Determinants of Neonatal Mortality in the Health Zone Kenge, DR Congo (2013-2016)

Childbirth is a happy event in a family and procreation is the wish of the human society. However, when a Child is born with health problems or dies, it is a moral and social burden for the community. Child mortality is decreasing elsewhere in our global society, there is a lot aim to be done in developing countries, the DRC included. The main goal of this research Was to determine the causes of neonatal mortality at the Kenge area health During the period from 2013 to 2016. The study used an analytical method based was descriptive and correlational design with a sample size of 84 757 Amongst Deaths Recorded at the health area Kenge During the Above period. Results show That entre 2013 and 2016 the health area Kenge Recorded year average rate of 19. 2 Deaths of less than 28 days out of 1000 births Estimated Within a confidence interval of 95% and a Range of 9.5 to 24 Neonatal Deaths. This early neonatal mortality Was Explained by Several factors, purpose Mainly by mothers’ irresponsibility and immaturity as well as the distance to health centers, the lack of midwives and premium parity. These Were responsible of the bad status of the baby at delivery gold icts way of delivery and the APGAR persistence after-birth child.


Introduction
The birth of a baby is a natural process and an important and joyful social event for the individual family and the wider In 2015, neonatal deaths accounted for 45% of total deaths, a proportional increase of 5% compared to 2000 [1]. According to WHO [2,3]. Africa has the neonatal mortality rate estimated as high 45 deaths per 1,000 live births against 5 deaths in developed countries. for Madagascar for example, the demographic and health surveys data (DHS 2003(DHS -2004) indicate a neonatal mortality rate of 32 per 1,000 live births. these neonatal deaths account for 55% of infant mortality (Madagascar, 2004). The main causes of this mortality are prematurity, respiratory distress and neonatal by mothers' irresponsibility and immaturity as well as the distance to health centers, the lack of midwives and premium parity. These Were responsible of the bad status of the baby at delivery gold icts way of delivery and the APGAR persistence after-birth child. These resulted from Prematurity, dystocia, hypoxia and choke, and infections specific to the perinatal period, qui were found to be Among the Most Significant causes of child death. These determinants of neonatal mortality need to be taken in gravement Addressing the sustainable development goal No. 3 That Promotes maternal child health and wellbeing. Mainly goal by mothers' irresponsibility and immaturity as well as the distance to health centers, the lack of midwives and premium parity.
These Were responsible of the bad status of the baby at delivery gold icts way of delivery and the APGAR persistence after-birth child. These resulted from Prematurity, dystocia, hypoxia and choke, and infections specific to the perinatal period, qui were found to be Among the Most Significant causes of child death. These determinants of neonatal mortality need to be taken in gravement Addressing the sustainable development goal No. 3 That Promotes maternal child health and wellbeing. dystocia, hypoxia and choke, and infections specific to the perinatal period, qui were found to be Among the Most Significant causes of child death. These determinants of neonatal mortality need to be taken in gravement Addressing the sustainable development goal No. 3 That Promotes maternal child health and wellbeing. dystocia, hypoxia and choke, and infections specific to the perinatal period, qui were found to be Among the Most Significant causes of child death. These determinants of neonatal mortality need to be taken in gravement Addressing the sustainable development goal No. 3 That Promotes maternal child health and wellbeing.
infection [4]. Early neonatal mortality in neonatal units in poor countries hospitals may brush against the slaughter in excess of 50% [5]. And their deficiency of 350,000 midwives worldwide to curb the scourge [6]. The challenge is particularly important in our country, and especially in the health Kenge zone which is exposed to the morbidity and mortality of mother and child. Indeed, maternal, newborn and child is alarming and marked by maternal and child mortality are among the highest in the world, for a ratio of 549 maternal deaths per 100,000 live births, a rates of childhood mortality at 158 to 1,000, an infant mortality rate 97 to 1000 and a neonatal mortality rate of 42 to 1000 (NIB, 2013) [7]. Despite the efforts, the health of mothers and children remains a concern. This requires effective neonatal mortality reduction programs that take into account the interventions on modifiable risk factors.
Of such interventions will focus on economic and health measures useful for the survival of newborns. Health facilities at the primary level recorded in the majority of cases of pregnant women with limited financial resources, that is to say a low socioeconomic level [8,9]. Health facilities at the primary level recorded in the majority of cases of pregnant women with limited financial resources, that is to say a low socioeconomic level. This reality does not save the province Kwango Kenge and specifically the health zone [10]. Our

