Epidemiology of Infant Deaths in Predominant Tribal Areas of Two Districts of Gujarat: Results of Pregnancy and Mortality Surveillance Program.

Abstract

To understand epidemiology of the neonatal and infant deaths in predominant areas of two tribal districts of Gujarat. A secondary analysis of pregnancy and mortality surveillance data was done to understand the causes and determinants of infant deaths in predominant tribal areas of two districts of Gujarat, India from 2015 to 2018. All pregnancies, their outcomes, and infant deaths were prospectively registered. A verbal autopsy tool was used to understand the cause of death. A total of 25,130 live births were recorded; 20,994 (83.5%) deliveries occurred at the hospital. Total 1,309 infant deaths (IMR-52.08/1,000 live births) and 879 neonatal deaths (NMR-34.97/1,000 live births) occurred during the program duration. The odds of infant deaths was high among male child aOR-1.5 (CI:1.3-1.7, p < 0.001), born to illiterate/primary educated mother aOR-1.2 (1.03-1.4, 0.013), born at home or on the way aOR-1.4 (1.1-1.8, 0.003), born with low birth weight (< 2.5kg), aOR-3.7 (3.2-4.3, < 0.001), born preterm (< 37 wk) aOR-1.9 (1.7-2.2, < 0.001), and born twins aOR-1.5 (1-2.1, 0.037) in comparison to female child, born to secondary/or above educated mother, born in hospital, born normal weight (>= 2.5kg), born full-term (>= 37 wk), and born single, respectively. The asphyxia/respiratory distress syndrome (RDS) 282 (56%), sepsis/pneumonia and asphyxia/RDS 188 (63%), and sepsis/pneumonia 281 (65%) were leading cause of death among 0-3 d, 4-28 d, and 29-365 d infant deaths. There is a need to improve quality of intrapartum and postpartum care. Additionally, sepsis detection among infants and referral by community health workers also need to be improved to reduce infant mortality due to sepsis.