Institutional Delivery Predisposes to Neonatal Sepsis and Its Associated Factors Among Neonates Admitted to Neonatal Intensive Care Units in Central Gondar Zone Primary Hospitals, Northwest Ethiopia, 2019.

Institutional Delivery Predisposes to Neonatal Sepsis and Its Associated Factors Among Neonates Admitted to Neonatal Intensive Care Units in Central Gondar Zone Primary Hospitals, Northwest Ethiopia, 2019. | 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 Research Institutional Delivery Predisposes to Neonatal Sepsis and Its Associated Factors Among Neonates Admitted to Neonatal Intensive Care Units in Central Gondar Zone Primary Hospitals, Northwest Ethiopia, 2019. Zelalem Agnche, Hedja Yenus Yeshita, Kedir Abdela Gonete This is a preprint; it has not been peer reviewed by a journal. https://doi.org/ 10.21203/rs.3.rs-51669/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 Background: Neonatal sepsis contributes substantially to neonatal morbidity and mortality and is an ongoing major global public health challenge particularly in developing countries. Studies conducted on proportion and risk factors of neonatal sepsis in Ethiopia are from referral hospital which may not be generalized to primary health care units where a significant proportion of mothers give birth in these health facilities. This study sought to determine the proportion of clinical neonatal sepsis and associated factors in the study areas. Methods: Institutional based cross-sectional study was conducted from March to April 2019, in Amhara regional state, central Gondar zone public primary hospitals in Ethiopia. A total of 352 subjects (mother-neonate pairs ) were selected using systematic random sampling technique and pre-tested and structured questionnaires were used to collect data. Multivariable logistic regression analysis was fitted to identify factors associated with neonatal sepsis. Adjusted Odds Ratio (AOR) with the corresponding 95% confidence Interval (CI) was used to show the strength of associations and variables with p-values of <0.05 were considered as statistically significant. Results: The overall proportion of neonatal sepsis was 64.8 %( 95% CI (59.2, 69.2). Being male neonate(AOR=3.7; 95% CI(1.76,7.89)), history of urinary tract infections during the index pregnancy(AOR =6,26; 95% CI (1.16,33.62)), frequency of per-vaginal examination greater than three during labor and delivery(AOR=6.06; 95% CI((2.45,14.99)), neonatal resuscitation at birth (AOR=6.1; 95% CI (1.71,21.84)), place of delivery at the health center(AOR=3.05; 95% CI(1.19,7.79)), lack of training of health workers on neonatal resuscitation and infection prevention practices (AOR=2.14; 95% CI (1.04,4.44)), late age of neonate at onset of illness(AOR=0.05; 95% CI(0.01, 0.21)) and maternal age of 30-34 years (AOR=0.19; 95% CI(.047, 0.81)) were significantly associated with neonatal sepsis. Conclusion: The proportion of neonatal sepsis is high. Maternal, neonatal and health service related factors were identified for neonatal sepsis. Therefore; training of health workers, provision of health care services as per standards and monitoring and evaluation of obstetrical/neonatal cares during labor and delivery are mandatory. Health Policy Neonatal sepsis risk factors neonatal intensive care units Figures Figure 1 Background Neonatal sepsis (NS) is defined as systemic inflammatory response syndrome in the presence of or as a result of suspected or proven infection in a neonate(1). Neonatal sepsis contributes substantially to neonatal morbidity and mortality and is an ongoing major global public health challenge (10). According to the World Health Organization (WHO), globally each year over 4 million neonates died within 28 days of birth (11). Infections are considered to be the leading cause of neonatal deaths (35%) followed by deaths resulted from preterm births (28%), intra-partum related complication (24%), and asphyxia (23%)(12) . Globally 7% of mortality in children under 5 years and 15% in neonates was related to sepsis and meningitis in 2016(13). Sepsis is the commonest cause of neonatal mortality and is probably responsible for 30-50% of the total neonatal deaths each year in developing countries (12). It is estimated that in 2012 about 6.9 million neonates were diagnosed with possible serious bacterial infection needing treatment and 2.6 million of these occurred in Sub Saharan Africa (2, 14). In Ethiopia; prematurity (37%), infection (28%), and asphyxia (24%) are the most common causes of death in neonates. Neonatal conditions which used to account for a quarter of under-five deaths in 2004 have recently increased to 43%. According to the current united nation estimate in Ethiopia, the neonatal deaths were reduced slowly by 48% in 2013 from the 1990 as compare to significant reduction rate of under-five mortality by 67%(15). Ethiopia demographic and health survey (EDHS, 2016) reported that neonatal mortality rate was 29/1000 live birth, which was reduced slowly from 39/1000 in 2005 and 37/1000 live births in 2011. Particularly Amhara region of the country was at the top in infant and neonatal mortality rates (NMRs). It was 67 and 47 per 1,000 live births, respectively (16). Neonatal sepsis also has an economic impact resulted from increased medical costs, prolonged hospital stay and potentially poor long-term neurodevelopmental outcomes. Despite of this fact, the world is witnessing a steady decline in the number of neonatal deaths due