Neonatal Mortality and Perinatal Risk Factors in Rural Southwestern Nigeria: A Community-Based Prospective Study

Abstract

BACKGROUND: Reliable data on births and deaths particularly at the community level are scarce yet they are urgently needed to inform policy and assess the improvements which may have occurred with recent interventions. OBJECTIVE: To determine neonatal mortality rate and identify perinatal risk factors associated with neonatal deaths. METHODS: In a community-based prospective study, baseline data on births and deaths were collected as they occurred in a rural community of Southwest Nigeria from 1993 to 1998. Data on births and deaths were collected for the period. RESULTS: There were 972 live births and 64 infant deaths giving an infant mortality rate of 65.8 per 1000. Neonatal deaths accounted for a half of all infant deaths (N=32) giving a neonatal mortality rate of 32.9 per 1000. Twelve (37.5%) of neonatal deaths occurred on the first day of life; half of all neonatal deaths occurred within two days of birth, 21(65.6%) occurred during the first seven days of life and only 11 (34.4%) occurred over the last three weeks of the first month. The commonest known cause of death was associated with low birth weight (LBW) which was responsible for eight (25%) of deaths, while sepsis/fever and maternal deaths/failure to thrive were responsible for four (12.5%) and three (9.4%) deaths respectively. Asphyxia accounted for 3(9.4%) deaths; neonatal tetanus, congenital abnormality and diarrhoea were responsible for one (3.1%) death each. Cause of death was unclassified in many early neonatal deaths particularly those which occurred at home. Predictors of neonatal death included LBW {RR=4.7 (1.7-13.1) p=0.03}, delivery outside a health facility {RR=3.6 (1.001-13.2) p=0.05}, lack of attendant at delivery {RR=5.01 (1.3-19.1) p=0.018} and Traditional Birth Attendant (TBA) delivering the baby {RR=2.7 (1.1-6.4) p=0.03). Effect of sex of the neonate, mother and fathers' ages were not significant at the 5% level in the model. CONCLUSION: Neonatal deaths contribute significantly to the high infant mortality in this rural community. Services provided by TBAs are not optimal but appear to be better than having no one in attendance at delivery. TBAs therefore need to be trained to identify at risk neonates and refer.

Causes of stillbirth, neonatal death and early childhood death in rural Zambia by verbal autopsy assessments

“…Like other studies, neonates appeared at highest risk from infection in the first week of life (Lawn et al. 2006; Lawoyin et al. 2010).…”

“…2008). Prior research has shown links between home delivery and poor birth outcomes (Lawoyin et al. 2010), because of obstetric complications and infection.…”

When Women Deliver with No One Present in Nigeria: Who, What, Where and So What?

“…The persistently high rates of maternal mortality in Nigeria are even more stark when the rates are disaggregated by political zone [2], [3]. Estimates from several studies were collated and are presented in Table 2, to illustrate variations in the picture of mortality patterns in the country [4], [5], [6], [7], [8], [9], [10]. For example, the rate is 1049 per 100,000 live births in Zamfara State [8] and 1500/100,000 live births in Sokoto State [7].…”

“…Globally and locally, studies have identified delivery assistance as a vitally important factor associated with positive improvements in maternal mortality rates [9], [10], [11], [12], [13]. Based on the analysis of MMR in 181 countries, Hogan and Foreman concluded that between 1990 and 2008, the increase in the proportion of women who gave birth with a skilled attendant was a main explanatory factor in the decline in global MMR.…”

Low birthweight delivery: Prevalence and associated factors as seen at a tertiary health facility

“…Low birth weight is defined as birth weight less than 2500 g irrespective of gestational age. [1] It occurs worldwide but by far more commonly in developing countries [2] It often results from prematurity or intrauterine growth restriction [3][4] though more from the latter than the former in developing countries [5] About one quarter of newborns in developing countries start life with impaired growth in utero often resulting in LBW at delivery [6][7][8] Complications arising from this include infections, hypoglycemia, hypothermia, jaundice and perinatal asphyxia often resulting in significant perinatal mortality [2] LBW infants are also predisposed to developing neurological problems including poor attention span and have much higher burden of disease throughout life [7] They often remain undernourished throughout childhood and adolescence and easily grow into undernourished women of childbearing age who themselves deliver LBW babies [8] It is easier and better to prevent the delivery of a LBW baby than preventing the perinatal morbidity and mortality, developmental problems, failure to thrive and other life time complications consequent on its delivery.…”