Impact of socioeconomic conditions on perinatal mortality in Karachi.

OBJECTIVE To study and compare the perinatal mortality (PNM) in hospitals located in various socio-economic areas of Karachi. DESIGN A prospective review of all births was done from May 1996 to April 1997. Precoded proformas were provided to each hospital and the birth and details of each mother and baby delivered recorded. SETTING All mothers and their newborn delivered during the time period mentioned. OUTCOME MEASURES Comparison of PNM in hospitals located in various socio-economic areas of Karachi. RESULTS A total of 4957 proformas were filled, 63.5% by doctors, 32% by LHVs, 2.9% by administrator and 2.3% by paramedics. Overall 92.3% mothers were housewives, less than 45% of the mothers received primary/secondary education; 42% mothers were of the age 21 to 25 years. More than 52.3% fathers were unskilled labourers. Only 27% mothers were booked while the rest were unbooked or came to deliver on walk in basis. Majority (62%) of the mothers had a > 37 week duration of pregnancy and 51% newborns were male and 49% female. Twenty three percent of the newborns weighed < 2500 grams, remaining weighed > 2500 grams but less than 4500 grams; 24.5% newborns died on day one of birth. The PNM per 1000 births in the high, middle and low socioeconomic hospital was 16.4 +/- 23.6, 24.9 +/- 51.20 and 80.4 +/- 177.78 respectively. A statistical significance (p < 0.0000) by the Chi-square for several proportions was seen between the high middle and low socioeconomic hospitals of Karachi. CONCLUSION The present socioeconomic conditions will take some time to change. However, this study indicates that perinatal mortality rate may be changed by an improvement in antenatal care of the mother, hence the fetus.