Neonatal mortality and associated factors among neonates admitted to neonatal intensive care unit of Gandhi memorial hospital in Addis Ababa, Ethiopia, 2019
Ethiopia witnessed an unprecedented decline in under-5 and neonatal mortalities since 2000. But, neonatal mortality still accounts for the largest proportion of under-five child mortality. Quality of service at hospitals may vary and determine the magnitude of neonatal mortality.
Objective
To assess the prevalence and associated factors of neonatal mortality among newborns Admitted to the Neonatal intensive care unit of Gandhi Memorial Hospital Addis Ababa, Ethiopia, 2019.
Methods
Institution-based cross-sectional study was conducted from November 1 to December 31, 2019. A sample of one in every 2 admitted patients was included in the study. our exclusion criterion was neonates who had no mothers or guardians and/or neonatal medical records incomplete for status at discharge. We used the Systematic random sampling technique to select the study participants. A pretested structured interviewer-administered questionnaire and a preliminary tested checklist were used to collect primary and secondary data respectively. Descriptive and summary statistics were performed. A binary logistic regression model was fitted and variables that had a P-value of < 0.05 in the multivariable model were considered statistically significant.
Results
A total of 570 neonates who have mothers were involved in the study giving a response rate of 98.8%. The prevalence of neonatal mortality was 7.7% (95% CI: 5.7, 9.8). Mothers' educational status (No education (AOR 3.37, CI 95%, 1.02–11.20), premature rupture of membrane (prolonged PROM) (AOR 5.59, CI 95%, 1.05–29.76), and birth weight less than 2500gm (AOR 3.23, CI 95%, 1.17–8.90) are the significant factors associated with neonatal mortality.
Conclusion
The prevalence of neonatal mortality at Gandhi memorial hospital was generally high. As our finding revealed, neonates who are underweight and whose mothers have no formal education as well as have prolonged PROM have higher odds of neonatal mortality. Thus, clinicians, policymakers, and program managers should give special attention to neonates of none educated mothers, mothers with prolonged PROM, and neonates with low birth weight.
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Abkürzungen
ANC
Antenatal Care
COR
Crude odds ratio
AOR
Adjusted Odd Ratio
APGAR
Appearance, Pulse, Grimace, Activity, and Respiration
CI
Confidence Interval
NICU
Neonatal Intensive Care Unit
NMR
Neonatal Mortality Rate
OAU
Organization of African Union
OR
Odds Ratio
PROM
Premature Rupture of Membrane
PPROM
Prolonged Premature Rupture of Membrane
SVD
Spontaneous vaginal delivery
CS
Cesarean section
SD
Standard deviation
TT
Tetanus toxoid
SPSS
Statistical Package for the Social Science
Introduction
The neonatal period, which incorporates the first 28 days of the infant’s life, is the most crucial time for a child’s survival and as it accounts for nearly half of the deaths of children below five years of age [1]. The neonatal mortality rate (NMR) is an important metric for measuring a society's overall quality of life. NMRs are frequently used as a standard index for evaluating health, education, and social systems, as well as nutritional status and health programs for newborns in countries, and identifying the causes of mortality is the first step in lowering mortality rates [2].
Although global neonatal mortality has dropped significantly from 5 million in 1990 to 2.4 million in 2019, newborn death still accounts for 47% of all deaths among children under the age of five, with nearly one-third dying on the day of birth and nearly three-quarters dying within the first week of life [3]. Each year, around 3.1 million babies die in their first month of life around the world, with the bulk of these deaths occurring in underdeveloped countries [4]. More than 1.1 million newborn fatalities occur in Sub-Saharan Africa, accounting for 28% of the global burden. Nigeria, Ethiopia, the Democratic Republic of the Congo, and Tanzania each contribute 6%, 4%, 3%, and 2% of the global burden of neonatal mortality, respectively [5]. Despite improvements over the past decade, according to the 2016 Ethiopian demographic health survey (EDHS) report, the neonatal mortality rate was 29 deaths per 1,000 live births which is still one of the highest in the world [6].
