Abstract
Globally about 9 million neonates are diagnosed with birth asphyxia yearly, of these 25% end up dying and among those who survive 25% end up with permanent neurological deficit. It remains a significant unpopular contributor to neonatal mortality not only in Tanzania but also globally. This article aims to unveil the causes, consequences, its contribution to Neonatal Mortality and recommended course of action in Tanzania.
Keywords: birth asphyxia, neonatal Mortality, recommendations, tanzania
Introduction
Birth asphyxia is characterized by failure to initiate and sustain breathing at birth[1]. It remains a significant unpopular contributor to neonatal mortality globally[2]. Worldwide around 9 million neonates are diagnosed with birth asphyxia each annually, of these at least 2.5 million die due to the condition[3] and 25% develop permanent disabilities[4]. Neonates in developing countries face a risk birth asphyxia during childbirth that is ten times greater than in developed countries[5]. Almost 900,000 newborns die each year from birth asphyxia in Low and middle income countries[6]. Tanzania on the other hand has a neonatal mortality of 24 per 1000 live births[7], of which 40.6% of these death are said to be attributed to birth asphyxia, which is slightly higher than Ethiopia and Uganda which are 31.6% and 28.6% respectively[8].
Despite advancements in medical technology and increased access to healthcare services, birth asphyxia continues to pose a substantial challenge to healthcare systems, often resulting in devastating consequences for families and communities. Understanding the causes, consequences, and courses of action for birth asphyxia is crucial for developing effective strategies to reduce neonatal mortality and improve maternal and child health outcomes in Tanzania.
The causes of birth asphyxia
The causes of birth asphyxia of which most of them are preventable have been divided into 3 major categories namely antepartum (before birth), intrapartum (during birth) and postpartum (after birth), studies have shown that majority of cases occur during birth[9]. Antepartum causes include but not limited to mothers age, history of previous preterm birth and maternal hypertension[10]. Intrapartum causes include but not confined to prolonged labor, fetal mal-presentation and non-hospital delivery[5]. A non-exhaustive list of postpartum causes includes prematurity, low birth weight and inadequate resuscitation, studies done in Tanzania concerning the causes of birth asphyxia are very limited however those done have reported maternal age, mother’s level of education, profession, child’s sex, previous unfavorable birth outcome, gestation age, birthweight, and delivery mode to be some the causes of birth asphyxia in the country[11].
Diagnostic tests and management
The diagnosis of Birth Asphyxia is established when the APGAR score (Appearance, Pulse, Grimace, Activity, and Respiration) at 1 and 5 minutes postpartum falls below 7 at the fifth minute, and presence of evidence on central nervous system manifestations such as convulsions, lethargy, unconsciousness, as well as hypotonic or hypertonic, along with multisystem organ dysfunction, neurological examination and clinical decision[12]. Birth Asphyxia is categorized into mild, moderate and severe. In order to establish proper breathing and circulation, management prioritizes prompt resuscitation, frequently with the aid of neonatal resuscitation protocols[5]. In order to reduce brain damage, post-resuscitation care may include oxygen therapy, fluid control, seizure prevention, and therapeutic hypothermia[5,11]. In order to lower mortality and avoid long-term neurodevelopmental impairments, early diagnosis and timely, coordinated management are essential[13].
Consequences of birth asphyxia
Birth asphyxia puts infants at serious risk and can have a variety of negative effects. Hypoxic-ischemic brain damage, which presents as cerebral palsy, intellectual difficulties, developmental delays, and seizures, can be caused by oxygen deprivation during childbirth. Furthermore, failure of other essential organs such as liver dysfunction, renal failure, respiratory distress syndrome, cardiovascular abnormalities, and metabolic disturbances may occur. In extreme situations, multiple organ failure brought on by birth asphyxia might result in life-threatening circumstances. In order to address cognitive, physical, and behavioral issues, survivors of birth asphyxia may experience long-term neurodevelopmental abnormalities that call for continuing medical and psychological treatment[14].
The impact on neonatal mortality in Tanzania
Birth asphyxia is the leading cause of neonatal mortality in Tanzania, with an annual impact on newborn survival rates that is noteworthy[7]. The lack of availability of trained birth attendants, along with inadequate prenatal care services and inadequate quality of treatment in medical facilities, all contribute to the national prevalence of birth asphyxia. The constraints imposed by insufficient healthcare resources, which obstruct efficient intervention and management techniques, exacerbate this problem. Socioeconomic variables that exacerbate the problem and make it harder for mothers and babies to receive timely and effective treatment during childbirth include pervasive poverty, a lack of educational opportunities, and inadequate infrastructure[15]. Because of this, tackling the various obstacles to providing high-quality maternity and newborn healthcare becomes essential to preventing the consistently rising.
Recommended courses of action in Tanzania
Addressing the issue of birth asphyxia requires a multi-faceted approach that encompasses various levels of the healthcare system in Tanzania. Improving access to quality maternal and neonatal healthcare services, particularly in rural and underserved areas, are essential for preventing and managing birth asphyxia. This includes investing in training and deploying skilled birth attendants, enhancing prenatal care services, and ensuring the availability of essential medical supplies and equipment in healthcare facilities.
Furthermore, community-based interventions aimed at raising awareness about the importance of antenatal care, birth preparedness, and early recognition of danger signs during childbirth can help empower mothers and families to seek timely medical assistance. Educating healthcare providers on evidence-based practices for managing birth asphyxia, including neonatal resuscitation techniques and postnatal care protocols, is also crucial for improving outcomes for newborns at risk.
Collaboration between government agencies, non-governmental organizations (NGOs), and international partners is essential for implementing comprehensive strategies to address the underlying determinants of birth asphyxia and reduce neonatal mortality rates in Tanzania. This includes advocating for policy reforms, mobilizing resources, and fostering partnerships to strengthen the healthcare system and improve access to essential services for mothers and newborns across the country.
Birth asphyxia is preventable with strategies such as increasing ANC coverage, skilled birth attendance, and postnatal care. Guidelines endorsed by WHO and the American Academy of Pediatrics for neonatal resuscitation represent a standard practice that improves outcomes in asphyxiated newborns
Conclusion
Generally, birth asphyxia remains a major threat to maternal and child health in Tanzania, contributing to high neonatal mortality and long-term complications. Addressing this challenge requires coordinated efforts from government, healthcare providers, communities, and families. Strengthening access to quality care, investing in preventive measures like prenatal care maternal education and building the capacity of healthcare workers are essential steps. Through a united and comprehensive approach, Tanzania can reduce the burden of birth asphyxia and improve health outcomes for mothers and children.
Footnotes
Sponsorships or competing interests that may be relevant to content are disclosed at the end of this article.
Contributor Information
Jovin R. Tibenderana, Email: jovintibe@gmail.com.
Sanun Ally Kessy, Email: sahnunally@outlook.com.
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Author contributions
J.R.T.: writing, editing, and final review; S.A.K.: editing and final review.
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Authors declare no conflict of interest.
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J.R.T. contributed fully to writing this paper.
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