Perinatal Deaths in South Africa,

2015 Findings from registered

deaths, 2015Dr Pali Lehohla

Statistician-General

#StatsSA

Perinatal death defined

Perinatal deaths § are a combination of foetuses that are born dead (stillbirths) and babies that die in

the first week after birth (early neonatal deaths)

Stillbirth or foetal death§ The intra-uterine death of a product of conception of at least 26 weeks of

pregnancy; the death is indicated by the fact that after complete birth, the foetus does not breathe or show any evidence of life

Early neonatal death§ Is the death of a live born-child during the first 7 completed days of life

Why perinatal deaths count

The National Development Plan 2030 aims to improve maternal health, child survival; child

development and children’s standard of living.

National and Provincial Governments must use information available about the perinatal deaths and their

distribution by age, sex, location and proportion vulnerable in their policy formulations and planning for

improvements in:

• the decentralisation of government services• the health of children and their mothers • social protection and care of children

• The data allows us to better understand perinatal deaths in South Africa and the rest of the provinces; reflects the state of health of pregnant women, and women delivering stillbirths and newborns that die.

• Quality of information on the perinatal deaths collected can be improved through:• Accurate and full completion of all fields on the death

notification form e.g. Information on mothers • Correct and detailed information on causes of death e.g

stillbirths causes

Why perinatal deaths count

From deaths to statistics

Dr. verifies perinatal death or Nurse only for stillbirths & completes death notification form

(DHA 1663)

1 2Submitted to DHA &

entered on population register

3Stats SA receives the form, code causes of death using ICD-10, process and analyse

Statistics releasedPerinatal

death occurs

Responsible for registration of births and

deaths

Registration of perinatal deaths is governed by the Births and Death

Registration Act No. 51 of 1992, as amended

Form BI/DHA-1663

Results

Number of perinatal deaths, 2015

64% 13 702Stillbirths

21 378Total perinatal deaths

recorded in 2015

7 676Early neonatal

deaths36%

5 982

11 969

13 702

5 702

11 019

7 676

25 310

21 378

5 000

10 000

15 000

20 000

25 000

30 000

1997

1998

1999

2000

2001

2002

2003

2004

2005

2006

2007

2008

2009

2010

2011

2012

2013

2014

2015

NU

MBE

R O

F D

EATH

S

YEAR OF DEATH

Stillbirths Early neonatal deaths Perinatal deaths

Since 1999, the number of stillbirths has been

higher than early neonatal deaths

Number of registered stillbirths and early neonatal deaths by year of death, 1997−2015

7 003

12 787

11 275

5 847

10 866

9 062

3 000

6 000

9 000

12 000

15 000

1997

1998

1999

2000

2001

2002

2003

2004

2005

2006

2007

2008

2009

2010

2011

2012

2013

2014

2015

NU

MBE

R O

F PE

RIN

ATAL

DEA

THS

YEAR OF DEATH

Male Female

Number of perinatal deaths by sex and year of death, 1997−2015*

*Excluding deaths with unspecified sex

More male than female perinatal

deaths

2015

55% 45%

8 590

7 115

5 853

3 000

6 000

9 00019

97

1998

1999

2000

2001

2002

2003

2004

2005

2006

2007

2008

2009

2010

2011

2012

2013

2014

2015

NU

MBE

R O

F ST

ILLB

IRTH

S D

EATH

S

YEAR OF DEATH

Male Female

Number of stillbirths by sex and year of death, 1997−2015*

2015

55% 45%

*Excluding deaths with unspecified sex

More male than female stillbirths

4251

6267

4160

2440

4349

32093000

600019

97

1998

1999

2000

2001

2002

2003

2004

2005

2006

2007

2008

2009

2010

2011

2012

2013

2014

2015

NUMBE

ROFEA

RLYNE

ONA

TALDE

ATHS

YEAROFDEATH

Male Female

Number of early neonatal deaths by sex and year of death, 1997−2015*

More male than female early neonatal

deaths

*Excluding deaths with unspecified sex

2015

56% 44%

Provincial distribution recorded perinatal deaths - 2015

in South Africa, 2014

Unspecified: 0,1%Outside of South Africa: 0,1%

Close to half of all perinatal deaths recorded in South Africa were in

KwaZulu-Natal and Gauteng

Perinatal deaths as a percentage of total infant deaths and stillbirths by province of death, 2015

