Neonatal mortality contributors using the three delays audit: a study from Albuluk paediatrics teaching hospital in Sudan
Abstract
Background: In certain developing countries neonatal mortality rates still showed a slower decline. Many factors were attributed to neonatal mortality that varies from one country to another. This study investigated factors attributed to neonatal mortality in Sudan.
Methods: Data was collected from 72 neonatal deaths records at Albuluk pediatrics' teaching hospital, and then it was analyzed using a modified three delays model to determine contributing delays.
Results: 31.9% of neonatal mortality occurred on the first day after birth and 86.1% thereafter. Newborn characteristics showed that more than half of dead newborn were male and more than 80% admitted in the age of more than 2 days although there was 26% of involved newborn were preterm. About two third of deliveries were home deliveries and only 52% of the mothers were in regular antenatal care. The leading causes of death were sepsis and pneumonia in 83% followed by birth asphyxia in 11% of total neonatal mortality. Regarding the three delays audit; delay in decision making were present in 54.2% and that was due to inability of the mothers to recognize danger signs, delay in reaching the health care facility was present in 9.8% of the neonatal mortality, while delay in initiation of treatment in the healthcare facility was present in only 6.9%.
Conclusions: Maternal knowledge of neonatal danger signs and decision to seek medical care is a major contributor for neonatal mortality in this study. Further efforts should be exerting to raise knowledge of the mothers about danger signs of neonatal illness.
Keywords
Full Text:
PDFReferences
Lawn JE, Cousens S, Zupan J, Lancet Neonatal Survival Steering Team. 4 million neonatal deaths: when? Where? Why?. Lancet. 2005;365(9462):891-900.
World Health Organization. The World Health Report 2005: Make every mother and child count. World Health Organization; 2005. Available at http://www.who.int/whr/2005/en/.
Jha P, Gajalakshmi V, Gupta PC, Kumar R, Mony P, Dhingra N, et al. Prospective study of one million deaths in India: rationale, design, and validation results. PLoS medicine. 2005;3(2):e18.
Liu L, Johnson HL, Cousens S, Perin J, Scott S, Lawn JE, et al. Global, regional, and national causes of child mortality: an updated systematic analysis for 2010 with time trends since 2000. Lancet. 2012;379(9832):2151-61.
Bashir AO, Ibrahim GH, Bashier IA, Adam I. Neonatal mortality in Sudan: analysis of the Sudan household survey, 2010. BMC Public Health. 2013;13:287.
Khalifa AL, El-Amin EO, Abdelkhair SM, El-Sheikh MA. Overview of maternal and perinatal mortality in Sudan. InSeminars in Fetal and Neonatal Medicine 2015;20(5):321-325.
Ali AA, Adam I. Lack of antenatal care, education, and high maternal mortality in Kassala hospital, eastern Sudan during 2005–2009. J Mater-Fetal Neo Medic. 2011;24(8):1077-8.
Thadeus S, Maine D. Too far to walk: maternal mortality in context. Soc Sci Med. 1994;38:1091-1110.
UNFPA. Maternal mortality reduction program in Rwanda. Available at http://rwanda.unfpa.org/drive/ MaternalMortalityReductioninRwanda%28VLR%29.pdf. Accessed 12 June2012.
USAID. MCH program description: Rwanda July2008. Available at http://pdf.usaid.gov/pdf_docs /PDACP019.pdf. Accessed 13 June 2012.
Padmanaban P, Raman PS, Mavalankar DV. Innovations and challenges in reducing maternal mortality in Tamil Nadu, India. J Health Popul Nutr. 2009;27:202-219.
Waiswa P, Kallander K, Peterson S, Tomson G, Pariyo GW. Using the three delays model to understand why newborn babies die in eastern Uganda. Trop Medic Inter Heal. 2010;15(8):964-72.
R. P. Upadhyay et al. Using Three Delays Model to Understand the Social Factors responsible for Neonatal Deaths in Rural Haryana, India. J Tropic Pediatr. 2013, 59 (5): 100-105.
Mbaruku G, van Roosmalen J, Kimondo I, Bilango F, Bergström S. Perinatal audit using the 3‐delays model in western Tanzania. Inter J Gynecol Obs. 2009;106(1):85-8.
Jammeh A, Sundby J, Vangen S. Barriers to emergency obstetric care services in perinatal deaths in rural gambia: a qualitative in-depth interview study. ISRN Obstet Gynecol. 2011:981096.
Bazzano AN, Kirkwood BR, Tawiah‐Agyemang C, Owusu‐Agyei S, Adongo PB. Beyond symptom recognition: care‐seeking for ill newborns in rural Ghana. Tropic Medic Inter Heal. 2008;13(1):123-8.
Kibaru EG, Otara AM. Knowledge of neonatal danger signs among mothers attending well baby clinic in Nakuru Central District, Kenya: cross sectional descriptive study. BMC Res Notes. 2016;9(1):481.
Dongre AR, Deshmukh PR, Garg BS. A community based approach to improve health care seeking for newborn danger signs in rural Wardha, India. Ind J Pediatr. 2009;76:45-50.
Rahman A, Leppard M, Rashid S, Jahan N, Nasreen HE. Community perceptions of behaviour change communication interventions of the maternal neonatal and child health programme in rural Bangladesh: an exploratory study. BMC health services research. 2016;16(1):389.
Rahman M, Yunus FM, Shah R, Jhohura FT, Mistry SK, Quayyum T, et al. A controlled before-and-after perspective on the improving maternal, neonatal, and child survival program in rural Bangladesh: an impact analysis. PloS one. 2016;11(9):e0161647.
Boone P, Eble A, Elbourne D, Frost C, Jayanty C, Lakshminarayana R, et al. Community health promotion and medical provision for neonatal health-CHAMPION cluster randomised trial in Nagarkurnool district, Telangana (formerly Andhra Pradesh), India. PLoS Medic. 2017;14(7):e1002324.324
World Health Organization. Child and adolescent health, 2014. Available at http://www.emro.who.int /child-adolescent-health/data-statistics/sudan.html.