Arbaminch University

College of Medicine and Health Sciences

Departement of Public Health

Assessment of prevalence and associated factors among neonates in

Arbaminch General Hospital.
Prepared by
1 Dr Yeshanbel Habtamu
2 Dr Kibrom H/Mariam
3 Dr Fantu Bekele
4 Dr Natnael Getachew
5 Dr Mikiyas Abera

Advisors: Sultan Husein and Selamawit Gebeyehu

 A research proposal submitted to Arbaminch university, college of medicine and
other health sciences, public health department in partial fulfillment of the
requirements for degree of doctor of medicine

June, 2022

Arbaminch,Ethiopia

Arbaminch University College of medicine and Other Health Sciences

Department of Public Health Research Proposal Submission form

Full title of research project

Study area Arbaminch University,Arbaminch Town, Gamo

Zone,SNNPR,Ethiopia
Total budget
Source of funding
Investigators Dr yeshanbel habtamu
Dr kibrom H/Mariam
Dr fantu bekele
Dr mikiyas abera
Dr natinael getachew
advisors Selamawit Gebeyehu
Sultan Husien
Address of advisors 0933539505
0926160867

Acknowledgement
First of all we would like to thank our GOD and then, we would like to express the
deepest appreciation and gratitude to Arbaminch University, College of Medicine
and Health Science departments of public health for every arrangement mode for
our research ,AMGH. We also extend our appreciation to our advisor, Mr
Selamawit Gebeyehu and Mr Sultan Husien for their unreserved assistance,
timely guidance and comments from proposal development until completion of
this.

We also give great appreciation and thanks for those who make research on
assessment of neonatal death and associated factors of neonatal mortality.
Table of content

Acronyms ……………………………………………………………………….IV

List of tables and figures………………………………………………….iv

Abstract…………………………………………………………………………..v

Introduction------------------------------------------------------------6

Background ……………………………………………………………...6

Statement of the problem ………………………………………..6

Significance of the study……………………………………………7

Literature Review…………………………………………………………….8

Objectives………………………………………………………………………..10

General Objectives…………….……………………………...........10

Specific Objectives………………………………………………….…10.

Methods…………………………………………………………………….......10

Study area and period…………………………………………10

Study design ……………………………………………………….10

Source Population…………………….…………………………11

Study population……………………………………….…………11

Exclusion and inclusion criteria…………………………….11

Sample size determination…………………………………..11

Sampling technique/ Sampling procedure..12

Data collection tools and procedures……….12
Data processing and analysis…………………….12
Data quality assurance………………………………13
Study variables………………………………………….13
Ethical consideration……………………………………………..14
Work plan…………………………………………………………………………..15
Budget breakdown….………………………………………………………….16

References………………………………………………………………………….18
 ACRONYMS

AMGH…..Arbaminch General Hospital

NMR…. Neonatal mortality rate

ANC……Antenatal care

PNC…………Postnatal care develop

NICU…….. Neonatal intensive care unit

SNNPR ….. Southern Nations, Nationalities, and Peoples Region

AMZ……Arbaminch zuria
ABSTRACT

Background:
Neonatal death is loss of the newborn with in the first twenty eight
days of life. In many societies, neonatal deaths and stillbirths are not
perceived as a problem, largely because they are very common.
However, it is remains untold grief for the mother especially in
developing countries likes Ethiopia where its magnitude is very high.

Because of the high magnitude of the problem and its direct linkage
with the quality of health services during pregnancy, peripartum and in
the first month of the neonates’ life, neonatal mortality rate are used as
an important indicators of the health status of a country.

Therefore, this study will have a role in fighting against neonatal death
through gathering information about neonatal death and its possible
causes in the study area.

In 2017 alone, an estimated 6.3 million children and young adolescents

died, mostly from preventable causes.

Of all, about 2.5 million deaths occurred before celebrating their 28th
days.

Methods

Hospital based, descriptive cross section study will be conducted from

june 3 to june 30 2014 among neonates admitted to arbaminch general
hospital.
Prevalence and associated factors of neonatal death will be assessed.

Objectives

The main objective of this study is to assess neonatal deaths and its
causes in neonatal intensive care unit of Arbaminch general Hospital,
Gamo gofa Zone, South Ethiopia, 2014.

Methods

Institution based cross sectional study was done from June 3 to June
30, 2014. The registration book of admitted neonate was reviewed by
using che klist to collect data.
1 Introduction
1.1 Background
The neonatal mortality rate is defined as the annual number of deaths
less than 28 days of age per one thousand live births and is an important
indicator of health.

The majority of the neonatal deaths are concentrated in the first day and
week with about 1million dying on the first day and close to one million
dying within the next six days.
Neonatal deaths may be subdivided into early neonatal deaths occuring
during the first seven days of life (0-6 days), and late neonatal deaths
occurring after the seventh day but before the 28th day of life (7-27
days) .
 Reducing neonatal mortality is increasingly important not only because
the proportions of under-five deaths that occur during the neonatal
period is increasing as under-five mortality declines but also because the
health interventions needed to address the major causes of neonatal
deaths generally differ from those needed to address other under-five
deaths.