Status Report
Neonatal mortality is defined as the probability that a newborn will die between birth and 28 days of life. About two-thirds of neonatal deaths occur in the WHO regions of Africa and Southeast Asia. The countries that have the largest number of deaths are mainly found in South Asia, because of the large populations in this region. India alone accounts for nearly a quarter of neonatal deaths This mortality risk experiencing tremendous changes during the neonatal period [12]. Each year 2,000,000 babies die within 24 hours of their existence, 99% of these deaths occur in low-income countries [6]. In Africa 70% of the population lives in rural areas and 50% below the poverty line, while 90% of qualified personnel is devoted in large urban centers, and only 60% of women receive prenatal care, half of deliveries take place at home without medical assistance. A midwife formed African supports 500 mothers each year. The Democratic Republic of Congo (DRC) is ranked among the countries with the least progress in child survival.
Its mortality rate of children under five years has remained virtually unchanged for twenty years, from the late 1980s [13,14].
According to WHO [4]  conditions. The intrauterine growth restriction, which is defined by insufficient fetal growth during pregnancy is a major risk of perinatal death highlights UNICEF [18]. Underweight is associated with malnutrition and poor health of the mother. Neonatal mortality follows the "2/3 rule" ie 2/3 of infant deaths occur in the first month.
The causes of neonatal mortality as its most important factors to risk are two-fold: the causes and factors of maternal and fetal order, firstly, and secondly, obstetric risk factors and the causes and sociocultural. The fundamental maternal causes of neonatal mortality include congenital uterine malformations, the contracted pelvis, incompatibility maternal fetal rhesus. Risk factors related to the mother include illegitimate pregnancies, unfavorable working conditions and transport, low socioeconomic class and unmonitored pregnancies, age and parity [13]. As for obstetric risk factors, they are for the most part related to pregnancy, including abnormalities in the evolution of pregnancy; premature rupture of the membrane and dystocia; colored amniotic fluid, etc. Finally, socio-cultural factors are behavioral and environmental conditions.
For example, neonatal mortality can be attributed to the difficult working conditions and transport, illegitimate pregnancies, which in turn can be explained by parental poverty that forces many women and girls into prostitution to survive (Rachidatou). In developing countries, the main causes of fetal neonatal mortality are infectious diseases including sepsis, pneumonia, tetanus and diarrhea in 36% of cases.
Premature births and complications attributable to that account for 27% of deaths, while neonatal asphyxia accounts for 23% of cases. Of the remaining 14%, 7% of all deaths are associated with a birth defect. From one year to another, prematurity presented in general more than 40% of neonatal deaths [19]. According

Description of the Study Environment
Our study is among the Rural Health Zone (Kenge Kenge ZS).  Data collection instruments were the registry, partographs mothers who gave birth to dead babies and newborns sheets died before the 7 th day of their births.
Selection Criteria: Before including a child in the study sample, the researchers considered two following criteria: (i) Newborns died in the maternity; and (ii) Newborns died on the 7 th day before the 7 th day of birth in the service of pediatrics and health centers.

Exclusion Criteria
Were excluded from the sample this study, all new life born, and newborns died after 7 days of their births.

Data Analysis Techniques
The study made use of descriptive and inferential statistics to analyze the from data partographs and cards containing the ad hoc information. Descriptive statistics allowed detect the prevalence of neonatal mortality through the calculation of the frequency, mean, mode, median, standard deviation, and the Z-score. The calculation of the frequencies has been to describe the sample workforce by age and sex based on Equation 1:

Analysis Results
This study has identified both the prevalence of neonatal mortality and its root causes in Kenge health zone during the period from 2013 to 2016. Regarding sanitary and socioeconomic characteristics of the surveyed mothers and babies, Table 2 shows that most deliveries among primiparous experienced complications (41.7%), and this at cause of asphyxia, neonatal infection and prematurity (Table 1).

Characteristics of Newborns and their Mothers
Many cases complications are referred to the hospital because of distance remote from the health center (46.4%). Unfortunately, most of the traditional midwives who dropped their train service to police harassment suffered during and after childbirth, only 15.5%of births were attended by midwives (Table 2). Source: Authors (2017).

