Under-estimation of maternal and perinatal mortality revealed by an enhanced surveillance system: enumerating all births and deaths in Pakistan

Table 4 Maternal, perinatal, and neonatal mortality from the enhanced surveillance system in Tehsil Havelian compared to previous routinely collected data from Lady Health Workers only

Events	Tehsil Havelian (study area)						p-value^g	Under-enumeration (%)
	Routinely collected data (LHW only)^a 2014-15^f			Enhanced Surveillance System 2015/16^e
	n	Rate	95% CI	n	Rate	95% CI
Maternal Mortality^b	15	180	101 – 297	18	247	147 - 391	0.362	27
Neonatal Mortality^d	170	20	17 – 23	290	40	35 - 44	< 0.001	50
Early Neonatal Mortality^d	126	15	13 – 18	215	30	26 - 33	< 0.001	50
Perinatal Mortality^c	401	47	42 – 51	454	60	55 - 66	< 0.001	22
Stillbirths^c	275	32	28 – 36	239	32	28 - 36	0.953	0
Denominators (n)
Total births	8599			7512
Live births	8324			7273

Bold: significant at p < 0.05. 95% CI: normal approximation of the binomial. Stillbirth: dead baby ≥28 weeks of pregnancy per total births; Abortions, dead fetus < 28 weeks of pregnancy; Early Neonatal Mortality, newborn death (0–6 days) per live births; Neonatal Mortality, newborn death (< 28) per live births; Perinatal Mortality: stillbirths plus early neonatal deaths per total births
CI Confidence Interval
^aTehsil Havelian (study area), prior to enhanced surveillance system
^bper 10⁵ live births (Poisson distribution used to calculate 95% confidence intervals)
^cper 10³ total births (normal approximation of binomial counts used to calculate 95% CI)
^dper 10³ live births
^e1 June 2015 to 31 May 2016
^f1 January 2014-31 May 2015
^gderived from chi-square

ISSN: 1471-2458