Mukunya David, Tumwine James K, Nankabirwa Victoria, Odongkara Beatrice, Tongun Justin B, Arach Agnes A, Tumuhamye Josephine, Napyo Agnes, Zalwango Vivian, Achora Vicentina, Musaba Milton W, Ndeezi Grace, Tylleskär Thorkild
Department of Research, Sanyu Africa Research Institute, Mbale, Uganda
Department of Global Public Health and Primary Care, Centrefor Intervention Science in Maternal and Child Health (CISMAC), Centre forInternational health, University of Bergen, Bergen, Norway.
BMJ Open. 2021 Feb 11;11(2):e041723. doi: 10.1136/bmjopen-2020-041723.
To determine the prevalence, predictors and case fatality risk of hypothermia among neonates in Lira district, Northern Uganda.
Three subcounties of Lira district in Northern Uganda.
This was a community-based cross-sectional study nested in a cluster randomised controlled trial.
Mother-baby pairs enrolled in a cluster randomised controlled trial. An axillary temperature was taken during a home visit using a lithium battery-operated digital thermometer.
The primary outcome measure was the prevalence of hypothermia. Hypothermia was defined as mild if the axillary temperature was 36.0°C to <36.5°C, moderate if the temperature was 32.0°C to <36.0°C and severe hypothermia if the temperature was <32.0°C. The secondary outcome measure was the case fatality risk of neonatal hypothermia. Predictors of moderate to severe hypothermia were determined using a generalised estimating equation model for the Poisson family.
We recruited 1330 neonates. The prevalence of hypothermia (<36.5°C) was 678/1330 (51.0%, 95% CI 46.9 to 55.1). Overall, 32% (429/1330), 95% CI 29.5 to 35.2 had mild hypothermia, whereas 18.7% (249/1330), 95% CI 15.8 to 22.0 had moderate hypothermia. None had severe hypothermia. At multivariable analysis, predictors of neonatal hypothermia included: home birth (adjusted prevalence ratio, aPR, 1.9, 95% CI 1.4 to 2.6); low birth weight (aPR 1.7, 95% CI 1.3 to 2.3) and delayed breastfeeding initiation (aPR 1.2, 95% CI 1.0 to 1.5). The case fatality risk ratio of hypothermic compared with normothermic neonates was 2.0 (95% CI 0.60 to 6.9).
The prevalence of neonatal hypothermia was very high, demonstrating that communities in tropical climates should not ignore neonatal hypothermia. Interventions designed to address neonatal hypothermia should consider ways of reaching neonates born at home and those with low birth weight. The promotion of early breastfeeding initiation and skin-to-skin care could reduce the risk of neonatal hypothermia.
ClinicalTrial.gov as NCT02605369.
确定乌干达北部利拉区新生儿体温过低的患病率、预测因素及病死率风险。
乌干达北部利拉区的三个乡。
这是一项基于社区的横断面研究，嵌套于一项整群随机对照试验中。
参与整群随机对照试验的母婴对。在家访期间使用锂电池供电的数字温度计测量腋温。
主要结局指标为体温过低的患病率。体温过低定义为：腋温36.0℃至<36.5℃为轻度，32.0℃至<36.0℃为中度，<32.0℃为重度体温过低。次要结局指标为新生儿体温过低的病死率风险。使用泊松族的广义估计方程模型确定中度至重度体温过低的预测因素。
我们招募了1330名新生儿。体温过低（<36.5℃）的患病率为678/1330（51.0%，95%CI 46.9至55.1）。总体而言，32%（429/1330），95%CI 29.5至35.2有轻度体温过低，而18.7%（249/1330），95%CI 15.8至22.0有中度体温过低。无人有重度体温过低。在多变量分析中，新生儿体温过低的预测因素包括：在家分娩（调整患病率比，aPR，1.9，95%CI 1.4至2.6）；低出生体重（aPR 1.7，95%CI 1.3至2.3）和母乳喂养开始延迟（aPR 1.2，95%CI 1.0至1.5）。体温过低的新生儿与体温正常的新生儿相比，病死率风险比为2.0（95%CI 0.60至6.9）。
新生儿体温过低的患病率非常高，表明热带气候地区的社区不应忽视新生儿体温过低问题。旨在解决新生儿体温过低的干预措施应考虑如何覆盖在家出生的新生儿和低出生体重儿。促进早期母乳喂养开始和皮肤接触护理可降低新生儿体温过低的风险。
ClinicalTrial.gov上的NCT02605369。
