Treatment Outcomes of Meningitis and Its Associated Factors among Neonates Admitted in Public Hospitals at Harar Town, Ethiopia: Cross-sectional study

Treatment Outcomes of Meningitis and Its Associated Factors among Neonates Admitted in Public Hospitals at Harar Town, Ethiopia: Cross-sectional study | Research Square window.SnipcartSettings = { analytics: { enabled: false } }; (function() { var accessVector = localStorage.getItem('access_vector') || ''; window.dataLayer = window.dataLayer || []; if (accessVector) { window.dataLayer.push({ user: { profile: { profileInfo: { snid: accessVector } } } }); } })(); (function(w,d,s,l,i){w[l]=w[l]||[];w[l].push({'gtm.start':new Date().getTime(),event:'gtm.js'});var f=d.getElementsByTagName(s)[0],j=d.createElement(s),dl=l!='dataLayer'?'&l='+l:'';j.async=true;j.src='https://www.googletagmanager.com/gtm.js?id='+i+dl;f.parentNode.insertBefore(j,f);})(window,document,'script','dataLayer','GTM-K279D39R'); Browse Preprints In Review Journals COVID-19 Preprints AJE Video Bytes Research Tools Research Promotion AJE Professional Editing AJE Rubriq About Preprint Platform In Review Editorial Policies Our Team Advisory Board Help Center Sign In Submit a Preprint Cite Share Download PDF Article Treatment Outcomes of Meningitis and Its Associated Factors among Neonates Admitted in Public Hospitals at Harar Town, Ethiopia: Cross-sectional study Getahun Tamiru Yirsaw, Tadesse Bekele Tadesse, Abera Jambo Bune, and 1 more This is a preprint; it has not been peer reviewed by a journal. https://doi.org/ 10.21203/rs.3.rs-7103387/v1 This work is licensed under a CC BY 4.0 License Status: Posted Version 1 posted You are reading this latest preprint version Abstract Aim & Background: Meningitis in neonates significantly burdens public health in low- and middle-income countries. However, data on treatment outcomes and factors contributing to poor prognosis are scarce. This study aimed to assess treatment outcomes of meningitis and associated factors among neonates treated at public hospitals in Harar, eastern Ethiopia. Methods A facility-based cross-sectional study was conducted involving 506 neonates who received treatment between October 1, 2020, and October 31, 2024, at Hiwot Fana Comprehensive Specialized University Hospital and Jugal General Hospital. Data were obtained from medical records. Treatment outcomes were classified as "good" or "poor." Both binary and multivariate logistic regression analyses were performed to identify factors associated with poor treatment outcomes. A P-value of less than 0.05 and an adjusted odds ratio with a 95% confidence interval were utilized to establish statistical significance. Results One hundred sixty-nine (33%) neonates had experienced poor treatment outcomes. Delivered by vacuum (AOR = 3.06, 95% CI: 1.03 to 9.05), positive culture of cerebrospinal fluid (CSF) (AOR = 3.53, 95% CI: 1.45 to 8.57), CSF protein more than 400 mg/dl at admission (AOR = 17.9, 95% CI: 7.95 to 40.3), CSF glucose less than 10 mg/dl at admission (AOR = 3.89, 95% CI: 1.55 to 9.77), seizure at admission (AOR = 5.6, 95% CI: 2.78 to 11.4), seizures during hospitalization (AOR = 14.4, 95% CI: 5.85 to 35.2), presences of early onset neonatal sepsis (AOR = 3.5, 95% CI: 1.49 to 8.20), and predisposition to congenital hydrocephalus (AOR = 4.73, 95% CI: 1.46 to 15.2) were factors associated with poor outcome of treatment. Conclusion The study found that approximately 33% of newborns with meningitis experienced poor treatment outcomes. Epilepsy and hydrocephalus were the most commonly observed neurological sequelae. Several factors were associated with poor outcomes, including congenital hydrocephalus, vacuum-assisted delivery, positive CSF culture, seizures, elevated CSF protein with low glucose, and co-occurrence with early-onset neonatal sepsis. Clinical Significance: This study is important for enhancing patient care by reducing mortality and morbidity. Recognizing the factors that influence outcomes allows for targeted measures, early detection of at-risk newborns, and more effective treatment strategies. Health sciences/Diseases Health sciences/Health care Health sciences/Medical research Health sciences/Neurology Biological sciences/Neuroscience associated factors cross-sectional treatment outcome meningitis neonates eastern Ethiopia Figures Figure 1 Introduction Meningitis is a central nervous system infection that can cause inflammation in the subarachnoid space of the brain and spinal cord. It is usually caused by infectious agents, such as bacteria, viruses, fungi, and parasites ( 1 ). Newborns are at a high risk for meningitis due to their immature immune systems ( 2 , 3 ). It can be classified as early-onset (≤ 72 hours) or late-onset (> 72 hours) based on the time of infection occurring after birth ( 3 ). Pathogens causing neonatal meningitis differ depending on the neonate's gestational age at birth, age at presentation, and geographic location ( 3 ). In early-onset meningitis, Group B Streptococcus (GBS) and Escherichia coli (E. coli ) are the most prevalent pathogens ( 2 , 4 – 7 ). The pathogens of late-onset meningitis vary depending on gestational weeks, birth weight, and setting ( 3 ). GBS and E. coli are prevalent pathogens among neonates that develop meningitis in the community ( 8 – 10 ). Staphylococci, Staphylococcus aureus (S. aureus) , and Klebsiella are prevalent pathogens among neonates that develop meningitis in the healthcare setting ( 7 , 8 ). Globally, the incidence and mortality rates of neonatal meningitis were 854 (609.2-1183.3) and 137.2 (109.5-177.8) per 100,000 population, respectively, in 2019 ( 11 ). It also accounts for healthcare expenditures ranging from $ 222 to $ 33,635 per patient worldwide ( 12 ). The incidences and mortality rates of neonatal meningitis are higher in low- and middle-income countries, at 0.5-6 per 1,000 live births and 20–37%, respectively ( 5 , 13 – 16 ), compared to high-income countries, which report rates of 0.3–0.4 per 1,000 live births and 2%-10%, respectively ( 5 , 6 , 17 , 18 ). Globally, among neonates who survive meningitis, 20–50% develop different neurological sequelae, such as hearing loss, blindness, epilepsy, hydrocephalus, subdural empyema, and psychomotor developmental delay ( 18 – 21 ). Incidence and mortality rates of meningitis are high in Sub-Saharan Africa, a region referred to as the “meningitis belt” ( 11 ). For example, the incidence rate of neonatal meningitis in Kenya was 96 per 1000 live births ( 22 ), and the mortality rate is reported as 24% in Angola, 29.4% in Tanzania, and 37% in the Gambia ( 16 , 23 , 24 ). According to the Global Burden of Disease, Ethiopia has the third-highest rate of meningitis fatalities ( 25 ). It is responsible for the median cost of 98,812 ETB (Ethiopian Birr) (approximately US $ 3,593.2) per patient in Ethiopia due to bacterial meningitis ( 26 ). The factors predicting a poor prognosis of meningitis among neonates include seizures, high protein levels in the cerebrospinal fluid (CSF), low birth weight or preterm birth, early onset of meningitis, and low CSF glucose levels ( 18 , 19 , 27 ). However, the predictors of poor prognosis may differ from place to place. Despite the high mortality and morbidity of neonatal meningitis in low-income countries, studies reporting the treatment outcomes and factors associated with poor prognosis have been limited, particularly in Ethiopia. To date, there is a single study done in Ethiopia on this topic ( 28 ). However, the study does not represent the broader population of newborn meningitis due to an inadequate sample size. Additionally, there is a scarcity of studies on treatment outcomes and factors associated with poor treatment outcomes in the study area. Therefore, this study aimed to assess the treatment outcomes of neonatal meningitis and its associated factors in Harar town, Eastern Ethiopia. Materials & Methods Study design and settings A cross-sectional study design was conducted in Hiwot Fana Comprehensive Specialized University Hospital (HFCSUH) and Jugal General Hospital (JGH) from February 10 to March 20, 2025. Harar is the capital city of the Harari regional administration. It is located in the eastern part of the country, around 500 kilometers from the Ethiopian capital city, Addis Ababa. HFCSH was founded in 1948 and transitioned to a university-specialized hospital in 2010. JGH was founded in 1909. They include four wards: medical, pediatric, surgical, gynecology, and obstetrics. They also provide care for neonates, gynecology, ophthalmology, dentistry, adult outpatient, pediatric outpatient, and chronic follow-up. Study population and variables All medical records of neonates admitted to the Neonatal Intensive Care Units (NICUs) of HFCSUH and JGH with meningitis between October 1, 2020, and October 31, 2024, were included in this study. Incomplete medical records (i.e., diagnosis, treatment regimen, and discharge summary), those discharged against medical advice, those discontinued treatment within 72 hours, and those referred to another institution were excluded from this study. Data were collected on socio-demographic factors (admission site, sex, age, birth weight, and gestational age), clinical factors ( pre-existing medical condition (congenital heart defects, down syndrome, congenital hydrocephalus), maternal health factors (complication during deliver (history of PROM, meconium stain in amniotic fluid, chroinammionitcs) and mode of deliver (spontaneous vaginal delivery, C/S, assisted by vacuum), symptoms at diagnosis, blood test, cerebrospinal fluid tests, type of pathogen, and specific isolated pathogen), and treatment-related factors (antimicrobial therapy (choice of antimicrobial) and supportive care (nutrition and management of complications)). Outcome measurement In this study, treatment outcomes were categorized into " good " for those who recovered or improved and were discharged without complications and poor for those who died in the hospital, were discharged with complications, or did not improve. Sample size determination and sampling technique Sample size was calculated for the outcome variable and factors associated with poor treatment outcomes (i.e., seizure, preterm, early-onset sepsis, prolonged shock, mechanical ventilation, and congenital heart disease). Single- and double-population proportion formulas were used to calculate sample sizes for the outcome variable and related factors, respectively. Sample size for the treatment outcome was calculated considering the following assumptions: a 95% confidence interval, a 5% margin of sampling error, and a 20.7% proportion from a study conducted at Tibebegion Comprehensive Specialized Hospital in Bahirdar, Ethiopia ( 28 ). Sample size for associated factors (i.e., seizure ( 29 ), preterm ( 30 ), early-onset sepsis ( 31 ), prolonged shock ( 32 ), mechanical ventilation ( 33 ), and congenital heart disease ( 34 )) were computed using Epi Info V.7. 1, with considered the following assumptions: a 95% confidence interval, a 5% margin of sampling error tolerated, and an 80% power. The higher sample size was used as the final value in the previously stated single and double population proportion computations. The sample size for early-onset sepsis was chosen since it provided a larger sample size. The final sample size was 506 after adding 5% for contingency. Finally, 506 medical records of patients were reviewed. Representatives from each institution were selected using a simple random selection method. Initially, the patient's register number was obtained from the registration logbook. Then, patients' medical records were entered into a computer program (Microsoft Excel) to select representatives through a lottery method. The sample size was allocated proportionally across HFCSUH and JGH based on the number of neonates admitted with meningitis between October 1, 2020, and October 31, 2024 (HFCSUH = 725 and JGH = 321). Three hundred fifty-one and 155 representative patients were chosen from HFCSUH and JGH, respectively. Data collection tool and procedure The data collection tool was developed based on relevant literature and includes closed-ended questions on socio-demographics, clinical factors, and treatment-related factors. Data was extracted from the medical records of patients. Before that, the number of medical records was obtained from the registry logbook of patients admitted to the neonate ward between October 1, 2020, and October 31, 2024, at HFCSUH and JGH, accessed from February 10 to March 20, 2025. Then, the medical records were traced from the card room store of the HFCSUH and JGH. Finally, all necessary information was extracted from complete medical records after checking the completeness of the information. Data quality assurance Before actual data collection, a counter-check was done on 5% of the sample size at Haramaya General Hospital, and the tool was modified as needed. Four clinical pharmacists participated in the data collection process. Appropriate orientation was given to the data collectors on the data abstraction tool and the objective of the data collection before starting actual data collection. Data was checked during collection and before processing to ensure completeness and consistency. Statistical analysis Data was collected by using the restricted Kobo-Collect tool V 2024.2.4, to ensure consistency, completeness, and then exported to SPSS version 27 for analysis. Descriptive data were summarized using frequencies and percentages for categorical variables and the mean (standard deviation) for continuous variables. A binary logistic regression model was used to analyze the independent effects of each variable on treatment outcome, and a variable with a p-value < 0.25 was selected for a multivariate logistic regression model, which identified the independent contribution of each variable. The Hosmer-Lemeshow test was applied to assess the goodness of fit for the logistic regression model. The model was well-fitted with a p-value of 0.53. The variance inflation factor (VIF) was applied to detect multicollinearity in the regression model. The VIF value was 1.74, indicating very weak correlations between the independent variables. The association between dependent and independent variables was measured using COR (crude odds ratio) and AOR (adjusted odds ratio) along with a 95% confidence interval. A p-value < 0.05 was considered a significant association factor for poor outcomes. Operational definitions Confirmed meningitis when the cause of pathogen isolated from primary CSF culture and present with clinical manifestations of meningitis such as fever, seizures, thermal instability, unable to suck, etc. with ( 35 , 36 ). Suspected meningitis when negative CSF culture or not cultured, but CSF characteristics fulfilled these values (leukocyte count > 32/mm 3 and > 29/mm 3 ; glucose level < 34 mg/dl and 170 mg/dl and > 150 mg/dl in term and preterm, respectively) ( 35 , 36 ). Neurological complication occurrences of any disease secondary to meningitis include seizure, subdural effusion, brain abscess, hearing loss, hydrocephalus, subdural empyema, subdural effusion, and brain abscess. Ethical considerations This study was approved by the Institutional Health Research Ethics Review Committee (IHRERC) of the College of Health and Medical Sciences, Haramaya University, with the reference number IHRERC/041/2025 that entitled ''Treatment Outcomes of Meningitis and Its Associated Factors among Neonates Admitted in Public Hospitals at Harar Town, Ethiopia: Cross-sectional study'' accessed from February 10 to March 20, 2025. Cooperative letters were sent to the Hiwot Fana Comprehensive Specialized University Hospital (HFCSUH) and the Jugal General Hospital (JGH). The patient's privacy and confidentiality were ensured. The patient's identification was not documented. Patients' consent was not obtained directly from patients' parents due to an unregistered phone number on the medical records and did not interact or interviews any patient’s parents. However, consent was obtained from the institution. Additionally, the patient’s information was kept confidential, and the patient's name and other details that could identify them were not recorded. Results Socio-demographic characteristics of patients This study included 506 neonates with meningitis from the NICUs of HFCSUH (351) and JGH (155). Of all, 278 (54.9%) patients were male, with a male-to-female ratio of 1.22:1. The ages of patients were distributed relatively high among early (< 7 days) newborns, with a mean age of 8.91 ± 5.92 days (Table 1). Table 1 Socio-demographic characteristics of neonates admitted with meningitis at public hospitals in Harar town, Eastern Ethiopia, from February 10 to March 20, 2025 [n = 506]. Variable Category Frequency Percent Site of admission HFCSUH 351 69.4 JGH 155 30.6 Sex Female 228 45.1 Male 278 54.9 Age (days) < 7 270 53.4 7–28 236 46.6 HFCSUH: Hiwot Fana Compressive Specialized University Hospital; JGH: Jugal General Hospital Neonatal and maternal characteristics of health In this study, 181(36.2%) patients co-existed with sepsis upon admission. From this, 116 (22.9%) were diagnosed with early-onset neonatal sepsis, and 65 (12.8%) were diagnosed with late-onset neonatal sepsis. The mean birth weight and gestational age of neonates with meningitis were 3099 ± 393 grams and 36.9 ± 1.13 weeks, respectively. Only a few patients, 69 (13.6%), had a low birth weight (< 2500 g), and 130 (25.7%) were preterm (gestational age < 37 weeks). Forty-two (8.3%) patients presented with pre-existing medical conditions. Most neonates, 314 (62.1%), were born via spontaneous vaginal delivery. One hundred nineteen (23.5%) mothers of neonates experienced complications during pregnancy, including 71 (14%) with premature rupture of membranes (PROM), 31(6.1%) with eclampsia, 11 (2.2%) with chorioamnionitis, and 6 (1.2%) with meconium staining in the amniotic fluid (Table 2). Table 2 Neonatal and maternal health characteristics among neonates admitted with meningitis at public hospitals in Harar town, Eastern Ethiopia, from February 10 to March 20, 2025 [N = 506]. Variable Category Frequency Percent Co-existing Illness EONS 116 22.9 LONS 65 12.8 Birth weight of neonate (grams) < 2500 69 13.6 ≥ 2500 437 86.4 Gestational age of neonate (weeks) < 37 130 25.7 ≥ 37 376 74.3 Pre-existing medical condition Yes 42 8.3 Type of pre-existing medical condition Congenital hydrocephalus 35 6.9 Down syndrome 4 - Congenital heart defects 3 - Mode of delivery C/S 153 30.2 Spontaneous vaginal 314 62.1 Vacuum 38 7.7 Complications during delivery Yes 119 23.5 Type of complication PROM 71 14.0 Eclampsia 31 6.1 Chorioamnionitis 11 2.2 Meconium stain in amniotic fluid 6 1.2 C/S: cesarean section; PROM: premature rupture of membranes Laboratory and clinical findings of patients In this study, the mean white cell count in cerebrospinal fluid (CSF) was 1764.3 ± 833.3 per µL. However, 72 (14.2%) patients had CSF white cell counts above 2500 cells/mm³. One hundred eighteen (23.3%) patients had elevated CSF protein levels above 400 mg/dl, while 79 (15.6%) had CSF glucose levels of < 10 mg/dl, with a mean of 300.2 ± 108.2 mg/dl and 15.4 ± 6.9 mg/dl of protein and glucose, respectively. 