Perinatal Asphyxia and Infant Mortality in Low-Income Countries

Introduction

One of the main factors used to determine how healthy a population is, is its infant mortality rate. This measure is particularly effective in revealing living standards and the extent to which improvements in paediatric care have made a difference. One medical condition that newborns face after birth — known as birth asphyxia — is caused by poor oxygen intake, which can lead to acutely low oxygen levels reaching vital organs. New research into the causes of newborn fatalities is vital to reduce the alarming numbers recorded in low- and middle-income countries. Recent research has identified elderly mothers, irregular antenatal appointments, pre-eclampsia, and the misuse of sedatives and diuretics as factors that elevate maternal risk. Effective measures for reducing high newborn death rates include improvements in paediatric training, development of safe delivery facilities, better health information dissemination, and early detection of complications by trained health personnel.

Over 4% of the approximately 130 million babies born worldwide each year do not survive past their first months of life. Newborns account for 40% of all deaths among children under five years of age globally. The infant mortality rate within a population reflects its general health conditions, living standards, and the effectiveness of paediatric health improvements (Shah, Khaliue, Khan, & Amir, 2011). Postnatal birth asphyxia may be induced by factors relating to the mother, the child, or both. Those fortunate enough to survive this condition may still endure lasting neurological difficulties such as epilepsy, cerebral palsy, and developmental delay. The severity of asphyxia experienced by the child depends on its underlying causes and how effectively the condition is managed (Aslam et al., 2014).

Prematurity, low birth weight, infection, asphyxia, and intrapartum complications have been identified as the principal causes of infant mortality, collectively responsible for over 80% of fatalities in this age group (World Health Organization, 2016). Reducing newborn deaths requires proper training of paediatric personnel and intensive care for low-birth-weight and premature infants.

Identifying Causes by Verbal Autopsy

The major causes identified for newborn deaths through verbal autopsy include asphyxia, prematurity (including low birth weight), pneumonia, diarrhoea, tetanus, neonatal sepsis, neonatal jaundice, and congenital malformation. For children under five years of age, birth asphyxia, prematurity, low birth weight, and septicaemia have emerged as the leading causes of mortality based on oral reports from health personnel. Newborns are most commonly killed by postnatal asphyxia, prematurity, aspiration pneumonia, or severe respiratory distress.

The community of Aligarh, which was surveyed for one of the studies reviewed in this paper, recorded only a single death from tetanus. This low number reflects successful health education efforts and wider distribution of tetanus vaccines to pregnant women. Diarrhoea, pneumonia, and inadequate feeding were found by that study to be the leading causes of post-delivery newborn fatalities (Shah, Khaliue, Khan, & Amir, 2011).

Community Surveillance

A surveillance study covered four communities in Bangladesh (Halim et al., 2016). The recorded causes of newborn death were birth asphyxia (43%), neonatal infections — including sepsis, meningitis, and pneumonia — (29.3%), and prematurity (22.2%). Fewer newborns died from prematurity in hospital settings (16.3%) than at home (26.3%). Among newborns who died within 24 hours of birth, asphyxia accounted for 63.8% of cases, with infection comprising most of the remainder. Unlike prematurity-related deaths, asphyxia-related newborn deaths were distributed similarly across home and facility births.

The study also examined the factors influencing women's choice between health facilities and traditional birth attendants. Antenatal care attendance and previous delivery location were found to have a substantial impact. Pregnant women who attended antenatal care visits more than four times were approximately 30% more likely to deliver at a hospital rather than a traditional birth centre. Similarly, mothers who had previously delivered at hospitals — whether by vaginal delivery (93%) or Caesarean section (94%) — were highly likely to return to hospital for subsequent births. However, mothers who had given birth more than five times were approximately 26% less likely to attend a hospital, preferring traditional delivery settings instead.

Conclusion

Most newborn fatalities could be avoided if properly trained medical personnel take appropriate steps immediately after delivery. Arranging for newborns to be assessed promptly following home deliveries could significantly reduce infant mortality rates, and has also proven effective in improving critical newborn care practices (World Health Organization, 2016). Despite most fatal newborn cases receiving some degree of medical attention, birth asphyxia and infection remain the leading causes of neonatal death. Drastic improvements in the quality of care provided in both hospitals and traditional delivery centres are essential to reducing infant mortality and to achieving the global health targets established for 2030.

References

Aslam, H. M., Saleem, S., Afzal, R., Iqbal, U., Saleem, S., Abid Shaikh, M. W., & Shahid, N. (2014). Risk factors of birth asphyxia. Italian Journal of Pediatrics.

Halim, A., Dewez, J., Biswas, A., Rahman, F., White, S., & Broek, N. v. (2016). When, where, and why are babies dying? Neonatal death surveillance and review in Bangladesh. PLoS ONE.

Shah, M., Khaliue, N., Khan, Z., & Amir, A. (2011). A community-based study of infant mortality in rural Aligarh. Australasian Medical Journal, 22–25.

World Health Organization. (2016, January). Newborns: Reducing mortality. Retrieved from WHO: Newborns — Reducing Mortality