Hierarchical Predictors of Mortality in Neonatal Sepsis at Jimma Medical Center, Ethiopia: A Case-Control Study

Daniel Geleta; Gemeda Abebe; Netsanet Workneh; Mekdes Ararso; Tsion Tilahun; Getenet Beyene

doi:10.2147/JMDH.S446303

Hierarchical Predictors of Mortality in Neonatal Sepsis at Jimma Medical Center, Ethiopia: A Case-Control Study

J Multidiscip Healthc. 2024 Feb 8:17:541-555. doi: 10.2147/JMDH.S446303. eCollection 2024.

Authors

Daniel Geleta^#¹, Gemeda Abebe^#^{1

2}, Netsanet Workneh^#³, Mekdes Ararso^#³, Tsion Tilahun^#³, Getenet Beyene^#¹

Affiliations

¹ School of Medical Laboratory Sciences, Faculty of Health Sciences, Jimma University, Jimma, Oromia, Ethiopia.
² Mycobacteriology Research Center, Institute of Health, Jimma University, Jimma, Oromia, Ethiopia.
³ Department of Pediatrics and Child Health, Faculty of Medicine, Jimma University, Jimma, Oromia, Ethiopia.

^# Contributed equally.

Abstract

Background: Neonatal sepsis made the neonatal period the most perilous time for child survival, and it continued to cause preventable mortalities worldwide. These mortalities stem from the interaction of several factors that have not been sufficiently studied and, in some cases, remain overlooked. Thus, the study aims to investigate the predictors of mortality that arise from the interaction of these factors and quantitatively determine their etiologic fraction.

Methods: A case-control study with hierarchical data input was conducted at Jimma Medical Center (JMC) in Oromia, Ethiopia, spanning from May 2022 to July 2023. It employed logistic regression to calculate adjusted odds ratios (AORs) and their corresponding 95% confidence intervals (CI) at a significance level of p ≤ 0.05. The model adjusted odds ratios (ORs) for variables within each level and farther levels and presented an etiologic fraction (EF), indicating the proportion of neonatal mortality attributable to specific factors.

Results: The analysis of 67 cases and 268 controls unveiled significant predictors of mortality in sepsis that emerged from distal, intermediate, and proximal levels. In the final model, thus, rural residence [AOR 3.1; 95% CI (1.5, 6.3), p ≤ 0.01], prolonged labor [AOR 4.5; 95% CI (2.2, 9.3), p ≤ 0.01], prematurity [AOR 3.9; 95% CI (1.9, 7.9), P ≤ 0.0], gram-negative bacteremia [AOR 3.8; 95% CI (1.9, 7.6); P ≤ 0.01], convulsion [AOR 3.2; 95% CI (1.6, 6.4); P ≤ 0.03], low birth weight [AOR 2.7; 95% CI (1.3, 5.4); P≤0.01], and delayed breastfeeding [AOR 2.5; 95% CI (1.2, 4.9); P ≤ 0.01] attributed a variable percentage of mortality.

Conclusion: Factors emerging and interacting at distal (residence), intermediate (prolonged labor), and proximal (prematurity, birth weight, convulsion, bacterial etiology, and feeding) levels influence neonatal mortality in sepsis at JMC. Therefore, concurrently improving rural family characteristics, managing labor duration, strengthening diagnostic stewardship, and promoting essential newborn care can actively prevent and reduce these mortalities.

Keywords: bacteremia; factor interaction; hierarchical predictors; neonatal sepsis.

Grants and funding

This study was funded by Jimma University, but no source of fund was received for publication of the manuscript.