Authors : GARMAI FORKPAH SACKEY; VINSAM OWINO OUKO

Volume/Issue : Volume 9 - 2024, Issue 9 - September

Google Scholar : https://tinyurl.com/mr45f32r

Scribd : https://tinyurl.com/bdhu3v72

DOI : https://doi.org/10.38124/ijisrt/IJISRT24SEP773

Note : A published paper may take 4-5 working days from the publication date to appear in PlumX Metrics, Semantic Scholar, and ResearchGate.

Abstract : Background: Neonatal mortality has remained a significant public health challenge in Liberia, necessitating a thorough understanding of factors contributing to adverse neonatal outcomes. This study aimed to investigate demographic and clinical factors associated with neonatal mortality among infants admitted to the Neonatal Intensive Care Unit (NICU) in Liberia.  Objectives: The primary objective was to identify demographic and clinical factors associated with neonatal mortality in NICU admissions. Secondary objectives include assessing the impact of antenatal care and the follow-up, mode of delivery, gestational age at birth, and multiple births on neonatal mortality rates.  Methods: A retrospective analysis was conducted using data from NICU admissions in Liberia. Demographic and clinical variables, including sex of neonate, ANC follow-up, mode of delivery, multiple births, and gestational age at birth, were analyzed for their association with neonatal mortality using logistic regression models.  Keyresults: The study included various neonatal admissions to the NICU. While male neonates constituted a slight majority of admissions, gender did not significantly influence neonatal mortality rates. Lack of ANC follow-up emerged as a significant risk factor for mortality, with neonates whose mothers did not receive ANC showing a substantially higher risk. C-Section delivery was correlated with a significantly increased risk of neonatal mortality compared to spontaneous vaginal delivery. Preterm birth was also identified as a significant risk factor for mortality, highlighting the vulnerability of preterm neonates. Multiple births presented unique challenges but did not significantly impact mortality rates after adjustment.  Conclusion: This study underscored the critical importance of ANC follow-up, appropriate delivery practices, and specialized care for preterm neonates in reducing neonatal mortality rates in Liberia. Findings provided informed valuable insights for policymakers and healthcare practitioners to develop targeted interventions aimed at improving neonatal health outcomes and reducing mortality rates in the country.

References :

1. Adjei, G., Darteh, E. K. M., Nettey, O. E. A., & Doku, D. T. (2021). Neonatal mortality in the central districts of Ghana: analysis of community and composition factors. BMC Public Health, 21(1). https://doi.org/10.1186/s12889-021-10156-6
2. Al-Sheyab, N. A., Khader, Y. S., Shattnawi, K. K., Alyahya, M. S., & Batieha, A. (2020). Rate, Risk Factors, and Causes of Neonatal Deaths in Jordan: Analysis of Data From Jordan Stillbirth and Neonatal Surveillance System (JSANDS). Frontiers in Public Health, 8. https://doi.org/10.3389/fpubh.2020.595379
3. Amin, S. (1990). The effect of women’s status on sex differentials in infant and child mortality in South Asia. Genus, 46(3–4).
4. Bech, C. M., Bloch, J., Kjærgaard, J., Lund, S., Pedersen, F. K., & Poulsen, A. (2021). Indirect effects of the COVID-19 pandemic on mortality of mothers and children in low- and middle-income countries. Ugeskrift for Laeger, 183(11).
