Determinants of birth asphyxia among live birth newborns in University of Gondar referral hospital, northwest Ethiopia: A case-control study

Time to recovery of asphyxiated neonates and its' predictors among newborns admitted to neonatal intensive care unit at Debre Berhan Comprehensive Specialized Hospital, Ethiopia

BACKGROUND

Neonatal asphyxia is a leading cause of early neonatal mortality, accounting for approximately 900,000 deaths each year. Assessing survival rates, recovery time and predictors of mortality among asphyxiated neonates can help policymakers design, implement, and evaluate programs to achieve the sustainable development goal of reducing neonatal mortality to 12/1,000 live births by 2030. The current study sought to ascertain the survival status, recovery time, and predictors of neonatal asphyxia.

METHODS

A retrospective follow-up study conducted in Debre Berhan Comprehensive Specialized Hospital, which carried out from May 20th to June 20th, 2023 using records of asphyxiated babies in NICUs from January 1st, 2020 to December 31st, 2022, involving a sample size of 330. Pre-structured questionnaires created in Google Form were used to collect data, and STATA Version 14.0 was utilized for data entry and analysis, respectively. The Kaplan-Meier survival curve, log rank test, and median time were calculated. A multivariable Cox proportional hazards regression model was fitted in order to determine the predictors of time to recovery. Variables were statistically significant if their p-value was less than 0.05.

RESULTS

Three hundred thirty admitted asphyxiated neonates were followed a total of 2706 neonate -days with a minimum of 1 day to 18 days. The overall incidence density rate of survival was 9.9 per 100 neonates' days of observation (95% CI: 8.85-11.24) with a median recovery time of 9 days (95% CI: 0.82-0.93). Prolonged labor (Adjusted hazard ratio (AHR: 0.42,95%CI:0.21-0.81), normal birth weight (AHR:2.21,95% CI: 1.30-3.70),non-altered consciousness (AHR:2.52,CI:1.50-4.24),non-depressed moro reflex of the newborn (AHR:2.40,95%CI: 1.03-5.61), stage I HIE (AHR: 5.11,95% CI: 1.98-13.19),and direct oxygen administration via the nose (AHR: 4.18,95% CI: 2.21-7.89) were found to be independent predictors of time to recovery of asphyxiated neonates..

CONCLUSION

In the current findings, the recovery time was prolonged compared to other findings. This implies early diagnosis, strict monitoring and provision of appropriate measures timely is necessary before the babies complicated into the highest stage of hypoxic -ischemic encephalopathy(HIE) and managing complications are the recommended to hasten recovery time and increase the survival of neonates.

Feasibility Analysis of ECG-Based pH Estimation for Asphyxia Detection in Neonates

Birth asphyxia is a potential cause of death that is also associated with acute and chronic morbidities. The traditional and immediate approach for monitoring birth asphyxia (i.e., arterial blood gas analysis) is highly invasive and intermittent. Additionally, alternative noninvasive approaches such as pulse oximeters can be problematic, due to the possibility of false and erroneous measurements. Therefore, further research is needed to explore alternative noninvasive and accurate monitoring methods for asphyxiated neonates. This study aims to investigate the prominent ECG features based on pH estimation that could potentially be used to explore the noninvasive, accurate, and continuous monitoring of asphyxiated neonates. The dataset used contained 274 segments of ECG and pH values recorded simultaneously. After preprocessing the data, principal component analysis and the Pan-Tompkins algorithm were used for each segment to determine the most significant ECG cycle and to compute the ECG features. Descriptive statistics were performed to describe the main properties of the processed dataset. A Kruskal-Wallis nonparametric test was then used to analyze differences between the asphyxiated and non-asphyxiated groups. Finally, a Dunn-Šidák post hoc test was used for individual comparison among the mean ranks of all groups. The findings of this study showed that ECG features (T/QRS, T Amplitude, Tslope, Tslope/T, Tslope/|T|, HR, QT, and QTc) based on pH estimation differed significantly (p < 0.05) in asphyxiated neonates. All these key ECG features were also found to be significantly different between the two groups.

Determinants of birth asphyxia among newborns in south Gondar Zone public hospitals, North West Ethiopia, 2021: A case control study

Introduction

Birth asphyxia is one of the leading causes of neonatal mortality, which accounts for around 24 % of overall neonatal mortality. Neonatal death usually results from preventable factors. Thus, this study has aimed to identify the determinant factors of birth asphyxia among newborns in South Gondar Zone public hospitals.

Methods

Institution based unmatched case control study and systematic random sampling technique was conducted in South Gondar zone public hospitals from March October 2021 to May 20/2021. A pretested interviewer administered questionnaire and a data retrieving checklist was used for data collection. Cases were selected if one of the following was present at birth: (gasping, no breathing, or breathing rate of below 30 per minute). Epidata version 4.6 software was used for data entry and bivariate logistic regression and multivariable logistic regression techniques were used for data analysis using SPSS version 23.

Result

In this study, Instrumental delivery (AOR = 3.19, 95%CI: 1.23-8.36), labor abnormality (AOR = 3.24, 95%CI: 1.31-8.03), cord prolapse (AOR = 7.06, 95%CI:2.25-22.50),APH (AOR = 4.68,95%CI:2.00-10.95) and preterm birth (AOR = 3.84,95%CI:1.32-11.20) were predictors of birth asphyxia.

Conclusion

Labor abnormality, ante-partum hemorrhage, cord prolapse, instrumental delivery and preterm birth were independent predictors of birth asphyxia.

Magnitude of neonatal asphyxia and its predictors among newborns at public hospitals of Wolaita Zone in Southern Ethiopia, 2023

BACKGROUND

Neonatal asphyxia is one of preventable causes of neonatal mortality throughout the world. It could be improved by early detection and control of the underlying causes. However, there was lack of evidence on it in the study setting. Thus, the aim of this study was to assess the magnitude and predictors of neonatal asphyxia among newborns at public hospitals of Wolaita Zone in Southern Ethiopia.

METHOD

A facility-based cross-sectional study was done among 330 mothers with neonates in selected public hospitals. A systematic random sampling technique was used to select the study participants. Data were collected through an interviewer-administered questionnaire and checklist. The collected data were entered into EpiData version 4.6 and exported to SPSS version 26 for analysis. Logistic regression was fitted to examine the association between explanatory variables and outcome variable. In multivariable logistic regression, AOR with 95% CI was reported, and p < 0.05 was used to declare statistically significant variables.

RESULTS

The magnitude of neonatal asphyxia was 26.4% with 95% CI: (21.8, 30.9). In multivariable logistic regression analysis primiparity (AOR = 2.63 95%CI 1.47, 4.72), low-birth-weight (AOR = 3.45 95%CI 1.33, 8.91), preterm birth (AOR = 3.58 95%CI 1.29, 9.92), and premature rupture of membranes (AOR = 5.19 95%CI 2.03, 13.26) were factors significantly associated with neonatal asphyxia.

CONCLUSIONS

In this study, the magnitude of neonatal asphyxia was high. From the factors, premature rapture of the membrane, parity, birth weight of the newborn, and gestational age at birth were significantly associated with neonatal asphyxia. Attention should be given to early detection and prevention of neonatal asphyxia from complicated labor and delivery.

Factors associated with perinatal and neonatal deaths in Sao Tome & Principe: a prospective cohort study

Background

Neonatal mortality reduction is a global goal, but its factors are seldom studied in most resource-constrained settings. This is the first study conducted to identify the factors affecting perinatal and neonatal deaths in Sao Tome & Principe (STP), the smallest Central Africa country.

Methods

Institution-based prospective cohort study conducted at Hospital Dr. Ayres Menezes. Maternal-neonate dyads enrolled were followed up after the 28th day of life (n = 194) for identification of neonatal death-outcome (n = 22) and alive-outcome groups (n = 172). Data were collected from pregnancy cards, hospital records and face-to-face interviews. After the 28th day of birth, a phone call was made to evaluate the newborn's health status. Crude odds ratios and corresponding 95% confidence intervals were obtained. A p value <0.05 was considered statistically significant.

Results

The mean gestational age of the death-outcome and alive-outcome groups was 36 (SD = 4.8) and 39 (SD = 1.4) weeks, respectively. Death-outcome group (n = 22) included sixteen stillbirths, four early and two late neonatal deaths. High-risk pregnancy score [cOR 2.91, 95% CI: 1.18-7.22], meconium-stained fluid [cOR 4.38, 95% CI: 1.74-10.98], prolonged rupture of membranes [cOR 4.84, 95% CI: 1.47-15.93], transfer from another unit [cOR 6.08, 95% CI:1.95-18.90], and instrumental vaginal delivery [cOR 8.90, 95% CI: 1.68-47.21], were factors significantly associated with deaths. The odds of experiencing death were higher for newborns with infectious risk, IUGR, resuscitation maneuvers, fetal distress at birth, birth asphyxia, and unit care admission. Female newborn [cOR 0.37, 95% CI: 0.14-1.00] and birth weight of more than 2,500 g [cOR 0.017, 95% CI: 0.002-0.162] were found to be protective factors.

Conclusion

Factors such as having a high-risk pregnancy score, meconium-stained amniotic fluid, prolonged rupture of membranes, being transferred from another unit, and an instrumental-assisted vaginal delivery increased 4- to 9-fold the risk of stillbirth and neonatal deaths. Thus, avoiding delays in prompt intrapartum care is a key strategy to implement in Sao Tome & Principe.

Perinatal Birth Asphyxia Among Newborns at Jiblah Public Health Hospital in Ibb City, Yemen, During Six Years of Conflict and Its Predictive Factors: A Retrospective Cross-Sectional Study

BACKGROUND

Birth asphyxia is a major cause of infant death across the world, especially in developing countries, where the issue is significantly underreported and underestimated, particularly in fragile and conflict-affected states.

OBJECTIVE

The purpose of this study was to determine the prevalence and risk factors for birth asphyxia in women at Jiblah University Hospital in Ibb, Yemen, and its predictive factors throughout six years of conflict.

METHOD

We conducted a retrospective cross-sectional chart review and analysis of the birth database spanning from June 2013 to September 2019 at Jiblah University Hospital in Ibb, Yemen. We used APGAR (appearance, pulse, grimace, activity, and respiration) scores <7 at both the first- and fifth-minute post-delivery with umbilical cord arterial blood pH <7 (metabolic acidosis) and/or neurologic manifestations (seizures or an altered tone) within the first 24 hours of life to define birth asphyxia cases. Factors associated with birth asphyxia were analyzed using univariate and multivariate regression analysis with an odds ratio (OR) and 95% confidence interval (CI).

RESULTS

A total of 5,193 neonates were delivered during the study period. The prevalence of birth asphyxia in 309 (6%) neonates. In a multivariate analysis, illiteracy (OR: 2.90; 95% CI: 0.98-8.41), referred mothers (OR: 3.04; 95% CI: 1.42-6.40), advanced maternal age (OR: 1.05; 95% CI: 1.02-1.07), home delivery (OR: 6.50; 95% CI: 3.09-12.57), prematurity (OR: 1.43; 95% CI: 1.05-1.93), and low birth weight (OR: 3.09; 95% CI: 1.93-4.93) were predictors for birth asphyxia and were statistically significant (p<0.05).