to sepsis (17, 18). Multiple factors including maternal, fetal and environmental factors have been associated with increased risk of infections in neonatal life(6). Early identification of the risk factors for neonatal sepsis would enable early clinical diagnosis and treatment aiming to reduce neonatal morbidity and mortality(2).Implementation of certain clinical strategies are also effective in reducing the incidence of neonatal sepsis(7) . The burden of neonatal sepsis and its complications can be averted and the target of Sustainable Development Goals for child survival can be achieved through expansion of clinical care for babies and mothers (13). Hence, there have been many advances in prevention, assessment and treatment of neonatal sepsis in the past few decades. However, the morbidity and mortality associated with sepsis remains high for susceptible neonates(8). World Health Assembly resolution(WHA) makes a number of recommendations including prevention, diagnosis and treatment of sepsis in national health systems, training all health professionals on infection prevention and patient safety, promoting research, and others. Therefore, sepsis is considered as a good example of a cross-cutting approach for measurable reductions in neonatal mortality (13). In Ethiopia various efforts have been made to reduce neonatal morbidity and mortality. However, some studies conducted in referral hospitals of the country showed that neonatal morbidity and mortality related to neonatal sepsis is still high.(9). Despite a considerable burden of neonatal sepsis in our setting, there were no studies conducted to assess proportion and associated factors of neonatal sepsis among neonates admitted in NICUs of recently established primary hospitals in Ethiopia. Therefore, this study was carried out to determine the proportion of neonatal sepsis and factors contributing to it among neonates in central Gondar Zone public primary hospitals of Amhara region in Ethiopia. Methods Study design, setting and period Institutional based cross – sectional study was conducted in Amhara region at central Gondar zone public primary hospitals in Ethiopia from March to April, 2019. These hospitals were established recently in the last few years. They are providing preventive, promotive and curative health care services to the population in central Gondar zone of the region and serve as a referral centers for the local health centers in the area. These primary hospitals are found in five districts (Dembiya, Chilga, Wogera, Delgi, and East Belesa) in central Gondar zone of the region. They are 781, 780, 787, 832 and 867 km away from Addis Ababa, the capital city of Ethiopia towards the Northwest ,respectively. All hospitals have a total number of 341 health workers. The neonatal intensive care units of each hospital have five neonatal beds for neonatal admission and have three clinical staff (one physician and two clinical nurses) and one cleaner. More than three thousand neonates were admitted in these hospitals annually to get medical services. Study population and sampling procedure All neonates admitted to neonatal intensive care units in central Gondar Zone primary hospitals were included in the study. The sample size was determined by using single population proportion formula and the proportion was taken from the previous literature in Ethiopia. According to study conducted at Gondar University teaching hospital, the prevalence of neonatal sepsis was 69.7%(23). By considering 95% confidence interval (CI), 5% marginal error, and 5% non-response rate. Therefore the final minimum adequate sample size was 352. The study participants included 352 mother-neonate pairs who were admitted to NICUs during the study period and consented to participate in the study. The study enrolled neonates from birth to 28 days of age. Neonates with sepsis admitted for two or more time during the study period were considered to be excluded to avoid double count. However, there were no such cases in this study. The study populations were neonates admitted and treated in NICUs of central Gondar zone public primary hospitals in Ethiopia. According to the data obtained from these hospitals in 2018, the annual number of neonates admitted in neonatal intensive care units (NICUs) of these hospitals was estimated to be 3000 i.e. on the average 375 neonates were estimated to be admitted during the study period. Systematic random sampling technique was used to select study subjects during the study period. In this study neonatal sepsis is asserted when a medical diagnose of the neonate is stated as ‘neonatal sepsis’ by the physician in the neonate’s medical record chart. Data collection tool, measurements, and quality management The tool was developed from different literatures to gather the desired information from the sample population. The questionnaire was initially prepared in English language and translated in to Amharic (local language) and again it was retranslated back to English language to check for any inconsistencies or distortions in the meaning of words and concepts. Two days training was given to five data collectors (clinical nurses, diploma) and two supervisors (BSc nurses) prior to the beginning of data collection. Data collectors collected the data from the mother or care giver of the neonates by using interviewer administered structured Amharic version questioner that contains detail questions comprising all the variables of the