Birth asphyxia at a district hospital in Kigali, Rwanda

Abstract

_________________________________________________________ AbstractBackground Prematurity, birth asphyxia (BA), and sepsis are the leading causes of neonatal mortality. The BA prevalence rate is 23% worldwide and affects up to 39% in Rwanda. Birth asphyxia is an insult with significant consequences to the neonate's brain and other vital organs due to decreased oxygen before, during or immediately after birth. Objective To assess the BA prevalence, associated factors, and outcomes at a district hospital in Kigali. Methods A retrospective, cross-sectional study of 340 neonates admitted to the NICU in 2016. ResultsBirth asphyxia was identified in 135 out of 340 newborns (39.7%). Associated factors included gravida, meconium-stained amniotic fluid, normal duration of labor, normal duration of ROM, vaginal delivery, Apgar score of ≤5 at 5 minutes, respiratory ventilation and cardiac massage and normal birth weight (2500-3999gr). Two-thirds were born via vaginal birth (66.5%), and nearly half (47.3%) had BA. One-third was born via cesarean (33.5%), and a quarter (24.6%) had BA. Other BA outcomes included prolonged hospitalization beyond the neonatal period at 75% compared to non asphyxiated babies (25%). The mean days of NICU stay was 7.6 (SD: 6.1) for BA while it was 5.3 (SD: 4.16) for non-asphyxiated babies; early seizures (52.6%) and high specific mortality (87%). DiscussionFindings revealed a 6% BA prevalence increase, and a BA-specific mortality rate 13 times higher than previously recorded. Trained healthcare professionals need to reverse this significant trend in both vaginal and cesarean births that likely has a profound effect on the neonate, family, and community.Rwanda J Med Health Sci 2019;2(2):96-104. ________________________________________________________________________

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

“…As far as our search, the pooled prevalence of birth asphyxia was not previously investigated in sub-Saharan Africa. The findings of previous studies on the magnitude of birth asphyxia were inconsistent and ranged from 3.1% [ 24 ] to 39.7% [ 27 ] across the sub-Saharan African countries. Hence, this systematic review and meta-analysis study was aimed at determining the pooled estimate prevalence of birth asphyxia and its association with gestational age, low birth weight, and parity among neonates in Sub-Saharan Africa.…”

Parents’ Knowledge of Neonatal Danger Signs and Associated Factors at Health Centers in Kigali, Rwanda

“…[4] Globally, birth asphyxia, preterm birth, birth defects, and infections caused the most neonatal deaths in 2017. [1] A recent retrospective study in Rwanda, by Uwingabire and Gowan, [5] found a 40% birth asphyxia rate among neonates admitted to the Neonatal Intensive Care Unit (NICU). A recent matched case-control study in Rwanda also found pneumonia and meningitis are common causes of neonatal mortality, with nearly a third dying at home.…”

Quality of Basic Care During Neonatal Resuscitation Among Health Care Providers at Three District Hospitals in Kigali

“…[1] According to the World Health Organization (WHO), about 10 million neonates do not breathe at birth, and six million require basic neonatal resuscitation (NR). [4] Basic NR, at time of birth, comprises of a set of interventions -beginning with drying and stimulation -that is required to establish breathing and circulation in a neonate who is not spontaneously breathing or crying. [4] Approximately 10% of all neonates require basic resuscitation at birth, [2] and less than 1% require advanced resuscitation and ongoing inpatient specialized care.…”

“…[4] Basic NR, at time of birth, comprises of a set of interventions -beginning with drying and stimulation -that is required to establish breathing and circulation in a neonate who is not spontaneously breathing or crying. [4] Approximately 10% of all neonates require basic resuscitation at birth, [2] and less than 1% require advanced resuscitation and ongoing inpatient specialized care. [5] The strategy to reduce neonatal mortality is to improve the quality of basic NR at birth, which is estimated to reduce the mortality rate by 30% in lowresource settings with full-term neonates.…”

“…[13] Birth asphyxia counts as a leading cause of neonatal death in Rwanda district hospitals, with recent findings indicating a rate of 39%. [4,14] In 2012, most (94%) neonatal deaths occurred in the early neonatal period, and of these, 68% occurred at the time of birth. [13] Quality of basic care during NR at birth could contribute to the reduction in neonatal mortality associated with asphyxia and prevent neonatal deaths, as well as improve the outcomes of neonates delivered with asphyxia.…”