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Ezenwa BN, Fajolu IB, Pius S, Ezeanosike OB, Iloh K, Umoru D, Tongo O, Abdulkadir I, Okolo AA, Nabwera HM, Oleolo-Ayodeji K, Daniel N, Abubakar I, Obu C, Onwe-Ogah E, Daniyan O, Adeke A, Nwegbu O, Bisumang JD, Hassan L, Abdullahi F, Mohammad A, Nasir U, Ezeaka VC, Allen S. Marked variability in institutional deliveries and neonatal outcomes during the COVID-19 lockdown in Nigeria. Trans R Soc Trop Med Hyg 2023; 117:780-787. [PMID: 37264932 DOI: 10.1093/trstmh/trad030] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/06/2023] [Revised: 04/05/2023] [Accepted: 05/22/2023] [Indexed: 06/03/2023] Open
Abstract
BACKGROUND The coronavirus disease 2019 (COVID-19) pandemic and the interventions to mitigate its spread impacted access to healthcare, including hospital births and newborn care. This study evaluated the impact of COVID-19 lockdown measures on newborn service utilization in Nigeria. METHODS The records of women who delivered in hospitals and babies admitted to neonatal wards were retrospectively reviewed before (March 2019-February 2020) and during (March 2020-February 2021) the COVID-19 pandemic lockdown in selected facilities in Nigeria. RESULTS There was a nationwide reduction in institutional deliveries during the COVID-19 lockdown period in Nigeria, with 14 444 before and 11 723 during the lockdown-a decrease of 18.8%. The number of preterm admissions decreased during the lockdown period (30.6% during lockdown vs 32.6% pre-lockdown), but the percentage of outborn preterm admissions remained unchanged. Newborn admissions varied between zones with no consistent pattern. Although neonatal jaundice and prematurity remained the most common reasons for admission, severe perinatal asphyxia increased by nearly 50%. Neonatal mortality was significantly higher during the COVID-19 lockdown compared with pre-lockdown (110.6/1000 [11.1%] vs 91.4/1000 [9.1%], respectively; p=0.01). The odds of a newborn dying were about four times higher if delivered outside the facility during the lockdown (p<0.001). CONCLUSIONS The COVID-19 lockdown had markedly deleterious effects on healthcare seeking for deliveries and neonatal care that varied between zones with no consistent pattern.
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Affiliation(s)
- Beatrice N Ezenwa
- Department of Paediatrics, College of Medicine, University of Lagos, Lagos, Nigeria
- Department of Paediatrics, Lagos University Teaching Hospital, Lagos, Nigeria
| | - Iretiola B Fajolu
- Department of Paediatrics, College of Medicine, University of Lagos, Lagos, Nigeria
- Department of Paediatrics, Lagos University Teaching Hospital, Lagos, Nigeria
| | - Simon Pius
- Department of Paediatrics, University of Maiduguri, Maiduguri, Nigeria
| | - Obumneme B Ezeanosike
- Department of Paediatrics, Alex Ekwueme Federal University Teaching Hospital, Abakaliki, Nigeria
| | - Kenechukwu Iloh
- Department of Paediatrics, University of Nigeria Teaching Hospital, Enugu, Nigeria
| | - Dominic Umoru
- Department of Paediatrics, Maitama District Hospital, Abuja, Nigeria
| | - Olukemi Tongo
- Department of Paediatrics, University College Hospital, Ibadan, Nigeria
| | - Isa Abdulkadir
- Department of Paediatrics, College of Medical Sciences, Ahmadu Bello University, Zaria, Nigeria
| | - Angela A Okolo
- Department of Paediatrics, Federal Medical Centre, Asaba, Delta State, Nigeria
| | - Helen M Nabwera
- Department of Clinical Sciences, Liverpool School of Tropical Medicine, Liverpool, UK
- Centre of Excellence for Women and Child Health, Aga Khan University, Nairobi, Kenya
| | | | - Nelson Daniel
- Department of Paediatrics, Lagos University Teaching Hospital, Lagos, Nigeria
| | - Ismaela Abubakar
- Insilico Unit, Cancer Therapeutic, Institute of Cancer Research, Sutton, UK
| | - Chinwe Obu
- Department of Paediatrics, Alex Ekwueme Federal University Teaching Hospital, Abakaliki, Nigeria
| | - Emeka Onwe-Ogah
- Department of Paediatrics, Alex Ekwueme Federal University Teaching Hospital, Abakaliki, Nigeria
| | - Olapeju Daniyan
- Department of Paediatrics, Alex Ekwueme Federal University Teaching Hospital, Abakaliki, Nigeria
| | - Azuka Adeke
- Department of Community Medicine, Alex Ekwueme Federal University Teaching Hospital, Abakaliki, Nigeria
| | - Obinna Nwegbu
- Department of Paediatrics, Alex Ekwueme Federal University Teaching Hospital, Abakaliki, Nigeria
| | - J D Bisumang
- Department of Paediatrics, University of Maiduguri, Maiduguri, Nigeria
| | - Laila Hassan
- Department of Paediatrics, University College Hospital, Ibadan, Nigeria
