Determinants of birth asphyxia among live birth newborns in University of Gondar referral hospital, northwest Ethiopia: A case-control study.

Lisanu Wosenu,Abebaw Addis Gelagay,Abebaw Gebeyehu Worku,Destaw Fetene Teshome,Sarah Saleem

doi:10.1371/journal.pone.0203763

Abstract

BackgroundBirth asphyxia, which accounts for 31.6% of all neonatal deaths, is one of the leading causes of such mortality in Ethiopia. Early recognition and management of its contributing factors would modify the problem. Thus, this study aimed to identify the determinants of birth asphyxia among live births at the University of Gondar Referral Hospital, northwest Ethiopia.MethodsA hospital-based unmatched case-control study was conducted from April to July 2017.Cases were newborn babies with an APGAR score of < 7at 5 minutes of birth; controls were newborn babies with an APGAR score of ≥7 at 5 minutes of birth. Every other asphyxiated baby was selected as a case and every 6th non-asphyxiated baby as a control. A pretested structured questionnaire was used to collect data on maternal sociodemographic characteristics. A pretested structured checklist was used to retrieve data on ante-partum, intra-partum, and neonatal factors of both cases and controls. Data were entered using Epi Info 7 and analyzed using SPSS 20. The bivariate logistic regression analysis was used to identify the relation of each independent variable to the outcome variable. Variables with p values of up to 0.2 in the bivariate analysis were considered for the multiple logistic regression analysis. An adjusted odds ratio (AOR) with a 95% CI and p-value of <0.05 was used to identify significant variables associated with birth asphyxia.ResultsIn this study, prolonged labor (AOR = 2.75, 95% CI: 1.18, 6.94), cesarean section delivery (AOR = 3.58, 95% CI: 1.13, 11.31), meconium stained amniotic fluid (AOR = 7.69, 95% CI: 2.99, 17.70), fetal distress (AOR = 5.74, 95% CI: 1.53, 21.55), and low birth weight (AOR = 7.72, 95% CI: 1.88, 31.68) were factors which significantly increased the odds of birth asphyxia.ConclusionProlonged labor, cesarean section (CS) delivery, meconium stained amniotic fluid (AF), fetal distress, and low birth weight were the determinants of birth asphyxia. Thus, efforts should be made to improve the quality of intra-partum care services in order to prevent prolonged labor and fetal complications, and to identify and make a strict follow up on mothers with meconium stained amniotic fluid.

Highlights

The first 28 days of life and neonatal period are the most vulnerable times for a child’s survival [1]
2.99, 17.70), fetal distress (AOR = 5.74, 95% confidence intervals (CI): 1.53, 21.55), and low birth weight (AOR = 7.72, 95% CI: 1.88, 31.68) were factors which significantly increased the odds of birth asphyxia
Cesarean section (CS) delivery, meconium stained amniotic fluid (AF), fetal distress, and low birth weight were the determinants of birth asphyxia

Summary

Introduction

The first 28 days of life and neonatal period are the most vulnerable times for a child’s survival [1]. About one million of them passed away on their first day of life, and more than two thirds (38%) of the deaths were in sub-Saharan Africa[2]. One of the countries with the highest neonatal mortality in the world, is responsible for 29 deaths per 1,000 live births[3]-over 9 times more than that of highly developed countries, where the rate is3per 1,000 live births[2]. Birth asphyxia, defined as failure to initiate and sustain default breathing at birth[6], is one of the leading and preventable causes of neonatal mortality. Twenty-three percent of the deaths each year around the world[7] and 31.6% in Ethiopia are attributed to birth asphyxia[8]. Birth asphyxia, which accounts for 31.6% of all neonatal deaths, is one of the leading causes of such mortality in Ethiopia. This study aimed to identify the determinants of birth asphyxia among live births at the University of Gondar Referral Hospital, northwest Ethiopia.

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