Factors Associated with Perinatal and Neonatal Deaths in Sao Tome & Principe: a Prospective Cohort Study

Overview

Journal Front Pediatr

Specialty Pediatrics

Date 2024 Mar 4

PMID 38434731

Authors

Alexandra Vasconcelos

Swasilanne Sousa

Nelson Bandeira

Marta Alves

Ana Luisa Papoila

Filomena Pereira

Maria Ceu Machado

Affiliations

Soon will be listed here.

Abstract

Background: Neonatal mortality reduction is a global goal, but its factors are seldom studied in most resource-constrained settings. This is the first study conducted to identify the factors affecting perinatal and neonatal deaths in Sao Tome & Principe (STP), the smallest Central Africa country.

Methods: Institution-based prospective cohort study conducted at Hospital Dr. Ayres Menezes. Maternal-neonate dyads enrolled were followed up after the 28th day of life ( = 194) for identification of neonatal death-outcome ( = 22) and alive-outcome groups ( = 172). Data were collected from pregnancy cards, hospital records and face-to-face interviews. After the 28th day of birth, a phone call was made to evaluate the newborn's health status. Crude odds ratios and corresponding 95% confidence intervals were obtained. A value <0.05 was considered statistically significant.

Results: The mean gestational age of the death-outcome and alive-outcome groups was 36 (SD = 4.8) and 39 (SD = 1.4) weeks, respectively. Death-outcome group ( = 22) included sixteen stillbirths, four early and two late neonatal deaths. High-risk pregnancy score [cOR 2.91, 95% CI: 1.18-7.22], meconium-stained fluid [cOR 4.38, 95% CI: 1.74-10.98], prolonged rupture of membranes [cOR 4.84, 95% CI: 1.47-15.93], transfer from another unit [cOR 6.08, 95% CI:1.95-18.90], and instrumental vaginal delivery [cOR 8.90, 95% CI: 1.68-47.21], were factors significantly associated with deaths. The odds of experiencing death were higher for newborns with infectious risk, IUGR, resuscitation maneuvers, fetal distress at birth, birth asphyxia, and unit care admission. Female newborn [cOR 0.37, 95% CI: 0.14-1.00] and birth weight of more than 2,500 g [cOR 0.017, 95% CI: 0.002-0.162] were found to be protective factors.

Conclusion: Factors such as having a high-risk pregnancy score, meconium-stained amniotic fluid, prolonged rupture of membranes, being transferred from another unit, and an instrumental-assisted vaginal delivery increased 4- to 9-fold the risk of stillbirth and neonatal deaths. Thus, avoiding delays in prompt intrapartum care is a key strategy to implement in Sao Tome & Principe.

References

Yadeta T, Worku A, Egata G, Seyoum B, Marami D, Berhane Y . Vertical transmission of group B and associated factors among pregnant women: a cross-sectional study, Eastern Ethiopia. Infect Drug Resist. 2018; 11:397-404. PMC: 5856028. DOI: 10.2147/IDR.S150029. View

Goldenberg R, Harrison M, McClure E . Stillbirths: The Hidden Birth Asphyxia - US and Global Perspectives. Clin Perinatol. 2016; 43(3):439-53. DOI: 10.1016/j.clp.2016.04.004. View

Mulowooza J, Santos N, Isabirye N, Inhensiko I, Sloan N, Shah S . Midwife-performed checklist and ultrasound to identify obstetric conditions at labour triage in Uganda: A quasi-experimental study. Midwifery. 2021; 96:102949. PMC: 7988503. DOI: 10.1016/j.midw.2021.102949. View

Pongou R . Why is infant mortality higher in boys than in girls? A new hypothesis based on preconception environment and evidence from a large sample of twins. Demography. 2012; 50(2):421-44. DOI: 10.1007/s13524-012-0161-5. View

Vasconcelos A, Sousa S, Bandeira N, Alves M, Papoila A, Pereira F . Determinants of antenatal care utilization - contacts and screenings - in Sao Tome & Principe: a hospital-based cross-sectional study. Arch Public Health. 2023; 81(1):107. PMC: 10273617. DOI: 10.1186/s13690-023-01123-1. View

Getiye Y, Fantahun M . Factors associated with perinatal mortality among public health deliveries in Addis Ababa, Ethiopia, an unmatched case control study. BMC Pregnancy Childbirth. 2017; 17(1):245. PMC: 5530490. DOI: 10.1186/s12884-017-1420-7. View

