A prospective survey was carried out in two Kathmandu hospitals and two rural districts to establish urban and rural perinatal mortality rates (PNMRs) for these four centres in Nepal and to ascertain the causes of perinatal mortality. All perinatal deaths occurring over a 1-year period in the four centres were included (during which time there was a total of 14,967 births). Cause of death was established by contemporary review of hospital case records or by structured questionnaire ('verbal autopsy') in the rural areas. The PNMRs in the hospitals were 48.0 and 23.7 per thousand total births respectively, whilst those of the rural settings were 96.2 and 42.5 per thousand births. Perinatal asphyxia, low birthweight and infection were the most common causes but many of the deaths were unexplained. The high mortality rates were felt to reflect the difficult circumstances of childbirth in Nepal. It was concluded that a number of interventions would appear appropriate, but that these should be introduced in a scientific manner.
PIP: A prospective survey was carried out in 2 Kathmandu hospitals and 2 rural districts to establish urban and rural perinatal mortality rates (PNMRs) and to ascertain the causes of perinatal mortality. The sites chosen for community-based studies were in Lalitpur district in the Kathmandu valley and Jumla in the remote north-west of Nepal as the second site. All perinatal deaths occurring over a 1-year period in the 4 centers were included. Cause of death was established by contemporary review of hospital case records or by structured questionnaire in the rural areas. The previous pregnancy was a live birth in 82% of cases at the Maternity Hospital, in 76% at Patan Hospital, in 87% in Jumla, and in 79% of cases from Lalitpur. On the other hand the overall poor outcome from previous pregnancies appeared to correlate with the present perinatal mortality rates. The PNMRs in the hospitals were 48.0 and 23.7 per 1000 total births, respectively, while those of the rural settings were 96.2/1000 and 42.5/1000 births. Perinatal asphyxia, low birth weight, and infection were the most common causes, but many of the deaths were unexplained. 32% of women at the Maternity Hospital had a previous pregnancy loss compared with 29% at Patan Hospital, 24% at Lalitpur and at Jumla. At Patan Hospital nearly 90% of patients had attended an antenatal clinic. Conversely, at the Maternity Hospital only 40% of women with a perinatal loss had received antenatal care; and in Jumla and Lalitpur less than 20% of women had. In Jumla 79% of the perinatal deaths were preterm and in Lalitpur 50%. At Patan Hospital, the PNMR in this weight category was 769.2/1000 and at Maternity Hospital 876.6/1000 total births. PNMRs were higher for male infants in the Maternity Hospital (51.7/1000 vs. 43/1000), in Patan Hospital (32/1000 vs. 15/1000), and in Jumla (108/1000 vs. 81/1000). Recognized risk factors for perinatal mortality were confirmed, such as increasing parity, increasing age, and being male.