DOWNLOAD PDF

Understanding the Drivers Behind Neonatal Sepsis Rates among Immunized and Outpatient Neonates at Hoima Regional Referral Hospital, Western Uganda

Mpanga Derick Denis

Faculty of Clinical Medicine and Dentistry Kampala International University Western Campus Uganda

ABSTRACT

Neonatal sepsis is a major cause of neonatal mortality in developing countries, accounting for a significant portion of annual infant deaths. This study investigated the determinants influencing the occurrence of neonatal sepsis among infants at Hoima Regional Referral Hospital in Western Uganda. The study revealed an overall neonatal sepsis prevalence of 12.5%, with 65% and 35% of cases classified as early-onset and late-onset sepsis, respectively. Factors significantly associated with neonatal sepsis included neonatal age, maternal history of fever, dysuria, and maternal/caretaker hygiene. The study emphasizes the importance of caretaker/mother’s age, maternal fever history, dysuria, and hygiene in contributing to neonatal sepsis. Prevention strategies should prioritize addressing these risk factors rather than solely focusing on post-occurrence treatment. Proactive measures are advocated to mitigate the incidence of neonatal sepsis.

Keywords: Neonatal sepsis, Immunization, Childhood mortality, Maternal/caretaker’s hygiene, maternal history of fever.

INTRODUCTION

According to [1], neonatal sepsis affects more than 3.0 million people worldwide annually and potentially leads to more neonatal deaths. Global rates of sepsis are growing rapidly, particularly in low and middle-income countries. At the 70th World Health Assembly in May 2017, member states adopted a resolution (WAA 70.7) on improving the prevention, diagnosis and treatment of sepsis to reduce on the burden of sepsis and support countries to obtain the necessary infrastructure, laboratory capacity, strategies and tools to address sepsis. This is done by improving access to quality, safe, efficacious and affordable treatments for sepsis and tools for infection prevention control (I.P.C) including immunization particularly in developing countries. According to [2], neonatal accounted for 18.2% of all neonatal mortality that is 3 deaths per 1000 live births in Uganda. According to [3], globally neonatal sepsis accounted for 2,202 per 100,000 live births accounting for 3.1 million deaths in 2018. Neonatal sepsis is a clinical syndrome characterized by the bloodstream infection of neonates and the inflammatory response mounted by the neonate. It usually presents as septicemia, pneumonia, meningitis and rarely as arthritis, osteomyelitis and U.T.I according to [2]. Some of the risk factors associated with neonatal sepsis include prematurity, low birth weight, premature rupture of membranes, maternal infection, bottle feeding, maternal hygiene, accessibility to healthcare facilities, and availability of equipment, drugs and healthcare professionals in these units, according to [2]. The government of Uganda has employed different innervations including safe delivery campaigns and parental education about newborn care, providing more health centres, and supplying more health workers and equipment to these health centres. However, despite all these efforts, neonatal sepsis is still among the leading causes of mobility and mortality among Ugandan neonates [4, 5, 6, 7]. However, our knowledge of the specific risk factors that are associated with neonatal sepsis from the population to be used in the study in the Hoima district and understanding how to reduce them will greatly reduce the prevalence of neonatal sepsis in Hoima. According to [8], estimated that more than 1 million deaths (10% of those under 5 years) are due to neonatal sepsis and that 42% of these occur in the first week of life. According to [9], NEONATAL sepsis accounted for 6.9 million deaths worldwide of which 2.6 million deaths occurred in sub-Saharan Africa. [10], documented that neonatal sepsis contributes to more than 2 million morbidity and 1.6 million deaths annually in developing countries. In Uganda, according to [2], neonatal sepsis accounted for 18.2% of neonatal deaths. According to [9], neonatal sepsis accounted for 29 deaths per 1000 live births. The majority of these die from intrapartum-related complications.