CONCLUSION

In this study, the prevalence of birth asphyxia was equivalent to that of other underdeveloped nations. However, continual attention and treatments are required to lower the risk of birth asphyxia. Illiteracy, referred mothers, advanced maternal age, home delivery, prematurity, and low birth weight were all predictors of birth asphyxia in this research. Most birth asphyxia factors mentioned in this study can be managed through effective prenatal, intrapartum, and postpartum care, as well as a strict following of national obstetrics and neonatal guidelines.

Determinants of birth asphyxia among neonates admitted to neonatal intensive care units in hospitals of the Wolaita zone, Southern Ethiopia: A case-control study

Background

Birth asphyxia, according to the World Health Organization (WHO), is the inability of breathing to start and continue automatically at birth. Blood-gas exchange is impaired, which results in increased hypoxia, hyperapnea, and substantial metabolic acidosis. The aim of this study was to determine the factors contributing to birth asphyxia in infants admitted to neonatal intensive care units in hospitals in the Wolaita Zone.

Methods

An institution-based, unmatched case-control study among neonates admitted to neonatal intensive care units in Wolaita Zone hospitals was conducted from March 1 to April 15, 2021. With 148 cases and 294 controls and a case-to- control ratio of 1:2, a sample size of 442 was determined. The pre-tested and structured Open Data Kit collect mobile application (v1.26.1) was used to collect the data, and SPSS version 25 was used for analysis. Using adjusted odd ratios and their corresponding 95 % confidence intervals, bivariate and multivariable logistic regression analyzes were performed.

Results

A total of 143 cases and 286 controls were included making. the response rate 97 %. Meconium or blood-stained amniotic fluid (AOR = 5.43, 95%CI:3.10-9.50), mothers who experienced any of dangerous symptom during pregnancy (AOR = 3.71, 95%CI: 1.56-8.65), premature rupture of membrane (AOR = 3.12, 95%CI: 1.42-6.83), hypothermic newborn (AOR = 4.57, 95CI: 1.77-11.81), labor not supported by Basic Emergency Obstetric and Neonatal Care (BEMONC) trained health professional (AOR = 3.23, 95%CI: 1.83-5.71), birth weight of less than 2500 gm (AOR = 2.68, 95%CI: 1.04-6.92), sub-standard filling of partograph (AOR = 4.03, 95%CI: 2.19-7.41), not filling on partograph during follow-up (AOR = 8.16, 95%CI: 2.24-29.66) and assisted vaginal delivery (AOR = 1.87, 95%CI:1.03-3.39) were identified as determinants of birth asphyxia.

Conclusion

In this study, fetal conditions such as hypothermia and low birth weight, changes in the color of amniotic fluid, dangerous pregnancy symptoms, membrane rupture, standard filling of the partograph, and BEMONC training were factors that predicted birth asphyxia. Therefore, prompt and effective management of fetal and maternal problems and as well as the development of health professionals' BEMONC competence are crucial.

Hypoxic-ischaemic encephalopathy based on clinical signs and symptoms and associated factors among neonates, Southern Ethiopian public hospitals: a case-control study

Background

Hypoxic-ischaemic encephalopathy (HIE) is a severe condition that results from reduced oxygen supply and blood flow to the brain, leading to brain injury and potential long-term neurodevelopmental impairments. This study aimed to identify the maternal and neonatal factors associated with hypoxic-ischaemic encephalopathy among Neonates.

Methods

The authors conducted a case-control study in 15 public hospitals with 515 neonates and mothers (175 cases and 340 controls). The authors used a questionnaire and clinical records created and managed by Kobo software to collect data. The authors diagnosed hypoxic-ischaemic encephalopathy (HIE) by clinical signs and symptoms. The authors used logistic regression to identify HIE factors.

Results

Hypoxic-ischaemic encephalopathy (HIE) was associated with maternal education, ultrasound checkup, gestational age, delivery mode, and labour duration. Illiterate mothers [adjusted odds ratio (AOR)= 1.913, 95% CI: 1.177, 3.109], no ultrasound checkup (AOR= 1.859, 95% CI: 1.073, 3.221), preterm (AOR= 4.467, 95% CI: 1.993, 10.012) or post-term birth (AOR= 2.903, 95% CI: 1.325, 2.903), caesarean section (AOR= 7.569, 95% CI: 4.169, 13.741), and prolonged labour (AOR= 3.591, 95% CI: 2.067, 6.238) increased the incidence of HIE.

Conclusion

This study reveals the factors for hypoxic-ischaemic encephalopathy among neonates in Ethiopia. The authors found that neonates born to illiterate women, those who experienced prolonged labour, those whose mothers did not have ultrasound checkups during pregnancy, those delivered by caesarean section, and those born preterm, or post-term were more likely to develop hypoxic-ischaemic encephalopathy. These findings indicate that enhancing maternal education and healthcare services during pregnancy and delivery may positively reduce hypoxic-ischaemic encephalopathy among neonates.

The determinants of neonatal asphyxia in the tropical province of China: A case-control study

As the major public health problem among under-5 children in the world, neonatal asphyxia (NA) contributes to 24% of the main causes of neonatal death. The effects of NA is not only limited to death but also has a long-term brain injury with lifelong adverse effects. Therefore, the goal of this study was to identify determinants of NA among newborns in the tropical province of China to guide early interventions and improve the survival and quality of life of these infants. A case control study was conducted at Hainan Women and Children's Medical Center from January 1 to December 31, 2021. A total of 255 newborns (85 cases and 170 controls, 1:2 case to control ratio) were enrolled in the study. A systematic random sampling approach was adopted based on hospital delivery registration. Structured questionnaires were used to collected data. The data was entered into statistical software SPSS version 20.0 for analysis. In the bivariable analysis, variables with P values less than .1 were entered into multivariable logistic regression analysis. At a P value of .05, a statistically significant level was reported. Amniotic fluid stained by meconium/blood (AOR = 3.19, 95% confidence interval [CI]: 1.47-6.95), primiparity, fetal presentation of malpresentation (AOR = 3.89, 95% CI: 1.25-12.09), and low birth weight (AOR = 10.51, 95% CI: 3.02-36.55) were to be significantly associated with NA. This study identified that amniotic fluid stained by meconium/blood, primiparity, low birth weight were determinants of NA. Thus, preventive solutions such as close monitoring of fetus presentation, meliorating the obstetric care setup during antenatal care consultations should be stressed in China.

Adverse birth outcomes and associated factors among newborns delivered in Sao Tome & Principe: A case‒control study

BACKGROUND

Newborns with one-or-more adverse birth outcomes (ABOs) are at greater risk of mortality or long-term morbidity with health impacts into adulthood. Hence, identifying ABO-associated factors is crucial for devising relevant interventions. For this study, ABOs were defined as prematurity (PTB) for gestational age <37 weeks, low birth weight (LBW) <2.5 kg, macrosomia >4 kg, asphyxia for a 5-minute Apgar score <7, congenital anomalies, and neonatal sepsis. This study aimed to assess factors associated with ABOs among babies delivered at the only hospital of Sao Tome & Principe (STP), a resource-constrained sub-Saharan-Central African country.

METHODS

A hospital-based unmatched case‒control study was conducted among newborns from randomly selected mothers. Newborns with one-or-more ABO were the cases (ABO group), while healthy newborns were the controls (no-ABO group). Data were collected by a face-to-face interview and abstracted from antenatal care (ANC) pregnancy cards and medical records. Multivariable logistic regression analysis was performed to identify ABO-associated factors considering a level of significance of α = 0.05.

RESULTS

A total of 519 newborns (176 with ABO and 343 no-ABO) were enrolled. The mean gestational age and birthweight of cases and controls were 36 (SD = 3.7) weeks with 2659 (SD = 881.44) g and 39.6 (SD = 1.0) weeks with 3256 (SD = 345.83) g, respectively. In the multivariable analysis, twin pregnancy [aOR 4.92, 95% CI 2.25-10.74], prolonged rupture of membranes [aOR 3.43, 95% CI 1.69-6.95], and meconium- fluid [aOR 1.59, 95% CI 0.97-2.62] were significantly associated with ABOs. Eight or more ANC contacts were found to be protective [aOR 0.33, 95% CI 0.18-0.60, p<0.001].

CONCLUSION

Modifiable factors were associated with ABOs in this study and should be considered in cost-effective interventions. The provision of high-quality ANC should be a priority. Twin pregnancies and intrapartum factors such as prolonged rupture of membranes and meconium-stained amniotic fluid are red flags for ABOs that should receive prompt intervention and follow-up.

Prevalence of birth injuries and associated factors among newborns delivered in public hospitals Addis Ababa, Ethiopia, 2021. Crossectional study

BACKGROUND

Birth injury is harm that a baby suffers during the entire birth process. It includes both birth asphyxia and birth trauma. In Ethiopia, birth injury has become the leading cause of neonatal morbidity and mortality, accounting around 28%-31.6% of neonatal mortality. The study aimed to assess the prevalence and factors associated with birth injuries among newborns delivered in public hospitals Addis Ababa, Ethiopia, 2021.

METHODS

Institution based cross-sectional study was conducted from February 15th to April 20th, 2021 in selected public hospitals of Addis Ababa, Ethiopia. Random sampling and systematic random sampling were used. Data was entered by using Epi data version 4.0.2 and exported in to SPSS Software version 25 for analysis. Both bivariate and multivariable logistic regressions analyses were used. Finally P-value <0.05 was used to claim statistically significant.

RESULT

The prevalence of birth injury was 24.7%. In the final model, birth asphyxia was significantly associated with the short height of the mothers (AOR = 10.7, 95% CI: 3.59-32.4), intrapartal fetal distress (AOR = 4.74, 95% CI: 1.81-12.4), cord prolapse (AOR = 7.7. 95% CI: 1.45-34.0), tight nuchal cord (AOR = 9.2. 95% CI: 4.9-35.3), birth attended by residents (AOR = 0.19, 95% CI: 0.05-0.68), male sex (AOR = 3.84, 95% CI: 1.30-11.3) and low birth weight (AOR = 5.28, 95% CI: 1.58-17.6). Whereas, birth trauma was significantly associated with gestational diabetic mellitus (AOR = 5.01, 95% CI: 1.38-18.1), prolonged duration of labor (AOR = 3.74, 95% CI: 1.52-9.20), instrumental delivery (AOR = 10.6, 95% CI: 3.45-32.7) and night time birth (AOR = 4.82, 95% CI: 1.84-12.6).

CONCLUSION

The prevalence of birth injury among newborns has continued to increases and become life-threatening issue in the delivery and neonatal intensive care unit in the study area. Therefore, considering the prevailing factors, robust effort has to be made to optimize the quality obstetric care and follow up and emergency obstetrics team has to be strengthened to reduce the prevalence of birth injury.

Obstetric emergencies and adverse maternal-perinatal outcomes in Ethiopia; A systematic review and meta-analysis

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.

Maternal factors associated with immediate low Apgar score in newborn babies at an intermediate hospital in Northern Namibia

BACKGROUND

All newborn infants are required to undergo the Apgar score/assessment immediately after birth and again at five minutes. This vital examination is performed to determine how well the infant is adjusting to the birthing process and the outside environment. Some newborns may have a normal Apgar score, while others may have a low score. The purpose of this study was to identify factors associated with low Apgar scores among newborns at an intermediate hospital in Northern Namibia.

