Factors associated with low Apgar score in newborn babies at a hospital in Namibia

Abstract

All newly born infants have to go under examination after birth and again for five minutes to check how well they are tolerating the birth process and the environment outside the uterus. The study aimed to identify factors associated with low Apgar scores among newborn babies in Onandjokwe Intermediate Hospital. The quantitative, 1:1 ratio case-control matching, retrospective, a descriptive research design was used. The target population was cases of 376 maternal records with low Apgar scores. Simple random sampling methods were used to select the sample size for maternal records of low Apgar score babies which was 194 and for babies with normal Apgar scores 194 will give a total of 388 maternal records. Data were collected from June to August 2020 in Onandjokwe Intermediate Hospital using a document review checklist as the data collection tool. A pilot study was done on 10% of maternal records. Data were entered and analyzed using SPSS version 26. Dependent variables were analyzed using Binary Logistic Regression to measure changes in the Independent Variables and results were presented in tables and graphs in the form of frequencies and percentages. In this study, the level of significance was determined by factors with a p-value less than 0.05. The results show that 161 (82.9%) of newborn babies had a low Apgar score at immediate Apgar scoreand of these 30 (18.6%) had severe low Apgar score while 131 (81%) had moderate low Apgar score The demographic and maternal factors were significantly associated with immediate low Apgar scores were gravidity (p<0.021), parity (p<0.029), Haemoglobin during the first Ante-natal care (ANC) visit (p<0.011), Antepartum haemorrhage (APH) (p<0.004), membrane status (p< 0.000), duration of labour (p< 0.000), and neonatal factors include; gestational age (p<0.000) as well as birth weight (p<0.000). The results of Apgar scores after five minutes showed that 33 (8.5%) of newbornbabies had low Apgar scores and those with normal Apgar scores were 355 (91.5%). Factors associated with low Apgar scores at five minutes after birth are maternal age (p<0.015), urinary tract infection (UTI) (p<0.000), other pregnancy comcomplications<0.000), and gestational age (p<0.000) and birth weight (p<0.000). Binary Logistic regression model results show factors that were found to be strong predictors on immediate Apgar score are: total duration of labour (OR 4.263; 95% CI:2592-7.010; p-value=0.000), foetal presentation (OR 2.988; 95% CI: 1.182-7.554; p-value=0.021) and cord around the neck (OR 18.473, 95% CI;1.936-176.262; p-value=0.021). While after five minutes Apgar score, proper monitoring of partograph (OR 2.228; 95% CI:1.656-2.997, p-value=0.000) and gestational age (OR 1.475; 95% CI: 1.259-1.728; p-value=0.000) were the factors that increase chances of neonates persisting with a low Apgar score. Maternal and neonatal factors associated more with low Apgar scores are identified, the study concluded that in-service training for midwives on effective monitoring of pregnant women during antenatal care and labor is needed. In addition, health education about the importance of antenatal care would contribute more to the early detection of complications for prompt action.