Neonatal mortality in Kenyan hospitals: a multisite, retrospective, cohort study.
cohort study
epidemiology
health services research
paediatrics
Journal
BMJ global health
ISSN: 2059-7908
Titre abrégé: BMJ Glob Health
Pays: England
ID NLM: 101685275
Informations de publication
Date de publication:
05 2021
05 2021
Historique:
received:
16
11
2020
revised:
31
03
2021
accepted:
01
04
2021
entrez:
1
6
2021
pubmed:
2
6
2021
medline:
25
6
2021
Statut:
ppublish
Résumé
Most of the deaths among neonates in low-income and middle-income countries (LMICs) can be prevented through universal access to basic high-quality health services including essential facility-based inpatient care. However, poor routine data undermines data-informed efforts to monitor and promote improvements in the quality of newborn care across hospitals. Continuously collected routine patients' data from structured paper record forms for all admissions to newborn units (NBUs) from 16 purposively selected Kenyan public hospitals that are part of a clinical information network were analysed together with data from all paediatric admissions ages 0-13 years from 14 of these hospitals. Data are used to show the proportion of all admissions and deaths in the neonatal age group and examine morbidity and mortality patterns, stratified by birth weight, and their variation across hospitals. During the 354 hospital months study period, 90 222 patients were admitted to the 14 hospitals contributing NBU and general paediatric ward data. 46% of all the admissions were neonates (aged 0-28 days), but they accounted for 66% of the deaths in the age group 0-13 years. 41 657 inborn neonates were admitted in the NBUs across the 16 hospitals during the study period. 4266/41 657 died giving a crude mortality rate of 10.2% (95% CI 9.97% to 10.55%), with 60% of these deaths occurring on the first-day of admission. Intrapartum-related complications was the single most common diagnosis among the neonates with birth weight of 2000 g or more who died. A threefold variation in mortality across hospitals was observed for birth weight categories 1000-1499 g and 1500-1999 g. The high proportion of neonatal deaths in hospitals may reflect changing patterns of childhood mortality. Majority of newborns died of preventable causes (>95%). Despite availability of high-impact low-cost interventions, hospitals have high and very variable mortality proportions after stratification by birth weight.
Sections du résumé
BACKGROUND
Most of the deaths among neonates in low-income and middle-income countries (LMICs) can be prevented through universal access to basic high-quality health services including essential facility-based inpatient care. However, poor routine data undermines data-informed efforts to monitor and promote improvements in the quality of newborn care across hospitals.
METHODS
Continuously collected routine patients' data from structured paper record forms for all admissions to newborn units (NBUs) from 16 purposively selected Kenyan public hospitals that are part of a clinical information network were analysed together with data from all paediatric admissions ages 0-13 years from 14 of these hospitals. Data are used to show the proportion of all admissions and deaths in the neonatal age group and examine morbidity and mortality patterns, stratified by birth weight, and their variation across hospitals.
FINDINGS
During the 354 hospital months study period, 90 222 patients were admitted to the 14 hospitals contributing NBU and general paediatric ward data. 46% of all the admissions were neonates (aged 0-28 days), but they accounted for 66% of the deaths in the age group 0-13 years. 41 657 inborn neonates were admitted in the NBUs across the 16 hospitals during the study period. 4266/41 657 died giving a crude mortality rate of 10.2% (95% CI 9.97% to 10.55%), with 60% of these deaths occurring on the first-day of admission. Intrapartum-related complications was the single most common diagnosis among the neonates with birth weight of 2000 g or more who died. A threefold variation in mortality across hospitals was observed for birth weight categories 1000-1499 g and 1500-1999 g.
INTERPRETATION
The high proportion of neonatal deaths in hospitals may reflect changing patterns of childhood mortality. Majority of newborns died of preventable causes (>95%). Despite availability of high-impact low-cost interventions, hospitals have high and very variable mortality proportions after stratification by birth weight.
Identifiants
pubmed: 34059493
pii: bmjgh-2020-004475
doi: 10.1136/bmjgh-2020-004475
pmc: PMC8169483
pii:
doi:
Types de publication
Journal Article
Research Support, Non-U.S. Gov't
Langues
eng
Sous-ensembles de citation
IM
Subventions
Organisme : Wellcome Trust
ID : 092654
Pays : United Kingdom
Organisme : Wellcome Trust
ID : 207522
Pays : United Kingdom
Organisme : Wellcome Trust
ID : 207522
Pays : United Kingdom
Organisme : Wellcome Trust
ID : 092654
Pays : United Kingdom
Investigateurs
Mercy Chepkirui
(M)
John Wainaina
(J)
Livingstone Mumelo
(L)
Edith Gicheha
(E)
Juma Vitalis
(J)
Nyumbile Bonface
(N)
Christine Manyasi
(C)
Caren Emadau
(C)
Charles Nzioki
(C)
Wagura Mwangi
(W)
Magdalene Kuria
(M)
Esther Njiru
(E)
Penina Mwangi
(P)
Rachel Inginia
(R)
Emma Namulala
(E)
Grace Ochieng
(G)
Lydia Thuranira
(L)
Felistus Makokha
(F)
Josephine Ojigo
(J)
Beth Maina
(B)
Bernadette Lusweti
(B)
Amilia Ngoda
(A)
Dolphine Mochache
(D)
Jane Mbungu
(J)
Joan Baswetty
(J)
Josephine Aritho
(J)
Beatrice Njambi
(B)
Zainab Kioni
(Z)
Lucy Kinyua
(L)
Alice Oguda
(A)
Loise N Mwangi
(LN)
Nancy Mburu
(N)
Celestine Muteshi
(C)
Salome Okisa Muyale
(SO)
Faith Mueni
(F)
Rosemary Mututa
(R)
Joyce Oketch
(J)
Orina Nyakina
(O)
Faith Njeru
(F)
Margaret Wanjiku Mwaura
(MW)
Seline Kulubi
(S)
Susan Wanjala
(S)
Pauline Njeru
(P)
John Ollongo
(J)
Samuel Soita
(S)
Mary Nguri
(M)
Margaret Waweru
(M)
Otieno George Obop
(OG)
Jeska Kuya
(J)
Esther Muthiani
(E)
Esther Mwangi
(E)
Joseph Nganga
(J)
Benjamin Tanui
(B)
Alfred Wanjau
(A)
Judith Onsongo
(J)
Peter Muigai
(P)
Arnest Namayi
(A)
Informations de copyright
© Author(s) (or their employer(s)) 2021. Re-use permitted under CC BY. Published by BMJ.
Déclaration de conflit d'intérêts
Competing interests: None declared.
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