Maternal Socio-Demographic Characteristics
A total of 698 admitted neonates during study period were included for further analysis. The present study shows that more than half 365 (52.3%) of mothers of neonates came from the urban areas while 333 (47.7%) were from rural. Maternal age was documented for 612 (87.7%), of which 51 (6.9%) of mothers were below age 20. From 698 mothers their median age was 27 years with an interquartile range of 10 years.
Obstetrics Characteristics
More than three fourth (74.1%) of mothers had ANC follow-up and 23.6% of mothers had 4 and above ANC visits. There were 269 (38.5%) primiparous mothers and 325 (46.6%) were multiparous mothers. There were 40 (5.7%) mothers with a history of neonatal death. The majority of 639 (91.5%) mothers had singleton pregnancy. The majority 590 (84.5%) of the neonates were delivered at the hospital while 32 (4.6%) of neonates were delivered at home. Among 698 delivered neonates, 161 (23.1%) of neonates were delivered by Cesarean section. Six hundred fifty-seven (94.1%) of neonates were born within 24 hours of the start of labor (Table 1).
Table 1
obstetrics characteristics mothers who gave birth to neonates admitted to HFSUH, Harar Ethiopia, 2020
Variables
|
Category
|
Frequency
|
Percentage
|
ANC follow-up (n = 698)
|
Yes
No
|
517
181
|
74.1
25.9
|
Number of ANC visit (n = 517)
|
≤Three
≥Four
|
395
122
|
76.4
23.6
|
Gravidity (n = 698)
|
Primigravida
Multigravida
Grand multi gravida
|
283
319
96
|
40.5
45.7
13.8
|
Number of gestations (n = 698)
|
Singleton
Multiple
|
639
59
|
91.5
8.5
|
History of neonatal loss(n = 698)
|
Yes
No
|
40
658
|
5.7
94.3
|
Place of delivery (n = 698)
|
Home
Health center
Hospital
|
32
76
590
|
4.6
10.9
84.5
|
Onset of labor (n = 698)
|
Spontaneous
Induced
C/S before onset
|
623
38
37
|
89.3
5.4
5.3
|
Duration of labor (n = 698)
|
< 24 hour
≥24 hour
|
657
41
|
94.1
5.9
|
Mode of delivery (n = 698)
|
SVD
C/S
Instrumental
|
508
161
29
|
72.8
23.1
4.2
|
ANC-Antenatal Care, SVD- Spontaneous Vaginal delivery, C/S-Cesarean Section |
One hundred ninety-four (27.8%) mothers experience obstetric complications during the current pregnancy (Fig. 2).
Almost one third (30.7%) of mothers experience an obstetrical complication during labor and delivery. The most common obstetrical complications were Eclampsia 49 (23%), Hemorrhage 47 (22.1%), Prolonged labor 47 (22%), Sepsis 34 (16%), and Obstructed labor 22 (10.3%).
Neonates Characteristics
Three hundred eighty-four (55%) neonates were males. More than two-thirds (69.1%) of neonates were admitted within 24 hours of life. The median age at admission was 9.5 hours with an interquartile range of 71 hours. Most 660 (80.4%) of neonates stayed at the hospital for less than 7 days. The median hospital stay was 72 hours with an interquartile range of 120 hours. APGAR score was documented for 674 (82.1%) of neonates. Out of those, a low APGAR score was recorded for 129 (19.1%) and 24 (3.6%) of neonates in the 1st and 5th minute respectively. Birth weight was documented for 613 (87.8%) neonates. Among those, one hundred eighty-six (30.3%) neonates were low birth weight, 39 (6.4%) neonates were very low birth weight and, 2 (0.3%) neonates were extremely very low birth weight. More than half (500, 71.6%) of neonates were term while 198 (29.4%) of neonates were preterm (Table 2).
