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ORIGINAL ARTICLE
Year : 2020  |  Volume : 23  |  Issue : 1  |  Page : 47-50

Patterns of morbidity and mortality among neonates seen in a tertiary hospital


1 Department of Paediatrics, Rasheed Shekoni Specialist Hospital, Dutse, Jigawa State, Nigeria
2 Department of Paediatrics, Aminu Kano Teaching Hospital, Bayero University, Kano, Nigeria

Date of Submission04-Apr-2019
Date of Decision16-Jun-2019
Date of Acceptance28-Jul-2019
Date of Web Publication18-Mar-2020

Correspondence Address:
Dr. Umar Also
Department of Paediatrics, Rasheed Shekoni Specialist Hospital, PMB 7200, Dutse, Jigawa State
Nigeria
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DOI: 10.4103/smj.smj_21_19

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  Abstract 


Background: Neonatal period is the first 28 days after birth. It carries high risk of morbidity and mortality. This risk is higher in developing countries. Nigeria, where about 700 babies die daily, contributes about 8% of the world's annual neonatal deaths. There is a paucity of published study of neonatal morbidity and mortality in this part of Nigeria. Objectives: We determined the pattern of neonatal morbidity and mortality, and neonatal mortality rate in a public tertiary health facility in Jigawa State, Nigeria. Materials and Methods: We conducted a hospital-based retrospective study of all babies admitted during the neonatal period between January 1, 2016, and December 31, 2017. Data on the patients' age, weight, diagnosis, and outcome were extracted from their file and analyzed. Ethical clearance was obtained before the commencement of the study. Results: Records of 522 newborns were analyzed. Common morbidities were neonatal sepsis, prematurity, and birth asphyxia. The mortality rate was 13.2%. Highest mortality (44.8%) occurred within 24 h of admission, and neonatal tetanus had the highest case fatality rate of 42.8%. Conclusions: Neonatal sepsis, prematurity, and birth asphyxia were the major causes of morbidity. Mortality rate was high (13.2%), and tetanus had the highest case fatality rate. These can be prevented.

Keywords: Morbidity, mortality, neonate


How to cite this article:
Also U, Gwarzo GD. Patterns of morbidity and mortality among neonates seen in a tertiary hospital. Sahel Med J 2020;23:47-50

How to cite this URL:
Also U, Gwarzo GD. Patterns of morbidity and mortality among neonates seen in a tertiary hospital. Sahel Med J [serial online] 2020 [cited 2020 Apr 1];23:47-50. Available from: http://www.smjonline.org/text.asp?2020/23/1/47/280939




  Introduction Top


The neonatal period is defined as the first 28 days after birth and may be further subdivided into very early (birth to <24 h), early (birth to <7 days), and late neonatal periods (7 days to <28 days).[1] The risk for mortality in fetuses and neonates is very high around the time of birth.[1] Therefore, the neonatal period is a critical time for the survival of any child.[2] It has been estimated that more than 4 million newborns die yearly within the first 4 weeks of life, with 3 million of these deaths occurring in the early neonatal period. Unfortunately, 98% of these deaths occur in developing countries.[2]

Globally, the neonatal mortality rate has reduced steadily from 1990 to 2015, with a decline in the neonatal deaths.[3] However, the decline in neonatal mortality during that period has been slower than that of postneonatal under-five mortality.[3],[4]

Worldwide, in 2013, it was estimated that 6.3 million children died before their fifth birthday, and 44% of them died within the first 28 days of life.[5] In addition, 73% of all neonatal deaths occurred within the early neonatal period with 36% occurring on the day of birth.[5]

In developing countries, the risk of death in the newborn period is six times greater than in developed countries; and over 8 times higher in the least developed countries.[2] Africa has the highest risk of neonatal death, with a figure of 41 neonatal deaths per 1000 live births.[2]

