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Apanga DA, Kumbeni MT, Salifu AM, Mireku-Gyimah N, Apanga PA. Predictors of neonatal mortality in the Eastern Regional Hospital in Ghana: A retrospective cohort study. PLOS GLOBAL PUBLIC HEALTH 2024; 4:e0003295. [PMID: 38843308 PMCID: PMC11156434 DOI: 10.1371/journal.pgph.0003295] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Figures] [Subscribe] [Scholar Register] [Received: 08/19/2023] [Accepted: 05/08/2024] [Indexed: 06/10/2024]
Abstract
Neonatal mortality accounts for nearly half of under-5 mortality in Ghana. The aim of this study was to identify the predictors of neonatal mortality in the Eastern Regional Hospital, Ghana. This was a retrospective cohort study conducted using secondary data from electronic medical records from the Eastern Regional Hospital between 1st January 2022 and 31st December 2022. The Kaplan-Meier estimator and adjusted Cox regression model were used to estimate survival probability and to assess the predictors of neonatal mortality. Data on 1684 neonates were analyzed and we found that 11.82% deaths occurred with a neonatal mortality rate (NMR) of 13.98 (95% CI: 12.05, 15.91) per 1000 person-days. Most neonatal deaths occurred within the first 24hrs of life (9.9%). The predictors of neonatal mortality were found to be low birthweight [Adjusted hazard rate (aHR): 1.63, 95% CI: 1.04, 2.54], hypothermia (aHR: 1.82, 95% CI: 1.16, 2.85), hyperthermia (aHR: 1.85, 95% CI: 1.01, 3.39), birth asphyxia (aHR: 3.69, 95% CI: 1.68, 8.11), and multiparty (aHR: 1.66, 95% CI: 1.02, 2.70). However, neonates aged 8-28 days (aHR: 0.41, 95% CI: 0.21, 0.81), born in the Eastern Regional Hospital (aHR: 0.39, 95% CI: 0.28, 0.55), walk-in neonates (aHR: 0.54, 95% CI: 0.32, 0.90), and neonates whose mothers had 8 or more antenatal contacts (aHR: 0.54, 95% CI: 0.32, 0.92) had lower neonatal mortality. There was high NMR in the Eastern Regional Hospital in Ghana. Averting complications such as low birthweight, hypothermia, hyperthermia, birth asphyxia, including the provision of obstetric and early neonatal care within the first 24 hours of life is critical to reducing neonatal mortality. Adherence to the World Health Organization's recommendation of 8 or more antenatal contacts among pregnant women is also essential in reducing neonatal mortality.
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Affiliation(s)
| | - Maxwell Tii Kumbeni
- School of Public Health and Nutrition, College of Health, Oregon State University, Corvallis, Oregon, United States of America
| | | | | | - Paschal Awingura Apanga
- Nuffield Department of Medicine, Jenner Institute, University of Oxford, Oxford, United Kingdom
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Poulin D, Nimo G, Royal D, Joseph PV, Nimo T, Nimo T, Sarkodee K, Attipoe-Dorcoo S. Infant mortality in Ghana: investing in health care infrastructure and systems. HEALTH AFFAIRS SCHOLAR 2024; 2:qxae005. [PMID: 38756556 PMCID: PMC10986301 DOI: 10.1093/haschl/qxae005] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 11/01/2023] [Revised: 11/16/2023] [Accepted: 01/23/2024] [Indexed: 05/18/2024]
Abstract
Child and infant mortality is a global problem. Almost half of deaths of children under age 5 years occur in the neonatal period, the first 28 days of life, with 2.4 million neonatal deaths globally in 2020. Sub-Saharan Africa has disproportionately high numbers of neonatal deaths. Ghana's neonatal mortality rate is 22.8 per 1000 live births and remains behind targets set by the United Nations Sustainable Development Goals. Quality antenatal care, postnatal monitoring, breastfeeding support, and postnatal family planning are important in preventing neonatal deaths. While Ghana has made progress in making care more financially accessible, it has not been matched with the improvements in the critical infrastructure required to ensure quality health care. The improvements have also not eliminated out-of-pocket costs for care, which have hindered progress in decreasing infant mortality. Policymakers should consider investments in health care infrastructure, including expanding public-private partnerships. Policies that improve workforce development programs, transportation infrastructure, and health insurance systems improvements are needed.
