This article outlines a community-based retrospective study in a remote are
a of Nepal and describes local birth practices and their impact on infant m
ortality. Data collection was carried out in two steps, a household survey
from September to October 1996 and a qualitative research phase. Data colle
cted include socio-economic background, reproductive history, birth practic
es and child survival. Among 3007 live-born children, 660 (22%) died before
their first birthday. In keeping with local customs, approximately half of
the children were delivered in an animal shed and the other half in the ho
me. Children born in an animal shed were at significantly higher risk of dy
ing than were those born in the home even after adjusting for socio-economi
c status and biological variables. The association was stronger in the neon
atal period (OR = 2.8, 95% CI 1.9-4.1) than during the post-neonatal period
(OR = 1.3, 95% CI 1.02-1.6). The preparation of the delivery place was ina
dequate and thereby facilitated infection of both the newborn and the mothe
r. Traditional norms and animal-shed delivery practices are common in the J
umla community. The reasons addressed for giving birth in the animal shed i
ncluded (1) Household Deity's anger if delivery takes place in the home and
(2) easy to clean the shed following the birth. (C) 2000 Elsevier Science
Ltd. All rights reserved.