study. Admission diagnosis of neonates was taken from the diagnosis of physician in the unit. The WHO IMNCI criteria were applied to assess babies for clinical sepsis. The IMNCI criteria uses the following clinical features to make a diagnosis of clinical neonatal sepsis: not feeding well, convulsions, drowsy or unconscious, movement only when stimulated or no movement at all, fast breathing (60 breaths per min), grunting severe chest in-drawing, raised temperature > 38 °C, hypothermia < 35.5 °C, central cyanosis or could be severe jaundice, severe abdominal distension or localizing signs of infection were diagnosed as having neonatal sepsis(35). A retrospective review of the history was taken to find out if the neonate had the symptoms suggestive of neonatal sepsis since birth. A conclusion of clinical neonatal sepsis was ascertained if the baby had any one of the symptoms of sepsis listed in the IMNCI criteria and admitted in NICUs. Medical documents from the health units attended were also used to get information on presentation of the patient to the health units and the treatment received . Data were checked for its completeness & accuracy during data collection. Close supervision of trained data collectors (five diploma nurses) was undertaken by the trained supervisors (two BSc nurses). The supervisor strictly supervised the data collection process and provided on-site advice and feedbacks to the data collectors on daily basis. Daily exchange of information between the principal investigator and supervisors was undertaken by telephone. The principal investigator had had regular onsite supervision of supervisors and data collectors on weekly basis. Operational definitions Neonatal sepsis : Neonates presented with any one of the systemic manifestation of danger signs:- not feeding well, convulsions, drowsy or unconscious, movement only when stimulated or no movement at all, fast breathing (60 breaths per min), grunting severe chest in-drawing, raised temperature > 38 °C, hypothermia < 35.5 °C, central cyanosis or could be severe jaundice, severe abdominal distension or localizing signs of infection were diagnosed as having neonatal sepsis(35). Early onset of sepsis : If sepsis is occurred from birth to 7 days of age. Late onset of sepsis : If sepsis is occurred between 8 and 28 days of age(32) Data management and analysis Questionnaires were checked daily for completeness and accuracy. All data was double entered, cleaned, edited, coded and entered into EPI INFO version 7.0 and exported to SPSS version 20.0 for analysis by binary logistic regression model. Both bivariate and multivariable analysis was used to see the association of different variables. Categorical variables were summarized into percentages and proportions. The continuous variables were summarized into means, medians, standard deviation and ranges and the results were presented with tables and figures. The proportion of clinical neonatal sepsis was obtained by calculating the proportion of neonates with symptoms and signs of clinical neonatal sepsis out of the total number of neonates who were admitted in NICUs during the study period. Bivariate analysis was used to determine association between neonatal sepsis and various independent variables including maternal factors, neonatal factors, and service related factors. Continuous independent variables were categorized and associations established using Chi-squared tests. This was similarly done for categorical variables. Adjusted odds ratio with 95% confidence interval was used to measure the degree of association between variables. P-value of < 0.05 was considered as statistically significant during multivariable logistic regression. Ethical consideration The proposal was reviewed and approved by the institute review board (IRB) of University of Gondar Institute of Public Health College of Medicine and Health Science before the start of the study. Informed consent was also obtained from mothers. A neonate aged 0 to 28 days of age who met the selection criteria was enrolled in the study. A pretested interviewer administered questionnaire was used to obtain history, physical examination and evaluate factors associated with neonatal sepsis. These included maternal factors, neonatal factors and neonatal health care practices, and service related factors. Results Neonatal characteristics A total of 338 mother-neonates pairs were included in five primary hospitals of central Gondar Zone making the response rate of 96%. The median age of neonates was 2 days with interquartile range of 4 days. Among all participants, more than half 200 (59.2%) were male neonates with male to female ratio 1.4:1. Nearly two-third of neonates were born at hospitals 212(62.7%). Similarly nearly two-third 218(64.5%) of neonates were term and the remaining one-third 120(35.5%) were preterm. Low birth weight was illustrated among 53.5% of neonates (Table1). Mothers socio-demographic and economic characteristics The median age of mothers of the neonate was 26 years with an inter quartile range of 8 years and 4 months. Among the participants, one-third of neonates mother 114(33.7%) were in the age range of 25 to 29 years. More than half 195 (57.7%) of them were from rural areas (table 2). Mothers medical and obstetric conditions In this study more than half of the mothers 202(59.8%) were multiparous women. Majority of the mothers 314(92.9%) had at least one ANC follow-up at the time of pregnancy and 10 (3%) of them