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Affiliation(s)
| | - Gloria Nimo
- Amazing Grace Children's Charity, Dansoman Accra GA-542-8377, Ghana
| | - Dorian Royal
- Amazing Grace Children's Charity, Dansoman Accra GA-542-8377, Ghana
| | | | - Tiffany Nimo
- Amazing Grace Children's Charity, Dansoman Accra GA-542-8377, Ghana
| | - Tyra Nimo
- Amazing Grace Children's Charity, Dansoman Accra GA-542-8377, Ghana
| | - Kofi Sarkodee
- Amazing Grace Children's Charity, Dansoman Accra GA-542-8377, Ghana
| | - Sharon Attipoe-Dorcoo
- TERSHA LLC, Alpharetta, GA 30005, United States
- Healthcare Administration Program, College of Business, Texas Woman's University, Denton, TX 76204, United States
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Abukari AS, Schmollgruber S. Perceived barriers of family-centred care in neonatal intensive care units: A qualitative study. Nurs Crit Care 2024. [PMID: 38228405 DOI: 10.1111/nicc.13031] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/12/2023] [Revised: 12/22/2023] [Accepted: 12/24/2023] [Indexed: 01/18/2024]
Abstract
BACKGROUND Family-centered care (FCC) approach in neonatal intensive care units (NICUs) has been shown to improve family satisfaction and quality of care. However, several contextual barriers influence its use in NICUs, and these barriers are understudied in Ghana. AIM To describe FCC practice in Ghanaian NICUs in order to understand the contextual barriers. DESIGN The study employed a descriptive qualitative design. METHODS The researchers used a structured interview guide to collect the data in 24 interviews and 12 focus group discussions. We engaged families (n = 42), nurses and midwives (n = 33), and doctors (n = 9) to describe their perspectives on the barriers to FCC in two public tertiary hospital NICUs. The data were mapped, triangulated, and aggregated to inform the findings. Thematic analysis and MAXQDA qualitative software version 2020 were employed to analyse the data. This qualitative study followed the COREQ guidelines and checklist. RESULTS Perceived family barriers and perceived facility barriers to FCC were the two main themes. The perceived family barriers include family stress and anxiety, inadequate information sharing and education, culture and religion. The perceived facility barriers are inadequate space and logistics, workload and inadequate staff, restricted entry, and negative staff attitudes. CONCLUSION The findings of this study shed light on the barriers to FCC practice in neonatal care in Ghanaian NICUs. Family stress and anxiety, a lack of information sharing, cultures and religious beliefs, NICU workload and staffing shortages, restrictions on family entry into NICUs, and staff attitudes towards families are all contextual barriers to FCC practice. RELEVANCE TO CLINICAL PRACTICE Health facility managers and NICU staff may consider addressing these barriers to implement FCC in the NICU in order to enhance family satisfaction and quality neonatal care. The design of future NICUs should consider family comfort zones and subunits to accommodate families and their sick infants for optimal health care outcomes. The development of communication models and guidelines for respectful NICU care may aid in integrating families into ICUs and promoting quality health care outcomes.
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Affiliation(s)
- Alhassan Sibdow Abukari
- Department of Nursing Education, School of Therapeutic Sciences, Faculty of Health Sciences, University of the Witwatersrand, Parktown, Johannesburg, South Africa
- Department of General Nursing, School of Nursing, Wisconsin International University College, Accra, Ghana
| | - Shelley Schmollgruber
- Department of Nursing Education, School of Therapeutic Sciences, Faculty of Health Sciences, University of the Witwatersrand, Parktown, Johannesburg, South Africa
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Tette EMA, Nartey ET, Nyarko MY, Aduful AK, Neizer ML. Trends in Neonatal Mortality at Princess Marie Louise Children's Hospital, Accra, and the Newborn Strategic Plan: Implications for Reducing Mortality in Hospital and the Community. CHILDREN (BASEL, SWITZERLAND) 2023; 10:1755. [PMID: 38002846 PMCID: PMC10670549 DOI: 10.3390/children10111755] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Subscribe] [Scholar Register] [Received: 08/06/2023] [Revised: 10/05/2023] [Accepted: 10/16/2023] [Indexed: 11/26/2023]
Abstract
BACKGROUND In low and middle-income countries, close to half of the mortality in children under the age of five years occurs in neonates. OBJECTIVES We examined the trend, medical conditions and factors associated with newborn deaths at the Princess Marie Louise Children's Hospital (PML), Accra, from 2014 to 2017 (4 years). METHODS The study was a cross-sectional study. Data on age, sex, date of admission, date of discharge, cause of death and place of residence of these babies were obtained from the records department. This was transferred into an Access database and analyzed. Components of the Newborn Strategic Plan implemented at the hospital were described. RESULTS Neonatal sepsis, pneumonia and kernicterus were the major causes of death. Admissions increased and 5.4% of the neonates died, declining from 6.5% in 2014 to 4.2% in 2017 due to deliberate actions to reduce neonatal death. The highest mortality occurred in babies residing in an area more than 1 hour's drive away from the hospital. CONCLUSION Implementing the Newborn Strategic Plan was associated with a drop in mortality. A preponderance of community-acquired infections was observed. Thus, locality-specific interventions targeted at known determinants and implementing the newborn strategic plan are essential for reducing neonatal mortality.
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Affiliation(s)
- Edem M. A. Tette
- Department of Community Health, University of Ghana Medical School, Accra P.O. Box 4236, Ghana
- Princess Marie Louise Children’s Hospital, Accra P.O. Box GP 122, Ghana; (M.Y.N.); (M.L.N.)
| | - Edmund T. Nartey
- Centre for Tropical Clinical Pharmacology and Therapeutics, University of Ghana Medical School, Accra P.O. Box 4236, Ghana;
| | - Mame Yaa Nyarko
- Princess Marie Louise Children’s Hospital, Accra P.O. Box GP 122, Ghana; (M.Y.N.); (M.L.N.)
| | - Abena K. Aduful
- Family Medicine Department, Korle-Bu Teaching Hospital, Accra P.O. Box GP 4236, Ghana;
| | - Margaret L. Neizer
- Princess Marie Louise Children’s Hospital, Accra P.O. Box GP 122, Ghana; (M.Y.N.); (M.L.N.)
