Neonatal Mortality and Morbidity in the Neonatology Unit of the Pediatrics Department of the Reference Health Center of Commune III of the District of Bamako ()
1. Introduction
Neonatal mortality is defined as the death of children between 0 and 28 days of life. It is composed of early neonatal mortality where death occurs within the first 7 days of life and late neonatal mortality which means the occurrence of death between the eighth and twenty-eighth day of life [1]. The birth of a baby is a natural process and an important social event for the newborn’s parents and for the wider community. However, the moment of birth and the first month constitute a very risky period for the child [1]. In 2022, the number of newborn deaths was 2.3 million. Neonatal deaths have decreased by 44% since 2000. Yet, in 2022, nearly half (47%) of deaths in children under five years of age occurred during the first 28 days of life, which corresponds to the neonatal period [2].
In 2022, sub-Saharan Africa accounted for 57% (between 2.5 and 3.3 million, or 2.8 million) of all under-five deaths and only 30% of live births worldwide. Its neonatal mortality rate was also the highest in the world at 27 deaths per 1000 live births, followed by Central and South Asia at 21 deaths per 1000 live births [2].
In 2022, of the 238 newborns admitted to the neonatology unit of the Felix Houphouët Boigny General Hospital, 75 died, representing an overall mortality rate of 31.5% [3].
In 2019, a study carried out in the pediatrics department of the Sylvanus-Olympio University Hospital in Lomé, Togo, showed a mortality rate of 17.8% among newborns [4]. Preterm births, birth complications (neonatal asphyxia and birth trauma), neonatal infections and congenital anomalies remain the leading causes of death in newborns [2].
Death within the first 28 days of life may be caused by a condition or illness related to inadequate care during childbirth, or to the lack of care or treatment provided by qualified personnel immediately after birth and during the first days of life [2].
In Mali in 2023, according to the Demographic Health Survey (EDS VII), the neonatal mortality rate is estimated at 29 per 1000 live births [5].
In Mali in 2024, according to the Annual Report on the Surveillance of Maternal, Perinatal and Pediatric Deaths, 2056 newborns died, including 1978 newborns aged 0 to 7 days, i.e., 96.2%, and 78 newborns aged 8 to 28 days, i.e., 3.8% [6]. The main causes of death in newborns aged 0 to 7 days were asphyxia (45.7%) followed by prematurity (39.1%) and neonatal bacterial infection (8.4%). As for newborns aged 8 to 28 days, the causes of death in order of frequency were bacterial infection (36%), asphyxia (33%) and prematurity (17%) [6].
In Mali, in 2017, a study carried out in the pediatric department of the Nianakoro Fomba regional hospital in Ségou revealed a neonatal mortality rate of 25.1%. [7].
In Mali, in 2023 another study conducted on newborns aged 0 to 28 days at the neonatology unit of the Commune I Reference Health Center showed a mortality rate of 26.9% [8].
The Neonatology Unit of the Pediatrics Department of the Reference Health Center of Commune III of the Bamako district did not have data on newborns, which is why we initiated this work to study neonatal morbidity and mortality in the said unit.
2. Goals
2.1. General Objective
To study neonatal morbidity and mortality in the Neonatology Unit of the Pediatrics Department of the Reference Health Center of Commune III of the Bamako District.
2.2. Specific Objectives
To determine the epidemiological characteristics of newborns hospitalized in the neonatology unit;
Identify the main pathologies observed in these newborns;
Describe the immediate outcome of sick newborns.
3. Methodology
3.1. Location of the Study
Presentation of the pediatric unit
Mali’s health services are organized into 3 levels of care:
The 1st level (community level): is the first contact for patients, it is made up of community health centers [9].
The 2nd level (circle level): is the 1st reference. It is made up of referral health centers where appropriate care is provided for the condition that could not be managed at level 1. There are 6 referral health centers for the 6 districts of Bamako [9].
The 3rd level (regional level): is the 2nd reference. It is made up of public hospital establishments which have a higher technical platform than the reference health centers where conditions which cannot be treated at the reference health center have been evacuated [9].
Our study took place in the Neonatology Unit of the Pediatrics Department of the Reference Health Center of Commune III of the Bamako district.
3.2. Type and Period of Study
This was a prospective, descriptive, cross-sectional study and analytical from September 1, 2022 to June 30, 2023, a period of 10 months.
3.3. Study Population
Our study population was newborns aged 0 - 28 days who were hospitalized in the Neonatology Unit of the Pediatrics Department of the Reference Health Center of Commune III of the district of Bamako. It was classified into 2 age categories: [≤7 days] and [>7 days].
3.4. Sampling
Our study sample was exhaustive (all sick newborns aged 0 - 28 days hospitalized in the department during the study period).
3.5. Inclusion Criteria
The following were included during the study period:
all sick newborns aged 0 - 28 days who were born in the maternity ward of our health center and who stayed in the Neonatology Unit during the study period;
all sick newborns aged 0 - 28 days who have been referred to by other health facilities or by their families for care.
