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      Factors Associated with Treatment Outcome of Preterm Babies at Discharge from the Neonatal Intensive Care Unit (NICU) of the Tamale Teaching Hospital, Ghana

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          Abstract

          Background

          Preterm birth and complications are now the leading cause of death in children under 5 years globally. In Ghana, studies assessing the survival rate of preterm babies and associated factors in Neonatal Intensive Care Units (NICU) are limited. Therefore, this study was designed to assess the survival rate and associated factors in this group of babies in a teaching hospital in the Northern Region of Ghana.

          Methods

          This was a 7-month retrospective descriptive study conducted in the NICU of the Tamale Teaching Hospital, Ghana. It involved review of charts of all preterm babies admitted between 1 March 2017 and 30 September 2017. Data retrieved from all eligible patients was analyzed using Stata version 12.1 software to generate descriptive statistics. Relationship between dependent and independent variables was tested using Pearson chi square. A logistic regression model was estimated to assess determinants of the treatment outcome.

          Results

          The overall survival rate at discharge in this cohort was 60.73%. The survival rate was lowest in the extremely low birth weight group (3/21; 14.3%) and extremely preterm babies (4/20; 20%). Significant association was observed between birth weight ( P = 0.0001), gestational age ( P = 0.0001), and survival. Preterm babies who were hypothermic at presentation, had respiratory distress syndrome, and had jaundice were 7.2 times (AOR = 7.2; 95%CI = 1.9‐28.1; P = 0.004), 10.2 times (AOR = 10.2; 95%CI = 3.7‐27.9; P ≤ 0.0001), and 2.9 times (AOR = 2.9; 95%CI = 1.0‐8.5; P = 0.045), respectively, more likely to die on admission compared to neonates who did not have these comorbidities.

          Conclusion

          We found a high mortality rate in the preterm babies admitted to our unit, and that mortality rate decreased with increasing gestational age and birth weight. A number of neonatal factors, either in isolation or in combination, were significantly associated with in-hospital mortality.

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          Preterm neonatal morbidity and mortality by gestational age: a contemporary cohort.

          Tracy Manuck, Madeline Rice, Jennifer Bailit … (2016)
          Although preterm birth <37 weeks' gestation is the leading cause of neonatal morbidity and mortality in the United States, the majority of data regarding preterm neonatal outcomes come from older studies, and many reports have been limited to only very preterm neonates. Delineation of neonatal outcomes by delivery gestational age is needed to further clarify the continuum of mortality and morbidity frequencies among preterm neonates.
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            The global burden of neonatal hypothermia: systematic review of a major challenge for newborn survival

            Karsten Lunze, David Bloom, Dean T Jamison … (2013)
            Background To provide evidence on the global epidemiological situation of neonatal hypothermia and to provide recommendations for future policy and research directions. Methods Using PubMed as our principal electronic reference library, we searched studies for prevalence and risk factor data on neonatal hypothermia in resource-limited environments globally. Studies specifying study location, setting (hospital or community based), sample size, case definition of body temperature for hypothermia, temperature measurement method, and point estimates for hypothermia prevalence were eligible for inclusion. Results Hypothermia is common in infants born at hospitals (prevalence range, 32% to 85%) and homes (prevalence range, 11% to 92%), even in tropical environments. The lack of thermal protection is still an underappreciated major challenge for newborn survival in developing countries. Although hypothermia is rarely a direct cause of death, it contributes to a substantial proportion of neonatal mortality globally, mostly as a comorbidity of severe neonatal infections, preterm birth, and asphyxia. Thresholds for the definition of hypothermia vary, and data on its prevalence in neonates is scarce, particularly on a community level in Africa. Conclusions A standardized approach to the collection and analysis of hypothermia data in existing newborn programs and studies is needed to inform policy and program planners on optimal thermal protection interventions. Thermoprotective behavior changes such as skin-to-skin care or the use of appropriate devices have not yet been scaled up globally. The introduction of simple hypothermia prevention messages and interventions into evidence-based, cost-effective packages for maternal and newborn care has promising potential to decrease the heavy global burden of newborn deaths attributable to severe infections, prematurity, and asphyxia. Because preventing and treating newborn hypothermia in health institutions and communities is relatively easy, addressing this widespread challenge might play a substantial role in reaching Millennium Development Goal 4, a reduction of child mortality.
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              Determinants of trends in neonatal, post-neonatal, infant, child and under-five mortalities in Tanzania from 2004 to 2016

