MAGNITUDE AND DETERMINANTS OF IMMEDIATE ADVERSE NEONATAL OUTCOMES OF CESAREAN SECTION AMONG PUBLIC HOSPITALS IN HARARI REGION, ETHIOPIA

Abstract

Although the Cesarean section (CS) is a safe operation, it puts babies at risk of short-term health problems when performed without medical need. Previous studies mainly relied upon chart review about the identification of immediate neonatal outcome after cesarean delivery. Therefore, there is a perceived gap in recent studies in determining the magnitude and determinants of the cesarean section’s immediate adverse neonatal outcome. Objective: Determine the magnitude and determinants of immediate adverse outcomes among babies born by cesarean section in public hospitals in the Harari region, Eastern Ethiopia. Methods: A prospective follow-up study was conducted among 715 eligible babies born by cesarean section in Jegula and Hiwot Fana public hospitals in Harar. Neonate is said to have immediate adverse outcomes if one of the following were detected: (1) baby died, or (2) admitted to NICU, or (3) its primitive reflexes were absent within 24 hours after CS. Adjusted risk ratios (ARRs) and 95% confidence intervals (CIs) were computed using modified Poisson regression. Result: During the follow-up period, a total of 44 babies died, 139 were admitted to the NICU, and 133 had absent neonatal reflexes. In general, 157 newborns had an adverse neonatal outcome after CS. The following conditions were positively and statistically related to the outcome: estimated household income (ARR 2.19 CI 1.57-3.07), having no Antenatal care (ARR 1.46 1.08-1.97), history of a medical or obstetric condition (ARR 1.78 CI 1.38-2.31, having an absolute indication for delivery (ARR 1.71 CI 1.28-2.29), presence of meconium (ARR 1.61 CI 1.22-2.12), low birth weight (ARR 1.96 CI 1.42-2.70), and respiratory depression at birth (ARR 2.50 CI 1.80-3.48). Conclusion: A fifth of neonates developed adverse outcomes after CS. Several maternal clinical factors were predictors for neonatal adverse outcomes. Assessing previous clinical and obstetric conditions of the women during ANC would help properly plan in averting the occurrence of immediate outcome in neonates after birth