1
|
Opare‐Asamoah K, Acquah SE, Vicar EK, Quaye L, Alhassan A, Majeed SF, Yakong VN, Yankson S. Predictors of the onset of neonatal sepsis at the Neonatal Intensive Care Unit of a tertiary hospital in Ghana: A cross-sectional study. Health Sci Rep 2023; 6:e1673. [PMID: 37927539 PMCID: PMC10620847 DOI: 10.1002/hsr2.1673] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/16/2023] [Revised: 10/10/2023] [Accepted: 10/17/2023] [Indexed: 11/07/2023] Open
Abstract
Background and Aim Neonatal sepsis is a systemic inflammatory response to infection during the first 4 weeks of an infant's life. It is a significant cause of neonatal morbidity and mortality in low- and middle-income countries. This study aimed to determine the predictors of the onset of sepsis at the Neonatal Intensive Care Unit of the Tamale Teaching Hospital, Ghana. Methods A cross-sectional study was conducted among 275 mothers and their singleton neonates diagnosed clinically with sepsis. A univariate and multivariate logistic regression analysis adjusted for maternal occupational status was performed to determine the maternal and neonatal predictors of early-onset (EOS) and late-onset sepsis (LOS), respectively. Results Single motherhood (AOR = 1.882, 95% CI = 0.926-3.822, p = .08) and home delivery (AOR = 3.667, 95% CI = 0.584-23.026, p = .17) were predictors of EOS, with single motherhood being the predictor for LOS (AOR = 2.906, 95% CI = 0.715-11.805, p = .14) in a univariate analysis. When maternal occupation was adjusted for in a multivariate analysis, single mother (AOR = 2.167, 95% CI = 1.010-4.648, p = .04) was the main predictor of EOS, with low neonatal birth weight being the main predictor of LOS (AOR = 0.193, 95% CI = 0.038-0.971, p = .04). Conclusion Maternal marital status is a significant predictor of both EOS and LOS, with predictors of EOS being lower gestational age and low birth weight, while for LOS, low birth weight is the main predictor. Findings from this study can serve as a commencement point for developing predictive models for the onset of sepsis in neonates in the study facility.
Collapse
Affiliation(s)
- Kwame Opare‐Asamoah
- Department of Biological Sciences, Faculty of BiosciencesUniversity for Development StudiesTamaleGhana
| | - Samuel E. Acquah
- Department of Clinical Microbiology, School of Allied Health SciencesUniversity for Development StudiesTamaleGhana
| | - Ezekial Kofi Vicar
- Department of Clinical Microbiology, School of MedicineUniversity for Development StudiesTamaleGhana
| | - Lawrence Quaye
- Department of Biomedical Laboratory Sciences, School of Allied Health SciencesUniversity for Development StudiesTamaleGhana
| | - Abdul‐Mumin Alhassan
- Department of Pediatrics and Child Health, School of MedicineUniversity for Development StudiesTamaleGhana
| | - Saeed F. Majeed
- Department of Biological Sciences, Faculty of BiosciencesUniversity for Development StudiesTamaleGhana
| | - Vida Nyagre Yakong
- Department of Preventive Health Nursing, School of Nursing and MidwiferyUniversity for Development StudiesTamaleGhana
| | - Samuel Yankson
- Department of Physiology and Biophysics, School of MedicineUniversity for Development StudiesTamaleGhana
| |
Collapse
|
2
|
McAbee L, Mundagowa PT, Agbinko-Djobalar B, Gyebi Owusu P, Sackey A, Sagoe-Moses I, Sacks E, Sakyi KS, Dail RB, Kanyangarara M. Evaluation of a device to detect neonatal hypothermia in a clinical setting in Ghana. PLOS GLOBAL PUBLIC HEALTH 2023; 3:e0001681. [PMID: 37874789 PMCID: PMC10597509 DOI: 10.1371/journal.pgph.0001681] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Grants] [Track Full Text] [Subscribe] [Scholar Register] [Received: 01/25/2023] [Accepted: 10/04/2023] [Indexed: 10/26/2023]
Abstract
Neonatal hypothermia poses an increased risk of infection, hypoglycemia, metabolic dysfunction, and mortality, particularly in preterm or low birthweight (LBW) infants. However, early detection of hypothermia and prompt thermoregulation can mitigate these effects thus, the need for continuous neonatal temperature monitoring. The BEMPU TempWatch is a small bracelet designed for continuous temperature monitoring for neonates. When the body temperature falls below 36.5˚C, the bracelet generates an alarm sound and flashes an orange light, indicating hypothermia. This study aimed to assess the validity of the BEMPU TempWatch in detecting hypothermia in a clinical setting in Ghana using sensitivity and specificity. Additionally, the study sought to identify factors associated with misclassification using logistic regression analysis. A standardized questionnaire collected information about the mother, pregnancy, delivery, and neonate. The BEMPU TempWatch was placed on the wrist of the neonate, and over a 24-hour follow-up period, a nurse took 4-hourly axillary temperature readings using a digital thermometer. Whenever the device's alarm sounded, a nurse immediately checked and recorded the axillary temperature, undertook necessary clinical actions, and rechecked after 30 minutes. Among the 249 neonates included in the study, 57.0% were female, 12.5% were extremely LBW, and 13.7% were extremely preterm. Based on 1,973 temperature readings, the sensitivity of the BEMPU TempWatch in detecting hypothermia was 67.8%, and the specificity was 95.9%. The sensitivity was lower among neonates being treated in incubators (58.4%) compared to those not (82.7%). Sensitivity was higher among neonates with LBW (1,500-2,500g) (73.5%) than very or extremely LBW neonates (<1,500g) (62.8%). The results showed that the BEMPU TempWatch had significantly fewer misclassifications among neonates who were not treated in an incubator, received only breastmilk, and were not born extremely preterm. Further studies are warranted to evaluate the effectiveness of the BEMPU TempWatch on neonatal health outcomes.