Determining Factors for Neonatal Mortality
Even the number of live births is pretty normal in this area, the rather worrying trend of stillbirth is a major concern of nongovernmental and political organizations responsible for providing reproductive health. Thus, the least squares method used in this study allowed us to predict, with high accuracy, the most significant determinants of neonatal mortality in the Health Area of Kenge. Tables 3 & 4 give us an overall view of these determinants. From type of work (agricultural or not) and the number of children of the mother, mode of delivery, the presence of midwives, the patented cord and parity were also significant in determining neonatal mortality in the health Area of Kenge.

Other factors listed above have presented regression parameters
with coefficients (B) significant at 95 or 99% confidence level.  Civil status ---

3)
The parameter value in specific units *Parameter statistically significant at 95% confidence interval **Parameter statistically significant 99% confidence interval  Table 5 shows that the neonatal mortality prediction model had proved statistically relevant. It recorded a high rate of adjustment represented by an adjusted coefficient of determination (adjusted R2) greater than 0.50 and a statistically significant F value 99% confidence interval. This means that factors related to neonatal mortality were normally distributed and therefore could not be coincidence.  Tables 3 and 4 above

Discussion on the Determinants of Neonatal Mortality in Kenge
This study of neonatal mortality in the Health Zone Kenge  (Table 5). For their part, Amon-Tanoh-Dick [24] posted a death rate of 28.2%oin 2006 the neonatology department of the University Hospital of Yopougon in Ivory Coast. These early neonatal mortality rates are not significantly different from those found at Cameroon, Algeria and Vietnam [25]. If harnessing the case of Algeria, and Moulkhaloua Belkheir [26] have evaluated the neonatal mortality rate to 26.1%o in 2012, while that of France was fixed at 03%oin 2010, according to statistics from the National Statistics Office (NSO). These same determinants summers found Nagaloka (2013), Chelo [27], Bezzaoucha [5], Berthin [28] and UNICEF [19] in their respective studies. However, the least squares method used in this study allowed us to predict, with high accuracy, the most   However, deaths due to prematurity and birth asphyxia remain important during the early neonatal period; and 60 to 80% of deaths occur among children with very low weight. Low birth weight is considered a risk factor rather than a direct cause of death, since it is often related to the mother's health (Serengbe et al., 2000).
Therefore, good care of mother and newborn would be the basis of the decline in death rates due to infection or respiratory distress.
For example, tetanus, who was among the main causes of neonatal deaths has decreased in importance with the intensification of vaccination [31]. Finally, the quality of care improves with midwifery training, which must be increasingly able to anticipate certain complications even before the child's birth [28]. Indeed, prenatal care and deliveries are conducted by nurses trained for this purpose.
There is no doctor to support pregnant women outside the pediatrician who provides neonatal consultations twice a week [32].

Conclusion
The descriptive and analytical design used in this study to to an average neonatal mortality rate of 19.2%o varying between 9.5 and 24.0%o. Thus, neonatal mortality stood around 19 deaths in less than a month in 1000 births. This rate approximates the observations made in Sub-Saharan Africa whose are variations are explained by various causes [33][34][35][36][37].
The following risk factors were identified: obstructed labor, premature rupture of membranes, parity, number of children, age of the mother, marital status, education level, type of work and income, underweight, gestational age and pathologies during pregnancy.
These factors were directly correlated with the irresponsibility and immaturity of the mother. Moreover, poor baby's condition at birth or its mode of delivery were the result of prematurity, dystocia, hypoxia and asphyxia, low birth weight, complaints to delivery, respiratory distress syndrome, the shortness of the umbilical cord, the amniotic fluid appearance, prenatal infections and other specific infections at the perinatal period, and distance from health centers, the presence of midwives, gender, presence of APGAR at birth, presence of jaundice peri / neonatal and as other congenital anomalies.

Recommendations
Neonatal death is a problem that does not only concern the health staff but also parents and administrative authorities. Among

Suggestions for Future Research
A single study cannot help determining the real causes and factors to be targeted by policies to prevent neonatal deaths in the ZS Kenge. Replicas of such a study in other health facilities will identify several relevant causes of the normality of neonatal mortality in the health area. They may also validate the suspected risk factors such as maternal age, parity, education level, obstructed labor, premature rupture of membranes, sex, underweight, gestational age.