Publication: Determinants of neonatal mortality in margaret kenyatta mother baby wing at Nakuru level 5 hospital, Nakuru county, Kenya
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2023-06
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Mount Kenya University
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Abstract
In Nakuru county, neonatal mortality rate is 41.9 per 1000 live babies born every year,
which is more than twice the national mortality rate of 19 deaths per 1000 live births.
This study investigated the risk factors associated with neonatal mortality at Nakuru level
5 hospital. The study design was unmatched case control study. The sample size was 429
neonates (143 cases and 286 controls) calculated using epi info version 7.3.2.1 assuming
case to control ratio of 1:2 and prevalence of exposure among controls at 18%. The results
of the study showed that high parity (OR<1.623), high number of still births (OR<8.399),
positive HIV status (OR<3.49), HBsAg status (OR<2.57), syphilis status (OR<25.69),
pregnancy induced hypertension (OR<2.5), antepartum hemorrhage (OR<2.1), PROM
18hours (OR<5.09), and maternal peri-partum (OR<4.6) increased the risk of neonatal.
Similarly, the data show that mothers who had fewer ANC visits throughout their
pregnancy had a greater risk neonatal mortality compared to mothers who attended more
than three ANC clinics with mortality risk reducing by 69% (OR 0.389) and 59% (OR
0.418) for 1-2 visit and more than 3 visits compared to noneattendance of ANC. From the
data, the mode of delivery affects the risk of mortality with vaginal assisted delivery
having an OR of 2.188 while vaginal unassisted OR 4.533 as compared to caesarian
delivery. Mother treatment with antibiotics (OR 0.658) and mother treatment with
antenatal dexamethasone (OR .578) reduced the risk of mortality. Similarly, treatment
with antibiotics reduced NMR by OR 0.381. New-born of mothers admitted to the facility
from a referral facility or labor ward had a higher risk of mortality of OR 1.11 and OR
6.220. Other factors that increased mortality include low birth weight, low weight on
admission, gain weeks, and congenital anomalies. These factors remained substantially
linked with infant mortality in this study; the findings indicate that increasing birthweight
reduced the risk of neonatal mortality by; 1>=2 OR .247, 2>=3 OR, and 3>=4.5 OR .160.
Similarly, the age of admission to the NBU reduced to the risk of mortality by 1>=2 OR
0.836, 2>=3 OR 0.236, and 3>=4.5 OR 0.441. The data also show that increasing
gestation period reduced neonatal mortality by; 32>37 OR 0.401, and 37>42 OR 0.227.
The study concluded that maternal characteristics, neonatal complications are key
determinants of neonatal outcomes. The study recommends regular training of staff
working in the maternity and newborn unit on emergency care and neonatal resuscitation.
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Keywords
mortality, infant, emergency care, neonatal resuscitation