Table 2
Characteristics of neonates admitted to HFSUH, Harar, Ethiopia, 2020
Variable
|
Category
|
Frequency
|
Percentage
|
Sex of neonate (n = 698)
|
Male
Female
|
384
314
|
55
45
|
Age of neonates (n = 698)
|
< 24 hours
24–168 hours
≥168 hours
|
402
186
110
|
57.6
26.6
15.8
|
Birth weight recorded (n = 698)
|
Yes
No
|
613
85
|
87.8
12.2
|
Birth weight (n = 613)
|
Normal
LBW
VLBW
EVLBW
Macrosomia
|
361
186
39
2
25
|
58.9
30.3
6.4
0.3
4.1
|
APGAR score documented (n = 698)
|
Yes
No
|
572
126
|
81.9
18.1
|
APGAR score on 1st minute (n = 572)
|
Low
Moderate
Normal
|
94
234
244
|
16.4
40.9
42.7
|
APGAR score on 5th minute (n = 572)
|
Low
Moderate
Normal
|
8
169
395
|
1,4
29.5
67.1
|
Length of stay at hospital (n = 698)
|
< 7days
≥7days
|
576
122
|
82.5
17.5
|
Gestational age (n = 698)
|
Preterm
Term
|
198
500
|
28.4
71.6
|
LBW = Low Birth weight, VLBW = Very Low Birth Weight, EVLBW = Extreme Very Low Birth Weight, APGAR = Appearance Pulse Grimace Activity Respiration. |
Neonatal Morbidity at Admission
More than half (387,55.4%) of admissions were due to neonatal sepsis. Of those,62 died, accounting for 51 % of total neonatal mortality. On the other hand, hypothermia accounts for 251 (36%) of admissions. Low birth weight was the third cause of admission to NICU, 35.2% and 50% of neonatal admissions and deaths respectively (Table 3).
Table 3
Common causes of neonatal admission to NICU of HFSUH, Harar, Ethiopia, 2020 (n = 698)
Variable
|
Category
|
Frequency
|
Percentage
|
Prematurity
|
Yes
No
|
198
500
|
28.4
71.6
|
Low birth weight
|
Yes
No
|
246
452
|
35.2
64.8
|
Neonatal sepsis
|
Yes
No
|
387
311
|
55.4
44.6
|
Congenital malformations
|
Yes
No
|
32
666
|
4.6
95.4
|
Respiratory distress syndrome
|
Yes
No
|
34
664
|
4.9
95.1
|
Perinatal asphyxia
|
Yes
No
|
163
535
|
23.4
76.6
|
Hypothermia
|
Yes
No
|
251
447
|
36
64
|
Hypoglycemia
|
Yes
No
|
98
600
|
14
86
|
Pathologic jaundice
|
Yes
No
|
53
645
|
7.6
92.4
|
Meconium aspiration syndrome
|
Yes
No
|
73
625
|
10.5
89.5
|
Hemorrhagic diseases of newborn
|
Yes
No
|
28
670
|
4
96
|
Birth trauma
|
Yes
No
|
18
680
|
2.6
97.4
|
Others
|
Yes
No
|
50
648
|
7.2
92.8
|
*others: Anemia, Necrotizing enterocolitis, Impetigo, Shock, and Neonatal seizure. |
Treatment given for Admitted Neonates
Antibiotics were given for more than half 485 (69.5%) of admitted neonates. The most frequently administered one being a combination of ampicillin and gentamycin 346 (71.3%). Other combinations were found to be ampicillin with ceftriaxone 54 (11.1%) and vancomycin with cefotaxime 31 (6.4%). Oxygen and glucose were administered for 437 (62.6%) and 392 (56.2%) neonates respectively (Fig. 3).
Treatment Outcome of Neonates
From a total of 698 admitted neonates during the two years, 594 of them were improved, 104 neonates were died (Fig. 4). The proportion of neonatal death become 14.9% (95% CI:12.3,17.9). Neonatal sepsis (51%), low birth weight (49%) and prematurity (42.3%) were identified as a leading cause of neonatal death. Other causes of neonatal death include perinatal asphyxia 43 (41.3%), multi-organ failure 25 (24%), and respiratory failure 15 (14%).
Pattern of neonatal mortality
More than three fourth of the deaths (76, 73%) occurred within the first 24 hours of age and 11% of death occurs within 72 hours of age. The death pattern declined as the age of the child crossed 72 hours (Fig. 5).
Factors Associated with Treatment Outcome of Admitted Neonates
In the bivariate model, treatment outcome was significantly associated with residency, ANC follow-up, complication during pregnancy, complication during labor and delivery, place of delivery, prematurity, LBW, sepsis, perinatal asphyxia, pathologic jaundice, respiratory distress syndrome, APGAR score on the 1st minute, neonatal resuscitation, glucose, oxygen, phototherapy, and length of hospital stay.
