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Prevalence and determinants of early onset neonatal sepsis at two selected public referral hospitals in the Northwest Ethiopia: a cross-sectional study

Abstract

Introduction

Globally, neonatal mortality is decreasing, and road maps such as the Early Newborn Action Plan set ambitious targets for 2030. Despite this, deaths in the first weeks of life continue to rise as a percentage of total child mortality. Neonatal sepsis with early onset continues to be a significant cause of death and illness. The majority of sepsis-related deaths occur in developing nations, where the prevalence and causes of newborn sepsis are yet unknown. As a result, the goal of this study was to determine the prevalence of early-onset sepsis and identify determinant factors.

Methods

A cross-sectional study was conducted on 368 study participants in referral hospitals of East and West Gojjam Zones from March 1st to April 30th, 2019. Study participants were selected at random using lottery method. Face-to-face interviews with index mothers for maternal variables and neonatal record review for neonatal variables were used to collect data using a structured pretested questionnaire. Data were entered into Epidata 3.1 and then exported to STATA/SE software version 14. Finally, the logistic regression model was used for analysis. Statistical significance was declared at P < 0.05 after multivariable logistic regression.

Results

A total of 368 newborns and their index mothers took part in this study. The mean age of the newborns was 4.69 days (± 1.93SD). Early-onset neonatal sepsis was seen in 34% of the babies. Nulliparity (AOR: 3.3, 95% CI: 1.1–9.5), duration of labor > 18 h after rupture of membranes (AOR: 11.3, 95% CI: 3.0—41.8), gestational age of 32–37 weeks (AOR: 3.2, 95% CI: 1.2—8.5), and neonates who require resuscitation at birth (AOR: 4, 95% CI: 1.4 -11.8) were all found to be significantly associated with early-onset neonatal sepsis.

Conclusion and recommendation

Early-onset neonatal sepsis was found to be high in this study. Early-onset neonatal sepsis was found to be associated with maternal, obstetric, and neonatal variables. Comprehensive prevention strategies that target the identified risk factors should be implemented right away.

Peer Review reports

Introduction

A neonate, often known as a newborn infant, is a baby who is born within the first 28 days of life [1]. The phrase "neonatal sepsis" refers to the systemic response to infection in newborns within the first four weeks following delivery [2]. It is a clinical pattern that develops as a result of microbial blood infection in the first month of life [3]. Neonatal sepsis is defined as early-onset sepsis (if the onset of clinical features occurs between birth and 7 days) or late-onset neonatal sepsis (LONS) if the onset of clinical features occurs between 8 and 28 days after birth [4, 5]. Early onset neonatal sepsis (EONS) has been defined in a variety of ways depending on the age of commencement, with bacteremia occurring as early as 7 days after birth [3]. Early onset neonatal sepsis (EONS) develops vertically from the mother and presents soon after birth [6]. EONS are caused by bacteria that infect the maternal genitourinary system, contaminating the amniotic fluid, placenta, cervix, and vaginal canal. When the amniotic membranes burst before delivery, the pathogen may ascend, causing an intra-amniotic infection. As a result, the infection can be acquired by the infant either in pregnancy or at delivery [7].

Maternal and neonatal risk factors for EONS include maternal age of 35 or less than 20 years, preterm, parity, cesarean delivery, urinary tract infection in the third trimester of pregnancy, and neonate sex, meconium stained amniotic fluid, birth asphyxia, and birth weight [8, 9]. Procedures that change the amniotic cavity during pregnancy, such as cervical cerclage and amniocentesis, can raise the risk of intra-amniotic infection and neonatal sepsis [10]. Prematurity, low birth weight, congenital malformations, complex or instrument-assisted delivery, [3]and low APGAR scores (score of 6 at 5 min) are all associated with EONS in addition to the mother's variables [11, 12]. Premature neonatal immune system immaturity, particularly low immunoglobulin G (IgG) levels due to diminished maternal IgG trans placental transfer, increases the risk of sepsis in preterm newborns [13, 14].

Neonatal death is still the leading cause of death among children under the age of five [15]. Prematurity, asphyxia, and sepsis account for 87% of neonatal deaths worldwide [16]. According to World Health Organization, nearly 45% of under-five deaths accounts for neonatal death, with 75% occurring in the first seven days of life, and sepsis being the second most common cause. [17]. Neonatal death rates from EONS range from 16.7 to 40% [6, 18, 19]. Despite significant advancements in neonatal care, 40% of infants die with sepsis or suffer with neurodevelopmental impairment as a result of a lack of laboratory reagents to detect early-onset neonatal sepsis [20].

