Neonatal mortality and associated factors among neonates admitted to neonatal intensive care unit at public hospitals of Somali Regional State, Eastern Ethiopia: A multicenter retrospective analysis

Neonatal mortality and associated factors among newborns in Mogadishu, Somalia: a multicenter hospital-based cross-sectional study

INTRODUCTION

Neonatal mortality is a significant public health problem in Sub-Saharan Africa, particularly in Somalia, where limited data exists about this. Mogadishu, the densely populated capital, faces a high rate of neonatal mortality, but this has not been widely studied on a national level. Healthcare providers and policymakers are working to reduce newborn deaths, but a comprehensive understanding of the contributing factors is crucial for effective strategies. Therefore, this study aims to determine the magnitude of neonatal death and identify factors associated with it in Mogadishu, Somalia.

METHOD

A multicenter hospital-based cross-sectional study was conducted to collect data from participants at 5 purposively selected hospitals in Mogadishu, Somalia. A well-structured, reliable, self-developed, validated questionnaire containing socio-demographic, maternal, and neonatal characteristics was used as a research tool. Descriptive statistics were used for categorical and continuous variables presented. Chi-square and logistic regression were used to identify factors associated with neonatal mortality at a significant level of α = 0.05.

RESULTS

A total of 513 participants were recruited for the study. The prevalence of neonatal mortality was 26.5% [95%CI = 22.6-30.2]. In a multivariable model, 9 variables were found: female newborns (AOR = 1.98, 95%CI = 1.22-3.19), those their mothers who did not attend ANC visits (AOR = 2.59, 95%CI = 1.05-6.45), those their mothers who did not take tetanus toxoid vaccination (AOR = 1.82, 95%CI = 1.01-3.28), those their mothers who delivered in instrumental assistant mode (AOR = 3.01, 95%CI = 1.38-6.56), those who had neonatal sepsis (AOR = 2.24, (95%CI = 1.26-3.98), neonatal tetanus (AOR = 16.03, 95%CI = 3.69-69.49), and pneumonia (AOR = 4.06, 95%CI = 1.60-10.31) diseases during hospitalization, premature (AOR = 1.99, 95%CI = 1.00-3.94) and postmature (AOR = 4.82, 95%CI = 1.64-14.16) neonates, those with a birth weight of less than 2500 gr (AOR = 4.82, 95%CI = 2.34-9.95), those who needed resuscitation after delivery (AOR = 2.78, 95%CI = 1.51-5.13), and those who did not initiate early breastfeeding (AOR = 2.28, 95%CI = 1.12-4.66), were significantly associated with neonatal mortality compared to their counterparts.

CONCLUSION

In this study, neonatal mortality was high prevalence. Therefore, the intervention efforts should focus on strategies to reduce maternal and neonatal factors related to neonatal mortality. Healthcare workers and health institutions should provide appropriate antenatal, postnatal, and newborn care.

Assessment of Neonatal Mortality and Associated Hospital-Related Factors in Healthcare Facilities Within Sunyani and Sunyani West Municipal Assemblies in Bono Region, Ghana

Objectives

Ghana's quest to reduce neonatal mortality, in hospital facilities and communities, continues to be a nightmare. The pursuit of achieving healthy lives and well-being for neonates as enshrined in Sustainable Development Goal three lingered in challenging hospital facilities and communities. Notwithstanding that, there have been increasing efforts in that direction. This study examines the contributing factors that hinder the fight against neonatal mortality in all hospital facilities in the Sunyani and Sunyani West Municipal Assemblies in Bono Region, Ghana.

Methods

The study utilized neonatal mortality data consisting of neonatal deaths, structural facility related variables, medical human resources, types of hospital facilities and natal care. The data was collected longitudinally from 2014 to 2019. These variables were analysed using the negative binomial hurdle regression (NBH) model to determine factors that contribute to this menace at the facility level. Cause-specific deaths were obtained to determine the leading causes of neonatal deaths within health facilities in the two municipal assemblies.

Results

The study established that the leading causes of neonatal mortality in these districts are birth asphyxia (46%), premature birth (33%), neonatal sepsis (11%) and neonatal jaundice (7%). The NBH showed that neonatal mortality in hospital facilities depend on the number of incubators, monitoring equipment, hand washing facilities, CPAPb machines, radiant warmers, physiotherapy machines, midwives, paediatric doctors and paediatric nurses in the hospital facility.

Conclusions

Early management of neonatal sepsis, birth asphyxia, premature birth and neonatal infections is required to reduce neonatal deaths. The government and all stakeholders in the health sector should provide all hospital facilities with the essential equipment and the medical human resources necessary to eradicate the menace. This will make the realization of Sustainable Development Goal three, which calls for healthy lives and well-being for all, a reality.

Time, cause of early neonatal death, and its predictors among neonates admitted to neonatal intensive care units at Bahir Dar City public hospitals, northwest Ethiopia: a prospective follow-up study

Background

Globally, 75% of neonatal deaths occur during the first weeks of life and more than 43% of deaths are covered by sub-Saharan Africa. Health-related policymakers and decision-makers need to use evidence-based treatments to reduce the time to early neonatal death and associated predictors. However, there are limited studies on median survival time, cause, incidence, and predictors in the study area as well as the country. Therefore, the aim of the present study was to assess time, the cause of early neonatal death, and its predictors among neonates admitted to neonatal intensive care units at Bahir Dar City public hospitals in northwest Ethiopia.

