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

Length of hospital stay and its factor associated among neonates with perinatal asphyxia in the Northwest Amhara Region, Northwest Ethiopia 2023: a multicentre retrospective cross-sectional study

OBJECTIVE

To determine the length of hospital stay and related factors in newborns with perinatal asphyxia in comprehensive specialised hospitals in Northwest Ethiopia.

DESIGN

A multicentre institutional-based cross-sectional study.

SETTING

Tertiary hospitals in Northwest Amhara Regional State, Northwest Ethiopia, from 1 to 30 December 2023.

PARTICIPANTS

A total of 609 neonates with perinatal asphyxia were admitted to the neonatal intensive care unit of selected public hospitals in Northwest Amhara from September 2018 to October 2023.

OUTCOME MEASURES

Length of hospital stay and associated factors in newborns with perinatal asphyxia were noted.

RESULTS

A total of 609 newborns with perinatal asphyxia were included in this study. The mean hospital stay for the newborns was 13.9 days (coef=13.9, 95% CI 13.43 to 14.38), with minimum and maximum hospital stays of 4-28 days, respectively. Neonatal sepsis, AKI, hypoxic ischaemic encephalopathy, fetal macrosomia and prolonged labour were significantly associated with a longer hospital stay in neonates with perinatal asphyxia.

CONCLUSIONS

The current study indicated that the mean length of hospital stay in newborns with perinatal asphyxia was 13.9 days. Contributing factors to prolonged hospital stays include neonates with neonatal sepsis, prolonged second-stage labour, acute neonatal kidney injury stages 2 and 3 hypoxic ischaemic encephalopathy and fetal macrosomia. The length of hospital stay for neonates with perinatal asphyxia can be reduced by implementing appropriate standards of care.

Determinants of Adverse Perinatal Outcomes in Ibadan, Nigeria: The influence of maternal lifestyle

Adverse perinatal outcomes (APO) are unfavourable incidents of at least one of the following: low birth weight, preterm delivery, stillbirths, neonatal deaths, and perinatal deaths. They contribute significantly to neonatal and infant morbidity and mortality, developmental abnormalities, and long-term impairments. Studies are lacking on the influence of maternal lifestyle on APO in Nigeria. Hence, we investigated the determinants of APO using the Ibadan Pregnancy Cohort Study (IbPCS) data and examined 1,339 mothers who had hospital delivery. The outcome variable was APO (low birth weight, birth asphyxia and preterm delivery). Explanatory variables comprised Antepartum Depression (Edinburgh Depression Scale ≥ 12), Physical activity (Pregnancy Physical Activity Questionnaire (PPAQ), Dietary pattern (Qualitative Food Frequency Questionnaire (FFQ), Maternal Stress (Perceived Stress Scale), Alcohol consumption, and Tobacco exposure. We used binary and multiple logistic regression to assess the associations between the risk factors and adverse perinatal outcomes at a significant P-value <0.05. Prevalence of APO was 26.7%, 95%CI (24.4-29.1); low birth weight - 8.5%, 95%CI (7.0-10.1) preterm delivery 14.8%, 95% CI (12.9-16.7); birth asphyxia 16.3%, 95%CI (14.0-18.9). The factors associated with LBW were being a female infant AOR: 2.00, 95%CI (1.13 -3.52); emergency caesarean section AOR: 2.40, 95%CI (1.06-5.42); a history of hypertension in pregnancy AOR: 3.34, 95%CI (1.45 -7.52). Preterm birth was associated with being poor AOR: 2.00, 95%CI (1.13 -3.52); history of stillbirth AOR: 2.05, 95%CI (1.14-3.68); antepartum depression AOR: 1.87, 95%CI (1.08-3.25). Of the lifestyle factors examined, only a high protein diet with a non-alcoholic beverage dietary pattern had a statistically significant association with preterm birth [AOR: 0.50, 95%CI (1.08-3.52)]. However, lifestyle factors had no significant association with LBW and birth asphyxia in our study. Understanding these risk factors can help policymakers and healthcare professionals create cost-effective interventions to curtail the burden of APO in Nigeria.

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.

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.

Prevalence of Perinatal Asphyxia Using Apgar Scores and Cord Blood pH and the Relationship between the Two Methods: A Study of FMC Umuahia

BACKGROUND

Perinatal asphyxia contributes significantly to neonatal morbidity and mortality. It occurs worldwide, and the Apgar score is the most widely used method of diagnosis. Recently, umbilical cord arterial pH has been reported as the most objective way to assess fetal acidosis at birth as it predicts the adverse outcome of perinatal asphyxia. It is imperative to establish the concordance between these two diagnostic methods to reinforce the practicality of the Apgar score as the preferred diagnostic tool for perinatal asphyxia in developing nations, such as Nigeria.

