In search of a primary outcome for community-based newborn infection trials in Eastern Uganda: a nested cohort study within the BabyGel pilot trial

A cluster randomised trial to evaluate the effectiveness of household alcohol-based hand rub for the prevention of sepsis, diarrhoea, and pneumonia in Ugandan infants (the BabyGel trial): a study protocol

BACKGROUND

Infections are one of the leading causes of death in the neonatal period. This trial aims to evaluate if the provision of alcohol-based hand rub (ABHR) to pregnant women for postnatal household use prevents severe infections (including sepsis, diarrhoea, pneumonia, or death) among infants during the first three postnatal months.

METHODS

Through a cluster-randomised trial in eastern Uganda, 72 clusters are randomised in a 2-arm design with rural villages as units of randomisation. We estimate to include a total of 5932 pregnant women at 34 weeks of gestation. All women and infants in the study are receiving standard antenatal and postnatal care. Women in the intervention group additionally receive six litres of ABHR and training on its use. Research midwives conduct follow-up visits at participants' homes on days 1, 7, 28, 42, and 90 after birth and telephone calls on days 14, 48, and 60 to assess the mother and infant for study outcomes. Primary analyses will be by intention to treat.

DISCUSSION

This study will provide evidence on the effectiveness of a locally available and low-cost intervention in preventing neonatal sepsis and early infant infections. If ABHR is found effective, it could be implemented by adding it to birthing kits.

TRIAL REGISTRATION

Pan African Clinical Trial Registry, PACTR202004705649428. Registered 1 April 2020, https://pactr.samrc.ac.za/ .

Neonatal sepsis and its associated factors in East Africa: a systematic review and meta-analysis

OBJECTIVES

This systematic review and meta-analysis aimed to reveal the magnitude of neonatal sepsis and its associated factors in East Africa.

METHODS

Using PRISMA guideline, we reviewed and meta-analyzed studies from Google Scholar, Cochrane library, and PubMed; last search date: October 15, 2019. Heterogeneity across the studies was estimated. The subgroup analysis was done. Publication bias was also assessed.

RESULTS

A total of 26 studies with 11,239 participants are included. The pooled prevalence of neonatal sepsis in East Africa was 29.765% (95% CI 23.36-35.94). Home delivery (AOR = 2.67; 95% CI 1.15-4.00), maternal history of urinary tract infection (UTI) (AOR = 2.083; 95% CI 0.24-3.93), gestational age/(preterm) (AOR = 1.56; 95% CI 1.04-2.08), prolonged labor (AOR = 3.23; 95% CI 0.04-6.51) and PROM (AOR = 1.95; 95% CI 0.53-3.37) were identified associated factors of neonatal sepsis.

CONCLUSIONS

The prevalence of neonatal sepsis in East Africa remains high. The relevant stockholders should give attention for neonates delivered from women with intranatal fever to prevent neonatal sepsis. Pregnant women should be screened for UTI. Appropriate interventions should be put in place to manage PROM to decrease the chance of ascending microorganisms.