Neonatal morbidity and mortality in Nigeria.

A retrospective analysis of neonatal morbidity and mortality was conducted over a ten-year period (1981-1990) at a tertiary hospital in Ilesa, Nigeria, to determine the trends in neonatal morbidity and mortality in relation to places of delivery. 7,225 babies were admitted into the neonatal unit during the period wherein 3,232 (44.7%) were inborns and 3,993 (55.3%) outborns. Places of delivery of outborn babies were government hospitals/maternity centres (44.1%), home (28.5%), private hospitals/clinics (18.8%), and mission houses (8.7%). Major indications for admission among inborns were neonatal jaundice (45.6%), low birthweight (18.6%), birth asphyxia (14.2%), and neonatal infections (9.3%), while those for outborns were neonatal jaundice (39.5%), low birthweight (23.2%), neonatal infections (18.0%), neonatal tetanus (5.7%), birth asphyxia (4.8%). Overall mortality rate was 13.0%. It was higher in outborns than inborns (p < 0.001). Mortality was lowest in 1983 and peaked in 1987 and 1988. It was higher in outborns than inborns during the period (p < 0.001). Major causes of death were low birth weight (42.8%), neonatal jaundice (14.1%), neonatal tetanus (12.8%), infections (12.4%), and birth asphyxia (11.6%). In almost all cases, case fatality rates were higher among the outborns (p < 0.001). Similarly, mortality was higher in outborns than inborns in almost all the weight range. Among the outborns, mortality was highest in babies delivered at home and private hospitals. Improved access to neonatal medical and antenatal care will significantly reduce neonatal morbidity and mortality in Nigeria.