Causes of Neonatal Admissions and Deaths at a Rural Hospital in Kwazulu-Natal; South Africa

One of the Millennium Development Goals (MDG-4) is to reduce child mortality by up to two-thirds by 2015. In most developing countries; a higher proportion of neonatal deaths are observed. We quantify the causes of neonatal morbidity and mortality at a rural hospital. A retrospective review of consecutive neonatal admissions to Empangeni Hospital; between January and December 2005; was conducted. Of 1;573 admissions; male babies made up 57.8 of admissions and 63 of the deaths. The most common causes of admission were birth asphyxia (38.2); prematurity (23.5); and infection (21). The average length of stay was 9.2 days (SD 12 days). The overall mortality rate was 13.8 but higher (23.4) among the referred babies. Admission and death rates of low birthweight babies ( 2;500g) were 53 and 84; respectively. Two-thirds (67.7) of those babies who died were born preterm. Over half (56.6) of the deaths took place within the first three days of life. Logistic regression showed that extremely low birthweight (OR

A comparative study of pregnancy complications and outcomes for the years 1999 and 2004 at a rural hospital in South Africa: implications for antenatal care

Background: Detection and management of high-risk pregnancies, all the way through antenatal care, have been advocated as a high-quality mean of reducing maternal and perinatal morbidity and mortality. Objectives: This study reviewed the demographic variables, pregnancy and obstetric complications and perinatal outcomes for the years 1999 and 2004 in a rural hospital in KwaZulu-Natal Province, South Africa, with the aim of evaluating trends and gaps that may enhance appropriate strategies for improvement of antenatal care. Method: A retrospective comparative study, with representative samples of pregnant women, were randomly selected for the respective years 1999 and 2004. Descriptive statistics were calculated depending on measurement scale. A Z-test was carried out to assess the significant difference (p < 0.05) in proportions between pregnancy complications and outcomes of the groups. Multivariate logistic regression analysis was undertaken to determine the significant predictors for outcome variables. Results: The numbers of pregnancies among young women (< 25 years) increased significantly by 8% (p < 0.05) in the year 2004. Compared with 1999, the reduction in the numbers of pregnancies (1%) among higher parity (parity 5 or more) women in 2004 was remarkable. There were significant reductions of eclampsia, anaemia and post partum haemorrhage. Women with breech presentation were 3.75 times more likely to deliver preterm, and 5.45 times more likely to deliver low birth-weight babies. Similarly, women with pregnancy-induced hypertension were more likely to have preterm (OR = 3.50, 95% CI 2.83; 4.35) and low birth-weight babies (OR = 2.09, 95% CI 1.62; 2.71). Eclampsia was also a risk factor associated with preterm deliveries (OR = 6.14, 95% CI 3.74; 10.09) and low birth-weight babies (OR = 3.40, 95% CI 1.83; 6.28). Conclusion: This study suggests that further research is needed to find the causes of higher rate of teenage pregnancies and an increase in quality of antenatal care is more important in improving maternal and perinatal health. Training of staff to standard protocol and guidelines on antenatal care and care during delivery, and adherence to it, should be encouraged to improve maternal and child health in South Africa

Timing of Spontaneous Birth and the Risk of Adverse Perinatal Outcome

Abstract:The study aspired to assess the impact of time of birth on spontaneous onset of labour and delivery. A retrospective descriptive study was conducted from the Empangeni Hospital delivery registry on 9;397 infant births between January to December 2005; weighing more than 1;000 g. Logistic regression; adjusting for birth weight and for gender was used to estimate the relationship between spontaneous birth and timing of birth. A higher proportion of births (59) occurred between 10h00 and 22h00 of the day. Estimating the hourly births; we found that the daytime peak is 5.3 and occurred at 10h00 while the night-time peak is 4.9 and occurred at 20h00. Maternal age was significantly associated with the timing of spontaneous births (p 0.05). A higher proportion of preterm babies was born during the day (6.4) and early night (3.4) compared to late night births (1.6). There were significant differences between multiple births and low birth weight infants born during the day (1.1; 6.9) and night (0.8; 6.3). However; low birth weight babies were born mostly during early night rather than late night (4 vs. 2.3; p 0.05). Adverse pregnancy outcome; measured by estimating the perinatal mortality rate; was the same for day and night and was equally distributed between early and late night. Timing of birth of infants did not influence the negative outcomes of pregnancy among this study population

Economic activities, illness pattern and utilisation of health care facilities in the rural population of KwaZulu-Natal, South Africa

Background: The study was undertaken among the rural and black communities of the Uthungulu health district of the KwaZulu-Natal province; South Africa. Methods: A cross-sectional community-based descriptive study was conducted. A multi-stage sampling strategy was adopted to obtain a representative sample of the communities. Results: The mean age of the population was 27 years and majority was female (54). Among the adult population only 30were educated; 19were engaged in some form of economic activities while 9were in the formal employment sector. The average monthly income per household was R1 301 (95CI; R1 283; R1 308). The illnesses were reported by 27of the total population over a period of one month. Notably higher rates of female individuals (29) were sick compared to males (24; p 0.001). The rates of illnesses among adult females (39) were also significantly higher than among males (31; p 0.009). Most of them (69) attended primary health care (PHC) clinics for medical services; while 67reported chronic conditions. Age (OR = 1.4); gender (OR = 0.711); education (OR = 0.64) and economic activities (OR = 1.9) were found to be associated with being ill or not. Conclusion: The rural black communities are underdeveloped and deprived; which results in higher prevalence of illnesses; however; the utilisation of PHC facilities is comparatively higher than in the rest of the province and other parts of the country. Interventions to improve community health care services among the deprived population should be focused through public health strategies such as all-encompassing PHC that includes health promotion; education and basic essential amenities