***TASK*** the task is to summarize an input biomedical literature in six sentences 
    ***INPUT*** the input is a biomedical literature 
    ***OUTPUT*** the output is the summary of an input biomedical literature in six sentences 
    ***DOCUMENTATION*** 
    ***EXAMPLES*** 
    Input: OBJECTIVE : To determine the primary causes of death in home-cared rural neonates by using prospect ively kept health records of neonates and a neonatologist 's clinical judgment . STUDY DESIGN : In the first year ( 1995 to 1996 ) of the field trial in Gadchiroli , India , trained village health workers observed neonates in 39 villages by attending home deliveries and making eight home visits during days 0 to 28 . The recorded data were vali date d in the field by a physician . An independent neonatologist assigned the most probable single primary cause of death based on these recorded data . FINDINGS : A total of 763 neonates were observed , of whom 40 died ( NMR 52.4/1000 ) . The primary causes of death were sepsis/pneumonia 21 ( 52.5 % ) , asphyxia 8 ( 20 % ) , prematurity < 32 weeks 6 ( 15 % ) , hypothermia 1 ( 2.5 % ) , and other/not known 4 ( 10 % ) . Most of the prematurity or asphyxia deaths occurred during the first 3 days of life . All 21 sepsis/pneumonia deaths occurred during days 4 to 28 . A similar picture existed in Engl and before the antibiotic era . CONCLUSION : Sepsis/pneumonia is the primary cause in half the deaths in rural neonates cared for at home in Gadchiroli , followed by asphyxia and prematurity . Infections cause a larger proportion of deaths in neonates in the community compared to the reported proportion in hospital-based studies Verbal autopsy ( VA ) is used to ascertain cause-specific neonatal mortality using parental/familial recall . We sought to compare agreement between causes of death obtained from the VA by physician review vs. computer-based algorithms . Data were drawn from a cluster-r and omised trial involving 4130 live-born infants and 167 neonatal deaths in the rural Sarlahi District of Nepal . We examined the agreement between causes ascertained by physician review and algorithm assignment by the kappa ( kappa ) statistic . We also compared responses to identical questions posed posthumously during neonatal VA interviews with those obtained during maternal interviews and clinical examinations regarding condition of newborns soon after birth . Physician review ers assigned prematurity or acute lower respiratory infection ( ALRI ) as causes of 48 % of neonatal deaths ; 41 % were assigned as uncertain . The algorithm approach assigned sepsis ( 52 % ) , ALRI ( 31 % ) , birth asphyxia ( 29 % ) , and prematurity ( 24 % ) as the most common causes of neonatal death . Physician review and algorithm assignment of causes of death showed high kappa for prematurity ( 0.73 ) , diarrhoea ( 0.81 ) and ALRI ( 0.68 ) , but was low for congenital malformation ( 0.44 ) , birth asphyxia ( 0.17 ) and sepsis ( 0.00 ) . Sensitivity and specificity of VA interview questions varied by symptom , with positive predictive values ranging from 50 % to 100 % , when compared with maternal interviews and examinations of neonates soon after birth . Analysis of the VA data by physician review and computer-based algorithms yielded disparate results for some causes but not for others . We recommend an analysis technique that combines both methods , and further validation studies to improve performance of the VA for assigning causes of neonatal death Background Three million babies are stillborn each year and 3.6 million die in the first month of life . In India , early neonatal deaths make up four-fifths of neonatal deaths and infant mortality three-quarters of under-five mortality . Information is scarce on cause-specific perinatal and neonatal mortality in urban setting s in low-income countries . We conducted verbal autopsies for stillbirths and neonatal deaths in Mumbai slum settlements . Our objectives were to classify deaths according to international cause-specific criteria and to identify major causes of delay in seeking and receiving health care for maternal and newborn health problems . Methods Over two years , 2005–2007 , births and newborn deaths in 48 slum areas were identified prospect ively by local informants .  