5. Boghossian, N. S., Geraci, M., Edwards, E. M., & Horbar, J. D. (2018). Morbidity and mortality in small for gestational age infants at 22 to 29 weeks’ gestation. Pediatrics, 141(2). https://doi.org/10.1542/peds.2017-2533
6. Determinants of Neonatal Mortality in Kenya: Evidence From Kenya Demographic Health Surveys, 2008 and 2014. (2019). Journal of Health, Medicine and Nursing. https://doi.org/10.7176/jhmn/65-06
7. Dhaded, S. M., Saleem, S., Goudar, S. S., Tikmani, S. S., Hwang, K., Guruprasad, G., Aradhya, G. H., Kusagur, V. B., Patil, L. G. C., Yogeshkumar, S., Somannavar, M. S., Reza, S., Roujani, S., Raza, J., Yasmin, H., Aceituno, A., Parlberg, L., Kim, J., Moore, J., … Silver, R. (2022). The causes of preterm neonatal deaths in India and Pakistan (PURPOSe): a prospective cohort study. The Lancet Global Health, 10(11). https://doi.org/10.1016/S2214-109X(22)00384-9
8. Farmakis, I., Valerio, L., Mavromanoli, A. C., Bikdeli, B., Connors, J. M., Giannakoulas, G., Goldhaber, S. Z., Hobohm, L., Hunt, B. J., Keller, K., Klok, F. A., Spyropoulos, A. C., Kucher, N., Konstantinides, S., & Barco, S. (2022). Mortality related to pulmonary embolism in the United States before and during the COVID-19 pandemic: an analysis of the CDC Multiple Cause of Death database. European Heart Journal, 43(Supplement_2). https://doi.org/10.1093/eurheartj/ehac544.1869
9. Gage, T. B., Fang, F., O’Neill, E., & DiRienzo, G. (2013). Maternal Education, Birth Weight, and Infant Mortality in the United States. Demography, 50(2). https://doi.org/10.1007/s13524-012-0148-2
10. Ghosh, S. (2004). Infant and Child Mortality. In Nutrition and Child Care: A Practical Guide. https://doi.org/10.5005/jp/books/11615_9
11. Gopalan, S. (2018). Low birth weight - causes, consequences and interventions to achieve reduction. In Proceedings of the Indian National Science Academy (Vol. 84, Issue 4). https://doi.org/10.16943/ptinsa/2018/49446
12. Griffin, J. B., Jobe, A. H., Rouse, D., McClure, E. M., Goldenberg, R. L., & Kamath-Rayne, B. D. (2019). Evaluating WHO-recommended interventions for preterm birth: A mathematical model of the potential reduction of preterm mortality in sub-Saharan Africa. Global Health Science and Practice, 7(2). https://doi.org/10.9745/GHSP-D-18-00402
13. Heron, M. (2021). Deaths: Leading causes for 2019. National Vital Statistics Reports, 70(9). https://doi.org/10.15620/cdc:107021
14. Imbo, A., Mbuthia, E., & Ngotho, D. (2021). Determinants of Neonatal Mortality in Kenya: Evidence from the Kenya Demographic and Health Survey 2014. International Journal of Maternal and Child Health and AIDS (IJMA), 10(2). https://doi.org/10.21106/ijma.508
15. Jung, D., & Kim, B. (2023). The effect of health facility births on newborn mortality in Malawi. International Journal of Health Economics and Management. https://doi.org/10.1007/s10754-023-09348-x
16. Kats-Ugurlu, G., Hogeveen, M., Driessen, A., Van Den Ouweland, A. M. W., & De Kaa, C. H. Van. (2011). Diagnosis of alpha-1-antitrypsin deficiency in bleeding disorder-related neonatal death. European Journal of Pediatrics, 170(1). https://doi.org/10.1007/s00431-010-1280-x
17. Khan, S. Q., Berrington De Gonzalez, A., Best, A. F., Chen, Y., Haozous, E. A., Rodriquez, E. J., Spillane, S., Thomas, D. A., Withrow, D., Freedman, N. D., & Shiels, M. S. (2018). Infant and Youth Mortality Trends by Race/Ethnicity and Cause of Death in the United States. JAMA Pediatrics, 172(12). https://doi.org/10.1001/jamapediatrics.2018.3317
18. Kinzler, W. L., Ananth, C. V., Smulian, J. C., & Vintzileos, A. M. (2002). The effects of labor on infant mortality among small-for-gestational-age infants in the USA. Journal of Maternal-Fetal and Neonatal Medicine, 12(3). https://doi.org/10.1080/jmf.12.3.201.206
19. Komro, K. A., Livingston, M. D., Markowitz, S., & Wagenaar, A. C. (2016). The effect of an increased minimum wage on infant mortality and birth weight. American Journal of Public Health, 106(8). https://doi.org/10.2105/AJPH.2016.303268
20. Lodenyo, H. A. (2023). Under five years high mortality in developing countries is largely preventable. African Journal of Health Sciences, 36(1). https://doi.org/10.4314/ajhs.v36i1.1
21. Mamani, R. P. P., Saico, C. Y., Arpi Mayta, R., & Mendoza, A. P. C. (2021). Socioeconomic and proximate determinants of mortality in children under five years of age in peru (2015–2018). Apuntes, 48(88). https://doi.org/10.21678/apuntes.88.1293
22. Moura, E. C., Cortez-Escalante, J., Lima, R. T. S., Cavalcante, F. V., Alves, L. C., & Santos, L. M. P. (2022). Mortality in children under five years old in Brazil: evolution from 2017 to 2020 and the influence of COVID-19 in 2020. Jornal de Pediatria, 98(6). https://doi.org/10.1016/j.jped.2022.03.004
23. NCT00623337. (2008). Ghana Newborn Home Visits Neonatal Mortality Trial. Https://Clinicaltrials.Gov/Show/NCT00623337.