113 (22.3%) revealed a positive Gram stain in their CSF. Gram-positive cocci (63, 12.5%) and gram-negative rods (40, 7.9%) were the most common infectious agents identified from the Gram stain. 71 (14%) had positive CSF cultures. GBS (25, 4.9%) and E. coli (14, 2.8%) were the most commonly identified organisms in this study. Thirty-five (6.9%) patients were thrombocytopenic (platelet concentration < 150*10 9 /L), 199 (39.3%) were anemic (hemoglobin level 15*10 9 /L) (Table 3). Table 3 Result of laboratory findings and identified pathogens of meningitis among neonates admitted at public hospitals in Harar town, Ethiopia, from February 10 to March 20, 2025. Variable Category Frequency Percent CSF WBC cells/mm³ < 2500 434 85.8 ≥ 2500 72 14.2 CSF Protein (mg/dl) < 400 388 76.7 ≥ 400 118 23.3 CSF Glucose (mg/dl) < 10 79 15.6 ≥ 10 427 84.4 CSF gram stain Yes 113 22.3 Identified the pathogen from the Gram stain Gram-positive coccus 63 12.5 Gram-negative rods 40 7.9 Gram-positive rods 9 1.8 Gram-negative coccus 1 0.2 CSF culture Yes 71 14.0 Isolated micro-organism GBS 25 4.9 E.coli 14 2.8 Klebsiella 10 2.0 S. aureus 4 - L. monocytogenes 1 - Acinetobacter 1 - WCC (10 9 /L) < 15 372 73.5 ≥ 15 134 26.5 Hgb (g/dl) < 11.5 199 39.3 ≥ 11.5 307 60.7 Platelet count (10 9 /L) < 150 35 6.9 ≥ 150 471 93.1 CSF: cerebrospinal fluid; EONS: Early Onset Neonatal Sepsis; GBS: Group B streptococcus; Hgb: Hemoglobin; LONS: Late Onset Neonatal Sepsis; WCC: White cell count The most common clinical manifestations of neonatal meningitis in this study were 475 (93.9%) fever, 419 (82.8%) failure to suck, 302 (59.7%) vomiting, and 298 (58.9%) irritability (Fig. 1). Prescribed medication and outcomes of treatment In this study, most patients (82.2%) were treated with a combination of Ampicillin and Gentamycin, followed by (10.7%) a combination of Ampicillin and Cefotaxime. Among 506 neonates treated for meningitis, 339 (67%) had good treatment outcomes, whereas 167 (33%) had poor treatment outcomes. The death rate for newborn meningitis in this study was 18.8%. In this study, 143 (28.3%) patients experienced complications in a healthcare setting, of which 130 patients developed complications after taking medications for meningitis for at least 72 hours. 411 (81.2%) newborns survived meningitis, and from these 73(14.4%) were discharged with neurological complications, including epilepsy (49, 9.7%), hydrocephalus (11, 2.2%), probable subdural effusion (5, 1.0%), weakness (5, 1.0%), hemiparesis (2, 0.4%), and hearing loss (1, 0.2%) (Table 4). Table 4 Complications of meningitis and treatment outcomes among neonates admitted at public hospitals in Harar town, Eastern Ethiopia, from February 10 to March 20, 2025. Variables Category Frequency Percent Complications developed after 72 hours of treatment Yes 130 25.7 Complications developed in-hospital Yes 143 28.3 Complications in the hospital Seizure 62 12.3 Renal failure 17 3.4 Septic shock 16 3.2 Hydrocephalus 11 2.2 Subdural effusion 11 2.2 Respiratory failure 10 2.0 Brain abscess 9 1.8 Others* 7 - Discharged with complications Yes 73 14.4 Complication at discharge Epilepsy 49 9.7 Hydrocephalus 11 2.2 Subdural effusion 5 1.0 Weakness 5 1.0 Others** 3 - Status of patients at discharge Improved 248 49 Recovered 154 30.4 Dead 95 18.8 Discharge without improvement 9 1.8 Outcomes of treatment Poor 167 33 Good 339 67 Others*…subdural empyema (3, 0.6%); weakness (2, 0.4%); brain infarction (1, 0.2%); ventriculomegaly (1, 0.2%). Others**…. Hemiparesis (2, 0.4%); deafness (1, 0.2%). Factors associated with poor treatment outcomes Multivariate logistic regression analysis identified that the independent predictive factors of poor outcome of treatment were delivery by vacuum (AOR = 3.06; 95% CI: 1.03 to 9.05), positive CSF culture (AOR = 3.53; 95% CI: 1.45 to 8.57), protein levels in CSF greater than 400 mg/dl at admission (AOR = 17.9; 95% CI: 7.95 to 40.3), glucose level in CSF less than 10 mg/dl at admission (AOR = 3.89; 95% CI: 1.55 to 9.77), presences of seizure upon admission (AOR = 5.6; 95% CI: 2.78 to 11.4), developing seizures during hospitalization (AOR = 14.4; 95% CI: 5.85 to 35.2), co-exist with EONS (AOR = 3.5; 95% CI: 1.49 to 8.20), and congenital hydrocephalus (AOR = 4.73; 95% CI: 1.46 to 15.2) (Table 5). Table 5 Factors associated with poor outcomes among neonates with meningitis treated at public hospitals in Harar town, Eastern Ethiopia, from February 10 to March 20, 2025. Variables Poor treatment outcome COR AOR P-value No (%) Yes (%) Age (days) < 7 161(59.6%) 109(40.4%) 2.08(1.42–3.05) 0.72(0.33–1.53) 0.39 7–28 178(75.4%) 58(24.6%) 1.00 1.00 Birth weight (grams) < 2500 22(31.9%) 47(68.1%) 5.64(3.26–9.76) 1.95(0.67–5.69) 0.22 ≥ 2500 317(72.5%) 120(27.5%) 1.00 1.00 Gestational ages (weeks) < 37 60(42.2%) 70(53.8%) 3.35(2.22–5.08) 1.64(0.68–3.95) 0.27 ≥37 279(74.2%) 97(25.8%) 1.00 1.00 Mode of delivery AV 21(53.8%) 18(46.2%) 2.13(1.09–4.19) 3.06(1.03–9.05) a 0.043 C/S 94(61.4%) 59(38.6%) 1.56(1.04–2.35) 0.91(0.42–1.96) 0.81 SV 224(71.3%) 90(28.7%) 1.00 1.00 CSF culture Yes 29(40.8%) 42(59.2%) 3.59(2.14–6.02) 3.53(1.45–8.57) a 0.005 No 310(71.3%) 125(28.7%) 1.00 1.00 CSF WBC ≥ 2500 15(21.4%) 55(78.6%) 10.9(5.85–19.9) 2.67(0.94–7.62) 0.066 < 2500 315(74.6%) 107(25.4%) 1.00 1.00 CSF protein ≥ 400 15(12.7%) 103(87.3%) 34.7(18.9–63.6) 17.9(7.95–40.3) b < 0.001 < 400 324(83.5%) 64(16.5%) 1.00 1.00 CSF glucose < 10 28(35.4%) 51(64.6%) 4.88(2.93–8.11) 3.89(1.55–9.77) a 0.004 ≥ 10 311(72.8%) 116(27.2%) 1.00 1.00 Hemoglobin < 11.5 103(51.8%) 96(48.2%) 3.09(2.11–4.55) 1.43(0.73–2.79) 0.28 ≥ 11.5 236(76.9%) 71(23.1%) 1.00 1.00 Platelet < 150 19(54.3%) 16(45.7%) 1.78(0.89–3.56) 0.42(0.11–1.56) 0.19 ≥ 150 320(67.9%) 151(32.1%) 1.00 1.00 Not exclusive breastfeeding Yes 32(47.8%) 35(52.2%) 2.54(1.51–4.28) 2.07(0.91–4.71) 0.08 No 307(69.9%) 132(30.1%) 1.00 1.00 Presence of seizure at admission Yes 43(34.4%) 82(65.6%) 6.64(4.27–10.3) 5.6(2.78–11.4) b < 0.001 No 296(77.7%) 85(22.3%) 1.00 1.00 Developed a seizure after admission Yes 16(25.8%) 46(74.2%) 12.3(6.04–24.9) 14.4(5.85–35.2) b < 0.001 No 323(72.7%) 121(27.3%) 1.00 1.00 Presence of EONS Yes 46(40%) 69(60%) 4.48(2.89–6.95) 3.5(1.49–8.20) a 0.004 No 293(74.9%) 98(25.1%) 1.00 1.00 Congenital hydrocephalus Yes 10(28.6%) 25(71.4%) 5.15(2.41–10.9) 4.73(1.46–15.2) a 0.009 No 329(69.9%) 142(30.1%) 1.00 1.00 Hosmer-Lemeshow goodness of fit test was fitted with a P-value of 0.53; a P > 0.05, b P < 0.001. AOR: adjusted odd ratio; CSF: cerebrospinal fluid; C/S: cesarean section; COR: crude odd ratio; EONS: early onset neonatal sepsis; AV: Assisted with vacuum; SV: Spontaneous vaginal; HFCSUH: Hiwot Fana Compressive Specialized University Hospital; JGH: Jugal General Hospital Discussion This study assessed the treatment outcomes of meningitis and its associated factors among newborns admitted to public hospitals in Harar, Eastern Ethiopia, and included 506 newborns with meningitis. This study found that 10.8% of CSF cultures confirmed bacterial meningitis. This finding was consistent with a study conducted in Angola (12%) ( 23 ). However, this result was higher than studies conducted in Ethiopia at North Gondar (6%) ( 37 ) and Kenya (4.8%) ( 38 ). These variances could be explained by differences in the number of CSF samples collected, patient selection criteria, early antibiotic initiation before the sample collection, and laboratory techniques used. In this study, all participants were taken from patients who had undergone lumbar puncture and met the diagnostic criteria of CSF analysis. In this study, fever (93.9%), inability to suck (82.8%), vomiting (59.7%), and irritability (58.9) were the most commonly identified clinical presentations of neonatal meningitis, while seizure (24.7%) and a bulging fontanelle (4.2%) had the least presentations. This finding aligns with studies done in Gondar, Ethiopia ( 37 ), Angola ( 23 ), and Taiwan ( 39 ). Streptococcus agalactiae (GBS) and E. coli were the most commonly isolated microorganisms from positive CSF cultures in this study, which was in line with research conducted in the UK and Ireland ( 40 ), in Taiwan ( 39 ), and in Hong Kong ( 10 ). These findings were in contrast to research conducted in Kenya ( 38 ) and Peru ( 15 ), where E. coli was the predominant organism, followed by GBS. Additionally, Klebsiella was the most frequently observed organism in studies conducted in Ethiopia at Gondar ( 41 ), in Angola ( 23 ), in South Africa ( 5 ), and in Iran ( 42 ). These Variations might be differences in age at presentation (early vs late), gestational age at birth, birth weight, and geographic location. This study found that 33% of patients experienced poor treatment outcomes, such as hospital death, discharge problems, or no improvement. 18.8% of patients died in hospital settings as a result. This result was less than studies done in Angola (24%) ( 23 ), Gambia (37%) ( 16 ), Tanzania (29.4%) ( 24 ), Tunisia (40%) ( 43 ), and India (29.1%) ( 44 ). However, this result was higher than those of research conducted in Taiwan (10.3%) ( 7 ), Colombia (9.5%) ( 45 ), and China (4.2%) ( 36 ). This variation may be related to differences in early detection, socioeconomic status, the number of people involved, antibiotic resistance patterns, and accessibility to healthcare services. This study found 14.4% neurological complications among 411 neonates who survived meningitis, comparable to a study conducted in Tunisia (16.4%) ( 43 ). However, this rate was lower than that observed in Canada (72.4%) ( 46 ), Taiwan (41.6%) ( 18 ), India (30.4%) ( 47 ), Nigeria (22.5%) ( 48 ), and Tunisia (21.6%) ( 49 ). Neurological complications were more prevalent in wealthy countries compared to low-income countries. This variation may be related to differences in diagnostic equipment availability, medical expertise, spectrum of pathogens, and incidence of mortality. This study found that epilepsy and hydrocephalus are common complications of newborn meningitis, in line with a study conducted in Taiwan ( 39 ). Many studies showed that secondary epilepsy is the most common neurological outcome of newborn meningitis ( 5 , 6 , 18 , 36 , 46 ) Most patients discharged with neurological complications had developed them during their hospitalization. This study found that patients born by vacuum (AOR = 3.06; 95% CI: 1.03 to 9.05) were three times more likely to die or have neurological complications at discharge than neonates born via cesarean section. Previous studies did not assess a relationship with poor treatment outcomes ( 6 , 7 , 18 , 27 , 36 , 47 ). This relationship may be linked to acquiring resistant bacteria from contaminated device surfaces during delivery. Neonatal drug-resistant meningitis is strongly linked to mortality and morbidity ( 47 , 48 ). This study found that having a seizure during admission (AOR = 5.6; 95% CI: 2.78 to 11.4) was 5.6 times more likely to result in poor treatment outcomes. This finding is consistent with studies done in Canada ( 50 ), India (AOR = 14; 95% CI: 1.3 to 21.8) ( 47 ), and Taiwan (AOR = 2.40; 95% CI: 1.12 to 4.14) ( 18 ). Similarly, developing seizures in hospitals (AOR = 14.4; 95% CI: 5.85 to 35.2) was associated with poor treatment outcomes, consistent with the study done in Taiwan (OR: 10.10; 95% CI: 2.11 to 48.32) ( 39 ). Seizures are a well-known symptom of newborn meningitis, as well as a complication of meningitis, that results in cerebral infarction, hydrocephalus, subdural empyema, or stroke, all of which can lead to poor outcomes ( 51 ). This study revealed that neonates who existed with EONS (AOR = 3.5; 95% CI: 1.49 to 8.20) were 3.5 times more likely to have poor treatment outcomes. This finding is in line with studies conducted in Nigeria ( 48 ), and Taiwan (OR = 3.38; 95% CI: 1.10 to 8.04) ( 7 ). Furthermore, neonates with confirmed meningitis by CSF culture (AOR = 3.53; 95% CI: 1.45 to 8.57) were 3.5 times more likely to experience poor treatment outcomes than those with probable meningitis. Neonates with CSF protein counts above 400 mg/dl (AOR = 17.9; 95% CI: 7.95 to 40.3) had a significantly higher risk of poor treatment outcomes than those with lower values. This finding is consistent with a study conducted in Taiwan (OR = 171; 95% CI interval: 25.6 to 1000) ( 39 ). The study found that newborns with CSF glucose levels less than 10 mg/dl at admission (AOR = 3.89; 95% CI: 1.55 to 9.77) were four times more likely to have poor treatment outcomes, which is comparable to a study conducted in Southern Taiwan ( 52 ). Protein and glucose are vital markers for diagnosing meningitis. CSF glucose levels are typically low, and protein levels rise in bacterial meningitis. This is due to glucose consumption by bacteria and white blood cells, slowed glucose transfer into the CSF, higher number of reproducing bacteria, and body cells fighting the infection ( 53 ). A high protein and low glucose concentration in CSF characterized the severity of the disease and also the presence of additional sequelae. Conclusion The study found that approximately 33% of newborns with meningitis experienced poor treatment outcomes. Epilepsy and hydrocephalus were the most commonly observed neurological sequelae. Several factors were associated with poor outcomes, including congenital hydrocephalus, vacuum-assisted delivery, positive CSF culture, seizures, elevated CSF protein with low glucose, and co-occurrence with early-onset neonatal sepsis. Limitations of the study The study has three primary limitations. First, the data were derived exclusively from retrospective reviews of medical records, which inherently limited the available information. Key maternal variables, such as history of infections during pregnancy, socioeconomic status, underlying maternal illnesses, antenatal care utilization, and substance use during pregnancy, were absent. These factors are known to influence neonatal outcomes. Second, the assessment of treatment outcomes for neonatal meningitis was confined to the duration of hospitalization. As a result, the study was unable to capture long-term neurodevelopmental consequences, such as cognitive impairment, behavioral challenges, or delays in motor and language development, which often emerge months or years after the acute illness. Furthermore, the impact of neonatal meningitis on school performance and quality of life in later childhood remains unexplored in this study. Third, the study did not differentiate between community-acquired and hospital-acquired (nosocomial) infections. This distinction is clinically significant, as the causative organisms, resistance patterns, and prognoses often differ between the two. The inability to categorize infections by their source may obscure important epidemiological and treatment-related insights that could inform infection control practices and antibiotic stewardship. Declarations Sources of funding The authors have not declared a specific grant for this research from any funding agency in the public, commercial, or not-for-profit sectors. Acknowledgments We would like to thank the administrators, data collectors, and card room staff at Hiwot Fana Comprehensive Specialized University Hospital and Jugal General Hospital for their support during data collection. Author contributions Conceptualization: Getahun Tamiru Yirsaw, Shambel Nigussie Amare, Tadesse Bekele Tafesse Data curation: Getahun Tamiru Yirsaw, Shambel Nigussie Amare, Tadesse Bekele Tafesse, Abera Jambo Bune Formal analysis: Getahun Tamiru Yirsaw, Shambel Nigussie Amare, Tadesse Bekele Tafesse, Abera Jambo Bune Investigation: Getahun Tamiru Yirsaw, Shambel Nigussie Amare Methodology: Getahun Tamiru Yirsaw, Shambel Nigussie Amare, Tadesse Bekele Tafesse, Abera Jambo Bune Project administration: Shambel Nigussie Amare, Tadesse Bekele Tafesse Software: Getahun Tamiru Yirsaw, Shambel Nigussie Amare Validation: Shambel Nigussie Amare, Tadesse Bekele Tafesse, Visualization: Abera Jambo Bune Writing– review & editing: Shambel Nigussie Amare, Tadesse Bekele Tafesse, Conflict of interest The authors declared that they have no competing interests in this work. Data availability statement The datasets generated during and/or analysed during the current study are available from the corresponding author on reasonable request. References World Health Organization. Meningitis. 2025. https://www.who. int/publications/ i/item/ 9789240108042. Bedetti L, Miselli F, Minotti C, Latorre G, Loprieno S, Foglianese A, et al. Lumbar Puncture and Meningitis in Infants with Proven Early-or Late-Onset Sepsis: An Italian Prospective Multicenter Observational Study. Microorganisms. 2023;11(6):1546. Bundy LM RM, Noor A. Neonatal Meningitis In: StatPearls [Internet]: Treasure Island (FL): StatPearls Publishing; 2023 [cited 2023 July 6]. Available from: https://www.ncbi.nlm.nih.gov/books/NBK532264/. Aleem S, Greenberg RG. When to include a lumbar puncture in the evaluation for neonatal sepsis. Neoreviews. 