3.6. Non-Inclusion Criteria
Not included in the study:
Patients over 28 days old;
Sick newborns aged 0 - 28 days whose parents did not give their consent by participating in the study;
Sick newborns aged 0 - 28 days hospitalized outside our study period;
healthy newborns aged 0 - 28 days admitted for a routine check-up during the study period;
Sick newborn files aged 0 - 28 days cannot be used (missing data).
3.7. Data Collection Process
It consisted of reviewing the medical records of newborns in order to include those that could be used in the study. Data collection was done using a questionnaire developed for this purpose. This questionnaire included the sociodemographic characteristics of the parents and newborns, the clinical and paraclinical characteristics, and their intra-hospital developments.
3.8. Variables Studied
The variables studied were of 3 orders:
Sociodemographic data
Like the sex, age, origin of the newborns, age, the level of education and the occupation of mothers.
Clinical data
Such as the mothers’ medical and obstetrical history, weight, temperature and diagnosis.
Scalable data
Such as the length of hospitalization and the outcome of patients.
The dependent variable was the outcome of the newborns
The independent variables were:
The age group, education level of the mothers, medical-surgical and gyneco-obstetric history, parity group, mode of delivery of the mothers;
The age group, sex, birth weight and term of the newborns.
3.9. Operational Definition
Newborn: is a child less than 28 days old [10].
Neonatal mortality: is defined as any death of a live-born child occurring between 0 and 28 days [10].
Early neonatal mortality: is the set of children born alive but who died before the 8th day of life [10].
Late neonatal mortality: is the set of children born alive but who died between birth and the 8th and 28th day of life [10].
Primiparous: is a woman who has given birth once [10].
Pauciparous: is a woman who has had 2 or 3 births [10].
Multiparous: is a woman who has had 4 to 5 births [10].
Large multiparous: is a woman who has given birth more than 5 times [10].
Full-term newborn: defined as a child born between 37 and 42 weeks of amenorrhea [10].
Post-maturity or post-term: is a birth after 42 weeks of amenorrhea [11].
Premature newborn: is a child born before the 37th week of amenorrhea [10].
Intrauterine growth retardation is defined by a birth weight below the 10th percentile for gestational age [10].
Macrosomia: is defined by a birth weight greater than 4 kilograms [12].
Twins: sharing the same uterus during the same gestation [13].
3.10. Data Entry and Analysis
Data was collected from the hospitalization medical records of newborns hospitalized during the study period. Missing data were supplemented by the maternity and neonatal unit registers and by imputation by the mean. They were entered and analyzed using SPSS software version 25and the software “R”. We conducted a univariate analysis by calculating frequencies, percentages, means, minimum values and minimum values. Bivariate analysis was used to determine the risk factors associated with mortality. Comparisons of proportions were performed using the Fisher test and Chi-square. The significance threshold was set at p < 0.05 and the confidence interval at 0.5%. Word and Excel version 2019 software were used for writing and processing the tables.
3.11. Ethical Considerations
In our study, data collection procedures were carried out with the permission of the local health authorities of the center and that of the patients’ parents. The information collected was only accessible to those involved in the study. Coding helped secure the collected data. There were no conflicts of interest. The results obtained will not be used for any other purposes; they will be used to improve medical practice.
4. Results
4.1. Univariate Analysis
Epidemiological Characteristics
1) Frequency
From September 2022 to June 2023, we consulted 518 newborns, 245 of whom were hospitalized in the neonatology unit, a proportion of 47.2%.
2) Sociodemographic characteristics
Table 1. Distribution of newborns according to the sociodemographic characteristics of the mothers.
Age in years |
Frequency N = 245 |
% |
[15 - 25] |
126 |
51.4 |
[26 - 35] |
95 |
38.8 |
>35 |
24 |
9.8 |
Mothers’ educational level |
Frequency N = 245 |
% |
Koranic |
7 |
2.9 |
not educated |
56 |
22.9 |
Primary |
77 |
31.4 |
Secondary |
68 |
27.8 |
Superior |
37 |
15.1 |
Mothers’ profession |
Frequency N = 245 |
% |
Housekeeper |
5 |
2.0 |
Hairdresser |
5 |
2.0 |
Shopkeeper |
14 |
5.7 |
Seamstress |
2 |
0.8 |
Student |
34 |
13.9 |
Housewife |
131 |
53.5 |
Restaurateur |
1 |
0.4 |
Employee |
27 |
11.0 |
Dyer |
2 |
0.8 |
Saleswoman |
24 |
9.8 |
More than half of the mothers of our newborns were in the age group [15 - 25 years] or 51.4%. The average age was 26.6 years with extremes of 16 and 45 years. They were mostly educated at primary level (31.4%), secondary level (27.8%) and higher level (15.1%). They were also mostly housewives (53.5%) (Table 1).
