Use of the International Classification of Diseases to Perinatal Mortality (ICD-PM) with verbal autopsy to determine the causes of stillbirths and neonatal deaths in rural Cambodia: a population-based, prospective, cohort studyResearch in context
Summary: Background: Perinatal mortality remains a significant global health challenge, particularly in low- and middle-income countries (LMICs). Accurate cause-of-death data are essential to inform effective interventions but are often scarce. This study aimed to identify causes of stillbirths and...
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Elsevier
2025-07-01
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| Series: | The Lancet Regional Health. Western Pacific |
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| Online Access: | http://www.sciencedirect.com/science/article/pii/S2666606525001634 |
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| author | Kaajal Patel Sopheakneary Say Daly Leng Sophanou Khut Sothearith Duong Chou Ly Arthur Riedel Koung Lo Verena Carrara Claudia Turner |
| author_facet | Kaajal Patel Sopheakneary Say Daly Leng Sophanou Khut Sothearith Duong Chou Ly Arthur Riedel Koung Lo Verena Carrara Claudia Turner |
| author_sort | Kaajal Patel |
| collection | DOAJ |
| description | Summary: Background: Perinatal mortality remains a significant global health challenge, particularly in low- and middle-income countries (LMICs). Accurate cause-of-death data are essential to inform effective interventions but are often scarce. This study aimed to identify causes of stillbirths and neonatal deaths in rural Cambodia using verbal autopsy (VA) and the WHO International Classification of Diseases to Perinatal Mortality (ICD-PM). Methods: A four-year prospective study (2018–2022) in Preah Vihear province, Cambodia, established a community health worker-based pregnancy surveillance system. Verbal autopsy was conducted on stillbirths and neonatal deaths, with dual physician analysis to interpret VA data. To classify causes of death, ICD-PM was applied with adaptations made for stillbirths with unknown timing of death. Findings: A total of 522 deaths (229 stillbirths, 293 neonatal deaths) were recorded, and 79.1% (413) had a VA. Applying ICD-PM, primary causes of death were identified for 36.6% of stillbirths and 95.0% of neonatal deaths. The leading cause of death was hypoxia for intrapartum stillbirths (78.3%), low birth weight and prematurity for early neonatal deaths (40.9%), and infection for late neonatal deaths (51.4%). Complications during labour and delivery were the leading maternal contributing condition for intrapartum stillbirths (63.3%) and early neonatal deaths (42.4%). Unknown timing of death was assigned to 12.0% of stillbirths. Interpretation: Application of ICD-PM with VA-derived data provides valuable insights into causes of stillbirths and neonatal deaths. However, adaptations are necessary to address ICD-PM's limitations, particularly to classify unknown timing of death. Our findings can contribute to global efforts to improve the reporting of perinatal mortality data. Funding: This study is nested in the Saving Babies' Lives study, which was supported by funding from Angkor Hospital for Children, Civil Society in Development, Fu Tak Iam Foundation, Manan Trust, T&J Meyer Family Foundation, Vitol Foundation, IF Foundation, and Wellcome Trust [220211]. This research was funded in part by the Wellcome Trust [220211/Z/20/Z]. |
| format | Article |
| id | doaj-art-870a8ecb6be7482abfa7f657e06eeb6e |
| institution | DOAJ |
| issn | 2666-6065 |
| language | English |
| publishDate | 2025-07-01 |
| publisher | Elsevier |
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| series | The Lancet Regional Health. Western Pacific |
| spelling | doaj-art-870a8ecb6be7482abfa7f657e06eeb6e2025-08-20T03:12:01ZengElsevierThe Lancet Regional Health. Western Pacific2666-60652025-07-016010162610.1016/j.lanwpc.2025.101626Use of the International Classification of Diseases to Perinatal Mortality (ICD-PM) with verbal autopsy to determine the causes of stillbirths and neonatal deaths in rural Cambodia: a population-based, prospective, cohort studyResearch in contextKaajal Patel0Sopheakneary Say1Daly Leng2Sophanou Khut3Sothearith Duong4Chou Ly5Arthur Riedel6Koung Lo7Verena Carrara8Claudia Turner9Saving Babies' Lives Programme, Angkor Hospital for Children, PO Box 50, Siem Reap, Cambodia; Cambodia Oxford Medical Research Unit, Angkor Hospital for Children, PO Box 50, Siem Reap, Cambodia; Corresponding author. Cambodia Oxford Medical Research Unit, Angkor Hospital for Children, Siem Reap, Cambodia.Saving Babies' Lives Programme, Angkor Hospital for Children, PO Box 50, Siem Reap, CambodiaSaving Babies' Lives Programme, Angkor Hospital for Children, PO Box 50, Siem Reap, CambodiaSaving Babies' Lives Programme, Angkor Hospital for Children, PO Box 50, Siem Reap, CambodiaSaving Babies' Lives Programme, Angkor Hospital for Children, PO Box 50, Siem Reap, CambodiaSaving Babies' Lives Programme, Angkor Hospital for Children, PO Box 50, Siem Reap, CambodiaSaving Babies' Lives Programme, Angkor Hospital for Children, PO Box 50, Siem Reap, CambodiaPreah Vihear Provincial Health Department, Preah