1.2. Statement of the problem

Despite improvements over the past decade, according to the 2016
Ethiopian demographic health survey (EDHS) report, the neonatal
mortality rate was 29 deaths per 1,000 live births which is still one of the
highest in the world .

Although being newborn is not a disease, large numbers of children die

soon after birth: many of them in the first four weeks of life(neonatal
deaths), and most of those during the first week.
Neonatal mortality rate is number of deaths among children below 28
days of age in a year per number of live births in the same year and it is
usually expressed per 1000 live birth. mortality rate (NMR) is an
important metric for measuring a society’s overall quality of lif

e.
NMRs are frequently used as a standard index for evaluating health,
education,and social systems, as well as nutritional status and health
programs for newborns in countries, and identifying the causes of
mortality is the first step in lowering mortality rates .
Although global neonatal mortality has dropped significantly from 5
million in 1990 to 2.4 million in 2019, newborn death still accounts for
47% of all deaths among children under the age of five, with nearly one-
third dying on the day of birth and nearly three-quarters dying within the
first week of life .

Each year, around 3.1million babies die in their first month of life
around the world, with the bulk of these deaths occurring in
underdeveloped countries .
More than 1.1 million newborn fatalities occur in Sub-Saharan Africa,
accounting for 28% of the global burden. Nigeria, Ethiopia, the
Democratic Republic of the Congo, and Tanzania each contribute 6%,
4%, 3%, and 2% of the global burden of neonatal mortality,respectively.

Perinatal death is related to problems such as intrauterine growth

restriction, embryonic asphyxia (such as fetal immaturity), severe
congenital malformations, early infection and neonatal risk, low birth
weight, premature birth, and fatal congenital abnormalities .
Some local studies conducted in Ethiopia have also reported that
sepsis, asphyxia, birth injuries, tetanus, preterm delivery, and
congenital malformations are primarily associated with neonatal
mortality .

According to diferent studies suggested there are many factors

contributing to neonatal mortality. Among these: educational level ,
sex of the neonate, duration of pregnancy , home delivery without
skilled provider , pregnancy complication , birth weight delay in
seeking care during illness , lack of preparedness of families and care
providers, harmful cultural practice, economic status , social exclusion,
maternal illiteracy , negative parental attitudes arising from the social
environment, gender bias, inability to pay for care , and lack of basic
prenatal, natal, and postnatal services were the main determinants.

As to the best knowledge of the researcher, neonatal mortality and its

associated factors in the hospital are not studied and are not well
documented mainly at the institutional level including in this study
area,AMGH.
Neonatal disease patterns and outcomes are important indicators for
sufficient health care planning and the outcomes are the changes in
health status on which nursing and medical care have direct infuence.

Besides those programs, improving women’s autonomy might be

produce good outcome for neonate health.

When we say women’s autonomy is the ability to access information

and make decisions about one’s own Business . Hence, women’s
autonomy undoubtedly contributes to several health advantages for
both the mother and their children and it’s a priority of proceeding
generations.

Evidence suggests that women in developing countries often have

limited autonomy and control over their health regarded decisions .
Even though, both the maternal and neonatal health provision needs a
multi-sector approach a robust decision making autonomy of the
mother is vital for reversing back the barriers at the household level .
Because, limited women’s decision-making power delays maternal
healthcare utilization like antenatal care (ANC), postnatal care (PNC),
and delivery health institutions .

Besides, limited participation in access to health services for their

interest, lower involvement of women in a decision has also impact on
the socio-economic, emotional, fertility decision, contraceptive use,
and sexual lifetime of the women , which results in an entire population
problem.
Therefore, the purpose of this study was to assess neonatal mortality
and associated factors among neonates admitted to the neonatal
intensive care unit (NICU) of AMGH

1.3. Rational of the study

The main aim of this study is decreasing the prevalence of neonatal

mortality in AMGH by decreasing causes which leads to neonatal
mortality,this are mainly perinatal infection ,perinatal asphyxia and
complication of prematurity and even to the extent of increasing the
quality of early antenatal care follow up.

Therefore the result of this study will have a great contribution to

improve the quality of services provided in the given areas.

The study may help the government of Ethiopia and development

partners to tailor their interventions based on the heterogeneity of the
capacities of the health facilities in Ethiopia. The study could also help
other countries to design similar studies to improve the capacity of the
health facilities and quality of neonatal intensive care unit and
treatment.
2. Literature review

According to literatures combining all significant variables related to

maternal, neonatal, and delivery factors associated with higher risk of neonatal
death.

64.2% of males and 35.8% of females who were admitted at public hospitals ,
pastoral region , Ethiopia 81.1% of them were to NICU at less than 7 days of life.

The maternal chart review revealed that more than two thirds of the mothers
had adequate ANC follow up and majority of the mothers gave birth through
SVD.of the total mothers 72.6% of them had history of multigravida and only
3.3% of the mothers had known recorded medical illnesses during pregnancy.

