Factors associated with mortality and length of stay in hospitalised neonates in Eritrea, Africa: a cross-sectional study.

OBJECTIVE: To determine the factors associated with mortality in a hospitalised cohort of infants in Asmara, Eritrea. DESIGN: Retrospective cross-sectional review of all 2006 admissions to a specialised neonatal intensive care unit. Data on gestational age (prematurity), age at presentation, birth weight, gender, mode of delivery, Apgar score, maternal age, birth location, admission diagnosis, admission comorbidities, time of admission and outcome were collected. SETTING: Orotta Pediatric Hospital 'Specialised Neonatal Intensive Care Unit' (SNCU) in Orotta National Maternity Referral Hospital, the nation's only tertiary newborn centre. PRIMARY AND SECONDARY OUTCOME MEASURES: Factors associated with mortality and length of stay via multivariate regression analysis and the combined association of both hypothermia and pneumonia. Other outcome measures were determination of the association of admission hypothermia, time of admission and pneumonia on mortality. RESULTS: A total of 1502 infants were admitted to the SNCU with an average preterm gestational age of 35.9 weeks. 87 died (mortality 8.2%). In bivariate analysis, the highest mortality rate (10.3%) was seen in patient's admitted <1 h after birth. Patients with hypothermia or pneumonia exhibited higher mortality rates (13.6% and 13.4%, respectively). In multivariate analysis, birth weight <2 kg (p<0.01), birth weight between 2.1 and 2.5 kg (p<0.01), Apgar score at 1 min (p<0.01), small for gestational age (p<0.01), hypothermia (p<0.04) and pneumonia (p<0.01) were associated with mortality. CONCLUSION: Hypothermia, pneumonia, younger gestational age, 1 min Apgar score and small size for gestational age are significantly associated with mortality and longer length of stay in the Eritrean SNCU.

Cracking the whip on childhood mortality--role of the specialized neonatal unit in Eritrea.

UNLABELLED: Health care services in developing countries are being challenged by high childhood mortality rates. Although there have been tremendous strides made in reducing infant mortality rates largely due to vaccinations and improved standards of living, a lot remains to be done to reduce neonatal mortality. Achievement of the Millennium Development Goal (MDG) number 4 on childhood mortality will remain unattainable in most developing countries unless purpose based interventions targeted at reducing neonatal mortality are instituted. This viewpoint is based on the experiences gained in Eritrea, a country that gained independence less than twenty years ago following a protracted war that left a trail of destruction of infrastructure in general and health facilities in particular. War that broke out with Ethiopia less than 10 years into its independence and border conflicts followed by a no peace no war stalemate situation aggravated by frequent droughts have continued to throttle economic recovery, reconstruction and rehabilitative efforts. The population is estimated at 3.5 million comprising of nine ethnic groups who speak different languages. The country has a surface area of 124,000 km2 which shares borders with Sudan, Ethiopia, Djibouti and the Red Sea. CONCLUSION: Attainment of the MDG number 4 on reduction of childhood mortality can be achieved by addressing morbidities of the neonate where the bottle neck currently appears to be sited.