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Malka ES, Solomon T, Kassa DH, Erega BB, Tufa DG. Time to death and predictors of mortality among early neonates admitted to neonatal intensive care unit of Addis Ababa public Hospitals, Ethiopia: Institutional-based prospective cohort study. PLoS One 2024; 19:e0302665. [PMID: 38843182 PMCID: PMC11156352 DOI: 10.1371/journal.pone.0302665] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/15/2023] [Accepted: 04/10/2024] [Indexed: 06/09/2024] Open
Abstract
INTRODUCTION The largest risk of child mortality occurs within the first week after birth. Early neonatal mortality remains a global public health concern, especially in sub-Saharan African countries. More than 75% of neonatal death occurs within the first seven days of birth, but there are limited prospective follow- up studies to determine time to death, incidence and predictors of death in Ethiopia particularly in the study area. The study aimed to determine incidence and predictors of early neonatal mortality among neonates admitted to the neonatal intensive care unit of Addis Ababa public hospitals, Ethiopia 2021. METHODS Institutional prospective cohort study was conducted in four public hospitals found in Addis Ababa City, Ethiopia from June 7th, 2021 to July 13th, 2021. All early neonates consecutively admitted to the corresponding neonatal intensive care unit of selected hospitals were included in the study and followed until 7 days-old. Data were coded, cleaned, edited, and entered into Epi data version 3.1 and then exported to STATA software version 14.0 for analysis. The Kaplan Meier survival curve with log- rank test was used to compare survival time between groups. Moreover, both bi-variable and multivariable Cox proportional hazard regression model was used to identify the predictors of early neonatal mortality. All variables having P-value ≤0.2 in the bi-variable analysis model were further fitted to the multivariable model. The assumption of the model was checked graphically and using a global test. The goodness of fit of the model was performed using the Cox-Snell residual test and it was adequate. RESULTS A total of 391 early neonates with their mothers were involved in this study. The incidence rate among admitted early neonates was 33.25 per 1000 neonate day's observation [95% confidence interval (CI): 26.22, 42.17]. Being preterm birth [adjusted hazard ratio (AHR): 6.0 (95% CI 2.02, 17.50)], having low fifth minute Apgar score [AHR: 3.93 (95% CI; 1.5, 6.77)], low temperatures [AHR: 2.67 (95%CI; 1.41, 5.02)] and, resuscitating of early neonate [AHR: 2.80 (95% CI; 1.51,5.10)] were associated with increased hazard of early neonatal death. However, early neonatal crying at birth [AHR: 0.48 (95%CI; 0.26, 0.87)] was associated with reduced hazard of death. CONCLUSIONS Early neonatal mortality is high in Addis Ababa public Hospitals. Preterm birth, low five-minute Apgar score, hypothermia and crying at birth were found to be independent predictors of early neonatal death. Good care and attention to neonate with low Apgar scores, premature, and hypothermic neonates.
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Affiliation(s)
- Erean Shigign Malka
- School of Public Health, College of Medicine and Health Sciences, Salale University, Salale, Ethiopia
| | - Tarekegn Solomon
- School of Public Health, College of Medicine and Health Sciences, Hawassa University, Hawassa, Ethiopia
| | - Dejene Hailu Kassa
- School of Public Health, College of Medicine and Health Sciences, Hawassa University, Hawassa, Ethiopia
| | - Besfat Berihun Erega
- School of Midwifery, College of Health Sciences, Debre Tabor University, Debre Tabor, Ethiopia
| | - Derara Girma Tufa
- School of Public Health, College of Medicine and Health Sciences, Salale University, Salale, Ethiopia
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Alene AA, Mengesha EW, Dagnew GW. Adverse fetal birth outcomes and its associated factors among mothers with premature rupture of membrane in Amhara region, Ethiopia. PLoS One 2024; 19:e0298319. [PMID: 38558073 PMCID: PMC10984396 DOI: 10.1371/journal.pone.0298319] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/18/2023] [Accepted: 01/22/2024] [Indexed: 04/04/2024] Open
Abstract
BACKGROUND Adverse birth outcomes are the leading cause of neonatal mortality worldwide. Ethiopia is one of the countries struggling to reduce neonatal mortality through different strategies, but neonatal mortality remains high for many reasons. Despite adverse birth outcomes being a public health problem in Ethiopia, the contribution of Premature rupture of the membrane to the adverse fetal birth outcome is neglected and not well explained in our country. This study aims to assess fetal birth outcomes and associated factors among mothers with all types of PROM at Specialized Hospitals in Amhara Region, Ethiopia. METHODS A facility-based cross-sectional study design was applied among 538 mothers with premature rapture of the membrane at Amhara region specialized hospitals. A simple random sampling technique was employed to select the medical charts diagnosed with all types of PROM and giving birth in the hospital within the period from July 8, 2019, to July 7, 2021. The data was collected using a checklist, entered into EPI Data version 3.1, and analyzed using SPSS version 23. A binary logistic regression model was used to see the association between independent and dependent variables. A P-value <0.05 was used to declare the statistical significance. The AOR with 95% CI was used to measure the strength of the association. RESULT Adverse birth outcome among all types of Premature rupture of membrane mothers was 33.1% [95% CI 29.2-37.2]. Rural residents [AOR = 2.94, 95% CI:1.73-4.97], have a history of urinary tract infection [AOR = 6.87, 95% CI: 2.77-17.01], anemia [AOR = 7.51, 95% CI: 2.88-19.62], previous history of adverse birth outcome [AOR = 3.54, 95% CI: 1.32-9.47] and less than two years interpregnancy interval [AOR = 6.07, 95% CI: 2.49-14.77] were positively associated with adverse birth outcome compared to their counterparts. CONCLUSION The adverse birth outcome was high in the Amhara region as compared to the World Health Organization's estimated figure and target; the target is less than 15%. History of the previous adverse birth outcome, residence, urinary tract infection, Anemia, and interpregnancy interval had an association with adverse birth outcomes. Therefore, strengthening close follow-up for mothers who had previous adverse birth outcomes, screening and treatment of urinary tract infection, anemia prevention, and maximizing birth interval are recommended for reducing adverse birth outcomes.
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Affiliation(s)
- Abebe Abrha Alene
- Department of Reproductive Health and Population Studies, School of Public Health, College of Medicine and Health Science, Bahir Dar University, Bahir Dar, Ethiopia
| | - Endalkachew Worku Mengesha
- Department of Reproductive Health and Population Studies, School of Public Health, College of Medicine and Health Science, Bahir Dar University, Bahir Dar, Ethiopia
| | - Gizachew Worku Dagnew
- Department of Reproductive Health and Population Studies, School of Public Health, College of Medicine and Health Science, Bahir Dar University, Bahir Dar, Ethiopia
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Rees CA, Ideh RC, Kisenge R, Kamara J, Coleman-Nekar YJG, Samma A, Godfrey E, Manji HK, Sudfeld CR, Westbrook AL, Niescierenko M, Morris CR, Whitney CG, Breiman RF, Duggan CP, Manji KP. Identifying neonates at risk for post-discharge mortality in Dar es Salaam, Tanzania, and Monrovia, Liberia: Derivation and internal validation of a novel risk assessment tool. BMJ Open 2024; 14:e079389. [PMID: 38365298 PMCID: PMC10875550 DOI: 10.1136/bmjopen-2023-079389] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 08/31/2023] [Accepted: 02/06/2024] [Indexed: 02/18/2024] Open
Abstract
INTRODUCTION The immediate period after hospital discharge carries a large burden of childhood mortality in sub-Saharan Africa. Our objective was to derive and internally validate a risk assessment tool to identify neonates discharged from the neonatal ward at risk for 60-day post-discharge mortality. METHODS We conducted a prospective observational cohort study of neonates discharged from Muhimbili National Hospital in Dar es Salaam, Tanzania, and John F Kennedy Medical Centre in Monrovia, Liberia. Research staff called caregivers to ascertain vital status up to 60 days after discharge. We conducted multivariable logistic regression analyses with best subset selection to identify socioeconomic, demographic, clinical, and anthropometric factors associated with post-discharge mortality. We used adjusted log coefficients to assign points to each variable and internally validated our tool with bootstrap validation with 500 repetitions. RESULTS There were 2344 neonates discharged and 2310 (98.5%) had post-discharge outcomes available. The median (IQR) age at discharge was 8 (4, 15) days; 1238 (53.6%) were male. In total, 71 (3.1%) died during follow-up (26.8% within 7 days of discharge). Leaving against medical advice (adjusted OR [aOR] 5.62, 95% CI 2.40 to 12.10) and diagnosis of meconium aspiration (aOR 6.98, 95% CI 1.69 to 21.70) conferred the greatest risk for post-discharge mortality. The risk assessment tool included nine variables (total possible score=63) and had an optimism corrected area under the receiver operating characteristic curve of 0.77 (95% CI 0.75 to 0.80). A score of ≥6 was most optimal (sensitivity 68.3% [95% CI 64.8% to 71.5%], specificity 72.1% [95% CI 71.5% to 72.7%]). CONCLUSIONS A small number of factors predicted all-cause, 60-day mortality after discharge from neonatal wards in Tanzania and Liberia. After external validation, this risk assessment tool may facilitate clinical decision making for eligibility for discharge and the direction of resources to follow-up high risk neonates.