Because of greater Group B Streptococci treatment during pregnancy, the proportion of EONS relative to late onset sepsis (LOS) has been quickly reducing in high-income countries (HIC) [21, 22]. Despite EONS can be treated and weakened quickly, it can also cause neonatal death in a matter of hours or days [23].Early onset neonatal sepsis is a common and serious problem for neonates, particularly preterm newborns [24].

The primary target of the national newborn and child survival plan is to reduce under-five mortality from 64 to 29 per 1000 children, infant mortality from 44 to 20 per 1000 children, and neonatal death from 28 to 11 per 1000 children by 2020 [25]. Identifying risk factors and putting in place core interventions are the keys towards preventing 415,688 and 210,234 deaths in children under the age of five and neonates, respectively [17]. As a result, quantifying the true number of cases of early-onset newborn sepsis in underdeveloped nations is extremely challenging [26]. A recent systematic review and meta-analysis in Ethiopia showed the prevalence of EONS was 75.44% and further studies were recommended [27]. Consequently, data on early onset infant sepsis is limited in the research area, which has the greatest rate of early neonatal death. As a result, the primary goal of this study was to quantify the prevalence of early-onset newborn sepsis in Northwest Ethiopia and identify associated factors. Knowledge of determinant factors related to early onset neonatal sepsis helps the clinician for early recognition and lowering death and illness.

Materials and methods

Study area and period

The study was done from March 1st to April 30, 2019, in public referral hospitals in the East and West Gojjam zones of Ethiopia's Amhara Region. There are only two public referral hospitals in the two zones, and both were included in the study since they provide inpatient neonatal treatment. Debre Markos Referral Hospital is located in Debre Markos, the town of East Gojjam Administrative Zone, while Felege Hiwot Referral Hospital is located in Bahir Dar, the town of Amhara regional state. Both are located in Northwest Ethiopia. According to information gathered from these hospitals' administrative offices, they offer a variety of services in the outpatient, inpatient, and operating room theatre departments. Debre Markos Referral Hospital [28] and Felege Hiwot Referral Hospital [29] serve a catchment area of around 3.5 million and 5 million people, respectively.

Study design and population

Study design and population

Data were collected from March 1st to April 30th, 2019, among neonates admitted to neonatal intensive care units using a hospital-based cross-sectional study design. The source population included all neonates who received care as inpatients or outpatients in the specified public referral hospital. During the data collecting period, all neonates admitted to neonatal intensive care units (NICUs) were included as study population. The study included neonates under the age of seven days who were admitted in the two public referral hospitals. Neonates with early discharge, incomplete charts, and died on arrival were all excluded from the study.

Sample size determination

The single population proportion formula was used to calculate the sample size. Given the prevalence of early onset sepsis, which is estimated to be 65% [12]. The level of confidence is 95%, while the margin of error is 5%. After calculating the sample size, a 5% non-response rate was added, yielding a total sample size of 368.

$$\begin{array}{cc}\mathrm{n}= \frac{{\left(\frac{\mathrm{Za}}{2}\right)}^{2}(\mathrm{P})(1-\mathrm{P})}{{(0.05)}^{2}}& \mathrm{n}=\frac{{(1.96)}^{2}(0.65)(0.35)}{{(0.05)}^{2}}=350\end{array}$$

where: n – initial sample size

  • Z – standard normal value at 95% CI which is 1.96

  • P – Prevalence of early onset sepsis 65%

  • d – Possible margin of error tolerated which is 5%

Sampling techniques and procedure

The study participants were selected using a simple random sampling technique using the medical registration numbers of neonates admitted to neonatal intensive care units. For the NICUs at the two hospitals, the samples were distributed proportionally using the probability proportional to size (PPS) allocation technique (215 samples from Felege Hiwot Referral Hospital and 153 samples from Debre Markos Referral Hospital).

Operational definition

Early onset neonatal sepsis: was defined as presence of at least one of [difficulty feeding, history of convulsions, movement only when stimulated, respiratory rate of 60 or more breaths per min, severe chest retractions, or a temperature of 37.5 °C or higher or 35.5 °C or lower, Cyanosis, grunting and change in level of activity] with in the first seven days after birth [30]. Presence of any one of clinical signs and symptoms predict severe infection (based on an expert pediatrician’s assessment) and was associated with a sensitivity and specificity of 85% and 75% [31].

Data collection tool and quality control

The questionnaire was written in English and then translated into the local language. An impartial translator checked for consistency by re-translating it into English. Four diploma nurses and two BSc degree nurses were recruited as data collectors and supervisors respectively. Before the actual data collection, the data collectors and supervisors were briefed for two days on data collection procedures and study objectives. In Finote Selam Hospital, a pretest was conducted using 5% of the total sample size, which was not included in the actual sampling, and necessary tool adjustments were made. Data was collected through a pretested questionnaire administered by an interviewer. Index mothers were interviewed and neonatal records were reviewed using checklists for neonatal characteristics such as the APGAR (Activity, Pulse, Grimace, Appearance, and Respiration) score. Supervisors and investigators oversaw the data gathering technique on a daily basis to ensure the quality of the data. A review was conducted to ensure that the questionnaire was complete, and corrections were made. Prior to data entry, each questionnaire and data sheet were double-checked.

