Being born is still a risky experience in many developing countries. The infant mortality rate in Nepal was approximately 95 per 1000 live births in 1994. The WHO estimates that around three percent of newborns suffer mild to moderate birth asphyxia - an inadequate supply of oxygen. This can cause brain damage, stillbirth or early death among babies. How common is birth asphyxia in Nepal? How can health services improve the survival of these babies?

Prasuti Griha is the major maternity hospital for the entire Kathmandu valley, delivering over 50 percent of the children born in the area. Researchers from the UK Institute of Child Health studied records from 14771 births at the hospital during the one year study period to discover the contribution of birth asphyxia to infant deaths and brain damage or 'neonatal encephalopathy' (NE).

Over the year, they found that:

• There were 400 stillbirths, and 254 babies died before leaving hospital.
• The prevalence of stillbirths was 8.5 per 1000 total births and of NE was 6.4 per 1000 live births.
• Sixty percent of cases of NE were either moderate or severe and mortality in this group was high.

It is likely that almost all of the stillbirths were due to birth asphyxia. The researchers estimate that birth asphyxia causes 10.8 deaths per 1000 live births, nearly a quarter of all perinatal deaths.

Birth asphyxia is probably a less important cause of disability among urban populations in developing countries than previously thought, as the mortality rate is so high. However, the majority of births in Nepal, as in much of south Asia, occur away from urban hospitals. The perinatal mortality rate is higher for home births, but the proportion of infants surviving NE is probably similar.

Programmes designed to reduce birth asphyxia in this urban population should aim to extend foetal monitoring to cover all the processes of labour and to encourage earlier obstetric intervention. But how can this be achieved when the majority of births occur outside of hospital? The researchers discuss several strategies, some of which could be incorporated into the training for traditional birth attendants (TBAs), including:

• supplying antenatal advice and supplements to improve general maternal health
• referring high-risk patients before birth to birthing centres or obstetric units where more intensive monitoring and interventions are available
• improving recognition of foetal distress during labour and encouraging transfers to obstetric units
• enhancing early management of asphyxiated infants, through basic resuscitation training and equipment for TBAs
• recommending appropriate referral of significantly asphyxiated infants.

Source(s):
'Stillbirths and neonatal encephalopathy in Kathmandu, Nepal: an estimate of the contribution of birth asphyxia to perinatal mortality in a low-income urban population' by M. Ellis, D. Manandhar, N. Manandhar, J. Wyatt, A. Bolam and A. Costello, Paediatric and Perinatal Epidemiology 14 (2000)

Funded by: The Wellcome Trust; UK Department for International Development

id21 Research Highlight: 22 February 2002

Further Information:
Matthew Ellis
Senior Clinical Lecturer in Child Health
Westgate House
Southmead Hospital
Bristol BS10 5NB

Tel: +44 (0)117 959 5364
Fax: +44 (0)117 959 5363
Contact the contributor: m.ellis@bristol.ac.uk

University of Bristol, UK

Anthony Costello
International Perinatal Care Unit
Centre for International Child Health
Institute of Child Health
30 Guildford Street
London WC1N 1EH
UK

Tel: +44 (0)20 7905 2261
Fax: +44 (0)20 7404 2062
Contact the contributor: A.Costello@ich.ucl.ac.uk

Institute of Child Health, University of London

Other related links:
Women and Children first is a health charity focussing particularly on the perinatal period.

See id21's collection of links relevant to maternal and child health.