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Affiliation(s)
- Chris A Rees
- Division of Pediatric Emergency Medicine, Emory University School of Medicine, Atlanta, Georgia, USA
- Department of Emergency Medicine, Children's Healthcare of Atlanta, Atlanta, Georgia, USA
| | - Readon C Ideh
- Department of Pediatrics, John F Kennedy Medical Center, Monrovia, Liberia
| | - Rodrick Kisenge
- Department of Pediatrics and Child Health, Muhimbili University of Health and Allied Sciences, Dar es Salaam, United Republic of Tanzania
| | - Julia Kamara
- Department of Pediatrics, John F Kennedy Medical Center, Monrovia, Liberia
| | | | - Abraham Samma
- Department of Pediatrics and Child Health, Muhimbili University of Health and Allied Sciences, Dar es Salaam, United Republic of Tanzania
| | - Evance Godfrey
- Department of Pediatrics and Child Health, Muhimbili University of Health and Allied Sciences, Dar es Salaam, United Republic of Tanzania
| | - Hussein K Manji
- Department of Emergency Medicine, Muhimbili University of Health and Allied Sciences, Dar es Salaam, Dar es Salaam, United Republic of Tanzania
- Accident and Emergency Department, The Aga Khan Health Services, Dar es Salaam, Dar es Salaam, United Republic of Tanzania
| | - Christopher R Sudfeld
- Departments of Nutrition and Global Health and Population, Harvard T.H. Chan School of Public Health, Boston, Boston, USA
| | - Adrianna L Westbrook
- Pediatric Biostatistics Core, Department of Pediatrics, Emory University School of Medicine, Atlanta, Georgia, USA
| | - Michelle Niescierenko
- Division of Emergency Medicine, Boston Children's Hospital, Boston, Massachusetts, USA
- Department of Pediatrics and Emergency Medicine, Harvard Medical School, Boston, Massachusetts, USA
| | - Claudia R Morris
- Division of Pediatric Emergency Medicine, Emory University School of Medicine, Atlanta, Georgia, USA
- Department of Emergency Medicine, Children's Healthcare of Atlanta, Atlanta, Georgia, USA
| | - Cynthia G Whitney
- Emory Global Health Institute, Emory University, Atlanta, Georgia, USA
| | - Robert F Breiman
- Hubert Department of Global Health, Rollins School of Public Health, Emory University, Atlanta, Georgia, USA
- Infectious Diseases and Oncology Research Institute, University of the Witwatersrand, Johannesburg, South Africa
| | - Christopher P Duggan
- Departments of Nutrition and Global Health and Population, Harvard T.H. Chan School of Public Health, Boston, Boston, USA
- Center for Nutrition, Children's Hospital Boston, Boston, Massachusetts, USA
| | - Karim P Manji
- Department of Pediatrics and Child Health, Muhimbili University of Health and Allied Sciences, Dar es Salaam, United Republic of Tanzania
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Tiruye G, Shiferaw K. Antenatal Care Reduces Neonatal Mortality in Ethiopia: A Systematic Review and Meta-Analysis of Observational Studies. Matern Child Health J 2023; 27:2064-2076. [PMID: 37789167 DOI: 10.1007/s10995-023-03765-7] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 09/06/2022] [Indexed: 10/05/2023]
Abstract
BACKGROUND Neonatal deaths remain a serious public health concern in Ethiopia; being one of the top five countries contributing to half of the neonatal deaths worldwide. Although antenatal care (ANC) is assumed as one of the viable options that contribute to neonatal survival, findings from original studies indicated disparities in the effect of ANC on neonatal mortality. Thus, this review aimed to determine the pooled effect of ANC on neonatal mortality in Ethiopia. METHODS Databases such as PubMed, EMBASE, CINAHL, HINARI, and Cochrane Central Library were searched for articles using keywords. Selection of eligible articles and data extraction were conducted by an independent author. The risk of a bias assessment tool for non-randomized studies was used to assess the quality of the articles. Comprehensive meta-analysis version 2 software was used for meta-analysis. Heterogeneity and publication bias of included studies were assessed using I2 test statistic and Egger test, respectively. The random-effect model was employed; an outcome is reported using a risk ratio with a 95% confidence interval. RESULTS Of 28 included studies, 20 showed receiving at least one ANC visit had a significant association with neonatal mortality. Accordingly, the estimated pooled risk ratio for neonatal mortality was 0.59 (95% CI 0.45, 0.77) among infants born to women who had at least one ANC visit compared to infants born to women who had no ANC visits. CONCLUSION This finding indicated that neonatal mortality was decreased among infants born to women who had at least one ANC visit compared to infants born to women who had no ANC visit. Therefore, promoting and strengthening ANC service utilization during pregnancy would accelerate the reduction of neonatal mortality in Ethiopia.
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Affiliation(s)
- Getahun Tiruye
- School of Nursing and Midwifery, College of Health and Medical Sciences, Haramaya University, Harar, Ethiopia
| | - Kasiye Shiferaw
- School of Nursing and Midwifery, College of Health and Medical Sciences, Haramaya University, Harar, Ethiopia.
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Dessie AM, Nigatu D, Yadita ZS, Yimer YA, Yalew AK, Aychew EW, Feleke SF. Neonatal mortality and its predictors among neonates in Jabitehnan district, Northwest Ethiopia: A single-arm retrospective cohort study. Health Sci Rep 2023; 6:e1613. [PMID: 37822845 PMCID: PMC10562526 DOI: 10.1002/hsr2.1613] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/27/2023] [Revised: 08/28/2023] [Accepted: 09/20/2023] [Indexed: 10/13/2023] Open
Abstract
Background and Aims Neonatal period is the most vulnerable time in which children face the greatest risk of death. Worldwide, each year, millions of newborns died in the first month of life. Sub-Saharan Africa, Ethiopia, in particular, is largely affected. However, there is a dearth of information regarding the survival status of neonates and determinants of their mortality in the study area. Therefore, this study was aimed at investigating neonatal mortality and its predictors in Jabitehnan district, Northwest Ethiopia. Method A single-arm community-based retrospective cohort study was conducted in March 2021 among 952 neonates born between August 2020 and February 2021. Data were collected by a semi-structured questionnaire, and a multistage stratified sampling technique was employed to select one urban and 10 rural kebeles from the district. Then, the total sample size was proportionally allocated to these selected kebeles. Neonatal death was ascertained by community diagnosis. Kaplan-Meier curve was used to estimate survival time. Cox regression was used to identify factors, the hazard ratio was estimated, and a p-value < 0.05 was considered statistically significant. Results The neonatal mortality rate was 44 (95% confidence interval [CI]: 33-60) per 1000 live births; and the incidence rate was 1.64 (95% CI: 1.21-2.23) per 1000 neonate days. Three-quarters of deaths occurred in the first week of life. Medium household wealth index (adjusted hazard ratio [AHR] = 3.54; 95 CI: 1.21-10.35), increased number of pregnancies (AHR = 1.22; 95%CI: 1.01-1.47), being male (AHR = 2.45, 95% CI: 1.12-5.35) and not starting breastfeeding in the first hour of life (AHR = 4.00; 95% CI: 1.52-11.10) were found to be predictors of neonatal mortality. Conclusion Neonatal mortality was high compared to the national target. Wealth, number of pregnancies, sex of the neonate, and breastfeeding initiation were factors associated with neonatal death. Hence, strengthening interventions such as providing sexual education in the population, considering households with a medium wealth index in the exemption service, and counseling mothers about early breastfeeding initiation would improve neonatal survival.
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Affiliation(s)
- Anteneh Mengist Dessie
- Department of Public Health, College of Health ScienceDebre Tabor UniversityDebre TaborEthiopia
| | - Dabere Nigatu
- Department of Reproductive Health and population studies, School of public health, College of Medical & Health SciencesBahir Dar UniversityBahir DarEthiopia
| | - Zemenu Shiferaw Yadita
- Department of Reproductive Health and population studies, School of public health, College of Medical & Health SciencesBahir Dar UniversityBahir DarEthiopia
| | - Yalemwork Anteneh Yimer
- Department of pediatric and child health, Tibebe Ghion specialized hospital, college of medicine and health scienceBahir Dar universityBahir DarEthiopia
| | - Anteneh Kassa Yalew
- Department of Public Health, College of Health ScienceWolkite UniversityWolkiteEthiopia
| | - Eden Workneh Aychew
- Department of Midwifery, College of Health ScienceDebre Tabor UniversityDebre TaborEthiopia
| | - Sefineh Fenta Feleke
- Department of Public Health, College of Health ScienceWoldia UniversityWoldiaEthiopia
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Bekele GG, Yohannes Roga E, Gonfa DN, Yami AT, Fekene DB, Kabale WD. The effects of advanced maternal age on perinatal mortality in Ethiopia: A systematic review and meta-analysis. SAGE Open Med 2023; 11:20503121231201282. [PMID: 37786897 PMCID: PMC10541735 DOI: 10.1177/20503121231201282] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/29/2023] [Accepted: 08/25/2023] [Indexed: 10/04/2023] Open
Abstract
Background Pregnancy in women over the age of 35 years is considered advanced maternal age. The relationship between advanced maternal age and the risk of perinatal mortality is still controversial. As a result, this systematic review and meta-analysis were carried out to clarify the relationship between advanced maternal age and perinatal mortality in Ethiopia. Methods The following electronic databases were used for this systematic review and meta-analysis: PubMed, Web of Science, Scopus, Science Direct, Google Scholar, HINARI, and African Journals Online up to March 2022. Addis Ababa, Gondor, and Jimma University research repositories were also searched. A random-effects model was used to pool study-specific odds ratios. Results A total of 18 articles, including a total of 45,541 participants, were included in the meta-analysis. A total of 11 cross-sectional, 2 case-control, and 5 cohort studies were included. The overall pooled estimate indicates that women with advanced maternal age had a 1.58 higher risk of perinatal mortality compared to women in the younger age group (odds ratio = 1.58; 95% Confidence Interval: 1.13-2.03). The subgroup analysis also revealed that there were differences in the effect size as the geographical region differed. The result showed that the odd of perinatal mortality was highest in the Oromia region and lowest in the Southern Nations Nationalities and Peoples' Region. Conclusion The overall pooled estimate indicates that women with advanced maternal age had a 1.58-fold higher risk of perinatal mortality. Even though this risk could also be increased with other comorbid diseases, it is important for healthcare providers and other concerned stakeholders to be aware of the increased risks associated with advanced maternal age and provide different intervention programs designed to create awareness and provide counseling services to couples who seek to have a child in their later ages about the risks of advanced maternal age pregnancy on perinatal mortality and other adverse pregnancy outcomes.
