Wondifraw Endalk Birrie, Wudu Muluken Amare, Tefera Birhanu Desu, Wondie Kindu Yinges
Department of Pediatric and Child Health Nursing, College of Medicine and Health Science, Wollo University, Dessie, Ethiopia.
Department of Emergency and Critical Care Nursing, College of Medicine and Health Science, Wollo University, Dessie, Ethiopia.
BMC Public Health. 2025 Mar 3;25(1):847. doi: 10.1186/s12889-025-22076-w.
Neonatal sepsis is a significant cause of newborn mortality in low- and middle-income countries (LMICs). Together, infections, complications of preterm birth, and intrapartum-related conditions contribute to nearly 90% of all neonatal deaths. Africa experiences high rates of neonatal deaths due to sepsis, with insufficient prevention efforts. Understanding the burden of neonatal sepsis is essential to reducing these deaths in the region. This study aims to estimate the pooled magnitude of neonatal sepsis and identify its associated risk factors in Africa.
For this study, we gathered data by searching various databases until August 20, 2024, including PubMed/MEDLINE, PubMed Central, Hinari, Google, Cochrane Library, African Journals Online, Web of Science, and Google Scholar. Full-text articles in English, both published and unpublished, from 2000 to 2024 were included. However, sources like citations without abstracts or full texts, unidentified reports, editorials, summaries of research, meta-analyses, and qualitative studies were not included in the study. We evaluated the quality of the selected papers using the Joanna Briggs Institute (JBI) critical appraisal checklist for observational studies. Data extraction was completed in Microsoft Excel, and analysis was conducted using STATA V.17 Statistical Software. We assessed study heterogeneity with the I statistic and the Cochrane Q test. Publication bias was evaluated both visually through a funnel plot and statistically through Egger's regression and Begg's tests. Subgroup analyses were performed to identify sources of heterogeneity, and a sensitivity analysis was conducted to find any outlier studies.
This review includes 49 studies with 87,548 neonates. The overall magnitude of neonatal sepsis in Africa was found to be 40.98% (95% confidence interval (CI): 30.50% to 51.46%) P: 0.00. The study found that factors such as prolonged rupture of membranes (Odds ratio (OR) 4.11, 95% CI: 2.81-5.41) P: 0.00, a history of the urinary tract or sexually transmitted infections (OR 3.28, 95% CI: 1.97-4.58) P: 0.00, low birth weight (< 2500 g) (OR 6.95, 95% CI: 3-10.89) P: 0.00, an Appearance, Pulse, Grimace, Activity, Respiration (APGAR) score below 7 at the first minute (OR 7.56, 95% CI: 3.39-11.73) P: 0.00, preterm birth (OR 5.38, 95% CI: 3.23-7.5) P: 0.00, and neonates who were resuscitated at birth (OR 3.26, 95% CI: 1.96-4.56) P: 0.00.
The magnitude of neonatal sepsis in Africa remains high. This study identified several contributing factors, including prolonged rupture of membranes, a history of urinary tract or sexually transmitted infections, low birth weight (< 2500 g), an APGAR score below 7 at one minute, preterm birth, and resuscitation at birth. These findings underscore the importance of routinely screening for risk factors such as prolonged membrane rupture and maternal infections. Enhancing antenatal care, training providers in early neonatal sepsis management, and enforcing infection control measures.
在低收入和中等收入国家（LMICs），新生儿败血症是新生儿死亡的一个重要原因。感染、早产并发症和分娩期相关疾病共同导致了近90%的新生儿死亡。非洲因败血症导致的新生儿死亡率很高，预防措施不足。了解新生儿败血症的负担对于减少该地区的这些死亡至关重要。本研究旨在估计非洲新生儿败血症的综合严重程度，并确定其相关危险因素。
在本研究中，我们通过检索各种数据库收集数据，直至2024年8月20日，包括PubMed/MEDLINE、PubMed Central、Hinari、谷歌、Cochrane图书馆、非洲在线期刊、科学网和谷歌学术。纳入了2000年至2024年发表和未发表的英文全文文章。然而，没有摘要或全文的引文、身份不明的报告、社论、研究摘要、荟萃分析和定性研究等来源未纳入本研究。我们使用乔安娜·布里格斯研究所（JBI）观察性研究的批判性评价清单评估所选论文的质量。数据提取在Microsoft Excel中完成，并使用STATA V.17统计软件进行分析。我们使用I统计量和Cochrane Q检验评估研究异质性。通过漏斗图直观地评估发表偏倚，并通过Egger回归和Begg检验进行统计学评估。进行亚组分析以确定异质性来源，并进行敏感性分析以找出任何异常研究。
本综述纳入了49项研究，涉及87548名新生儿。非洲新生儿败血症的总体严重程度为40.98%（95%置信区间（CI）：30.50%至51.46%）P：0.00。研究发现，胎膜早破（比值比（OR）4.11，95%CI：2.81 - 5.41）P：0.00、有泌尿系统或性传播感染史（OR 3.28，95%CI：1.97 - 4.58）P：0.00、低出生体重（<2500克）（OR 6.95，95%CI：3 - 10.89）P：0.00、出生后第一分钟阿氏评分（APGAR）低于7分（OR 7.56，95%CI：3.39 - 11.73）P：0.00、早产（OR 5.38，95%CI：3.23 - 7.5）P：0.00以及出生时进行复苏的新生儿（OR 3.26，95%CI：1.96 - 4.56）P：0.00等因素。
非洲新生儿败血症的严重程度仍然很高。本研究确定了几个促成因素，包括胎膜早破、泌尿系统或性传播感染史、低出生体重（<2500克）、出生一分钟时阿氏评分低于7分、早产和出生时复苏。这些发现强调了常规筛查危险因素（如胎膜早破延长和母体感染）的重要性。加强产前护理、培训早期新生儿败血症管理的医护人员以及实施感染控制措施。
