BACKGROUND: Reliable data on births and deaths particularly
at the community level are scarce yet they are urgently needed
to inform policy and assess the improvements which may have
occurred with recent interventions.
OBJECTIVE: To determine neonatal mortality rate and identify
perinatal risk factors associated with neonatal deaths.
METHODS: In a community-based prospective study, baseline
data on births and deaths were collected as they occurred in a
rural community of Southwest Nigeria from 1993 to 1998. Data
on births and deaths were collected for the period.
RESULTS: There were 972 live births and 64 infant deaths
giving an infant mortality rate of 65.8 per 1000. Neonatal deaths
accounted for a half of all infant deaths (N=32) giving a neonatal
mortality rate of 32.9 per 1000. Twelve (37.5%) of neonatal deaths
occurred on the first day of life; half of all neonatal deaths
occurred within two days of birth, 21(65.6%) occurred during
the first seven days of life and only 11 (34.4%) occurred over the
last three weeks of the first month. The commonest known cause
of death was associated with low birth weight (LBW) which was
responsible for eight (25%) of deaths, while sepsis/fever and
maternal deaths/failure to thrive were responsible for four
(12.5%) and three (9.4%) deaths respectively. Asphyxia accounted
for 3(9.4%) deaths; neonatal tetanus, congenital abnormality
and diarrhoea were responsible for one (3.1%) death each. Cause
of death was unclassified in many early neonatal deaths
particularly those which occurred at home. Predictors of
neonatal death included LBW {RR=4.7 (1.7-13.1) p=0.03},
delivery outside a health facility {RR=3.6 (1.001-13.2) p=0.05},
lack of attendant at delivery {RR=5.01 (1.3–19.1) p=0.018} and
Traditional Birth Attendant (TBA) delivering the baby {RR=2.7
(1.1–6.4) p=0.03). Effect of sex of the neonate, mother and fathers’
ages were not significant at the 5% level in the model.
CONCLUSION: Neonatal deaths contribute significantly to the
high infant mortality in this rural community. Services provided
by TBAs are not optimal but appear to be better than having no
one in attendance at delivery. TBAs therefore need to be trained
to identify at risk neonates and refer. Obstetric and public health
services have to be available and made more accessible at the
grass root level.