58,6

%

37,4

%

53,5

%

53,5

%

57,4

%

52,3

%

55,7

%

52,3

%

48,9

%

53,3

%

WESTERN CAPE

EASTERN CAPE

NORTHERN CAPE

FREE STATE

KWAZULU-ZULU

NORTH WEST

GAUTENG MPUMA-LANGA

LIMPOPO SOUTH AFRICA

Perinatal deaths accounted for more than half of of infant deaths and stillbirths in 7 of the 9 provinces

Perinatal deaths as a percentage of total infant deaths and stillbirths by district of death, 2015• Perinatal deaths account for over 50% of infant deaths in 41 of the 52 districts• Ranging from 17,2% in O.R Tambo to 74,0% in iLembe

Non-metro Rank Metros iLembe 74,0% 1 eThekwini 67,1%

Sisonke 70,6% 2 City of Cape Town 64,8%

West Coast 69,6% 3 Ekurhuleni 62,4%

Eden 68,1% 4 Nelson Mandela Bay 55,4%

Amajuba 67,9% 5 City of Johannesburg 55,3%

Namakwa 67,8% 6 Mangaung 54,4%

uThungulu 66,6% 7 City of Tshwane 52,0%

Ugu 65,6% 8 Buffalo City 48,8%

Sex ratios of early neonatal deaths, 2015

Sex ratios of stillbirths, 2015

LP130

MP143

KZN118

EC125

FS122

NW145

NC156

WC139

GP126

LP113

MP121

KZN115

EC124

FS138

NW121

NC132

WC115

GP130

SA 122 male per 100 female

stillbirths

SA 130 male per 100 female early

neonatal deaths

Sex ratios at perinatal death, 2015

LP120

MP128

KZN116

EC124

FS132

NW131

NC141

WC122

GP128South Africa

124 male per 100 female perinatal

deaths

Unadjusted perinatal mortality rates, 2015

Perinatal mortality rate 17,4 per 1 000 total births

Stillbirth rate 11,2 per 1 000 total births

Early neonatal rate 6,3 per 1 000 live births

Age at early neonatal death, 2015

Age in days

More than a third (37,6%) of early neonates die on their First and Only day of life

Population group of perinatal deaths, 2015

Population groupStillbirths Early neonatal

deathsPerinatal deaths

N=13 702 N= 7 676 N= 21 378

Black African 77,8% 81,5% 79,1%

Coloured 1,3% 1,1% 1,2%

White 0,6% 0,6% 0,6%

Indian or Asian 6,2% 8,2% 5,8%

Other 0,2% 0,1% 0,2%

Unspecified 14,0% 11,4% 13,1%

Distribution of stillbirths by birth weight, 2015

Birth weight (grams) Number Percentage

Less than 1 000 2 298 16,8

1 000−1 499 1 898 13,9

1 500−1 999 1 690 12,3

2 000−2 499 1 403 10,2

2 500 and above 2 595 18,9

Unspecified 3 818 27,9

Total 13 702 100,0

53,2% of recorded stillbirths weighed less than 2,5kg

Overview ofmothers experiencing

perinatal deaths

Information on mothers based on new death notification form

• The new death notification form: • Contains a section on perinatal deaths with pertinent details of both the

mother and the child while the old form only contains information on the child.

• Statistics are coded from what is recorded on the death notification form• Analysis on mother information excludes high unspecified cases• There is need for medical practitioners to fully and accurately complete

the mother’s section

• The new death notification form accounted for 96,7% (20 665) of the 21 378 perinatal deaths in 2015.

Percentage distribution of perinatal deaths by age of the mother, 2015

*Excluding unknown/unspecified

0,3%

12,7

%

24,9

%

24,5

%

19,6

%

12,8

%

4,7%

0,4%

0,1%

10-14 15−19 20−24 25−29 30−34 35−39 40−44 45−49 50−54

PER

CEN

TAG

E O

F PE

RIN

ATAL

DEA

THS

AGE OF MOTHER

N= 8 458*Almost half of perinatal deaths occur amongst mothers aged 20 to 29 years

Percentage distribution of mothers experiencing perinatal loss by outcome of last previous pregnancy, 2015

