SUMMARY
Introduction and Objectives
According to the World Health Organization, more than 3
million neonates die within the first month of life and 75% of these deaths
occur during the first week of life. The highest rates have been noted in
sub-Saharan Africa (35 %o) and South Asia (33 %o). In Cameroon, the neonatal
mortality rate was at 31 %o in 2011. However, risk factors for neonatal
mortality have not been well established in this context. The main objective of
our study was to identify and analyze the risk factors associated with neonatal
mortality in the Yaounde Gynaeco-Obstetric and Pediatric Hospital of (YGOPH).
Materials and Methods
It was a case-control study, with retrolective data collected
from hospital records of newborns admitted in the neonatal unit (NNU) of the
YGOPH from 1st April 2003 to 31stDecember 2012. Cases
were defined as any infant admitted in this NNU during the study period and
died during hospitalization. Controls were defined as any infant admitted
immediately after its respective case in the NNU of the YGOPH during the study
period, discharged alive, and with the same gestational age as its
corresponding case. The variables studied were maternal and neonatal. Data
analysis was performed using Epi-Info ™ version 3.5.3. Odds ratio and its
confidence interval at 95% were used to assess the degree of association of
these variables with the risk of neonatal death. The level of significance was
taken at P<0.05.
Results
We observed that 7824 newborns were admitted in the NNU of
this hospital during the study period and 769 died, giving an intra-hospital
neonatal mortality rate of 9.83%. The highest mortality rate was in the early
neonatal period with 72.2%of the death. Risk factors for neonatal mortality
after multivariate analysis were: prolonged rupture of membranes for more than
12 hours, low birth weight, Apgar score less than 7 at the 5th
minute and congenital malformations. Provenance of the neonates from the YGOPH
and caesarean section were protective factors. The main causes of these deaths
were in descending order: neonatal infections (60.2%), prematurity (42.6%),
birth asphyxia (37.4%), congenital malformations (11.8%) and other disorders
(7.8%).
Conclusion
Neonatal mortality was influenced by maternal factors
(prolonged rupture of membranes for more than 12 hours, caesarean section), and
neonatal factors (low birth weight, Apgar score less than 7 at the
5th minute, congenital malformations, provenance from the YGOPH).
Recommendations
We thus recommend that pregnant women should be sensitized
through information-education-communication on the importance of antenatal
care for early detection and appropriate management of pregnancies at risk;
that a specialized clinic with permanent staff for monitoring and management of
these high-risk pregnancies and neonatal emergencies be institute; that the
technical platform of the hospital be improved for better management of
congenital malformations; and that the competence and skills of health
personnel on the management of newborns at risk (infections, prematurity, low
birth weight), and basic neonatal resuscitation should be reinforced.
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