were positive with HIV AIDS. Among the positive mothers, majority 7(70%) were from urban areas. About one-third101 (29.9%) of them had history of PROM during the index pregnancy and nearly three-fourths 247(73.1%) of neonates were delivered by spontaneous vaginal delivery (table3). Medical procedures related to neonatal health care services None of the neonates were on mechanical ventilation. About 2.7% of neonates had history of end tracheal intubation for resuscitation and 61(18%) were on oxygen therapy through intranasal oxygen catheter or face mask (table 4). Proportion of neonatal sepsis and clinical characteristics of neonates Two-thirds of the neonates158 (72.1%) were admitted within one week of age and the overall proportion of Neonatal sepsis was 64.8 %( 95% CI (59.2, 69.2). From these 158(72.1%) were early onset neonatal sepsis. Gross congenital malformation like neural tube defect, cleft palate and hydrocephalus were also found in 7(2.1%) of neonates (table 5 and figure 1). Factors associated with neonatal sepsis All the variables which fulfilled the chi-square assumption were fitted into bivariable and multivariable logistic regression. Residency, age of neonate, sex of neonate, place of birth, gestational age, birth weight, maternal age, maternal marital status, parity, ANC follow-up, duration of labor, history of UTI/STIs, history of PROM, history of foul smelling liquor, birth asphyxia, place of delivery and training of health works at NICUs fulfilled the variable screening criteria (p- value < 0.2) and entered into multivariable logistic regression analysis. Consequently, age of neonate, sex of neonates, maternal age, history of UTIs, frequency of PV examination, resuscitation at birth, and getting care from trained health workers were significantly associated with neonatal sepsis at multivariable with less than 0.05 p values. Accordingly, sex of neonate showed significant association with the risk of onset of neonatal sepsis. The odds of having neonatal sepsis among male neonates were 3.7 times higher as compared to female neonates [AOR = 3.73; 95%CI(1.76 , 7.89)] This study showed that, neonates born to mothers who had UTIs during the index pregnancy had 6 times higher odds of developing sepsis as compared to those neonates born from mothers who did not have a UTIs during the index pregnancy [AOR =6.26; 95% CI[(1.16 , 33.62)]. Likewise, increased odds of neonatal sepsis was noted among mothers who have history of more than three PV examination during labor compared to mothers who had PV examination less than or equal to three [AOR = 6.06; 95% CI [(2.45, 14.99]. Similarly, those neonates who were resuscitated at birth had 6 times higher odds of developing sepsis compared to those neonates who were not resuscitated [AOR = 6.110; 95% CI[(1.71,21.84)]. Nevertheless, the odds of neonatal sepsis decreased by 95% among neonates whose age is less than one week compared to those aged greater than a week [AOR = 0.05; 95% CI[(0.01, 0.21)]. Maternal age was significantly associated with neonatal sepsis. Neonates from older mother whose age is 30 – 34 years were 81% less likely to develop neonatal sepsis when compared to neonates from mothers whose age is 35 years and older [AOR=0.19; 95%CI (0.05, 0.81]. Place of delivery also has significant effect on neonatal sepsis. Neonates delivered in the health center were three times more likely to develop sepsis compared to those delivered at the hospital [AOR=3.05; 95% CI ((1.19, 7.79). Finally neonates who get care by health workers who had no training on NICU/ IPPs were 2 times more likely to develop sepsis as compared to neonates who get care by trained health professionals. [AOR = 2.14; 95% CI [(1.04, 4.44)] (table 6). Discussion Neonatal sepsis contributes substantially to neonatal morbidity and mortality and is a major global public health challenge(10). In this study the overall proportion of neonatal sepsis was 64.8 %( 95% CI (59.2, 69.2). This finding is in line with a study conducted in Gondar (67.9 %,) (23). The possible reason for having similar results might be due to similarities of study population studied in the same area and the period in which the studies were conducted. This finding is, however, much higher than findings of studies from Uganda(11%)(14), India(32%)(6), Tanzania(31.4%)(2) and Nigeria(34%)(21). This difference might have been contributed by methodological difference and the difference in diagnostic modality to confirm neonatal sepsis. In contrast to the finding of these studies the prevalence of neonatal sepsis in Bishoftu (72.2%)(3) and Shashemene(77.9%) (9)were much higher than the current finding. This higher prevalence is likely due to the fact that these study sites are referral hospitals, most frequently receiving neonates with complications as well as complicated pregnancies. Furthermore, these differences could be due to difference in sample size, socio-demographic and economic status of study population and access to health facilities(9). In this study, neonates born from mothers who had a history of urinary tract infections (UTIs) during the index pregnancy were six times more likely to develop neonatal sepsis. This finding is in agreement with the findings of studies conducted previously in Mekelle(19) and Bishoftu(3) which revealed that maternal urinary tract and sexual infections was a significant factor for the development of neonatal sepsis. This finding may support the reason that maternal health