Characterization of neonatal sepsis among patients admitted in Kenyatta National Hospital paediatric wards.

Abstract

Introduction: Neonatal sepsis remains a common and serious problem. There are four million neonatal deaths annually worldwide. One out the four million neonatal deaths is due to neonatal sepsis. Background: Neonatal sepsis is a major cause of neonatal mortality. It accounted for 44% of all deaths of under -five year old children globally in year 2012. Statistics indicate that 98% of the global one million deaths as a result of neonatal sepsis occur in Africa. Neonatal sepsis contributes to 69% of neonatal mortality in Nigeria and 28% of neonatal mortality in Kenya. Study objective: The study sought to identify characteristics of neonates admitted for management of neonatal sepsis in Kenyatta National Hospital (K.N.H) paediatric wards. Hypothesis: Neonatal, maternal and environmental characteristics contribute to the development of neonatal sepsis. Methodology The study adopted a descriptive cross-sectional design. It was carried out within paediatric wards in K.N.H-Kenya. Data was obtained from consenting mothers and healthcare workers. The researcher gathered data on maternal, neonatal and environmental characteristics associated to the development of neonatal sepsis. Study subjects were selected by systematic random sampling method in which every alternate participant was selected. A total of 107 study participants constituted the study sample. Three focused group discussions comprising nurses, doctors and clinical officers were conducted.

Data was collected by use of researcher administered semi-structured questionnaire. Qualitative data was audio-taped. Data was cleaned, entered into computer and analyzed using Statistical Package for Social Sciences (SPSS) version 20. Level of significance was at < 0.05. Study results More than half of the neonates 62(57.9%) were males. Fifty percent of the neonates managed in nursery after delivery had fetal distress at birth. Sixty-seven (62.6%) had mild neonatal sepsis and 40(37.4%) had severe neonatal sepsis during admission. Among the sampled mothers, (44.9%) were aged between 20-25 years, (78.5%) were married while fifty-two (48.6%) had attained secondary school education. Fifty-two (47.7%) of the mothers were unemployed and most (42.1%) were earning between KShs of 10,000 – 20,000 per month. More than half 60(56.1%) of the mothers were primiparas. Majority 68(63.6%) of the deliveries took place at public/government health facility. Twenty (18.7%) of the mothers were discharged hours after delivery. Cord care practice was varied. There was a statistical significance of more severe forms of NNS among neonates whose mothers attended 1-3 times of antenatal care [OR=2.67; P=0.044], those who developed NNS within 8 to 28 days of life [OR=3.16; P=0.024] as well as neonates who were formula-fed after delivery [OR=5.33; P=0.019]. Maternal characteristics which demonstrated a statistical significance to severe neonatal sepsis included; primary level of education (55.0%) [OR=4.89; P=0.010], primiparity [OR=3.46; P=0.003] households whose income was less than KShs 10,000 per month more severe NNS (50.0%) [OR=6.33; P=0.008].

Conclusion Neonatal characteristics such as male gender, fetal distress at birth and being a first- born child predisposes the newborn to development of neonatal sepsis, Maternal characteristics such as primary level of education, low economic class, being a firsttime mother and unemployment predispose their newborn to development of neonatal sepsis. Primiparity, maternal low economic status and poor antenatal clinic attendance were associated to development of a more severe form of neonatal sepsis to the newborn. The study duration was 4 months at a cost of Kshs. 132,480.