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Background: Globally, approximately 4.1 million infants died, accounting for 75% of all under-five deaths. In sub-Saharan Africa (SSA), infant mortality was 52.7/1000 live births in 2018 This study aimed to assess the pooled estimate of infant mortality rate (IMR), time to death, and its associated factors in SSA using the recent demographic and health survey dataset between 2010 and 2018., Methods: Data were retrieved from the standard demographic and health survey datasets among 33 SSA countries. A total of 93,765 samples were included. The data were cleaned using Microsoft Excel and STATA software. Data analysis was done using R and STATA software. Parametric shared frailty survival analysis was employed. Statistical significance was declared as a two-side P-value < 0.05., Results: The pooled estimate of IMR in SSA was 51 per 1000 live births (95% Confidence Interval (CI): 46.65-55.21). The pooled estimate of the IMR was 53 in Central, 44 in Eastern, 44 in Southern, and 57 in Western Africa per 1000 live births. The cumulative survival probability at the end of 1 year was 56%. Multiple births (Adjusted Hazard ratio (AHR) = 2.68, 95% CI: 2.54-2.82), low birth weight infants (AHR = 1.28, 95% CI: 1.22-1.34), teenage pregnancy (AHR = 1.19, 95 CI: 1.10-1.29), preceding birth interval <  18 months (AHR = 3.27, 95% CI: 3.10-3.45), birth order ≥ four (AHR = 1.14, 95% CI:1.10-1.19), home delivery (AHR = 1.08, 95% CI: 1.04-1.13), and unimproved water source (AHR = 1.07, 95% CI: 1.01-1.13), female sex (AHR = 0.86, 95% CI: 0.83-0.89), immediately breastfeed (AHR = 0.24, 95% CI: 0.23-0.25), and educated mother (AHR = 0.88, 95% CI: 0.82-0. 95) and educated father (AHR = 0.90, 95% CI: 0.85-0.96) were statistically significant factors for infant mortality., Conclusion: Significant number of infants died in SSA. The most common cause of infant death is a preventable bio-demographic factor. To reduce infant mortality in the region, policymakers and other stakeholders should pay attention to preventable bio-demographic risk factors, enhance women education and improved water sources., (© 2021. The Author(s).)

Background: Neonatal sepsis is a significant cause of morbidity and mortality in low- income countries. Neonatal sepsis is classified as early-onset neonatal sepsis (EONS) and late-onset neonatal sepsis (LONS). Etiologies responsible for EONS are mostly acquired vertically from the mother during or before birth with the possibility of prevention. The burden and etiology of neonatal sepsis is not uniform across the globe with huge disparities based on the income level of the countries. This study aimed to determine neonatal sepsis trends, prevalence, and etiologies at Hawassa University Comprehensive Specialised Hospital (HUCSH). Methods: A hospital-based retrospective cross-sectional study was conducted among newborns aged 0 to 90 days who were admitted to the HUCSH from January 2019 to July 2023. Patient-related information and the culture results were obtained from HUCSH microbiology laboratory registration book. Data analysis was performed using SPSS version 25 software. Results: Out of 2364 newborns suspected of having sepsis, 56% (95% CI: 54−58%) had culture-confirmed sepsis. When excluding Coagulase Negative Staphylococcus (CONS), the prevalence of culture-confirmed neonatal sepsis was 36.9%. The highest numbers of culture-confirmed cases was observed in 2021. The predominant bacteria identified were Coagulase Negative Staphylococcus (CONS) (34.1%), Klebsiella pneumoniae (12.9%), and Enterococcus (10.6%). Among culture-confirmed neonatal sepsis, 59.9% and 40.1% of cases were EONS and LONS, respectively. Coagulase Negative Staphylococcus and Enterococcus were the major bacteria found in both EONS and LONS while. Klebsiella pneumoniae was the second most common bacteria among newborns with EONS following CONS. Conclusions: The prevalence of culture-confirmed neonatal sepsis was relatively high in the study area. Early-onset neonatal sepsis was consistently more prevalent than LONS. The predominant etiologies of neonatal sepsis excluding CONS were K. pneumoniae, Enterococcus, Enterobacter agglomerans, Acinetobacter species, and Staphylococcus aureus. Among newborns with EONS, the predominant bacteria were K. pneumoniae, Enterococcus, Enterobacter agglomerans, and Acinetobacter species. [ABSTRACT FROM AUTHOR]

