Commentary: Utilizing information on causes of neonatal deaths in less-developed countries

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Using rigorous and transparent methods, Lawn et al. 3 have provided, for 193 countries in the year 2000, systematic estimates, with associated uncertainty, of the distribution of neonatal deaths for programme-relevant causes. Only 2.5% of neonatal deaths had reliable cause-of-death information available through vital registration systems, primarily in well-developed countries. The distribution of reported causes of deaths varied substantially between countries and across studies. The major direct causes of neonatal deaths globally were estimated to be infections (sepsis, pneumonia, tetanus, and diarrhoea; 35%), preterm birth (28%), and birth asphyxia (23%). There was substantial uncertainty around these estimates owing to the limited quantity and quality of data from settings in which the great majority (97.5%) of neonatal deaths had occurred. It is obvious that complex statistical models are not a panacea, and collecting reliable information on the causes of deaths should receive due attention. Simultaneously, it would be pertinent to highlight other important limitations and practical implications of this review. Several studies included in this review, primarily from low-income and middle-income countries, used verbal autopsy (lay reporting) tools to determine the causes of deaths. The neonate, especially in the first week of life, offers a limited symptomatic response to different insults resulting in substantial overlap of clinical manifestations of several diseases. The sensitivity and specificity of verbal autopsy technique in correctly identifying various causes of deaths is, therefore, sub-optimal. Validation studies suggest that although major congenital malformations and neonatal tetanus have high levels of sensitivity (0.79–0.98 for tetanus) and specificity (>0.9), the performance for other important conditions like septicaemia is poor. 4,5 The instrument using both open-ended