Most newborns were in the age range [0 - 7 days] of life at admission, i.e. 96.7%. The mean age was 0.93 days with extremes of 0 and 28 days. The male sex was predominant with a sex ratio of 1.2 in favor of boys. Most of our newborns come from 2nd level health centers (Table 2).
Table 2. Distribution of newborns according to their sociodemographic characteristics.
Age in days |
Frequency N = 245 |
% |
[0 - 7] |
237 |
96.7% |
>7 |
8 |
3.3 |
Sex |
Frequency |
% |
Male |
138 |
56.3 |
Female |
107 |
43.7 |
Total |
245 |
100.0 |
Origin |
Frequency |
% |
Residence |
29 |
11.8 |
1st level health center |
35 |
14.3 |
2nd level health center |
180 |
73.5 |
Private clinic |
1 |
0.4 |
3) Clinical features
A small proportion of our newborns’ mothers had a medical or surgical history (7.3%). The most common medical histories were high blood pressure (4.5%), followed by diabetes (2.6%) and sickle cell disease (1.2%) (Table 3).
Table 3. Distribution of newborns according to the mothers’ medical and surgical history.
Medical and surgical history |
Frequency N = 245 |
% |
Asthma |
1 |
0.4 |
Diabetes |
3 |
1.2 |
Sickle cell disease |
3 |
1.2 |
High blood pressure |
7 |
2.9 |
High blood pressure and diabetes |
4 |
1.6 |
No background |
227 |
92.7 |
Table 4. Distribution of newborns according to the mothers’ gynecological-obstetric history.
Pregnancy number range |
Frequency N = 245 |
% |
1 |
69 |
28.2 |
[2 - 3] |
80 |
32.7 |
≥4 |
96 |
39.2 |
Parity |
Frequency N = 245 |
% |
Primiparous |
69 |
28.2 |
Pauciparous |
94 |
38.4 |
Multiparous |
55 |
22.4 |
Large multiparous woman |
27 |
11.0 |
Abortion number range |
Frequency N = 245 |
% |
0 |
226 |
92.2 |
[1 - 2] |
15 |
6.1 |
≥3 |
4 |
1.6 |
Total |
245 |
100.0 |
Obstetric history |
Frequency N = 245 |
% |
Boundary basin |
1 |
0.4 |
Caesarean section |
10 |
4.1 |
No obstetric history |
234 |
95.5 |
More than half of the mothers of our newborns had one to three pregnancies, i.e. 60.7%. Ninety-four mothers out of the 245 were pauciparous, i.e. 38.4%, and 28.2% were primiparous. Most of the mothers of our newborns did not have an abortion, i.e. 92.2%. A small proportion of the mothers of our newborns had a history of obstetrics (4.5%). This was a cesarean section in 4.1% and borderline pelvic section in 0.4% (Table 4).
The vast majority of our newborns’ mothers had three or more prenatal visits, or 73.1% of them. A small proportion of our newborns’ mothers were fully immunized against tetanus, or 4.1%.
HbsAg serology was performed on 156 of our 245 newborn mothers, a proportion of 63.6%. It came back positive in 3.3% (Table 5).
Table 5. Distribution of newborns according to the progress of the mothers’ pregnancy.
Prenatal consultation period |
Frequency N = 245 |
% |
0 |
38 |
15.5 |
[1 - 2] |
28 |
11.4 |
≥3 |
179 |
73.1 |
Tetanus vaccine dose range |
Frequency N = 245 |
% |
0 dose |
175 |
71.4 |
[1 - 2 doses] |
60 |
24.5 |
≥3 doses |
10 |
4.1 |
Serologies |
|
|
Hbs antigen |
Frequency N = 156 |
% |
Negative |
151 |
96.7 |
Positive |
5 |
3.3 |
BW |
Frequency N = 164 |
% |
Negative |
162 |
98.7 |
Positive |
2 |
1.3 |
Toxoplasmosis |
Frequency N = 115 |
% |
Negative |
107 |
93.0 |
Positive |
8 |
7.0 |
HIV |
Frequency N = 194 |
% |
Negative |
189 |
97.4 |
Positive |
5 |
2.6 |
BW serology was performed on 164 of the 245 mothers of our newborns, a proportion of 66.9%. It came back positive in 1.3%.
Toxoplasmosis serology was performed on 115 of our 245 newborn mothers, a proportion of 46.9%. It came back positive in 7%.
HIV serology was performed on 194 of our 245 newborn mothers, a proportion of 79.1%. It came back positive in 2.6%.
Obstetric ultrasound was performed in 66.9% of the mothers of our newborns. It revealed, in order of frequency, multiple pregnancies in 11% of patients, followed by hydrocephalus in 1.2% and malformations in multiple pregnancies in 0.8% (Table 6).
Table 6. Distribution of newborns according to the number and results of obstetric ultrasound performed by the mothers.
