Risk Factors Associated with Birth Asphyxia in Rural District Matiari, Pakistan: A Case Control Study
ABSTRACT
Background: During the past two decades there has been a sustained decline in child mortality; however, neonatal mortality has remained stagnant. Each year approximately 4 million babies are born asphyxiated resulting in 2 million neonatal deaths and intrapartum stillbirths. Almost all neonatal deaths occur in developing countries, where the majority is delivered at homes with negligible antenatal care and poor perinatal services. Objectives: To identify socio-demographic and clinical risk factors associated with birth asphyxia in Matiari District of Sindh Province, Pakistan. Method: A matched case control study was conducted in Matiari District with 246 cases and 492 controls. Newborn deaths with birth asphyxia diagnosed through verbal autopsy accreditation during 2005 and 2006 were taken as cases. Controls were the live births during the same period, matched on area of residence, gender and age. Result: The factors found to be associated with birth asphyxia mortality in Matiari District of Sindh Province, Pakistan are maternal education, history of stillbirths, pregnancy complications (including smelly or excessive vaginal discharge and anemia), intrapartum complications (including fever, prolong or difficult labour, breech delivery, cord around child’s neck, premature delivery, large baby size) and failure to establish spontaneous respiration after birth. Conclusion and Recommendation: There is an immediate need to develop strategies for early identification and management of factors associated with birth asphyxia by involving women, families, communities, community health workers, health professionals and policy makers. Community health workers should be trained for emergency obstetric care, basic newborn care including preliminary resuscitation measures to provide skilled birth attendance and encourage early recognition and referral.
Cite this paper
Tabassum, F. , Rizvi, A. , Ariff, S. , Soofi, S. and Bhutta, Z. (2014) Risk Factors Associated with Birth Asphyxia in Rural District Matiari, Pakistan: A Case Control Study. International Journal of Clinical Medicine, 5, 1430-1441. doi: 10.4236/ijcm.2014.521181.
Tabassum, F. , Rizvi, A. , Ariff, S. , Soofi, S. and Bhutta, Z. (2014) Risk Factors Associated with Birth Asphyxia in Rural District Matiari, Pakistan: A Case Control Study. International Journal of Clinical Medicine, 5, 1430-1441. doi: 10.4236/ijcm.2014.521181.
References
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[1] UN Inter-Agency Group (2013) Levels & Trends in Child Mortality. [2] Lawn, J.E., et al. (2014) Every Newborn: Progress, Priorities, and Potential beyond Survival. Lancet, 384, 189-205.
http://dx.doi.org/10.1016/S0140-6736(14)60496-7 [3] (2013) Levels and Trends in Child Mortality. The World Bank, United Nations. [4] Lawn, J.E., et al. (2012) Newborn Survival: A Multi-Country Analysis of a Decade of Change. Health Policy Plan, 27, iii6-iii28. http://dx.doi.org/10.1093/heapol/czs053 [5] Lopez, A.D., et al. (2006) Global and Regional Burden of Disease and Risk Factors, 2001: Systematic Analysis of Population Health Data. Lancet, 367, 1747-1757. http://dx.doi.org/10.1016/S0140-6736(06)68770-9 [6] (2013) Committing to Child Survival: A Promise Renewed. [7] Lopez, A.D. and Mathers, C.D. (2006) Measuring the Global Burden of Disease and Epidemiological Transitions: 2002-2030. Annals of Tropical Medicine and Parasitology, 100, 481-499. http://dx.doi.org/10.1179/136485906X97417 [8] Leviton, A. and Nelson, K.B. (1992) Problems with Definitions and Classifications of Newborn Encephalopathy. Pediatric Neurology, 8, 85-90. http://dx.doi.org/10.1016/0887-8994(92)90026-U [9] Casey, B.M., McIntire, D.D. and Leveno, K.J. (2001) The Continuing Value of the Apgar Score for the Assessment of Newborn Infants. New England Journal of Medicine, 344, 467-471. http://dx.doi.org/10.1056/NEJM200102153440701 [10] Murray, C.J.L. and Lopez, A.D. (1996) The Global Burden of Disease: A Comprehensive Assessment of Mortality and Disability Form Diseases, Injuries and Risk Factors in 1990 and Projected to 2020. Harvard University Press, Cambridge, 429-453. [11] Lawn, J.E., Manandhar, A., Haws, R.A. and Darmstadt, G.L. (2007) Reducing One Million Child Deaths from Birth Asphyxia—A Survey of Health Systems Gaps and Priorities. Health Research Policy and Systems, 5, 4.
