TY - JOUR
T1 - Risk factors for neonatal sepsis in Sub-Saharan Africa
T2 - a systematic review with meta-analysis
AU - Bech, Christine Manich
AU - Stensgaard, Christina Nadia
AU - Lund, Stine
AU - Holm-Hansen, Charlotte
AU - Brok, Jesper Sune
AU - Nygaard, Ulrikka
AU - Poulsen, Anja
N1 - © Author(s) (or their employer(s)) 2022. Re-use permitted under CC BY-NC. No commercial re-use. See rights and permissions. Published by BMJ.
PY - 2022/9/1
Y1 - 2022/9/1
N2 - OBJECTIVES: To identify the risk factors for neonatal sepsis in Sub-Saharan Africa.DESIGN: Systematic review and meta-analysis.DATA SOURCES: PubMed, Embase, Web of Science, African Index Medicus and ClinicalTrials.gov were searched for observational studies from January 2010 to August 2020.SETTING: Sub-Saharan Africa, at all levels of healthcare facilities.PARTICIPANTS: 'Neonates' (<28 days of age) at risk of developing either clinical and/or laboratory-dependent diagnosis of sepsis.OUTCOME MEASURES: Identification of any risk factors for neonatal sepsis.RESULTS: A total of 36 studies with 23 605 patients from secondary or tertiary level of care facilities in 10 countries were included. Six studies were rated as good quality, 8 as fair and 22 as poor. Four studies were omitted in the meta-analysis due to insufficient data. The significant risk factors were resuscitation (OR 2.70, 95% CI 1.36 to 5.35), low birth weight <1.5 kg (OR 3.37, 95% CI 1.59 to 7.13) and 1.5-2.5 kg (OR 1.36, 95% CI 1.01 to 1.83), low Apgar score at the first minute (OR 3.69, 95% CI 2.34 to 5.81) and fifth minute (OR 2.55, 95% CI 1.46 to 4.45), prematurity <37 weeks (OR 1.91, 95% CI 1.27 to 2.86), no crying at birth (OR 3.49, 95% CI 1.42 to 8.55), male sex (OR 1.30, 95% CI 1.01 to 1.67), prolonged labour (OR 1.57, 95% CI 1.08 to 2.27), premature rupture of membranes (OR 2.15, 95% CI 1.34 to 3.47), multiple digital vaginal examinations (OR 2.22, 95% CI 1.27 to 3.89), meconium-stained amniotic fluid (OR 2.72, 95% CI 1.58 to 4.69), intrapartum maternal fever (OR 2.28, 95% CI 1.18 to 4.39), foul-smelling vaginal discharge (OR 3.31, 95% CI 2.16 to 5.09) and low socioeconomic status (OR 1.93, 95% CI 1.11 to 3.35). We found considerable heterogeneity in the meta-analysis of 11 out of 15 identified risk factors.CONCLUSION: Multiple risk factors for neonatal sepsis in Sub-Saharan Africa were identified. We revealed risk factors not listed by the WHO guidelines. The included studies overall had high risk of bias and high heterogeneity and thus, additional research of high quality is needed.PROSPERO REGISTRATION NUMBER: CRD42020191067.
AB - OBJECTIVES: To identify the risk factors for neonatal sepsis in Sub-Saharan Africa.DESIGN: Systematic review and meta-analysis.DATA SOURCES: PubMed, Embase, Web of Science, African Index Medicus and ClinicalTrials.gov were searched for observational studies from January 2010 to August 2020.SETTING: Sub-Saharan Africa, at all levels of healthcare facilities.PARTICIPANTS: 'Neonates' (<28 days of age) at risk of developing either clinical and/or laboratory-dependent diagnosis of sepsis.OUTCOME MEASURES: Identification of any risk factors for neonatal sepsis.RESULTS: A total of 36 studies with 23 605 patients from secondary or tertiary level of care facilities in 10 countries were included. Six studies were rated as good quality, 8 as fair and 22 as poor. Four studies were omitted in the meta-analysis due to insufficient data. The significant risk factors were resuscitation (OR 2.70, 95% CI 1.36 to 5.35), low birth weight <1.5 kg (OR 3.37, 95% CI 1.59 to 7.13) and 1.5-2.5 kg (OR 1.36, 95% CI 1.01 to 1.83), low Apgar score at the first minute (OR 3.69, 95% CI 2.34 to 5.81) and fifth minute (OR 2.55, 95% CI 1.46 to 4.45), prematurity <37 weeks (OR 1.91, 95% CI 1.27 to 2.86), no crying at birth (OR 3.49, 95% CI 1.42 to 8.55), male sex (OR 1.30, 95% CI 1.01 to 1.67), prolonged labour (OR 1.57, 95% CI 1.08 to 2.27), premature rupture of membranes (OR 2.15, 95% CI 1.34 to 3.47), multiple digital vaginal examinations (OR 2.22, 95% CI 1.27 to 3.89), meconium-stained amniotic fluid (OR 2.72, 95% CI 1.58 to 4.69), intrapartum maternal fever (OR 2.28, 95% CI 1.18 to 4.39), foul-smelling vaginal discharge (OR 3.31, 95% CI 2.16 to 5.09) and low socioeconomic status (OR 1.93, 95% CI 1.11 to 3.35). We found considerable heterogeneity in the meta-analysis of 11 out of 15 identified risk factors.CONCLUSION: Multiple risk factors for neonatal sepsis in Sub-Saharan Africa were identified. We revealed risk factors not listed by the WHO guidelines. The included studies overall had high risk of bias and high heterogeneity and thus, additional research of high quality is needed.PROSPERO REGISTRATION NUMBER: CRD42020191067.
KW - Female
KW - Humans
KW - Infant, Low Birth Weight
KW - Infant, Newborn
KW - Infant, Newborn, Diseases
KW - Male
KW - Neonatal Sepsis/complications
KW - Risk Factors
KW - Sepsis/epidemiology
KW - PAEDIATRICS
KW - NEONATOLOGY
KW - Paediatric infectious disease & immunisation
KW - OBSTETRICS
UR - http://www.scopus.com/inward/record.url?scp=85137917361&partnerID=8YFLogxK
U2 - 10.1136/bmjopen-2021-054491
DO - 10.1136/bmjopen-2021-054491
M3 - Review
C2 - 36253895
SN - 2044-6055
VL - 12
JO - BMJ Open
JF - BMJ Open
IS - 9
M1 - e054491
ER -