Associated Factors of Neonatal Death at the Yaounde Central Hospital

Abstract

Purpose: This study was aimed at determining the associated factors of neonatal mortality amongst newborn babies at the Yaounde central hospital (YCH).

Problem: According to UNICEF (2020), 80% of all newborn deaths result from three preventable and treatable conditions: complications due to prematurity, intra-partum related deaths including birth asphyxia and neonatal infections. However, still 6,700 neonates, babies in their first 28 days of life, the neonatal period, are dying daily around the world. Virtually all (99%) newborn deaths occur in low and middle-income countries. It is especially in Africa and South Asia that the least progress in reducing neonatal deaths has been made [1]. Since 2004, neonatal mortality rate (NMR) in Cameroon only shows a slight insignificant drop and is missing its target for the 2030s sustainable development goal [2]. Most of neonates’ death causes get lost as we climb the health pyramid and they remain invisible at the national level. Meanwhile, there is a sudden raise of neonatal death rate since 2019 at the Yaounde Central Hospital.

Methods: We conducted a 1 to 5 matched case-controls study. Using a quota sampling followed by systematic sampling procedures and with the help of Cochran formula for a probabilistic sampling size calculation, a developed questionnaire was addressed to a sample population of 1,428 neonates (cases = 238, controls = 1,190) in the Yaounde central hospital.

Results: After adjustment, associated factors of neonatal death at the YCH were the absence of placental abnormality (AHR=0.235; P-value =0.016; 95%; CI= [0.072; 0.765]), placenta praevia grade 1 (AHR =1.237; P-value = 0.007; 95%; CI= [1.084; 1.679]), placenta praevia grade 3 (AHR =1.193; P-value = 0.01; 95%; CI= [1.055; 1.679]), placenta abruptio sher 0 (AHR =5.092; P-value = 0.015; 95%; CI= [1.378; 18.820]), placenta abruptio sher 3 (AHR =17.944; P-value = 0.016; CI= [1.728; 186.322]), caesarean delivery (AHR =1.777; P-value = 0.002; 95%; CI= [1.241; 2.545]), the absence of prematurity (AHR =0.376; P-value = 0.0; 95%; CI= [0.274; 0.514]), the odds of not being placed under oxygen (AHR =5.680; P-value = 0.0; 95%; CI= [3.898; 8.275]), and referral after delivery (AHR=11.966; P-value = 0.018; 95%; CI= [1.53; 93.597]).

Conclusion: From the results of our study, the raise of neonatal mortality at the Yaounde Central Hospital was explained at 73.6% by the type of placenta involved in pregnancy (8.3%), the mode of delivery (11.6%), the age of pregnancy at birth (prematurity, 20%), the obvious practice of putting a new-born under oxygen (26.8%), and the referral status of the new-born (6.9%). From this perspective, acting only on the three main preventable and treatable causes of neonatal death revealed by UNICEF (2020) [1], is not sufficient to cause a drop of NMR at the YCH. Particular attention should be paid on cases of pregnancy with placental abnormality and an extra effort should be made.

Significance: To reduce neonatal mortality when facing placental abnormality, pregnancy should be pushed to at least 37 weeks, late c-section intervention should be avoided and in case of complications, referral should be done before childbirth.