Number of obstetric ultrasounds
performed |
Frequency N = 245 |
% |
0 |
42 |
17.1 |
1 |
88 |
35.9 |
2 |
76 |
31.0 |
≥3 |
39 |
15.9 |
Obstetric ultrasound results |
Frequency N = 245 |
% |
Anamnios |
1 |
0.4 |
Circular cord |
1 |
0.4 |
Triple circular cord |
1 |
0.4 |
Double circular cord |
1 |
0.4 |
Multiple pregnancy |
25 |
10.2 |
Hydrocephalus |
3 |
1.2 |
Functional ovarian cyst |
1 |
0.4 |
Malformations in multiple pregnancies |
2 |
0.8 |
Moderate oligoamnion |
1 |
0.4 |
Low fetal weight and circular cord |
1 |
0.4 |
Placenta previa type 2 |
1 |
0.4 |
Seat presentation |
1 |
0.4 |
No anomaly |
166 |
67.8 |
Total |
245 |
100.0 |
Pathologies were observed in 124 of the 245 mothers, a proportion of 50.6%. The most frequently found pathologies were malaria (45.1%), followed by non-malarial infection (20.1%) and pre-eclampsia and eclampsia (16.1%) (Table 7).
Table 7. Distribution of newborns according to pregnancy pathologies.
Pregnancy pathologies |
Frequency |
% |
Anemia |
14 |
5.7 |
Anemia and non-malarial infection |
2 |
0.8 |
Anemia and preeclampsia |
1 |
0.4 |
Chorioamnionitis and malaria |
1 |
0.4 |
Eclampsia |
2 |
0.8 |
Retroplacental hematoma |
4 |
1.6 |
Retroplacental hematoma and malaria |
2 |
0.8 |
High blood pressure |
4 |
1.6 |
Non-malarial infection |
20 |
8.2 |
Non-malarial infection and high blood pressure |
3 |
1.2 |
Malaria |
48 |
19.6 |
High blood pressure and malaria |
2 |
0.8 |
Placenta previa |
3 |
1.2 |
Preeclampsia |
14 |
5.7 |
Preeclampsia and malaria |
3 |
1.2 |
Providence of the cord |
1 |
0.4 |
Without associated pathology |
121 |
49.4 |
Total |
245 |
100.0 |
Delivery was spontaneous in 74.2% of mothers. The rupture of the water bag was observed in 8.2 of them. The vaginal route was the most frequent mode of delivery (67.3%). The presentation was cephalic in many of our newborns (96.3%). Instrumental maneuvers were performed in 10.6% of mothers (Table 8).
Clinical characteristics of newborns
Twenty-one of the 245 newborns were twins, a proportion of 8.6% (Table 9).
The mean gestational age was 35.7 weeks of amenorrhea with extremes of 28 and 47 weeks of amenorrhea. 63.7% of cases were full-term newborns, 35.9% were premature, and one was a post-mature newborn.
A large number of newborns (48.6%) have a weight in the range [25,001 - 3999 grams]. The average weight was 2449.3 grams with extremes of 990 and 5300 grams. More than half of the newborns (56.7%) are in the size range [46 - 54 centimeters]. The average size is 46.7 centimeters with extremes of 38 to 55 centimeters. One hundred and eighteen newborns out of the 245 have a head circumference in the range [32 - 36 centimeters] or a proportion of 48.6%. The average head circumference is 32.2 centimeters with variances of 25 and 42 centimeters.
Table 8. Distribution of newborns according to the course of delivery.
Childbirth |
Frequency N = 245 |
% |
Spontaneous |
182 |
74.3 |
Triggered |
63 |
25.7 |
Premature rupture of the water bag |
Frequency N = 245 |
% |
No |
225 |
91.8 |
Yes |
20 |
8.2 |
Mode of delivery |
Frequency N = 245 |
% |
low track |
165 |
67.3 |
Caesarean section |
80 |
32.7 |
Presentation |
Frequency N = 245 |
% |
Cephalic |
236 |
96.3 |
Seat |
8 |
3.3 |
Transversal |
1 |
0.4 |
Instrumental maneuver |
Frequency N = 245 |
% |
Forceps |
2 |
0.8 |
Suction cup |
24 |
9.8 |
Without instrumental maneuver |
219 |
89.4 |
Table 9. Distribution of newborns according to their gestational ages and birth parameters.
Twin |
Frequency N = 245 |
% |
No |
224 |
91.4 |
Yes |
21 |
8.6 |
Gestational age range |
Frequency N = 245 |
% |
Premature newborn |
88 |
35.9 |
Full-term newborn |
156 |
63.7 |
Post-mature newborn |
1 |
0.4 |
Weight range in grams |
Frequency N = 245 |
% |
<1500 |
32 |
13.1 |
[1500 - 2499] |
91 |
37.1 |
[2500 - 3999] |
119 |
48.6 |
[4000 - 6000] |
3 |
1.2 |
Size range in centimeters |
Frequency N = 245 |
% |
<46 |
105 |
42.9 |
[46 - 54] |
139 |
56.7 |
>54 |
1 |
0.4 |
Head circumference slice in centimeters |
Frequency N = 245 |
% |
<32 |
118 |
48.2 |
[32 - 36] |
115 |
46.9 |
>36 |
12 |
4.9 |
Perinatal anoxia was the most frequent pathology (62.8%) followed by prematurity (35.4%) and neonatal infection (23.2%) associated or not with other pathologies (Table 10).
