 0 | 0 | 0 | |||||||||||
Sepsis/pneumonia (n=21) | 0 | 5 (23.8) | 11 (52.3) | 5 (23.8) | |||||||||||
Tetanus (n=0) | 0 | 0 | 0 | 0 | |||||||||||
Hypothermia (n=1) | 0 | 1 (100) | 0 | 0 | |||||||||||
Others/not known | 1 (7.1) | 2 (22.2) | 0 | 1(16.7) | |||||||||||
Edmond et al.,13 Ghana | Prospective; January 2003–June 2004 | Central Ghana | Neonatal deaths: 590 | VA | Cause | Day 0 | Days 1–6 | Weeks 2–4 | |||||||
Infection (n=236) | 16 (6.7) | 91 (38.5) | 129 (54.6) | ||||||||||||
Birth asphyxia (n=196) | 148 (75.5) | 45 (22.9) | 3 (1.5) | ||||||||||||
Prematurity (n=118) | 64 (54.2) | 43 (36.4) | 11 (9.3) | ||||||||||||
Congenital defects (n=16) | 6 (37.5) | 9 (56.2) | 1 (6.2) | ||||||||||||
Others (n=6) | 4 (66.7) | 0 | 2 (33.3) | ||||||||||||
Unexplained (n=8) | 3 (37.5) | 3 (37.5) | 2 (25) | ||||||||||||
Jehan et al.,18 Pakistan | Prospective | Data collected from four units of Latifabad, Pakistan | Total live births: 1121 Neonatal deaths: 53 | Cause of death assigned by neonatologist as per Pattinson's adaptation of Aberdeen classification | Cause | Days 0–2 | Days 3–6 | Weeks 2–4 | Outcome at 28 days known only for 1121 of the 1280 enrolled women | ||||||
Asphyxia (n=14) | 8 (57.1) | 6 (42.8) | 0 | ||||||||||||
Prematurity (n=14) | 11 (78.5) | 2 (14.2) | 1 (7.14) | ||||||||||||
Infections (n=12) | 0 | 5 (41.6) | 7 (58.3) | ||||||||||||
Congenital defects (n=4) | 0 | 2 (50) | 2 (50) | ||||||||||||
Others (n=5) | 1 (20) | 2 (40) | 2 (40) | ||||||||||||
Undetermined (n=4) | 2 (50) | 0 | 2 (50) | ||||||||||||
Khanal et al.,19 Nepal | Prospective | Morang district in rural Nepal | Neonatal deaths: 183 | VA by community health volunteers | Cause | Days 0–3 | Days 4–7 | Weeks 2–4 | |||||||
Birth asphyxia (n=68) | 65 (95.5) | 2 (2.9) | 1 (1.4) | ||||||||||||
Prematurity (n=21) | 16 (76.1) | 5 (23.8) | 0 | ||||||||||||
Infection (n=75) | 16 (21.3) | 27 (36.0) | 32 (42.7) | ||||||||||||
LBW-related (n=8) | 6 (75) | 0 | 2 (25) | ||||||||||||
Congenital defects (n=4) | 1 (25) | 2 (50) | 1 (25) | ||||||||||||
Hypothermia (n=3) | 2 (66.7) | 1 (33.3) | 0 | ||||||||||||
HDN (n=2) | 0 | 1 (50) | 1 (50) | ||||||||||||
Others (n=2) | 1 (50) | 1(50) | 0 | ||||||||||||
Nga et al.,9 Vietnam | Prospective July 2008–June 2010 | Data collected in 14 districts of Quang Ninh Province, Vietnam, as part of NeoKIP | Neonatal deaths for which VA performed: 233 | VA using questionnaire derived from WHO causes of death assigned by three experienced pediatricians reviewing forms independently | Cause | Day 0 (n=136) | Days 1–6 (n=52) | Weeks 2–4 (n=45) | |||||||
Birth asphyxia (n=79) | 61 (77.2) | 14 (17.7) | 4 (5.1) | ||||||||||||
Prematurity/LBW(n=90) | 58 (64.4) | 15 (16.7) | 17 (18.9) | ||||||||||||
Infection (n=31) | 0 (0) | 14 (45.2) | 17 (54.8) | ||||||||||||
Congenital defects (n=16) | 9 (56.3) | 4 (25) | 3 (18.7) | ||||||||||||
Others/unknown (n=17) | 8 (47.1) | 5 (29.4) | 4 (23.5) | ||||||||||||
Other studies (not included in the pooled analysis) | |||||||||||||||
Baiden et al.,25 Ghana | Retrospective | Demographic surveillance system data (1995–2002) | Neonatal deaths: 1068 | VA conducted by field workers Cause of death assigned independently by three physicians Agreement of at least two physicians required | Cause | Early | Late | ||||||||
Infections | 37% | 63% | |||||||||||||
