BMJ Global Health (May 2021)

Neonatal mortality in Kenyan hospitals: a multisite, retrospective, cohort study

  • Grace Irimu,
  • Morris Ogero,
  • George Mbevi,
  • David Gathara,
  • Samuel Akech,
  • Mike English,
  • Jalemba Aluvaala,
  • Ambrose Agweyu,
  • Mercy Chepkirui,
  • Sylvia Omoke,
  • Lucas Malla,
  • Emma Namulala,
  • Juma Vitalis,
  • Rachel Inginia,
  • Grace Ochieng,
  • Lydia Thuranira,
  • Esther Njiru,
  • Charles Nzioki,
  • Caren Emadau,
  • Christine Manyasi,
  • Fred Were,
  • Magdalene Kuria,
  • Mary Waiyego,
  • Beth Maina,
  • Edith Gicheha,
  • Joseph Nganga,
  • Esther Mwangi,
  • Esther Muthiani,
  • Mary Nguri,
  • Samuel Soita,
  • Margaret Waweru,
  • Alfred Wanjau,
  • Caroline Mwangi,
  • John Wainaina,
  • Livingstone Mumelo,
  • Nyumbile Bonface,
  • Wagura Mwangi,
  • Penina Mwangi,
  • Felistus Makokha,
  • Josephine Ojigo,
  • Bernadette Lusweti,
  • Amilia Ngoda,
  • Dolphine Mochache,
  • Jane Mbungu,
  • Joan Baswetty,
  • Josephine Aritho,
  • Beatrice Njambi,
  • Zainab Kioni,
  • Lucy Kinyua,
  • Alice Oguda,
  • Loise N. Mwangi,
  • Nancy Mburu,
  • Celestine Muteshi,
  • Salome Okisa Muyale,
  • Faith Mueni,
  • Rosemary Mututa,
  • Joyce Oketch,
  • Orina Nyakina,
  • Faith Njeru,
  • Margaret Wanjiku Mwaura,
  • Seline Kulubi,
  • Susan Wanjala,
  • Pauline Njeru,
  • John Ollongo,
  • Otieno George Obop,
  • Jeska Kuya,
  • Benjamin Tanui,
  • Judith Onsongo,
  • Peter Muigai,
  • Arnest Namayi

DOI
https://doi.org/10.1136/bmjgh-2020-004475
Journal volume & issue
Vol. 6, no. 5

Abstract

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Background Most of the deaths among neonates in low-income and middle-income countries (LMICs) can be prevented through universal access to basic high-quality health services including essential facility-based inpatient care. However, poor routine data undermines data-informed efforts to monitor and promote improvements in the quality of newborn care across hospitals.Methods Continuously collected routine patients’ data from structured paper record forms for all admissions to newborn units (NBUs) from 16 purposively selected Kenyan public hospitals that are part of a clinical information network were analysed together with data from all paediatric admissions ages 0–13 years from 14 of these hospitals. Data are used to show the proportion of all admissions and deaths in the neonatal age group and examine morbidity and mortality patterns, stratified by birth weight, and their variation across hospitals.Findings During the 354 hospital months study period, 90 222 patients were admitted to the 14 hospitals contributing NBU and general paediatric ward data. 46% of all the admissions were neonates (aged 0–28 days), but they accounted for 66% of the deaths in the age group 0–13 years. 41 657 inborn neonates were admitted in the NBUs across the 16 hospitals during the study period. 4266/41 657 died giving a crude mortality rate of 10.2% (95% CI 9.97% to 10.55%), with 60% of these deaths occurring on the first-day of admission. Intrapartum-related complications was the single most common diagnosis among the neonates with birth weight of 2000 g or more who died. A threefold variation in mortality across hospitals was observed for birth weight categories 1000–1499 g and 1500–1999 g.Interpretation The high proportion of neonatal deaths in hospitals may reflect changing patterns of childhood mortality. Majority of newborns died of preventable causes (>95%). Despite availability of high-impact low-cost interventions, hospitals have high and very variable mortality proportions after stratification by birth weight.