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Affiliation(s)
- Gemechu Gelan Bekele
- Department of Midwifery, College of Medicine and Health Sciences, Ambo University, Ambo, Ethiopia
| | - Ephrem Yohannes Roga
- Department of Midwifery, College of Medicine and Health Sciences, Ambo University, Ambo, Ethiopia
| | - Dajane Negesse Gonfa
- Department of Midwifery, College of Medicine and Health Sciences, Ambo University, Ambo, Ethiopia
| | - Amare Tesfaye Yami
- Department of Midwifery, College of Medicine and Health Sciences, Ambo University, Ambo, Ethiopia
| | - Daniel Belema Fekene
- Department of Midwifery, College of Medicine and Health Sciences, Ambo University, Ambo, Ethiopia
| | - Wogene Daro Kabale
- Department of Midwifery, College of Medicine and Health Sciences, Ambo University, Ambo, Ethiopia
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Kassie A, Kassie M, Bantie B, Bogale TW, Aynalem ZB. Neonatal Mortality at Felege Hiwot Comprehensive Specialized Hospital in Ethiopia Over 5 years: Trends and Associated Factors. Clin Med Insights Pediatr 2023; 17:11795565231187500. [PMID: 37529621 PMCID: PMC10387765 DOI: 10.1177/11795565231187500] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/03/2022] [Accepted: 06/26/2023] [Indexed: 08/03/2023] Open
Abstract
Background Globally, neonatal mortality remains a serious catastrophic problem for newborns, particularly in a low-resource setting. There were no neonatal mortality trend studies in the study area. Objective This study aimed to determine the trends and risk factors of neonatal mortality at the neonatal intensive care unit of Felege Hiwot Comprehensive Specialized Hospital, Northwest Ethiopia. Methods An institution-based retrospective cross-sectional study was conducted among 870 admitted neonates from January 1, 2016 to December 31, 2020 in the neonatal intensive care unit by a stratified simple random sampling technique. Data were entered into EpiData and then exported to STATA 14.0 for analysis. A linear regression statistical model was used for trend analysis and binary logistic regression was carried out to identify explanatory variables of neonatal mortality. Results Overall, neonatal mortality averagely increased by 2.1% per year throughout the 5 consecutive years. In this study, rural residency [adjusted odds ratio (AOR): 1.96, 95% confidence interval (CI): (1.26, 3.06)], birth asphyxia (AOR: 7.73, 95% CI: 4.31, 13.84), congenital deformity (AOR: 3.61, 95% CI: 1.17, 11.18), low birth weight (AOR: 2.13, 95% CI: 1.23, 3.67), respiratory distress syndrome (AOR: 3.32, 95% CI: 1.97, 5.59), Ambu-bag resuscitation (AOR: 0.16, 95% CI: 0.07, 0.38), taking antibiotics (AOR: 0.50, 95% CI: 0.27, 0.90), glucose (AOR: 0.47, 95% CI: 0.30, 0.72), and oxygen (AOR: 0.26, 95% CI: 0.16, 0.41) were associated with neonatal mortality. Conclusions This 5-year trend analysis revealed an increased trend of NMR, indicating more work is still needed to make progress toward meeting the SDG goal by 2030. Rural residency, birth asphyxia, congenital deformity, low birth weight, respiratory distress syndrome, Ambu-bag resuscitation, taking antibiotics, glucose, and oxygen were associated with neonatal mortality. Therefore, all stakeholders shall give due attention to reducing this timely-increasing trend of neonatal mortality.
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Affiliation(s)
- Ayalew Kassie
- Department of Nursing, Bahir Dar Health Science College, Bahir Dar, Ethiopia
| | - Mulugeta Kassie
- Department of Nursing, Wogeda Primary Hospital, Bahir Dar, Ethiopia
| | - Berihun Bantie
- Department of Nursing, College of Medicine and Health Sciences, Debre Tabor University, Debre Tabor, Amhara, Ethiopia
| | - Tewodros Worku Bogale
- Department of Midwifery, College of Medicine and Health Sciences, Injibara University, Injibara, Ethiopia
| | - Zewdu Bishaw Aynalem
- Department of Nursing, College of Medicine and Health Sciences, Injibara University, Injibara, Ethiopia
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Chekole B, Terefe TF, Tenaw SG, Zewudie BT, GebreEyesus FA, Kassaw A, Gelaw Walle B, Aynalem Mewahegn A, Tadesse B, Mesfin Y, Argaw M, Abebe H, Tesfa S, Tamene Zeleke F. Survival Status, Length of Stay, and Predictors of Mortality Among Neonates Admitted in the Neonatal Intensive Care Unit of Gurage Zone Public Hospitals. SAGE Open Nurs 2023; 9:23779608231187480. [PMID: 37476331 PMCID: PMC10354824 DOI: 10.1177/23779608231187480] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/08/2021] [Revised: 06/20/2023] [Accepted: 06/26/2023] [Indexed: 07/22/2023] Open
Abstract
Background Many countries need to accelerate their progress to achieve the sustainable development goal target of neonatal death. It is still high in Ethiopia. Thus, this study aimed to assess the mortality predictors and length of hospital stay among Neonates admitted to the Neonatal Intensive Care Unit of Gurage zone public Hospitals. Method In this study, a facility-based retrospective follow-up study was applied among 375 neonates admitted to the NICU of selected public hospitals in the Gurage zone from June 1, 2019 to June 30, 2021. The researchers used Epi-Data entry 3.1 for the data entry and then exported it to STATA version 14 for analysis. The Kaplan-Meier survival curve and log-rank test were used to estimate and compare the survival time of categorical variables, respectively. Result The researchers observed about 85 (22.7% with 95%CI: 18.7, 27.2) deaths from the 2305 person-days follow-up. The median survival time was 14 days. The overall incidence density rate was 36.9 per 1000 person-days observed (95%CI: 29.8, 45.6). Perinatal asphyxia (AHR: 2.9[CI: 1.8; 4.8]), cesarean section as a mode of delivery (AHR: 1.1[CI; 1.01; 1.15]), maternal age of greater or equal to 35 years (AHR: 1.1[95% CI: 1.01, 1.15]), and twin pregnancy (AHR: 2.3[95% CI: 1.2, 4.3]) were predictors of neonatal mortality. Conclusion The survival rate of neonates was higher compared to other studies. So, to reduce the burden of neonatal mortality, health care providers should give special attention to twin pregnancies, neonates delivered via cesarean section, and neonates with a problem of perinatal asphyxia.