AIM

To determine the prevalence of perinatal asphyxia by using the Apgar score and arterial cord blood pH and the relationships between these methods at the Federal Medical Center (FMC), Umuahia.

MATERIALS AND METHODS

This cross-sectional study enrolled 245-term newborns. Perinatal asphyxia was diagnosed using both Apgar scoring and arterial cord blood pH measurements. Data obtained were analyzed using SPSS version 20 and a P value < 0.05 was considered significant.

RESULTS

Perinatal asphyxia was reported in 33.1% and 31.4% by using the Apgar score and arterial cord blood pH, respectively. There was a moderate agreement between the two methods for diagnosing perinatal asphyxia (κ = 0.44), and no statistically significant difference was observed in the prevalence of perinatal asphyxia between these methods (McNemar's χ2 = 0.27, P = 0.699). Furthermore, a strong positive correlation was observed between the Apgar score at 1 and 5 minutes of life and arterial cord blood pH (rs = 0.87, P ≤ 0.001 and rs = 0.80, P ≤ 0.001 respectively).

CONCLUSION

The prevalence of perinatal asphyxia by the two methods was high, and there was no significant difference between both methods of assessing perinatal asphyxia. Thus, the diagnosis of perinatal asphyxia can effectively be made using either the Apgar score or arterial cord blood pH, affirming the practicality and reliability of the Apgar score in resource-limited healthcare settings.

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.

Predictors of Birth Asphyxia Among Newborns in Public Hospitals of Eastern Amhara Region, Northeastern Ethiopia, 2022

Background

Ethiopia ranked fourth in the world in terms of neonatal mortality rates, with birth asphyxia accounting for the majority of neonatal deaths.

Objective

This study aimed to determine the prevalence of birth asphyxia and associated factors among newborns delivered in government hospitals of the Eastern Amhara region, Northeastern Ethiopia, 2022.

Methods

A hospital-based cross-sectional study was conducted in 4 government hospitals between March 10, 2022, and May 8, 2022. The subjects in the study were selected using a systematic random sampling technique. Face-to-face interviews and chart reviews were used to collect the data. The association was discovered through multivariate logistic regression analysis.

Result

In this study, the prevalence of birth asphyxia was 13.1% (48) of the total 367 newborns. Mothers who could not read and write (AOR = 9.717; 95% CI = 3.06, 10.857); infants born with low birth weight (AOR = 2.360; 95% CI = 1.004, 5.547); primipara mothers (AOR = 5.138; 95% CI = 1.060, 26.412); mothers with less than 37 weeks of gestation (AOR = 4.261; 95% CI = 1.232, 14.746); and caesarian section delivery (AOR = 2.444; 95% CI = 1.099, 5.432) were predictors of birth asphyxia.

Conclusion

The magnitude of birth asphyxia has managed to remain a health concern in the study setting. As a result, special attention should be paid to uneducated and primi-mothers during antenatal care visits, and prematurity and caesarian section delivery complication reduction efforts should be bolstered to prevent birth asphyxia and its complications.

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..

Perinatal maternal characteristics predict a high risk of neonatal asphyxia: A multi-center retrospective cohort study in China

Objective

This study aimed to identify various perinatal maternal characteristics that contributed to neonatal asphyxia (NA) in term and late-preterm newborns based on the data obtained from a Chinese birth registry cohort and to establish an effective model for predicting a high risk of asphyxia.

Method

We retrospectively reviewed and analyzed the birth database from July 1, 2016, to June 30, 2017, in the main economically developed regions of China. Asphyxia was defined as an Apgar score <7 at 5 min post-delivery with umbilical cord arterial blood pH < 7.2 in the infant born after 34weeks. We compared the perinatal maternal characteristics of the newborns who developed asphyxia (NA group, n = 1,152) and those who did not (no NA group, n = 86,393). Candidate predictors of NA were analyzed using multivariable logistic regression. Subsequently, a prediction model was developed and validated by an independent test group.

Result

Of the maternal characteristics, duration of PROM ≥ 48 h, a gestational week at birth <37, prolonged duration of labor, hypertensive disorder, nuchal cord, and birth weight <2,500 or ≥4,000 g, abnormal fetal heart rate, meconium-stained amniotic fluid, and placenta previa were included in the predicting model, which presented a good performance in external validation (c-statistic of 0.731).

