ASPHYXIA OF THE NEWBORN IN EAST, CENTRAL AND SOUTHERN AFRICA

Very scanty information is available in East, Central and Southern Afr ica on the incidence and risk factors associated with asphyxia of the newborn. A multicentre prospective study involving 4267 deliveries in eight countries was undertaken over a three month period, in maternity units of the central hospitals to determine the incidence; maternal, service and logistic risk factors for asphyxia of the newborn as deter mined by an abnormally low apgar score. 30% of births were by primigra vida mothers, of whom 67% were teenagers. A birth by a teenager had a higher risk for low birth weight, Overall incidence of low birth weigh t was 13.9%. The overall incidence of asphyxia of the newborn was 22.9 % while that associated with low birth weight (i.e. babies weighing le ss than 2500 grams) was 29.3 % compared with 21.5 % among the normal b irth weight babies. Low birth weight contributed a large proportion of the high neonatal mortality of 15.9% compared to 1.8% for normal birt h weight babies by 24 hours after birth. The mean mortality by 24 hour s post delivery was 3.8%. Obstetrical complications are important risk factors for asphyxia of the newborn. Among the important risk factors are those associated with prolonged labour and intra partum accidents . The incidence of risk for asphyxia broadly was 21.3%, which is very close to the actual incidence of asphyxia of 22%. Lack of referral con tributed to increased risk of asphyxia. In a significant proportion of infants, resuscitation measures taken were inappropriate. The stillbi rth rate was 3.0% while the incidence of externally evident congenital malformations was 1.2%. There is urgent need to institute appropriate measures to prevent and manage asphyxia of the newborn in the region. These should include identification of the at risk mother, proper ref erral and management while adhering to correct established procedures. There is also need to develop appropriate and relevant technologies f or perinatal and neonatal care through research undertaken in the regi on. It is also concluded that the co-operation and joint effort betwee n the obstetricians, paediatricians and the nursing staff who all cont ributed to the collection of this data is a cost effective approach to research in perinatal health and consequently in instituting interven tions.