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Habibelahi A, Heidarzadeh M, Abdollahi L, Taheri M, Ghaffari-Fam S, Vakilian R, Daemi A. Clinical cause of neonatal mortality in Iran: analysis of the national Iranian Maternal And Neonatal network. BMJ Paediatr Open 2024; 8:e002315. [PMID: 38508661 PMCID: PMC10961515 DOI: 10.1136/bmjpo-2023-002315] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 10/11/2023] [Accepted: 03/07/2024] [Indexed: 03/22/2024] Open
Abstract
BACKGROUND The neonatal mortality rate is a main indicator of the health and development of a country. Having insight into the cause of neonatal deaths may be the first step to reducing it. This paper depicts the cause of newborn deaths in Iran. METHODS This cross-sectional study was performed on data from the national Iranian Maternal And Neonatal network to investigate all neonatal deaths in the country during the year 2019. The cause of death data were reported according to categories of birth weight, gestational age (GA), death time and place. RESULTS The main causes of the 9959 neonatal deaths during the study period were respiratory distress syndrome (RDS) (37%), malformation (21%), prematurity of <26 weeks (20%), others (12%), asphyxia (7%) and infection (3%). The major causes of neonatal mortality in delivery rooms were prematurity of <26 weeks and in the inpatient wards the RDS. By increasing the GA and birth weight towards term babies, the rate of RDS gets lower, while that of malformation gets higher. CONCLUSIONS RDS was the main cause of neonatal mortality in Iran which is seen mainly in preterm babies. Prematurity of <26 weeks was another main cause. Thus, suggestions include reducing prematurity by preconception and pregnancy care and, on the other hand, improving the care of preterm infants in delivery rooms and inpatient wards.
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Affiliation(s)
- Abbas Habibelahi
- Iran Ministry of Health and Medical Education, Tehran, Iran (the Islamic Republic of)
| | | | - Leila Abdollahi
- Department of Health Services Management, Iran University of Medical Sciences, Tehran, Iran (the Islamic Republic of)
| | - Majzoubeh Taheri
- Iran Ministry of Health and Medical Education, Tehran, Iran (the Islamic Republic of)
| | - Saber Ghaffari-Fam
- Department of Epidemiology, Hamadan University of Medical Sciences, Hamadan, Iran (the Islamic Republic of)
| | - Roshanak Vakilian
- Iran Ministry of Health and Medical Education, Tehran, Iran (the Islamic Republic of)
| | - Amin Daemi
- Department of Health Services Management, Iran University of Medical Sciences, Tehran, Iran (the Islamic Republic of)
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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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Feng B, Zhang Z, Wei Q, Mo Y, Luo M, Jing L, Li Y. A prediction model for neonatal necrotizing enterocolitis in preterm and very low birth weight infants. Front Pediatr 2023; 11:1242978. [PMID: 37920794 PMCID: PMC10619757 DOI: 10.3389/fped.2023.1242978] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 06/22/2023] [Accepted: 09/29/2023] [Indexed: 11/04/2023] Open
Abstract
Objectives Neonatal necrotizing enterocolitis (NEC) is a severe gastrointestinal disease that primarily affects preterm and very low birth weight infants, with high morbidity and mortality. We aim to build a reliable prediction model to predict the risk of NEC in preterm and very low birth weight infants. Methods We conducted a retrospective analysis of medical data from infants (gestational age <32 weeks, birth weight <1,500 g) admitted to Maternal and Child Health Hospital of Guangxi Zhuang Autonomous Region. We collected clinical data, randomly dividing it into an 8:2 ratio for training and testing. Multivariate logistic regression was employed to identify significant predictors for NEC. Principal component analysis was used for dimensionality reduction of numerical variables. The prediction model was constructed through logistic regression, incorporating all relevant variables. Subsequently, we calculated performance evaluation metrics, including Receiver Operating Characteristic (ROC) curves and confusion matrices. Additionally, we conducted model performance comparisons with common machine learning models to establish its superiority. Results A total of 292 infants were included, with 20% (n = 58) randomly selected for external validation. Multivariate logistic regression revealed the significance of four predictors for NEC in preterm and very low birth weight infants: temperature (P = 0.003), Apgar score at 5 min (P = 0.004), formula feeding (P = 0.007), and gestational diabetes mellitus (GDM, P = 0.033). The model achieved an accuracy of 82.46% in the test set with an F1 score of 0.90, outperforming other machine learning models (support vector machine, random forest). Conclusions Our logistic regression model effectively predicts NEC risk in preterm and very low birth weight infants, as confirmed by external validation. Key predictors include temperature, Apgar score at 5 min, formula feeding, and GDM. This study provides a vital tool for NEC risk assessment in this population, potentially improving early interventions and child survival. However, clinical validation and further research are necessary for practical application.
