ABSTRACT
Background: Kangaroo mother care (KMC) is an evidence-based approach to reducing morbidity and mortality in low-birth-weight and preterm newborns. Barriers for KMC and its effective practice at a larger scale are highly affected by contextual factors. The purpose of this study is to explore barriers and enablers in the community and health facilities for implementation and continuation of KMC. Methods: This formative study employed a qualitative exploratory approach using focus group discussions and in-depth interviews in five zones of Tigray region, Northern Ethiopia. A total of 16 focus group discussions and 46 in-depth interviews were conducted with health workers and community members. The whole process of data collection took an iterative approach. An inductive thematic analysis was done by going through the transcribed data using ATLAS.ti software. Results: The current study found that problems of infrastructure and equipment for KMC practice, shortage of staff, and absence of trained health workers as the most frequently mentioned barriers by health workers. Low level of awareness, lack of support, mother being responsible for the rest of the family, holding babies in the front being traditionally unacceptable, and preference of incubators for better care of small babies were among the barriers identified in the community. Presence of community health workers and the positive attitude of the community towards them, as well as antenatal and postnatal care were among the favorable conditions for the implementation of KMC at health facilities and continuation of KMC at home. Conclusion: Empowering health workers through training to identify preterm and low-birth-weight babies, to do follow-ups after discharge, and creating awareness in the community to change the perception of kangaroo mother care are necessary.
ABSTRACT
BACKGROUND: The neonatal period is the most vulnerable time of human life for diseases. Neonatal morbidity and mortality are significant contributors to under-five morbidity and mortality in sub-Saharan Africa. OBJECTIVE: To assess prevalence and factors associated with neonatal mortality at Ayder Comprehensive Specialized Hospital. METHODS: A facility-based cross-sectional study was conducted on neonates admitted to the neonatal intensive care unit of Ayder Comprehensive Specialized Hospital from June 1, 2018 to May 30, 2019. Data were taken retrospectively from patient records during admission, discharge, and death certificate issue. The data were entered and analyzed using SPSS version 23. Descriptive and logistic regression analysis was done to describe and identify associated factors with neonatal mortality. P-values <0.05 were considered statistically significant. RESULTS: During the study period, 1785 neonates were seen and 1069 (60%) were males. Neonatal mortality rate was 298 (16.7%). Of all the deaths, 98.3% occurred during the first 7 days of age. Respiratory distress syndrome (AOR: 12.56; 95% CI: 6.40-24.66:), perinatal asphyxia (AOR: 19.64; 95% CI: 12.35-31.24), congenital anomaly (AOR: 2.42; 95% CI: (1.48-4.01), early neonatal sepsis (AOR: 3.68; 95% CI: 2.32-5.81), late onset sepsis (AOR: 8.9; 95% CI: 4.14-19.21), gestational age, 34-36+6 weeks (AOR: 0.09; 95% CI: 0.014-0.59), 3741+6 weeks (AOR: 0.025; 95% CI: 0.0030.218), >42 weeks (AOR: 0.039; 95% CI: 0.004-0.4250), parity (AOR: 0.64; 95% CI: 0.44-0.93) and hospital stay (AOR: 0.09; 95% CI: 0.05-0.14) were significantly associated with neonatal mortality. Neonates with a birth weight of less than 1500 g were at 49%, 70%, and 80% increased odds of mortality compared to those 1500-2499 g, 2500-3999 g, and more than 4000 g, respectively. CONCLUSION: In this study neonatal mortality was significantly high. Neonatal mortality was highly associated with primipara, prematurity, low birth weight, perinatal asphyxia, respiratory distress syndrome, congenital anomaly, neonatal sepsis and duration of hospital stay. Many of those cases could be prevented by improving antenatal care follow up, emergency obstetric services, and the enhancement of neonatal resuscitation skills and management of sick neonates.
ABSTRACT
BACKGROUND: Low birth weight (Birth weight < 2500 g) is a leading cause of prenatal and neonatal deaths. The early identification of Low birth weight (LBW) neonates is essential for any comprehensive initiative to improve their chance of survival. However, a large proportion of births in developing countries take place at home and birth weight statistics are not available. Therefore, there is a need to develop simple, inexpensive and practical methods to identify low birth weight (LBW) neonates soon after birth. METHODS: This is a hospital based cross sectional study. Four hundred twenty two (422) live born neonates were included and anthropometric measurements were carried out within 24 h of birth by three trained nurses. Birth weight was measured by digital scale. Head and chest circumference were measured by using non extendable measuring tape and foot length with hard transparent plastic ruler. Data was entered into SPSS version 20 for analysis. Characteristics of study participants were analyzed using descriptive statistics such as frequency and percentage for categorical data and mean and standard deviation for continuous data. Correlation with birth weight using Pearson's correlation coefficient and linear regression were used to identify the association between dependent and independent variables. Receiver operating characteristic (ROC) curve was used to evaluate accuracy of the anthropometric measurements to predict LBW. RESULTS: The prevalence of low birth weight was found to be 27%. All anthropometric measurements had a positive correlation with birth weight, chest circumference attaining the highest correlation with birth weight (r = 0.85) and foot length had the weakest correlation (r = 0.74). Head circumference had the highest predictive value for birth weight (AUC = 0.93) followed by Chest circumference (AUC = 0.91). A cut off point of chest circumference 30.15 cm had 84.2% sensitivity, 85.4% specificity and diagnostic accuracy (P < 0.001). A cut off point of head circumference 33.25 had the highest positive predictive value (77%). CONCLUSION: Chest circumference and head circumference were found to be better surrogate measurements to identify low birth weight neonates.