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Perinatal death is related to problems such as intrauterine growth restriction, embryonic asphyxia (such as fetal immaturity), severe congenital malformations, early infection and neonatal risk, low birth weight, premature birth, and fatal congenital abnormalities [1, 7]. Some local studies conducted in Ethiopia have also reported that sepsis, asphyxia, birth injuries, tetanus, preterm delivery, and congenital malformations are primarily associated with neonatal mortality [8].
As to the best knowledge of the researcher, neonatal mortality and its associated factors in the hospital are not studied and are not well documented mainly at the institutional level including in this study area, Gandhi Memorial Hospital. Therefore, the purpose of this study was to assess neonatal mortality and associated factors among neonates admitted to the neonatal intensive care unit (NICU) of Gandhi memorial hospital.
Methods
Study design, study setting, and study period
An institution-based cross-sectional study was conducted at Gandhi memorial hospital, Addis Ababa, Ethiopia from 1st November to 31 December 2019. There are 12 governmental Hospitals in Addis Ababa, of these only six hospitals (Black Lion, St. Paul, Gandhi, Zewditu, Yekatit 12, and Tirunesh Beijing) have their own neonatal intensive care unit (NICU). Gandhi Memorial hospital is a governmental hospital that specializes in maternity services. The hospital serves as a teaching center for Addis Ababa University students who specialize in gynecology and obstetrics and other undergraduate medical students. The hospital daily manages 40–50 delivery cases of pregnant mothers who come from various corners of Addis Ababa and nearby towns.
The hospital NICU receives high-risk babies delivered within the institution, referrals from other health facilities, and referrals from home deliveries. On average the hospital has 6,658 annual and 555 monthly admissions to NICU. The NICU had a 32-bed capacity and was staffed with two Public health officer professionals, one Neonatologist, and 22 nurses.
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Populations of the study
All neonates, who were admitted to the NICU of Gandhi Memorial Hospital in Addis Ababa, were the source population and all neonates who were admitted to the NICU of Gandhi Memorial during the study period, were the study population.
Inclusion
A sample of one in every 2 admitted neonates was included in the study.
Sample size determination
The sample size was determined by using both single and double population proportion formulas for the first and second objectives respectively.
For the single population formula,
We used a 4% margin of error, 95% confidence interval and Prevalence of Neonatal mortality (35.5%) from the previous study conducted in Jimma Zone [9] and the calculated sample size was 549.
By taking additional 5% contingency for non-response rate, 5%*549 = 27.45, therefore the total sample size found to be = 577.
Since the sample size calculated for objective one (n = 577) was greater than the sample size calculated for objective 2, the final sample size was 577.
Sampling technique and procedure
A systematic random sampling technique was used to select participants (neonate's mother) attending the Gandhi Memorial Hospital. The monthly average number of neonates admitted to the Gandhi memorial hospital was estimated by reviewing the hospital logbook for the previous three years and found 600 per month. This gives an average two months admission of 1,200 neonates. Using the two-month admission as the study population, we determine the 'k' value by dividing 1,200 by 577 which gives approximately 2. Therefore, to select the first participant, we randomly select one number from 1 and 2. One was drawn. Then, every other (2nd) subject was included until the final sample size is achieved.
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Variables of the study
The dependent variable in this study was neonatal mortality whereas the explanatory variables were socio-demographic and socio-economic factors such as maternal age, maternal education, place of residence, marital status, economic status and religion, reproductive and obstetric factors (complication during pregnancy, parity, ANC, birth order interval, PROM, type (mode) of delivery, TT immunization, gestational age at birth, initiation of breastfeeding, exclusive breastfeeding), health care practice and related factors (place of delivery and skilled birth attendant), neonatal related factors (age at admission, sex of the baby, birth weight of the baby, APGAR score) and medical factors (hypothermia, hypoglycemia, asphyxia, infection, prematurity, congenital malformation, and birth trauma).
Operational definitions
Neonatal Mortality: Death of neonates within the first 28th day of life.
Congenital Malformations: are structural or functional anomalies that occur during intrauterine life and can be identified prenatally, at birth, or sometimes may only be detected later in infancy [10].
