Abstract
Georgia has one of the highest perinatal mortality rates (i.e., stillbirths and early neonatal deaths combined) in Europe. The Georgian Birth Registry was started in 2016 to provide data for preventive measures of maternal and child health. In this study, we aim to determine the incidence of perinatal mortality, assess the distribution of stillbirths and early neonatal deaths, and to determine the major causes of perinatal mortality in Georgia. Data sources were the Georgian Birth Registry and the vital registration system for the year 2017. Causes of early neonatal deaths were assigned into five categories, using the Wigglesworth classification with the Neonatal and Intrauterine deaths Classification according to Etiology modification. The study used descriptive statistics only, specifically counts, means, proportions, and rates, using the statistical software STATA version 15.0 (StataCorp, College Station, TX, USA). In 2017, 489 stillbirths and 238 early neonatal deaths were recorded, resulting in a perinatal mortality rate of 13.6 per 1000 births. About 80% of stillbirths had an unknown cause of death. The majority of stillbirths occurred before the start of labor (85%), and almost one-third were delivered by caesarean section (28%). Prematurity (58%) and congenital malformations (23%) were the main causes of early neonatal deaths, and 70% of early neonatal deaths occurred after the first day of life. The perinatal mortality rate in Georgia remained high in 2017. The major causes of early neonatal deaths were comparable to those of many high-income countries. Contrary to global data, most early neonatal deaths occurred after the first day of life.
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World Health Organization, UNICEF. Every newborn: An action plan to end preventable deaths. 2014. http://www.healthynew-bornnetwork.org/hnn-content/uploads/Every_Newborn_Action_Plan-ENGLISH_updated_July2014.pdf (accessed June 3, 2017).
UNICEF, World Health Organization, World Bank Group, United Nations. Levels & Trends in Child Mortality. 2015. https://data.unicef.org/wp-content/uploads/2015/12/IGME-report-2015-child-mortality-final_236.pdf (accessed June 10, 2017).
Lehtonen L, Gimeno A, Parra-Llorca A, Vento M. Early neonatal death: a challenge worldwide. Semin Fetal and Neonatal Med. 2017;22;153–60.
Pathirana J, Muñoz FM, Abbing-Karahagopian V, Bhat N, Harris T, Kapoor A, et al. Neonatal death: case definition & guidelines for data collection, analysis, and presentation of immunization safety data. Vaccine 2016;34;6027–37.
Lawn JE, Cousens S, Zupan J. 4 million neonatal deaths: when? where? why? Lancet 2005;365;891–900.
Lawn JE, Kerber K, Enweronu-Laryea C, Cousens S. 3.6 million neonatal deaths—what is progressing and what is not? Semin Perinatol 2010;34;371–86.
Oza S, Cousens SN, Lawn JE. Estimation of daily risk of neonatal death, including the day of birth, in 186 countries in 2013: a vital-registration and modelling-based study. Lancet Glob Health 2014;2;e635–e44.
Ending preventable stillbirths, an executive summery for The Lancet’s series. 2016. http://www.thelancet.com/pb/assets/raw/Lancet/stories/series/stillbirths2016-exec-summ.pdf (accessed June 13, 2017).
Blencowe H, Cousens S, Jassir FB, Say L, Chou D, Mathers C, et al. National, regional, and worldwide estimates of stillbirth rates in 2015, with trends from 2000: a systematic analysis. Lancet Glob Health 2016;4;e98–e108.
Brämer GR. International statistical classification of diseases and related health problems. Tenth revision. World Health Stat Q 1988;41:32–6.
Tavares Da Silva F, Gonik B, McMillan M, Keech C, Dellicour S, Bhange S, et al. Stillbirth: case definition and guidelines for data collection, analysis, and presentation of maternal immunization safety data. Vaccine 2016;34;6057–68.
Berhan Y, Berhan A. Perinatal mortality trends in Ethiopia. Ethiop J Health Sci 2014;24 Suppl;29–40.
Yirgu R, Molla M, Sibley L, Gebremariam A. Perinatal mortality magnitude, determinants and causes in west Gojam: population-based nested case-control study. PLoS One 2016;11;e0159390.
Gardosi J, Kady SM, McGeown P, Francis A, Tonks A. Classification of stillbirth by relevant condition at death (ReCoDe): population based cohort study. BMJ 2005;331;1113–17.
Frøen JF, Pinar H, Flenady V, Bahrin S, Charles A, Chauke L, et al. Causes of death and associated conditions (Codac) — a utilitarian approach to the classification of perinatal deaths. BMC Pregnancy Childbirth 2009;9;22.