To control the effect of confounders variables including residency, presence of ANC follow-up, complication during labor and delivery, place of delivery, APGAR score on 1st minute, prematurity, LBW, neonatal sepsis, RDS, neonatal resuscitation, phototherapy, oxygen, and glucose were selected for the final model. Residency, LBW, neonatal sepsis, RDS, phototherapy, and oxygen were significantly associated with treatment outcome.
The multivariable analysis showed that the odds of neonatal death among mothers of neonates who come from the rural area were 2.3 times higher than that of mothers of neonates who come from the urban area [ AOR = 2.30, 95%CI: (1.3, 4.12)]. The odds of death among newborns who had low birth weight were 2.5 times that of neonates who did not have the conditions [AOR = 2.52, 95%CI: (1.24,5.13))]. Neonates with a diagnosis of respiratory distress had 2.86 times higher odds of death compared to those neonates without RDS [AOR = 2.86, 95%CI:(1.11.7.35)]. The odds of death among neonates who had neonatal sepsis were 2.48 times that of neonates who did not have the conditions [AOR = 2.48, 95%CI: (1.40, 4.38)]. Neonates treated with phototherapy and oxygen had 0.22, and 0.47 times less likely to die than neonates without those conditions [AOR = 0.22, 95% CI:(0.088,0.54)], [AOR = 0.47,95%CI:(0.22,0.99)] respectively (Table 4).
Table 4
Factors associated with treatment outcome at Hiwot Fana Specialized University Hospital, Harar, Ethiopia, 2020 (n = 698)
Variables
|
Treatment outcome
|
Improved
|
Died
|
COR (95% CI)
|
AOR (95%CI)
|
Residency
|
Urban
|
303
|
30
|
1
|
1
|
Rural
|
291
|
74
|
2.57(1.63,4.04) **
|
2.30(1.3, 4.12) *
|
ANC follow-up
|
Yes
|
451
|
66
|
1
|
1
|
No
|
143
|
38
|
1.82 (1.17,2.81) *
|
1.24(0.70, 2.21)
|
Complication during labor and delivery
|
No
|
429
|
55
|
1
|
1
|
Yes
|
165
|
49
|
2.32(1.52,3.54) **
|
1.70(0.90,2.88)
|
APGAR score on 1st minute
|
Reassuring
|
221
|
23
|
1
|
1
|
Moderate
|
193
|
41
|
2.04(1.44,5.28)
|
1.55(0.83,2.88)
|
Low
|
73
|
21
|
2.76 (1.18,3.52) *
|
2.03(0.87,4.77)
|
Prematurity
|
No
|
448
|
52
|
1
|
1
|
Yes
|
146
|
52
|
3.07(2.01,4.70) **
|
1.10(0.53,2.28)
|
LBW
|
No
|
414
|
38
|
1
|
1
|
Yes
|
180
|
66
|
4.0(2.60,6.2) **
|
2.52(1.24,5.13) *
|
Sepsis
|
No
|
273
|
38
|
1
|
1
|
Yes
|
321
|
66
|
1.48 (1.07,2.6)
|
2.48(1.40, 4.38) *
|
RDS
|
No
|
572
|
92
|
1
|
1
|
Yes
|
22
|
12
|
3.4(1.61,7.10) **
|
2.86(1.11.7.35) *
|
Resuscitation
|
Yes
|
118
|
32
|
1
|
|
No
|
476
|
72
|
0.56(0.35,0.88) *
|
0.61(0.311,1.81)
|
Phototherapy
|
Yes
|
37
|
14
|
1
|
1
|
No
|
557
|
90
|
0.43(0.22,0.82) *
|
0.22(0.088,0.54) **
|
Oxygen
|
Yes
|
353
|
84
|
1
|
1
|
No
|
241
|
20
|
0.35(0.21,0.58) **
|
0.47(0.22,0.99) *
|
Glucose
|
Yes
|
312
|
80
|
1
|
|
No
|
282
|
24
|
0.33(0.21,0.54) **
|
0.69(0.35,1.35)
|
*Significant with P < 0.05 and ** Significant with P < 0.001, CI = Confidence Interval, COR = Crude Odds Ratio, AOR = Adjusted Odds ratio, APGAR: Appearance Pulse Grimace Activity Respiration; LBW: Low Birth Weight; RDS Respiratory Distress Syndrome. |