Prevalence and risk factors of birth asphyxia at Livingstone University teaching hospital

Birth asphyxia remains a leading cause of neonatal mortality in low-resource settings, with Zambia reporting a rate of 24 deaths per 1,000 live births. Birth asphyxia accounts for over 20% of neonatal ICU admissions. This study aimed to determine its prevalence and risk factors to inform targeted interventions. We conducted a secondary data analysis of medical records at Livingstone University Teaching Hospital, Zambia, including 497 maternal-neonatal records of deliveries between 15 July 2024 and 31 March 2025. Data were abstracted from the Obstetrics and Gynaecology Department and Neonatal Intensive Care Unit between 1 and 20 April 2025 using REDCap. The primary outcome was birth asphyxia, defined as failure to establish spontaneous respiration with Apgar ≤5 at 5 minutes or hypoxic-ischemic encephalopathy. Maternal, obstetric, and neonatal demographic and clinical variables were collected. Bivariate and multivariable logistic regression were used to identify factors associated with birth asphyxia, with statistical significance set at p < 0.05. The prevalence of birth asphyxia was 6.8% (34/497). Significant correlates included eclampsia (adjusted odds ratio [AOR]=17.3; 95% CI:2.7-111.0; p = 0.002), foetal distress (AOR = 7.3; 95% CI:2.5-20.9; p < 0.001), and resuscitation with suction (AOR = 3.8; 95% CI:1.2-11.5; p = 0.018) or facial oxygen (AOR = 3.5; 95% CI:1.0-11.6; p = 0.044). Neonates requiring bag-mask ventilation had 65.6% asphyxia rates versus 5% without (p < 0.001). Post-term gestation (15.2% asphyxia) and abnormal foetal heart rates (28.6%) were also associated with higher risk. The 6.8% asphyxia prevalence at LUTH reflects regional disparities, with eclampsia and foetal distress being critical modifiable risks. Strengthening emergency obstetric care, foetal monitoring, and neonatal resuscitation capacity could reduce preventable cases. These findings underscore the need for context-specific strategies to improve perinatal outcomes in Zambia and similar settings.