Neonatal hypothermia is a great concern with near epidemic levels globally. In Kenya, its prevalence is as high as 87% with limited local data on the associated factors such as adherence to warm chain guidelines as recommended by the World Health Organisation (WHO) is limited. This study aimed to determine the prevalence of hypothermia and level of adherence to the WHO thermal care guidelines among newborns admitted at Moi Teaching and Referral Hospital (MTRH). It adopted a prospective study design of following up neonates for the first 24 hours of admission to the MTRH newborn unit. Thermometry, interview of mothers and observation of thermal care practices was done. Descriptive and inferential statistical techniques were adopted. Specifically, Pearson’s chi-square test of associations between predictors of neonatal hypothermia and management outcomes was conducted with their corresponding risk estimates at 95% confidence interval. Among the 372 participants, 64.5% (n = 240) were born at MTRH, 47.6% (177) were preterm and 53.2% (198) had birth weights below 2500 grams. Admission hypothermia was noted among 73.7% (274) and 13% (49) died on the first day of admission. Only 7.8% (29) newborns accessed optimal thermal care. Prematurity, day one mortality and adherence to the warm chain were significantly (p<0.001) associated with admission hypothermia. Inappropriate thermal appliance, inadequate clothing and late breastfeeding significantly increased the risk of neonatal hypothermia. Absence of admission hypothermia increased the likelihood of neonatal survival more than twenty-fold (AOR = 20.91, 95% CI: 2.15–153.62). Three out four neonates enrolled had admission hypothermia which was significantly associated with prematurity, lack of adherence to warm chain and increased risk of neonatal mortality on the first day of life. There was low adherence to the WHO thermal care guidelines. This should be optimized among preterm neonates to improve likelihood of survival.

Background: Neonatal hypothermia is a great concern with near epidemic levels globally. The prevalence in Kenya is as high as 87%. Local data on the associated factors including adherence to warm chain guidelines as recommended by the World Health Organisation (WHO) is limited. Objective: To determine the prevalence of hypothermia and level of adherence to the WHO thermal care guidelines among newborns admitted at Moi Teaching and Referral Hospital (MTRH). Methods: This descriptive cross-sectional study was carried out among neonates admitted at the MTRH newborn unit. Systematic sampling was used to recruit 372 eligible participants. Axillary thermometry, interview of respective mothers and observation of thermal care practices was done. Means and medians described continuous variables while frequencies with corresponding percentages summarized categorical variables. Associations between various variables and neonatal hypothermia were computed using the Pearson chi-square test. Relative Risks and Odds Ratios were assessed between predictor and outcome variables. Independence among significant variables was determined through the logistic regression model at 5% prediction level. Results: Among the 372 participants, 64.5% (n=240) were born at MTRH, 47.6% (177) were preterm while 53.2% (198) had birth weights below 2500 grams. Admission hypothermia was noted among 73.7% (n= 274) while 13% (49) died on day one of admission. Only 7.8 % (29) newborns accessed optimal thermal care. Prematurity (RR=1.62, 95% CI: 1.43-1.84), day one mortality (RR=17.7, 95% CI: 2.40, 122.71) and adherence to the warm chain (p<0.001) was significantly associated with admission hypothermia. Inappropriate thermal resuscitation appliance (RR=1.50, 95% CI: 1.34-1.67) inappropriate clothing (RR = 1.78, 95% CI: 1.54 - 2.05) and late breastfeeding (RR = 2.01, 95% CI: 1.39-2.89) significantly increased the risk of hypothermia. Non hypothermic newborns had twenty-fold increased odds of survival (AOR=20.91, 95% CI: 2.15-153.62). Conclusion: Three out four neonates at the MTRH newborn unit had hypothermia at admission. Hypothermia was significantly associated with prematurity, adherence to warm chain and day one mortality. There was notably low adherence to the warm chain. Recommendation: Strategies to optimize adherence to the warm chain at MTRH with emphasis on thermal care of the preterm neonate should be instituted.