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Vaishnav K, Galhotra A, Jindal A, Parhad P. Profile and predictors of babies admitted to SNCUs of two tribal districts of Chhattisgarh. J Family Med Prim Care 2023; 12:1165-1171. [PMID: 37636189 PMCID: PMC10451588 DOI: 10.4103/jfmpc.jfmpc_2309_22] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/25/2022] [Revised: 02/15/2023] [Accepted: 02/21/2023] [Indexed: 08/29/2023] Open
Abstract
Background The neonatal period is the crucial and vulnerable period of the human life cycle. Various research has been conducted worldwide that provide the baseline data on clinical profiles and predictors of outcomes of babies admitted to sick newborn care units (SNCUs). Nonetheless, studies on tribal areas and community outreach areas are rare. In the present study, predictors and profiles of patients admitted to SNCU, in the Dantewada and Bijapur districts of Chhattisgarh, India, were evaluated which shall help prioritize patient care and preventive approaches. Methods This retrospective study was undertaken from January 2019 to December 2020 in the SNCUs of Dantewada and Bijapur. Neonatal and maternal characteristics, course during labor, treatment given to the neonates, and outcome data were obtained and analysed. Results In total, 1,531 neonates were enrolled in the study. Mothers had a mean age of 25.6 years (standard deviation [SD] ±4.9) with birth spacing less than 2 years (60.3%) and antenatal care (ANC) visits less than 4 (50.4%). Neonates were low birth weight (43.75%) and were home-delivered (15.8%). One hundred forty-nine neonates died. In the multivariate regression model, extremely low birth weight babies, less than 1 kg (odds ratio [OR]: 11.59 confidence interval [CI] 4.625-31.58), gestational age less than 34 weeks (OR: 2.13 CI 1.291-3.532), central cyanosis (OR: 10.40 CI: 3.269-32.35), duration of IV fluid > 3 days (OR: 2.16 CI 0.793-0.880), duration of antibiotic >3 days (OR 0.63 CI 0.408-0.979) were found to be independent predictors of mortality among neonates. Conclusion The prevalence of newborns aged less than 12 h is higher among the study population. Birth asphyxia, prematurity, neonatal jaundice, and sepsis were fundamental and leading causes of morbidity. Preterm birth and low birth weight babies had significantly high mortality. The government needs to focus on marginalized communities with target-based interventions and policies.
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Affiliation(s)
| | | | - Atul Jindal
- Department of Pediatrics, AIIMS Raipur, Chhattisgarh, India
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Diala UM, Usman F, Appiah D, Hassan L, Ogundele T, Abdullahi F, Satrom KM, Bakker CJ, Lee BW, Slusher TM. Global Prevalence of Severe Neonatal Jaundice among Hospital Admissions: A Systematic Review and Meta-Analysis. J Clin Med 2023; 12:3738. [PMID: 37297932 PMCID: PMC10253859 DOI: 10.3390/jcm12113738] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/23/2023] [Revised: 05/03/2023] [Accepted: 05/05/2023] [Indexed: 06/12/2023] Open
Abstract
Evidence regarding the adverse burden of severe neonatal jaundice (SNJ) in hospitalized neonates in resource-constrained settings is sparse. We attempted to determine the prevalence of SNJ, described using clinical outcome markers, in all World Health Organization (WHO) regions in the world. Data were sourced from Ovid Medline, Ovid Embase, Cochrane Library, African Journals Online, and Global Index Medicus. Hospital-based studies, including the total number of neonatal admissions with at least one clinical outcome marker of SNJ, defined as acute bilirubin encephalopathy (ABE), exchange blood transfusions (EBT), jaundice-related death, or abnormal brainstem audio-evoked response (aBAER), were independently reviewed for inclusion in this meta-analysis. Of 84 articles, 64 (76.19%) were from low- and lower-middle-income countries (LMICs), and 14.26% of the represented neonates with jaundice in these studies had SNJ. The prevelance of SNJ among all admitted neonates varied across WHO regions, ranging from 0.73 to 3.34%. Among all neonatal admissions, SNJ clinical outcome markers for EBT ranged from 0.74 to 3.81%, with the highest percentage observed in the African and South-East Asian regions; ABE ranged from 0.16 to 2.75%, with the highest percentages observed in the African and Eastern Mediterranean regions; and jaundice-related deaths ranged from 0 to 1.49%, with the highest percentage observed in the African and Eastern Mediterranean regions. Among the cohort of neonates with jaundice, the prevalence of SNJ ranged from 8.31 to 31.49%, with the highest percentage observed in the African region; EBT ranged from 9.76 to 28.97%, with the highest percentages reported for the African region; ABE was highest in the Eastern Mediterranean (22.73%) and African regions (14.51%). Jaundice-related deaths were 13.02%, 7.52%, 2.01% and 0.07%, respectively, in the Eastern Mediterranean, African, South-East Asian and European regions, with none reported in the Americas. aBAER numbers were too small, and the Western Pacific region was represented by only one study, limiting the ability to make regional comparisons. The global burden of SNJ in hospitalized neonates remains high, causing substantial, preventable morbidity and mortality especially in LMICs.
