BACKGROUND: Ninety-six percent of the world's 3 million neonatal deaths occur in developing countries where the majority of births occur outside health facility. The objective of this study was to evaluate the demographic, clinical profile and outcome of neonates admitted to Neonatal Intensive Care Unit of Dekemhare Hospital of Eritrea. METHODS: The study was a retrospective register-based review of all neonates admitted from January 2018 to December 2021 to Dekemhare Hospital. Overall, 509 neonates were enrolled in this study. Data were collected from neonatal register book from January 5 to February 5, 2022 by general practitioners using a predesigned data collection tool. Data entry was done using CSpro 7.3 and analyzed through SPSS version 22. Results were presented in frequencies, percent and odds ratio. Univariable and multivariable analysis was done to measure the association between the variables. RESULTS: Three quarter (75.6%) of the neonates had normal birth weight and 80.0% were term. Majority (75.4%) of the neonates was delivered vaginally and 92.7% were delivered at health facility. Neonatal infection (33.0%), birth asphyxia (20%) and prematurity (14.3%) were the top three primary causes of neonatal admission to the Neonatal Intensive Care Unit. Furthermore, 31% of neonatal deaths occurred during 24-72 hours of their life and the mortality rate was 16.3%. Multivariable analysis indicated that low birth weight (AOR: 7.28; 95%CI: 2.85-18.55) increased neonatal mortality. Whereas delivery at health facility (AOR: 0.17; 95%CI: 0.06-0.47), hospital stay 4-7 days (AOR: 0.06; 95% CI: 0.02-0.23) and above 8 days (AOR: 0.06; 95%CI: 0.02-0.23) were showing protective effect on neonatal mortality. CONCLUSION: Congenital abnormality, prematurity and birth asphyxia had higher case fatality rate. And, low birth weight, delivery at health facility and hospital stay were found to be predictors of neonatal mortality. Training of health professionals on neonatal resuscitation, further improvement on the diagnostic setup, treatment tools, infrastructure and raising community awareness to deliver at health facility are crucial to decrease the neonatal mortality in Eritrea.
United Nations Inter-agency Group for Child Mortality Estimation (UNIGME): ‘Levels & Trends in Child Mortality: Report. Estimates developed by the United Nations Inter-agency Group for Child Mortality Estimation. New York: United Nations Children’s Fund; 2020.
World health statistics: monitoring health for the SDGs, sustainable development goals. Geneva: World Health Organization; 2020. Licence: CC BY-NC-SA 3.0 IGO. 2020.
Carlo WA, et al. Newborn Care Training and Perinatal Mortality in Communities in Developing Countries. N Engl J Med. 2010;362(7):614–23.
[DOI: 10.1056/NEJMsa0806033]
Engmann et al: causes of community stillbirths and early neonatal deaths in low-income countries using verbal autopsy: an international, multicenter study. J Perinatol 2012 32(8):585–592.
Oluwayemi IO, Ogundaren EO, Olatunya OS. Care of the Newborn in Developing Countries. J Neonatal Biol. 2014;3(162).
Hedstrom A, et al. Demographics, clinical characteristics and neonatal outcomes in a rural Ugandan NICU. BMC Pregnancy and Childbirth. 2014;14(327).
Lucia Hug MA, You D, Alkema L. on behalf of the UN Inter-agency Group for Child Mortality Estimation: National, regional, and global levels and trends in neonatal mortality between 1990 and 2017, with scenario-based projections to 2030: a systematic analysis. Lancet Glob Health. 2019:7.
Haws RATA, Bhutta ZA, Darmstadt GL. Impact of packaged interventions on neonatal health: a review of the evidence. Health Policy Plan. 2007;22:193–215.
[DOI: 10.1093/heapol/czm009]
World health statistics 2018: monitoring health for the SDGs, sustainable development goals. Geneva: World Health Organization; 2018. Licence: CC BY-NC-SA 3.0 IGO.
MCEE-WHO methods and data sources for child causes of death 2000-2016. Global Health Estimates Technical Paper WHO/HMM/IER/GHE/2018.1.
Lawn JEKM, Black RE, Pitt C, Cousens S, Kerber K, Corbett E, et al. Newborn survival: a multi-country analysis of a decade of change. Health Policy Plan. 2012;17(3).
