Neonatal Mortality In Nigeria Research Articles

A blended curriculum to improve student community health officers’ competencies in newborn infection prevention and control

Background Infections contribute significantly to neonatal mortality in Nigeria. Community health officers (CHOs) provide maternal, newborn and child health services at the primary health care level. However, newborn infection prevention and control (NB-IPC) is not included in their current training curriculum, which has little innovation in teaching methods. This study assessed the effectiveness of a blended curriculum on NB-IPC in improving the competencies of student CHOs. Methods This pre- and post-test study was conducted in the CHO training school of Lagos University Teaching Hospital (LUTH), which has 70 students enrolled. We developed and implemented a blended curriculum on NB-IPC using Kern’s six-step framework. Twelve videos were recorded of content experts teaching various aspects of NB-IPC and were watched online or downloaded by students. Two interactive practical sessions were held in class. Pre- and post-course assessment of knowledge was with multiple choice questions, attitude with a Likert scale, and skills with an objective structured clinical examination (OSCE). Course satisfaction was also assessed with a validated scale. Paired t-test was used to determine mean differences at a significance level of 0.05. Results The mean knowledge score of students increased from 10.70 (95% confidence interval (CI): 10.15–11.24) pre-course out of a possible score of 20 to 13.25 (95%CI: 12.65–13.84) post-course (p < 0.001). Mean attitude score increased from 63.99 (95%CI: 62.41–65.56) out of a possible score of 70 to 65.17 (95%CI: 63.68–66.67) (p = 0.222). The mean OSCE score increased from 21.27 (95%CI: 20.20–22.34) out of a possible score of 58.5 to 34.73 (95%CI: 33.37–36.09) (p < 0.001). Mean post-course satisfaction score of students was 127.84 (95%CI: 124.97–130.89) out of a possible score of 147. Conclusion The new curriculum on NB-IPC improved the competencies of student CHOs in LUTH and they were highly satisfied. The blended curriculum may be a feasible addition to learning in CHO schools across Nigeria. Key message A blended curriculum on NB-IPC involving video teaching is effective in improving the competencies of student CHOs

Serum magnesium levels of term neonates with birth asphyxia and relationship to severity of asphyxia.

Birth asphyxia is one of the three main causes of neonatal mortality in Nigeria. Hypomagnesaemia has been reported amongst severely asphyxiated babies. Despite this, the prevalence of hypomagnesaemia amongst newborns with birth asphyxia has not been well researched in Nigeria. This study set out to determine the prevalence of hypomagnesaemia in term neonates with birth asphyxia and the relationship (if any) between magnesium levels and the severity of birth asphyxia or encephalopathy. In this cross-sectional analytical study, the serum magnesium levels of consecutive cases of birth asphyxia were compared to that of gestational age-matched healthy term neonates. Babies with Apgar scores <7 in the 5th minute of life were recruited into the study. Blood samples were taken from each baby at birth and 48 h. Serum magnesium was measured using spectrophotometry. Hypomagnesaemia was found in 36 (35.3%) babies with birth asphyxia and 14 (13.7%) healthy controls; this difference was statistically significant (χ2 = 18.098, P = 0.001), with an odds ratio of 3.4 (95% confidence interval = 1.7, 6.9). The median (interquartile range) levels of serum magnesium in babies with mild, moderate and severe asphyxia were 0.7 mmol/L (0.5-1.1), 0.7 mmol/L (0.4-0.9) and 0.7 mmol/L (0.5-1.0), respectively (P = 0.316), while those of babies with mild (stage 1), moderate (stage 2) and severe (stage 3) encephalopathy were 1.2 mmol/L (1.0-1.3), 0.7 mmol/L (0.5-0.8) and 0.8 mmol/L (0.6-1.0), respectively (P = 0.789). This study has shown that hypomagnesaemia was more common in babies with birth asphyxia and there was no relationship between magnesium levels and the severity of asphyxia or encephalopathy.

