DILLA UNIVERSITY

COLLEGE OF MEDICINE AND HEALTH SCIENCE

DEPARTEMEN OF PUBLIC HEALTH OFFICER

PREVALENCE OF PERINATAL ASPYXIA AND

ASSOCIATED FACTORS IN DILLA UNIVERISTY
REFERRAL HOSPITAL

BY; ZURASHWERK EDO

Advisor፡- Mr. ZELEKE .G

A PROPOSAL SUBMITTED TO DILLA UNIVERSITY, COLLEGE OF MEDICINE AND

HEALTH SCIENCE, DEPARTEMENT OF PUBLIC HEALTH IN PARTIAL FULFILLMENT
FOR THE REQUIREMENTS OF THE AWARD OF BACHELOR DEGREE IN PUBLIC
HEALTH. Nov, 2017
DILLA UNIVERSITY
COLLEGE OF MEDICINE AND HEALTH SCIENCE
Page | 1
 DEPARTEMEN OF PUBLIC HEALTH OFFICER

PREVALENCE OF PERINATAL ASPYXIA AND

ASSOCIATED FACTORS IN DILLA UNIVERISTY
REFERRAL HOSPITAL

Advisor፡- Mr. ZELEKE .G(BSc,Mph)

A PROPOSAL SUBMITTED TO DILLA UNIVERSITY, COLLEGE OF MEDICINE AND

HEALTH SCIENCE, DEPARTEMENT OF PUBLIC HEALTH IN PARTIAL FULFILLMENT
FOR THE REQUIREMENTS OF THE AWARD OF BACHELOR DEGREE IN PUBLIC
HEALTH. Nov, 2017

Table of content
ACKNOWLEDGEMENT--------------------------------------------------------------------------I

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LISTOF ABERVATION---------------------------------------------------------------------------II

ABSTRACT-----------------------------------------------------------------------------------------III

CHAPTER ONE ------------------------------------------------------------------------------------1

1 INTRODUCTION---------------------------------------------------------------------------------1

1.1 BACKGROUND--------------------------------------------------------------------------------1
1.2 STETMENT OF PROBLEM------------------------------------------------------------------1
1.3 SIGNIFICANCE OF STUDY-----------------------------------------------------------------2
CHAPTER TWO----------------------------------------------------------------------------------3
2 LITRATURE RIVEW--------------------------------------------------------------------------3
2.1 MAGNITUDE OF PNA-----------------------------------------------------------------------3
2.2 FACTOR ASSOCIATED WITH PNA-------------------------------------------------------4
CHAPTER THREE-------------------------------------------------------------------------------5
3 OBJECTIVS------------------------------------------------------------------------------------5
3.1 GENRAL OBJECTIVES---------------------------------------------------------------------5
3.2 SPECFIC OBJECTIVES --------------------------------------------------------------------5
CHAPTER FOUR-----------------------------------------------------------------------------6
4 MATERIAL AND METHODE--------------------------------------------------------------6
4.1 STUDY AREA---------------------------------------------------------------------------------6
4.2 STUDY DESIGN-----------------------------------------------------------------------------6
4.3 SOURCE OF POPULATION--------------------------------------------------------------- 6
4.4 STUDY POPULATION----------------------------------------------------------------------6
4.5 STUDY UNIT----------------------------------------------------------------------------------6
4.6 SAMPLE SIZE--------------------------------------------------------------------------------6
4.7 SAMPLING TECHINQUE-----------------------------------------------------------------6
4.8 STUDY VARIABLES------------------------------------------------------------------------6
4.9 INCLUSION AND EXCLUSION CRITERIA-------------------------------------------7
4.10 DATA COLLECTION PROCEDURE---------------------------------------------------7
4.11 ENSURING DATA QUALITY------------------------------------------------------------7
4.12 DATA ANALYSIS AND PROCESSING------------------------------------------------7
4.13 DISSEMINATION AND UTILIZATION OF RESULT-------------------------------7
4.14 OPERATIONAL DEFINITION-----------------------------------------------------------7
4.15 ETHICAL CONSIDERATION-----------------------------------------------------------7