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Affiliation(s)
- Udochukwu M. Diala
- Department of Paediatrics, Faculty of Clinical Sciences, College of Health Sciences, University of Jos, University of Jos Lamingo Campus, Jos 930232, Nigeria
| | - Fatima Usman
- Department of Paediatrics, Faculty of Clinical Services, College of Health Sciences, Bayero University, Aminu Kano Teaching Hospital Campus, Kano 700006, Nigeria
| | - Duke Appiah
- Department of Public Health, School of Population and Public Health, Faculty of Public Health, Texas Tech University Health Sciences Center, Lubbock, TX 79430, USA
| | - Laila Hassan
- Department of Paediatrics, Faculty of Clinical Sciences, College of Medical Sciences, Ahmadu Bello University, Main Campus, Zaria 810211, Nigeria
| | - Tolulope Ogundele
- Department of Paediatrics, Obafemi Awolowo University Teaching Hospital, Ile-Ife 220005, Nigeria
| | - Fatima Abdullahi
- Department of Paediatrics, Faculty of Clinical Sciences, College of Medical Sciences, Ahmadu Bello University, Main Campus, Zaria 810211, Nigeria
| | - Katherine M. Satrom
- Department of Pediatrics, Faculty of Medical School, School of Medicine, University of Minnesota, University of Minnesota Twin Cities Campus, Minneapolis, MN 55455, USA
| | - Caitlin J. Bakker
- Dr. John Archer Library and Archives, University of Regina, Regina, SK S4S 0A2, Canada
| | - Burton W. Lee
- National Institute of Health, Bethesda, MD 20892, USA
| | - Tina M. Slusher
- Department of Pediatrics, Faculty of Medical School, School of Medicine, University of Minnesota, University of Minnesota Twin Cities Campus, Minneapolis, MN 55455, USA
- Hennepin Healthcare, Minneapolis, MN 55415, USA
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Ziem MS, Saaka FA, Vicar EK, Kuugbee ED, Karikari AB, Ninimiya SY, Ziem JB, Walana W. Pregnancy and the risk of NICU admissions in Nandom Municipality of Ghana: A cross-sectional retrospective study. Health Sci Rep 2023; 6:e1070. [PMID: 36698703 PMCID: PMC9847282 DOI: 10.1002/hsr2.1070] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/18/2022] [Revised: 01/05/2023] [Accepted: 01/08/2023] [Indexed: 01/19/2023] Open
Abstract
Background Neonatal intensive care units (NICU) are specialized units that provide medical attention to neonates, and thus have become a vital aspect in the provision of critical care to infants who are faced with special challenges following birth. Aim To determine antepartum and intrapartum factors that predispose to NICU admissions in the Nandom Municipal of the Upper West Region of Ghana. Method This was a cross-sectional retrospective study, spanning from January 1, 2021 to December 31, 2021. Records covering 1777 women who were delivered or had their babies referred to the St. Theresa's Hospital in the Nandom Municipality were involved in the study. Descriptive statistics and multinomial logistic regression analysis were used to compare variables, and statistical significance was determined where the p-value was less than 0.05. Results From the study, the rate of NICU admission was 10.4%. There was a significant association between mothers who attended less than four antenatal sessions (p = 0.004) and admission to NICU. Nulliparous mothers (p = 0.027) and mothers who presented with multiple pregnancy (p < 0.001) were more likely to have their babies sent to NICU. Both preterm delivery (p < 0.001) and post-term delivery (p < 0.001) were prone to admission to NICU. Also, instrumental delivery (p < 0.001), cesarean section (p < 0.001), low birth weight (p < 0.001), and male infants (p = 0.003) had an increased risk of being admitted to NICU. Furthermore, severe (p < 0.001) and moderate (p < 0.001) birth asphyxia in the first minute following delivery were significantly associated with NICU admission whereas severely asphyxiated babies at 5 min (p < 0.001) were associated with NICU admission. Conclusion The study revealed a relatively high NICU admission rate in the study area, and the predictors are multifaceted. Tailored intervention programs aimed at curbing these predictors will be required to reduce the rate of NICU admissions in the Nandom Municipality of Ghana.
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Affiliation(s)
- Maroun Soribang Ziem
- Department of Community Medicine, School of MedicineUniversity for Development StudiesTamaleGhana
| | - Fidelis Adam Saaka
- Department of Community Medicine, School of MedicineUniversity for Development StudiesTamaleGhana
| | - Ezekiel Kofi Vicar
- Department of Microbiology, School of MedicineUniversity for Development StudiesTamaleGhana
| | | | - Akosua Bonsu Karikari
- Department of Microbiology, School of MedicineUniversity for Development StudiesTamaleGhana
| | | | - Juventus Benogle Ziem
- Department of Clinical Microbiology and Immunology, School of Medicine and DentistryCKT‐UTASNavrongoGhana
| | - Williams Walana
- Department of Microbiology, School of MedicineUniversity for Development StudiesTamaleGhana
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Gebremariam H, Tesfai B, Tewelde S, Abay S, Tekeste D, Kibreab F. Demographic, Clinical Profile and Outcomes of Neonates Admitted to Neonatal Intensive Care Unit of Dekemhare Hospital, Eritrea. BMC Pediatr 2022; 22:716. [PMID: 36517769 PMCID: PMC9753419 DOI: 10.1186/s12887-022-03779-0] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 05/09/2022] [Accepted: 11/28/2022] [Indexed: 12/23/2022] Open
Abstract
BACKGROUND Ninety-six percent of the world's 3 million neonatal deaths occur in developing countries where the majority of births occur outside health facility. The objective of this study was to evaluate the demographic, clinical profile and outcome of neonates admitted to Neonatal Intensive Care Unit of Dekemhare Hospital of Eritrea. METHODS The study was a retrospective register-based review of all neonates admitted from January 2018 to December 2021 to Dekemhare Hospital. Overall, 509 neonates were enrolled in this study. Data were collected from neonatal register book from January 5 to February 5, 2022 by general practitioners using a predesigned data collection tool. Data entry was done using CSpro 7.3 and analyzed through SPSS version 22. Results were presented in frequencies, percent and odds ratio. Univariable and multivariable analysis was done to measure the association between the variables. RESULTS Three quarter (75.6%) of the neonates had normal birth weight and 80.0% were term. Majority (75.4%) of the neonates was delivered vaginally and 92.7% were delivered at health facility. Neonatal infection (33.0%), birth asphyxia (20%) and prematurity (14.3%) were the top three primary causes of neonatal admission to the Neonatal Intensive Care Unit. Furthermore, 31% of neonatal deaths occurred during 24-72 hours of their life and the mortality rate was 16.3%. Multivariable analysis indicated that low birth weight (AOR: 7.28; 95%CI: 2.85-18.55) increased neonatal mortality. Whereas delivery at health facility (AOR: 0.17; 95%CI: 0.06-0.47), hospital stay 4-7 days (AOR: 0.06; 95% CI: 0.02-0.23) and above 8 days (AOR: 0.06; 95%CI: 0.02-0.23) were showing protective effect on neonatal mortality. CONCLUSION Congenital abnormality, prematurity and birth asphyxia had higher case fatality rate. And, low birth weight, delivery at health facility and hospital stay were found to be predictors of neonatal mortality. Training of health professionals on neonatal resuscitation, further improvement on the diagnostic setup, treatment tools, infrastructure and raising community awareness to deliver at health facility are crucial to decrease the neonatal mortality in Eritrea.
