Is facility based neonatal care in low resource setting keeping pace? A glance at Uganda's National Referral Hospital.

Yaser Abdallah,Yvonne Vaucher,Flavia Namiiro,Douglas Mcmillan,Jamir Mugalu,Jolly Nankunda

doi:10.4314/ahs.v16i2.2

Abstract

To identify reasons for neonatal admission and death with the aim of determining areas needing improvement. A retrospective chart review was conducted on records for neonates admitted to Mulago National Referral Hospital Special Care Baby Unit (SCBU) from 1(st) November 2013 to 31(st) January 2014. Final diagnosis was generated after analyzing sequence of clinical course by 2 paediatricians. A total of 1192 neonates were admitted. Majority 83.3% were in-born. Main reasons for admissions were prematurity (37.7%) and low APGAR (27.9%).Overall mortality was 22.1% (Out-born 33.6%; in born 19.8%). Half (52%) of these deaths occurred in the first 24 hours of admission. Major contributors to mortality were prematurity with hypothermia and respiratory distress (33.7%) followed by birth asphyxia with HIE grade III (24.6%) and presumed sepsis (8.7%). Majority of stable at risk neonates 318/330 (i.e. low APGAR or prematurity without comorbidity) survived. Factors independently associated with death included gestational age <30 weeks (p 0.002), birth weight <1500g (p 0.007) and a 5 minute APGAR score of < 7 (p 0.001). Neither place of birth nor delayed and after hour admissions were independently associated with mortality. Mortality rate in SCBU is high. Prematurity and its complications were major contributors to mortality. The management of hypothermia and respiratory distress needs scaling up. A step down unit for monitoring stable at risk neonates is needed in order to decongest SCBU.

Highlights

An estimated 6.3 million children under 5 years die annually with 44% of these deaths occurring during the first month of life[1,2]
A retrospective chart review was conducted on records for neonates admitted to Mulago National Referral Hospital Special Care Baby Unit (SCBU) from 1st November 2013 to 31st January 2014
Many community based interventions designed to address neonatal mortality in developing countries may have contributed to some decline in neonatal deaths[6] but further reduction in neonatal deaths in the developing countries will need scaling up care in health facilities

Summary

Introduction

An estimated 6.3 million children under 5 years die annually with 44% of these deaths occurring during the first month of life[1,2]. Ninety eight percent of the global neonatal deaths occur in developing countries[2,3]. Whereas most developing countries have made strides towards reducing under five mortality, further reduction has become challenging and the slow decline in neonatal mortality rate has been identified as the major obstacle to further reduction of under-five mortality[2,4,5]. Like most developing countries; decline in neonatal mortality rate in Uganda at 2.2% per annum has not been significant[7]. With intensive effort in addressing maternal and neonatal mortality in the community[6,8] there has been an increase in health facility deliveries (57%) but the total number of neonates dying annually has reduced decimally[7,9].

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Conclusion