OBJECTIVE

To identify maternal factors associated with an immediate low Apgar score in newborns at an intermediate hospital in Northern Namibia and to examine the association between maternal factors and an immediate low Apgar score. Quantitative, retrospective, descriptive research methodology was employed. A document review checklist was utilized to collect data at Onandjokwe Intermediate Hospital between August 2020 and October 2020.

RESULTS

Gravidity (p0.021), parity (p0.029), haemoglobin after the first ante-natal care visit (p0.011), ante-partum haemorrhage (APH) (p0.004), membrane status (p0.000), duration of labour (p0.000), type of delivery (p0.000), and caesarean section type and indication (p0.000) were found to be associated with an immediate low Apgar score.

CONCLUSIONS

The study identified maternal factors that influence an infant's initial low Apgar score. Strengthen maternal health education regarding gravidity and parity, diet, and recognizing danger signs during pregnancy. In addition, strict monitoring of patients with a partograph, cardiotocography, accurate record keeping, and prompt referral of patients with risk factors is strongly advised.

Comparison of the predictive ability for perinatal acidemia in neonates between the NICHD 3-tier FHR system combined with clinical risk factors and the fetal reserve index

BACKGROUND

Electronic fetal monitoring alone is a poor screening test for detecting fetuses at risk of acidemia or asphyxia. We aimed to evaluation of predictive ability of the National Institute of Child Health and Human Development (NICHD) 3-tier fetal heart rate (FHR) system combined with the maternal, obstetric, and fetal risk factors for predicting perinatal acidemia, and to compare this with the predictive of the NICHD 3-tier system alone, and the Fetal Reserve Index (FRI).

METHODS

A retrospective cohort study was conducted among singleton term pregnant women. Fetal heart rate tracings of the last two hours before delivery were interpreted into the NICHD 3-tier FHR classification system by two experienced obstetricians. Demographic data were compared using the χ2 or Fisher's exact test for categorical variables and the Student's t test for continuous variables. Logistic regression model was used to identify factors associated with perinatal acidemia in neonates. The Odds ratios (OR) and probabilities with 95% confidence intervals (CI) were calculated.

RESULTS

A total of 674 pregnant women were enrolled in this study. Using the NICHD 3-tier FHR categories I and II combined with the selected risk factors (AUC 0.62) had a better performance for perinatal acidemia prediction than the NICHD 3-tier FHR alone (AUC 0.55) and the FRI (AUC 0.52), (P<0.01). Improvement of predicting perinatal acidemia was found when NICHD category I was combined with preeclampsia or arrest disorders of labor (OR 3.2, 95% CI 1.30‒7.82) or combined with abnormal second stage of labor (OR 6.19, 95% CI 1.07‒36.06) and when NICHD category II was combined with meconium-stained amniotic fluid (OR 4.73, 95% CI 2.17‒10.31).

CONCLUSIONS

The NICHD 3-tier FHR categories I or II combined with selected risk factors can improve the predictive ability of perinatal acidemia in neonates compared with the NICHD 3-tier system alone or the FRI.

Prognostic risk score development to predict birth asphyxia using maternal and fetal characteristics in South Gondar zone hospitals, north West Ethiopia

Background

Birth asphyxia leads to profound systemic and neurological sequela to decrease blood flow or oxygen to the fetus followed by lethal progressive or irreversible life-long pathologies. In low resource setting countries, birth asphyxia remains a critical condition. This study aimed to develop and validate prognostic risk scores to forecast birth asphyxia using maternal and neonatal characteristics in south Gondar zone hospitals.

Methods

Prospective cohorts of 404 pregnant women were included in the model in south Gondar Zone Hospitals, Northwest Ethiopia. To recognize potential prognostic determinants for birth asphyxia, multivariable logistic regression was applied. The model discrimination probability was checked using the receiver operating characteristic curve (AUROC) and the model calibration plot was assessed using the ‘givitiR’ R-package. To check the clinical importance of the model, a cost-benefit analysis was done through a decision curve and the model was internally validated using bootstrapping. Lastly, a risk score prediction measurement was established for simple application.

Results

Of 404, 108 (26.73%) (95% CI: 22.6–31.3) newborns were exposed to birth asphyxia during the follow-up time. Premature rupture of membrane, meconium aspiration syndrome, malpresentation, prolonged labor, Preterm, and tight nuchal was the significant prognostic predictors of birth asphyxia. The AUROC curve for birth asphyxia was 88.6% (95% CI: 84.6-92.2%), which indicated that the tool identified the newborns at risk for birth asphyxia very well. The AUROC of the simplified risk score algorithm, was 87.9 (95% CI, 84.0– 91.7%) and the risk score value of 2 was selected as the optimal cut-off value, with a sensitivity of 78.87%, a specificity of 83.26%, a positive predictive value of 63.23%, and a negative predictive value of 91.52%.

Conclusions

We established birth asphyxia prediction tools by applying non-sophisticated maternal and neonatal characteristics for resource scares countries. The driven score has very good discriminative ability and prediction performance. This risk score tool would allow reducing neonatal morbidity and mortality related to birth asphyxia. Consequently, it will improve the overall neonatal health / under-five child health in low-income countries.

Determinants of low fifth minute Apgar score among newborns delivered by cesarean section at Wolaita Sodo University Comprehensive Specialized Hospital, Southern Ethiopia: an unmatched case control study

BACKGROUND

Apgar score is used to evaluate the neonates' overall status and response to resuscitation, as well as its prognosis beyond the neonatal period. Low fifth minute Apgar scores is more frequent and is associated with markedly increased risks of neonatal mortality and morbidity. In Ethiopia, the prevalence of birth asphyxia is high (22.52%). Birth asphyxia contributes to significant neonatal morbidities and mortalities due to severe hypoxic-ischemic multi-organ damage, mainly brain damage. Therefore, this study was aimed to identify determinants of low fifth minute Apgar score among newborns delivered by cesarean section.

METHODS

An unmatched case control study design was conducted. The Apgar score is based on measures of heart rate, respiratory effort, skin color, muscle tone, and reflex irritability. The data collection tool or checklist was adapted from previous study done at Addis Ababa, Ethiopia. In this study, cases were all newborns with Apgar score < 7 whereas controls were all newborns with Apgar score >  = 7. The study participants were selected by simple random sampling technique. Data was into Epidata version 4.6 and exported to SPSS software version 24. Multivariable logistic regression was used to identify the independent effect of different factors at P < 0.05.

RESULT

Factors associated with low Apgar score were fetal birth weight < 2.5 kg [adjusted odds ratio (AOR) = 8.17, 95% confidence interval (CI): 1.03 ‒ 64.59] P = 0.046, skin incision to delivery time (AOR = 5.27; 95% CI: 2.20 ‒ 12.60) P = 0.001, pregnancy induced hypertension (AOR = 4.58, 95% CI: 1.75 ‒ 11.92) P = 0.002, antepartum hemorrhage (AOR = 3.96; 95% CI: 1.75 ‒ 8.94) 0.001, general anesthesia (AOR = 3.37, 95% CI: 1.72 ‒ 6.62) P = 0.001, meconium stained amniotic fluid (AOR = 3.07, 95% CI: 1.32 ‒ 7.12) P = 0.009 and emergency cesarean section (AOR = 2.17, 95% CI: 1.13 ‒ 4.15) P = 0.019.

CONCLUSIONS

Fetal birth weight < 2.5 kg, skin incision to delivery time, pregnancy induced hypertension, antepartum hemorrhage, type of anesthesia, meconium stained amniotic fluid and type of cesarean section were factors independently associated with Apgar score. Therefore, it is important to work on identified risk factors to reduce the impacts low fifth minute Apgar score in the in early adulthood..

Magnitude of birth asphyxia and its associated factors among live birth in north Central Ethiopia 2021: an institutional-based cross-sectional study

Background

The leading cause of neonatal death worldwide is birth asphyxia. Yearly, in the first month of life, 2.5 million children died around the world. Birth asphyxia is a major problem, particularly in developing nations like Ethiopia. The goal of this study was to determine the magnitude of birth asphyxia and the factors that contributed to it among neonates delivered at the Aykel Primary Hospital in north-central Ethiopia.

Methods

From August 1 to August 31, 2021, a hospital-based cross-sectional study was conducted on 144 live births. An Apgar score less than 7 in the fifth minute of birth authorized the diagnosis of birth asphyxia. Variable contention (P < 0.250) for multivariable analysis was determined after data examination and cleaning. Then, to identify important factors of birth asphyxia, a multivariable logistic regression model with a p-value of 0.05 was developed. Finally, a significant relationship between a dependent variable and independent factors was defined as a p-value less than 0.05 with a 95% confidence interval.

Results

The majority of the mothers, 71.53%, received at least one Antenatal care visit, and more than half of the newborns were male (62.50%). The percentage of neonates that had asphyxia at delivery was 11.11% (95% CI: 6.3 -16.9%). Male newborns were 5.02 times more probable than female newborns to asphyxiate [AOR: 5.02, 95% CI (1.11–22.61)]. Mothers who have not had at least one Antenatal Care visit were 3.72 times more likely to have an asphyxiated newborn than those who have at least one Antenatal Care visit [AOR: 3.72, 95%CI (1.11–12.42)]. Similarly, mothers who had an adverse pregnancy outcome were 7.03 times more likely to have an asphyxiated newborn than mothers who had no such history [AOR: 7.03, 95% CI (2.17–22.70)].

Conclusion

Birth asphyxia in newborn has come to a standstill as a major public health issue. The sexual identity of the newborn, Antenatal Care visits, and a history of poor pregnancy outcomes were all found to be significant risk factors for birth asphyxia. These findings have great importance for various stakeholders who are responsible for reducing birth asphyxia; in addition, policymakers should establish and revise guidelines associated to newborn activities and workshops.

The effect of gestational age, low birth weight and parity on birth asphyxia among neonates in sub-Saharan Africa: systematic review and meta-analysis: 2021

Background

Despite simple and proven cost-effective measures were available to prevent birth asphyxia; studies suggested that there has been limited progress in preventing birth asphyxia even in healthy full-term neonates. In Sub-Saharan Africa, Inconsistency of magnitude of birth asphyxia and its association gestational age, Low birth Weight and Parity among different studies has been observed through time.

Objective

This study aimed to estimate the Pooled magnitude of birth asphyxia and its association with gestational age, Low birth Weight and Parity among Neonates in Sub-Saharan Africa.

Method

PubMed, Cochrane library and Google scholar databases were searched for relevant literatures. In addition, reference lists of included studies were retrieved to obtain birth asphyxia related articles. Appropriate search term was established and used to retrieve studies from databases. Searching was limited to cohort, cross-sectional, and case-control studies conducted in Sub-Saharan africa and published in English language. Joanna Briggs Institute Meta-Analysis of Statistics Assessment and Review Instrument (JBI-MAStARI) was used for critical appraisal of studies. Heterogeneity across the included studies was evaluated by using the inconsistency index (I²) test. Funnel plot and the Egger’s regression test were used to test publication bias. A weighted inverse variance random effects- model was used to estimate the pooled prevalence of birth asphyxia among neonates in Sub-Saharan Africa. STATA™ version 11softwarewasused to conduct the meta-analysis.