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Affiliation(s)
- Bogale Chekole
- Department of Nursing, College of Medicine and Health Science, Wolkite University Southwest, Wolkite, Ethiopia
| | - Tamene Fetene Terefe
- Department of Nursing, College of Medicine and Health Science, Wolkite University Southwest, Wolkite, Ethiopia
| | - Shegaw Geze Tenaw
- Department of Midwifery, College of Medicine and Health Science, Wolkite University Southwest, Wolkite, Ethiopia
| | - Bitew Tefera Zewudie
- Department of Nursing, College of Medicine and Health Science, Wolkite University Southwest, Wolkite, Ethiopia
| | - Fisha Alebel GebreEyesus
- Department of Nursing, College of Medicine and Health Science, Wolkite University Southwest, Wolkite, Ethiopia
| | - Amare Kassaw
- Department of Pediatric Nursing, College of Medicine and Health Science, Debre Tabor University, Debre Tabor, Northwest Ethiopia
| | - Belete Gelaw Walle
- Department of Pediatric Nursing, College of Medicine and Health Science, Wolaita Sodo University, Wolaita sodo, Southwest Ethiopia
| | - Agerie Aynalem Mewahegn
- Department of Nursing, College of Medicine and Health Science, Wolkite University Southwest, Wolkite, Ethiopia
| | - Betelihem Tadesse
- Department of Nursing, College of Medicine and Health Science, Wolkite University Southwest, Wolkite, Ethiopia
| | - Yibeltal Mesfin
- Department of Midwifery, College of Medicine and Health Science, Wolkite University Southwest, Wolkite, Ethiopia
| | - Muche Argaw
- Department of Midwifery, College of Medicine and Health Science, Wolkite University Southwest, Wolkite, Ethiopia
| | - Haimanot Abebe
- Department of Nursing, College of Medicine and Health Science, Wolkite University Southwest, Wolkite, Ethiopia
| | - Shegaw Tesfa
- Department of Nursing, College of Medicine and Health Science, Wolkite University Southwest, Wolkite, Ethiopia
| | - Fentahun Tamene Zeleke
- Department of Midwifery, College of Medicine and Health Science, Wolkite University Southwest, Wolkite, Ethiopia
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Chanie ES, Engedaw D, Eyayu T, Admasu FT, Amera ED, Azanaw KA, Kassaw A, Feleke DG, Ayehu GW, Jimma MS, GebreEyesus FA, Moges N, Woelile TA, Kerebeh G, Birrie E. Escalating the limit of median survival time and predictors of mortality among preterm neonates in Northwest Ethiopia, 2021: a 1-year prospective follow-up study. BMJ Open 2022; 12:e061385. [PMID: 36576181 PMCID: PMC9723894 DOI: 10.1136/bmjopen-2022-061385] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 12/12/2022] Open
Abstract
OBJECTIVES To examine the survival rate and predictors of mortality among preterm neonates in the neonatal intensive care unit at South Gondar public hospitals, 2021. DESIGN Prospective follow-up study. SETTING South Gondar public hospitals, Northwest, Ethiopia. PARTICIPANTS We recruited 283 preterm neonates who were admitted at neonatal intensive care unit at selected hospitals from 15 February 2020 to 22 January 2021. OUTCOME MEASURES The primary outcome measure of this study was the survival rate of preterm neonates in the neonatal intensive care unit. Moreover, the study assessed the predictors for the occurrence of mortality by the Cox-proportional hazard model. Data were entered into Epi data V.4.2 and exported to Stata V.14 statistical software for analysis. The log-rank test determines the survival difference between predictor variables. RESULTS A total of 283 preterm neonates, 61 died during the follow-up. Born from antepartum haemorrhage mother (adjusted HR (AHR)=2.2 (95% CI 1.10 to 4.37)), being small weight for gestational age (AHR=4.6 (95% CI 2.22 to 9.53)), not having kangaroo mother care practice initiated (AHR=2.7 (95% CI 1.39 to 7.74)), hypothermia (AHR=4.0 (95% CI 1.96 to 8.30)) and perinatal asphyxia (AHR=3.9 (95% CI 1.97 to 7.94)) were significant predictors of preterm neonate mortality. CONCLUSION In this study, the preterm neonates survival rate (78.4%) and the median survival time (21 days) were found to be low. Preventing and managing the predictors, including an antepartum haemorrhagic mother, small weight for gestational age, hypothermia and prenatal asphyxia, is crucial. In addition, more emphasis should be placed on initiating universal kangaroo mother care practice soon after birth to increase the survival of preterm neonates.
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Affiliation(s)
- Ermias Sisay Chanie
- Pedatric and Neonatal Nursing, Debre Tabor University, Debre Tabor, Ethiopia
| | - Destaw Engedaw
- Pedatric and Neonatal Nursing, Debre Tabor University, Debre Tabor, Ethiopia
| | - Tahir Eyayu
- Department of Medical Laboratory Sciences, Debre Tabor University, Debre Tabor, Amhara, Ethiopia
| | | | - Eninur Dejen Amera
- Department of Medical Laboratory Sciences, Debre Tabor University, Debre Tabor, Amhara, Ethiopia
| | | | - Amare Kassaw
- Pedatric and Neonatal Nursing, Debre Tabor University, Debre Tabor, Ethiopia
| | | | - Gashaw Walle Ayehu
- Biomedical Science, Debre Tabor University, Debre Tabor, Amhara, Ethiopia
| | | | | | - Natnael Moges
- Pedatric and Neonatal Nursing, Debre Tabor University, Debre Tabor, Ethiopia
| | | | - Gashaw Kerebeh
- Pedatric and Neonatal Nursing, Debre Tabor University, Debre Tabor, Ethiopia
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Jemal B, Abebe T, Zemedkun A, Basu B, Mola S, Neme D, Hailu S. Determinants of neonatal mortality in the neonatal intensive care unit of Dilla University Referral Hospital, Southern Ethiopia; 2019–2020; A matched, case–control study. Heliyon 2022; 8:e10389. [PMID: 36091958 PMCID: PMC9459422 DOI: 10.1016/j.heliyon.2022.e10389] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/20/2021] [Revised: 10/26/2021] [Accepted: 08/15/2022] [Indexed: 11/19/2022] Open
Abstract
Background Neonatal mortality rate (NMR) refers to the number of deaths occurring from birth to 28 days of life per-1000 Live Births (LB). The global NMR declined from 37 deaths per- 1,000 LB in 1990 to 18 in 2017, whereas it was 27 deaths per 1000 LB in the Sub-Saharan region. Ethiopia plans to reduce the NMR from 28 deaths to 11 deaths per 1,000 LB by 2020 and to end all preventable child deaths by 2035. The aim of this study was to identify the determinants of neonatal mortality in the neonatal intensive care unit (NICU) of Dilla University Referral Hospital (DURH). Methods An age-matched case control study was conducted at DURH's NICU. Two controls having age 2 days before or after the case were used for matching. One hundred eighteen cases (died) and 236 controls (survived) neonates admitted to the NICU from January 11, 2018, to February 25, 2020, were studied. Missed data were filled by multiple imputations. Multicollinearity was checked by the variance inflation factor. For variables with a P-value <0.2 on bivariable conditional logistic regression, multivariable conditional logistic regression analysis was performed to control for confounders using clogit command in a survival package to identify the risk factors for neonatal mortality using R version 3.6.3. Result Gestational age <37 weeks (Adjusted matched odds ratio (AmOR): 14.02; 95% confidence interval (CI): 3.68–53.46), first-minute APGAR score <7 (AmOR: 5.68; 95% CI: 1.76–18.31), perinatal asphyxia (PNA) (AmOR: 4.62; 95% CI: 1.15–18.53) and being twins (AmOR: 6.84; 95% CI: 1.34–34.96) were significantly associated with neonatal deaths in our study. Furthermore, antenatal care and follow-up during pregnancy (AmOR: 0.15; 95% CI: 0.04–0.53) and having a normal random blood sugar level at admission (AmOR: 0.1; 95% CI: (0.02–0.66) were found to be determinant of neonatal mortalities in our study. Conclusion Gestational age less than 37 weeks, first-minute APGAR scores <7, being twins, diagnosis of PNA, antenatal care and follow-up of mothers during pregnancy and normoglycemia in neonates at admission were significant determinant of neonatal death in the NICU of DURH.
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Affiliation(s)
- Bedru Jemal
- Department of Anesthesiology, College of Medicine and Health Sciences, Dilla University, Dilla, Ethiopia
- Corresponding author.
| | - Teshome Abebe
- Department of Anesthesiology, College of Medicine and Health Sciences, Diredawa University, Diredawa, Ethiopia
| | - Abebayehu Zemedkun
- Department of Anesthesiology, College of Medicine and Health Sciences, Dilla University, Dilla, Ethiopia
| | - Bivash Basu
- Department of Anesthesiology, College of Medicine and Health Sciences, Dilla University, Dilla, Ethiopia
| | - Simeneh Mola
- Department of Anesthesiology, College of Medicine and Health Sciences, Dilla University, Dilla, Ethiopia
| | - Derartu Neme
- Department of Anesthesiology, College of Medicine and Health Sciences, Dilla University, Dilla, Ethiopia
| | - Seyoum Hailu
- Department of Anesthesiology, College of Medicine and Health Sciences, Dilla University, Dilla, Ethiopia
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Oumer M, Aragie H, Worede AG. Institutional delivery service utilisation and associated factors among mothers of childbearing age in Delgi District, Northwest Ethiopia: a community-based cross-sectional study design. BMJ Open 2022; 12:e060141. [PMID: 36038182 PMCID: PMC9464781 DOI: 10.1136/bmjopen-2021-060141] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/26/2022] Open
Abstract
OBJECTIVE This study aimed to assess the use of institutional delivery services and associated factors among Delgi District mothers of childbearing age. DESIGN A community-based cross-sectional study design. SETTING At five Kebeles in Delgi District, Northwest Ethiopia. PARTICIPANTS The study was performed on 403 childbearing age mothers using a structured questionnaire and a face-to-face interview. We used a systematic random sampling method to select the study participants. METHODS The data were analysed using descriptive analysis, binary logistic regression analysis, and multivariable logistic regression analysis. OUTCOME Institutional delivery service utilisation. RESULTS In the present study, 75.9% (95% CI: 71.7% to 80.1%) of respondents used health facilities for their last delivery. After adjusting for covariates, diploma holders (adjusted odds ratio (AOR)=5.63; 95% CI: 3.77 to 8.39), maternal age at 23-27 years (AOR=6.47; 95% CI: 2.74 to 15.32), divorced women (AOR=0.30; 95% CI: 0.12 to 0.75), husband's primary education (AOR=0.38; 95% CI: 0.18 to 0.82), the distance required above 10 km to reach the health facility (AOR=0.17; 95% CI: 0.04 to 0.72) and the time required above 4 hours to reach the health facility (AOR=0.30; 95% CI: 0.12 to 0.73) were significantly associated with institutional delivery service utilisation. CONCLUSIONS The majority of respondents utilised institutional delivery services in this study. High-level maternal education, younger maternal age, divorce marital status, low-level husband education, long distances to reach a health facility and prolonged time to reach a health facility were all independently linked to the use of institutional delivery services. One of the foundations for increasing institutional delivery service use is improving mother-waiting centres for delivery services, infrastructure and transportation services and awareness about institutional delivery services. Providing counselling services for mothers during antenatal care visits or house-to-house health education on institutional delivery services for rural residents will improve institutional delivery service use even more.
