Factors associated with culture proven neonatal sepsis in the Ho municipality 2016

Pan African Medical Journal, Volume 36, Year 2020

Interpretação

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.

AI Digest

Study Justification:

– Neonatal sepsis is a significant public health problem that can lead to death or disability if not treated promptly.
– Despite improvements in healthcare, sepsis remains a major cause of morbidity and mortality in neonates globally.
– This study aimed to assess the factors associated with culture-proven sepsis among neonates in the Ho Municipality, Ghana.

Study Highlights:

– The study was conducted between January and May 2016 in two public hospitals in the Ho Municipality.
– A total of 150 neonates suspected of sepsis and their mothers were recruited for the study.
– Blood samples were taken from the neonates and subjected to microbiological procedures to confirm sepsis.
– The study found that 17% of the neonates had laboratory-confirmed sepsis, with Staphylococcus epidermidis being the most common pathogen isolated.
– Neonates whose mothers were primigravida and those who attended antenatal clinics fewer than three times had higher odds of developing culture-proven sepsis.
– The study concluded that neonates who were the first babies of their mothers and those whose mothers attended fewer than three antenatal clinic schedules were more likely to develop sepsis.
– The study highlights the importance of a high index of suspicion for diagnosing neonatal sepsis in certain groups.

Recommendations for Lay Reader and Policy Maker:

– Increase awareness and education about neonatal sepsis among healthcare providers, mothers, and caregivers.
– Encourage pregnant women to attend antenatal clinics regularly and emphasize the importance of early detection and treatment of sepsis.
– Strengthen infection prevention and control measures in neonatal intensive care units.
– Improve access to quality healthcare services for neonates, especially in underserved areas.
– Enhance surveillance systems to monitor and track cases of neonatal sepsis.

Key Role Players:

– Healthcare providers (doctors, nurses, laboratory scientists) for diagnosis, treatment, and surveillance.
– Public health officials for policy development and implementation.
– Community health workers for education and awareness campaigns.
– Researchers for further studies and evidence-based interventions.

Cost Items for Planning Recommendations:

– Training programs for healthcare providers on neonatal sepsis management and infection control.
– Development and dissemination of educational materials for healthcare providers, mothers, and caregivers.
– Strengthening laboratory capacity for timely and accurate diagnosis of sepsis.
– Improving healthcare infrastructure and equipment in neonatal intensive care units.
– Monitoring and evaluation systems to assess the effectiveness of interventions.
– Research funding for further studies on neonatal sepsis prevention and management.

Força da prova

The strength of evidence for this abstract is 7 out of 10.
The evidence in the abstract is moderately strong. The study design is a cross-sectional study, which limits the ability to establish causality. However, the study conducted a thorough data collection process, including interviews, case note reviews, and laboratory investigations. The sample size was calculated and appropriate for the prevalence of neonatal sepsis. The statistical analysis was conducted using logistic regression, which is suitable for determining factors associated with the outcome. To improve the strength of the evidence, a prospective cohort or case-control study design could be considered to establish a temporal relationship between the factors and neonatal sepsis. Additionally, a larger sample size and multi-center study could enhance the generalizability of the findings.

Resumo

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.

Materiais

N/A

Inovações

Based on the information provided, it seems that you are looking for innovations to improve access to maternal health. Here are some potential recommendations:

1. Telemedicine: Implementing telemedicine services can improve access to maternal health by allowing pregnant women to consult with healthcare providers remotely. This can be especially beneficial for women in rural or remote areas who may have limited access to healthcare facilities.

2. Mobile health (mHealth) applications: Developing mobile applications that provide information and resources related to maternal health can empower women to take control of their own health. These apps can provide guidance on prenatal care, nutrition, and exercise, as well as reminders for appointments and medication.

3. Community health workers: Training and deploying community health workers who can provide basic maternal health services, education, and support in underserved areas can help improve access to care. These workers can conduct home visits, provide antenatal and postnatal care, and refer women to healthcare facilities when necessary.

4. Maternal health clinics on wheels: Mobile clinics equipped with necessary medical equipment and staffed by healthcare professionals can travel to remote areas, bringing essential maternal health services directly to women who may not have access to traditional healthcare facilities.

5. Public-private partnerships: Collaborating with private healthcare providers and organizations can help expand access to maternal health services. This can involve subsidizing costs, establishing referral networks, or providing training and resources to private providers.

6. Health education and awareness campaigns: Implementing targeted health education and awareness campaigns can help improve knowledge and understanding of maternal health issues. This can include educating women and their families about the importance of prenatal care, nutrition, and safe delivery practices.

7. Improved transportation infrastructure: Investing in transportation infrastructure, such as roads and ambulances, can help ensure that pregnant women can reach healthcare facilities in a timely manner, especially in remote areas.

It’s important to note that the specific context and needs of the Ho Municipality in Ghana should be taken into consideration when implementing any of these recommendations.

