perinatal deaths, 2015 - 31 july 2017
TRANSCRIPT
Perinatal Deaths in South Africa,
2015 Findings from registered
deaths, 2015Dr Pali Lehohla
Statistician-General
#StatsSA
Perinatal death defined
Perinatal deaths § are a combination of foetuses that are born dead (stillbirths) and babies that die in
the first week after birth (early neonatal deaths)
Stillbirth or foetal death§ The intra-uterine death of a product of conception of at least 26 weeks of
pregnancy; the death is indicated by the fact that after complete birth, the foetus does not breathe or show any evidence of life
Early neonatal death§ Is the death of a live born-child during the first 7 completed days of life
Why perinatal deaths count
The National Development Plan 2030 aims to improve maternal health, child survival; child
development and children’s standard of living.
National and Provincial Governments must use information available about the perinatal deaths and their
distribution by age, sex, location and proportion vulnerable in their policy formulations and planning for
improvements in:
• the decentralisation of government services• the health of children and their mothers • social protection and care of children
• The data allows us to better understand perinatal deaths in South Africa and the rest of the provinces; reflects the state of health of pregnant women, and women delivering stillbirths and newborns that die.
• Quality of information on the perinatal deaths collected can be improved through:• Accurate and full completion of all fields on the death
notification form e.g. Information on mothers • Correct and detailed information on causes of death e.g
stillbirths causes
Why perinatal deaths count
From deaths to statistics
Dr. verifies perinatal death or Nurse only for stillbirths & completes death notification form
(DHA 1663)
1 2Submitted to DHA &
entered on population register
3Stats SA receives the form, code causes of death using ICD-10, process and analyse
Statistics releasedPerinatal
death occurs
Responsible for registration of births and
deaths
Registration of perinatal deaths is governed by the Births and Death
Registration Act No. 51 of 1992, as amended
Form BI/DHA-1663
Results
Number of perinatal deaths, 2015
64% 13 702Stillbirths
21 378Total perinatal deaths
recorded in 2015
7 676Early neonatal
deaths36%
5 982
11 969
13 702
5 702
11 019
7 676
25 310
21 378
5 000
10 000
15 000
20 000
25 000
30 000
1997
1998
1999
2000
2001
2002
2003
2004
2005
2006
2007
2008
2009
2010
2011
2012
2013
2014
2015
NU
MBE
R O
F D
EATH
S
YEAR OF DEATH
Stillbirths Early neonatal deaths Perinatal deaths
Since 1999, the number of stillbirths has been
higher than early neonatal deaths
Number of registered stillbirths and early neonatal deaths by year of death, 1997−2015
7 003
12 787
11 275
5 847
10 866
9 062
3 000
6 000
9 000
12 000
15 000
1997
1998
1999
2000
2001
2002
2003
2004
2005
2006
2007
2008
2009
2010
2011
2012
2013
2014
2015
NU
MBE
R O
F PE
RIN
ATAL
DEA
THS
YEAR OF DEATH
Male Female
Number of perinatal deaths by sex and year of death, 1997−2015*
*Excluding deaths with unspecified sex
More male than female perinatal
deaths
2015
55% 45%
8 590
7 115
5 853
3 000
6 000
9 00019
97
1998
1999
2000
2001
2002
2003
2004
2005
2006
2007
2008
2009
2010
2011
2012
2013
2014
2015
NU
MBE
R O
F ST
ILLB
IRTH
S D
EATH
S
YEAR OF DEATH
Male Female
Number of stillbirths by sex and year of death, 1997−2015*
2015
55% 45%
*Excluding deaths with unspecified sex
More male than female stillbirths
