A PROSPECTIVE AUTOPSY STUDY OF THE CAUSES OF PERINATAL AND UNDER-FIVE MORTALITY AT THE UNIVERSITY OF UYO TEACHING HOSPITAL (U.U.T.H.), NIGERIA

PROSPECTIVE AUTOPSY STUDY OF THE CAUSES OF PERINATAL AND UNDER-FIVE MORTALITY AT THE UNIVERSITY OF UYO TEACHING HOSPITAL (U.U.T.H.), NIGERIA
Abstract

Introduction/Aim: Perinatal and childhood mortality is a global health burden with an estimated 8.1 million under-five deaths in 2009. The highest rates of child mortality is in sub Saharan Africa and South East Asia. The millennium development goal four (MDG-4) which targets the reduction of childhood mortality by two thirds from 1990 to 2015 can only be realizable if adequate and accurate epidemiological information is available to prioritize, plan, and implement public health interventions. Autopsy validation of cause of death information is one way of improving accuracy of our vital statistics. Materials and Method: the study was a one year (January to December 2012) prospective autopsy study of all the perinatal and under-five mortalities for which an informed consent was duly obtained. All autopsies were performed according to a defined working protocol Results: There were a total of 2967 deliveries recorded in UUTH for the year 2012 with a perinatal mortality rate of 119.2/1000 total births while the under-five mortality rate is 103.8/1000 live births. The perinatal autopsy rate is 50.3% while the under-five autopsy rate is 44.9%. the overall male to female ratio is 1.14:1. The most common causes of perinatal death are infection (30.3%),placental causes (20.6%), and prematurity/immaturity (16.0%). Congenital anomalies accounted for 10.9% of deaths. Respiratory and cardiovascular disorders specific to the perinatal period accounted for most under-five deaths (24.7%), infections were responsible for 18.4%, while pre-maturity was responsible for 14.4% of under-five deaths. Conclusion: This study shows that perinatal and childhood mortality is still a major problem in our environment. We would suggest that a multidisciplinary perinatal death team be put in place with a perinatal death protocol that will institutionalize perinatal autopsies.

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Background
The Millennium Development Goal #4 to reduce child
mortality by two thirds by the end of 2015 resulted in an
unprecedented focus on child health and a 52% reduc-
tion in sub-Saharan Africa between 1990 to 2015, from
179 to 86 deaths per 1000 live births [1]. Despite global
achievements, only one-third of the priority countries in
sub-Saharan Africa reached their child mortality target.
This achievement gap translated into an estimated 2.9
million child deaths in 2015 in sub-Saharan Africa, of
which two-thirds were likely from preventable causes [2]
and 45% occurred in the neonatal period. Poverty and
maternal education continue to play a key role in deter-
mining child mortality, and severe challenges remain in
health care financing, human resources, service
utilization, and information systems [3–5].
Rwanda, a country of 11.4 million people in the Great
Lakes region of Africa, has made dramatic improve-
ments in child mortality, moving from 37 neonatal and
152 under-5 deaths per 1000 live births in 2005 to 20
and 50 per 1000 live births, respectively, in 2015 [6].
This reduction in child mortality occurred in the context
of multiple cross-sectional national and decentralized in-
terventions designed to increase access to care, improve
health resources, and strengthen the provision of effect-
ive care. These included the national introduction of a
community health insurance program, high coverage for
vaccination and vitamin A supplementation, implemen-
tation of community-based Integrated Management of
Childhood Illness (IMCI), provision of insecticide
treated nets, near elimination of mother to child HIV in-
fections, increase in facility-based deliveries, and mobile
phone reporting/support for emergency pre- and
post-natal care [7–9].
Despite these efforts, child mortality in Rwanda, as in
other countries in resource-poor regions of sub-Saharan
Africa, varies widely across the country. Child mortality
remains higher in the Eastern Province of Rwanda,
which has the highest infant (51 deaths per 1000 live
births) and under-5 mortality (86 deaths per 1000 live
births) as compared to other provinces [6]. Nationally,
under-5 mortality is largely associated with poverty (84/
1000 live births in the lowest wealth quintile vs. 40/1000
live births in the highest quintile), maternal education
(89/1000 live births in mothers with no education vs.
43/1000 for women with secondary education or higher),
and residence (70/1000 in rural areas vs. 51/1000 in
urban areas) [7]. However, the immediate causes and
sociodemographic drivers for mortality particularly
among those in the lowest wealth quintiles are poorly
understood.
In order to fill this knowledge gap, we implemented a
verbal social autopsy (VSA). In addition to the biologic
factors identified in traditional verbal autopsy interviews,

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