Infant death rates and animal-shed delivery in remote rural areas of Nepal

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.