Neonatal hypothermia and adherence to World Health Organisation thermal care guidelines among newborns at Moi Teaching and Referral Hospital, Kenya

ABSTRACT Background Neonatal hypothermia is a great concern with near epidemic levels globally. The prevalence in Kenya is as high as 87%. Local data on the associated factors including adherence to warm chain guidelines as recommended by the World Health Organisation (WHO) is limited. Objective To determine the prevalence of hypothermia and level of adherence to the WHO thermal care guidelines among newborns admitted at Moi Teaching and Referral Hospital (MTRH). Methods This descriptive cross-sectional study was carried out among neonates admitted at the MTRH newborn unit. Systematic sampling was used to recruit 372 eligible participants. Axillary thermometry, interview of respective mothers and observation of thermal care practices was done. Means and medians described continuous variables while frequencies with corresponding percentages summarized categorical variables. Associations between various variables and neonatal hypothermia were computed using the Pearson chi-square test. Relative Risks and Odds Ratios were assessed between predictor and outcome variables. Independence among significant variables was determined through the logistic regression model at 5% prediction level. Results Among the 372 participants, 64.5% (n=240) were born at MTRH, 47.6% (177) were preterm while 53.2% (198) had birth weights below 2500 grams. Admission hypothermia was noted among 73.7% (n= 274) while 13% (49) died on day one of admission. Only 7.8 % (29) newborns accessed optimal thermal care. Prematurity (RR=1.62, 95% CI: 1.43-1.84), day one mortality (RR=17.7, 95% CI: 2.40, 122.71) and adherence to the warm chain (p<0.001) was significantly associated with admission hypothermia. Inappropriate thermal resuscitation appliance (RR=1.50, 95% CI: 1.34-1.67) inappropriate clothing (RR = 1.78, 95% CI: 1.54 - 2.05) and late breastfeeding (RR = 2.01, 95% CI: 1.39-2.89) significantly increased the risk of hypothermia. Non hypothermic newborns had twenty-fold increased odds of survival (AOR=20.91, 95% CI: 2.15-153.62). Conclusion Three out four neonates at the MTRH newborn unit had hypothermia at admission. Hypothermia was significantly associated with prematurity, adherence to warm chain and day one mortality. There was notably low adherence to the warm chain. Recommendation Strategies to optimize adherence to the warm chain at MTRH with emphasis on 1 thermal care of the preterm neonate should be instituted.