Table 10. Distribution of newborns according to morbidity.
Morbidity |
Frequency |
% |
Perinatal anoxia |
81 |
33.1 |
Perinatal anoxia and anemia |
3 |
1.2 |
Perinatal anoxia and imperforation of the right choana |
1 |
0.4 |
Perinatal anoxia and neonatal infection |
22 |
9.0 |
Perinatal anoxia, neonatal infection, prematurity and twinning |
1 |
0.4 |
Perinatal anoxia, neonatal infection and heart disease |
1 |
0.4 |
Perinatal anoxia and macrosomia |
2 |
0.8 |
Perinatal anoxia and malformation |
1 |
0.4 |
Perinatal anoxia and prematurity |
25 |
10.2 |
Perinatal anoxia, prematurity, twinning and malformation |
1 |
0.4 |
Perinatal anoxia, prematurity and twinning |
2 |
0.8 |
Perinatal anoxia, prematurity and microphthalmia |
1 |
0.4 |
Perinatal anoxia and intrauterine growth retardation |
12 |
4.9 |
Perinatal anoxia, twinning and intrauterine growth retardation |
1 |
0.4 |
Hydrocephalus and intrauterine growth retardation |
1 |
0.4 |
Congenital hydrocephalus |
1 |
0.4 |
Jaundice and intrauterine growth retardation |
1 |
0.4 |
Neonatal infection |
20 |
8.2 |
Neonatal infection and hypoglycemia |
1 |
0.4 |
Neonatal infection and prematurity |
6 |
2.4 |
Neonatal infection, twins and prematurity |
2 |
0.8 |
Neonatal infection and intrauterine growth retardation |
2 |
0.8 |
Neonatal infection, intrauterine growth retardation due to trisomy |
1 |
0.4 |
Neonatal infection and twinning |
1 |
0.4 |
Prematurity |
24 |
9.8 |
Prematurity and intrauterine growth retardation |
4 |
1.6 |
Prematurity and twinning |
21 |
8.6 |
Intrauterine growth retardation |
4 |
1.6 |
Delayed resorption of pulmonary fluid |
1 |
0.4 |
Hemorrhagic syndrome |
1 |
0.4 |
Total |
245 |
100.0 |
We recorded a cure rate of 83.7%, a dropout rate of 0.8%, and a mortality rate of 13.9%. This included early mortality in 73.5% of cases and late mortality in 26.4%. Four of the 245 newborns were referred to third-level hospitals for specific care (Table 11).
Table 11. Distribution of newborns according to their intra-hospital outcome.
Intra-hospital care of newborns |
Frequency |
% |
Cured |
205 |
83.7 |
Early death |
25 |
10.2 |
Late death |
9 |
3.7 |
Referred |
4 |
1.6 |
Abandon |
2 |
0.8 |
Total |
245 |
100.0 |
4.2. Bivariate Analysis
4.2.1. Sociodemographic Characteristics and Future
Table 12. Distribution of newborns according to outcome and level of education, and the age group of their mothers.
Age group of mothers in years |
Outcome |
Total |
p-value1 |
Death |
Healing |
[16-25] |
20 (50.0%) |
106 (51.7%) |
126 (51.4%) |
0.8 |
[26-35] |
15 (37.5%) |
80 (39.0%) |
95 (38.8%) |
|
[≥36] |
5 (12.5%) |
19 (9.3%) |
24 (9.8%) |
|
Mothers’ educational level |
Death |
Healing |
Total |
p-value1 |
Schooled |
28 (70.0%) |
161 (78.5%) |
189 (77.1%) |
0.33 |
No scolored |
12 (30.0%) |
44 (21.5%) |
56 (22.9%) |
|
Total |
40 (100.0%) |
205 (100.0%) |
245 (100.0%) |
|
Table 13. Distribution of newborns by age group, sex and their outcome.
Age group in days |
Outcome |
Total |
p-value1 |
Death |
Healing |
≤7 |
36 (90.0%) |
201 (98.0%) |
237 (96.7%) |
0.032 |
>7 |
4 (10.0%) |
4 (2.0%) |
8 (3.3%) |
|
Sex |
Death |
Healing |
Total |
p-value1 |
Male |
19 (47.5%) |
119 (58.0%) |
138 (56.3%) |
0.2 |
Female |
21 (52.5%) |
86 (42.0%) |
107 (43.7%) |
|
Origin |
Death |
Healing |
Total |
p-value1 |
Residence |
9 (31%) |
20 (69%) |
29 (100%) |
|
1st level health center |
5 (15%) |
28 (85%) |
33 (100%) |
|
2nd level health center |
26 (15%) |
152 (85%) |
178 (100%) |
0.06 |
Private structures |
0 (0%) |
1 (100%) |
1 (100%) |
|
Total |
40 (100.0%) |
205 (100.0%) |
245 (100.0%) |
|
4.2.2. Clinical Characteristics and Outcome
Clinical characteristics of mothers and the outcome of newborns (Tables 14-16).
