Content uploaded by Liyew Mekonen Ayehubizu
Author content
All content in this area was uploaded by Liyew Mekonen Ayehubizu on Jan 27, 2025
Content may be subject to copyright.
https://doi.org/10.1177/11795565221098346
Creative Commons Non Commercial CC BY-NC: This article is distributed under the terms of the Creative Commons Attribution-NonCommercial
4.0 License (https://creativecommons.org/licenses/by-nc/4.0/) which permits non-commercial use, reproduction and distribution of the work without
further permission provided the original work is attributed as specified on the SAGE and Open Access pages (https://us.sagepub.com/en-us/nam/open-access-at-sage).
Clinical Medicine Insights: Pediatrics
Volume 16: 1–8
© The Author(s) 2022
Article reuse guidelines:
sagepub.com/journals-permissions
DOI: 10.1177/11795565221098346
Introduction
Neonatal sepsis is a clinical syndrome characterized by signs
and symptoms of inflammatory response with or without con-
firmed infection in the first month after birth, and it is caused
by bacteria, viruses or fungi.1 Neonatal sepsis can be divided
into early-onset neonatal sepsis and late-onset neonatal sepsis.
Early neonatal sepsis (EOS) is defined as the occurrence of
sepsis within 72 hours after birth, or within 7 days after birth.
This is mainly due to the vertical transmission of bacteria from
maternal to child at birth. Late neonatal sepsis (LOS) is an
infection that occurs after 72 hours or after 1 week following
birth and it is related to the horizontal transmission of patho-
gens after birth.2
More than 2.5 million newborns died worldwide in 2017,
with neonatal sepsis accounting for roughly two-thirds of
infant mortality. In the countries with the highest neonatal
mortality rates, infection accounts for roughly half of all neo-
natal deaths, most of which occur shortly after birth. Severe
neonatal infections, such as sepsis, are the leading cause of neo-
natal mortality and morbidity. According to WHO data, there
were 1.3 to 3.9 million cases of neonatal sepsis worldwide in
2018, with 400 000 to 700 000 newborns dying in the same
year due to sepsis. Hospital-acquired infections account for 4%
to 56% of all neonatal deaths among babies born in hospitals,
with three-quarters of them having occurred in South-East
Asia and Sub-Saharan Africa. Sepsis accounts for 28% of neo-
natal mortality in Africa, and it is also believed that early
detection and treatment of the cases can prevent about 84% of
neonatal sepsis-related mortality.3
Several risk factors of neonatal sepsis are reported in previ-
ous studies, which include: perinatal asphyxia, APGAR score,
prolonged rupture of membranes, and pre-existing maternal
infection.4,5
Ethiopia ranks among the top ten countries in neonatal
morbidity and mortality, with over 100 000 newborn deaths
each year. The neonatal mortality rate (NMR) in Ethiopia
Neonatal Sepsis and Associated Factors Among
Neonates Admitted to Neonatal Intensive Care
Unit in General Hospitals, Eastern Ethiopia 2020
Abdurahman Kedir Roble1, Liyew Mekonen Ayehubizu2
and Hafsa Mohamed Olad3
1Department of Midwifery, College of Medicine and Health Science, Jigjiga University, Jigjiga,
Ethiopia. 2Department of Public Health, College of Medicine and Health Science, Jigjiga
University, Jigjiga, Ethiopia. 3Department of Midwifery, Sultan Sheikh Hassen Yebere Referral
Hospital, Jigjiga University, Jigjiga, Ethiopia.
ABSTRACT
INTRODUCTION: Globally, the major cause of neonatal mor tality and morbidity is neonatal sepsis, which is defined as a clinical course
marked by systemic inflammation in the presence of infection in a newborn. There are limited data concerning neonatal sepsis in eastern
Ethiopia. As a result, this study aimed to determine the prevalence of neonatal sepsis and associated factors among neonates admitted to
intensive care units at general hospitals in Eastern Ethiopia.
METHODS: A hospital-based cross-sectional study with retrospective document review was conducted among newborns hospitalized in
neonatal intensive care units. Using simple random sampling, the charts of 356 newborns who were hospitalized between January and
December 2019 were included, and data were collected using a pretested checklist. Data were entered into Epi data version 3.1 and ana-
lyzed with SPSS version 22.
RE S ULTS : The overall prevalence of neonatal sepsis was 45.8% (95% CI 40.7, 51.4). Prolonged rupture of the membrane (AOR = 2.38, 95%
CI: [1.27-4.45]), vaginal delivery (AOR = 1.78, 95%, CI: [1.09, 2.96]) APGAR score <7 (AOR = 4.55, 95% CI: [2.49-8.29]), prelacteal feeding
(AOR = 3.54, 95% CI: [1.68-8.23]), and mechanical ventilation (AOR = 4.97,95%CI: [2.78-8.89]) were predictors associated with neonatal
sepsis.