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Affiliation(s)
- Baoying Feng
- Maternal and Child Health Hospital of Guangxi Zhuang Autonomous Region, Nanning, China
- Guangxi Clinical Research Center for Pediatric Disease, Nanning, China
| | - Zhihui Zhang
- Department of Applied Mathematics, The Hong Kong Polytechnic University, Kowloon, Hong Kong SAR, China
| | - Qiufen Wei
- Maternal and Child Health Hospital of Guangxi Zhuang Autonomous Region, Nanning, China
- Guangxi Clinical Research Center for Pediatric Disease, Nanning, China
| | - Yan Mo
- Maternal and Child Health Hospital of Guangxi Zhuang Autonomous Region, Nanning, China
- Guangxi Clinical Research Center for Pediatric Disease, Nanning, China
| | - Mengmeng Luo
- Department of Biological Sciences, University of Liverpool, Liverpool, United Kingdom
| | - Lianfang Jing
- Maternal and Child Health Hospital of Guangxi Zhuang Autonomous Region, Nanning, China
- Guangxi Clinical Research Center for Pediatric Disease, Nanning, China
| | - Yan Li
- Maternal and Child Health Hospital of Guangxi Zhuang Autonomous Region, Nanning, China
- Guangxi Clinical Research Center for Pediatric Disease, Nanning, China
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Gudayu TW. Epidemiology of neonatal mortality: a spatial and multilevel analysis of the 2019 mini-Ethiopian demographic and health survey data. BMC Pediatr 2023; 23:26. [PMID: 36647037 PMCID: PMC9843859 DOI: 10.1186/s12887-023-03838-0] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 06/29/2022] [Accepted: 01/06/2023] [Indexed: 01/18/2023] Open
Abstract
BACKGROUND Sub-Saharan African countries are a high-burden region of neonatal mortality and showed slow progress in its reduction. In developing countries, as long as the current trend of mortality persists, achieving a sustainable development target for neonatal mortality would be challenging. The aim of this study was to detect significant geographic areas and identify community and individual-level predictors of neonatal mortality in Ethiopia to draw attention to a policy. METHODS A weighted total sample of 24,136 mothers from the 2019 mini-Ethiopian demographic and health survey data were included in the analysis. Global Moran's I statistics was run to check the clustering of neonatal mortality and then kriging interpolation was done to predict the magnitude of neonatal mortality in Ethiopia. In addition, SaTScan analysis was also executed to identify hot spot clusters of neonatal mortality. Finally, a multilevel mixed-effect logistic regression model was used to identify community and individual-level predictors of early neonatal and neonatal mortality. RESULTS The lifetime early neonatal and neonatal mortality among mothers in Ethiopia was 5.08 (95% CI: 4.13-6.03) and 6.54 (5.55, 7.52) per 1000 births respectively. Neonatal mortality was spatially clustered in the country and the SaTScan analysis identified significant hotspot areas of neonatal mortality in the Amhara and Afar regions and some areas of the Somali and Oromia regions. Its predicted magnitude was > 8 per 1000 births in wide areas of the Amhara and Benishangul regions. A multilevel mixed-effect logistics regression analysis identified that a lower level of maternal education, being a twin neonate, and being a male neonate were predictors of both early neonatal and neonatal mortality. Whereas, the younger age of mothers predicted neonatal mortality. CONCLUSIONS Neonatal mortality in Ethiopia is geographically clustered and sociodemographic and obstetric factors played a significant role. Policy direction should focus on evidence-based practices like midwives-led community and facility-based continuum of care from preconception to postnatal periods to possibly reduce neonatal mortality.
