A study on the incidence and factors associated with birth asphyxia at the University Teaching Hospital in Lusaka, Zambia

Abstract

Birth asphyxia is a significant contributor to newborn morbidity and mortality as well as long term neurological deficits. It has remained a common problem in the developing world. Labour related problems for example, prolonged labour, intrapartum accidents, abnormal fetal presentation, fetal distress and primaparity continue to be important causes of asphyxia. This was a cross- sectional study conducted during a six month period from 1st February to 31st July 2001 to establish the incidence of birth asphyxia defined as an apgar score < 6 at 5 minutes at UTH and to document maternal, intrapartum and fetal factors associated with birth asphyxia and case fatality rate in the first week or life. During the study period, there were 4529 singleton live births weighing more than 1500g. Of these infants, 229 were born with an apgar score < 6 at 5 min giving an incidence of 50/ 1000 Iive births. When only term infants defined by birth weight of > 2500g the incidence was 43 / 1000. Most mothers (66.8%) had a satisfactory antenatal attendance with an average of 6 visits (range 0-13). Of the asphyxiated babies, 29.4% were born to teenager mothers (15-19yrs) and 55% of the mothers were primagravidas. Labour was prolonged in 46% of the cases. Fetal distress was diagnosed in 30% of the cases. Meconium staining of liquor was present in 23% of the cases and it was significantly associated with fetal distress (0R= 43.7, 95% €1= 13.8.14.7.p<0.001).An intra-partum accident occurred in 12% of the cases. The caesarean section rate of 35% among the cases was higher than that of the general delivering population at 12.5% and the commonest indication was fetal distress. The case fatality rate of neonates born with a low apgar score of 6 or less at 5 minutes at the end of the first week was 45% and 9.2% of these newborns died within the first 24hours. An apgar score < 3 at 5 min was significantly associated with death (OR=22, 95% CI 4.86,13.8, p<0.001).Male neonates were 1.47 times more likely to die than their female counterparts (OR. 1.87, 95% CI 1.02-3.41, p<0.04).The study has shown that birth asphyxia is a common problem at UTH with a high case fatality rate. Improved obstetrical care, especially intra-partum monitoring and appropriate resuscitation techniques will assist in reducing birth asphyxia and it's associated morbidity and mortality.