Result

A total of 40 studies with 176,334 study participants were included in this systematic review and meta-analysis. The overall pooled magnitude of birth asphyxia in Sub-Saharan Africa was 17.28% (95% CI; (15.5, 19.04). low birth weight (AOR = 2.58(95% CI: 1.36, 4.88)), primigravida (AOR = 1.15 (95% CI: 0.84, 1.46) andMeconium-stained amniotic fluid (AOR = 6(95% CI: 3.69, 9.74)) werevariables significantly associated with the pooled prevalence of birth asphyxia.

Conclusion

The pooled magnitude of birth asphyxia was found to be high in Sub-Saharan Africa. Low birthweight and Meconium-stained amniotic fluid were variables significantly associated with birth asphyxia in Sub-Saharan Africa. Hence, it is better to develop early detection and management strategies for the affected neonates with low birth weight and born from mothers intrapartum meconium stained amniotic fluid.

Determinants of birth asphyxia at public hospitals in Ilu Aba Bor zone southwest, Ethiopia: a case control study

Birth asphyxia is a leading cause of neonatal deaths, which accounts for about 31.6% of all neonatal deaths in Ethiopia. Despite its being one of the important causes of morbidity and mortality in newborns, its determinants were not investigated according to local context. So, this study was aimed at investigating the determinants of asphyxia at Illu Aba Bor zone public health facilities. An institution-based case–control study was employed. A pre-tested, structured and adapted interviewer administered questionnaire for mothers of newborn interviews and a data extraction tool for chart review were used. The collected data were entered into Epi-data version 3.1 and exported to SPSS version 24 for further analysis. A binary logistic regression was employed, and variables with a p-value < 0.25 were taken to a multi-variable logistic regression. Finally, a Bonferroni correction was used and variables with a p-value < 0.0038 at 95% CI were declared statistically significant. A total of 308 (103 cases vs 205 controls) mothers of newborns were interviewed, yielding a response rate of 100%. The mean age (SD) of mothers for the cases and the controls were (25.97 ± 4.47) and (25.52 ± 4.17) respectively. Prolonged duration of labor [AOR 4.12; 95% CI 1.78, 9.50], non-cephalic fetal presentation [AOR 4.35; 95% CI 1.77, 10.67], being preterm [AOR 5.77; l95% CI 2.62, 12.69] and low birth weight [AOR 4.43; (95% CI 1.94, 10.13) were found to be the determinants of birth asphyxia. Prolonged duration of labor, non-cephalic presentation, prim parous, preterm, and low birth weight were the independent determinants of birth asphyxia. Hence, improving the utilization of parthograph during labor and interventions focusing on this area should give priority to reducing the risk of morbidity and mortality.

Adolescent pregnancy in Sao Tome and Principe: are there different obstetric and perinatal outcomes?

BACKGROUND

Adolescent childbirth is a major public health problem in Sao Tome and Principe (STP). Adolescent pregnancy and childbirth can carry a risk of morbidity associated with the physiological and sociological characteristics of teenage girls. This study aims to identify the main adverse obstetric and perinatal outcomes for adolescent pregnancies in the Hospital Dr. Ayres de Menezes (HAM), the only hospital in STP.

METHODS

An institution-based cross-sectional study. Pregnant women ≤ 19 years of age (n = 104) were compared to non-adolescent women (n = 414). The obstetric and perinatal outcomes were compared between groups using the t test. Odds ratio (OR) were calculated through Cochran's and Mantel-Haenszel statistics test for odds ratio equal to 1, 95% confidence intervals (CI) and p values (p < 0.05) were considered significant.

RESULTS

The adverse perinatal outcomes imputable to adolescent births were foetal distress with low first minute Apgar score < 7 (OR 1.94, 95% CI 1.18-3.18, p = 0.009) and performance of neonatal resuscitation manoeuvres (OR 2.4, 95% CI 1.07-5.38, p = 0.032). Compared to older mothers, teenage girls were likely to have a non-statistically significant threefold higher risk of having an obstructed labour (OR 3.40, 95% CI 0.89-12.94, p = 0.07). Other perinatal outcomes as neonatal asphyxia, risk for cerebral palsy, premature birth, early neonatal infection, and neonatal death were identical between groups as well as maternal anaemia, mode of delivery or other obstetrical outcomes.

CONCLUSION

Adolescent pregnancies were associated with worse perinatal outcomes as foetal distress and higher need for neonatal resuscitation manoeuvres. This study may support STP health authorities in their efforts to make Sustainable Development Goals 3 (good health and wellbeing), 4 (quality education) and 5 (gender equality) a reality by 2030, since it identifies specific problems that need to be addressed to improve maternal adolescent health.

Determinants of birth asphyxia among newborn live births in public hospitals of Gamo and Gofa zones, Southern Ethiopia

BACKGROUND

Birth asphyxia is the inability of a newborn to start and conserve breathing immediately after birth. Globally, 2.5 million infants die within their first month of life every year, contributing nearly 47% of all deaths of children. It is the third cause of neonatal deaths next to infections and preterm birth. Ethiopia is one of the countries with the highest neonatal mortality and high burden of birth asphyxia in the world. The state of birth asphyxia is about 22.52% in Ethiopia, with incidence of 18.0% in East Africa Neonatal mortality incidence ratio was 9.6 deaths per 1000 live births among which 13.5% of neonatal mortality cases were due to birth asphyxia in southern Ethiopia. The effect of birth asphyxia is not only limited to common clinical problems and death; it also has a socio-economic impact on the families. Therefore, this study is aimed to identify determinants of birth asphyxia among newborn live births in public hospitals Southern Ethiopia.

METHODS

An Institution based unmatched case-control study was conducted among newborn live births in public hospitals of Gamo & Gofa zones, with a total sample size of 356 (89 cases and 267 controls, 1:3 case to control ratio) from March 18 to June 18, 2021, after obtaining ethical clearance from Arba Minch University. Cases were selected consecutively and controls were selected by systematic random sampling method. Data were collected using an adapted pretested semi-structured questionnaire through face-to-face interviews and record reviews using an extraction checklist for intrapartum & neonatal-related information. The collected data were entered into Epi data version 4.4 and exported to STATA version 14 for analysis. Finally, bi-variable and multivariable logistic regression analyses were performed to identify determinants of birth asphyxia. Statistical significance was declared at p-value ≤ 0.05 along with corresponding 95% CI of AOR used to declare statistical significance.

RESULTS

Anemia during pregnancy [AOR = 3.87, 95% CI (1.06- 14.09)], breech presentation [AOR = 3.56, 95% CI (1.19-10.65)], meconium stained amniotic fluid [AOR = 6.16, 95% CI (1.95-19.46)], cord prolapse [AOR = 4.69, 95%CI (1.04-21.05)], intrapartum fetal distress [AOR = 9.83, 95% CI (3.82-25.25)] and instrumental delivery [AOR = 5.91, 95% CI (1.51-23.07)] were significantly associated with birth asphyxia.

CONCLUSION

The study revealed that anemia during pregnancy, breech presentation, meconium-stained amniotic fluid, cord prolapse, intrapartum fetal distress, and instrumental delivery were identified as determinants of birth asphyxia. Therefore, health professional and health institutions should give emphasis on care of mother and the newborn in actively detecting and managing asphyxia.

Risk Factors of Birth Asphyxia among Newborns at Debre Markos Comprehensive Specialized Referral Hospital, Northwest Ethiopia: Unmatched Case-Control Study

Background

Despite a global decline in under-five deaths, the neonatal mortality rate remains slow in developing countries and birth asphyxia remains the third cause of neonatal deaths. Globally, neonatal deaths accounts for 45% of under-five deaths, birth asphyxia causes 23-40% of neonatal deaths in Ethiopia. There is limited data on risk factors of asphyxia in Ethiopia, particularly in the study area. Therefore, this study aimed to identify the risk factors of birth asphyxia among newborns.

Methods

This research followed a hospital-based unmatched case-control study design at Debre Markos comprehensive specialized referral hospital, Northwest Ethiopia, among 372 newborns (124 cases and 248 controls). Data were collected by interviewing index mothers and chart review using a pre-tested questionnaire. Then it was entered in Epi-data version 3.1 and transferred to STATA version 14.0 for analysis. Bivariate and multiple variable logistic regression were carried out to the possible risk factors. Finally, statistical significance was declared using adjusted odds ratio with 95% CI and p-value <0.05.

Results

Prolonged labor >12, meconium-stained amniotic fluid, assisted vaginal delivery, gestational age < 37 weeks, noncephalic presentation, comorbidity, birthweight<2500grams were found to be significant factors of birth asphyxia.

Conclusion

In this study, Prolonged labor >12 hours, meconium-stained amniotic fluid, assisted vaginal delivery, gestational age < 37 weeks, non-cephalic presentation comorbidity, fetal distress, birthweight<2500grams were found to be risk factors of birth asphyxia were risk factors of birth asphyxia. Therefore, to reduce neonatal mortality associated with birth asphyxia, attention should be given to holistic pregnancy, labor and delivery care, and post-natal care. Moreover, interventions aimed at reducing birth asphyxia should target the identified factors.

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

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

Determinants of birth asphyxia among newborns in Debre Berhan referral hospital, Debre Berhan, Ethiopia: a case-control study

Background

Birth asphyxia is the major public health problem in the world. It is estimated that around 23% of all newborn deaths are caused by birth asphyxia worldwide. Birth asphyxia is the top three causes of newborn deaths in sub-Saharan Africa and more than one-third of deaths in Ethiopia. Therefore, the aim of this study was to identify determinants of birth asphyxia which can play a crucial role to decrease the death of newborns.

Methods

Unmatched case-control study design was implemented among 276 (92 cases and 184 controls) newborns from January 1st to March 30th, 2020. A systematic sampling technique was used to select the study participants. Data were collected by using a semi-structured interviewer-administered questionnaire and document review by trained nurses and midwives who work at the delivery ward of the hospitals. Bivariate logistic regression analysis was done to identify determinants of birth asphyxia. Adjusted odds ratios with 95% confidence intervals and p-value less than and equal to 0.05 were used to assess the level of significance.

Results

In this study, maternal education of being can’t read & write [AOR = 4.7, 95% CI: (1.2, 11.9)], ante-partum hemorrhage [AOR = 7.7, 95% CI: (1.5, 18.5)], prolonged labor [AOR =13.5, 95% CI: (2.0, 19.4)], meconium stained amniotic fluid [AOR = 11.3, 95% CI: (2.7, 39.5)], breech fetal presentation [AOR = 4.5, 95% CI: (2.0, 8.4)] and preterm birth [AOR: 4.1, 95% CI: (1.8, 9.2)] were factors which showed significantly associated with birth asphyxia among newborns.

Conclusions

In this study, maternal education can’t read & write, antepartum hemorrhage, prolonged labor, stained amniotic fluid, breech fetal presentation, preterm birth were significantly associated with birth asphyxia. So, educating mothers to enhance health-seeking behaviors and close monitoring of the labor and fetus presentation were recommended to reduce birth asphyxia.

Supplementary Information

The online version contains supplementary material available at 10.1186/s12887-022-03223-3.

