The effects of standardised protocols of obstetric and neonatal care on perinatal and early neonatal mortality at a rural hospital in Tanzania

Abstract

The care of pregnant women and neonates in peripheral hospitals in many developing countries is in a critical state. Through a retrospective analysis we assessed the effects of the introduction of standardised protocols in obstetric and neonatal care (implementation from 1998 onwards) on perinatal and neonatal outcomes of all deliveries over seven years (1996-2002) at a first-referral hospital in rural Tanzania. In all, there were 18 026 deliveries (18 316 live births and 606 stillbirths). Perinatal mortality rates (PMR) varied from 42.8-54.5/1000 live births during the years. Early neonatal mortality rates (eNMR) fell from 21.9/1000 live births in 1996 to 14.8/1000 live births in 2002 (all p > 0.05). Fresh stillbirth rates decreased over time (p = 0.041), however macerated stillbirth rates increased during the second half of the period (p = 0.067). Sixty-two to seventy-two percent of eNMR occurred on the first day of life (p < 0.001). Maternal mortality ratio declined from 729/100 000 live births in 1996 to 119/100 000 live births in 2002 (p = 0.002). Our clinical project was associated with a reduction of PMR and eNMR (and maternal mortality ratios), but with considerable fluctuations during the years. Improving obstetric and neonatal care in the hospital setting in developing countries is essential, but needs long-term commitment and support.

Impact of mothers’ socio-demographic factors and antenatal clinic attendance on neonatal mortality in Nigeria

“…Similarly, Yaya et al (2014) found out that socioeconomic factors affect neonatal mortality, especially among poorest households headed by illiterates and far from the health facility. Another study revealed that neonatal mortality was higher in the poorest families as compared to the wealthier families and the majority of these deaths occurred in rural areas (Kruger et al, 2015;Wang et al, 2016). Whereas place of delivery plays a significant role in predicting neonatal mortality (Eugene & Sdumo, 2012;Jana & Sebastian, 2017;Mazalale et al, 2015), poor social conditions are known to affect maternal health which again has an impact on neonatal mortality (Jana & Sebastian, 2017;Mazalale et al, 2015;Stokowski, 2005).…”

Frequent brief on-site simulation training and reduction in 24-h neonatal mortality—An educational intervention study

“…Globally, around 2.9 million newborn infants die each year with as much as 36-70 per cent of these deaths occurring within the first day of life [1][2][3][4][5]. Moreover, neonatal mortality accounts for a steadily increasing proportion of under-five child mortality [1,3,5,6].…”

“…Moreover, neonatal mortality accounts for a steadily increasing proportion of under-five child mortality [1,3,5,6]. Therefore, to meet Millennium Developmental Goal 4 of reducing under-five child mortality by two thirds by 2015, a major focus on optimizing basic newborn care is needed [4,7].…”

Newborn Mortality and Fresh Stillbirth Rates in Tanzania After Helping Babies Breathe Training

“…1,2 In recent years progress has been made toward meeting this goal; however, this has been slowed by limited reduction in ND resulting in an overrepresentation of the global under-5 deaths. 5,6 The common causes include birth asphyxia (BA), infection, and prematurity. 5,6 The common causes include birth asphyxia (BA), infection, and prematurity.…”

“…7 It is estimated that ∼1 million infants die each year from BA. 6,8,9 Several interwoven factors likely contributed to this sobering observation, including the fact that BA was not a national priority, resuscitation training was localized, training was not targeted at the appropriate provider (ie, the midwife), there was often a lack of basic equipment, and a failure to initiate resuscitative steps in a timely manner. A comparable number of fresh stillborn (FSB) infants are also delivered annually.…”