Kinoti S N
Reproductive Health Research Programme, Commonwealth Regional Health Community for East, Central and Southern Africa, Arusha, Tanzania.
East Afr Med J. 1993 Jul;70(7):422-33.
Very scanty information is available in East, Central and Southern Africa 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 determined by an abnormally low apgar score. 30% of births were by primigravida mothers, of whom 67% were teenagers. A birth by a teenager had a higher risk for low birth weight. Overall incidence of low birth weight 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 less than 2500 grams) was 29.3% compared with 21.5% among the normal birth weight babies. Low birth weight contributed a large proportion of the high neonatal mortality of 15.9% compared to 1.8% for normal birth weight babies by 24 hours after birth. The mean mortality by 24 hours 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 contributed to increased risk of asphyxia. In a significant proportion of infants, resuscitation measures taken were inappropriate. The stillbirth 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 referral and management while adhering to correct established procedures. There is also need to develop appropriate and relevant technologies for perinatal and neonatal care through research undertaken in the region. It is also concluded that the co-operation and joint effort between the obstetricians, paediatricians and the nursing staff who all contributed to the collection of this data is a cost effective approach to research in perinatal health and consequently in instituting interventions.
关于东非、中非和南非新生儿窒息的发病率及相关风险因素，现有信息非常匮乏。在三个月的时间里，在八个国家的中心医院产科开展了一项涉及4267例分娩的多中心前瞻性研究，以确定新生儿窒息的发病率；以及由异常低的阿氏评分所确定的新生儿窒息的母体、服务和后勤风险因素。30%的分娩产妇为初产妇，其中67%是青少年。青少年分娩出现低体重儿的风险更高。低体重儿的总体发病率为13.9%。新生儿窒息的总体发病率为22.9%，而与低体重（即体重低于2500克的婴儿）相关的窒息发病率为29.3%，正常出生体重婴儿的这一发病率为21.5%。出生后24小时内，低体重儿在15.9%的高新生儿死亡率中占很大比例，而正常出生体重婴儿的这一死亡率为1.8%。分娩后24小时的平均死亡率为3.8%。产科并发症是新生儿窒息的重要风险因素。其中重要的风险因素包括与产程延长和产时意外相关的因素。窒息风险的总体发生率约为21.3%，这与22%的实际窒息发生率非常接近。缺乏转诊导致窒息风险增加。在很大一部分婴儿中，所采取的复苏措施并不恰当。死产率为3.0%，外部明显的先天性畸形发生率为1.2%。该地区迫切需要采取适当措施来预防和处理新生儿窒息。这些措施应包括识别高危母亲、进行恰当的转诊和管理，同时遵守正确的既定程序。还需要通过该地区开展的研究，开发适用于围产期和新生儿护理的相关技术。研究还得出结论，产科医生、儿科医生和护理人员之间的合作与共同努力为收集这些数据做出了贡献，这是一种在围产期健康研究以及因此在制定干预措施方面具有成本效益的方法。