CONCLUSION: In this study, the prevalence of neonatal sepsis was high, and factors associated with neonatal sepsis included prolonged
rupture of membrane, mode of delivery, low APGAR score, prelacteal feeding and mechanical ventilation. As a result, maternal and neonatal
care should be enhanced to lower the risk of neonatal sepsis.
KEYWORDS: Neonatal sepsis, infection, newborn, morbidity, mortality
RECEIVED: September 2 , 2021. ACCEPTED: April 8, 202 2.
TYPE: Original Research
FUNDING: The author(s) re ceived no nancia l suppor t for the research, a uthors hip, and/or
publication of this article.
DECLARATION OF CONFLICTING INTERESTS: The author(s) decl ared no pote ntial
conic ts of inter est with re spect to t he resear ch, autho rship, an d/or publ icatio n of this
article.
CORRESPONDING AUTHOR: Abdurahm an Kedir Rob le, Depar tment of Midwife ry,
Colleg e of Medic ine and He alth Sci ence, Ji gjiga Uni versit y, P.O. Box 1020 Jigji ga, Ethio pia.
Email: kedirabdurahman114@gmail.com
1098346PDI0010.1177/11795565221098346Clinical Medicine Insights: PediatricsRoble et al
research-article2022
2 Clinical Medicine Insights: Pediatrics
was 29 per 1000 live births according to 2016 Ethiopian
Demographic Health Survey (EDHS). This is a significant
decrease from the previous EDHS report of 37/1000 live births
in 2011. However, according to the mini EDHS 2019, the neo-
natal mortality rate has risen to 30 deaths per 1000 live births.
Moreover, the prevalence of neonatal sepsis ranged from 11.7%
to 77.9% among Ethiopian neonates hospitalized across the
country.6,7
Only few previous studies have been conducted in Ethiopia,
and most of the previous studies have been confined to single
medical facility. Evidence of neonatal sepsis is also limited in
eastern Ethiopia and the Somali region. Therefore, this study
increased the study setting and aimed to assess prevalence of
neonatal sepsis and associated factors at general hospitals of the
Somali region, eastern Ethiopia.
Methods and Materials
Study design, period, and setting
A retrospective chart review was conducted at Degahbur,
Kebridahar, and Godey general hospitals in Somali regional
state, Eastern Ethiopia. Degahbur hospital is found in
Degahbur town, which is located in the Jarar Zone of the
Somali region. The town is located 780 km from Addis Ababa,
and 180 km away from the regional capital. The hospital was
used by the population living in the Jarar zone.8 Kebridahar
General hospital is located in the Kebridahar administration of
the Somali region, part of the Korahey Zone, The hospital was
established in 1958 and it has all the essential departments
with around 303 staff, including doctors, anesthesia, nurses,
midwifes, neonatologists, and other supportive staff.9 Gode
hospital was found in Godey town in the Shebelle Zone in the
Somali region and it is located about 600 km away from the
regional capital (Jigjiga capital town) and 1230 km from
Addis Ababa. The hospital serves the total population of the
Shebele zone.10 In this study, data was collected for a period of
2 months, from April 1st to May 30th, 2020.
Study population and design
All neonates aged 0 to 28 days and admitted to Neonatal
Intensive Care (NICU) of selected public hospitals in the
Somali region from January 1st, 2019 to December 31st, 2019
were considered as the source population. All randomly selected
medical charts of neonates who were admitted to NICU of
selected public hospitals in the Somali region were enrolled in
the study using a hospital based cross-sectional study design.
Whereas those medical records with incomplete pertinent
information were excluded from the study.
Sample size determination
The sample size of this study was determined using a single
population proportion formula. The proportion of neonatal
sepsis was taken from a study conducted in Wolaita sodo,
southern Ethiopia, which reported a proportion of neonatal
sepsis of 33.8%.11 With the assumption of margin of error of
5%, confidence interval 95%, the non-response rate is assumed
to be 5%.
n Zpp
d
=
()
−
()
()
α/21
2
2
Where n = Sample size, Z = value corresponding to a 95% level
of significance = 1.96
P = proportion neonatal sepsis done in Wolaita sodo 33.8%
d = marginal error assumed to be 5%.
n=
()
×
()
()
=
1960338 0 662
005
344
2
2
...
.
