Contents - Middle East Journal of Family Medicine

MEDICINE AND SOCIETY(2000, DHS) and in spite of the reduction in this rate,in infants and children under 5 years during the last15 years, neonatal mortality has remained stable andaccounts for 50% of deaths in children under 5 years ofage. 5 Prematurity, low weight, congenital malformationand infectious diseases are factors affecting neonataldeath in Iran. 2,6 The index of neonatal death did notreduce in Fars Province during these years and even anincrease was observed in some areas of the province. Thisindex was 16.41/1000 in rural areas of the Province in2001 and the most common causes were prematurity andmalformation. 7 So, this study was conducted to determinethe causes and factors affecting neonatal death in theregion, for intervention measures and future programs.METHODS AND MATERIALSIn a descriptive and analytical study, a questionnaire wasprovided to record and evaluate the causes of neonataldeath which were provided for all hospitals and urban andrural health centers from the beginning of the year 2004.The collected questionnaires were sent to the Office ofFars Province Neonatal Death Committee for evaluationand correction and accuracy. Data were entered in AccessSoftware and were statistically analyzed. The populationof this study was all dead neonates recorded in FarsProvince.RESULTSThe reasons and factors affecting neonatal death among417 recorded cases in urban and rural areas are presentedin Tables 1-4 and Figures 1-3. In figure 1 the rate is basedon births and percentage according to total death. Themost common cause of neonatal death was prematurity(57.07%) and the lowest one was low birth weight(3.84%). This frequency is demonstrated in Table 1 andwas higher in males.Figure 2 shows that the highest neonatal mortality ratewas in the families whose mother’s age was in the agegroup 18-35. The highest rate of births in 2004 was inthis age group.Table 2 shows neonatal death based on birth order. Thehighest mortality rate was in the first birth followedby second and third orders respectively. Of course itshould be noticed that the first, second and third births(particularly the first) were seen more often. Regardingthe importance of neonatal death in the first, second andthird orders, they were reported separately in Table 2.The data in Table 3 showed that 67% of neonatalmortality rates were in the gestational age of 37 weeksin 2004. Although prematurity was recognized as themost important factor of neonatal death in Fars Province,attention and accuracy in completing the questionnaire forcauses of death causes would be important. Fig 3 showsneonatal mortality rate in different age groups, fromwhich 30% of neonatal deaths occurred in the first dayand 42.45% after 1-7 days. Generally, 85% of neonataldeaths occurred in the first week and 50% in the first 24hours after birth. 6Table 4 shows the relationship between neonatal deathand birth weight. 52% of neonatal deaths occurred in theless than 2500 g weight group, whereas, no mortality wasseen in 18.5% of neonates in relation to birth weight.89.69% of births and 81.77% of mortalities were inhospitals showing the high percentage of labor in hospital,which seems reasonable. On the other hand, infants withmedical problems are usually admitted to hospitals withthe above mentioned causes. The most common causeof death in infants in the present study, was related tothe physicians (48.68%); and midwives (47.24%);explaining the mortality rate of the majority of infants inthe hospitals. It is notable that 2.88% of dead infants weredelivered by untrained personnel. In the present study, itwas shown that the percentage of normal labor (62.35%)was more than that by Caesarian section (3.18%).DISCUSSIONThe findings of this study showed that the mostcommon causes of neonatal death were prematurity andmalformation, which are similar to the previous studiesin Iran and in the world. In relation to this, evaluationson 96,797 cases of neonatal death in 45 countries and 56studies on 13,685 cases of death in 29 countries, haveestablished seven classifications for the main causes ofneonatal death including severe infections, neonataltetanus, diarrhoea, asphyxia, prematurity and congenitalmalformation. 8The results of the present study used the sameclassification. It is notable that based upon the abovementionedclassification, in the countries with neonatalmortality rate of 45/1000, more than 50% of deathshave been due to severe infections, neonatal tetanus anddiarrhoea, whereas, in the countries with neonatal deathless than 15/1000, severe infections covered less than20% of death causes, and malformations and prematuritywere also of importance. 9 Neonatal death occurrence inIran was affected by four main diseases and disordersincluding prematurity, low birth weight (which accountedfor 71% of deaths), congenital malformations, laboringinjuries and infections that were similar to neonatal deathcauses patterns in developed countries. 1,6,10The present study, the comparison between death causesand sex of dead neonates showed that the only differencewas between prematurity and infant sex, in which theMEJFM - Volume 5 Issue 1 - January 2007 43