Background: National facility-based neonatal mortality audits are an important source of data to identify
areas for improvement of service delivery and outcome of care.
Objectives: To examine admissions to the neonatal unit, Edward Francis Small Teaching Hospital, Banjul,
The Gambia and make recommendations for programme action to reduce mortality through improvements
in the quality of care, particularly with respect to suspected neonatal infections.
Methods: Case notes were reviewed for all neonates admitted to the neonatal unit during a 5-year period
(1 January 2009 to 31 December 2013) to assess outcome and quality of care. Data for 2009 were
subsequently excluded because of the low proportion of records retrieved.
Results: Of the 4944 admissions between 1 January 2010 and 31 December 2013, 1734 infants (35%)
died, with 57% of all deaths occurring within the first 48 hours of admission. There were 1267 early
neonatal deaths (deaths occurring during the first 7 days of life), 67% of which occurred during the first
48 hours of life. Independent predictors of neonatal death in the multivariable analysis were; maternal
lack of antenatal care, non-teaching hospital delivery, admission weight v1500g, abnormal blood glucose
concentration (v2.6 mmol/L or w6.9 mmol/L) and hypothermia (axillary temperature v36.5˚C). Forty-eight
per cent of newborns had point-of-admission hypothermia. Possible severe bacterial infection (pSBI)
accounted for 44% (2166/4944) of admissions, prematurity/low birthweight for 27% (1340/4944) and intrapartum-related
conditions for 20%. Only 5% (104/2166) of pSBI cases had at least one supportive investigation;
41 had a chest radiograph, 26 had a blood culture and 43 had a lumbar puncture. Although 94%
of the newborns received intravenous antibiotics, 55% of those who did lacked clinical evidence of pSBI
and had no diagnostic work-up.
Conclusion: Priority areas for action include infection prevention and improved diagnosis and management.
There is also scope to reduce hypothermia with feasible interventions particularly targeting preterm
infants. Improved patient records and audit data with linked action and accountability are interventions
which could prevent such deaths of newborns in The Gambia and other developing countries