Perceived determinants of poor outcome of neonatal sepsis at pediatric unit of Kenyatta National Hospital.

Abstract

Introduction: Neonatal sepsis is the most common reason for neonatal admissions in developing countries. It is also a major cause of neonatal mortality in both developed and developing countries. Although neonatal sepsis infection rates have modestly decreased across the globe as a result of ongoing health care quality improvement measures, they remain a frequent and devastating problem among hospitalized neonates. Despite multiple attempts to address this unmet need, there had been minimal empirical efforts to evaluate the perceived determinants of poor outcome of neonatal sepsis. Objective: This study sought to establish the perceived determinants of poor outcome of neonatal sepsis in Kenyatta National Hospital’s Paediatric Unit. Methods: This was a hospital based descriptive cross-sectional study conducted in the Paediatric Unit of Kenyatta National Hospital. A total of 175 mothers of neonates with neonatal sepsis admitted in KNH selected using consecutive sampling method were recruited into the study. A validated researcher-administered semi-structured questionnaire was used to collect the data. Descriptive statistics involved calculation of measures of central tendencies like means, modes and medians between variables while the qualitative data was analyzed through content analysis. Association between the study variables was estimated using both chi-square and odds ratio statistics at 95% confidence interval. The study results were presented in tables, graphs and charts, as appropriate. Results: Maternal demographic factors associated with poor outcomes of neonatal sepsis included - younger or advanced maternal age (X2 = 4.735, df = 2, p = 0.031); low education level (X2 = 6.362, df = 1, p = 0.012) and short birth intervals of < 2 years (X2 = 5.108, df = 2, p = 0.023). Maternal socioeconomic factors associated with poor outcomes of neonatal sepsis included - low household income level (X2 = 6.163, df = 1, p = 0.014); large family sizes of ≥5 members (X2 = 4.844, df = 1, p = 0.028) and lack of a health insurance cover (X2 = 5.382, df = 1, p = 0.019). Newborn associated factors associated with poor outcomes of neonatal sepsis included - prematurity at birth (X2 = 5.786, df = 1, p = 0.016); low birth weight (X2 = 6.470, df = 1, p = 0.011) and low APGAR scores in the first and fifth minute (X2 = 7.358, df = 1, p = 0.006). Health care system factors associated with poor outcomes of neonatal sepsis included - mothers’ low ANC attendance (X2 = 7.270, df = 1, p = 0.007); delay in care-seeking (X2 = 5.135, df = 1, p = 0.022) and mothers’ lack of health information on child caregiving (X2 = 6.561, df = 1, p = 0.010). Conclusion: Various maternal demographic, maternal socioeconomic, newborn associated and health care system factors were significant determinants of poor outcome of neonatal sepsis in Kenyatta National Hospital’s Paediatric Unit. Recommendations: There is need for awareness creation among mothers on the value of antenatal and postnatal care services utilization and observing high standards of personal hygiene and good nutrition prior to, during and after birth.