Background: An estimated 75.8 under-five deaths per 1000 live births occurred in sub-Saharan Africa. This study aimed to investigate the prevalence and factors associated with under-five mortality in Sub-Saharan Africa. Methods: This study was based on secondary data sources from 33 Sub-Saharan countries' recent Demography and Health surveys from 2010 to 2020. A weighted sample of 360,397 under-five children was included in the study. Bayesian multilevel binary logistic regression was fitted using the brms R package. Besides, leave one out information criteria was used for model comparison. The adjusted odds ratio (AOR) and its 95% credible interval (CrI) were reported for significant factors associated with under-five mortality. Clinical trial number: not applicable. Results: The prevalence of under-five mortality in sub Saharan Africa was 62 per 1000 live births (95%CI (56.29, 68.29). In sub region of SSA, it was 65 in central, 52 in eastern, 50 in southern and 73 in western region per 1000 live births. Multiple birth (AOR = 5.27; 95%CrI: 4.72, 5.87), number of under-five children 3 to 5 (AOR = 3.31; 95%CrI: 3.01, 3.60), caesarean section delivery (AOR = 1.64; 95%CrI: 1.47, 1.83), being unmarried (AOR = 1.16; 95%CrI 1.08, 1.26), using unimproved toilet (AOR = 1.08;95%CrI: 1.02, 1.16), birth order of 4th to 6th (AOR = 1.18; 95%CrI:1.1, 1.25),were risk factors of under-five mortality. Whereas, being female (AOR = 0.86; 95%CrI: 0.82, 0.91), preceding birth interval of 24–35 months (AOR = 0.61; 95%CrI: 0.57, 0.65) and above 36 months (AOR = 0.48; 95%CrI: 0.43, 0.49), ANC visit (AOR = 0.80; 95%CrI: 0.74 0.86), contraceptive use (AOR = 0.57; 95%CrI: 0.53, 0.61), were preventive factors of under-five mortality. Conclusion: Under-five mortality remains the highest in sub-Saharan Africa. Most of the risk factors of under-five mortality were found to be preventable. Policymakers and other stakeholders should enhance maternal education, lengthen birth interval, ANC visit, improved toilet facilities and, giving special attention to small size child and cesarean section delivery to reduce under-five mortality. [ABSTRACT FROM AUTHOR]

Objective: To investigate the demographic characteristics, maternal, and perinatal factors associated with the hospitalization of moderate to late preterm and term neonates within 72 h of birth in the Dedza and Mangochi districts of Malawi. Methods: This case-control study was conducted with one-to-one matching for age, location, and sex. Cases were sick neonates who were admitted in the Sick Intensive Neonatal Care Unit (SINCU) within 72 h of life, while controls were non-sick neonates delivered within two weeks of the birth dates of cases. Prenatal data were extracted from case files, while other maternal practices and demographic characteristics were obtained by interviewing primary care takers or legal guardians after obtaining consent. Descriptive analyses and logistic regression were used to identify factors associated with hospitalization of moderate to late preterm and term neonates within 72 h of birth. Results: Application of tetracycline eye ointment (AOR: 0.41, 95% CI: 0.20–0.82, p = 0.012) applying chlorhexidine to the umbilical cord stump (AOR: 0.30, 95% CI: 0.10–0.88, p = 0.027), and stimulation resuscitation (AOR: 0.20, 95% CI: 0.05–0.78, p = 0.020) were associated with a reduced odd of hospitalization. An increased odds of hospitalization was significantly associated with low birth weight (AOR: 10.48, 95% CI: 4.25–25.89, p = 0.001), Apgar score < 5 (AOR: 5.0, 95% CI: 2.14–11.63, p = 0.001), suctioning resuscitation (AOR: 2.82, 95% CI: 1.17–6.83, p = 0.021), and resuscitation using O2 (AOR: 4.23, 95% CI: 1.32–13.56, p = 0.015). Maternal factors associated with reduced odds of hospitalization included the mother testing positive and successfully