Prevalence and risk factors of birth asphyxia at Livingstone University Teaching Hospital
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Background
Birth asphyxia remains a leading cause of neonatal mortality in low-resource settings, with Zambia reporting a rate of 24 deaths per 1,000 live births. Birth asphyxia accounts for over 20% of neonatal ICU admissions. This study aimed to determine its prevalence and risk factors to inform targeted interventions.
Methods
A retrospective cross-sectional analysis of 497 maternal-neonatal records (July 15, 2024-March 31 st 2025) was conducted at LUTH, Zambia. Data on maternal demographics, obstetric history, intrapartum events, and neonatal outcomes were extracted using REDCap. Birth asphyxia was defined as failure to initiate breathing with Apgar ≤5 or hypoxic-ischemic encephalopathy. Univariable and multivariable logistic regression identified risk factors.
Results
The prevalence of birth asphyxia was 6.8% (34/497). Significant predictors included eclampsia (adjusted odds ratio [AOR]=19.3; 95% CI:3.0-123.0; p=0.002), foetal distress (AOR=6.9; 95% CI:2.4-20.0; p<0.001), and resuscitation with suction (AOR=3.8; 95% CI:1.2–11.8; p=0.019) or facial oxygen (AOR=4.3; 95% CI:1.2-15.9; p=0.026). Neonates requiring bag-mask ventilation had 65.6% asphyxia rates versus 5% without (p<0.001). Post-term gestation (15.2% asphyxia) and abnormal foetal heart rates (28.6%) were also associated with higher risk.
Conclusion
The 6.8% asphyxia prevalence at LUTH reflects regional disparities, with eclampsia and foetal distress being critical modifiable risks. Strengthening emergency obstetric care, foetal monitoring, and neonatal resuscitation capacity could reduce preventable cases. These findings underscore the need for context-specific strategies to improve perinatal outcomes in Zambia and similar settings