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Affiliation(s)
- Mohammed Oumer
- Department of Human Anatomy, School of Medicine, College of Medicine and Health Sciences, University of Gondar, Gondar, Ethiopia
- Epidemiology, University of Gondar, Gondar, Ethiopia
| | - Hailu Aragie
- Department of Human Anatomy, School of Medicine, College of Medicine and Health Sciences, University of Gondar, Gondar, Ethiopia
| | - Amanuel Girma Worede
- Department of Human Anatomy, School of Medicine, College of Medicine and Health Sciences, University of Gondar, Gondar, Ethiopia
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Assessing Individual- and Community-Level Variability in Predictors of Neonatal, Infant, and Under-Five Child Mortality in Ethiopia Using a Multilevel Modeling Approach. CHILDREN (BASEL, SWITZERLAND) 2022; 9:children9071071. [PMID: 35884055 PMCID: PMC9320923 DOI: 10.3390/children9071071] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Subscribe] [Scholar Register] [Received: 05/23/2022] [Revised: 06/17/2022] [Accepted: 07/16/2022] [Indexed: 11/16/2022]
Abstract
Background: In low-and middle-income countries, child mortality rates are basic indicators of a country’s socio-economic situation and quality of life. The Ethiopian government is currently working to reduce child mortality to accomplish its long-term development goals. Using data from the Ethiopian Mini Demographic and Health Survey, 2019, this study analyzed the determinants of child mortality in Ethiopia. Methods: A total of 4806 children were considered in the final analyses. Multivariate analysis was used to estimate the effects of the predictors simultaneously on each child mortality outcome. Results: The findings revealed that 31.6% of children died during the neonatal stage, 39.1% during the infant stage, and 48.5% during the under-five stage. Variation in child mortality was discovered between Ethiopian community clusters, with the result of heterogeneity between clusters on newborn mortality (χ2 = 202.4, p-value < 0.0001), (χ2 = 777.35, p-value < 0.0001), and (χ2 = 112.92, p-value < 0.0001). Children’s neonatal, infant, and under-five mortality intracluster correlation coefficient (ICC) were 0.35, 0.33, and 0.36, respectively, across communities. Conclusions: In Ethiopia, under-five mortality remains a serious public health issue, with wide variations and high rates among community clusters. Intervention measures focusing on lowering rates of household poverty, increasing education opportunities, and improving access to health care could assist in reducing child mortality in Ethiopia.
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Shiferaw K, Mengistie B, Gobena T, Dheresa M, Seme A. Neonatal Mortality Rate and Its Determinants: A Community-Based Panel Study in Ethiopia. Front Pediatr 2022; 10:875652. [PMID: 35676909 PMCID: PMC9169089 DOI: 10.3389/fped.2022.875652] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 02/14/2022] [Accepted: 04/07/2022] [Indexed: 11/13/2022] Open
Abstract
Background The Sustainable Development Goals specifically target a reduction in neonatal mortality rates. However, the highest neonatal mortality rates occur in sub-Saharan Africa, including Ethiopia. Although several factors contributing to these high rates have been explored, there continues to be a general dearth of studies and inconsistencies of factors to understand the problem. Therefore, this study aimed to identify the prevalence and factors associated with neonatal mortality in Ethiopia. Methods A panel study was conducted among 2,855 pregnant or recently postpartum women selected using the multistage cluster sampling technique from October 2019 to September 2020. Data were collected by experienced and trained female resident enumerators and coded, cleaned, and analyzed using STATA version 16.1 software. We used the Kaplan-Meier survival curve to show the pattern of neonatal deaths during the first 28 days of life. Frequencies and rates were reported along with the percentages and using a 95% confidence interval, respectively. The Cox proportional hazard regression model was used to explore the association of explanatory and outcome variables. Finally, an adjusted hazard ratio with a 95% confidence interval was used to report the results, with a p < 0.05 to declare statistical significance. Results The neonatal mortality rate was 26.84 (95% CI: 19.43, 36.96) per 1,000 live births. Neonates born to rural resident mothers (AHR = 2.18, 95% CI: 1.05, 4.54), mothers of advanced age (AHR = 2.49, 95% CI: 1.19, 5.21), and primipara mothers (AHR = 3.16, 95% CI: 1.52, 6.60) had a higher hazard of neonatal mortality. However, neonates born to women who attended technical and vocational level education (AHR = 0.08, 95% CI: 0.01, 0.62) had a lower hazard of neonatal mortality. Conclusions The neonatal mortality rate in Ethiopia is high, with increased risk among specific subsets of the population. The findings highlight that neonatal survival can be improved through tailored interventions for rural residents, emerging regions, and primipara women by improving female education and avoiding pregnancy at an advanced maternal age to achieve Sustainable Development Goal target 3.2.
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Affiliation(s)
- Kasiye Shiferaw
- School of Nursing and Midwifery, College of Health and Medical Sciences, Haramaya University, Harar, Ethiopia
| | - Bezatu Mengistie
- School of Public Health, St. Paul's Hospital Millennium Medical College, Addis Ababa, Ethiopia
| | - Tesfaye Gobena
- Department of Environmental Health Science, College of Health and Medical Sciences, Haramaya University, Harar, Ethiopia
| | - Merga Dheresa
- School of Nursing and Midwifery, College of Health and Medical Sciences, Haramaya University, Harar, Ethiopia
| | - Assefa Seme
- School of Public Health, Addis Ababa University, Addis Ababa, Ethiopia
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14
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Predictors of respiratory distress syndrome, sepsis and mortality among preterm neonates admitted to neonatal intensive care unit in northern Ethiopia. J Pediatr Nurs 2022; 63:e113-e120. [PMID: 34649733 DOI: 10.1016/j.pedn.2021.09.029] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 10/28/2020] [Revised: 09/26/2021] [Accepted: 09/30/2021] [Indexed: 11/24/2022]
Abstract
PURPOSE We aim to identify the predictors of respiratory distress syndrome, neonatal sepsis and mortality among preterm neonates admitted to neonatal intensive care unit at Ayder Comprehensive Specialized Hospital, northern Ethiopia. MATERIALS AND METHODS An institutional-based retrospective cross-sectional study was conducted on 816 preterm neonates. An association between variables was decided at p-value ≤0.05, or AOR, 95% CI. RESULTS Neonatal sepsis was significantly associated with cesarean section (AOR = 0.62, CI (0.43-0.91)), male (AOR = 1.6, CI (1.12-2.28)), 4-6 APGAR score at 1-min (AOR = 1.67, CI (1.15-2.42)) and hospitalization for more than 14 days (AOR = 2.62, CI (1.5-4.58)) days. Also, the determinants of respiratory distress syndrome were compound fetal presentation (AOR = 2.17, CI (1-4.71)), < 28 weeks of gestational age (AOR = 3.32, CI (1.07-10.22)), 28-31 6/7 weeks of gestational age (AOR = 4.19, CI (2.39-7.33)), 1-1.49 kg birth weight (AOR = 4.22, CI (1.79-9.93)) and 4-6 APGAR score at 1-min (AOR = 2.22, CI (1.54-3.19)). Respiratory distress syndrome (AOR =12, CI (5.42-26.94)) and perinatal asphyxia (AOR = 3.42, CI (1.64-7.11)) were also associated with preterm neonatal mortality. CONCLUSION The predictors of respiratory distress syndrome were fetal presentation, gestational age, birth weight and 1st minute APGAR score. Also, neonatal sepsis was significantly associated with mode of delivery, sex, 1st minute APGAR score, respiratory distress syndrome and duration of hospitalization. Lastly, the predictors of mortality were respiratory distress syndrome, 1st minute APGAR score and perinatal asphyxia. PRACTICE IMPLICATIONS It will give clues to mobilize resources towards the main predictors of comorbidity and mortality in preterms in the health care settings.
