Facteurs de risque de la mortalité néonatale à l'Hôpital gynéco- obstétrique et pédiatrique de Yaoundé
par Vanessa TAKOU TSAPMENE
Faculté de médecine et des sciences biomédicales Université de Yaoundé I - Mémoire présenté et soutenu en vue de l'obtention du grade de docteur en médecine 2012
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.
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%).
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).
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.