Nigeria has the highest neonatal death in Africa with an estimate of 700 babies dying daily (around 30 every hour), and second highest in the world. Hence, Nigeria contributes about 8% of the world's annual neonatal deaths.[4] Early neonatal deaths are due to obstetric complications while intrapartum deaths are closely linked to place of delivery and care at delivery.[2] In most developing countries, about 40% of deliveries occur in health facilities and few actually take place with the assistance of trained health personnel.[2]

There is no published hospital-based study from State-owned health facility in Jigawa State that documented the pattern of neonatal morbidity and mortality. In view of this, the study was aimed to (1) identify the pattern of neonatal morbidity and mortality, and (2) calculate mortality rate among newborns admitted to the special care baby unit (SCBU).


  Materials and Methods Top


Study area

The study was carried out in special care baby unit (SCBU) of Specialist Hospital, Dutse, Jigawa State, Nigeria. The hospital has a total estimated catchment population of 4,348,649 according to 2006 population census.[6] The SCBU has eight beds capacity with three resuscitaires, four cots, one incubator, and two phototherapy lamps with blue light fluorescent. One resident consultant, two visiting consultants, three medical officers, and house officers on rotation manage the whole department. Due to the limited bed capacity, about 70% of the patients were outborn. Inborn babies were managed beside their mothers; those who were critically ill were transferred to the SCBU.

Study design

The study was a hospital-based and retrospective in design.

Inclusion criteria

All neonates from birth to 28 days of age admitted to SCBU of the pediatric department.

Data collection

Medical records of all neonates admitted from January 1, 2016, to December 31, 2017 were retrieved and analyzed.

A pro forma record form was designed and used to extract information from the medical records. Age, sex, and weight on admission, date of admission, place of delivery, gestational age, and diagnosis at the time of discharge or death, duration of hospitalization before discharge, or death and possible outcome was obtained from the pro forma.

Data analysis

Data were analyzed using SPSS version 16, Chicago, Illinois, USA. Data are presented as categorical variables expressed as percentages. Simple tables and figures were utilized in data presentation.

Ethical consideration

Ethical clearance for the study (protocol no RSSH/GEN/226/V 11/3 dated 13th July 2018) was obtained from the Research and Ethics Committee of the Hospital. The 2013 guidelines of Helsinki's declaration were complied with.


  Results Top


There were 558 babies admitted to the unit over a 2-year period (January 2016–December 2017), of these 522 (93.5%) had complete records for analysis. Majority 390 (74.7%) were outborn babies, whereas 132 (25.3%) were inborn babies. There were 308 (59.0%) male and 214 (49.0%) female with a male to female ratio of 1.4: 1. The ages of the patients ranged from 1 h to 28 days with a mean age of 6.35 ± 6.52 days. The age distribution of the study individuals is shown in [Table 1]. Two hundred and ninety-six (56.7%) of the patients were in the 1–7 days of age group.
Table 1: Distribution of patients by age on admission

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Morbidity

[Table 2] shows that neonatal sepsis was the most common reason (39.3%) for admission in the unit. This is followed by asphyxia (18.2%) and prematurity (16.9%). Neonatal tetanus contributed 21 (4.0%) of morbidity.
Table 2: Disease pattern and mortalities in 522 babies

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Mortality

Sixty-nine (13.2%) out of 522 babies died while on admission. Majority of the babies (44.9%) died <24 h after admission, as shown in [Table 3]. Major causes of mortality were prematurity, neonatal sepsis, and severe birth asphyxia, as shown in [Table 2]. Other causes of mortality were neonatal tetanus, ruptured spina bifida, severe anemia following uvulectomy, and macrosomic infant of diabetic mother.
Table 3: Neonatal mortalities based on admission weight and length of hospitalization

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Neonatal tetanus had the highest case fatality rate (42.8%). All patients with hemorrhagic disease of the newborn and necrotizing fasciitis survived, as shown in [Figure 1].
Figure 1: Case fatality rates

