Factors associated with peri-neonatal mortality in Sao Tome & Principe: a prospective cohort study

Background Neonatal mortality reduction is a global goal but its factors in high-burden nations vary and are poorly understood. This study was conducted to identify the factors affecting peri- neonatal mortality in Sao Tome & Principe (STP), one of the smallest African countries. Methods Institution-based prospective cohort study conducted at Hospital Dr. Ayres Menezes. Maternal-neonate dyads enrolled were followed up after the 28 th day of life (n=194) for identification of neonatal death-outcome (n=22) and alive-outcome groups (n=172). Data were collected from pregnancy cards, hospital records and face-to-face interviews. After the 28 th day of birth, a phone call was made to evaluate the newborn’s health status. A logistic regression model was used to identify the relevant factors associated with mortality, a p value <0.05 was considered statistically significant. Results The mean gestational age of the death-outcome and alive-outcome groups was 36 (SD=4.8) and 39 (SD=1.4) weeks, respectively. Death-outcome group (n=22) included sixteen stillbirths, four early and two late neonatal deaths. High-risk pregnancy score [cOR 2.91, 95%CI:1.18-7.22], meconium-stained fluid [cOR 4.38, 95%CI:1.74–10.98], prolonged rupture of membranes [cOR 4.84, 95%CI:1.47–15.93], transfer from another unit [cOR 6.08, 95%CI:1.95–18.90], and instrumental vaginal delivery [cOR 8.90, 95%CI:1.68–47.21], were factors significantly associated with mortality. The odds of experiencing death were higher for newborns with infectious risk, IUGR, resuscitation maneuvers, fetal distress at birth, birth asphyxia, and unit care admission. Female newborn [cOR 0.37, 95%CI:0.14-1.00] and birth weight of more than 2500 g [cOR 0.017, 95%CI:0.002-0.162] were found to be protective factors. In the multivariable model, meconium-stained fluid was significantly associated with death outcome. Conclusion Factors such as having a high-risk pregnancy score, meconium-stained amniotic fluid, prolonged rupture of membranes, being transferred from another unit, and an instrumental- assisted vaginal delivery increased 4– to 9–fold the risk of stillbirth and neonatal death. Of the factors associated with peri-neonatal mortality in this study, avoiding health-worker- related factors associated with delays in prompt intrapartum care is a key strategy to implement in Sao Tome & Principe.