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

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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.