Neonatal mortality in Kenyan hospitals: a multisite, retrospective, cohort study

Abstract

Background: Most of the deaths among neonates in low-income and middle-income countries (LMICs) can be prevented through universal access to basic high-quality health services including essential facility-based inpatient care. However, poor routine data undermines data-informed efforts to monitor and promote improvements in the quality of newborn care across hospitals.

Methods: Continuously collected routine patients' data from structured paper record forms for all admissions to newborn units (NBUs) from 16 purposively selected Kenyan public hospitals that are part of a clinical information network were analysed together with data from all paediatric admissions ages 0-13 years from 14 of these hospitals. Data are used to show the proportion of all admissions and deaths in the neonatal age group and examine morbidity and mortality patterns, stratified by birth weight, and their variation across hospitals.

Findings: During the 354 hospital months study period, 90 222 patients were admitted to the 14 hospitals contributing NBU and general paediatric ward data. 46% of all the admissions were neonates (aged 0-28 days), but they accounted for 66% of the deaths in the age group 0-13 years. 41 657 inborn neonates were admitted in the NBUs across the 16 hospitals during the study period. 4266/41 657 died giving a crude mortality rate of 10.2% (95% CI 9.97% to 10.55%), with 60% of these deaths occurring on the first-day of admission. Intrapartum-related complications was the single most common diagnosis among the neonates with birth weight of 2000 g or more who died. A threefold variation in mortality across hospitals was observed for birth weight categories 1000-1499 g and 1500-1999 g.

Interpretation: The high proportion of neonatal deaths in hospitals may reflect changing patterns of childhood mortality. Majority of newborns died of preventable causes (>95%). Despite availability of high-impact low-cost interventions, hospitals have high and very variable mortality proportions after stratification by birth weight.

Keywords: cohort study; epidemiology; health services research; paediatrics.

Figure 1

(A) Entire patient population aged 0–13 years admitted in H1–H14 during study period (population A). (B) Inborn newborns admitted in the 16 NBUs during the entire study period (Population B). NBU, newborn unit.

Figure 2

(A) Admissions in the 14 CIN hospitals of all patients aged 0–13 years (population A) disaggregated in age categories. (B) Mortalities in the 14 CIN hospitals of all patients aged 0–13 years (population A) disaggregated in age categories. CIN, Clinical Information Network.

Figure 3

Funnel plots of mortality of inborn newborns by number of inborn newborns admitted in each of the 16 CIN NBUs (population B) during the study period. Plots A, B, C and D depict plots for admissions birth weight category <1000 g, 1000–<1500 g, 1500–<2000 g and 2000–<2500 g, respectively. Each dot represents neonatal mortality of each of the 16 NBUs. Blue dots represent H10 that had consistently lower mortality in all weight categories, and red dots represent H1 and H7 that had consistently higher mortality for babies in the 1000–2000 g range. The red line within the funnel represents the median mortality in the 16 NBUs.