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Observation of Birth Asphyxia and Its Impact on Neonatal Mortality in Khulna Urban Slum Bangladesh
Abstract
Birth asphyxia and its impact on neonatal mortality were observed in Khulna urban slum during July, 2010 to June, 2011. The descriptive type of cross sectional study was conducted on 132 neonatal deaths among 9373 live birth. The study has found that neonatal mortality rate is 14 (n=132) in the study area compared to birth rate (9373). Of 132 neonatal deaths, birth asphyxia is responsible for 52(39%), low birth weight 32(24%), neonatal sepsis 22(17%), premature delivery 10(8%), developmental malformation 7(5%), neonatal jaundice 2(2%), acute respiratory infection 1(1%), and others 6(4%). Out of total live birth (9373) birth asphyxia was 266(2.83%), among them cured cases were 214(2.28%) and death was 52(0.55%). About 7961 under facilitate delivery in hospital/clinic, the neonatal death was 90(68%) and comprises birth asphyxia death was 30(33%). But in 1412 home delivery, the neonatal death was 42(32%) and the asphyxia death was 22(53%). Their knowledge on birth asphyxia due to lack of any institutional education (20%) or primary to high school level education (70%) and also the economic status ranges from 1500-2200BDT/month (44%) or from 2300-3000BDT/month (42%) may be the main risk factors which play an important role in neonatal mortality. The awareness of facilitated delivery rather than home delivery may improve the birth asphyxia death rate in Bangladesh and help to achieve the millennium development goal.
... Electroencephalogram, like the neurologic examination, can predict outcome based on the severity and duration of the abnormalities. 60,67 At any time, a burstsuppression or an isoelectric pattern is associated with a poor outcome. If there is only an early mild depression, there can be a normal outcome. ...
... If there is only an early mild depression, there can be a normal outcome. 67 If there is depression after 12 days, a poor outcome is expected. A normal EEG at 7 days predicts a normal outcome. ...
... In Ethiopia, birth asphyxia is one of the driving causes of neonatal mortality, constituting 34% (7). Besides, Findings from Nigeria (8), Southern Nepal (9), and Khulna Urban Slum, Bangladesh (10) indicate that birth asphyxia is blamable for about 23.9%, 30%, and 39% of neonatal deaths, respectively. Neonatal consequences following birth asphyxia include multisystem organ dysfunction, neonatal neurological problems such as seizure, coma, and hypotonic (neonatal encephalopathy) (4,11). ...
Background:
Despite a global decline in under-five deaths, the neonatal mortality rate remains slow in developing countries and birth asphyxia remains the third cause of neonatal deaths. Globally, neonatal deaths accounts for 45% of under-five deaths, birth asphyxia causes 23-40% of neonatal deaths in Ethiopia. There is limited data on risk factors of asphyxia in Ethiopia, particularly in the study area. Therefore, this study aimed to identify the risk factors of birth asphyxia among newborns.
Methods:
This research followed a hospital-based unmatched case-control study design at Debre Markos comprehensive specialized referral hospital, Northwest Ethiopia, among 372 newborns (124 cases and 248 controls). Data were collected by interviewing index mothers and chart review using a pre-tested questionnaire. Then it was entered in Epi-data version 3.1 and transferred to STATA version 14.0 for analysis. Bivariate and multiple variable logistic regression were carried out to the possible risk factors. Finally, statistical significance was declared using adjusted odds ratio with 95% CI and p-value <0.05.
Results:
Prolonged labor >12, meconium-stained amniotic fluid, assisted vaginal delivery, gestational age < 37 weeks, noncephalic presentation, comorbidity, birthweight<2500grams were found to be significant factors of birth asphyxia.
Conclusion:
In this study, Prolonged labor >12 hours, meconium-stained amniotic fluid, assisted vaginal delivery, gestational age < 37 weeks, non-cephalic presentation comorbidity, fetal distress, birthweight<2500grams were found to be risk factors of birth asphyxia were risk factors of birth asphyxia. Therefore, to reduce neonatal mortality associated with birth asphyxia, attention should be given to holistic pregnancy, labor and delivery care, and post-natal care. Moreover, interventions aimed at reducing birth asphyxia should target the identified factors.
... The proportion of birth asphyxia is 2 per 1000 births in developed countries and it is more than 10 times higher in lowincome countries with limited access to quality obstetrics care during pregnancy, intrapartum and postpartum period [6]. Studies done in Nigeria [7], Nepal [8], and Bangladesh [9] reported that perinatal asphyxia is the cause of 23.9%, 30%, and 39% of newborns' deaths respectively. ...
