Epidemiological Profile of Newborns Who Died during Their Hospitalization in the Neonatology Unit, Mali Hospital ()
1. Introduction
Neonatal mortality is defined as the death of a child between 0 - 28 days of life. It is composed of early neonatal mortality (0 - 7 days) and late neonatal mortality (8 - 28 days). This mortality is related to both pregnancy and delivery pathologies and to socio-environmental factors [1].
According to the World Health Organization, two point five million children worldwide died in 2017 during their first month of life and more than two-thirds of these deaths occur during the first week of life [2].
In Africa, the neonatal mortality rate is the highest, estimated at 45 per thousand live births; Asia at 34 per thousand; Latin America at 17 per thousand compared to 5 per thousand in developed countries [3].
In Mali, this rate is estimated at 33 per thousand live births [1].
In 2016, a study carried out at the Mali Hospital on neonatal morbidity and mortality showed a mortality rate of 28.2%, but no study has yet been carried out on the epidemiological profile of these deaths, hence the interest of the present study, the objective of which is to study the epidemiological and clinical profile of newborns who died during hospitalization in the neonatology unit of the pediatric service of the Mali Hospital.
2. Patients and Method
2.1. Study Setting
The study took place in the neonatology unit of the pediatrics department of the Hôpital du Mali. The pediatric service of the Mali Hospital is composed of three units: a neonatology unit, a general pediatrics unit, and a pediatric emergency unit.
The neonatology unit has a capacity of 20 beds, 2 phototherapy machines, 2 incubators, and 2 heating tables, 1 bilirubin meter, 12 oxygen outlets with bubblers, 1 vacuum cleaner, and 1 ambulance. It welcomes sick newborns on a permanent basis with a day and night team.
The neonatology staff is composed of 9 agents: 1 neonatologist pediatrician, 1 general pediatrician, 1 state nurse, 1 health technician, 1 obstetrician nurse, and 4 students enrolled in a medical thesis.
2.2. Type and Period of Study
This is a prospective descriptive study that took place over a 12-month period from January 1 to December 31, 2020.
2.3. Study Population
The study included all neonates hospitalized in neonatology.
2.4. Inclusion Criteria
All neonates who died during hospitalization during the study period were included.
2.5. Non-Inclusion Criteria
Not included were deceased infants older than 28 days and any death noted on arrival.
2.6. Variables Studied
· Socio-demographic characteristics: age of the newborn, sex, age of the mother, occupation of the father and mother, education level of the father and mother, the residence of the parents, residence of the newborn.
· The course of the pregnancy: number of prenatal consultations, presence of infectious risks, completion of the prenatal check-up.
· The circumstance of the delivery: term, place of delivery, method of delivery, the notion of resuscitation at birth.
· Clinical examination: the reason for consultation, the reason for hospitalization, weight, temperature.
· Evoked diagnosis.
· Duration of hospitalization.
· Period of death.
2.7. Operational Definitions
· Newborn: is a child less than 28 days old [1].
· Neonatal mortality: any death of a live-born child occurring between 0 and 28 days of life [1].
· A full-term newborn: is a child born between 37 and 42 weeks of amenorrhea [4].
· A preterm newborn: is a child born before 37 weeks of amenorrhea [4].
· Pauper: is a woman who has had 1 or 2 births [5].
· Multiparous: is a woman who has had 3 or 4 births [5].
· Neonatal resuscitation: is the set of gestures and care aimed at restoring and ensuring adequate alveolar respiration for the newborn [6].
2.8. Data Processing and Analysis
Data were collected from the medical records of the newborns who died during the study period. In these files, the variables studied (from admission to death) were recorded and filled in. These variables were entered into a database. Data analysis was done using IBM SPSS version 25 software.
2.9. Ethical Considerations
Verbal permission was obtained from hospital officials and from the parents of the newborns for the use of the data. The use of hospital data is part of the general knowledge contribution missions of the Mali Hospital in order to improve the general knowledge of the population and the reduction of infant and neonatal mortality.
Anonymity was guaranteed; no results were disseminated that could identify the patient. The integrity of the data was respected.
3. Results
3.1. Frequency
During the study period, 424 newborns were hospitalized for neonatology. Of the 424 newborns, 54 died, or a frequency of 12.7%.
3.2. Socio-Demographic Characteristics of Newborns
The vast majority of our newborns were admitted within the first 72 hours of life or 72.2%. The average age was 4.3 days with extremes of 0 - 25 days; the 0 - 7 days were the most represented, or 79.63%. The sex ratio was 1.17 in favor of boys. The parents resided in urban areas in more than 68% (Table 1).
Mothers with no schooling were the most represented and were housewives in 79.6% of cases (Table 2).
3.3. Clinical Aspects
More than half of our mothers had performed less than 4 ANC, or 53.7%. Almost all of our babies were born by vaginal delivery (94.4%) and more than 38% were resuscitated at birth (21/54) (Table 3).
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Table 1. Distribution of newborns by socio-demographic characteristics of newborns.
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Table 2. Distribution of newborns by socioeconomic characteristics of mothers.
