To estimate levels and determinants of perinatal mortality, we conducted a hospital-based surveillance and case-control study, linked with a population survey, in Ahmedabad, India. The perinatal mortality rate was 79.0 per 1000, and was highest for preterm low-birth-weight babies. The case-control study of 451 stillbirths, 160 early neonatal deaths and 1465 controls showed that poor maternal nutritional status, absence of antenatal care, and complications during labour were independently associated with substantially increased risks of perinatal death. Multivariate analyses indicate that socioeconomic factors largely operate through these proximate factors and do not have an independent effect. Estimates of attributable risk derived from the prevalence of exposures in the population survey suggest that improvements in maternal nutrition and antenatal and intrapartum care could result in marked reductions of perinatal mortality.
PIP: Levels and risk factors for perinatal mortality in Ahmedabad, India, were investigated through an approach that combined institutional surveillance, a case-control survey, and a linked population-based survey. In the three government teaching hospitals in Ahmedabad, there were 15,893 births in July 1987-June 1988, of which 739 were stillbirths and 517 were early (within the first week of life) neonatal deaths. The case-control study collected detailed data on 451 of these stillbirths and 160 of the early neonatal deaths while the population-based survey covered 1102 women who delivered in the study period. The perinatal mortality rate in the study hospitals was 79/1000 births (46.4/1000 for stillbirths and 34.1/1000 for early neonatal deaths). The relative risk of perinatal mortality was 21.1 (95% confidence interval, 17.8-25.2) for preterm low-birthweight infants compared to full-term normal-birthweight babies, but only 2.6 (2.1-3.2) for full-term low-birthweight infants. Multivariate analysis indicated that the risks of both stillbirth and early neonatal mortality were significantly increased by a history of previous stillbirth, prematurity in the last pregnancy, low maternal weight, clinical anemia, no prenatal care, vaginal bleeding during pregnancy, elevated diastolic blood pressure, convulsions, antepartum hemorrhage, breech delivery, Cesarean section delivery, and congenital malformations. Socioeconomic factors such as low maternal education, agricultural occupation, and lack of a toilet lost all significance after adjustment for confounding factors. Overall, these findings suggest that improved maternal nutrition and antenatal/intrapartum care could have a substantial impact on reducing perinatal mortality in India.