Baby survival in Zambia: Stillbirth and neonatal death in a local hospital setting

7 April, 2019

Dear HIFA-Zambia and CHIFA colleagues,

I was interested to read this paper in BMC Pregnancy and Childbirth. Citation, abstract, selected extracts and a comment from me below.

CITATION: Baby survival in Zambia: Stillbirth and neonatal death in a local hospital setting

BMC Pregnancy and Childbirth. 19 (1) (no pagination), 2019. Article

Date of Publication: 12 Mar 2019.

Miyoshi Y.; Matsubara K.; Takata N.; Oka Y.


Background: Globally, 2.6 million stillbirths occur every year. Of these, 98% occur in developing countries. According to the United Nations Children's Fund, the neonatal mortality rate in Zambia in 2014 was 2.4%. In 2016, the World Health Organization released the International Classification of Diseases - Perinatal Mortality (ICD-PM) as a globally applicable and comparable system for the classification of the causes of perinatal deaths. However, data for developing countries are scarce. The aim of this study was to evaluate the rates and causes of stillbirths and neonatal deaths at a local hospital in Zimba, Zambia to identify opportunities for preventive interventions.

Method(s): All cases of stillbirths and neonatal deaths at Zimba Mission Hospital in Zambia in 2017 were included in this study. Outborn neonates who were transferred to the hospital and later died were also included in the study. Causes of stillbirths and neonatal deaths were analyzed and classified according to ICD-PM.

Result(s): In total, 1754 babies were born via 1704 deliveries at the hospital, and 28 neonates were transferred to the hospital after birth. The total number of perinatal deaths was 75 (4.2%), with 7 deaths in the antepartum, 25 deaths in the intrapartum, and 43 deaths in the neonatal period. Most antepartum deaths (n = 5; 71.4%) were classified as fetal deaths of unspecified causes. Intrapartum deaths were due to acute intrapartum events (n = 21; 84.0%) or malformations, deformations, or chromosomal abnormalities (n = 4; 16.0%). Neonatal deaths were related primarily to complications from intrapartum events (n = 19; 44.2%); low birth weight or prematurity (n = 16; 37.2%); or infection (n = 3; 7.0%).

Conclusion(s): Perinatal deaths were associated with acute intrapartum events and considered preventable in 40 cases (53.3%). Effective interventions to prevent perinatal deaths are needed.


'There were 3 perinatal deaths due to entrapment of the head that resulted from lack of training. Another 6 cases of stillbirth were referred for cord prolapse. Staff at health centers should have been trained to push up the presenting part to prevent umbilical cord compression and refer these patients earlier to prevent those deaths. Therefore, training on breech delivery and management of cord prolapse is essential.

'abnormal signs on CTG, such as late deceleration, are often missed and monitoring is not continuous, even for patients at risk for preeclampsia. Seven babies (9.3%) in this study were impacted by this failure to monitor appropriately. Earlier detection by staff may have led to cesarean section and prevented perinatal death.'

'In addition to improving perinatal care at health care facilities, appropriate education for pregnant women is crucially important to reduce the rate of stillbirths and neonatal deaths.'

Comment (NPW): This paper provides information on causes of death and suggests 'More than half of perinatal deaths resulted from acute intrapartum events that could have been prevented'. What is needed is a better understanding of why those deaths were not prevented, including pre-admission decisions and actions and in-facility health care. Social autopsy and hospital audit have a role in this respect, but social autopsy is a rarely used research method and systematic hospital audit is challenging in low-resource settings (though arguably it could be much stronger). An alternative approach is to measure quality of care, including assessment of staffing levels and competencies. Can CHIFA members provide examples of the above and how they can be implemented?

Best wishes, Neil

Joint Coordinator, CHIFA Project on Newborn Care

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CHIFA profile: Neil Pakenham-Walsh is the coordinator of the HIFA campaign (Healthcare Information For All) and assistant moderator of the CHIFA forum. Twitter: @hifa_org FB: