Factors associated with mortality and length of stay in hospitalised neonates in Eritrea, Africa: a cross-sectional study

Abstract

Objective

To determine the factors associated with mortality in a hospitalised cohort of infants in Asmara, Eritrea.

Design

Retrospective cross-sectional review of all 2006 admissions to a specialised neonatal intensive care unit. Data on gestational age (prematurity), age at presentation, birth weight, gender, mode of delivery, Apgar score, maternal age, birth location, admission diagnosis, admission comorbidities, time of admission and outcome were collected.

Setting

Orotta Pediatric Hospital ‘Specialised Neonatal Intensive Care Unit’ (SNCU) in Orotta National Maternity Referral Hospital, the nation's only tertiary newborn centre.

Primary and secondary outcome measures

Factors associated with mortality and length of stay via multivariate regression analysis and the combined association of both hypothermia and pneumonia. Other outcome measures were determination of the association of admission hypothermia, time of admission and pneumonia on mortality.

Results

A total of 1502 infants were admitted to the SNCU with an average preterm gestational age of 35.9 weeks. 87 died (mortality 8.2%). In bivariate analysis, the highest mortality rate (10.3%) was seen in patient's admitted <1 h after birth. Patients with hypothermia or pneumonia exhibited higher mortality rates (13.6% and 13.4%, respectively). In multivariate analysis, birth weight <2 kg (p<0.01), birth weight between 2.1 and 2.5 kg (p<0.01), Apgar score at 1 min (p<0.01), small for gestational age (p<0.01), hypothermia (p<0.04) and pneumonia (p<0.01) were associated with mortality.

Conclusion

Hypothermia, pneumonia, younger gestational age, 1 min Apgar score and small size for gestational age are significantly associated with mortality and longer length of stay in the Eritrean SNCU.

Article summary

Article focus

• Limited data exist on the causes of mortality in Eritrea.

• Review of inpatient hospitalisation data in Eritrea's only tertiary care intensive care nursery allows for insight into factors associated with mortality.

• The purpose of the study was to determine factors associated with mortality in a hospitalised cohort of infants in Asmara, Eritrea.

Key messages

• Pneumonia, hypothermia, abnormalities of gestational age, lower Apgar scores, decreased birth weight and younger gestational age are associated with mortality and morbidity (including longer length of stay) in Eritrea and should be a focus area for improving care.

• Increasing attendance of skilled resuscitation personnel at deliveries and improved attention post-delivery may improve mortality by reducing hypothermia, improving Apgar scores and increasing prompt treatment of medical sequalle of small- and large-for-gestational-age neonates.

• Substantial reduction in neonatal mortality with increased attention to these factors may be possible without significant increases in costs and should be an area for future research effects aimed at evaluating the effect of skilled resuscitators on short- and long-term neonatal mortality.

Strengths and limitations of this study

• Information was obtained in 2006 and may not be indicative of real-time annual changes in neonatal mortality rate. Furthermore, information on birth weight, Apgar score and temperature may not be representative of national data as many births occur at home, a commonly encountered problem for research in the developing world. Also potentially confounding is the inclusion of pneumonia versus sepsis as two distinct categories.