Risk factors for neonatal mortality in Busia district, Uganda.
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INTRODUCTION: Uganda is one of the developing countires with a high neonatal mortality rate (NMR). In a resource poor country, improving a neonatal outcome requires simple preventive measures and prompt newborn care. However, institutional delivery is low (20% for Busia district) and there is little integration for neonatal health into existing maternal and child (MCH) programmes. For Busia district, where the majority of births occur at home, simple interventions at community level are very essential fo meaningful reduction in neonatal mortality. METHODS: This was a 2-phase study conducted in Busia district. Focus group discussions with mothers, and key informant interviews with traditional birth attendants (TBAs) comprised the first phase. Qualitative information got was used to enrich the study by modifying the questionnaire that was used in the second phase. The second phase of data collection was a community based unmatched case control study with three controls per case in 4 selected sub counties. Using multiple sources, 49 cases were identified and 147 neighbourhood controls randomly selected for this study. RESULTS: In total, 196 rural interviews participated in this study. The risk factors associated with neonatal mortality included; being a samia mother (OR 7.45, 95%C1 2.27-24.43); unclean delivery surface (OR 3.85, 95%C1 1.28-11.58); Premature (OR 8.31, 95%C1 1.77-39.05), non use of gloves by attendants (OR 18.09, 95%C1 5.08-64.45). Other factors were not cleaning cord at home (OR 161.31, 95%C1 23.80-1093.34); hypothermia (OR 6.08 95% C1 1.77-20.90) and unskilled attendants (OR 28.45 95%C1 1.23-660.82). CONCLUSIONS: Poor neonatal care practices and poor health seeking behaviour were associated with high neonatal mortality. RECOMMENDATIONS: The DHO, through research should identify risk factors for prematurity. The DHT should sensitize the community about good neonatal practices and should devise incentives for mothers to deliver in health units.