2019;20(3):e124-e34. Mashau RC, Meiring ST, Dramowski A, Magobo RE, Quan VC, Perovic O, et al. 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Meconium-Stained Amniotic Fluid: Impact on Prognosis of Neonatal Bacterial Meningitis. Journal of Tropical Pediatrics. 2022;68(5):fmac064. Wondimu MN, Toni AT, Zamanuel TG. Magnitude of neonatal meningitis and associated factors among newborns with neonatal sepsis admitted to the University of Gondar Comprehensive Specialized Hospital, North Gondar, Ethiopia. PLoS One. 2023;18(9):e0290639. Laving A, Musoke R, Wasunna A, Revathi G. Neonatal bacterial meningitis at the newborn unit of Kenyatta National Hospital. East African medical journal. 2003;80(9):456-62. Lin M-C, Chi H, Chiu N-C, Huang F-Y, Ho C-S. Factors for poor prognosis of neonatal bacterial meningitis in a medical center in Northern Taiwan. Journal of Microbiology, Immunology and Infection. 2012;45(6):442-7. Okike IO, Johnson AP, Henderson KL, Blackburn RM, Muller-Pebody B, Ladhani SN, et al. Incidence, etiology, and outcome of bacterial meningitis in infants aged< 90 days in the United Kingdom and the Republic of Ireland: prospective, enhanced, national population-based surveillance. Clinical Infectious Diseases. 2014;59(10):e150-e7. Biset S, Benti A, Molla L, Yimer S, Cherkos T, Eyayu Y, et al. Etiology of neonatal bacterial meningitis and their antibiotic susceptibility pattern at the University of Gondar Comprehensive Specialized Hospital, Ethiopia: a seven-year retrospective study. Infection and Drug Resistance. 2021:1703-11. Boskabadi H, Heidari E, Zakerihamidi M. Etiology, clinical findings, and laboratory parameters in neonates with acute bacterial meningitis. Iranian Journal of Microbiology. 2020;12(2):89. Kamoun F, Dowlut MB, Ameur SB, Sfaihi L, Mezghani S, Chabchoub I, et al. Neonatal purulent meningitis in southern Tunisia: Epidemiology, bacteriology, risk factors and prognosis. Fetal and pediatric pathology. 2015;34(4):233-40. 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Diagnostic accuracy of cerebrospinal fluid lactate for differentiating bacterial meningitis from aseptic meningitis: a meta-analysis. Journal of Infection. 2011;62(4):255-62. Additional Declarations No competing interests reported. Supplementary Files S1.sav Cite Share Download PDF Status: Posted Version 1 posted You are reading this latest preprint version Research Square lets you share your work early, gain feedback from the community, and start making changes to your manuscript prior to peer review in a journal. As a division of Research Square Company, we’re committed to making research communication faster, fairer, and more useful. We do this by developing innovative software and high quality services for the global research community. Our growing team is made up of researchers and industry professionals working together to solve the most critical problems facing scientific publishing. Also discoverable on Platform About Our Team In Review Editorial Policies Advisory Board Help Center Resources Author Services Accessibility API Access RSS feed Manage Cookie Preferences © Research Square 2026 | ISSN 2693-5015 (online) Privacy Policy Terms of Service Do Not Sell My Personal Information {"props":{"pageProps":{"initialData":{"identity":"rs-7103387","acceptedTermsAndConditions":true,"allowDirectSubmit":true,"archivedVersions":[],"articleType":"Article","associatedPublications":[],"authors":[{"id":496215464,"identity":"c24c549b-8f79-4c7c-9ec9-337a2b10224a","order_by":0,"name":"Getahun Tamiru Yirsaw","email":"data:image/png;base64,iVBORw0KGgoAAAANSUhEUgAAAZAAAAAyAQMAAABI0h/eAAAABlBMVEX///8AAABVwtN+AAAACXBIWXMAAA7EAAAOxAGVKw4bAAABCUlEQVRIiWNgGAWjYJCCAxCKh4GB8U+NHFjkAR7lPDAtPGAtDceMwVoSCGhhQNLCnNgA4uHTYs9+OvFwZVutnD372WPShTvY0ueHHX4ItMVOTrcBhy08uRsOnm07bszDk5cmPfOMTO7G22kGQC3JxmYHcDkMqKWx7VhiD0OOmTQPG1vuxtkJIC0HErfh0sL/Fqylvof/DUgLc7rh7PQP+LVIgG2pSeCRANrC28acIC+dQ8CWG0BbGs4dMOy58cbYmufMMcMN0jkFBxIMcPuFvT9388eGsjp59v4cw9s8FTXy8rPTN3/4UGEnh0sLFBxGMA3AKg3wKgeBOgRTvoGg6lEwCkbBKBhhAAB5VGK3OhBIpQAAAABJRU5ErkJggg==","orcid":"","institution":"Haramaya University","correspondingAuthor":true,"prefix":"","firstName":"Getahun","middleName":"Tamiru","lastName":"Yirsaw","suffix":""},{"id":496215465,"identity":"36ec5d71-5bd1-41ee-a452-a8ddba253e01","order_by":1,"name":"Tadesse Bekele Tadesse","email":"","orcid":"","institution":"Haramaya University","correspondingAuthor":false,"prefix":"","firstName":"Tadesse","middleName":"Bekele","lastName":"Tadesse","suffix":""},{"id":496215466,"identity":"672547de-a455-4a85-891d-0aa6a5c3a661","order_by":2,"name":"Abera Jambo Bune","email":"","orcid":"","institution":"Haramaya University","correspondingAuthor":false,"prefix":"","firstName":"Abera","middleName":"Jambo","lastName":"Bune","suffix":""},{"id":496215467,"identity":"aeb9a2aa-333c-4d3b-827d-ed64c65316fe","order_by":3,"name":"Shambel Nigussie Amare","email":"","orcid":"","institution":"Haramaya University","correspondingAuthor":false,"prefix":"","firstName":"Shambel","middleName":"Nigussie","lastName":"Amare","suffix":""}],"badges":[],"createdAt":"2025-07-11 16:23:23","currentVersionCode":1,"declarations":"","doi":"10.21203/rs.3.rs-7103387/v1","doiUrl":"https://doi.org/10.21203/rs.3.rs-7103387/v1","draftVersion":[],"editorialEvents":[],"editorialNote":"","failedWorkflow":false,"files":[{"id":88503699,"identity":"165ad125-c62b-441d-ba3d-92eb79e082ab","added_by":"auto","created_at":"2025-08-07 07:04:20","extension":"png","order_by":1,"title":"Figure 1","display":"","copyAsset":false,"role":"figure","size":28320,"visible":true,"origin":"","legend":"\u003cp\u003eSigns and symptoms of meningitis among neonates admitted at public hospitals in Harar town, Eastern Ethiopia, from February 10 to March 20, 2025.\u003c/p\u003e","description":"","filename":"floatimage1.png","url":"https://assets-eu.researchsquare.com/files/rs-7103387/v1/b69edc6ef7263d9a95009993.png"},{"id":96708319,"identity":"bc33a6e7-b546-4587-a922-97ccdcd183fc","added_by":"auto","created_at":"2025-11-25 10:01:05","extension":"pdf","order_by":0,"title":"","display":"","copyAsset":false,"role":"manuscript-pdf","size":1275892,"visible":true,"origin":"","legend":"","description":"","filename":"manuscript.pdf","url":"https://assets-eu.researchsquare.com/files/rs-7103387/v1/500ae46c-46d9-4e69-a4ea-cd191107dff6.pdf"},{"id":88503707,"identity":"9e286692-d41b-495f-916f-2b9170c02554","added_by":"auto","created_at":"2025-08-07 07:04:20","extension":"sav","order_by":0,"title":"","display":"","copyAsset":false,"role":"supplement","size":734827,"visible":true,"origin":"","legend":"","description":"","filename":"S1.sav","url":"https://assets-eu.researchsquare.com/files/rs-7103387/v1/514828974fcb9215ac733a3b.sav"}],"financialInterests":"No competing interests reported.","formattedTitle":"Treatment Outcomes of Meningitis and Its Associated Factors among Neonates Admitted in Public Hospitals at Harar Town, Ethiopia: Cross-sectional study","fulltext":[{"header":"Introduction","content":"\u003cp\u003eMeningitis is a central nervous system infection that can cause inflammation in the subarachnoid space of the brain and spinal cord. It is usually caused by infectious agents, such as bacteria, viruses, fungi, and parasites (\u003cspan citationid=\"CR1\" class=\"CitationRef\"\u003e1\u003c/span\u003e). Newborns are at a high risk for meningitis due to their immature immune systems (\u003cspan citationid=\"CR2\" class=\"CitationRef\"\u003e2\u003c/span\u003e, \u003cspan citationid=\"CR3\" class=\"CitationRef\"\u003e3\u003c/span\u003e). It can be classified as early-onset (≤ 72 hours) or late-onset (\u0026gt; 72 hours) based on the time of infection occurring after birth (\u003cspan citationid=\"CR3\" class=\"CitationRef\"\u003e3\u003c/span\u003e).\u003c/p\u003e\u003cp\u003ePathogens causing neonatal meningitis differ depending on the neonate's gestational age at birth, age at presentation, and geographic location (\u003cspan citationid=\"CR3\" class=\"CitationRef\"\u003e3\u003c/span\u003e). In early-onset meningitis, Group B Streptococcus (GBS) and \u003cem\u003eEscherichia coli (E. coli\u003c/em\u003e) are the most prevalent pathogens (\u003cspan citationid=\"CR2\" class=\"CitationRef\"\u003e2\u003c/span\u003e, \u003cspan additionalcitationids=\"CR5 CR6\" citationid=\"CR4\" class=\"CitationRef\"\u003e4\u003c/span\u003e–\u003cspan citationid=\"CR7\" class=\"CitationRef\"\u003e7\u003c/span\u003e). The pathogens of late-onset meningitis vary depending on gestational weeks, birth weight, and setting (\u003cspan citationid=\"CR3\" class=\"CitationRef\"\u003e3\u003c/span\u003e). GBS and \u003cem\u003eE. coli\u003c/em\u003e are prevalent pathogens among neonates that develop meningitis in the community (\u003cspan additionalcitationids=\"CR9\" citationid=\"CR8\" class=\"CitationRef\"\u003e8\u003c/span\u003e–\u003cspan citationid=\"CR10\" class=\"CitationRef\"\u003e10\u003c/span\u003e). Staphylococci, \u003cem\u003eStaphylococcus aureus (S. aureus)\u003c/em\u003e, and Klebsiella are prevalent pathogens among neonates that develop meningitis in the healthcare setting (\u003cspan citationid=\"CR7\" class=\"CitationRef\"\u003e7\u003c/span\u003e, \u003cspan citationid=\"CR8\" class=\"CitationRef\"\u003e8\u003c/span\u003e).\u003c/p\u003e\u003cp\u003eGlobally, the incidence and mortality rates of neonatal meningitis were 854 (609.2-1183.3) and 137.2 (109.5-177.8) per 100,000 population, respectively, in 2019 (\u003cspan citationid=\"CR11\" class=\"CitationRef\"\u003e11\u003c/span\u003e). It also accounts for healthcare expenditures ranging from \u003cspan\u003e$\u003c/span\u003e222 to \u003cspan\u003e$\u003c/span\u003e33,635 per patient worldwide (\u003cspan citationid=\"CR12\" class=\"CitationRef\"\u003e12\u003c/span\u003e). The incidences and mortality rates of neonatal meningitis are higher in low- and middle-income countries, at 0.5-6 per 1,000 live births and 20–37%, respectively (\u003cspan citationid=\"CR5\" class=\"CitationRef\"\u003e5\u003c/span\u003e, \u003cspan additionalcitationids=\"CR14 CR15\" citationid=\"CR13\" class=\"CitationRef\"\u003e13\u003c/span\u003e–\u003cspan citationid=\"CR16\" class=\"CitationRef\"\u003e16\u003c/span\u003e), compared to high-income countries, which report rates of 0.3–0.4 per 1,000 live births and 2%-10%, respectively (\u003cspan citationid=\"CR5\" class=\"CitationRef\"\u003e5\u003c/span\u003e, \u003cspan citationid=\"CR6\" class=\"CitationRef\"\u003e6\u003c/span\u003e, \u003cspan citationid=\"CR17\" class=\"CitationRef\"\u003e17\u003c/span\u003e, \u003cspan citationid=\"CR18\" class=\"CitationRef\"\u003e18\u003c/span\u003e).\u003c/p\u003e\u003cp\u003eGlobally, among neonates who survive meningitis, 20–50% develop different neurological sequelae, such as hearing loss, blindness, epilepsy, hydrocephalus, subdural empyema, and psychomotor developmental delay (\u003cspan additionalcitationids=\"CR19 CR20\" citationid=\"CR18\" class=\"CitationRef\"\u003e18\u003c/span\u003e–\u003cspan citationid=\"CR21\" class=\"CitationRef\"\u003e21\u003c/span\u003e). Incidence and mortality rates of meningitis are high in Sub-Saharan Africa, a region referred to as the “meningitis belt” (\u003cspan citationid=\"CR11\" class=\"CitationRef\"\u003e11\u003c/span\u003e). For example, the incidence rate of neonatal meningitis in Kenya was 96 per 1000 live births (\u003cspan citationid=\"CR22\" class=\"CitationRef\"\u003e22\u003c/span\u003e), and the mortality rate is reported as 24% in Angola, 29.4% in Tanzania, and 37% in the Gambia (\u003cspan citationid=\"CR16\" class=\"CitationRef\"\u003e16\u003c/span\u003e, \u003cspan citationid=\"CR23\" class=\"CitationRef\"\u003e23\u003c/span\u003e, \u003cspan citationid=\"CR24\" class=\"CitationRef\"\u003e24\u003c/span\u003e). According to the Global Burden of Disease, Ethiopia has the third-highest rate of meningitis fatalities (\u003cspan citationid=\"CR25\" class=\"CitationRef\"\u003e25\u003c/span\u003e). It is responsible for the median cost of 98,812 ETB (Ethiopian Birr) (approximately US\u003cspan\u003e$\u003c/span\u003e 3,593.2) per patient in Ethiopia due to bacterial meningitis (\u003cspan citationid=\"CR26\" class=\"CitationRef\"\u003e26\u003c/span\u003e).\u003c/p\u003e\u003cp\u003eThe factors predicting a poor prognosis of meningitis among neonates include seizures, high protein levels in the cerebrospinal fluid (CSF), low birth weight or preterm birth, early onset of meningitis, and low CSF glucose levels (\u003cspan citationid=\"CR18\" class=\"CitationRef\"\u003e18\u003c/span\u003e, \u003cspan citationid=\"CR19\" class=\"CitationRef\"\u003e19\u003c/span\u003e, \u003cspan citationid=\"CR27\" class=\"CitationRef\"\u003e27\u003c/span\u003e). However, the predictors of poor prognosis may differ from place to place. Despite the high mortality and morbidity of neonatal meningitis in low-income countries, studies reporting the treatment outcomes and factors associated with poor prognosis have been limited, particularly in Ethiopia. To date, there is a single study done in Ethiopia on this topic (\u003cspan citationid=\"CR28\" class=\"CitationRef\"\u003e28\u003c/span\u003e).\u003c/p\u003e\u003cp\u003eHowever, the study does not represent the broader population of newborn meningitis due to an inadequate sample size. Additionally, there is a scarcity of studies on treatment outcomes and factors associated with poor treatment outcomes in the study area. Therefore, this study aimed to assess the treatment outcomes of neonatal meningitis and its associated factors in Harar town, Eastern Ethiopia.\u003c/p\u003e\u003cdiv id=\"Sec2\" class=\"Section2\"\u003e\u003cp\u003e\u003c/p\u003e\u003cp\u003e\u003c/p\u003e\u003c/div\u003e"},{"header":"Materials \u0026 Methods","content":"\u003cp\u003e\u003cstrong\u003eStudy design and settings\u003c/strong\u003e\u003c/p\u003e\n\u003cp\u003eA cross-sectional study design was conducted in Hiwot Fana Comprehensive Specialized University Hospital (HFCSUH) and Jugal General Hospital (JGH) from February 10 to March 20, 2025. Harar is the capital city of the Harari regional administration. It is located in the eastern part of the country, around 500 kilometers from the Ethiopian capital city, Addis Ababa. HFCSH was founded in 1948 and transitioned to a university-specialized hospital in 2010. JGH was founded in 1909. They include four wards: medical, pediatric, surgical, gynecology, and obstetrics. They also provide care for neonates, gynecology, ophthalmology, dentistry, adult outpatient, pediatric outpatient, and chronic follow-up.\u003c/p\u003e\n\u003cp\u003e\u003cstrong\u003eStudy population and variables\u003c/strong\u003e\u003c/p\u003e\n\u003cp\u003eAll medical records of neonates admitted to the Neonatal Intensive Care Units (NICUs) of HFCSUH and JGH with meningitis between October 1, 2020, and October 31, 2024, were included in this study. Incomplete medical records (i.e., diagnosis, treatment regimen, and discharge summary), those discharged against medical advice, those discontinued treatment within 72 hours, and those referred to another institution were excluded from this study. Data were collected on \u003cstrong\u003esocio-demographic factors\u003c/strong\u003e (admission site, sex, age, birth weight, and gestational age), \u003cstrong\u003eclinical factors (\u003c/strong\u003epre-existing medical condition (congenital heart defects, down syndrome, congenital hydrocephalus), maternal health factors (complication during deliver (history of PROM, meconium stain in amniotic fluid, chroinammionitcs) and mode of deliver (spontaneous vaginal delivery, C/S, assisted by vacuum), symptoms at diagnosis, blood test, cerebrospinal fluid tests, type of pathogen, and specific isolated pathogen), and \u003cstrong\u003etreatment-related factors\u003c/strong\u003e (antimicrobial therapy (choice of antimicrobial) and supportive care (nutrition and management of complications)).\u003c/p\u003e\n\u003cp\u003e\u003cstrong\u003eOutcome measurement\u003c/strong\u003e\u003c/p\u003e\n\u003cp\u003eIn this study, treatment outcomes were categorized into \u0026quot;\u003cstrong\u003egood\u003c/strong\u003e\u0026quot; for those who recovered or improved and were discharged without complications and \u003cstrong\u003epoor\u003c/strong\u003e for those who died in the hospital, were discharged with complications, or did not improve.\u003c/p\u003e\n\u003cp\u003e\u003cstrong\u003eSample size determination and sampling technique\u003c/strong\u003e\u003c/p\u003e\n\u003cp\u003eSample size was calculated for the outcome variable and factors associated with poor treatment outcomes (i.e., seizure, preterm, early-onset sepsis, prolonged shock, mechanical ventilation, and congenital heart disease). Single- and double-population proportion formulas were used to calculate sample sizes for the outcome variable and related factors, respectively.\u003c/p\u003e\n\u003cp\u003eSample size for the treatment outcome was calculated considering the following assumptions: a 95% confidence interval, a 5% margin of sampling error, and a 20.7% proportion from a study conducted at Tibebegion Comprehensive Specialized Hospital in Bahirdar, Ethiopia (\u003cspan class=\"CitationRef\"\u003e28\u003c/span\u003e).