Vihear, CambodiaCentre for Tropical Medicine and Global Health, Nuffield Department of Medicine, University of Oxford, Oxford, OX3 7FZ, UK; Institute of Global Health, Faculty of Medicine, University of Geneva, Geneva, SwitzerlandSaving Babies' Lives Programme, Angkor Hospital for Children, PO Box 50, Siem Reap, Cambodia; Cambodia Oxford Medical Research Unit, Angkor Hospital for Children, PO Box 50, Siem Reap, Cambodia; Centre for Tropical Medicine and Global Health, Nuffield Department of Medicine, University of Oxford, Oxford, OX3 7FZ, UKSummary: Background: Perinatal mortality remains a significant global health challenge, particularly in low- and middle-income countries (LMICs). Accurate cause-of-death data are essential to inform effective interventions but are often scarce. This study aimed to identify causes of stillbirths and neonatal deaths in rural Cambodia using verbal autopsy (VA) and the WHO International Classification of Diseases to Perinatal Mortality (ICD-PM). Methods: A four-year prospective study (2018–2022) in Preah Vihear province, Cambodia, established a community health worker-based pregnancy surveillance system. Verbal autopsy was conducted on stillbirths and neonatal deaths, with dual physician analysis to interpret VA data. To classify causes of death, ICD-PM was applied with adaptations made for stillbirths with unknown timing of death. Findings: A total of 522 deaths (229 stillbirths, 293 neonatal deaths) were recorded, and 79.1% (413) had a VA. Applying ICD-PM, primary causes of death were identified for 36.6% of stillbirths and 95.0% of neonatal deaths. The leading cause of death was hypoxia for intrapartum stillbirths (78.3%), low birth weight and prematurity for early neonatal deaths (40.9%), and infection for late neonatal deaths (51.4%). Complications during labour and delivery were the leading maternal contributing condition for intrapartum stillbirths (63.3%) and early neonatal deaths (42.4%). Unknown timing of death was assigned to 12.0% of stillbirths. Interpretation: Application of ICD-PM with VA-derived data provides valuable insights into causes of stillbirths and neonatal deaths. However, adaptations are necessary to address ICD-PM's limitations, particularly to classify unknown timing of death. Our findings can contribute to global efforts to improve the reporting of perinatal mortality data. Funding: This study is nested in the Saving Babies' Lives study, which was supported by funding from Angkor Hospital for Children, Civil Society in Development, Fu Tak Iam Foundation, Manan Trust, T&J Meyer Family Foundation, Vitol Foundation, IF Foundation, and Wellcome Trust [220211]. This research was funded in part by the Wellcome Trust [220211/Z/20/Z].http://www.sciencedirect.com/science/article/pii/S2666606525001634CambodiaNeonatal mortalityPerinatal mortalityStillbirthsCommunity health workerSurveillance |
| spellingShingle | Kaajal Patel Sopheakneary Say Daly Leng Sophanou Khut Sothearith Duong Chou Ly Arthur Riedel Koung Lo Verena Carrara Claudia Turner Use of the International Classification of Diseases to Perinatal Mortality (ICD-PM) with verbal autopsy to determine the causes of stillbirths and neonatal deaths in rural Cambodia: a population-based, prospective, cohort studyResearch in context The Lancet Regional Health. Western Pacific Cambodia Neonatal mortality Perinatal mortality Stillbirths Community health worker Surveillance |
| title | Use of the International Classification of Diseases to Perinatal Mortality (ICD-PM) with verbal autopsy to determine the causes of stillbirths and neonatal deaths in rural Cambodia: a population-based, prospective, cohort studyResearch in context |
| title_full | Use of the International Classification of Diseases to Perinatal Mortality (ICD-PM) with verbal autopsy to determine the causes of stillbirths and neonatal deaths in rural Cambodia: a population-based, prospective, cohort studyResearch in context |
| title_fullStr | Use of the International Classification of Diseases to Perinatal Mortality (ICD-PM) with verbal autopsy to determine the causes of stillbirths and neonatal deaths in rural Cambodia: a population-based, prospective, cohort studyResearch in context |
| title_full_unstemmed | Use of the International Classification of Diseases to Perinatal Mortality (ICD-PM) with verbal autopsy to determine the causes of stillbirths and neonatal deaths in rural Cambodia: a population-based, prospective, cohort studyResearch in context |
| title_short | Use of the International Classification of Diseases to Perinatal Mortality (ICD-PM) with verbal autopsy to determine the causes of stillbirths and neonatal deaths in rural Cambodia: a population-based, prospective, cohort studyResearch in context |
| title_sort | use of the international classification of diseases to perinatal mortality icd pm with verbal autopsy to determine the causes of stillbirths and neonatal deaths in rural cambodia a population based prospective cohort studyresearch in context |
| topic | Cambodia Neonatal mortality Perinatal mortality Stillbirths Community health worker Surveillance |
| url | http://www.sciencedirect.com/science/article/pii/S2666606525001634 |
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