Neonatal sepsis affects more than 3 million neonates worldwide with a mortality rate of 2.4 million in 2020, [11]. The burden of neonatal sepsis in Sub-Saharan Africa is 29 per 1000 live births mortality rate [12]. The value of statical life estimates predicts an annual economic burden ranging from 10 billion to 469 billion dollars in loss on neonatal sepsis in sub-Saharan Africa [13]. The pooled prevalence of neonatal sepsis in East Africa was 29.765% [14]. In Uganda, sepsis carries 19 deaths per 1000 live births claiming 18.2% [15]. Guidelines on prevention, early diagnosis and management of neonatal sepsis exist and are very clear, but unfortunately, implementation is limited due to various health system constraints, including poor newborn care practices, insufficient and late identification of cases at community and facility levels, limited availability of neonatal health services, poor surveillance systems, low turn up numbers of mothers who attend antenatal care, seeking skilled care during delivery, and unhygienic places of delivery. There is a significant challenge which occurs in the diagnosis of neonatal sepsis due to the non-specific nature of the clinical presentation. Blood culture which is the gold standard for a definitive diagnosis takes at least 48 -72 hours as reported by which time the infection may have progressed with consequences on the morbidity and mortality of the neonates in cases where the empirical treatment of first-line drugs fails (ampicillin and gentamycin) and there is a need for organism eradication after culture and sensitivity test. Therefore, improved prevention, early case detection and management of sepsis strategies are needed. However, this study will determine the prevalence of neonatal sepsis among neonates attending immunization and outpatient departments at Hoima Regional Referral Hospital.

CONCLUSION

The study demonstrates the prevalence of neonatal sepsis among neonates attending Hoima Regional Referral Hospital with mother’s/caretaker factors ranking highest among the risk factors while institutional factors were less considered to be contributory factors. The research was more focused on the prevalence of neonatal with attempts to establish the related associated causative factors.

Prevalence of neonatal sepsis

The findings of this study showed that approximately 1 out of 10 neonates attending Hoima Regional Referral Hospital in Hoima district had neonatal sepsis. This prevalence is due to Age, Hygiene, Level of education, Income, Occupation, Frequency of earning, Distance, Availability of services, and number of health workers.

Maternal factors

Age of mother/caretaker (12-35 years %), Level of education (primary level-50%), History of dysuria (36%), History of fever (35.3%). These in the study were pointed out as the major contributors to neonatal sepsis.

Socio-Economic Factors

  • Occupation of mother/caretaker; Most were farmers who were 47 (31.3%) %.
  • How much the mother/caretaker earns on average monthly; most mothers/caretakers were earning below 100,000 accounting for 102 respondents (68%). These were the major socio-economic factors that contributed to neonatal sepsis in the study.

Health Care Related Factors

  • Sex of neonate; The Majority of the neonates were males accounting for 93 respondents with a percentage of 62.
  • Distance to health facility; The Majority of the mothers/caretakers were living between 1-10 kilometers from the health facility accounting for 87 respondents (58%).

Recommendation

Policy measures on family planning should be enacted to ensure birth control among vulnerable mothers is always provided free of charge and accessible. Health education programs with local translations be directed towards enlightening mothers about the risks of neonatal sepsis. Standardization of obstetrical guidelines on the management of febrile illnesses (u.t.i) for expectant mothers should be streamlined across all departments handling these mothers to minimize risks of infection. Special wards fully equipped with clean beddings should be established to cater for maternal hygiene. Infrastructural improvement should be improved with infection control measures instituted. Medicines prescribed by obstetricians should be availed to all mothers free of charge. Antenatal care/maternity areas should effectively identify and refer at-risk mothers to bigger health facilities with specialists. Utilize statistics/ research in informing decisions at the planning level. School health services should be strengthened to reduce teenage pregnancies. Establishment of more health facilities in order to reduce the distance to near health centres for early diagnosis and treatment.

