Demographics, clinical characteristics and neonatal outcomes in a rural Ugandan NICU

BMC Pregnancy and Childbirth

Maneesh Batra¹  Deborah Lester³  Ryan M McAdams¹  James Nyonyintono²  Christine Otai²  Tove Ryman⁴  Anna Hedstrom¹ 

[1] Department of Pediatrics, Division of Neonatology, University of Washington, Seattle, USA;Kiwoko Hospital, Luweero, Uganda;ISIS Foundation, Edmonds, USA;Department of Epidemiology, University of Washington, Seattle, USA

关键词: Low and Middle Income Countries;    Gestational age;    Birthweight;    Global health;    Low-resource settings;    Infant mortality;    Sick newborn care;    Neonatal mortality;    Millennium development goals;   

Others  :  1125462
DOI  :  10.1186/1471-2393-14-327

 received in 2013-10-31, accepted in 2014-09-09,  发布年份 2014

【 摘 要 】

Background

Ninety-six percent of the world’s 3 million neonatal deaths occur in developing countries where the majority of births occur outside of a facility. Community-based approaches to the identification and management of neonatal illness have reduced neonatal mortality over the last decade. To further expand life-saving services, improvements in access to quality facility-based neonatal care are required. Evaluation of rural neonatal intensive care unit referral centers provides opportunities to further understand determinants of neonatal mortality in developing countries. Our objective was to describe demographics, clinical characteristics and outcomes from a rural neonatal intensive care unit (NICU) in central Uganda from 2005–2008.

Methods

The NICU at Kiwoko hospital serves as a referral center for three rural districts of central Uganda. For this cross sectional study we utilized a NICU clinical database that included admission information, demographics, and variables related to hospital course and discharge. Descriptive statistics are reported for all neonates (<28 days old) admitted to the NICU between December 2005 and September 2008, disaggregated by place of birth. Percentages reported are among neonates for which data on that indicator were available.

Results

There were 809 neonates admitted during the study period, 68% (490/717) of whom were inborn. The most common admission diagnoses were infection (30%, 208/699), prematurity (30%, 206/699), respiratory distress (28%, 198/699) and asphyxia (22%, 154/699). Survival to discharge was 78% (578/745). Mortality was inversely proportional to birthweight and gestational age (P-value test for trend <0.01). This was true for both inborn and outborn infants (p < 0.01). Outborn infants were more likely to be preterm (44%, (86/192) vs. 33%, (130/400), P-value <0.01) and to be low birthweight (58%, (101/173) vs. 40%, (190/479), P-value <0.01) than inborn infants. Outborn neonates had almost twice the mortality (33%, 68/208) as inborn neonates (17%, 77/456) (P-value <0.01).

Conclusions

Understanding determinants of neonatal survival in facilities is important for targeting improvements in facility based neonatal care and increasing survival in low and middle income countries.

