The OFANNM study: obstetric factors associated with neonatal near miss, at a public mother and child hospital in Johannesburg, South Africa

Mpehle, Chileshe Raphael
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Background Obstetric factors can impact pregnancy outcomes such as neonatal morbidity, mortality and near miss. Neonatal near miss has not been well documented in our environment. Objective We investigated the association between maternal socio-biological and obstetric characteristics and neonatal near miss at a teaching hospital in Johannesburg, South Africa. Methods A case-control study of 744 mother-infant pairs was conducted at a public mother and child hospital in Johannesburg, South Africa, from 1 January 2016 to 31 December 2016. Maternal Socio-demographic and obstetric factors of 372 cases of neonatal near miss and 372 cases of normal babies were obtained from clinical records. The annual neonatal near miss rate was calculated by dividing the number of near miss cases by total deliveries, for 2016. Descriptive statistics was conducted. We respectively used Pearson’s Chi-Square, Mann Whitney U and Student’s t-test, to compare categorical and continuous variables among the neonatal outcomes. Univariable and multivariable logistic regression was conducted to assess for factors associated with neonatal near miss. Results The neonatal near miss rate was 110 per 1000 deliveries for 2016. The mean maternal age and median parity for our study population were 28.07 (±5.97) years and 2(IQR: 1-2) respectively. After multivariable logistic regression, advanced maternal age (OR=2.65, 95%CI:1.10-6.41, P-value=0.029), substance abuse (OR=4.48, 95%CI:1.54-13.05, P-value=0.006), underweight (OR=4.40, 95%CI:1.22- 15.80, P-value=0.023), preterm delivery ≤33+6 weeks (OR=4.56, 95%CI:1.92-10.83, P-value=0.001), pregnancy specific antenatal disorders (OR=5.19, 95%CI:2.61- 10.30, P-value<0.001), delivery by interns (OR=44.7 95%CI:2.27-880.06) and registrar doctors (OR=5.91 95%CI:1.61-21.74, P-value=0.008), had statistically significant association with neonatal near miss. Elective (Adjusted OR=0.22, 95%CI:0.06-0.88, P-value=0.032) and emergency (Adjusted OR=0.19, 95%CI:0.050.69, P-value=0.012) caesarean section deliveries, were respectively associated with reduced neonatal near miss risk. Conclusion This study identified risk factors of neonatal near miss in our environment, to improve policy and care. Elective and emergency caesarean delivery appear to be protective against neonatal near miss. Health policy interventions should be initiated to reduce and mitigate the impact of neonatal near miss in our environment.
A submissible research article submitted to the Faculty of Health Sciences at the University of the Witwatersrand, Johannesburg, in partial fulfilment of the requirements for the degree of Master of Medicine (M-MED), in the field of Obstetrics and Gynaecology, 2021