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Bayih WA, Ayalew MY, Chanie ES, Abate BB, Alemayehu SA, Belay DM, Aynalem YA, Sewyew DA, Kebede SD, Demis A, Yitbarek GY, Tassew MA, Birhan BM, Alemu AY. The burden of neonatal sepsis and its association with antenatal urinary tract infection and intra-partum fever among admitted neonates in Ethiopia: A systematic review and meta-analysis. Heliyon 2021; 7:e06121. [PMID: 33644445 PMCID: PMC7887389 DOI: 10.1016/j.heliyon.2021.e06121] [Citation(s) in RCA: 6] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/16/2020] [Revised: 12/24/2020] [Accepted: 01/25/2021] [Indexed: 11/24/2022] Open
Abstract
BACKGROUND More than one-third of the neonatal death in Ethiopia has been attributed to neonatal sepsis. However, there is no recent national evidence about the burden of neonatal sepsis and its association with antenatal urinary tract infection and intra-partum fever, which are commonly reported maternal morbidities in Ethiopia. Therefore, the aim of this systematic review and meta-analysis was to assess the pooled burden of neonatal sepsis and its association with antenatal urinary tract infection as well as intra-partum fever in the country. METHODS Primary studies were accessed through Google scholar, HINARI, SCOPUS and PubMed databases. The methodological and evidence quality of the included studies were critically appraised by the modified Newcastle-Ottawa quality assessment tool scale adapted for observational studies. From eligible studies, two authors extracted author/year, study region, study design, sample size, reported prevalence of neonatal sepsis, antenatal urinary tract infection and intrapartum fever on an excel spreadsheet. During critical appraisal and data extraction, disagreements between the two authors were resolved by the involvement of a third author. The extracted data were then exported to stata version 14. Effect sizes were pooled using the random inverse varience-effects model due to significant heterogeneity between studies (I2= 99.2%). Subgroup analysis was performed for evidence of heterogeneity. Sensitivity analyses were performed. Absence of publication bias was declared from symmetry of funnel plot and Egger's test (p = 0.244). RESULTS In this systematic review and meta-analysis, a total of 36,016 admitted neonates were included from 27 studies. Of these 27 studies, 23 employed cross-sectional design whereas 3 studies had case control type and only one study had cohort design. The prevalence of neonatal sepsis among admitted Ethiopian neonates at different regions of the country ranged from 11.7%-77.9%. However, the pooled prevalence of neonatal sepsis was 40.25% [95% CI: 34.00%, 46.50%; I2 = 99.2%]. From regional subgroup analysis, the highest prevalence was observed in the Oromiya region. Neonates born to mothers who had antenatal urinary tract infection were at 3.55 times (95% CI: 2.04, 5.06) higher risk of developing neonatal sepsis as compared to those neonates born to mothers who didn't have antenatal urinary tract infection. Moreover, neonates born to mothers having intra-partum fever were 3.63 times (95% CI: 1.64, 5.62) more likely to develop neonatal sepsis as compared to those born to mothers who were nonfebrile during intrapartum. CONCLUSION Neonatal sepsis has remained a problem of public health importance in Ethiopia. Both antenatal urinary tract infection and intra-partum fever were positively associated with neonatal sepsis. Therefore, preventing maternal urinary tract infection during pregnancy and optimizing the intra-partum care are recommended to mitigate the burden of neonatal sepsis in Ethiopia.
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Affiliation(s)
- Wubet Alebachew Bayih
- Department of Pediatrics and Neonatal Health Nursing, College of Health Sciences, Debre Tabor University, PO.BOX: 272, Debre Tabor, 6300, Ethiopia
| | | | - Ermias Sisay Chanie
- Department of Pediatrics and Neonatal Health Nursing, College of Health Sciences, Debre Tabor University, PO.BOX: 272, Debre Tabor, 6300, Ethiopia
| | | | - Sintayehu Asnakew Alemayehu
- Department of Pediatrics and Neonatal Health Nursing, College of Health Sciences, Debre Tabor University, PO.BOX: 272, Debre Tabor, 6300, Ethiopia
| | - Demeke Mesfin Belay
- Department of Pediatrics and Neonatal Health Nursing, College of Health Sciences, Debre Tabor University, PO.BOX: 272, Debre Tabor, 6300, Ethiopia
| | | | - Dagne Addisu Sewyew
- Department of Pediatrics and Neonatal Health Nursing, College of Health Sciences, Debre Tabor University, PO.BOX: 272, Debre Tabor, 6300, Ethiopia
| | - Solomon Demis Kebede
- Department of Pediatrics and Neonatal Health Nursing, College of Health Sciences, Debre Tabor University, PO.BOX: 272, Debre Tabor, 6300, Ethiopia
| | | | - Getachew Yideg Yitbarek
- Department of Pediatrics and Neonatal Health Nursing, College of Health Sciences, Debre Tabor University, PO.BOX: 272, Debre Tabor, 6300, Ethiopia
| | - Misganaw Abie Tassew
- Department of Pediatrics and Neonatal Health Nursing, College of Health Sciences, Debre Tabor University, PO.BOX: 272, Debre Tabor, 6300, Ethiopia
| | - Binyam Minuye Birhan
- Department of Pediatrics and Neonatal Health Nursing, College of Health Sciences, Debre Tabor University, PO.BOX: 272, Debre Tabor, 6300, Ethiopia
| | - Abebaw Yeshambel Alemu
- Department of Pediatrics and Neonatal Health Nursing, College of Health Sciences, Debre Tabor University, PO.BOX: 272, Debre Tabor, 6300, Ethiopia
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