Data processing and analysis

The data were entered into the EPI-data Version 3.1 software. The data that were entered was checked and cleaned. Then, it was exported to STATA version 14 for analysis. To describe the research variables in relation to the population, descriptive statistics such as frequency, proportions, and percentages were generated and displayed in tables and graphs. To see if there were any relationships between the dependent and explanatory variables, bivariable and multivariable logistic regressions were used. To determine the relationship between the two variables, the odds ratio and p-value were calculated. To adjust for probable confounders, variables with a p-value ≤ 0.25 were entered into a multivariable logistic regression model. Finally, statistical significance was declared at a P-value of ≤ 0.05 and 95% confidence interval.

Results

Socio-demographic characteristics of study participants

A total of 368 newborns and their index mothers took part in this study, with a 100% response rate. The mean age of neonates was 4.69 days with (± 1.93 SD), while the mean age of index mothers was 29.5 years with (± 7 SD). More over half of the index mothers (232) were between the ages of 20 and 34, and the majority of the study participants (84%) were married. When it came to where they lived, the majority (263, or 71.5%) were from urban centers. In terms of household income, 179 (48.6%) of study participants had a low socioeconomic level. In terms of gender, female neonates comprised 199 (54.08%) of the total, while male neonates comprised 169 (45.92%). (Table 1).

Table 1 Socio-demographic characteristics of neonates and their index mothers admitted at two selected Public Referral Hospitals in the Northwest Ethiopia: 2019

Gynecologic and obstetric characteristics of the mother

In terms of antenatal care (ANC), the majority of women 305 (82.88%) received ANC during their current pregnancy, with 238 (64.8%) receiving complete ANC. In terms of method of birth, the proportion of newborns delivered spontaneously was greater 208 (56.5%) than the number of neonates born via caesarian Sect. 40(10.9%) and instrumental 120(32.6%). Similarly, 351 (95.4%) of infants were attended by health care professionals. The proportion of neonates born to mothers whose labor lasted less than 12 h following rupture of membranes was roughly half of the study participants 179 (48.64%). However, 54 (14.67%) of women had a labor that lasted more than 18 h following the rupture of the membrane. Twenty three present of index mothers had intranatal fever. But, most of the index mothers (77%) had no history of intranatal fever besides Majority of mothers (91%, 94%) had no history of foul smelling amniotic fluid and antepuartum hemorrhage respectively. Majority of index mothers, (82%, and 91.3%) had no history of urinary tract infection (UTI) and pregnancy induced hypertension (PIH) respectively during their pregnancy (Fig. 1).

Fig. 1
figure 1

Gynecologic and obstetric characteristics of index mothers for the study on prevalence and determinants of Early Onset Neonatal Sepsis at two selected public referral Hospitals in the Northwest Ethiopia: 2019

Birth characteristics of neonatal variables

In terms of gestational age, the majority of the study participants 253 (68.7%) were born between 37 and 42 weeks after the last normal menstrual period. Similarly, the majority of the study participants' first and fifth minute APGAR scores were above seven, with 265 (72.01%) and 293 (79.62%) respectively. In terms of neonatal weight, more than half 228 (62.0%) were born in the normal birth weight range (2500–4000 g), although a small percentage of neonates were either overweight (> 4000 g) or very low birth weight (1500 g), accounting for 14(3.8%) and 13(3.5%), respectively. Similarly, the majority of the study participants 250 (67.9%) cried right after birth (Table 2).

Table 2 Birth characteristics of neonates who were admitted at two selected Public Referral Hospitals in the Northwest Ethiopia: 2019

Associated factors of early onset neonatal sepsis

This study was intended to determine the prevalence of early onset neonatal sepsis and its determinant factors. Early onset neonatal sepsis was found in 34% of newborns admitted during the study period. In the multivariable logistic regression, all variables with a P-value of less than 0.25 in bivariable analysis (Maternal age, Maternal age, Maternal parity, Duration of labor after rupture of membranes, Number digital of per-vaginal examination, Gestational age, Birth weight, Resuscitation at birth) were adjusted for nulliparity, duration of membrane rupture, gestational age, and resuscitation at birth were all found to be significantly associated with the occurrence of early onset neonatal sepsis in the adjusted multivariable logistic regression.

Maternal parity was found to be a significant risk factor for neonatal sepsis with early onset neonatal sepsis. In particular, neonates born from nulliparous mothers were three times (AOR: 3.3, 95% CI: 1.1- 9.5) more likely than those born to para one mothers to develop early onset sepsis.

