[Neonatal morbidity and mortality in a low-resource urban district hospital of Douala, Cameroon]

2.5 Million Annual Deaths-Are Neonates in Low- and Middle-Income Countries Too Small to Be Seen? A Bottom-Up Overview on Neonatal Morbi-Mortality

(1) Background: Every year, 2.5 million neonates die, mostly in low- and middle-income countries (LMIC), in total disregard of their fundamental human rights. Many of these deaths are preventable. For decades, the leading causes of neonatal mortality (prematurity, perinatal hypoxia, and infection) have been known, so why does neonatal mortality fail to diminish effectively? A bottom-up understanding of neonatal morbi-mortality and neonatal rights is essential to achieve adequate progress, and so is increased visibility. (2) Methods: We performed an overview on the leading causes of neonatal morbi-mortality and analyzed the key interventions to reduce it with a bottom-up approach: from the clinician in the field to the policy maker. (3) Results and Conclusions: Overall, more than half of neonatal deaths in LMIC are avoidable through established and well-known cost-effective interventions, good quality antenatal and intrapartum care, neonatal resuscitation, thermal care, nasal CPAP, infection control and prevention, and antibiotic stewardship. Implementing these requires education and training, particularly at the bottom of the healthcare pyramid, and advocacy at the highest levels of government for health policies supporting better newborn care. Moreover, to plan and follow interventions, better-quality data are paramount. For healthcare developments and improvement, neonates must be acknowledged as humans entitled to rights and freedoms, as stipulated by international law. Most importantly, they deserve more respectful care.

Hypothermia in Preterm Newborns: Impact on Survival

Background. Globally, prematurity is the leading cause of neonatal mortality, and hypothermia is one of its contributing factors. The goal of this study was to determine the association between hypothermia and mortality. Methods. A prospective, multi-center, descriptive clinical study was conducted in 5 hospitals in Ethiopia. Axillary temperatures were taken at the time of admission to the newborn intensive care units (NICU) and followed during the NICU stay. Results. A total of 3852 premature neonates (<37 weeks) were admitted to the NICUs from July 2016 to May 2018. Of these infants, 1109 (28.8%) died and 2991 (79.6%) had hypothermia. Hypothermia was associated with perinatal asphyxia (89.5%), RDS (86.2%), and resuscitation at birth (82.7%). Admission temperatures in preterm newborns were inversely associated with mortality and morbidity. Conclusion. Hypothermia at admission is associated with neonatal mortality in premature neonates in Ethiopia. RDS and perinatal asphyxia were the main factors associated with hypothermia. The very high prevalence and association with mortality warrants quality improvement interventions.

Low birthweight in rural Cameroon: an analysis of a cut-off value

Background

Low birthweight (LBW) is a major predictor of early neonatal mortality which disproportionately affects low-income countries. WHO recommends regional definitions for LBW to prevent misclassifications and ensure appropriate care of babies with LBW. We conducted this study to define a clinical cut-off for LBW, and to determine the predictors and adverse foetal outcomes of LBW babies in a rural sub-division in Cameroon.

Methods

We conducted a retrospective register analysis of 1787 singleton deliveries in two health facilities in the Northwest Region of Cameroon. Records with no birthweight or birthweight less than 1000 g, babies born before arrival, multiple deliveries and deliveries before 28 weeks gestation were excluded from this study. The 10th percentile of birthweights was computed to obtain a statistical cut-off value for the LBW. To assess the clinical significance of the newly defined cut-off value, we compared the prevalence of adverse foetal outcomes between LBW (birthweight <10th percentile) and heavier babies (birthweight ≥10th percentile) in our study population.

Results

The 10th percentile of the birthweights was 2700 g. Preterm delivery was the lone predictor of LBW (aOR = 2.0, 95% CI = 1.3–3.1; p = 0.001). LBW babies were more likely to be stillborn (OR = 9.6; 95% CI = 4.2–21.6; p < 0.001) or asphyxiated at the 5th minute (OR = 2.0; 95% CI = 1.2–3.3; p = 0.006), compared with heavier babies. Also, 6.1% of babies who had a birthweight between 2500 and 2700 g were more likely to be stillborn compared to heavier babies.

Conclusion

This study suggests that the clinical cut-off for LBW in this rural community is 2700 g; with 6.1% of babies born with LBW probably receiving inadequate care as the traditional cut-off value of 2500 g proposed by WHO is still used to define LBW in our setting. Further studies are necessary to define a national cut-off value for harmonisation of LBW definitions in the country to prevent misclassifications and ensure appropriate neonatal care.

A cohort analysis of neonatal hospital mortality rate and predictors of neonatal mortality in a sub-urban hospital of Cameroon

BACKGROUND

In Cameroon, sustainable effort needs to be done to reduce the current neonatal mortality rate from 21 deaths per 1000 live births to the global target of fewer than ten deaths per 1000 live births by 2035. We aimed to determine the neonatal hospital mortality rate and predictors of neonatal hospital mortality (NHM) in a major referral sub-urban hospital of Cameroon in a bit to formulate interventions to curb this burden.