Including 5% (Non respondents) = the final sample size for this
study was 361 neonates.
Sampling techniques and procedure
In the Somali region, there are 8 general public hospitals, 3 of
which (Degahbur, Kebridahar, and Gode General Hospitals)
were deliberately chosen. The sample size was allocated pro-
portionally to all selected hospitals based on the number of
admitted neonates in the previous year. Then, from each hospi-
tal, a list of neonatal medical records was compiled, and a sam-
pling frame was invented. Neonatal medical charts were
randomly chosen using a computer-generated simple random
sampling technique. Finally, the charts of the patients were
reviewed, and the necessary information was obtained.
Data collection tools and procedures
Data were extracted retrospectively from medical charts using
pretested data extraction tools adapted from the related litera-
ture. After that, the tools were organized and classified into 3
major categories: socio-demographic, neonatal, and maternal
factors. Four BSc nurses who had been trained in data collec-
tion tools and procedures, as well as 3 supervisors of MSc neo-
natal nurses, were used as data collectors and supervisors,
respectively.
Variables
The outcome variable in this study was clinically based neona-
tal sepsis. The outcome variable was dichotomized as “Yes” if a
physician diagnosed newborn sepsis after admission to the
NICU and “No” if the neonate was admitted to the NICU
without having been diagnosed with neonatal sepsis. Before
data gathering, all charts with neonatal sepsis were reviewed for
cross-validation of clinical diagnosis of neonatal sepsis. When
a newborn has so far been admitted to the NICU with one of
the sepsis symptoms described in the Integrated Management
of Newborn and Childhood Illness (IMNCI) criteria, the
Roble et al 3
clinical finding of neonatal sepsis is validated. This IMNCI
criterion determines the presence of clinical neonatal sepsis in
neonates with the following clinical features: if the neonate was
not feeding well, drowsy or unconscious, convulsions, move-
ment only when stimulated or no movement at all, fast breath-
ing (>60 breaths per minute), grunting, severe chest in-drawing,
elevated temperature > 38°C or fever, hypothermia 35.5°C,
central cyanosis, severe abdominal distension, or localized signs
of infection.12-14 Other independent variables included mater-
nal factors such as parity, Antenatal Care (ANC) follow-up,
rupture of membranes, gestational age, and mode of delivery,
while neonatal factors included birth weight, APGAR score,
meconium aspiration syndrome (MAS), prelacteal feeding,
resuscitation at birth, birth asphyxia, and Respiratory Distress
Syndrome (RDS).
Operational definition
Neonatal sepsis is defined as a clinical syndrome characterized
by systemic signs and symptom of an inflammatory response in
the presence of or as a result of suspected or proven infection
during the first month of life.
Early onset neonatal sepsis defined as onset of sepsis in the
first 72 hours of life
Late onset neonatal sepsis defined infection occurring
after 72 hours of life
Prolonged rupture of membrane: If amniotic membranes of
mother ruptured for duration of 18 and more hours.
Data quality control
To ensure data quality, an English-language structured check-
list with 3 main sections was created. For 2 days, data collectors
and supervisors were trained on the purpose of the study, study
tools, data collection procedures, and data handling. A pre-test
of the checklist was performed on the medical records of 25
neonates at Karamara General Hospital to ensure the tool’s
validity, and corrections were made prior to data collection. The
data collection process was monitored and supervised on a
regular basis by the principal investigators and supervisors.
Data processing and analysis
After entering the data into Epidata version 3.1, it was exported
to SPSS version 22 for analysis. Descriptive statistics were
computed and displayed as frequency tables and percentages.
Bivariable analysis was carried out and all variables having
P-value <.25 in the bivariable analysis were included in the
final model of multivariable analysis in order to control for
potential confounders. In the final model of multivariable
logistic regression analysis, Adjusted Odds Ratios (AOR)
along with 95% CI were estimated to identify the true effects
of independent variables on outcome variables. The level of
statistical significance was declared at P-value <.05.
Ethical consideration
The study was carried out after receiving ethical approval and
an official letter from Jigjiga University’s College of Medicine
and Health Sciences’ Ethics Review Committee. Permission
was sought from each hospital’s medical director and NICU
director. Only clinical records were collected, ensuring the con-
fidentiality of the information. Furthermore, no names or other
personally identifiable information about the study neonates
was obtained.
Results
The study included 356 medical charts of neonates admitted to
the NICU. The neonates’ ages ranged from 1 to 26 days, with a
mean of 4.75 days and a standard deviation of ±5.7 days. The
majority of neonates (81.5%) were between the ages of 1 and
7 days. More than half (52.8%) of the neonates in this study
were male. The mothers’ mean age was 26 years (SD ± 5.09),
with a range of 16 to 40 years, and the majority (62.1%) were
between the ages of 21 and 30 (Table 1).
