Neonatal mortality in Kenyan hospitals: a multisite, retrospective, cohort study. Issue 5 (31st May 2021)

• Record Type: Journal Article
• Authors: Irimu, Grace; Aluvaala, Jalemba; Malla, Lucas; Omoke, Sylvia; Ogero, Morris; Mbevi, George; Waiyego, Mary; Mwangi, Caroline; Were, Fred; Gathara, David; Agweyu, Ambrose; Akech, Samuel; English, Mike
• Other Names: author non-byline.; Chepkirui Mercy author non-byline.; Wainaina John author non-byline.; Mumelo Livingstone author non-byline.; Gicheha Edith author non-byline.; Vitalis Juma author non-byline.; Bonface Nyumbile author non-byline.; Manyasi Christine author non-byline.; Emadau Caren author non-byline.; Nzioki Charles author non-byline.; Mwangi Wagura author non-byline.; Kuria Magdalene author non-byline.; Njiru Esther author non-byline.; Mwangi Penina author non-byline.; Inginia Rachel author non-byline.; Namulala Emma author non-byline.; Ochieng Grace author non-byline.; Thuranira Lydia author non-byline.; Makokha Felistus author non-byline.; Ojigo Josephine author non-byline.; Maina Beth author non-byline.; Lusweti Bernadette author non-byline.; Ngoda Amilia author non-byline.; Mochache Dolphine author non-byline.; Mbungu Jane author non-byline.; Baswetty Joan author non-byline.; Aritho Josephine author non-byline.; Njambi Beatrice author non-byline.; Kioni Zainab author non-byline.; Kinyua Lucy author non-byline.; Oguda Alice author non-byline.; Mwangi Loise N. author non-byline.; Mburu Nancy author non-byline.; Muteshi Celestine author non-byline.; Muyale Salome Okisa author non-byline.; Mueni Faith author non-byline.; Mututa Rosemary author non-byline.; Oketch Joyce author non-byline.; Nyakina Orina author non-byline.; Njeru Faith author non-byline.; Mwaura Margaret Wanjiku author non-byline.; Kulubi Seline author non-byline.; Wanjala Susan author non-byline.; Njeru Pauline author non-byline.; Ollongo John author non-byline.; Soita Samuel author non-byline.; Nguri Mary author non-byline.; Waweru Margaret author non-byline.; Obop Otieno George author non-byline.; Kuya Jeska author non-byline.; Muthiani Esther author non-byline.; Mwangi Esther author non-byline.; Nganga Joseph author non-byline.; Tanui Benjamin author non-byline.; Wanjau Alfred author non-byline.; Onsongo Judith author non-byline.; Muigai Peter author non-byline.; Namayi Arnest author non-byline.;
• Is Part Of: BMJ global health. Volume 6:Issue 5(2021)
• Publication Date: 2021-05-31
• Subjects: epidemiology -- health services research -- paediatrics -- cohort study; World health -- Periodicals; 362.105
• DOI: 10.1136/bmjgh-2020-004475
• Languages: English
• ISSNs: 2059-7908

Abstract

Abstract : 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.