Department of Paediatrics and Child Health, Makerere University College of Health Sciences, P.O. Box 7062, Kampala, Uganda.
Mulago National Referral Hospital, P.O. Box 7051, Kampala, Uganda.
BMC Pediatr. 2018 Nov 13;18(1):355. doi: 10.1186/s12887-018-1323-4.
Neonatal sepsis is one of the most important causes of mortality in developing countries and yet the most preventable. In developing countries clinical algorithms are used to diagnose clinical neonatal sepsis because of inadequate microbiological services. Most information on incidence and risk factors of neonatal sepsis are from hospital studies which may not be generalized to communities where a significant proportion of mothers do not deliver from health facilities. This study, conducted in urban Uganda, sought to determine the community based incidence of clinical neonatal sepsis and the factors associated.
This was a cohort of mother-neonate pairs in Kampala, Uganda from March to May 2012. The enrolled neonates were assessed for clinical sepsis and factors associated, and followed up till the end of the neonatal period. STATA version 10 was used to analyse the data.
The community based incidence of neonatal sepsis was 11% (95% CI: 7.6-14.4). On bivariate analysis, lack of financial support from the father (OR 4.09, 95% CI 1.60-10.39) and prolonged rupture of membranes more than 18 h prior to delivery (OR 11.7, 95% CI 4.0-31.83) were significantly associated with neonatal sepsis. Maternal hand washing prior to handling the baby was found to be protective of neonatal sepsis (OR 0.41, 95% CI 0.18-0.94). Of the 317 infants who completed the follow up period, one died within the neonatal period giving a neonatal mortality of 0.003%.
The high incidence of clinical neonatal sepsis in this urban community with high rates of antenatal care attendance and health facility delivery places a demand on the need to improve the quality of antenatal, perinatal and postnatal care in health facilities with regards to infection prevention including promoting simple practices like hand washing. The astoundingly low mortality rate is most likely because this was a low risk cohort. However it may also suggest that the neonatal mortality in developing countries may be reduced with promotion of simple low cost interventions like community follow up of neonates using village health teams or domiciliary care.
新生儿败血症是发展中国家最重要的死亡原因之一，也是最可预防的原因之一。在发展中国家，由于微生物服务不足，临床算法被用于诊断临床新生儿败血症。大多数关于新生儿败血症发病率和危险因素的信息都来自医院研究，这些信息可能无法推广到社区，因为那里有很大一部分母亲不在医疗机构分娩。本研究在乌干达的城市进行，旨在确定社区中临床新生儿败血症的发病率及其相关因素。
这是 2012 年 3 月至 5 月在乌干达坎帕拉的母亲-新生儿队列研究。纳入的新生儿评估临床败血症及其相关因素，并随访至新生儿期结束。使用 STATA 版本 10 分析数据。
社区新生儿败血症的发病率为 11%（95%CI：7.6-14.4）。在单变量分析中，父亲缺乏经济支持（OR 4.09，95%CI 1.60-10.39）和分娩前胎膜破裂时间延长超过 18 小时（OR 11.7，95%CI 4.0-31.83）与新生儿败血症显著相关。母亲在接触婴儿前洗手被发现可预防新生儿败血症（OR 0.41，95%CI 0.18-0.94）。在完成随访期的 317 名婴儿中，有 1 名在新生儿期死亡，新生儿死亡率为 0.003%。
在这个城市社区中，尽管有很高的产前护理就诊率和医疗机构分娩率，但仍存在很高的临床新生儿败血症发病率，这就需要提高医疗机构中产前、围产期和产后护理的质量，预防感染，包括推广简单的实践，如洗手。令人惊讶的低死亡率很可能是因为这是一个低风险队列。然而，这也可能表明，通过推广简单、低成本的干预措施，如利用乡村卫生队或家庭护理对新生儿进行社区随访，发展中国家的新生儿死亡率可能会降低。