Clinical characteristics of newborns and their outcome (Table 17, Table 18).
Table 14. Distribution of newborns according to their outcome and the medical and surgical history of their mothers.
Medical and surgical history |
Outcome |
Total |
p-value1 |
Death |
Healing |
Asthma |
0 (0.0%) |
1 (0.5%) |
1 (0.4%) |
0.8 |
Diabetes |
0 (0.0%) |
3 (1.5%) |
3 (1.2%) |
|
Sickle cell disease |
1 (2.5%) |
2 (1.0%) |
3 (1.2%) |
|
High blood pressure |
1 (2.5%) |
6 (2.9%) |
7 (2.9%) |
|
High blood pressure and diabetes |
0 (0.0%) |
4 (2.0%) |
4 (1.6%) |
|
No medical or surgical history |
38 (95.0%) |
189 (92.2%) |
227 (92.7%) |
|
Total |
40 (100.0%) |
205 (100.0%) |
245 (100.0%) |
|
Table 15. Distribution of newborns according to their outcome and the gynecological-obstetric history of their mothers.
Parity |
Outcome |
Total |
p-value1 |
Death |
Healing |
Primiparous |
13 (32.5%) |
56 (27.3%) |
69 (28.2%) |
0.6 |
Pauciparous |
17 (42.5%) |
77 (37.6%) |
94 (38.4%) |
|
Multiparous |
6 (15.0%) |
49 (23.9%) |
55 (22.4%) |
|
Large multiparous woman |
4 (10.0%) |
23 (11.2%) |
27 (11.0%) |
|
Obstetric history |
Death |
Healing |
Total |
p-value1 |
Boundary basin |
0 (0.0%) |
1 (0.5%) |
1 (0.4%) |
0.7 |
History of cesarean section |
1 (2.5%) |
9 (4.4%) |
10 (4.1%) |
|
No Obstetric History |
39 (97.5%) |
195 (95.1%) |
234 (95.5%) |
|
Total |
40 (100.0%) |
205 (100.0%) |
245 (100.0%) |
|
Table 16. Distribution of newborns according to their outcome and monitoring of the pregnancy, method of delivery.
Prenatal consultation |
Outcome |
Total |
p-value1 |
Death |
Healing |
Poorly monitored pregnancy |
13 (32.5%) |
53 (25.9%) |
66 (26.9%) |
0.5 |
Pregnancy well monitored |
27 (67.5%) |
152 (74.1%) |
179 (73.1%) |
|
Mode of delivery |
Death |
Healing |
Total |
p-value1 |
Caesarean section |
11 (27.5%) |
69 (33.7%) |
80 (32.7%) |
0.5 |
low track |
29 (72.5%) |
136 (66.3%) |
165 (67.3%) |
|
Total |
40 (100.0%) |
205 (100.0%) |
245 (100.0%) |
|
Table 17. Distribution of newborns according to gestational age, birth weight and their outcome.
Gestational age range in weeks of amenorrhea |
Outcome |
Total |
p-value1 |
Death |
Healing |
<37 |
13 (32.5%) |
75 (36.6%) |
88 (35.9%) |
0.7 |
[37 - 42] |
27 (67.5%) |
129 (62.9%) |
156 (63.7%) |
|
>42 |
0 (0.0%) |
1 (0.5%) |
1 (0.4%) |
|
Weight range in grams |
Death |
Healing |
Total |
p-value1 |
<1500 |
3 (7.5%) |
25 (12.2%) |
28 (11.4%) |
0.7 |
[1500 - 4000] |
37 (92.5%) |
177 (86.3%) |
214 (87.3%) |
|
>4000 |
0 (0.0%) |
3 (1.5%) |
3 (1.2%) |
|
Total |
40 (100.0%) |
205 (100.0%) |
245 (100.0%) |
|
Table 18. Association of deaths with newborn age and maternal parity.