The duration of labor following membrane rupture was revealed to be a major determinant in early onset neonatal sepsis. Specifically, neonates born after a labor lasting more than 18 h (AOR: 11.3, 95% confidence CI: 3.0—41.8) were eleven times (AOR: 11.3, 95% CI: 3.0—41.8) more likely to develop early onset sepsis than neonates born after a labor lasting less than 12 h. Neonatal gestational age was also found to be a major predictor of neonatal sepsis with early onset. Early onset sepsis was three times more common in neonates born between 32 and 37 weeks gestational age (AOR: 3.2, 95% CI: 1.2—8.5) than in neonates born between 37 and 42 weeks gestational age. Furthermore, resuscitation at birth was found to be an independent predictor of neonatal sepsis with early onset. When compared to neonates who were not resuscitated at birth, neonates who were resuscitated at birth were approximately four times more likely to develop early onset neonatal sepsis (AOR: 4, 95% CI: 1.4 -11.8) (Table 3).

Table 3 Bivariable and multivariable logistic regression showing the association between EONS and the different variables in neonates admitted at two selected Public Referral Hospitals in the Northwest Ethiopia: 2019

Discussion

The goal of this study was to determine the prevalence of early onset neonatal sepsis (EONS) and identify possible determinant factors in neonates admitted to public referral hospitals in Northwest Ethiopia. According to this finding, the prevalence of early onset neonatal sepsis was 34%, and nulliparity, duration of membrane rupture, gestational age, and resuscitation at birth were the significant independent predictors.

Early onset sepsis was found to be prevalent in 34% of research participants referred to neonatal intensive care units at the two selected referral hospitals. This conclusion was consistent with a study conducted in Dil Chora Referral Hospital, Eastern, Ethiopia [32]and South Sinai, Egypt [33] which found that the prevalence of early onset neonatal sepsis in neonatal intensive care units was 40.5% and 31.8% respectively. Early onset neonatal sepsis (EONS) was found to be higher than studies conducted in Indonesia 26.6% [34] and in India 20.9% [35], in hospitals of Wolaita Sodo Town 26.9% [36]. The primary cause of the disparity could be differences in sociodemographic factors. Women in these developed countries are thought to have a higher level of awareness and knowledge. Women in Ethiopia, on the other hand, are considered ineligible for school and financially unable to care for their newborns. The second likely explanation is that diagnostic criteria for cases of EONS varied. For example, in our study, we employed just clinical signs suggestive of sepsis, which overestimates EONS, whereas studies in developed countries, culture positive results were used to identify EONS. Other possible factors were no standardized policy for screening for infections in asymptomatic pregnant women and poor antenatal care which could result in insufficient time for maternal antibiotic coverage prior to or during labour. This finding was lower than a systematic review and meta-analysis in Ethiopia 75.4% (95% CI: 68.3, 82.6) [27], Gondar 59.6% [37], in Bishoftu General Hospital, Neonatal Intensive Care Unit, Debrezeit-Ethiopia 81.4% [13], in a tertiary center in Kathmandu, Nepal 91.39% [38] Public Hospitals of Hawassa City Administration, Southern Ethiopia,80.9% [39]. This variation could be due to unique cultural features of the population, local obstetrics and neonatal practices, socioeconomic and sexual practice, hygiene, and nutritional differences over settings [33] as well as due to clinical features for sepsis identification, study methodology, and sample size differences were observed among studies.

The occurrence of EONS was shown to be significantly associated with gestational age in this study. When compared to term neonates, neonates born less than 37 weeks were three times more likely to develop early onset sepsis. This finding was supported by studies in Indonesia [40], Mexico [41], India [42], South Africa [43], Pakistan [44], Ghana [45], Nepal [46] and China [47]. This association could be related to premature newborns' undeveloped immune systems and malfunctioning neutrophils. Furthermore, premature newborns lack complement proteins, making them prone to sepsis ascending [48]. Furthermore, premature neonates have insufficient immunoglobulin G (IgG), making them susceptible to sepsis from pathogenic microorganisms [49].

Early onset newborn sepsis was found to be significantly associated with the length of labor following membrane rupture. In particular, neonates born from women who had a labor after rupture of membrane that lasted more than 18 h were eleven times more likely to suffer with early onset sepsis than those born from women who had a labor after rupture of membrane that lasted less than 18 h. This finding was consistent with research conducted in the United States [50], Thailand [51], Tanzania [52] and India [42] that found labor time to be an independent determinant factor for early onset sepsis. Membrane rupture that lasts a long time (PROM) before delivery was associated with Chorioamnionitis which poses direct fetal risks from vertical transmission or ascending infection from vaginal flora due to the loss of a barrier, it is possible that PROM could be an independent risk factor for early onset neonatal sepsis.

