Title: Predictors of neonatal sepsis in public referral hospitals of East and West Gojjam zones: A    case control study.

Background: Despite remarkable progress in the reduction of death in under-five children, neonatal mortality has shown little or no concomitant reduction globally. It is also one of the most common causes of neonatal death in Ethiopia. Little is known on predictors of neonatal sepsis. Risk based screening and commencement of treatment appreciably reduces neonatal death and illness. Therefore, the main aim of this study was to identify predictors of neonatal sepsis in public referral hospitals of North west Ethiopia.

Methods: Institutional based unmatched case-control study was conducted among a total of 231 neonates in Debre Markos and Felege Hiwot referral hospitals from March 2018- April 2018.  Neonates who fulfill our preseted criteria for sepsis were considered as cases and neonates diagnosed with other medical reasons except sepsis were controls. For each case, two consecutive controls were selected by lottery method. Data was collected using structured pretested questionnaire through a face to face interview with index mothers and by neonatal record review using checklists.  It was entered into Epi data version 3.1 and exported to STATA/ SE software version 14. Finally, it was analyzed by logistic regression model. Variables with p< 0.25 in bivariate analysis, were entered to multivariable logistic regression. Statistical significance was declared at P<0.05.

Results: In this study, 77 neonates as cases and 154 as controls with their mothers were included with the overall response rate of 100%. After multivariable logistic regression analysis, significantly associated variables with sepsis were; Number of maternal antenatal care service <3 (AOR=4.4, 95%CI=1.7-11.5), Duration of rupture of membrane > 18hours (AOR=10.4, 95%CI= 2.3-46.5), meconium stained amniotic fluid ( AOR =3.9, 95%CI=1.5-9.8), urinary tract infection during pregnancy (AOR=10.8, 95% CI=3.4-33.9), intranatal fever (AOR=3.2, 95% CI=1.1-9.5), first minute APGAR score <7 (AOR=3.2, 95% CI=1.3-7.7), resuscitation at birth (AOR= 5.4, 95% CI= 1.9-15.5), nasogastric tube (NGT) insertion (AOR=3.7, 95% CI=1.4-10.2).

Conclusions/Recommendations: In this study, neonatal invasive procedures, neonatal and maternal variables were found to be significantly associated with the risk of neonatal sepsis. Therefore, Professionals should give attention for neonates born from women with fever during labor and adhere to aseptic technique while carrying out invasive procedures. Potential researchers on sepsis should include neonates in the community which may increase external a validity of the study.

Keywords: Case control, North West Ethiopia, neonatal sepsis, predictors.