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Updated: Nov 3, 2025
Biochemical Measurement of Neonatal Hypoxia
Published on: August 24, 2011
Neonatal mortality in Kenyan hospitals: a multisite, retrospective, cohort study
Grace Irimu1,2, Jalemba Aluvaala3,2, Lucas Malla2
1Department of Paediatrics and Child Health, University of Nairobi, Nairobi, Kenya GIrimu@kemri-wellcome.org.
Insights
Neonatal deaths in Kenyan hospitals are high, with 46% of admissions being neonates who account for 66% of deaths. Most neonatal deaths are preventable, indicating a need for improved newborn care quality and data monitoring.
Area of Science:
- Global Health
- Neonatalogy
- Public Health Data
Background:
- Preventable neonatal deaths are a major concern in low- and middle-income countries (LMICs).
- Poor routine health data hinders efforts to improve newborn care quality in hospitals.
- Essential facility-based inpatient care is crucial for reducing neonatal mortality.
Purpose of the Study:
- To analyze neonatal mortality patterns in Kenyan public hospitals.
- To assess variations in newborn care quality across facilities.
- To identify key factors contributing to neonatal deaths.
Main Methods:
- Analysis of routine patient data from newborn units (NBUs) and pediatric wards in 16 Kenyan public hospitals.
- Inclusion of data for all admissions (0-13 years) from 14 hospitals over a defined study period.
- Stratification of morbidity and mortality patterns by birth weight and hospital.
Main Results:
- Neonates constituted 46% of admissions but 66% of deaths in the 0-13 year age group.
- The crude mortality rate for admitted neonates was 10.2%, with 60% dying on admission day.
- Intrapartum complications were the leading cause of death for neonates >=2000g; significant hospital variation in mortality was observed for lower birth weight categories.
Conclusions:
- High neonatal mortality in hospitals suggests shifts in childhood mortality patterns.
- Over 95% of neonatal deaths were due to preventable causes.
- Despite available interventions, significant and variable mortality rates persist across hospitals, highlighting data quality and care improvement needs.
Background:
Most of the deaths among neonates in low-income and middle-income countries (LMICs) can be prevented through universal access to basic high-quality health services including essential facility-based inpatient care. However, poor routine data undermines data-informed efforts to monitor and promote improvements in the quality of newborn care across hospitals.
Methods:
Continuously collected routine patients' data from structured paper record forms for all admissions to newborn units (NBUs) from 16 purposively selected Kenyan public hospitals that are part of a clinical information network were analysed together with data from all paediatric admissions ages 0-13 years from 14 of these hospitals. Data are used to show the proportion of all admissions and deaths in the neonatal age group and examine morbidity and mortality patterns, stratified by birth weight, and their variation across hospitals.
Findings:
During the 354 hospital months study period, 90 222 patients were admitted to the 14 hospitals contributing NBU and general paediatric ward data. 46% of all the admissions were neonates (aged 0-28 days), but they accounted for 66% of the deaths in the age group 0-13 years. 41 657 inborn neonates were admitted in the NBUs across the 16 hospitals during the study period. 4266/41 657 died giving a crude mortality rate of 10.2% (95% CI 9.97% to 10.55%), with 60% of these deaths occurring on the first-day of admission. Intrapartum-related complications was the single most common diagnosis among the neonates with birth weight of 2000 g or more who died. A threefold variation in mortality across hospitals was observed for birth weight categories 1000-1499 g and 1500-1999 g.
Interpretation:
The high proportion of neonatal deaths in hospitals may reflect changing patterns of childhood mortality. Majority of newborns died of preventable causes (>95%). Despite availability of high-impact low-cost interventions, hospitals have high and very variable mortality proportions after stratification by birth weight.
