Introduction: Clinical registration of the cause of death is available for less than one-third of the
global newborn deaths, but the need for good quality data on causes of death for public health
planning has renewed the interest in the Verbal Autopsy (VA). We aimed to determine the cause of
neonatal deaths by VA in Morang district of Nepal.
Methods: Caretakers of the deceased were interviewed using a semi-structured VA questionnaire by
female community health volunteers. The cause of death was assigned by two senior pediatricians
independently and disagreements in ascertaining the proximate cause of death were resolved by
consensus.
Results: The proximate causes of deaths were infections (41 %), birth asphyxia (37.2 %), prematurity
(11.5 %), and low birth weight related causes (6.9 %). There was no signifi cant statistical difference
in deaths due to infection seen in non-institutional deliveries (43.5 %) than institutional deliveries
(34.6 %). More than half of the deaths (58.5 %) occurred within the fi rst three days of life where the
predominant cause of death was birth asphyxia (60.7 %).
Conclusions: Analysis of verbal autopsies demonstrates that the major causes of death still are
infections and birth asphyxia. The timing of deaths suggests that neonatal interventions should be
aimed at the fi rst week of life. There is no comparative advantage between institutional deliveries
at below district level institutions and non-institutional deliveries to prevent neonatal infection.
Thus, further study on the quality of care at institutes below the district level should be conducted.
Disparities still occur in deaths, with most deaths in Morang occurring in non-institutional deliveries
and in disadvantaged groups.