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15
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Predictors of Neonatal Mortality in Ethiopia: A Comprehensive Review of Follow-Up Studies. Int J Pediatr 2022; 2022:1491912. [PMID: 35189632 PMCID: PMC8856832 DOI: 10.1155/2022/1491912] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 12/01/2021] [Revised: 01/20/2022] [Accepted: 01/31/2022] [Indexed: 11/18/2022] Open
Abstract
Background Neonatal mortality remains a prominent public health problem in developing countries. Particularly, Ethiopia has a higher neonatal mortality rate than the average sub-Saharan African countries. Hereafter, this review article was aimed at synthesizing existing predictors of neonatal mortality in Ethiopia. Methods A systematic search and review of peer-reviewed articles were conducted on the predictors of neonatal mortality in Ethiopia. A search of key terms across different databases including Web of Science, SCOPUS, Cochrane Library, PubMed, EMBASE, Hinari, and Google Scholar was conducted, supplemented by reference screening. The SANRA tool was used to critically appraise studies included in the review. Results After removing duplicates and applying the eligibility criteria, 14 of the 64 initially identified articles were included in the final review. These were original articles published between 2011 and 2021. The identified predictors were narrated and presented under different domains. Accordingly, sociodemographic predictors such as residence, distance from the health facility, and maternal age; service delivery-related predictors such as no ANC follow-up, not taking iron-folic acid supplementation during pregnancy, and no PNC visit; neonate-related predictors such as low birth weight, extreme prematurity/preterm, and low APGAR score; pregnancy and childbirth-related predictors such as birth interval < 18 months, twin pregnancy, and time of rupture of membrane > 12 hours; and maternal-related predictors such as maternal HIV infection, maternal childbirth-related complications, and maternal near-miss were stated to increase a likelihood of newborn death in Ethiopia. Conclusion Public health interventions directed at decreasing neonatal mortality should address the rural residents, mothers not having ANC follow-up, low birth weight, twin pregnancy, and maternal HIV infection. The wealth of data gathered during primary research should not only lead to identification of predictors, but should also provide guidance for health system intervention strategies in a country aiming to reduce neonatal mortality.
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16
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Liu W, Yang Q, Xu ZE, Hu Y, Wang Y, Liu Z, Zhao Q, Wang Z, Wei H, Hua Z. Impact of the COVID-19 pandemic on neonatal admissions in a tertiary children's hospital in southwest China: An interrupted time-series study. PLoS One 2022; 17:e0262202. [PMID: 35025931 PMCID: PMC8758080 DOI: 10.1371/journal.pone.0262202] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/25/2021] [Accepted: 12/20/2021] [Indexed: 12/23/2022] Open
Abstract
Background The unprecedented coronavirus disease 2019 (COVID-19) pandemic has caused millions of infections worldwide and represents a significant challenge facing modern health care systems. This study was conducted to investigate the impact of lockdown measures in a tertiary Children’s Hospital in southwest China, which might be used to predict long-term effects related to health-seeking behavior of parents/caregivers. Methods This study included newborns enrolled over a span of 86 weeks between January 4, 2019, and August 27, 2020. We designated two time periods for analysis purposes: a stable pre-COVID period(55 weeks between January 4, 2019, and January 23, 2020) and a COVID-impacted period (31 weeks between January 24, 2020, and August 27, 2020). An interrupted time-series analysis was employed to compare changes and trends in hospital admissions and disease spectra before and after the period of nonpharmaceutical interventions (NPIs). Furthermore, this study was conducted to evaluate whether the health-seeking behavior of parents/caregivers was influenced by pandemic factors. Results Overall, 16,640 infants were admitted to the neonatology department during the pre-COVID period (n = 12,082) and the COVID-impacted period (n = 4,558). The per week neonatal admissions consistently decreased following the first days of NPIs (January 24, 2020). The average weekly admission rates of 220/week pre-COVID period and 147/week COVID-impacted period. There was an evident decrease in the volume of admissions for all disease spectra after the intervention, whereas the decrease of patients complaining about pathological jaundice-related conditions was statistically significant (p<0.05). In the COVID-impacted period, the percentage of patients who suffered from respiratory system diseases, neonatal encephalopathy, and infectious diseases decreased, while the percentage of pathological jaundice-related conditions and gastrointestinal system diseases increased. The neonatal mortality rates (NMRs) increased by 8.7% during the COVID-impacted period compared with the pre-COVID period. Conclusions In summary, there was a significant decline in neonatal admissions in a tertiary care hospital during the COVID-19 Pandemic and the associated NPIs. Additionally, this situation had a remarkable impact on disease spectra and health-seeking behavior of parents/caregivers. We, therefore, advise continuing follow-ups and monitoring the main health indicators in vulnerable populations affected by this Pandemic over time.
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Affiliation(s)
- Weiqin Liu
- Department of Neonatology, Children’s Hospital of Chongqing Medical University, National Clinical Research Center for Child Health and Disorders, Ministry of Education Key Laboratory of Child Development and Disorders, Chongqing, China
- Chongqing Key Laboratory of Pediatrics, Children’s Hospital of Chongqing Medical University, Chongqing, China
| | - Qifen Yang
- School of Life Sciences, Southwest University, Chongqing, China
| | - Zhen-e Xu
- Department of Neonatology, Children’s Hospital of Chongqing Medical University, National Clinical Research Center for Child Health and Disorders, Ministry of Education Key Laboratory of Child Development and Disorders, Chongqing, China
- Chongqing Key Laboratory of Pediatrics, Children’s Hospital of Chongqing Medical University, Chongqing, China
| | - Ya Hu
- Department of Neonatology, Children’s Hospital of Chongqing Medical University, National Clinical Research Center for Child Health and Disorders, Ministry of Education Key Laboratory of Child Development and Disorders, Chongqing, China
- Chongqing Key Laboratory of Pediatrics, Children’s Hospital of Chongqing Medical University, Chongqing, China
| | - Yongming Wang
- Department of Neonatology, Children’s Hospital of Chongqing Medical University, National Clinical Research Center for Child Health and Disorders, Ministry of Education Key Laboratory of Child Development and Disorders, Chongqing, China
- Chongqing Key Laboratory of Pediatrics, Children’s Hospital of Chongqing Medical University, Chongqing, China
| | - Zhenqiu Liu
- Department of Neonatology, Children’s Hospital of Chongqing Medical University, National Clinical Research Center for Child Health and Disorders, Ministry of Education Key Laboratory of Child Development and Disorders, Chongqing, China
- Chongqing Key Laboratory of Pediatrics, Children’s Hospital of Chongqing Medical University, Chongqing, China
| | - Qianqian Zhao
- Department of Neonatology, Children’s Hospital of Chongqing Medical University, National Clinical Research Center for Child Health and Disorders, Ministry of Education Key Laboratory of Child Development and Disorders, Chongqing, China
- Chongqing Key Laboratory of Pediatrics, Children’s Hospital of Chongqing Medical University, Chongqing, China
| | - Zhuangcheng Wang
- Children’s Medical Big Data Intelligent Application Chongqing University Engineering Research Center, Chongqing, China
| | - Hong Wei
- Department of Neonatology, Children’s Hospital of Chongqing Medical University, National Clinical Research Center for Child Health and Disorders, Ministry of Education Key Laboratory of Child Development and Disorders, Chongqing, China
- Chongqing Key Laboratory of Pediatrics, Children’s Hospital of Chongqing Medical University, Chongqing, China
| | - Ziyu Hua
- Department of Neonatology, Children’s Hospital of Chongqing Medical University, National Clinical Research Center for Child Health and Disorders, Ministry of Education Key Laboratory of Child Development and Disorders, Chongqing, China
- Chongqing Key Laboratory of Pediatrics, Children’s Hospital of Chongqing Medical University, Chongqing, China
- * E-mail:
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Zapata HA, Fort P, Roberts KD, Kaluarachchi DC, Guthrie SO. Surfactant Administration Through Laryngeal or Supraglottic Airways (SALSA): A Viable Method for Low-Income and Middle-Income Countries. Front Pediatr 2022; 10:853831. [PMID: 35372140 PMCID: PMC8966228 DOI: 10.3389/fped.2022.853831] [Citation(s) in RCA: 10] [Impact Index Per Article: 5.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 01/13/2022] [Accepted: 02/21/2022] [Indexed: 11/24/2022] Open
Abstract
Administration of liquid surfactant through an endotracheal tube for the treatment of respiratory distress syndrome has been the standard of care for decades. A skilled health care provider is needed to perform this procedure. In lower-income and middle-income countries (LMICs), healthcare resources are often limited, leading to increased mortality of premature infants, many of whom would benefit from surfactant administration. Therefore, having a simplified procedure for delivery of surfactant without the need for advanced skills could be life-saving, potentially diminish gaps in care, and help ensure more equitable global neonatal survival rates. Modifications to the standard approach of surfactant administration have been put into practice and these include: INtubation-SURfactant-Extubation (INSURE), thin catheter surfactant administration (TCA), aerosolized surfactant, and surfactant administration through laryngeal or supraglottic airways (SALSA). Although there is a need for larger studies to evaluate the comparative effectiveness of these newer methods, these methods are being embraced by the global community and being implemented in various settings throughout the world. Because the SALSA technique does not require laryngoscopy, a provider skilled in laryngoscopy is not required for the procedure. Therefore, because of the ease of use and safety profile, the SALSA technique should be strongly considered as a viable method of delivering surfactant in LMICs.
