To study neonatal morbidity and mortality in the Neonatology Unit of the Pediatrics Department of the Reference Health Center of Commune III of the Bamako District.

Presentation of the pediatric unit

Mali’s health services are organized into 3 levels of care:

Our study took place in the Neonatology Unit of the Pediatrics Department of the Reference Health Center of Commune III of the Bamako district.

This was a prospective, descriptive, cross-sectional study and analytical from September 1, 2022 to June 30, 2023, a period of 10 months.

Our study population was newborns aged 0 - 28 days who were hospitalized in the Neonatology Unit of the Pediatrics Department of the Reference Health Center of Commune III of the district of Bamako. It was classified into 2 age categories: [≤7 days] and [>7 days].

Our study sample was exhaustive (all sick newborns aged 0 - 28 days hospitalized in the department during the study period).

The following were included during the study period:

Not included in the study:

It consisted of reviewing the medical records of newborns in order to include those that could be used in the study. Data collection was done using a questionnaire developed for this purpose. This questionnaire included the sociodemographic characteristics of the parents and newborns, the clinical and paraclinical characteristics, and their intra-hospital developments.

The variables studied were of 3 orders:

Data was collected from the hospitalization medical records of newborns hospitalized during the study period. Missing data were supplemented by the maternity and neonatal unit registers and by imputation by the mean. They were entered and analyzed using SPSS software version 25and the software “R”. We conducted a univariate analysis by calculating frequencies, percentages, means, minimum values and minimum values. Bivariate analysis was used to determine the risk factors associated with mortality. Comparisons of proportions were performed using the Fisher test and Chi-square. The significance threshold was set at p < 0.05 and the confidence interval at 0.5%. Word and Excel version 2019 software were used for writing and processing the tables.

In our study, data collection procedures were carried out with the permission of the local health authorities of the center and that of the patients’ parents. The information collected was only accessible to those involved in the study. Coding helped secure the collected data. There were no conflicts of interest. The results obtained will not be used for any other purposes; they will be used to improve medical practice.

1) Frequency

From September 2022 to June 2023, we consulted 518 newborns, 245 of whom were hospitalized in the neonatology unit, a proportion of 47.2%.

2) Sociodemographic characteristics

More than half of the mothers of our newborns were in the age group [15 - 25 years] or 51.4%. The average age was 26.6 years with extremes of 16 and 45 years. They were mostly educated at primary level (31.4%), secondary level (27.8%) and higher level (15.1%). They were also mostly housewives (53.5%) ( Table 1 ).

Most newborns were in the age range [0 - 7 days] of life at admission, i.e. 96.7%. The mean age was 0.93 days with extremes of 0 and 28 days. The male sex was predominant with a sex ratio of 1.2 in favor of boys. Most of our newborns come from 2nd level health centers ( Table 2 ).

3) Clinical features

A small proportion of our newborns’ mothers had a medical or surgical history (7.3%). The most common medical histories were high blood pressure (4.5%), followed by diabetes (2.6%) and sickle cell disease (1.2%) ( Table 3 ).

More than half of the mothers of our newborns had one to three pregnancies, i.e. 60.7%. Ninety-four mothers out of the 245 were pauciparous, i.e. 38.4%, and 28.2% were primiparous. Most of the mothers of our newborns did not have an abortion, i.e. 92.2%. A small proportion of the mothers of our newborns had a history of obstetrics (4.5%). This was a cesarean section in 4.1% and borderline pelvic section in 0.4% ( Table 4 ).

The vast majority of our newborns’ mothers had three or more prenatal visits, or 73.1% of them. A small proportion of our newborns’ mothers were fully immunized against tetanus, or 4.1%.

HbsAg serology was performed on 156 of our 245 newborn mothers, a proportion of 63.6%. It came back positive in 3.3% ( Table 5 ).

BW serology was performed on 164 of the 245 mothers of our newborns, a proportion of 66.9%. It came back positive in 1.3%.