1.1.1.1.1 CHAPTRE FIVE

5.1 TIME SCHDULE------------------------------------------------------------------------------8

5.2 COST BREAK DOWN-----------------------------------------------------------------------9

6. ANNEX-------------------------------------------------------------------------------------------10
6.1 DATA OLLETION CHECK LIST-----------------------------------------------------------11

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7. REFERANCE------------------------------------------------------------------------------------12

ACKNOWLEGEMENT

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First of I will like to thank the almighty GOD for giving us the patience wisdom, knowledge and
strength i needed to complete this study and for always guiding us in every phase of our study. I
will like to express our sincere and heartfelt gratitude to our advisory mr . zeleke G for his
unreserved help and constructive advice up on preparing this proposal. Next i gratefully
acknowledge all respondents who were kind to cooperation and willing to give genuine
information for preparation of the main body of this project.

LIST OF ABBREVIATIONS

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NMR-----------------------------Neonatal Mortality Rate

SPSS-----------------------------Statistical Packaging for Social Sciences

HIE------------------------------Hypoxic Ischemic Encephalopathy

TBA-----------------------------Traditional Birth Attendant

EDHS---------------------------Ethiopia Demographic and Health Survey

CHW---------------------------Community Health Worker

PNA----------------------------Prenatal Asphexia

PMR---------------------------Perinatal Mortality Rate

AMGH------------------------Arbaminch General Hospital

C/S-----------------------------Cesarean Delivery

FTBA--------------------------Full Term Birth Asphexia

MAS---------------------------Meconium Aspiration Syndrome

APGAR-----------------------Appearance Pulse rate Grimace Activity Respiratory rate

NICU-------------------------Neonatal Intensive Care Unit

SVD--------------------------Spontaneous Vaginal Delivery

UTI--------------------------Urinary Tract Infection

HIV-------------------------Human Immune Deficiency Virus

HMD-----------------------Hyaline Membrane Disease

MCH-----------------------Maternal and Child Health

MSAF---------------------Meconium Stained amniotic fluid

WHO-------------------------world health organization

ABSTRACT
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INTRODCTON
Perinatal Asphyxia is a global neonatal problem which significantly ant contributes to both
morbidity and mortality. It is the second most common cause of three major cause of neonatal
morality.

OBJECTIVE
The aim of this study is to assess the prevalence and associated factors of birth asphyxia /.

Methods
Institution based retrospective cross sectional study will be used among all neonates admitted
in DURH in neonatal intensive care unit from NOV 6- FEB 10/2010 EC. All in born baby with
Apgar score <7 at 5 min and out born baby's with no Apgar score but, with features of asphyxia
will be included in the study. Systemic random sampling technique will be used to sample the
study population. Clinical information will be collected from NICU register log Book and case fill
of the patient will be retrieved to obtain relevant information.

Time frame and Budget:……………………………………………………………………………………………………………

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 CHAPTER ONE

1. INTRODCTION

1.1BACK GROUND
Perinatal asphyxia is a common and serious neonatal problem globally and it
significantly contributes to both neonatal morbidity and mortality. According to
WHO in 2000, of the 130 million infants born globally each year, approximately 4
million baby’s die before they reach the age of one month(1). It has been shown
that 99% of this neonatal death takes place in the developing countries where
perinatal asphyxia contributes to almost 23% of these deaths(1). Over half of these
delivers occur at home (1). In the last world health statistics 2013(2), neonatal
death have decreased from 4.4 million 1990 to 3 million in 2011.

Perinatal asphyxia is estimated to be the fifth largest causes of under -five child
death, after pneumonia, diarrhea, neonatal infections and complication of preterm
birth (3). Millennium developmental goal 4(aiming at two-third reduction in under-
five mortality by the year 2015 from a base line in 1990) can only be met by
substantially reducing neonatal deaths. Indeed, new born deaths constitute over
40% of all deaths in children under-five (3).