Modelling Neonatal Mortality Rate in Nigeria Using a Continuous Poisson-Lindley Distribution

Nigeria’s effort to reduce under-five mortality has been biased in favour of childhood mortality to the neglect of neonates and as such the literature is short of adequate information on the determinants of neonatal mortality, whereas studies have shown that about half of infant deaths occur in the neonatal period. Knowledge of the determinants of neonatal mortality is essential for the design of intervention programmes that will enhance neonatal survival. Therefore, this study was conducted to investigate the trends in neonatal mortality in Nigeria. It also proposed a Poisson based continuous probability distribution called Poisson-Lindley distribution to neonatal mortality rate in Nigeria. Some properties of the new model and other relevant measures were obtained. The unknown parameters of the model were also estimated using the method of maximum likelihood. The fitness of the proposed model to the neonatal mortality rate was considered using a dataset on neonatal mortality rate from 1967 to 2019.

Caesarean section rate in Nigeria between 2013 and 2018 by obstetric risk and socio-economic status.

Caesarean section (CS) can be life-saving for both mother and child, but in Nigeria the CS rate remains low, at 2.7% of births. We aimed to estimate the rate of CS and early neonatal mortality in Nigeria according to obstetric risk and socio-economic background and to identify factors associated with CS. We used the 2018 Nigeria Demographic and Health Survey, encompassing 33924 live births within the last 5years, to estimate the CS rate and early neonatal mortality rate (ENMR) by obstetric risk group, informed by the Robson classification. The CS rate and ENMR were assessed within each Robson group and stratified by socio-economic background. Logistic regression analyses were used to explore determinants of CS. Almost three-quarters (72.4%) of all births were to multiparous women, with a singleton baby of normal birthweight, thus a low-risk group similar to Robson 3, and with a CS rate of 1.0%. CS rates in the two high-risk groups (multiple pregnancy and preterm/low birthweight) were low, 7.1% (95% CI: 5.2-9.7) and 1.8 % (95% CI: 1.4-2.4), respectively. The ENMR was particularly high for multiple pregnancy (175 per 1000 live births; 95% CI: 131-230). Greater number of antenatal visits, unwanted pregnancy, multiple pregnancy, household wealth, maternal education, Christians/Others versus Muslims and referral during childbirth were positively associated with CS. Inequitable access to CS is not limited to socio-economic determinants, but also related to obstetric risk factors, calling for increased efforts to improve access to CS for high-risk pregnancies.

Using propensity scores to estimate the effectiveness of maternal and newborn interventions to reduce neonatal mortality in Nigeria

BackgroundNigeria is the largest country in sub-Saharan Africa, with one of the highest neonatal mortality rates and the second highest number of neonatal deaths in the world. There is broad international consensus on which interventions can most effectively reduce neonatal mortality, however, there is little direct evidence on what interventions are effective in the Nigerian setting.MethodsWe used the 2013 Nigeria Demographic and Health Survey (NDHS) and the follow-up 2014 Verbal and Social Autopsy study of neonatal deaths to estimate the association between neonatal survival and mothers’ and neonates’ receipt of 18 resources and interventions along the continuum of care with information available in the NDHS. We formed propensity scores to predict the probability of receiving the intervention or resource and then weighted the observations by the inverse of the propensity score to estimate the association with mortality. We examined all-cause mortality as well as mortality due to infectious causes and intrapartum related events.ResultsAmong 19,685 livebirths and 538 neonatal deaths, we achieved adequate balance for population characteristics and maternal and neonatal health care received for 10 of 18 resources and interventions, although inference for most antenatal interventions was not possible. Of ten resources and interventions that met our criteria for balance of potential confounders, only early breastfeeding was related to decreased all-cause neonatal mortality (relative risk 0.42, 95% CI 0.32–0.52, p < 0.001). Maternal decision making and postnatal health care reduced mortality due to infectious causes, with relative risks of 0.29 (95% CI 0.09–0.88; 0.030) and 0.46 (0.22–0.95; 0.037), respectively. Early breastfeeding and delayed bathing were related to decreased mortality due to intrapartum events, although these are not likely to be causal associations.ConclusionAccess to immediate postnatal care and women’s autonomous decision-making have been among the most effective interventions for reducing neonatal mortality in Nigeria. As neonatal mortality increases relative to overall child mortality, accessible interventions are necessary to make further progress for neonatal survival in Nigeria and other low resource settings.

