Neonatal mortality in Kenyan hospitals: a multisite, retrospective, cohort study
BMJ Glob Health
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.
Irimu, G., Aluvaala, J., Malla, L., Omoke, S., Ogero, M., Mbevi, G., Waiyego, M., Mwangi, C., Were, F., Gathara, D., Agweyu, A., Akech, S., English, M., Clinical Information Network, authors
Pages:, Volume:6, Edition:6/2/2021, Date,May
Notes: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|eng|092654/WT_/Wellcome Trust/United Kingdom|207522/WT_/Wellcome Trust/United Kingdom|207522 /WT_/Wellcome Trust/United Kingdom|092654 /WT_/Wellcome Trust/United Kingdom|Research Support, Non-U.S. Gov’t|England|2021/06/02 06:00|BMJ Glob Health. 2021 May;6(5). pii: bmjgh-2020-004475. doi: 10.1136/bmjgh-2020-004475.
ISBN: 2059-7908 (Print)|2059-7908 (Linking) Permanent ID: PMC8169483 Accession Number: 34059493
Author Address: Department of Paediatrics and Child Health, University of Nairobi, Nairobi, Kenya GIrimu@kemri-wellcome.org.|Health Services Unit, KEMRI – Wellcome Trust Research Institute, Nairobi, Kenya.|Department of Paediatrics and Child Health, University of Nairobi, Nairobi, Kenya.|Health Services, Nairobi Metropolitan Services, Nairobi, Kenya.|Division of Neonatal and Child Health, Kenya Ministry of Health, Nairobi, Kenya.|Kenya Paediatric Research Consortium (KEPRECON), Nairobi, Kenya.|MARCH Centre, London School of Hygiene and Tropical Medicine, London, UK.|Nuffield Department of Clinical Medicine, Oxford, Oxfordshire, UK.