Community-based new born care practice and its associated factors among women who give birth at home in Ethiopia: cross-sectional study

BACKGROUND

In Ethiopia, perinatal mortality rate was 33 per 1000 pregnancies and 64.4% of this death was occurred within the first 7 days of neonatal life. Moreover, more than 2.1% of new born babies were died within their first seven days of life in Ethiopia. Majority of neonatal deaths are preventable by applying an effective and lifesaving interventions. However, little is known about newborn care practice at the community level.

METHODS

A community-based cross-sectional study design was used. Multi-stage sampling techniques were used to get a total of 540 mothers who gave birth at home within the past six months from their kebeles in Ethiopia. Data was collected by using face-to-face interview with structured questionnaires. Then the data was coded, cleaned, and entered into Epidemiological data version 3.1 and exported to statistical package for social science version 23.0 for analyses. Bivariate and multivariable logistic regression model was used to identify statistically significant associations between dependent and independent variables. The odds ratio at 95% confidence interval with P-Value 0.05% was computed.

RESULTS

A total of 540 women were participated with a response rate of 98.3%. Only 208 (44%) of the women had good practice towards essential newborn care. Head of households [AOR (95%CI) 2.7417 (1.80-4.25)], type of birth attendant [AOR (95%CI) 3.962 (3.329-7.171)] and bad obstetrical history [AOR (95%CI) 3.151 (2.209-4.969)] were significantly associated with maternal newborn care practice.

CONCLUSION

Less than half of the mothers had good newborn care practice. In this study, head of household, type of birth attendant, and bad obstetrical history were significantly associated with maternal newborn care practice. Therefore, Ministry of Women and Woreda women and Child offices needs to promote the socioeconomic empowerment of women to increase the practice of essential newborn care practices.

Predicting developmental dysplasia of the hip in at-risk newborns

Background

The development of developmental dysplasia of the hip can be attributed to several risk factors and often in combination with each other. When predicting the likelihood of developing this condition, clinicians tend to over and underestimate its likelihood of occurring.

Therefore, the study aim is to determine among at-risk newborns how to best predict developmental dysplasia of the hip (DDH) within 8 weeks post-partum.

Methods

Prospective cohort study in secondary care. Patient population included newborns at-risk for DDH – we assessed 13,276 consecutive newborns for the presence of DDH risk factors. Only newborns with at least one of the predefined risk factors and those showing an abnormal examination of the hip were enrolled (n = 2191). For the development of a risk prediction model we considered 9 candidate predictors and other variables readily available at childbirth.

The main outcome measure was ultrasonography at a median age of 8 weeks using consensus diagnostic criteria; outcome assessors were blinded.

Results

The risk model includes four predictors: female sex (OR = 5.6; 95% CI: 2.9–10.9; P <  0.001); first degree family history of DDH (OR = 4.5; 95% CI: 2.3–9.0; P <  0.001), birthweight > 4000 g (OR = 1.6; 95% CI: 0.6–4.2; P = 0.34), and abnormal examination of hip (OR = 58.8; 95% CI: 31.9, 108.5; P <  0.001). This model demonstrated excellent discrimination (C statistic = 0.9) and calibration of observed and predicted risk (P = 0.35). A model without the variable ‘hip examination’ demonstrated similar performance.

Conclusion

The risk model quantifies absolute risk of DDH within 8 weeks postpartum in at-risk newborns. Based on clinical variables readily available at the point of childbirth, the model will enhance parental counselling and could serve as the basis for real time decisions prior to discharge from maternity wards.

Risk factors of neonatal mortality in Iran: a systematic review

Background: Reducing neonatal mortality is an important measure to reduce the overall under-five-years' mortality. Identifying the risk factors is the first step in this regard. This study performed with the aim of determining the risk factors of the neonatal mortality in Iran. Methods: Databases of SID, MagIran, IranMedex, IronDoc and Google Scholar for the Persian resources and Scopus, Science Direct, PubMed, Ovid, EMBASE, ISI web of science and Cochrane for English resources were searched up to January 2017. The inclusion criteria were the studies analyzing at least one risk factor for neonatal mortality in Iran with a control group and multivariate regression analysis. Eight papers met the inclusion criteria. The risk factors were extracted and tabulated. Results: Of the 1713 records retrieved, 8 were eligible to include in the analysis. Preterm birth, low birth weight, smoking and addiction, and anomaly were the important risk factors of neonatal mortality in Iran. Moreover, an extended list of potential risk factors identified on most of which the evidence was controversial and insufficient. The factors categorized into modifiable and identifiable ones. Conclusion: On the modifiable risk factors, proper intervention, and on the non-modifiable ones, early detection and special care may be helpful in preventing the babies from death. Population-based studies with large sample size and multivariate analysis are needed to make clear the effect size of the identified risk factors.

Congenital Acute Myeloid Leukaemia with Pseudo-Chediak-Higashi Like Granules: A Case Report

Congenital leukaemia is a very rare entity comprising 0.8% of all childhood leukaemias. Pseudo-Chediak-Higashi Anomaly (PCHA) in acute leukaemia is a rarely described entity. However, co-existence of congenital myeloid leukaemia with PCHA is a very rare entity and to the best of our knowledge has not been described in literature till date. A full term new-born presented on the 27^th day of life with severe gastroenteritis. Complete blood counts and peripheral smear examination revealed leucocytosis with presence of 76% blast cells. Approximately 15% of these blast cells showed presence of pseudo-Chediak-Higashi like granules. The diagnosis of acute myeloid leukaemia was confirmed by flow cytometry. The case report is presented due to its rarity and to highlight the differential diagnosis and clinical implications of this entity.

Pulmonary rhabdomyomatous dysplasia of the newborn in neurofibromatosis type 1

Proliferation of non-neoplastic striated muscle cells in the lung is rare and has been frequently observed in cases of cardiovascular and pulmonary congenital malformations. We present an extremely rare case of pulmonary rhabdomyomatous dysplasia (RD) in neurofibromatosis type 1 (NF-1). A male neonate was born at 35 weeks' gestation after normal pregnancy. Postnatally, besides patent ductus arteriosus and posterior mediastinal mass, abnormal cystic lesions in the left upper and lower lung were detected. No bronchial atresia and stenosis were identified. Partial lobectomy specimens showed hypoplastic lung parenchyma with cystic lesions resembling terminal bronchioles and distinctive proliferation of non-neoplastic striated muscle fibers in the interstitium. The posterior mediastinal mass consisted of neurofibroma. Considering that café au lait spots and freckling occurred at 2 months of age, a diagnosis of NF-1 was made. The patient died of aspiration pneumonia at the age of 30 months. To the best of our knowledge, this is the first case of pulmonary RD in NF-1.

Hemolytic Disease of the Newborn Due to Anti-c Isoimmunization: A Case Report

The Rhesus (Rh) blood group is one of the most complex blood groups known in humans. It has remained of primary importance in obstetrics, being the main cause of hemolytic disease of the newborn (HDN). Anti-D causes the most severe form of HDN. Other Rh allo antibodies that are capable of causing severe HDN include anti-c, which clinically is the most important Rh antigen after the D antigen. We report a case of hemolytic disease of the newborn due to Rh anti-c in an infant of an Rh positive mother.

Large mucocele involving the ventral surface of tongue in a new born: rare occurrence

This report describes a case of new born baby with large swelling involving the ventral surface of the tongue. Antenatal history was not significant. The swelling was causing difficulty in breathing and deglutition. The swelling was excised completely. Histological report was suggestive of intravasation cyst.