【 授权许可】

   
2014 Hedstrom et al.; licensee BioMed Central Ltd.

【 图 表 】

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【 参考文献 】

• [1]UNICEF, WHO, The World Bank, UN DESA/Population Division: Levels and Trends in Child Mortality—Report 2002. UNICEF; 2012.
• [2]United Nations, General Assembly: United Nations Millennium Declaration. A/RES/55/2 (18 September 2000), available from http://www.un.org/millennium/declaration/ares552e.pdf webcite
• [3]Lawn JE, Cousens S, Zupan J: 4 million neonatal deaths: When? Where? Why? Lancet 2005, 365(9462):891-900.
• [4]Lawn JE, Kinney MV, Black RE, Pitt C, Cousens S, Kerber K, Corbett E, Moran AC, Morrissey CS, Oestergaard MZ: Newborn survival: a multi-country analysis of a decade of change. Health Policy Plan 2012, 27 Suppl 3:iii6-iii28.
• [5]Montagu D, Yamey G, Visconti A, Harding A, Yoong J: Where do poor women in developing countries give birth? A multi-country analysis of demographic and health survey data. PLoS One 2011, 6(2):e17155.
• [6]Oestergaard MZ, Inoue M, Yoshida S, Mahanani WR, Gore FM, Cousens S, Lawn JE, Mathers CD, United Nations Inter-Agency Group for Child Mortality E, the Child Health Epidemiology Reference G: Neonatal mortality levels for 193 countries in 2009 with trends since 1990: a systematic analysis of progress, projections, and priorities. PLoS Med 2011, 8(8):e1001080.
• [7]Blanc AK, Wardlaw T: Monitoring low birth weight: an evaluation of international estimates and an updated estimation procedure. Bull World Health Organ 2005, 83(3):178-185.
• [8]Liu L, Johnson HL, Cousens S, Perin J, Scott S, Lawn JE, Rudan I, Campbell H, Cibulskis R, Li M, Mathers C, Black R, for the Child Health Epidemiology Reference Group of WHO and UNICEF: Global, regional, and national causes of child mortality: an updated systematic analysis for 2010 with time trends since 2000. Lancet 2012, 379(9832):2151-2161.
• [9]Haws RA, Thomas AL, Bhutta ZA, Darmstadt GL: Impact of packaged interventions on neonatal health: a review of the evidence. Health Policy Plan 2007, 22(4):193-215.
• [10]Carlo WA, Goudar SS, Jehan I, Chomba E, Tshefu A, Garces A, Parida S, Althabe F, McClure EM, Derman RJ, Goldenberg RL, Bose C, Krebs NF, Panigrahi P, Buekens P, Chakraborty H, Hartwel T, Wright LL, the First Breath Study Group: Newborn-care training and perinatal mortality in developing countries. N Engl J Med 2010, 362(7):614-623.
• [11]Rhee V, Mullany LC, Khatry SK, Katz J, LeClerq SC, Darmstadt GL, Tielsch JM: Maternal and birth attendant hand washing and neonatal mortality in southern Nepal. Arch Pediatr Adolesc Med 2008, 162(7):603-608.
• [12]Baqui AH, El-Arifeen S, Darmstadt GL, Ahmed S, Williams EK, Seraji HR, Mannan I, Rahman SM, Shah R, Saha SK, Syed U, Winch PJ, Lefevre A, Santosham M, Black RE: Effect of community-based newborn-care intervention package implemented through two service-delivery strategies in Sylhet district, Bangladesh: a cluster-randomised controlled trial. Lancet 2008, 371(9628):1936-1944.
• [13]Zaidi AK, Ganatra HA, Syed S, Cousens S, Lee AC, Black R, Bhutta ZA, Lawn JE: Effect of case management on neonatal mortality due to sepsis and pneumonia. BMC Public Health 2011, 11 Suppl 3:S13.
• [14]Darmstadt G, Bhutta Z, Cousens S, Adam T, Walker N, Debernis L: Evidence-based, cost-effective interventions: how many newborn babies can we save? Lancet 2005, 365(9463):977-988.
• [15]Klingenberg C, Olomi R, Oneko M, Sam N, Langeland N: Neonatal morbidity and mortality in a Tanzanian tertiary care referral hospital. Ann Trop Paediatr 2003, 23(4):293-299.
• [16]Sen A, Mahalanabis D, Singh AK, Som TK, Bandyopadhyay S: Impact of a district level sick newborn care unit on neonatal mortality rate: 2-year follow-up. J Perinatol 2009, 29(2):150-155.
• [17]Mwaniki MK, Gatakaa HW, Mturi FN, Chesaro CR, Chuma JM, Peshu NM, Mason L, Kager P, Marsh K, English M, Berkley JA, Newton CR: An increase in the burden of neonatal admissions to a rural district hospital in Kenya over 19 years. BMC Public Health 2010, 10:591. BioMed Central Full Text
• [18]Uganda Bureau of Statistics (UBOS) and ICF International Inc: Uganda Demographic and Health Survey 2011. Kampala, Uganda and Maryland: UBOS and Calverton, ICF International Inc; 2012.
• [19]Uganda Bureau of Statistics (UBOS) and Macro International Inc: Uganda Demographic and Health Survey 2006. Calverton, Maryland, USA: UBOS and Macro International Inc; 2007.
• [20]Lester DA: Development of a neonatal intensive care unit in Uganda, Africa. J Perinat Neonatal Nurs 2002, 16(3):84-92.
• [21]Omoigberale AI, Sadoh WE, Nwaneri DU: A 4 year review of neonatal outcome at the University of Benin Teaching Hospital, Benin City. Niger J Clin Pract 2010, 13(3):321-325.
• [22]Mukhtar-Yola M, Iliyasu Z: A review of neonatal morbidity and mortality in Aminu Kano Teaching Hospital, northern Nigeria. Trop Doct 2007, 37(3):130-132.
• [23]Owa JA, Osinaike AI: Neonatal morbidity and mortality in Nigeria. Indian J Pediatr 1998, 65(3):441-449.
• [24]Lawn JE, Lee AC, Kinney M, Sibley L, Carlo WA, Paul VK, Pattinson R, Darmstadt GL: Two million intrapartum-related stillbirths and neonatal deaths: where, why, and what can be done? Int J Gynaecol Obstet 2009, 107 Suppl 1:S5-S18. S19
• [25]United Nations Children’s Fund and World Health Organization: Low Birthweight: Country, regional and global estimates. New York: UNICEF; 2004.