Birth asphyxia is one of the leading causes of death in low and middle-income countries and the prominent cause of neonatal mortality in Ethiopia. Early detection and managing its determinants would change the burden of birth asphyxia. Thus, this study identified determinants of birth asphyxia among newborns delivered in public hospitals of West Shoa Zone, central Ethiopia. A hospital-based unmatched case-control study was conducted from May to July 2020. Cases were newborns with APGAR (appearance, pulse, grimaces, activity, and respiration) score of <7 at first and fifth minute of birth and controls were newborns with APGAR score of ≥ 7 at first and fifth minute of birth. All newborns with birth asphyxia during the study period were included in the study while; two comparable controls were selected consecutively after each birth asphyxia case. A pre-tested and structured questionnaire was used to collect maternal socio-demographic and antepartum characteristics. The pre-tested checklist was used to retrieve intrapartum and fetal related factors from both cases and controls. The collected data were entered using Epi-Info and analyzed by SPSS. Bi-variable logistic regression analysis was done to identify the association between each independent variable with the outcome variable. Adjusted odds ratio (AOR) with a 95% CI and a p-value of <0.05 was used to identify determinants of birth asphyxia. In this study, prolonged labor (AOR = 4.15, 95% CI: 1.55, 11.06), breech presentation (AOR = 5.13, 95% CI: 1.99, 13.21), caesarean section delivery (AOR = 3.67, 95% CI: 1.31, 10.23), vaginal assisted delivery (AOR = 5.69, 95% CI: 2.17, 14.91), not use partograph (AOR = 3.36, 95% CI: 1.45, 7.84), and low birth weight (AOR = 3.74, 95% CI:1.49, 9.38) had higher odds of birth asphyxia. Prolonged labor, breech presentation, caesarean and vaginal assisted delivery, fails to use partograph and low birth weights were the determinants of birth asphyxia. Thus, health care providers should follow the progress of labor with partograph to early identify prolonged labor, breech presentation and determine the mode of delivery that would lower the burden of birth asphyxia.
... In Ethiopia, birth asphyxia is one of the driving causes of neonatal mortality, constituting 34% [8]. Studies conducted in Osogbo, Southwestern Nigeria [9], Southern Nepal [10], and Khulna Urban Slum, Bangladesh [11] also suggest that birth asphyxia is responsible for about 23.9%, 30%, and 39% of the deaths, respectively. Common outcomes after birth asphyxia include multisystem organ dysfunction, neonatal neurological problems such as seizure, coma, and hypotonic (neonatal encephalopathy) [5,12]. ...
... Inclusion criteria: a. Gestational age ≥37 weeks, b.APGAR Score ≤6 at 1 min of birth [8], c.Requirement of ≥1min positive pressure ventilation (PPV) before sustained respiration occurred, d. Need for mechanical ventilation at birth. ...
Introduction: Perinatal asphyxia can lead to hypoxic ischemic encephalopathy (HIE). The mortality due to hypoxic ischemic encephalopathy is as high as 28.8 % and morbidity is 30 % of surviving new-born due to hypoxic ischemic encephalopathy. Aim & Objective: To study the neuro developmental outcome of surviving neonate with hypoxic ischemic encephalopathy till one year of age and to give early stimulation to such baby to decrease the morbidity. Material & Method: It isa hospital based prospective study done in tertiary care hospital in SCB Medical College Hospital & SVP PG Institute, Cuttack from July 2015 to June 2017. Result: The incidence of asphyxia neonatorum among the babies in normal delivery was very high compared to the babies of lower section caesarean section (LSCS) delivery. Severity of birth asphyxia was high in face presentation, followed by breech than normal vertex presentation. Respiratory distress was found to be associated with neonatal asphyxia in this study. Mortality is highest in severe encephalopathy and least in mild variety. In follow, up study neurodevelopmental abnormality is found to be 100% in HIE-III. 34.4% in HIE-II and normal development in stage –I HIE. Conclusion: Institutional delivery with trained personal with neonatal resuscitation at first golden minute will prevent birth asphyxia. Timely screening of asphyxiated babies and early sensory stimulation decreases the morbidity in asphyxiated newborn.
... Notwithstanding this, esti- mates of neonatal asphyxia are critical especially in low resource setting where these estimates are hardly made ( Daripa et al., 2013 ). The prevalence rate in the current study is similar to the rates re- ported from India ( Agarwal et al., 2008 ) but slightly higher than in Bangladesh ( Sampa et al., 2012 ). The prevalence rates reported from Nigeria are much higher where 21.1% neonatal asphyxia has been reported ( Ilah et al., 2015 ). ...
Background: Adverse birth outcomes continue to be a global public health challenge, particularly in low resource settings. Therefore, the present study aimed at assessing maternal determinants of low birth weight and neonatal asphyxia in the Upper West region of Ghana. Methods: An analytical cross sectional survey was conducted among mothers who attended child welfare clinics (CWC) in six sub-districts. Pregnancy outcome data and maternal nutritional, health service and socio-demographics were obtained using a pre-tested questionnaire. Determinants of low birth weight (LBW) and neonatal asphyxia were analyzed using chi-square and multivariable logistic regression mod- elling.