Prematurity/LBW | 88% | 12% | |||||||||||||
Birth injury | 97% | 3% | |||||||||||||
Infanticide | 46% | 54% | |||||||||||||
Others | 63% | 37% | |||||||||||||
Undiagnosed | 63% | 37% | |||||||||||||
Ngoc et al.,20 Argentina, Egypt, India, Peru, South Africa, Vietnam | Prospective | Data from multicenter study | Early neonatal deaths: 71 | Cause of death assigned by one of the investigators | Early neonatal deaths (n=71) Prematurity: 43/71 (60.6%) Asphyxia and birth trauma: 16 (22.5%) Infection: 1/71 (1.4%) Congenital anomalies: 9/71 (12.7%) Others: 2/71 (2.8%) | WHO multicenter study on calcium supplementation for prevention of pre-eclampsia | |||||||||
Kalter et al.,21 Palestine | Prospective | Clusters from West Bank, East Jerusalem, Gaza Strip | Neonatal deaths: 68 | Data collected by field workers, supervised and cause of death assigned by two investigators | Cause | Early | Late | No details on the place of delivery; respiratory distress syndrome added to prematurity Cases with two different causes of death not included | |||||||
Asphyxia (n=7) | 6 (85.7) | 1 (14.2) | |||||||||||||
Prematurity/LBW (n=16) | 11 (68.7) | 5 (31.2) | |||||||||||||
Congenital anomaly (n=15) | 12 (80) | 3 (20) | |||||||||||||
Sepsis (n=10) | 7 (70) | 3 (30) | |||||||||||||
Others (n=8) | 4 (50) | 4 (50) | |||||||||||||
Chowdhury et al.,22 Bangladesh | Retrospective; 2003–2004 | Data from HDSS | Neonatal deaths: 365 | VA by interviewers Three physicians assigned cause of death Agreement of at least two physicians required | Cause | Early | Late | No details on the place of delivery; respiratory distress syndrome added to prematurity | |||||||
Asphyxia (n=164) | 162 (98.7) | 2 (1.2) | |||||||||||||
Prematurity/LBW (n=80) | 76 (95) | 4 (5) | |||||||||||||
Sepsis (n=45) | 17 (37.7) | 28 (62.2) | |||||||||||||
Pneumonia (n=20) | 9 (45) | 11 (55) | |||||||||||||
Others (n=56) | 43 (76.7) | 13 (23.2) | |||||||||||||
Gill et al.,17 Zambia | Prospective; June 2006–November 2008 | Data from Lufwanyama district | Neonatal deaths in the control group: 58 | Data collected by data collectors; helped by birth attendants Cause of death assigned by WHO VA algorithm | Cause | Days 0–1 | Days 2–27 | Data taken from the control group of cluster RCT | |||||||
Serious infection (n=17) | 6 (64.7) | 11 (35.2) | |||||||||||||
Birth asphyxia (n=21) | 21 (100) | 0 | |||||||||||||
Prematurity (n=10) | 8 (80) | 2 (20) | |||||||||||||
Congenital defects (n=2) | 2 (100) | 0 | |||||||||||||
Diarrhea (n=4) | 0 | 4 (100) | |||||||||||||
Others/unknown (n=4) | 3 (75) | 1 (25) | |||||||||||||
Bapat et al.,15 India | Prospective; 2005–2007 | 48 slum settlements in Mumbai | Newborn deaths: 210 (but data available only for 116) | VA by trained field researchers Cause of death classified by clinicians | Cause | Early (n=87) (%) | Late (n=29) (%) | ||||||||
Asphyxia (n=33) | 32 (97) | 1 (3.0) | |||||||||||||
Prematurity/LBW (n=27) | 27 (100) | 0 (0) | |||||||||||||
Sepsis (n=25) | 5 (20) | 20 (80) | |||||||||||||
Congenital anomalies (n=7) | 5 (71.4) | 2 (28.6) | |||||||||||||
Others/unclassified (n=24) | 18 (75) | 6 (25) |
Abbreviations: HDN, hemorrhagic disease of newborn; HDSS, health and demographic surveillance system; LBW, low birth weight; NeoKIP, Knowledge into Practice for Improving Neonatal Survival; VA, verbal autopsy; WHO, World Health Organization.