Morbidity, Mortality Patterns and Factors Associated With Mortality among Neonates Admitted in Wajir County Referral Hospital
DOI:
https://doi.org/10.53819/81018102t2106Abstract
Background: Neonatal morbidity and mortality is a global burden despite management measures that has been developed. Approximately 75% of all newborn deaths occur in the first week of life. In 2018 alone, around 2.5 million neonates died globally as a result of preventable causes such as prematurity, complications at birth, infections, and congenital abnormalities.
Objective: The objective of the study was to determine neonatal morbidity and mortality patterns, and factors associated with mortality among neonates admitted in Wajir County Referral Hospital.
Methodology: A hospital-based retrospective cross-sectional study was conducted among all neonates admitted to the New Born Unit of the WCRH from 01 January 2019 to 31 December 2020. A consecutive sampling technique based on the inclusion criteria was used. A data abstraction tool was used to extract data from the medical records of neonates admitted to the New Born Unit of the hospital.
Results: A total of 615 neonates were included in the study. There were 336 (54.6%) male and 279 (45.4%) female neonates. Almost all the deliveries 566 (92.0%) were performed at the health facility with a minority of about 49 (8%) delivered at home. The home deliveries and referrals admissions from tertiary hospitals together were 66 (10.7%). Neonatal morbidity included birth asphyxia 335 (54.5%), neonatal sepsis 144 (23.4%), 57 (9.3%) meconium aspiration syndrome and 52 (8.5%) low birth weight/preterm. Overall mortality in 2019 at the health facility was 45 (12.97%) and in 2020, 35 (13.06%) presenting no significant difference. The deaths that occurred in the first 24 hours of life was 36 (45%). Bivariate and multivariate analysis produced a significant association between the factors associated with neonatal mortality. The multivariate analysis with day of admission (OR 2.872, 95% CI 1.293, 6.375), Sex, (OR 1.02, 95% CI 1.0.627, 1.66) and Birth weight, (OR 0.936, 95% CI 0.423, 2.068) at p<0.05. The logistic regression model was statistically significant, χ2(7) = 20.770, p <0.001. The model explained 27% (Nagelkerke R2) of the variance in discharge outcome and correctly classified 87% of cases. The male gender were 1.02 times more likely to die than females while the place of delivery was 0.572 times likely to result in death.
Conclusions: Birth asphyxia was found to be the leading cause of admission, followed by neonatal sepsis and meconium aspiration syndrome respectively. The leading cause of death was birth asphyxia and neonatal sepsis. The mortality rate at the facility was 13%. Neonatal fatality of the newborns admitted to NBU is high in Wajir County. Since majority of the deaths are from preventable causes, this offers chances to improve newborn survival.
Key Words: Morbidity, Mortality, Neonates, Asphyxia
References
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13. Murphy GAV, Nyakangi VN, Gathara D, Ogero M, English M. A hidden burden of neonatal illness? A cross-sectional study of all admissions aged less than one month across twelve Kenyan County hospitals. Wellcome Open Res. 2018 Jan 30;2:119.
14. Masaba B Barasa. Socioeconomic inequality in neonatal mortality in a county referral hospital in Kenya. Internal Journal of Social Science and Technology. 2019;4:27–34.
15. AFIDEP. Reproductive, Maternal, Neonatal and Child Health: Wajir County [Internet]. Africa Institute of Development Policy. 2020 [cited 2020 Aug 18]. Available from: https://www.afidep.org/publication/reproductive-maternal-neonatal-and-child-health-wajir-county/
16. Ranjeva SL, Warf BC, Schiff SJ. Economic burden of neonatal sepsis in sub-Saharan Africa. BMJ Global Health. 2018 Jan 1;3(1):e000347.
17. De Franco E, Flanagan SE, Houghton JA, Allen HL, Mackay DJ, Temple IK, et al. The effect of early, comprehensive genomic testing on clinical care in neonatal diabetes: an international cohort study. Lancet. 2015 Sep 5;386(9997):957–63.
18. Belizán JM, McClure EM, Goudar SS, Pasha O, Esamai F, Patel A, et al. Neonatal death in low- to middle-income countries: a global network study. Am J Perinatol. 2012 Sep;29(8):649–56.
19. Ekwochi U, Ndu IK, Nwokoye IC, Ezenwosu OU, Amadi OF, Osuorah DIC. Pattern of morbidity and mortality of newborns admitted into the sick and special care baby unit of Enugu State University Teaching Hospital, Enugu state. Nigerian Journal of Clinical Practice. 2014 May 1;17(3):346.
20. Lawn JE, Cousens S, Zupan J, Lancet Neonatal Survival Steering Team. 4 million neonatal deaths: when? Where? Why? Lancet. 2005 Mar 5;365(9462):891–900.
21. Ibrahim J, Yorifuji T, Tsuda T, Kashima S, Doi H. Frequency of antenatal care visits and neonatal mortality in Indonesia. J Trop Pediatr. 2012 Jun;58(3):184–8.