Neonatal Mortality and Maternal/Child Health Care in Nigeria: An Impact Analysis

Reducing the rate of mortality in neonates to as low as 12 per 1,000 live births is one of the clearly spelt out aims of the third tenet of the Sustainable Development Goals (SDG) because of its importance to the dynamics of population. While there have been various studies focused majorly on the causes, rates and determinants of neonatal mortality in Nigeria, studies on the impact of maternal/child care characteristics on neonatal mortalityand the potential implication of failing to attain the SDG target for neonatal mortality have seemingly been neglected. In this study, we undertake an analysis of the impact of maternal / child care characteristics on neonatal mortality using the logistic regression model. Results from the study showed that antenatal care (P-value = 0.000, odds ratio = 0.546 for women who visited the hospital during pregnancy on more than 5 occasions), post natal care (P-value = 0.004, odds ratio = 0.402 for women who received early neonatal care from skilled medical personnel), place ofdelivery (P-value = 0.000, odds ratio = 0.592 for babies that were delivered in a government hospital) and skill of birth attendant (P-value = 0.000, odds ratio = 0.706 for babies who were delivered by trained doctors/nurses/midwives) had significant impact on neonatal mortality at the 95% confidence level implying that improved maternal health care: before, during and immediately after delivery as well as the quality of care to motherand child are both important and necessary to the reduction of neonatal mortality in Nigeria. To achieve the sustainable development target for neonatal mortality, it is therefore recommended that stake holders in the public health sector improve the quality of existing health care facilities and access to quality services.&#x0D; Keywords: Neonatal mortality, logistic regression, maternal care, child health care, Nigeria

Impact of mothers’ socio-demographic factors and antenatal clinic attendance on neonatal mortality in Nigeria

Neonatal death is often referred to maternal complications during pregnancy, and other exogenous factors that exist around the time of birth or shortly after birth. The United Nations Sustainable D...

Pragmatic approach to halt preventable maternal and neonatal deaths in Nigeria

Objectives: The objective of the paper is to promote a pragmatic approach to stem high maternal and neonatal mortality in Nigeria as it is becoming increasingly evident that ending preventable maternal and neonatal deaths goes beyond counting the numbers. Methods: A literature search was performed of Pub Med, HINARI, Google scholar using keywords in the review to build a set of search terms. Reference lists of all the included studies were scanned to identify additional relevant studies. Results: Facility-based death review, review of near-miss and clinical audit are quality improvement methods and on their own are health care interventions. Conclusion: Though findings from reviews and audit provide actionable information, the commitment of health care providers to act on the information is key to achieving the purpose of reviews and audits. There is need to invest in health system researches that focus on quality improvements in maternal and neonatal care in Nigeria. Keywords: audit, review, quality, improvement

Socio-demographic determinants of post-caesarean neonatal mortality in Nigeria

Neonatal mortality remains a major health concern in sub-Saharan Africa. We conducted a cross-sectional, population-based, retrospective analysis of 31,828 births between 2009 and 2013 to explore the relationship between socio-demographic variables and post-caesarean neonatal mortality in Nigeria. We calculated the caesarean section (CS) rates, the odds of having a CS and post-CS neonatal mortality within variable subgroups. The national average CS rate was 2.1%. The CS rate increased with the increasing wealth index, educational attainment, maternal age, higher among urban residents and among those from the Southern part of Nigeria. The odds of experiencing post-CS neonatal mortality was significantly higher in the Northern regions (OR 2.51–3.17) among rural residents (OR 2.63), economically poorer groups (OR 3.68), with no formal education (OR 3.01) and older maternal age groups (OR 1.76–2.0). Efforts to increase the rate and quality of peripartum services delivered to pregnant women are needed among both advantaged and disadvantaged groups.Impact statementWhat is already known on this subject? In sub-Saharan Africa, a caesarean section is a lifesaving procedure for both the women and their unborn babies. The neonatal mortalities that occur following the procedure need to be explored and quantified.What do the results of this study add? Socioeconomic differentials exist in the access to a caesarean section. However, these differentials have a limited influence on neonatal mortality post-caesarean section in Nigeria.What are the implications of these findings for clinical practice and/or further research? While socio-demographic variables influence access to health care services, timeliness and quality of care are factors to be considered in ensuring societies get the benefits of caesarean section as a lifesaving procedure.

