Care of the Sick Newborn in a Cottage Hospital Level in a Developing Country

Abstract

INTRODUCTION: Neonatal morbidity and mortality are high in Nigeria. The establishment of more centers that could offer adequate management of high-risk pregnancies and neonates is essential. OBJECTIVES: This study seeks to describe sick newborn care at the cottage hospital level in Southern Nigeria with the aim of drawing lessons that may be useful to similar environments. SUBJECTS AND METHODS: A description of facility upgrading and staff training in perinatal care at a public-private partnership cottage hospital with a robust community health insurance scheme in Nigeria is made. A retrospective descriptive study of the morbidity and outcomes of admitted neonates in the facility between March 2016 and February 2017 was made. RESULTS: Out of 3630 babies born in the facility (302 per month), 189 were admitted, yielding an admission rate of 52.1/1000 live births. The main morbidities were neonatal hypoglycemia (32.4%), preterm low-birth weight (24.9%), neonatal sepsis (22.8%), and neonatal jaundice (12.7%). Sixteen of the 109 neonates died giving a mortality rate of 8.5%. The main causes of deaths were birth asphyxia (7 or 43.8%), meconium aspiration (6 or 37.5%), and congenital malformation (3 or 18.8%). CONCLUSION AND RECOMMENDATIONS: The neonatal admission and mortality rates are quite low in this cottage hospital and similar to the situation even in developed environments. This salutary scenario is probably due to good antenatal and perinatal care, and a robust community health insurance scheme which enhances services uptake and public-private partnership which engenders infrastructure expansion and maintenance. This model is recommended for the hospitals in our region.