Incidence and predictors of preterm neonatal mortality at Mbarara Regional Referral Hospital in South Western Uganda

<h4>Introduction</h4> Preterm neonatal mortality contributes substantially to the high neonatal mortality globally. In Uganda, preterm neonatal mortality accounts for 31% of all neonatal deaths. Previous studies have shown variability in mortality rates by healthcare setting. Also, diffe...

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Autores principales:	Leevan Tibaijuka, Stephen M. Bawakanya, Asiphas Owaraganise, Lydia Kyasimire, Elias Kumbakumba, Adeline A. Boatin, Musa Kayondo, Joseph Ngonzi, Stephen B. Asiimwe, Godfrey R. Mugyenyi
Formato:	article
Lenguaje:	EN
Publicado:	Public Library of Science (PLoS) 2021
Materias:	Medicine R Science Q
Acceso en línea:	https://doaj.org/article/a77b9b9e9e2a4e3aa2147e9952ddde37
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spelling	oai:doaj.org-article:a77b9b9e9e2a4e3aa2147e9952ddde372021-11-11T06:44:18ZIncidence and predictors of preterm neonatal mortality at Mbarara Regional Referral Hospital in South Western Uganda1932-6203https://doaj.org/article/a77b9b9e9e2a4e3aa2147e9952ddde372021-01-01T00:00:00Zhttps://www.ncbi.nlm.nih.gov/pmc/articles/PMC8562818/?tool=EBIhttps://doaj.org/toc/1932-6203<h4>Introduction</h4> Preterm neonatal mortality contributes substantially to the high neonatal mortality globally. In Uganda, preterm neonatal mortality accounts for 31% of all neonatal deaths. Previous studies have shown variability in mortality rates by healthcare setting. Also, different predictors influence the risk of neonatal mortality in different populations. Understanding the predictors of preterm neonatal mortality in the low-resource setting where we conducted our study could guide the development of interventions to improve outcomes for preterm neonates. We thus aimed to determine the incidence and predictors of mortality among preterm neonates born at Mbarara Regional Referral Hospital (MRRH) in South Western Uganda. <h4>Methods</h4> We prospectively enrolled 538 live preterm neonates born at MRRH from October 2019 to September 2020. The neonates were followed up until death or 28 days, whichever occurred first. We used Kaplan Meier survival analysis to describe preterm neonatal mortality and Cox proportional hazards regression to assess predictors of preterm neonatal mortality over a maximum of 28 days of follow up. <h4>Results</h4> The cumulative incidence of preterm neonatal mortality was 19.8% (95% C.I: 16.7–23.5) at 28 days from birth. Birth asphyxia (adjusted hazard ratio [aHR], 14.80; 95% CI: 5.21 to 42.02), not receiving kangaroo mother care (aHR, 9.50; 95% CI: 5.37 to 16.78), delayed initiation of breastfeeding (aHR, 9.49; 95% CI: 2.84 to 31.68), late antenatal care (ANC) booking (aHR, 1.81 to 2.52; 95% CI: 1.11 to 7.11) and no ANC attendance (aHR, 3.56; 95% CI: 1.51 to 8.43), vaginal breech delivery (aHR, 3.04; 95% CI: 1.37 to 5.18), very preterm births (aHR, 3.17; 95% CI: 1.24 to 8.13), respiratory distress syndrome (RDS) (aHR, 2.50; 95% CI: 1.11 to 5.64) and hypothermia at the time of admission to the neonatal unit (aHR, 1.98; 95% CI: 1.18 to 3.33) increased the risk of preterm neonatal mortality. Attending more than 4 ANC visits (aHR, 0.35; 95% CI: 0.12 to 0.96) reduced the risk of preterm neonatal mortality. <h4>Conclusions</h4> We observed a high cumulative incidence of mortality among preterm neonates born at a low-resource regional referral hospital in Uganda. The predictors of mortality among preterm neonates were largely modifiable factors occurring in the prenatal, natal and postnatal period (lack of ANC attendance, late ANC booking, vaginal breech delivery, birth asphyxia, respiratory distress syndrome, and hypothermia at the time of admission to the neonatal unit, not receiving kangaroo mother care and delayed initiation of breastfeeding). These findings suggest that investment in and enhancement of ANC attendance, intrapartum care, and the feasible essential newborn care interventions by providing the warm chain through kangaroo mother care, encouraging early initiation of breastfeeding, timely resuscitation for neonates when indicated and therapies reducing the incidence and severity of RDS could improve outcomes among preterm neonates in this setting.Leevan TibaijukaStephen M. BawakanyaAsiphas OwaraganiseLydia KyasimireElias KumbakumbaAdeline A. BoatinMusa KayondoJoseph NgonziStephen B. AsiimweGodfrey R. MugyenyiPublic Library of Science (PLoS)articleMedicineRScienceQENPLoS ONE, Vol 16, Iss 11 (2021)
institution	DOAJ
collection	DOAJ
language	EN
topic	Medicine R Science Q
