Burden of disease and risk factors for mortality amongst hospitalized newborns in Nigeria and Kenya

Abstract

Objective To describe the patient population, priority diseases and outcomes in newborns admitted <48 hours old to neonatal units in both Kenya and Nigeria. Study design In a network of seven secondary and tertiary level neonatal units in Nigeria and Kenya, we captured anonymised data on all admissions <48 hours of age over a 6-month period. Results 2280 newborns were admitted. Mean birthweight was 2.3 kg (SD 0.9); 57.0% (1214/2128) infants were low birthweight (LBW; <2.5kg) and 22.6% (480/2128) were very LBW (VLBW; <1.5 kg). Median gestation was 36 weeks (interquartile range 32, 39) and 21.6% (483/2236) infants were very preterm (gestation <32 weeks). The most common morbidities were jaundice (987/2262, 43.6%), suspected sepsis (955/2280, 41.9%), respiratory conditions (817/2280, 35.8%) and birth asphyxia (547/2280, 24.0%). 18.7% (423/2262) newborns died; mortality was very high amongst VLBW (222/472, 47%) and very preterm infants (197/483, 40.8%). Factors independently associated with mortality were gestation <28 weeks (adjusted odds ratio 11.58; 95% confidence interval 4.73–28.39), VLBW (6.92; 4.06–11.79), congenital anomaly (4.93; 2.42–10.05), abdominal condition (2.86; 1.40–5.83), birth asphyxia (2.44; 1.52–3.92), respiratory condition (1.46; 1.08–2.28) and maternal antibiotics within 24 hours before or after birth (1.91; 1.28–2.85). Mortality was reduced if mothers received a partial (0.51; 0.28–0.93) or full treatment course (0.44; 0.21–0.92) of dexamethasone before preterm delivery. Conclusion Greater efforts are needed to address the very high burden of illnesses and mortality in hospitalized newborns in sub-Saharan Africa. Interventions need to address priority issues during pregnancy and delivery as well as in the newborn.

Etiology of severe invasive infections in young infants in rural settings in sub-Saharan Africa

“…The inclusion and exclusion criteria captured a higher number of infants suspected to be severe invasive infections. However, they did not exclude important co-morbidities such as birth asphyxia, preterm birth or severe congenital anomalies which are related to neonatal morbidity [6,26] and made it difficult to ascertain the role of a potential pathogen compared with other risk factors on the clinical presentation and outcome of these cases.…”

Enteral Feeding Practices for Very Preterm and Very Low Birth Weight Infants in Nigeria and Kenya

“…Preterm birth is the single most important cause of death in the neonatal period accounting for up to a million neonatal deaths annually ( 2 , 4 , 5 ). Amongst LBW infants, very low birth weight (VLBW; 1,000 g to <1,500 g), and very preterm (born 28 to <32 weeks gestational age) are even more at risk, with higher incidences of late onset sepsis (LOS), necrotising enterocolitis (NEC), feeding intolerance and ultimately, mortality ( 6 , 7 ).…”

Neonatal Jaundice and Autism: Precautionary Principle Invocation Overdue

“…These deaths are likely to affect poorer countries, preterms, and especially preterms in poorer countries in a vastly disproportionate manner. For example, Nabwera et al reported high mortality amongst preterms in Kenya and Nigeria [ 161 ], countries where the burden of severe neonatal jaundice is also high.…”