The evaluation of the antepartum and intrapartum risk factors in predicting the risk of birth asphyxia

PURPOSE

This study aimed to determine the related antepartum and intrapartum factors of birth asphyxia among neonates born in a tertiary referral hospital.

METHODS

A total of 45 singleton pregnant women who delivered live births with a gestational age of ≥35 weeks and their neonates who suffered from birth asphyxia from June 2016 to June 2021 were included in this retrospective study. Data regarding maternal demographic features, maternal laboratory values, pregnancy complications, and obstetric and neonatal outcomes were collected.

RESULTS

Significant risk factors associated with birth asphyxia were nulliparity (odds ratio [OR] = 5.357, 95% confidence interval [CI] = 2.169-24.950, p = 0.001), placental abruption (OR = 8.667, 95% CI = 2.223-33.784, p = 0.002), intrauterine growth restriction (OR = 1.394, 95% CI = 1.109-8.631, p = 0.012), the prolonged second stage of labor (OR = 6.121, 95% CI = 2.120-17.595, p = 0.001), meconium-stained amniotic fluid (OR = 7.615, 95% CI = 2.394-24.223, p = 0.001), bloody amniotic fluid (OR = 9.423, 95% CI = 2.885-35.232, p = 0.001), the presence of FHR category II (OR = 12.083, 95% CI = 7.081-48.849, p <0.001) and FHR category III before labor (OR = 15.500, 95% CI = 8.394-56.176, p <0.001).

CONCLUSION

We identified that nulliparity, placental abruption, intrauterine growth restriction, the prolonged second stage of labor, meconium-stained or bloody amniotic fluid, and FHR tracings categories II and III were significantly associated with birth asphyxia.

Determinants of birth asphyxia among newborns in Northwest Ethiopia, 2019: Case Control Study

Introduction

Birth asphyxia is a condition of impaired gas exchange in newborns when the Apgar score is < 7 in the first 5 min. It accounts 31.6% of all neonatal deaths, and the leading causes of neonatal mortality in Ethiopia. Identifying its determinant factors is very important to prevent the problem.

Therefore, this study was aimed at identifying the determinant factors of birth asphyxia among newborns at Benishangul Gumuz region hospital.

Methods and materials

The hospital-based unmatched case-control study was done from March 04 to July 16, 2019 in Benishangul Gumuz Region Hospitals. Total sample size is 275 with 69 cases and 206 controls. Newborns with an Apgar score of less than 7 at 5 min were taken as cases, and those with greater or equal to 7 were taken as controls. All asphyxiated newborns were enrolled as cases, where as in every three-step non-asphyxiated newborns were taken as controls. The data was entered into Epi Info 7 and exported to SPSS for analysis. Bivariable logistic regression analysis was used. Those variables with a p-value <0.05 were identified as significant determinants of birth asphyxia.

Results

In the current study, anemia during pregnancy [AOR = 2.95, 95% CI: (1.02, 8.54)], no ANC visit at all [AOR = 4.26, 95% CI: (1.23,14.7)], prolapsed cord [AOR = 4.52, 95% CI: (1.3, 21)], and low birth weight [AOR = 4.1, 95% CI: (1.11, 15.36] were all determinant factors for birth asphyxia.

Conclusion

and Recommendations: The identified determinants of birth asphyxia were anemia during pregnancy, no ANC visit at all, prolapsed cord, cesarean birth, and low birth weight.

Based on our study, most of identified determinant factors of birth asphyxia were preventable so, policy makers, clinicians, and other stakeholders need to invest their maximum effort on prevention of birth asphyxia.

Perinatal asphyxia and associated factors among neonates admitted to a specialized public hospital in South Central Ethiopia: A retrospective cross-sectional study

Introduction

Perinatal asphyxia continues to be a significant clinical concern around the world as the consequences can be devastating. World Health Organization data indicates perinatal asphyxia is encountered amongst 6–10 newborns per 1000 live full-term birth, and the figures are higher for low and middle-income countries. Nevertheless, studies on the prevalence of asphyxia and the extent of the problem in poorly resourced southern Ethiopian regions are limited. This study aimed to determine the magnitude of perinatal asphyxia and its associated factors.

Methods

A retrospective cross-sectional study design was used from March to April 2020. Data was collected from charts of neonates who were admitted to NICU from January 2016 to December 31, 2019.

Result

The review of 311 neonates’ medical records revealed that 41.2% of the neonates experienced perinatal asphyxia. Preeclampsia during pregnancy (AOR = 6.2, 95%CI:3.1–12.3), antepartum hemorrhage (AOR = 4.5, 95%CI:2.3–8.6), gestational diabetes mellitus (AOR = 4.2, 95%CI:1.9–9.2), premature rupture of membrane (AOR = 2.5, 95%CI:1.33–4.7) fetal distress (AOR = 3,95%CI:1.3–7.0) and meconium-stained amniotic fluid (AOR = 7.7, 95%CI: 3.1–19.3) were the associated factors.

Conclusion

Substantial percentages of neonates encounter perinatal asphyxia, causing significant morbidity and mortality. Focus on early identification and timely treatment of perinatal asphyxia in hospitals should, therefore, be given priority.

Risk Factors Associated With Birth Asphyxia in Term Newborns at a Tertiary Care Hospital of Multan, Pakistan

Background

Perinatal asphyxia is one of the main causes of death in term newborns. During the past two decades, no significant progress has been made in reducing neonatal deaths in developing countries. This study was aimed to determine various factors associated with birth asphyxia in term newborns at a tertiary care hospital of Multan, Pakistan.

Methods

This case-control study was conducted at the Neonatal pediatrics Department, The Children’s Hospital, Multan in collaboration with the labor room of Nishtar Hospital Multan from April 2020 to September 2020. Newborns delivered in the labor room with a low Apgar score of five or less at the first minute were recruited as cases and newborns with an Apgar score of more than five in the first minute were recruited as controls. The demographic information of neonates and mothers was noted. A Performa was used to collect all information. All data were analyzed through SPSS 26.0 (IBM SPSS Inc., Chicago, IL, USA).

Results

A total of 426 newborns (213 cases and 213 controls) were enrolled. In cases, there were 132 males and 81 females whereas there were 115 males and 98 females in the control group (P=0.09). Majority 132 (62%) mothers of cases were primiparous compared with 110 (52%) mothers of control. The difference in parity of mothers of cases and control (P=0.03) was significant. Prolonged labour was noted in cases 123 (58%) vs. controls 55 (26%) (P=0.001) while fetal distress was found in 120 (56%) cases and 45 (21%) controls (P=0.001). Meconium was found in the amniotic fluid in 171 (80%) cases and 86 (40%) controls (P=0.001). All other risk factors turned out to be insignificant between cases and controls (P>0.05).

Conclusion

Meconium stained liquor is a major risk factor for birth asphyxia. Prolonged labor of more than 24-hour period, as well as fetal distress, is also a major risk factor of perinatal asphyxia. Involving obstetricians in the present research give more reliability and reproducibility of the data collected.

The state of birth asphyxia in Ethiopia: An umbrella review of systematic review and meta-analysis reports, 2020

BACKGROUND

To this date, there are 4 systematic reviews and meta-analyses studies about the burden and associated factors of birth asphyxia in Ethiopia. However, findings of these studies are inconsistent which is difficult to make use of the findings for preventing birth asphyxia in the country. Therefore, umbrella review of these studies is required to pool the inconsistent findings into a single summary estimate that can be easily referred by the information users in Ethiopia.

METHODS

PubMed, Science direct, web of science, data bases specific to systematic reviews such as the Cochrane Database of Systematic Reviews and the Database of Abstracts of Reviews of Effects were searched for systematic reviews and meta-analyses (SRM) studies on the magnitude and risk factors of perinatal asphyxia in Ethiopia. The methodological quality of the included studies was assessed using the Assessment of Multiple Systematic Reviews (AMSTAR) tool. The estimates of the included SRM studies on the prevalence and predictors of perinatal asphyxia were pooled and summarized with random-effects meta-analysis models. From checking PROSPERO, this umbrella review wasn't registered.

RESULTS

We included four SRM studies with a total of 49,417 neonates. The summary estimate for prevalence of birth asphyxia was 22.52% (95% CI = 17.01%-28.02%; I2 = 0.00). From the umbrella review, the reported factors of statistical significance include: maternal illiteracy [AOR = 1.96; 95% CI: 1.44-2.67], primiparity [AOR = 1.29; 95% CI: 1.03-1.62], antepartum hemorrhage [AOR = 3.43; 95% CI: 1.74-6.77], pregnancy induced hypertension [AOR = 4.35; 95% CI: 2.98-6.36], premature rupture of membrane [AOR = 12.27; 95% CI: 2.41, 62.38], prolonged labor [AOR = 3.18; 95% CI: 2.75, 3.60], meconium-stained amniotic fluid [AOR = 5.94; 95% CI: 4.86, 7.03], instrumental delivery [AOR = 3.39; 95% CI: 2.46, 4.32], non-cephalic presentation [AOR = 3.39; 95% CI: 1.53, 5.26], cord prolapse [AOR = 2.95; 95% CI: 1.64, 5.30], labor induction [AOR = 3.69; 95% CI: 2.26-6.01], cesarean section delivery [AOR = 3.62; 95% CI: 3.36, 3.88], low birth weight [AOR = 6.06; 95% CI: 5.13, 6.98] and prematurity [AOR = 3.94; 95% CI: 3.67, 4.21] at 95% CI.

CONCLUSION

This umbrella review revealed high burden of birth asphyxia in Ethiopia. The study also indicated significant risk of birth asphyxia among mothers who were unable to read and write, primiparous mothers, those mothers having antepartum hemorrhage, pregnancy induced hypertension, premature rupture of membrane, prolonged labor, meconium-stained amniotic fluid, instrumental delivery, cesarean section delivery, non-cephalic presentation, cord prolapse and labor induction. Moreover, low birth weight and premature neonates were more vulnerable to birth asphyxia compared to their normal birth weight and term counterparts. Therefore, burden of birth asphyxia should be mitigated through special consideration of these risk mothers and neonates during antenatal care, labor and delivery. Mitigation of the problem demands the collaborative efforts of national, regional and local stakeholders of maternal and neonatal health.

A multicenter study of incidence, risk factors and outcomes of babies with birth asphyxia in Nepal

Background

Perinatal events which result in compromised oxygen delivery to the fetus can lead to Birth Asphyxia (BA). While the incidence, risk factors and outcomes of BA have been characterized, less is known in low resource settings.

Aim

To determine the incidence of Birth Asphyxia (BA) in Nepal and to evaluate associated risk factors and outcomes of this condition.

Methods

A nested observational study was conducted in 12 hospitals of Nepal for a period of 14 months. Babies diagnosed as BA at ≥37 weeks of gestation were identified and demographics were reviewed. Data were analyzed using binary logistic regression followed by multiple logistic regression analysis.

Results

The incidence of BA in this study was 6 per 1000 term livebirths and was higher among women 35 years and above. Predictors for BA were instrumented vaginal delivery (aOR:4.4, 95% CI, 3.1–6.1), fetal distress in labour (aOR:1.9, 95% CI, 1.0–3.6), malposition (aOR:1.8, 95% CI, 1.0–3.0), birth weight less than 2500 g (aOR:2.0, 95% CI, 1.3–2.9), gestational age ≥ 42 weeks (aOR:2.0, 95% CI, 1.3–3.3) and male gender (aOR:1.6, 95% CI, 1.2–2.0). The risk of pre-discharge mortality was 43 times higher in babies with BA (aOR:42.6, 95% CI, 32.2–56.3).

