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Perinatal and Infant Mortality in Rural Burkina Faso

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Perinatal and Infant Mortality in Rural Burkina Faso Perinatal and infant mortality in rural Burkina Faso A prospective community-based cohort study Abdoulaye Hama Diallo Dissertation for the degree of philosophiae doctor (PhD) University of Bergen, Norway 2012 Abdoulaye Hama Diallo 2 Perinatal and infant mortality in rural Burkina Faso Dedication To my beloved mother For her dedication to avoid me a child death and her endless care To my late father For sending me at school while most of my age mates were just playing in the hot ‘beach’ of Dori and for raising me in strict life principles To my son Barké Yasser This was part of the reasons for my repeated absences during the first years of your life and I hope you will find this piece of work worthy To Cpt. Thomas Sankara, former President of Burkina Faso For his dedication to improve maternal and newborn heath care in rural Burkina Faso 3 Abdoulaye Hama Diallo Contributors This thesis was part of a collaborative research study between Centre MURAZ Research Institute, Ministry of Health, 01 BP 390 Bobo-Dioulasso, Burkina Faso and The Centre for International Health, University of Bergen, PO Box 7800, N-5020 Bergen, Norway. The data were partly collected through the PROMISE-EBF trial (NCT00397150) which was an EU-funded study (Contract INCO-DEV-CT 003660). Abdoulaye Hama DIALLO was a Quota student and received funding for his PhD training from the Norwegian Government through Lånekassen, the Norwegian educational loan funds. 4 Perinatal and infant mortality in rural Burkina Faso Table of contents Dedication ..............................................................................................................................................3 Contributors ..........................................................................................................................................4 Table of contents ...................................................................................................................................5 List of abbreviations .............................................................................................................................8 List of figures.......................................................................................................................................10 List of tables.........................................................................................................................................11 Glossary of terms ................................................................................................................................12 Abstract (English) ...............................................................................................................................14 Abstract (French)................................................................................................................................16 Original papers....................................................................................................................................19 Acknowledgements .............................................................................................................................20 Introduction.........................................................................................................................................21 Background information and literature review...............................................................................24 Definitions............................................................................................................................................24 Mortality outcomes .....................................................................................................................24 Course of pregnancy ...................................................................................................................25 Birth attendants ...........................................................................................................................25 The global burden of perinatal deaths..................................................................................................26 The global burden of neonatal deaths ..................................................................................................28 The global burden of infant deaths ......................................................................................................29 Causes and risk factors for perinatal death ..........................................................................................31 Factors associated with antepartum stillbirth risk.......................................................................32 Factors associated with intrapartum stillbirth risk ......................................................................32 Predictors of early neonatal death risk ........................................................................................32 Causes and risk factors for neonatal death...........................................................................................33 Causes and risk factors of infant death ................................................................................................33 Evidence-based interventions to reduce perinatal and infant mortality...............................................36 Literature review on perinatal and infant mortality in Burkina Faso...................................................40 Search methods ...........................................................................................................................40 Actual levels of perinatal and infant mortality rates in Burkina .................................................40 Causes and risk factors for perinatal and infant deaths in Burkina Faso ....................................44 Evaluation of health interventions to reduce child deaths in Burkina Faso................................44 Rationale for the studies.....................................................................................................................47 Study objectives...................................................................................................................................48 Settings.................................................................................................................................................49 Burkina Faso ........................................................................................................................................49 5 Abdoulaye Hama Diallo General overview ........................................................................................................................49 The health system........................................................................................................................50 Banfora Health District........................................................................................................................53 Study methods .....................................................................................................................................56 Study design.........................................................................................................................................56 Selection and randomization of the study villages ..............................................................................56 Study population ..................................................................................................................................57 Sample size estimation.........................................................................................................................57 Participants’ selection and enrolment procedures................................................................................59 Training of field study personnel.........................................................................................................61 Data collection and participants’ follow-up.........................................................................................63 Ethical considerations ..........................................................................................................................65 Field supervisions and prevention of bias............................................................................................66 Data management.................................................................................................................................67 Data entry and cleaning .......................................................................................................................67 Statistical analysis................................................................................................................................68 Summary of findings...........................................................................................................................71 Study profile.........................................................................................................................................71 Baseline characteristics of the cohort ..................................................................................................71 Perinatal mortality (Paper I).................................................................................................................74 Stillbirths.....................................................................................................................................74 Early
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