Toxoplasmosis serology was performed on 115 of our 245 newborn mothers, a proportion of 46.9%. It came back positive in 7%.

HIV serology was performed on 194 of our 245 newborn mothers, a proportion of 79.1%. It came back positive in 2.6%.

Obstetric ultrasound was performed in 66.9% of the mothers of our newborns. It revealed, in order of frequency, multiple pregnancies in 11% of patients, followed by hydrocephalus in 1.2% and malformations in multiple pregnancies in 0.8% ( Table 6 ).

Pathologies were observed in 124 of the 245 mothers, a proportion of 50.6%. The most frequently found pathologies were malaria (45.1%), followed by non-malarial infection (20.1%) and pre-eclampsia and eclampsia (16.1%) ( Table 7 ).

Delivery was spontaneous in 74.2% of mothers. The rupture of the water bag was observed in 8.2 of them. The vaginal route was the most frequent mode of delivery (67.3%). The presentation was cephalic in many of our newborns (96.3%). Instrumental maneuvers were performed in 10.6% of mothers ( Table 8 ).

Perinatal anoxia was the most frequent pathology (62.8%) followed by prematurity (35.4%) and neonatal infection (23.2%) associated or not with other pathologies ( Table 10 ).

We recorded a cure rate of 83.7%, a dropout rate of 0.8%, and a mortality rate of 13.9%. This included early mortality in 73.5% of cases and late mortality in 26.4%. Four of the 245 newborns were referred to third-level hospitals for specific care ( Table 11 ).

1) Frequency

From September 2022 to June 2023, we consulted 518 newborns, 245 of whom were hospitalized in the neonatology unit, a proportion of 47.2%. Our frequency is higher than that of Sangaré et al. [14] and Zagré et al. [15] which respectively recorded frequencies of 13.7% and 8.6%. It is lower than that of Omoigberale et al. [16] who found a frequency of 84.6% in their study.

2) Sociodemographic characteristics

More than half of the mothers of our newborns (51.4%) were in the age group (15 - 25 years) with a mean age of 26.6 years and extremes of 16 and 45 years. The mean age of the mothers in our series is close to that of Kedy et al. [17] . (26.8 years old) and that of Mr. Diarra [18] (27 years). It is lower than that reported by C. Sylla [19] (29.5 years old).

The mothers of our newborns were mostly educated (74.3%): primary level (31.4%), secondary level (27.8%), higher level (15.1%). Our data are higher than those of S. NKounou [20] who found a frequency of 57.6% of educated mothers in his study. However, Mr. Diarra [18] reported a high frequency (66.5%) of non-school-going mothers in their study.

In our study, the mothers of our newborns were mostly housewives (53.5%) as in most studies, notably that of Mr. Diarra [18] (82%), that of S. Nkounou [20] (61.9%) and Sangaré et al. [14] (60%).

Most newborns were less than one week old at admission, i.e., 96.7%. The mean age of our newborns was 0.93 days, with extremes of 0 and 28 days. This is lower than that of Nagalo et al. [21] and Kedy et al. [17] who respectively recorded average ages of 2 and 4 days. It is higher than that of and Zagré et al. [15] which recorded an average age of 0.18 days.

In our series, the male sex was predominant with a sex ratio of 1.2 in favor of boys. Our result is consistent with data from the literature. [12] [22] and those reported by most authors, notably that of Yenan et al. [23] , Okechukwu et al. [24] , Zagré et al. [15] , Mukhtar-Yola et al. [25] . On the other hand, Boiro et al. [26] had a female predominance (58.2%) in their series.

A small proportion of our newborns’ mothers had a medical or surgical history (7.3%). The most common medical histories were high blood pressure (4.5%) followed by diabetes (2.6%) and sickle cell disease (1.2%). Our data are similar to those of Boiro et al. [26] who mainly observed high blood pressure as a antecedent in 18.1% of mothers followed by obesity (13.4%) and sickle cell disease (5.5%). They are different from those of S. NKounou [20] who reported in order of frequency sickle cell disease (50%) and asthma (20%).