Furthermore, maternal parity was found to be an independent predictor of with early onset neonatal sepsis. When compared to neonates delivered to para-one mothers, neonates from nulliparous women were three times more likely to develop early onset neonatal sepsis. A study conducted in Ghana [45], India [53], and South Africa [43] supports this finding. Null parity is commonly accompanied with a number of sepsis related factors, including prolonged labor and repeated per-vaginal digital examinations. Early onset neonatal sepsis was also observed to be associated with resuscitation at birth. When compared to neonates who were not resuscitated at birth, neonates who were resuscitated at birth were four times more likely to have early-onset sepsis. This finding was supported by research conducted in Tanzania [54], Ghana, [45] and the United States [50]. Poor practices and non-compliance with guidelines by health professionals during the process may expose the neonate to a higher risk of sepsis. These findings could be due to the fact that, if procedure of resuscitation is done forcefully, it may cause laceration to the susceptible and easily breakable mucous membrane of the neonate and serve as a route of entry for pathogens from unsterile equipment [5]. It’s going to also lead microbes into the lower air way of the newborn with an immature immune system. This is often due to the lumen of airways of the neonate is too narrow, and respiratory secretions are copious compared to older children which could predispose to easily destruction of smaller air sacs and leads to sepsis. In conclusion, the outcomes of this study reveal that the prevalence of early onset newborn sepsis was found to be considerably higher at the two public referral hospitals. In addition, maternal obstetric parameters such as maternal parity, duration of labor after membrane rupture, and neonatal variables such as gestational age of the neonate and neonatal resuscitation at birth were revealed to be risk factors for early onset neonatal sepsis. Comprehensive risk-reduction methods that target the identified determinants should be improved. As a result, health care providers working in neonatal intensive care units should follow guidelines when performing invasive procedures, improve maternal education on determinants such as prolonged rupture of membrane (PROM), and incorporate routine neonatal sepsis screening into neonatal and maternal care. To avoid early-onset newborn sepsis, neonates who have been resuscitated at delivery and those born to nulliparous should get special attention.

Strength and limitations of the study

This research has a number of advantages. First, we used primary data, with the exception of certain neonatal variables, to reduce the number of missing values. Second, it was carried out relatively over a wider research region. But, this study is not unique, because participant memory and self-report nature of determinant factors are potential limitations that could cause bias. Furthermore, sepsis cases were not identified based on culture-confirmed laboratory results. Neonates with signs and symptoms of sepsis may not be truly septic for culture, this could expose our findings to selection bias. Therefore, the true figure of EONS could more or less than the findings of this study for it’s based only on sign and symptoms.

Availability of data and materials

The data sets analyzed during the current study are available from the corresponding author upon reasonable request.

Abbreviations

ANC:

Antenatal Care

APGAR:

Activity, Pulse, Grimace, Appearance, Respiration

CI:

Confidence Interval

EONS:

Early Onset Neonatal Sepsis

LONS:

Late Onset Neonatal Sepsis

NICU:

Neonatal Intensive Care Unit

AOR:

Adjusted Odds Ratio

PROM:

Prolonged Rupture of Membrane

References

  1. World, Health, Organization: Health Topics/ newborn health https://www.who.int/westernpacific/health-topics/newborn-health.

  2. Goldstein B, Giroir B, Randolph A. International pediatric sepsis consensus conference: definitions for sepsis and organ dysfunction in pediatrics. Pediatr Crit Care Med. 2005;6(1):2–8.

    Article  Google Scholar 

  3. Shane AL, Sánchez PJ, Stoll BJ. Neonatal sepsis. Lancet. 2017;390(10104):1770–80.

    Article  Google Scholar 

  4. Cizmeci MN, Kara S, Kanburoglu MK, Simavli S, Duvan CI, Tatli MM. Detection of cord blood hepcidin levels as a biomarker for early-onset neonatal sepsis. Med Hypotheses. 2014;82(3):310–2.

    Article  CAS  Google Scholar 

  5. Wilson W, DL L. Maternal Child Nursing. In: Elsevier Publishers. UK raser, Cooper and Nolte. 2006.

    Google Scholar 

  6. Edwards MS, Gonik B. Preventing the broad spectrum of perinatal morbidity and mortality through group B streptococcal vaccination. Vaccine. 2013;31:D66–71.

    Article  CAS  Google Scholar 

  7. Hornik CP, Fort P, Clark RH, Watt K, Benjamin DK Jr, Smith PB, Manzoni P, Jacqz-Aigrain E, Kaguelidou F, Cohen-Wolkowiez M. Early and late onset sepsis in very-low-birth-weight infants from a large group of neonatal intensive care units. Early Human Dev. 2012;88:S69–74.

