Morbidities, Rate and Time Trends of Neonatal Mortality in Dilchora Referral Hospital, Dire Dawa, Ethiopia, 2012- 2017

Research Article

Austin Med Sci. 2017; 2(1): 1019.

Morbidities, Rate and Time Trends of Neonatal Mortality in Dilchora Referral Hospital, Dire Dawa, Ethiopia, 2012- 2017

Roba AA1* and Diro DH1

1College of Health and Medical Sciences, Haramaya University, Ethiopia

*Corresponding author: Roba AA, Department of Pediatrics and Neonatal Nurses, School of Nursing and Midwifery, College of Health and Medical Sciences, Haramaya University, Ethiopia

Received: September 28, 2017; Accepted: October 27, 2017; Published: November 03, 2017

Abstract

Introduction: The study assessed causes of admission, the rate and time trends of neonatal mortality in DilChora referral hospital, Dire Dawa, Ethiopia, 2013-2017.

Methods: A hospital based 5 years retrospective study was conducted among neonates admitted to NICU from January 1/2013 to September 10/2017 in DilChora hospital, Dire Dawa, Ethiopia. Data was abstracted from Neonatal Intensive Care Unit Registration logbook by four data collectors. It was coded, and entered in to Epi Data version 3.02 and exported to SPSS version 20 for analysis. Descriptive statistics was used to describe the frequency, mean and standard deviations.

Results: A total of 3418 neonates were admitted to NICU from January 1/2013 to September 10/2017 and 391 neonatal deaths were registered. This indicated that the overall neonatal mortality rate was 11.44%. Suspected sepsis (35.31%), prematurity (19.05%), respiratory distress (15.27%) and perinatal asphyxia (12.73) were the leading causes of admission (more than 82%) to Neonatal Intensive Care Unit (NICU). The major causes of neonatal mortality were complications of prematurity 97 (24.8%), infection 125 (31.97%) and birth asphyxia (22.25%). Neonatal mortality rate in NICU had sharp decline from 2013 to 2015, but the after it was almost constant and slightly increasing.

Conclusion: Suspected sepsis, prematurity, respiratory distress and perinatal asphyxia were the leading causes of admission to NICU while sepsis, prematurity and birth asphyxia were the major causes of neonatal deaths. There was steady little declining in neonatal mortality between 2013 and 2015, but then after, it was slightly increasing up to 2017.Future studies are required to investigate the factors contributing to the neonatal mortality and trends in Dire Dawa, Eastern Ethiopia.

Keywords: Cause of admission; Rate and trends of neonatal mortality; Neonatal morbidity; Dire Dawa; Ethiopia

Introduction

Every year 1.16 million African babies die in the first month of life. Half of these newborn deaths occur in just five countries: Nigeria, Democratic Republic of Congo, Ethiopia, Tanzania, and Uganda. Neonatal deaths account for 45% of all deaths among children fewer than 5. The majority of all neonatal deaths (75%) occur during the first week of life, and 25% to 45% occurs within the first 24 hours. 80% of causes of death were due to prematurity, infections, asphyxia and birth trauma [1,2].

In Ethiopia, Rates of neonatal mortality were highest in sub- Saharan Africa and Asia. The gaps between rich and poor countries were widening: neonatal mortality is now 6.5 times lower in the highincome countries than in low income Countries. The life time risk for a woman to lose a newborn baby was 1 in 5 in Africa, compared with 1 in 125 in more developed countries [3]. Most newborn deaths occur during the first week of life as a result of sepsis, birth asphyxia, birth injuries, complications of prematurity and low birth weight, and birth defects [4].

Neonatal mortality has been declining worldwide. The number of deaths among babies 0-28 days of life decreased from 4.4 million in 1990 to 3 million in 2010. There was also 28% reduction in neonatal mortality rates over the same period of time. Although both, numbers and rates, have been lessening over the last 20 years, neonatal mortality account for an increasingly proportion of under five deaths [5].

Evidences indicated that the second half of the twentieth century witnessed a remarkable reduction in child mortality, with a halving of the risk of death before the age of 5 years. The majority of this reduction, however, has been due to lives saved after the first four weeks of life, with relatively little reduction in the risk of death in the neonatal period [6-8]. In Ethiopia also, even if MDG 4 was achieved 2 years ahead of deadline, new-born mortality was very high and stagnant over the past decade (42% of under-five death was due to NMR) [9].