http://dx.doi.org/10.1186/1478-4505-5-4 [12] World Health Organization (2005) World Health Report. WHO, Geneva.
http://www.who.int/whr/2004/annex/en/index.html [13] World Health Organization (1997) Basic Newborn Resuscitation: A Practical Guide. WHO, Geneva. [14] Rademakers, R.P., van der Knaap, M.S., Verbeeten Jr., B., Barth, P.G. and Valk, J. (1995) Central Cortico-Subcortical Involvement: A Distinct Pattern of Brain Damage Caused by Perinatal and Postnatal Asphyxia in Term Infants. Journal of Computer Assisted Tomography, 19, 256-263. http://dx.doi.org/10.1097/00004728-199503000-00017 [15] Gadian, D.G., Aicardi, J., Watkins, K.E., Porter, D.A., Mishkin, M. and Vargha-Khadem, F. (2000) Developmental Amnesia Associated with Early Hypoxic-Ischaemic Injury. Brain, 123, 499-507.
http://dx.doi.org/10.1093/brain/123.3.499 [16] Barkovich, A.J. (1992) MR and CT Evaluation of Profound Neonatal and Infantile Asphyxia. AJNR: American Journal of Neuroradiology, 13, 959-972. [17] Mañeru, C., Serra-Grabulosa, J.M., Junqué, C., Salgado-Pineda, P., Bargalló, N., Olondo, M., et al. (2003) Residual Hippocampal Atrophy in Asphyxiated Term Neonates. Journal of Neuroimaging, 13, 68-74.
http://dx.doi.org/10.1111/j.1552-6569.2003.tb00159.x
http://dx.doi.org/10.1177/1051228402239720 [18] Toft, P.B. (1999) Prenatal and Perinatal Striatal Injury: A Hypothetical Cause of Attention-Deficit-Hyperactivity Disorder? Pediatric Neurology, 21, 602-610. http://dx.doi.org/10.1016/S0887-8994(99)00046-6 [19] Van Petten, C. (2004) Relationship between Hippocampal Volume and Memory Ability in Healthy Individuals across the Lifespan: Review and Meta-Analysis. Neuropsychologia, 42, 1394-1413.
http://dx.doi.org/10.1016/j.neuropsychologia.2004.04.006 [20] de Haan, M., Wyatt, J.S., Roth, S., Vargha-Khadem, F., Gadian, D. and Mishkin, M. (2006) Brain and Cognitive-Behavioral Development after Asphyxia at Term Birth. Developmental Science, 9, 350-358.
http://dx.doi.org/10.1111/j.1467-7687.2006.00499.x [21] De Long, G.R. (1992) Autism, Amnesia, Hippocampus, and Learning. Neuroscience & Biobehavioral Reviews, 16, 63-70. http://dx.doi.org/10.1016/S0149-7634(05)80052-1 [22] Dilenge, M.E., Majnemer, A. and Shevell, M.I. (2001) Long-Term Developmental Outcome of Asphyxiated Term Neonates. Journal of Child Neurology, 16, 781-792.
http://dx.doi.org/10.1177/08830738010160110201 [23] Lou, H.C. (1996) Etiology and Pathogenesis of Attention-Deficit Hyperactivity Disorder (ADHD): Significance of Prematurity and Perinatal Hypoxic-Haemodynamic Encephalopathy. Acta Paediatrica, 85, 1266-1271.
http://dx.doi.org/10.1111/j.1651-2227.1996.tb13909.x [24] Dilenge, M.E., Majnemer, A. and Shevell, M.I. (2001) Long-Term Developmental Outcome of Asphyxiated Term Neonates. Journal of Child Neurology, 16, 781-792.
