Causes and contributors to neonatal deaths during a Health system strengthening project in Luuka District , Eastern Uganda

Abstract

Background; In Sub Sahara Africa and Uganda, neonatal mortality is high. There are evidence- based interventions for reducing neonatal deaths, but they are not widely available. In addition, numerous interventions to improve neonate outcomes are being implemented in Uganda. Despite this, significant number of neonates are still lost. Despite health system strengthening measures, there is a lack of data to determine which neonates die and why. A three-year project named Community in which Mothers and Newborns Thrive (COMONETH) was undertaken in Luuka district. The project had concerted efforts to strength health services to reduce neonatal deaths. This study aimed at identifying the causes of death, associated factors in regards to neonatal mortality during a health strengthening project in Luuka district. Objectives; to determine the causes and contributors of neonatal deaths during a health system strengthening project in Luuka district, eastern Uganda. Methods; This study used secondary community verbal and social autopsy data collected for a period of 3 years from 2017 to 2019, in a health system strengthening intervention –the Community in which Mothers and Newborns Thrive project using a verbal and social autopsy questionnaire. To determine the cause of death, two independent medical officers used WHO- ICD -10 criteria to code them. STATA14.0 was used to evaluate the verbal and social autopsy codes while thematic content analysis was used to study the qualitative data. Furthermore, 10 Key informant interviews were held with the 2 Community Health workers, 8 health workers and 6 in-depth interviews were held with household members. Results; Between 2017 and 2019, data was collected on 172 neonatal deaths, of which 45.5% were female and 54.1% were male. In the early neonatal period (0 to 7 days) ,95.9% neonates died while 4.1% died in late neonatal period (8 to 28days). Birth asphyxia (43%), low birth weight/prematurity (18.6%), other perinatal causes (12.2%) and neonatal sepsis (9.3%) were the leading cause of mortality. Delay in receiving proper care in the facility or Delay 3 (45.9%) and delay in seeking for care or Delay 1 (43%) were the leading contributors to neonatal mortality. The neonatal deaths which had no identifiable delay contributing to the deaths were 6.4%. The government facilities accounted for 43 percent of all births while private clinics accounted for 30.8%. However, private health facilities were responsible for the majority of neonatal mortality (34.1%), followed by home deaths (26.2%) and government facilities (25.4%). Qualitative analysis revealed that TBAs/homedeliveries, a lack

of understanding about neonatal danger signs, poor referral systems and stock outs of essential drugs and supplies and a lack of room for neonatal care facilities were the major contributing factors of neonatal mortality. Conclusion: The greatest contributors to neonate death were delays at home (Delay 1) and delays in receiving proper care in health facilities (Delay 3). The delay caused by transportation was minimal. Private clinics had 34.1% of the newborn‘s deaths. Birth asphyxia was the main cause of death followed by preterm and other perinatal factors, with sepsis contributing the least. There is a need to improve neonatal care in health facilities, regulate private healthcare providers and strengthen /empower families and communities. The use of verbal and social autopsy as part of district programming could improve health care and provide policy guidance.