    Article  Google Scholar 

  8. Hayun M, Alasiry E, Daud D, Febriani DB, Madjid D. The risk factors of early onset neonatal sepsis. Am J Clin Exp Med. 2015;3(3):78–82.

    Article  Google Scholar 

  9. Polin RA, St Geme 3rd J. Neonatal sepsis. Adv Pediatr Infect Dis. 1992;7:25–61.

  10. Cortese F, Scicchitano P, Gesualdo M, Filaninno A, De Giorgi E, Schettini F, Laforgia N, Ciccone MM. Early and late infections in newborns: where do we stand? A review. Pediatr Neonatol. 2016;57(4):265–73.

    Article  Google Scholar 

  11. Gebremedhin D, Berhe H, Gebrekirstos K. Risk Factors for Neonatal Sepsis in Public Hospitals of Mekelle City, North Ethiopia, 2015: Unmatched Case Control Study. PLoS One. 2016;11(5):e0154798.

    Article  Google Scholar 

  12. Getabelew A, Aman M, Fantaye E, Yeheyis T. Prevalence of Neonatal Sepsis and Associated Factors among Neonates in Neonatal Intensive Care Unit at Selected Governmental Hospitals in Shashemene Town, Oromia Regional State, Ethiopia, 2017. Int J Pediatr. 2018;2018:7801272.

    Article  Google Scholar 

  13. Woldu MA, Guta M, Lenjisa J, Tegegne G, Tesafye G, Dinsa H. Assessment of the incidence of neonatal sepsis, its risk factors, antimicrobial use and clinical outcomes in Bishoftu General Hospital. Neonatal Intensive Care Unit, Debrezeit-Ethiopia Pediat Therapeut. 2014;4(214):2161.

    Google Scholar 

  14. Benitz WE, Gould JB, Druzin ML. Risk factors for early-onset group B streptococcal sepsis: estimation of odds ratios by critical literature review. Pediatrics. 1999;103(6):e77–e77.

    Article  CAS  Google Scholar 

  15. Shehab El-Din EM, El-Sokkary MM, Bassiouny MR, Hassan R. Epidemiology of Neonatal Sepsis and Implicated Pathogens: A Study from Egypt. Biomed Res Int. 2015;2015:509484.

    Article  Google Scholar 

  16. Liu L, Johnson HL, Cousens S, Perin J, Scott S, Lawn JE, Rudan I, Campbell H, Cibulskis R, Li M, et al. Global, regional, and national causes of child mortality: an updated systematic analysis for 2010 with time trends since 2000. Lancet (London, England). 2012;379(9832):2151–61.

    Article  Google Scholar 

  17. World Health Organization. World health statistics 2016: monitoring health for the SDGs sustainable development goals. World Health Organization; 2016.

  18. Liu L, Oza S, Hogan D, Chu Y, Perin J, Zhu J, Lawn JE, Cousens S, Mathers C, Black RE. Global, regional, and national causes of under-5 mortality in 2000–15: an updated systematic analysis with implications for the Sustainable Development Goals. Lancet (London, England). 2016;388(10063):3027–35.

    Article  Google Scholar 

  19. Nadeem MA, Zia ulHaq M, Waseem MA, Sajjad R, Ahmed F. Early onset neonatal sepsis in preterm premature rupture of membranes. Pak Armed Forces Med J. 2015;65(2):226–30.

    Google Scholar 

  20. Weldearegawi B, Melaku YA, Abera SF, Ashebir Y, Haile F, Mulugeta A, Eshetu F, Spigt M. Infant mortality and causes of infant deaths in rural Ethiopia: a population-based cohort of 3684 births. BMC Public Health. 2015;15(1):1–7.

    Article  Google Scholar 

  21. Schrag SJ, Farley MM, Petit S, Reingold A, Weston EJ, Pondo T, Hudson Jain J, Lynfield R. Epidemiology of invasive early-onset neonatal sepsis, 2005 to 2014. Pediatrics. 2016;138(6):e20162013.

    Article  Google Scholar 

  22. Stoll BJ, Hansen NI, Sánchez PJ, Faix RG, Poindexter BB, Van Meurs KP, Bizzarro MJ, Goldberg RN, Frantz ID, Hale EC. Early onset neonatal sepsis: the burden of group B Streptococcal and E. coli disease continues. Pediatrics. 2011;peds:2010–217.

    Google Scholar 

  23. Hasan M, Mahmood C. Predictive values of risk factors in neonatal sepsis. J Bangladesh Coll Phys Surg. 2012;29(4):187–95.

    Article  Google Scholar 

  24. Eidelman AI, Nevet A, Rudensky B, Rabinowitz R, Hammerman C, Raveh D, Schimmel MS. The effect of meconium staining of amniotic fluid on the growth of Escherichia coli and group B streptococcus. J Perinatol. 2002;22(6):467–71.