Asphyxia is defined as inability of the new born to initiate and sustain adequate
respiration after delivery (4). The American college of Obstetricians and
Gynecologists and the American academy of pediatrics assign a neonate to be
asphyxiated in the following condition s are fulfilled;

Umbilical cord arterial pH < 7;

Apgar score 0-3 for longer than 5minute;

Neurological manifestation (e.g. Seizures, coma or hypertomia); and

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 Multisystem organ dysfunction, example, cardiovascular,
gastrointestinal, hematological, pulmonary or renal system (5).

This study will be carried out to determine the prevalence of perinatal asphyxia in
our at DURH. Neonatal Intensive Care Unit (NICU). Our aim is also to determine
the factors associated with perinatal asphyxia.

1.2STETMENT OF PROBLEM
Perinatal asphexia is a third common causes of neonatal mortality worldwide
accounting for death of 23% of live term birth. In sub-Saharan countries it is the
leading case of neonatal death (5).

Incidence of birth asphexia in term babies studied in INDIA India was 6.6% the
study was conducted in tertiary care center. In this study 60% of the mothers didn’t
took minimal ANC (7). Fetal distress was observed in 34% of BA and 71.4% of
HIE patient (8). This intrapartum fetal distress has a significant association whit
with HIE and BA. Presence of bradycardia is an indicator of poor outcome.
Meconium staining was observed in 56% of baby's with BA (9).

Ethiopia is one of the lowest socioeconomic countries among early perinatal

asphyxia prevalent in the world in general and region. According to EDHS (2011)
NMR is 37 per 1000 live births.

Fetal hypoxia may be caused by various disorders in the mother including in

adequate oxygenation of maternal blood from hypo-ventilation during anesthesia,
cyanotic heart disease, respiratory failure or carbon monoxide poisoning, low
maternal blood pressure from acute blood loss, spinal anesthesia or compression of
vena cava and aorta by the gravid uterus, inadequate relaxation of uterus to permit
placental filling as result of uterine tetany caused by administration of excessive
oxytocin, premature separation of placenta in impedance to the circulation of

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blood through the umbilical cord as the result of compression or knotting of the
cord, placenta inefficiency from toxemia or post maturity, instrumental delivery(6).

15-20% of infant with hypoxic -ischemic encephalopathy (HIE) die in neonatal

period and 25-30% of survivors suffer from permanent neuro-developmental
abnormality (cerebral palsy, mental retardation) later in the life (10).

Up to the level of my knowledge there is no published research that was done in

this topic in DURH. Therefore this research contributes for the level of knowledge
of prevalence and associated factors of perinatal asphexia in DURH in NICU and
also for the stakeholder in their involvement and intervention to tackle the
problem.

1.3 SIGNIFICANT OF THE STUDY

Assessing of the prevalence and associated factors of PNA in DURH in NICU this
research contribute for the level of knowledge of prevalence and associated factors
of PNA in DURH in NICU. It also helps for the stakeholder (Government and non-
government of the organization) in their involvement to tackle the problem. More
over the result can be also used as a reference for those who are interested to do
similar studies in the future as a secondary source.

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 CHAPTER TWO

2. LITTERATURE REVIEW

MAGNTIITUIDE OF PNA

Globally, 23% of neonatal death (11) and 10% of all death in children < 5 years of
age are (12,13) estimated to occur as result of birth asphyxia defined as failure to
initiate and sustain normal breathing at birth (4) and account for one million deaths
each year in world wide.

The WHO has estimated that 4 million babies die during the neonatal period every
year and 99% of those death occur in low income and middle income countries.
The top 3 major causes of neonatal deaths which account for three quarter of the
death are serious infection 28%, complication of preterm birth (26%) & birth
asphyxia (23%) (14). from these birth asphyxia is estimated to causes around 1
million neonatal deaths each year. Because of some reason the incidence of birth
asphyxia is difficult to quantify. This is demonstrated by the difference in
occurrence according to different study the incidence of asphyxia in full term
infants varies from 2.9-9.0 cases per thousands in industrial countries (14).

The incidence of birth asphyxia is major in developing counties (6). Hospital based
studies in Nipal (2) and South Africa (3) estimated that of birth asphyxia
accounting for 24% and 14% of prenatal asphyxia respectively. The birth asphyxia
in term the study in India was 6.6 % (7).