24. Njoumemi, Z., Fadimatou, A., Honore Ntavoua, S., Nkariepoun Njoya, I., Mongbet, O., & Manouore, R. (2023). Economic and Social Determinants of Infant Under-Five Years’ Mortality in Cameroon. Central African Journal of Public Health. https://doi.org/10.11648/j.cajph.20230904.12
25. Odejimi, A., Quinley, J., Eluwa, G. I., Kunnuji, M., Wammanda, R. D., Weiss, W., James, F., Bello, M., Ogunlewe, A., King, R., & Franca-Koh, A. C. (2022). Causes of deaths in neonates and children aged 1–59 months in Nigeria: verbal autopsy findings of 2019 Verbal and Social Autopsy study. BMC Public Health, 22(1). https://doi.org/10.1186/s12889-022-13507-z
26. Office for National Statistics. (2020). Child and Infant Mortality in England and Wales: 2018. Statistical Bulletin, Feb.
27. Opondo, C., Jayaweera, H., Hollowell, J., Li, Y., Kurinczuk, J. J., & Quigley, M. A. (2020). Variations in neonatal mortality, infant mortality, preterm birth and birth weight in England and Wales according to ethnicity and maternal country or region of birth: An analysis of linked national data from 2006 to 2012. Journal of Epidemiology and Community Health, 74(4). https://doi.org/10.1136/jech-2019-213093
28. Ou, Z., Yu, D., Liang, Y., He, H., He, W., Li, Y., Zhang, M., Gao, Y., Wu, F., & Chen, Q. (2022). Global trends in incidence and death of neonatal disorders and its specific causes in 204 countries/territories during 1990–2019. BMC Public Health, 22(1). https://doi.org/10.1186/s12889-022-12765-1
29. Premru-Srsen, T., Verdenik, I., Ponikvar, B. M., Steblovnik, L., Geršak, K., & Cerar, L. K. (2018). Infant mortality and causes of death by birth weight for gestational age in non-malformed singleton infants: A 2002-2012 population-based study. Journal of Perinatal Medicine, 46(5). https://doi.org/10.1515/jpm-2017-0103
30. Reid, A., Garrett, E., Jaadla, H., Schürer, K., & Rafferty, S. (2023). Fatal Places? Contextual Effects on Infant and Child Mortality in Early Twentieth Century England and Wales. Social Science History, 47(3). https://doi.org/10.1017/ssh.2023.5
31. Rutstein, S. O. (2005). Effects of preceding birth intervals on neonatal, infant and under-five years mortality and nutritional status in developing countries: Evidence from the demographic and health surveys. International Journal of Gynecology and Obstetrics, 89(SUPPL. 1). https://doi.org/10.1016/j.ijgo.2004.11.012
32. Samaké, Y., keita, S., Djibrilah, K., Sylla, C., Traor, M., Traoré, S., Oura, D., Diarra, D., Coulibaly, Ha., & Kanté, L. (2023). Maternal and Neonatal Mortality in Fana Health District, Koulikoro, Mali. Scholars Journal of Medical Case Reports, 11(04). https://doi.org/10.36347/sjmcr.2023.v11i04.076
33. Sanyang, Y. (2019). Prevalence of under-five years of age mortality by infectious diseases in West African region. In International Journal of Africa Nursing Sciences (Vol. 11). https://doi.org/10.1016/j.ijans.2019.100175
34. Shour, A., Garacci, E., Palatnik, A., Dawson, A. Z., Anguzu, R., Walker, R. J., & Egede, L. (2022). Association between pregestational diabetes and mortality among appropriate-for-gestational age birthweight infants. Journal of Maternal-Fetal and Neonatal Medicine, 35(25). https://doi.org/10.1080/14767058.2021.1878142
35. Sulistyoningtyas, S., & Nur’aisyah, N. (2021). The Correlation Between Preeclampsia and the Incidence of Low Birth Weight (LBW) in Rsu PKU Muhammadiyah Bantul. International Journal of Health Science and Technology, 2(2). https://doi.org/10.31101/ijhst.v2, S., & Nur’aisyah, N. (2021). The Correlation Between Preeclampsia and the Incidence of Low Birth Weight (LBW) in Rsu PKU Muhammadiyah Bantul. International Journal of Health Science and Technology, 2(2). https://doi.org/10.31101/ijhst.v2i2.1837
36. Tessema, G., Misganaw, A., Berheto, T., Pereira, G., & Kinfu, Y. (2023). National and subnational burden of under-5 mortality in Ethiopia: evaluation of data from three decades using the Global Burden of Disease Study 2019. Population Medicine, 5(Supplement). https://doi.org/10.18332/popmed/165122
37. Tripathi, N., & Hardt, N. (2021). Pandemic meets epidemic: Co-location of COVID-19 and drug overdose deaths in the United States. Journal of Community Safety and Well-Being, 6(4). https://doi.org/10.35502/jcswb.216