Hypoglycemia: A measure of low blood glucose (< 40 mg/dL) that was diagnosed and recorded on charts by professionals on admission.
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Hypothermia: Any low body temperature measurement (< 36 °C) diagnosed and recorded on or during admission of neonates.
Premature birth: Any viable neonate before term (< 37 weeks of gestation) that was already diagnosed by professionals in charge of admission of neonates to neonatal intensive care units [11].
Premature Rupture of Membrane (PROM): Rupture of membrane before the onset of labor. Prolonged rupture of membranes (PROM) is considered when the duration is more than 12 h before delivery [12].
Stillbirth: it was measured as fetal death (i.e., death before the complete expulsion or extraction of a product of conception from its mother) in the third trimester (≥ 28 completed weeks of gestation) using the WHO definition of stillbirth [13].
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Abortion: is the termination of a pregnancy that occurs with/without intervention (a miscarriage or "spontaneous abortion" or induced abortion).
Data collection procedure
A structured questionnaire and checklist were developed based on literature for collecting data from study participants in the Hospitals. The Structured questionnaire and checklist were prepared in the English version and translated to Amharic to maintain smooth communication with participants and translate back to English to see the consistency and clarity of the questionnaire. The medical diagnosis information was collected from the chart of the newborn through the checklists and socio-demographic and obstetric history data were collected from their mothers through face-to-face interviews after written informed consent had been obtained. Data was collected by 5 BSc female nurses after they were provided with a two-days training on the data collection tools and the supervision was done by the researcher.
Data quality control
The instrument of data collection was pretested in neonates who were admitted to Zewditu Memorial Hospital and who were not included in the study. After the pre-test, necessary modifications were made accordingly before actual data collection was performed. Data was collected after training was given for data collectors on how to approach and interview participants and how to review charts. In the fieldwork, the principal investigator was closely following the day-to-day data collection process and ensured completeness and internal consistency of the collected data.
Data processing and analysis
The collected data were checked for completeness and coded manually first and entered into EPI info 7.2 software, and then, were exported to SPSS version 23 software for data cleaning, coding, and analyses.
Descriptive statistics like frequencies with percentage and mean with standard deviation were used to describe the study population. Bi-variable and multivariable logistic regression analyses were performed to test the association. Variables that had a P-value of 0.2 and less were considered for the multivariable analysis. The odds ratio with 95% CI was considered to determine the presence of an association between the dependent and independent variables.
Results
Socio-demographic characteristics of participants
A total of 577 neonates who have mothers were included in this study. No participants met the exclusion criteria. Seven of them refused and the final number of study participants was 570, which makes the response rate 98.78%. The majority of participants 531(93.2%) were from the urban area, and the rest 39 (6.8%) were from the rural area. The mean age of participants was 26 0.66 with SD = 4.08. The largest proportion of age distribution was found between 25 to 29 years (252 (44.2%). Of all mothers involved in this study, 537(94.2%) were married. About 14.9% of mothers were none educated (Table 1).
Table 1
Socio-demographic characteristics of mothers whose neonates were admitted to NICU at Gandhi Memorial Hospital from Nov 1 to December 31, 2019, Addis Ababa, Ethiopia (n = 570)
Variables
Category
Frequency
Percentage (%)
Age (years)
≤ 24
191
33.5
25–29
252
44.2
30–34
98
17.2
≥ 35
29
5.1
Educational Status
None educated
85
14.9
Primary education
117
20.5
Secondary education
169
29.7
Certificate and above
199
34.9
Marital Status
Unmarried
30
5.3
Married
537
94.2
Separated
3
0.5
Religion
Orthodox
338
59.3
Muslim
126
22.1
Protestant
103
18.1
Catholic
3
0.5
Occupation
Government
132
23.2
Private
294
51.6
Housewife
142
24.9
Student
2
0.3
Monthly Family income in USA dollar
≤ 60$
143
25.1
60.02$-100$ -
196
34.4
100.02$-140$-
123
21.6
> 140$
108
18.9
Residence
Urban
531
93.2
Rural
39
6.8
Reproductive and obstetrics related characteristics
Among all participants, 169 (29.6%) of the mothers had an abortion history, 308 (54%) were family planning users, and 540 (94.7%) had ANC follow-up. The majority of the participants 531 (93.2%)) had taken TT immunization. Concerning in initiation of breastfeeding, 503 (88.2%) mothers initiated breastfeeding within the first hour of birth. About 26.1% of mothers had a premature rupture of membrane greater than 12 h before delivery. The majority of the mothers, 327 (57.4%) had a gestational age between 37 and 42 weeks (inclusive). Regarding the mode of delivery, 330 (57.9%) of the mothers had a spontaneous vaginal delivery, 223 (39.1%) had a Cesarean section, and the rest 17 (3%) had instrumental delivery (Table 2).