Variable |
Estimate (β) |
Std. Error |
z-value |
p-value |
OR (exp(β)) |
95% CI OR (approximate) |
(Intercept) |
2.4677 |
0.9853 |
2505 |
0.0123* |
— |
— |
Tetanus vaccination for mothers |
0.7613 |
0.4411 |
1726 |
0.0844 |
2.14 |
[0.90; 5.07] |
Age range of newborns |
−1.6606 |
0.7388 |
−2.248 |
0.0246* |
0.19 |
[0.04; 0.83] |
Mothers’ education level |
−0.6358 |
0.415 |
−1.53 |
0.125 |
0.529 |
|
Parity number |
0.9024 |
0.434 |
2.08 |
0.038 |
0.9024 |
|
Number of pregnancies |
−0.7144 |
0.483 |
−1.48 |
0.139 |
0.489 |
|
5. Comments and Discussion
5.1. Descriptive Study
Epidemiological Characteristics
1) Frequency
From September 2022 to June 2023, we consulted 518 newborns, 245 of whom were hospitalized in the neonatology unit, a proportion of 47.2%. Our frequency is higher than that of Sangaré et al. [14] and Zagré et al. [15] which respectively recorded frequencies of 13.7% and 8.6%. It is lower than that of Omoigberale et al. [16] who found a frequency of 84.6% in their study.
2) Sociodemographic characteristics
More than half of the mothers of our newborns (51.4%) were in the age group (15 - 25 years) with a mean age of 26.6 years and extremes of 16 and 45 years. The mean age of the mothers in our series is close to that of Kedy et al. [17]. (26.8 years old) and that of Mr. Diarra [18] (27 years). It is lower than that reported by C. Sylla [19] (29.5 years old).
The mothers of our newborns were mostly educated (74.3%): primary level (31.4%), secondary level (27.8%), higher level (15.1%). Our data are higher than those of S. NKounou [20] who found a frequency of 57.6% of educated mothers in his study. However, Mr. Diarra [18] reported a high frequency (66.5%) of non-school-going mothers in their study.
In our study, the mothers of our newborns were mostly housewives (53.5%) as in most studies, notably that of Mr. Diarra [18] (82%), that of S. Nkounou [20] (61.9%) and Sangaré et al. [14] (60%).
Most newborns were less than one week old at admission, i.e., 96.7%. The mean age of our newborns was 0.93 days, with extremes of 0 and 28 days. This is lower than that of Nagalo et al. [21] and Kedy et al. [17] who respectively recorded average ages of 2 and 4 days. It is higher than that of and Zagré et al. [15] which recorded an average age of 0.18 days.
In our series, the male sex was predominant with a sex ratio of 1.2 in favor of boys. Our result is consistent with data from the literature. [12] [22] and those reported by most authors, notably that of Yenan et al. [23], Okechukwu et al. [24], Zagré et al. [15], Mukhtar-Yola et al. [25]. On the other hand, Boiro et al. [26] had a female predominance (58.2%) in their series.
5.2. Clinical Features
5.2.1. Clinical Characteristics of Mothers
A small proportion of our newborns’ mothers had a medical or surgical history (7.3%). The most common medical histories were high blood pressure (4.5%) followed by diabetes (2.6%) and sickle cell disease (1.2%). Our data are similar to those of Boiro et al. [26] who mainly observed high blood pressure as a antecedent in 18.1% of mothers followed by obesity (13.4%) and sickle cell disease (5.5%). They are different from those of S. NKounou [20] who reported in order of frequency sickle cell disease (50%) and asthma (20%).
Gynecological-obstetric history
Ninety-four mothers out of 245 were pauciparous (38.4%) and 28.2% were primiparous. Our data are comparable to those of Boiro et al. [26] who found mostly pauciparous (42.5%) and primiparous (40.9%) mothers in their series while Nagalo et al. [21] had a high frequency of multiparous (56.1%) in their study.
We noted a history of abortion in 19 mothers out of 245, a proportion of 7.7%, whereas Boiro et al. [26] noted almost double in their sample (15.7%).
A small proportion of the mothers of our newborns had a history of obstetrical complications (4.5%). This included a history of cesarean section in 4.1% and borderline pelvic delivery in 0.4%.
Course of pregnancy
Pregnancy was well monitored in most mothers of our newborns (73.1%) because they had more than 3 prenatal consultations. Our data are higher than those of S. NKounou [20] (41%), of C. Sylla [19] (35.3%) and Boiro et al. [26] (34.6%).
Malaria was the most frequently associated pathology with pregnancy in the mothers of our newborns (45.1%) followed by non-malaria infection (20.1%) and preeclampsia/eclampsia (16.1%). However, in the study by Boiro et al. [26], preeclampsia was the most frequently observed in mothers with a frequency of 15.3%.
Progress of childbirth
Rupture of water membranes lasting more than 18 hours was observed in 8.2% of mothers. Our result is close to that of Boiro et al. [27] who observed rupture of water membranes in 10.2% of mothers. However, it is significantly lower than that of Yasmina et al. [28] who observed rupture of the water membranes in 66.6% of mothers in their study.
Labor was induced in 25.7% of our parturients while Ben Guigui et al. [29] induced labor in 54.5% of the parturients in their study.
Vaginal delivery was performed in 67.3% of mothers. Our result is slightly lower than that of Sangaré et al. [14] who found a frequency of 78%. It is significantly higher than that of Boiro et al. [26] who only had a frequency of 2.4% of vaginal delivery.