Verbal autopsies were collected by trained field research ers , cause of death was classified by clinicians , and family narratives were analysed to investigate delays on the pathway to mortality . Results Of 105 stillbirths , 65 were fresh ( 62 % ) and obstetric complications dominated the cause classification . Of 116 neonatal deaths , 87 were early and the major causes were intrapartum-related ( 28 % ) , prematurity ( 23 % ) , and severe infection ( 22 % ) . Bereavement was associated with socioeconomic quintile , previous stillbirth , and number of antenatal care visits . We identified 201 individual delays in 121/187 birth narratives ( 65 % ) . Overall , delays in receiving care after arrival at a health facility dominated and were mostly the result of referral from one institution to another . Most delays in seeking care were attributed to a failure to recognise symptoms of complications or their severity . Conclusions In Mumbai ’s slum settlements , early neonatal deaths made up 75 % of neonatal deaths and intrapartum-related complications were the greatest cause of mortality . Delays were identified in two-thirds of narratives , were predominantly related to the provision of care , and were often attributable to referrals between health providers . There is a need for clear protocol s for care and transfer at each level of the health system , and an emphasis on rapid identification of problems and communication between health facilities . Trial registration IS RCT OBJECTIVE To evaluate the prevalence , sex distribution and causes of neonatal mortality , as well as its risk factors , in an urban Pakistani population with access to obstetric and neonatal care . METHODS Study area women were enrolled at 20 - 26 weeks ' gestation in a prospect i ve population -based cohort study that was conducted from 2003 to 2005 .  Physical examinations , antenatal laboratory tests and anthropometric measures were performed , and gestational age was determined by ultrasound to confirm eligibility . Demographic and health data were also collected on pretested study forms by trained female research staff . The women and neonates were seen again within 48 hours postpartum and at day 28 after the birth . All neonatal deaths were review ed using the Pattinson et al. system to assign obstetric and final causes of death ; the circumstances of the death were determined by asking the mother or family and by review ing hospital records . Frequencies and rates were calculated , and 95 % confidence intervals were determined for mortality rates . Relative risks were calculated to evaluate the associations between potential risk factors and neonatal death . Logistic regression models were used to compute adjusted odds ratios . FINDINGS Birth outcomes were ascertained for 1280 ( 94 % ) of the 1369 women enrolled . The 28-day neonatal mortality rate was 47.3 per 1000 live births . Preterm birth , Caesarean section and intrapartum complications were associated with neonatal death . Some 45 % of the deaths occurred within 48 hours and 73 % within the first week . The primary obstetric causes of death were preterm labour ( 34 % ) and intrapartum asphyxia ( 21 % ) . Final causes were classified as immaturity-related ( 26 % ) , birth asphyxia or hypoxia ( 26 % ) and infection ( 23 % ) . Neither delivery in a health facility nor by health professionals was associated with fewer neonatal deaths . The Caesarean section rate was 19 % . Almost all ( 88 % ) neonates who died received treatment and 75 % died in the hospital . CONCLUSION In an urban population with good access to professional care , we found a high neonatal mortality rate , often due to preventable conditions . These results suggest that , to decrease neonatal mortality , improved health service quality is crucial Objective To determine whether training  traditional birth attendants  to manage several common perinatal conditions could reduce  neonatal mortality in the setting of a re source poor country with limited access to healthcare . Design Prospect i ve , cluster r and omised and controlled effectiveness study . Setting Lufwanyama , an agrarian , poorly developed district located in the Copperbelt province , Zambia . All births carried out by study birth attendants occurred at mothers ’ homes , in rural village setting s. Participants 127 traditional birth attendants and mothers and their newborns ( 3559 infants delivered regardless of vital status ) from Lufwanyama district . Interventions Using an unblinded design , birth attendants were cluster r and omised