BMC Pediatrics
(2023) 23:10
Akalu et al. BMC Pediatrics
https://doi.org/10.1186/s12887-022-03824-y
Open Access
RESEARCH
Prevalence and determinants of early
onset neonatal sepsis at two selected public
referral hospitals in the Northwest Ethiopia:
a cross-sectional study
Tadesse Yirga Akalu1*, Yared Asmare Aynalem2, Wondimeneh Shibabaw Shiferaw2, Melaku Desta1, Haile Amha1,
Dejen Getaneh3, Bayachew Asmare1 and Yoseph Merkeb Alamneh4
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. Faceto-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.
Keywords Early-onset sepsis, Ethiopia, Neonate, Prevalence, Determinants
*Correspondence:
Tadesse Yirga Akalu
tadesseyirga680@gmail.com
1
College of Health Science, Debre Markos University, P.O. Box 269, Debre
Markos, Ethiopia
2
College of Health Science, Debre Berihan University, Debre Berihan,
Ethiopia
3
4
College of Health Science, Debre Tabor University, Debre Tabor, Ethiopia
School of Medicine, Debre Markos University, Debre Markos, Ethiopia
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Akalu et al. BMC Pediatrics
(2023) 23:10
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 earlyonset 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].
Page 2 of 9
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
Akalu et al. BMC Pediatrics
(2023) 23:10
Page 3 of 9
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.
n=
Za
2
2
(P)(1−P)
(0.05)2
n=
(1.96)2 (0.65)(0.35)
(0.05)2
= 350
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
Akalu et al. BMC Pediatrics
(2023) 23:10
Page 4 of 9
Table 1 Socio-demographic characteristics of neonates and
their index mothers admitted at two selected Public Referral
Hospitals in the Northwest Ethiopia: 2019
Variables
Maternal age
Marital status
Maternal religion
Maternal occupation
Neonatal sex
Categories
frequency
percentage
< 20
28
7.6%
20–34
232
63.0%
> = 35
108
29.4%
Single
32
8.7%
Widow
26
7.1%
Married
310
84.2%
Orthodox
231
62.8%
Muslim
92
25.0%
Protestant
45
12.2%
Housewife
153
41.6%
Civil servants
94
25.5%
private employed
48
13.0%
Business woman
73
19.8%
Male
169
45.9%
Female
199
54.1%
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).
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).
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
Fig. 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
Akalu et al. BMC Pediatrics
(2023) 23:10
Page 5 of 9
Table 2 Birth characteristics of neonates who were admitted at two selected Public Referral Hospitals in the Northwest Ethiopia: 2019
Variables
Gestational age of the neonate at birth
First minute APGAR score
Fifth minute APGAR score
Birth weight
Immediate cry at birth
Resuscitated at birth
Categories
frequency
Percentage
> 42 weeks
14
3.8%
37–42 weeks
253
68.8%
32–37 weeks
88
23.9%
< 32 weeks
13
3.5%
<7
93
25.3%
>7
265
72.0%
<7
65
17.7%
>7
293
79.6%
> 4000 g
14
3.8%
2500–4000 g
228
62.0%
1500-2500 g
113
30.7%
< 1500 g
13
3.5%
Yes
250
67.9%
No
118
32.1%
Yes
96
26.1%
No
272
73.9%
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).
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).
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
Akalu et al. BMC Pediatrics
(2023) 23:10
Page 6 of 9
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
Variables
Maternal age
Maternal parity
Duration of labor after rupture of membrane
Number digital of per-vaginal examination
Gestational age
Birth weight
Resuscitation at birth
Category
Early onset sepsis
Yes
No
Count
(Percent)
Count
(percent)
COR with 95%CI
AOR with 95%CI
< 20
20 (16)
8 (3.3)
5.3(2.2–12.7)
20–34
74 (59.2)
158 (65)
1
> 35
31 (24.8)
77 (31.7)
0.8(0.5–1.4)
Nulli-para
43 (34.4)
40 (16.5)
2.1(1.1–3.7)
3.3 (1.1- 9.5)
Para-one
48 (38.4)
95 (39.1)
1
1
Multi-para
34 (27.2)
108 (44.4)
0.6(0.4–1.0)
0.3(0.2 -0.5)
< 12 h
27 (21.6)
152 (62.6)
12-18 h
52 (41.6)
83 (34.2)
1
1
> 18 h
46 (36.8)
8 (3.3)
9(4.0 -21.0)
11.3(3.0 -41.8)
<3
24 (19.2)
134 (55.0)
1
>3
101 (80.8)
109 (45.0)
5(3.1- 8.63)
> 42 weeks
4 (3.2)
10 (4.1)
1.5(0.4 -4.8)
37–42 weeks
54 (43.2)
199 (81.9)
1
1
32–37 weeks
60 (48.0)
28 (11.5)
7.8(4.6–13.6)
3.2(1.2—8.5)
< 32 weeks
7 (5.6)
6 (2.5)
4.3(1.4–13.3)
> 4000 g
5 (4.00
9 (3.7)
2(0.7–6.5)
2500–4000 g
48 (38.4)
180 (74.1)
1
1500-2500 g
64 (51.2)
49 (20.2)
4.8(3.0 -8.0)
< 1500 g
8 (6.4)
5 (2.1)
6(1.8—19.2)
yes
70 (56.0)
26 (10.7)
10.6(6.2–8.2)
4(1.4 -11.8)
No
55 (44.0)
217 (89.3)
1
1
(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].
Akalu et al. BMC Pediatrics
(2023) 23:10
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
Page 7 of 9
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 cultureconfirmed 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.
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
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.
Authors’ contributions
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.
Funding
This research didn’t receive any grant from any funding agency in the public,
commercial, or not-for-profit sectors.
Availability of data and materials
The data sets analyzed during the current study are available from the corresponding author upon reasonable request.
Akalu et al. BMC Pediatrics
(2023) 23:10
Declarations
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.
Consent for publication
Not applicable
Competing interests
The authors declared that, we have no any competing interest.
Received: 21 May 2022 Accepted: 27 December 2022
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