Determinants of Neonatal Mortality in Laikipia East Subcounty in Kenya: A Case Study of Nanyuki Teaching and Referrral Hospital

Abstract

The purpose of the study was to explore the determinants of neonatal mortality in Nanyuki Teaching and Referral Hospital (NTRH) of Laikipia East Sub County. The specific objectives were to: evaluate the demographic factors affecting neonatal mortality; socioeconomic factors affecting neonatal mortality; and facility factors affecting neonatal mortality in NTRH. Descriptive study design was used to collect quantitative data since it was deemed suitable for primary and secondary data collection and the sampling method employed was simple random sampling technique. The study targeted all neonates who died at the NTRH in the period between January 2014 – December 2017 and health workers stationed in the maternity and neonatal departments. Questionnaires and a questionnaire guide were used to extract primary and secondary data from 21 health workers and 60 neonatal files respectively. Data was analysed using descriptive statistics, specifically frequency and mean. The Statistical Package for Social Science (SPSS) software was used during analysis. The data obtained has been presented in form of tables, charts, narratives, percentages, correlation using Chi-square and P-value. The study revealed that majority of neonates died within the first 7 days of life with low birth weight being the greatest contributors accounting for 93% of cases. Young maternal age was also identified as a key demographic factor that contributed to the neonatal mortalities with majority of the women concurrently having low education at 35% and 47% for primary and secondary education respectively. On the socioeconomic factors, no /few ANC attendance was a significant determinant of neonatal mortality predisposing mothers to low birth weight and poor neonatal outcomes. On facility factors affecting neonatal mortality, poor resuscitation practises were notably high with 14% of staff having no training on neonatal resuscitation whereas 45% of those trained had outdated training practises. This was identified as a fundamental contribution to the neonatal mortality rates during the early neonatal period. Free maternity program and Linda mama policies were seen to have a positive impact on better neonatal outcomes as seen by 65% and 95% support in the findings implicating the benefit of health policy on the neonatal outcomes. The study concludes that low birth weight and prematurity, young maternal age, few or no ANC visits, lower education levels and poor resuscitation practises were the major determinants of neonatal mortality in the Laikipia east sub county. The study recommends on demographic factors, increased funding to boost care of low birth weight and premature neonates with community mobilisation to increase maternal age at first birth. The study also recommends on socioeconomic factors that there should be community sensitization and education on the benefits of timely ANC attendance and follow up during pregnancy for pregnant mothers to make good use of health facilities within their reach to improve neonatal outcomes. Regular enhanced training and continuous updates on neonatal resuscitation practices among staff in neonatal and maternity units is recommended to alleviate the facility factors contributing to higher neonatal mortalities. Finally the study recommends further studies on impact of infrastructural and cultural practises on neonatal mortality.