In current study, the vast majority (77.8%) of the mothers
were multiparous. It was also found that more than half of the
mothers (58.1%) did not receive ANC during their indexed
pregnancy. One hundred thirty-eight (38.8%) of mothers were
gave birth via cesarean section. It was also noticed that 75
(21.1%) of the mothers had a history of prolonged ruptured
membrane (Table 2).
Table 1. Socio-demographic characteristics of neonates admitted to NICU at selected public hospitals in Somali regional state, Eastern Ethiopia,
2020.
VARIABLE CATEGORY FREQUENCY (N) PERCENT
Neo nat e ag e(days) 1-7 d ays 290 81.5
8-28 days 66 18.5
Sex of neonate Male 188 52.8
Female 168 4 7. 2
Maternal age <20 73 20.5
21-30 221 6 2 .1
>30 62 17.4
4 Clinical Medicine Insights: Pediatrics
Regarding neonatal APGAR score, approximately 155
(43.5%) neonates had an APGAR score of less than 7 within
the at the fifth minutes of birth. More than three-quarters
(75.1%) of neonates were born with normal birth weight (birth
weight between 2500 and 4000 g). The average neonatal birth
weight was 2902.53 g (SD ± 819.632). The vast majority of
283 neonates (79.5%) were term neonates born between 37
and 42 weeks, while 73 (20.5%) were preterm neonates born
between 28 and 36 weeks. There was a history of birth asphyxia
in 47 (13.2%) and respiratory distress in 84 (23.6%) of the
cases. Roughly 109 (24.7%) had a history of pre-lacteals feed-
ing, and 38 (10.7%) had MAS. More over 136 neonates were
mechanically ventilated during hospitalization (Table 2).
In this study, the prevalence of neonatal sepsis among neo-
nates admitted to the neonatal intensive care unit of selected
public hospitals in the Somali region was found to be 45.8%
Table 2. Maternal and Neonatal related factors of mothers and neonates who admitted to NICU of the selected public hospitals in Somali region,
Eastern Ethiopia, 2020.
VARIABLE CATEGORY FREQUENCY (N) PERCENT
Parity Primiparous 79 22.2
Multiparous 227 7 7. 8
ANC follow up Yes 14 9 41. 9
No 207 58.1
History of maternal fever Yes 51 14 .3
No 305 85.7
History of APH Ye s 42 11. 8
No 314 88.2
Duration of ruptured membrane >18 h 75 21.1
<18 h 281 78.9
Meconium stained amniotic uid Yes 38 10.7
No 318 89.3
Gestational Age Preterm 73 20.5
Ter m 283 79.5
Mode of delivery Vaginal delivery 218 61. 2
C/S 138 38.8
Fifth minute APGAR score ⩾7219 61.5
<7137 38.5
Birth weight <2500 92 24.8
⩾2500 264 75.2
Birth asphyxia Yes 47 13 .2
No 309 86.8
Respiratory distress Yes 84 23.6
No 272 76.4
Pre-lacteal feeding Yes 109 30.6
No 247 69.4
Mechanical ventilation Yes 13 0 36.5
No 226 63.5
Abbreviations: APGAR, A-Appearance, P-pulse, G-Grimace, Activity, Respiration; Delivery, ANC: Antenatal care, APH, Antepartum Hemorrhage; C/S caesarian delivery;
NICU, neonatal intensive care unit.
Roble et al 5
(95% IC 40.7, 51.4). Of the total 163 neonates who developed
sepsis, more than three-fourths, 131 (80.4%), were reported to
have EOS, and 32 (19.6%) neonates were diagnosed with LOS.
Concerning the clinical characteristics of neonates with neona-
tal sepsis, approximately 62 (38%) had fever, 24 (14.7%) had
grunting, and 17 (10.4%) had rapid breathing (Table 3).
Factor associated with neonatal sepsis
(multivariable analysis)
Those variables with a P-value less than <.25 at bivariable
analysis were included in multivariable logistic regression anal-
ysis. In this study neonates born to mothers whose membranes
had been ruptured for eighteen hours or more were about 2.38
times (AOR = 2.38, 95% CI: [1.27-4.45]) more likely to
develop neonatal sepsis than their counterparts. The risk of
neonatal sepsis was 1.78 times higher in vaginal deliveries
compared to cesarean sections (AOR = 1.78, 95%, CI: [1.09,
2.96]). The odds of developing neonatal sepsis was 4.55 folds
higher among neonates with a fifth minute APGAR score of
less than 7 as compared with those neonates with APGAR
score of 7 or higher (AOR = 4.55, 95% CI: [2.49-8.29]).