AI Innovations Description

Based on the information provided, the study conducted in the Ho Municipality of Ghana identified factors associated with culture proven neonatal sepsis. The study found that neonates whose mothers were primigravida (first-time mothers) and those who attended antenatal clinics (ANC) fewer than three times had higher odds of developing culture proven sepsis.

To improve access to maternal health and reduce the risk of neonatal sepsis, the following recommendations can be considered:

1. Strengthen antenatal care services: Emphasize the importance of regular attendance at antenatal clinics, particularly for first-time mothers. Provide education and support to ensure that pregnant women understand the benefits of ANC visits and are encouraged to attend the recommended number of visits.

2. Enhance early detection and diagnosis: Train healthcare providers, especially those working in neonatal intensive care units (NICUs), to have a high index of suspicion for neonatal sepsis. This will enable early detection and prompt initiation of appropriate treatment.

3. Improve infection prevention and control practices: Implement and enforce strict infection prevention and control measures in healthcare facilities, particularly in NICUs. This includes proper hand hygiene, sterilization of equipment, and adherence to standard precautions to prevent the spread of infections.

4. Strengthen laboratory capacity: Ensure that healthcare facilities have the necessary resources and trained personnel to perform timely and accurate laboratory investigations for the diagnosis of neonatal sepsis. This will enable prompt identification of pathogens and appropriate antibiotic treatment.

5. Enhance community awareness: Conduct community-based education programs to raise awareness about the signs and symptoms of neonatal sepsis. This will empower parents and caregivers to seek early medical attention for their newborns if they suspect an infection.

By implementing these recommendations, access to maternal health can be improved, leading to a reduction in the incidence of neonatal sepsis and improved health outcomes for both mothers and newborns.

AI Innovations Methodology

Based on the information provided, here are some potential recommendations to improve access to maternal health:

1. Strengthen Antenatal Care (ANC) Services: Increase the number of ANC visits and ensure that pregnant women attend at least three ANC schedules. This can be achieved by improving awareness and education about the importance of ANC, providing incentives for attending ANC visits, and ensuring that ANC services are easily accessible and available in all areas.

2. Enhance Maternal Education: Implement programs that focus on educating mothers about the importance of proper hygiene practices, nutrition, and early recognition of signs of neonatal sepsis. This can be done through community-based health education programs, mobile health clinics, and partnerships with local community organizations.

3. Improve Neonatal Intensive Care Units (NICUs): Enhance the capacity and quality of NICUs in public hospitals by providing adequate resources, equipment, and trained healthcare professionals. This includes ensuring that NICUs have the necessary infrastructure, such as incubators, ventilators, and monitoring devices, to provide optimal care for neonates with sepsis.

4. Strengthen Referral Systems: Develop and implement effective referral systems to ensure timely and appropriate care for neonates with sepsis. This includes establishing clear protocols for transferring neonates from primary healthcare facilities to higher-level facilities with specialized NICUs.

To simulate the impact of these recommendations on improving access to maternal health, a methodology could be developed as follows:

1. Define the indicators: Identify specific indicators that can measure the impact of the recommendations, such as the number of ANC visits, the percentage of neonates with sepsis, and the availability of NICU services.

2. Collect baseline data: Gather data on the current status of maternal health access, including the number of ANC visits, the prevalence of neonatal sepsis, and the availability and quality of NICU services.

3. Develop a simulation model: Create a simulation model that incorporates the identified indicators and their interrelationships. This model should consider factors such as population demographics, healthcare infrastructure, and resource allocation.

4. Input data and run simulations: Input the baseline data into the simulation model and run multiple simulations to assess the potential impact of the recommendations. This can involve adjusting variables such as the number of ANC visits, the availability of NICU services, and the level of maternal education.

5. Analyze results: Analyze the results of the simulations to determine the potential impact of the recommendations on improving access to maternal health. This can include assessing changes in the number of ANC visits, the reduction in neonatal sepsis cases, and the improvement in NICU services.

6. Refine and validate the model: Refine the simulation model based on the analysis of the results and validate it using additional data and real-world observations. This will ensure that the model accurately reflects the potential impact of the recommendations.

7. Communicate findings: Present the findings of the simulation study to relevant stakeholders, such as policymakers, healthcare providers, and community organizations. This can help inform decision-making and guide the implementation of interventions to improve access to maternal health.

It is important to note that the methodology described above is a general framework and may need to be adapted based on the specific context and available data.

Autor

Dima Health

Statistics:

Citations: 2

Identifiers:

DOI: 10.11604/pamj.2020.36.281.20408

Research Areas:

Disability, Health System and Policy, Maternal and Child Health, Sexual and Reproductive Health, Social Determinants, Substance Abuse

Study Countries:

Ghana

Study Design:

Cross Sectional Study, Grounded Theory

Study Approach:

Quantitative

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