\u003c/p\u003e\n\u003cp\u003e\u003cimg src=\"data:image/png;base64,iVBORw0KGgoAAAANSUhEUgAAASwAAAA7CAYAAADB2bfiAAAAAXNSR0IArs4c6QAAAARnQU1BAACxjwv8YQUAAAAJcEhZcwAADsMAAA7DAcdvqGQAAApYSURBVHhe7Z2/bhU7EIc39zGiKELAM1AgkoIi8AAUhIoqEjwANJQ0IGoipaIKFHkAoKAgKAXPAAhFUV7j3v2WnTCZ2PvnnMM96/D7JJNde9ee8cyOvd4Er/xbUwkhRAH80/4UQojJo4AlhCgGBSwhRDEoYAkhikEBSwhRDApYQohiUMASQhSDApYQohgUsIQQxaCAJYQoBgWsP8jjx4+rlZWVJn358qXNFULMSmfA8g8c6fr1623JdCEwpOR8+fJlo08f3Gv6pq735b6dWP+PHz+axJ9qfv/+vXr+/HlbkoZ7qSNy9+7d6t27d+1ZHvQ2uUi03YXXgxShXSvzenHs7/PJylN6kBfzkdHf3xfUvUykqKOXjWsN2vX3+dTXT8sip0sOr1O8Hv/x5ZG+8rF0+Vb0U5L3ryjLBV/ij59T3Llzp0meR48e8YfS7dk0uXbt2r91gGjPfvHixYtGbuTvgnu9zlzv70mV+3OO37592579BnliX3oODw+T5eQhd6pOD/dznenN9V12ol6vF8foZsRyyujDHFFGrkcmQCbrexLHlFm+XRd1iHCv7yOzqRHLow6RPp2WyVhdrH8Nf33sV3T2to6+EsvHEmXl2NdH/bl+j7Kaj3jfyno1F5ozeWIFNE6epZzDAeXx+kVC3b6zTGES+b4skntgLK8vCAB1pIyNEVN9aXCPL7e2uI8y398pUrp13Rf1tH7ipz82qCelF6QeJq4nH6we08XAVnaNwXnOmWMfAXJanj8GjslLgbyx7SkxRhf6K2cbiL4R7Zvq89j+GHzdENtDllzd8fmFKH/2CaQT+oxKA74j43mEMt+51B8FNKyuVPId4olOzXX20EbFIzmnII8y5Bni5FGGeB6hzPcJILPpSFku8Bgpp+vT1+N198dGdDrDrk3Zw+ebfD7wpeQb2sfgZfLHHvJi39u1MX8eqC+Vhva/Z4wuMMbOQB97f0v5l9nLZEml6G85oj/RHsnq6bN39O3sGta3b9+qDx8+nHufjGsMe3t7Va1se1ZVT548qWphkmsYhl/LuX37dnYNgbpq+ZLp6tWr7VW/oZ66g6vV1dU2p2quu3//fnvWza1btxrZ/fu01+Pnz59NfX1rC1tbW9X+/n5zzLv8x48fm7pzHB0dnVsLA2RO6ZgDW62vr7dn48EmtdM3xycnJ00/DMHuS8laO1p1cHDQHL9//76xJ3ohK2CvK1euNMez8OrVq6YN2j49PW3yhvSZ3ddlk7GkfJT0+vXr9orhjNEFrB/9+p73YcPWhp4+fVq9efOmza2aZ2Ztba09Ow8ypPQiYc8heN+yZ3RnZ+esHsit0RFviEH37t1rc3oW3a1SGoGNjY1GaSOlLA8sD3eOeL058Lx8/fq1edCGGjoFsuzu7p4ZPkLZ5uZmZ2fjPBgGB6F/kIm6YlAyPn361ATuZYH86D324UJHnOnBgwdtznmwQ5cfzAMPJLYgEI6F+x4+fNieXQ4IQs+ePTvzSwbJGLQYLKyc5xj//NNE37IA6IMdZfgR/uQhWCEnEyL/TA/6tQYfaftmUItiWV92TE+Sj+zASOFnbDgJnR3BSN5BSIsKzH4ktb4gGB4fH7dXDIf7kMvLxoBiA1QXzJ7wha6ZSpedZg1o6E/QoU8Nm1X3+YU9pN6Gi8Dbw6fUTKePobp46lemc3ZgVkPQyoEff/78uTnGhsyqUyBDSi9SXwxI+dZQsJMFq2irZMCy6WMKP4NKKUtHzTPVN8a+Ev4JmLUBzsDMaii52dQiYFYR+yL18GOHLpmR0ZzKk3pgUrNXZob4QhdddrKZqKdvtmkjNnp7rB17nQJbvvAPMg8pr4OLxtvDp1leCYfqYvTNzumzruCCD8TBjkH45s2bjSwpvUhdr4Q530KPGFfiKzCxZ3t7uzo8PEwPLHXjSWoHvbAgVo+8zUKZLf6xGOariOcRfy9wPe0sApONnynqUaV3cZL7/QIk537BL8qP7LHOIe14qD/2s4c24qJoxBY2TTau5zwH7XW1GcuRwfcD9MnF/fEej9nL6jAduuzX5SuxnPajHfpkmgpDdDFSfs+56Wm+YOU5X7Fy7uvq5z6QlZSDur0NODfdomwp8l5dQ8NU4FN0KBr35V1Q7oWZt3Mi1JV7iOiUaHTa951rxrfkO9bw5SnDIENXh0fMSDm6dPKY41nydvJ6Wnup5OWmXctPPSzx+gjl0VciURZfn5VBtItPvm+8v+ZsM6Qvp0CXLlGP2D8pP/fl0W6xfFaiPX3ybfp8L6vX2Sev/6XaNYfpJNP+Wabii4ApLwu6Y9/bmbazHta1HlQS2IEvUbMsigvRxaXb5ot3Z9Zv6lGozRFiHMt8JHJrx8tgiqHh0gWsWWc588LCJovGs84q+KLEQvTQ32+ZKvZlbFmzXHG50UaqQohiGPR7WEIIMQUUsIQQxaCAJYQoBgUsIUQxKGAJIYpBAUsIUQwKWEKIYlDAEkIUgwKWEKIYFLCEEMWggCWEKAYFLCFEMShgCSGKQQFLCFEMClhCiGJQwBJCFIMCVuHYlmxD9ooTonQUsGaEAGH76sUNJ20fuRw+yJA8qc0r2aQCqJf/s97jd/zd29trc8VUwX5m174Bps+vuvwIfFn0G+ry5aRZNn793+G/SBbjYGsi22bJtliybYxsq6PcFle2HZfBFkts22RQntpWy+D6XLmvR0wP7IP9DPwgt+1Yn1/1+VFsi62y/HZZlPnyUlDAGgmO4x0Do8d94zjPOUOqzDsmZTknNrzjGtyXa1MsHws4HuwVfcdIlXnf6fIjC3ae2D6DnvlcSeiVcCT7+/vVzs5Oe1Y1W8THLdnZPpwddFKwm8/6+np79ova+aqjo6PmmPt4zbNpepzKQ+1s1cHBQXv2e6ea0nfcucycnJxc2HqO7eDZFj5Fn191+ZFtMe+J7bMVHrtLmZ/ZssPUUcAaCYb2jsI6A9tzDaUe/aq1tbX27CI48NbWVuNwJI5j0Nrc3DxbryJYca5gNW2Oj4+Tg0+OPr/q86MIg6ANtNTN/Zybn0EJQUsBawRm6Bs3brQ5iwfn8Xv6cUybfsEVRyUPeXZ3d6vt7e2zkZI8ITwESpINajYD84McfsZgOXX/UcCaE4zP9H0oTMuZni8KGyEtxdcIMQ2YlY/Z3LfPr4b6kS0rzLrB79RQwJoTpu1xVGKdgfWGFDgPrwceRjbWM6gnzpLseHV1tfnpUXAqB5sVe1hvYt0pRZ9fdfmRgS+x3hmDlf1Kg+f09LT5OXmfqkdlMQK+EPqveLUTNl9fLM++xpCfwj5HWzlfeqjT4OuP/7UFzkke6vD3iDLAZt623m8ifX7V50exrQjl/itj3/VTQQFrJBg1GtacyZL/XGxlHhzFXx/BeawsBiug/fhJW5SBt3u0IXkp37HkyyDnRxbMUskPpD6/hGAFK/xTCywGwjSdL3dj1iMWDdP52vH0Sij+OrSGNRKCBAGLP4tYBvw5Rz0aKliJvxLNsGZkGbMcFks3NjaY+7c5QvxdKGAJIYpBr4RCiGJQwBJCFEJV/Qfo9ehVKLttFAAAAABJRU5ErkJggg==\"\u003e\u003c/p\u003e\n\u003cp\u003eSample size for associated factors (i.e., seizure (\u003cspan class=\"CitationRef\"\u003e29\u003c/span\u003e), preterm (\u003cspan class=\"CitationRef\"\u003e30\u003c/span\u003e), early-onset sepsis (\u003cspan class=\"CitationRef\"\u003e31\u003c/span\u003e), prolonged shock (\u003cspan class=\"CitationRef\"\u003e32\u003c/span\u003e), mechanical ventilation (\u003cspan class=\"CitationRef\"\u003e33\u003c/span\u003e), and congenital heart disease (\u003cspan class=\"CitationRef\"\u003e34\u003c/span\u003e)) were computed using Epi Info V.7. 1, with considered the following assumptions: a 95% confidence interval, a 5% margin of sampling error tolerated, and an 80% power.\u003c/p\u003e\n\u003cp\u003eThe higher sample size was used as the final value in the previously stated single and double population proportion computations. The sample size for early-onset sepsis was chosen since it provided a larger sample size. The final sample size was 506 after adding 5% for contingency. Finally, 506 medical records of patients were reviewed. Representatives from each institution were selected using a simple random selection method. Initially, the patient\u0026apos;s register number was obtained from the registration logbook. Then, patients\u0026apos; medical records were entered into a computer program (Microsoft Excel) to select representatives through a lottery method. The sample size was allocated proportionally across HFCSUH and JGH based on the number of neonates admitted with meningitis between October 1, 2020, and October 31, 2024 (HFCSUH\u0026thinsp;=\u0026thinsp;725 and JGH\u0026thinsp;=\u0026thinsp;321). Three hundred fifty-one and 155 representative patients were chosen from HFCSUH and JGH, respectively.\u003c/p\u003e\n\u003cp\u003e\u003cstrong\u003eData collection tool and procedure\u003c/strong\u003e\u003c/p\u003e\n\u003cp\u003eThe data collection tool was developed based on relevant literature and includes closed-ended questions on socio-demographics, clinical factors, and treatment-related factors. Data was extracted from the medical records of patients. Before that, the number of medical records was obtained from the registry logbook of patients admitted to the neonate ward between October 1, 2020, and October 31, 2024, at HFCSUH and JGH, accessed from February 10 to March 20, 2025. Then, the medical records were traced from the card room store of the HFCSUH and JGH. Finally, all necessary information was extracted from complete medical records after checking the completeness of the information.\u003c/p\u003e\n\u003cp\u003e\u003cstrong\u003eData quality assurance\u003c/strong\u003e\u003c/p\u003e\n\u003cp\u003eBefore actual data collection, a counter-check was done on 5% of the sample size at Haramaya General Hospital, and the tool was modified as needed. Four clinical pharmacists participated in the data collection process. Appropriate orientation was given to the data collectors on the data abstraction tool and the objective of the data collection before starting actual data collection. Data was checked during collection and before processing to ensure completeness and consistency.\u003c/p\u003e\n\u003ch2\u003eStatistical analysis\u003c/h2\u003e\n\u003cp\u003eData was collected by using the restricted Kobo-Collect tool V 2024.2.4, to ensure consistency, completeness, and then exported to SPSS version 27 for analysis. Descriptive data were summarized using frequencies and percentages for categorical variables and the mean (standard deviation) for continuous variables. A binary logistic regression model was used to analyze the independent effects of each variable on treatment outcome, and a variable with a p-value\u0026thinsp;\u0026lt;\u0026thinsp;0.25 was selected for a multivariate logistic regression model, which identified the independent contribution of each variable. The Hosmer-Lemeshow test was applied to assess the goodness of fit for the logistic regression model. The model was well-fitted with a p-value of 0.53. The variance inflation factor (VIF) was applied to detect multicollinearity in the regression model. The VIF value was 1.74, indicating very weak correlations between the independent variables. The association between dependent and independent variables was measured using COR (crude odds ratio) and AOR (adjusted odds ratio) along with a 95% confidence interval. A p-value\u0026thinsp;\u0026lt;\u0026thinsp;0.05 was considered a significant association factor for poor outcomes.\u003c/p\u003e\n\u003cp\u003e\u003cstrong\u003eOperational definitions\u003c/strong\u003e\u003c/p\u003e\n\u003cp\u003e\u003cstrong\u003eConfirmed meningitis\u003c/strong\u003e\u003c/p\u003e\n\u003cp\u003ewhen the cause of pathogen isolated from primary CSF culture and present with clinical manifestations of meningitis such as fever, seizures, thermal instability, unable to suck, etc. with (\u003cspan class=\"CitationRef\"\u003e35\u003c/span\u003e, \u003cspan class=\"CitationRef\"\u003e36\u003c/span\u003e).\u003c/p\u003e\n\u003cp\u003e\u003cstrong\u003eSuspected meningitis\u003c/strong\u003e\u003c/p\u003e\n\u003cp\u003ewhen negative CSF culture or not cultured, but CSF characteristics fulfilled these values (leukocyte count\u0026thinsp;\u0026gt;\u0026thinsp;32/mm\u003csup\u003e3\u003c/sup\u003e and \u0026gt;\u0026thinsp;29/mm\u003csup\u003e3\u003c/sup\u003e; glucose level\u0026thinsp;\u0026lt;\u0026thinsp;34 mg/dl and \u0026lt;\u0026thinsp;24 mg/dl; and protein level\u0026thinsp;\u0026gt;\u0026thinsp;170 mg/dl and \u0026gt;\u0026thinsp;150 mg/dl in term and preterm, respectively) (\u003cspan class=\"CitationRef\"\u003e35\u003c/span\u003e, \u003cspan class=\"CitationRef\"\u003e36\u003c/span\u003e).\u003c/p\u003e\n\u003cp\u003e\u003cstrong\u003eNeurological complication\u003c/strong\u003e\u003c/p\u003e\n\u003cp\u003eoccurrences of any disease secondary to meningitis include seizure, subdural effusion, brain abscess, hearing loss, hydrocephalus, subdural empyema, subdural effusion, and brain abscess.\u003c/p\u003e\n\u003cp\u003e\u003cstrong\u003eEthical considerations\u003c/strong\u003e\u003c/p\u003e\n\u003cp\u003eThis study was approved by the Institutional Health Research Ethics Review Committee (IHRERC) of the College of Health and Medical Sciences, Haramaya University, with the reference number IHRERC/041/2025 that entitled \u0026apos;\u0026apos;Treatment Outcomes of Meningitis and Its Associated Factors among Neonates Admitted in Public Hospitals at Harar Town, Ethiopia: Cross-sectional study\u0026apos;\u0026apos; accessed from February 10 to March 20, 2025. Cooperative letters were sent to the Hiwot Fana Comprehensive Specialized University Hospital (HFCSUH) and the Jugal General Hospital (JGH). The patient\u0026apos;s privacy and confidentiality were ensured. The patient\u0026apos;s identification was not documented. Patients\u0026apos; consent was not obtained directly from patients\u0026apos; parents due to an unregistered phone number on the medical records and did not interact or interviews any patient\u0026rsquo;s parents. However, consent was obtained from the institution. Additionally, the patient\u0026rsquo;s information was kept confidential, and the patient\u0026apos;s name and other details that could identify them were not recorded.\u003c/p\u003e"},{"header":"Results","content":"\u003cp\u003e\u003cstrong\u003eSocio-demographic characteristics of patients\u003c/strong\u003e\u003c/p\u003e\n\u003cp\u003eThis study included 506 neonates with meningitis from the NICUs of HFCSUH (351) and JGH (155). Of all, 278 (54.9%) patients were male, with a male-to-female ratio of 1.22:1. The ages of patients were distributed relatively high among early (\u0026lt; 7 days) newborns, with a mean age of 8.91 ± 5.92 days \u003cstrong\u003e(Table\u0026nbsp;1).\u003c/strong\u003e\u003c/p\u003e\n\u003cdiv\u003e\n \u003ctable id=\"Tab1\" border=\"1\"\u003e\n \u003ccaption language=\"En\"\u003e\n \u003cdiv\u003eTable 1\u003c/div\u003e\n \u003cdiv\u003e\n \u003cp\u003eSocio-demographic characteristics of neonates admitted with meningitis at public hospitals in Harar town, Eastern Ethiopia, from February 10 to March 20, 2025 [n = 506].\u003c/p\u003e\n \u003c/div\u003e\n \u003c/caption\u003e\n \u003cthead\u003e\n \u003ctr\u003e\n \u003cth align=\"left\"\u003e\n \u003cp\u003eVariable\u003c/p\u003e\n \u003c/th\u003e\n \u003cth align=\"left\"\u003e\n \u003cp\u003eCategory\u003c/p\u003e\n \u003c/th\u003e\n \u003cth align=\"left\"\u003e\n \u003cp\u003eFrequency\u003c/p\u003e\n \u003c/th\u003e\n \u003cth align=\"left\"\u003e\n \u003cp\u003ePercent\u003c/p\u003e\n \u003c/th\u003e\n \u003c/tr\u003e\n \u003c/thead\u003e\n \u003ctbody\u003e\n \u003ctr\u003e\n \u003ctd align=\"left\" rowspan=\"2\"\u003e\n \u003cp\u003eSite of admission\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd align=\"left\"\u003e\n \u003cp\u003eHFCSUH\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd align=\"char\"\u003e\n \u003cp\u003e351\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd align=\"char\"\u003e\n \u003cp\u003e69.4\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd align=\"left\"\u003e\n \u003cp\u003eJGH\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd align=\"char\"\u003e\n \u003cp\u003e155\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd align=\"char\"\u003e\n \u003cp\u003e30.6\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd align=\"left\" rowspan=\"2\"\u003e\n \u003cp\u003eSex\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd align=\"left\"\u003e\n \u003cp\u003eFemale\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd align=\"char\"\u003e\n \u003cp\u003e228\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd align=\"char\"\u003e\n \u003cp\u003e45.1\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd align=\"left\"\u003e\n \u003cp\u003eMale\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd align=\"char\"\u003e\n \u003cp\u003e278\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd align=\"char\"\u003e\n \u003cp\u003e54.9\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd align=\"left\" rowspan=\"2\"\u003e\n \u003cp\u003eAge (days)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd align=\"left\"\u003e\n \u003cp\u003e\u0026lt; 7\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd align=\"char\"\u003e\n \u003cp\u003e270\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd align=\"char\"\u003e\n \u003cp\u003e53.4\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd align=\"left\"\u003e\n \u003cp\u003e7–28\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd align=\"char\"\u003e\n \u003cp\u003e236\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd align=\"char\"\u003e\n \u003cp\u003e46.6\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003c/tbody\u003e\n \u003ctfoot\u003e\n \u003ctr\u003e\n \u003ctd colspan=\"4\"\u003eHFCSUH: Hiwot Fana Compressive Specialized University Hospital; JGH: Jugal General Hospital\u003c/td\u003e\n \u003c/tr\u003e\n \u003c/tfoot\u003e\n \u003c/table\u003e\n\u003c/div\u003e\n\u003ch2\u003eNeonatal and maternal characteristics of health \u0026nbsp;\u003c/h2\u003e\n\u003cp\u003eIn this study, 181(36.2%) patients co-existed with sepsis upon admission. From this, 116 (22.9%) were diagnosed with early-onset neonatal sepsis, and 65 (12.8%) were diagnosed with late-onset neonatal sepsis. The mean birth weight and gestational age of neonates with meningitis were 3099 ± 393 grams and 36.9 ± 1.13 weeks, respectively. Only a few patients, 69 (13.6%), had a low birth weight (\u0026lt; 2500 g), and 130 (25.7%) were preterm (gestational age \u0026lt; 37 weeks). Forty-two (8.3%) patients presented with pre-existing medical conditions. Most neonates, 314 (62.1%), were born via spontaneous vaginal delivery. One hundred nineteen (23.5%) mothers of neonates experienced complications during pregnancy, including 71 (14%) with premature rupture of membranes (PROM), 31(6.1%) with eclampsia, 11 (2.2%) with chorioamnionitis, and 6 (1.2%) with meconium staining in the amniotic fluid \u003cstrong\u003e(Table\u0026nbsp;2).\u003c/strong\u003e\u003c/p\u003e\n\u003cdiv\u003e\n \u003ctable id=\"Tab2\" border=\"1\"\u003e\n \u003ccaption language=\"En\"\u003e\n \u003cdiv\u003eTable 2\u003c/div\u003e\n \u003cdiv\u003e\n \u003cp\u003eNeonatal and maternal health characteristics among neonates admitted with meningitis at public hospitals in Harar town, Eastern Ethiopia, from February 10 to March 20, 2025 [N = 506].\u003c/p\u003e\n \u003c/div\u003e\n \u003c/caption\u003e\n \u003cthead\u003e\n \u003ctr\u003e\n \u003cth align=\"left\"\u003e\n \u003cp\u003eVariable\u003c/p\u003e\n \u003c/th\u003e\n \u003cth align=\"left\"\u003e\n \u003cp\u003eCategory\u003c/p\u003e\n \u003c/th\u003e\n \u003cth align=\"left\"\u003e\n \u003cp\u003eFrequency\u003c/p\u003e\n \u003c/th\u003e\n \u003cth align=\"left\"\u003e\n \u003cp\u003ePercent\u003c/p\u003e\n \u003c/th\u003e\n \u003c/tr\u003e\n \u003c/thead\u003e\n \u003ctbody\u003e\n \u003ctr\u003e\n \u003ctd align=\"left\" rowspan=\"2\"\u003e\n \u003cp\u003eCo-existing\u003c/p\u003e\n \u003cp\u003eIllness\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd align=\"left\"\u003e\n \u003cp\u003eEONS\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd align=\"char\"\u003e\n \u003cp\u003e116\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd align=\"left\"\u003e\n \u003cp\u003e22.9\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd align=\"left\"\u003e\n \u003cp\u003eLONS\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd align=\"char\"\u003e\n \u003cp\u003e65\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd align=\"left\"\u003e\n \u003cp\u003e12.8\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd align=\"left\" rowspan=\"2\"\u003e\n \u003cp\u003eBirth weight of neonate (grams)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd align=\"left\"\u003e\n \u003cp\u003e\u0026lt; 2500\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd align=\"char\"\u003e\n \u003cp\u003e69\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd align=\"left\"\u003e\n \u003cp\u003e13.6\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd align=\"left\"\u003e\n \u003cp\u003e≥ 2500\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd align=\"char\"\u003e\n \u003cp\u003e437\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd align=\"left\"\u003e\n \u003cp\u003e86.4\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd align=\"left\" rowspan=\"2\"\u003e\n \u003cp\u003eGestational age of neonate (weeks)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd align=\"left\"\u003e\n \u003cp\u003e\u0026lt; 37\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd align=\"char\"\u003e\n \u003cp\u003e130\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd align=\"left\"\u003e\n \u003cp\u003e25.7\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd align=\"left\"\u003e\n \u003cp\u003e≥ 37\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd align=\"char\"\u003e\n \u003cp\u003e376\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd align=\"left\"\u003e\n \u003cp\u003e74.3\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd align=\"left\"\u003e\n \u003cp\u003ePre-existing medical condition\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd align=\"left\"\u003e\n \u003cp\u003eYes\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd align=\"char\"\u003e\n \u003cp\u003e42\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd align=\"left\"\u003e\n \u003cp\u003e8.3\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd align=\"left\" rowspan=\"3\"\u003e\n \u003cp\u003eType of pre-existing medical condition\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd align=\"left\"\u003e\n \u003cp\u003eCongenital hydrocephalus\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd align=\"char\"\u003e\n \u003cp\u003e35\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd align=\"left\"\u003e\n \u003cp\u003e6.9\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd align=\"left\"\u003e\n \u003cp\u003eDown syndrome\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd align=\"char\"\u003e\n \u003cp\u003e4\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd align=\"left\"\u003e\n \u003cp\u003e-\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd align=\"left\"\u003e\n \u003cp\u003eCongenital heart defects\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd align=\"char\"\u003e\n \u003cp\u003e3\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd align=\"left\"\u003e\n \u003cp\u003e-\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd align=\"left\" rowspan=\"3\"\u003e\n \u003cp\u003eMode of delivery\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd align=\"left\"\u003e\n \u003cp\u003eC/S\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd align=\"char\"\u003e\n \u003cp\u003e153\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd align=\"left\"\u003e\n \u003cp\u003e30.2\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd align=\"left\"\u003e\n \u003cp\u003eSpontaneous vaginal\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd align=\"char\"\u003e\n \u003cp\u003e314\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd align=\"left\"\u003e\n \u003cp\u003e62.1\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd align=\"left\"\u003e\n \u003cp\u003eVacuum\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd align=\"char\"\u003e\n \u003cp\u003e38\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd align=\"left\"\u003e\n \u003cp\u003e7.7\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd align=\"left\"\u003e\n \u003cp\u003eComplications during delivery\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd align=\"left\"\u003e\n \u003cp\u003eYes\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd align=\"char\"\u003e\n \u003cp\u003e119\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd align=\"left\"\u003e\n \u003cp\u003e23.5\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd align=\"left\" rowspan=\"4\"\u003e\n \u003cp\u003eType of complication\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd align=\"left\"\u003e\n \u003cp\u003ePROM\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd align=\"char\"\u003e\n \u003cp\u003e71\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd align=\"left\"\u003e\n \u003cp\u003e14.0\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd align=\"left\"\u003e\n \u003cp\u003eEclampsia\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd align=\"char\"\u003e\n \u003cp\u003e31\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd align=\"left\"\u003e\n \u003cp\u003e6.1\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd align=\"left\"\u003e\n \u003cp\u003eChorioamnionitis\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd align=\"char\"\u003e\n \u003cp\u003e11\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd align=\"left\"\u003e\n \u003cp\u003e2.2\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd align=\"left\"\u003e\n \u003cp\u003eMeconium stain in amniotic fluid\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd align=\"char\"\u003e\n \u003cp\u003e6\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd align=\"left\"\u003e\n \u003cp\u003e1.2\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003c/tbody\u003e\n \u003ctfoot\u003e\n \u003ctr\u003e\n \u003ctd colspan=\"4\"\u003eC/S: cesarean section; PROM: premature rupture of membranes\u003c/td\u003e\n \u003c/tr\u003e\n \u003c/tfoot\u003e\n \u003c/table\u003e\n\u003c/div\u003e\n\u003cp\u003e\u003cstrong\u003eLaboratory and clinical findings of patients\u003c/strong\u003e\u003c/p\u003e\n\u003cp\u003eIn this study, the mean white cell count in cerebrospinal fluid (CSF) was 1764.3 ± 833.3 per µL. However, 72 (14.2%) patients had CSF white cell counts above 2500 cells/mm³. One hundred eighteen (23.3%) patients had elevated CSF protein levels above 400 mg/dl, while 79 (15.6%) had CSF glucose levels of \u0026lt; 10 mg/dl, with a mean of 300.2 ± 108.2 mg/dl and 15.4 ± 6.9 mg/dl of protein and glucose, respectively. 113 (22.3%) revealed a positive Gram stain in their CSF. Gram-positive cocci (63, 12.5%) and gram-negative rods (40, 7.9%) were the most common infectious agents identified from the Gram stain. 71 (14%) had positive CSF cultures. GBS (25, 4.9%) and \u003cem\u003eE. coli\u003c/em\u003e (14, 2.8%) were the most commonly identified organisms in this study. Thirty-five (6.9%) patients were thrombocytopenic (platelet concentration \u0026lt; 150*10\u003csup\u003e9\u003c/sup\u003e/L), 199 (39.3%) were anemic (hemoglobin level \u0026lt; 11.5 g/dl), and 134 (26.5%) had an increased white cell count (\u0026gt; 15*10\u003csup\u003e9\u003c/sup\u003e/L) \u003cstrong\u003e(Table\u0026nbsp;3).\u003c/strong\u003e\u003c/p\u003e\n\u003cdiv\u003e\n \u003ctable id=\"Tab3\" border=\"1\"\u003e\n \u003ccaption language=\"En\"\u003e\n \u003cdiv\u003eTable 3\u003c/div\u003e\n \u003cdiv\u003e\n \u003cp\u003eResult of laboratory findings and identified pathogens of meningitis among neonates admitted at public hospitals in Harar town, Ethiopia, from February 10 to March 20, 2025.\u003c/p\u003e\n \u003c/div\u003e\n \u003c/caption\u003e\n \u003cthead\u003e\n \u003ctr\u003e\n \u003cth align=\"left\"\u003e\n \u003cp\u003eVariable\u003c/p\u003e\n \u003c/th\u003e\n \u003cth align=\"left\"\u003e\n \u003cp\u003eCategory\u003c/p\u003e\n \u003c/th\u003e\n \u003cth align=\"left\"\u003e\n \u003cp\u003eFrequency\u003c/p\u003e\n \u003c/th\u003e\n \u003cth align=\"left\"\u003e\n \u003cp\u003ePercent\u003c/p\u003e\n \u003c/th\u003e\n \u003c/tr\u003e\n \u003c/thead\u003e\n \u003ctbody\u003e\n \u003ctr\u003e\n \u003ctd align=\"left\" rowspan=\"2\"\u003e\n \u003cp\u003eCSF WBC cells/mm³\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd align=\"left\"\u003e\n \u003cp\u003e\u0026lt; 2500\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd align=\"char\"\u003e\n \u003cp\u003e434\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd align=\"left\"\u003e\n \u003cp\u003e85.8\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd align=\"left\"\u003e\n \u003cp\u003e≥ 2500\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd align=\"char\"\u003e\n \u003cp\u003e72\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd align=\"left\"\u003e\n \u003cp\u003e14.2\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd align=\"left\" rowspan=\"2\"\u003e\n \u003cp\u003eCSF Protein (mg/dl)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd align=\"left\"\u003e\n \u003cp\u003e\u0026lt; 400\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd align=\"char\"\u003e\n \u003cp\u003e388\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd align=\"left\"\u003e\n \u003cp\u003e76.7\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd align=\"left\"\u003e\n \u003cp\u003e≥ 400\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd align=\"char\"\u003e\n \u003cp\u003e118\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd align=\"left\"\u003e\n \u003cp\u003e23.3\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd align=\"left\" rowspan=\"2\"\u003e\n \u003cp\u003eCSF Glucose (mg/dl)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd align=\"left\"\u003e\n \u003cp\u003e\u0026lt; 10\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd align=\"char\"\u003e\n \u003cp\u003e79\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd align=\"left\"\u003e\n \u003cp\u003e15.6\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd align=\"left\"\u003e\n \u003cp\u003e≥ 10\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd align=\"char\"\u003e\n \u003cp\u003e427\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd align=\"left\"\u003e\n \u003cp\u003e84.4\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd align=\"left\"\u003e\n \u003cp\u003eCSF gram stain\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd align=\"left\"\u003e\n \u003cp\u003eYes\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd align=\"char\"\u003e\n \u003cp\u003e113\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd align=\"left\"\u003e\n \u003cp\u003e22.3\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd align=\"left\" rowspan=\"4\"\u003e\n \u003cp\u003eIdentified the pathogen from the Gram stain\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd align=\"left\"\u003e\n \u003cp\u003eGram-positive coccus\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd align=\"char\"\u003e\n \u003cp\u003e63\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd align=\"left\"\u003e\n \u003cp\u003e12.5\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd align=\"left\"\u003e\n \u003cp\u003eGram-negative rods\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd align=\"char\"\u003e\n \u003cp\u003e40\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd align=\"left\"\u003e\n \u003cp\u003e7.9\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd align=\"left\"\u003e\n \u003cp\u003eGram-positive rods\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd align=\"char\"\u003e\n \u003cp\u003e9\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd align=\"left\"\u003e\n \u003cp\u003e1.8\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd align=\"left\"\u003e\n \u003cp\u003eGram-negative coccus\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd align=\"char\"\u003e\n \u003cp\u003e1\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd align=\"left\"\u003e\n \u003cp\u003e0.2\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd align=\"left\"\u003e\n \u003cp\u003eCSF culture\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd align=\"left\"\u003e\n \u003cp\u003eYes\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd align=\"char\"\u003e\n \u003cp\u003e71\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd align=\"left\"\u003e\n \u003cp\u003e14.0\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd align=\"left\" rowspan=\"6\"\u003e\n \u003cp\u003eIsolated micro-organism\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd align=\"left\"\u003e\n \u003cp\u003eGBS\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd align=\"char\"\u003e\n \u003cp\u003e25\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd align=\"left\"\u003e\n \u003cp\u003e4.9\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd align=\"left\"\u003e\n \u003cp\u003e\u003cem\u003eE.coli\u003c/em\u003e\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd align=\"char\"\u003e\n \u003cp\u003e14\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd align=\"left\"\u003e\n \u003cp\u003e2.8\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd align=\"left\"\u003e\n \u003cp\u003eKlebsiella\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd align=\"char\"\u003e\n \u003cp\u003e10\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd align=\"left\"\u003e\n \u003cp\u003e2.0\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd align=\"left\"\u003e\n \u003cp\u003e\u003cem\u003eS. aureus\u003c/em\u003e\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd align=\"char\"\u003e\n \u003cp\u003e4\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd align=\"left\"\u003e\n \u003cp\u003e-\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd align=\"left\"\u003e\n \u003cp\u003e\u003cem\u003eL. monocytogenes\u003c/em\u003e\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd align=\"char\"\u003e\n \u003cp\u003e1\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd align=\"left\"\u003e\n \u003cp\u003e-\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd align=\"left\"\u003e\n \u003cp\u003eAcinetobacter\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd align=\"char\"\u003e\n \u003cp\u003e1\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd align=\"left\"\u003e\n \u003cp\u003e-\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd align=\"left\" rowspan=\"2\"\u003e\n \u003cp\u003eWCC (10\u003csup\u003e9\u003c/sup\u003e/L)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd align=\"left\"\u003e\n \u003cp\u003e\u0026lt; 15\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd align=\"char\"\u003e\n \u003cp\u003e372\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd align=\"left\"\u003e\n \u003cp\u003e73.5\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd align=\"left\"\u003e\n \u003cp\u003e≥ 15\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd align=\"char\"\u003e\n \u003cp\u003e134\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd align=\"left\"\u003e\n \u003cp\u003e26.5\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd align=\"left\" rowspan=\"2\"\u003e\n \u003cp\u003eHgb (g/dl)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd align=\"left\"\u003e\n \u003cp\u003e\u0026lt; 11.5\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd align=\"char\"\u003e\n \u003cp\u003e199\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd align=\"left\"\u003e\n \u003cp\u003e39.3\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd align=\"left\"\u003e\n \u003cp\u003e≥ 11.5\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd align=\"char\"\u003e\n \u003cp\u003e307\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd align=\"left\"\u003e\n \u003cp\u003e60.7\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd align=\"left\" rowspan=\"2\"\u003e\n \u003cp\u003ePlatelet count (10\u003csup\u003e9\u003c/sup\u003e/L)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd align=\"left\"\u003e\n \u003cp\u003e\u0026lt; 150\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd align=\"char\"\u003e\n \u003cp\u003e35\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd align=\"left\"\u003e\n \u003cp\u003e6.9\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd align=\"left\"\u003e\n \u003cp\u003e≥ 150\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd align=\"char\"\u003e\n \u003cp\u003e471\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd align=\"left\"\u003e\n \u003cp\u003e93.1\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003c/tbody\u003e\n \u003ctfoot\u003e\n \u003ctr\u003e\n \u003ctd colspan=\"4\"\u003eCSF: cerebrospinal fluid; EONS: Early Onset Neonatal Sepsis; GBS: Group B streptococcus; Hgb: Hemoglobin; LONS: Late Onset Neonatal Sepsis; WCC: White cell count\u003c/td\u003e\n \u003c/tr\u003e\n \u003c/tfoot\u003e\n \u003c/table\u003e\n\u003c/div\u003e\n\u003cp\u003eThe most common clinical manifestations of neonatal meningitis in this study were 475 (93.9%) fever, 419 (82.8%) failure to suck, 302 (59.7%) vomiting, and 298 (58.9%) irritability \u003cstrong\u003e(Fig.\u0026nbsp;1).\u003c/strong\u003e\u003c/p\u003e\n\u003cp\u003e\u003cstrong\u003ePrescribed medication and outcomes of treatment\u003c/strong\u003e\u003c/p\u003e\n\u003cp\u003eIn this study, most patients (82.2%) were treated with a combination of Ampicillin and Gentamycin, followed by (10.7%) a combination of Ampicillin and Cefotaxime. Among 506 neonates treated for meningitis, 339 (67%) had good treatment outcomes, whereas 167 (33%) had poor treatment outcomes. The death rate for newborn meningitis in this study was 18.8%. In this study, 143 (28.3%) patients experienced complications in a healthcare setting, of which 130 patients developed complications after taking medications for meningitis for at least 72 hours. 411 (81.2%) newborns survived meningitis, and from these 73(14.4%) were discharged with neurological complications, including epilepsy (49, 9.7%), hydrocephalus (11, 2.2%), probable subdural effusion (5, 1.0%), weakness (5, 1.0%), hemiparesis (2, 0.4%), and hearing loss (1, 0.2%) (Table\u0026nbsp;4).\u003c/p\u003e\n\u003cdiv\u003e\n \u003ctable id=\"Tab4\" border=\"1\"\u003e\n \u003ccaption language=\"En\"\u003e\n \u003cdiv\u003eTable 4\u003c/div\u003e\n \u003cdiv\u003e\n \u003cp\u003eComplications of meningitis and treatment outcomes among neonates admitted at public hospitals in Harar town, Eastern Ethiopia, from February 10 to March 20, 2025.