D Kedy Koum1, C Exhenry2, C-I Penda3, V Nzima Nzima4, R E Pfister5. 1. Unité de néonatologie, service de pédiatrie, hôpital de district de Bonassama, BP 9023, Douala, Cameroun; Département des sciences cliniques, faculté de médecine et de sciences pharmaceutiques, université de Douala, BP 2701, Douala, Cameroun. 2. 24, chemin des Tulipiers, 1208 Genève, Suisse. 3. Service de pédiatrie, hôpital Laquintinie de Douala, BP 4035, Douala, Cameroun; Département des sciences cliniques, faculté de médecine et de sciences pharmaceutiques, université de Douala, BP 2701, Douala, Cameroun. 4. Service de santé du district de Bonassama, BP 9023, Douala, Cameroun. 5. Service de néonatologie et de soins intensifs pédiatriques, université de Genève, hôpitaux universitaires de Genève, département de l'enfant et de l'adolescent, rue Willy-Donzé 6, 1211 Genève, Suisse. Electronic address: riccardo.pfister@hcuge.ch.
Abstract
INTRODUCTION: In countries with limited health-care resources, achieving the fourth Millennium Development Goal recommended by the WHO requires the reduction of neonatal mortality. Interventions at different levels of the community and the health-care system are needed, including in district hospitals. METHOD: This was a descriptive study in the neonatal unit of the District Hospital of Bonassama/Douala in Cameroon that analyzed neonatal mortality and morbidity to discover possible intervention levers. The clinical, sociodemographic, and outcome data of hospitalized newborns were recorded from November 2009 to May 2012. The analysis was performed anonymously. RESULTS: During 29 months, 813 infants were hospitalized; 71% were delivered naturally and 16% by cesarean section. Globally, 20% were premature, 55% were male, and 24% had a birth weight of less than 2500 g. At admission, 35% of the infants had hyperthermia and 29% hypothermia. The most common diagnoses were early infection (77%), late infection (22%), jaundice (17%), early adaptation disorders (18%), and hypoxic-ischemic encephalopathy (2.2%). The hospital mortality rate was 8% and the main diagnoses associated with death were: low birth weight, prematurity, hypothermia, and early adaptation disorders with and without encephalopathy. No excess mortality was found for neonates treated for infection. CONCLUSION: In developing sub-Saharan countries, the main causes of neonatal mortality must be taken care of by hospitals at a peripheral district level. Epidemiological knowledge of neonatal diseases at the peripheral level (district) allows for an estimation of the requirements in terms of competence and equipment. Specific needs for transfer to a superior care unit can be estimated but the high transfer risk and the limited resources of the referral center should be taken into account.
INTRODUCTION: In countries with limited health-care resources, achieving the fourth Millennium Development Goal recommended by the WHO requires the reduction of neonatal mortality. Interventions at different levels of the community and the health-care system are needed, including in district hospitals. METHOD: This was a descriptive study in the neonatal unit of the District Hospital of Bonassama/Douala in Cameroon that analyzed neonatal mortality and morbidity to discover possible intervention levers. The clinical, sociodemographic, and outcome data of hospitalized newborns were recorded from November 2009 to May 2012. The analysis was performed anonymously. RESULTS: During 29 months, 813 infants were hospitalized; 71% were delivered naturally and 16% by cesarean section. Globally, 20% were premature, 55% were male, and 24% had a birth weight of less than 2500 g. At admission, 35% of the infants had hyperthermia and 29% hypothermia. The most common diagnoses were early infection (77%), late infection (22%), jaundice (17%), early adaptation disorders (18%), and hypoxic-ischemicencephalopathy (2.2%). The hospital mortality rate was 8% and the main diagnoses associated with death were: low birth weight, prematurity, hypothermia, and early adaptation disorders with and without encephalopathy. No excess mortality was found for neonates treated for infection. CONCLUSION: In developing sub-Saharan countries, the main causes of neonatal mortality must be taken care of by hospitals at a peripheral district level. Epidemiological knowledge of neonatal diseases at the peripheral level (district) allows for an estimation of the requirements in terms of competence and equipment. Specific needs for transfer to a superior care unit can be estimated but the high transfer risk and the limited resources of the referral center should be taken into account.
Authors: Danielle Christiane Kedy Koum; Noel Emmanuel Essomba; Guy Pascal Ngaba; Sintat Sintat; Paul Koki Ndombo; Yves Coppieters Journal: Pan Afr Med J Date: 2015-03-17