The Factors Increasing The Prevalence of Neonatal Sepsis At Kagadi Hospital-Kibaale District

ABSTRACT

Neonatal sepsis (NS) is a severe systemic bacterial infection in newborn infants within the first 4 weeks of life. NS claims over 1.5 million infant lives each year, the majority in sub-Saharan

Africa and southern Asia. There are two classes of NS: early onset, within the first week of life presumed to be acquired

from prenatal and intrapartum maternal transmission, and late onset within weeks 2–4 of life from environmental and nosocomial sources (Nelson Text book of Pediatrics volume1 by Kliegman, Behrman, Jenson, and Stanton page 798).

It is a syndrome expressing both metabolic and hemodynamic impairment brought about by infection characterized by circulation of bacteria in the blood stream (bacteraemia) associated with signs and symptoms of infection and other tissue derangement which over time lead to multi systemic (multiple organ) damage (Mandell G.L et al 2005).

Neonatal sepsis is a commonly found condition in developing countries. In sub Saharan Africa it is a consequence of aseptic technique commonly arising from prenatal and postnatal that is

maternal, fetal and environmental conditions (Kliegman R.M et al 2007). High incidence of neonatal sepsis in Uganda may be a reflection of qualities of the perinatal and postnatal care available in the neonatal unit (http:// www.google.com/Baraza/en thread).

The World Health Organization (WHO) estimates that 85% of newborn deaths are due to infections including sepsis, pneumonia and tetanus. 5 million neonatal deaths per year, 98% in developing countries; infection, prematurity and birth asphyxia are the commonest causes. In Europe the incidence of neonatal sepsis is 2 per 1,000, mortality 13 -15% (untreated 50%). In Africa the Incidence of neonatal sepsis is 6.5 – 25 per 1,000. It has considerable decline in under 5 and infant mortality in the past two decades. However neonatal mortality remains relatively unchanged especially in the developing countries (UNICEF2009; WHO 2006). These rates increase in maternal, fetal and environmental factors. The incidence is also varied in the entire world due to the microbiological pattern of neonatal sepsis, time, and institute and from researcher to researcher. Also this incidence is variable due to fetal poor immunity (Gupte S. et al 2009). Almost all of the neonatal mortality is observed in developing countries and mostly are born at home (Cheng K. K 2005) Some few studies in sub Saharan Africa differentiate between EONS( is when the neonate is infected a few days after birth that is 7 days-28 days; the infection is due to the organisms present in the environment of hospital or home(Mandell G.L et al 2005).

Differentiation is important as EONS is more likely to reflect vertically acquired infection from maternal genital tract. It is therefore has different etiology as compared to LONS and potential different means of prevention (Kliegman R.M et al 2007) Neonatal sepsis in sub Saharan Africa occurs in significant of neonatal hospital admissions that is 30% over 100 1dmissions during first 7 days of child birth to rural Ugandan it accounts for 25% of mortality. Little is known about the long term sequel in this setting (Dawabu et al 1984; Ahmed et al 1995).

Objectives: To study factors contributing to increasing prevalence of neonatal sepsis at Kagadi hospital Kibaale district.

Design: A retrospective cohort study (1st August 2013-1st August 2014)

Place and duration of study: Record department and neonatal care unit at Kagadi hospital from 1st August to 1st August 2014.

Subject and methods: The study was carried out basing on selected hospital recorded admissions of all neonates with different morbidity. It was classified, defined and its

predisposing factors elaborated basing on EONS and LONS classification, according to WHO its illness occurring soon after delivery to 7 days and from 8 days to 28 days respectively.

Results: Sample size of 100 cases was selected systemically from 200 neonatal files. The factors increasing neonatal factors were divided into neonatal and maternal factors. . Neonatal factors that were assessed included; age of the neonate (63% in males and 37% in females) and maturity of the neonate (NS was prevalent in preterm babies with 89% as compared to mature babies at 11%). Maternal factors that lead to the prevalence of Kagadi hospital were divided into two that

is infections and medical intervention procedures during or before labor. Medical interventions during or before labor included; missed antenatal care(10%), membrane sweeping(16%), excessive vaginal examinations(21%), instrumental delivery(16%), and traditional birth attendant

deliveries(37%).Maternal infections included; UTI(32%), Immunosuppression(5%), diabetes in pregnancy(21%), chorio amnionitis(26%) and trichomoniasis(16%).

Conclusion: Neonatal sepsis is mainly caused by maternal, fetal and environmental factors. Its clinical presentation provides a diagnostic challenge due to non specific signs and symptoms thus contributing an increasing incidence. So there is need for high index of suspicion and good environmental and maternal fetal care to minimize these occurrences.

TABLE OF CONTENTS

DECLARATION............................................................................................................................i

SUPERVISOR’S APPROVAL......................................................................ii

DEDICATION............................................................iii

ACKNOWLEDGEMENT...........................................................................................................iv

TABLE OF CONTENTS..............................................................v

LIST OF TABLES.........................................................................vii

LIST OF FIGURES.............................................................vii

ACRONYMS AND ABBREVIATIONS.....................................................viii

DEFINATION OF TERMS........................................................................x

ABSTRACT..................................................................x

CHAPTER ONE......................................................1

INTRODUCTION..............................................................1

1.1 Introduction.........................................................1

1.2 Background................................................................1

1.3 Statement of the Problem................................................................3

Objectives.............................................................4

1.4.1General Objective..............................................................4

1.4.2 Specific Objective................................................................4

1.5 Research questions...................................................................4

1.6 Significance of the Study....................................................................4

CHAPTER TWO..................................................................6

LITERATURE REVIEW.........................................................................6

2.1Background Information on neonatal sepsis...................................................................6

2.2 Risk factors that increase neonatal sepsis....................................................................11

CHAPTER THREE......................................................................18

METHODOLOGY...........................................................18

3.1 Study area...................................................................18

3.2 Study population..........................................................................................................18

3.3 Study design.................................................................................................................18

3.4 Sample size............................................................................19

3.5 Data collection....................................................................20

3.6 Inclusion criteria.....................................................................20

3.7 Exclusion criteria..............................................................20

3.8 Ethical considerations..................................................................................................21

3.9 Study limitation............................................................................................................21

CHAPTER FOUR.........................................................................22

4.0 RESULTS.......................................................................22

4.1 Neonatal factors leading to neonatal sepsis.................................................................24

4.2 Maternal factors leading to neonatal sepsis.................................................................30

CHAPTER FIVE......................................................................33

DISCUSSION................................................................33

REFERENCES......................................................................38

APPENDIX I.......................................................................41

RESEARCH BUDGET............................................................41

APPENDIX II......................................................................42

STUDY WORK PLAN.................................................................42

APPENDIX ..............................................................43

MAP OF KIBAALE DISTRICT.............................................43

APPENDIX IV..............................................................................44

LETTER OF INTRODUCTION.............................................................................44