Abstract

PIP: Over the January 1, 1979 to March 31, 1980 period sterilization-attributable deaths were identified in Dacca and Rajshahi Divisions, Bangladesh. These deaths were identified primarily through government records of compensation to families of deceased sterilization patients. This list was augmented by deaths reported from clinics of the Bangladesh Association for Voluntary Sterilization, detected through a prospective study of sterilization in Bangladesh, and identified by interviews with government family planning officials. A sterilization-associated death was defined as the death of a patient from any cause occurring within 42 days of tubal ligation or vasectomy. Death-to-case rates for vasectomy and tubal ligation were calculated for each month with 95% confidence intervals based on the Poisson distribution. 31 sterilization-associated deaths were identified over the study period. 28 of these were sterilization attributable and 3 were not. The mean age of the 21 women was 30.6 years, and their mean parity was 4.8. The mean age of the 7 vasectomy patients was 37.0 years. Abdominal Pomeroy method of tubal ligation was the only female sterilization technique used. 2 temporal clusters of sterilization attributable deaths occurred during the study. The 1st was a cluster of 5 deaths from tubal ligation performed in June 1979. 3 of these operations took place on June 5, 1979 but in different facilities. 1 factor common to each of these operations was the unseasonably hot weather. The 2nd temporal cluster consisted of 3 deaths after vasectomy in July 1979. 2 men from the same village died from scrotal infections after vasectomy on July 19, 1979 by the same surgeon at a single clinic. A similar death occurred earlier the same month. Another patient of the same surgeon and clinic associated with the deaths after operation on July 19 died from scrotal infection in January 1980. 3 vasectomy deaths related to 1 surgeon in a single remote facility suggests a breach of sterile technique. This could not be confirmed as this clinic physician could not be interviewed. The death-to-case rate for all procedures combined was 21.3 deaths/100,000 procedures, with the rate for vasectomy 1.6 times higher than that for tubal ligation. Anesthesia overdosage was the leading cause of death attributed to tubal ligation with tetanus (24%), intraperitoneal hemorrhage (14%), and infection other than tetanus (5%) as other leading causes. 2 patients (10%) died from pulmonary embolism after tubal ligation; 1 (5%) died from each of the following: anaphylaxis from anti-tetanus serum, heat stroke, small bowel obstruction, and aspiration of vomitus. All 7 men died from scrotal infections after vasectomy. Improvement in anesthesia management and sterile technique can lower the death-to-case rate for contraceptive sterilization in 2 Divisions of Bangladesh.