Background The protracted conflict in Yemen has taken a massive toll on the health system, negatively impacting the health of children, especially the most vulnerable age group; the newborns. Methods A 2-year retrospective study of admissions into the Neonatal Intensive Care Unit (NICU) in Al-Gomhoury Hospital Hajjah, Northwest Yemen was conducted. Data was analyzed with IBM SPSS® version 25.0 statistical software using descriptive/inferential statistics. Results A total of 976 newborns were eligible and included in this study; 506 preterm newborns (51.8%) and 470 term newborns (48.2%). Over half, 549 (56.3%) newborns were admitted within 24 h after birth and 681 (69.8%) newborns travelled for over 60 min to arrive at the NICU. The most common admission diagnoses were complications of prematurity (341; 34.9%), perinatal asphyxia (336; 34.4%), neonatal jaundice (187; 18.8%), and neonatal sepsis (157, 16.1%). The median length of stay in the NICU was 4 days. There were 213 neonatal deaths (Facility neonatal mortality rate was 218 neonatal deaths per 1000 livebirths); 192 (90.1%) were preterm newborns, while 177 (83.1%) were amongst newborns that travelled for more 60 min to reach the NICU. Significant predictors of neonatal deaths are preterm birth (aOR = 3.09, 95% CI: 1.26–7.59, p = 0.014 for moderate preterm neonates; aOR = 6.18, 95% CI: 2.12–18.01, p = 0.001 for very preterm neonates; and aOR = 44.59, 95% CI: 9.18–216.61, p < 0.001 for extreme preterm neonates); low birth weight (aOR = 3.67, 95% CI: 1.16–12.07, p = 0.032 for very low birth weight neonates; and aOR = 17.42, 95% CI: 2.97–102.08, p = 0.002 for extreme low birth weight neonates); and traveling for more than 60 min to arrive at the NICU (aOR = 2.32, 95% CI: 1.07–5.04, p = 0.033). Neonates delivered by Caesarean section had lower odds of death (aOR = 0.38, 95% CI 0.20–0.73, p = 0.004) than those delivered by vaginal birth. Conclusions Preterm newborns bear disproportionate burden of neonatal morbidity and mortality in this setting which is aggravated by difficulties in accessing early neonatal care. Community-based model of providing basic obstetric and neonatal care could augment existing health system to improve neonatal survival in Yemen.
This is a retrospective descriptive study carried out in Saudi Hospital Hajjah between July 2016 and December 2017: The aim of this study is to assess the etiology and outcome of acute bacterial meningitis among children in Saudi Hospital Hajjah. We included in this study all children aged one month or more to 12 years who had symptoms and signs suggested acute bacterial meningitis confirmed by lumber puncture of cerebrospinal fluid for cells, biochemistry and culture. The data of all patients were retrieved from the hospital records and patient`s charts. These data included age, clinical presentation, etiologic microorganism and outcome. A total of 196 patients who had confirmed bacterial meningitis was recorded. Of these, 71 patients (36.2%) were aged under 12 months, 25% aged between 1-2 years old, 17.9% between 3-5 years and 20.9% > 5 years. Cerebrospinal fluid culture was positive among 94.9% of patients. Among the positive isolates, 43.5% were having Nesseria meningitidis, 34.9% Streptococcus pneumonia, 18.2% Hemophillus influenza type b, 2.7% group B Streptococci and 0.5% E.coli. There were 19 patients died giving the case fatality rate as 9.7%. Of those, 47.3% had aged less than 12 months, 31.5% aged 1-2 years, one child (5.2%) aged 4 years and 3 cases (15.8%) were > 5 years. Eleven cases of deaths (57.9%) had s. pneumonia infections. There were 24 patients (12.2%) of survivors developed neurological complications. This study demonstrates that there is no change in the epidemiology of the main causes of acute bacterial meningitis among children compared to that reported prior to introduction Hib and pneumococcal vaccines indicating a limited coverage of vaccination in the Northwest Territories of Yemen. The case fatality rate noted in this study is relatively low, but aggressive efforts by the health care system both to vaccinate and to early treat infected children, meningitis incidence and mortality will decline.
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