Avelino Israel C, Van-Dúnem Joaquim, Varandas Luís
Global Health and Tropical Medicine (GHTM), LA-REAL, Instituto de Higiene e Medicina Tropical (IHMT), Universidade NOVA de Lisboa, 1169-056 Lisboa, Portugal.
Clínica Multiperfil, Luanda 2177, Angola.
Int J Environ Res Public Health. 2024 Nov 30;21(12):1609. doi: 10.3390/ijerph21121609.
Neonatal mortality rates in developing countries are influenced by a complex array of factors. Despite advancements in healthcare, Angola has one of the highest neonatal mortality rates in sub-Saharan Africa, with significant contributors including premature birth, intrapartum events, tetanus, and sepsis. This study, utilizing key theoretical frameworks such as intersectionality, social determinants of health (SDOH), and ecosocial theory, aimed to identify the primary causes and contributing factors of neonatal mortality among infants admitted to the Neonatology Service at DBPH in Luanda from May 2022 to June 2023. A retrospective matched case-control design was employed, pairing each neonatal death with two surviving neonates based on age and sex. The analysis included 318 newborns, of whom 106 experienced hospital deaths. A stepwise binary logistic regression model was used to examine associations between variables and neonatal mortality. Variables with < 0.25 in bivariate analysis were included in the multivariate model. Significant factors associated with neonatal mortality included the following: a low Apgar score at 1 min (<7) (OR 2.172; 95% CI: 1.436-4.731); maternal age under 20 years (OR 3.746; 95% CI: 2.172-6.459); home delivery (OR 1.769; 95% CI: 1.034-3.027); and duration of illness before admission ≥ 3 days (OR 2.600; 95% CI: 1.317-5.200). Addressing these issues requires urgent interventions, including improving Apgar score management through enhanced training for healthcare professionals, supporting young mothers with intensified maternal education, ensuring deliveries occur in appropriate healthcare settings, and improving universal health coverage and referral systems. These measures could be crucial for enhancing neonatal care and reducing mortality.
发展中国家的新生儿死亡率受到一系列复杂因素的影响。尽管医疗保健有所进步，但安哥拉仍是撒哈拉以南非洲新生儿死亡率最高的国家之一，主要因素包括早产、分娩期事件、破伤风和败血症。本研究利用交叉性、健康的社会决定因素（SDOH）和生态社会理论等关键理论框架，旨在确定2022年5月至2023年6月在罗安达DBPH新生儿科住院的婴儿中新生儿死亡的主要原因和促成因素。采用回顾性匹配病例对照设计，根据年龄和性别将每例新生儿死亡与两名存活新生儿配对。分析包括318名新生儿，其中106名在医院死亡。采用逐步二元逻辑回归模型检验变量与新生儿死亡率之间的关联。双变量分析中P<0.25的变量纳入多变量模型。与新生儿死亡率相关的重要因素如下：1分钟时阿氏评分低（<7）（比值比2.172；95%置信区间：1.436 - 4.731）；母亲年龄在20岁以下（比值比3.746；95%置信区间：2.172 - 6.459）；在家分娩（比值比1.769；95%置信区间：1.034 - 3.027）；入院前患病时间≥3天（比值比2.600；95%置信区间：1.317 - 5.200）。解决这些问题需要紧急干预，包括通过加强对医护人员的培训来改善阿氏评分管理，通过强化孕产妇教育来支持年轻母亲，确保在适当的医疗环境中分娩，以及改善全民健康覆盖和转诊系统。这些措施对于加强新生儿护理和降低死亡率可能至关重要。
