Correlation Of Maternal Characteristics And Birth Asphyxia At Kenyatta National Hospital And Pumwani Maternity Hospital In Kenya

Abstract

Background: Birth asphyxia is a serious condition in the neonate worldwide. It is the second leading cause of neonatal mortality at 24% in the world. It is caused by events that have roots in the ante partum, intrapartum or post-partum periods and it accounts for an estimated 900,000 deaths each year. It therefore remains a severe condition leading to significant mortality and morbidity. Objective: To identify the maternal risk factors associated with birth asphyxia. Methods: A cross-sectional study was conducted at Kenyatta National Hospital and Pumwani Maternity hospital among 209 mothers with babies who had birth asphyxia. Purposive sampling was done and an interviewer guided questionnaire was administered. Statistical package for social sciences (SPSS) version 23 was used to analyze the data. Results: A total of 209 mothers were interviewed, majority 57 % (n=121) had a medical condition in pregnancy while the rest 42.1% didn‟t have any medical condition (n=88) [x2=6.71; df =1; p value=0.010]. Anemia was the leading cause of birth asphyxia 33.1% (n=40), prolonged labour 24.0 % (n=29), elevated blood pressure (14.9%), urinary tract infection 11.6% (n=14), bleeding (5%), HIV 4.1% (n=5). Meconium stained liquor was the most observed 66% (n=138), blood stained liquor 6.2 % (n=14). It was a significant risk factor for grade 1 asphyxia (16.2%) [x2 value =31.90; p value=0.000].There was statistical significance between birth weight and asphyxia where underweight was significantly more among grade 1asphyxia (43.2%) than those with grade 2 or grade 3 asphyxia (20.0%) [x2value=12.75; p value =0.002], the age group most affected was the age of 20 to 30 years old at 63.6% (n=133. Participants <20 years were 11.0% (n=23), 20-30 years 63% (n=133) and 31-42 years 25.4% (n=53). Number of babies delivered was significant [x2 value= 6.93; df=1 p value= 0.048] and mode of delivery was also significant (p value= 0.023). Conclusion: Anemia in pregnancy, prolonged labour, elevated blood pressure in pregnancy, urinary tract infections, chorioamnionitis, HIV and antepartum hemorrhage in pregnancy were the maternal medical conditions associated with a higher incidence of birth asphyxia. Secondary school education level and below, primiparity, delay in seeking healthcare services more than six hours and meconium stained liquor were other maternal risk factors for birth asphyxia. Neonates of male gender and birth weight above 3kgs were the fetal risk factors for birth asphyxia. This was additional information that was observed as the research was being carried out. Recommendations: Identification of mothers who are at risk in early pregnancy, with improved ante partum, intrapartum and post-partum health services may reduce the incidence and neonatal mortality and morbidity caused by birth asphyxia. Judicious use of the partograph is encouraged. Introduction of sexual and reproductive health education at primary school level curricula will help in reducing birth asphyxia in the long-term.