The mean gestational age was 35.8 weeks of amenorrhea with extremes of 28 and 67 weeks of amenorrhea. 63.7% of the cases were full-term newborns, 35.9% were premature and 0.4% were post-maturity. Our data were comparable to those of Nagalo et al. [21] who reported a high frequency of full-term newborns (64.1%) followed by premature (33.6%) and post-maturity (2.3%) while Boiro et al. [26] observed 66.3% of premature and 33.7% of full-term newborns in their series.

In our sample, a large number of newborns had a weight in the (2001 - 300 grams) range. The average weight was 2449.3 grams with extremes of 990 and 5300 grams. The average weight of the newborns in our sample is close to that of Nagalo et al. [21] (2632 grams). It is higher than that of Boiro et al. [26] (1879 grams) and lower than those of Kedy et al. [17] and Mukuku et al. who respectively found average birth weights of 3000 and 3168 grams in their studies.

Perinatal anoxia was the most frequent pathology (62.8%) followed by prematurity (35.4%) and neonatal infection (23.2%) associated or not with other pathologies. Our data are comparable to those of most authors, notably those of Omoigberale et al. [16] , Hedstrom et al. [30] , by Mukhtar-Yola et al., by Okechukwu et al. [24] and Ekwochi et al. [31] . On the other hand, Nagado et al. [21] found in order of frequency neonatal infection (23.5%), anomalies related to the duration of gestation and fetal growth (17.9%) and congenital malaria (15.1%). As for Kedy et al. [17] , they observed in their series a high frequency of neonatal infection (76.8%) followed by neonatal jaundice (16.6%) and asphyxia (15.9%).

We recorded a cure rate of 83.7%, a dropout rate of 0.8%, and a mortality rate of 13.9%. Our mortality rate is identical to those of Miles et al. [32] (13.9%) from Thomson et al. [33] (13.5%) and Okechukwu et al. [24] (13.3%). It is slightly higher than those of Diallo et al. [10] (12.7%) and Katamea et al. [34] (12.9%). However, rates higher than ours have been recorded by several authors, notably by Ekwochi et al. [31] (14.2%), by Ntambue et al. [35] (27%) by Ouattara et al. [36] (29.8%) and by Zagré et al. [15] (92.7%).

It was mainly early mortality (73.5%) as in Arsène’s studies et al. [37] of Ouattara et al. [36] , and of Hadgu et al. [38] which respectively reported high early neonatal mortality rates of 85.6%, 89% and 98.3% in their series.

The only factors significantly associated with neonatal deaths in our study were the age of newborns and the number of parities of the mothers. Newborns less than a few days old were significantly more at risk of death than those a little older (OR: 0.19, [95% CI OR: 0.04; 0.83], (p = 0.024) and newborns of multiparous and grand multiparous women were also significantly more at risk of death than those of primiparous women (OR = 2.465, p = 0.038). These risk factors for death are different from those of most authors. Ouattara et al. [36] showed in their study that the number of prenatal consultations, the occurrence of a pathology during pregnancy, the use of sulfadoxine pyrimethamine, the term of pregnancy at delivery, the place of delivery, the mode of delivery, the sex of the newborn, his age, his weight, the health structure that referred him and the main diagnosis were significantly associated with neonatal mortality at the threshold of 20%. As for Arsene et al. [37] , they found as risk factors associated with death in their study asphyxia (p = 0.007) and neonatal infection (0.042). In the study of Akolly et al. [4] , neonatal factors significantly associated with death were admission during the first 24 hours of life (p = 0.001), place of birth outside the university hospital (p = 0.002) and duration of initial resuscitation greater than ten minutes (p = 0.000*).

In that of Djivohessoun A et al. [3] , the determining factors of early neonatal mortality found were the insufficient number of prenatal consultations (p = 0.001), poor Apgar (p = 0.001), prematurity (p = 0.001) and very low birth weight (p = 0.001).