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Affiliation(s)
| | - Berhe Tesfai
- Massawa Hospital, Northern Red Sea, Ministry of Health, Massawa, Eritrea
| | - Seltene Tewelde
- Hazhaz Hospital, Zoba Maekel, Ministry of Health, Asmara, Eritrea
| | - Samsom Abay
- Pediatrician, Mendefera Zonal Referral Hospital, Zoba Debub, Ministry of Health, Asmara, Eritrea
| | - Danait Tekeste
- Statistician, Ministry of Health, Debub Branch, Mendefera, Eritrea
| | - Fitsum Kibreab
- Epidemiologist, Ministry of Health, Health Research and Resource Center Division, Asmara, Eritrea
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Determinants of neonatal jaundice in Ethiopia: a systematic review and meta-analysis. World J Pediatr 2022; 18:725-733. [PMID: 36114364 DOI: 10.1007/s12519-022-00597-3] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 02/28/2022] [Accepted: 07/19/2022] [Indexed: 10/14/2022]
Abstract
BACKGROUND Neonatal jaundice is a common condition characterized by a yellowish discoloration of the skin, conjunctiva, and sclera caused by elevated serum or plasma bilirubin levels during the newborn period. The condition is usually not dangerous, but it can progress to severe hyperbilirubinemia, which can lead to acute bilirubin encephalopathy and kernicterus, a bilirubin-induced neurological damage. Therefore, this study aimed to assess the pooled prevalence of neonatal jaundice and its determinants in Ethiopia. METHODS Scopus, PubMed, Google Scholar, Embase, and CINAHL databases were searched for studies published between January 1, 2010 and July 30, 2021. A weighted DerSimonian Laird random-effects model was used to estimate the pooled prevalence of neonatal jaundice and its associated factors. The I2 was used to calculate the degree of heterogeneity. The funnel plot and Egger's regression test were used to assess publication bias. RESULTS Totally 697 articles were generated from various databases, and the review included a total of eight articles. The pooled prevalence of neonatal jaundice was 30.96% [95% confidence interval (CI) 16.61%-45.31%)] in Ethiopia. This review showed that prolonged labor [adjusted odd ratio (AOR) = 3.39; 95% CI 2.41-4.77), low birth weight (AOR = 5.12; 95% CI 3.11-8.72), birth asphyxia (AOR = 3.75; 95% CI 2.11-6.66), cephalohematoma (AOR = 7.07; 95% CI 2.72-18.38), ABO incompatibility (AOR = 6.05; 95% CI 2.95-12.42), Rhesus (RH) incompatibility (AOR = 3.77; 95% CI 2.04-6.96), male sex (AOR = 4.53; 95% CI 3.39-6.07), and neonatal sepsis (AOR = 2.47; 95% CI 1.49-4.08) were identified as a determining factor for neonatal jaundice in Ethiopia. CONCLUSIONS In low- and middle-income countries, neonatal jaundice is a significant healthcare burden, accounting for a significant portion of global childhood mortality and morbidity. However, some low-cost, effective, practical, and dependable solutions have been implemented. Prolonged labor, ABO incompatibility, RH incompatibility, birth asphyxia, neonatal sepsis, low birth weight, cephalohematoma, and male sex were identified as risk factors for neonatal jaundice in Ethiopia.
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Fenny AP, Otieku E, Labi KAK, Asante FA, Enemark U. Cost-effectiveness analysis of alcohol handrub for the prevention of neonatal bloodstream infections: Evidence from HAI-Ghana study. PLoS One 2022; 17:e0264905. [PMID: 35245332 PMCID: PMC8896731 DOI: 10.1371/journal.pone.0264905] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/01/2021] [Accepted: 02/21/2022] [Indexed: 11/19/2022] Open
Abstract
Published evidence of the cost-effectiveness of alcohol-based handrub (ABH) for the prevention of neonatal bloodstream infections (BSI) is limited in sub-Saharan Africa. Therefore, this study evaluates the cost-effectiveness of a multimodal hand hygiene involving alcohol-based hand rub (ABH) for the prevention of neonatal BSI in a neonatal intensive care unit (NICU) setting in Ghana using data from HAI-Ghana study. Design was a before and after intervention study using economic evaluation model to assess the cost-effectiveness of a multimodal hand hygiene strategy involving alcohol-based hand rub plus soap and water compared to existing practice of using only soap and water. We measured effect and cost by subtracting outcomes without the intervention from outcomes with the intervention. The primary outcome measure is the number of neonatal BSI episode averted with the intervention and the consequent cost savings from patient and provider perspectives. The before and after intervention studies lasted four months each, spanning October 2017 to January 2018 and December 2018 to March 2019, respectively. The analysis shows that the ABH program was effective in reducing patient cost of neonatal BSI by 41.7% and BSI-attributable hospital cost by 48.5%. Further, neonatal BSI-attributable deaths and extra length of hospital stay (LOS) decreased by 73% and 50% respectively. Also, the post-intervention assessment revealed the ABH program contributed to 16% decline in the incidence of neonatal BSI at the NICU. The intervention is a simple and adaptable strategy with cost-saving potential when carefully scaled up across the country. Though the cost of the intervention may be more relative to using just soap and water for hand hygiene, the outcome is a good reason for investment into the intervention to reduce the incidence of neonatal BSI and the associated costs from patient and providers’ perspectives.
