Epidemiology of neonatal infections in hospitals of Nepal: evidence from a large- scale study

Shyam Sundar Budhathoki,Pragya Gautam Paudel,Jeevan Thapa,Sandeepa Karki,Avinash K Sunny,Rejina Gurung,Ashish Kc,Prajwal Paudel,Lila Bahadur Basnet

doi:10.1186/s13690-020-00424-z

Abstract

BackgroundEvery year, neonatal infections account for approximately 750,000 neonatal deaths globally. It is the third major cause of neonatal death, globally and in Nepal. There is a paucity of data on clinical aetiology and outcomes of neonatal infection in Nepal. This paper aims to assess the incidence and risk factors of neonatal infection in babies born in public hospitals of Nepal.MethodsThis is a prospective cohort study conducted for a period of 14 months, nested within a large-scale cluster randomized control trial which evaluated the Helping Babies Breathe Quality Improvement package in 12 public hospitals in Nepal. All the mothers who consented to participate within the study and delivered in these hospitals were included in the analysis. All neonates admitted into the sick newborn care unit weighing > 1500 g or/and 32 weeks or more gestation with clinical signs of infection or positive septic screening were taken as cases and those that did not have an infection were the comparison group. Bivariate and multi-variate analysis of socio-demographic, maternal, obstetric and neonatal characteristics of case and comparison group were conducted to assess risk factors associated with neonatal infection.ResultsThe overall incidence of neonatal infection was 7.3 per 1000 live births. Babies who were born to first time mothers were at 64% higher risk of having infection (aOR-1.64, 95% CI, 1.30–2.06, p-value< 0.001). Babies born to mothers who had no antenatal check-up had more than three-fold risk of infection (aOR-3.45, 95% CI, 1.82–6.56, p-value< 0.001). Babies born through caesarean section had more than two-fold risk (aOR-2.06, 95% CI, 1.48–2.87, p-value< 0.001) and babies with birth asphyxia had more than three-fold risk for infection (aOR-3.51, 95% CI, 1.71–7.20, p-value = 0.001).ConclusionAntepartum factors, such as antenatal care attendance, and intrapartum factors such as mode of delivery and birth asphyxia, were risk factors for neonatal infections. These findings highlight the importance of ANC visits and the need for proper care during resuscitation in babies with birth asphyxia.

Highlights

Every year, neonatal infections account for approximately 750,000 neonatal deaths globally
Incidence of Neonatal infection was high among babies of advantageous ethnic group (0.9, 95% confidence interval (CI), 0.8–1.0) in comparison with babies of disadvantageous ethnic group (0.6, 95% CI, 0.6–0.7)
The incidence was higher among babies of mothers who did not receive any antenatal check-ups by skilled providers (2.1, 95% CI, 1.2–3.7) than babies of mothers who received antenatal check-up (0.7, 95% CI, 0.6–0.7) (Table 1)

Summary

Introduction

Neonatal infections account for approximately 750,000 neonatal deaths globally. It is the third major cause of neonatal death, globally and in Nepal. In 2018 the global neonatal death rate was 18 per 1000 live births, accounting for 2.5 million neonatal deaths [1]. This represents approximately 7000 neonatal deaths every day [1]. More than two-fifth of deaths occur during the neonatal period and one third of these neonatal deaths are due to infection [2]. There is limited population-based evidence available from low-income countries and a lack of standardised diagnostic criteria and definitions which together serve as obstacles to accurate estimation of the global burden of neonatal infections [3]

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