Risk factors associated with neonatal mortality among neonates admitted to neonatal intensive care unit of the university teaching hospital in Lusaka, Zambia: A retrospective analysis

Abstract

Abstract Background: Globally, several children die shortly after birth and many more of them within the first 28 days of life. Sub-Sharan Africa accounts for almost half (43%) of the global neonatal death with slow progress in reduction. These neonatal deaths are associated with lack of quality care at or immediately after birth and in the first 28 days of life. This study aimed to determine the trends and risk factors of neonatal mortality in a major referral hospital in Lusaka, Zambia. Methods: We conducted retrospective analysis involving all neonates admitted in the University Teaching Hospital Neonatal Intensive Care Unit (UTH-NICU) in Lusaka from January 2018-December 2019 (N=2340). We determined the trends and assessed the factors associated with neonatal mortality using Generalized Linear Models (GLM) with a Poisson distribution and log link function. Results: Overall, the neonatal mortality was 40.2% (95% CI: 38.0-42.0) per 1000 live births for the two-year period with a slight decline in mortality rate from 42.9% (95% CI: 40.0-46.0) in 2018 to 37.3% (95% CI: 35.0-40.0) in 2019. In a final multivariable model, home delivery (ARR: 1.70, 95% CI: 1.46-1.96), preterm birth (ARR: 1.59, 95% CI: 1.36-1.85), congenital anomalies (ARR: 1.59, 95% CI: 1.34-1.88), low birthweight (ARR: 1.57, 95% CI: 1.37-1.79), and health centre delivery (ARR: 1.48, 95% CI: 1.25-1.75) were independently associated with increase in neonatal mortality. Conversely, hypothermia (ARR: 0.36, 95% CI: 0.22-0.60), antenatal attendance (ARR: 0.76, 95% CI: 0.68-0.85), and one-day increase in neonatal age (ARR: 0.96, 95% CI: 0.95-0.97) were independently associated with reduction in neonatal mortality. Conclusion: In this hospital-based study, neonatal mortality was high compared to the national and global targets. While non-modifiable risk factors were associated with increase in neonatal mortality, proper management of modifiable risk factors resulted in reduced neonatal mortality. Early identification and interventions to reduce the impact of both non-modifiable and modifiable risks factors of neonatal mortality in Zambia are important.