Early Neonatal Mortality In Two District Hospitals In Yaounde

Shu Geofred Shu
Pediatrics, University of Yaounde 1
June, 2017
 

Abstract

INTRODUCTION
According to the World Health Organization report in 2015, about 45% of deaths in children below 5 years occur during the neonatal period. From which 75% of these deaths occur before one week of life. These newborns die from preventable causes. So many sub-Saharan countries including Cameroon failed to attain the millennium development goal target 4 by the close of 2015. The neonatal mortality rate in Cameroon still remains high. In 2013 it stood at 28.2 deaths per thousand live births. These deaths occur in the community and health institutions alike. Therefore, Interventions at different levels of the community and the health system, including district hospitals, are needed in order to attain the sustainable development goal target 3 by 2030 whose objective is to end preventable deaths of newborns and children under five years of age, with all countries aiming to reduce neonatal mortality to at least as low as 12 deaths per 1,000. Epidemiologic awareness of early neonatal mortality at the peripheral level (district) allows for an estimation of the requirements in terms of competence and equipment. The objective of this study was to evaluate early neonatal mortality in two district hospitals in Yaoundé.

METHODOLOGY
We carried out a descriptive prospective study on newborns delivered at Biyem-Assi and Efoulan district hospitals in Yaoundé over a duration of six months. Included in the study were all newborns delivered in the hospitals mentioned above and whose mothers signed our consent form. We excluded all newborns who were referred to the site of study after birth, all stillbirths and babies who died after the seventh day of life. Records were collected from mothers in the maternity room immediately after delivery on a daily basis (after obtaining participant’s informed consent). Data on pregnancy follow-up, labour and delivery, state of newborn at birth were got from the medical files. Women whose babies died before leaving the hospital were recorded. Meanwhile appointments were made on the seventh day of life for those who were discharged after delivery. Mothers who did not come back for our appointment were contacted through phone calls and appointment rescheduled either at the district or at the facility where these babies were followed-up. Neonates who were admitted into the neonatal unit immediately after birth and those who were referred to more competent hospitals were equally followed-up. The reason(s) for admission, age, parameters and working diagnosis were recorded. These babies were followed-up during the early neonatal period. The parameters studied were maternal, paternal and neonatal. Data were collected with the help of a pretested questionnaire. Analysis of the number of death was done using Epi-Info version 3.5.3
RESULTS
Within the period of this study, 751 newborns were delivered. A total of 577 babies were enrolled in the study. A hundred and seventy four neonates (from 170 women) declined to be part of our study. Three were unreachable throughout the study neither through phone nor appointments thus were considered ‘missing’ and excluded from the study. A total of 574 babies were retained. Out of which, 553 babies were from singleton pregnancy and 24 resulted from twin pregnancy. A total of 18 deaths were obtained, giving a death rate of 24 deaths per thousand live births. Most newborns died on the first day of life (83.3%). These deaths occurred in the hospital milieu. The causes of death were: birth Asphyxia (72.2%), prematurity (16.6%), congenital malformation (5.5%) and severe anemia (5.5%).
CONCLUSIONS
Early neonatal mortality is high in these facilities. Asphyxia and prematurity were the main causes of death in these newborns. Young mothers with low level of education and poor antenatal follow-up were more affected by early neonatal death.
RECOMMENDATIONS
We therefore recommend that pregnant women should be sensitized (information–education-communication) on the paramount importance of antenatal consultations for early detection and effective management of pregnancies at risk. Creation of a specialized unit with permanent staff for the follow-up and management of high risk pregnancies and neonatal emergencies. The need to refer high risk pregnancies and newborns at risk to gynecologists and pediatricians and in time.
.
Key words: Early neonatal mortality, district hospital, Cameroon


********************************************************************************************