Trend of neonatal mortality in Nigeria from 1990 to 2017 using time series analysis

The study examined the incidence of the rate of Neonatal Mortality in Nigeria. The incidence tested with use of Time Series Analysis (ARIMA). The trend plot of the incidence shows that there has been steady decrease in the incidence rate over the years. The series was stationarity using the Augmented Dickey-Fuller (ADF) Test, the result found to be stationary. The Correlogram of the incidence also supports the stationarity of the series at 1% level of significance. The model that best describes the incidence was tested using the Box-Jenkins four step procedures, which involve identification, explanation, diagnostic and forecasting. ARMA (1, 1), and ARIMA (1, 1, 1) models were tested, and ARIMA (1, 1, 1) model happens to be the best model that best fits the series. The time series analysis shows that neonatal mortality rate has reduced by 17.8% from 51. 7% in the year 1990 to 33. 9% in the year 2017.Keywords: Auto regression, Moving average, Mortality, Stationarity, Correlogram

A Population-Based Study on Association Between Cesarean Section and Neonatal Mortality in Nigeria

OBJECTIVETo examine the association between cesarean section and neonatal mortality Nigeria.METHODA retrospective analysis using Nigeria Demographic Health Survey 2013 national population-based cross-sectional survey. The national prevalence of cesarean section was calculated, and logistic regression was used to estimate the odds of neonatal mortality outcome following cesarean delivery.RESULTSThe national cesarean section rate for the 2009–2013 period was 2.1% among 31,495 deliveries. The odds of having a neonatal death was twice as high in cesarean deliveries in comparison to noncesarean deliveries (aOR = 2.56, 95% CI 1.75 to 3.74).CONCLUSIONCesarean section increases the odds of neonatal mortality in Nigeria. There is a need to scale up the quality and timeliness of emergency obstetric services offered to pregnant women.

Factors Associated with Perinatal Mortality in Africa

Background: Pregnancy in the society is a typical sign and a promise to gain a new member of the family and celebrations as well, unlike in poor world pregnancy are sometimes associated with problems. Unfortunately cause death of the newborn immediately after birth or few days before delivery. Critical Review: In this article review four articles were reviewed for the factors affecting perinatal mortality, according to Abdoulaye Hama DIALLO’s study titled as Epidemiology of perinatal mortality in rural Burkina Faso, three main risk factors were the young age of the mother where mothers younger than 20 had odds ratio of OR=2.93, the season of birth with OR of 1.85, and the intention to EBF with OR of 1.7., we argued that, the focus was to be cause of home delivery despite of 99% ANC attendance. According to two different retrospective studies conducted in Nigeria in years 2003, 2004, 2005, 2008 and 2013, which were Perinatal Mortality in Southern Nigeria and First-day and Early Neonatal Mortality in Nigeria, both studies demonstrated a constant perinatal mortality that doesn’t improve over the study period. unbooked pregnancies resulting in difficult labors, ruptured uterus, chorio-amnionitis, preterm or low-birth weight babies and severe neonatal asphyxia, outside the hospital deliveries , c-section delivery, being twins and low antenatal visits were risk factors highlighted , ANC again was an issue to be argued about to cause the constant mortalities. According to d’Almeida M1, Noudamadjo A, Obossou AAA, Agossou J, Adedemy JD2 2013 describing perinatal morbidity and mortality in the Regional University Teaching Hospital of Borgou (Benin), the study identified acute fetal suffering and premature rupture of the membranes as the common morbidities and ½ of registered women come for delivery themselves among them only 58.90% attended ANC 4 times, which significantly poor follow up of pregnant women who were to be transferred in active ANC system. According to Aimable Musafili and his colleagues in 2013, conducted an audit research in Rwanda reviewing perinatal deaths at hospitals in Kigali, Rwanda, results showed that Out of 8424 births, there were 269 perinatal deaths giving a stillbirth rate of 20/1000 births and a perinatal mortality rate of 32/1000 births, furthermore factors contributing to mortality were highlighted as delay in care-seeking was identified in 39% of deaths, delay in arriving at the health facility in 10%, and provision of suboptimal care at the health facility in 37%. The argument was that, insufficient care is more likely to be brought by shortage of staff. Therefore concrete measures and their implementation should be put in place followed via multidimensional bnhuycollaborations to eliminate preventable causes of perinatal mortality.