Furthermore, the odds of neonatal sepsis were 3.54 times
higher in neonates who had prelacteal feeding than their coun-
terparts (AOR = 3.54, 95% CI: [1.68-8.23]). In addition,
mechanically ventilated neonates had 4.97 odds to develop
neonatal sepsis (AOR = 4.97, 95%CI: [2.78-8.89]) than their
counterparts (Table 4).
Discussion
According to this study, the overall prevalence of neonatal sep-
sis was found to be 45.8% (95%IC 40.7-51.4) among neonates
admitted to NICUs of selected public hospitals in the Somali
region of eastern Ethiopia. This finding is in line with a previ-
ous study (44.7%) conducted at Tikur Anbessa University
Hospital in Ethiopia, as well as another study conducted in
Tanzania (47.1%).15,16 However, the prevalence of neonatal
sepsis was lower in this study than in previous studies, which
found a prevalence of 64.8% in Gondar primary hospitals
in northwest Ethiopia, 77.9% in Shashemene hospitals in
central Ethiopia, and 69.35% in Dhaka public hospitals in
Bangladesh.17-19 The difference could be attributed to the
method by which neonatal sepsis is diagnosed. Clinical param-
eters alone were used to classify neonatal sepsis in our study.
Another reason could be differences in the sociodemographic
characteristics of the study population. Aside from that, the
current study’s results were higher than those of the Arsi
University Teaching and Referral Hospital in Ethiopia (34%),
and the University of Gondar, Northwest Ethiopia’s compre-
hensive specialized hospital.20,21 A possible explanation for the
discrepancy is that previous studies were conducted in special-
ized hospitals while the current studies were conducted in gen-
eral hospitals.
Neonatal sepsis was more likely in babies whose mothers’
had prolonged rupture of membrane. Previous studies found
similar results in the northwest part of Ethiopia, central
Ethiopia, Mekele city public hospitals in northern Ethiopia,
and public hospitals in western Mexico.22-25 This could be
because pathogens in the birth canal infect amniotic fluids and
the fetus, increasing the probability of neonatal sepsis after
birth.
Previous research at Uganda’s Mulago national referral hos-
pital and a case study at Ghana’s specialist hospital found that
Caesarian delivery was a strong predictor of neonatal sepsis.26,27
In contrast to previous research, we found that neonates deliv-
ered vaginally were more likely to develop neonatal sepsis than
those delivered though CS. This could be explained by the fact
that vaginally born babies have been exposed to vaginal and
fecal bacteria. Multiple vaginal examinations during labor and
Table 3. Clinical characteristics of neonate diagnosed with sepsis.
CLINICAL CHARACTERISTICS FREQUENCY (N = 163) PERCENTAGE
Not being able to feed since birth or stopped feeding well 11 6.8
Convulsions 95.5
Fast breathing (60 breaths per minute or more) 17 10.4
Severe chest in-drawing 10 6.1
Fever (38°C or greater) 62 38.0
Low body temperature (<35.5°C) 63.7
Movement only when stimulated or no movement at all 8 4.9
Grunting 24 14.7
Central cyanosis 42.5
Severe abdominal distension, or localized signs of infection 53.1
Lethargy 74.3
6 Clinical Medicine Insights: Pediatrics
delivery may also expose a newborn to a variety of pathogens,
leading to neonatal sepsis.
The fifth minute APGAR score was one of a strong predic-
tor of neonatal sepsis in this study. Neonates whose fifth min-
utes APGAR score was less than 7 are more likely to develop
neonatal sepsis than neonates with an APGAR score of 7 and
more. Another studies with similar results were reported from
studies done at Wolaita Sodo hospital in Southern Ethiopia
and referral hospitals in northwest Ethiopia.28,29 Any newborn
with an APGAR score of less than 7 at birth must undergo
life-saving procedures, which might increase their risk of con-
tracting infectious diseases from resuscitation equipment dur-
ing emergency procedures.
Prelacteal feeding was not associated with neonatal sepsis in
a previous study conducted in Ghana.30 However, our findings
showed that neonatal prelacteal feeding was significantly asso-
ciated with the development of neonatal sepsis. Another study
conducted in Zimbabwe’s Chipinge District backs up this
finding.31 It is possible that prelacteal feeding and the bottles
used were contaminated with infectious pathogens, causing
necrotizing enterocolitis and promoting pathogen entry into
the circulatory system, resulting in neonatal sepsis. These find-
ings highlight the importance of ongoing health education
about the dangers of prelacteal feeding.