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Affiliation(s)
- Temesgen Worku Gudayu
- grid.59547.3a0000 0000 8539 4635Department of Clinical Midwifery, School of Midwifery, College of Medicine and Health Sciences, University of Gondar, Gondar, Ethiopia
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Leta M, Assefa N, Tefera M. Obstetric emergencies and adverse maternal-perinatal outcomes in Ethiopia; A systematic review and meta-analysis. Front Glob Womens Health 2022; 3:942668. [PMID: 36386434 PMCID: PMC9643843 DOI: 10.3389/fgwh.2022.942668] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/12/2022] [Accepted: 08/25/2022] [Indexed: 11/29/2022] Open
Abstract
Background Obstetric emergencies are life-threatening medical problems that develop during pregnancy, labor, or delivery. There are a number of pregnancy-related illnesses and disorders that can endanger both the mother's and the child's health. During active labor and after delivery, obstetrical crises can arise (postpartum). While the vast majority of pregnancies and births proceed without a hitch, all pregnancies are not without risk. Pregnancy can bring joy and excitement, but it can also bring anxiety and concern. Preterm birth, stillbirth, and low birth weight are all adverse pregnancy outcomes, leading causes of infant illness, mortality, and long-term physical and psychological disorders. Purpose The purpose of this study is to assess the magnitude and association of obstetric emergencies and adverse maternal-perinatal outcomes in Ethiopia. Method We used four databases to locate the article: PUBMED, HINARI, SCIENCE DIRECT, and Google Scholar. Afterward, a search of the reference lists of the identified studies was done to retrieve additional articles. For this review, the PEO (population, exposure, and outcomes) search strategy was used. Population: women who had obstetric emergencies in Ethiopia. Exposure: predictors of obstetric emergencies. Outcome: Women who had an adverse perinatal outcome. Ethiopian women were the object of interest. The primary outcome was the prevalence of adverse maternal and perinatal outcomes among Ethiopian women. Obstetrical emergencies are life-threatening obstetrical conditions that occur during pregnancy or during or after labor and delivery. The Joanna Briggs Institute quality assessment tool was used to critically appraise the methodological quality of studies. Two authors abstracted the data by study year, study design, sample size, data collection method, and study outcome. Individual studies were synthesized using comprehensive meta-analysis software and STATA version 16. Statistical heterogeneity was checked using the Cochran Q test, and its level was quantified using the I 2 statistics. Summary statistics (pooled effect sizes) in an odd ratio with 95% confidence intervals were calculated. Result A total of 35 studies were used for determining the pooled prevalence of adverse maternal and perinatal outcomes; twenty-seven were included in determining the odd with 95% CI in the meta-analysis, from which 14 were cross-sectional, nine were unmatched case-control studies, and 14 were conducted in the south nation and nationality Peoples' Region, and eight were from Amhara regional states, including 40,139 women who had an obstetric emergency. The magnitude of adverse maternal and perinatal outcomes following obstetric emergencies in Ethiopia was 15.9 and 37.1%, respectively. The adverse maternal outcome increased by 95% in women having obstetric emergencies (OR 2.29,95% CI 2.43-3.52), and perinatal deaths also increased by 95% in women having obstetric emergencies (OR 3.84,95% CI 3.03-4.65) as compared with normotensive women. Conclusion This review demonstrated the high prevalence of perinatal mortality among pregnant women with one of the obstetric emergencies in Ethiopia. Adverse maternal and perinatal outcomes following obstetric emergencies such as ICU admission, development of PPH, giving birth via CS, maternal death, NICU admission, LBW, and perinatal death were commonly reported in this study.
