Factors associated with poor outcome in new born babies born before arrival (BBA) admitted in mulago hospital.

Abstract

BACKGROUND: New born care practices in sub-saharan Africa and Uganda in particular have proved to be suboptimal especially if the child is born before arrival (BBA). Neonatal mortality rate (NMR) in Uganda is at 27/1000 live births, has not declined in the last 15 years and contributed to the slow progress of millennium development goals (MDGs). Giving priority to neonatal health is the best option of attaining the MDG4. Babies BBA at a hospital constitute a special group with regard to neonatal mortality and morbidity. Majority of the BBA die at home because of lack of resuscitation facilities, labour monitoring and septic conditions that sorrounds birth. The few babies who reach hospitals are often very sick with hypothermia, hypoglycaemia, severe asphyxia, septicaemia and other conditions. Such factors are responsible for the poor outcome observed in these babies. Data from Mulago SCBU show a high mortality of 50% forBBA babies compared to13% mortality for babies born within the hospital. It thus follows that deaths among the babies BBA also significantly contribute to the high mortality in SCBU. OBJECTIVE: To study the outcome and factors associated with poor outcome of newborns born before arrival admitted in mulago hospital. STUDY DESIGN: This was a prospective longitudinal cohort study, which followed up three arms of new born babies for the period of seven days, where by BBAs were compared with babies born in Mulago (Inborns) and babies born in other health facilities (Outborns). STUDY SETTING: The study was carried out in the special care baby unit, which admits high risk new born babies born in mulago and outside mulago. Mulago hospital is the main national referral hospital in Uganda and a teaching centre for makerere university college of health sciences. STUDY POPULATION: New born babies admitted in special care unit during the study period. OUTCOME MEASURES: Occurrence of death while the baby is admitted in SCBU or discharge or being alive in the ward after 7 days of follow up. RESULTS: Mortality in babies was 41.5% while mortality in inborn and out born babies were 13.9% and 38.9% respectively with majority of deaths (86%) occurring within 48 hours of admission. The risk of death in BBA babies was 5.1 times and in out born babies was 3.7 times more than inborn. Among the studied maternal factors, Lack of ANC (P=0.42) was found to be associated with mortality in BBA babies. The baby factors associated with mortality in BBA were hypothermia (p=0.020). CONCLUSIONS: Babies BBA admitted to SCBU of Mulago hospital have higher mortality than those delivered in health facilities (institutional deliveries). Both BBAs and out born babies have increased risk of death compared to inborn babies with majority of death occurring in the first 48 hours. Factors associated with poor outcome in babies BBA include inadequate antenatal care to mothers, hypothermia, hypoglycaemia and suboptimal cord care in new born babies. RECOMMENDATIONS: For SCBU In view of high mortality of babies in the first 48 hours of admission, close monitoring and interventions to prevent and treat hypoglycaemia and hypothermia in the first 2 days of admission are crucial in order to reduce mortality in the SCBU. For Ministry of Health • Since majority of mothers attend ANC at least once, health education and maximum care and interventions in the first ANC visit should be emphasized to make sure that the mothers get all the needed information and care. • There is an urgent need to improve on newborn resuscitation, post resuscitation care in all health units that conducts labour and delivery. MOH should ensure that these units have at least ambu bag and bulb syringe for resuscitation order to improve survival of newborns. • There is a need to initiate home based neonatal care to cater for the large number of newborn babies born at home. The care should include health education to the mother and families during ANC, and to village health workers, midwives, TBAs and the whole community on newborn care, I.e benefits of early and exclusive breastfeeding, keeping the baby warm, proper cord care, recognition of danger signs and early referrals.