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Affiliation(s)
- Henry A Zapata
- Department of Pediatrics, Division of Neonatology, University of Wisconsin-Madison School of Medicine and Public Health, Madison, WI, United States
| | - Prem Fort
- Department of Pediatrics, Maternal, Fetal, Neonatal Institute, Johns Hopkins All Children's Hospital, St. Petersburg, FL, United States.,Department of Pediatrics, Division of Neonatology, Johns Hopkins University School of Medicine, Baltimore, MD, United States
| | - Kari D Roberts
- Department of Pediatrics, Division of Neonatology, University of Minnesota, Minneapolis, MN, United States
| | - Dinushan C Kaluarachchi
- Department of Pediatrics, Division of Neonatology, University of Wisconsin-Madison School of Medicine and Public Health, Madison, WI, United States
| | - Scott O Guthrie
- Department of Pediatrics, Division of Neonatology, Vanderbilt University School of Medicine, Nashville, TN, United States
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Belsti Y, Nigussie ZM, Tsegaye GW. Derivation and Validation of a Risk Score to Predict Mortality of Early Neonates at Neonatal Intensive Care Unit: The END in NICU Score. Int J Gen Med 2021; 14:8121-8134. [PMID: 34795517 PMCID: PMC8594787 DOI: 10.2147/ijgm.s336888] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/24/2021] [Accepted: 11/02/2021] [Indexed: 12/17/2022] Open
Abstract
BACKGROUND Early neonatal death is death of infants in the first week of life. And 34% to 92% of neonatal deaths happen within 7 days of postnatal period. Thus, the early neonatal period is the most critical time for an infant, requiring different strategies to prevent mortality. Among strategies, deriving and implementing early warning scores is crucial to predict early neonatal mortality earlier upon hospital admission. OBJECTIVE To derive and validate a risk score to predict mortality of early neonates at Felege Hiwot Specialized Hospital neonatal intensive care unit, Bahir Dar, 2021. METHODS The document review was conducted from February 24, to April 08, 2021, on all early neonates admitted to neonatal intensive care unit from January 1, 2018 to December 31, 2020. The total number of early neonates included in the derivation study was 1100. Data were collected by using checklists prepared on EpiCollect5 software. After exporting the data to R version 4.0.5 software, variables with (p < 0.25) from the simple binary regression were entered into a multiple logistic regression model, and significant variables (p < 0.05) were kept in the model. The discrimination and calibration were assessed. The model was internally validated using bootstrapping technique. RESULTS Admission weight, birth Apgar score, perinatal asphyxia, respiratory distress syndrome, mode of delivery, sepsis, and gestational age at birth remained in the final multiple logistic regression prediction model. The area under curve of receiver operating characteristic curve for early neonatal mortality score was 90.7%. The model retained excellent discrimination under internal validation. The sensitivity, specificity, and positive predictive value, negative predictive value of the model was 89.4%, 82.5%, 55.5%, and 96.9%, respectively. CONCLUSION The derived score has an excellent discriminative ability and good prediction performance. This is an important tool for predicting early neonatal mortality in neonatal intensive care units at admission.
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Affiliation(s)
- Yitayeh Belsti
- Department of Physiology, School of Medicine, College of Medicine and Health Science, University of Gondar, Gondar, Ethiopia
| | - Zelalem Mehari Nigussie
- Department of Epidemiology and Biostatistics, School of Public Health, College of Medicine and Health Science, Bahir Dar University, Bahir Dar, Ethiopia
| | - Gebeyaw Wudie Tsegaye
- Department of Epidemiology and Biostatistics, School of Public Health, College of Medicine and Health Science, Bahir Dar University, Bahir Dar, Ethiopia
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Yeshaneh A, Tadele B, Dessalew B, Alemayehu M, Wolde A, Adane A, Shitu S, Abebe H, Adane D. Incidence and predictors of mortality among neonates referred to comprehensive and specialized hospitals in Amhara regional state, North Ethiopia: a prospective follow-up study. Ital J Pediatr 2021; 47:186. [PMID: 34526106 PMCID: PMC8444490 DOI: 10.1186/s13052-021-01139-9] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 04/12/2021] [Accepted: 08/27/2021] [Indexed: 11/25/2022] Open
Abstract
Background Neonatal mortality is a major global public health problem. Ethiopia is among seven countries that comprise 50 % of global neonatal mortality. Evidence on neonatal mortality in referred neonates is essential for intervention however, there is no enough information in the study area. Neonates who required referral frequently became unstable and were at a high risk of death. Therefore, this study aimed to assess the incidence and predictors of mortality among referred neonates. Method A prospective follow-up study was conducted among 436 referred neonates at comprehensive specialized hospitals in the Amhara regional state, North Ethiopia 2020. All neonates admitted to the selected hospitals that fulfilled the inclusion criteria were included. Face-to-face interviews, observations, and document reviews were used to collect data using a semi-structured questionnaire and checklists. Epi-data™ version 4.2 software for data entry and STATA™ 14 version for data cleaning and analysis were used. Variables with a p-value < 0.25 in the bi-variable logistic regression model were selected for multivariable analysis. Multivariable analyses with a 95% confidence level were performed. Variables with P < 0.05 were considered statistically significant. Result Over all incidence of death in this study was 30.6% with 95% confidence interval of (26.34–35.16) per 2 months observation. About 23 (17.83%) deaths were due to sepsis, 32 (24.80%) premature, 40 (31%) perinatal asphyxia, 3(2.33%) congenital malformation and 31(24.03%) deaths were due to other causes. Home delivery [AOR = 2.5, 95% CI (1.63–4.1)], admission weight < 1500 g [AOR =3.2, 95% CI (1.68–6.09)], travel distance ≥120 min [AOR = 3.8, 95% CI (1.65–9.14)], hypothermia [AOR = 2.7, 95% CI (1.44–5.13)], hypoglycemia [AOR = 1.8, 95% CI (1.11–3.00)], oxygen saturation < 90% [AOR = 1.9, 95% (1.34–3.53)] at admission time and neonate age ≤ 1 day at admission [AOR = 3.4, 95% CI (1.23–9.84) were predictors of neonatal death. Conclusion The incidence of death was high in this study. The acute complications arising during the transfer of referral neonates lead to an increased risk of deterioration of the newborn’s health and outcome. Preventing and managing complications during the transportation process is recommended to increase the survival of neonates.
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Affiliation(s)
- Alex Yeshaneh
- Departments of Midwifery, College of Medicine and Health Sciences, Wolkite University, Wolkite, Ethiopia.
| | - Bizuayehu Tadele
- Departments of Public health, College of Medicine and Health Sciences, Debra Markos University, Debra Markos, Ethiopia
| | - Bogale Dessalew
- Departments of Public health, College of Medicine and Health Sciences, Debra Markos University, Debra Markos, Ethiopia
| | - Mulunesh Alemayehu
- Departments of Public health, College of Medicine and Health Sciences, Debra Markos University, Debra Markos, Ethiopia
| | - Awraris Wolde
- Departments of Public health, College of Medicine and Health Sciences, Debra Markos University, Debra Markos, Ethiopia
| | - Addisu Adane
- Departments of Health Service Managment, Kotebe Metropolitan University Menelik II Medical and Health science college, Addis Ababa, Ethiopia
| | - Solomon Shitu
- Departments of Midwifery, College of Medicine and Health Sciences, Wolkite University, Wolkite, Ethiopia
| | - Haimanot Abebe
- Departments of Public Health, College of Medicine and Health Sciences, Wolkite University, Wolkite, Ethiopia
| | - Daniel Adane
- Departments of Midwifery, College of Medicine and Health Sciences, Wolkite University, Wolkite, Ethiopia
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Chanie ES, Alemu AY, Mekonen DK, Melese BD, Minuye B, Hailemeskel HS, Asferie WN, Bayih WA, Munye T, Birlie TA, Amare AT, Tibebu NS, Tiruneh CM, Legas G, Gebre Eyesus FA, Belay DM. Impact of respiratory distress syndrome and birth asphyxia exposure on the survival of preterm neonates in East Africa continent: systematic review and meta-analysis. Heliyon 2021; 7:e07256. [PMID: 34189307 PMCID: PMC8215220 DOI: 10.1016/j.heliyon.2021.e07256] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/24/2020] [Revised: 04/21/2021] [Accepted: 06/03/2021] [Indexed: 11/22/2022] Open
Abstract
INTRODUCTION Several kinds of researches are available on preterm mortality in the East Africa continent; however, it is inconsistent and inconclusive, which requires the pooled evidence to recognize the burden in general. PURPOSE To collect and synthesis evidence on preterm mortality and identify factors in the East Africa continent. METHODS PubMed, Google Scholar, Hinary, Cochrane library, research gate, and institutional repositories were retrieved to identity eligible articles through Preferred Reporting Items for Systematic Review and Meta-Analysis (PRISMA) guidelines. The articles were selected if the publication period is between 2010-2021 G.C. Data were extracted by a standardized JBI data extraction format for mortality rate and stratified the associated factors. Then exported to STATA 14 for further analysis. I2 and Egger's tests were employed to estimate the heterogeneity and publication bias respectively. Subgroup analysis based on country, study design, year of publication, and the sample size was also examined. RESULT This meta-analysis included 32 articles with a total of 21,405 study participants. The pooled mortality rate among preterm in the East Africa continent was found to be 19.2% (95% CI (confidence interval (16.0-22.4)). Regarding the study design, the mortality rate was found to be 18.1%, 19.4%, and 19.7% concerning the prospective cohort, retrospective cohort, and cross-sectional studies. The pooled odds of mortality among preterm with respiratory distress syndrome decreased survival by nearly three folds [AOR (Adjusted odds ratio = 3.2; 95% CI: 22, 4.6)] as compared to their counterparts. Similarly, preterm neonates presented with birth asphyxia were nearly three times higher in death as compared with preterm without birth asphyxia [AOR = 2.6; 95% CI: 1.9, 3.4]. CONCLUSION Preterm mortality was found to be unacceptably high in Eastern Africa continent.Fortunately, the main causes of death were found to be respiratory distress syndrome and birth asphyxia which are preventable and treatable hence early detection and timely management of this problem are highly recommended to improve preterm survival.