Table 2
Maternal Reproductive and Obstetrics characteristics of mothers whose neonates were admitted to NICU at Gandhi Memorial Hospital from Nov 1 to December 31, 2019, Addis Ababa, Ethiopia (n = 570)
Variable
Response
Frequency
(%)
Abortion
Yes
169
29.6
No
401
70.4
Still Birth
Yes
5
0.9
No
565
99.1
Family planning use
Yes
308
54
No
262
46
ANC Follow Up
Yes
540
94.7
No
30
5.3
ANC visit time
Incomplete(not regular)
147
25.8
4thcomplete(Regular follow up)
423
74.2
TT immunization
Yes
531
93.2
No
39
6.8
TT immunization dose
Not immunized
13
2.3
≤ 2 dose
417
73.2
> 2 dose
140
24.6
Age at first birth
15–19
33
5.8
29–24
336
58.9
25–29
184
32.3
30–34
13
2.3
35–39
4
0.7
Birth interval
First Birth
296
52
< 2yrs
96
16.8
2–4
147
25.8
> 4 yrs
31
5.4
Type of pregnancy
Single
549
96.3
Multiple
21
3.7
Initiation of breastfeeding
Yes
503
88.2
No
67
11.8
Pregnancy-related disease
Yes
119
20.9
No
451
79.1
Preeclampsia
Yes
112
19.6
No
458
80.4
Diabetic Mellitus
Yes
2
0.4
No
568
99.6
Urinary tract infection
Yes
22
3.9
No
548
96.1
Preeclampsia and UTI
Yes
15
12.6
Diabetic Mellitus and preeclampsia
yes
1
0.84
Premature Rupture of membrane
Yes
218
38.2
No
352
61.8
Prolonged PROM
No
421
73.9
Yes
149
26.1
Gestational Age
< 37 wks
186
32.6
≥ 37-42wks
327
57.4
> 42 wks
17
3.0
Unknown
40
7.0
Mode of Delivery
SVD
330
57.9
Instrumental
17
3.0
C/S
223
39.1
Health service care related characteristics
The majority of the mothers, 558 (97.9%), get a skilled birth attendant. In terms of delivery place, 558 (97.9%) were delivered at health facilities including health centers and hospitals, and 12(2.1%) were delivered at home.
Neonatal related characteristics
More than half, 347 (60.9%), of neonates admitted to NICU in the study period were male. The majority 478 (83.8%) admitted when they were less than one day old. Most, 372(65.3%), neonates weighed more than 2,500 gm at admission. According to the APGAR measure of the neonates, most, 296 (52%) were having an APGAR score between 7 & 10 in the 1st minute. On the other hand, the APGAR 5th score of the majority, 424 (74.4%), of the neonates was also found between 7 & 10 (Table 3).
Table 3
Characteristics of neonates admitted to NICU at Gandhi Memorial Hospital from Nov 1 to December 31, 2019, Addis Ababa, Ethiopia (n = 570)
Variable
Category
Frequency
Percentage (%)
Sex of the baby
Male
347
60.9
Female
223
39.1
Age at admission
≤ 1 day
478
83.8
2–7 days
91
16
8–28 days
1
0.2
Birth weight at admission
< 2500 g
198
34.7
≥ 2500 g
372
65.3
APGAR score at 1st minute
≥ 7–10
296
52
4–6
161
28.2
0–3
93
16.3
Unknown
20
3.5
APGAR score at 5th minute
≥ 7–10
424
74.4
4–6
80
14
0–3
46
8.1
Unknown
20
3.5
Medical diagnosis and causes of neonatal death
There were different medical diagnoses made for the neonates during admission to NICU. The most prevalent cause of neonatal admission was sepsis (41.8%), respiratory distress syndrome (RDS) (34.3%), low birth weight (25%), and preterm birth (24%) (Fig. 1).
