Institutional Delivery Predisposes to Neonatal Sepsis and Its Associated Factors Among Neonates Admitted to Neonatal Intensive Care Units in Central Gondar Zone Primary Hospitals, Northwest Ethiopia, 2019.

Abstract

Background: Neonatal sepsis contributes substantially to neonatal morbidity and mortality and is an ongoing major global public health challenge particularly in developing countries. Studies conducted on proportion and risk factors of neonatal sepsis in Ethiopia are from referral hospital which may not be generalized to primary health care units where a significant proportion of mothers give birth in these health facilities. This study sought to determine the proportion of clinical neonatal sepsis and associated factors in the study areas.Methods: Institutional based cross-sectional study was conducted from March to April 2019, in Amhara regional state, central Gondar zone public primary hospitals in Ethiopia. A total of 352 subjects (mother-neonate pairs ) were selected using systematic random sampling technique and pre-tested and structured questionnaires were used to collect data. Multivariable logistic regression analysis was fitted to identify factors associated with neonatal sepsis. Adjusted Odds Ratio (AOR) with the corresponding 95% confidence Interval (CI) was used to show the strength of associations and variables with p-values of <0.05 were considered as statistically significant.Results: The overall proportion of neonatal sepsis was 64.8 %( 95% CI (59.2, 69.2). Being male neonate(AOR=3.7; 95% CI(1.76,7.89)), history of urinary tract infections during the index pregnancy(AOR =6,26; 95% CI (1.16,33.62)), frequency of per-vaginal examination greater than three during labor and delivery(AOR=6.06; 95% CI((2.45,14.99)), neonatal resuscitation at birth (AOR=6.1; 95% CI (1.71,21.84)), place of delivery at the health center(AOR=3.05; 95% CI(1.19,7.79)), lack of training of health workers on neonatal resuscitation and infection prevention practices (AOR=2.14; 95% CI (1.04,4.44)), late age of neonate at onset of illness(AOR=0.05; 95% CI(0.01, 0.21)) and maternal age of 30-34 years (AOR=0.19; 95% CI(.047, 0.81)) were significantly associated with neonatal sepsis.Conclusion: The proportion of neonatal sepsis is high. Maternal, neonatal and health service related factors were identified for neonatal sepsis. Therefore; training of health workers, provision of health care services as per standards and monitoring and evaluation of obstetrical/neonatal cares during labor and delivery are mandatory.

Neonatal Sepsis Among Neonates Admitted to Neonatal Intensive Care Unit in Hawassa University Comprehensive Specialized Hospital, Southern Ethiopia, 2022

“…Neonates delivered at the home were 2.34 times more likely to develop sepsis compared to those delivered at the hospital [AOR = 2.34; 95% CI (1.4 to 4.8)]. This nding was similar to the study done in North West Ethiopia [4] and Nigeria [21] . This could be explained as neonates being born at home might lack skilled attendants, care for the umbilical cord, early breastfeeding, prophylaxis (application of tetracycline), and other infection prevention approaches and this may increase the risk of neonatal infection [9] .…”

“…Increased odds of neonatal sepsis were noted among mothers who have a history of more than 4 PV examinations during labor compared to mothers who had PV examinations less than or equal to 4 [AOR = 2.6; 95% CI [ (1.3 to 5.3]]. This nding was linked to a study done in Bangladesh [18] and North West Ethiopia [4] . This might be explained as multiple per-vaginal examinations can introduce vaginal organisms into the cervical canal, which, in turn, increases the risk of infection [19] .…”

“…Neonatal sepsis (NS) is referred to as any systemic manifestation such as abnormal body temperature, respiratory problems, food intolerance, and isolation of bacteria or other pathogens from the bloodstream [3][4] . If not prevented and managed early, NS can lead to long-term morbidity and increase burden on health care resources as well as has an economic impact resulting from a prolonged hospital stay, increased medical costs, and potentially poor long-term neurodevelopmental outcomes [2]- [4] .…”

Neonatal Sepsis and Associated Factors Among Neonates Admitted to Neonatal Intensive Care Unit in General Hospitals, Eastern Ethiopia 2020

“…15,16 However, the prevalence of neonatal sepsis was lower in this study than in previous studies, which found a prevalence of 64.8% in Gondar primary hospitals in northwest Ethiopia, 77.9% in Shashemene hospitals in central Ethiopia, and 69.35% in Dhaka public hospitals in Bangladesh. [17][18][19] The difference could be attributed to the method by which neonatal sepsis is diagnosed. Clinical parameters alone were used to classify neonatal sepsis in our study.…”

A Mini-Review of Neonatal Sepsis Patterns with Emphasis on Zoonotic Causes

“…In a similar manner in Ethiopia, neonatal sepsis continued an important public threat across all regions whereof different time Hospital-based studies showed different prevalence for overall, early and late onsets of neonatal sepsis. Accordingly, the overall prevalence of neonatal sepsis was 63.69% (EOS comprised 59.33%) in 2017 [26] and 64.8% in 2019 [27] at the University of Gonder, 78.3% at Arba Minch General Hospital in 2018 [28], 33.8% in Wolayita Sodo in 2018 [29], and 77.9% in Shashamane 10 Shigella…”