              Felix Ogbo, Osita Ezeh, Akorede Awosemo … (2019)
              Background Under-five mortality is still a major health issue in many developing countries like Tanzania. To achieve the Sustainable Development Goal target of ending preventable child deaths in Tanzania, a detailed understanding of the risk factors for under-five deaths is essential to guide targeted interventions. This study aimed to investigate trends and determinants of neonatal, post-neonatal, infant, child and under-five mortalities in Tanzania from 2004 to 2016. Methods The study used combined data from the 2004–2005, 2010 and 2015–2016 Tanzania Demographic and Health Surveys, with a sample of 25,951 singletons live births and 1585 under-five deaths. We calculated age-specific mortality rates, followed by an assessment of trends and determinants (community, socioeconomic, individual and health service) of neonatal, postneonatal, infant, child and under-five mortalities in Cox regression models. The models adjusted for potential confounders, clustering and sampling weights. Results Between 2004 and 2016, we found that neonatal mortality rate remained unchanged, while postneonatal mortality and child mortality rates have halved in Tanzania. Infant mortality and under-five mortality rates have also declined. Mothers who gave births through caesarean section, younger mothers (< 20 years), mothers who perceived their babies to be small or very small and those with fourth or higher birth rank and a short preceding birth interval (≤2 years) reported higher risk of neonatal, postneonatal and infant mortalities. Conclusion Our study suggests that there was increased survival of children under-5 years in Tanzania driven by significant improvements in postneonatal, infant and child survival rates. However, there remains unfinished work in ending preventable child deaths in Tanzania. Electronic supplementary material The online version of this article (10.1186/s12889-019-7547-x) contains supplementary material, which is available to authorized users.
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                Author and article information

                Contributors
                Alhassan Abdul-Mumin:
                ORCID: https://orcid.org/0000-0003-3792-5384
                Journal
                Journal ID (nlm-ta): Int J Pediatr
                Journal ID (iso-abbrev): Int J Pediatr
                Journal ID (publisher-id): IJPEDI
                Title: International Journal of Pediatrics
                Publisher: Hindawi
                ISSN (Print): 1687-9740
                ISSN (Electronic): 1687-9759
                Publication date Collection: 2020
                Publication date (Electronic): 14 August 2020
                Volume: 2020
                Electronic Location Identifier: 5696427
                Affiliations
                1Department of Paediatrics and Child Health, School of Medicine and Health Sciences, University for Development Studies, Tamale, Ghana
                2Department of Paediatrics and Child Health, Tamale Teaching Hospital, Tamale, Ghana
                3Department of Public Health, School of Allied Health Sciences, University for Development Studies, Tamale, Ghana
                Author notes

                Academic Editor: Samuel Menahem

                Author information
                https://orcid.org/0000-0003-3792-5384
                Article
                DOI: 10.1155/2020/5696427
                PMC ID: 7474387
                SO-VID: 82434ba6-c0b1-4215-9963-57f6ead6ced7
                Copyright © Copyright © 2020 Alhassan Abdul-Mumin et al.
                License:

                This is an open access article distributed under the Creative Commons Attribution License, which permits unrestricted use, distribution, and reproduction in any medium, provided the original work is properly cited.

                History
                Date received : 3 April 2020
                Date revision received : 14 July 2020
                Date accepted : 4 August 2020
                Categories
                Subject: Research Article

                ScienceOpen disciplines: Pediatrics
                Data availability:
                ScienceOpen disciplines: Pediatrics

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