A multicenter study involving in Hospital in Africa countries including Zambia

birth asphyxia (defined as APGAR SCORE <7 at 5min to be the leading (23%)
cause of neonatal mortality (4). In spite of large impact that birth asphexia had on
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neonatal mortality, this study found that 87% of infant diagnosed with birth
asphyxia survived to discharge home (4).

Birth asphyxia survivors account for 23% of infant seen in a NICU follow up clinic
in developing country (15). On study collecting on all infants seen in University of
Zambia NICU follow up clinic over a four week period of the 182 infants. 42(23%)
had a clinical diagnose of birth asphyxia. of 42 infant with birth asphyxia, 13
(31%) had an abnormal neurological examination during the clinic in contrast 13
of 141 infants without birth asphyxia (9%) had abnormal examination (4).

A Multicenter study involving Hospital in Africa countries including Zambia

found birth asphyxia (Defined as 'an Apgar score of <7 at 5min to be the leading
23% cause of neonatal mortality (4). In spite of large impact that birth asphyxia
had on neonatal mortality this study found that 87% of infant Diagnosed with birth
asphyxia survived to discharge to home (4).

Infant and child mortality rates are basic indicators of country socioeconomic
situations and quality of life. Ethiopia is one of the low socioeconomic country are
among high level of perinatal asphyxia prevalent in the world in general in the
region. According to EDHS (2011) NMR 37 Per 1000 Life birth. Birth asphyxia is
the second (25%) common cause of the three major case of neonatal mortality (5).

Factors associated with PNA

Study done in India 60% of the mothers has not taken minimum required ANC (9).
Fetal distress was observed in 34% of BA and 71.4% of HIE patients (7). Thus
intrapartum fetal distress has a significant association with HIE and BA. Presence
of bradycardia is an indicator of poor outcome. Meconium staining liquor was
observed in 56% of babies with BA (9).

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Survivors of birth asphyxia are at risk for neurodevelopment sequelae including
motor and cognitive disability (16-19). One of the beast population studies of
asphyxia in a developing country reported that 18% of survivors of mild to
moderate birth asphyxia had neonatal encephalopathy and permanent severe
neurologic impairment (20). Birth asphyxia was a common cause of mental
retardation, cerebral palsy and other neuro-developmental disorders.

Although accurate estimates of neurodevelopmental sequelae from birth asphyxia

in developing countries are not available, studies in developed countries have
found that 15 to 18% of infants who suffer moderate to severe asphyxia are
disabled by 8 years of age (17). Moderate to severe asphyxia was defined as altered
consciousness with altered muscle tone or primitive reflex after one hour of age
along with intrapartum fetal distress, immediate neonatal distress or immediate
neonatal resuscitation. Given current socio cultural factors n developing countries
such as Zambia, the burden of care is likely to be much greater than in developed
countries (21). Poverty, illiteracy, low status of women, poor hygiene, lack f clean
water and sanitation, family inability to recognize danger signs, and inadequate
access to medical care all increase the s for morbidity following birth asphyxia in
developing countries. Often rehabilitation resources are not available in these
setting (21).

Birth asphyxia is likely a leading cause of neonatal death in most developing

countries such as Zambia however; prospective studies to assess the early
morbidity following birth asphyxia have not been performed in Sub-Saharan
Africa. Although prevention and prompt treatment of birth asphyxia and reduction
of its sequelae are among the developing world’s top health care priorities, studies
are needed to determine the frequency of such sequelae and the resulting burden on
the health system and society (22).

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In study done on Nepal, assessment of early neuro-developmental outcomes
revealed that 31% of surviving infants with clinical birth asphyxia had abnormal
neurologic examinations at early follow-up. Half of the children seen in the NICU
follow-up clinic with abnormal neurologic examination had birth asphyxia (5).

Although birth asphyxia is known to be a leading cause of neonatal mortality,

survivors of birth asphyxia may suffer from hypoxic-ischemic brain injury
affecting vulnerable areas of the brain leading to neuro-developmental sequelae
including problems with sensory-motor, auditory and language processing (15).