Maternal health care utilization and neonatal mortality in Nigeria: looking beyond the micro-level pathway of influence

Neonatal mortality is a neglected but largely preventable public health challenge in Nigeria. The country contributes the largest number of neonatal deaths in Africa, and this is an important reason for the failure of the country to meet Millennium Development Goal (MDG4) of reducing child mortality. Maternal health services provide the platform for delivering cost-effective interventions that reduce maternal and child mortality. Thus, we examined the relationship between the utilization of maternal health services and neonatal mortality in Nigeria by carrying out a multilevel Cox proportional regression analysis of the most recent Nigeria Demographic and Health Survey (2013 NDHS) in order to decompose the micro and macro level factors on the pathway of influence for neonatal mortality. Hazards of neonatal death were significantly lower for children whose mothers had 4 or more antenatal visits by skilled providers (HR: 0.78, CI: 0.61-0.98, p<0.05) and whose mothers received postnatal care from skilled provider (HR: 0.41, CI: 0.30-0.56, p<0.05) even after adjusting for other control variables. There was also a significantly elevated hazards of neonatal mortality for mothers in rural areas (HR: 1.44, CI: 1.09-1.90). Our findings highlight the importance of maternal health care services for neonatal mortality reduction especially in the rural areas.

Trends and population-attributable risk estimates for predictors of early neonatal mortality in Nigeria, 2003–2013: a cross-sectional analysis

ObjectivesTo assess trends in early neonatal mortality (ENM) and population-attributable risk (PAR) estimates for predictors of ENM in Nigeria.Design, setting and participantsA cross-sectional data on 63 844 singleton live births...

First-day and Early Neonatal Mortality in Nigeria: A Pooled Cross-sectional Analysis of Nigeria DHS Data

First-day and Early Neonatal Mortality in Nigeria: A Pooled Cross-sectional Analysis of Nigeria DHS Data

Socioeconomic, bio-demographic and health/behavioral determinants of neonatal mortality in Nigeria: a multilevel analysis of 2013 demographic and health survey

Background: Nigeria ranks as one of the countries in the world with considerable burden of neonatal mortality. This study aims to investigate the association of socioeconomic, bio-demographic and health/behavioural factors with neonatal mortality in the country using the most current available evidence. Methods: The 2013 Nigeria demographic and health survey (NDHS) dataset was analyzed. Multiple logistic regression analysis was applied to identify determinants associated with neonatal mortality. The role of breastfeeding was examined by conducting analyses with and without adjustment for ‘breastfeeding status’. Complex sample analysis was used to control for the complex sampling design used in NDHS . Results: Neonatal mortality rate (NMR) stood at 33 deaths per 1000 live births. With or without adjustment for ‘breastfeeding status’, bio-demographic factors – maternal marital status, rural-urban residence, birth size, gender of child, birth interval and maternal body mass index (BMI) – were predictive of neonatal mortality. Maternal age and ethnicity became additional bio-demographic predictors after adjusting for ‘breastfeeding status’. Maternal literacy (socioeconomic factor) and mode of delivery (health/behavioral factor) were significant predictors only when breastfeeding status was not adjusted for. Conclusions: Bio-demographic factors formed the bulk of predictors of neonatal mortality in Nigeria. The effect of socioeconomic and health/behavioural factors disappeared when breastfeeding status was adjusted for. Intervention programs would need to prioritize the identified predictors for an accelerated reduction of neonatal mortality in Nigeria.