\u003c/p\u003e\n \u003c/div\u003e\n \u003c/caption\u003e\n \u003cthead\u003e\n \u003ctr\u003e\n \u003cth align=\"left\"\u003e\n \u003cp\u003eVariables\u003c/p\u003e\n \u003c/th\u003e\n \u003cth align=\"left\"\u003e\n \u003cp\u003eCategory\u003c/p\u003e\n \u003c/th\u003e\n \u003cth align=\"left\"\u003e\n \u003cp\u003eFrequency\u003c/p\u003e\n \u003c/th\u003e\n \u003cth align=\"left\"\u003e\n \u003cp\u003ePercent\u003c/p\u003e\n \u003c/th\u003e\n \u003c/tr\u003e\n \u003c/thead\u003e\n \u003ctbody\u003e\n \u003ctr\u003e\n \u003ctd align=\"left\"\u003e\n \u003cp\u003eComplications developed after 72 hours of treatment\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd align=\"left\"\u003e\n \u003cp\u003eYes\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd align=\"char\"\u003e\n \u003cp\u003e130\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd align=\"left\"\u003e\n \u003cp\u003e25.7\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd align=\"left\"\u003e\n \u003cp\u003eComplications developed in-hospital\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd align=\"left\"\u003e\n \u003cp\u003eYes\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd align=\"char\"\u003e\n \u003cp\u003e143\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd align=\"left\"\u003e\n \u003cp\u003e28.3\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd align=\"left\" rowspan=\"8\"\u003e\n \u003cp\u003eComplications in the hospital\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd align=\"left\"\u003e\n \u003cp\u003eSeizure\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd align=\"char\"\u003e\n \u003cp\u003e62\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd align=\"left\"\u003e\n \u003cp\u003e12.3\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd align=\"left\"\u003e\n \u003cp\u003eRenal failure\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd align=\"char\"\u003e\n \u003cp\u003e17\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd align=\"left\"\u003e\n \u003cp\u003e3.4\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd align=\"left\"\u003e\n \u003cp\u003eSeptic shock\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd align=\"char\"\u003e\n \u003cp\u003e16\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd align=\"left\"\u003e\n \u003cp\u003e3.2\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd align=\"left\"\u003e\n \u003cp\u003eHydrocephalus\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd align=\"char\"\u003e\n \u003cp\u003e11\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd align=\"left\"\u003e\n \u003cp\u003e2.2\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd align=\"left\"\u003e\n \u003cp\u003eSubdural effusion\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd align=\"char\"\u003e\n \u003cp\u003e11\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd align=\"left\"\u003e\n \u003cp\u003e2.2\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd align=\"left\"\u003e\n \u003cp\u003eRespiratory failure\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd align=\"char\"\u003e\n \u003cp\u003e10\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd align=\"left\"\u003e\n \u003cp\u003e2.0\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd align=\"left\"\u003e\n \u003cp\u003eBrain abscess\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd align=\"char\"\u003e\n \u003cp\u003e9\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd align=\"left\"\u003e\n \u003cp\u003e1.8\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd align=\"left\"\u003e\n \u003cp\u003eOthers*\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd align=\"char\"\u003e\n \u003cp\u003e7\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd align=\"left\"\u003e\n \u003cp\u003e-\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd align=\"left\"\u003e\n \u003cp\u003eDischarged with complications\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd align=\"left\"\u003e\n \u003cp\u003eYes\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd align=\"char\"\u003e\n \u003cp\u003e73\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd align=\"left\"\u003e\n \u003cp\u003e14.4\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd align=\"left\" rowspan=\"5\"\u003e\n \u003cp\u003eComplication at discharge\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd align=\"left\"\u003e\n \u003cp\u003eEpilepsy\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd align=\"char\"\u003e\n \u003cp\u003e49\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd align=\"left\"\u003e\n \u003cp\u003e9.7\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd align=\"left\"\u003e\n \u003cp\u003eHydrocephalus\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd align=\"char\"\u003e\n \u003cp\u003e11\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd align=\"left\"\u003e\n \u003cp\u003e2.2\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd align=\"left\"\u003e\n \u003cp\u003eSubdural effusion\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd align=\"char\"\u003e\n \u003cp\u003e5\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd align=\"left\"\u003e\n \u003cp\u003e1.0\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd align=\"left\"\u003e\n \u003cp\u003eWeakness\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd align=\"char\"\u003e\n \u003cp\u003e5\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd align=\"left\"\u003e\n \u003cp\u003e1.0\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd align=\"left\"\u003e\n \u003cp\u003eOthers**\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd align=\"char\"\u003e\n \u003cp\u003e3\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd align=\"left\"\u003e\n \u003cp\u003e-\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd align=\"left\" rowspan=\"4\"\u003e\n \u003cp\u003eStatus of patients at discharge\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd align=\"left\"\u003e\n \u003cp\u003eImproved\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd align=\"char\"\u003e\n \u003cp\u003e248\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd align=\"left\"\u003e\n \u003cp\u003e49\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd align=\"left\"\u003e\n \u003cp\u003eRecovered\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd align=\"char\"\u003e\n \u003cp\u003e154\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd align=\"left\"\u003e\n \u003cp\u003e30.4\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd align=\"left\"\u003e\n \u003cp\u003eDead\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd align=\"char\"\u003e\n \u003cp\u003e95\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd align=\"left\"\u003e\n \u003cp\u003e18.8\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd align=\"left\"\u003e\n \u003cp\u003eDischarge without improvement\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd align=\"char\"\u003e\n \u003cp\u003e9\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd align=\"left\"\u003e\n \u003cp\u003e1.8\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd align=\"left\" rowspan=\"2\"\u003e\n \u003cp\u003eOutcomes of treatment\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd align=\"left\"\u003e\n \u003cp\u003ePoor\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd align=\"char\"\u003e\n \u003cp\u003e167\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd align=\"left\"\u003e\n \u003cp\u003e33\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd align=\"left\"\u003e\n \u003cp\u003eGood\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd align=\"char\"\u003e\n \u003cp\u003e339\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd align=\"left\"\u003e\n \u003cp\u003e67\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003c/tbody\u003e\n \u003c/table\u003e\n\u003c/div\u003e\n\u003cp\u003eOthers*…subdural empyema (3, 0.6%); weakness (2, 0.4%); brain infarction (1, 0.2%); ventriculomegaly (1, 0.2%). Others**…. Hemiparesis (2, 0.4%); deafness (1, 0.2%).\u003c/p\u003e\n\u003cp\u003e\u003cstrong\u003eFactors associated with poor treatment outcomes\u003c/strong\u003e\u003c/p\u003e\n\u003cp\u003eMultivariate logistic regression analysis identified that the independent predictive factors of poor outcome of treatment were delivery by vacuum (AOR = 3.06; 95% CI: 1.03 to 9.05), positive CSF culture (AOR = 3.53; 95% CI: 1.45 to 8.57), protein levels in CSF greater than 400 mg/dl at admission (AOR = 17.9; 95% CI: 7.95 to 40.3), glucose level in CSF less than 10 mg/dl at admission (AOR = 3.89; 95% CI: 1.55 to 9.77), presences of seizure upon admission (AOR = 5.6; 95% CI: 2.78 to 11.4), developing seizures during hospitalization (AOR = 14.4; 95% CI: 5.85 to 35.2), co-exist with EONS (AOR = 3.5; 95% CI: 1.49 to 8.20), and congenital hydrocephalus (AOR = 4.73; 95% CI: 1.46 to 15.2) (Table\u0026nbsp;5).\u003c/p\u003e\n\u003cdiv\u003e\n \u003ctable id=\"Tab5\" border=\"1\"\u003e\n \u003ccaption language=\"En\"\u003e\n \u003cdiv\u003eTable 5\u003c/div\u003e\n \u003cdiv\u003e\n \u003cp\u003eFactors associated with poor outcomes among neonates with meningitis treated at public hospitals in Harar town, Eastern Ethiopia, from February 10 to March 20, 2025.\u003c/p\u003e\n \u003c/div\u003e\n \u003c/caption\u003e\n \u003ctbody\u003e\n \u003ctr\u003e\n \u003ctd align=\"left\" colspan=\"2\" rowspan=\"2\"\u003e\n \u003cp\u003eVariables\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd align=\"left\" colspan=\"2\"\u003e\n \u003cp\u003ePoor treatment outcome\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd align=\"left\" rowspan=\"2\"\u003e\n \u003cp\u003eCOR\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd align=\"left\" rowspan=\"2\"\u003e\n \u003cp\u003eAOR\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd align=\"left\" rowspan=\"2\"\u003e\n \u003cp\u003eP-value\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd align=\"left\"\u003e\n \u003cp\u003e\u003cstrong\u003eNo (%)\u003c/strong\u003e\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd align=\"left\"\u003e\n \u003cp\u003e\u003cstrong\u003eYes (%)\u003c/strong\u003e\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd align=\"left\" rowspan=\"2\"\u003e\n \u003cp\u003eAge (days)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd align=\"left\"\u003e\n \u003cp\u003e\u0026lt; 7\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd align=\"left\"\u003e\n \u003cp\u003e161(59.6%)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd align=\"left\"\u003e\n \u003cp\u003e109(40.4%)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd align=\"char\"\u003e\n \u003cp\u003e2.08(1.42–3.05)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd align=\"left\"\u003e\n \u003cp\u003e0.72(0.33–1.53)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd align=\"char\"\u003e\n \u003cp\u003e0.39\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd align=\"left\"\u003e\n \u003cp\u003e7–28\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd align=\"left\"\u003e\n \u003cp\u003e178(75.4%)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd align=\"left\"\u003e\n \u003cp\u003e58(24.6%)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd align=\"char\"\u003e\n \u003cp\u003e1.00\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd align=\"left\"\u003e\n \u003cp\u003e1.00\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd align=\"left\"\u003e\u0026nbsp;\u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd align=\"left\" rowspan=\"2\"\u003e\n \u003cp\u003eBirth weight (grams)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd align=\"left\"\u003e\n \u003cp\u003e\u0026lt; 2500\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd align=\"left\"\u003e\n \u003cp\u003e22(31.9%)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd align=\"left\"\u003e\n \u003cp\u003e47(68.1%)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd align=\"char\"\u003e\n \u003cp\u003e5.64(3.26–9.76)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd align=\"left\"\u003e\n \u003cp\u003e1.95(0.67–5.69)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd align=\"char\"\u003e\n \u003cp\u003e0.22\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd align=\"left\"\u003e\n \u003cp\u003e≥ 2500\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd align=\"left\"\u003e\n \u003cp\u003e317(72.5%)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd align=\"left\"\u003e\n \u003cp\u003e120(27.5%)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd align=\"char\"\u003e\n \u003cp\u003e1.00\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd align=\"left\"\u003e\n \u003cp\u003e1.00\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd align=\"left\"\u003e\u0026nbsp;\u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd align=\"left\" rowspan=\"2\"\u003e\n \u003cp\u003eGestational ages (weeks)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd align=\"left\"\u003e\n \u003cp\u003e\u0026lt; 37\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd align=\"left\"\u003e\n \u003cp\u003e60(42.2%)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd align=\"left\"\u003e\n \u003cp\u003e70(53.8%)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd align=\"char\"\u003e\n \u003cp\u003e3.35(2.22–5.08)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd align=\"left\"\u003e\n \u003cp\u003e1.64(0.68–3.95)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd align=\"char\"\u003e\n \u003cp\u003e0.27\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd align=\"left\"\u003e\n \u003cp\u003e≥37\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd align=\"left\"\u003e\n \u003cp\u003e279(74.2%)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd align=\"left\"\u003e\n \u003cp\u003e97(25.8%)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd align=\"char\"\u003e\n \u003cp\u003e1.00\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd align=\"left\"\u003e\n \u003cp\u003e1.00\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd align=\"left\"\u003e\u0026nbsp;\u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd align=\"left\" rowspan=\"3\"\u003e\n \u003cp\u003eMode of delivery\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd align=\"left\"\u003e\n \u003cp\u003eAV\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd align=\"left\"\u003e\n \u003cp\u003e21(53.8%)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd align=\"left\"\u003e\n \u003cp\u003e18(46.2%)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd align=\"char\"\u003e\n \u003cp\u003e2.13(1.09–4.19)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd align=\"left\"\u003e\n \u003cp\u003e3.06(1.03–9.05)\u003csup\u003ea\u003c/sup\u003e\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd align=\"char\"\u003e\n \u003cp\u003e\u003cstrong\u003e0.043\u003c/strong\u003e\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd align=\"left\"\u003e\n \u003cp\u003eC/S\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd align=\"left\"\u003e\n \u003cp\u003e94(61.4%)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd align=\"left\"\u003e\n \u003cp\u003e59(38.6%)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd align=\"char\"\u003e\n \u003cp\u003e1.56(1.04–2.35)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd align=\"left\"\u003e\n \u003cp\u003e0.91(0.42–1.96)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd align=\"char\"\u003e\n \u003cp\u003e0.81\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd align=\"left\"\u003e\n \u003cp\u003eSV\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd align=\"left\"\u003e\n \u003cp\u003e224(71.3%)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd align=\"left\"\u003e\n \u003cp\u003e90(28.7%)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd align=\"char\"\u003e\n \u003cp\u003e1.00\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd align=\"left\"\u003e\n \u003cp\u003e1.00\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd align=\"left\"\u003e\u0026nbsp;\u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd align=\"left\" rowspan=\"2\"\u003e\n \u003cp\u003eCSF culture\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd align=\"left\"\u003e\n \u003cp\u003eYes\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd align=\"left\"\u003e\n \u003cp\u003e29(40.8%)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd align=\"left\"\u003e\n \u003cp\u003e42(59.2%)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd align=\"char\"\u003e\n \u003cp\u003e3.59(2.14–6.02)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd align=\"left\"\u003e\n \u003cp\u003e3.53(1.45–8.57)\u003csup\u003ea\u003c/sup\u003e\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd align=\"char\"\u003e\n \u003cp\u003e\u003cstrong\u003e0.005\u003c/strong\u003e\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd align=\"left\"\u003e\n \u003cp\u003eNo\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd align=\"left\"\u003e\n \u003cp\u003e310(71.3%)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd align=\"left\"\u003e\n \u003cp\u003e125(28.7%)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd align=\"char\"\u003e\n \u003cp\u003e1.00\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd align=\"left\"\u003e\n \u003cp\u003e1.00\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd align=\"left\"\u003e\u0026nbsp;\u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd align=\"left\" rowspan=\"2\"\u003e\n \u003cp\u003eCSF WBC\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd align=\"left\"\u003e\n \u003cp\u003e≥ 2500\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd align=\"left\"\u003e\n \u003cp\u003e15(21.4%)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd align=\"left\"\u003e\n \u003cp\u003e55(78.6%)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd align=\"char\"\u003e\n \u003cp\u003e10.9(5.85–19.9)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd align=\"left\"\u003e\n \u003cp\u003e2.67(0.94–7.62)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd align=\"char\"\u003e\n \u003cp\u003e0.066\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd align=\"left\"\u003e\n \u003cp\u003e\u0026lt; 2500\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd align=\"left\"\u003e\n \u003cp\u003e315(74.6%)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd align=\"left\"\u003e\n \u003cp\u003e107(25.4%)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd align=\"char\"\u003e\n \u003cp\u003e1.00\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd align=\"left\"\u003e\n \u003cp\u003e1.00\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd align=\"left\"\u003e\u0026nbsp;\u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd align=\"left\" rowspan=\"2\"\u003e\n \u003cp\u003eCSF protein\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd align=\"left\"\u003e\n \u003cp\u003e≥ 400\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd align=\"left\"\u003e\n \u003cp\u003e15(12.7%)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd align=\"left\"\u003e\n \u003cp\u003e103(87.3%)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd align=\"char\"\u003e\n \u003cp\u003e34.7(18.9–63.6)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd align=\"left\"\u003e\n \u003cp\u003e17.9(7.95–40.3)\u003csup\u003eb\u003c/sup\u003e\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd align=\"char\"\u003e\n \u003cp\u003e\u003cstrong\u003e\u0026lt; 0.001\u003c/strong\u003e\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd align=\"left\"\u003e\n \u003cp\u003e\u0026lt; 