| dc.description.abstract | Background: Preterm birth, defined as childbirth occurring before 37 weeks of gestation, remains a significant public health issue, particularly in low- and middle-income countries (LMICs) like Uganda. The survival of preterm newborns is heavily influenced by their transportation from lower-level health facilities to tertiary care centers equipped with neonatal intensive care units (NICU). This study examined the transportation characteristics and outcomes among preterm newborns referred to Kawempe National Referral Hospital (KNRH), focusing on identifying predictors of mortality. Methods: This prospective cohort study enrolled a consecutive sample of 248 preterm newborns referred to KNRH over a three-month period. Data was collected on transportation characteristics (mode of transport, travel time), admission patterns (gestational age, birth weight, referral source, reason for referral, admission parameters) and mortality within 72 hours of admission. A Cox Proportional Hazard regression model was used to identify predictors of mortality, controlling for potential confounders such as socioeconomic status and maternal health factors. Findings: The median (IQR) gestation age of the participants was 32 (IQR=30-34) and 128 (52 %) were male. Ambulances were the most common mode of transport (66.5%) for the neonates but private cars or taxis (23.7%) and motorcycles (8.0%) were other means that a significant proportion of the population uses to transport the neonates. Majority of the neonates (93.1%) that were transported were not monitored during the transfer and availability of monitoring equipment during transport was very low (9.3%). Forty (16.1%) participants died, with an overall mortality rate among the preterm infants transported to KNRH of 54.2 deaths per 1,000 person-hours at risk. The mortality risk was associated with TOPS score of 2 (aHR = 20.36, 95% CI: 2.62-158.48, p = 0.004), TOPS score of 3 (aHR = 38.24, 95% CI: 4.19-349.09, p = 0.001) and TOPS score of 4 (aHR = 118.41, 95% CI: 6.80-2061.00, p = 0.001), presence of CPAP (Continuous Positive Airway Pressure) during transport (aHR = 0.27, 95% CI: 0.12-0.59, p = 0.001) and gestational age between 32 and <34 weeks (aHR = 0.27; 95% CI: 0.08-0.91; p = 0.034). Conclusions and Recommendations: Most preterm newborns were transported by ambulance. At 54 deaths per 1000-person hours, the mortality rate was relatively high. The presence of CPAP in the ambulance was the only transport factor associated with the mortality risk while hypoxia, prolonged CRT and gestational age were the neonatal factors associated with mortality among the preterm infants. Preterm infants referred to NICU should be routinely monitored during transportation to prevent the possibility of hypoxia. | en_US |