The most frequently reported method for identifying the asphyxiated baby by
TBAs and CHWs were “baby not crying (55% and 67%, respectively) and “baby
not breathing at birth” (48% and 40%, respectively) at birth.”Not breathing crying”
and “not breathing at birth“ also received the highest scores for both effectiveness
and feasibility, concurring with methods already in use (22). Presence of
meconium was also deemed a moderately effective and feasible sign. Other
possible clinical identification methods, such as floppy baby, cyanosis and
convulsions in the first 24 hours after birth, received fairly high scores for
effectiveness but lower scores for feasibility at community level. APGAR score,
neonatal encephalopathy score, and maternal risk factor assessment received low
effectiveness and feasibility score (18).

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 CHATER THREE

3. OBEJECTIVE
GENERAL OBEJECTIVE

To determine assess the prevalence and assess factors associated with PNA
in DURH neonatal unit from Nov 10 to Feb 06/2010 E.C .
SPECIFIC OBJECTIVES

To determine assess the prevalence of PNA in DURH from Nov 10 to Feb

06/2010 E.C
To identify factors associated with PNA in DURH neonatal unit from Nov
10 to Feb 06/2010 E.C

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 CHAPTER FOURE

4. MATERIALS AND METHODS

4.1 STUDY AREA

The study will be conducted in DURH. Dilla University Referral Hospital is found in Gedio
Zone, Dilla Town. It is located ҄ 366 km away from Addis Ababa; and 90 Km away from
Hawassa, Capital city of SNNPR. DURH was first established as a clinic in 1920 E.C which
latter in 1950 E.C upgraded to hospital and named as Leul Mekonen. In 1977 E.C. the hospital
was upgraded to give service for 250,000 people bring the name Dilla district hospital. Currently
it the hospital provides service for about 2 million catchment population with a total capacity of
about 108 beds and it has 68 nurses,35 general practitioners and 13 seniors specialist Doctors. It
provide range of services in outpatient (2576/month), in-patient and emergency basis
(625/month)in various wards: namely internal medicine, pediatrics, obstetrics and gynecology,
surgery, dentistry, ophthalmology and psychiatry

4.2 STUDY DESIGN

Institution based retrospective cross sectional study was will be conducted on all
neonates that are admitted in DURH neonatal unit.

4.3 STUDY PERIOD

The study will be conducted from Nov 10 to Feb 06/2010 E.C.

4.4 SOURCE OF POPULATION

All neonates admitted to NICU in DURH from Nov 10 to Feb 06/2010 E.C
STUDY POPULATION

Neonates selected by systematic random sampling using interval method from

those who are admitted to NICU in DURH from Nov 10 to Feb 06/2010 E.C
STUDY UNIT

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Neonates selected by systematic random sampling using interval method from
those who are admitted to NICU in DURH from Nov 10 to Feb 06/2010 E.C

4.6 SAMPLE SIZE

To draw a minimum sample size the following standard the sample size by the
prevalence taken from the research done in Zambia,23%(15), with pecision of
5%,95% confidence level.

n=Z2p (1-p)/d2

n= (1.96*1.96)*0.23(1-0.23)/(0.0025)

n=272

4.5 SAMPLING TECHNQUE

Systematic random sampling using interval method; i.e. Newborns who fulfill the
inclusion criteria were selected from the total admitted cases in the NICU during
the study period.

4.6 STUDY VARIABLES

INDEPENDENT VARIABLES
 Gender of baby
 Age of the mother
 Parity
 ANC
 Duration of labor
 Duration of ROM
 Maternal illnesses

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  Place of delivery
 Mode of delivery
 APGAR score
 Fetal distress
 Meconium staining
 Birth weight
 Duration of resuscitation

DEPENDENT VARIABLE
 Occurrence of PNA

4.7 INCLUSION AND EXCLSION CRITERIA

1.1.1.[4.9.1.] INCLUSION CITERIA

All babies neonates admitted during from Nov 10 to Feb 06/2010 E.C

1.1.2.[4.9.2.] EXCLUSION CRITERIA

All babies with gross congenital anomaly and preterm

4.8DATA COLLECTION PROPCEDURE

Data will be collected by questionnaire prepared by ourselves.