problem is often associated with neonatal sepsis, especially if untreated during the third trimester pregnancy or labor. Hence, neonatal sepsis may result from the colonization of the birth canal by the infectious agent(3,24). This study also identified significant association between neonatal resuscitation and neonatal sepsis. The odds of developing neonatal sepsis among neonates who has history of neonatal resuscitation at birth were six times higher as compared to neonates who were not resuscitated. This finding was in agreement with studies from Bangladesh(24), Tanzania(2) and Ghana(25) which identified neonatal resuscitation at birth was a significant risk factor for neonatal sepsis. Resuscitation procedures at birth pose greater risk of neonatal sepsis. Many life- supporting procedures such as suctioning and endotracheal intubations can lead to transient and persistent bacteremia(24). Newborn infants are especially vulnerable to nosocomial infections because of their intrinsic susceptibility to infection as well as the performance of invasive procedures for neonatal resuscitation to which they are subjected (25). Studies from china, Korea and Ethiopia revealed that different medical procedures which are undertaken below the optimal level of asepsis (sterility or disinfection) for the management of neonatal health problems predispose the neonate to a great risk of neonatal sepsis(9,28,33) This might resulted from poor practices and non-adherence to guideline by health professionals during resuscitation that may predispose the neonate with a greater risk of developing sepsis(25). Furthermore, in this study neonatal age was found to be significant factor for neonatal sepsis. Neonates whose age was less than or equal seven days were 95% less likely to develop neonatal sepsis compared with the age of neonates greater than seven days of age. This finding is in line with finding from a study in Ghana(25) and Shashemene (Ethiopia)(9) which revealed that the probability of to develop sepsis increased with increasing neonatal age. In fact nosocomial and community acquired neonatal infections occurs after 3 days of life. Consequently this will have an effect on the prevalence of late onset neonatal sepsis(36). This is also supported by the finding from this study which revealed that majority of neonates were delivered in the health institutions. This may in turn increased the possibility to develop neonatal sepsis after discharged from these institutions at late age. Per-vaginal examination (PV) during labour and delivery was found to be significant factor for neonatal sepsis. Neonates from mothers who had history of PV examination greater than three were six times more likely to develop neonatal sepsis. This finding was in line with finding from study in Bangladesh in which neonates from mothers who have history of vaginal examination greater than three was found to be 2.5 times more likely to develop neonatal sepsis(24). Vaginal organisms can be introduced into the cervical canal even during sterile conditions. Hence, babies are at risk from ascending infection thought to be caused by vertical transmission from an infected mother. Therefore vaginal examination can increase the risk of harm for women and their babies(37). However, a study in Mekelle, Ethiopia reported that there was no significant association between PV examination and neonatal sepsis(19) This may also result from difference in study settings where the quality of obstetrical and neonatal health care services provided to mothers and neonates in primary hospitals differs to that of referral hospitals. Sex of neonate was significantly associated with neonatal sepsis. This study found that being male was 3.7 times more likely to develop neonatal sepsis as compared to their counterparts. This finding is in agreement with finding of a study in Australia. It reported that risk of neonatal sepsis was found increase three times more in male neonates as compared to female neonates(30). Male sex is associated with a higher risk of neurological, pulmonary, cardiovascular and infectious morbidities as well as overall mortality when compared to female infants of similar preterm gestation(29). Important differences in the immune response between male and female preterm neonates have also been noted (31). However, the etiology of sex-specific differences in disease remains relatively undetermined and is likely multifactorial, with genetic, immunological and hormonal influences playing key roles(30). Place of birth was found to be statistically significant with neonatal sepsis. Neonates delivered at the health center were three times more likely to develop sepsis as compared to neonates delivered at hospitals. This finding is in agreement with findings from studies in Nigeria(21) and Ethiopia(3,19). This might be due to the reason that neonates who were delivered at health center may be less likely to be screened based on a risk approach and treated with intra-partum antibiotic prophylaxis(38). Furthermore, difference in the level of knowledge about the maternal and neonatal health among health workers in hospitals and health centers and level of adherence of health workers to guidelines and protocols on IPPs to prevent infections in newborns might be the possible reason for this finding. Maternal age was also significantly associated with neonatal sepsis. Neonates from mothers whose age was from 30 - 34 years were 81% less likely to develop neonatal