Background: Neonatal
health appears not to have received
the deserved attention in
the context of the Child Survival
Strategies and this must have contributed
to the non-attainment of
the MDG-4 in Nigeria. Neonatal
mortality contributes 40% or more
to the current rate of child deaths
globally, with birth asphyxia, prematurity
and its complications and
severe infections as the leading
causes. This emphasises the need
to re-focus on neonatal health.
Given the state of the economy in
the low- and middle-income countries,
Nigeria, like most of the
other countries lack the resources
required for efficient neonatal
health care with minimal attention
on the strategies needed to address
the major causes of newborn
death.
Objectives: To assess the contemporary
situation of neonatal care
in Benin City, Nigeria and examine
diverse approaches to be
adopted to provide high level neonatal
care services aimed at improving
neonatal survival rates.
Methods: The trends of neonatal
morbidities and mortality over the
period between 1974 and 2014
were studied by reviewing the
hospital records covering admissions
and weekly mortality
records. The pattern of categories
of babies and the causes of death
were recorded. The information
gathered identified the gaps in the
management strategies for newborns
over the years. Electronic
databases such as the Medline and
Pubmed were searched for relevant
literatures published between
1960 and 2015 which might provide
ideas required to fill the
gaps.
Results: In the 1974-1976 era, the
major cause of neonatal mortality
at the University of Benin Teaching
Hospital (UBTH), Benin City,
Nigeria, was birth asphyxia with
an attendant perinatal mortality of
80.9/1000 births. The decline in
the perinatal mortality to
33.4/1000 births between 1976 and
1980 was linked to the introduction
of delivery room resuscitation
with a reciprocal decline in the
incidence of birth asphyxia. Thereafter,
neonatal mortality rate has
continued to increase. This
increase could be attributed to a
three-fold rise in the proportion of
very preterm admissions from
6.5% in 1985 to 19.3% in 2013.
This population of babies is predisposed
to Respiratory Distress Syndrome
and respiratory failure.
Neonatal intensive care did not
include respiratory supports until
very recently (2013) when the facilities
were provided but at high
cost to the patient and the health
system.
Conclusion: The strategies required
to address reduction in neonatal
mortality rates should necessarily
include neonatal resuscitation
and mechanical ventilation, all
within the context of Neonatal
Intensive Care. In order to provide
the full range of neonatal intensive
care services in a resource- constrained
setting such as Benin City,
Nigeria, regionalisation of care in
a stepwise manner is recommended,
both for improved medical
outcomes and economic realities.