REFERENCES

  1. World Health Organization (WHO) (2017) World Health Statistics 2017: Monitoring Health for the SDGs, Sustainable Development Goals. WHO, Geneva.
  2. UNICEF (2015) Monitoring Situation of Children and Women.
  3. Abera, L., Dejene, T. & Laelago, T. Magnitude of stunting and its determinants in children aged 6–59 months among rural residents of Damot Gale district; southern Ethiopia. BMC Res Notes, 2018, 11, 557. https://doi.org/10.1186/s13104-018-3666-1
  4. Tumuhamye, J., Sommerfelt, H., Bwanga, F., Ndeezi, G., Mukunya, D., Napyo, A., Nankabirwa, V., & Tumwine, J. K. Neonatal sepsis at Mulago national referral hospital in Uganda: Etiology, antimicrobial resistance, associated factors and case fatality risk. PLoS One. 2020 Aug 10;15(8):e0237085. doi: 10.1371/journal.pone.0237085. PMID: 32776958; PMCID: PMC7416959.
  5. Egesa, W. I., Odong, R. J., Kalubi, P., Yamile, E. A. O., Atwine, D., Turyasiima, M., & Ssebuufu, R. Preterm Neonatal Mortality and Its Determinants at a Tertiary Hospital in Western Uganda: A Prospective Cohort Study. Pediatric health, medicine and therapeutics, 2020, 11, 409-420.
  6. Turyasiima, M., Nduwimana, M., Andres, S. M., Kiconco, G., Egesa, W. I., Maren, B. M., & Ssebuufu, R. Neonatal umbilical cord infections: incidence, associated factors and cord care practices by nursing mothers at a tertiary Hospital in Western Uganda. Open Journal of Pediatrics, 2020, 10(02), 288.- 301.
  7. Usman, I. M., Agbon, A. N., Ivang, A. E., Peter, A. B., Afodun, A. M., Okesina, A. A., & Kasozi, K. I. Ethyl acetate fraction of Tamarindus indica leaf ameliorates aluminium chloride induced neural damage in neonatal Wistar rats. Journal of Trace Elements and Minerals, 2023, 3, 100047.
  8. (2015). Make every mother and child count. Geneva.
  9. Mugalu, J., Nakakeeto, M. K., Kiguli, S., & Kaddu-Mulindwa, D. H. Aetiology, risk factors and immediate outcome of bacteriologically confirmed neonatal septicaemia in Mulago hospital, Uganda. Afr Health Sci, 2016.
  10. John, B. D. M., Mathias, L., & Elizabeth, N. Risk factors and practices contributing to newborn sepsis in a rural district of Eastern Uganda, August 2013: a cross sectional study . BMC research notes 2015, 8:339.
  11. UNICEF, WHO, World Bank Group (2021) Joint Child Malnutrition Estimates. WHO, Vol. 24, 51-78.
  12. Kayom, V.O., Mugalu, J., Kakuru, A. et al.Burden and factors associated with clinical neonatal sepsis in urban Uganda: a community cohort study. BMC Pediatr 18, 355 (2018). https://doi.org/10.1186/s12887-018-1323-4
  13. Ranjeva S, Subramanian R, Fang VJ, Leung GM, Ip DKM, Perera RAPM, Peiris JSM, Cowling BJ, Cobey S. Age-specific differences in the dynamics of protective immunity to influenza. Nat Commun. 2019 Apr 10;10(1):1660. doi: 10.1038/s41467-019-09652-6. PMID: 30971703; PMCID: PMC6458119.
  14. Waters D, Jawad I, Ahmad A, Luksic I, Nair H, Zgaga L, et al. Aetiology of community-acquired neonatal sepsis in low and middle income countries. Journal of global health. 2011;1(2):154–70.
  15. Maternal and Newborn Health Disparities Country Profiles. United Nations Children’s Fund 2018. https://data.unicef.org/resources/maternal-newborn-health-disparities-country-profiles. 