Determinants of Early Neonatal Mortality in Nigeria: Results from 2013 Nigeria DHS

Child mortality remains a significant public health challenge particularly in developing countries of sub-Saharan Africa where around 50% of the global 6.3 million children die before their fifth birth day. Additionally, all the 16 countries with under-5 mortality rate of more than 100 per 1000 live births are located in sub-Saharan Africa and the region experienced one of the slowest annual rates of reduction in child mortality of 2.7% between 1990 and 2012 [1]. Of the 6.3 million child death estimated to have occurred worldwide in 2032, around 44% of these deaths took place during the neonatal period (i.e. within the first 28 days of life) and a further 75% of these neonatal deaths occurred during the first week of life (i.e. the early neonatal period) [2,3]. It follows that around 33% (or 2.1 million) of the global child death took place during the early neonatal period while the remaining 67% takes place in the remaining 1818 days. These deaths are substantial and targeting their determinants in the form of programmatic interventions will lead to significant reduction in child mortality overall. Therefore, strategies that promote better survival during the early neonatal period will have the greatest impact to reduce the overall child mortality as well as sustaining the progress made in reducing child mortality thus far. In Nigeria, child mortality continues to be a public health challenge despite adopting the various international health agendas aimed at reducing child mortality such as millennium development goals (MDGs), partnerships for maternal, neonatal and child health (PMNCH) and the Countdown Strategy. Despite keying into these programs, neonatal, infant, child and under-5 mortality rates remain high at 37, 69, 64 and 128 per 1000 live births respectively and Nigeria’s contribution to the global burden of child mortalityis immensely huge at around 13% (or 804,000 child deaths) in 2013 [4,5]. Nigeria’s contribution to global pool of child mortality has marginally decreased from 849,000 in 1990 to 827,000 in 2012 while there is a reversal in the expected decline as neonatal deaths increasing from 207, 000 to 267,000 during the same period [4]. Past literature on the subject matter have continued to give more emphasis on either under-five mortality [6-11] or on neonatal mortality [12,13] ignoring the significant proportion of early neonatal deaths as an important component of both Research Article Abstract

Spousal Age Differences and Risk of Infant Mortality in Nigeria: A Multi-level Analysis

Background/objectives: Nigeria remains the largest contributor to neonatal mortality in Africa. Nigeria’s neonatal mortality rate is 48/1000 live births. Existing research on the causes of neonatal mortality in Nigeria has placed great emphasis on factors such as diarrhea, malaria, measles and acute respiratory infections, whooping cough, tuberculosis, bronchopneumonia, dirty feeding bottles and utensils, inadequate disposal of household refuse, poor storage of drinking water and household wealth index1-4. However, insufficient attention has been given to parental age-related factors. Understanding the implications of parental age differences for child health can add to our knowledge of the correlates of neonatal mortality and furnish insights to support the design and delivery of interventions to address the problem. To examine the implications of spousal age-related factors for child health outcomes. Methods: Data for this study were drawn from the 2008 Nigeria Demographic and Health Survey. Univariate and multivariate statistical analyses were used to assess the relationship between neonatal mortality and parental age-related contextual factors focusing on maternal and paternal ages, spousal age, sex of child, household wealth index and place of residence. Results: The multivariate logistic regression analyses yielded significantly increased risk of neonatal mortality among neonates of parents with age differences of 15 years or more. Conclusions: Neonates of couples with age differences of less than 15 years die less compared to neonate of spouses with age difference of 15 years and above.