Conclusion

The incidence of Birth asphyxia in Nepal higher than in more resourced setting. A range of obstetric and neonatal risk factors are associated with BA with an associated high risk of pre-discharge mortality. Interventions to improve management and decrease rates of BA could have marked impact on outcomes in low resource settings.

Prevalence and risk factors associated with birth asphyxia among neonates delivered in Ethiopia: A systematic review and meta-analysis

BACKGROUND

A number of primary studies in Ethiopia address the prevalence of birth asphyxia and the factors associated with it. However, variations were seen among those studies. The main aim of this systematic review and meta-analysis was carried out to estimate the pooled prevalence and explore the factors that contribute to birth asphyxia in Ethiopia.

METHODS

Different search engines were used to search online databases. The databases include PubMed, HINARI, Cochrane Library and Google Scholar. Relevant grey literature was obtained through online searches. The funnel plot and Egger's regression test were used to see publication bias, and the I-squared was applied to check the heterogeneity of the studies. Cross-sectional, case-control and cohort studies that were conducted in Ethiopia were also be included. The Joanna Briggs Institute checklist was used to assess the quality of the studies and was included in this systematic review. Data entry and statistical analysis were carried out using RevMan 5.4 software and Stata 14.

RESULT

After reviewing 1,125 studies, 26 studies fulfilling the inclusion criteria were included in the meta-analysis. The pooled prevalence of birth asphyxia in Ethiopia was 19.3%. In the Ethiopian context, the following risk factors were identified: Antepartum hemorrhage(OR: 4.7; 95% CI: 3.5, 6.1), premature rupture of membrane(OR: 4.0; 95% CI: 12.4, 6.6), primiparas(OR: 2.8; 95% CI: 1.9, 4.1), prolonged labor(OR: 4.2; 95% CI: 2.8, 6.6), maternal anaemia(OR: 5.1; 95% CI: 2.59, 9.94), low birth weight(OR = 5.6; 95%CI: 4.7,6.7), meconium stained amniotic fluid(OR: 5.6; 95% CI: 4.1, 7.5), abnormal presentation(OR = 5.7; 95% CI: 3.8, 8.3), preterm birth(OR = 4.1; 95% CI: 2.9, 5.8), residing in a rural area (OR: 2.7; 95% CI: 2.0, 3.5), caesarean delivery(OR = 4.4; 95% CI:3.1, 6.2), operative vaginal delivery(OR: 4.9; 95% CI: 3.5, 6.7), preeclampsia(OR = 3.9; 95% CI: 2.1, 7.4), tight nuchal cord OR: 3.43; 95% CI: 2.1, 5.6), chronic hypertension(OR = 2.5; 95% CI: 1.7, 3.8), and unable to write and read (OR = 4.2;95%CI: 1.7, 10.6).

CONCLUSION

According to the findings of this study, birth asphyxia is an unresolved public health problem in the Ethiopia. Therefore, the concerned body needs to pay attention to the above risk factors in order to decrease the country's birth asphyxia.

REVIEW REGISTRATION

PROSPERO International prospective register of systematic reviews (CRD42020165283).

Adverse Neonatal Outcome are More Common among Babies Born by Cesarean Section than Naturally Born Babies at Public Hospitals in Eastern Ethiopia: A Comparative Prospective Follow-Up Study at Eastern Ethiopia

The adverse neonatal outcome is defined as the presence of birth asphyxia, respiratory distress, birth trauma, hypothermia, meconium aspiration syndrome, neonatal intensive care admission, and neonatal death. It is a major concern in developing countries, including Ethiopia. This study tried to identify predictors of adverse neonatal outcomes at selected public hospitals in Eastern Ethiopia. A hospital-based prospective follow-up study was conducted in three public hospitals in Eastern Ethiopia from June to October 2020. A total of 2,246 laboring women and neonates born at the hospitals were enrolled in the study. Data were collected through interviews, observation checklists, and clinical chart review. Reports were presented in relative risks with 95% CIs. The overall magnitude of adverse neonatal outcome was 20.97% (95% CI: 19.33- 22.71%). It was 24.3% for babies born through cesarean section (95% CI: 21.3%, 27.5). The presence of meconium in the amniotic fluid increased the risk for neonates delivered via cesarean section (ARR, 1.52 95% CI; 1.04, 2.22). Among neonates born via vaginal delivery, the risk of adverse neonatal outcome was higher among nullipara women (ARR, 1.42 95% CI; 1.02, 1.99) and among women diagnosed with abnormal labor or pregnancy such as APH, pre-eclampsia, obstructed labor, fetal distress, and mal-presentation at admission (ARR, 1.30 95%CI; 1.01, 1.67). The risk of adverse neonatal outcome was higher among babies born through the cesarian section than those born via vaginal delivery. Abnormal labor or pregnancy and being primiparous increased the risk of adverse neonatal outcome in vaginal delivery.

The difference between C-reactive protein (CRP) level in mother with preterm rupture membranes (PROM) and mothers with prolonged labor

OBJECTIVE

This study aimed to compare CRP between mother with PROM and mother with prolonged labor.

METHODS

It was a Cross-Sectional Study and sampling technique used was consecutive sampling, sample size was 50 mothers, consist of 25 PROM mothers and 25 prolonged labor mothers. Inclusion criteria were pregnant women over 37 weeks with PROM or prolonged labor, not suffering from HIV/AIDS, Hepatitis B, preeclampsia, eclampsia, kidney and diabetes mellitus. Blood was collected in both groups through vein. The blood was centrifuged to obtain serum and CRP was examined by the ELISA method in the laboratory of the Hasanuddin University Makassar. Data analyzed using Chi-square and independent T-test.

RESULTS

The mean CRP level of maternal with PROM was 11.00mg/l while the mean CRP protein level in prolonged labor was 16.00mg/l. Maternal CRP levels with prolonged labor are higher at 5.00mg/l compared to CRP PROM levels and it is statistically significant (p=0.002, p<0.05).

CONCLUSION

CRP levels of prolonged labor is higher compared to CRP PROM levels.

Assessing the impact of mentorship on knowledge about and self-efficacy for neonatal resuscitation among nurses and midwives in Rwanda

In the first minute of life after birth, it is critical to effectively manage an infant's respiratory status. Given the critical nature of newborn airway management, it is vital that health professionals have the knowledge and confidence to engage in airway management procedures. Consequently, there has been a call for nurses and midwives to be prepared to skillfully enact neonatal resuscitation interventions when required, especially in low-resource environments, to help reduce neonatal death. The purpose of this study was to assess the impact of a mentorship program that involves an education component for neonatal resuscitation in the first minute after birth. The study examined changes to knowledge and self-efficacy of Rwandan nurses and midwives towards newborn airway care outcomes. A pre-/post-test, quasi-experimental study design was used to assess the changes in knowledge about and self-efficacy for neonatal resuscitation. Using a paired t-test, the results suggested that nurses' and midwives' knowledge and self-efficacy increased significantly, and participants' knowledge correlated positively to self-efficacy. Therefore, a mentorship program that supports professional development through education appears to be an effective strategy to enhance nurses' and midwives' knowledge about and self-efficacy for neonatal resuscitation and could eventually lead to neonatal practice improvements.

Determinants of birth asphyxia among newborns delivered in public hospitals of West Shoa Zone, Central Ethiopia: A case-control study

Birth asphyxia is one of the leading causes of death in low and middle-income countries and the prominent cause of neonatal mortality in Ethiopia. Early detection and managing its determinants would change the burden of birth asphyxia. Thus, this study identified determinants of birth asphyxia among newborns delivered in public hospitals of West Shoa Zone, central Ethiopia. A hospital-based unmatched case-control study was conducted from May to July 2020. Cases were newborns with APGAR (appearance, pulse, grimaces, activity, and respiration) score of <7 at first and fifth minute of birth and controls were newborns with APGAR score of ≥ 7 at first and fifth minute of birth. All newborns with birth asphyxia during the study period were included in the study while; two comparable controls were selected consecutively after each birth asphyxia case. A pre-tested and structured questionnaire was used to collect maternal socio-demographic and antepartum characteristics. The pre-tested checklist was used to retrieve intrapartum and fetal related factors from both cases and controls. The collected data were entered using Epi-Info and analyzed by SPSS. Bi-variable logistic regression analysis was done to identify the association between each independent variable with the outcome variable. Adjusted odds ratio (AOR) with a 95% CI and a p-value of <0.05 was used to identify determinants of birth asphyxia. In this study, prolonged labor (AOR = 4.15, 95% CI: 1.55, 11.06), breech presentation (AOR = 5.13, 95% CI: 1.99, 13.21), caesarean section delivery (AOR = 3.67, 95% CI: 1.31, 10.23), vaginal assisted delivery (AOR = 5.69, 95% CI: 2.17, 14.91), not use partograph (AOR = 3.36, 95% CI: 1.45, 7.84), and low birth weight (AOR = 3.74, 95% CI:1.49, 9.38) had higher odds of birth asphyxia. Prolonged labor, breech presentation, caesarean and vaginal assisted delivery, fails to use partograph and low birth weights were the determinants of birth asphyxia. Thus, health care providers should follow the progress of labor with partograph to early identify prolonged labor, breech presentation and determine the mode of delivery that would lower the burden of birth asphyxia.

Prevalence and determinants of asphyxia neonatorum among live births at Debre Tabor General Hospital, North Central Ethiopia: a cross-sectional study

BACKGROUND

More than one third of the neonatal deaths at Neonatal Intensive Care Unit of Debre Tabor General Hospital (DTGH) are attributable to birth asphyxia. Most of these neonates are referred from maternity ward of the hospital. However, there is no recent evidence on the prevalence and specific determinants of birth asphyxia at DTGH. Besides, public health importance of factors like birth spacing weren't addressed in the prior studies.

METHODS

A cross sectional study was conducted on a sample of 240 newborns at delivery ward. The collected data were cleaned, coded and entered into Epi -data version 4.2 and exported to Stata version 14. Binary logistic regression model was considered and statistical significance was declared at P< 0.05 using adjusted odds ratio.

RESULTS

The prevalence of asphyxia neonatorum was 6.7 % based on the fifth minute APGAR score. From multi-variable logistic regression analysis, antenatal obstetric complications (AOR = 2.63, 95% CI: 3.75, 14.29), fetal malpresentation (AOR = 3.17, 95% CI: 1.21, 15.20), premature rupture of fetal membranes (AOR = 6.56, 95% CI: 3.48, 18.12) and meconium stained amniotic fluid (AOR = 2.73, 95% CI: 1.76, 14.59) were significant predictors.

CONCLUSION

The prevalence of fifth minute asphyxia neonatorum was relatively low. Fortunately, its predictors are modifiable. Thus, we can mitigate the problem even with our limited resources such as enhancing the existing efforts of antenatal and intra-partum care, which could help early detection and management of any obstetric and neonatal health abnormality."