22. World Health Organization. World health statistics 2016: monitoring health for the SDGs, sustainable development goals [Internet]. Geneva: World Health Organization; 2016 [cited 2021 Sep 27]. 121 p. Available from: https://apps.who.int/iris/handle/10665/206498
23. World Health Organization. Guidelines on optimal feeding of low birth-weight infants in low- and middle-income countries [Internet]. Geneva: World Health Organization; 2011 [cited 2021 Sep 27]. ii, 51 p. Available from: https://apps.who.int/iris/handle/10665/85670
24. McCall EM, Alderdice F, Halliday HL, Vohra S, Johnston L. Interventions to prevent hypothermia at birth in preterm and/or low birth weight infants. Cochrane Database Syst Rev. 2018 Feb 12;2:CD004210.
25. Rodrigues NCP, Monteiro DLM, Almeida AS de, Barros MB de L, Pereira Neto A, O’Dwyer G, et al. Temporal and spatial evolution of maternal and neonatal mortality rates in Brazil, 1997-2012. J Pediatr (Rio J). 2016 Dec;92:567–73.
26. Hussein J, Hirose A, Owolabi O, Imamura M, Kanguru L, Okonofua F. Maternal death and obstetric care audits in Nigeria: a systematic review of barriers and enabling factors in the provision of emergency care. Reproductive Health. 2016 Apr 22;13(1):47.
27. Akombi BJ, Agho KE, Hall JJ, Wali N, Renzaho AMN, Merom D. Stunting, Wasting and Underweight in Sub-Saharan Africa: A Systematic Review. Int J Environ Res Public Health. 2017 Aug;14(8):863.
28. Love C, David RJ, Rankin KM, Collins JW. Exploring weathering: effects of lifelong economic environment and maternal age on low birth weight, small for gestational age, and preterm birth in African-American and white women. Am J Epidemiol. 2010 Jul 15;172(2):127–34.
29. Boyle EM, Poulsen G, Field DJ, Kurinczuk JJ, Wolke D, Alfirevic Z, et al. Effects of gestational age at birth on health outcomes at 3 and 5 years of age: population based cohort study. BMJ. 2012 Mar 1;344:e896.
30. Liu L, Oza S, Hogan D, Chu Y, Perin J, Zhu J, et al. Global, regional, and national causes of under-5 mortality in 2000-15: an updated systematic analysis with implications for the Sustainable Development Goals. Lancet. 2016 Dec 17;388(10063):3027–35.
31. Chawanpaiboon S, Vogel JP, Moller AB, Lumbiganon P, Petzold M, Hogan D, et al. Global, regional, and national estimates of levels of preterm birth in 2014: a systematic review and modelling analysis. Lancet Glob Health. 2019 Jan;7(1):e37–46.
32. Blencowe H, Cousens S, Oestergaard MZ, Chou D, Moller AB, Narwal R, et al. National, regional, and worldwide estimates of preterm birth rates in the year 2010 with time trends since 1990 for selected countries: a systematic analysis and implications. Lancet. 2012 Jun 9;379(9832):2162–72.
33. Glass HC, Costarino AT, Stayer SA, Brett CM, Cladis F, Davis PJ. Outcomes for extremely premature infants. Anesth Analg. 2015 Jun;120(6):1337–51.
34. Nair A, Bharuka A, Rayani BK. The Reliability of Surgical Apgar Score in Predicting Immediate and Late Postoperative Morbidity and Mortality: A Narrative Review. Rambam Maimonides Med J. 2018 Jan 29;9(1):e0004.
35. Pejovic NJ. No cry at birth : Neonatal resuscitation in low-resource settings: role of the laryngeal mask airway [Internet]. The University of Bergen; 2020 [cited 2021 Sep 27]. Available from: https://bora.uib.no/bora-xmlui/handle/1956/21575
36. Razaz N, Cnattingius S, Joseph KS. Association between Apgar scores of 7 to 9 and neonatal mortality and morbidity: population based cohort study of term infants in Sweden. BMJ. 2019 May 7;365:l1656.
37. Oliveira TG de, Freire PV, Moreira FT, Moraes J da SB de, Arrelaro RC, Rossi S, et al. Apgar score and neonatal mortality in a hospital located in the southern area of São Paulo city, Brazil. Einstein (São Paulo). 2012 Mar;10:22–8.
38. Ferrari RAP, Bertolozzi MR, Dalmas JC, Girotto E. Determining factors for neonatal mortality in a city in the Southern Region of Brazil. Rev esc enferm USP. 2013 Jun;47:531–8.
39. Razaz N, Cnattingius S, Persson M, Tedroff K, Lisonkova S, Joseph KS. One-minute and five-minute Apgar scores and child developmental health at 5 years of age: a population-based cohort study in British Columbia, Canada. BMJ Open. 2019 May 1;9(5):e027655.
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2022-11-10
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Sheikh, D. A., Irimu, G., & Wasunna, A. (2022). Morbidity, Mortality Patterns and Factors Associated With Mortality among Neonates Admitted in Wajir County Referral Hospital. Journal of Medicine, Nursing & Public Health, 5(3), 83–109. https://doi.org/10.53819/81018102t2106
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