Fig. 1
Medical diagnosis of neonates admitted to NICU at Gandhi Memorial Hospital from Nov 1– Dec 31, 2019, Addis Ababa, Ethiopia. (n = 570). Key RDS = Respiratory Distress, LBW = Low Birth Weight
×
Prevalence and cause of neonatal mortality
Out of all neonates included in this study, 44(7.7%) (95% CI: 5.7, 9.8) neonates died from November 1 to December 31, 2019. Almost half (45.5%) of the neonates died because of respiratory distress which is followed by prematurity which accounts for 27.3%, sepsis which accounts for 11.4%, cardiac arrest for 9.1%, and congested heart failure for 6.8%.
Factors associated with neonatal mortality
Among the variables included in the multivariable analysis, maternal educational status, PROM, and birth weight had a significant association with neonatal mortality. The odds of having neonatal mortality for neonates from non-educated mothers is 3.37 ((AOR: 3.37; 95% CI: 1.02, 11.20) times higher compared to neonates from educated mothers The odds of having neonatal mortality for neonates of Mothers with prolonged PROM is 5.59 ((AOR: 5.59; 95% CI:1.05, 29.76) times higher than neonates of mothers not having prolonged PROM. On the other hand, the odds of neonatal mortality among neonates with a birth weight less than 2500gm is 3 (( AOR: 3.23;95% CI:1.17,8.90) times higher compared to neonates whose birth weight is 2500gm and above (Table 4).
Table 4
Bi variable and multivariate logistic regression analyses for neonatal mortality among neonates who were admitted to Gandhi memorial hospital Addis Ababa, 2019 (n = 570)
Variable
Category
Neonatal Death
COR(95%CI)
AOR(95%CI)
Died
Not died
Age of Mother
≤ 24
8(4.2%)
183(95.8%)
0.17(0.05,0.526)
0.21(0.03,1.27)
25–29
19(7.5%)
233(92.5%)
0.31(0.11,0.86)
0.55(0.12,2.64)
30–34
11(11.2%
87(88.8%)
0.49(0.16,1.450)
0.30(0.05,1.90)
≥ 35
6(20.7%)
23(79.3%)
1
1
Educational Status
No education
17(20%)
68(80%)
4.27(1.91,9.581)
3.37(1.02,11.20)*
Primary Education
5(4.3%)
112(95.7%)
0.76(0.26,2.25)
0.96(0.20,4.52)
Secondary Education
11(6.5%)
158(93.5%)
1.19(0.50,2.82)
0.54(0.12,2.31)
Above Secondary Education
11(5.5%)
188(94.5%)
1
1
Pregnancy-Related Disease
Yes
15(12.6%)
104(87.4%)
2.10(1.09,4.06)
0.78(0.20,3.08)
No
29(6.4%)
422(93.6%)
1
1
Prolonged PROM
No
21(14%)
400(86%)
1
1
Yes
23(15.4%)
126(84.6%)
5.66(1.29,24.77)
5.59(1.05,29.76)*
Birth Weight
< 2500
26(13.1%)
172(86.9%)
2.97(1.59,5.57)
3.23(1.17,8.91)*
≥ 2500
18(4.8%)
354(95.2%)
1
1
Hypoglycemia
Yes
3(37.5%)
5(62.5%)
7.62(1.76,33.04)
1.40(0.11,17.35)
No
41(7.3%)
521(92.7%)
1
1
Hypothermia
Yes
5(19.2%)
21(80.8%)
3.08(1.10,8.62)
2.53(0.49,13.21)
No
39(7.2%)
505(92.8%)
1
1
Respiratory Distress
Yes
28(14.3%)
168(85.7%)
3.73(1.96,7.08)
2.24 (0.74,6.83)
No
16(4.3%)
358(95.7%)
1
1
Preterm Birth
Yes
17(12.4%)
120(87.6%)
2.13(1.12,4.04)
1.74(0.33,9.03)
No
27(6.2%)
406(93.8%)
1
1
Apgar 1st
≥ 7–10
0(0.0%)
296(100%)
1
1
4–6
8(5%)
153(95%)
4.07(1.67,9.95)
1.56(0.40,6.04)
0–3
27(29%)
66(71%)
6.88(2.70,17.50)
0.60(0.02,19.30)
Unknown
9(45%)
11(55%)
10.64(3.94,28.70)
2.25(0.25,20.00)
Apgar 5th
≥ 7–10
0(0.0%)
424(100%)
1
1
4–6
27(33.8%)
53(66.2%)
10.04(4.90,20.60)
2.66(0.71,9.88)
0–3
8(17.4)
38(82.6)
3.23(1.12,9.31)
2.18(0.47,10.0)
Unknown
9(45%)
11(55%)
9.22(2.27,37.66)
9.65(0.93,100.5)
1 = Reference, * = P < 0.05, PROM Premature rapture of membrane