METHODS

This was a prospective cohort study consecutively enrolling all neonates admitted into the neonatology unit of the Bamenda Regional Hospital (BRH) from November 2015 to February 2016. Through interviewed questionnaires to parents and physical examination of neonates, we studied socio-demographic characteristics, antenatal history, intrapartum history and clinical findings of neonates. Neonates further underwent relevant laboratory investigations for diagnosis. All neonates were followed up till 28 days after the post-menstrual term for the neonatal outcomes. Multiple logistic regression was used to determine predictors of NHM.

RESULTS

We enrolled 332 out of 337 neonates admitted to the neonatology unit of BRH during the study period. Fifty-three percent (53%) were males. Their mean gestational age and birth weight were 36.9 ± 3.9 weeks and 2677.2 ± 923 g, respectively. The main causes of neonatal admissions were complications of preterm birth (32.2%), neonatal infections (31.3%), and birth asphyxia (14.5%). The neonatal hospital mortality rate was 15.7%. NHM was related to complications of preterm birth (69%), birth asphyxia (23%) and neonatal infections (6%). A five-minute Apgar score less than seven was the only predictor of NHM (aOR: 16.41; CI 95%: 6.35-42.47; p < 0.01).

CONCLUSION

Neonatal mortality still remains a significant health problem in sub-urban Cameroon, mainly as a result of three pathologies; complications of preterm birth, birth asphyxia, and infections. There is an urgent need to revamp the current health policies through the improvement of antenatal care, skilled birth attendants, neonatal resuscitation, timely detection and treatment of complications of preterm births, birth asphyxia, and infections.

Low birth weight in a sub-urban area of Cameroon: an analysis of the clinical cut-off, incidence, predictors and complications

Background

The World Health Organisation recommends that each country adopts its own cut-off value of low birth weight (LBW) for clinical use. The aims of this study were to establish a clinical cut-off point for LBW and to determine its incidence, predictors and complications in a sub-urban area’s hospital of Cameroon.

Methods

We conducted a study in two phases: a 6-year retrospective phase during which we collected demographic and clinical information from the records of the maternity of the Buea Regional Hospital (BRH) and a 3-month prospective phase during which data were collected from consenting pregnant women using a structured questionnaire, and newborns were examined and followed after birth.

Results

A total of 4941 records were reviewed during the retrospective phase and the 10^th centile of birth weights was 2600 g. In the 200 pregnant women enrolled during the prospective phase, using this cut-off yielded an incidence of LBW of 19.0 %. Independent predictors of LBW were preterm delivery, hypertensive disorders in pregnancy, HIV infection, maternal age >36 years, maternal height <150 cm and pre-delivery BMI < 25 kg/m². Neonates with LBW were more likely to have neonatal asphyxia, foetal distress, respiratory distress and neonatal death.

Conclusions

Our results suggest that newborns under 2600 g have LBW in sub-urban Cameroon. They represent one out of every five babies, and they deserve close care. Preventive measures targeting the predictors described here are warranted to reduce the incidence and complications. Similar studies in urban areas are required in order to generalize the results.

[Morbidity and risk factors for neonatal mortality in Douala Referral Hospital]

Introduction

Cette étude avait pour but d’étudier la mortalité néonatale hospitalière et les facteurs associés, dans un hôpital de référence de la ville de Douala au Cameroun.

Méthodes

Il s'agit d'une étude de cohorte prospective qui s'est déroulée du 1er janvier au 31 avril 2014 dans l'unité de néonatologie de l'hôpital Laquintinie de Douala. Les nouveau-nés de 0 à 28 jours étaient concernés. Les données sociodémographiques, cliniques et l’évolution hospitalière ont été enregistrées. La durée moyenne d'hospitalisation était de 9,9± 6,9. Les tests du Chi2, de Student et une analyse bivariée ont permis de mesurer les associations entre variables. A l'aide de la régression multivariée les facteurs associés à la mortalité ont été déterminés. Le taux de significativité était de 0,05.

Résultats

Au total,350 nouveau-nés ont été inclus, avec un taux de mortalité de 20,3%. L'hyperthermie était le principal motif de consultation avec 102 (29%) patients. Les principales affections associées au décès étaient: les infections 39 (54,9%) (p = 0,0001), la prématurité 31 (43,6%) (p < 0,05), les troubles de l'adaptation 23 (32,4%) (p < 0,005), les encéphalopathies 5 (7%) (p < 0,005) et le paludisme 5 (7%) (p = 0,03). L'on notait comme facteurs associés à cette mortalité, la naissance hors de l'hôpital 51(71,8%) (p< 0,005), la présentation de siège (p = 0,02), l’âge gestationnel < 0,005), l’âge < 1500g (p < 0,005).

Conclusion

Le contrôle des facteurs associés à la mortalité peut conduire à une réduction de la mortalité néonatale.