The presentation was the seat in 3.3% of our parturients almost as in the study of Mukuku et al. which had a frequency of 2.5%.
5.2.2. Clinical Characteristics of Newborns
The mean gestational age was 35.8 weeks of amenorrhea with extremes of 28 and 67 weeks of amenorrhea. 63.7% of the cases were full-term newborns, 35.9% were premature and 0.4% were post-maturity. Our data were comparable to those of Nagalo et al. [21] who reported a high frequency of full-term newborns (64.1%) followed by premature (33.6%) and post-maturity (2.3%) while Boiro et al. [26] observed 66.3% of premature and 33.7% of full-term newborns in their series.
In our sample, a large number of newborns had a weight in the (2001 - 300 grams) range. The average weight was 2449.3 grams with extremes of 990 and 5300 grams. The average weight of the newborns in our sample is close to that of Nagalo et al. [21] (2632 grams). It is higher than that of Boiro et al. [26] (1879 grams) and lower than those of Kedy et al. [17] and Mukuku et al. who respectively found average birth weights of 3000 and 3168 grams in their studies.
Perinatal anoxia was the most frequent pathology (62.8%) followed by prematurity (35.4%) and neonatal infection (23.2%) associated or not with other pathologies. Our data are comparable to those of most authors, notably those of Omoigberale et al. [16], Hedstrom et al. [30], by Mukhtar-Yola et al., by Okechukwu et al. [24] and Ekwochi et al. [31]. On the other hand, Nagado et al. [21] found in order of frequency neonatal infection (23.5%), anomalies related to the duration of gestation and fetal growth (17.9%) and congenital malaria (15.1%). As for Kedy et al. [17], they observed in their series a high frequency of neonatal infection (76.8%) followed by neonatal jaundice (16.6%) and asphyxia (15.9%).
We recorded a cure rate of 83.7%, a dropout rate of 0.8%, and a mortality rate of 13.9%. Our mortality rate is identical to those of Miles et al. [32] (13.9%) from Thomson et al. [33] (13.5%) and Okechukwu et al. [24] (13.3%). It is slightly higher than those of Diallo et al. [10] (12.7%) and Katamea et al. [34] (12.9%). However, rates higher than ours have been recorded by several authors, notably by Ekwochi et al. [31] (14.2%), by Ntambue et al. [35] (27%) by Ouattara et al. [36] (29.8%) and by Zagré et al. [15] (92.7%).
It was mainly early mortality (73.5%) as in Arsène’s studies et al. [37] of Ouattara et al. [36], and of Hadgu et al. [38] which respectively reported high early neonatal mortality rates of 85.6%, 89% and 98.3% in their series.
5.2.3. Analytical Study
The only factors significantly associated with neonatal deaths in our study were the age of newborns and the number of parities of the mothers. Newborns less than a few days old were significantly more at risk of death than those a little older (OR: 0.19, [95% CI OR: 0.04; 0.83], (p = 0.024) and newborns of multiparous and grand multiparous women were also significantly more at risk of death than those of primiparous women (OR = 2.465, p = 0.038). These risk factors for death are different from those of most authors. Ouattara et al. [36] showed in their study that the number of prenatal consultations, the occurrence of a pathology during pregnancy, the use of sulfadoxine pyrimethamine, the term of pregnancy at delivery, the place of delivery, the mode of delivery, the sex of the newborn, his age, his weight, the health structure that referred him and the main diagnosis were significantly associated with neonatal mortality at the threshold of 20%. As for Arsene et al. [37], they found as risk factors associated with death in their study asphyxia (p = 0.007) and neonatal infection (0.042). In the study of Akolly et al. [4], neonatal factors significantly associated with death were admission during the first 24 hours of life (p = 0.001), place of birth outside the university hospital (p = 0.002) and duration of initial resuscitation greater than ten minutes (p = 0.000*).
In that of Djivohessoun A et al. [3], the determining factors of early neonatal mortality found were the insufficient number of prenatal consultations (p = 0.001), poor Apgar (p = 0.001), prematurity (p = 0.001) and very low birth weight (p = 0.001).
6. Conclusions
Neonatal mortality remains a major public health problem in Mali, despite efforts by the government and its partners. Newborns continue to die in our health facilities from often preventable causes. Generally, high-quality prenatal consultations and the monitoring of deliveries by qualified personnel in well-equipped health facilities contribute to a reduction in this rate.
Our study revealed that the main pathologies suffered by our newborns were, in order of frequency, perinatal anoxia, prematurity and neonatal infection. It also found that the only factors significantly associated with neonatal deaths were the age of the newborns and the number of parities of the mothers. These conditions can be prevented by proper pregnancy monitoring and delivery surveillance. However, it also emerged that the pregnancies of a large majority of the mothers of our newborns had been monitored and most of them had given birth in a health facility.