HIGH BURDEN OF PERINATAL ASPHYXIA AT A TERTIARY REFERRAL HOSPITAL IN THE GAMBIA: PREVALENCE AND MODIFIABLE RISK FACTORS

Abstract

Background: Perinatal asphyxia (PNA) is a leading cause of neonatal mortality and morbidity, disproportionately affecting low resource settings. The Gambia lacks recent, facility-specific data on its burden and determinants, hindering interventions. targeted
Objective: To determine the prevalence of PNA and identify associated maternal and neonatal risk factors at the Edward Francis Small Teaching Hospital (EFSTH), The Gambia’s primary tertiary referral center.
Methods: A retrospective cohort study was conducted. The prevalence was calculated from all live births (n = 3,936) between January 2022 and June 2023. For risk factor analysis, a case-control design was employed among inborn neonates admitted to the Neonatal Intensive Care Unit (NICU) from January to December 2022 (n = 315). Cases were neonates with PNA (5-minute Apgar score <7 and/or requiring prolonged positive pressure ventilation). Controls were non asphyxiated NICU admissions. Bivariate and multivariable logistic regression analyses were performed to identify independent risk factors.
Results: The prevalence of PNA among live births was 3.15% (124/3936). PNA accounted for 33.7% (106/315) of all NICU admissions, with a case fatality rate of 30.2%. Multivariable analysis identified several independent risk factors: meconium-stained amniotic fluid (aOR=14.8, 95% CI: 8.12 26.86, p<0.001), obstructed labour (aOR=4.3, 95% CI: 2.56–7.26, p<0.001), birth weight ≥2.5kg (aOR=2.6, 95% CI: 1.59–4.36, p<0.001), term gestation (≥37 weeks) (aOR=2.3, 95% CI: 1.37–3.91, p=0.002), primiparity (aOR=1.8, 95% CI: 1.10–2.88, p=0.02), and lack of maternal formal education (aOR=1.8, 95% CI: 1.07-3.03, p=0.03).
Conclusion: Perinatal asphyxia represents a significant burden at EFSTH, driven by intrapartum complications and deep-rooted social factors. A multi-faceted intervention strategy is urgently needed, encompassing improved intrapartum monitoring and emergency obstetric care, enhanced neonatal resuscitation, and long-term investments in female education.