Socio-demographic and behavioral characteristics
A total of 193 asphyxiated newborn-mother pairs (cases) and 193 non-asphyxiated newborn-mother pairs (controls) were included in the study. Infants’ mothers mean (±SD) age was 26.63(±5.09) years. Among the total study groups, 109(56%) of cases and 105(54%) of controls were in the age group of 25-34 years. Majority of respondents (182 (94%) of cases and 170(88%) of controls) were married. More than half of the respondents; i.e. 103(53%) of cases and 121(63%) of controls were came from urban area. Housewives and farmers constituted 133(69%) of cases and 101(52%) of controls. Sixty three (33%) of cases and 53(28%) of controls were at elementary school (1-8 grades). One hundred thirteen (59%) of cases and 95 (49%) of controls had less than 2000 ETB monthly incomes. Most of the cases and controls were come to hospitals from the nearby areas. All respondents did not have smoking behavior. Majority of cases and controls (374 (97%)) hadn’t ever khat chewing behavior. However, 62 (32%) of cases and 65 (34%) of controls had ever drunk alcohol during the last pregnancy (Table 1).
Maternal health related variables
Majorly 173 (90%) of cases and 177 (92%) of controls didn’t faced pre-eclampsia /eclampsia, however, 20 (10%) of cases and 16 (8%) of controls faced the problem. Eight (4%) of cases and 9(5%) of controls have HIV. Twenty two (9%) of cases and 14 (7%) of controls faced bleeding during their last pregnancy. Forty four (23%) of cases and 32(17%) of controls had iron-deficiency anemia. One hundred twenty four (64%) of cases and 89 (46%) of controls were referred from another health facilities (Table 2).
Antepartum and Intra-partum related variables
Among the total respondents, 91(47%) of mothers with cases and 105(54%) of mothers with controls experienced more than one pregnancies, however, 102(53%) of cases and 88(46%) of controls experienced their first pregnancies. Of the study units, 84(44%) of cases and 96(50%) of controls; and 109(57%) of cases and 97(50%) of controls were multiparous and primiparous respectively. Five (2.6%) of the cases and 16(8.3%) of controls had given twins during their last pregnancy. Nearly 189(98%) of cases and 188(97%) of controls had antenatal care (ANC) visits. Of the total respondents, 88(46%) of cases and 67(35%) of controls experience prolonged labor during the last pregnancy. Of the infants’ mothers, 45 (23%) of cases and 27 (14%) of controls faced premature rapture of membranes before labor starts. Only 17 (9%) of cases and 12 (6%) of controls faced prolonged rapture of membranes after 24 hours. Very few number of study subjects (11 (6%) of cases and 4 (2%) of controls) faced cord prolapse. Twelve (13%) of cases and 7 (4%) of controls had breech presentation. Of the total subjects, 53(28%) of cases and 61(32%) of controls were delivered with cesarean section, and 38(20%) of cases and 15(8%) of controls were delivered with instrumental assisted. Few respondents (30 (16%) of cases and 5 (3%) of controls) got the delivery service at health centers (Table 3).
Of the total newborns, 117(61%) of cases and 104(54%) of controls are males. Among all sexes, 65(35%) of cases and 10(5%) of controls had low birth weight. Both preterm and post-terms contributed 43(22%) of cases and 17(9%) of controls. One hundred forty six (76%) of cases were unable to breath after birth, however, only 31(16%) of cases experienced spasm. The majority, 189 (98%) of cases were unable to suckle normally after birth, and 184 (95%) of cases were unable to cry after birth (Table 4).
Determinants of birth asphyxia
In binary logistic regression analysis, twenty seven variables were entered in the analysis and only twenty variables were identified as determinants of birth asphyxia (Table 6). The others theme of variables did not have association to birth asphyxia. Variables that have p< 0.2 in the bivariate analysis and enter to multivariable analysis were; maternal marital status, place of residence, occupation, education, distance from the hospitals, bleeding during pregnancy, iron-deficiency anemia, referral status, gravidity, multiple births, number of ANC visits, prolonged labor, premature rapture of membrane, cord prolapse, fetal presentation, mode of delivery, place of delivery, gestational age, sex of newborn, and birth weight. After adjustment, the determinants that have p<0.05 at 95% confidence interval are only prolonged labor, mode of delivery, place of delivery, and birth weight (Table 6).
Newborns born from mothers with prolonged labor were 2 times more likely to suffer from birth asphyxia as compared to their counterparts (AOR: 2.00, 95% CI: 1.20, 3.36). Newborns that were born using instrumental delivery were 3.03 times more likely to develop birth asphyxia than those delivered by vaginally (AOR: 3.03, 95% CI: 1.41, 6.49). Newborns that were born at health centers were 7.36 times more likely to develop birth asphyxia than those born at hospitals (AOR: 7.36, 95% CI: 2.44, 22.13). Newborns with low birth weight (2.5kg) had 8.94 higher odds of birth asphyxia than those of normal (>=2.5kg) at birth (AOR: 8.94, 95% CI: 4.08, 19.56) (Table 5).