Risk factors for a low five-minute Apgar score at a provincial referral hospital in southern Mozambique: A secondary analysis of a matched case-control study
- 1University of Eduardo Mondlane Faculty of Medicine
Abstract
Perinatal asphyxia is a leading cause of neonatal death in Mozambique and the main cause of early neonatal death in the referral hospitals of Gaza Province. Where blood gas analysis is unavailable, a low five-minute Apgar score remains a key marker of intrapartum compromise. This study aimed to identify maternal, obstetric, fetal and institutional factors associated with a low five-minute Apgar score at Xai-Xai Provincial Hospital, Mozambique. We conducted a secondary analysis of the records of 471 newborns delivered between January 2016 and December 2018, drawn from a matched case-control study of early neonatal death. The outcome was a five-minute Apgar score below 7. Associations were estimated with bivariate and multivariable conditional logistic regression and are reported as odds ratios with 95% confidence intervals. Of the 471 newborns, 76 (16.1%) had a low five-minute Apgar score. In the multivariable model, a gestational age of 42 weeks or more (adjusted odds ratio 4.04; 95% confidence interval 1.18-13.82) and ruptured membranes on admission (adjusted odds ratio 3.69; 95% confidence interval 1.37-9.96) were associated with higher odds of a low score, whereas partograph use during labour was associated with lower odds (adjusted odds ratio 0.07; 95% confidence interval 0.01-0.31). The association with preterm birth was attenuated after adjustment for birth weight. Post-term birth and ruptured membranes on admission were associated with a low five-minute Apgar score, and partograph use with lower odds. Because the sample was drawn from a study of early neonatal death, these associations should be confirmed in unselected birth cohorts. They nonetheless support strengthening intrapartum monitoring in Mozambican referral maternities.
Related
- High prevalence and multidrug resistance of Methicillin-resistant Staphylococcus aureus at a provincial referral hospital in Zambia: A 5-year retrospective study
- Spatiotemporal distribution of timely measles-containing vaccine coverage among children born in Hebei Province during 2019–2023: a secondary analysis of provincial routine immunisation registry data
- The value of angiogenic biomarkers in determining preeclampsia-related perinatal deaths: A cross-sectional study in a high burden setting of southern Mozambique
- Concordancia diagnóstica entre la cápsula endoscópica y la enteroscopía de doble balón en la hemorragia digestiva de intestino medio en un hospital de referencia en Perú Diagnostic Agreement Between Capsule Endoscopy and Double-Balloon Enteroscopy in Mid-Gut Gastrointestinal Bleeding at a Referral Hospital in Peru
- Prevalence and associated factors of type 2 diabetes among HIV-infected patients at Arsi University Teaching and Referral Hospital, Southeast Ethiopia, 2023
BibTeX
@misc{maculuve2026risk,
title = {{Risk factors for a low five-minute Apgar score at a provincial referral hospital in southern Mozambique: A secondary analysis of a matched case-control study}},
author = {B. Z. I. Maculuve and N. Fernandes},
howpublished = {medRxiv},
year = {2026},
month = oct,
doi = {10.64898/2026.10.13.26365388},
url = {https://www.medrxiv.org/content/10.64898/2026.10.13.26365388v1},
note = {CC BY},
}
RIS
TY - UNPB
TI - Risk factors for a low five-minute Apgar score at a provincial referral hospital in southern Mozambique: A secondary analysis of a matched case-control study
AU - B. Z. I. Maculuve
AU - N. Fernandes
PY - 2026
DA - 2026/10/13
PB - medRxiv
DO - 10.64898/2026.10.13.26365388
UR - https://www.medrxiv.org/content/10.64898/2026.10.13.26365388v1
AB - Perinatal asphyxia is a leading cause of neonatal death in Mozambique and the main cause of early neonatal death in the referral hospitals of Gaza Province. Where blood gas analysis is unavailable, a low five-minute Apgar score remains a key marker of intrapartum compromise. This study aimed to identify maternal, obstetric, fetal and institutional factors associated with a low five-minute Apgar score at Xai-Xai Provincial Hospital, Mozambique. We conducted a secondary analysis of the records of 471 newborns delivered between January 2016 and December 2018, drawn from a matched case-control study of early neonatal death. The outcome was a five-minute Apgar score below 7. Associations were estimated with bivariate and multivariable conditional logistic regression and are reported as odds ratios with 95% confidence intervals. Of the 471 newborns, 76 (16.1%) had a low five-minute Apgar score. In the multivariable model, a gestational age of 42 weeks or more (adjusted odds ratio 4.04; 95% confidence interval 1.18-13.82) and ruptured membranes on admission (adjusted odds ratio 3.69; 95% confidence interval 1.37-9.96) were associated with higher odds of a low score, whereas partograph use during labour was associated with lower odds (adjusted odds ratio 0.07; 95% confidence interval 0.01-0.31). The association with preterm birth was attenuated after adjustment for birth weight. Post-term birth and ruptured membranes on admission were associated with a low five-minute Apgar score, and partograph use with lower odds. Because the sample was drawn from a study of early neonatal death, these associations should be confirmed in unselected birth cohorts. They nonetheless support strengthening intrapartum monitoring in Mozambican referral maternities.
ER -