    Article  Google Scholar 

  25. Federal Minstry of Health. National newborn and child survival strategy document brief summary 2015/16-2019/20. FMOH;. 2015.

  26. Simonsen KA, Anderson-Berry AL, Delair SF, Davies HD. Early-onset neonatal sepsis. Clin Microbiol Rev. 2014;27(1):21–47.

    Article  Google Scholar 

  27. Assemie MA, Alene M, Yismaw L, Ketema DB, Lamore Y, Petrucka P, Alemu S. Prevalence of neonatal sepsis in Ethiopia: a systematic review and meta-analysis. Int J Pediatr. 2020;2020:646849.

    Article  Google Scholar 

  28. Debre Markos referral hospital annual report. 2017.

  29. Felege hiwot referral hospital annual report. 2017.

  30. Lancet. The Young Infants Clinical signs that predict severe illness in children under age 2 months: a multicentre study. Lancet (London, England). 2008;371(9607):135–42.

    Article  Google Scholar 

  31. Opiyo N, English M. What clinical signs best identify severe illness in young infants aged 0–59 days in developing countries? A systematic review. Arch Dis Child. 2011;96(11):1052–9.

    Article  Google Scholar 

  32. Serbesa M, Oumer A, Iffa M. Assessment of Reason for Admission and Factors Associated with their Treatment outcome of Neonates in Dilchora Referral Hospital, Eastern, Ethiopia: Institutional Based Cross-Sectional Record Review Study. J Neonatal Stud. 2018;1:103 Abstract Keywords: Neonatal Admission.

    Google Scholar 

  33. Medhat H, Khashana A. Incidence of neonatal infection in South Sinai, Egypt. Int J Infect 2017;4(1).

  34. Salsabila K, Toha NMA, Rundjan L, Pattanittum P, Sirikarn P, Rohsiswatmo R, Wandita S, Hakimi M, Lumbiganon P, Green S. Early-onset neonatal sepsis and antibiotic use in Indonesia: a descriptive, cross-sectional study. BMC Public Health. 2022;22(1):1–12.

    Article  Google Scholar 

  35. Swarnkar K, Swarnkar M. A Study Of Early Onset Neonatal Sepsis With Special Reference To Sepsis Screening Parameters In A Tertiary Care Centre Of Rural India. Int J Infect Dis. 2012;10(1):1–8.

    Google Scholar 

  36. Mersha A, Worku T, Shibiru S, Bante A, Molla A, Seifu G, Huka G, Abrham E, Teshome T. Neonatal sepsis and associated factors among newborns in hospitals of Wolaita Sodo Town, Southern Ethiopia. Res Rep Neonatol. 2019;9:1.

    Google Scholar 

  37. Demisse AG, Alemu F, Gizaw MA, Tigabu Z. Patterns of admission and factors associated with neonatal mortality among neonates admitted to the neonatal intensive care unit of University of Gondar Hospital, Northwest Ethiopia. Pediatric Health Med Ther. 2017;8:57.

    Article  Google Scholar 

  38. Thapa B, Thapa A, Aryal DR, Thapa K, Pun A, Khanal S, Mahat K. Neonatal sepsis as a major cause of morbidity in a tertiary center in Kathmandu. J Nepal Med Assoc. 2013;52(192):549–56.

    Article  Google Scholar 

  39. Ahmed A. Neonatal sepsis and associated factors among neonates in public hospitals of Hawassa city administration, Southern Ethiopia. 2018.

    Google Scholar 

  40. Hayun M, Alasiry E, Daud D, Febriani B, Madjid D. The Risk Factors of Early Onset Neonatal Sepsis. Am J Clin Exp Med. 2015;3(3):78–82.

    Article  Google Scholar 

  41. Leal YA, Alvarez-Nemegyei J, Velazquez JR, Rosado-Quiab U, Diego-Rodriguez N, Paz-Baeza E, Davila-Velazquez J. Risk factors and prognosis for neonatal sepsis in southeastern Mexico: analysis of a four-year historic cohort follow-up. BMC Pregnancy Childbirth. 2012;12:48.

    Article  Google Scholar 

  42. Bhat YR, Baby LP. Early onset of neonatal sepsis: Analysis of the risk factors and the bacterial isolates by using the BacT alert system. J Clin Diagn Res. 2011;5(7):1385–8.

    Google Scholar 

  43. Schrag SJ, Cutland CL, Zell ER, Kuwanda L, Buchmann EJ, Velaphi SC, Groome MJ, Madhi SA, PoPS Trial Team. Risk factors for neonatal sepsis and perinatal death among infants enrolled in the prevention of perinatal sepsis trial, Soweto, South Africa. J Pediatr Infect Dis. 2012;31(8):821-6.