The neonatal chart review found that 23.5% were preterm and 30.2% of them
had a birth weight less than 2.5KG.in addition 69.1% of the neonate had a
resuscitation history at birth and only 2.6% of the admitted patients were from
HIV positive mothers. The leading cause of admission were EONS(43.5%),
LBW(27.1%),and prematurity(23.5%).and the leading cause of neonatal
mortality were prematuriy(43.9%) , early onset neonatal sepsis(35.1%),low birth
weight(33.4%),and birth asphyxia(21.1%)

Neonates born from mothers who did not receive ANC follow up during
pregnancy had 4.7 times a greater odds of neonatal mortality compared to
neonates born from mothers who had ANC follow up. The odds of neonatal
mortalities among neonates born from through cesarean section was 3,6%
times greater compared to neonates born through SVD. neonates who
admitted because of birth asphyxia had 7.1% times greater of neonatal death
compared to those who were not asphyxiated . the odds of neonatal death
among neonates who had a body temperature less than 36.5 at admission was
10.7% higher compared to neonates who had a normal body temperature at
admission .

3. Objectives

3.1. General Objective

To assess the prevalence and associated factors of neonatal mortality among

neonates admitted to AMGH

3.2. Specific Objectives

To assess the prevalence of neonatal mortality in AMGH

To assess the causes of neonatal mortality in AMGH

4. Methods and materials

4.1. Study area and period

The study will be conducted in AMGH whic is found in arbaminch town

is the administrative center for Gamo gofa zone of the SNNPR about
500 kilometers south of Addis Ababa, at an elevation of 1285 meters
above sea level. It is the largest town in Gamo Zone and the second
town in SNNPR next to Hawassa, which is now the capital city of newly
formed Sidama Region. It is surrounded by AMZ woreda. This Town has
plenty of natural gifts including the bridge of God, Crocodile ranch,
crocodile market, different fruits and vegetables, different fishes
farmed from Chamo and Abaya Lakes, more than 40 springs, different
cereals, and crops, surprisingly having the two big Lakes in the country,
lake Abaya and Chamo, respectively, next to Lake Tana, etc. This makes
the town an attraction for domestic and international tourism.

The study will be done within one month from june 3 to 30 E.c.

4.2. Study Design

Among descriptive study designs, cross sectional study is the preferred

design to conduct.

4.3. Source Population

The source populations constituted all neonates admitted to AMGH

4.4. Study population

Neonates who are admitted to neonatal intensive care unit in AMGH .

4.5. Inclusion and exclusion criteria

All neonates born and admitted to intensive neonatal care unit of
AMGH, whose age less than 28 days were included in the study.

Sample size determination

The sample size was determined by using single population
proportion formulas .
For the single population formula,We used a 4% margin of error, 95%
confdence interval and Prevalence of Neonatal mortality (35.5%) from
the previous study conducted in Jimma Zone [9] and the calculated
sample size was 549.
N=( 1.96 X 1.96) X0.355( 1-0.355)/(0.04 X0.04)=54.97

By taking additional 5% contingency for non-response

rate, 5%*54.9 = 2.745, therefore the total sample size

found to be = 58.

4.8. Sampling technique/ Sampling procedure

We are going to perform cross-sectional study in neonates who fulfill

the inclusion criteria to assess the prevalence and causes of neonatal
mortality in AMGH.
Simple random sampling method will be employed for this study.

4.9. Data collection tools and procedures

First we will get permission from AMU then from AMGH.

We will use patient medical record review to extract and counter check
the clinical data reports of the participants.

The data will be collected by

The registration book of admitted neonates in NICU taken and then all
needed data according to the objectives were recorded by using the
check lists.

4.10. Data processing and analysis

The collected data were checked for completeness and
coded manually first and entered into EPI info 7.2 software,
and then, were exported to SPSS version 23 software
for data cleaning, coding, and analyses.
Descriptive statistics like frequencies with percentage
and mean with standard deviation were used to describe
the study population. Bi-variable and multivariable logistic
regression analyses were performed to test the association.
Variables that had a P-value of 0.2 and less were
considered for the multivariable analysis. The odds ratio
with 95% CI was considered to determine the presence of
an association between the dependent and independent
variables.
Variables of the study
The dependent variable in this study will neonatal mortality.
whereas the explanatory variables were socio demographic and socio-
economic factors such as maternal age, maternal education, place of
residence,marital status, economic status and religion, reproductive and
obstetric factors (complication during pregnancy,parity, ANC, birth
order interval, PR OM, type (mode) of delivery, TT immunization,
gestational age at birth, initiation of breastfeeding, exclusive
breastfeeding),health care practice and related factors (place of delivery
and skilled birth attendant), neonatal related factors age at admission,
sex of the baby, birth weight of the baby, APGAR score) and medical
factors (hypothermia, hypoglycemia, asphyxia, infection, prematurity,
congenital malformation, and birth trauma).
Ethics Approval and Consent to Participate
This study was not involved in any experiment on human subjects.

Ethical approval will be obtained from Arba Minch University College of

Medicine and Health Sciences, Institutional Review Board to communicate with
hospital administrative body. Permission letter will be obtained from
administrative body of Arba Minch General Hospital.
Project work Plan

6.Budget
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