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Affiliation(s)
| | - Nega Assefa
- School of Nursing and Midwifery, College of Health and Medical Sciences, Haramaya University, Harar, Ethiopia
| | - Maleda Tefera
- School of Nursing and Midwifery, College of Health and Medical Sciences, Haramaya University, Harar, Ethiopia
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Tesfay N, Tariku R, Zenebe A, Dejene Z, Woldeyohannes F. Cause and risk factors of early neonatal death in Ethiopia. PLoS One 2022; 17:e0275475. [PMID: 36174051 PMCID: PMC9521835 DOI: 10.1371/journal.pone.0275475] [Citation(s) in RCA: 9] [Impact Index Per Article: 4.5] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/21/2022] [Accepted: 09/16/2022] [Indexed: 11/30/2022] Open
Abstract
Background Globally, three fourth of neonatal deaths occur during the early neonatal period, this makes it a critical time to reduce the burden of neonatal death. The survival status of a newborn is determined by the individual (neonatal and maternal), and facility-level factors. Several studies were conducted in Ethiopia to assess early neonatal death; however, most of the studies had limited participants and did not well address the two main determinant factors covered in this study. In response to this gap, this study attempted to examine factors related to early neonatal death based on perinatal death surveillance data in consideration of all the possible determinants of early neonatal death. Methods The national perinatal death surveillance data were used for this study. A total of 3814 reviewed perinatal deaths were included in the study. Bayesian multilevel parametric survival analysis was employed to identify factors affecting the survival of newborns during the early neonatal period. Adjusted time ratio (ATR) with 95% Bayesian credible intervals (CrI) was reported and log-likelihood was used for model comparison. Statistical significance was declared based on the non-inclusion of 1.0 in the 95% CrI. Result More than half (52.4%) of early neonatal deaths occurred within the first two days of birth. Per the final model, as gestational age increases by a week the risk of dying during the early neonatal period is reduced by 6% [ATR = 0.94,95%CrI:(0.93–0.96)]. There was an increased risk of death during the early neonatal period among neonates deceased due to birth injury as compared to neonates who died due to infection [ATR = 2.05,95%CrI:(1.30–3.32)]; however, perinates who died due to complication of an intrapartum event had a lower risk of death than perinates who died due to infection [ATR = 0.87,95%CrI:(0.83–0.90)]. As the score of delay one and delay three increases by one unit, the newborn’s likelihood of surviving during the early neonatal period is reduced by 4% [ATR = 1.04,95%CrI:(1.01–1.07)] and 21% [ATR = 1.21,95%CrI:(1.15–1.27)] respectively. Neonates born from mothers living in a rural area had a higher risk of dying during the early neonatal period than their counterparts living in an urban area [ATR = 3.53,95%CrI:(3.34–3.69)]. As compared to neonates treated in a primary health facility, being treated in secondary [ATR = 1.14,95%CrI:(1.02–1.27)] and tertiary level of care [ATR = 1.15,95%CrI:(1.04–1.25)] results in a higher risk of death during the early neonatal period. Conclusion The survival of a newborn during the early neonatal period is determined by both individual (gestational age, cause of death, and delay one) and facility (residence, type of health facility and delay three) level factors. Thus, to have a positive early neonatal outcome, a tailored intervention is needed for the three major causes of death (i.e Infection, birth injury, and complications of the intrapartum period). Furthermore, promoting maternal health, improving the health-seeking behaviour of mothers, strengthening facility readiness, and narrowing down inequalities in service provision are recommended to improve the newborn’s outcomes during the early neonatal period.
