A review of perinatal mortality in an urban situation in a developing country

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Abstract
Perinatal deaths occurring within the City of Harare, Zimbabwe, during 1983 were studied. Data were collected from all known delivers within the city. This included exact numbers from three central maternity hospitals, and from referring midwife - run maternity clinics. An estimate was made of the number of births and perinatal deaths occurring within the city, but outside these official maternity facilities. All perinatal deaths were reviewed. The birthweight, the cause of death, and the antenatal care registration status of the mother were established. There were 2103 perinatal deaths from an estimated 53,665 total births. Deliveries includ 50,138 (93.4%) in hospitals or clinics, 972 (1.8%) before arrival to the maternity services (table I). One thousand seven hundred and fourteen (81.5%) perinatal deaths occurred in hospital or clinic delivered babies, and 134 (6.4%) from babies delivered before arrival at medical services. An estimated 255 (12.1%) of deaths occurred elsewhere (table II). A total of 6380 (12%) patients did not register for antenatal care. There were 909 (43.2%) perinatal deaths in this unregistered group of patients. The overall perinatal mortality rate (PNMR) for infants weighing 500 g or more was 39.2/1000. For registered patients the PNMR was 25.3/1000 and for unregistered patients, 142.5/1000. For infants weighing 1000 grams or more the PNMR was 31.6/1000. The causes of death in the 2103 perinatal deaths were established and classified by clinical cause (table IV) and by a simple pathological grouping with breakdown by birthweight [8] (table V). Comparison with perinatal mortality in other countries is difficult because of the wide variety of definitions used and undefined terminology noted in many papers. The recommendations of the FIGO Committee on Perinatal Mortality and Morbidity were used in this review, and we strongly recommend that they become universally adopted. The classification of perinatal deaths of recommended by Wigglesworth (table V) was found to be clear and simple to use and provided important basic data with birthweight tabulation. We hope to continue to use this classification to monitor trends in perinatal mortality within the city.

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