{"status":"ok","message-type":"work","message-version":"1.0.0","message":{"indexed":{"date-parts":[[2026,10,6]],"date-time":"2026-10-06T00:31:18Z","timestamp":1791246678728,"version":"4.1.0"},"reference-count":51,"publisher":"Public Library of Science (PLoS)","issue":"4","license":[{"start":{"date-parts":[[2024,4,5]],"date-time":"2024-04-05T00:00:00Z","timestamp":1712275200000},"content-version":"vor","delay-in-days":0,"URL":"http:\/\/creativecommons.org\/licenses\/by\/4.0\/"}],"funder":[{"DOI":"10.13039\/100000865","name":"Bill and Melinda Gates Foundation","doi-asserted-by":"publisher","award":["OPP1160891"],"award-info":[{"award-number":["OPP1160891"]}],"id":[{"id":"10.13039\/100000865","id-type":"DOI","asserted-by":"publisher"}]}],"content-domain":{"domain":["www.plosone.org"],"crossmark-restriction":false},"short-container-title":["PLoS ONE"],"abstract":"<jats:sec id=\"sec001\">\n<jats:title>Introduction<\/jats:title>\n<jats:p>Neonatal deaths and stillbirths are significant public health concerns in Pakistan, with an estimated stillbirth rate of 43 per 1,000 births and a neonatal mortality rate of 46 deaths per 1,000 live births. Limited access to obstetric care, poor health seeking behaviors and lack of quality healthcare are the leading root causes for stillbirths and neonatal deaths. Rehri Goth, a coastal slum in Karachi, faces even greater challenges due to extreme poverty, and inadequate infrastructure. This study aims to investigate the causes and pathways leading to stillbirths and neonatal deaths in Rehri Goth to develop effective maternal and child health interventions.<\/jats:p>\n<\/jats:sec>\n<jats:sec id=\"sec002\">\n<jats:title>Methods<\/jats:title>\n<jats:p>A mixed-method cohort study was nested with the implementation of large maternal, neonatal and child health program, captured all stillbirths and neonatal death during the period of May 2014 till June 2018. The Verbal and Social Autopsy (VASA) tool (WHO 2016) was used to collect primary data from all death events to determine the causes as well as the pathways. Interviews were conducted both retrospectively and prospectively with mothers and caregivers. Two trained physicians reviewed the VASA form and the medical records (if available) and coded the cause of death blinded to each other. Descriptive analysis was used to categorize stillbirth and neonatal mortality data into high- and low-mortality clusters, followed by chi-square tests to explore associations between categories, and concluded with a qualitative analysis.<\/jats:p>\n<\/jats:sec>\n<jats:sec id=\"sec003\">\n<jats:title>Results<\/jats:title>\n<jats:p>Out of 421 events captured, complete VASA interviews were conducted for 317 cases. The leading causes of antepartum stillbirths were pregnancy-induced hypertension (22.4%) and maternal infections (13.4%), while obstructed labor was the primary cause of intrapartum stillbirths (38.3%). Neonatal deaths were primarily caused by perinatal asphyxia (36.1%) and preterm birth complications (27.8%). The qualitative analysis on a subset of 40 death events showed that health system (62.5%) and community factors (37.5%) contributing to adverse outcomes, such as delayed referrals, poor triage systems, suboptimal quality of care, and delayed care-seeking behaviors.<\/jats:p>\n<\/jats:sec>\n<jats:sec id=\"sec004\">\n<jats:title>Conclusion<\/jats:title>\n<jats:p>The study provides an opportunity to understand the causes of stillbirths and neonatal deaths in one of the impoverished slums of Karachi. The data segregation by clusters as well as triangulation with qualitative analysis highlight the needs of evidence-based strategies for maternal and child health interventions in disadvantaged communities.