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Affiliation(s)
- Neamin Tesfay
- Centre of Public Health Emergency Management, Ethiopian Public Health Institutes, Addis Ababa, Ethiopia
- * E-mail:
| | - Rozina Tariku
- Centre of Public Health Emergency Management, Ethiopian Public Health Institutes, Addis Ababa, Ethiopia
| | - Alemu Zenebe
- Centre of Public Health Emergency Management, Ethiopian Public Health Institutes, Addis Ababa, Ethiopia
| | - Zewdnesh Dejene
- Centre of Public Health Emergency Management, Ethiopian Public Health Institutes, Addis Ababa, Ethiopia
| | - Fitsum Woldeyohannes
- Health Financing Program, Clinton Health Access Initiative, Addis Ababa, 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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Tola MA, Semahegn A, Tiruye G, Tura AK. Magnitude of neonatal near miss in public hospitals in Eastern Ethiopia: A cross-sectional study. SAGE Open Med 2022; 10:20503121221108926. [PMID: 35837571 PMCID: PMC9274431 DOI: 10.1177/20503121221108926] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/28/2022] [Accepted: 06/06/2022] [Indexed: 11/15/2022] Open
Abstract
Objectives Although neonatal near miss is an emerging concept and a tool for improving neonatal care, its magnitude and associated factors are less researched in Ethiopia. Thus, this study was aimed to uncover the magnitude of neonatal near miss and its associated factors in public hospitals in Eastern Ethiopia. Methods A facility-based cross-sectional study was employed on a randomly selected 405 mother-neonate pairs. An interview using a structured questionnaire accompanied by review of medical records was used to collect data from the mothers and records of the neonates. Neonatal near miss was defined as having any of the pragmatic (gestational age < 33 weeks, birth weight < 1750 g, and fifth minutes Apgar score < 7) or management criteria. Crude and adjusted logistic regression analysis was done to identify associated factors and presented with adjusted odds ratio with 95% confidence interval. Results Of 401 mother-neonate pairs included in the study, 126 (31.4%, 95% confidence interval = [26.9, 36.2]) neonates had at least one neonatal near miss event at discharge. Neonatal near miss was more likely among neonates from referred women (adjusted odds ratio = 2.24, 95% confidence interval = [1.25, 4.03]), no antenatal care (adjusted odds ratio = 2.08, 95% confidence interval = [1.10, 3.93]), antepartum hemorrhage (adjusted odds ratio = 4.29, 95% confidence interval = [2.16, 8.53]), premature rupture of membrane (adjusted odds ratio = 4.07, 95% confidence interval = [2.05, 8.07]), obstructed labor (adjusted odds ratio = 2.61, 95% confidence interval = [1.23, 5.52]), non-vertex presentation (adjusted odds ratio = 3.03, 95% confidence interval = [1.54, 5.95]), and primiparous (adjusted odd ratio = 2.67, 95% confidence interval = [1.49, 4.77]). Conclusions In this study, we found that neonatal near miss is higher than previous findings in Ethiopia. Improving neonatal near miss requires promoting antenatal care, maternal referral system, and early identification and management of obstetric complications.
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Affiliation(s)
- Melese Adugna Tola
- Department of Midwifery, College of
Health Sciences, Mettu University, Mettu, Ethiopia
- School of Nursing and Midwifery,
College of Health and Medical Sciences, Haramaya University, Harar, Ethiopia
| | - Agumasie Semahegn
- School of Nursing and Midwifery,
College of Health and Medical Sciences, Haramaya University, Harar, Ethiopia
- Department of Population, Family and
Reproductive Health, School of Public Health, University of Ghana, Accra,
Ghana
| | - Getahun Tiruye
- School of Nursing and Midwifery,
College of Health and Medical Sciences, Haramaya University, Harar, Ethiopia
| | - Abera Kenay Tura
- School of Nursing and Midwifery,
College of Health and Medical Sciences, Haramaya University, Harar, Ethiopia
- Department of Obstetrics and
Gynecology, University Medical Center Groningen, University of Groningen, Groningen,
The Netherlands
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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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Abera T, Bayisa L, Bekele T, Dessalegn M, Mulisa D, Gamtessa LC. Neonatal Mortality and Its Associated Factors among Neonates Admitted to Wollega University Referral Hospital Neonatal Intensive Care Unit, East Wollega, Ethiopia. Glob Pediatr Health 2021; 8:2333794X211030157. [PMID: 34286050 PMCID: PMC8267021 DOI: 10.1177/2333794x211030157] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/06/2021] [Accepted: 06/15/2021] [Indexed: 11/16/2022] Open
