ABSTRACT
Background In low-income countries; the majority of neonatal deaths occur during the perinatal period. The fourth millennium development goal of reducing child mortality cannot therefore be met without substantial reduction in perinatal deaths. Objective To investigate the risk factors for perinatal mortality in Arua regional referral hospital; West Nile region. Methods We conducted a facility based unmatched case-control study at Arua Regional Referral hospital during January- March 2006. A total of 60 new cases of perinatal deaths and 120 controls were selected over a 3 months period. A case was defined as any baby born after 28 weeks of gestation either as a still birth or born alive but died within 7 days post delivery. A control was any baby born after 28 weeks of gestation and survived the first seven days of life. Control mothers were followed at home after one week to check if any perinatal death occurred. Logistic regression analysis was used to determine the risk factors for perinatal mortality. Results: The mean age of case mothers was similar to that of controls 24.1 years; range 15-38 years versus 24.9 years range 16-40 years (p-value = 0.52). Babies who died during the perinatal period were more likely not to have been resuscitated (OR= 24.85; 95CI 8.77-74.17). Mothers whose babies died were more likely to have travelled more than 5 kilometres to Arua hospital (OR= 3.89 CI 1.96-7.74); having had transport problem (OR= 3.35; CI 1.00-12.00); first sought help from other health facilities or TBA (OR= 8.03; CI 3.38-19.46); have been referred due to obstetric complications (OR= 11.45; CI 4.75-27.59); and had obstetric interventions i.e. C/S or vacuum extraction (OR= 3.79; CI 1.64-8.83). After controlling for confounding; significant risk factors for perinatal deaths included living more than 5 kilometres from the hospital (Adjusted OR= 0.91; CI 0.83-0.95); transport problem (Adjusted OR= 4.37; CI 1.14-39.75); baby not being resuscitated (Adjusted OR=4.87; CI 4.371-7.11) and baby being born with low Apgar score (Adjusted OR= 6.76; CI 2.75-187.38). Conclusion and Recommendations: Our study has identified several risk factors for perinatal deaths related to poor accessibility to and low quality of health care services in the setting. The study underscores the importance of improved accessibility to and quality of basic and comprehensive emergency obstetrical care. The findings suggest the need to improve the capacity of local health system at first; second and tertiary levels; accessibility to and quality health care services in the settings
Subject(s)
Infant Care , Perinatal Mortality , Referral and Consultation , Risk Factors , UgandaABSTRACT
Traditional birth attendants (TBAs) represent an important component of the healthcare system in resource-limited settings, and are present at 50% of deliveries in developing countries. While several studies have been carried out on the effectiveness of TBAs in reducing maternal morbidity and mortality, very little attention has been given to the needs assessment of TBAs within the environment they practice. We conducted a cross-sectional study among trained TBAs (TTBAs) in the Mukono District of Uganda with needs assessment as one of the aims of the survey. A total of 48 TTBAs within the age range of 19-80 years were interviewed. Knowledge of the TTBAs regarding obstetric cases requiring referral and years of experience gathered were satisfactory. Among the 38 referred mothers, one maternal and fetal death intra-partum were recorded, yielding a case fatality rate of 2.6%. The single most important need of TTBAs was transportation. On average, the distance between the residence and the workplace of a TTBA was 7 km, and lack of transportation hampered the actual transfer of cases to a higher level of care. To remedy this, we recommend the introduction of a practical, cheap and sustainable single-ambulance-multiple-cellular phone system to facilitate prompt referral of complicated obstetric cases within the entire Health District.
