RT Journal Article
SR Electronic
T1 Neonatal mortality in Kenyan hospitals: a multisite, retrospective, cohort study
JF BMJ Global Health
JO BMJ Global Health
FD BMJ Publishing Group Ltd
SP e004475
DO 10.1136/bmjgh-2020-004475
VO 6
IS 5
A1 Irimu, Grace
A1 Aluvaala, Jalemba
A1 Malla, Lucas
A1 Omoke, Sylvia
A1 Ogero, Morris
A1 Mbevi, George
A1 Waiyego, Mary
A1 Mwangi, Caroline
A1 Were, Fred
A1 Gathara, David
A1 Agweyu, Ambrose
A1 Akech, Samuel
A1 English, Mike
A1 ,
YR 2021
UL http://gh.bmj.com/content/6/5/e004475.abstract
AB 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.Data are available on request. Data for this report are under the primary jurisdiction of the Ministry of Health in Kenya. Enquiries about using the data can be made to the KEMRI-Wellcome Trust Research Programme Data Governance Committee.