Newborn Transport Practices: Influence on Newborn Survival in Benin City, Nigeria

Abstract

Objective: To assess the transfer process, modes of transportation, distances covered to access care, condition on arrival, and outcomes of newborns admitted to hospital in Benin City, Nigeria. Methods: This was a cross sectional survey of all consecutively presenting neonates to the children's emergency unit over a 12-month period. Their demographic information, antepartum and perinatal antecedents, clinical information, main complaint, and co-morbidities were noted on a structured questionnaire. Other information gathered included transfer process, mode of transport, distance covered to reach facility, interventions during transport, condition on arrival, and outcome. Data were analyzed using descriptive statistics, frequencies, and chi-square comparisons; significance was set at P<0.05. Results: Responsible persons for 115 babies-73 males and 42 females-completed the questionnaire. Of the newborns, 62 (53.9%) were of normal birth weight and 43 (37.3%) of low birth weight; of these 37 (32.2%) were preterm. Most cases arrived from peripheral hospitals without referral notes or prior contact with the receiving hospitals. There was no organized pre-or intra-transfer stabilization or medical interventions. Patients came mainly with relatives (89%) or healthcare workers (10%). They arrived in private cars (81%), and were not kept in warm clothes. Distance covered was 10-20 km for more than 50% and over 100 km for less than 8%. Perinatal asphyxia was the commonest reason for transfer (14%). Lower gestational age and cyanosis on presentation significantly affected survival, as only 13 of 25 (52%) with cyanosis and 23 of 37 (62.2%) preterm babies survived. Overall mortality was 30/ 115 (26.1%), and preterm mortality was significantly higher at 14/37 (37.8%). Conclusions: The neonatal transfer process is poorly developed. Prior contact with receiving hospitals is infrequent. Staffing, monitoring, and stabilizing interventions during transfer of sick newborns are inadequate. Transfer mode might have affected survival of preterm infants in particular.