Risk Factors and Practices contributing to Newborn Sepsis in Buyende District, Uganda.

Author(s) John Bua1, David Mukanga2, Elizabeth Nabiwemba3
Affiliation(s) 1Department of Health Policy Planning and Management, Makerere University School of Public Health, Kampala, Uganda, 2Bill & Melinda Gates Foundation, Bill & Melinda Gates Foundation, Kampala, Uganda, 3Department of Community Health and Behavioural Sciences, Makerere University School of Public Health, Kampala, Uganda.
Country - ies of focus Uganda
Relevant to the conference tracks Women and Children
Summary This was a facility based cross sectional study in Kidera sub-county, Buyende district, Uganda. It aimed at identifying potential risk factors and describing practices contributing to newborn sepsis in Buyende district in order to make recommendations that will influence behaviour change at community level. 174 newborns participated. 21.8% were laboratory confirmed to have sepsis. The main causative agent was staphylococcus aureus (31.6%). Risk factors included inappropriate cord care (77.6%) and not practicing routine hand washing (78.2%). Therefore health education messages should target importance of hand washing and cord care for newborns in the communities.
Background In Uganda, it’s estimated that newborn deaths contribute to over 38% of all infant deaths (92,000 in 2010). Despite different mitigation interventions over years, the newborn mortality rate is high at 27/1000 and newborn sepsis contributes to 31% of mortality in Uganda. Therefore, improved strategies that will contribute to the reduction of newborn sepsis need to be developed. However we need to understand the actual practices and risks present that contribute to new cases of sepsis. These need to be put in context, for without reliable evidence it’s difficult to know whether proposed interventions will work.
Objectives To identify potential risk factors and describe practices contributing to newborn sepsis in Buyende district so that recommendations can be made that will influence behaviour change at community level.
The specific study objectives were;
 To assess the prevalence of risk factors for newborn sepsis in Kidera County, Buyende district.
 To describe practices contributing to newborn sepsis within the health facilities.
 To describe practices of mothers or caregivers of newborn contributing to newborn sepsis.
Methodology The study was conducted at Kidera Health Centre, a level IV facility located in Kidera County, Buyende District Eastern Uganda. Kidera health centre is the highest and main referral unit for Buyende District. Kidera Health Centre serves the 5 counties in the district with an estimated population of 248,000 people.This was a health facility based cross sectional study in Kidera sub county, Buyende district. Mothers or care takers of sick newborns and health workers were interviewed. The dependent variable was a newborn having laboratory confirmed sepsis. Independent variables include; social demographics, mother’s ANC, delivery and PNC history, birth weight, gestation age and newborn care practices. Semi-structured questionnaires and Key informant guides were used to collect quantitative and qualitative data.
Results 174 mothers and 174 newborns participated in the study. The majority of the mothers (73%) were peasant farmers. Few of the mothers had attained an education level above primary school (33.9%). The age range for the mothers was from 16 to 44 years (mean: 26.3 years).21.8% of the admitted newborns with signs and symptoms for sepsis were laboratory confirmed. The identified causative agents included; staphylococcus aureus (31.6%), Neisseria meningitides (21.%), streptococcus pyogenes (10.5%) and Haemophilus influenza (5.3%). The causative agents were found to be resistant to some of the commonly used drugs that included; penicillin, chloramphenicol, cloxacillin and gentamycin.Prevalent risk factors included delivery outside the health facility (43.1%), inappropriate cord care (77.6%), care givers not practicing hand washing before handling the newborn (78.2%) and lack of knowledge about newborn care (39.7%).The interview of key informants revealed that the health facility didn’t have resources to offer routine screening for bacterial infections among pregnant women during ANC visits. The available resources were for vertical programs targeting only HIV and malaria. The health facility also had no equipment or a special room were sick newborns in critical condition could be managed appropriately. The other health system challenges identified included lack of antibiotic syrups for treating newborns and inadequate supply of laboratory reagents to investigate causes of ill health in newborns.

Since the study was facility based some sick newborn cases that weren’t brought to the health unit for care could have been missed. However, community health workers in areas served by the health facility were encouraged to refer all cases of sick newborns for care.

Conclusion Most common aetiological agent for newborn sepsis was Staphylococcus aureus followed by Neisseria meningitides. The practice of not routinely washing hands before touching the newborn and inappropriate cord care were leading factors contributing to spread of infection to newborns in the community. Therefore all pregnant women and women in postnatal positions need to be health educated about the importance of hygienic cord care and washing hands before touching the newborn. The health education can be given to mothers attending antenatal, delivery or postnatal at the facility by the health workers. Community health workers, where they exist, can be used to educate mothers in the community about proper newborn care and how to prevent spread of sepsis.

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