The prevalence of birth asphyxia, associated factors and outcomes at a district Hospital in Kigali, Rwanda

Abstract

Neonatal mortality is the death of a newborn within the first 28 days of the life. Despite global efforts, neonatal mortality remains on the rise. It is estimated that 3 million neonates die within the first seven days of life and the highest number of those deaths (99%) occurs in LMICs (WHO, 2015:pp.1-6). The leading causes of neonatal mortality are prematurity, birth asphyxia (BA), and sepsis. Worldwide the neonatal mortality related to BA is 23% while it is at 41% in Rwanda (Liu et al., 2015:p.430 & MOH, 2014a:p:39). BA is an insult to the brain and other vital organs due to a decrease of oxygen before, during or immediately after birth (MOH, 2014b). The purpose of this study was to determine the prevalence, associated factors and outcomes of BA at adistrict hospital in Kigali, Rwanda. Methodology: A descriptive, retrospective, cross sectional study was done on 340 neonates admitted at the study site NICU in 2016. A valid and reliable data collection tool was used to collect data on researche variables. The analysis was done using SPSS version 20. The UR IRB ethical clearance was obtained prior to collect data. Results: BA was confirmed in 135 out of 340 (39.7%). Associated fetal factors were normal birth weight [OR: 12.982, p: 0.013*, CI: 1.7; 98.852]; term babies [OR: 2.279, p: 0.002*, CI: 1.081; 4.805]. Maternal factor was grand multigravida [OR: 5.266, p: 0.010*, CI: 1.500; 18.492]. Placental factors were normal duration of ROM [OR: 1.885, p: 0.049*, CI: 0.998; 3.560]; and meconium stained AF [OR: 3.562, p: 0.000*, CI: 1.881; 6.745]. Labor and birth factors identified were normal duration of labor [OR: 4.746, p: 0.042*, CI: 1.060; 21.257]; vaginal mode of delivery [OR: 2.762, p: 0.000*, CI: 1.675; 4.553]; Apgar score of at 5 minutes [OR: 5.186, p: 0.001*, CI: 2.004; 13.417]; no cry history in the first 5 minutes of life [OR: 38.811, p: 0.000*, CI: 16.267; 92.599]; resuscitation up to cardiac massage [OR: 2.598, p: 0.003*, CI: 1.595; 4.248] and ventilated babied [OR: 2.030, p: 0.003*, CI: 1.487; 2.679]. BA outcomes were early seizures at 52.6%; a prolonged NICU stay with a mean days of 7.6 (SD 6.1) and a high specific mortality at 87%. Conclusion: BA prevalence was found to be 39.7%. Several modifiable and non modifiable risk factors were identified. BA outcomes were found to be high mortality, early seizures, and prolonged hospital stay. Further researches are needed to generate knowledge towards the global target of ending preventable neonatal deaths (SDG3:2).