Risk Factors for Neonatal Deaths: An Audit of Neonatal Care: A Retrospective Cross-Sectional Study

Antenatal care for women and care during labour are of utmost importance in identifying the risks for mothers and neonates for prompt interventions to improve health outcomes. The objectives were to characterize the obstetric, antenatal and neonatal care indicators of pregnant women at birth and to calculate and estimate the risk factors for neonatal mortality. A cross-sectional retrospective study was undertaken at a health facility targeting all deliveries and neonates for two years. The study variables were summarized using descriptive summary measures. Cross-table analysis of independent and outcome variables was undertaken using chi-square (X2) and p-values. Significant exposure variables were entered into logistic regression to identify predictors. The results were expressed with adjusted odds ratios (OR) with corresponding two-sided 95% confidence intervals and associated p-values. A total of 1561 women gave birth to 1541 live-born neonates. Most of the neonatal care indicators were good (>90%) except for confirming HIV status for HIV exposed neonates (88.7%) and tuberculosis vaccination (69%). The birth outcomes of all 699 HIV infected pregnant women were recorded. Of them, 3 had neonatal deaths and 4 had stillbirths in this group. Among those (692) HIV exposed live-born neonates, 92.4% had PCR tests undertaken, and 95.9% of them had their results available in the birth register, of which 1.8% were PCR positive at birth. Considering all HIV exposed 692 (excluding stillbirths and NNDs) livebirths, the PCR results of the HIV exposed neonates were known to 88.8%. This means 11.2% HIV-exposed live-born neonates HIV status remained unknown at birth. Among those 681 received ART at birth HIV exposed live-born neonates, 91.7% had a record of receiving ART prophylaxis. This means nearly 1 in 10 HIV-exposed children who qualify for HIV prophylaxis at birth did not receive it. The neonatal death rate was 1.3% (7.5 per 1000 live births). Neonates born before 32 weeks of gestation had an OR of 15.9 (95% CI: 2.3-106.2, p = 0.004) and women who did not initiate antenatal care had an OR of 7.0 (95% CI: 1.1-42.3, p = 0.033). The compliance of neonatal care indicators from this facility was commendable. We emphasise the need to strengthen primary health care systems for tuberculosis and HIV-related care at the time of delivery to avoid missed opportunities for maternal and neonatal care.