School of public health, College of Medicine and Health Sciences, Wachemo University, Hosanna, Ethiopia.
Department of public health, College of Medicine and Health Sciences, Wolkite University, Wolkite, Ethiopia.
PLoS One. 2022 May 6;17(5):e0268041. doi: 10.1371/journal.pone.0268041. eCollection 2022.
Neonatal near-miss (NNM) cases refer to situations in which babies are on the verge of dying between the ages of 0 and 28 days due to severe morbidity that occurs during pregnancy, delivery, or extra-uterine life, but survive either by luck or due to high-quality health care. Identifying NNM cases and addressing their determinants is crucial for devising comprehensive and relevant interventions to tackle neonatal morbidity and mortality. Hence, this study aimed at finding out the determinants of NNM in neonates admitted to public hospitals in Hadiya zone, southern Ethiopia.
A hospital-based unmatched case-control study was conducted in three selected hospitals in southern Ethiopia from May 1 to June 30, 2021. A total of 484 participants took part in the study (121 cases and 363 controls). Controls were chosen using systematic sampling approaches, whereas cases were recruited consecutively at the time of discharge. Cases were selected based on the Latin American Centre for Perinatology (CLAP) criteria of an NNM. A structured interviewer-administered questionnaire and a data extraction checklist were used for data collection. The Data were entered into Epi-Data version 3.1 and exported to SPSS version 23 for analysis. A multivariable logistic regression analysis with a p-value of <0.05 was used to determine the determinants of NNM.
Ninety-seven (80.1%) and 56 (46.2%) near-miss cases encountered at least one pragmatic and management criteria, respectively. The most common pragmatic and management criteria were gestational age less than 33 weeks (44.6%) and intravenous antibiotic usage up to 7 days and before 28 days of life (27.3%), respectively. A short birth interval [AOR = 2.15, 95% CI: 1.29, 3.57], lack of ANC [AOR = 3.37; 95%CI: 1.35, 6.39], Caesarean mode of delivery [AOR = 2.24; 95%CI: 1.20, 4.16], the occurrence of a third maternal delay [AOR = 3.47; 95% CI: 2.11, 5.75], and poor birth preparedness and complication readiness (BPCR) plan[AOR = 2.50; 95% CI: 1.49,4.13] were identified as a significant determinants of NNM.
The provision of adequate ANC should be a priority for health care providers at service delivery points. To avoid serious neonatal problems, mothers who deliver by Cesarean section should receive more attention from their families and health care providers. Health care providers in the ANC unit should encourage pregnant women to implement the WHO-recommended elements of the BPCR plan. To achieve optimal birth spacing, healthcare providers should focus on the contraceptive provision. Unnecessary delays in health facilities during childbirth should be avoided at all costs.
新生儿near-miss（NNM）病例是指婴儿在 0 至 28 天龄期间由于妊娠、分娩或子宫外生命期间发生严重发病而濒临死亡，但由于运气或高质量的医疗保健而存活的情况。确定 NNM 病例并解决其决定因素对于制定全面和相关的干预措施以解决新生儿发病率和死亡率至关重要。因此，本研究旨在确定埃塞俄比亚南部哈迪亚地区公立医院收治的新生儿 NNM 的决定因素。
这是一项在埃塞俄比亚南部 3 家选定医院进行的基于医院的病例对照研究，时间为 2021 年 5 月 1 日至 6 月 30 日。共有 484 名参与者参加了这项研究（121 例病例和 363 例对照）。对照采用系统抽样方法选择，而病例则在出院时连续招募。病例是根据拉丁美洲围产期中心（CLAP）的 NNM 标准选择的。使用结构化访谈员管理的问卷和数据提取检查表进行数据收集。数据输入 Epi-Data 版本 3.1 并导出到 SPSS 版本 23 进行分析。采用 p 值<0.05 的多变量逻辑回归分析确定 NNM 的决定因素。
97（80.1%）和 56（46.2%）例接近病例分别遇到至少一个实用和管理标准。最常见的实用和管理标准分别为胎龄小于 33 周（44.6%）和静脉使用抗生素长达 7 天且在 28 天生命之前（27.3%）。短出生间隔（AOR=2.15，95%CI：1.29，3.57）、缺乏 ANC（AOR=3.37；95%CI：1.35，6.39）、剖宫产分娩方式（AOR=2.24；95%CI：1.20，4.16）、发生第三次产妇延迟（AOR=3.47；95%CI：2.11，5.75）和出生准备和并发症准备不良（BPCR）计划（AOR=2.50；95%CI：1.49，4.13）被确定为 NNM 的显著决定因素。
在服务提供点，应优先为医疗保健提供者提供足够的 ANC。为避免严重的新生儿问题，接受剖宫产分娩的母亲应得到家庭和医疗保健提供者的更多关注。 ANC 单位的医疗保健提供者应鼓励孕妇实施世界卫生组织推荐的 BPCR 计划要素。为实现最佳分娩间隔，医疗保健提供者应专注于提供避孕措施。在分娩期间，应不惜一切代价避免在卫生设施中发生不必要的延误。
