Public Health Importance of Birth Asphyxia in Kathmandu, Nepal

Background Birth asphyxia is considered to be an important cause of perinatal mortality and neurodevelopmental impairment but epidemiological data from developing countries is scarce. Objectives To describe the prevalence, risk factors and outcome of birth asphyxia in the main maternity hospital in Kathmandu, Nepal where more than 50% of local mothers deliver. Methods The prevalence of birth asphyxia Design: Prospective descriptive cross-sectional survey Subjects: 14,771 births Outcomes: Fresh stillbirths (SB) over 2.0 kg/Neonatal encephalopathy (NE) in term infants / Perinatal death Risk factors for neonatal encephalopathy and fresh stillbirth in term infants Design: Retrospective case control study Subjects: 131 NE cases / 107 fresh stillbirths over 2.0 kg / 635 controls Outcomes following neonatal encephalopathy Design: Prospective cohort study Subjects: 131 NE cases / 208 controls Outcomes: Death / Neurodevelopmental impairment at one year Results The prevalence of birth asphyxia The prevalence of fresh stillbirth and NE (as measures of birth asphyxia in term infants) were 8.5 per 1000 total births and 6.4 per 1000 livebirths respectively. Birth asphyxia in term infants accounts for 24% of the total perinatal mortality of 44 per 1000 total births in the study population. Risk factors for neonatal encephalopathy and fresh stillbirth Evidence of intrapartum compromise was more likely during the labours of fresh stillbirths (76%) and NE infants (68%) than of controls (12%). Multivariate analysis found significant (p