Perinatal deaths, comprising stillbirths and deaths during the first week of life, were monitored over the eight-year period 1979 to 1986 in a rural Bangladeshi population of 196,000. The perinatal mortality rate was 75 per 1000 total births. The rate was 13% higher in males than females. Stillbirth and early neonatal mortality rates were 37 and 38 per 1000 total births, respectively. The major causes of perinatal deaths are presented, as well as some of the maternal determinants. During the period under study, perinatal mortality declined regularly and significantly over time in an area covered by an intensive Family Planning and Health Services programme, but not in the adjacent control area. This raises the issue of the impact of such a programme upon perinatal mortality, and the need to include a strong maternity care component into primary healthcare strategies if further reductions of perinatal mortality are to be achieved.
PIP: In 1986, as part of the ongoing Demographic Surveillance System of the International Centre for Diarrhoeal Disease Research, Bangladesh, health workers regularly visited households in Matlab district to record vital events and other demographic data. They recorded 497 fetal deaths and early neonatal deaths. Low birth weight contributed to 25% of fetal deaths followed by prolonged labor (19%), maternal medical problems (13%), malpresentation at term (12%), and twins (2%). The cause of fetal death for 28% could not be determined. Similarly, low birth weight causes 63% of very early neonatal deaths followed by prolonged labor (31%) and 37% and 15% respectively in 4-7 day old neonates. The 2nd leading cause of death for 4-7 day old neonates was neonatal tetanus (25%w0. Males were more likely to die from tetanus than females (relative risk=4.3; p=.015). The women at lowest risk included those 20-24 years old who were pregnant for the 2nd-3rd time, those 25-29 years old who were pregnant for the 4th-5th time, and those 30-34-years old who were pregnant for the 6th-7th time. Even though the perinatal mortality rates in the study and comparison areas in Matlab did not significantly differ (74 and 75 total births/1000), the rate fell significantly from 82 (1979) to 65 (1986) in the area where maternal and child health and family planning services (MCH-FP) existed (p.001). Further, the rate declined significantly more in the 2nd half of the study period (1983-1986) than in the 1st half (1979-1982) in the MCH-FP area (p.002). Moreover the difference between the 2 areas was only significant in the 2nd half (p.04). Perinatal mortality was highest from August to December. The researchers credit the tetanus toxoid as having more of an impact on reducing the perinatal mortality in the study area than family planning interventions.