38. UNICEF. (2023). Child Mortality - UNICEF DATA. Unicef.
39. Uribe-Quintero, R., Álvarez-Castaño-Castaño, L. S., Caicedo-Velásquez, B., & Ruiz-Buitrago, I. C. (2022). Trends in undernutrition mortality among children under five years of age and adults over 60. Biomédica, 42(1). https://doi.org/10.7705/biomedica.5937
40. Wei, Z., Lei, J., Shen, F., Dai, Y., Sun, Y., Liu, Y., Dai, Y., Jian, Z., Wang, S., Chen, Z., Liao, K., & Hong, S. (2020). Cavin1 Deficiency Causes Disorder of Hepatic Glycogen Metabolism and Neonatal Death by Impacting Fenestrations in Liver Sinusoidal Endothelial Cells. Advanced Science, 7(19). https://doi.org/10.1002/advs.202000963
41. Wen, S. W., Kramer, M. S., Liu, S., Dzakpasu, S., Sauvé, R., Allen, A. C., Cyr, M., Fair, M., Joseph, K. S., Liston, R. M., Marcoux, S., McCarthy, B., McMillan, D. D., Ohlsson, A., & Wilkins, R. (2000). Infant mortality by gestational age and birth weight in Canadian provinces and territories, 1990-1994 births. Chronic Diseases in Canada, 21(1).
42. World Health Organization. (2022a). Kematian Bayi Baru Lahir. World Health Organization.
43. World Health Organization. (2022b). Key facts HIV/ AIDS. World Health Organization.
44. World Health Organization (WHO). (2022). Child mortality (under 5 years). Fact Sheets, January.
45. Odejimi A, Quinley J, Eluwa GI, Kunnuji M, Wammanda RD, Weiss W, James F, Bello M, Ogunlewe A, King R, Franca-Koh AC. Causes of deaths in neonates and children aged 1-59 months in Nigeria: verbal autopsy findings of 2019 Verbal and Social Autopsy study. BMC Public Health. 2022 Jun 6;22(1):1130. doi: 10.1186/s12889-022-13507-z. PMID: 35668378; PMCID: PMC9172014.
46. Tessema GA, Berheto TM, Pereira G, Misganaw A, Kinfu Y, GBD 2019 Ethiopia Child Mortality Collaborators (2023) National and subnational burden of under-5, infant, and neonatal mortality in Ethiopia, 1990–2019: Findings from the Global Burden of Disease Study 2019. PLOS Glob Public Health 3(6): e0001471. https://doi.org/10.1371/journal.pgph.0001471
47. Collaborators. (2018). Global, regional, and national under-5 mortalities, adult mortality, age-specific mortality, and life expectancy, 1970-2016: a systematic analysis for the Global Burden of Disease Study 2016. The Lancet, 390(10100), 1084-1150.
48. Liberia Institute of Statistics and Geo-Information Services (LISGIS) and ICF. (2019). Liberia Demographic and Health Survey 2019. Monrovia, Liberia, and Rockville, Maryland, USA: LISGIS and ICF.
49. Kruk, M. E., et al. (2016). Maternal and child health disparities reflect inequities in Liberia. The Lancet Global Health, 4(12), e878-e879.
50. Moyer, C. A., et al. (2013). Determinants of neonatal mortality in Liberia: a cross-sectional study. The Journal of Global Health, 3(1), 010402.