Many neonatal deaths are preventable with existing lowcost, low-tech interventions but to make effective use of limited resources, planners and policymakers require reliable cause-of-death information. Information regarding causes of neonatal morbidities and mortality, particularly in the first week of life when three-quarters of neonatal deaths occur, is fundamental for developing and tracking public health strategies. There is very limited information regarding cause of admission, death, rate and trends in neonatal death to NICU admitted neonates in Ethiopia, particularly to eastern Ethiopia. So, the aim of this study is to find-out the cause-of admission and death, rate and trends of neonatal mortality in DilChora referral hospital, Dire Dawa, eastern Ethiopia.

Methods and Materials

Study area and period

Hospital based retrospective descriptive study covering a period of five years from January 1/2013-September 10/2017 were conducted in Dire Dawa town, DilChora Hospital, eastern Ethiopia. Dire Dawa was founded in 1902 when the railroad from Djibouti reached the area. It is center of Dire Dawa city administration and the second largest city in Ethiopia. Based on the 2007 Census conducted by the Central Statistical Agency of Ethiopia (CSA), Dire Dawa has a population of 341,834, of whom 171,461 are men and 170,461 women; 233,224 or 68.23% of the population are urban inhabitants. DilChora Referral Hospital (DCRH), the only governmental hospital in the region, which was established in 1952 and since then, has been serving the ever increasing population of the Dire Dawa City and its adjacent regions, Oromiya and Somalia.

Study population: All neonates who were admitted to NICU and died in DilChora hospital from January 1/2013-September 10/2017 and that fulfill inclusion criteria.

Inclusion criteria: The admission files of all new born babies who were admitted to NICU and died in the unit during the study period were investigated. In-patient neonatal mortality rate/Neonatal death rate/ was defined as the ratio of total number of newborn deaths occurring among admitted sick neonates to total number of newborn discharged (including death) for a period multiplied by 100%.

Exclusion criteria: Patient cards with incomplete data/missing variable and unknown diagnosis were excluded.

Data collection

Secondary data was abstracted from Neonatal ICU treatment registers by using a structured questionnaire. These include sociodemographic data (age, sex, residence), Mode of delivery, para, gravida, maternal HIV status, ANC follow-up, multiple birth, birth weight, infant temperature, extra uterine adaptation (crying, need of resuscitation), problems identified at birth/cause of admission, treatments given, treatment outcome, and duration of hospital stay.

Data quality control

Training was given to four data collectors who were BSc nurses on how to gather information from registration cards. Registrations with incomplete data/missing variables were discarded. Close supervision was undertaken during data collection by principal investigator.

Data processing and analysis

Epi Data version 3.02 was used for data entry while SPSS version 20 and Microsoft Excel were used for data analysis. Descriptive statistics was used to describe the frequency, mean and standard deviations. Tables and graphs were used to summarize and present the data.

Ethical considerations

Ethical clearance was obtained from Haramaya University, College of Health and Medical Sciences Institutional Health Research and Ethics Review Committee (IHRERC) and submitted to DilChora hospital. The hospital managements were informed about the objectives of the study, risks, benefits and confidentiality. Written and signed consent was obtained from hospital administrator after reading the information sheet.

Result

Five years newborn registration logbook reviews were conducted. A total of 3418 neonates were admitted to NICU from January 1/2013 to September 10/2017 and 391 neonatal deaths were registered. This indicated that the overall neonatal mortality rate was 11.44%.

Neonatal morbidities

Suspected sepsis, prematurity, respiratory distress and perinatal asphyxia were the leading problems of neonates in which they constituted more than 82% of admission to Neonatal Intensive Care Unit (NICU). Sepsis was the top leading and anemia was the least for admission (Table 1). Regarding the congenital anomalies, defects in central nervous system and gastro-intestinal tract were the leading identified problems. In the “others” category, the leading problems for admission were unable to suck, jaundice, skin infection, cord bleeding, vomiting, infants of diabetic mother with hypoglycemia and macrosomia and birth trauma. More than one admission criteria’s were observed for some neonates and it was counted as it is.