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Outcome

The outcome of 522 babies who were admitted is shown in [Figure 2]. Four hundred and forty-three (84.9%) were discharged home, while 2 (0.4%) absconded and 69 (13.2%) died.
Figure 2: Outcome of 522 babies admitted. DAMA: Discharged against medical advice

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  Discussion Top


The number of babies admitted per year and the preponderance of male babies reported in this study were similar to that reported by Ekwochi et al., in Enugu State hospital,[7] and Garba et al. in Gusau[8] but lower than that reported by other authors[9],[10] and higher than that reported by Abdullahi[11] at B/kudu which was about 40 km away from Dutse. The number of admissions was lower than figures reported from other centers. This may be due to the presence of other health facilities with neonatal unit about 40 km away from our facility. Lack of good patronage of the neonatal unit by the community may have also contributed to lower admission rate in our center.

The common reasons for admission to the unit were neonatal sepsis, prematurity, severe birth asphyxia, and neonatal tetanus. SCBU in other parts of Nigeria reported similar findings.[7],[9],[11],[12],[13] Many of these are largely preventable disease conditions. Hygiene, good obstetrics care, and immunization will reduce substantially the burden of neonatal morbidity and mortality. This is not far from the reasons stated by other authors such as lack of skilled birth attendants, poor antenatal attendance, inadequate newborn care, and pooling of high-risk pregnancies in the hospital as a result of referral while in labor and poor labor management.

Traditional uvulectomy contributed to mortality and morbidity in our study. This is a traditional harmful practice which is associated with significant mortality. Nine of twenty-one cases of tetanus found in our study had a site of traditional uvulectomy as a port of entry of the infection. The overall morbidity and mortality from uvulectomy were 3.3% and 14.4%, respectively. Although cases of neonatal tetanus were reported by other authors,[8],[9],[11],[12] none reported traditional uvulectomy performed by barbers using unsterilized knives as a port of entry of the bacteria. This could possibly be attributed to traditional belief of the usefulness of the practice to newborn and lack of knowledge and awareness of gravity of the complications by most parents.

The overall mortality rate in this study was 13.2%. This is similar to the figures reported by Owa and Osinaike[13] in Ilesa with 13.0%, while Ekwochi et al.[7] in Enugu reported a rate of 14.2%. This is, however, smaller than that reported by Mukhtar-Yola and Iliyasu[9] in Kano who reported a rate of 16.9%, Imoudu et al.,[12] 25.9% in Azare, Garba et al.,[8] 20.4% in Gusau, and Toma et al.,[14] 19.4% in Jos. The relatively low mortality rate in this study could be explained by the fact that majority of neonates presented after 24 h of life, possibly those critically ill might have died earlier at home. Some of the 36 (6.45%) neonates with incomplete record could be part of the mortalities. Majority of the neonates died <24 h on admission. This is similar to find by other authors such as Garba et al. and Toma et al. Proactive measures need to be put in place to identify those babies at high risk for dying and prompt attention so as to prevent those mortalities.

Prematurity, neonatal sepsis, severe birth asphyxia, and neonatal tetanus were the major causes of neonatal mortality in our study. This is in keeping with what was reported in Azare,[12] Gusau,[8] Ilesa,[13] and Enugu.[7] Prematurity accounted for the highest number of mortality. This is similar to the finding by Toma et al., in Jos and Imoudu et al., in Azare. Good antenatal care, supervised delivery, provision of essential newborn care, and timely referral would help in improve preterm survival and overall reduction of morbidity and mortality.

The least cause of mortality was spina bifida. Congenital malformations were low in the study, unlike other authors such as Toma et al. who reported congenital malformations to rank second as a cause of mortality. In our area, congenital malformations may not be that common as babies born with congenital malformation might be dying at home because the parents were unwilling to bring them to the hospital due to stigma.

Limitation

A major limitation of this study is incomplete data, which is common with retrospective data collection.

Our findings may not be true reflections of neonatal mortality and morbidity in the study population.