4251
6267
4160
2440
4349
32093000
600019
97
1998
1999
2000
2001
2002
2003
2004
2005
2006
2007
2008
2009
2010
2011
2012
2013
2014
2015
NUMBE
ROFEA
RLYNE
ONA
TALDE
ATHS
YEAROFDEATH
Male Female
Number of early neonatal deaths by sex and year of death, 1997−2015*
More male than female early neonatal
deaths
*Excluding deaths with unspecified sex
2015
56% 44%
Provincial distribution recorded perinatal deaths - 2015
in South Africa, 2014
Unspecified: 0,1%Outside of South Africa: 0,1%
Close to half of all perinatal deaths recorded in South Africa were in
KwaZulu-Natal and Gauteng
Perinatal deaths as a percentage of total infant deaths and stillbirths by province of death, 2015
58,6
%
37,4
%
53,5
%
53,5
%
57,4
%
52,3
%
55,7
%
52,3
%
48,9
%
53,3
%
WESTERN CAPE
EASTERN CAPE
NORTHERN CAPE
FREE STATE
KWAZULU-ZULU
NORTH WEST
GAUTENG MPUMA-LANGA
LIMPOPO SOUTH AFRICA
Perinatal deaths accounted for more than half of of infant deaths and stillbirths in 7 of the 9 provinces
Perinatal deaths as a percentage of total infant deaths and stillbirths by district of death, 2015• Perinatal deaths account for over 50% of infant deaths in 41 of the 52 districts• Ranging from 17,2% in O.R Tambo to 74,0% in iLembe
Non-metro Rank Metros iLembe 74,0% 1 eThekwini 67,1%
Sisonke 70,6% 2 City of Cape Town 64,8%
West Coast 69,6% 3 Ekurhuleni 62,4%
Eden 68,1% 4 Nelson Mandela Bay 55,4%
Amajuba 67,9% 5 City of Johannesburg 55,3%
Namakwa 67,8% 6 Mangaung 54,4%
uThungulu 66,6% 7 City of Tshwane 52,0%
Ugu 65,6% 8 Buffalo City 48,8%
Sex ratios of early neonatal deaths, 2015
Sex ratios of stillbirths, 2015
LP130
MP143
KZN118
EC125
FS122
NW145
NC156
WC139
GP126
LP113
MP121
KZN115
EC124
FS138
NW121
NC132
WC115
GP130
SA 122 male per 100 female
stillbirths
SA 130 male per 100 female early
neonatal deaths
Sex ratios at perinatal death, 2015
LP120
MP128
KZN116
EC124
FS132
NW131
NC141
WC122
GP128South Africa
124 male per 100 female perinatal
deaths
Unadjusted perinatal mortality rates, 2015
Perinatal mortality rate 17,4 per 1 000 total births
Stillbirth rate 11,2 per 1 000 total births
Early neonatal rate 6,3 per 1 000 live births
Age at early neonatal death, 2015
Age in days
More than a third (37,6%) of early neonates die on their First and Only day of life
Population group of perinatal deaths, 2015
Population groupStillbirths Early neonatal
deathsPerinatal deaths
N=13 702 N= 7 676 N= 21 378
Black African 77,8% 81,5% 79,1%
Coloured 1,3% 1,1% 1,2%
White 0,6% 0,6% 0,6%
Indian or Asian 6,2% 8,2% 5,8%
Other 0,2% 0,1% 0,2%
Unspecified 14,0% 11,4% 13,1%
Distribution of stillbirths by birth weight, 2015
Birth weight (grams) Number Percentage
Less than 1 000 2 298 16,8
1 000−1 499 1 898 13,9
1 500−1 999 1 690 12,3
2 000−2 499 1 403 10,2
2 500 and above 2 595 18,9
Unspecified 3 818 27,9
Total 13 702 100,0
53,2% of recorded stillbirths weighed less than 2,5kg
Overview ofmothers experiencing
perinatal deaths
Information on mothers based on new death notification form
• The new death notification form: • Contains a section on perinatal deaths with pertinent details of both the
mother and the child while the old form only contains information on the child.
• Statistics are coded from what is recorded on the death notification form• Analysis on mother information excludes high unspecified cases• There is need for medical practitioners to fully and accurately complete
the mother’s section
• The new death notification form accounted for 96,7% (20 665) of the 21 378 perinatal deaths in 2015.
