Risk Factors for Birth Asphyxia in Togo: A Case-Control Study

Background: Birth Asphyxia (BA) is one of the leading causes of neonatal death in developing countries. In Togo, 30.55% of neonatal deaths were related to BA and caused by several risk factors. The purpose of this piece of work is to analyse the antepartum, intrapartum, and foetal risk factors of BA. Methods: This is a case control study, conducted from 1st December 2019 to 28th February 2020 in obstetrics wards and at neonatal intensive care of paediatric ward at the Sylvanus Olympio university teaching hospital (CHU-SO) in Lomé, Togo. Neonates diagnosed with BA (Apgar score < 7 at 5th minute) were considered as “cases” (N = 200) while neonates born either with normal vaginal delivery or by cesarean section having no abnormality were considered as “control” (N = 200). Results: The prevalence rate of BA was 9.13%. Age (p = 0.0391), gravidity (p = 0.0040), type of facility for prenatal follow-up (p < 0.0001), use of Long-lasting impregnated mosquito nets (LLIN) (p < 0.0001), notion of maternal fever (p < 0.0001) and chronic pathology (p < 0.0001) were related to occurrence of BA. Significant antepartum risk factors observed were age < 25 years (OR = 1.15;CI 95% [0.66 - 1.98], p = 0.0391), primigravidity (OR = 1.82;95% CI [0.86 - 3.85], 0.0040), prenatal follow-up in a private one (OR = 1.62;CI95% [1.03 - 12.55], p < 0.0001), non-use of LLIN (OR = 2.50;CI 95% [1.61 - 3.88], p < 0.0001), maternal fever (OR = 3.73;CI 95% [2.33 - 5.97], p < 0.0001) and existence of maternal chronic pathology (OR = 36.0, 95% [4.94 - 262.60], p < 0.0001). Significant intrapartum risk factors were PRM (OR = 7.89;CI 95% [2.62 - 14.02], p < 0.0001), abnormal AF (OR = 5.40;CI 95% [2.57 - 11.38],], p < 0.0001), long labour (OR = 2.11;CI 95% [1.34 - 3.34],], p = 0.0004), use of oxytocin (OR = 2.14;CI 95% [1.38 - 3.32], p = 0.0003), and spontaneous vaginal (OR = 1.76;CI 95% [1.14 - 2.72,], p = 0.0008]). Significant Foetal risk factors were male gender (OR = 1.55;CI 95% [1.03 - 2.33], p = 0.0423), preterm babies (OR = 8.83;CI 95% [3.79 - 20.60], p < 0.0001) and baby birth weight < 2500 gr (OR = 2.96;CI 95% [1.82 - 4.79], p < 0.0001). The Sarnat score had shown anoxo-ischemic encephalopathy stage III (19.00%), corresponding to 87.80% of case fatality rate (p < 0.0001). Conclusion: Various risk factors lead to BA in Lomé. Early identification of high-risk cases with improved antenatal and perinatal care can decrease the high mortality of BA in Togo.