4.9ENSURING DATA QUALITY

Data will be collected by us. Since we prepared the questionnaire there is no
understanding gap between the questionnaire and our objective. as a principal
investigator, I will cross cheek my questionnaire everyday at the end of data
collection.

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4.10 DATA ANALYSIS AND PROCESSING
Data will be cleaned and entered in to SPSS version 16 20, for cleaning and
analysis using standard methods. Then association between the dependent and
independent variables will be made by using binary logistic regression. Detailed
explanation and interpretation of the collected data will be done by presenting the
data in the form of percentage using the table and graph.

4.11 DISSEMINATION AND UTILIZATION OF RESULT

The result of this study will be compiled with three copies and would will be
given to Dilla University College of medicine and health science, Department of
public health and DURH-NICU.

4.12 OPERATIONAL DEFFINATION

4.13 ETHICAL CONSIDERATION
Formal letter will be written from Dilla University College of medicine and health
science, Department of Public health and forwarded to DURH in order to gatet
permission to conduct the study. Consent from staff of NICU will be asked
accordingly.

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 CHAPTER FIVE

Project time schedule Work plan

Table 5.1:- Time table for the research project

Use Ghantt Chart

No ACTIVITIES NOV DES JANUA FEBR

1 Topic  
selection

2 Reviewing 
literature

3 Proposal    
preparation

4 First draft
writing

5 Final proposal
writing

6 Questioners
preparation

7 First draft 
writing
submission

8 Sample
collection

9 Data
interpretation

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 10 Report writing

11 Submission of
date

Chapter Six

Project Budget Breakdown

Table 6.1:- Cost Breakdown for the research project

No COST ITEM UNIT OF QUANT UNIT TOTAL

MEASUREM ITY COST(birr COST(bir
ENET ) r)

1 Transport Number 4 200 .00 800 .00

2 Photocopy Desta or 4 130 .00 520 .00

paper(80g) packet

3 Flash disc 4GB Number 1 250 .00 250 .00

4 CD-Re writable Number 2 40 .00 80 .00

5 Other stationer, LULP 300 .00

fixers ,pain, SUM(Ls)
pencils, eraser,
paper clip

6 For printing Paper 250 125 .00 125 .00

7 Subtotal 695 .00 202 .00

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 5

8 Contingency(20 139 .00

%)*695

Total budget 217 .00

4

CHAPTER SEVEN: REFFERANCE

1.Lawn,cousens,ZupanJ.Lancet Neonatal Survival Steering Team.4 million

neonatal death;when?where?why?Lancet. 2005;365:9-900
2.World Health Organization’s neonatal and perinatal mortality, 2004 country
regional and global estimate Geneva WHO 2007.
3.Bryce J.Bosch i-Pinto C,Shibua K, Black RE.WHO Child Health Epidemiology
Reference Group.WHO estimate of the causes of death in
children.Lancet.2005;365;1147-1152.
4.Ellis M,Stillbirth and neonatal encephalopathy in Kathmandu, Nepal;An
estimated of the contribution of birth 2004;2;211-220
5.Bushman EJ, Palliation RC, Mythical N .Intraparum -related birth asphyxia in
South Africa lesson from the first neonatal perinatal care survey.s AF Med J 2002;
92; 897-901.
Page | 22
6.EDHS 2011. Addis Abeba, Ethiopia.
7.Nelson KB , Ellen berg J .Apgar score as precidtore of chronic neurological
disability.Pediatrics 1981;68;36-44.
8.Rehana Majeed , Yachtsmen Me non, Farrakhan Majeed, Na heed parveen
Shaikh, Uzma D M Rajar. Risk factors for birth asphyxia. Journal of Ayub Medical
college of, Abbotabad; JAMC 19(3); 67-71.
9.Rashmi Tanv. A clinical study on birth asphyxia, Gujaat University. 1995;7;32-
40.
10.Namasivayam A. Hypoxic-Ischemic Encephalopathy. Philadelphia; an imprint
of Elsevier Inc., 2011, 19thed.
11.Chandre S,Ramji S,Thirupurum S,Perinatal asphyxia;multivariate analysis of
risk factors in Hospitals birth.Indian pediatric 1997;34:206-12

12. Namasivayam A.Hypoxic-Ischemic Encephalopathy.Philadelphia:an imprint of

Elsevier Inc.,2011,19th ed.