Abstract
Ethiopia has a high neonatal mortality rate in spite of dearth of study. Therefore we aimed to assess magnitude and associated factors of neonatal mortality among neonates admitted to neonatal intensive care units of Wollega University Referral Hospital. Accordingly, a facility based cross-sectional study was conducted on 289 by reviewing medical records of neonates admitted to neonatal intensive care unit. The collected data were entered in to Epi data version 3.1 and Stata version 14 used for analysis. Variables with P-value < 0.25 at with 95% confidence interval in binary logistic regression analysis were taken to the multiple logistic regression analysis. Finally, variables with Likewise, variable with P-value < 0.05 at 95% confidence interval in multiple logistic regression analysis were considered as statistically significant. Among 289 neonates admitted to neonatal intensive care unit, 53 (18.34 %) were died. Majority 42(79.25%) of those deaths occurred at ≤ 7 days of birth. Preterm [AOR 4.15, 95% CI (1.67-10.33)], neonates faced birth asphyxia [AOR 3.26, 95% CI (1.33-7.98)], neonates who developed sepsis [AOR 2.29 95% CI (1.01-5.20)] and neonates encountered with jaundice [(AOR 11.08, 95% CI (1.03-119.59)] were more at risk to die. In general, the magnitude of neonatal mortality among neonates admitted to neonatal intensive care unit was high. Gestational age (maturity of new born), birth asphyxia, neonatal sepsis and neonatal jaundice were predictors of neonatal mortality. Neonates admitted to neonatal intensive care unit with sepsis, jaundice, and birth asphyxia demand special attention to reduce neonatal mortality.
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Affiliation(s)
| | - Lami Bayisa
- Wollega University, Nekemte, Oromia Ethiopia
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Minuye Birihane B, Alebachew Bayih W, Yeshambel Alemu A, Belay DM, Demis A. The burden of hyaline membrane disease, mortality and its determinant factors among preterm neonates admitted at Debre Tabor General Hospital, North Central Ethiopia: A retrospective follow up study. PLoS One 2021; 16:e0249365. [PMID: 33784349 PMCID: PMC8009412 DOI: 10.1371/journal.pone.0249365] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/22/2020] [Accepted: 03/13/2021] [Indexed: 11/20/2022] Open
Abstract
BACKGROUND Hyaline membrane disease (HMD) is a leading cause of morbidity and mortality in preterm newborn babies. Though, there are studies related to Hyaline membrane disease inclusive of all neonates, studies related to the burden among preterm neonates were limited. In addition, increasing neonatal mortality in Ethiopia could be related to increase in the burden of hyaline membrane disease among preterm neonates. Therefore, this study was aimed to assess the burden of hyaline membrane disease, mortality and its associated factors among preterm neonate admitted at neonatal intensive care unit, North Central Ethiopia. METHODOLOGY An institution-based retrospective follow-up study was conducted among 535 preterm neonates admitted at neonatal intensive care unit from January 1, 2014-December 30, 2017. Data were entered into EPi-data 4.2.0.0 and transferred to STATA version 14 statistical software for statistical analysis. Binary logistic regression was used for the analysis. All variables with P-value < 0.25 during bi-variable analysis were considered for multivariable logistic regression. Level of statistical significance was declared at P value ≤0.05. RESULTS In the current study, proportion of hyaline membrane disease was 40% (95% CI; 35.8, 44.3) of which 49.5% died. Preterm neonate born with Gestational age of less than 34 weeks of age (Adjusted odd ratio (AOR = 2.64; 95 CI: 1.49, 4.66)), 5th minute Apgar score less than 7 (AOR = 2.2; 95% CI: 1.20, 4.07), and newborn with birth weight of less than 1500 gram (AOR = 2.4, 95% CI: 1.3, 4.3) were predictors of hyaline membrane disease. CONCLUSIONS The mean gestational age (±) was 33.46 (±2.55) weeks. The incidence of hyaline membrane disease among preterm admissions was high. Preterm neonate born with gestational age of less than 34 weeks of age, asphyxiated newborns and newborn with birth weight of less than 1500 gram were predictors of hyaline membrane disease. So, emphasis should be given on early screening, follow up and timely interventions for preterm neonate.