68,5%

23,3%

6,5%

N = 5 225**Excluding unknown/unspecified

Stillbirth

More than two thirds of women who experienced perinatal deaths had a previous live birth

Percentage distribution of perinatal deaths by delivery type, 2015

*Excluding unknown/unspecified

66,5% 76,7%

74,1%

29,5%

18,7%

21,5%

4,0%

4,6%

4,5%

EARLY NEONATAL DEATHS ST ILLB IRTHS PERINATAL DEATHS

Spontaneous Ceasarean section Other

N= 7 044*N= 5 233*N= 1 811*

Most perinatal deaths were delivered through spontaneous delivery

Percentage of perinatal deaths by mother’s attendant at delivery, 2015

N= 10 281*

*Excluding unknown/unspecified

N = 10 281*6,0%

2,3%

51,3%

40,4%

Other(Traditionalbirthattendant/Familymember)

Othertrainedperson

Trainedmidwife

Physician

More than 90% of deliveries were attended by a healthcare worker

Causes of Stillbirths, Early neonatal deaths &

Perinatal deaths

Proportion of perinatal deaths with Ill-defined causes

7 67

6

13 7

02

21 3

78

1,1%

60,8%

39,4%

0,0%

10,0%

20,0%

30,0%

40,0%

50,0%

60,0%

70,0%

5 000

10 000

15 000

20 000

25 000

Early neonatal deaths Stillbirths Perinatal deaths

Perc

enta

ge il

l-def

ined

Num

ber o

f per

inat

al d

eath

s

The high levels of ill-defined causes of deaths among stillbirths remain problematic

Main groups of underlying causes, 2015Percentage of perinatal deaths

Almost all perinatal deaths were due to ‘certain conditions originating in the

perinatal period’

Top ten leading broad causes of perinatal deaths

1Fetus and newborn affected by maternal factors and by complications of pregnancy, labour and delivery

21,3%

2 Respiratory and cardiovascular disorders specific to the perinatal period 17,0%

3 Disorders related to length of gestation and fetalgrowth 7,6%

4 Infections specific to the perinatal period 2,8%

5 Other congenital malformations 2,0%

6 Haemorrhagic and haematological disorders of fetus and newborn 1,5%

7 Congenital malformations of the circulatory system 0,7%

8 Congenital malformations of the nervous system 0,7%

9 Digestive system disorders of fetus and newborn 0,6%

10 Chromosomal abnormalities, not elsewhere classified 0,4%

1Fetus and newborn affected by maternal factors and by complications of pregnancy, labour and delivery

21,4%

2 Respiratory and cardiovascular disorders specific to the perinatal period 16,8%

3 Disorders related to length of gestation and fetalgrowth 7,3%

4 Infections specific to the perinatal period 2,8%

5 Other congenital malformations 1,9%

6 Haemorrhagic and haematological disorders of fetus and newborn 1,6%

7 Congenital malformations of the nervous system 0,7%

7 Congenital malformations of the circulatory system 0,7%

9 Digestive system disorders of fetus and newborn 0,7%

10 Chromosomal abnormalities, not elsewhere classified 0,5%

2014 2015

Fetus & fetal is spelt according to ICD-10 standards

Top 5 leading broad causes of death, 2015Stillbirths

13 702 Stillbirths

1. Fetus and newborn affected by maternal factors and by complications of pregnancy, labour and delivery (27,5%)

2. Respiratory and cardiovascular disorders specific to the perinatal period (4,6%)

3. Disorders related to length of gestation and fetal growth (3,7%)

4. Other congenital malformations (1,3%)5. Congenital malformations of the

nervous system (0,6%)

