Dear Editor

I read the review article by Vergnano S et al. with interest.

It is correct that many deaths in developing countries do occur without health facility notification. Up to 70% of deliveries occur at home and nearly 50% of those may occur in unhygienic conditions. Both mother and baby remain at risk.

We also agree that neonatal deaths are frequently under-reported. This could be for many reasons. It can be difficult for the health worker or person responsible for reporting of such deaths to reach the home of the baby who died.

Verbal autopsy under these situation can be a better tool to use. If conducted with reasonable care, the cause could be identified and recorded to help the National /Local registry system for active planning. Verbal autopsy frequently brings out single cause of neonatal death, though at times it can be multiple. The process of validating this system of death recording with hospital deaths could be an area for research. More precisely, since neonatal sepsis is the single most important cause of death in developing countries its record by verbal autopsy is an area of priority for health workers in South-East Asia and African countries.