Predictors of Neonatal Sepsis in Hospitals at Wolaita Sodo Town, Southern Ethiopia: Institution-Based Unmatched Case-Control Study, 2019

Abstract

Background. Neonatal sepsis plays a significant role in neonates’ mortality in developing countries accounting for 30-50% of total deaths each year. Gaining insight into neonatal sepsis predictors will provide an opportunity for the stakeholders to reduce the causes of neonatal sepsis. This research is aimed at determining the predictors of neonatal sepsis at Wolaita Sodo University Teaching Referral Hospital and Sodo Christian General Hospital, Ethiopia, April-July 2019. Method. This study employed an institution-based unmatched case-control study by selecting neonates in selected hospitals through consecutive sampling technique. The cases of this study are neonates diagnosed with sepsis. The study used a pretested structured questionnaire for a face-to-face interview to collect data from index mothers. Besides, the review of the record was done using checklists. The data were entered into EpiData version 3.1 and exported to Statistical Package for the Social Sciences version 24.0 for analysis. The study used descriptive, bivariate, and multivariate analyses. The odds ratio with 95% confidence interval was used to measure the association’s strength. p < 0.05 was the cut-off point for declaration of statistical significance for the multivariate analysis. Results. Factors significantly associated with neonatal sepsis among neonates were maternal age of 15-20 years and 21-30 years, mothers with low income/wealth, history of urinary tract infections/sexually transmitted infections, presence of intrapartum infections, antenatal care follow ‐ up < 3 visits, Apgar (Appearance, Pulse, Grimace, Activity, and Respiration) score < 7 , low birth weight, and the time in which breastfeeding started after delivery < 60 minutes. Conclusion. Maternal age, wealth/income, maternal urinary tract infections/sexually transmitted infections, intrapartum fever, antenatal care visit ≤ 3 times, Apgar score < 7 , low birth weight, and starting time of breastfeeding were independent predictors of neonatal sepsis. Therefore, maternal health education during antenatal care visits, perinatal and newborn care, and early initiation of breastfeeding might decrease neonatal mortality and morbidity due to sepsis.

Determinants of Neonatal Sepsis Admitted In Neonatal Intensive Care Unit At Public Hospitals Of Kaffa Zone, South West Ethiopia

“…Breast feeding was also had association with neonatal sepsis, Mothers who breast feed their neonate after 1 hour were nearly four times more likely to suffer from neonatal sepsis than that of neonates who breast feed within 1 hour. These finding is consistent with a study conducted in Wolayta sodo (32). Early initiation of breast feeding has different health benefit like increase ability to defense infection and increase the survival rate of children because colostrum is the first milk that is very important for newborns in protecting infection since rich in immunoglobin G that has great role in disease resistance.…”

“…Intra-partum fever was also had a significant association with neonatal sepsis, mothers who had history of intra-partum fever were eight times more risk for their neonates to develop neonatal sepsis than mothers who had no fever. These finding is consistent with studies conducted in Mekele, Wolayta sodo, and Pakistan (32). This might be because of the reason that fever is a sign of local or systemic infections such as chorioamnionitis and urinary tract infection, which are frequently transmitted to the baby in the uterus or during passage through the canal This results in hematogenious spread and vertical transmission of pathogens to the newborn before or during labor and delivery which further results in neonatal sepsis.…”

“…Invasive procedures: Procedures which have either of the following like Surgical procedures, Umbilical catheterization, Urinary catheterization, Nasogastric/oropharynx tube insertion, Endotracheal tube) (32).…”

“…On the contrary a study in Ethiopia showed that, all the three variables were not determinants of neonatal sepsis(10). Also a study in Wolayta Sodo showed that ANC visit, maternal age, maternal income as independent determinants of neonatal sepsis but in a study conducted in Jinka the above variables are not determinants(32, 33).…”

Risk of infection in neonates born in accidental out-of-hospital deliveries

“…These adverse circumstances and poor perinatal care, such as being born in contaminated places and suboptimal cord practices, may increase the risk of infection from OHDs, which can also result in neonatal sepsis. Neonatal infection is the most common cause of neonatal mortality in developing countries [ 13 , 14 ]. However, previous studies of OHDs have not clearly proposed the risk factors associated with infection among these neonates.…”