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Affiliation(s)
| | | | | | | | - Asmamaw Demis
- Department of Nursing, College Health Sciences, Woldia University, Woldia, Ethiopia
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Desta M, Admas M, Yeshitila Y, Meselu B, Bishaw K, Assemie M, Yimer N, Kassa G. Effect of Preterm Birth on the Risk of Adverse Perinatal and Neonatal Outcomes in Ethiopia: A Systematic Review and Meta-Analysis. INQUIRY : A JOURNAL OF MEDICAL CARE ORGANIZATION, PROVISION AND FINANCING 2021; 58:469580211064125. [PMID: 34907788 PMCID: PMC8802133 DOI: 10.1177/00469580211064125] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Indexed: 11/16/2022]
Abstract
Despite remarkable progress in the reduction of under-five mortality, the rate of perinatal and neonatal mortality is still high especially in developing countries. The adverse outcome associated with preterm birth is one of the major public health challenges in Africa. However, there are limited and inconsistent studies conducted on the effect of preterm birth on adverse perinatal and neonatal outcomes in Ethiopia. Therefore, this systematic review and meta-analysis aimed to investigate the association between preterm birth and its adverse perinatal and neonatal outcomes in Ethiopia. We systematically searched several electronic databases like PubMed, Web of Science, SCOPUS, CINAHL, Google Scholar, African Journals Online databases and Science Direct. All identified observational studies were included. The I1 statistics were used to assess the heterogeneity among the studies. A random-effects model was computed to estimate the pooled effect of preterm birth on adverse perinatal and neonatal outcomes. Thirty-three studies with a total of 20 109 live births were included in the final meta-analysis. Our meta-analysis showed that preterm birth increased the odds of perinatal mortality by 10-folds [POR = 9.56 (95% CI: 5.47, 19.69)] and there was a 5.44-folds risk of stillbirth [Odds Ratio = 5.44 (95% CI: 3.57, 8.28)] among women who gave birth before 37 weeks of gestation. In addition, preterm birth was significantly associated with neonatal hypothermia [OR=3.54 (95% CI: 2.41, 5.21)], neonatal mortality [OR= 3.16 (95% CI: 1.57, 6.34). The sub-group analysis of this meta-analysis showed that there was an increased risk of neonatal sepsis [OR=2.33 (95% CI: 1.15, 4.71)] among preterm babies. Preterm births significantly increased the risk of adverse perinatal and neonatal outcomes in Ethiopia. Therefore, scale-up strategies and improving the quality of maternal and child health care providers should be an area of intervention to reduce adverse outcomes associated with preterm birth. The Federal Ministry of Health and concerned bodies should work towards the prevention of preterm birth and its adverse outcomes.
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Affiliation(s)
- Melaku Desta
- Department of Midwifery, Debre Markos University, Debre Markos, Ethiopia
| | - Melaku Admas
- Debre Markos University College of Health Science, Debre Markos, Ethiopia
| | - Yordanos Yeshitila
- Departments of Nursing, College of Health Sciences, Arba Minch University, Arba Minch, Ethiopia
| | - Belsity Meselu
- Debre Markos University College of Health Science, Debre Markos, Ethiopia
| | - Keralem Bishaw
- Debre Markos University College of Health Science, Debre Markos, Ethiopia
| | - Moges Assemie
- Debre Markos University College of Health Science, Debre Markos, Ethiopia
| | - Nigus Yimer
- Department of Midwifery, Woldia University, Woldia, Ethiopia
| | - Getachew Kassa
- Debre Markos University College of Health Science, Debre Markos, Ethiopia
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