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 Table of Contents  
ORIGINAL ARTICLE
Year : 2018  |  Volume : 5  |  Issue : 1  |  Page : 8-10

Neonatal morbidity and mortality in a Rural Tertiary Hospital in Nigeria


Department of Paediatrics, Federal Medical Centre, Birnin Kudu, Jigawa State, Nigeria

Date of Web Publication12-Jan-2018

Correspondence Address:
Umma Idris Abdullahi
Department of Paediatrics, Federal Medical Centre, Birnin Kudu, Jigawa State
Nigeria
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Source of Support: None, Conflict of Interest: None


DOI: 10.4103/cjhr.cjhr_64_17

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  Abstract 


Background: Nigeria is one of the greatest contributors to the neonatal morbidity and maternity worldwide. Objective: This study was undertaken to determine the morbidity and mortality pattern of the neonatal admission including the outcome. Materials and Methods: This was a 1-year (March 2015 to February 2016) retrospective study of all the consecutive neonatal admissions in the special care baby unit (SCBU) of Federal Medical Centre Birnin Kudu, Jigawa State, Nigeria. The data obtained were entered into a predesigned pro forma and analyzed appropriately. Results: A total of 205 neonates were admitted to SCBU during the study period with the ratio of the males to females admitted was 2.1:1. The major causes of morbidity were neonatal sepsis (32.2%), birth asphyxia (29.3%), and prematurity (18.5%). In this study, overall mortality rate was 7.16% with birth asphyxia accounting for 13 (40.6%) of the total deaths (χ2 = 1.50, P = 0.68). One hundred and fifty-nine (77%) were discharged, 12 (6%) were discharged against medical advice, while 2 (1%) were referred. Conclusion: Neonatal sepsis, birth asphyxia, and prematurity are the major causes of neonatal morbidity and mortality in this locality.

Keywords: Morbidity, mortality, neonatal, Nigeria, rural


How to cite this article:
Abdullahi UI. Neonatal morbidity and mortality in a Rural Tertiary Hospital in Nigeria. CHRISMED J Health Res 2018;5:8-10

How to cite this URL:
Abdullahi UI. Neonatal morbidity and mortality in a Rural Tertiary Hospital in Nigeria. CHRISMED J Health Res [serial online] 2018 [cited 2018 Apr 26];5:8-10. Available from: http://www.cjhr.org/text.asp?2018/5/1/8/223125




  Introduction Top


More than a quarter of the estimated 1 million children who die under the age of 5 years annually in Nigeria die during the first 28 days of life.[1] Main causes of neonatal deaths are birth asphyxia, severe infection including tetanus, and premature birth.[2] Much of the focus on neonatal survival has been driven by the millennium development goal (MDG) 4, which targeted a two-thirds reduction in under-five mortality. Evaluation of the pattern of morbidity and mortality among neonates presenting to this facility is highly desirable and critical in measuring the quality of the health services provided and identifies the deficiencies in their overall management. It will also assist policy-makers in effective planning.

Objective of the study

This study aimed to determine the patterns of morbidity, mortality, and outcome of neonatal admissions in the special care baby units (SCBUs) of the hospital of the Federal Medical Centre of Birnin Kudu (FMCB), Jigawa state, in northwestern Nigeria. It is the first of its kind in our center and the state at large.


  Materials and Methods Top


This retrospective study was carried out at the SCBU of FMCB. The SCBU has 10 beds capacity. Parents or guardians bear all the cost of admissions including drugs, antibiotics, and investigations. This study was authorized by the Ethical Committee of the FMCB.

All consecutive neonates admitted from February 2015 to January 2016 were reviewed. The information obtained from the case files included age, sex, admitting diagnosis, and length of hospital stay. The outcome of admission in the form of discharge, death, referral, or discharge against medical advice (DAMA) was also documented. Microsoft Excel spreadsheet was used for data collection and the data were analyzed using the Statistical Package for the Social Sciences version 16.0 (SPSS Inc., Chicago, IL, USA).


  Results Top


Two hundred and five neonates were admitted during the study period. One hundred and thirty-nine (68%) were males, and 66 (32%) (95% confidence interval: 61.61%–74.39%) were females with m:f ratio of 2.1:1. Thirty-two of the neonates died on admission, giving the mortality rate of 15.6%. Twenty of the deaths occurred among males and 12 among females though it was not statistically significant (χ2 = 0.353, P = 0.53).

The most common diagnosis at admission was neonatal sepsis 66 (32.2%), birth asphyxia 60 (29.3%), and prematurity 38 (18.5%). Other diagnoses included neonatal jaundice, hemorrhagic disease of the newborn, macrosomia, failure to thrive, and hypoglycemia [Table 1].
Table 1: Morbidity pattern of the neonates

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Birth asphyxia accounted for 13 (40.6%) deaths with a case fatality rate of 19.7%; this is followed by prematurity and jaundice with case fatality rate of 15.8% and 15.9%, respectively. The difference was not statistically significant (χ2 = 1.50, P = 0.68) [Table 2].
Table 2: Distribution of mortalities by diagnosis

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One hundred and fifty-nine (77%) neonates were discharged home, 32 (16%) died, 12 (6%) DAMA, and 2 (1%) were referred [Figure 1].
Figure 1: Distribution of admission outcome

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  Discussion Top


Two hundred and five neonates were admitted during the study period; this figure falls within the range of 126–356 reported by some Nigerian authors.[3],[4],[5] The 205 admissions recorded in this study are lower than 2963 reported from Kano,[6] Northwestern Nigeria. The disparity may be explained partly by the fact that Kano is urban and densely populated and the populace is better informed and has a better health-seeking behavior compared to FMCB which is predominantly rural with poor health-seeking behavior.

