University of Bergen Centre for International Health Academic year: 2009 Master Thesis for the Degree of Master of Philosophy in International Health (Option Clinical Epidemiology) By Abdoulaye Hama DIALLO Epidemiology of perinatal mortality in rural Burkina Faso: A community-based prospective cohort study May 2009 Table of content: Table of content:......................................................................................................................... 2 Dedication .................................................................................................................................. 4 Acknowledgment ....................................................................................................................... 5 List of abbreviations and acronym ............................................................................................. 6 Executive summary.................................................................................................................... 8 List of figures and tables ............................................................................................................ 9 List of definitions ..................................................................................................................... 10 Introduction .............................................................................................................................. 11 Study objectives ....................................................................................................................... 13 General objective: ................................................................................................................ 13 Specific objectives: .............................................................................................................. 13 Literature review & background information .......................................................................... 14 Definitions............................................................................................................................ 14 Global estimates of the perinatal mortality .......................................................................... 16 Risk factors and determinants of perinatal death ................................................................. 19 Efficacious health interventions and health policy .............................................................. 21 Perinatal mortality in Burkina Faso (A literature review).................................................... 22 Description of the study site..................................................................................................... 26 Burkina Faso ........................................................................................................................ 26 Geography ........................................................................................................................ 26 Economics ........................................................................................................................ 26 Demography and health ................................................................................................... 27 Organization of the health system and the health care..................................................... 28 Centre MURAZ Research Institute ...................................................................................... 29 History of the Centre ........................................................................................................ 29 Missions & organization .................................................................................................. 30 Experience and partnership .............................................................................................. 30 Perspectives for Centre MURAZ ..................................................................................... 31 Role in the PROMISE/EBF study.................................................................................... 31 Banfora Health District ........................................................................................................ 33 Selection and randomization of the study clusters ........................................................... 34 Study methods.......................................................................................................................... 37 Study design ......................................................................................................................... 37 Study population .................................................................................................................. 37 Sampling & randomization procedures................................................................................ 37 Training of data collectors and community-workers (peer-counsellors and recruiters) ...... 39 Recruitment and inclusion of study participants .................................................................. 41 Data collection and participants’ follow-up ......................................................................... 42 Ethical considerations .......................................................................................................... 43 Data quality control and prevention of bias ......................................................................... 43 Data management................................................................................................................. 44 Data entry and cleaning........................................................................................................ 44 Data analysis ........................................................................................................................ 45 Results ...................................................................................................................................... 47 Study profile......................................................................................................................... 47 Baseline characteristics of the cohort................................................................................... 49 Description of the perinatal deaths....................................................................................... 53 Distribution of the stillbirths ............................................................................................ 56 Master_Thesis_HamaDIALLO_Final.doc 2 Distribution of early neonatal deaths ............................................................................... 61 Analysis of risk factors......................................................................................................... 64 Risk factors for perinatal deaths....................................................................................... 64 Risk factors for stillbirths................................................................................................. 66 Risk factors for early neonatal deaths .............................................................................. 68 Sensitivity analysis............................................................................................................... 69 Discussion ................................................................................................................................ 70 Baseline characteristics of the cohort................................................................................... 70 The perinatal mortality rate .................................................................................................. 70 The risk factors for perinatal mortality ................................................................................ 73 Conclusion................................................................................................................................ 79 Recommendations .................................................................................................................... 80 Appendix .................................................................................................................................. 81 Bibliography......................................................................................................................... 81 Data collection forms (recruitment form, D7 form, verbal autopsy forms)........................ 85 Informed consent forms ..................................................................................................... 142 Ethical approval.................................................................................................................. 148 Master_Thesis_HamaDIALLO_Final.doc 3 Dedication This work is dedicated to: My beloved mother In recognition of all your sacrifices to make life better for me, your commitment to avoid me a perinatal death and your daily care for us. Thank you mom! My late father Your advice and your “upright conduct” are my source of inspiration and behaviour. Wherever you are, I am sure you rest in peace, as do the right people! My son, Barké Yasser Few days ago, I have missed for the third time your birthday when you were just celebrating your fourth anniversary. You are too young to understand the continuous moves of daddy, but I hope you will find them worthy when you will be able to read this thesis. I wish you a long and prosperous life and may you do better than your father as we say in Fulfuldé. Master_Thesis_HamaDIALLO_Final.doc