51. Doctor, H. V., et al. (2016). Cultural practices contributing to the transmission of human immunodeficiency virus in Kwazulu. Journal of Tropical Pediatrics, 52(5), 345-349.
52. Lori, J. R., et al. (2013). Traditional Birth Attendants in Rural Northern Ghana: Policy, Practice, and Priorities. Journal of Midwifery & Women's Health, 58(5), 478-488.
53. Barros, A. J., et al. (2010). Equity in maternal, newborn, and child health interventions in Countdown to 2015: a retrospective review of survey data from 54 countries. The Lancet, 376(9752), 2032-2040.
54. Lawn, J. E., et al. (2014). Every Newborn: progress, priorities, and potential beyond survival. The Lancet, 384(9938), 189-205.
55. Waiswa, P., et al. (2015). Advancing social and economic development by investing in women’s and children’s health: a new Global Investment Framework. The Lancet, 383(9925), 1333-1354.
56. United Nations. (2015). Transforming our world: the 2030 Agenda for Sustainable Development. Resolution adopted by the General Assembly on 25 September 2015. New York: United Nations.
57. Bartlett, L. A., Mawji, S., Whitehead, S., Crouse, C., Dalil, S., Ionete, D., ... & Campbell, O. M. (2014). Where giving birth is a forecast of death: maternal mortality in four districts of Afghanistan, 1999-2002. The Lancet, 364(9450), 2152-2157.
58. Chou, D., Daelmans, B., Jolivet, R. R., Kinney, M. V., Say, L., & Smith, J. M. (2016). Ending preventable maternal and newborn mortality and stillbirths. BMJ, 353, i1850.
59. Dickson, K. E., Kinney, M. V., Moxon, S. G., Ashton, J., Zaka, N., Simen-Kapeu, A., ... & Lawn, J. E. (2013). Scaling up quality care for mothers and newborns around the time of birth: an overview of methods and analyses of intervention-specific bottlenecks and solutions. BMC Pregnancy and Childbirth, 13(Suppl 1), S12.
60. Hill, Z., Dumbaugh, M., Benton, L., Källander, K., Strachan, D., ten Asbroek, A., ... & Kirkwood, B. R. (2014). Supervising community health workers in low-income countries–a review of impact and implementation issues. Global Health Action, 7(1), 24085.
61. Kikuchi, K., Angeles-Agdeppa, I., & Angeles-Agdeppa, U. (2015). Undernutrition in children under 5 years of age in Indonesia: The double burden of malnutrition. Asia Pacific Journal of Clinical Nutrition, 24(3), 368-375.
62. Lawn, J. E., Kinney, M. V., Black, R. E., Pitt, C., Cousens, S., Kerber, K., ... & Darmstadt, G. L. (2014). Newborn survival: a multi-country analysis of a decade of change. Health Policy and Planning, 30(suppl_2), ii6-ii28.
63. Rahman, A., Hafeez, A., & Ahmed, J. (2010). Determinants of neonatal mortality in Pakistan: Secondary analysis of Pakistan demographic and health survey 2006–07. The Pakistan Journal of Social Work, 7(1), 25-37.
64. Shrestha, N., Rana, H. P., & Malla, D. S. (2017). Determinants of neonatal mortality in Nepal: a case control study. BMC Research Notes, 10(1), 192.
65. Wang, H., Bhutta, Z. A., Coates, M. M., Coggeshall, M., Dandona, L., Diallo, K., ... & Fraser, M. (2017). Global, regional, national, and selected subnational levels of stillbirths, neonatal, infant, and under-5 mortality, 1980–2015: a systematic analysis for the Global Burden of Disease Study 2015. The Lancet, 388(10053), 1725-1774.
66. Wall, S. N., Lee, A. C., Niermeyer, S., English, M., Keenan, W. J., Carlo, W., ... & Lawn, J. E. (2016). Neonatal resuscitation in low-resource settings: what, who, and how to overcome challenges to scale up?. International Journal of Gynecology & Obstetrics, 107, S47-S64.
67. Wardlaw, T., You, D., & Hug, L. (2014). UNICEF report: enormous progress in child survival but greater focus on newborns urgently needed. Reproductive Health Matters, 22(43), 170-173.
68. Zaka, N., Alexander, E. C., & Manikam, L. (2018). Effectiveness of training in improving essential neonatal care practices in health facilities in Afghanistan. Journal of Paediatrics and Child Health, 54(3), 258-266.