Percentage distribution of perinatal deaths by age of the mother, 2015
*Excluding unknown/unspecified
0,3%
12,7
%
24,9
%
24,5
%
19,6
%
12,8
%
4,7%
0,4%
0,1%
10-14 15−19 20−24 25−29 30−34 35−39 40−44 45−49 50−54
PER
CEN
TAG
E O
F PE
RIN
ATAL
DEA
THS
AGE OF MOTHER
N= 8 458*Almost half of perinatal deaths occur amongst mothers aged 20 to 29 years
Percentage distribution of mothers experiencing perinatal loss by outcome of last previous pregnancy, 2015
68,5%
23,3%
6,5%
N = 5 225**Excluding unknown/unspecified
Stillbirth
More than two thirds of women who experienced perinatal deaths had a previous live birth
Percentage distribution of perinatal deaths by delivery type, 2015
*Excluding unknown/unspecified
66,5% 76,7%
74,1%
29,5%
18,7%
21,5%
4,0%
4,6%
4,5%
EARLY NEONATAL DEATHS ST ILLB IRTHS PERINATAL DEATHS
Spontaneous Ceasarean section Other
N= 7 044*N= 5 233*N= 1 811*
Most perinatal deaths were delivered through spontaneous delivery
Percentage of perinatal deaths by mother’s attendant at delivery, 2015
N= 10 281*
*Excluding unknown/unspecified
N = 10 281*6,0%
2,3%
51,3%
40,4%
Other(Traditionalbirthattendant/Familymember)
Othertrainedperson
Trainedmidwife
Physician
More than 90% of deliveries were attended by a healthcare worker
Causes of Stillbirths, Early neonatal deaths &
Perinatal deaths
Proportion of perinatal deaths with Ill-defined causes
7 67
6
13 7
02
21 3
78
1,1%
60,8%
39,4%
0,0%
10,0%
20,0%
30,0%
40,0%
50,0%
60,0%
70,0%
5 000
10 000
15 000
20 000
25 000
Early neonatal deaths Stillbirths Perinatal deaths
Perc
enta
ge il
l-def
ined
Num
ber o
f per
inat
al d
eath
s
The high levels of ill-defined causes of deaths among stillbirths remain problematic
Main groups of underlying causes, 2015Percentage of perinatal deaths
Almost all perinatal deaths were due to ‘certain conditions originating in the
perinatal period’
Top ten leading broad causes of perinatal deaths
1Fetus and newborn affected by maternal factors and by complications of pregnancy, labour and delivery
21,3%
2 Respiratory and cardiovascular disorders specific to the perinatal period 17,0%
3 Disorders related to length of gestation and fetalgrowth 7,6%
4 Infections specific to the perinatal period 2,8%
5 Other congenital malformations 2,0%
6 Haemorrhagic and haematological disorders of fetus and newborn 1,5%
7 Congenital malformations of the circulatory system 0,7%
8 Congenital malformations of the nervous system 0,7%
9 Digestive system disorders of fetus and newborn 0,6%
10 Chromosomal abnormalities, not elsewhere classified 0,4%
1Fetus and newborn affected by maternal factors and by complications of pregnancy, labour and delivery
21,4%
2 Respiratory and cardiovascular disorders specific to the perinatal period 16,8%
3 Disorders related to length of gestation and fetalgrowth 7,3%
4 Infections specific to the perinatal period 2,8%
5 Other congenital malformations 1,9%
6 Haemorrhagic and haematological disorders of fetus and newborn 1,6%
7 Congenital malformations of the nervous system 0,7%
7 Congenital malformations of the circulatory system 0,7%
9 Digestive system disorders of fetus and newborn 0,7%
10 Chromosomal abnormalities, not elsewhere classified 0,5%
2014 2015
Fetus & fetal is spelt according to ICD-10 standards
Top 5 leading broad causes of death, 2015Stillbirths
13 702 Stillbirths
1. Fetus and newborn affected by maternal factors and by complications of pregnancy, labour and delivery (27,5%)
2. Respiratory and cardiovascular disorders specific to the perinatal period (4,6%)
3. Disorders related to length of gestation and fetal growth (3,7%)
4. Other congenital malformations (1,3%)5. Congenital malformations of the
nervous system (0,6%)
The Top 5 broad causes of stillbirths
represent
37,7% of stillbirths cases
Fetus & fetal is spelt according to ICD-10 standards
Top 5 leading broad causes of death, 2015Early neonatal deaths
7 676 early neonatal deaths
1. Respiratory and cardiovascular disorders specific to the perinatal period (38,5%)
2. Disorders related to length of gestation and fetal growth (13,8%)
3. Fetus and newborn affected by maternal factors and by complications of pregnancy, labour and delivery (10,4%)
4. Infections specific to the perinatal period (7,6%)