treated for syphilis antenatally (AOR: 0.06, 95% CI: 0.02–0.18, p = 0.001) and the mother being married (AOR: 0.39, 95% CI: 0.16–0.93, p = 0.34). Maternal factors associated with an increased odds of hospitalization include premature rupture of membranes (AOR: 2.49, 95% CI: 1.12–5.52, p = 0.025) and presence of meconium stain during delivery (AOR: 3.14, 95% CI: 1.63–6.06, p = 0.001). Conclusion: The research findings indicate that several interventions significantly reduce infections in neonates within their initial 72 h of life. These include the application of ophthalmic ointment to all neonates, utilization of chlorhexidine on the umbilical cord stump, and provision of antenatal treatment for syphilis and HIV in infected mothers. Conversely, certain factors increase the likelihood of neonatal morbidity and potential hospitalization during this critical period. These risk factors include low birth weight, a low Apgar score, and conditions necessitating suctioning or oxygen resuscitation at birth. Furthermore, infants born to mothers who experienced premature rupture of membranes or meconium-stained amniotic fluid during parturition are more susceptible to infectious conditions, which may necessitate hospitalization within the first 72 h postpartum. We recommend that stimulation be used as the core procedure for resuscitation, whereas suctioning should be used with caution and only when it is essential. Infection prevention measures should always be adhered to during all procedures on neonates. We recommend intensifying HIV and syphilis testing and treating during the antenatal period to reduce neonatal infection. [ABSTRACT FROM AUTHOR]

Background: Birth defects (BDs) are the major causes of infant morbidity and mortality in both developed and developing countries. Regardless of their clinical importance, few studies on predisposing factors have been conducted in Ethiopia. However, due to a lack of advanced diagnostic materials, we only considered the externally visible BDs. Objective: To assess the determinants of externally visible birth defects among perinatal deaths at Adama Comprehensive Specialized Hospital. Methods: A retrospective unmatched case-control study design was conducted from November 01 to 30, 2021. The sample size was determined by Epi Info version 7 software considering sample size calculation for an unmatched case-control study. A total of 315 participants (63 cases, and 252 controls) were selected by simple random sampling. Data were collected by an open data kit (ODK) and transported to a statical package for social sciences (SPSS) version 26 software for analysis. The bivariate followed by multivariable logistic regression analyses were done to determine the factors associated with the BD. Results: This study showed that drinking alcohol during pregnancy (AOR = 6.575; 95% CI: 3.102,13.937), lack of antenatal care (ANC) follow-up during pregnancy (AOR = 2.794; 95% CI: 1.333, 5.859), having a history of stillbirth in a previous pregnancy (AOR = 3.967; 95% CI: 1.772, 8.881), exposure to pesticides during pregnancy (AOR = 4.840; 95% CI: 1.375, 17.034), having a history of BDs in a previous pregnancy (AOR = 4.853; 95% CI: 1.492, 15.788), and lack of folic acid supplementation during early pregnancy (AOR = 4.324; 95% CI: 2.062, 9.067) were significant determinants of externally visible BDs among perinatal deaths. Conclusion: In this study, alcohol use, exposure to pesticides, and lack of folic acid supplementation during pregnancy were identified as the major determinants of externally visible BDs among perinatal deaths. Thus, health education regarding the associated factors of BDs and their preventive strategies should be given to pregnant mothers. [ABSTRACT FROM AUTHOR]

