Birth asphyxia is defined by the World Health Organization (WHO) as ‘the failure to initiate and sustain breathing at birth [1]. It is a major contributor to the neonatal mortality worldwide [2-5], and it contributes to 24% of all neonatal deaths [3] and 11% of deaths of those under 5 years worldwide [2]. Almost all asphyxia-related deaths (98%) occur due to asphyxia that occurred in the first week of life [6]. About 75% of the total asphyxia-related deaths were caused on the first day alone. Less than 2% of these deaths occurred after 72 hours of birth [5].
Birth asphyxia is a leading cause of brain damage. If severe, it can injure brain cells and cause potentially fatal conditions, including
hypoxic-ischemic encephalopathy,
brain injuries, autism, attention deficit hyperactivity disorder, behavioral problems, seizures, and
cerebral palsy [7]. Additionally, survivors often face lifelong health problems (80%), such as disabilities, developmental delays, palsy, mental retardation, intellectual disabilities and behavioral problems [7-9]. Furthermore, it places financial and emotional burdens on the concerned families and communities as a whole [7].
Birth asphyxia is caused by a complex range of factors, which vary between industrialized and non-industrialized countries. The factors are grouped as occurring before birth (antepartum factors) (50–70%), during birth (intra-partum factors) (20–40%) and after birth (post-partum factors) (10%) [10, 11]. Antepartum factors include severe maternal hypotension or hypertensive diseases during pregnancy [12, 16], antepartum hemorrhage [13, 14], history of still birth [15], no antenatal care follow up or antenatal care visits [13, 15, 16], oligohydramnios [16], maternal fever [12, 13, 16, 17] and maternal anemia [12, 15, 16]. Intrapartum factors including malpresentation [12, 13, 15, 16 ,35], prolonged second stage of labor [13,14,18], home delivery [12,17], obstructed labor( [12,17,19], oxytocin use [14] and meconium stained amniotic fluid [12, 15 - 17]. Fetal factors associated for birth asphyxia include low birth weight [12, 17, 16], large birth weight [18], multiple gestation [16], tight nuchal cord [13, 18], preterm delivery [12, 16, 18], resuscitation and fetal distress [16, 32].
In addition, some studies revealed that young age [12, 17, 21], advanced maternal age [20], and educational status (illiterate and primary education level) [15, 21] are contributing factors of birth asphyxia. The concept that difficult birth is the main reason of birth asphyxia and subsequent squeal has in industrialized countries been challenged the recent years. However, in developing countries intrapartum, events still are the most important cause of birth asphyxia [9].
The Federal Ministry of Health (FMOH) developed the first comprehensive National Child Survival Strategy (2005-2015) in 2005, aiming to reduce under-five mortality by two thirds. Since its development in 2005, several evidence-based interventions that need to be incorporated in the strategy have been initiated. These include community management of pneumonia through Integrated Community Case Management; community-based newborn sepsis management through the Community Based Newborn Care; Newborn Intensive Care Unit; Newborn Corner; and introduction of Hemophilus Influenza, Pneumococcal, and shifting PMTCT to “Option B+” [22]. The guidelines to treat birth asphyxia are also well established in Ethiopia and made available even at the health-center level to assess by classifying [23].
Despite this a high proportion of newborn deaths due birth asphyxia was reported in Ethiopia. From the observations thus far, the issue of birth asphyxia remains unresolved. Ethiopia’s rate of neonatal mortality is still among the highest in Sub Saharan Africa [24, 25]. In 2015, nearly 240 babies in their first month died each day [26]. Birth asphyxia is the leading cause of neonatal deaths and accounts about 31.6% of neonatal mortality, followed by preterm birth (21.8%) and sepsis (18.5%) [27]. Moreover, the findings from studies conducted in Tigray [28] and Gondor [29] to identify causes of neonatal mortality revealed that birth asphyxia was responsible for 35% and 12.5% of neonatal deaths, respectively.
Analysis of birth asphyxia is important because it may reveal possible statuses leading to the birth asphyxia, which, if acted upon, may benefit a child’s health. Therefore, this study aimed to assess the magnitude and risk factors of birth asphyxia among neonates delivered in the Negist Eleni Mohammed memorial teaching Hospital, Southern Ethiopia.