Neonatal sepsis is one of the most common reasons for admission to neonatal intensive care units in developing countries. It is also a major cause of mortality in both developed and developing countries. One-fourth of neonatal deaths are due to neonatal sepsis and nearly 98% of these deaths are occurring in low- and middle-income countries. Early diagnosis and management can prevent the risk of neonatal sepsis and improve the outcome[2][8].
The overall prevalence of neonatal sepsis was 34.3%. This finding was congruent with the study done in Tanzania (31.4%)[14]. However, higher compared with the studies done in Southern-Eastern Mexico (4.3%)[15]. The possible reasons for this difference might be an advancement in health care systems such as trained health care providers, advanced investigation tools, safe delivery practices, basic obstetric emergency care, enhanced health care seeking behavior, socioeconomic status of the study population, and access to health facilities[9].
Maternal education was risk factor that predisposes the newborn to sepsis. The maternal educational level below secondary had a significant effect on the development of neonatal sepsis [16]. Neonates from mothers who were unable to read and write were 5.4 more likely prone to develop neonatal sepsis when compared to neonates from mothers educated up to diploma and above [AOR = 5.4; 95% CI (1.0to27))]. This was in line with studies done in Tanzania [14] and Ghana[17]. These may be due to mothers who did not educate and lack adequate knowledge of infection prevention techniques and they may not easily access media that provides healthcare-related information[9].
The last pregnancy planned was identified as an influencing factor that affects the occurrence of neonatal sepsis. Neonates born from mothers who did not plan their last pregnancy were 2.8 times more likely prone to develop sepsis than their opposite group. This might be explained by the mother could not provide more attention to unplanned pregnancy; not seeking health care for their neonate, and doing nothing to promote their health.
The frequent digital vaginal examination was identified as a statistically significant variable in the study. Increased odds of neonatal sepsis were noted among mothers who have a history of more than 4 PV examinations during labor compared to mothers who had PV examinations less than or equal to 4 [AOR = 2.6; 95% CI [(1.3 to 5.3]]. This finding was linked to a study done in Bangladesh[18] and North West Ethiopia[4]. This might be explained as multiple per-vaginal examinations can introduce vaginal organisms into the cervical canal, which, in turn, increases the risk of infection [19].
Neonate's birth weight, particularly low birth weight, had a significant effect on developing neonatal sepsis [16]. Those neonates who had low birth weight at birth had 5.4 times higher odds of developing sepsis compared to those neonates who were normal weight. This finding was similar to the study carried out in Dhaka[16]. The possible reasons for this may be that most neonates are very sensitive to different infection agents if born with low birth weight because of the immaturity of the body system, reduced subcutaneous fat, and increased risk of hypothermia due to high body surface area to weight ratio.
Surgical procedure before the occurrence of sepsis was significantly associated with the outcome variable. Those neonates who undertook surgical procedures were 3 times more likely to develop sepsis compared to their contrast group. The possible reason might be due to transmission of microorganisms during the procedure or through nosocomial infection as the operation area is more at risk for infection.
Place of last delivery significantly affects the occurrence of neonatal sepsis. Neonates born outside of health institutions were considered at higher risk of developing neonatal sepsis and need aggressive treatment[20]. Neonates delivered at the home were 2.34 times more likely to develop sepsis compared to those delivered at the hospital [AOR = 2.34; 95% CI (1.4 to 4.8)]. This finding was similar to the study done in North West Ethiopia[4] and Nigeria[21]. This could be explained as neonates being born at home might lack skilled attendants, care for the umbilical cord, early breastfeeding, prophylaxis (application of tetracycline), and other infection prevention approaches and this may increase the risk of neonatal infection[9].
Last delivery attendant has also a significant effect to predispose the development of neonatal sepsis. Neonates who did not attend by skilled providers were 2.7 times more likely to have neonatal sepsis compared to neonates attended by a skilled attendant. This could be related to neonates born by unskilled attendants were did not get appropriate care such as safe delivery, an aseptic procedure that prevents infection, and lack of standard management protocols or guidelines.