1Department of Nursing Sciences, Bayero University, Kano, Nigeria
2Department of Medicine, Aminu Kano Teaching Hospitals, Kano, Nigeria
Neonatal mortality rates remained a public health problem in developing nations, especially in sub-Saharan Africa heavily associated to poverty and poor access to health service. Identifying the etiology of neonatal mortality is a strong indicator to decreasing the neonatal mortality rate in Nigeria. Nigeria continues to have one of the highest rates of neonatal deaths in Africa, therefore, this study aimed at identify risk factors associated with neonatal death in North- Western Nigeria. A retrospective survey was employed for the study and an adapted World Health Organization instrument was used for data collections. A sample size of two hundred and fifty five was employed for the study. The subjects were recruited from hospital records department of Aminu Kano Teaching Hospital. The data were analyzed using descriptive and inferential statistics The results showed that the maternal socio-demographic variables associated with neonatal mortality are; poor antenatal visits and low socio- economic status. The study also revealed, sepsis, prematurity and asphyxia in decreasing frequency as the leading causes of neonatal death with sepsis being the independent determinant of neonatal mortality P< 0.05. The study concluded that, sepsis being the independent determinant of neonatal mortality and therefore, it is recommended that there is need for improved obstetric services, monitoring and evaluation with frequent reporting on the major determinants of neonatal mortality to the hospital management.Keywords: Neonates, Health, Mortality, Prevalence, Determinant
Neonatal mortality has been recognized as a global public health burden mostly concentrated in low- and middle-income countries (Lawn et al. 2012).The majority of these deaths are caused by preventable or treatable diseases, such as infectious diseases, which contribute to approximately 36% of these deaths. Previous study have shown that there is a global decline in neonatal mortality rates compared with infant and under-5 years of age mortality, especially in the sub-Sahara African region (Rajaratnam, et al., 2010). The neonatal mortality rate consists of early and late neonatal mortality, with the first representing the main component that reflects the health care provided to pregnant women in the ante partum period, at delivery, and also the care given to the newborn soon after birth and in neonatal units (Almeida, Guinsburg, Martinez, Procianoy,Leone, & Marba, 2012). Available evidences suggested that early neonatal deaths occur during the perinatal period, and have obstetric origins, similar to those leading to stillbirths. Globally, it is believed that, there are over 6.3 million perinatal deaths each year, and almost all of which occur in developing countries, and 27% of them in the least developed countries UNICEF and WHO 2014 . In low income countries, nearly over 40% of deliveries occur in health facilities and little more than one in two takes place with the assistance of a doctor, Midwife or qualified nurse (Oestergaard et al., 2009). High neonatal mortality rates remain a public health problem in developing nations, especially in sub-Saharan Africa because of poverty and poor access to health services.
Neonatal mortality has been found to be declining globally but more slowly than post-neonatal (1-59 months) mortality UNICEF 2014. Various reports on neonatal mortality associated significant proportion of under-five deaths that occur during the neonatal period is increasing as under-five mortality declines, however, the health interventions needed to address the major causes of neonatal deaths generally differ from those needed to address and protect maternal health (UNICEF, WHO, 2014). Existing literature has established that early neonatal deaths occur during the perinatal period, and have obstetric origins, and similar to those leading to stillbirths. More so, it is a common knowledge that globally , there are over 6.3 million perinatal deaths each year.
A Retrospective survey was employed for the study. The study was carried out at the Special Care Baby Unit (SCBU) of Aminu Kano Teaching Hospital (AKTH). The hospital is located within Kano metropolis, Kano State, North-western Nigeria. The hospital serves as a referral centre for both private and public health institutions in and around Kano. The hospital is projected to serve about six hundred thousand patient outflow annually, with multiple ethnic variations. Target population were neonates, admitted into the Special Baby Care Unit of Aminu Kano Teaching Hospital, Kano between January and December, 2015 formed the target population. The sample size was determined from the total number of neonatal deaths that occurred within the year 2015, based on the Krecie Morgan Formula. The study employed a systematic sampling technique to meeting the objectives of the study.
