Stillbirths and newborn deaths in slum settlements in Mumbai, India a prospective verbal autopsy study 英文参考文献.docVIP

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Stillbirths and newborn deaths in slum settlements in Mumbai, India a prospective verbal autopsy study 英文参考文献.doc

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Stillbirths and newborn deaths in slum settlements in Mumbai, India a prospective verbal autopsy study 英文参考文献

Bapatetal.BMCPregnancyandChildbirth2012,12:39 /1471-2393/12/39 RESEARCH ARTICLE OpenAccess Stillbirthsandnewborndeathsinslum settlementsinMumbai,India:aprospective verbalautopsystudy UjwalaBapat1,GlynAlcock2,NeenaShahMore1,SushmitaDas1,WasundharaJoshi1andDavidOsrin2* Abstract Background:Threemillionbabiesarestillborneachyearand3.6milliondieinthefirstmonthoflife.InIndia,early neonataldeathsmakeupfour-fifthsofneonataldeathsandinfantmortalitythree-quartersofunder-fivemortality. Informationisscarceoncause-specificperinatalandneonatalmortalityinurbansettingsinlow-incomecountries. WeconductedverbalautopsiesforstillbirthsandneonataldeathsinMumbaislumsettlements.Ourobjectiveswere toclassifydeathsaccordingtointernationalcause-specificcriteriaandtoidentifymajorcausesofdelayinseeking andreceivinghealthcareformaternalandnewbornhealthproblems. Methods:Overtwoyears,2005–2007,birthsandnewborndeathsin48slumareaswereidentifiedprospectivelyby localinformants.Verbalautopsieswerecollectedbytrainedfieldresearchers,causeofdeathwasclassifiedby clinicians,andfamilynarrativeswereanalysedtoinvestigatedelaysonthepathwaytomortality. Results:Of105stillbirths,65werefresh(62%)andobstetriccomplicationsdominatedthecauseclassification.Of 116neonataldeaths,87wereearlyandthemajorcauseswereintrapartum-related(28%),prematurity(23%),and severeinfection(22%).Bereavementwasassociatedwithsocioeconomicquintile,previousstillbirth,andnumberof antenatalcarevisits.Weidentified201individualdelaysin121/187birthnarratives(65%).Overall,delaysinreceiving careafterarrivalatahealthfacilitydominatedandweremostlytheresultofreferralfromoneinstitutiontoanother. Mostdelaysinseekingcarewereattributedtoafailuretorecognisesymptomsofcomplicationsortheirseverity. Conclusions:InMumbai’sslumsettlements,earlyneonataldeathsmadeup75%ofneonataldeathsand intrapartum-relatedcomplicationswerethegreatestcauseofmortality.Delayswereidentifiedintwo-thirdsof narratives,werepredominantlyrelatedtotheprovisionofcare,andwereoftenattributableto