Rationale of indications for caesarean delivery and associated factors among primigravidae in Tanzania

Objective

This study aimed to determine the prevalence of modes of delivery and associated maternal and newborn outcomes among singleton primigravidae in the Iringa region of Tanzania.

Methods

A cross-sectional, analytical hospital-based study was conducted in the Iringa region among 356 singleton primigravidae between April and August 2018. Convenience sampling and consecutive collection of data using a face-to-face interviewer-administered questionnaire was done.

Results

A total of 356 singleton primigravid women with a mean age of 22.0 years (range: 15–49) participated in the study. The majority of the participants (73.0%, n = 250) were in the 20–35 age group. Caesarean and vaginal delivery were performed in 41.3% (n = 147) and 58.7% (n = 209) of the cases, respectively. The maternal height and weight of the newborn were significantly associated with caesarean delivery; (p = 0.001) and (p = 0.029), respectively. After adjusting for all variables, birth asphyxia (AOR = 3.25, 95% CI: 1.867–5.646, p = 0.000) and low birth weight (AOR = 0.03, 95% CI: 0.003–0.211, p = 0.001) were associated with caesarean delivery.

Conclusions

The findings of our study indicated the prevalence of caesarean section to be three times more than that recommended by the World Health Organization. Pregnant women with a height of less than 150 cm should be considered for caesarean section. Therefore, it is necessary for stakeholders in the health sector to formulate guidelines for absolute indications for caesarean section.

Clinico-Biochemical Correlation in Birth Asphyxia and Its Effects on Outcome

Background Birth asphyxia is a major cause of early neonatal death and leads to severe consequences such as epilepsy, cerebral palsy, and developmental delay. This study aims to determine the correlation between dyselectrolytemia and the degree of hypoxic-ischemic encephalopathy (HIE) and to find out major risk factors contributing to the severity of HIE and neonatal death. Methods In this prospective cohort study (n=150), term babies weighing ≥ 2.5 kg at birth, with the diagnosis of birth asphyxia, admitted in a medical college in Odisha state from September 2014 to August 2016 were included. Clinical findings, biochemical parameters, treatment, and outcome of HIE babies were recorded. Result The majority of the asphyxiated babies were having moderate HIE (HIE II) (57.33%), whereas mild and severe stages were seen in 15.33%, and 27.34% of babies, respectively. Factors like prolonged labor (87.8%) and meconium-stained liquor (63.4%) were mostly attributed to the severe degree of birth asphyxia (p < 0.001). Apnea, lethargy, and hypothermia were the most remarkable feature of HIE III. The degree of hyponatremia, hypocalcemia, and hyperkalemia (124.4±4.4 mmol/l, 0.83±0.08 mmol/l, and 6.17± 0.89 mmol/l, respectively) were more severely affected in HIE III as compared to HIE l (137.5±3.8 mmol/l, 1.06±0.17 mmol/l, and 5.0±0.79 mmol/l, respectively). Serum urea and creatinine increased proportionately with an increase in the severity of HIE grade. The mildly asphyxiated neonates recovered completely, whereas all the cases who died (n=29,19.3%) belonged to the moderate or severe degree of birth asphyxia. Conclusion The asphyxiated neonates had hyponatremia, hypocalcemia, hyperkalemia, raised serum urea, and creatinine and correlated with the severity of birth asphyxia. Prolonged labor and meconium-stained liquor were the most attributable factor for the severe degree of birth asphyxia. Effective neonatal resuscitation and quick correction of electrolyte imbalances will help in the reduction of neonatal mortality and long-term neurological sequelae.

Prevalence and associated factors of birth asphyxia among live births at Debre Tabor General Hospital, North Central Ethiopia

BACKGROUND

More than one third of the neonatal deaths at Neonatal Intensive Care Unit (NICU) in Debre Tabor General Hospital (DTGH) are attributable to birth asphyxia. Most of these neonates are referred from the maternity ward in the hospital. Concerns have also been raised regarding delayed intrapartum decisions for emergency obstetrics action in the hospital. However, there has been no recent scientific evidence about the exact burden of birth asphyxia and its specific determinants among live births at maternity ward of DTGH. Moreover, the public health importance of delivery time and professional mix of labor attendants haven't been addressed in the prior studies.

METHODS

Hospital based cross sectional study was conducted on a sample of 582 mother newborn dyads at maternity ward. Every other mother newborn dyad was included from December 2019 to March 2020. Pre-tested structured questionnaire and checklist were used for data collection. The collected data were processed and entered into Epidata version 4.2 and exported to Stata version 14. Binary logistic regressions were fitted and statistical significance was declared at p less than 0.05 with 95% CI.

RESULTS

The prevalence of birth asphyxia was 28.35% [95% CI: 26.51, 35.24%]. From the final model, fetal mal-presentation (AOR = 6.96: 3.16, 15.30), premature rupture of fetal membranes (AOR = 6.30, 95% CI: 2.45, 16.22), meconium stained amniotic fluid (AOR = 7.15: 3.07, 16.66), vacuum delivery (AOR =6.21: 2.62, 14.73), night time delivery (AOR = 6.01: 2.82, 12.79) and labor attendance by medical interns alone (AOR = 3.32:1.13, 9.78) were positively associated with birth asphyxia at 95% CI.

CONCLUSIONS

The prevalence of birth asphyxia has remained a problem of public health importance in the study setting. Therefore, the existing efforts of emergency obstetric and newborn care should be strengthened to prevent birth asphyxia from the complications of fetal mal-presentation, premature rupture of fetal membranes, meconium stained amniotic fluid and vacuum delivery. Moreover, night time deliveries and professional mixes of labor and/delivery care providers should be given more due emphasis.

Risk Factors of Perinatal Asphyxia Among Newborns Delivered at Public Hospitals in Addis Ababa, Ethiopia: Case-Control Study

Background

Perinatal asphyxia determines the newborn’s future health status and viability with risk factors yet to be completely understood. It measures the status of the healthcare delivery of an organization including antenatal, intranatal, and postnatal care. In Ethiopia, 31.6% of neonatal mortality was attributed to perinatal asphyxia. This study aimed to assess the risk factors of perinatal asphyxia.

Methods

An unmatched case–control study was conducted on 213 (71 cases selected using lottery method and 142 controls systematically) subjects in Addis Ababa from November 1, 2018 to June 30, 2019. Data were collected using a structured questionnaire through face-to-face interviews, entered to Epi data version 4.4, and exported to SPSS version 25 for analysis. Logistic regression was used for analysis. Variables with p< 0.25 in bivariate analysis were taken to multivariable analysis. Statistical significance was declared at P<0.05 and findings were presented using texts and tables.

Results

A total of 210 newborns (70 cases and 140 controls) and their mothers were included with an overall response rate of 98.5%. Antepartum hemorrhage [AOR=7.17; 95% CI 1.73–29.72], low birth weight [AOR=2.87; 95% CI 1.01–8.13], preterm birth [AOR=3.4; 95% CI 1.04–11.16], caesarean section delivery [AOR=2.75; 95% CI 1.01–7.42], instrumental delivery [AOR=4.88; 95% CI 1.35–17.61], fetal distress [AOR=4.77; 95% CI 1.52–14.92] and meconium-stained amniotic fluid [AOR=9.02; 95% CI 2.96–30.24] were significantly associated with perinatal asphyxia. Hence, efforts ought to go to improve the quality of antenatal and intra-natal services.

Prevalence of perinatal asphyxia in East and Central Africa: systematic review and meta-analysis

Background

Birth asphyxia leads to about 4 million neonatal deaths every year around the globe. But, the pooled prevalence of asphyxia was not yet collated in East and Central African countries. Hence, this systematic review and meta-analysis aimed to determine the pooled prevalence of perinatal asphyxia in Central and East Africa.

Methods

PubMed, Google Scholar, Science Direct, Africa Index Medicus, Africa Journal Online, Excerpta Medica Database, and Cochrane Library databases were searched. All necessary data were extracted using a standardized data extraction format. Data were analyzed using STATA 14 statistical software. A heterogeneity of studies was assessed using the I² statistics. Publication bias was checked by using a funnel plot and Egger's regression test. A random-effect model was computed to estimate the pooled prevalence of perinatal asphyxia.

Results

Thirteen full-text studies were included in the present meta-analysis. The pooled prevalence of perinatal asphyxia in this study was 15.9% (95%CI: 10.8, 21.0% [I² = 94.6, p = 0.000]). Regional subgroup analysis indicated that the pooled prevalence of perinatal asphyxia was 18.0 % (95%CI:11.4, 26.7% [I² = 96.00, p = 0.000]) and 9.1 % (95%CI:2.0, 16.2% [I² = 90.80, P = 0.000]) in East and Central African countries respectively. Similarly, the level of perinatal asphyxia was varied based on asphyxia measuring tools. But the trim fill analysis pointed that there was no difference in the pooled prevalence of perinatal asphyxia in this study.

Conclusion

The pooled prevalence of perinatal asphyxia was high in the current study. It had also substantial variation across the regions and measuring tools. Therefore, there is a call to reduce the high burden of this problem in the region.

Perinatal asphyxia and its associated factors in Ethiopia: a systematic review and meta-analysis

BACKGROUND

Despite different preventive strategies that have been implemented in different health institutions in the country, neonatal mortality and morbidity are still significantly increasing in Ethiopia. Perinatal asphyxia is the leading cause of neonatal morbidity and mortality worldwide. As a result, this systematic review and meta-analysis aimed to assess the prevalence and associated factors of perinatal asphyxia in Ethiopia.

METHODS

Online databases (PubMed, HINARI, EMBASE, Google Scholar and African Journals), other gray and online repository accessed studies were searched using different search engines. Newcastle-Ottawa Quality Assessment Scale (NOS) was used for critical appraisal of studies. The analysis was done using STATA 11 software. The Cochran Q test and I2 test statistics were used to test the heterogeneity of studies. The funnel plot and Egger's test were used to detect publication bias of the studies. The pooled prevalence of perinatal asphyxia and the odds ratio (OR) with a 95% confidence interval was presented using forest plots.

RESULT

Nine studies were included in this review, with a total of 12,249 live births in Ethiopia. The overall pooled prevalence of perinatal asphyxia in Ethiopia was 24.06% (95 95%CI: 18.11-30.01). Associated factors of perinatal asphyxia included prolonged labor (OR = 2.79, 95% CI: 1.98, 3.93), low birth weight (OR = 6.52, 95% CI: 4.40, 9.65), meconium-stained amniotic fluid (OR = 5.91, 95% CI: 3.95, 8.83) and instrumental delivery (OR = 4.04, 95% CI: 2.48, 6.60) were the determinant factors of perinatal asphyxia in Ethiopia.

CONCLUSIONS

The overall pooled prevalence of perinatal asphyxia was remarkably high. Duration of labor, meconium-stained amniotic fluid, instrumental deliveries, and birth weight were the associated factors of perinatal asphyxia in Ethiopia. Therefore, efforts should be made to improve the quality of intrapartum care service to prevent prolonged labor and fetal complications and to identify and make a strict follow up of mothers with meconium-stained amniotic fluid. This finding is important to early recognition and management of its contributing factors, might modify hypoxic-ischemic encephalopathy and may improve the implementation of the standard guideline effectively and consistently.