sepsis as compared to those neonates from mothers older than 35 years. However, studies from Bangladesh(24) and Tanzania(2) showed that the attack rates of sepsis increased significantly among neonates born from mothers less than 20yrs of age. This difference may result from the high number of mothers less than 20 years of age in Bangladesh (67%), and Tanzania (17.7%) as compared to the current finding (13.6%) in Ethiopia. Sample size and methodological difference may also have its own impact for this difference. Training of health workers in NICUs in all matters related to neonatal health and infection prevention in particular was significantly associated with neonatal sepsis. Pathogenic agents can be transmitted by direct contact or indirectly via contaminated equipment, intravenous fluids, medications, blood products, or enteral feedings(36). Poor practices and non-adherence to guidelines by health professionals during resuscitation and other medical procedures may predispose the neonate with a greater risk of developing sepsis(25). This might not be different with the finding of current study. Residence, ANC, parity, duration of labor, mode of delivery, foul smelling liquor, birth asphyxia, PROM, gestational age, and birth weight were not found to be predictors of neonatal sepsis in this study. This is in against the findings of studies on risk factors of neonatal sepsis in different parts of the world(3,9,19,21,24,25). Conclusion The proportion of neonatal sepsis is high. Late neonatal age at onset of sepsis, being male sex, 30 -34 years of age of the mother, neonatal resuscitation at birth, history urinary tract infections during pregnancy, frequency of per-vaginal examinations greater than three times during labor and delivery, and place o delivery(health center)were identified risk factors for neonatal sepsis. Therefore; training of health workers, provision of health care services as per standards and monitoring and evaluation of obstetrical/neonatal cares during labor and delivery are mandatory. Limitations of the study Since the study was done on admitted neonates, these findings may lack generalizability to the entire population in the catchment area. Additionally, Clinical diagnosis of neonatal sepsis may overestimate the proportion of neonatal sepsis. Abbreviations ANC: Antenatal Care, APGAR: Appearance, Pulse, Grimace, Activity and respiration, CNS: Central Nervous System, EDHS: Ethiopia Demographic and Health Service Survey, EONS: Early Onset Neonatal Sepsis, HEW: Health Extension Workers, HIV: Human Immune Deficiency Virus, LMICs: Low and Middle Income Countries, LONS: Late Onset Neonatal Sepsis, NICU: Neonatal Intensive Care Unit, NMR: Neonatal Mortality Rate, NS: Neonatal Sepsis, PMTCT: Prevention of Mother to Child Transmission, PROM: Premature Rupture of Membrane, PV: Per-vaginal Examination, STIs: Sexually Transmitted Infections, SVD: Spontaneous Vaginal Delivery, UTIs: Urinary Tract Infections, VDRL: Venereal Disease Research Laboratory, VLBW :Very Low Birth Weight, WHO: World Health Organization. Declarations Ethics approval and consent to participate Ethical clearance was obtained from the Ethical Review Committee of the Institute of Public Health, the University of Gondar. An official permission letter was obtained central Gondar Zone. Written informed consent was obtained from study participants in their local language after explaining the purpose, potential risks and benefits of the study, along with the right to withdraw from the study at any time. The participants were also assured that the data was confidential. Consent for publication Not applicable Availability of data and material The datasets used and/or analyzed during the current study are available from the corresponding author on reasonable request. Competing interest We the authors declare that there is no any competing interest Funding The authors have declared that there was no funding. Authors’ contributions ZA,wrote the proposal, involved in study design, analyzed the data, drafted paper. KAG, and HYY, approved the design, the proposal, involved in data analysis, revised subsequent drafts of the paper and reviewing of the manuscript. All authors read and approved the final manuscript. Authors' detail Amhara Regional State, central Gondar zone ,West Dembia district ,kolladba primary Hospital Department of Reproductive Health, Institute of Public Health, College of Medicine and Health sciences, University of Gondar, Gondar, Ethiopia Department of Human Nutrition, Institute of Public Health, College of Medicine and Health sciences, University of Gondar, Gondar, Ethiopia Acknowledgements The authors would like to thank the study participants, data collectors, and the supervisor References Goldstein B, Giroir B RA. International pediatric sepsis consensus conference: Definitions for sepsis and organ dysfunction in pediatrics*. Pediatr Crit Care Med. 2005;6(1):2–8. Jabiri A, Wella HL, Semiono A, Sariah A, Protas J. Prevalence and factors associated with neonatal sepsis among neonates in Temeke and Mwananyamala Hospitals in Dar es Salaam, Tanzania. Tanzan J Health Res. 2016;18(4):1–7. Woldu M, Lenjisa J, Tegegne G, Tesfaye G, Dinsa H, Guta M. Assessment of the incidence of neonatal sepsis, its risk factors, antimicrobials use and clinical outcomes in Bishoftu general hospital, neonatal intensive care unit, Debrezeit-Ethiopia. Int J Contemp Pediatr [Internet]. 