Trends in neonatal mortality in Nigeria and effects of bio-demographic and maternal characteristics.

BackgroundNigeria’s efforts to reduce under-five mortality has been biased in favour of childhood mortality to the neglect of neonates and as such the literature is short of adequate information on the determinants of neonatal mortality. Whereas studies have shown that about half of infant deaths occur in the neonatal period. Knowledge of the determinants of neonatal mortality are essential for the design of intervention programes that will enhance neonatal survival. Therefore, this study was conducted to investigate the trends and factors associated with neonatal mortality in Nigeria.MethodsThis was a retrospective analysis of the reproductive history data collected in the Nigeria Demographic and Health Surveys (NDHS) for 1990, 2003, 2008 and 2013. Neonatal mortality rates were estimated as the probability of dying before 28 completed days using synthetic cohort life table techniques. Univariate and multiple Cox proportional hazards regression models were used to explore the effects of selected maternal and bio-demographic variables on neonatal mortality. The Hazard Ratio (HR) and its 95% Confidence Interval (CI) were estimated to prioritize obtained significant factors.ResultsNigeria neonatal mortality rate stagnated at 41 per 1000 live births between 1990 and 2013. There were rural-urban and regional differences with more deaths occurring in rural areas and northern regions. In 1990, antenatal care (HR = 0.76; CI = 0.61-0.95), facility delivery (HR = 0.69; CI = 0.53-0.90) and births interval less than 24 months (HR = 1.67; CI = 1.41-1.98) were significantly associated with neonatal deaths. Factors identified from the 2013 data were antenatal care (HR = 0.76; CI = 0.61-0.95), birth interval less than 24 months (HR = 1.67; CI = 1.41-1.98), delivery at health facility (HR = 0.69; CI = 0.53-0.90), and small birth size (HR = 1.72; CI = 1.39-2.14).ConclusionThere was little improvement in neonatal survival in Nigeria between 1990 and 2013. Bio-demographic and health care related characteristics are significant determinants of neonatal survival. Family planning should be intensified while government should improve the quality of maternal and child health services to enhance the survival of neonates.

Improvised bubble continuous positive airway pressure (BCPAP) device at the National Hospital Abuja gives immediate improvement in respiratory rate and oxygenation in neonates with respiratory distress

Background : Prematurity accounts for 25% of Neonatal mortality in Nigeria and Respiratory Distress Syndrome is responsible for half of these deaths. Introducing continuous positive airway pressure for the treatment of RDS in Nigeria where health care financing is predominantly out-of-pocket is quite challenging. It was hypothesized that applying the principle of under-water-seal pressure generation could convert a simple oxygen delivery system into an effective Bubble CPAP device. Objectives : To provide evidence in support of the immediate clinical effectiveness of the NHBCPAP device. Design/Methods : At the neonatal unit of the National Hospital Abuja, we assembled a circuit of tubing connecting a gas source (oxygen concentrator or cylinder) through an interface (nasal prongs) to the baby and this was further connected through an expiratory tube to an under-waterseal bottle to generate CPAP. The device is activated by turning on the oxygen source. The device was applied to preterm babies with RDS as well as some term babies with respiratory distress admitted into the neonatal intensive care units. Respiratory rate, SPO2 and other signs of respiratory distress were monitored before and at 1 hour, 6 hours and 12 hours after the application. Results : Forty eight newborn babies with respiratory distress were treated with the device out of whom twenty three (48%) were very low birth weight with respiratory distress syndrome. The mean respiratory rate dropped from 64.5 (19.2)/min before commencement of CPAP to 59.5(11.6)/min, 56.6 (10.5), and 56.6(10.7) at 1, 6 and 12 hours respectively, p<0.05. The corresponding values for SPO2 were 84.5(14) before and 95.9 (5.3), 95.9(6.5) and 96.9(6.4) at 1, 6 and 12 hours respectively, p<0.05. The respiratory changes were however less marked among very low birth weight babies. Conclusion : The simplified customized device produces clinical responses similar to those reported for the conventional CPAP devices.