13.Jones G,steketce RW,Black RE,Zultigar AB,Morris SS.Bellag Group.How

many child death can we prevent this year?Lancet.

14.Enlish M ,Muhoro A ,Aluda M, Were S ,Ross A ,Peshu N, Outcome of delivery

and cause-specific mortality and severe morbidity in early infancy:a kenyan district
hospital birth cohort.Am J Trop Med Hyg.2003;69:228-232.

15. Robertson CMT, Finer NN.Long-term follow-up of term neonates with

perinatal asphyxia.Clin prenatal.1993; 20:483-499

16. Simon NP.Longer-term neurodevelopmental outcome of asphyxiated

newborns.Resuscitation Fetus Newborn.1999; 26:767-778.

17.Roberson CMT, Finer NN, Grace MGA.School performance of survivors of

neonatal encephalopathy associated with birth asphyxia at term.J
Pediatr.1989;114:753-760.

18.Cioni G,prechti HFR, Ferrari F,paolicelli PB, Einspieler C,Roversi MF. Which
bette predicts later outcome in fullterm infants: quality of general movements or
neurolgical examination?Early Hum Dev.1997:50:71-85.

19. Brookhoser PE.Sensorienural hearing loss in childeren. Pediatric Clin North

Am 1996, 43(6);1195-1216.

Page | 23
 20.Ellis M,Manandhar N,Shrestha PS,Shresth L,Manandhar,Ds,deL Costello
AM.Outcome at one year of neonatal encephalopathy in kathmandu,Nepal.Dev
Mad child neurol.1999;41:689-695.

21. Stoll BJ Mesham AR.Children cannot wait;Improving the feature for the world
poorest infants.Jpediatr.2001;139:729-733.

22. Lawn JE,Estimating the causes of four million neonatal deaths,Statistical

Annex.2000;4:433-439.

23.English M,Muhoro A,Aluda M,Were S,Ross A,Peshu N.Outcome of delivery

and cause-specific mortality and sever morbidity in early infancy;a Kenyan district
Hospital birth cohort.Am J Trop Med Hyg.2003;69:228-232.

Annex

Annex -1:- Questionaire

Welcome to this interview

My name is ------------------and my colleague name is ------------.We are here to
collectinformation about CVHBC for PLWHA. Its aim is to study about the
experience of CVHBCgivers in HBC of PLWHA and to identify the major
challenges in HBC in order to suggestpossible solutions for improvement of the
program.Now we ask you some questions about HBC of PLWHA that you answer
according to yourknowledge and experience. There is no right or wrong answer.

Page | 24
 All comments, both positiveand negative are welcome. We would like to have
many points of view and to be openinterview, so feel free to express your opinion
honestly and openly.

Assessment of prevalence of perinatal asphexia and associated factors in DURH,

SNNPR, Ethiopia from May 11, 2016 – May 12, 2017

1. Socio-demographic data

1.1.Socio demographic data of the baby

1.1.1. Name of the baby

1.1.2. Hospital Number

1.1.3. Date of birth

1.1.4. Age at admission

1.1.5. Sex Male Female

1.2.Socio demographic data of the mother

1.2.1. Name of the mother

1.2.2. Hospital number

1.2.3. Age

1.2.4. Address

1.2.5. Occupation

1.2.6. Date of admission to

maternity
1.2.7. Date of delivery

2. Assessment of birth event

2.1. Place of delivery A. Hospital B. Health center C. Home
2.2. Onset of labor A. Spontaneous B. Induced

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 2.3. If the answer to question 2.2.
is ‘B’ what is the indication
2.4. Assessment of fetal status

