Burden of disease and risk factors for mortality amongst hospitalized newborns in Nigeria and Kenya

Helen Nabwera; Dingmei Wang; Olukemi O. Tongo; Pauline E.A. Andang’o; Isa Abdulkadir; Chinyere V. Ezeaka; Beatrice N. Ezenwa; Iretiola B. Fajolu; Zainab O. Imam; Martha K. Mwangome; Dominic D. Umoru; Abimbola E. Akindolire; Walter Otieno; Grace M. Nalwa; Alison W. Talbert; Ismaela Abubakar; Nicholas D. Embleton; Stephen Allen

doi:10.1371/journal.pone.0244109

Burden of disease and risk factors for mortality amongst hospitalized newborns in Nigeria and Kenya

Helen Nabwera, Dingmei Wang, Olukemi O. Tongo, Pauline E.A. Andang’o, Isa Abdulkadir, Chinyere V. Ezeaka, Beatrice N. Ezenwa, Iretiola B. Fajolu, Zainab O. Imam, Martha K. Mwangome, Dominic D. Umoru, Abimbola E. Akindolire, Walter Otieno, Grace M. Nalwa, Alison W. Talbert, Ismaela Abubakar, Nicholas D. Embleton, Stephen Allen

Research output: Contribution to journal › Article › peer-review

15 Citations (Scopus)

Abstract

Objective

To describe the patient population, priority diseases and outcomes in newborns admitted <48 hours old to neonatal units in both Kenya and Nigeria.

Study design

In a network of seven secondary and tertiary level neonatal units in Nigeria and Kenya, we captured anonymised data on all admissions <48 hours of age over a 6-month period.

Results

2280 newborns were admitted. Mean birthweight was 2.3 kg (SD 0.9); 57.0% (1214/2128)

infants were low birthweight (LBW; <2.5kg) and 22.6% (480/2128) were very LBW (VLBW; <1.5 kg). Median gestation was 36 weeks (interquartile range 32, 39) and 21.6% (483/2236) infants were very preterm (gestation <32 weeks). The most common morbidities were jaundice (987/2262, 43.6%), suspected sepsis (955/2280, 41.9%), respiratory conditions (817/ 2280, 35.8%) and birth asphyxia (547/2280, 24.0%). 18.7% (423/2262) newborns died; mortality

was very high amongst VLBW (222/472, 47%) and very preterm infants (197/483, 40.8%). Factors independently associated with mortality were gestation <28 weeks (adjusted odds ratio 11.58; 95% confidence interval 4.73–28.39), VLBW (6.92; 4.06–11.79),

congenital anomaly (4.93; 2.42–10.05), abdominal condition (2.86; 1.40–5.83), birth asphyxia (2.44; 1.52–3.92), respiratory condition (1.46; 1.08–2.28) and maternal antibiotics within 24 hours before or after birth (1.91; 1.28–2.85). Mortality was reduced if mothers

received a partial (0.51; 0.28–0.93) or full treatment course (0.44; 0.21–0.92) of dexamethasone before preterm delivery.

Conclusion

Greater efforts are needed to address the very high burden of illnesses and mortality in hospitalized newborns in sub-Saharan Africa. Interventions need to address priority issues during

pregnancy and delivery as well as in the newborn.

Original language	English
Article number	e0244109
Pages (from-to)	e0244109
Journal	PLoS ONE
Volume	16
Issue number	1 January
DOIs	https://doi.org/10.1371/journal.pone.0244109
Publication status	Published - 14 Jan 2021

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10.1371/journal.pone.0244109Licence: CC BY

Nabwera Burden of Disease PLoS One 2021Final published version, 1.7 MBLicence: CC BY

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Nabwera, H., Wang, D., Tongo, O. O., Andang’o, P. E. A., Abdulkadir, I., Ezeaka, C. V., Ezenwa, B. N., Fajolu, I. B., Imam, Z. O., Mwangome, M. K., Umoru, D. D., Akindolire, A. E., Otieno, W., Nalwa, G. M., Talbert, A. W., Abubakar, I., Embleton, N. D., & Allen, S. (2021). Burden of disease and risk factors for mortality amongst hospitalized newborns in Nigeria and Kenya. PLoS ONE, 16(1 January), e0244109. Article e0244109. https://doi.org/10.1371/journal.pone.0244109