Methods

An institution-based prospective follow-up study design was conducted among 387 early neonates selected by systematic sampling between 22 February and 22 April 2023. Statistical software, Epi Data version 4.6 and Stata version 14, was used for entry and analysis, respectively. Proportional hazard assumption and model fitness were checked by the Schoenfeld residual test and the Cox-Snell residual test, respectively. Descriptive statistics, the Kaplan-Meier curve, and the life table were used to describe variables. The Cox regression analysis model was fitted to identify the predictors of early neonatal death.

Result

During the follow-up time, 59 (15.25%) early neonates died, with an incidence of 31.79 per 1,000 early neonate days [95% confidence interval (CI): 0.024-0.041]. The leading causes of early neonatal death were prematurity complications, asphyxia, sepsis, meconium aspiration syndrome, and necrotizing enterocolitis. The mean survival time was 2.72 days. Being born from a multigravida mother [adjusted hazard ratio (AHR) 4.34; 95% CI: 1.63-11.55], a grand multigravida mother (AHR 3.50; 95% CI: 1.12-10.95), respiratory distress syndrome (AHR 2.60; 95% CI: 1.03-6.58), birth asphyxia (AHR 7.51; 95% CI: 2.30-24.51), a small gestational age (AHR 2.05; 95% CI: 1.08-4.92), and being unable to exclusively breastfeed (AHR 3.46; 95% CI: 1.52-7.88) were significantly associated predictors for time to early neonatal death.

Conclusion and recommendations

The incidence of early neonatal death was high, and the mean survival time was 2.72 days. Gravidity, respiratory distress syndrome, birth asphyxia, and being unable to exclusively breastfeed were identified as predictors of early neonatal death. Therefore, future research will consist of long-term prospective follow-up studies at a multicenter, nationwide level.

Predictors of neonatal mortality in the Eastern Regional Hospital in Ghana: A retrospective cohort study

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.

Risk factors associated with neonatal mortality among neonates admitted to neonatal intensive care unit of the University Teaching Hospital in Lusaka

Globally, several children die shortly after birth and many more of them within the first 28 days of life. Sub-Sharan Africa accounts for almost half (43%) of the global neonatal death with slow progress in reduction. These neonatal deaths are associated with lack of quality care at or immediately after birth and in the first 28 days of life. This study aimed to determine the trends and risk factors of facility-based neonatal mortality in a major referral hospital in Lusaka, Zambia. We conducted retrospective analysis involving all neonates admitted in the University Teaching Hospital Neonatal Intensive Care Unit (UTH-NICU) in Lusaka from January 2018 to December 2019 (N = 2340). We determined the trends and assessed the factors associated with facility-based neonatal mortality using Generalized Linear Models (GLM) with a Poisson distribution and log link function. Overall, the facility-based neonatal mortality was 40.2% (95% CI 38.0-42.0) per 1000 live births for the 2-year period with a slight decline in mortality rate from 42.9% (95% CI 40.0-46.0) in 2018 to 37.3% (95% CI 35.0-40.0) in 2019. In a final multivariable model, home delivery (ARR: 1.70, 95% CI 1.46-1.96), preterm birth (ARR: 1.59, 95% CI 1.36-1.85), congenital anomalies (ARR: 1.59, 95% CI 1.34-1.88), low birthweight (ARR: 1.57, 95% CI 1.37-1.79), and health centre delivery (ARR: 1.48, 95% CI 1.25-1.75) were independently associated with increase in facility-based neonatal mortality. Conversely, hypothermia (ARR: 0.36, 95% CI 0.22-0.60), antenatal attendance (ARR: 0.76, 95% CI 0.68-0.85), and 1-day increase in neonatal age (ARR: 0.96, 95% CI 0.95-0.97) were independently associated with reduction in facility-based neonatal mortality. In this hospital-based study, neonatal mortality was high compared to the national and global targets. The improvement in neonatal survival observed in this study may be due to interventions including Kangaroo mother care already being implemented. Early identification and interventions to reduce the impact of risks factors of neonatal mortality in Zambia are important.

Predictors of Death in Patients with Neonatal Sepsis in a Peruvian Hospital

Reducing neonatal mortality is a global challenge. This study’s objective was to determine the predictors of mortality in patients with neonatal sepsis. The study was a retrospective cohort study in a Peruvian hospital from January 2014 to April 2022. Neonates diagnosed with sepsis were included. To find predictors of mortality, we used Cox proportional regression models. We evaluated 288 neonates with sepsis; the median birth weight and hospitalization time were 3270 g and seven days, respectively. During follow-up, 18.4% did not survive, and the most common complications were jaundice (35.42%), respiratory distress syndrome (29.51%), and septic shock (12.5%). The most isolated bacteria were Klebsiella pneumoniae. The risk factors associated with higher mortality were prematurity (aHR = 13.92; 95% CI: 1.71−113.51), platelets <150,000 (aHR = 3.64; 1.22−10.88), creatinine greater than 1.10 (aHR = 3.03; 1.09−8.45), septic shock (aHR = 4.41; 2.23−8.74), and admission to IMV (aHR = 5.61; 1.86−16.88), On the other hand, breastfeeding was associated with a lower risk of death (aHR = 0.25; 0.13−0.48). In conclusion, we report a high incidence of death and identify clinical (prematurity, septic shock, admission to IMV) and laboratory characteristics (elevated creatinine and thrombocytopenia) associated with higher mortality in patients with neonatal sepsis. Breastfeeding was a factor associated with survival in these patients.