  Conclusions Top


Neonatal sepsis, asphyxia and prematurity were most frequent indications for hospitalization. Mortality rate was 13.2% with most deaths occurring within less than 24 hours of admission.

Acknowledgment

The HOD Record and his staffs were appreciated for retrieval of the medical records of the patients.

Self-sponsored study, no grants from anybody, or organization.

Financial support and sponsorship

Nil.

Conflicts of interest

There are no conflicts of interest.



 
  References Top

1.
Carlo WA. Overview of mortality and morbidity. In: Nelson Textbook of Paediatrics. 20th ed. Philadelphia: Elsevier; 2016. p. 789-93.  Back to cited text no. 1
    
2.
World Health Organization. Neonatal and Perinatal Mortality: Country, Regional and Global Estimates. Geneva, Switzerland: WHO Press; 2006.  Back to cited text no. 2
    
3.
Levels and Trends in Child Mortality- Report 2015. Estimates Developed by the UN Interagency Group for Child Mortality Estimation. UNICEF. United Nations Children's Fund; 2015.  Back to cited text no. 3
    
4.
Federal Ministry of Health. Savingnewborn Lives in Nigeria: Newborn Health in the Context of the Integrated Maternal, Newborn and Child Health Strategy. 2nd ed. Abuja: Federal Ministry of Health, Save the Children, Jhpiego; 2011.  Back to cited text no. 4
    
5.
Dahiru T. Determinants of early neonatalmortality in Nigeria: Results from 2013 Nigeria demographic and health survey. J Pediatr Neonatal Care 2015;2:00089. Doi: 10.15406/Jpnc. 2015.02.00089.  Back to cited text no. 5
    
6.
Jigawa State Wikipedia. Available from: http://en.m.wikipedia.org/wiki/Jigawa state. [Last accessed on 2017 Aug 16, 18:05].  Back to cited text no. 6
    
7.
Ekwochi U, Ndu IK, Nwokoye IC, Ezenwosu OU, Amadi OF, Osuorah D. Pattern of morbidity and mortality of newborns admitted into the sick and special care baby unit of Enugu state university teaching hospital, Enugu state. Niger J Clin Pract 2014;17:346-51.  Back to cited text no. 7
[PUBMED]  [Full text]  
8.
Garba BI, Muhammad AS, Mohammad BO, Obaji BO, Adeniji AO. A study of neonatal mortality in a specialist hospital in Gusau, Zamfara, North-Western Nigeria. Int J Trop Dis 2017;28:1-6.  Back to cited text no. 8
    
9.
Mukhtar-Yola M, Iliyasu Z. A review of neonatal morbidity and mortality in Aminu Kano teaching hospital, Northern Nigeria. Trop Doct 2007;37:130-2.  Back to cited text no. 9
    
10.
Fajolu IB, Egri-Okwaji MT. Childhood mortality in children emergency centre of Lagos university teaching hospital. Nig J Paediatr 2011;38:131-5.  Back to cited text no. 10
    
11.
Abdullahi UI. Neonatal morbidity and mortality in a rural tertiary hospital in Nigeria. CHRISMED J Health Res 2018;5:8-10.  Back to cited text no. 11
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12.
Imoudu IA, Ahmad H, Yusuf MO, Makarfi HU, Umar T. An analysis of neonatal morbidity and mortality in Azare, North-Eastern Nigeria. J Dent Med Sci 2014;13:25-8.  Back to cited text no. 12
    
13.
Owa JA, Osinaike AI. Neonatal morbidity and mortality in Nigeria. Indian J Pediatr 1998;65:441-9.  Back to cited text no. 13
    
14.
Toma BO, Ige OO, Abok II, Onwuanaku C, Abah RO, Donli A. Pattern of neonatal admissions and outcome in a tertiary institution in north central Nigeria. J Med Trop 2013;15:121-5.  Back to cited text no. 14
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    Figures

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    Tables

  [Table 1], [Table 2], [Table 3]



 

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