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Table 3. Distribution of newborns according to the number of prenatal consultations, the route of delivery and the notion of resuscitation.
Respiratory distress and fever were the most common reasons for hospitalization, respectively 29.6% and 24.1% (Table 4).
3.4. Evolutionary Aspects
The vast majority of our babies 87% died during the first week of hospitalization of which 59.2% in the first three days and these deaths concerned the early neonatal period in more than 60% of cases (Table 5).
4. Discussion
Over a period of twelve months, from January 1 to December 31, 2020, we recorded 54 deaths among the 424 newborns hospitalized in neonatology or a frequency
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Table 4. Distribution of newborns by reason for hospitalization.
Other*: weight loss, jaundice, plaintive cries, convulsion.
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Table 5. Distribution of newborns according to duration of hospitalization and period of death.
of 12.73%. Our result is lower than the 27.88% found by Barro Macourra et al. [7] in Bobo Djoulasso and the 25% found by Kalondji D.C. et al. [8] in the Democratic Republic of Congo, but higher than the 8% found by Kedy Koum D. et al. [9] in Douala, Cameroon.
In our study, the parents of our deceased neonates were out of school in 46.3% of cases. Our result reflects the low literacy rate of the general population, confirmed by a demographic health survey 6th edition [2] in 2018 according to which 65.5% of women had no education. This finding is made by M.Garba et al. [10] in Niamey who found a relationship between the low level of education of the mother and the death of the newborn. The mothers of our deceased newborns were mostly housewives; this was also confirmed by M. Garba et al. [10] who found that newborns born to housewives were three times more likely to die. More than half of our mothers had made less than 4 prenatal visits (53.7%). This low rate of prenatal consultation was also found in the study by Yaméogo W. et al. [11] and Kalondji D. C. et al. [8] in the Congo who found respectively 64.43% and 92.9% of mothers who had less than 4 prenatal consultations. In our study, the age group most represented at admission was 0 - 7 days; the same observation was made by Barro Makoura et al. [7] who found that 72% of babies admitted between 0-7 days. Also Yaméogo W. et al. [11] in Ouagadougou found 80% of admissions during the first 24 days of life. All these figures allow us to understand the high rate of hospitalization of newborns during the first week of life. In our study, boys were the most represented with a sex ratio of 1.17. This male predominance is also found by other authors: Barro et al. [7] in Bobo Djoulasso; Kalondji D.C. et al. [8] in Congo (62.2%); Kedy Koum D. et al. [9] in Cameroon (55%); Yaméogo W. et al. [11] in Ouagadougou (58.19%); this could be linked to a supposed biological fragility of the male sex.
Forty percent of our newborns had less than 2500 g on admission, this result is lower than that of Kalondji D.C. et al. [8] in Congo who recorded 59.2% of newborns with a weight of less than 2500 g. This low weight could contribute in part to increasing the risk of death in these newborns.
The vast majority of our babies were born by vaginal delivery (94.4%). Our result is higher than those of Barro Makoura et al. [7] and Yaméogo W. et al. [11] who found respectively 65.83% and 66.6% of babies born by vaginal delivery. In our study, nearly 80% of the mothers had given birth at most two times. This result is confirmed by Deddy C. et al. [8] in Congo who recorded 72.4% of primiparous mothers. The study shows that respiratory distress was the reason for hospitalization in 37% of cases. These figures confirm the data in the literature according to which respiratory distress syndrome is a major factor of mortality in the world.
Our study shows that neonatal infection was the most frequently mentioned diagnosis alone (40%) or in combination (96.29%); this same observation was made by many other authors, including Kedy Koum D. et al. [9] in Cameroon in more than 90% of cases; Yaméogo W. et al. [11] in Ouagadougou (33.23%); Chabni N. et al. [12]; Barro Makoura et al. [7] in Bobo Djoulasso (34.31%).
The vast majority 87% of our babies died during the first week of hospitalization. This result is comparable to that of Barro who found 96% of deaths during the first 7 days of hospitalization and Yaméogo W. et al. [11] who found up to 38.68% of deaths only during the first day of hospitalization. In our study, death during the first week of life was the most common, or 79.63%; this result confirms those of Kalondji DC. et al. [8] in Congo and Yaméogo W. et al. [11] in Ouagadougou, who found respectively more than 90% during the first 24 days of life and 88.10% of deaths during the first 7 days of life.
5. Conclusions
The high frequency of deaths during the neonatal period is a reality at the pediatric level of the hospital in Mali. Newborns were admitted in the first week of life (early neonatal period) in 79.63% of cases. More than half of the mothers of our newborns (53.7%) had performed less than four ANC and the vast majority had an infectious risk on history (74.1%). Respiratory distress and fever were the most common reasons for hospitalization and infection was by far the most frequently mentioned diagnosis, either alone (40.4%) or in association with other pathologies (96.2%).
This work shows us that a particular emphasis should be put on the prevention of risk factors for neonatal morbidity and mortality. However, good monitoring of pregnancy, deliveries, and correct management of newborns both at birth and in the pediatric services can help reduce the neonatal mortality rate in our facilities.