Maternal Determinants of Neonatal Mortality Among Mothers Delivering in Nakuru County Level 5 Hospital.

Abstract

Background: Neonatal mortality is a major global health concern especially in the African continent and accounts for 40% of all child mortality globally and 60% in middle and low income countries.Available statistics have shown that many children die before 28 days of life. Study Objective: This study sought to establish the maternal determinants of neonatal mortality among mothers delivering in Nakuru county level 5 Hospital. It describes the extent of maternal role and contribution to the causes of neonatal mortality through their knowledge, attitudes, practice and behavior. Methods: This was an institutional based descriptive cross-sectional qualitative and quantitative study in which 278 consenting mothers who delivered in Nakuru county level 5 referral hospital were interviewed.Data was collected through researcher administered Pre-tested Semi-structured questionnaires, focussed group discussion and key informants interview guides. Sample size was calculated using Fishers et al 1998 method. Study participants were recruited by simple random sampling. All collected data was cleaned and analyzed using SPSS computer package version 20. Clear operational framework was presented to guide the study and the findings were presented using both descriptive and inferential statistics. The study was approved by the University of Nairobi-Kenyatta National Hospital Ethics and Research Committee.Ethical Considerations were addressed. Descriptive statistics has been presented using pie charts frequency distribution table among others. Inferential statistics results have also been presented. RESULTS: The mean age of the participants was 27.2 years (+_ SD 6.6). The majority of mothers interviewed were married (29.3%). 20% (n=56) of the respondents reported having had a neonatal death in their present and past pregnancies. This gave a prevalence rate of 21 %( 95% CI). Neonatal mortality was significantly associated with the mother‟s demographic factors; marital status (p=<0.001) and neonatal death in family/relatives (p=<o.oo1), social factors (social group with p=0.02), maternal awareness (p=<0.001), disposition (p=0.001), abits (p=0.009)) all had significant relationships. There was no significance association between neonatal mortality, health institutional factors, cultural factors and economic factors.However, from qualitative data, there was a linkage between neonatal deaths and these factors. Cultural factors such as traditional practices and home delivery, maternal economic factors like poverty and inadequate health care providers‟ services, like lack of counseling to mothers on prevention of neonatal deaths, were strongly stated by the participants as being associated with neonatal deaths. CONCLUSION:Neonatal mortality rates remain high in Nakuru county with one in every five mothers in this study reporting that they had ever experienced a newborn death.The study has therefore accepted the directional hypothesis by demonstrating that maternal determinants are associated with neonatal mortality. The maternal demographic, social, knowledge, disposition and habits factors were all associated with neonatal mortality. Health care providers should therefore ensure that mothers are empowered with knowledge on how to prevent neonatal mortality including counseling on risk factors during and after pregnancy. The mothers should also be discouraged from habits that predispose newborns to death during the neonatal period. Moreover, more studies in other establishments should also be done to support and validate the findings of this study