Outcomes in a Rural Ugandan Neonatal Unit Before and During the Early COVID-19 Pandemic: A Retrospective Cohort Study

Abstract

Background: Little has been published on neonatal outcomes from low resource facilities during the COVID-19 pandemic. In the past 20 years Uganda has improved newborn mortality but the pandemic and resulting restrictions threaten to affect this vulnerable segment of the population. During the first two months of the pandemic in Uganda travel was tightly restricted for pregnant women and sick newborns and public transport was difficult to access for two months thereafter. Methods: We report outcomes from admissions captured in an existing electronic dataset of a well-established newborn unit in central Uganda before (September 2019 to March 2020) and during the early COVID-19 period (April – September 2020). We report excess mortality as the percent change in mortality over what was expected based on seasonal trends. Findings: There was an 8% decrease in admissions from outside the facility and an increase in overall admissions with birth asphyxia (22% vs. 15%) during the early pandemic. Patients born outside the facility were older on admission than previously (median 1 day of age vs. on the day of birth). Mortality significantly differed between the COVID-19 period and pre-COVID-19 periods [15·7% (89/567) vs. 11·1% (69/619), p=0·017]. Mortality was increased in all categories of birthweight and diagnosis. Most prominent was the increased mortality among patients born outside the facility (21·2% vs. 14·3%, p= 0·028), a relative increase of 55% above seasonal expected mortality in this group. Interpretation: This increased mortality is likely attributed to disruptions due to the pandemic affecting maternal and newborn demand for, access to and quality of peripartum healthcare. Impacts on these vulnerable newborns requires deliberate focus by health officials to prioritize their care despite pandemic conditions. Funding Information: Adara Development. Declaration of Interests: The authors declare no conflict of interest. Ethics Approval Statement: Human Subjects Approval was obtained from Makerere University School of Public Health Institutional Review Board (protocol number 917) and approved by the Uganda National Council for Science and Technology (registration number SS813ES). The University of Washington institutional review board designated this as an exempt study.