Birth asphyxia is defined by the World Health Organisation (WHO) as ‘the failure to initiate and sustain breathing at birth’ [1]. It is a major contributor to neonatal mortality worldwide [2-5], it contributes to 24% of all neonatal deaths [3] and 11% of deaths of those under 5 years worldwide [2]. Almost all asphyxia related deaths (98%) occur during the first week of life [6]. About 75% of the total asphyxia related deaths occurred on the first day and less than 2% of these after 72 hours of birth [5].
Birth asphyxia is a leading cause of brain damage. If severe, it can injure brain cells and cause potentially fatal conditions, including hypoxic-ischemic encephalopathy, brain injuries, autism, attention deficit hyperactivity disorder, behavioural problems, seizures, and cerebral palsy [7]. Survivors often face lifelong health problems (80%) such as disabilities, developmental delays, palsy, intellectual disabilities, and behavioural problems [7-9]. Furthermore, birth asphyxia places financial and emotional burdens on the families and communities involved [7].
Birth asphyxia is associated by a complex range of risk factors which vary between industrialised and non-industrialised countries. The risk factors are grouped as occurring before birth, antepartum risk actors; during birth, intrapartum risk factors; and after birth, postpartum risk factors [10, 11]. Antepartum risk factors include severe maternal hypertensive diseases during pregnancy [12, 13], antepartum haemorrhage [14, 15], history of still birth [16], antenatal care visits [13, 14, 16], oligohydramnios [13], maternal fever [12, -14, 17] and maternal anaemia [12, 13, 16, 16], young maternal age [12, 17, 18], advanced maternal age [19], and low educational status (illiterate and primary education level) [16, 18]. Intrapartum risk factors include malpresentation [12-14, 16, 20], prolonged second stage of labour [14, 15, 21], home delivery [12, 17], obstructed labour [12, 17, 22], oxytocin use [14], and meconium stained amniotic fluid [12, 13, 16 , 17]. Fetal risk factors associated with birth asphyxia include low birth weight [12, 17], high birth weight [21], multiple gestation [13], tight nuchal cord [14, 21], preterm delivery [12, 13, 21], resuscitation and fetal distress [16, 23].
The Federal Ministry of Health developed the first comprehensive National Child Survival Strategy (2015–2020) in 2015, aiming to reduce under-five mortality by two thirds. Since its development in 2015, several evidence-based interventions that need to be incorporated in the strategy have been initiated. These include community management of pneumonia through integrated community case management; community-based newborn sepsis management through the community based newborn care; newborn intensive care unit; newborn corner; and the introduction of Haemophilus influenza, pneumococcal, and shifting PMTCT to ‘Option B+’ [24]. The guidelines to treat birth asphyxia are also well established in Ethiopia and made available even at the health-centre level for assessing and classifying [25].
Despite this, a high proportion of newborn deaths due to birth asphyxia was reported in Ethiopia. From the observations thus far, the issue of birth asphyxia remains unresolved. Ethiopia’s rate of neonatal mortality is still among the highest in Sub-Saharan Africa [26, 27]. In 2015, nearly 240 babies in their first month died each day [28]. Birth asphyxia is the leading cause of neonatal deaths and accounts for about 31.6% of neonatal mortality, followed by preterm birth (21.8%) and sepsis (18.5%) [29]. Moreover, the findings from studies conducted in Tigray [30] and Gondor [31] to identify causes of neonatal mortality revealed that birth asphyxia was responsible for 35% and 12.5% of neonatal deaths, respectively.
Analysis of birth asphyxia is important because it may reveal possible statuses leading to the birth asphyxia, which, if acted upon, may benefit a child’s health. Therefore, this study aimed to assess the magnitude and risk factors of birth asphyxia among neonates delivered in the Negist Eleni Mohammed Memorial Teaching Hospital, Southern Ethiopia.