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Cause-specific neonatal mortality: analysis of 3772 neonatal deaths in Nepal, Bangladesh, Malawi and India
  1. Edward Fottrell1,
  2. David Osrin1,
  3. Glyn Alcock1,
  4. Kishwar Azad2,
  5. Ujwala Bapat3,
  6. James Beard1,
  7. Austin Bondo4,
  8. Tim Colbourn1,
  9. Sushmita Das3,
  10. Carina King1,
  11. Dharma Manandhar5,
  12. Sunil Manandhar5,
  13. Joanna Morrison1,
  14. Charles Mwansambo6,
  15. Nirmala Nair7,
  16. Bejoy Nambiar1,
  17. Melissa Neuman1,
  18. Tambosi Phiri8,
  19. Naomi Saville1,
  20. Aman Sen5,
  21. Nadine Seward1,
  22. Neena Shah Moore3,
  23. Bhim Prasad Shrestha5,
  24. Bright Singini8,
  25. Kirti Man Tumbahangphe5,
  26. Anthony Costello1,
  27. Audrey Prost1
  1. 1University College London, Institute for Global Health, London, UK
  2. 2Diabetic Association of Bangladesh, Perinatal Care Project, Dhaka, Bangladesh
  3. 3Society for Nutrition, Education and Health Action, Mumbai, India
  4. 4Parent and Child Health Initiative, Lilongwe, Malawi
  5. 5Mother and Infant Research Activities, Kathmandu, Nepal
  6. 6Ministry of Health, Government of Malawi, Lilongwe, Malawi
  7. 7Ekjut, Chakradharpur, India
  8. 8MaiMwana Project, Mchinji, Malawi
  1. Correspondence to Dr Edward Fottrell, University College London, Institute for Global Health, 30 Guilford Street, London WC1N 1EH, UK; e.fottrell{at}


Objective Understanding the causes of death is key to tackling the burden of three million annual neonatal deaths. Resource-poor settings lack effective vital registration systems for births, deaths and causes of death. We set out to describe cause-specific neonatal mortality in rural areas of Malawi, Bangladesh, Nepal and rural and urban India using verbal autopsy (VA) data.

Design We prospectively recorded births, neonatal deaths and stillbirths in seven population surveillance sites. VAs were carried out to ascertain cause of death. We applied descriptive epidemiological techniques and the InterVA method to characterise the burden, timing and causes of neonatal mortality at each site.

Results Analysis included 3772 neonatal deaths and 3256 stillbirths. Between 63% and 82% of neonatal deaths occurred in the first week of life, and males were more likely to die than females. Prematurity, birth asphyxia and infections accounted for most neonatal deaths, but important subnational and regional differences were observed. More than one-third of deaths in urban India were attributed to asphyxia, making it the leading cause of death in this setting.

Conclusions Population-based VA methods can fill information gaps on the burden and causes of neonatal mortality in resource-poor and data-poor settings. Local data should be used to inform and monitor the implementation of interventions to improve newborn health. High rates of home births demand a particular focus on community interventions to improve hygienic delivery and essential newborn care.

  • Neonatology
  • Mortality
  • Epidemiology
  • Measurement
  • Data Collection

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