Fengqing Chao DY, Pedersen J, Hug L, Alkema L. National and regional under-5 mortality rate by economic status for low-income and middle-income countries: a systematic assessment. Lancet Glob Health. 2018:6.
WHO SDG 3. Ensure healthy lives and promote wellbeing for all at all ages. Available from: https://www.who.int/sdg/targets/en/ . Accessed July 28, 2020.
Lawn JE, Cousens S, Zupan J. 4 million neonatal deaths: When? Where? Why? Lancet. 2005;365(9462).
Darmstadt GL, et al. Saving newborn lives in Asia and Africa: cost and impact of phased scale-up of interventions within the continuum of care. Health Policy Plan. 2008;23:101–17.
[DOI: 10.1093/heapol/czn001]
Cousens HBS. Addressing the challenge of neonatal mortality. Trop Med Int Health. 2013;18(3):303–12.
Mabaso et al: Overview of Maternal, Neonatal and Child Deaths in South Africa: Challenges, Opportunities, Progress and Future Prospects. Int J MCH and AIDS 2014, 2(2):182-189.
Wondemagegn et al: The effect of antenatal care follow-up on neonatal health outcomes: a systematic review and meta-analysis. Public Health Rev 2018, 39(33).
Rhee et al: Impact of Maternal and Birth Attendant Hand-washing on Neonatal Mortality in Southern Nepal. Arch Pediatr Adolesc Med 2008, 162(7):603-608.
Shah S, Zemichael O, Meng H. Factors associated with mortality and length of stay in hospitalised neonates in Eritrea, Africa: a cross-sectional study. BMJ. 2012.
Ndombo PK, et al. A cohort analysis of neonatal hospital mortality rate and predictors of neonatal mortality in a sub-urban hospital of Cameroon. Ital J Pediatr. 2017;43(52).
Verma J, et al. Neonatal outcome in new-borns admitted in NICU of tertiary care hospital in central India: a 5-year study. Int J Contemp Pediatr. 2018;5(4):1364–7.
[DOI: 10.18203/2349-3291.ijcp20182512]
Khasawneh et al: Indications and Clinical Profile of Neonatal Admissions: A Cross-Sectional Descriptive Analysis from a Single Academic Center in Jordan. J Multidiscip Healthc 2020, 13.
Zeinalzadeh AH, Khodaei R, Heidarzadeh M. Causes of Neonatal Mortality in the Neonatal Intensive Care Unit of Taleghani Hospital. Iranian J Neonatol. 2017;8(3).
Hoque M, Haaq S, Islam R. Causes of neonatal admissions and deaths at a rural hospital in KwaZulu-Natal, South Africa. Southern African J Epidemiol Infect. 2011;26(1):26–9.
[DOI: 10.1080/10158782.2011.11441416]
Elmi Farah A, Abbas AH, Tahir Ahmed A. Trends of admission and predictors of neonatal mortality: A hospital based retrospective cohort study in Somali region of Ethiopia. PLoS One. 2018;13(9).
Bokade CM, Meshram RM. Morbidity and mortality patterns among outborn referral neonates in central India: Prospective observational study. J Clin Neonatol. 2018;7:130–5.
[DOI: 10.4103/jcn.JCN_27_18]
Alemu m: assessment of pattern of admission and outcome of neonates admitted to neonatal intensive care unit at tikur anbessa sepecialized teaching hospital, addis ababa, ethiopia, 2017.
Grady SC, et al. Neonatal mortality in East Africa and West Africa: a geographic analysis of district-level demographic and health survey data. Geospatial Health. 2017;12(501).
KUMAR M, et al. Neonatal Outcomes at a Subdistrict Hospital in North India. J Tropical Pediatr. 2002:48.
Sivasubramaniam PG, et al. Neonatal Outcomes of Infants Admitted to a Large Government Hospital in Amman, Jordan. Global J Health Sci. 2015;7(4).
Tette EMANE, Nuertey BD, Azusong EA, Akaateba D, Yirifere J, et al. The pattern of neonatal admissions and mortality at a regional and district hospital in the Upper West Region of Ghana; a cross sectional study. PLoS One. 2020;15(5).
Mengesha HG, Sahle BW. Cause of neonatal deaths in Northern Ethiopia: a prospective cohort study. BMC Public Health. 2017;17(62).
Indongo N. risk factors and causes of neonatal deaths in namibia. Eur Sci J. 2014.
