Cause and predictors of neonatal mortality among neonates admitted to neonatal intensive care units of public hospitals in eastern Ethiopia: a facility-based prospective follow-up study

Abstract

Background: The first month is the most crucial period for child survival. Neonatal mortality continues to remain high with little improvement over the years in Sub-Saharan Africa, including Ethiopia. This region shows the least progress in reducing neonatal mortality and continues to be a significant public health issue. In this study setting, the causes and predictors of neonatal death in the neonatal intensive care units are not well documented. Hence, this study aimed to determine the causes and predictors of neonatal mortality among infants admitted to neonatal intensive care units in eastern Ethiopia.Methods: A facility-based in prospective follow-up study was conducted among neonates admitted to neonatal intensive care units of public hospitals of eastern Ethiopia from November 1 to December 30, 2018. Data were collected using a pretested structured questionnaire and a follow-up checklist. The main outcomes and causes of death were set by pediatricians and medical residents. EpiData 3.1 and Statistical Package for Social Sciences Version 25 software were used for data entry and analysis, respectively. Multivariable logistic regression was used to identify the predictors of facility-based neonatal mortality.Results: The proportion of facility-based neonatal mortality was 20% (95% CI:16.7-23.8%). The causes of death were complications of preterm birth (28.58%), birth asphyxia (22.45%), neonatal infection (18.36%), meconium aspiration syndrome (9.18%), respiratory distress syndrome (7.14%), and congenital malformation (4.08%). Low birth weight, preterm births, length of stay of the neonatal intensive care unit, low 5 min APGAR score, hyperthermia, and initiation of feeding were predictors of neonatal death among infants admitted to the neonatal intensive care units of public hospitals in eastern Ethiopia. Conclusions:The proportion of facility-based neonatal deaths was unacceptably high. The main causes of death were preventable and treatable. Hence, improving the timing and quality of antenatal care is essential for early detection, anticipating high-risk newborns, and timely interventions. Furthermore, early initiation of feeding and better referral linkage to tertiary health facilities could lead to a reduction in neonatal death in this setting.

Burden of disease and risk factors for mortality amongst hospitalized newborns in Nigeria and Kenya

“…Although inferior to an antenatal ultrasound scan, assessment based on date of last menstrual period, the most common method in our study, has been shown to be relatively reliable for the estimation of gestational age in LMICs [ 38 ]. Our findings are consistent with the multivariable logistic regression analysis in the prospective studies in Ethiopia, where both gestation <37 weeks and LBW were independently associated with mortality in the multicentre study [ 21 ] and gestational age below mean value (<36.6 weeks) in the single centre study [ 22 ]. In our analysis and the study by Desalaw et al ., although not mutually exclusive, both prematurity and LBW were retained in the multiple regression model suggesting that preterm birth and intra-uterine growth restriction independently increase the risk of mortality.…”

“…Variability in mortality between NNUs was marked and ranged between 4.0–28.0%. Mortality in our study is consistent with prospective studies of admissions to six NNUs in public hospitals in Eastern Ethiopia (mortality of 20.0%) [ 21 ] and to a public teaching hospital in Addis Ababa, Ethiopia (23.1%) [ 22 ]. In retrospective studies, mortality ranged from 13–38% in NNUs in Kenya [ 29 , 30 ], 5.7–23.3% in Ethiopia [ 23 , 24 ], 18.8% in Nigeria [ 25 ], 15.7% in Cameroon [ 26 ] and 8.2% in Eritrea [ 27 ].…”

Neonatal mortality among neonates admitted to NICU of Hiwot Fana specialized university hospital, eastern Ethiopia, 2020: a cross-sectional study design

“…Health service utilization during pregnancy and child birth minimize neonatal death due to those preventable conditions, similarly in this study, the odds of death among newborns that had low birth weight were 4.01 times that of neonates who did not have the conditions. This is consistent with studies conducted in Brazil, Guinea-Bissau, Eritrea, Jimma, and eastern Ethiopia [ 1 , 5 , 9 , 13 , 21 ]. The possible justification is that in fact that low birth weight had immaturity of immune systems and, other body defense mechanisms that control newborn disease susceptibility [ 15 ].…”

A population-based study of neonatal deaths in Indonesia based on the Indonesian demographic health survey: what determinants play an essential role?

“…Our nding is in line with Titaley's report, which elucidated higher odds of women experiencing the death of their neonates in public hospitals than in private hospitals (32). Based on a report in Ethiopia, the rate of neonatal deaths in public hospitals was in uenced mostly by preterm birth, birth asphyxia and neonatal infection (38). In addition, Adams et al suggested that a disparity exists between the ability to alleviate the burden of the neonatal mortality rate in public hospitals and private hospitals, in which public hospitals demonstrated a higher rate of neonatal deaths.…”