Factors associated with severity of neonatal sepsis during admission in Kenyatta national hospital paediatric wards, Kenya: a descriptive cross-sectional study
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Background: Neonatal sepsis is a major cause of neonatal mortality. In the year of 2012, it accounted for 44% of all deaths of underfive years old children globally. 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. Objective: To establish factors associated with severity of neonatal sepsis among patients admitted in Kenyatta National Hospital Paediatric Wards. Design: The study adopted a descriptive cross-sectional design. Setting: The study was carried out in paediatric wards of Kenyatta National Hospital (KNH), Kenya. Subjects: Data was obtained from consenting mothers whose neonates had been admitted with neonatal sepsis and healthcare workers who worked within the paediatric wards. A total of 107 respondents were selected by systematic sampling method in which every alternate participant was selected. A semi-structured questionnaire was used to gather data on maternal and neonatal characteristics and environmental factors. In addition, three focused group discussions comprising nurses, doctors and clinical officers were conducted. Chi-square test was used to determine the factors associated with severity of neonatal sepsis (NNS) during admission. Results: Binary logistic regression analysis was performed to determine predictors of severe NNS. Of the 107 patients with neonatal sepsis, 37.4% had severe neonatal sepsis during admission.After multiple logistic regression analysis, the following factors were found to be independently associated with severe NNS: Neonates aged 8 to 28 days [AOR=2.89; 95%CI=1.07-7.99; P=0.047]compared to those neonates aged less than 8 days; Mothers with primary level of education [AOR=4.57; 95%CI=1.18-17.67; P=0.028]compared to those with tertiary education; primipara mothers [AOR=4.64; 95%CI=1.74-12.37; P=0.002]than multipara mothers and greenish amniotic fluid during labor [AOR=3.11; 95%CI=1.05-9.24; P=0.041]compared to clear amniotic fluid. Conclusion: The study found that severity of NNS was still high. The factors associated with severe NNS were; primiparity, maternal low economic status and poor antenatal clinic attendance. The study thus recommends that newborns at risk of developing severe neonatal sepsis should get prophylactic treatment and mothers be included in specialized programs geared towards reduction of the severity of NNS.
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