400\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd align=\"left\"\u003e\n \u003cp\u003e324(83.5%)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd align=\"left\"\u003e\n \u003cp\u003e64(16.5%)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd align=\"char\"\u003e\n \u003cp\u003e1.00\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd align=\"left\"\u003e\n \u003cp\u003e1.00\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd align=\"left\"\u003e\u0026nbsp;\u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd align=\"left\" rowspan=\"2\"\u003e\n \u003cp\u003eCSF glucose\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd align=\"left\"\u003e\n \u003cp\u003e\u0026lt; 10\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd align=\"left\"\u003e\n \u003cp\u003e28(35.4%)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd align=\"left\"\u003e\n \u003cp\u003e51(64.6%)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd align=\"char\"\u003e\n \u003cp\u003e4.88(2.93–8.11)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd align=\"left\"\u003e\n \u003cp\u003e3.89(1.55–9.77)\u003csup\u003ea\u003c/sup\u003e\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd align=\"char\"\u003e\n \u003cp\u003e\u003cstrong\u003e0.004\u003c/strong\u003e\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd align=\"left\"\u003e\n \u003cp\u003e≥ 10\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd align=\"left\"\u003e\n \u003cp\u003e311(72.8%)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd align=\"left\"\u003e\n \u003cp\u003e116(27.2%)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd align=\"char\"\u003e\n \u003cp\u003e1.00\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd align=\"left\"\u003e\n \u003cp\u003e1.00\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd align=\"left\"\u003e\u0026nbsp;\u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd align=\"left\" rowspan=\"2\"\u003e\n \u003cp\u003eHemoglobin\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd align=\"left\"\u003e\n \u003cp\u003e\u0026lt; 11.5\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd align=\"left\"\u003e\n \u003cp\u003e103(51.8%)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd align=\"left\"\u003e\n \u003cp\u003e96(48.2%)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd align=\"char\"\u003e\n \u003cp\u003e3.09(2.11–4.55)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd align=\"left\"\u003e\n \u003cp\u003e1.43(0.73–2.79)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd align=\"char\"\u003e\n \u003cp\u003e0.28\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd align=\"left\"\u003e\n \u003cp\u003e≥ 11.5\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd align=\"left\"\u003e\n \u003cp\u003e236(76.9%)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd align=\"left\"\u003e\n \u003cp\u003e71(23.1%)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd align=\"char\"\u003e\n \u003cp\u003e1.00\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd align=\"left\"\u003e\n \u003cp\u003e1.00\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd align=\"left\"\u003e\u0026nbsp;\u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd align=\"left\" rowspan=\"2\"\u003e\n \u003cp\u003ePlatelet\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd align=\"left\"\u003e\n \u003cp\u003e\u0026lt; 150\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd align=\"left\"\u003e\n \u003cp\u003e19(54.3%)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd align=\"left\"\u003e\n \u003cp\u003e16(45.7%)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd align=\"char\"\u003e\n \u003cp\u003e1.78(0.89–3.56)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd align=\"left\"\u003e\n \u003cp\u003e0.42(0.11–1.56)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd align=\"char\"\u003e\n \u003cp\u003e0.19\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd align=\"left\"\u003e\n \u003cp\u003e≥ 150\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd align=\"left\"\u003e\n \u003cp\u003e320(67.9%)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd align=\"left\"\u003e\n \u003cp\u003e151(32.1%)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd align=\"char\"\u003e\n \u003cp\u003e1.00\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd align=\"left\"\u003e\n \u003cp\u003e1.00\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd align=\"left\"\u003e\u0026nbsp;\u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd align=\"left\" rowspan=\"2\"\u003e\n \u003cp\u003eNot exclusive breastfeeding\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd align=\"left\"\u003e\n \u003cp\u003eYes\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd align=\"left\"\u003e\n \u003cp\u003e32(47.8%)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd align=\"left\"\u003e\n \u003cp\u003e35(52.2%)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd align=\"char\"\u003e\n \u003cp\u003e2.54(1.51–4.28)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd align=\"left\"\u003e\n \u003cp\u003e2.07(0.91–4.71)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd align=\"char\"\u003e\n \u003cp\u003e0.08\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd align=\"left\"\u003e\n \u003cp\u003eNo\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd align=\"left\"\u003e\n \u003cp\u003e307(69.9%)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd align=\"left\"\u003e\n \u003cp\u003e132(30.1%)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd align=\"char\"\u003e\n \u003cp\u003e1.00\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd align=\"left\"\u003e\n \u003cp\u003e1.00\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd align=\"left\"\u003e\u0026nbsp;\u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd align=\"left\" rowspan=\"2\"\u003e\n \u003cp\u003ePresence of seizure at admission\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd align=\"left\"\u003e\n \u003cp\u003eYes\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd align=\"left\"\u003e\n \u003cp\u003e43(34.4%)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd align=\"left\"\u003e\n \u003cp\u003e82(65.6%)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd align=\"char\"\u003e\n \u003cp\u003e6.64(4.27–10.3)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd align=\"left\"\u003e\n \u003cp\u003e5.6(2.78–11.4)\u003csup\u003eb\u003c/sup\u003e\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd align=\"char\"\u003e\n \u003cp\u003e\u003cstrong\u003e\u0026lt; 0.001\u003c/strong\u003e\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd align=\"left\"\u003e\n \u003cp\u003eNo\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd align=\"left\"\u003e\n \u003cp\u003e296(77.7%)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd align=\"left\"\u003e\n \u003cp\u003e85(22.3%)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd align=\"char\"\u003e\n \u003cp\u003e1.00\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd align=\"left\"\u003e\n \u003cp\u003e1.00\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd align=\"left\"\u003e\u0026nbsp;\u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd align=\"left\" rowspan=\"2\"\u003e\n \u003cp\u003eDeveloped a seizure after admission\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd align=\"left\"\u003e\n \u003cp\u003eYes\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd align=\"left\"\u003e\n \u003cp\u003e16(25.8%)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd align=\"left\"\u003e\n \u003cp\u003e46(74.2%)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd align=\"char\"\u003e\n \u003cp\u003e12.3(6.04–24.9)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd align=\"left\"\u003e\n \u003cp\u003e14.4(5.85–35.2)\u003csup\u003eb\u003c/sup\u003e\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd align=\"char\"\u003e\n \u003cp\u003e\u003cstrong\u003e\u0026lt; 0.001\u003c/strong\u003e\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd align=\"left\"\u003e\n \u003cp\u003eNo\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd align=\"left\"\u003e\n \u003cp\u003e323(72.7%)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd align=\"left\"\u003e\n \u003cp\u003e121(27.3%)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd align=\"char\"\u003e\n \u003cp\u003e1.00\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd align=\"left\"\u003e\n \u003cp\u003e1.00\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd align=\"left\"\u003e\u0026nbsp;\u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd align=\"left\" rowspan=\"2\"\u003e\n \u003cp\u003ePresence of EONS\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd align=\"left\"\u003e\n \u003cp\u003eYes\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd align=\"left\"\u003e\n \u003cp\u003e46(40%)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd align=\"left\"\u003e\n \u003cp\u003e69(60%)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd align=\"char\"\u003e\n \u003cp\u003e4.48(2.89–6.95)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd align=\"left\"\u003e\n \u003cp\u003e3.5(1.49–8.20)\u003csup\u003ea\u003c/sup\u003e\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd align=\"char\"\u003e\n \u003cp\u003e\u003cstrong\u003e0.004\u003c/strong\u003e\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd align=\"left\"\u003e\n \u003cp\u003eNo\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd align=\"left\"\u003e\n \u003cp\u003e293(74.9%)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd align=\"left\"\u003e\n \u003cp\u003e98(25.1%)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd align=\"char\"\u003e\n \u003cp\u003e1.00\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd align=\"left\"\u003e\n \u003cp\u003e1.00\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd align=\"left\"\u003e\u0026nbsp;\u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd align=\"left\" rowspan=\"2\"\u003e\n \u003cp\u003eCongenital hydrocephalus\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd align=\"left\"\u003e\n \u003cp\u003eYes\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd align=\"left\"\u003e\n \u003cp\u003e10(28.6%)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd align=\"left\"\u003e\n \u003cp\u003e25(71.4%)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd align=\"char\"\u003e\n \u003cp\u003e5.15(2.41–10.9)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd align=\"left\"\u003e\n \u003cp\u003e4.73(1.46–15.2)\u003csup\u003ea\u003c/sup\u003e\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd align=\"char\"\u003e\n \u003cp\u003e\u003cstrong\u003e0.009\u003c/strong\u003e\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd align=\"left\"\u003e\n \u003cp\u003eNo\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd align=\"left\"\u003e\n \u003cp\u003e329(69.9%)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd align=\"left\"\u003e\n \u003cp\u003e142(30.1%)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd align=\"char\"\u003e\n \u003cp\u003e1.00\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd align=\"left\"\u003e\n \u003cp\u003e1.00\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd align=\"left\"\u003e\u0026nbsp;\u003c/td\u003e\n \u003c/tr\u003e\n \u003c/tbody\u003e\n \u003c/table\u003e\n\u003c/div\u003e\n\u003cp\u003eHosmer-Lemeshow goodness of fit test was fitted with a P-value of 0.53; \u003csup\u003ea\u003c/sup\u003e P \u0026gt; 0.05, \u003csup\u003eb\u003c/sup\u003e P \u0026lt; 0.001.\u003c/p\u003e\n\u003cp\u003eAOR: adjusted odd ratio; CSF: cerebrospinal fluid; C/S: cesarean section; COR: crude odd ratio; EONS: early onset neonatal sepsis; AV: Assisted with vacuum; SV: Spontaneous vaginal; HFCSUH: Hiwot Fana Compressive Specialized University Hospital; JGH: Jugal General Hospital\u003c/p\u003e"},{"header":"Discussion","content":"\u003cp\u003eThis study assessed the treatment outcomes of meningitis and its associated factors among newborns admitted to public hospitals in Harar, Eastern Ethiopia, and included 506 newborns with meningitis. This study found that 10.8% of CSF cultures confirmed bacterial meningitis. This finding was consistent with a study conducted in Angola (12%) (\u003cspan citationid=\"CR23\" class=\"CitationRef\"\u003e23\u003c/span\u003e). However, this result was higher than studies conducted in Ethiopia at North Gondar (6%) (\u003cspan citationid=\"CR37\" class=\"CitationRef\"\u003e37\u003c/span\u003e) and Kenya (4.8%) (\u003cspan citationid=\"CR38\" class=\"CitationRef\"\u003e38\u003c/span\u003e). These variances could be explained by differences in the number of CSF samples collected, patient selection criteria, early antibiotic initiation before the sample collection, and laboratory techniques used. In this study, all participants were taken from patients who had undergone lumbar puncture and met the diagnostic criteria of CSF analysis.\u003c/p\u003e\u003cp\u003eIn this study, fever (93.9%), inability to suck (82.8%), vomiting (59.7%), and irritability (58.9) were the most commonly identified clinical presentations of neonatal meningitis, while seizure (24.7%) and a bulging fontanelle (4.2%) had the least presentations. This finding aligns with studies done in Gondar, Ethiopia (\u003cspan citationid=\"CR37\" class=\"CitationRef\"\u003e37\u003c/span\u003e), Angola (\u003cspan citationid=\"CR23\" class=\"CitationRef\"\u003e23\u003c/span\u003e), and Taiwan (\u003cspan citationid=\"CR39\" class=\"CitationRef\"\u003e39\u003c/span\u003e).\u003c/p\u003e\u003cp\u003e\u003cem\u003eStreptococcus agalactiae\u003c/em\u003e (GBS) and \u003cem\u003eE. coli\u003c/em\u003e were the most commonly isolated microorganisms from positive CSF cultures in this study, which was in line with research conducted in the UK and Ireland (\u003cspan citationid=\"CR40\" class=\"CitationRef\"\u003e40\u003c/span\u003e), in Taiwan (\u003cspan citationid=\"CR39\" class=\"CitationRef\"\u003e39\u003c/span\u003e), and in Hong Kong (\u003cspan citationid=\"CR10\" class=\"CitationRef\"\u003e10\u003c/span\u003e). These findings were in contrast to research conducted in Kenya (\u003cspan citationid=\"CR38\" class=\"CitationRef\"\u003e38\u003c/span\u003e) and Peru (\u003cspan citationid=\"CR15\" class=\"CitationRef\"\u003e15\u003c/span\u003e), where E. coli was the predominant organism, followed by GBS. Additionally, Klebsiella was the most frequently observed organism in studies conducted in Ethiopia at Gondar (\u003cspan citationid=\"CR41\" class=\"CitationRef\"\u003e41\u003c/span\u003e), in Angola (\u003cspan citationid=\"CR23\" class=\"CitationRef\"\u003e23\u003c/span\u003e), in South Africa (\u003cspan citationid=\"CR5\" class=\"CitationRef\"\u003e5\u003c/span\u003e), and in Iran (\u003cspan citationid=\"CR42\" class=\"CitationRef\"\u003e42\u003c/span\u003e). These Variations might be differences in age at presentation (early vs late), gestational age at birth, birth weight, and geographic location.\u003c/p\u003e\u003cp\u003eThis study found that 33% of patients experienced poor treatment outcomes, such as hospital death, discharge problems, or no improvement. 18.8% of patients died in hospital settings as a result. This result was less than studies done in Angola (24%) (\u003cspan citationid=\"CR23\" class=\"CitationRef\"\u003e23\u003c/span\u003e), Gambia (37%) (\u003cspan citationid=\"CR16\" class=\"CitationRef\"\u003e16\u003c/span\u003e), Tanzania (29.4%) (\u003cspan citationid=\"CR24\" class=\"CitationRef\"\u003e24\u003c/span\u003e), Tunisia (40%) (\u003cspan citationid=\"CR43\" class=\"CitationRef\"\u003e43\u003c/span\u003e), and India (29.1%) (\u003cspan citationid=\"CR44\" class=\"CitationRef\"\u003e44\u003c/span\u003e). However, this result was higher than those of research conducted in Taiwan (10.3%) (\u003cspan citationid=\"CR7\" class=\"CitationRef\"\u003e7\u003c/span\u003e), Colombia (9.5%) (\u003cspan citationid=\"CR45\" class=\"CitationRef\"\u003e45\u003c/span\u003e), and China (4.2%) (\u003cspan citationid=\"CR36\" class=\"CitationRef\"\u003e36\u003c/span\u003e). This variation may be related to differences in early detection, socioeconomic status, the number of people involved, antibiotic resistance patterns, and accessibility to healthcare services.\u003c/p\u003e\u003cp\u003eThis study found 14.4% neurological complications among 411 neonates who survived meningitis, comparable to a study conducted in Tunisia (16.4%) (\u003cspan citationid=\"CR43\" class=\"CitationRef\"\u003e43\u003c/span\u003e). However, this rate was lower than that observed in Canada (72.4%) (\u003cspan citationid=\"CR46\" class=\"CitationRef\"\u003e46\u003c/span\u003e), Taiwan (41.6%) (\u003cspan citationid=\"CR18\" class=\"CitationRef\"\u003e18\u003c/span\u003e), India (30.4%) (\u003cspan citationid=\"CR47\" class=\"CitationRef\"\u003e47\u003c/span\u003e), Nigeria (22.5%) (\u003cspan citationid=\"CR48\" class=\"CitationRef\"\u003e48\u003c/span\u003e), and Tunisia (21.6%) (\u003cspan citationid=\"CR49\" class=\"CitationRef\"\u003e49\u003c/span\u003e). Neurological complications were more prevalent in wealthy countries compared to low-income countries. This variation may be related to differences in diagnostic equipment availability, medical expertise, spectrum of pathogens, and incidence of mortality.\u003c/p\u003e\u003cp\u003eThis study found that epilepsy and hydrocephalus are common complications of newborn meningitis, in line with a study conducted in Taiwan (\u003cspan citationid=\"CR39\" class=\"CitationRef\"\u003e39\u003c/span\u003e). Many studies showed that secondary epilepsy is the most common neurological outcome of newborn meningitis (\u003cspan citationid=\"CR5\" class=\"CitationRef\"\u003e5\u003c/span\u003e, \u003cspan citationid=\"CR6\" class=\"CitationRef\"\u003e6\u003c/span\u003e, \u003cspan citationid=\"CR18\" class=\"CitationRef\"\u003e18\u003c/span\u003e, \u003cspan citationid=\"CR36\" class=\"CitationRef\"\u003e36\u003c/span\u003e, \u003cspan citationid=\"CR46\" class=\"CitationRef\"\u003e46\u003c/span\u003e) Most patients discharged with neurological complications had developed them during their hospitalization.