In our study, neonatal sepsis was more likely to develop
when mechanical ventilation was used. Similar study reported
from Nepal.32 This could be due to a lack of sterile procedures,
a long duration of utilizing mechanical ventilators without
stylizing, or faulty mechanical ventilator application, which
could allow microorganisms to enter the neonate and induce
sepsis. Despite the fact that mechanical ventilation is an inva-
sive procedure that is an important part of newborn care in the
NICU, our research showed that mechanical ventilation was
associated with neonatal sepsis. As a result, the importance of
Table 4. Multivariable Logistic Regression Analysis of Factors Associated With Neonatal Sepsis Among Neonates Admitted to NICU of Selected
Public hospitals in Somali region, Eastern Ethiopia, 2020 (N = 356).
VARIABLE CATEGORY NEONATAL SEPSIS
YES = N (%) NO = N (%)
COR (95%CI) AOR (95%CI)
History of APH Yes 29 (69.0) 13 (31.0) 3.0 (1.50-5.98) 1.2 0 (0.48 -2 .99)
No 134 (42.7) 18 0 ( 5 7. 3) 1 1
History of maternal
fever
Yes 28 (54.9) 2 3 (4 5 .1) 1.53 (0. 85- 2.78) 1.16 (0.57-2.36)
No 135 (44.3) 170 (55.7) 1 1
Duration of rupture
of membrane
⩾18 51 (68.0) 24 (32.0) 3.21 (1.87-5.51) 2.38 (1.2 7-4.45)
<18 112 (3 9 . 9) 169 (6 0.1) 11
Gestational age Preterm 43 (58.9) 30 (41 .1) 1.95 (1.16- 3. 28) 0.67 (0.27-1.68)
Ter m 120 (42 .4) 163 (57.6) 1
Mode of delivery Vaginal delivery 114 (52.3) 10 4 (4 7.7) 1.99 (1.28, 3.09) 1.78 (1. 08 -2.96)
CS 49 (35.5) 89 (64.5) 1 1
Fifth minute Apgar
score
⩾766 (32.8) 135 ( 6 7. 2 ) 11
<797 (62.6) 58 ( 3 7.4) 3.42 (2.21-5.31) 4.55 (2.49-8.29)
MSAF Yes 21 (55.3) 17 (44.7 ) 1.53 (0.78-3.01) 1.20 (0.55-2.65)
No 142 (44.7 ) 176 (55 .3) 1 1
Birth weight <2500 52 (56.5) 40 (43.5) 1.79 (1.11-2.89) 1.0 6 (0. 59 -1.91)
⩾2500 111 (4 2 . 0) 153 (58.0) 1 1
Pre-lacteal feeding Yes 74 (6 7. 9 ) 35 (32 .1) 3.75 (2.33-6.06) 3.54 (1.6 8-8 .2 3)
No 89 (36.0) 158 (64.0) 1 1
Mechanical
ventilation
Yes 76 (58.5) 54 (41.5 ) 2.25 (1.45-3.49) 4.97 (2 .78-8. 89)
No 87 (38.5) 13 9 (61.5) 11
Abbreviations: APGAR, A-Appearance, P-pulse, G-Grimace, Activity, Respiration; ANC, Antenatal care; APH, Antepartum Hemorrhage; C/S, caesarian delivery; NICU,
Neonatal intensive care unit MSAF, Meconium stained amniotic uid.
*P-value ⩽ .05, **P-value < .001.
Hosmer lemeshow = 0.41.
Roble et al 7
enhancing local infection control methods such as aseptic
device setup and maintenance protocols must be emphasized.
Limitation and strength
The study’s strength was that it was conducted in remote
areas of Ethiopia where no previous research had been con-
ducted, and it included 3 general hospitals to cover a large
geographic area. Because the study was based on document
review, some factors may have been ignored. Additionally,
this study used a cross-sectional design, the true effect of
predictors on the outcome variable was not demonstrated.
Furthermore, there was no cultural evidence for detecting
neonatal sepsis, and no list of sepsis-causing microbes were
identified, meaning that it was only based on clinical criteria
of sepsis, which could lead to overestimation or inaccurate
diagnosis.
Conclusion and Recommendation
In this study, the prevalence of neonatal sepsis was found to be
high. Factors associated with neonatal sepsis included pro-
longed membrane rupture, mode of delivery, low APGAR
score, prelacteal feeding and mechanical ventilation. To reduce
the risk of neonatal sepsis, maternal and neonatal care should
be improved. Furthermore, exclusive and early breast feeding
should be encouraged.
