PERINATAL FACTORS ASSOCIATED WITH BIRTH ASPHYXIA AMONG NEONATES IN MATERNITY WARD KAKAMEGA COUNTY REFFERAL HOSPITAL, KENYA

Abstract

Despite the important advances in perinatal care in the past decades, asphyxia remains a severe condition leading to significant mortality and morbidity. Perinatal asphyxia has an incidence of 1 to 6 per 1,000 live full-term births, and represents the third most common cause of neonatal death (23%) after preterm birth (28%) and severe infections (26%). Each year approximately 24% of neonatal deaths occur due to birth asphyxia with an equal number of survivors with serious neurological sequel, leading to detrimental long term consequences for both child and family. The objective of this study was to determine the risk factors associated with Birth asphyxia in order to identify preventive interventions to reduce neonatal morbidity and mortality. The study design was retrospective institutional based study which involved all neonates born at term diagnosed with and without birth asphyxia. Systematic random sampling to get subjects files, purposive method used for key informant interview. Data for analysis was captured via SPSS version 19 and summary descriptive statistics such as mean, percentages and standard deviations were generated. Inferential statistics Transformation of data was done to obtain appropriate categories for data analysis and logistics regression modeling for asphyxia against identified risk factors. To determine the risk factors of asphyxia, odds ratios (OR) at 95% CI were obtained together with their respective p-values results were set at < 0.05. Logistic regression modeling was done to determine the strength of association of the risk factors with asphyxia. Out of total 422 neonates, (29.1%) had birth asphyxia and rest (70.9%) were normal. Significant socio-demographic risk factors were maternal age (OR 3.0 CI 95% 1.9 – 4.9, <0.0001), education level (OR 3.8; CI 95% p-value <.0001) and parity (OR 1.8; CI 95% 1.0-3.0; p-value=0.0226). Significant Antepartum risk factors were birth interval (OR 3.8 CI 95% 2.4-6.0, p = <0.0001) gestation (OR 1.8; CI 95% 1.1-2.9; p<0.003). Significant intrapartum factors included mode of delivery and induction of labor (OR 6.7 CI 95% 2.5-17.9, p < 0.0001). Fetal risk factors included baby birth weight (OR 2.10 CI 95% 1.2-3.6, p = 0.0073). A number of risk factors have been identified in the current study. The study concludes that among the social demographics risk factors are mother’s age, education level and parity. Antepartum risk factors included birth interval of the mothers and gestation while intrapartum risk factors include delivery mode and induced deliveries. Fetal risk factor of asphyxia was birth weight. The study makes recommendations based on the conclusions in terms of age of the mothers, counseling to be identified if they are at risk, education should be individualized to every mother of low education level. Mothers with short birth interval should be encouraged to space their births above 2 years and special care for low birth weight neonate on preventive measures.