Risk Factors of Birth Asphyxia Among Neonates Born in Public Hospitals of Tigray, Northern Ethiopia

Introduction

Birth asphyxia is defined by the World Health Organization as not initiating and maintaining default breathing at birth. Approximately 24% of neonatal deaths occurred annually worldwide due to birth asphyxia. About 3% of the 120 million neonates born each year acquire asphyxia in third world countries. Long-term survivors may experience cerebral palsy, delay in growth, vision, hearing and intellectual deficiency, epilepsy, difficulties with communication and behavior. Thus, this study aims to determine the risk factors of birth asphyxia among neonates who were delivered at public hospitals of Tigray, Ethiopia.

Materials and Methods

Hospital-based unmatched case-control study design was implemented on 390 samples from January to February 2018. Data were collected by interviews using a structured questionnaire and checklist. The collected data were coded and entered using EpiData version 3.1 statistical software and transported to statistical package for social science (SPSS) version 20 software for analysis. Cross-tabulation and odds ratio with 95% confidence interval were computed. Bivariate logistic regression and multivariable logistic regression were done. Multicollinearity was checked. Goodness of fit was checked by the Hosmer–Lemeshow test.

Results

A total of 260 controls and 130 cases were enrolled in the study. Multivariable logistic regression showed that Primi-parity [AOR 5.5 (CI: 2.5, 12.3)], pre-eclamcia/pregnancy-induced hypertension [AOR12.4 (CI: 4.17, 37.15)], post-term pregnancy [AOR 2.73 (CI: 1.00, 7.55)] meconium-stained liquor [AOR 29.2 (CI: 12.0, 71.1)], cord entangled [AOR 5.67 (CI: 1.66,19.3)] and non-vertex presentation [AOR 5.49 (CI: 2.20,13.7)] were found to be risk factors for perinatal birth asphyxia.

Conclusion and Recommendations

Intrapartum factors and neonatal factors in the index pregnancy have an association with perinatal birth asphyxia. The research finding suggests effective antenatal care follow-up and follow-up of labor progress using partograph after labor initiation.

Determinants of Birth Asphyxia Among Newborns in Referral Hospitals of Amhara National Regional State, Ethiopia

Background

Globally, every year, 2.5 million infants die within their first month of life. Birth asphyxia is one of the leading causes in all low- and middle-income countries and the leading single cause of neonatal mortality in Ethiopia. Therefore, the aim of this study was to identify the determinants of birth asphyxia among newborns admitted to neonatal intensive care units (NICU) in Amhara region referral hospitals, Ethiopia.

Methods

Facility-based unmatched case-control study was employed from March 1 to April 30, 2018. Cases were newborn babies admitted to neonatal intensive care units with an admission criteria of birth asphyxia with APGAR score of <7 at five min of birth and controls were newborn babies admitted to NICU with an admission criteria of other complications (such as jaundice, congenital anomalies, sepsis, hemorrhagic diseases) with APGAR score of ≥7 at five min of birth. Using SPSS version 20, bivariate logistic regression model was fitted to check the relation of each independent variable to the outcome variable. Variables with p<0.2 in bivariate analysis were transferred to multivariable logistic regression model for final analysis. Variables with an adjusted odds ratio (AOR) of 95%CI and p<0.05 were reported as determinants of birth asphyxia.

Results

Data were collected from 193 cases and 193 controls with a response rate of 100%. Low birth weight (AOR: 8.94, 95%CI: 4.08, 19.56), born at health centers (AOR: 7.36, 95%CI: 2.44, 22.13), instrumental delivery (AOR: 3.03, 95%CI: 1.41, 6.49), and prolonged labor (AOR: 2.00, 95%CI: 1.20, 3.36) were significant determinants of birth asphyxia.

Conclusion

Even though most of the identified variables are the common and familiar causes of birth asphyxia, neonates born at health centers were more exposed to birth asphyxia than neonates born in hospitals. This might be due to delay of referral process and lack of skilled professionals in health centers. Further research might be needed to identify the root causes of delays and follow-up issues by adding qualitative component.

Determinants of birth asphyxia among newborns in Ethiopia: A systematic review and meta-analysis

OBJECTIVE

The aim of this systematic review and meta-analysis was to estimate the pooled magnitude of birth asphyxia and its determinants in Ethiopia.

METHODS

The databases, including PubMed, Medline, CINAHL, EMBASE, and other relevant sources, were used to search relevant articles. Both published and unpublished studies, written in English and carried out in Ethiopia, were included in the study. Quality of evidence was assessed by the relevant of the Joanna Briggs Institute tool. RevMan v5.3 statistical software was used to undertake the meta-analysis using a Mantel-Haenszel random-effects model. Heterogeneity was evaluated using the Cochran Q test, and I2 statistics was considered to assess its level. The outcome was measured using a 95% confidence interval (CI).

RESULTS

The pooled prevalence of birth asphyxia was 22.8% (95% CI: 13-36.8%]. Illiterate mothers (adjusted odds ratio [AOR]; 1.96, 95% CI: 1.44-2.67), antepartum hemorrhage (APH) (AOR; 3.43, 95% CI: 1.74-6.77), cesarean section (AOR; 3.66, 95% CI: 1.35-9.91), instrumental delivery (AOR; 2.74, 95% CI: 1.48-5.08), duration of labor (AOR; 3.09, 95% CI: 1.60-5.99), pregnancy induced hypertension (AOR; 4.35, 95% CI: 2.98-6.36), induction of labor (AOR; 3.69, 95% CI: 2.26-6.01), parity (AOR; 1.29, 95% CI: 1.03-1.62), low birth weight (LBW) (AOR; 5.17, 95% CI: 2.62-10.22), preterm (AOR; 3.98, 95% CI: 3.00-5.29), non-cephalic presentation (AOR; 4.33, 95% CI: 1.97-9.51), and meconium staining (AOR; 4.59, 95% CI: 1.40-15.08) were significantly associated with birth asphyxia.

CONCLUSION

The magnitude of birth asphyxia was very high. Maternal education, APH, mode of delivery, prolonged labor, induction, LBW, preterm, meconium-staining, and non-cephalic presentation were determinants of birth asphyxia. Hence, to reduce birth asphyxia and associated neonatal mortality, attention should be directed to improve the quality of intrapartum service and timely communication between the delivery team. In addition, intervention strategies aimed at reducing birth asphyxia should target the identified determinants.

Birth asphyxia and its associated factors among newborns in public hospital, northeast Amhara, Ethiopia

Background

Birth asphyxia is a leading cause of infant morbidity and mortality in developing nations, such as Ethiopia. Though Ethiopia has made considerable achievement in the reduction of under-five mortality rate, the neonatal mortality burden has not experienced the same reduction, which may be attributed to birth asphyxia. Thus, this study attempts to assess the prevalence and associated factors of birth asphyxia among newborns in public hospitals in the northeastern Amhara region, Ethiopia.

Methods

An institution-based cross-sectional study was conducted on 357 births from 1^st April to 2^nd May 2018. The sample size was proportionally allocated to randomly selected three public hospitals namely, Dessie referral hospital, Debre Berhan referral hospital, and Woldia general hospital. The allocation was made by taking the average number of deliveries given in each hospital six months before the data collection period. Using the delivery registration of hospitals a systematic random sampling technique was used to get all study participants. The diagnosis of birth asphyxia was confirmed based on the physician’s diagnosis of an APGAR score < 7 in the 1^st and 5^th minutes of birth. A pretested and structured questionnaire was used to collect data. Variables with p-values < 0.25 in the bivariable analysis were entered into a multivariable logistic regression analysis. A statistical significant level was declared at a p-value of <0.05.

Results

The prevalence of birth asphyxia was found to occur 22.6% of the time [95% CI 19.2% - 26.4%] in the first minute of birth. In the multivariable logistic regression being primipara [AOR = 3.77: 95% CI 1.86, 7.65], presented with complicated labor [AOR = 3.45: 95% CI 1.58, 7.49], premature rupture of membrane [AOR = 3.85: 95% CI 1.76, 8.44) and having blood-stained amniotic fluid at birth [AOR = 5.02: 95% CI 1.69, 14.87] were the independent predictors of birth asphyxia.

Conclusion

The study revealed that birth asphyxia is a common newborn complication in the Amhara region. Integrated mitigation measure to reduce neonatal mortality in the Amahar region should give due attention to primipara women and for these high-risk pregnancies in order for the region to achieve national and global commitment to have sustainable change in women and neonatal health.

Birth asphyxia following delayed recognition and response to abnormal labour progress and fetal distress in a 31-year-old multiparous Malawian woman

Reducing neonatal mortality is one of the targets of Sustainable Development Goal 3 on good health and well-being. The highest rates of neonatal death occur in sub-Saharan Africa. Birth asphyxia is one of the major preventable causes. Early detection and timely management of abnormal labour progress and fetal compromise are critical to reduce the global burden of birth asphyxia. Labour progress, maternal and fetal well-being are assessed using the WHO partograph and intermittent fetal heart rate monitoring. However, in low-resource settings adherence to labour guidelines and timely response to arising labour complications is generally poor. Reasons for this are multifactorial and include lack of resources and skilled health care staff. This case study in a Malawian hospital illustrates how delayed recognition of abnormal labour and prolonged decision-to-delivery interval contributed to birth asphyxia, as an example of many delivery rooms in low-income country settings.

Healthcare Professionals' Knowledge of Neonatal Resuscitation in Ethiopia: Analysis from 2016 National Emergency Obstetric and Newborn Care Survey

Background

Birth asphyxia, which accounts for 31.6% of all neonatal deaths, is one of the principal causes of neonatal mortality in Ethiopia. Adequate knowledge of newborn resuscitative procedures plays an important role in early diagnoses and suitable management. However, there are limited data on healthcare professionals' knowledge about neonatal resuscitation. Thus, this study aimed to determine the knowledge of healthcare professionals about neonatal resuscitation and factors affecting it.

Methods

Data from the Ethiopian 2016 national Emergency Obstetric and Newborn Care survey of 3,804 health facilities that provided maternal and newborn health services were analyzed. We have included 3804 healthcare providers, who attended the largest number of deliveries in the last month prior to the survey, and assessed their knowledge of neonatal resuscitation. It was also determined whether certain factors were associated with healthcare providers' knowledge through linear regression method.

Result

The overall knowledge score of the healthcare providers about neonatal resuscitation ranged from 12 to 24 out of 37 items (with mean score of 18.4 (±5.47) and mean score percentage of 49%). The findings showed that providers trained on neonatal resuscitation (β=2.65, 95% CI: 0.65, 4.62; p <0.00), facilities that had guideline of neonatal resuscitation (β=2.50, 95% CI: 0.60, 3.52; p =0.01), and availability of essential equipment (β=0.95, 95% CI: 0.44, 1.45; p =0.02) were significantly associated with sufficient knowledge of neonatal resuscitation in Ethiopia.

Conclusion

Overall knowledge of neonatal resuscitation was insufficient. Trained healthcare providers, having guideline on neonatal resuscitation, and availability of essential equipment were significantly associated with knowledge of neonatal resuscitation. Competency and simulation-based in-service training and refresher training complemented by supportive supervision and mentorship are helpful ways to put up providers capability to perform neonatal resuscitation.