\u003c/p\u003e\u003cp\u003eThis study found that patients born by vacuum (AOR\u0026thinsp;=\u0026thinsp;3.06; 95% CI: 1.03 to 9.05) were three times more likely to die or have neurological complications at discharge than neonates born via cesarean section. Previous studies did not assess a relationship with poor treatment outcomes (\u003cspan citationid=\"CR6\" class=\"CitationRef\"\u003e6\u003c/span\u003e, \u003cspan citationid=\"CR7\" class=\"CitationRef\"\u003e7\u003c/span\u003e, \u003cspan citationid=\"CR18\" class=\"CitationRef\"\u003e18\u003c/span\u003e, \u003cspan citationid=\"CR27\" class=\"CitationRef\"\u003e27\u003c/span\u003e, \u003cspan citationid=\"CR36\" class=\"CitationRef\"\u003e36\u003c/span\u003e, \u003cspan citationid=\"CR47\" class=\"CitationRef\"\u003e47\u003c/span\u003e). This relationship may be linked to acquiring resistant bacteria from contaminated device surfaces during delivery. Neonatal drug-resistant meningitis is strongly linked to mortality and morbidity (\u003cspan citationid=\"CR47\" class=\"CitationRef\"\u003e47\u003c/span\u003e, \u003cspan citationid=\"CR48\" class=\"CitationRef\"\u003e48\u003c/span\u003e).\u003c/p\u003e\u003cp\u003eThis study found that having a seizure during admission (AOR\u0026thinsp;=\u0026thinsp;5.6; 95% CI: 2.78 to 11.4) was 5.6 times more likely to result in poor treatment outcomes. This finding is consistent with studies done in Canada (\u003cspan citationid=\"CR50\" class=\"CitationRef\"\u003e50\u003c/span\u003e), India (AOR\u0026thinsp;=\u0026thinsp;14; 95% CI: 1.3 to 21.8) (\u003cspan citationid=\"CR47\" class=\"CitationRef\"\u003e47\u003c/span\u003e), and Taiwan (AOR\u0026thinsp;=\u0026thinsp;2.40; 95% CI: 1.12 to 4.14) (\u003cspan citationid=\"CR18\" class=\"CitationRef\"\u003e18\u003c/span\u003e). Similarly, developing seizures in hospitals (AOR\u0026thinsp;=\u0026thinsp;14.4; 95% CI: 5.85 to 35.2) was associated with poor treatment outcomes, consistent with the study done in Taiwan (OR: 10.10; 95% CI: 2.11 to 48.32) (\u003cspan citationid=\"CR39\" class=\"CitationRef\"\u003e39\u003c/span\u003e). Seizures are a well-known symptom of newborn meningitis, as well as a complication of meningitis, that results in cerebral infarction, hydrocephalus, subdural empyema, or stroke, all of which can lead to poor outcomes (\u003cspan citationid=\"CR51\" class=\"CitationRef\"\u003e51\u003c/span\u003e).\u003c/p\u003e\u003cp\u003eThis study revealed that neonates who existed with EONS (AOR\u0026thinsp;=\u0026thinsp;3.5; 95% CI: 1.49 to 8.20) were 3.5 times more likely to have poor treatment outcomes. This finding is in line with studies conducted in Nigeria (\u003cspan citationid=\"CR48\" class=\"CitationRef\"\u003e48\u003c/span\u003e), and Taiwan (OR\u0026thinsp;=\u0026thinsp;3.38; 95% CI: 1.10 to 8.04) (\u003cspan citationid=\"CR7\" class=\"CitationRef\"\u003e7\u003c/span\u003e). Furthermore, neonates with confirmed meningitis by CSF culture (AOR\u0026thinsp;=\u0026thinsp;3.53; 95% CI: 1.45 to 8.57) were 3.5 times more likely to experience poor treatment outcomes than those with probable meningitis.\u003c/p\u003e\u003cp\u003eNeonates with CSF protein counts above 400 mg/dl (AOR\u0026thinsp;=\u0026thinsp;17.9; 95% CI: 7.95 to 40.3) had a significantly higher risk of poor treatment outcomes than those with lower values. This finding is consistent with a study conducted in Taiwan (OR\u0026thinsp;=\u0026thinsp;171; 95% CI interval: 25.6 to 1000) (\u003cspan citationid=\"CR39\" class=\"CitationRef\"\u003e39\u003c/span\u003e). The study found that newborns with CSF glucose levels less than 10 mg/dl at admission (AOR\u0026thinsp;=\u0026thinsp;3.89; 95% CI: 1.55 to 9.77) were four times more likely to have poor treatment outcomes, which is comparable to a study conducted in Southern Taiwan (\u003cspan citationid=\"CR52\" class=\"CitationRef\"\u003e52\u003c/span\u003e). Protein and glucose are vital markers for diagnosing meningitis. CSF glucose levels are typically low, and protein levels rise in bacterial meningitis. This is due to glucose consumption by bacteria and white blood cells, slowed glucose transfer into the CSF, higher number of reproducing bacteria, and body cells fighting the infection (\u003cspan citationid=\"CR53\" class=\"CitationRef\"\u003e53\u003c/span\u003e). A high protein and low glucose concentration in CSF characterized the severity of the disease and also the presence of additional sequelae.\u003c/p\u003e"},{"header":"Conclusion","content":"\u003cp\u003eThe study found that approximately 33% of newborns with meningitis experienced poor treatment outcomes. Epilepsy and hydrocephalus were the most commonly observed neurological sequelae. Several factors were associated with poor outcomes, including congenital hydrocephalus, vacuum-assisted delivery, positive CSF culture, seizures, elevated CSF protein with low glucose, and co-occurrence with early-onset neonatal sepsis.\u003c/p\u003e"},{"header":"Limitations of the study","content":"\u003cp\u003eThe study has three primary limitations. First, the data were derived exclusively from retrospective reviews of medical records, which inherently limited the available information. Key maternal variables, such as history of infections during pregnancy, socioeconomic status, underlying maternal illnesses, antenatal care utilization, and substance use during pregnancy, were absent. These factors are known to influence neonatal outcomes. Second, the assessment of treatment outcomes for neonatal meningitis was confined to the duration of hospitalization. As a result, the study was unable to capture long-term neurodevelopmental consequences, such as cognitive impairment, behavioral challenges, or delays in motor and language development, which often emerge months or years after the acute illness. Furthermore, the impact of neonatal meningitis on school performance and quality of life in later childhood remains unexplored in this study. Third, the study did not differentiate between community-acquired and hospital-acquired (nosocomial) infections. This distinction is clinically significant, as the causative organisms, resistance patterns, and prognoses often differ between the two. The inability to categorize infections by their source may obscure important epidemiological and treatment-related insights that could inform infection control practices and antibiotic stewardship.\u003c/p\u003e"},{"header":"Declarations","content":"\u003cp\u003e\u003cstrong\u003eSources of funding\u0026nbsp;\u003c/strong\u003e\u003c/p\u003e\n\u003cp\u003eThe authors have not declared a specific grant for this research from any funding agency in the public, commercial, or not-for-profit sectors.\u0026nbsp;\u003c/p\u003e\n\u003cp\u003e\u003cstrong\u003eAcknowledgments\u0026nbsp;\u003c/strong\u003e\u003c/p\u003e\n\u003cp\u003eWe would like to thank the administrators, data collectors, and card room staff at Hiwot Fana Comprehensive Specialized University Hospital and Jugal General Hospital for their support during data collection.\u003c/p\u003e\n\u003cp\u003e\u003cstrong\u003eAuthor contributions\u003c/strong\u003e\u003c/p\u003e\n\u003cp\u003e\u003cstrong\u003eConceptualization:\u003c/strong\u003e Getahun Tamiru Yirsaw, Shambel Nigussie Amare, Tadesse Bekele Tafesse\u003c/p\u003e\n\u003cp\u003e\u003cstrong\u003eData curation:\u0026nbsp;\u003c/strong\u003eGetahun Tamiru Yirsaw,\u0026nbsp;Shambel Nigussie Amare, Tadesse Bekele Tafesse,\u0026nbsp;Abera Jambo Bune\u003c/p\u003e\n\u003cp\u003e\u003cstrong\u003eFormal analysis:\u0026nbsp;\u003c/strong\u003eGetahun Tamiru Yirsaw,\u0026nbsp;Shambel Nigussie Amare, Tadesse Bekele Tafesse,\u0026nbsp;Abera Jambo Bune\u003c/p\u003e\n\u003cp\u003e\u003cstrong\u003eInvestigation:\u0026nbsp;\u003c/strong\u003eGetahun Tamiru Yirsaw,\u0026nbsp;Shambel Nigussie Amare\u003c/p\u003e\n\u003cp\u003e\u003cstrong\u003eMethodology:\u0026nbsp;\u003c/strong\u003eGetahun Tamiru Yirsaw,\u0026nbsp;Shambel Nigussie Amare, Tadesse Bekele Tafesse,\u0026nbsp;Abera Jambo Bune\u003c/p\u003e\n\u003cp\u003e\u003cstrong\u003eProject administration:\u0026nbsp;\u003c/strong\u003eShambel Nigussie Amare, Tadesse Bekele Tafesse\u003c/p\u003e\n\u003cp\u003e\u003cstrong\u003eSoftware:\u0026nbsp;\u003c/strong\u003eGetahun Tamiru Yirsaw,\u0026nbsp;Shambel Nigussie Amare\u003c/p\u003e\n\u003cp\u003e\u003cstrong\u003eValidation:\u0026nbsp;\u003c/strong\u003eShambel Nigussie Amare, Tadesse Bekele Tafesse,\u0026nbsp;\u003c/p\u003e\n\u003cp\u003e\u003cstrong\u003eVisualization:\u003c/strong\u003e Abera Jambo Bune\u003c/p\u003e\n\u003cp\u003e\u003cstrong\u003eWriting– review \u0026amp; editing:\u0026nbsp;\u003c/strong\u003eShambel Nigussie Amare, Tadesse Bekele Tafesse,\u0026nbsp;\u003c/p\u003e\n\u003cp\u003e\u003cstrong\u003eConflict of interest\u0026nbsp;\u003c/strong\u003e\u003c/p\u003e\n\u003cp\u003eThe authors declared that they have no competing interests in this work.\u0026nbsp;\u003c/p\u003e\n\u003cp\u003e\u003cstrong\u003eData availability statement\u003c/strong\u003e\u003c/p\u003e\n\u003cp\u003eThe datasets generated during and/or analysed during the current study are available from the corresponding author on reasonable request.\u003c/p\u003e\n"},{"header":"References","content":"\u003col\u003e\n\u003cli\u003eWorld Health Organization. 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Iranian Journal of Microbiology. 2020;12(2):89.\u003c/li\u003e\n\u003cli\u003eKamoun F, Dowlut MB, Ameur SB, Sfaihi L, Mezghani S, Chabchoub I, et al. Neonatal purulent meningitis in southern Tunisia: Epidemiology, bacteriology, risk factors and prognosis. Fetal and pediatric pathology. 2015;34(4):233-40.\u003c/li\u003e\n\u003cli\u003eBarik KL, Biswas P, Das KK, Laha S, Paul S, Mondal S. Bacteriological profile, antibiotic susceptibility pattern and other factors related to neonatal meningitis: A cross-sectional hospital-based study from West Bengal. Asian Journal of Medical Sciences. 2022;13(1):93-8.\u003c/li\u003e\n\u003cli\u003eZ\u0026uacute;\u0026ntilde;iga YA, V\u0026eacute;lez-Mart\u0026iacute;nez LF, L\u0026oacute;pez-Garc\u0026iacute;a LC, Beltr\u0026aacute;n-Arroyave CP, Cornejo-Ochoa JW. Bacterial Meningitis in Neonates: A Multicenter Descriptive Study in the City of Medell\u0026iacute;n, Colombia. Iatreia. 2023;36(4).\u003c/li\u003e\n\u003cli\u003eOuchenir L, Renaud C, Khan S, Bitnun A, Boisvert A-A, McDonald J, et al. The epidemiology, management, and outcomes of bacterial meningitis in infants. Pediatrics. 2017;140(1).\u003c/li\u003e\n\u003cli\u003eKumar M, Tripathi S, Kumar H, Singh S. Predictors of poor outcome in neonates with pyogenic meningitis in a level-three neonatal intensive care unit of a developing country. Journal of Tropical Pediatrics. 2018;64(4):297-303.\u003c/li\u003e\n\u003cli\u003eAirede K, Adeyemi O, Ibrahim T. Neonatal bacterial meningitis and dexamethasone adjunctive usage in Nigeria. Nigerian journal of clinical practice. 2008;11(3):235-45.\u003c/li\u003e\n\u003cli\u003eHamouda B, Hamza M, Ayadi A, Soua H, Khedher M, Sfar M. Clinical outcome and prognosis of neonatal bacterial meningitis. Archives de Pediatrie: Organe Officiel de la Societe Francaise de Pediatrie. 2013;20(9):938-44.\u003c/li\u003e\n\u003cli\u003eKlinger G, Chin C-N, Beyene J, Perlman M. Predicting the outcome of neonatal bacterial meningitis. Pediatrics. 2000;106(3):477-82.\u003c/li\u003e\n\u003cli\u003eMart\u0026iacute;n Del Valle F, Calvo C, Martinez-Rienda I, Cilla A, Romero M, Menasalvas A, et al. Grupo de Estudio de las infecciones por enterovirus y parechovirus en ni\u0026ntilde;os. [Epidemio logical and clinical characteristics of infants admitted to hospital due to human parechovirus infections: A prospective study in Spain]. An Pediatr (Engl Ed). 2018;88(2):82-8.\u003c/li\u003e\n\u003cli\u003eChang C-J, Chang W-N, Huang L-T, Huang S-C, Chang Y-C, Hung P-L, et al. Neonatal bacterial meningitis in southern Taiwan. Pediatric neurology. 2003;29(4):288-94.\u003c/li\u003e\n\u003cli\u003eSakushima K, Hayashino Y, Kawaguchi T, Jackson JL, Fukuhara S. Diagnostic accuracy of cerebrospinal fluid lactate for differentiating bacterial meningitis from aseptic meningitis: a meta-analysis. Journal of Infection. 2011;62(4):255-62.\u003c/li\u003e\n\u003c/ol\u003e"}],"fulltextSource":"","fullText":"","funders":[],"hasAdminPriorityOnWorkflow":false,"hasManuscriptDocX":true,"hasOptedInToPreprint":true,"hasPassedJournalQc":"","hasAnyPriority":false,"hideJournal":true,"highlight":"","institution":"","isAcceptedByJournal":false,"isAuthorSuppliedPdf":false,"isDeskRejected":"","isHiddenFromSearch":false,"isInQc":false,"isInWorkflow":false,"isPdf":false,"isPdfUpToDate":true,"isWithdrawnOrRetracted":false,"journal":{"display":true,"email":"[email protected]","identity":"researchsquare","isNatureJournal":false,"hasQc":true,"allowDirectSubmit":true,"externalIdentity":"","sideBox":"","snPcode":"","submissionUrl":"/submission","title":"Research Square","twitterHandle":"researchsquare","acdcEnabled":true,"dfaEnabled":false,"editorialSystem":"","reportingPortfolio":"","inReviewEnabled":false,"inReviewRevisionsEnabled":true},"keywords":"associated factors, cross-sectional, treatment outcome, meningitis, neonates, eastern Ethiopia","lastPublishedDoi":"10.21203/rs.3.rs-7103387/v1","lastPublishedDoiUrl":"https://doi.org/10.21203/rs.3.rs-7103387/v1","license":{"name":"CC BY 4.0","url":"https://creativecommons.org/licenses/by/4.0/"},"manuscriptAbstract":"\u003ch2\u003eAim \u0026amp; Background:\u003c/h2\u003e\u003cp\u003eMeningitis in neonates significantly burdens public health in low- and middle-income countries. However, data on treatment outcomes and factors contributing to poor prognosis are scarce. This study aimed to assess treatment outcomes of meningitis and associated factors among neonates treated at public hospitals in Harar, eastern Ethiopia.\u003c/p\u003e\u003ch2\u003eMethods\u003c/h2\u003e\u003cp\u003eA facility-based cross-sectional study was conducted involving 506 neonates who received treatment between October 1, 2020, and October 31, 2024, at Hiwot Fana Comprehensive Specialized University Hospital and Jugal General Hospital. Data were obtained from medical records. Treatment outcomes were classified as \"good\" or \"poor.\" Both binary and multivariate logistic regression analyses were performed to identify factors associated with poor treatment outcomes. A P-value of less than 0.05 and an adjusted odds ratio with a 95% confidence interval were utilized to establish statistical significance.\u003c/p\u003e\u003ch2\u003eResults\u003c/h2\u003e\u003cp\u003eOne hundred sixty-nine (33%) neonates had experienced poor treatment outcomes. Delivered by vacuum (AOR\u0026thinsp;=\u0026thinsp;3.06, 95% CI: 1.03 to 9.05), positive culture of cerebrospinal fluid (CSF) (AOR\u0026thinsp;=\u0026thinsp;3.53, 95% CI: 1.45 to 8.57), CSF protein more than 400 mg/dl at admission (AOR\u0026thinsp;=\u0026thinsp;17.9, 95% CI: 7.95 to 40.3), CSF glucose less than 10 mg/dl at admission (AOR\u0026thinsp;=\u0026thinsp;3.89, 95% CI: 1.55 to 9.77), seizure at admission (AOR\u0026thinsp;=\u0026thinsp;5.6, 95% CI: 2.78 to 11.4), seizures during hospitalization (AOR\u0026thinsp;=\u0026thinsp;14.4, 95% CI: 5.85 to 35.2), presences of early onset neonatal sepsis (AOR\u0026thinsp;=\u0026thinsp;3.5, 95% CI: 1.49 to 8.20), and predisposition to congenital hydrocephalus (AOR\u0026thinsp;=\u0026thinsp;4.73, 95% CI: 1.46 to 15.2) were factors associated with poor outcome of treatment.\u003c/p\u003e\u003ch2\u003eConclusion\u003c/h2\u003e\u003cp\u003eThe study found that approximately 33% of newborns with meningitis experienced poor treatment outcomes. Epilepsy and hydrocephalus were the most commonly observed neurological sequelae. Several factors were associated with poor outcomes, including congenital hydrocephalus, vacuum-assisted delivery, positive CSF culture, seizures, elevated CSF protein with low glucose, and co-occurrence with early-onset neonatal sepsis.\u003c/p\u003e\u003ch2\u003eClinical Significance:\u003c/h2\u003e\u003cp\u003eThis study is important for enhancing patient care by reducing mortality and morbidity. Recognizing the factors that influence outcomes allows for targeted measures, early detection of at-risk newborns, and more effective treatment strategies.\u003c/p\u003e","manuscriptTitle":"Treatment Outcomes of Meningitis and Its Associated Factors among Neonates Admitted in Public Hospitals at Harar Town, Ethiopia: Cross-sectional study","msid":"","msnumber":"","nonDraftVersions":[{"code":1,"date":"2025-08-07 07:04:15","doi":"10.21203/rs.3.rs-7103387/v1","editorialEvents":[{"type":"communityComments","content":0}],"status":"published","journal":{"display":true,"email":"[email protected]","identity":"researchsquare","isNatureJournal":false,"hasQc":true,"allowDirectSubmit":true,"externalIdentity":"","sideBox":"","snPcode":"","submissionUrl":"/submission","title":"Research Square","twitterHandle":"researchsquare","acdcEnabled":true,"dfaEnabled":false,"editorialSystem":"","reportingPortfolio":"","inReviewEnabled":false,"inReviewRevisionsEnabled":true}}],"origin":"","ownerIdentity":"8130b016-4aa1-4a09-a32d-8a045312a9c0","owner":[],"postedDate":"August 7th, 2025","published":true,"recentEditorialEvents":[],"rejectedJournal":[],"revision":"","amendment":"","status":"posted","subjectAreas":[{"id":52703839,"name":"Health sciences/Diseases"},{"id":52703840,"name":"Health sciences/Health care"},{"id":52703841,"name":"Health sciences/Medical research"},{"id":52703842,"name":"Health sciences/Neurology"},{"id":52703843,"name":"Biological sciences/Neuroscience"}],"tags":[],"updatedAt":"2025-11-21T20:08:20+00:00","versionOfRecord":[],"versionCreatedAt":"2025-08-07 07:04:15","video":"","vorDoi":"","vorDoiUrl":"","workflowStages":[]},"version":"v1","identity":"rs-7103387","journalConfig":"researchsquare"},"__N_SSP":true},"page":"/article/[identity]/[[...version]]","query":{"redirect":"/article/rs-7103387","identity":"rs-7103387","version":["v1"]},"buildId":"8U1c8b4HqxoKbykW_rLl7","isFallback":false,"isExperimentalCompile":false,"dynamicIds":[84888],"gssp":true,"scriptLoader":[]}