The data were collected based on the WHO standardized data
The data collected was analysed descriptively (frequency, charts, percentage, figures) and inferentially (odd ratio) using statistical package for the social science (SPSS) software programme 20.0 version. Ethical consideration was sought and granted by the research ethical committee of the hospital.
Table 1: Distribution of subjects by socio-demographic characteristics
Table 1 above shows that most of the neonatal deaths 191 (74.3%) occurred between the age of 0-7 days and most were males 131 (51.4%) with the mean of age of 1.3 . With respect to place of birth, majority of the subjects 201(78.8%) had home delivery, most of them were Muslims (91.4%) and Hausas by tribe 231(83.5%). With respect to parental education, most of their parents 153 (60%) had no Western education and fall within the non working class 141 (55.3%).
Table 2: Neonatal factors associated with neonatal mortality
Table 2 Shows that most 195 (74.7%) of the neonates had normal birth weight with mean weight of 2.0kg, normal admitted temperature 161 (63.1%), and majority 169 (66.3%) had Apgar score of ≤7 at 5 minute, with 101 (39.6%) of the neonates had co morbid condition.
Table 3: Maternal factors associated with neonatal mortality
Table 3 above shows that majority of the mothers 195 (76.5%) are within the child bearing age, 77(30.2%) had hypertension while 52 (20.4%) had anemia. Majority of the mothers 183 (71.1%) attended Antenatal Clinic while 60 (23.5%) had mal–presentation, 42 (16.5) had obstructed labor during delivery; others are reflected in the table.
Table 4: clinical conditions associated with neonatal mortality
Table 4 shows that 93 (36.5%) presented with asphyxia while 100 (39.2%) presented with prematurity. 108 (42.4%) of the neonates had sepsis, while congenital abnormality and neonatal jaundice occurred at similar rates of 18.8% and 19.6% respectively.
In this study, males gender were found to be more at risk of neonatal death than female neonate. Similar demographic observation was reported in South-Western Nigeria ( Ezeh et al 2014). This finding could be due to the theoretical assertion that male babies are more susceptible to premature death than female neonates perhaps due to genetic disposition of x- chromosome that confers immunity to female neonates than the male counterparts. Another possible reason for the lower rate of neonatal deaths among female neonate could be related to development of early foetal lung maturity in the first week of life, which in turn results to respiratory diseases benefit in female neonates compared with male neonates.
The study also, found that two-thirds of the neonatal deaths occurred
within 0-7 days of life with the mean of 24-72 hours, this
finding seems to be contrary to the report around the world which
showed higher neonatal death within the first 24 hours of life
(Eveline et al., 2016).
In addition, the study revealed that the major maternal health problem related to neonatal mortality are maternal hypertension and anaemia ,similar findings was reported around the world (Tyson, et al., 2008). The possible explanation to this findings could be related to the increase tension on blood supply in the maternal circulation that might interfere with normal foetal perfusion, thereby increasing the risk of neonatal death. However, a contrary report on maternal health problem associated with neonatal mortality was found to be intra-partum haemorrhage ( WHO 2006).
The present study also, revealed that failure of antenatal visits, and
intra-partum problems have increased risk of neonatal mortality
by two folds OR (2). This findings is not unique to this study, similar
finding was documented in many part of the worlds which
showed that intra-partum problems, high blood pressure, breech
presentation, antenatal corticosteroid therapy have increased
risk of neonatal mortality by five folds (Elahi et al,. 2005,Tyson,Parich,Langer,Green
& Higgens 2007).
The study also showed that low educational level, high parity and null parity are associated with increased risk of neonatal mortality, this findings is also similar to the report in some part of the world (Carl & Kenneth 2012).The reason for this could reflect deviance from the normal uterine function. In another study ,pre mature rupture of membrane, maternal malaria and infection are the leading causes of neonatal mortality (Iyoke et al,. 2014). The major finding in this study is that, maternal sepsis is an independent determinant of neonatal mortality, this finding is in agreement with the report from Iran by Hamidah, Hamid, Zahra ,Zahira and his colleagues (2014).
It is concluded that sepsis is the independent determinant of neonatal mortality among the studied group and therefore, recommended the need for improved obstetric services and health education to curbing the predictors of neonatal mortality rate.
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