  16. Ugwu, Chinyere. N. and Eze Val, H. U. Qualitative Research. IDOSR Journal Of Computer and Applied Sciences, 2023, 8(1) 20-35. https://www.idosr.org/wp-content/uploads/2023/01/IDOSR-JCAS-8120-35-2023.docx.pdf
  17. Fisher, B., Turner, R.K. and Morling, P. Defining and Classifying Ecosystem Services for Decision Making. Ecological Economics, 2009, 68, 643-653.
    http://dx.doi.org/10.1016/j.ecolecon.2008.09.014
  18. Val Hyginus Udoka Eze, Chidinma Esther Eze, Asiati Mbabazi, Ugwu Chinyere N, Ugwu Okechukwu Paul-Chima, Ogenyi, Fabian Chukwudi, Ugwu Jovita Nnenna, Alum Esther Ugo and Obeagu Emmanuel I. Qualities and Characteristics of a Good Scientific Research Writing; Step-by-Step Approaches. IAA Journal of Applied Sciences, 2023, 9(2):71-76. https://www.iaajournals.org/wp-content/uploads/2023/08/IAA-JAS-9271-76-2023.docx.pdf
  19. Ugwu Chinyere Nneoma, Eze Val Hyginus Udoka, Ugwu Jovita Nnenna, Ogenyi Fabian Chukwudi and Ugwu Okechukwu Paul-Chima. Ethical Publication Issues in the Collection and Analysis of Research Data. Newport International Journal Of Scientific and Experimental Sciences (NIJSES), 2023, 3(2): 132-140. https://nijournals.org/wp-content/uploads/2023/07/NIJSES-32-132-140-2023.pdf
  20. Ugwu, Chinyere. N. and Eze Val, H. U. Qualitative Research. IDOSR JOURNAL OF COMPUTER AND APPLIED SCIENCES, 2023, 8(1) 20-35. https://www.idosr.org/wp-content/uploads/2023/01/IDOSR-JCAS-8120-35-2023.docx.pdf
  21. Okube, O.T., Wanjiru, M. and Andemariam, W. Magnitude and Determinants of Undernutrition among Pregnant Women Attending a Public Hospital in Kenya. Open Journal of Obstetrics and Gynecology, 2022, 12, 541-561. https://doi.org/10.4236/ojog.2022.126048
  22. Abate BB, Kasie AM, Reta MA, Kassaw MW. Neonatal sepsis and its associated factors in East Africa: a systematic review and meta-analysis. Int J Public Health. 2020 Dec;65(9):1623-1633. doi: 10.1007/s00038-020-01489-x. Epub 2020 Sep 30. PMID: 32997150.
  23. Adatara P, Afaya A, Salia SM, Afaya RA, Konlan KD, Agyabeng-Fandoh E, Agbinku E, Ayandayo EA, Boahene IG. Risk Factors Associated with Neonatal Sepsis: A Case Study at a Specialist Hospital in Ghana. Scientific World Journal. 2019 Jan 1; 2019:9369051. doi: 10.1155/2019/9369051. PMID: 30692878; PMCID: PMC6332869.
  24. Onyedibe, K., Onyedibe, K., Utoh-Nedosa, A., Mark, O., Onyedibe, K., Ita, O., Udoh, U., Nedosa, I., Bode-Thomas, F., & Egah, D. Impact 0f Socioeconomic Factors On Neonatal Sepsis In Jos, Nigeria. Jos Journal of Medicine, 2012, 6. 54-58.
  25. Mersha, A., Bante, A. & Shibiru, S. Factors associated with neonatal near-miss in selected hospitals of Gamo and Gofa zones, southern Ethiopia: nested case-control study. BMC Pregnancy Childbirth19, 516 2019. https://doi.org/10.1186/s12884-019-2684-x

CITE AS: Mpanga Derick Denis (2023). Understanding the Drivers Behind Neonatal Sepsis Rates among Immunized and Outpatient Neonates at Hoima Regional Referral Hospital, Western Uganda. INOSR Experimental Sciences 12(2):1-22. https://doi.org/10.59298/INOSRES/2023/2.1.1000

DOWNLOAD PDF