Collapse
Affiliation(s)
- Lauren McAbee
- Department of Epidemiology and Biostatistics, University of South Carolina, Arnold School of Public Health, Columbia, South Carolina, United States of America
| | - Paddington T. Mundagowa
- Department of Epidemiology and Biostatistics, University of South Carolina, Arnold School of Public Health, Columbia, South Carolina, United States of America
| | - Babbel Agbinko-Djobalar
- Korle-Bu Teaching Hospital, Accra, Ghana
- Center for Learning and Childhood Development-Ghana, Accra, Ghana
| | - Prince Gyebi Owusu
- Center for Learning and Childhood Development-Ghana, Accra, Ghana
- Michigan State University, East Lansing, Michigan, United States of America
| | | | | | - Emma Sacks
- Department of International Health, Johns Hopkins School of Public Health, Baltimore, Maryland, United States of America
| | - Kwame Sarfo Sakyi
- Center for Learning and Childhood Development-Ghana, Accra, Ghana
- Public and Environmental Wellness, School of Health Sciences, Oakland University, Rochester, Michigan, United States of America
| | - Robin B. Dail
- University of South Carolina, College of Nursing, Columbia, South Carolina, United States of America
| | - Mufaro Kanyangarara
- Department of Epidemiology and Biostatistics, University of South Carolina, Arnold School of Public Health, Columbia, South Carolina, United States of America
| |
Collapse
|
3
|
Omenako KA, Enimil A, Marfo AFA, Timire C, Chinnakali P, Fenny AP, Jeyashree K, Buabeng KO. Pattern of Antimicrobial Susceptibility and Antimicrobial Treatment of Neonates Admitted with Suspected Sepsis in a Teaching Hospital in Ghana, 2021. INTERNATIONAL JOURNAL OF ENVIRONMENTAL RESEARCH AND PUBLIC HEALTH 2022; 19:12968. [PMID: 36232262 PMCID: PMC9566692 DOI: 10.3390/ijerph191912968] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 08/15/2022] [Revised: 09/16/2022] [Accepted: 10/05/2022] [Indexed: 06/16/2023]
Abstract
Neonatal sepsis is a life-threatening emergency, and empirical antimicrobial prescription is common. In this cross-sectional study of neonates admitted with suspected sepsis in a teaching hospital in Ghana from January-December 2021, we described antimicrobial prescription patterns, compliance with national standard treatment guidelines (STG), blood culture testing, antimicrobial resistance patterns and treatment outcomes. Of the 549 neonates admitted with suspected sepsis, 283 (52%) were males. Overall, 529 (96%) received empirical antimicrobials. Most neonates (n = 407, 76.9%) were treated empirically with cefuroxime + gentamicin, while cefotaxime was started as a modified treatment in the majority of neonates (46/68, 67.6%). Only one prescription complied with national STGs. Samples of 257 (47%) neonates underwent blood culture testing, of which 70 (27%) were positive. Isolates were predominantly Gram-positive bacteria, with coagulase-negative Staphylococcus and Staphylococcus aureus accounting for 79% of the isolates. Isolates showed high resistance to most penicillins, while resistance to aminoglycosides and quinolones was relatively low. The majority of neonates (n = 497, 90.5%) were discharged after successfully completing treatment, while 50 (9%) neonates died during treatment. Strengthening of antimicrobial stewardship programmes, periodic review of STGs and increased uptake of culture and sensitivity testing are needed to improve management of sepsis.
Collapse
Affiliation(s)
- Kwaku Anim Omenako
- Eastern Regional Hospital, Ghana Health Service, Koforidua P.O. Box KF 201, Ghana
- Department of Pharmacy Practice, Kwame Nkrumah University of Science and Technology (KNUST), Kumasi 00233, Ghana
| | - Anthony Enimil
- Komfo Anokye Teaching Hospital (KATH), Kumasi P.O. Box KS 1934, Ghana
- School of Medicine and Dentistry (SMD), Kwame Nkrumah University of Science and Technology (KNUST), Kumasi 00233, Ghana
| | - Afia Frimpomaa Asare Marfo
- Department of Pharmacy Practice, Kwame Nkrumah University of Science and Technology (KNUST), Kumasi 00233, Ghana
| | - Collins Timire
- Centre for Operational Research, International Union Against Tuberculosis and Lung Disease, 68 Boulevard Saint Michel, 75006 Paris, France
| | - Palanivel Chinnakali
- Department of Preventive and Social Medicine, Jawaharlal Institute of Postgraduate Medical Education & Research (JIPMER), Puducherry 605006, India
| | - Ama Pokuaa Fenny
- Institute of Statistical, Social and Economic Research (ISSER), University of Ghana, Legon, Accra P.O. Box LG 25, Ghana
| | - Kathiresan Jeyashree
- Department of Epidemiology and Biostatistics, National Institute of Epidemiology, Chennai 600077, India
| | - Kwame Ohene Buabeng
- Department of Pharmacy Practice, Kwame Nkrumah University of Science and Technology (KNUST), Kumasi 00233, Ghana
| |
Collapse
|