Bold = significant categories
Discussion
This study assesses the prevalence and associated factors of neonatal mortality among newborns admitted to NICU in Gandhi memorial hospital. The prevalence of neonatal mortality was 7.7 (95% CI: 5.7, 9.8). Being a Non-educated mother, prolonged PROM and low birth weight at delivery were significantly associated with neonatal mortality.
The prevalence of neonatal mortality in this study was 7.7 (95% CI: 5.7, 9.8). It was lower than a study conducted in Bahir Dar (13.29) [14], Jimma (35.5%) [15], India (26.26) [16], and Congo (47%) [17]. The possible explanation for the difference can be the difference in the study design, and study setting. For example, evidence from Jimma was generated by a community-based prospective follow-up study [15]. Being community-based will help the investigators to trace the hidden mortality that occurs without getting medical care at home and being a prospective follow-up study will increase the chance of getting appropriate evidence over a long period [15, 16]. Evidence from India was from a prospective follow-up study on neonates of 24hs old admitted at NICU [18]. It is obvious that the highest percentage of neonatal mortality occurs within the 1st 24 h of life and being admitted exacerbates the rate of mortality. In the India study, the leading causes of mortality were higher (low birth weight babies were 63.5% and respiratory distress was present in 47.2% of neonates) [18] compared to the current study.
Our finding is almost comparable with a study conducted in Northern Ethiopian, Ayder referral hospital (6.6%) [19].
But it was higher than a study conducted in Zambia (3.4%) [20]. This variation in the result of neonatal mortality might be due to the difference in the study population. In our study, the study populations were all neonates admitted to ICU whereas, in Zambia, they were all live births. Admitted neonates have a high chance of being died as compared to non-admitted and relatively healthy neonates.
Maternal education was one of the factors associated with neonatal mortality. Newborns whose mothers were illiterate or non-educated were almost more than threefold times higher risk of having neonatal mortality when compared with educated or literate mothers. This finding is in line with a study conducted in Zambia and a systematic review conducted in Ethiopia that infants born to mothers with lower education were associated with increased odds of dying [20, 21]. The above systematic review showed that attending primary education was associated with a 28% reduction and attending secondary education and above was associated with a 45% reduction in the odds of infant mortality compared to those infants born to illiterate mothers [21] The possible explanation for this could be, Education levels can influence newborn survival by affecting reproductive behavior and improving mothers' health-care seeking behavior in areas such as contraception, nutrition, hygiene, preventative care, and disease treatment [22]. Educated mothers also provide better care for themselves during pregnancy and for their children during the most vulnerable stages of their lives than non-educated mothers [23] which can enhance the survival of neonates.
