Determinants of neonatal mortality in Margaret Kenyatta Mother Baby Wing at Nakuru level 5 hospital, Nakuru County, Kenya
DOI:
https://doi.org/10.18203/2394-6040.ijcmph20231770Keywords:
Neonatal mortality, Maternal factors, Hospital factors, Neonatal factorsAbstract
Background: Nakuru county has 41.9 neonatal deaths per 1000 live births, more than double the national average of 19. This study examined Nakuru level 5 hospital neonatal mortality risk factors.
Methods: A retrospective mismatched case-control study was used. The 429 neonates (143 cases and 286 controls) were estimated assuming a 1:2 case-to-control ratio and 18% prevalence of exposure among controls. Binary logistic regression measured dependent-independent variable correlation.
Results: The study found that high parity, high number of stillbirths, positive HIV, HBsAg, syphilis, pregnancy-induced hypertension, antepartum hemorrhage, PROM 18hours, and maternal peri-partum increased the risk of neonatal. Similarly, mothers who had fewer ANC visits throughout their pregnancy had a higher risk of neonatal mortality compared to mothers who attended more than three ANC clinics, with mortality risk reducing by 69% and 59% for 1-2 visits and more than 3 visits, respectively, compared to non-attendance. Vaginal aided birth had an or of 2.188 and vaginal unassisted OR=4.533 compared to caesarian delivery. Antibiotics and prenatal dexamethasone decreased maternal mortality. Antibiotics lowered NMR or 0.381. Newborns admitted from referral facilities or labor wards had or 1.11 and or 6.220 death rates. Low birth weight, admission weight, gain weeks, and congenital defects increased mortality. In this study, birthweight decreased newborn mortality.
Conclusions: The study concluded that maternal characteristics, neonatal complications are key to improving neonatal outcomes. The study recommends regular training of staff working in the maternity and newborn unit on emergency care and neonatal resuscitation.
References
Kenya Demographic and Health Survey Report. 2014.
Irimu G, Aluvaala J, Malla L, Omoke S, Ogero M, Mbevi G et al. Neonatal mortality in Kenyan hospitals: a multisite, retrospective, cohort study. BMJ Global Health. 2021;6(5):e004475.
Salvador JT. Exploring quantitative and qualitative methodologies: A guide to novice nursing researchers. Eur Scientific J. 2016;12(18).
World Health Organization. Preterm Birth. 2018. Available at: https://www.who.int/news-room/fact-sheets/detail/preterm-birth. Accessed on 1 May 2023
Owili PO, Muga MA, Chou YJ, Hsu YH, Huang N, Chien LY. Associations in the continuum of care for maternal, newborn and child health: a population-based study of 12 sub-Saharan Africa countries. BMC Publ Health. 2016;16(1):1-5.
Waldenström U, Cnattingius S, Vixner L, Norman M. Advanced maternal age increases the risk of very preterm birth, irrespective of parity: a population‐based register study. Int J Obstetr Gynaecol. 2017;124(8):1235-44.
Fonseca SC, Flores PV, Camargo Jr KR, Pinheiro RS, Coeli CM. Maternal education and age: inequalities in neonatal death. Revista De Saude Publica. 2017;51:94.
Boucheron P, Lu Y, Yoshida K, Zhao T, Funk AL, Lunel-Fabiani F et al. Accuracy of HBeAg to identify pregnant women at risk of transmitting hepatitis B virus to their neonates: a systematic review and meta-analysis. Lancet Infect Dis. 2021;21(1):85-96.
Schillie S, Vellozzi C, Reingold A, Harris A, Haber P, Ward JW et al. Prevention of hepatitis B virus infection in the United States: recommendations of the Advisory Committee on Immunization Practices. MMWR Recommendations Rep. 2018;67(1):1.
Deryabina EG, Yakornova GV, Pestryaeva LA, Sandyreva ND. Perinatal outcome in pregnancies complicated with gestational diabetes mellitus and very preterm birth: case-control study. Gynecological Endocrinol. 2016;32(2):52-5.
Khanam R, Ahmed S, Creanga AA, Begum N, Koffi AK, Mahmud A et al. Antepartum complications and perinatal mortality in rural Bangladesh. BMC Pregnancy Childbirth. 2017;17(1):1-8.
Gupta S, Malik S, Gupta S. Neonatal complications in women with premature rupture of membranes (PROM) at term and near term and its correlation with time lapsed since PROM to delivery. Trop Doctor. 2020;50(1):8-11.
Aftab F, Ahmed I, Ahmed S, Ali SM, Amenga-Etego S, Ariff S et al. Direct maternal morbidity and the risk of pregnancy-related deaths, stillbirths, and neonatal deaths in South Asia and sub-Saharan Africa: A population-based prospective cohort study in 8 countries. PLoS Med. 2021;18(6):e1003644.
Iyanda AE, Osayomi T. Association between childbirth modes and neonatal and maternal deaths using a negative binomial model. Women's Reproductive Heal. 2019;6(2):128-40.
Duby J, Lassi ZS, Bhutta ZA. Community‐based antibiotic delivery for possible serious bacterial infections in neonates in low‐and middle‐income countries. Cochrane Database Systematic Rev. 2019(4).
Atif M, Zia R, Malik I, Ahmad N, Sarwar S. Treatment outcomes, antibiotic use and its resistance pattern among neonatal sepsis patients attending Bahawal Victoria Hospital, Pakistan. PloS oOne. 2021;16(1):e0244866.
Olusanya BO, Kaplan M, Hansen TW. Neonatal hyperbilirubinaemia: a global perspective. Lancet Child Adolescent Health. 2018;2(8):610-20.
Hamese MH, Mashego MP, Shipalana N, Sutton C, Ntuli TS. Factors associated with preterm very low birthweight infant mortality at a tertiary hospital in Limpopo Province, South Africa. South African J Child Heal. 2020;14(1):10-4.
