BACKGROUND:
Birth asphyxia (BA), defined as the failure of a neonate to initiate and maintain breathing after birth is the second leading cause of neonatal mortality globally, accounting for 23% of all neonatal deaths. In Kenya, BA contributes to 29% of neonatal deaths. Despite the presence of clinical guidelines to prevent and manage BA, mortality rates remain unacceptably high.

OBJECTIVES:
To determine risk factors associated with BA among newborns at Pumwani Maternity Hospital.

METHODS:
A matched case-control study was conducted with a total sample of 540 newborns (270 cases and 270 controls). Cases were defined as newborns with an APGAR score <7 at five minutes, while controls had scores ≥7. Data were collected using a pretested questionnaire and a structured data extraction tool. Analysis was performed using SPSS. Bivariable logistic regression was used to identify significant risk factors for BA. Ethical approvals were sought from ISERC, NACOSTI, Nairobi County and Pumwani Maternity Hospital research committee. Informed consent was obtained from participants.

RESULTS:
Malpresentation (AOR = 4.13, 95% CI: 1.55–11.04), non-reassuring fetal status (AOR = 3.59, 95% CI: 1.28–10.19), prolonged labour (AOR = 5.11, 95% CI: 1.90–13.15), and primiparity (AOR = 5.59, 95% CI: 2.13–13.88) were significantly associated with birth asphyxia.

CONCLUSIONS:
Malpresentation, non-reassuring fetal status, prolonged labour, and being primiparous were significant risk factors for BA. Strengthening antenatal care, timely diagnosis of labour complications, and effective intrapartum monitoring including use of the partograph are essential strategies to reduce BA and its contribution to neonatal mortality.

KEY MESSAGE:
Improving intrapartum monitoring and antenatal risk identification can significantly reduce birth asphyxia and advance newborn survival. Newborn 1