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Introduction: Neonatal Sepsis (NNS) is a public health problem which causes death or disability unless appropriate antibiotic treatment is given promptly. Globally, sepsis is an important cause of morbidity and mortality in neonates despite recent progress in health care delivery. We assessed the factors associated with culture proven sepsis among neonates in the Ho Municipality, Ghana. Methods: a cross-sectional study was conducted in two public hospitals in the Ho Municipality between January and May, 2016. All neonates who were clinically suspected with sepsis in the Neonatal Intensive Care Unit (NICU) and their mothers were recruited. A 2ml blood sample was taken aseptically and dispensed into a mixture of thioglycollate and tryptone soy broth in a 1: 10 dilution and microbiological procedures performed. Case notes of both neonates and their mothers were reviewed and interviews conducted to collect both clinical and socio-demographic data. We determined the factors associated with culture proven neonatal sepsis using logistic regression model and statistical significance was determined at 95% confidence intervals. Results: out of 150 neonates, 26 (17%) had laboratory confirmed sepsis. The most common pathogen isolated was Staphylococcus epidermidis 14, (54%). Neonates whose mothers were primigravida (OR=2.74; 95% CI: 1.12-6.68), and those who attended antenatal clinics (ANC) fewer than three schedules (OR=2.90; 95% CI: 1.06-7.96) had higher odds of developing culture proven sepsis. Conclusion: neonates who were the first babies of their mothers were more likely to develop laboratory confirmed sepsis. Also, neonates of mothers who attended ANC less than 3 times were more likely to develop laboratory confirmed sepsis. High index of suspicion is required to diagnose neonatal sepsis among neonates of primigravida mothers and mothers who attend fewer than three ANC schedules.
Study design and setting: the study was a cross-sectional study conducted at two public hospitals in the Ho Municipality of the Volta Region of Ghana between January and May, 2016. The study population was neonates admitted at the Neonatal Intensive Care Units (NICU) of the Volta Regional and Ho Municipal Hospitals. Both hospitals are the two main public health care facilities in the municipality; with the regional hospital serving as a main referral centre. There are health care staff including clinicians and nurses that manage the NICUs. Inclusion and exclusion criteria: all neonates that were admitted at the NICUs of both hospitals, who were clinically diagnosed of sepsis by a clinician during the study period, and whose mothers or caretakers consented to be part of the study were included in the study. However, neonates who met the inclusion criteria but died immediately before blood culture sample could be obtained, or those who were referred to a tertiary facility immediately upon assessment were excluded. Sample size and sampling method: a prevalence of 11% of neonates with sepsis, with a 5% margin of error to obtain a normal deviate at 95% confidence level was used to calculate the minimum sample size of 150. All neonates that met the inclusion criteria and whose mothers or caretakers consented to be part of the study within the period were serially recruited until the sample size was obtained. Data collection: a structured questionnaire was used to collect socio-demographic, clinical, and laboratory data on the neonates. Mothers of neonates who were recruited were interviewed to obtain their socio-demographic data. Case notes of both neonates and their mothers were reviewed to collect clinical data. Sample collection and laboratory investigation: the antecubital fossa of neonates was cleaned twice with 70% alcohol and veins located. Trained laboratory scientists obtained 2ml blood samples aseptically from neonates into culture bottles containing a mixture of thioglycollate and tryptone soy broth in a 1: 10 dilution, labelled and transported into the laboratory for microbiological procedures to be performed on them. Samples were incubated overnight at 37°C then, sub-cultured unto commercially prepared blood, chocolate and MacConkey agar. The sub-cultured agars were incubated overnight at 37°C under both aerobic and anaerobic conditions and observed for growth. Agars with significant growth were identified for specific pathogens. Samples with no growth were incubated and observed for 7 consecutive days before determined as negative for culture. Data were then collected on the causative organisms that were isolated. Data management and analysis: all variables collected were given unique identifiers and entered into Microsoft excel software. Data analysis was done using STATA software version 13.0. Continuous variables were presented as means and standard deviation whiles categorical variables were presented in tables as frequencies and proportions. Binary logistic regression was used to determine the association between culture proven sepsis and maternal sociodemographic; neonatal and pregnancy related factors. Variables that had a p-value <0.05 were entered into a multiple into a logistic regression model in a forward stepwise direction. The level of significance was set at 95% confidence interval. Ethical issues: approval for this study was obtained from the Ethical Review Committee of the Research and Development division of the Ghana Health Service (GHS-ERC09/10/15). Permission was obtained from the Volta Regional Health Directorate, the management teams of both hospitals, as well as the management teams of the Neonatal Intensive Care Units (NICU) of the participating hospitals. Informed consent was sought from mothers or caretakers of neonates before recruiting them into the study. Each study participant was given a unique identifier to ensure confidentiality. All data collected were also kept under lock and key, such that no unauthorized person had access to them except the principal investigator.
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