Acknowledgements
The authors expressed their gratitude to Jigjiga University. All
of the data collectors who took part in this study are also to be
thanked for their efforts. We’d also like to express our gratitude
to all of the hospitals that participated in the research.
Author Contribution
All authors have made a significant contribution to the concep-
tion, study design, acquisition, data analysis and interpretation
of the results. They also took part in drafting the manuscript,
critically reviewed and agreed on the journal to which the article
was to be submitted. All authors read and approved the final
version of the manuscript and agreed to be accountable for all
the contents of the manuscript.
Data Sharing Statement
The datasets used for analysis are available from the corre-
sponding author on reasonable request.
Ethical Approval and Consent to Participate
Jigjiga University’s College of Medicine and Health Sciences’
Research Ethics Review Committee granted ethical approval.
Letters of support were written to all public health facilities
where the study was conducted. All concerned bodies in the
hospitals in charge of this information provided informed writ-
ten voluntary consent. Permission was granted for data collec-
tion by hospitals. Information confidentiality was maintained
by not extracting personal identifiers and storing data in a
secure location.
ORCID iDs
Abdurahman Kedir Roble https://orcid.org/0000-0003-0567
-8737
Liyew Mekonen Ayehubizu https://orcid.org/0000-0003-1795
-9608
REFERENCES
1. Wynn JL. Defining neonatal sepsis. Curr Opin Pediatr. 2016;28:135-140.
2. Ekman B, Paudel P, Basnet O, Ashish KC, Wrammert J. Adherence to World
Health Organisation guidelines for treatment of early onset neonatal sepsis in
low-income settings; a cohort study in Nepal. BMC Infect Di s. 2020;20:666.
3. WHO. Global Report on the Epidemiology and Burden of Sepsis: Current Evidence,
Identifying Gaps and Future Directions. WHO; 2020.
4. Olorukooba A A, Ifusemu WR, Ibrahim MS, Jibril MB, Amadu L, Lawal BB.
Prevalence and factors associated with neonatal sepsis in a Tertiary Hospital,
North West Nigeria. Niger Med J. 2020;61:60-66.
5. Lona-Reyes JC, Pérez-Ramírez RO, Rodríguez-Patiño V, Cordero-Zamora A,
Gómez-Ruiz LM, Llamas-Ramos L . Prevalencia de β-lactamasas de espectro
extendido en enterobacterias causantes de sepsis neonatal y factores asociados.
Revista chilena de infectologia : organo ofi cial de la Sociedad Chilena de Infectologia.
2019;36:433-441.
6. Bayih WA, Ayalew MY, Chanie ES, et al. e burden of neonatal sepsis and its
association with antenatal urinary tract infection and intra-partum fever among
admitted neonates in Ethiopia: a systematic review and meta-analysis. Heliyon.
2021;7:e06121.
7. MOH. Ethiopian Mini Demographic Health Survey. 2019. https://www.moh.gov.
et/ejcc/sites/default/files/2019-08/Complete_KIR_EMDHS-%20Final.pdf
(2019).
8. Degehabur. Degahbur. 2020. Accessed January 20, 2020. https://www.gtp.gr/
Degahbur
9. Wikipedia. Kebridahar. 2020, Accessed January 20, 2020. https://en.wikipedia.
org/wiki/Kebri_Dahar
10. Godey. Report. 2016. City Council Health Office
11. Mersha A, Worku T, Shibiru S, et al. Neonatal sepsis and associated factors
among ne wborns in hospit als of Wolaita Sod o To wn, Souther n Ethiopia. Re s Rep
Neonatol. 2019;9:1-8.
12. Aneja S. Integrated management of newborn and childhood illness (IMNCI)
strategy and its implementation in real life situation. Indian J Pediatr. 2019;
86:622-627.
13. Gerensea H, Kebede A, Baraki Z, et al. Consistency of integrated management
of newborn and childhood illness (IMNCI) in Shire Governmental Health
Institution in 2017. BMC Res Notes. 2018;11:476.
14. Teferi E, Teno D, Ali I, et al. Quality and use of IMNCI services at health
center under-five clinics after introduction of integrated community-based case
management (ICCM) in three regions of Ethiopia. Ethiop Med J. 2014;52:
91-98.
15. Shitaye D, Asrat D, Woldeamanuel Y, Worku B. Risk factors and etiology of
neonatal sepsis in tikur Anbessa University Hospital, Ethiopia. Ethiop Med J.
2010;48:11-21.
