Risk factors associated with birth asphyxia at Pumwani Maternity Hospital, Nairobi, Kenya: a case-control study.

BACKGROUND: Birth asphyxia remains a leading cause of neonatal mortality and morbidity in low- and middle-income countries. In Kenya, it accounts for approximately 29% of neonatal deaths despite the implementation of national newborn care guidelines. This study investigated the risk factors associated with birth asphyxia at Pumwani Maternity Hospital, Nairobi, Kenya. METHODS: A matched case-control study was conducted at Pumwani Maternity Hospital, Nairobi, Kenya, between February and September 2024. Cases were newborns with a five-minute APGAR score <7, while controls had a five-minute APGAR score ≥7. A total of 540 newborns (270 cases and 270 controls) were consecutively recruited. Data were collected using a researcher-administered questionnaire and a data abstraction tool. Univariable and multivariable conditional logistic regression analyses were performed to identify factors associated with birth asphyxia. All analyses were conducted using R version 4.5.1 (2025-06-13 ucrt), and statistical significance was set at p < 0.05. RESULTS: Most mothers were aged above 20 years (80.2%), married or cohabiting (75.6%), unemployed (61.9%), and had attained secondary level education (58.0%). Complications during labour were strongly associated with birth asphyxia (AOR: 24.26; 95% CI: 7.65-76.95). Additionally, previous adverse obstetric history (AOR: 2.18; 95% CI: 1.14-4.17), maternal medical and obstetric conditions during pregnancy (AOR: 1.82; 95% CI: 1.04-3.19), and non-cephalic fetal presentation (AOR: 8.92; 95% CI: 1.77-45.00) were also independently associated with higher odds of birth asphyxia. Conversely, spontaneous onset of labour (AOR: 0.20; 95% CI: 0.05-0.76), spontaneous vaginal delivery (AOR: 0.02; 95% CI: 0.00-0.10), and delivery conducted by trained healthcare providers were associated with reduced odds of birth asphyxia. CONCLUSION: Birth asphyxia was strongly associated with several maternal and obstetric factors. Strengthening antenatal risk identification, timely management of labour complications, skilled intrapartum care, and early recognition of high-risk deliveries may reduce the burden of birth asphyxia and improve neonatal outcomes in similar low-resource settings.