  44. Alam MM, Saleem AF, Shaikh AS, Munir O, Qadir M. Neonatal sepsis following prolonged rupture of membranes in a tertiary care hospital in Karachi, Pakistan. J Infect Dev Ctries. 2014;8(1):67–73.

    Article  Google Scholar 

  45. SIAKWA M, 2, KPIKPITSE, 3, MUPEPI D, 4, S. S, MOHAMED, 1. Neonatal sepsis in rural Ghana: a case control study of risk factors in a birth cohort. Int J Res Med Health Sci 2014, 4(5):ISSN 2307-2083.

  46. Medscape: https://emedicine.medscape.com/article/239278-workup. 2021.

  47. Jiang Z, Ye GY. 1:4 matched case-control study on influential factor of early onset neonatal sepsis. Euro Rev Med Pharmacol Sci. 2013;17:2460–6.

    CAS  Google Scholar 

  48. Decloedt EH, Maartens G, Smith P, Merry C, Bango F, McIlleron H. The safety, effectiveness and concentrations of adjusted lopinavir/ritonavir in HIV-infected adults on rifampicin-based antitubercular therapy. PLoS One. 2012;7(3):e32173.

    Article  CAS  Google Scholar 

  49. Vergara TR, Estrela RC, Suarez-Kurtz G, Schechter M, Cerbino-Neto J, Barroso PF. Limited penetration of lopinavir and ritonavir in the genital tract of men infected with HIV-1 in Brazil. Ther Drug Monit. 2006;28(2):175–9.

    Article  CAS  Google Scholar 

  50. Phares C, Lynfield R, Farley M, Mohle-Boetani J, Harrison L, Petit S, Craig A, Schaffner W, Zansky S, Gershman K, Active Bacterial Core surveillance/Emerging Infections Program N. Epidemiology of invasive group B streptococcal disease in the United States, 1999–2005. JAMA. 2008;299(17):2056–65.

    Article  CAS  Google Scholar 

  51. Husada D, Chanthavanich P, Chotigeat U, Sunttarattiwong P, Sirivichayakul C, Pengsaa K, Chokejindachai W, Kaewkungwal J. Predictive model for bacterial late-onset neonatal sepsis in a tertiary care hospital in Thailand. BMC Infect Dis. 2020;20(1):1–11.

    Article  Google Scholar 

  52. Masanja PP, Kibusi SM, Mkhoi ML. Predictors of early onset neonatal sepsis among neonates in Dodoma, Tanzania: a case control study. J Trop Pediatr. 2020;66(3):257–66.

    Article  Google Scholar 

  53. Wang M, Patel AB, Hansen NI, Arlington L, Prakash AL, Hibberd P. Risk factors for possible serious bacterial infection in a rural cohort of young infants in central India. BMC Public Health. 2016;16:1–10.

    Article  Google Scholar 

  54. Jabiri AL, Wella H, Semiono A, Sariah A, Protas J. Prevalence and factors associated with neonatal sepsis among neonates in Temeke and Mwananyamala Hospitals in Dar es Salaam, Tanzania. Tanzan J Health Res. 2016;18(4):1–7.

    Article  Google Scholar 

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Acknowledgements

First of all, our special thanks & deepest gratitude goes to Debre Markos University for supporting us to undertake this research work. We would also like to extend our heartfelt thanks for the study participants, data collectors and supervisor who participated in the study. We are also thankful for administrators of Hospitals, and head nurses of NICU in the respective Hospitals.

Funding

This research didn’t receive any grant from any funding agency in the public, commercial, or not-for-profit sectors.

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All authors contributed significantly to the work reported, whether in the conception, study design, execution, data acquisition, analysis, and interpretation, or in all of these areas; participated in the drafting, revising, or critical review of the article; gave final approval of the version to be published; agreed on the journal to which the article was submitted; and agreed to be accountable for all aspects of the work.

Corresponding author

Correspondence to Tadesse Yirga Akalu.

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Ethics approval and consent to participate

A written letter of permission from the research committee Debre Markos University, College of Health Science, was obtained and submitted to selected hospitals. Oral permission was obtained from hospital coordinators and written informed consent was obtained from study participants. Confidentiality of the patient profiles was ensured throughout the research process. Over all, study was done under the declaration of Helsinki.

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The authors declared that, we have no any competing interest.

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Akalu, T.Y., Aynalem, Y.A., Shiferaw, W.S. et al. Prevalence and determinants of early onset neonatal sepsis at two selected public referral hospitals in the Northwest Ethiopia: a cross-sectional study. BMC Pediatr 23, 10 (2023). https://doi.org/10.1186/s12887-022-03824-y

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Keywords

  • Early-onset sepsis
  • Ethiopia
  • Neonate
  • Prevalence
  • Determinants