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title = "Burden of disease and risk factors for mortality amongst hospitalized newborns in Nigeria and Kenya",

abstract = "ObjectiveTo describe the patient population, priority diseases and outcomes in newborns admitted <48 hours old to neonatal units in both Kenya and Nigeria.Study designIn a network of seven secondary and tertiary level neonatal units in Nigeria and Kenya, we captured anonymised data on all admissions <48 hours of age over a 6-month period.Results2280 newborns were admitted. Mean birthweight was 2.3 kg (SD 0.9); 57.0\% (1214/2128)infants were low birthweight (LBW; <2.5kg) and 22.6\% (480/2128) were very LBW (VLBW; <1.5 kg). Median gestation was 36 weeks (interquartile range 32, 39) and 21.6\% (483/2236) infants were very preterm (gestation <32 weeks). The most common morbidities were jaundice (987/2262, 43.6\%), suspected sepsis (955/2280, 41.9\%), respiratory conditions (817/ 2280, 35.8\%) and birth asphyxia (547/2280, 24.0\%). 18.7\% (423/2262) newborns died; mortalitywas very high amongst VLBW (222/472, 47\%) and very preterm infants (197/483, 40.8\%). Factors independently associated with mortality were gestation <28 weeks (adjusted odds ratio 11.58; 95\% confidence interval 4.73–28.39), VLBW (6.92; 4.06–11.79),congenital anomaly (4.93; 2.42–10.05), abdominal condition (2.86; 1.40–5.83), birth asphyxia (2.44; 1.52–3.92), respiratory condition (1.46; 1.08–2.28) and maternal antibiotics within 24 hours before or after birth (1.91; 1.28–2.85). Mortality was reduced if mothersreceived a partial (0.51; 0.28–0.93) or full treatment course (0.44; 0.21–0.92) of dexamethasone before preterm delivery.ConclusionGreater efforts are needed to address the very high burden of illnesses and mortality in hospitalized newborns in sub-Saharan Africa. Interventions need to address priority issues duringpregnancy and delivery as well as in the newborn.",

author = "Helen Nabwera and Dingmei Wang and Tongo, \{Olukemi O.\} and Andang{\textquoteright}o, \{Pauline E.A.\} and Isa Abdulkadir and Ezeaka, \{Chinyere V.\} and Ezenwa, \{Beatrice N.\} and Fajolu, \{Iretiola B.\} and Imam, \{Zainab O.\} and Mwangome, \{Martha K.\} and Umoru, \{Dominic D.\} and Akindolire, \{Abimbola E.\} and Walter Otieno and Nalwa, \{Grace M.\} and Talbert, \{Alison W.\} and Ismaela Abubakar and Embleton, \{Nicholas D.\} and Stephen Allen",

year = "2021",

month = jan,

day = "14",

doi = "10.1371/journal.pone.0244109",

language = "English",

volume = "16",

pages = "e0244109",

journal = "PLoS ONE",

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Nabwera, H, Wang, D, Tongo, OO, Andang’o, PEA, Abdulkadir, I, Ezeaka, CV, Ezenwa, BN, Fajolu, IB, Imam, ZO, Mwangome, MK, Umoru, DD, Akindolire, AE, Otieno, W, Nalwa, GM, Talbert, AW, Abubakar, I, Embleton, ND & Allen, S 2021, 'Burden of disease and risk factors for mortality amongst hospitalized newborns in Nigeria and Kenya', PLoS ONE, vol. 16, no. 1 January, e0244109, pp. e0244109. https://doi.org/10.1371/journal.pone.0244109

TY - JOUR

T1 - Burden of disease and risk factors for mortality amongst hospitalized newborns in Nigeria and Kenya

AU - Nabwera, Helen

AU - Wang, Dingmei

AU - Tongo, Olukemi O.

AU - Andang’o, Pauline E.A.

AU - Abdulkadir, Isa

AU - Ezeaka, Chinyere V.

AU - Ezenwa, Beatrice N.

AU - Fajolu, Iretiola B.

AU - Imam, Zainab O.

AU - Mwangome, Martha K.

AU - Umoru, Dominic D.

AU - Akindolire, Abimbola E.

AU - Otieno, Walter

AU - Nalwa, Grace M.

AU - Talbert, Alison W.

