Predictors of Early Onset Neonatal Sepsis among Neonates in Dodoma, Tanzania: A Case Control Study

Abstract

Objective To assess the predictors of early onset neonatal sepsis (EONS) among neonates in Dodoma Tanzania. Methods A hospital-based case-control study of randomly selected 105 cases and 217 controls in three hospitals in Dodoma region. Cases were neonates diagnosed with neonatal sepsis. Controls were matched to the cases by mother’s age and parity at a ratio of 1 case to 2 controls. A semi-structured questionnaire was used to collect data on the potential mother, neonate and interventional predictors of EONS. Both descriptive and inferential statistical analysis were employed to test for independent association Results Most (92.5%) of neonates were born at term (≥37 weeks) and 84% had normal birth weight of ≥3 kg. After adjusting for confounders, the maternal factors which showed significant association with EONS were maternal history of chorioamnionitis [adjusted odds ratios (AOR) = 1.910, p = 0.042, 95% confidence interval (CI): 1.0223.56], HIV status (AOR = 2.909, p = 0.012, 95% CI: 1.020–8.296), prolonged rupture of membrane (AOR = 2.857, p = 0.014, 95% CI: 1.233–6.619) and multiple digital vaginal examinations during labor (AOR = 5.178, p = 0.026, 95% CI: 1.220–21.986). The neonatal history of perinatal asphyxia was observed to have a significant association with EONS (AOR = 6.781, p = 0.006, 95% CI: 1.725–26.652). Conclusion Both maternal and neonatal predictors had significant contribution to EONS. Results shed light on critical factors for consideration to prevent this disease and poor outcomes.

Neonatal Sepsis, Antibiotic Susceptibility Pattern, and Treatment Outcomes among Neonates Treated in Two Tertiary Care Hospitals of Yangon, Myanmar from 2017 to 2019

“…Our study found that septic neonates more frequently had a Gram-negative source of infection (68% versus 37%, respectively) and were typically late-onset clinically, similar findings from developing countries have been reported [ 23 , 29 , 34 ]. These two findings suggest that infections are more frequently not vertically related from the mother, but rather horizontally transmitted from individuals responsible for the care of the baby, the hospital environment, or community-acquired [ 27 , 28 ].…”

“…There was no significant association between demographic, perinatal, and clinical characteristics with unfavorable treatment outcomes among neonates with bacteriologically confirmed sepsis ( Table S5 ). In contrast, other studies have reported that preterm, low birth weight, late onset sepsis, home delivery, and Gram-negative sepsis were associated with unfavorable treatment outcomes [ 23 , 24 , 33 ]. These discordant findings may be due to the mixing of clinical factors from two different tertiary hospitals and other contextual variability.…”

“…Among neonatal factors, very low and low birth weights (54.4%) were found to be associated with overall clinically suspected sepsis in this study ( Table 2 ). Preterm birth and low birth weight were reported as associated risk factors of neonatal sepsis in previous studies as well [ 22 , 23 , 31 , 32 ]. However, others have found no association between neonatal sepsis and preterm birth or low birth weight [ 24 , 33 ].…”

“…This study describes the frequency of neonatal bacterial sepsis in two large tertiary care NICUs, which is one of the principal causes of hospitalization and mortality for neonates in developing countries [ 22 , 23 ]. We found the prevalence of bacteriologically confirmed neonatal sepsis (672/10,935, 6.1%) in the two study facilities to be lower than reports from Bangladesh (14.5%) [ 24 ] and Nepal (14%) [ 25 ], but similar to one from India (6.2%) [ 26 ].…”

Neonatal sepsis at Mulago national referral hospital in Uganda: Etiology, antimicrobial resistance, associated factors and case fatality risk

“…Crude odds ratios (OR) and 95% confidence intervals (95% CI) were estimated for each exposure variable. Based on previous literature, we decided to include the following variables in our multivariable model; PROM, maternal fever in the last trimester and mode of delivery [27,28]. Other variables we included were birth weight, umbilical cord infection, prior antibiotic use, foul-smelling vaginal discharge, maternal age and education background.…”