Birth asphyxia, neonatal sepsis, and prematurity were the most common diagnoses at presentation. Neonatal sepsis is the most common morbidity among the neonates admitted in this study which is in keeping with findings of other authors [4],[7],[8] from Nigeria and South Africa [9] and India.[10],[11] This reflects poor utilization of antenatal care services and inadequate essential newborn care since most deliveries took place at home and unsupervised.

The mortality rate in this study is 15.6% which is in keeping with 15.6% documented in Sagamu,[5] 16.9% recorded in Kano,[6] and 14.2% reported from Enugu.[3] The high mortality rate may be attributed to the nonskill attendants of home deliveries, harmful traditional practices, and late presentation of sick newborn to this hospital been a referral center in the state.

DAMA was documented in 6% of the neonates which is in consonance with 5.2% documented in Azare,[4] 5.3% reported in Abuja,[12] but higher than 4.3% reported from Port Harcourt.[12] This may partly be attributed to poverty and ignorance among the rural dwellers studied.

Neonatal morbidity and mortality are still prevalent as documented in this study. The most common contributors to neonatal morbidity and mortality in developing countries like ours can largely be prevented by improving antenatal care, maternal health, timely referral at the appropriate time to tertiary care centers for high-risk cases, and prevention of preterm deliveries.


  Conclusion Top


Common causes of admission were birth asphyxia, sepsis, and prematurity with associated significant mortality.

Financial support and sponsorship

Nil.

Conflicts of interest

There are no conflicts of interest.



 
  References Top

1.
UNICEF Nigeria – The Children-Maternal and Child Health. Available from: http://www.unicef.org/nigeria/children_1926.htmL. [Last accessed on 2018 Jun 05].  Back to cited text no. 1
    
2.
World Health Organization. Maternal, Newborn, Child and Adolescent Health Programme. Available from: http://www.who.int/maternal_child_adolescent/epidemiology/newborn/en/. [Last accessed on 2016 Feb 04].  Back to cited text no. 2
    
3.
Ekwochi U, Ezenwosu OU, Nwokoye IC, Ndu IK. The Pattern of Morbidity and Mortality of Admissions into the Special Care Baby Unit of Enugu State University Teaching Hospital, Parklane, Enugu, South-East Nigeria. Paper Presented at The Annual General and Scientific Meeting of Paediatric Association of Nigeria; 2013 January 22-26: Enugu, Nigeria; 2013.  Back to cited text no. 3
    
4.
Imoudu IA, Ahmad H, Yusuf MO, Makarfi HU, Umara T. An analysis of neonatal morbidity and mortality in Azare, North-Eastern Nigeria. OSR J Dent Med Sci 2014;13:50-7.  Back to cited text no. 4
    
5.
Ayeni VA, Oladipo AO, Ogunlesi TA, Olowu AO, Ogunfowora OB, Fetuga MB, et al. Morbidity and Mortality Pattern among In-Patients in the Paediatric Department of Olabisi Onabanjo University Teaching Hospital Over a Twelve-Month Period. Paper Presented at The Annual General and Scientific Meeting of the Paediatric Association of Nigeria; 2013 January 22-26; Enugu, Nigeria; 2013.  Back to cited text no. 5
    
6.
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. 6
[PUBMED]    
7.
Samuel NO, Benson NO. Pattern of neonatal admission and outcome at a Nigerian tertiary health institution. Oxford J Med 2004;16:31-7.  Back to cited text no. 7
    
8.
McGil Ugwu GI. The pattern of morbidity and mortality in the newborn special care unit in a tertiary institution in the Niger Delta region of Nigeria: A two-year prospective study. Glob Adv Res J Med Med Sci 2012;1:133-8.  Back to cited text no. 8
    
9.
Hoque M, Haqq S, Islam R. Causes of neonatal admissions and death at a rural hospital in KwaZulu-Natal, South Africa. South Afr J Epidemiol Infect 2011;2:26-39.  Back to cited text no. 9
    
10.
Sridhar PV, Thammanna PS, Sandeep M. Morbidity pattern and hospital outcome of neonates admitted in a tertiary care teaching hospital, Mandya. Int J Sci Stud 2015;3:126-9.  Back to cited text no. 10
    
11.
Okechukwu AA. Discharge against medical advice in children at university of Abuja Teaching Hospital, Gwagwalada, Nigeria. J Med Med Sci 2011;2:949-54.  Back to cited text no. 11
    
12.
Opara P, Eke G. Discharge against medical advice amongst neonates admitted into a special care unit in Port Harcourt, Nigeria. Internet J Paediatr Neonatol 2010;12:40-7.  Back to cited text no. 12
    


    Figures

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    Tables

  [Table 1], [Table 2]



 

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