A comprehensive community-based case-control study conducted by the health authorities on the cause and risk factors for neonatal mortality in the district has identified domestic violence during pregnancy as one of the major risk factors.

The study report was submitted to District Medical Officer K. Salila earlier in October.

A.L. Sheeja, District Reproductive Child Health Officer; S. Subhagan, District Programme Manager of the National Rural Health Mission; and P.S. Rakesh, District Epidemiologist, conducted the study.

Neonatal death pertains to the death of a newborn baby within 28 days of its birth. The study shows that women who complained of having experienced domestic violence (physical or verbal abuse) during pregnancy have 11 times higher odds (a way of expressing probability) of having a neonatal death compared with those who did not experience domestic violence.

Domestic violence may elevate mortality risk by affecting the mother’s stress and nutritional levels or by deterring her from seeking appropriate healthcare. This conclusion as a major risk factor of neonatal death was arrived at on the basis of information collected from hospitals and verbal autopsy. Mothers of 40 infants who died and 80 babies alive were interviewed using a structured questionnaire.

The study was carried out from January to March. Preterm delivery and congenital anomalies were identified by the study as the two leading causes for neonatal deaths in the district.

Preterm delivery is delivery before 37 weeks of gestation as compared to the usual 40.

The study shows that 45 per cent of the infants who died during the neonatal period were born preterm and 22.5 per cent, before 32 weeks of gestation. “It clearly points to the fact that neonatal-care facilities are not equipped enough to handle preterm babies of less than 32-week gestation,” the study says.

Low birth weight (below 2.5 kg) was a cause for a good number of neonatal deaths in the district.

The study stresses the need to focus on preventing premature deliveries by scaling up infrastructure for the care of preterm babies. The referral pattern of neonatal deaths has shown that neonatal intensive care services are deficient in the district. It underlines the need to set up special newborn care units in the government sector to handle neonates with complications.

A majority of congenital anomalies that lead to deaths are heart defects. The facilities to do the complex correction procedures are very limited in the government sector, limiting the chances of babies to survive. The study calls for neonatal death audits in all facilities where deliveries take place in the district to ensure quality of service.

Even ambulances with trained persons and basic facilities are not available in the district for a majority of the referrals, the study says.