Background: Under-five child mortality (UFCM) is one of the major significant and sensitive indicators of the health status of the public. Although the world has seen a remarkable and substantial decrease in UFCM since 1990, its progression rate still remains alarmingly high in Sub-Saharan African (SSA) countries, particularly in Ethiopia. Therefore, this study aimed to assess associations between mortality and under-five children in rural Ethiopia. Methods: This study used a secondary data analysis of the 2019 Ethiopia Mini Demographic and Health Survey (EMDHS) report. A total of 4,425 under-five children were included in the final analysis. The Kaplan-Meier (K-M) and Cox proportional hazard (PH) model analyses were utilized to estimate survival time and investigate the major predictors of mortality in under-five children, respectively. An adjusted hazard ratio (AHR) along with a 95% confidence interval (CI) was employed to measure the association size and direction of the association (STATA 12). Results: The study showed that 6.2% (95% CI: 5.43, 6.86) of children died beforehand celebrating their fifth birthday in rural Ethiopia. The multivariable Cox PH regression model analysis revealed associations of large spacing preceding birth interval (16–26 months) (AHR = 0.61; 95% CI: (0.402–0.920)), 27–38 months (AHR = 0.72; 95% CI: (0.496–1.03)), and ≥ 39 months, multiple births (AHR = 3.9; 95% CI: (2.77–5.62)), being breastfeeding (AHR = 0.13; 95% CI: (0.099–0.162)), and unvaccinated child (AHR = 11.6; 95% CI: (1.62–83.1)) were significant associations of under-five children mortality. Conclusions: In this study, the UFCM rate was present, with 6.2% in the rural areas of Ethiopia. The birth type, preceding birth interval, vaccination of the child, and breastfeeding are identified as significant associations with under-five child mortality in rural Ethiopia. Therefore, public health interventions should be given attention to multiple births, unvaccinated, and non-breastfeeding children, as well as mothers' better encouragement to have a large spacing preceding the birth interval. Moreover, investigators should conduct continuous research on UFCM, which is imperative to provide current information and inform interventions in a timely manner. [ABSTRACT FROM AUTHOR]

Background: Sub-Saharan African countries are a high-burden region of neonatal mortality and showed slow progress in its reduction. In developing countries, as long as the current trend of mortality persists, achieving a sustainable development target for neonatal mortality would be challenging. The aim of this study was to detect significant geographic areas and identify community and individual-level predictors of neonatal mortality in Ethiopia to draw attention to a policy. Methods: A weighted total sample of 24,136 mothers from the 2019 mini-Ethiopian demographic and health survey data were included in the analysis. Global Moran's I statistics was run to check the clustering of neonatal mortality and then kriging interpolation was done to predict the magnitude of neonatal mortality in Ethiopia. In addition, SaTScan analysis was also executed to identify hot spot clusters of neonatal mortality. Finally, a multilevel mixed-effect logistic regression model was used to identify community and individual-level predictors of early neonatal and neonatal mortality. Results: The lifetime early neonatal and neonatal mortality among mothers in Ethiopia was 5.08 (95% CI: 4.13–6.03) and 6.54 (5.55, 7.52) per 1000 births respectively. Neonatal mortality was spatially clustered in the country and the SaTScan analysis identified significant hotspot areas of neonatal mortality in the Amhara and Afar regions and some areas of the Somali and Oromia regions. Its predicted magnitude was > 8 per 1000 births in wide areas of the Amhara and Benishangul regions. A multilevel mixed-effect logistics regression analysis identified that a lower level of maternal education, being a twin neonate, and being a male neonate were predictors of both early neonatal and neonatal mortality. Whereas, the younger age of mothers predicted neonatal mortality. Conclusions: Neonatal mortality in Ethiopia is geographically clustered and sociodemographic and obstetric factors played a significant role. Policy direction should focus on evidence-based practices like midwives-led community and facility-based continuum of care from preconception to postnatal periods to possibly reduce neonatal mortality. [ABSTRACT FROM AUTHOR]