1.1.1.[2.4.1.] Fetal heart rate A. < 110 BPM B. 110 - 170 BPM C. > 170
BPM
1.1.2.[2.4.2.] Fetal movement A. < 3 in 30 minute B. >= 3 in 30 minute

1.1.3.[2.4.3.] Cord A. Normal B. Around the neck C. Prolapsed

1.1.4.[2.4.4.] Was there A. Yes B. No
vaginal bleeding
1.1.5.[2.4.5.] Duration of A. > 1 hour before B. > 8 hour before the C. < 1 hour
rupture of membrane the onset of onset of labor before the
labor onset of
labor
1.1.6.[2.4.6.] Color of liquor A. Clear B. Meconium stained
2.5. Mode of delivery A. S.V.D B. Assisted vaginal C. Caesarian
delivery delivery
Please choose one
A. Episiotomy
B. Vacuum
assisted
delivery
C. Forceps
delivery
2.6. If the answer to question 2.5.
is ‘B’ or ‘C’ what is the
indication
2.7. Total duration of labor A. Less than 24 hours B. Greater than 24 hour
2.8. Duration of second stage A. 1 hour B. 2 hour C. 3 hour D. > 3 hour
3. Immediate assessment of the new born after birth
3.1. APGAR score assessment

3.1.1. APGAR score at 1 min Sign 0 1 2

Heart Rate Absent Less than 100 Over 100

Respiratory Slow, Irregular Good cry

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 Rate Absent

Muscle Tone Limp Some Flexion Active

motion

Reflex No response Grimace Cry

Irritability

Color Pale Body Pink, All Pink

Extremities
blue

Total score

3.1.2. APGAR score at 5 min Sign 0 1 2

Heart Rate Absent Less than 100 Over 100

Respiratory Slow, Irregular Good cry

Rate Absent

Muscle Tone Limp Some Flexion Active

motion

Reflex No response Grimace Cry

Irritability

Color Pale Body Pink, All Pink

Extremities
blue

Total score

3.1.3. APGAR score at 10 min Sign 0 1 2

Heart Rate Absent Less than 100 Over 100

Respiratory Slow, Irregular Good cry

Rate Absent

Muscle Tone Limp Some Flexion Active

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 motion

Reflex No response Grimace Cry

Irritability

Color Pale Body Pink, All Pink

Extremities
blue

Total score

4. Risk factor assessment

4.1.Maternal risk factors

4.1.1. Mother’s Age A. < 18 year B. 18 – 35 yr C. 35 – 49 yr D. > 49

yr
4.1.2. Level of education A. Non- B. Primary C. High school D. Grad
educated education completed uated
completed from
colle
ge/
unive
rsity
4.1.3. Parity of the mother A. Para - I B. Para - II C. Para - III D. Other
____
___
4.1.4. Height of the mother A. < 1.5 m B. 1.5 m – C. 1.75 m – 2 m D. > 2m
1.75 m
4.1.5. MUAC of the mother A. < 18 cm B. 18 – 21 C. > 21 cm
cm
4.1.6. Did the mother attended A. Yes B. No
ANC follow up?
4.1.7. If yes, how many times? A. I B. II C. III D. IV
4.1.8. Problems identified
during pregnancy
1.1.6.1.[4.4.8.1.] High BP? A. Yes B. No
1.1.6.2.[4.4.8.2.] If yes, how

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 much is the record?
1.1.6.3.[4.4.8.3.] Was there A. Yes B. No
edema identified
during pregnancy?
1.1.6.4.[4.4.8.4.] Was there A. Yes B. No
febrile illness
diagnosed during
pregnancy?
1.1.6.5.[4.4.8.5.] If yes, what
was the diagnosis?
1.1.6.6.[4.4.8.6.] Was anemia A. Yes B. No
diagnosed during
pregnancy?
1.1.6.7.[4.4.8.7.] What was
the Hct?
1.1.6.8.[4.4.8.8.] Urine WBC
analysis profile during RBC
pregnancy Glucose
Ketone
Bilurubin

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