5. Haemorrhagic and haematological disorders of fetus and newborn (4,2%)
The Top 5 broad causes of death for
early neonates represent
74,5%of early neonatal
deaths
Fetus & fetal is spelt according to ICD-10 standards
South Africa top five underlying causes of stillbirths, 2015
1 Fetus and newborn affected by maternal conditions that may be unrelated to present pregnancy 14,1%
2 Fetus and newborn affected by complications of placenta, cord and membranes 10,8%
3 Intrauterine hypoxia (Lack of Oxygen) 4,1%
4 Disorders related to short gestation and low birth weight, not elsewhere classified 3,5%
5 Fetus and newborn affected by other complications of labour and delivery 1,3%
N=13 702
Fetus & fetal is spelt according to ICD-10 standards
N = 7 676
South Africa top five underlying causes of early neonatal deaths, 2015
1 Fetus and newborn affected by maternal conditions that may be unrelated to present pregnancy 14,0%
2 Disorders related to short gestation and low birth weight, not elsewhere classified 7,5%
3 Birth asphyxia (Brain lacking oxygen) 5,3%
4 Other conditions originating in the perinatal period 4,3%
5 Bacterial sepsis of newborn 4,0%
Fetus & fetal is spelt according to ICD-10 standards
South Africa top five underlying causes of perinatal deaths, 2015
1 Fetus and newborn affected by maternal conditions that may be unrelated to present pregnancy 11,2%
2 Fetus and newborn affected by complications of placenta, cord and membranes 7,8%
3 Disorders related to short gestation and low birth weight, not elsewhere classified 7,0%
4 Respiratory distress of newborn 5,1%
5 Birth asphyxia (Brain lacking oxygen) 3,4%
N = 21 378
Fetus & fetal is spelt according to ICD-10 standards
Where do perinatal deaths occur?
68,1%1,7%
Hospital
Emergency Roomoutpatient
0,9%Dead on arrival
3,5%0,4%NursingHome
Distribution of perinatal deaths by place of death occurrence, 2015
*Other, Unknown or Unspecified 25,5%
Home
Over two thirds of perinatal deaths
occurred in a hospital
Remarks
Summary• Perinatal deaths decreased by 6,8% from 22 948 in 2014 to 21 378 in 2015.
• In 2015, the proportion of stillbirths was 64,1% (13 702) whereas early neonatal deaths accounted for 34% (7 676) of all perinatal deaths.
• Overall, in 2015 there were:• 17,4 perinatal deaths per 1 000 total births; 11,2 stillbirths per 1 000 total births
& 6,3 early neonatal deaths per 1 000 live births.
• The sex profile of perinatal deaths for 2015 shows more male than female perinatal deaths. • The sex ratio at death was 124 male deaths per 100 female perinatal deaths.• All provinces had more male perinatal deaths, ranging from • 116 (KwaZulu-Natal) to 141 (Northern Cape) male perinatal deaths per 100
female perinatal deaths
• Higher proportions of perinatal deaths in Gauteng and KwaZulu-Natal.
SummaryLeading causes show that:For perinatal deaths:
• Fetus and newborn affected by maternal factors and by complications of pregnancy, labour and delivery was the leading cause of perinatal deaths in 201
• Respiratory and cardiovascular disorders specific to the perinatal period 2ndleading cause in 2015
For stillbirths & early neonatal deaths: • Stillbirths: In 2015, Fetus and newborn affected by maternal hypertensive
disorders was the 1st leading cause of stillbirths. • Early neonatal deaths: In 2015, Respiratory and cardiovascular disorders
specific to the perinatal period was the 1st leading cause of early neonatal deaths.
Fetus & fetal is spelt according to ICD10 standards
The NDP and SDGs call for ending preventable deaths of newborns and universal access to health care by 2030
Perinatal deaths show importance of:
Reducing ‘Scandal of
Invisibility’ of perinatal deaths
• Perinatal deaths account for 56% of all infant deaths
• High unspecified causes for stillbirths (61%)• 69% unspecified antenatal care visits information
Investing in maternal and
perinatal health
• High proportion of perinatal deaths can be prevented
• Top causes:N = 21 378 1. Maternal conditions unrelated to present pregnancy (11,2%)2. Complications of placenta, cord and membranes (7,8%)3. Short gestation and low birth weight (7,0%)4. Respiratory distress (5,1 %)5. Birth asphyxia (3,4%)
2015 Data set on mortality and causes of death is available on Stats SA
website or on request from Stats SA
Thank you