Perinatal Factors Associated with Birth Asphyxia among Neonates at Mbagathi County Referral Hospital, Nairobi, Kenya

Abstract

Perinatal asphyxia is a common and serious neonatal problem in every part of the world and significantly contributes to both neonatal morbidity and mortality, given that it is a major cause of death and of acquired brain damage in newborns. Globally, deaths caused by perinatal asphyxia account for 23% of the deaths among the four million neonatal deaths. The study aimed at determining the perinatal risk factors associated with perinatal asphyxia among neonates. Specifically, the study sought to determine the antepartum risk factors associated with perinatal asphyxia among neonates at Mbagathi County Referral Hospital; to assess the intrapartum risk factors associated with perinatal asphyxia among neonates at Mbagathi County Referral Hospital; and to determine the neonatal factors associated with perinatal asphyxia among neonates at Mbagathi County Referral Hospital. This was an unmatched case control study that employed mixed methods, carried out at Mbagathi County Referral Hospital (MCRH), Nairobi. A sample size of 124 mothers (31 cases and 93 controls) was arrived at using census for cases and systematic sampling technique for controls, at an interval of 4. Quantitative data was collected using questionnaires and data abstraction forms, whereas a key informant interview guide was used to collect qualitative data. Pretesting of the study tools was carried out at Mama Lucy Kibaki County Referral Hospital. Epidata and STATA 14 software were used for data entry and analysis respectively. The analysis of quantitative data included descriptive statistics and inferential statistics used to examine relationships between the outcome and predictor variables. Hypothesis testing was done at an alpha significance level of 0.05. Qualitative data were analysed thematically in order to triangulate the quantitative data. Study findings revealed that birth interval was the only significant antepartum factor associated with perinatal asphyxia after adjusting for the role of other factors. As such, for every unit increase in birth interval, the likelihood of developing perinatal asphyxia reduces by 0.5 times (OR = 0.5; p=.03). Foetal distress (OR = 6.5 [95 % CI 2.4 - 17.4]) and membrane rupture (10 [95% CI 3.1 - 33.2]) provided statistically significant differences between those who were exposed compared to those who were not exposed, across cases and controls. Following these findings, the study concludes that less birth interval, foetal distress and membrane rupture contributed significantly to perinatal asphyxia diagnosis. The study recommends mother education on birth interval management in a bid to ensure that such preventable risk factors are eliminated.