16. Kayange N, Kamugisha E, Mwizamholya DL, Jeremiah S, Mshana SE. Predic-
tors of posit ive blood cult ure and deat hs among neonates w ith suspec ted neonatal
sepsis in a tertiary hospital, Mwanza-Tanzania. BMC Pediatr. 2010;10:39.
17. Agnche Z, Yenus Yeshita H, Abdela Gonete K. Neonatal sepsis and its associ-
ated factors among neonates ad mitted to neonata l intensive care units in primary
hospitals in central Gondar Zone, Northwest Ethiopia, 2019. Infect Drug Resist.
2020;13:3957-3967.
18. Getabelew A , Aman M, Fantaye E , Yeheyis T. Preva lence of neonatal sepsis and
associated factors among neonates in Neonatal Intensive Care Unit at selected
govern mental hospitals in Shashemene Town, Orom ia Regional State, Ethiopia,
20 17. Int J Pediatr. 2018;2018:7801272.
19. Nyma Z , Rahman M, Hasan SMM, et al. Prevalence and associated risk factors
of sepsis among neonates admitted into neonatal intensive care units of public
hospitals in Dhaka. Cureus. 2020;12:e7461.
20. Sorsa A. Epidemiology of neonatal sepsis and associated factors implicated:
observational study at Neonata l Intensive Care Unit of Arsi Universit y Teaching
and Referral Hospital, South East Ethiopia. Ethiop J Health Sci. 2019;29:
333-342.
21. Yismaw AE, Abebil TY, Biweta MA, Araya BM. Proportion of neonatal sepsis
and determinant factors among neonates admitted in Universit y of Gondar
8 Clinical Medicine Insights: Pediatrics
comprehen sive special ized hospita l neonatal Inten sive care unit Nor thwest Ethi-
opia 2017. BMC Res Notes. 2019;12:542.
22. Alemu M, Ayana M, Abiy H, Minuye B, Alebachew W, Endalamaw A. Deter-
minants of neonata l sepsis among neonates in the northwest part of Ethiopia:
case-control study. Ital J Pediatr. 2019;45:150.
23. Bulto GA, Fekene DB, Wolde yes BS, Debelo BT. Dete rminants of ne onatal sep-
sis among neonates admitted to public hospitals in central Ethiopia: Unmatched
Case-control study. Glob Pediatr Health. 2021;8:2333794X211026186.
24. 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:e0154798.
25. Oswaldo Pérez R, Lona JC, Quiles M, Verdugo MÁ, Ascencio EP, Benítez EA.
Sepsis n eonatal tempra na, incidenci a y factores de rie sgo asociados e n un hospital
público del occidente de México. Revi sta chilena de infecto logia : organo ofici al de la
Sociedad Chilena de Infectologia. 2015;32:447-452.
26. Tumuhamye J, Sommerfelt H, Bwanga F, et al. Neonatal sepsis at Mulago
national referral hospital in Uganda: etiology, antimicrobial resistance, associ-
ated factors and case fatality risk. PLoS One. 2020;15:e0237085.
27. Adatara P, Afay a A, Salia SM, et al. R isk factors associated w ith neonatal sepsis:
A Case Study at a Specialist Hospita l in Ghana. Sci World J. 2019;2019:1-8.
28. A lemayehu A, Alemayehu M, Arba A, et al. Pre dictors of neonata l sepsis in hos-
pitals at Wolaita Sodo Town, southern Ethiopia: institution-based unmatched
case-control study, 2019. Int J Pediat r. 2020;2020:3709672.
29. Akalu T Y, Gebremichael B, Desta KW, Aynalem YA, Shiferaw WS, Alamneh
YM. Predictors of neonatal sepsis in public referral hospitals, Northwest Ethio-
pia: a case control st udy. PLoS One. 2020;15:e0234472.
30. Edmond KM, Kirk wood BR, Amenga-Etego S, Owusu-Ag yei S, Hurt LS.
Effect of early infant feeding practices on infection-specific neonatal mortality:
an inve stigation of th e causal lin ks with obser vational d ata from rur al Ghana. Am
J Clin Nutr. 2007;86:1126-1131.
31. Mugadza G, Zvinavashe M, Gumbo FZ, Pedersen BS. Early breastfeeding ini-
tiation and incidence of neonatal sepsis in Chipinge District Zimbabwe. Int J
Contemp Pediatr. 2018;5:1-5.
32. Manandha r S, Amatya P, Ans ari I, et al. R isk factors for t he development of neo -
natal sepsis in a neonatal intensive care unit of a tertiary care hospital of Nepal.
BMC Infect Dis. 2021;21:546.