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Affiliation(s)
- Ama Pokuaa Fenny
- Economics Division, Institute of Statistical, Social and Economic Research (ISSER), University of Ghana, Legon, Accra, Ghana
- * E-mail: ,
| | - Evans Otieku
- Economics Division, Institute of Statistical, Social and Economic Research (ISSER), University of Ghana, Legon, Accra, Ghana
- Department of Public Health, Aarhus University, Aarhus, Denmark
| | - Kwaku Appiah-Korang Labi
- Department of Medical Microbiology, University of Ghana Medical School, University of Ghana, Accra, Ghana
| | - Felix Ankomah Asante
- Economics Division, Institute of Statistical, Social and Economic Research (ISSER), University of Ghana, Legon, Accra, Ghana
| | - Ulrika Enemark
- Department of Public Health, Aarhus University, Aarhus, Denmark
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Mamo SA, Teshome GS, Tesfaye T, Goshu AT. Perinatal asphyxia and associated factors among neonates admitted to a specialized public hospital in South Central Ethiopia: A retrospective cross-sectional study. PLoS One 2022; 17:e0262619. [PMID: 35025979 PMCID: PMC8758104 DOI: 10.1371/journal.pone.0262619] [Citation(s) in RCA: 6] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/02/2021] [Accepted: 12/29/2021] [Indexed: 11/18/2022] Open
Abstract
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.
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Affiliation(s)
- Seifu Awgchew Mamo
- Department of Pediatric Nursing, College of Medicine and Health Sciences, Wachemo University, Hosaena, Ethiopia
| | - Girum Sebsibie Teshome
- School of Nursing and Midwifery, College of Health Sciences, Addis Ababa University, Addis Ababa, Ethiopia
| | - Tewodros Tesfaye
- School of Nursing and Midwifery, College of Health Sciences, Addis Ababa University, Addis Ababa, Ethiopia
| | - Abel Tibebu Goshu
- School of Nursing and Midwifery, College of Health and Medical Sciences, Haramaya University, Harar, Ethiopia
- * E-mail:
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12
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Oo NAT, Edwards JK, Pyakurel P, Thekkur P, Maung TM, Aye NSS, Nwe HM. Neonatal Sepsis, Antibiotic Susceptibility Pattern, and Treatment Outcomes among Neonates Treated in Two Tertiary Care Hospitals of Yangon, Myanmar from 2017 to 2019. Trop Med Infect Dis 2021; 6:tropicalmed6020062. [PMID: 33924746 PMCID: PMC8167801 DOI: 10.3390/tropicalmed6020062] [Citation(s) in RCA: 4] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/11/2021] [Revised: 04/16/2021] [Accepted: 04/18/2021] [Indexed: 11/30/2022] Open
Abstract
Neonatal sepsis is a leading cause of morbidity and mortality in developing countries. This study aimed to assess the proportion of culture-confirmed sepsis, bacteriological pathogen profile, culture report turnaround times, antibiotic susceptibility patterns, and treatment outcomes of all with neonatal sepsis admitted in two tertiary care hospitals in Yangon, Myanmar, 2017–2019. This was a cross sectional study utilizing a standardized electronic database and paper-based records. Bacteriological profiles and associated factors were analyzed with descriptive statistics and Poisson Regression. Of those with suspected sepsis, 42% were bacteriologically confirmed and 74% of confirmed sepsis was resistant to at least first-line antibiotics. Neonates with late onset sepsis (LOS) (aPR: 1.2 (95% CI: 1.1–1.4, p = 0.008)) were more likely to have bacteriologically confirmed sepsis (45%) versus early onset sepsis (38%). Gram-negative organisms were most commonly isolated (63%), associated with multidrug-resistant organisms and with a high case-fatality rate (64%). These findings suggest that enhanced national guidance regarding infection control and prevention, antibiotic stewardship, and first-line antibiotic choices need to be provided. The link between LOS with infection and prevention protocols needs to be further explored in this context to decrease sepsis risk, neonatal mortality, and reduce further antimicrobial resistance.
