Journal Article

Burden of disease and risk factors for mortality amongst hospitalized newborns in Nigeria and Kenya

Imam, Zainab O., Tongo, Olukemi O., Abdulkadir, Isa, Mwangome, Martha K., Umoru, Dominic D., Otieno, Walter, Ezeaka, Chinyere V., Akindolire, Abimbola E., Embleton, Nicholas D., Nalwa, Grace M., Ezenwa, Beatrice N., Wang, Dingmei, Fajolu, Iretiola B., Talbert, Alison W., Allen, Stephen J., Andang’o, Pauline E. A., Abubakar, Ismaela, Nabwera, Helen M.

2021

Overview

To describe the patient population, priority diseases and outcomes in newborns admitted <48 hours old to neonatal units in both Kenya and Nigeria. In a network of seven secondary and tertiary level neonatal units in Nigeria and Kenya, we captured anonymised data on all admissions <48 hours of age over a 6-month period. 2280 newborns were admitted. Mean birthweight was 2.3 kg (SD 0.9); 57.0% (1214/2128) infants were low birthweight (LBW; <2.5kg) and 22.6% (480/2128) were very LBW (VLBW; <1.5 kg). Median gestation was 36 weeks (interquartile range 32, 39) and 21.6% (483/2236) infants were very preterm (gestation <32 weeks). The most common morbidities were jaundice (987/2262, 43.6%), suspected sepsis (955/2280, 41.9%), respiratory conditions (817/2280, 35.8%) and birth asphyxia (547/2280, 24.0%). 18.7% (423/2262) newborns died; mortality was very high amongst VLBW (222/472, 47%) and very preterm infants (197/483, 40.8%). Factors independently associated with mortality were gestation <28 weeks (adjusted odds ratio 11.58; 95% confidence interval 4.73-28.39), VLBW (6.92; 4.06-11.79), congenital anomaly (4.93; 2.42-10.05), abdominal condition (2.86; 1.40-5.83), birth asphyxia (2.44; 1.52-3.92), respiratory condition (1.46; 1.08-2.28) and maternal antibiotics within 24 hours before or after birth (1.91; 1.28-2.85). Mortality was reduced if mothers received a partial (0.51; 0.28-0.93) or full treatment course (0.44; 0.21-0.92) of dexamethasone before preterm delivery. Greater efforts are needed to address the very high burden of illnesses and mortality in hospitalized newborns in sub-Saharan Africa. Interventions need to address priority issues during pregnancy and delivery as well as in the newborn.

• Publisher: Public Library of Science,Public Library of Science (PLoS)
• Subject: Adolescent / Adult / Asphyxia Neonatorum - diagnosis / Asphyxia Neonatorum - economics / Asphyxia Neonatorum - epidemiology / Biology and Life Sciences / Birth Weight / Children / Collaboration / Computer programs / Cost of Illness / Data analysis / Diseases / Drafting software / Editing / Ethics / Female / Funding / Gestational Age / Health risks / Hospitalization / Humans / Infant / Infant Mortality / Infant, Newborn / Infants (Newborn) / Intensive Care Units, Neonatal / Jaundice - diagnosis / Kenya - epidemiology / Kenyatta, Jomo (1894-1978) / Male / Medical research / Medicine / Medicine and Health Sciences / Methodology / Mortality / Neonatal intensive care / Neonates / Newborn babies / Nigeria - epidemiology / Nutrition / Patient outcomes / Pediatric research / People and Places / Premature birth / Protocol (computers) / Research ethics / Reviews / Risk analysis / Risk Factors / Sepsis / Sepsis - diagnosis / Sepsis - economics / Software / Teaching hospitals / Ventilators / Visualization / Young Adult