to intervention or control groups . The intervention had two components : training in a modified version of the neonatal resuscitation protocol , and single dose amoxicillin coupled with facilitated referral of infants to a health centre . Control birth attendants continued their existing st and ard of care ( basic obstetric skills and use of clean delivery kits ) . Main outcome measures The primary outcome was the proportion of liveborn infants who died by day 28 after birth , with rate ratios statistically adjusted for clustering . Secondary outcomes were mortality at different time points ; and comparison of causes of death based on verbal autopsy data . Results Among 3497 deliveries with reliable information , mortality at day 28 after birth was 45 % lower among liveborn infants delivered by intervention birth attendants than control birth attendants ( rate ratio 0.55 , 95 % confidence interval 0.33 to 0.90 ) . The greatest reductions in mortality were in the first 24 hours after birth : 7.8 deaths per 1000 live births for infants delivered by intervention birth attendants compared with 19.9 per 1000 for infants delivered by control birth attendants ( 0.40 , 0.19 to 0.83 ) . Deaths due to birth asphyxia were reduced by 63 % among infants delivered by intervention birth attendants ( 0.37 , 0.17 to 0.81 ) and by 81 % within the first two days after birth ( 0.19 , 0.07 to 0.52 ) . Stillbirths and deaths from serious infection occurred at similar rates in both groups . Conclusions Training traditional birth attendants to manage common perinatal conditions significantly reduced neonatal mortality in a rural African setting . This approach has high potential to be applied to similar setting s with dispersed rural population s. Trial registration Clinical trials.gov NCT00518856 Obstetric complications and newborn illnesses amenable to basic medical interventions underlie most perinatal deaths . Yet , despite good access to maternal and newborn care in many transitional countries , perinatal mortality is often not monitored in these setting s. The present study identified risk factors for perinatal death and the level and causes of  stillbirths and neonatal deaths in the West Bank and Gaza Strip .  Baseline and follow-up censuses with prospect i ve monitoring of pregnant women and newborns from September 2001 to August 2002 were conducted in 83 r and omly selected clusters of 300 households each . A total of 113 of 116 married women 15 - 49 years old with a stillbirth or neonatal death and 813 r and omly selected women with a surviving neonate were interviewed , and obstetric and newborn care records of women with a stillbirth or neonatal death were abstract ed . The perinatal and neonatal mortality rates , respectively , were 21.2 [ 95 % confidence interval ( CI ) 16.5 , 25.9 ] and 14.7 [ 95 % CI 10.2 , 19.2 ] per 1000 livebirths . The most common cause ( 27 % ) of 96 perinatal deaths was asphyxia alone ( 21 ) or with neonatal sepsis ( 5 ) , while 18/49 ( 37 % ) early and 9/19 ( 47 % ) late neonatal deaths were from respiratory distress syndrome ( 12 ) or sepsis ( 9 ) alone or together ( 6 ) . Constraint in care seeking , mainly by an Israeli checkpoint , occurred in 8 % and 10 % , respectively , of 112 pregnancies and labours and 31 % of 16 neonates prior to perinatal or late neonatal death . Poor quality care for a complication associated with the death was identified among 40 % and 20 % , respectively , of 112 pregnancies and labour/deliveries and 43 % of 68 neonates . ( Correction added after online publication 5 June 2008 : The denominators 112 pregnancies , labours , and labour/deliveries , and 16 and 68 neonates were included ; and 9 % of labours was corrected to 10 % . ) Risk factors for perinatal death as assessed by multivariable logistic regression included preterm delivery ( odds ratio [ OR ] = 11.9 , [ 95 % CI 6.7 , 21.2 ] ) , antepartum haemorrhage ( OR = 5.6 , [ 95 % CI 1.5 , 20.9 ] ) , any severe pregnancy complication ( OR = 3.4 , [ 95 % CI 1.8 , 6.6 ] ) , term delivery in a government hospital and having a labour and delivery complication ( OR = 3.8 , [ 95 % CI 1.2 , 12.0 ] ) , more than one delivery complication ( OR = 4.4 , [ 95 % CI 1.8 , 10.5 ] ) , mother 's age > 35 years ( OR = 2 
    Output:
    
The first week of life accounts for most of asphyxia- , prematurity- and malformation-related mortality and one-half of sepsis-related deaths