Conclusion

Our model relied heavily on clinical predictors that may be determined before or during birth, and pregnant women at high risk of NA might be recognized earlier in pregnancy and childbirth using this methodology, allowing them to avoid being neglected and delayed. Future studies should be conducted to assess its usefulness.

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 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.

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.

Preparedness for neonatal emergencies at birth and associated factors among healthcare providers working at hospitals in northwest Ethiopia: A multi-center cross-sectional study

BACKGROUND

Neonatal mortality remains a public health concern, especially in Southern Asia and Sub-Saharan Africa. Despite substantial efforts, the neonatal mortality rate is increasing from 29 per 1000 live births in 2016 to 33 per 1000 live births in 2019 in Ethiopia. To avert this unacceptably high mortality, the healthcare provider's readiness for neonatal emergencies at birth is crucial. Hence, this study aimed to assess healthcare providers' preparedness for neonatal emergencies at birth in northwest Ethiopia.

METHODS

A multicenter cross-sectional study was conducted at hospitals in northwest Ethiopia from November 15/2020 to March 10/2021. A simple random sampling technique was used to select 406 study participants. Data were collected through face-to-face interviews using a structured questionnaire, and direct observation and chart review using standardized checklists. The data were then entered into EPI INFO version 7.1.2 and exported to SPSS version 25 for analysis. Both bivariable and multivariable logistic regression analyses were undertaken. The level of significance was claimed based on the adjusted odds ratio (AOR) with a 95 % confidence interval (CI) at a p-value of ≤0.05.

RESULTS

The proportion of healthcare providers having adequate preparedness for neonatal emergencies was 60.1% (95% CI: 55.3, 64.8). The final model analysis illustrates that healthcare providers who received neonatal resuscitation training (AOR = 2.87; 95% CI: 1.74, 7.74) and working at the general hospital (AOR = 5.2; 95% CI: 1.96, 13.8) were adequately prepared for neonatal emergencies. On the other hand, healthcare providers who complained about workload or shortage of staff (AOR = 0.41; 95% CI: 0.26, 0.66) were poorly prepared for neonatal emergencies.

CONCLUSION

In this study, about two-fifths of the healthcare providers were inadequately prepared for neonatal emergencies at birth. Strengthening the provision of neonatal resuscitation training, deploying adequate healthcare professionals, and reducing the healthcare provider's workload would improve healthcare providers' preparedness for neonatal emergencies.

Perinatal Asphyxia and Its Associated Factors among Live Births in the Public Health Facilities of Bahir Dar City, Northwest Ethiopia, 2021

BACKGROUND

Birth asphyxia is a serious clinical problem of newborn babies, which occurs due to impaired blood-gas exchange and results in hypoxemia. Despite improvements in the diagnosis and management of perinatal asphyxia, it has become the leading cause of admission and neonatal mortality, especially in developing countries.

OBJECTIVE

This study was aimed at assessing factors associated with perinatal asphyxia among live births in the public health facilities of Bahir Dar city, Northwest Ethiopia, 2021.

METHOD

Health facility-based cross-sectional study was employed from April 1-30/2021 in the public health facilities of Bahir Dar city among 517 mother-newborn pairs. The data were collected by systematic random sampling technique, entered by using Epi data 3.1, and analyzed using SPSS 25.0 version. Bivariate and multivariable logistic regression analyses were employed to estimate the crude and adjusted odds ratio with a confidence interval of 95% and a P value of less than 0.05 considered statistically significant. Frequency tables, figures, and descriptive summaries were used to describe the study variables.

RESULT

In this study, 21.7% (95% CI: 18.2%-25.5%) of the newborns had perinatal asphyxia. Malpresentation (AOR = 4.06, 95%CI = 2.08-7.94), uterotonic drug administration (AOR = 2.78, 95%CI = 1.67-4.62), meconium-stained amniotic fluid (AOR = 4.55, 95%CI = 2.66, 7.80), night time delivery (AOR = 1.91, 95%CI = 1.17, 3.13), and preterm delivery (AOR = 3.96, 95%CI = 1.98, 7.89) were significantly associated with perinatal asphyxia. Conclusion and Recommendation. In the present study, the proportion of perinatal asphyxia was high. To mitigate this problem, there is a need to focus on early identification of the risk factors like fetal malpresentation, preterm labor/delivery, and managing them appropriately. Administering uterotonic drugs should be based on indication with close supervision.

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.