spellingShingle	Medicine R Science Q Leevan Tibaijuka Stephen M. Bawakanya Asiphas Owaraganise Lydia Kyasimire Elias Kumbakumba Adeline A. Boatin Musa Kayondo Joseph Ngonzi Stephen B. Asiimwe Godfrey R. Mugyenyi Incidence and predictors of preterm neonatal mortality at Mbarara Regional Referral Hospital in South Western Uganda
description	<h4>Introduction</h4> Preterm neonatal mortality contributes substantially to the high neonatal mortality globally. In Uganda, preterm neonatal mortality accounts for 31% of all neonatal deaths. Previous studies have shown variability in mortality rates by healthcare setting. Also, different predictors influence the risk of neonatal mortality in different populations. Understanding the predictors of preterm neonatal mortality in the low-resource setting where we conducted our study could guide the development of interventions to improve outcomes for preterm neonates. We thus aimed to determine the incidence and predictors of mortality among preterm neonates born at Mbarara Regional Referral Hospital (MRRH) in South Western Uganda. <h4>Methods</h4> We prospectively enrolled 538 live preterm neonates born at MRRH from October 2019 to September 2020. The neonates were followed up until death or 28 days, whichever occurred first. We used Kaplan Meier survival analysis to describe preterm neonatal mortality and Cox proportional hazards regression to assess predictors of preterm neonatal mortality over a maximum of 28 days of follow up. <h4>Results</h4> The cumulative incidence of preterm neonatal mortality was 19.8% (95% C.I: 16.7–23.5) at 28 days from birth. Birth asphyxia (adjusted hazard ratio [aHR], 14.80; 95% CI: 5.21 to 42.02), not receiving kangaroo mother care (aHR, 9.50; 95% CI: 5.37 to 16.78), delayed initiation of breastfeeding (aHR, 9.49; 95% CI: 2.84 to 31.68), late antenatal care (ANC) booking (aHR, 1.81 to 2.52; 95% CI: 1.11 to 7.11) and no ANC attendance (aHR, 3.56; 95% CI: 1.51 to 8.43), vaginal breech delivery (aHR, 3.04; 95% CI: 1.37 to 5.18), very preterm births (aHR, 3.17; 95% CI: 1.24 to 8.13), respiratory distress syndrome (RDS) (aHR, 2.50; 95% CI: 1.11 to 5.64) and hypothermia at the time of admission to the neonatal unit (aHR, 1.98; 95% CI: 1.18 to 3.33) increased the risk of preterm neonatal mortality. Attending more than 4 ANC visits (aHR, 0.35; 95% CI: 0.12 to 0.96) reduced the risk of preterm neonatal mortality. <h4>Conclusions</h4> We observed a high cumulative incidence of mortality among preterm neonates born at a low-resource regional referral hospital in Uganda. The predictors of mortality among preterm neonates were largely modifiable factors occurring in the prenatal, natal and postnatal period (lack of ANC attendance, late ANC booking, vaginal breech delivery, birth asphyxia, respiratory distress syndrome, and hypothermia at the time of admission to the neonatal unit, not receiving kangaroo mother care and delayed initiation of breastfeeding). These findings suggest that investment in and enhancement of ANC attendance, intrapartum care, and the feasible essential newborn care interventions by providing the warm chain through kangaroo mother care, encouraging early initiation of breastfeeding, timely resuscitation for neonates when indicated and therapies reducing the incidence and severity of RDS could improve outcomes among preterm neonates in this setting.
format	article
author	Leevan Tibaijuka Stephen M. Bawakanya Asiphas Owaraganise Lydia Kyasimire Elias Kumbakumba Adeline A. Boatin Musa Kayondo Joseph Ngonzi Stephen B. Asiimwe Godfrey R. Mugyenyi
author_facet	Leevan Tibaijuka Stephen M. Bawakanya Asiphas Owaraganise Lydia Kyasimire Elias Kumbakumba Adeline A. Boatin Musa Kayondo Joseph Ngonzi Stephen B. Asiimwe Godfrey R. Mugyenyi
author_sort	Leevan Tibaijuka
title	Incidence and predictors of preterm neonatal mortality at Mbarara Regional Referral Hospital in South Western Uganda
title_short	Incidence and predictors of preterm neonatal mortality at Mbarara Regional Referral Hospital in South Western Uganda
title_full	Incidence and predictors of preterm neonatal mortality at Mbarara Regional Referral Hospital in South Western Uganda
title_fullStr	Incidence and predictors of preterm neonatal mortality at Mbarara Regional Referral Hospital in South Western Uganda
title_full_unstemmed	Incidence and predictors of preterm neonatal mortality at Mbarara Regional Referral Hospital in South Western Uganda
title_sort	incidence and predictors of preterm neonatal mortality at mbarara regional referral hospital in south western uganda
publisher	Public Library of Science (PLoS)
publishDate	2021
url	https://doaj.org/article/a77b9b9e9e2a4e3aa2147e9952ddde37
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Incidence and predictors of preterm neonatal mortality at Mbarara Regional Referral Hospital in South Western Uganda

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