TITLE:
Neonatal References: Epidemiology and Prognosis in a Malian Context
AUTHORS:
Fatoumata L. F. Diakité, Djénèba Konaté, Nouhoum L. Traoré, Noel Banou, Lala N. Sidibé, Oumar Coulibaly, Belco Maiga, Karamoko Sacko, Fousseyni Traoré, Abdoul K. Doumbia, Hawa G. Diall, Leila Maiga, Ibrahim Ahamadou, Alou Traoré, Adama Koné, Guediouma Dembélé, Djita Ba-Sidibé, Pierre Togo, Adama Dembélé, El Mouloud Cissé, Abdoul A. Diakité, Boubacar Togo, Mariam Sylla, Fatoumata Dicko-Traoré
KEYWORDS:
Neonatal References, Epidemiology, Prognosis, Malian Context
JOURNAL NAME:
Open Journal of Pediatrics,
Vol.11 No.3,
September
15,
2021
ABSTRACT: Neonatal mortality remains a public health problem in Mali. The neonatal
referral is a systemic factor determining the neonatal prognosis. This work was
initiated to determine the frequency of neonatal referrals and to determine
their prognosis. Patients and Methods: A cross-sectional study was
carried out from November 1, 2019 to January 31, 2020 in the neonatology
service of the pediatrics department of the Gabriel Toure University Hospital
in Bamako. All newborns referred by another health structure in the country
were included in this stud. All newborns referred by another health structure
in the country were included in this study. To determine the risk factors
related to the neonatal referral, we performed univariate and multivariate
analyzes to determine the odds ratios and fitted with a significant p
probability if p 0.05 and the 95% confidence interval. Results: The frequency of
referrals was 54.3%. Newborns came from basic structures in 19.3% of cases, from tertiary
structures in 6.7%. The main reason for transfer was prematurity (40.2%) followed by
perinatal anoxia (15.3%), malformations (15.3%), respiratory distress (15.2%)
and infection neonatal (9.1%). The ambulance was the primary means of transfer
in 71.3%. In 80% of cases the transfer had been made within the first 24 hours of
life. On admission, a third of the newborns (31.1%) were less than 1500 g,
hypothermic in 43.8% and febrile in 15.1%. The
evolution was marked by 40.2% of deaths. The analysis of prognostic factors,
allowed us to observe that the more the newborn is premature or of low weight
the more risk of death was very high with respectively 18.5 times in the less than 28 weeks of amenorrhea (WA) (ORa = 18.5; CI = 1.9 - 180; p = 0.012) and 6.6 times in those less than 1000g
(ORa = 6.6; CI = 1.4 - 29.7; p = 0.015). Likewise, any change in body temperature increased risk
of death by 1.9 times compared to normothermia. Conclusion: The establishment
of a neonatal referral system is necessary to reduce neonatal mortality in our
context.