Immediate outcomes and predictors of mortality among term neonates referred to Kawempe National Referral Hospital: A prospective study

Abstract

Background: Neonatal mortality persists as a major public health concern in Sub-Saharan Africa, including Uganda. Challenges within referral systems complicate the situation for neonates referred from lower facility levels to tertiary hospitals for advanced care. Consequently, mortality rates are higher among outborn neonates compared to inborn neonates. This study aimed to assess the immediate outcomes and predictors of mortality among term neonates referred to Kawempe National Referral Hospital (KNRH). Methods: The study was a prospective cohort study among term neonates referred to KNRH. A structured questionnaire was used to collect quantitative data on the patient demographics, referral factors, and maternal factors. These were collected through reviewing referral documents and interviewing caregivers or accompanying health workers. Clinical status of the term newborns was determined upon arrival, and assessments included Respiratory Rate, Oxygen saturation, Temperature, pulse, and Random Blood Sugar. All the enrolled neonates were followed up for a period of 48 hours to determine their immediate outcomes. Results: Among the 295 term neonates referred to Kawempe National Referral Hospital that were recruited in this study, 24(8.1%) died yielding a mortality rate of 47.4 deaths per 1000 person-days at risk., while 91.9% (271) survived. Only 65(22%) had been discharged during the follow-up period, with 200(67.8%) still on treatment and 6(2%) were referred out to other facilities, during the follow-up period. (p<0.05). Neonates who did not receive pre-referral care had a 3.31 times higher risk of mortality compared to those who received (aHR 3.31, p=0.033). Additionally, neonates with a pulse rate <120 beats per minute had a 3.88 increased risk of death compared to those with a pulse rate of 120-160 beats per minute (aHR 3.88, p=0.008). Children who were diagnosed with HEI and Meconium Aspiration Syndrome had a 5.85 and 9.24 increased risk of mortality compared to those who were diagnosed with neonatal sepsis with (aHR 5.85, p=0.001) and (aHR 9.24, p=0.002), respectively. Conclusion: In this study mortality was relatively high within 48 hours of admission among term neonates referred to Kawempe National Referral Hospital. The Ministry of Health and Kampala Capital City Authority should ensure that lower health facilities are able to identify sick neonates, give pre-referral treatment and immediately refer critically sick neonates to higher health facilities.