AU - Abubakar, Ismaela

AU - Embleton, Nicholas D.

AU - Allen, Stephen

PY - 2021/1/14

Y1 - 2021/1/14

N2 - ObjectiveTo describe the patient population, priority diseases and outcomes in newborns admitted <48 hours old to neonatal units in both Kenya and Nigeria.Study designIn a network of seven secondary and tertiary level neonatal units in Nigeria and Kenya, we captured anonymised data on all admissions <48 hours of age over a 6-month period.Results2280 newborns were admitted. Mean birthweight was 2.3 kg (SD 0.9); 57.0% (1214/2128)infants were low birthweight (LBW; <2.5kg) and 22.6% (480/2128) were very LBW (VLBW; <1.5 kg). Median gestation was 36 weeks (interquartile range 32, 39) and 21.6% (483/2236) infants were very preterm (gestation <32 weeks). The most common morbidities were jaundice (987/2262, 43.6%), suspected sepsis (955/2280, 41.9%), respiratory conditions (817/ 2280, 35.8%) and birth asphyxia (547/2280, 24.0%). 18.7% (423/2262) newborns died; mortalitywas very high amongst VLBW (222/472, 47%) and very preterm infants (197/483, 40.8%). Factors independently associated with mortality were gestation <28 weeks (adjusted odds ratio 11.58; 95% confidence interval 4.73–28.39), VLBW (6.92; 4.06–11.79),congenital anomaly (4.93; 2.42–10.05), abdominal condition (2.86; 1.40–5.83), birth asphyxia (2.44; 1.52–3.92), respiratory condition (1.46; 1.08–2.28) and maternal antibiotics within 24 hours before or after birth (1.91; 1.28–2.85). Mortality was reduced if mothersreceived a partial (0.51; 0.28–0.93) or full treatment course (0.44; 0.21–0.92) of dexamethasone before preterm delivery.ConclusionGreater efforts are needed to address the very high burden of illnesses and mortality in hospitalized newborns in sub-Saharan Africa. Interventions need to address priority issues duringpregnancy and delivery as well as in the newborn.

AB - ObjectiveTo describe the patient population, priority diseases and outcomes in newborns admitted <48 hours old to neonatal units in both Kenya and Nigeria.Study designIn a network of seven secondary and tertiary level neonatal units in Nigeria and Kenya, we captured anonymised data on all admissions <48 hours of age over a 6-month period.Results2280 newborns were admitted. Mean birthweight was 2.3 kg (SD 0.9); 57.0% (1214/2128)infants were low birthweight (LBW; <2.5kg) and 22.6% (480/2128) were very LBW (VLBW; <1.5 kg). Median gestation was 36 weeks (interquartile range 32, 39) and 21.6% (483/2236) infants were very preterm (gestation <32 weeks). The most common morbidities were jaundice (987/2262, 43.6%), suspected sepsis (955/2280, 41.9%), respiratory conditions (817/ 2280, 35.8%) and birth asphyxia (547/2280, 24.0%). 18.7% (423/2262) newborns died; mortalitywas very high amongst VLBW (222/472, 47%) and very preterm infants (197/483, 40.8%). Factors independently associated with mortality were gestation <28 weeks (adjusted odds ratio 11.58; 95% confidence interval 4.73–28.39), VLBW (6.92; 4.06–11.79),congenital anomaly (4.93; 2.42–10.05), abdominal condition (2.86; 1.40–5.83), birth asphyxia (2.44; 1.52–3.92), respiratory condition (1.46; 1.08–2.28) and maternal antibiotics within 24 hours before or after birth (1.91; 1.28–2.85). Mortality was reduced if mothersreceived a partial (0.51; 0.28–0.93) or full treatment course (0.44; 0.21–0.92) of dexamethasone before preterm delivery.ConclusionGreater efforts are needed to address the very high burden of illnesses and mortality in hospitalized newborns in sub-Saharan Africa. Interventions need to address priority issues duringpregnancy and delivery as well as in the newborn.

U2 - 10.1371/journal.pone.0244109

DO - 10.1371/journal.pone.0244109

M3 - Article

VL - 16

SP - e0244109

JO - PLoS ONE

JF - PLoS ONE

IS - 1 January

M1 - e0244109

ER -

Burden of disease and risk factors for mortality amongst hospitalized newborns in Nigeria and Kenya

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