Study area and period: The study was conducted in Debre Berhan referral hospital at Debre Berhan town. It is located in North Shoa Zone, Amara regional state, North East part of Ethiopia. It is 130 km far from the capital city Addis Ababa, and 695 km far from the regional city Bahir Dar. It is one of the largest public referral hospitals in the zone, providing preventive, curative and rehabilitative services to about more 3 million people in the catchment area. It also provides delivery service 24 hours a day, 7days a week by 24 midwives, 3 general practitioners and 4 gynecologists who assist about 3366 deliveries annually. In NICU ward there are 22 nurses, 3 general practitioners and 2 pediatricians. The total admission of NICU wards from 2019 report 1056 neonates 313 by birth asphyxia. The study was conducted from January 1st to March 30th, 2020.
Study design: An institution-based unmatched case-control study design was employed to assess determinants of birth asphyxia among newborns in Debre Berhan Referral Hospital.
Population: All newborns delivered in Debre Berhan referral hospital were the source population and all newborns delivered in the hospital during the study period were the study population. Newborns who had heart deformity and more than one malformation were excluded from the study.
Sample size determination: The sample size was determined by Epi Info 7 version software package for the unmatched case control study. By considering, 29.4% proportion of controls exposed and odds ratio of 2 for low gestational age from a previous study conducted in Ethiopia Tigray region [12], with an assumption of, 95% confidence interval, 80% power of the study, two- to- one control to cases ratio, and 5% non-response rate. The final sample size was 276 (92 cases and 184 controls).
Sampling procedure: A systematic random sampling technique was used to select the study participants. Every third study subjects were included for both cases and controls. On the first day of data collection the first study participant was taken by using simple random sampling technique from the registration book.
Data collection tools and procedure: The data were collected by using interviewer administered structured questionnaire adapted from different literatures [7, 12], and document review. The questionnaire was first prepared in English and translated to local language Amhric and back translates to English to keep its consistency. The questionnaire was pre-tested in another health facilities and essential amendment were made based on the results. Data were collected by four midwives and two supervisors who have en experience of work on neonatal intensive care unit of the hospital.
Operational definition:
Cases: When the newborn has at least one of the following signs, not breathing, gasping, < 30 breaths per minute or < 7 APGAR score [15].
Outcome variable: Birth asphyxia
Independent variable
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Socio demographic determinants: age, marital status, residence, educational status, maternal occupation
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Ante partum determinants: parity, pregnancy induced hypertension, anemia, ante-partum hemorrhage, ANC follow up, chronic disease
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Intra-partum determinants: fetal presentation, duration of labor, amniotic fluid, type of labor, mode of delivery, labor attendant, PROM
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Neonatal determinants: Sex, birth weight, gestational age
Data quality control: The quality of data was assured by using properly designed and validated questionnaire by expertise. Training was given for the data collectors and supervisors on how to collect the data for three days. Pre-testing was performed in another health facility and essential amendment was made on the questionnaire. The principal investigator and supervisors were made a day to day on site supervision and check the collected data for completeness, clarity and consistency.
Data processing and analysis: The data was coded and entered to Epi-data version 3.1 and exported to SPSS Version 21 for data analysis. Descriptive statistics were performed and presented in the form of means, standard deviations, frequencies and percentages. Binary logistic regression was computed to identify determinates of birth asphyxia. Variable which have p-value less than 0.25 in binary logistic regression analysis were transferred to multiple logistic regression model to see the relative effect of the confounder. Model goodness of fit test was checked by using Hosmer Lemeshow goodness of fit and Multicolinearity was assessed by variance inflation factor (VIF) among variables. Adjusted odd ratios with 95% confidence interval and P-value less than 0.05 was used to identify determinates of birth asphyxia.