<\/jats:p>\n<\/jats:sec>","DOI":"10.1371\/journal.pone.0298120","type":"journal-article","created":{"date-parts":[[2024,4,5]],"date-time":"2024-04-05T16:15:25Z","timestamp":1712333725000},"page":"e0298120","update-policy":"https:\/\/doi.org\/10.1371\/journal.pone.corrections_policy","source":"Crossref","is-referenced-by-count":1,"title":["Uncovering the causes and socio-demographic constructs of stillbirths and neonatal deaths in an urban slum of Karachi"],"prefix":"10.1371","volume":"19","author":[{"ORCID":"https:\/\/orcid.org\/0000-0001-8485-641X","authenticated-orcid":true,"given":"Ameer","family":"Muhammad","sequence":"first","affiliation":[],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Muhammad Salman Haider","family":"Rizvee","sequence":"additional","affiliation":[],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Uzma","family":"Khan","sequence":"additional","affiliation":[],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Hina","family":"Khan","sequence":"additional","affiliation":[],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Alishan","family":"Bachlany","sequence":"additional","affiliation":[],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Benazir","family":"Baloch","sequence":"additional","affiliation":[],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Yasir","family":"Shafiq","sequence":"additional","affiliation":[],"role":[{"vocabulary":"crossref","role":"author"}]}],"member":"340","published-online":{"date-parts":[[2024,4,5]]},"reference":[{"key":"pone.0298120.ref001","author":"World Health Organization","journal-title":"Fact sheets: Newborn Mortality n.d."},{"key":"pone.0298120.ref002","doi-asserted-by":"crossref","first-page":"e98","DOI":"10.1016\/S2214-109X(15)00275-2","article-title":"National, regional, and worldwide estimates of stillbirth rates in 2015, with trends from 2000: a systematic analysis","volume":"4","author":"H Blencowe","year":"2016","journal-title":"Lancet Glob Health"},{"key":"pone.0298120.ref003","doi-asserted-by":"crossref","first-page":"e1002990","DOI":"10.1371\/journal.pmed.1002990","article-title":"Estimating the global impact of poor quality of care on maternal and neonatal outcomes in 81 low-and middle-income countries: a modeling study.","volume":"16","author":"VB Chou","year":"2019","journal-title":"PLoS Med"},{"key":"pone.0298120.ref004","doi-asserted-by":"crossref","first-page":"e710","DOI":"10.1016\/S2214-109X(19)30163-9","article-title":"National, regional, and global levels and trends in neonatal mortality between 1990 and 2017, with scenario-based projections to 2030: a systematic analysis","volume":"7","author":"L Hug","year":"2019","journal-title":"Lancet Glob Health"},{"key":"pone.0298120.ref005","doi-asserted-by":"crossref","first-page":"1","DOI":"10.1186\/s12889-018-6241-8","article-title":"Temporal trends in spatial inequalities of maternal and newborn health services among four east African countries, 1999\u20132015.","volume":"18","author":"CW Ruktanonchai","year":"2018","journal-title":"BMC Public Health"},{"key":"pone.0298120.ref006","doi-asserted-by":"crossref","first-page":"e011253","DOI":"10.1136\/bmjgh-2022-011253","article-title":"Neonatal and perinatal mortality in the urban continuum: a geospatial analysis of the household survey, satellite imagery and travel time data in Tanzania.","volume":"8","author":"PM Macharia","year":"2023","journal-title":"BMJ Glob Health"},{"key":"pone.0298120.ref007","doi-asserted-by":"crossref","first-page":"106","DOI":"10.1016\/S2352-4642(21)00311-4","article-title":"Global, regional, and national causes of under-5 mortality in 2000\u201319: an updated systematic analysis with implications for the Sustainable Development Goals","volume":"6","author":"J Perin","year":"2022","journal-title":"Lancet Child Adolesc Health"},{"key":"pone.0298120.ref008","author":"World Health Organization and the United Nations Children\u2019s Fund, (UNICEF, World Health Organization","year":"2020","journal-title":"Every newborn progress report 2019"},{"key":"pone.0298120.ref009","doi-asserted-by":"crossref","first-page":"e1196","DOI":"10.1016\/S2214-109X(18)30386-3","article-title":"High-quality health systems in the Sustainable Development Goals era: time for a revolution","volume":"6","author":"ME Kruk","year":"2018","journal-title":"Lancet Glob Health"},{"key":"pone.0298120.ref010","author":"DA Watkins","year":"2018","journal-title":"Universal health coverage and essential packages of care"},{"key":"pone.0298120.ref011","article-title":"A Situational Analysis on Stillbirths, Newborn Deaths and Small and Sick Newborn Care.","author":"S Aziz","year":"2019","journal-title":"Key Findings from Pakistan-2019. 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