Factors associated with mortality and length of stay in hospitalised neonates in Eritrea, Africa: a cross-sectional study
- 1Division of Neonatology, Department of Pediatrics, State University of New York at Stony Brook School of Medicine, Stony Brook, New York, USA
- 2Department of Pediatrics and Neonatology, Orotta Pediatric Hospital, Orotta National Maternity Referral Hospital, Asmara, Eritrea
- 3School of Aging Studies, University of South Florida, Tampa Bay, Florida, USA
- Correspondence to Dr Shetal Shah;
- Received 20 December 2011
- Accepted 7 February 2012
- Published 14 September 2012
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.
To cite: Shah S, Zemichael O, Meng H. Factors associated with mortality and length of stay in hospitalised neonates in Eritrea, Africa: a cross-sectional study. BMJ Open 2012;2:000792. doi:10.1136/bmjopen-2011-000792
Contributors SS made substantial contributions to conception and design of the study, wrote the text of the manuscript, performed all revisions and performed part of the data analysis. OZ collected the information and data for all patients in the study, made substantial contributions to conception and design of the study and made critical revisions to the abstract. HDM made substantial contributions to conception and design of the study, performed part of the data analysis, including the regression analysis. All authors were involved in drafting all or part of the manuscript.
Funding Travel costs related to the study were underwritten by the Partnership for Eritrea and George Washington University School of Medicine as part of an international health exchange programme. No specific grant supported directly related to the study was obtained. This work supported in part by the Partnership for Eritrea and George Washington University.
Competing interests SS once served on the Speaker's Bureau of Abbott Nutrition.
Patient consent Exempted from review per the State University of New York Institutional Review Board.
Ethics approval Ethics approval was provided by the State University of Stony Brook Institutional Review Board.
Provenance and peer review Not commissioned; externally peer reviewed.
Data sharing statement There are no additional unpublished data from this study that are available. Another article specifically looking at outcomes in infants with pneumonia and hypothermia was published in the Journal of Tropical Pediatrics last year.
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