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Affiliation(s)
- Ermias Sisay Chanie
- Department of Pediatrics and Child Health Nursing, College of Health Sciences, Debre Tabor University, Debre Tabor, Ethiopia
| | - Abebew Yeshambel Alemu
- Department of Pediatrics and Child Health Nursing, College of Health Sciences, Debre Tabor University, Debre Tabor, Ethiopia
| | - Demewoze Kefale Mekonen
- Department of Pediatrics and Child Health Nursing, College of Health Sciences, Debre Tabor University, Debre Tabor, Ethiopia
| | - Biruk Demissie Melese
- Department of Environmental Health, College of Health Sciences, Debre Tabor University, Debre Tabor, Ethiopia
| | - Binyam Minuye
- Department of Maternity and Neonatal Health Nursing, College of Health Sciences, Debre Tabor University, Debre Tabor, Ethiopia
| | - Habtamu Shimels Hailemeskel
- Department of Maternity and Neonatal Health Nursing, College of Health Sciences, Debre Tabor University, Debre Tabor, Ethiopia
| | - Worku Necho Asferie
- Department of Maternity and Neonatal Health Nursing, College of Health Sciences, Debre Tabor University, Debre Tabor, Ethiopia
| | - Wubet Alebachew Bayih
- Department of Maternity and Neonatal Health Nursing, College of Health Sciences, Debre Tabor University, Debre Tabor, Ethiopia
| | - Tigabu Munye
- Department of Adult Health Nursing, College of Health Sciences, Debre Tabor University, Debre Tabor, Ethiopia
| | - Tekalign Amera Birlie
- Department of Adult Health Nursing, College of Health Sciences, Debre Tabor University, Debre Tabor, Ethiopia
| | - Abraham Tsedalu Amare
- Department of Adult Health Nursing, College of Health Sciences, Debre Tabor University, Debre Tabor, Ethiopia
| | - Nigusie Selomon Tibebu
- Department of Pediatrics and Child Health Nursing, College of Health Sciences, Debre Tabor University, Debre Tabor, Ethiopia
| | - Chalie Marew Tiruneh
- Department of Pediatrics and Child Health Nursing, College of Health Sciences, Debre Tabor University, Debre Tabor, Ethiopia
| | - Getasew Legas
- Department of Psychiatric, School of Medicine, College of Health Sciences, Debre Tabor University, Debre Tabor, Ethiopia
| | | | - Demeke Mesfin Belay
- Department of Pediatrics and Child Health Nursing, College of Health Sciences, Debre Tabor University, Debre Tabor, Ethiopia
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Berhanu B, Oljira L, Demana M, Negash B, Mamo Ayana G, Beshir Raru T, Haile D. Survival and Predictors of Mortality Among Neonates Admitted to Neonatal Intensive Care Unit at Bombe Primary Hospital, Southern Ethiopia: Institution-Based Retrospective Cohort Study. PEDIATRIC HEALTH MEDICINE AND THERAPEUTICS 2021; 12:239-249. [PMID: 34040481 PMCID: PMC8140944 DOI: 10.2147/phmt.s303158] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.7] [Reference Citation Analysis] [Abstract] [Key Words] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 01/23/2021] [Accepted: 04/28/2021] [Indexed: 12/03/2022]
Abstract
Background Neonatal mortality includes all deaths of neonate occurring before the 28th day of life. Neonatal mortality has been declining over two decades in Sub-Saharan Africa, including Ethiopia. The foremost causes of death are preventable and treatable. Regardless, recognizing the predictors may be a crucial step in lowering neonatal mortality. However, evidences on the survival status of neonates and/or neonatal death predictors were limited in Ethiopia, particularly in the study area. Thus, this study aimed to answer these questions. Methods An institution-based retrospective cohort study was done among 380 Neonates admitted to the Neonatal Intensive Care Unit at Bombe Primary Hospital from January 1, 2018, to December 31, 2019. Bivariable and multivariable Cox regression analyses were conducted to identify predictors of mortality. Association was summarized using adjusted hazard ratio (AHR), and statistical significances were declared at 95% CI and P-value <0.05. Proportionality assumption was tested by a global test based on Schoenfeld residuals analysis. Results The overall incidence of neonatal mortality was 20.8 (95% CI: 15.2, 28.5) per 1000 neonatal days. Late initiation of early breastfeeding (EBF) after 1 hr. [AHR: 2.9; 95% CI: 1.32, 6.37], 5th min APGAR score <5 [AHR: 3; 95% CI: 1.32; 6.88], low birth weight [AHR: 2.59; 95% CI: 1.1,6.26], hypothermia [AHR: 2.6; 95% CI: 1.1, 6.22] and mothers’ time of rupture of membrane >12 hours before delivery [AHR: 2.49; 95% CI: 1.25, 4.97] were increased the risk of neonatal mortality, while cesarean section delivery 91.6% [AHR= 0.084; 95% CI: 0.10, 0.65] and antenatal care (ANC) utilization 61% [AHR: 0.39; 95% CI: 0.15–0.91] decreased the risk of neonatal mortality. Conclusion The incidence of neonatal mortality rate was high at the Bombe primary hospital. Therefore, to improve neonatal survival, it is recommended that complications and low birth weight be managed, that early exclusive breastfeeding be initiated, that service quality be improved, and that a continuum of care be ensured.
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Affiliation(s)
- Bizuayehu Berhanu
- Department of Maternal and Child Health Core Process, Wolaita Zone, Southern Ethiopia, Ethiopia
| | - Lemessa Oljira
- Department of Reproductive Health, School of Public Health, Haramaya University, Harar, Ethiopia
| | - Melake Demana
- Department of Epidemiology and Biostatistics, School of Public Health, Haramaya University, Harar, Ethiopia
| | - Belay Negash
- Department of Public Health and Health Policy, School of Public Health, College of Health and Medical Science Haramaya University, Harar, Ethiopia
| | - Galana Mamo Ayana
- Department of Epidemiology and Biostatistics, School of Public Health, Haramaya University, Harar, Ethiopia
| | - Temam Beshir Raru
- Department of Epidemiology and Biostatistics, School of Public Health, Haramaya University, Harar, Ethiopia
| | - Dereje Haile
- Department of Reproductive Health and Nutrition, School of Public Health, College of Medicine and Health Science, Wolaita Sodo University, Sodo, Ethiopia
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Incidence Density Rate of Neonatal Mortality and Predictors in Sub-Saharan Africa: A Systematic Review and Meta-Analysis. Int J Pediatr 2020; 2020:3894026. [PMID: 33123204 PMCID: PMC7586147 DOI: 10.1155/2020/3894026] [Citation(s) in RCA: 6] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 07/14/2020] [Accepted: 09/26/2020] [Indexed: 11/19/2022] Open
Abstract
Background Neonatal mortality in Sub-Saharan countries is remarkably high. Though there are inconsistent studies about the incidence density rate of neonatal mortalities (IDR) and predictors in Sub-Saharan Africa, they are inconclusive to policymakers and program planners. In this study, the IDR of neonatal mortalities and predictors was determined. Methods Electronic databases (Web of Science, PubMed, EMBASE (Elsevier), Scopus, CINAHL (EBSCOhost), World Cat, Google Scholar, and Google) were explored. 20 out of 818 studies were included in this study. The IDRs and predictors of neonatal mortality were computed from studies conducted in survival analysis. Fixed and random effect models were used to compute pooled estimates. Subgroup and sensitivity analyses were performed. Results Neonates were followed for a total of 1,095,611 neonate-days; 67142 neonate-days for neonates treated in neonatal intensive care units and 1,028,469 neonate-days for community-based studies. The IDRs of neonatal mortalities in neonatal intensive care units and in the community were 24.53 and 1.21 per 1000 person-days, respectively. The IDRs of early and late neonatal mortalities neonatal intensive care units were 22.51 and 5.09 per 1000 neonate-days, respectively. Likewise, the IDRs of early and late neonatal mortalities in the community were 0.85 and 0.31, respectively. Not initiating breastfeeding within one hour, multiple births, rural residence, maternal illness, low Apgar score, being preterm, sepsis, asphyxia, and respiratory distress syndrome were independent predictors of time to neonatal mortality in neonatal intensive care units and male gender, perceived small size, multiple births, and ANC were predictors of neonatal mortality in the community. Conclusion The incidence density rate of neonatal mortality in Sub-Saharan Africa is significantly high. Multiple factors (neonatal and maternal) were found to be independent predictors. Strategies must be designed to address these predictors, and prospective studies could reveal other possible factors of neonatal mortalities.
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