http://dx.doi.org/10.1177/08830738010160110201 [25] Committee on Fetus and Newborn, American Academy of Pediatrics, and Committee on Obstetric Practice, American College of Obstetricians and Gynecologists (1996) American Academy of Pediatrics: Use and Abuse of the Apgar Score. Pediatrics, 98, 141-142. [26] Pakistan Demographic and Health Survey 2006-2007. [27] Lee, A.C., Mullany, L.C., Tielsch, J.M., Katz, J., Khatry, S.K., LeClerq, S.C., et al. (2008) Risk Factors for Neonatal Mortality Due to Birth Asphyxia in Southern Nepal: A Prospective, Community-Based Cohort Study. Pediatrics, 121, e1381-e1390. http://dx.doi.org/10.1542/peds.2007-1966 [28] Cruz-Anguiano, V., Talavera, J.O., Vázquez, L., Antonio, A., Castellanos, A., Lezana, M.A. and Wacher, N.H. (2004) The Importance of Quality of Care in Perinatal Mortality: A Case-Control Study in Chiapas, Mexico. Archives of Medical Research, 35, 554-562. http://dx.doi.org/10.1016/j.arcmed.2004.11.014 [29] Shireen, N., Nahar, N. and Mollah, A.H. (2009) Risk Factors and Short-Term Outcome of Birth Asphyxiated Babies in Dhaka Medical College Hospital. Bangladesh Journal of Child Health, 33, 83-89. [30] Bouwhuis, S.A. and Davis, M.D. (2004) Contribution of Sexually Transmitted Diseases and Socioeconomic Factors to Perinatal Mortality in Rural Ghana. International Journal of Dermatology, 43, 27-30.
http://dx.doi.org/10.1111/j.1365-4632.2004.01841.x [31] Gissler, M., Merilainen, J., Vuori, E. and Hemminki, E. (2003) Register Based Monitoring Shows Decreasing Socioeconomic Differences in Finnish Perinatal Health. Journal of Epidemiology and Community Health, 57, 433-439.
http://dx.doi.org/10.1136/jech.57.6.433 [32] Stephansson, O., Dickman, P.W., Johansson, A.L. and Cnattingius, S. (2001) The Influence of Socioeconomic Status on Stillbirth Risk in Sweden. International Journal of Epidemiology, 30, 1296-1301.
http://dx.doi.org/10.1093/ije/30.6.1296 [33] Surkan, P.J., Stephansson, O., Dickman, P.W. and Cnattingius, S. (2004) Previous Preterm and Small-for-Gestational-Age Births and the Subsequent Risk of Stillbirth. The New England Journal of Medicine, 350, 777-785.
http://dx.doi.org/10.1056/NEJMoa031587 [34] Crawford, J.S. (1966) Maternal Age as an Isolated Factor in the Incidence of Perinatal Asphyxia. American Journal of Obstetrics and Gynecology, 94, 281-282. [35] Chalumeau, M., Salanave, B., Bouvier-Colle, M.H., de Bernis, L., Prual, A. and Bréart, G. (2000) Risk Factors for Perinatal Mortality in West Africa: A Population-Based Study of 20326 Pregnancies. MOMA Group. Acta Paediatrica, 89, 1115-1121. http://dx.doi.org/10.1111/j.1651-2227.2000.tb03361.x [36] Jansone, M., Lindmark, G. and Langhoff-Roos, J. (2001) Perinatal Deaths and Insufficient Antenatal Care in Latvia. Acta Obstetricia et Gynecologica Scandinavica, 80, 1091-1095. http://dx.doi.org/10.1034/j.1600-0412.2001.801203.x [37] Milsom, I., Ladfors, L., Thiringer, K., Niklasson, A., Odeback, A. and Thornberg, E. (2002) Influence of Maternal, Obstetric and Fetal Risk Factors on the Prevalence of Birth Asphyxia at Term in a Swedish Urban Population. Acta Obstetricia et Gynecologica Scandinavica, 81, 909-917.
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