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Romano Byaruhanga, Anna Bergstrom, Pius Okong, Neonatal Hypothermia in Uganda: Prevalence and Risk Factors, Journal of Tropical Pediatrics, Volume 51, Issue 4, August 2005, Pages 212–215, https://doi.org/10.1093/tropej/fmh098
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Abstract
The aim of the study was to determine the prevalence of neonatal hypothermia and associated risk factors. A cross sectional, descriptive study of neonatal hypothermia was performed on 300 newborns consecutively recruited day and night during 2 months at a Ugandan periurban hospital. Parallel tympanic and rectal temperature measurements were made at 10, 30, 60, and 90 min post partum. Rectal temperatures taken at 10, 30, 60, and 90 min showed that 29, 82, 83, and 79 per cent of the newborns, respectively, were hypothermic. Newborns observed to have no body contact with the mother comprised 87 per cent of hypothermic newborns, whereas this was the case in 75 per cent of non-hypothermic newborns (p=0.03). The mean birthweight was 3218 g. Low birthweight newborns constituted 9/86 (10 per cent) among hypothermic newborns, whereas this was the case in 9/209 (4 per cent) among non-hypothermic newborns at 10 min (p=0.08). Adolescent mothers were encountered more often among mothers with neonatal hypothermia of the newborn than among non-hypothermic newborns (p=0.025). Parity, preterm delivery, daytime or night time delivery, rupture of membranes >24 h and location of newborns in theatre, labour ward, or nursery did not differ when hypothermic and non-hypothermic newborns were compared. A persistent pattern of high prevalence of neonatal hypothermia was confirmed and indicates that more vigorous efforts have to be undertaken, also in a tropical setting, to overcome problems of non-adherence to appropriate methods for thermoprotection of the newborn.
Author notes
1Department of Obstetrics and Gynaecology, St. Francis Hospital, Nsambya, Uganda, 2Division of International Health (IHCAR), Department of Public Health Sciences, Karolinska Institutet, Stockholm, Sweden
Comments
During a recent visit to Sudan, I was also struck by the high incidence neonatal hypothermia, described by Byaruhanga et al, in Uganda. Some reasons for hypothermia, (which has been shown to be an independent risk factor for death in neonates) in Suadan, appeared obvious. These included air conditioning to temperatures that were cool for lightly clothed adults. A lack of appropriate towels and other laundry items also was apparent. However, the main reason for neonatal hypothermia subsequently emerged later in our visit. Midwives in Sudan are not that well paid. They are dependent on tips from the mothers to supplement their meagre salaries. The birthing tip, equivalent to approximately 5 euros, is given to the midwife when she presents the baby to the mother. Immediately after birth, however, babies are left to lie naked in open cots, while the busy midwife completes the the third stage of labour. Later the baby is washed and clothed and is then presented to the mother. Thus, neonatal hypothermia due to the lack of body contact with the mother, can be due financial incentives. The practice of delaying body contact may be difficult to alter by education alone, unless the underlying issue of midwives' remuneration is also addressed.
Conflict of Interest:
None declared