Risk Factors Associated With Early – Onset Neonatal Sepsis Occurring Within 24 Hours After Birth in Mwingi Level 4 Hospital, Kitui County

Abstract

Background: Neonatal mortality in most low income countries is due to infections, with the majority of deaths occurring as a result of early onset neonatal sepsis (EONS). EONS occurs within 72 hours of life; 85% occurring within the first 24 hours. Objective: This study aimed to determine the risk factors associated with EONS and the association between hospital length of stay and antibiotic treatment regimen among neonates admitted in Mwingi Level 4 Hospital who developed sepsis within the first 24 hours of life in the year 2018. Methodology: A retrospective case control hospital- based study covering a period of 1 year (2018). Cases were neonates born in Mwingi Level 4 Hospital who developed neonatal sepsis within 24 hours after birth, and controls were neonates born in Mwingi Level 4 Hospital who didn’t develop the disease within 24 hours after birth. Systematic random sampling method was used to obtain the required sample size. Medical records of 340 neonates (85 cases and 255 controls) were studied and data collected using semi structured data collection tool. Results: Majority of the neonates were males with 47 (55.3%) in cases and 142 (55.7%) in controls (Figure 2).The mean age of neonates was 22.7 hours (SD±3.74, n=340) ranging from 6 to 24 hours. Mean age of neonates with EONS was 23.1 hours (SD±3.19, n=85) while in controls was 22.6 hours (SD±3.90, n=340) ranging from10-24 and 6-24 hours respectively. Multivariable logistic regression analysis showed that the possible risk factor of EONS occurring within 24 hours after birth in this study was spontaneous vertex delivery [AOR= 2.041, 95% CI (1.24-3.36)] p < 0.005. Three variables showed an overall association with neonatal sepsis at the 5% level of significance though without statistical significance after adjusting the odds ratio. These were primiparous [AOR=1.50;95% CI (0.88-2.53)] P< 0.045, referrals from other health facilities [AOR=1.83; 95% CI (0.99-3.40)] P< 0.004, distance from residence to the health facility, [AOR= 1.78; 95% CI (0.95-3.33)] P< 0.004. Neonates treated with gentamicin and benzyl pencillin had 88% less likilihood of staying in the hospital for more than 5 days [ OR =0.122 CI 95% ( 0.031, 0.478)] p< 0.001 Conclusion: This study showed that maternal risk factors are possible leading contributors to EONS occurring within 24 hours after birth in Mwingi Level 4 Hospital, these include spontaneous vertex delivery (SVD), primiparity, distance from residence to the health facility (the longer the distance the higher the risk), and referrals from other health facilities. Use of benzyl penicillin and gentamicin combination as first line antibiotic regimen is associated with shorter hospital length of stay compared to the other antibiotic combination used.