Peer-reviewed article
Predictors and survival of birth asphyxia-related neonatal mortality in rural Ghana: a five-year retrospective cohort study (2018-2023).
Amponsah SK, Duah J, Yeboah P, Dormechele W, Kuupiel D ·
Summary
Written by AI, not yet AICS's view · claude-haiku-4-5-20251001This study examined neonatal deaths from birth asphyxia in 22 rural hospitals in Ghana between 2018 and 2023. Of 211 neonates admitted with birth asphyxia, 36% died during their hospital stay. The research identified several factors linked to higher death rates, including mothers without health insurance, lack of antenatal care, and delivery outside hospitals. The findings show that improving monitoring during labour, resuscitation services, and health insurance access could help reduce these deaths.
Key points
- 36% of neonates with birth asphyxia died during follow-up; 64% survived to discharge
- Lack of maternal health insurance increased mortality risk by 3.56 times
- Non-use of antenatal care increased mortality risk by 2.31 times
- Multiparity was protective, reducing mortality risk by 48%
- Delivery outside hospitals (CHPS compound or home) increased mortality risk by 1.70 times
Limitations
This is a retrospective study using routine clinical records, so data quality and completeness depend on what was recorded. The study describes associations between factors and mortality but cannot definitively prove causation, and findings are specific to rural Ghana with limited access to care.
Abstract
Background Birth asphyxia remains a leading cause of neonatal mortality in low- and middle-income countries, particularly in rural settings with limited access to skilled intrapartum and neonatal care. Evidence on survival patterns and predictors of birth asphyxia-related neonatal mortality in rural Ghana is limited. This study assessed neonatal mortality among neonates admitted with birth asphyxia and predictors among neonates admitted with birth asphyxia in rural Ghana. Methods An institution-based multicentre retrospective cohort study was conducted using routinely collected clinical records from 22 Christian Health Association of Ghana (CHAG) district hospitals in rural Ghana. All neonates diagnosed with birth asphyxia and admitted to Neonatal Intensive Care Units (NICUs) of these facilities between January 2018 and October 2023 who met the eligibility criteria were included (n = 211). Survival time was defined as the number of days from NICU admission to death; neonates who survived to discharge were right-censored. Kaplan-Meier estimates were generated and log-rank tests used to assess survival differences across covariates. Multivariable analysis was conducted using Cox proportional hazards regression with cluster-robust standard errors at the hospital level to account for intra-facility correlation. Predictor selection was guided by a conceptual framework incorporating clinical relevance, prior evidence, and potential confounding. Results Of the 211 neonates included, 76 (36.0%) died during follow-up and 135 (64.0%) survived to discharge and were right-censored. Deaths were concentrated predominantly in the early post-admission period. In the adjusted Cox proportional hazards model, significant independent predictors of neonatal mortality were: lack of maternal health insurance (HR = 3.56; 95% CI: 2.16-5.84; p < 0.001), non-utilisation of antenatal care (HR = 2.31; 95% CI: 1.49-3.57; p < 0.001), multiparity as a protective factor (HR = 0.52; 95% CI: 0.34-0.80; p = 0.003), absence of partograph-based labour monitoring (HR = 2.01; 95% CI: 1.21-3.34; p = 0.007), delivery at a CHPS compound or home versus hospital (HR = 1.70; 95% CI: 1.29-2.23; p < 0.001), poor foetal progress during labour (HR = 3.21; 95% CI: 1.49-6.94; p = 0.003), head circumference (HR = 0.98; 95% CI: 0.97-0.99; p = 0.005), and five-minute Apgar score (HR = 0.77; 95% CI: 0.68-0.86; p < 0.001). Conclusion Birth asphyxia-related neonatal mortality in rural Ghana reflects maternal, intrapartum, neonatal, and health-system factors. Strengthening monitoring, resuscitation, referral, and insurance, particularly in peripheral facilities, is critical to reducing deaths and advancing progress toward SDG 3.2.