In this finding, mothers having prolonged PROM have higher odds of neonatal mortality compared to mothers who had no prolonged PROM. This finding is consistent with studies conducted in Jimma and Arbaminch that premature and prolonged rupture of membrane before the onset of labor > 12 h had increased the likelihood of neonatal death [9, 24]. This might be as the time of rupture of membrane increases, the risk of respiratory distress and sepsis for a neonate with a PROM mother will increase [25]. PPROM is associated with neonatal death due to prematurity complications, infection, and pulmonary hypoplasia [26]. Evidence from the International federation of gynecology and obstetrics (FIGO) shows, PPROM can contribute for about 20% of all perinatal death. It also leads to significant perinatal morbidity associated with prematurity such as respiratory distress syndrome, neonatal sepsis, umbilical cord prolapse, placental abruption, and fetal death [27].
The other finding of this study was low birth weight. The odds of neonatal mortality among birth weight less than 2,500 g were almost threefold higher as compared to birth weight greater than 2,500 g. This finding is supported by studies conducted in Bangladesh [28] Nigeria [29] and Assosa [30] Zone that found neonates born at low birth weights were at a higher high risk of death compared to normal birth weight neonates.. This may be the case in that babies with low birth weight might be unable to cope-up with a new environment and possible infections and as a result, could be at risk of neonatal death as compared to normal birth weight. Another possible explanation can be, that small size neonates were highly susceptible to different infections due to having low immunity defense [30].
Limitation of the study
Since this study was conducted in a hospital sample that may be different from the general population; it may not be inferred to neonates who are dying out of the health institution.
Conclusion
The prevalence of neonatal mortality at Gandhi memorial hospital was generally high. As our finding revealed, neonates who are underweight and whose mothers have no formal education as well as have prolonged PROM have higher odds of neonatal mortality. Thus, clinicians, policymakers, and program managers should give special attention to neonates of none educated mothers, mothers with prolonged PROM, and neonates with low birth weight.
Acknowledgements
The authors would like to thank all the study participants, data collectors, supervisors, the staff of Gandhi memorial hospital, especially the staff of the neonatology unit, and all other individuals involved in the process of this study.
Declarations
Ethics approval and consent to participate
The Ethical clearance letter was obtained from the Institutional Review Board (IRB) of University of Gondar, College of Medicine and Health Sciences, and Institute of Public Health (IRB. No_/IPH/676/2/2019) (Additional file 1). Permission was asked from Gandhi memorial hospitals administration before the kick-off of the project. Informed consent was obtained from all participants. Illiterate mothers assured their consent by putting their signature using a finger button after the consent form was read to them by the persons they trust more. The information about the study participants was kept confidential. It's believed that there was no anticipated harm to the participants except for their time at the time of data collection. All methods of this research were done following the declaration of Helsinki.
Consent for publication
Not applicable.
Competing interests
The author(s) declared no conflicts of interest concerning the authorship and/or publication of this article.
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Neonatal mortality and associated factors among neonates admitted to neonatal intensive care unit of Gandhi memorial hospital in Addis Ababa, Ethiopia, 2019
Wer ihn je erlebt hat, wird ihn nicht vergessen: den Schmerz, den die beim Öffnen oder Schließen des Reißverschlusses am Hosenschlitz eingeklemmte Haut am Penis oder Skrotum verursacht. Eine neue Methode für rasche Abhilfe hat ein US-Team getestet.
Laut einer Studie aus den USA und Kanada scheint es bei der Reanimation von Kindern außerhalb einer Klinik keinen Unterschied für das Überleben zu machen, ob die Wiederbelebungsmaßnahmen während des Transports in die Klinik stattfinden oder vor Ort ausgeführt werden. Jedoch gibt es dabei einige Einschränkungen und eine wichtige Ausnahme.
Welchen Einfluss das Alter ihrer Mutter auf das Risiko hat, dass Kinder mit nicht chromosomal bedingter Malformation zur Welt kommen, hat eine ungarische Studie untersucht. Sie zeigt: Nicht nur fortgeschrittenes Alter ist riskant.
Ob ungeborene Kinder, die kleiner als die meisten Gleichaltrigen sind, schneller wachsen, wenn die Mutter sich mehr ausruht, wird diskutiert. Die Ergebnisse einer US-Studie sprechen dafür.
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