Prevalence of birth injuries and associated factors among newborns delivered in public hospitals Addis Ababa, Ethiopia, 2021. Crossectional study

Abstract

Background Birth injury is harm that a baby suffers during the entire birth process. It includes both birth asphyxia and birth trauma. In Ethiopia, birth injury has become the leading cause of neonatal morbidity and mortality, accounting around 28%-31.6% of neonatal mortality. The study aimed to assess the prevalence and factors associated with birth injuries among newborns delivered in public hospitals Addis Ababa, Ethiopia, 2021. Methods Institution based cross-sectional study was conducted from February 15th to April 20th, 2021 in selected public hospitals of Addis Ababa, Ethiopia. Random sampling and systematic random sampling were used. Data was entered by using Epi data version 4.0.2 and exported in to SPSS Software version 25 for analysis. Both bivariate and multivariable logistic regressions analyses were used. Finally P-value <0.05 was used to claim statistically significant. Result The prevalence of birth injury was 24.7%. In the final model, birth asphyxia was significantly associated with the short height of the mothers (AOR = 10.7, 95% CI: 3.59–32.4), intrapartal fetal distress (AOR = 4.74, 95% CI: 1.81–12.4), cord prolapse (AOR = 7.7. 95% CI: 1.45–34.0), tight nuchal cord (AOR = 9.2. 95% CI: 4.9–35.3), birth attended by residents (AOR = 0.19, 95% CI: 0.05–0.68), male sex (AOR = 3.84, 95% CI: 1.30–11.3) and low birth weight (AOR = 5.28, 95% CI: 1.58–17.6). Whereas, birth trauma was significantly associated with gestational diabetic mellitus (AOR = 5.01, 95% CI: 1.38–18.1), prolonged duration of labor (AOR = 3.74, 95% CI: 1.52–9.20), instrumental delivery (AOR = 10.6, 95% CI: 3.45–32.7) and night time birth (AOR = 4.82, 95% CI: 1.84–12.6). Conclusion The prevalence of birth injury among newborns has continued to increases and become life-threatening issue in the delivery and neonatal intensive care unit in the study area. Therefore, considering the prevailing factors, robust effort has to be made to optimize the quality obstetric care and follow up and emergency obstetrics team has to be strengthened to reduce the prevalence of birth injury.

Prevalence and Patterns of Neonatal Birth Trauma in Ethiopia: Systematic Review and Meta-Analysis

“…Sensitivity analysis was done by removing outliers and inliers, and no significant difference was investigated. While removing outliers, we noticed that the pooled prevalence of neonatal birth trauma was 15% (95% CI [12][13][14][15][16][17][18], and after removing inliers, the pooled prevalence was 14% (95% CI 12-15), so we can say this metaanalysis result is not sensitive.…”

“…Not applicable. 8,10,13,16 Random Less 24 (13-36) 83. 16 .00 Cephalohematoma [8][9][10]13,16 Random Marked 27 93.06 .00 Skeletal fractures 8,9,12,16 Random Marked 18 (4-32) 93.20 .00 Soft tissue injury 8,9,12,13,16 Random Marked 17 (5-48) 97.57 .00 Nerve injury 8,9,13,16 Random Less 13 (6-21) 74.24 .01…”

“…8,9 Moreover, the types of birth trauma varies among the existing studies. [8][9][10][11][12][13] The existing studies in Ethiopia are limited to specific geographical areas; hence, they could not represent the prevalence and patterns of birth trauma among neonates at the national level. Moreover, the available data have not been systematically combined to generate a precise understanding of the prevalence and patterns of birth trauma among neonates.…”

Incidence, contributing factors and outcomes of birth injury among newborns in Africa: a systematic review of quantitative evidence protocol

“…A number of factors have been identified as predictors of birth injury in Africa. Maternal and fetal factors including macrosomia,14 15 17–19 place of birth,20 short height of the mothers,10 parity,9 12 educational status,9 place of residence,12 antenatal care,9 occupational status,9 sex of the neonate,10 14 birth weight,10 11 13 gestational diabetic mellitus10 and night-time birth 10. On the other hand, labour and delivery-related factors were duration of labour,10 11 15 fetal distress,10 12 instrumental delivery,10 11 13 14 17 cord prolapse,10 birth attended by residents,10 shoulder dystocia,11 fetal presentation and position 12–14…”

Neonatal birth trauma and associated factors in low and middle-income countries: A systematic review and meta-analysis

“…In LMICs, estimates from individual studies suggest that the cumulative incidence of birth-related trauma ranges from an estimated 3 per 1,000 live births [ 18 ] to 869 per 1,000 live births [ 19 ] in Africa; 3 per 1,000 live births [ 20 , 21 ] to 4.7 per 1,000 live births [ 22 ] in Asia and Pacific region; and 6.7 per 1,000 live births [ 23 ] to 87.3 per 1,000 live births [ 24 ] in the middle east. Operative vaginal deliveries such as vacuum extractions or forceps [ 25 – 34 ], fetal presentation other than vertex [ 25 , 26 , 30 , 31 , 35 , 36 ], shoulder dystocia [ 28 , 29 , 31 ], gestational age [ 35 ], prolonged labor [ 27 , 29 , 31 , 36 ], general anesthesia [ 35 ], and newborn birth weight greater than 4000 grams [ 26 , 29 , 30 , 34 , 36 ] have been found to increase the odds of sustaining birth trauma. Moreover, logistic regression analysis demonstrated that nulliparous women [ 25 , 28 ], lack of or inadequate antenatal care follow-up [ 29 , 30 , 32 , 36 ], gestational diabetes mellitus [ 36 ], residence in rural settings [ 25 , 26 , 30 ], maternal age [ 32 , 35 ], and abnormal fetal heart rate patterns [ 25 ] have been correlated with a statistically significant increase in neonatal birth trauma.…”