2014;4(4):1. Available from: http://www.ijpediatrics.com/?mno=166126 Hoogen AV, Gerards LJ, Verboon-Maciolek MA, Fleer A KT. Long-term trends in the epidemiology of neonatal sepsis and antibiotic susceptibility of causative agents. Pall Med Life Sci Neonatol 2009;9722–8. Simonsen KA, Anderson-Berry AL, Delair SF DH. Early-onset neonatal sepsis. Clin Microbiol Rev. 2014;27(1):21–47. Gandhi S. , Ranjan K. , KP, Neelima R. , Neha S. MM. Incidence of neonatal sepsis in tertiary hospita: an overview. Int J Med Sci Public Heal. 2013;2(3):548–52. Kim JK, Chang YS, Sung S, Ahn SY, Park WS. Trends in the incidence and associated factors of late-onset sepsis associated with improved survival in extremely preterm infants born at 23 – 26 weeks ’ gestation : a retrospective study. BMC Pediatr. 2018;18(172):1–9. Maryniak K. Neonatal Sepsis: Assessment and Care. RN.com. 2015. p. 1–51. Getabelew A, Aman M, Fantaye E, Yeheyis T. Prevalence of Neonatal Sepsis and Associated Factors among Neonates in Neonatal Intensive Care Unit at Selected Governmental Hospitals in Shashemene Town, Oromia Regional State, Ethiopia, 2017. Int J Pediatr [Internet]. 2018;2018:1–7. Available from: https://www.hindawi.com/journals/ijpedi/2018/7801272/ UNICEF. Committing to Child Survival : A Promise Renewed Progress Report. New York; 2014. Yamey G, Horváth H, Schmidt L, Myers J, Brindis CD. Reducing the global burden of Preterm Birth through knowledge transfer and exchange : a research agenda for engaging effectively with policymakers. Reprod Health [Internet]. 2016;13(26):1–9. Available from: http://dx.doi.org/10.1186/s12978-016-0146-8 Nighat A., Nasrul H. SK. Disease Burden of NICU at a Tertiary Care Hospital,Karachi,Pakistan. J DOW Univ Heal Sci. 2012;6(1):32–5. WHO. WHO Sepsis Technical Expert Meeting. 2018;1–36. Available from: http://www.who.int/sepsis/en/ Kayom VO, Mugalu J, Kakuru A, Kiguli S, Karamagi C. Burden and factors associated with clinical neonatal sepsis in urban Uganda: a community cohort study. BMC Pediatr. 2018;18(1):355. FMOH(Ethiopia). Health Sector Transformation Plan (2015/16-2019/20). 2015. CSA. Federal Democratic Republic of Ethiopia Demographic and Health Survey. Addis Ababa,Ethiopia; 2016. Liang L, Kotadia N, English L, Kissoon N, Ansermino JM, Kabakyenga J, et al. Predictors of Mortality in Neonates and Infants Hospitalized With Sepsis or Serious Infections in Developing Countries: A Systematic Review. Front Pediatr [Internet]. 2018;6(October):1–12. Available from: https://www.frontiersin.org/article/10.3389/fped.2018.00277/full WHO and UNICEF. Every newborn: An action plan to end Preventable deaths: Executive summary. Geneva; 2014. Gebremedhin D, Berhe H, Gebrekirstos K. Risk factors for neonatal sepsis in public hospitals of Mekelle City, North Ethiopia, 2015: Unmatched case control study. PLoS One. 2016;11(5):1–10. Dwiana O. WT. Risk Factors for Neonatal Sepsis in Pregnant Women with Premature Rupture of the Membrane. J Pregnancy. 2018;2018. Shobowale E. et.al. Aetiology and risk factors for neonatal sepsis at the Lagos University Teaching Hospital Idi-Araba, Lagos, Nigeria. South Afrca J child Heal. 2016;10(3):4–7. Meron A. Pattern ofadmission and outcome of neonates admitted to NICU at Tikur Anbesa specialized teaching hospital, Addis Abeba, Ethiopia. 感染症誌. 2017;91:399–404. Demisse AG, Alemu F, Gizaw MA, Tigabu Z. Patterns of admission and factors associated with neonatal mortality among neonates admitted to the neonatal intensive care unit of University of Gondar Hospital, Northwest Ethiopia. Pediatr Heal Med Ther [Internet]. 2017;Volume 8:57–64. Available from: https://www.dovepress.com/patterns-of-admission-and-factors-associated-with-neonatal-mortality-a-peer-reviewed-article-PHMT Hasan S. MC. Predictive V alues of Risk Factors in Neonatal Sepsis. J Bangladesh Coll Physicians Surg. 2011;29(4):187–95. Adatara P, Afaya A, Salia SM, Afaya RA, Konlan KD, Agyabeng-fandoh E, et al. Risk Factors Associated with Neonatal Sepsis : A Case Study at a Specialist Hospital in Ghana. 2019;2019:0–2. Peter B. JSSEMF. Cesarean Delivery and Risk of Intestinal Bacterial Infection. J Infect Dis. 2010;201(6):898–902. Hamid J. , Fayaz B. SA. Comparsion of late neonatel Ssepsis in reast fed and bottle fed infants amitted to Khyber Teaching Hospital, Peshawar, Pakistan. Pakistan J Heal Sci. 2017;01(01). Hwang J., Choi C., Chang Y., Choe Y., Park W., Shin S. et al. The efficacy of clinical strategies to reduce nosocomial sepsis in extremely low birth weight infants. J Korean Med Sci [Internet]. 2005;20:177–81. Available from: http://dx.doi.org/10.1016/j.drudis.2016.09.013 Abdel-latif ME, Capital. Mortality and Adverse Neurologic Outcomes Are Greater in Preterm Male Infants.Australian Neonatal, Territory Care, Intensive Audit, Units. Am Acad Pediatr. 2012;129(1):124–31. Driscoll DNO, Mcgovern M, Greene CM, Molloy EJ. Gender disparities in preterm neonatal outcomes. Found Acta Pædiatrica. 2018;107(Acta Pædiatrica ISSN 0803-5253):1494–9. O’Driscoll DN, Greene CM ME. Immune function ? A missing link in the gender disparity in preterm neonatal outcomes . Expert Rev Clin Immunol. 2017;13:1061–71. Tewabe T, Mohammed S, Tilahun Y, Melaku B, Fenta M, Dagnaw T, et al. Clinical outcome and risk factors of neonatal sepsis among neonates in Felege Hiwot referral Hospital, Bahir Dar, Amhara Regional State, North West Ethiopia 2016: A retrospective chart review. BMC Res Notes. 