Cause‐specific neonatal morbidity and mortality in the Solomon Islands: An assessment of data from four hospitals over a three‐year period

Abstract

Aim: Data on stillbirths and neonatal morbidity and mortality in low-middle income Pacific Island Nations such as Solomon Islands is limited, partly due to weak health information systems. We describe the perinatal mortality and clinical factors associated with poor newborn outcomes at four hospitals in Solomon Islands. Methods: This was a registry based retrospective cohort study at three provincial hospitals and the National Referral Hospital (NRH) from 2014-2016 inclusive. Results: 23 966 labour ward births and 3148 special care nursery (SCN) admissions were reviewed. Overall still birth rate was 29.2/1000 births and the perinatal mortality rate was 35.9/1000 births. PNMR were higher in provincial hospitals (46.2, 44.0 and 34.3/1000) than at NRH (33.3/1000). The commonest reasons for admission to SCN across the hospitals were sepsis, complications of prematurity and birth asphyxia. SCN mortality rates were higher in the 3 provincial hospitals than at NRH (15.9% (95/598) vs. 7.9% (202/2550), P value <0.01). At NRH, the conditions with the highest case fatality rates were birth asphyxia (21.3%), congenital abnormalities (17.7%), and prematurity (15.1%). Up to 11% of neonates did not have a diagnosis recorded. Conclusions: The perinatal mortality rates are high and intrapartum complications, prematurity and sepsis are the main causes of morbidity and mortality for neonates at hospitals in Solomon Islands. Stillbirths account for 81% of perinatal deaths. These results are useful for planning for quality improvement at provincial level. Improved vital registration systems are required to better capture stillbirths and neonatal outcomes.

Defining Preterm Birth and Stillbirth in the Western Pacific: A Systematic Review

“…Stillbirth was defined in 36 data sources using 9 discrete definitions, all in completed weeks. 23-25,29,30,36,37,44,52-78 Of these, 13 were defined by gestational age in weeks and birth weight in grams, 25,29,30,44,52-55,60,61,73,75,78 and 2 specified (Australia and New Zealand) that the birth weight definition should only be used when the gestational age in weeks was not known. 52,55 Birth weight alone was not used by any country.…”

Prevalence and Factors Associated With Low Birth Weight in the Solomon Islands: Evidence From the 2015 Solomon Islands Demographic and Health Survey data

“…Other local hospital-based studies reported prevalence of 12.5% and 23.3%. 32,33 These high-prevalence rates can be explained by the increased referrals of high-risk pregnancies from rural health facilities with elevated LBW risk and may not reflect the actual LBW prevalence for the Solomon Islands’ population.…”

Improving maternal and newborn health and reducing stillbirths in the Western Pacific Region – current situation and the way forward

“…Research from Papua New Guinea and the Solomon Islands 37 , 38 , 39 , 40 highlights factors leading to poor maternal and perinatal outcomes, including stillbirth and early neonatal death. In Papua New Guinea, stillbirth is defined as a baby born without a heartbeat after 22 weeks gestation and weighing more than 500 g. 41 A recent study conducted in two provinces in Papua New Guinea identified a stillbirth rate of 23.4 per 1000 total births 37 and an early neonatal mortality rate (NMR-death within the first seven days) of 14 per 1000 livebirths.…”