Results: The results showed that the prevalence of low birth weight and neonatal asphyxia were 8.2% and 9.3% respectively. Multiple logistic regression showed that the risk of giving birth to a LBW baby was high among mothers who consumed alcoholic beverages [AOR = 5.93; 95% CI (1.22–28.84); p = 0.03], those who had food taboos during pregnancy [AOR = 3.31; 95% CI (1.02–10.77); p = 0.047] and not having additional meals [AOR = 3.16; 95% CI (1.0–10.0); p = 0.05] during pregnancy. Neonatal asphyxia was higher among new born babies whose mothers did not receive nutritional counselling in pregnancy [AOR = 5.64; 95% CI (1.48–21.60); p = 0.01] and those who had anaemia at 36 weeks gestation [AOR = 2.69; 95% CI (0.95–7.65); p = 0.06].
Conclusion: Maternal dietary practices during pregnancy could positively affect birth outcome in the Upper West Region of Ghana.
... Twenty-three percent of the deaths each year around the world [7] and 31.6% in Ethiopia are attributed to birth asphyxia [8]. Studies conducted in Osogbo, Southwestern Nigeria [9], Southern Nepal [10], and Khulna Urban Slum, Bangladesh [11] also suggest that birth asphyxia is responsible for about 23.9%, 30%, and 39% of the deaths, respectively. ...
Background
Birth asphyxia, which accounts for 31.6% of all neonatal deaths, is one of the leading causes of such mortality in Ethiopia. Early recognition and management of its contributing factors would modify the problem. Thus, this study aimed to identify the determinants of birth asphyxia among live births at the University of Gondar Referral Hospital, northwest Ethiopia.
Methods
A hospital-based unmatched case-control study was conducted from April to July 2017.Cases were newborn babies with an APGAR score of < 7at 5 minutes of birth; controls were newborn babies with an APGAR score of ≥7 at 5 minutes of birth. Every other asphyxiated baby was selected as a case and every 6th non-asphyxiated baby as a control. A pretested structured questionnaire was used to collect data on maternal sociodemographic characteristics. A pretested structured checklist was used to retrieve data on ante-partum, intra-partum, and neonatal factors of both cases and controls. Data were entered using Epi Info 7 and analyzed using SPSS 20. The bivariate logistic regression analysis was used to identify the relation of each independent variable to the outcome variable. Variables with p values of up to 0.2 in the bivariate analysis were considered for the multiple logistic regression analysis. An adjusted odds ratio (AOR) with a 95% CI and p-value of <0.05 was used to identify significant variables associated with birth asphyxia.
Results
In this study, prolonged labor (AOR = 2.75, 95% CI: 1.18, 6.94), cesarean section delivery (AOR = 3.58, 95% CI: 1.13, 11.31), meconium stained amniotic fluid (AOR = 7.69, 95% CI: 2.99, 17.70), fetal distress (AOR = 5.74, 95% CI: 1.53, 21.55), and low birth weight (AOR = 7.72, 95% CI: 1.88, 31.68) were factors which significantly increased the odds of birth asphyxia.
Conclusion
Prolonged labor, cesarean section (CS) delivery, meconium stained amniotic fluid (AF), fetal distress, and low birth weight were the determinants of birth asphyxia. Thus, efforts should be made to improve the quality of intra-partum care services in order to prevent prolonged labor and fetal complications, and to identify and make a strict follow up on mothers with meconium stained amniotic fluid.
... Multivariate analysis of risk factors of birth asphyxia mortality.Size of baby at birth?significantly associated with neonatal deaths due to BA. This is in accordance with several previously published studies in similar settings[27] [29][42] [48][49]. Our findings are different from the statement that post maturity is an important risk factor of birth asphyxia[50] [51]. ...
Background: During the past two decades there has been a sustained decline in child mortality;
however, neonatal mortality has remained stagnant. Each year approximately 4 million babies are
born asphyxiated resulting in 2 million neonatal deaths and intrapartum stillbirths. Almost all
neonatal deaths occur in developing countries, where the majority is delivered at homes with negligible
antenatal care and poor perinatal services. Objectives: To identify socio-demographic and
clinical risk factors associated with birth asphyxia in Matiari District of Sindh Province, Pakistan.