| | - Fatimah Abdullahi
- Department of Paediatrics, University College Hospital, Ibadan, Nigeria
| | - Aisha Mohammad
- Department of Paediatrics, University College Hospital, Ibadan, Nigeria
| | - Usman Nasir
- Department of Paediatrics, University College Hospital, Ibadan, Nigeria
| | - Veronica Chinyere Ezeaka
- Department of Paediatrics, College of Medicine, University of Lagos, Lagos, Nigeria
- Department of Paediatrics, Lagos University Teaching Hospital, Lagos, Nigeria
| | - Stephen Allen
- Department of Clinical Sciences, Liverpool School of Tropical Medicine, Liverpool, UK
- Department of Paediatrics, Edwards Francis Small Teaching Hospital, Banjul, The Gambia
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Ezenwa BN, Olorunfemi G, Fajolu I, Adeniyi T, Oleolo-Ayodeji K, Kene-Udemezue B, Olamijulo JA, Ezeaka C. Trends and predictors of in-hospital mortality among babies with hypoxic ischaemic encephalopathy at a tertiary hospital in Nigeria: A retrospective cohort study. PLoS One 2021; 16:e0250633. [PMID: 33901237 PMCID: PMC8075215 DOI: 10.1371/journal.pone.0250633] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.7] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/22/2020] [Accepted: 04/09/2021] [Indexed: 11/19/2022] Open
Abstract
Background Globally, approximately 9 million neonates develop perinatal asphyxia annually of which about 1.2 million die. Majority of the morbidity and mortality occur in Low and middle-income countries. However, little is known about the current trend in incidence, and the factors affecting mortality from hypoxic ischaemic encephalopathy (HIE), in Nigeria. Objective We assessed the trends in incidence and fatality rates and evaluated the predictors of mortality among babies admitted with HIE over five years at the Lagos University Teaching Hospital. Methods A temporal trend analysis and retrospective cohort study of HIE affected babies admitted to the neonatal unit of a Nigerian Teaching Hospital was conducted. The socio-demographic and clinical characteristics of the babies and their mothers were extracted from the neonatal unit records. Kaplan-Meir plots and Multivariable Cox proportional hazard ratio was used to evaluate the survival experienced using Stata version 16 (StataCorp USA) statistical software. Results The median age of the newborns at admission was 26.5 (10–53.5) hours and the male to female ratio was 2.1:1. About one-fifth (20.8%) and nearly half (47.8%) were admitted within 6 hours and 24 hours of life respectively, while majority (84%) of the infants were out-born. The prevalence and fatality rate of HIE in our study was 7.1% and 25.3% respectively. The annual incidence of HIE among the hospital admissions declined by 1.4% per annum while the annual fatality rate increased by 10.3% per annum from 2015 to 2019. About 15.7% died within 24 hours of admission. The hazard of death was related to the severity of HIE (p = 0.001), antenatal booking status of the mother (p = 0.01) and place of delivery (p = 0.03). Conclusion The case fatality rate of HIE is high and increasing at our centre and mainly driven by the pattern of admission of HIE cases among outborn babies. Thus, community level interventions including skilled birth attendants at delivery, newborn resuscitation trainings for healthcare personnel and capacity building for specialized care should be intensified to reduce the burden of HIE.
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Affiliation(s)
- Beatrice Nkolika Ezenwa
- Neonatology Unit, Department of Paediatrics, College of Medicine University of Lagos, Lagos, Nigeria
- Department of Paediatrics, Lagos University Teaching Hospital, Lagos, Nigeria
- * E-mail:
| | - Gbenga Olorunfemi
- Department of Obstetrics & Gynecology, Lagos University Teaching Hospital, Lagos, Nigeria
- Division of Epidemiology and Biostatistics, School of Public Health, University of Witwatersrand, Johannesburg, South Africa
| | - Iretiola Fajolu
- Neonatology Unit, Department of Paediatrics, College of Medicine University of Lagos, Lagos, Nigeria
- Department of Paediatrics, Lagos University Teaching Hospital, Lagos, Nigeria
| | - Toyin Adeniyi
- Department of Paediatrics, Lagos University Teaching Hospital, Lagos, Nigeria
| | | | | | - Joseph A. Olamijulo
- Department of Obstetrics & Gynecology, Lagos University Teaching Hospital, Lagos, Nigeria
| | - Chinyere Ezeaka
- Neonatology Unit, Department of Paediatrics, College of Medicine University of Lagos, Lagos, Nigeria
- Department of Paediatrics, Lagos University Teaching Hospital, Lagos, Nigeria
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