Gamkrelidze A, Kereselidze M, Gambashidze K, Kandelaki L, Kazanjan K, Shakhnazarova M, et al. Health Care Statistical yearbook, Georgia: NCDC; 2017. http://ncdc.ge/Handlers/GetFile.ashx?ID=114b7ef6-0fa1-424a-9c01-6af08ffa63cc
Ministry of Labour, Health and Social Affairs of Georgia. Perinatal health Report Georgia 2016. 2017. http://ncdc.ge/Handlers/GetFile.ashx?ID=84ea74ca-f670-4243-ba6b-2ee8558dfc9d (accessed February 22, 2018) (in Georgian language)
World Health Organization. European health for all database (HFA-DB). 2017. http://www.euro.who.int/en/data-and-evidence/databases/european-health-for-all-family-of-databases-hfa-db (Updated June 15, 2018) (accessed September 20, 2017).
Ministry of Labour, Health and Social Affairs of Georgia. National strategy of supporting maternal and child health in Georgia 2017–2030. 2017. https://matsne.gov.ge/ka/document/view/3825285 (accessed February 10, 2018) (In Georgian language)
Anda EE, Nedberg IH, Rylander C, Gamkrelidze A, Turdziladze A, Skjeldestad FE, et al. Implementing a birth registry in a developing country - experiences from Georgia. Tidsskr Nor Laegeforen 2017;138–43.
Mmbaga BT, Lie RT, Olomi R, Mahande MJ, Kvåle G, Daltveit AK. Cause-specific neonatal mortality in a neonatal care unit in Northern Tanzania: a registry based cohort study. BMC Pediatr 2012;12;116.
Winbo IG, Serenius FH, Dahlquist GG, Källén BA. NICE, a new cause of death classification for stillbirths and neonatal deaths. Int J Epidemiol 1998;27;499–504.
Patel RM, Kandefer S, Walsh MC, Bell EF, Carlo WA, Laptook AR, et al. Causes and timing of death in extremely premature infants from 2000 through 2011. N Engl J Med 2015;372;331–40.
World Health Organization. Neonatal and perinatal mortality: country, regional and global estimates. 2006. http://apps.who.int/iris/bitstream/handle/10665/43444/9241563206_eng.pdf?se-quence=1&isAllowed=y (accessed May 15, 2018).
Reinebrant HE, Leisher SH, Coory M, Henry S, Wojcieszek AM, Gardener G, et al. Making stillbirths visible: a systematic review of globally reported causes of stillbirth. BJOG 2018;125;212–24.
Allanson ER, Muller M, Pattinson RC. Causes of perinatal mortality and associated maternal complications in a South African province: challenges in predicting poor outcomes. BMC Pregnancy Childbirth 2015;15;37.
Stormdal Bring H, Hulthén Varli IA, Kublickas M, Papadogiannakis N, Pettersson K. Causes of stillbirth at different gestational ages in singleton pregnancies. Acta Obstet Gynecol Scand 2014;93;86–92.
Demirel G, Tezel B, Ozbas S, Oguz SS, Erdeve O, Uras N, et al. Rapid decrease of neonatal mortality in Turkey. Matern Child Health J 2013;17;1215–21.
Shapiro-Mendoza CK, Lackritz EM. Epidemiology of late and moderate preterm birth. Semin Fetal Neonatal Med 2012; 17;120–5.
Tomashek KM, Shapiro-Mendoza CK, Davidoff MJ, Petrini JR. Differences in mortality between late-preterm and term singleton infants in the United States, 1995–2002. J Pediatr 2007;151;450–456.e1.
Norwegian Institute of Public Health. Medical birth registry and Abortion registry, FHI. 2016. https://www.fhi.no/en/hn/health-registries/medical-birth-registry-of-norway/medical-birth-registry-of-norway/
Oza S, Lawn JE, Hogan DR, Mathers C, Cousens SN. Neonatal cause-of-death estimates for the early and late neonatal periods for 194 countries: 2000–2013. Bull World Health Organ 2015;93;19–28.
Lawn JE, Lee AC, Kinney M, Sibley L, Carlo WA, Paul VK, et al. Two million intrapartum-related stillbirths and neonatal deaths: where, why, and what can be done? Int J Gynaecol Obstet 2009;107 Suppl 1;S5–S19.
Lawn J, Shibuya K, Stein C. No cry at birth: global estimates of intrapartum stillbirths and intrapartum-related neonatal deaths. Bull World Health Organ 2005;83;409–17.
Lawn JE, Manandhar A, Haws RA, Darmstadt GL. Reducing one million child deaths from birth asphyxia — a survey of health systems gaps and priorities. Health Res Policy Syst 2007;5;4.
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Data availability statement: An anonymized version of the dataset is available upon request.
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Manjavidze, T., Rylander, C., Skjeldestad, F.E. et al. Incidence and Causes of Perinatal Mortality in Georgia. J Epidemiol Glob Health 9, 163–168 (2019). https://doi.org/10.2991/jegh.k.190818.001
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DOI: https://doi.org/10.2991/jegh.k.190818.001