Method: A matched case control study was conducted in Matiari District with 246 cases and 492
controls. Newborn deaths with birth asphyxia diagnosed through verbal autopsy accreditation
during 2005 and 2006 were taken as cases. Controls were the live births during the same period,
matched on area of residence, gender and age. Result: The factors found to be associated with
birth asphyxia mortality in Matiari District of Sindh Province, Pakistan are maternal education,
history of stillbirths, pregnancy complications (including smelly or excessive vaginal discharge
and anemia), intrapartum complications (including fever, prolong or difficult labour, breech delivery,
cord around child’s neck, premature delivery, large baby size) and failure to establish spontaneous
respiration after birth. Conclusion and Recommendation: There is an immediate need to
develop strategies for early identification and management of factors associated with birth asphyxia
by involving women, families, communities, community health workers, health professionals
and policy makers. Community health workers should be trained for emergency obstetric care,
basic newborn care including preliminary resuscitation measures to provide skilled birth attendance
and encourage early recognition and referral.
Background: More than one third of the neonatal deaths at Neonatal Intensive Care Unit (NICU) in Debre Tabor General Hospital (DTGH) are attributable to birth asphyxia. Most of these neonates are referred from the maternity ward in the hospital. Concerns have also been raised regarding delayed intrapartum decisions for emergency obstetrics action in the hospital. However, there has been no recent scientific evidence about the exact burden of birth asphyxia and its specific determinants among live births at maternity ward of DTGH. Moreover, the public health importance of delivery time and professional mix of labor attendants haven't been addressed in the prior studies.
Background:
More than one third of the neonatal deaths at Neonatal Intensive Care Unit of Debre Tabor General Hospital (DTGH) are attributable to birth asphyxia. Most of these neonates are referred from maternity ward of the hospital. However, there is no recent evidence on the prevalence and specific determinants of birth asphyxia at DTGH. Besides, public health importance of factors like birth spacing weren't addressed in the prior studies.
Methods:
A cross sectional study was conducted on a sample of 240 newborns at delivery ward. The collected data were cleaned, coded and entered into Epi -data version 4.2 and exported to Stata version 14. Binary logistic regression model was considered and statistical significance was declared at P< 0.05 using adjusted odds ratio.
Results:
The prevalence of asphyxia neonatorum was 6.7 % based on the fifth minute APGAR score. From multi-variable logistic regression analysis, antenatal obstetric complications (AOR = 2.63, 95% CI: 3.75, 14.29), fetal malpresentation (AOR = 3.17, 95% CI: 1.21, 15.20), premature rupture of fetal membranes (AOR = 6.56, 95% CI: 3.48, 18.12) and meconium stained amniotic fluid (AOR = 2.73, 95% CI: 1.76, 14.59) were significant predictors.
Conclusion:
The prevalence of fifth minute asphyxia neonatorum was relatively low. Fortunately, its predictors are modifiable. Thus, we can mitigate the problem even with our limited resources such as enhancing the existing efforts of antenatal and intra-partum care, which could help early detection and management of any obstetric and neonatal health abnormality."
Background
More than one third of the neonatal deaths at Neonatal Intensive Care Unit (NICU) in Debre Tabor General Hospital (DTGH) are attributable to birth asphyxia. Most of these neonates are referred from the maternity ward in the hospital. Concerns have also been raised regarding delayed intrapartum decisions for emergency obstetrics action in the hospital. However, there has been no recent scientific evidence about the exact burden of birth asphyxia and its specific determinants among live births at maternity ward of DTGH. Moreover, the public health importance of delivery time and professional mix of labor attendants haven’t been addressed in the prior studies.
Methods
Hospital based cross sectional study was conducted on a sample of 582 mother newborn dyads at maternity ward. Every other mother newborn dyad was included from December 2019 to March 2020. Pre-tested structured questionnaire and checklist were used for data collection. The collected data were processed and entered into Epidata version 4.2 and exported to Stata version 14. Binary logistic regressions were fitted and statistical significance was declared at p less than 0.05 with 95% CI.
Results
The prevalence of birth asphyxia was 28.35% [95% CI: 26.51, 35.24%]. From the final model, fetal mal-presentation (AOR = 6.96: 3.16, 15.30), premature rupture of fetal membranes (AOR = 6.30, 95% CI: 2.45, 16.22), meconium stained amniotic fluid (AOR = 7.15: 3.07, 16.66), vacuum delivery (AOR =6.21: 2.62, 14.73), night time delivery (AOR = 6.01: 2.82, 12.79) and labor attendance by medical interns alone (AOR = 3.32:1.13, 9.78) were positively associated with birth asphyxia at 95% CI.
Conclusions
The prevalence of birth asphyxia has remained a problem of public health importance in the study setting. Therefore, the existing efforts of emergency obstetric and newborn care should be strengthened to prevent birth asphyxia from the complications of fetal mal-presentation, premature rupture of fetal membranes, meconium stained amniotic fluid and vacuum delivery. Moreover, night time deliveries and professional mixes of labor and/delivery care providers should be given more due emphasis.
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