Risk Factors for Neonatal Sepsis in Public Hospitals of Mekelle City, North Ethiopia, 2015: Unmatched Case Control Study

ObjectivesNeonatal sepsis is a leading cause of neonatal morbidity and mortality, particularly in the developing countries. Delays in the identification and treatment of neonatal sepsis are among the main contributors to the high mortality. The aim of this study was to determine the risk factors of neonatal sepsis in public hospitals of Mekelle City, Tigray Region, North Ethiopia, 2015.MethodsA hospital based case control study was done in public hospitals of Mekelle City, Tigray region. Cases were neonates who had sepsis with their index mothers and controls were neonates who hadn’t had sepsis with their index mothers. Hematologic findings were used to diagnose sepsis once the neonates were being clinically suspected. Cases and controls were selected using the systematic sampling technique. Data were entered using Epi info version 7 and then analyzed using SPSS window 20. The binary logistic regression model was used to test the association between dependent and independent variables and multivariable logistic regression was used to identify the associated risk factors to neonatal sepsis.FindingsA total of 78 cases and 156 controls were included in this study. More than three quarters (76.8%) of cases had early onset sepsis. The multivariable logistic regression analysis showed that the possible risk factors of neonatal sepsis in this study were; history of maternal urinary tract infection or sexually transmitted infection [AOR = 5. 23; 95% CI (1.82, 15.04)], prolonged rupture of membrane [AOR = 7. 43; 95% CI (2.04, 27.1)], Place of delivery; health center delivery [AOR = 5. 7; 95% CI (1.71, 19.03)], intrapartum fever [AOR = 6. 1 95% CI (1.29, 28.31)], APGAR score th minute [AOR = 68. 9; 95% CI (3.63, 1308)] and not crying immediately at birth [AOR = 124. 0; 95% CI (6.5, 2379)].ConclusionBoth maternal and neonatal factors had contributed to the risk of neonatal sepsis. Strengthening of the existing risk based prevention strategies as well as improvement of institutional delivery practices are crucial.一、研究目标 新生儿败血症（Neonatal Sepsis）是新生儿发病与死亡的主要诱因之一，在发展中国家尤为突出。新生儿败血症的识别与治疗延误是导致高死亡率的核心原因之一。本研究旨在明确2015年埃塞俄比亚北部提格雷地区默克莱市公立医院新生儿败血症的危险因素。 二、研究方法 本研究在默克莱市提格雷地区的公立医院开展以医院为基础的病例对照研究（Hospital-based Case-Control Study）。病例组为确诊新生儿败血症的新生儿及其匹配母亲，对照组为未发生新生儿败血症的新生儿及其匹配母亲。当新生儿出现临床疑似败血症表现时，通过血液学检查结果明确诊断。采用系统抽样方法（Systematic Sampling Technique）选取病例与对照。数据通过Epi Info 7软件录入，使用SPSS 20.0统计软件进行数据分析。采用二元logistic回归模型（Binary Logistic Regression Model）检验因变量与自变量之间的关联，并通过多因素logistic回归分析（Multivariable Logistic Regression）筛选新生儿败血症的独立危险因素。 三、研究结果 本研究共纳入78例病例与156例对照。超过四分之三（76.8%）的病例为早发型新生儿败血症（Early Onset Sepsis）。多因素logistic回归分析显示，本研究中新生儿败血症的潜在危险因素包括：孕产妇尿路感染或性传播感染史[调整后比值比（Adjusted Odds Ratio, AOR）=5.23；95%置信区间（95% Confidence Interval, 95%CI）：1.82~15.04]、胎膜早破[AOR=7.43；95%CI：2.04~27.1]、分娩地点为卫生中心[AOR=5.7；95%CI：1.71~19.03]、产时发热[AOR=6.1；95%CI：1.29~28.31]、出生时th分钟APGAR评分（APGAR Score）[AOR=68.9；95%CI：3.63~1308]以及出生时未立即啼哭[AOR=124.0；95%CI：6.5~2379]。 四、研究结论 孕产妇与新生儿相关因素均与新生儿败血症的发病风险相关。强化现有的基于风险分层的预防策略，并改进机构分娩的临床实践流程，具有重要意义。