title: Risk factors and practices contributing to newborn sepsis in a rural district of Eastern Uganda, August 2013: a cross sectional study.
abstract: BACKGROUND
  In Uganda, newborn deaths constituted over 38% of all infant deaths in 2010. Despite different mitigation interventions over years, the newborn mortality rate is high at 27/1,000 and newborn sepsis contributes to 31% of that mortality. Therefore, improved strategies that contribute to reduction of newborn sepsis need to be developed and implemented. Understanding the context relevant risk factors that determine and practices contributing to newborn sepsis will inform this process.
  
  
  METHODS
  A cross sectional study was conducted at Kidera Health Centre in Kidera Sub County, Buyende district between January and August 2013. A total of 174 mothers of sick newborns and 8 health workers were interviewed. Main outcome was newborn sepsis confirmed by blood culture. Independent variables included; mothers' demographics characteristics, maternal care history and newborn care practices. The odds ratios were used to measure associations and Chi square or Fisher's exact tests to test the associations. 95% confidence intervals and P values for the odds ratios were determined. Logistic regression was conducted to identify predictor factors for newborn sepsis.
  
  
  RESULTS
  21.8% (38/174) of newborns had laboratory confirmed sepsis. Staphylococcus aureus was the commonest aetiological agent. Mothers not screened and treated for infections during antenatal (OR = 3.37; 95% CI 1.23-9.22) plus inability of sick newborns to breast feed (OR = 3.9; 95% CI 1.54-9.75) were factors associated with increased likelihood of having laboratory confirmed sepsis. Women not receiving health education during antenatal about care seeking (OR 2.22; 95% CI 1.07-4.61) and newborn danger signs (OR 2.26; 95% CI 1.08-4.71) was associated with laboratory confirmed newborn sepsis. The supply of antibiotics and sundries was inadequate to sufficiently control sepsis within health facility.
  
  
  CONCLUSIONS
  Lack of antenatal care or access to it at health facilities was likely to later result in more sick newborns with sepsis. Poor breastfeeding by sick newborns was a marker for serious bacterial infection. Therefore district sensitization programs should encourage women to attend health facility antenatal care where they will receive health education about alternative feeding practices, screening and treatment for infections to prevent spread of infections to newborns. Supply of antibiotics and sundries should be improved to sufficiently control sepsis within the health facility.
authors.affiliation: Department of Health Policy Planning and Management, School of Public Health, Makerere University College of Health Sciences, P.O. Box 7072, Kampala, Uganda. buanev@yahoo.com.
authors.forename: Bua
authors.initials: B
authors.lastname: John
authors.affiliation: African Field Epidemiology Network (AFENET), P.O BOX 12874, Kampala, Uganda. dmukanga@gmail.com.
authors.forename: Mukanga
authors.initials: M
authors.lastname: David
authors.affiliation: Kidera Health Centre, Buyende, Uganda. lwangakm@gmail.com.
authors.forename: Lwanga
authors.initials: L
authors.lastname: Mathias
authors.affiliation: Department of Maternal and Child Health, School of Public Health, Makerere University College of Health Sciences, P.O. Box 7072, Kampala, Uganda. enabiwem@musph.ac.ug.
authors.forename: Nabiwemba
authors.initials: N
authors.lastname: Elizabeth
mesh_terms: D000293:Adolescent; D000328:Adult; D003430:Cross-Sectional Studies; D005260:Female; D006801:Humans; D007231:Infant, Newborn; D007232:Infant, Newborn, Diseases / Q000175:diagnosis; D008297:Male; D015233:Models, Statistical; D009035:Mothers; D016017:Odds Ratio; D011295:Prenatal Care; D012307:Risk Factors; D012424:Rural Population; D018805:Sepsis / Q000175:diagnosis* / Q000453:epidemiology*; D013203:Staphylococcal Infections / Q000175:diagnosis; D013211:Staphylococcus aureus; D014454:Uganda; D055815:Young Adult