Characteristics of newborns with surgical conditions, referred to and seen at a tertiary-level hospital in western Kenya

Abstract

Background: World over, neonatal mortality contributes significantly to the under-five mortality rate, and 10% of neonatal deaths in low and middle-income countries (LMICs) are due to surgical conditions. The majority of surgical conditions are congenital malformations that are only amenable to surgical treatment in the neonatal period. In Kenya, specialized neonatal surgical care is only available in the two tertiary level hospitals in Eldoret and Nairobi. Since the majority of newborns with surgical conditions are born or seek initial care in the lower level health facilities, appropriate referral and transport to the tertiary-level hospitals determines the overall outcome of their treatment. Moreover, socio-demographic and clinical characteristics of newborns with surgical conditions are important determinants of the outcome of their care at the tertiary-level hospital.

Study Objective: To describe the socio-demographic; clinical; and referral and transport characteristics of the newborns with surgical conditions, who were referred to and seen at Moi Teaching and Referral Hospital (MTRH).

Study design: A hospital-based cross-sectional study was done on all newborns with surgical conditions referred, transported to and seen at the Newborn Unit.

Study Setting: Moi Teaching and Referral Hospital, Eldoret, Kenya.

Main Outcomes: Socio-demographic; clinical; and referral and transport characteristics of the newborns who met the inclusion criteria.

Results: One-hundred and twenty-six newborns who met the inclusion criteria were recruited into the study between February 2018 and January 2019. The median age of the newborns at admission was 4.4 days (106.5 hours), and only 26 (20.6%) of their mothers had optimal antenatal care during pregnancy. The level of education and the occupation of their mothers had a significant association with the uptake of antenatal care during pregnancy (p-value = 0.000). The majority had congenital anomalies that were mainly gastroschisis (23.0%), hydrocephalus (18.3%), ano-rectal malformations (ARM) (14.3%) and Hirschsprung’s disease (14.3%). Most (96.0%) of the newborns were transported to MTRH using road ambulance, and 95.2% were escorted by trained medical personnel during transport.

Conclusions: Congenital anomalies were the major surgical conditions seen in the newborns referred and transported to MTRH, and gastroschisis was the leading condition. The newborns had delay in accessing neonatal surgical care; and the majority of their mothers had poor antenatal care during pregnancy, despite the apparent high health-facility delivery.