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Affiliation(s)
- Nan Aye Thida Oo
- Department of Medical Research, Ministry of Health and Sports, Yangon 11191, Myanmar;
- Correspondence: ; Tel.: +95-9-5126148
| | - Jeffrey K. Edwards
- Department of Global Health, University of Washington, Seattle, WA 98195, USA;
| | - Prajjwal Pyakurel
- School of Public Health and Community Medicine, B.P. Koirala Institute of Health Sciences, Dharan 56700, Nepal;
| | - Pruthu Thekkur
- Centre for Operational Research, International Union against Tuberculosis and Lung Disease (The Union), 68 Boulevard Saint Michel, 75006 Paris, France;
| | - Thae Maung Maung
- Department of Medical Research, Ministry of Health and Sports, Yangon 11191, Myanmar;
| | - Nant San San Aye
- Neonatal Intensive Care Unit, Central Women Hospital, Yangon 11121, Myanmar;
| | - Hla Myat Nwe
- Department of Neonatology, Yangon Children Hospital, Yangon 11191, Myanmar;
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13
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Pelkonen T, Urtti S, Cardoso O, Kyaw MH, Roine I, Peltola H. Risk factors for death in suspected severe bacterial infection in infants aged <90 days in Luanda, Angola. Int J Infect Dis 2021; 106:223-227. [PMID: 33781903 DOI: 10.1016/j.ijid.2021.03.070] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/20/2021] [Revised: 03/22/2021] [Accepted: 03/24/2021] [Indexed: 11/17/2022] Open
Abstract
BACKGROUND Yearly, about two million infants die during the first 28 days of life. Most of these deaths occur in sub-Saharan Africa and a third of those are caused by severe infections. The early identification of infants at risk of death is important when trying to prevent poor outcomes. OBJECTIVE The aim of this study was to identify risk factors for death among young infants with possible serious bacterial infection (pSBI) at hospital admission. METHODS This prospective, observational, single-site, descriptive study forms part of a larger study on bacterial meningitis in infants <90 days of age admitted to the Pediatric Hospital of Luanda, the capital of Angola, from February 1, 2016 to October 23, 2017. Infants with pSBI, a known outcome, and a final diagnosis were included. RESULTS Of 574 young infants with pSBI, 115 (20%) died in hospital. An altered level of consciousness, absence of spontaneous movements, dyspnea, CSF that is not clear, low CSF glucose, high CSF protein, heart rate over the median, and seizures were identified as risk factors for death in the univariate analysis. In the multivariate analysis, only heart rate over the median and seizures were independent predictors of death. CONCLUSIONS Easily recognizable clinical signs - tachycardia and seizures - may guide clinicians to identify infants at high risk of death due to severe bacterial infections in sub-Saharan Africa.
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Affiliation(s)
- Tuula Pelkonen
- New Children's Hospital, Pediatric Research Center, Helsinki, Finland; Pediatrics, University of Helsinki and Helsinki University Hospital, Helsinki, Finland; Hospital Pediátrico David Bernardino (HPDB), Luanda, Angola.
| | - Suvi Urtti
- New Children's Hospital, Pediatric Research Center, Helsinki, Finland; Pediatrics, University of Helsinki and Helsinki University Hospital, Helsinki, Finland.
| | - Ondina Cardoso
- Hospital Pediátrico David Bernardino (HPDB), Luanda, Angola.
| | - Moe H Kyaw
- Sanofi Pasteur, Epidemiology, Swiftwater, Pennsylvania, USA.
| | - Irmeli Roine
- Faculty of Medicine, University Diego Portales, Santiago, Chile.
| | - Heikki Peltola
- New Children's Hospital, Pediatric Research Center, Helsinki, Finland; Pediatrics, University of Helsinki and Helsinki University Hospital, Helsinki, Finland.
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Birhanu MY, Workineh AA, Molla Y, Abebaw E, Arora A, Bazezew Y. Rate and Predictors of Neonatal Jaundice in Northwest Ethiopia: Prospective Cohort Study. J Multidiscip Healthc 2021; 14:447-457. [PMID: 33654404 PMCID: PMC7910087 DOI: 10.2147/jmdh.s298034] [Citation(s) in RCA: 4] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/19/2020] [Accepted: 02/04/2021] [Indexed: 12/26/2022] Open
Abstract
Background Neonatal jaundice is one of the most common clinical disorders occurred worldwide. About 1.1 million neonates develop jaundice per year globally and the vast majority of them found in sub-Saharan Africa and South Asia. There is a paucity of evidence on the incidence rate and predictors of neonatal jaundice in Ethiopia. Therefore, this study was aimed at determining the rate and predictors of neonatal jaundice in the northwest, Ethiopia. Methods A prospective cohort study design was conducted at Debre Markos comprehensive, specialized Hospitals using 334 neonates from October 1, 2019, to June 30, 2020. Using a systematic random sampling technique, the study subjects were drawn. Data were entered into the Epi-DataTM Version 4.2 and analyzed using STATATM Version 14.0. The Kaplan-Meier survival curve was used to estimate the survival time. A generalized Log rank test was used to compare the survival curves of different categorical variables. Finally, both bi-variable and multivariable Cox-proportional hazards regression models were used to identify the predictors of neonatal jaundice. The Results The overall incidence rate of jaundice among neonates was 4.5 per 100 person-hours. Long duration of labor [ARR = 3.5; 95% confidence interval (CI), (2.8–8.7)], being male neonates [ARR= 5.2; 95% CI (3.5–7.3)], “O” blood group mothers [ARR = 4.5; 95% CI (3.4–10.3)], and having neonatal sepsis 3.4 [ARR=3.4; 95% CI: (2.5–6.1)] were predictors. Conclusion The incidence rate of jaundice was higher in this study than the finding of the previous one. Being male, prolonged duration of labor, “O” blood group mothers and sepsis were the significant predictors. Hence, an effort has to be made to decrease the incidence rate of neonatal jaundice through improving newborn care and timely intervention for neonates with sepsis and delivered at a long duration of time as well as the neonates born from “o” blood type mothers are our recommendation.
