Hospital-onset Neonatal Sepsis and Mortality in Low-resource Settings: Will Bundles Save the Day?

Community-based mortality surveillance among internally displaced vulnerable populations in Banadir region, Somalia, 2022-2023

Somalia faces a severe humanitarian crisis driven by conflict, drought, and rising food prices, straining its fragile health system. Internally displaced persons (IDPs) suffer high mortality rates, yet data on causes of death remain limited. This study integrates verbal autopsy (VA) with community-based surveillance (CBS) to identify mortality causes in IDP populations. A hybrid retrospective-prospective mortality surveillance study was conducted in 57 IDP camps across Daynile and Kahda districts, Banadir region, from October 2022 to November 2023. Retrospective baseline data from 20,323 individuals were collected in January-February 2023, followed by prospective surveillance rounds in March, April, and May-November 2023. Causes of death were determined using WHO-standardized VA methods. During the retrospective period, Daynile had a CDR of 3.15 per 10,000 person-time, while Kahda's was 1.26. Mortality rates fluctuated, showing significant reductions at certain times. Over the prospective data collection period, the overall CDR was 0.64 per 10,000 person-time. Verbal autopsies revealed that severe malnutrition, respiratory infections, and diarrheal diseases were the leading causes of death. Among children under five, malnutrition, measles, and neonatal pneumonia were the primary causes. Our study highlights the severe impact of malnutrition and infectious diseases on mortality rates among IDPs in Banadir. Continuous surveillance and targeted health interventions are crucial to address the ongoing humanitarian crisis in Somalia. Enhancing training for data collectors and fostering community engagement can improve data accuracy and support timely humanitarian responses.

Modelling mortality within 28 days among preterm infants at a tertiary hospital in Lusaka, Zambia: a retrospective review of hospital-based records

Introduction

globally, almost half of all deaths in children under five years of age occur among neonates. We investigated the predictors of mortality within 28 days among preterm infants at a tertiary hospital in Lusaka, Zambia.

Methods

we reviewed admission records linked to birth, mortality, and hospital discharge from 1^st January 2018 to 30^th September 2019. Information was retrieved with a follow-up period of 28 days post-delivery to discharge/mortality. We used the Weibull hazards regression to establish the best predictor model for mortality among the neonates.

Results

a total of 3237 case records of women with a median age of 27 years (IQR, 22-33) were included in the study, of which 971 (30%) delivered term infants and 2267 (70%) preterm infants. The overall median survival time of the infants was 98 hours (IQR, 34-360). Preterm birth was not associated with increased hazards of mortality compared to term birth (p=0.078). Being in the Kangaroo Mother Care compared to Neonatal Intensive Care Unit (NICU), and a unit increase in birth weight were independently associated with reduced hazards of mortality. On the other hand, having hypoxic-ischemic encephalopathy, experiencing difficulty in feeding and vaginal delivery compared to caesarean section independently increased the hazards of mortality.

Conclusion

having hypoxic-ischemic encephalopathy, vaginal delivery, and experiencing difficulty in feeding increases the risk of mortality among neonates. Interventions to reduce neonatal mortality should be directed on these factors in this setting.