The Top 5 broad causes of stillbirths

represent

37,7% of stillbirths cases

Fetus & fetal is spelt according to ICD-10 standards

Top 5 leading broad causes of death, 2015Early neonatal deaths

7 676 early neonatal deaths

1. Respiratory and cardiovascular disorders specific to the perinatal period (38,5%)

2. Disorders related to length of gestation and fetal growth (13,8%)

3. Fetus and newborn affected by maternal factors and by complications of pregnancy, labour and delivery (10,4%)

4. Infections specific to the perinatal period (7,6%)

5. Haemorrhagic and haematological disorders of fetus and newborn (4,2%)

The Top 5 broad causes of death for

early neonates represent

74,5%of early neonatal

deaths

Fetus & fetal is spelt according to ICD-10 standards

South Africa top five underlying causes of stillbirths, 2015

1 Fetus and newborn affected by maternal conditions that may be unrelated to present pregnancy 14,1%

2 Fetus and newborn affected by complications of placenta, cord and membranes 10,8%

3 Intrauterine hypoxia (Lack of Oxygen) 4,1%

4 Disorders related to short gestation and low birth weight, not elsewhere classified 3,5%

5 Fetus and newborn affected by other complications of labour and delivery 1,3%

N=13 702

Fetus & fetal is spelt according to ICD-10 standards

N = 7 676

South Africa top five underlying causes of early neonatal deaths, 2015

1 Fetus and newborn affected by maternal conditions that may be unrelated to present pregnancy 14,0%

2 Disorders related to short gestation and low birth weight, not elsewhere classified 7,5%

3 Birth asphyxia (Brain lacking oxygen) 5,3%

4 Other conditions originating in the perinatal period 4,3%

5 Bacterial sepsis of newborn 4,0%

Fetus & fetal is spelt according to ICD-10 standards

South Africa top five underlying causes of perinatal deaths, 2015

1 Fetus and newborn affected by maternal conditions that may be unrelated to present pregnancy 11,2%

2 Fetus and newborn affected by complications of placenta, cord and membranes 7,8%

3 Disorders related to short gestation and low birth weight, not elsewhere classified 7,0%

4 Respiratory distress of newborn 5,1%

5 Birth asphyxia (Brain lacking oxygen) 3,4%

N = 21 378

Fetus & fetal is spelt according to ICD-10 standards

Where do perinatal deaths occur?

68,1%1,7%

Hospital

Emergency Roomoutpatient

0,9%Dead on arrival

3,5%0,4%NursingHome

Distribution of perinatal deaths by place of death occurrence, 2015

*Other, Unknown or Unspecified 25,5%

Home

Over two thirds of perinatal deaths

occurred in a hospital

Remarks

Summary• Perinatal deaths decreased by 6,8% from 22 948 in 2014 to 21 378 in 2015.

• In 2015, the proportion of stillbirths was 64,1% (13 702) whereas early neonatal deaths accounted for 34% (7 676) of all perinatal deaths.

• Overall, in 2015 there were:• 17,4 perinatal deaths per 1 000 total births; 11,2 stillbirths per 1 000 total births

& 6,3 early neonatal deaths per 1 000 live births.

• The sex profile of perinatal deaths for 2015 shows more male than female perinatal deaths. • The sex ratio at death was 124 male deaths per 100 female perinatal deaths.• All provinces had more male perinatal deaths, ranging from • 116 (KwaZulu-Natal) to 141 (Northern Cape) male perinatal deaths per 100

female perinatal deaths

• Higher proportions of perinatal deaths in Gauteng and KwaZulu-Natal.

SummaryLeading causes show that:For perinatal deaths:

• Fetus and newborn affected by maternal factors and by complications of pregnancy, labour and delivery was the leading cause of perinatal deaths in 201

• Respiratory and cardiovascular disorders specific to the perinatal period 2ndleading cause in 2015

For stillbirths & early neonatal deaths: • Stillbirths: In 2015, Fetus and newborn affected by maternal hypertensive

disorders was the 1st leading cause of stillbirths. • Early neonatal deaths: In 2015, Respiratory and cardiovascular disorders

specific to the perinatal period was the 1st leading cause of early neonatal deaths.

Fetus & fetal is spelt according to ICD10 standards

The NDP and SDGs call for ending preventable deaths of newborns and universal access to health care by 2030

Perinatal deaths show importance of:

Reducing ‘Scandal of

Invisibility’ of perinatal deaths

• Perinatal deaths account for 56% of all infant deaths

• High unspecified causes for stillbirths (61%)• 69% unspecified antenatal care visits information

Investing in maternal and

perinatal health

• High proportion of perinatal deaths can be prevented

• Top causes:N = 21 378 1. Maternal conditions unrelated to present pregnancy (11,2%)2. Complications of placenta, cord and membranes (7,8%)3. Short gestation and low birth weight (7,0%)4. Respiratory distress (5,1 %)5. Birth asphyxia (3,4%)

2015 Data set on mortality and causes of death is available on Stats SA

website or on request from Stats SA

Thank you