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Affiliation(s)
- Molla Yigzaw Birhanu
- Department of Public Health, College of Health Sciences, Debre Markos University, Debre Markos, Ethiopia
| | - Aytenew Atnaf Workineh
- Department of Medical Laboratory Sciences, College of Health Sciences, Debre Markos University, Debre Markos, Ethiopia
| | - Yalew Molla
- Department of Pharmacy, College of Health Sciences, Debre Markos University, Debre Markos, Ethiopia
| | - Ermias Abebaw
- Department of Pediatrics, School of Medicine, Debre Markos University, Debre Markos, Ethiopia
| | - Amit Arora
- School of Health Sciences, Western Sydney University, Penrith, NSW, 2751, Australia
| | - Yibelu Bazezew
- Department of Midwifery, College of Health Sciences, Debre Markos University, Debre Markos, Ethiopia
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Ogunkunle TO, Gabriel TY, Bello SO, Abdullahi Y, Bulus J, Ozhe SI, Imam A. Facility-Based Newborn Deaths at a Referral Tertiary Hospital in North-Central Nigeria during the Sustainable Development Goal Era: A Retrospective Cohort Analysis. J Trop Pediatr 2021; 67:6076725. [PMID: 33421090 DOI: 10.1093/tropej/fmaa126] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/12/2022]
Abstract
BACKGROUND Nigeria has the largest number of global under-five deaths and almost half of these occur in the newborn period in an almost 50:50 ratio across hospital facilities and communities. We examine and describe risk factors for newborn mortality at a busy neonatal unit of a referral tertiary hospital in North-central Nigeria. METHODS We conducted a retrospective cohort analysis of all newborn admissions to the Dalhatu Araf Specialist Hospital between September 2018 and March 2020. We determined the newborn mortality rate (NMR) and case fatality rates (CFRs) for individual diagnostic categories and determined risk predictors for mortality using cox-proportional hazard models. RESULTS Of 1171 admitted newborn infants, 175 (14.9%) died with about half of these occurring within 24 h of admission. Extremely low birth weight infants and those with congenital anomalies had the highest CFRs. Identified risk factors for mortality were age at admission [adjusted hazard ratio (AHR): 0.996, 95% CI: 0.993-0.999], admitting weight (AHR: 0.9995, 95% CI: 0.9993-0.9997) and home delivery (AHR: 1.65, 95% CI: 1.11-to 2.46). CONCLUSIONS Facility-based newborn mortality is high in North-central Nigeria. Majority of these deaths occur within the first 24 h of admission, signifying challenges in acute critical newborn care. To improve the current situation and urgently accelerate progress to meet the sustainable development goal NMR targets, there is an urgent need to develop human and material resources for acute critical newborn care while encouraging facility-based delivery and decentralizing existing newborn care. Lay summaryNigeria now has the greatest number of deaths in children below the age of five globally. Almost half of these occurred in the newborn period and these deaths occur within hospital facilities and also in communities in an almost 50:50 ratio. As such, the country might not attain global newborn mortality rates that were set as targets for the sustainable development goals (SDGs). In this article, we examine and describe the risk factors for newborn deaths occurring at a typical newborn unit in North-central Nigeria. During the period under review, we found that about 175 (14.9%) died and about half of these deaths occurred within 24 h of admission. Extremely small babies and those who were born with physical defects had the highest death rates. Older babies and those who weighed more at admission had decreased risks of dying while being delivered at home increased the risk of death. Hospital newborn deaths remain high in North-central Nigeria and the pattern of early admission deaths signifies challenges in stabilizing critically ill newborn infants. There is an urgent need to develop human and material resources for acute critical newborn care while encouraging institutional delivery and decentralizing of existing newborn care.
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Affiliation(s)
| | - Tiya Yohanna Gabriel
- Department of Paediatrics, Dalhatu Araf Specialist Hospital, 950101 Lafia, Nassarawa, Nigeria
| | | | - Yakubu Abdullahi
- Department of Paediatrics, Dalhatu Araf Specialist Hospital, 950101 Lafia, Nassarawa, Nigeria
| | - Joel Bulus
- Department of Paediatrics, Dalhatu Araf Specialist Hospital, 950101 Lafia, Nassarawa, Nigeria
| | - Sunday Ikukpla'si Ozhe
- Department of Paediatrics, Dalhatu Araf Specialist Hospital, 950101 Lafia, Nassarawa, Nigeria
| | - Abdulazeez Imam
- Vaccines and Immunity Theme, Medical Research Council Unit The Gambia at London School of Hygiene and Tropical Medicine, PO Box 273 Banjul, Fajara, Gambia
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Tette EMA, Gyan BA, Koram KA. Perspectives on Research Internships for Medical Students and Young Doctors in Ghana: An Opportunity to Replenish the Stock of Physician Investigators? ADVANCES IN MEDICAL EDUCATION AND PRACTICE 2020; 11:473-478. [PMID: 32753996 PMCID: PMC7354947 DOI: 10.2147/amep.s243719] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 12/25/2019] [Accepted: 06/01/2020] [Indexed: 06/11/2023]
Abstract
The corona virus pandemic undoubtedly demonstrates the growing need for research in medical science. However, with the decline in physician scientists world-wide, innovative ways are needed to engender interest in research among medical students and young doctors to replenish the stock of physician investigators. One way of doing this is to create compulsory and elective projects for them. We describe research internships created for medical students at the Noguchi Memorial Institute for Medical Research to expose them to the rudiments of biomedical research and proposal development. We also describe research internships for doctors waiting for house job postings or keen to do research who needed mentorship. Though the response has been positive, the full impact will be realized with time. The recognition that training should be backed with a supportive environment, mentorship and clear career paths for physician scientists is also mentioned.
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Affiliation(s)
- Edem M A Tette
- Department of Community Health, University of Ghana Medical School, Accra, Greater Accra Region, Ghana
| | - Ben A Gyan
- Department of Immunology, Noguchi Memorial Institute for Medical Research University of Ghana, Accra, Greater Accra Region, Ghana
| | - Kwadwo A Koram
- Department of Epidemiology, Noguchi Memorial Institute for Medical Research University of Ghana, Accra, Greater Accra Region, Ghana
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