Demisse A, Alemu F, Gizaw M, Tigabu Z . Patterns of admission and factors associated with neonatal mortality among neonates admitted to the neonatal intensive care unit of University of Gondar Hospital, Northwest Ethiopia. Pediatric Health Med Ther. 2018; 8:57-64. PMC: 5774602. DOI: 10.2147/PHMT.S130309. View

Pimentel J, Ansari U, Omer K, Gidado Y, Baba M, Andersson N . Factors associated with short birth interval in low- and middle-income countries: a systematic review. BMC Pregnancy Childbirth. 2020; 20(1):156. PMC: 7069040. DOI: 10.1186/s12884-020-2852-z. View

. Committee Opinion No. 644: The Apgar Score. Obstet Gynecol. 2015; 126(4):e52-e55. DOI: 10.1097/AOG.0000000000001108. View

10.

Huynh B, Kermorvant-Duchemin E, Herindrainy P, Padget M, Rakotoarimanana F, Feno H . Bacterial Infections in Neonates, Madagascar, 2012-2014. Emerg Infect Dis. 2018; 24(4):710-717. PMC: 5875286. DOI: 10.3201/eid2404.161977. View

11.

Da Silva F, Gonik B, McMillan M, Keech C, Dellicour S, Bhange S . Stillbirth: Case definition and guidelines for data collection, analysis, and presentation of maternal immunization safety data. Vaccine. 2016; 34(49):6057-6068. PMC: 5139804. DOI: 10.1016/j.vaccine.2016.03.044. View

12.

Vasconcelos A, Sousa S, Bandeira N, Alves M, Papoila A, Pereira F . Antenatal screenings and maternal diagnosis among pregnant women in Sao Tome & Principe-Missed opportunities to improve neonatal health: A hospital-based study. PLOS Glob Public Health. 2023; 2(12):e0001444. PMC: 10021443. DOI: 10.1371/journal.pgph.0001444. View

13.

. Global, regional, and national progress towards Sustainable Development Goal 3.2 for neonatal and child health: all-cause and cause-specific mortality findings from the Global Burden of Disease Study 2019. Lancet. 2021; 398(10303):870-905. PMC: 8429803. DOI: 10.1016/S0140-6736(21)01207-1. View

14.

Weissmann-Brenner A, Meyer R, Domniz N, Levin G, Hendin N, Yoeli-Ullman R . The perils of true knot of the umbilical cord: antepartum, intrapartum and postpartum complications and clinical implications. Arch Gynecol Obstet. 2021; 305(3):573-579. DOI: 10.1007/s00404-021-06168-7. View

15.

Lawn J, Cousens S, Zupan J . 4 million neonatal deaths: when? Where? Why?. Lancet. 2005; 365(9462):891-900. DOI: 10.1016/S0140-6736(05)71048-5. View

16.

Assefa N, Berhe H, Girma F, Berhe K, Berhe Y, Gebreheat G . Risk factors of premature rupture of membranes in public hospitals at Mekele city, Tigray, a case control study. BMC Pregnancy Childbirth. 2018; 18(1):386. PMC: 6162906. DOI: 10.1186/s12884-018-2016-6. View

17.

Adane A, Ayele T, Ararsa L, Bitew B, Zeleke B . Adverse birth outcomes among deliveries at Gondar University Hospital, Northwest Ethiopia. BMC Pregnancy Childbirth. 2014; 14:90. PMC: 3996071. DOI: 10.1186/1471-2393-14-90. View

18.

Lawn J, Kerber K, Enweronu-Laryea C, Massee Bateman O . Newborn survival in low resource settings--are we delivering?. BJOG. 2009; 116 Suppl 1:49-59. DOI: 10.1111/j.1471-0528.2009.02328.x. View

19.

Mekonnen Dagne H, Takele Melku A, Abdurkadir Abdi A . Determinants of Stillbirth Among Deliveries Attended in Bale Zone Hospitals, Oromia Regional State, Southeast Ethiopia: A Case-Control Study. Int J Womens Health. 2021; 13:51-60. PMC: 7802824. DOI: 10.2147/IJWH.S276638. View

20.

Gutman A, Harty T, ODonoghue K, Greene R, Leitao S . Perinatal mortality audits and reporting of perinatal deaths: systematic review of outcomes and barriers. J Perinat Med. 2022; 50(6):684-712. DOI: 10.1515/jpm-2021-0363. View