2017;10(1):1–7. Wu IH, Tsai MH, Lai MY, Hsu LF, Chiang MC, Lien R, et al. Incidence, clinical features, and implications on outcomes of neonatal late-onset sepsis with concurrent infectious focus. BMC Infect Dis. 2017;17(1):1–10. Chan GJ, Lee ACC, Baqui AH, Tan J, Black RE. Prevalence of early-onset neonatal infection among newborns of mothers with bacterial infection or colonization: A systematic review and meta-analysis. BMC Infect Dis. 2015;15(1):1–16. FMOH(Ethiopia). Neonatal Intensive Care Unit managment protocol. Addis ababa,Ethiopia; 2014. Nelson Textbook of Pediatrics 17th edition (May 2003): by Richard E., Md. Behrman (Editor), Robert M., Md. Kliegman (Editor), Hal B., Md. Jenson (Editor) By W B Saunders By OkDoKeY. 2003. 629-30 p. Lesley D. The vaginal examination during labour : Is it of benefit or harm ? New Zeal Coll Midwives J. 2010;42(May):21–6. Edmond K ZA. New Approaches to Preventing , Diagnosing , and Treating Neonatal Sepsis. 2010;7(3):1–8. Tables Table 1. Socio-demographic characteristics of neonates admitted to neonatal intensive care units (NICUs) of central Gondar zone primary hospitals, Northwest Ethiopia, 2019. Variables Frequency Percent Age 0-7 days 278 82.2 8-28 days 60 17.8 Sex Male 200 59.2 Female 138 40.8 Place of delivery Home 28 8.3 Health centre 98 29 Hospital 212 62.7 Gestational age < 37 weeks 120 35.5 37 – 42 weeks 218 64.5 Birth weight <1500 g 43 12.7 1500 – 2499 g 138 40.8 2500 -3499 g 137 40.5 ≥ 4000 g 20 5.9 Table 2 . Socio-demographic and economic characteristics of mothers of neonates admitted to NICU in central Gondar zone primary hospitals, Northwest Ethiopia, 2019. Variables Frequency Percent Residence Urban 143 42.3 Rural 195 57.7 Maternal age 15 - 19 years 46 13.6 20 – 24 years 82 24.3 25 – 29 years 114 33.7 30 – 34 years 46 13.6 ≥ 35 years 50 14.8) Marital status Married 322 95.3 Unmarried 16 4.7 Maternal educational level Unable to read and write 136 40.2 Able to read and write 87 25.7 Primary education 57 16.9 Secondary education 45 13.3 Certificate and above 13 3.8 Occupation Housewife 256 75.7 Government employee 45 15.3 NGO(private) 14 4.1 0thers* 23 6.8 Monthly income 2050 birr 84 24.8 Religion Orthodox 330 97.7 Muslim 8 2.3 *Merchant, daily labourer and house servant Table 3 . Medical and obstetrical characteristics of mothers of neonates admitted to NICU in central Gondar zone primary hospitals, Northwest, Ethiopia, 2019. Variables Frequency Percent parity I 136 40.2 II 58 17.2 III and more 144 42.6 Antenatal care Yes 314 92.9 No 24 7.1 HIV test result Positive 10 3 Unknown 311 92 Negative 17 5 VDRL/RPR status Reactive 20 5.9 Non-reactive 272 80.5 Unknown 46 13.6 Mode of delivery Spontaneous vaginal delivery 247 73.1 Caesarean section 38 11.2 Instrumental 53 15.7 Duration of labor 3 times 195 57.7 History of foul smelling liquor Yes 19 5.6 No 319 94.4 History of PROM** Yes 101 29.9 No 237 70.1 History of high grade fever during pregnancy Yes 74 21.9 No 264 78.1 *Per-vaginal, **premature rupture of membrane Table 4 . Medical procedures done for neonates who were admitted to NICU in central Gondar zone primary hospitals, Northwest Ethiopia, 2019 Variables Frequency Percent Mechanical ventilation No 338 100 Oxygen administration Yes 61 18 No 277 82 Endotracheal tube intubation Yes 9 2.7 No 329 97.3 Nasogastric tube insertion Yes 21 6.2 No 317 93.8 Central venous catheterization Yes 50 14.8 No 288 85.2 Table 5. Clinical characteristics of neonates who were admitted to central Gondar zone primary hospitals, Northwest Ethiopia, 2019. Variables Frequency Percent Birth injury Yes 26 7.7 No 312 92.3 Birth asphyxia Yes 56 16.6 No 282 83.4 Gross congenital malformation Yes 7 2.1 No 331 97.9 Cry at birth Yes 271 80.2 No 67 19.8 Table 6. Bivariable and multivariable analysis of factors associated with neonatal sepsis among neonates admitted at central gonad zone primary hospitals, Northwest Ethiopia, 2019. Variables Neonatal sepsis N (%) COR(95%CI) AOR(95%CI) Yes No Residence Urban 105(31.1) 38(11.2) 1 0.51(0.32, 0.81) 1 0.75(0.34 ,1.66) Rural 114(33.7) 81(24) Parity I 97(28.7) 39(11.5) 1.49(0.90,2.47) 0.74(0.398,1.370) 1 1.21(0.41 ,3.62) 0.58(0.18 ,1.88) 1 II 32(9.7) 26(7.7) III 90(26.6) 54(16) Duration of labor 24 hours 21(9.6) 4(3.4) Frequency of PV examination ≤ 3 times 84(24.9) 59(17.5) 1 1.58((1.01, 2.48) 1 6.06(2.45, 14.99)** >3 times 135(39.9) 60(17.8 Sex of neonate Male 139(41.1) 61(18) 1.65(1.05 , 2.59) 1 3.73(1.76, 7.89)** 1 Female 80(23.7) 58(17.2) Gestational age < 37 weeks 66(19.5) 54(16) 0.52(0.32, 0.82) 1 0.98(0.35 , 2.78) 1 37 – 42 weeks 153(45.3) 65(19.3) History of birth asphyxia Yes 31(9.2) 25(7.4) 0.62(0.35 , 1.11) 1 0.55(0.18 , 1.68) 1 No 188(55.6) 94(27.8) History of oxygen administration Yes 45(13.3) 16(4.4) 1.67(0.89 , 3.09) 1 2.06(0.642, 6.59) 1 No 174(51.5) 103(30.5) History of NG tube insertion Yes 20(5.9) 1(0.3) 11.86(1.57,89.51) 1 10.36(0.81 ,132.78) 1 No 199(58.9) 118(34.9) History IV catheterization Yes 42(12.4) 8(2.4) 3.29(1.49 , 7.27) 1 2.81(0.89, 8.93) 1 No 177(52.4) 111(32.8) History of neonatal resuscitation Yes 37(10.9) 12(3.6) 1.81(0.91 , 3.63) 1 6.11(1.71 , 21.84) * 1 No 182(53.8) 107(31.7) Training of Health workers Yes 112(33.1) 39(11.5) 1 2.17(1.35 , 3.42) 1 2.14(1.04 , 4.44)* No 107(31.7) 80(23.7) Marital status Married 204(60.4) 118(34.9) 1 8.68(1.13 , 66.52) 1 0.14(0.01 , 1.42) Not married 15(4.4) 1(0.3) Maternal age category 15 -19 yrs. 36(10.7) 10(3) 1.14(0.44 , 2.95) 0.52(0.24 , 1.14) 0.63(0.29, 1.35) 0.20(0.08, 0.49) 1 0 .97(0.16 , 5.95) 0.32(0.07 , 1.57) 0.63(0.18 , 2.29) 0.19(0.05, 0.81)* 1 20 -24 yrs. 51(15.1) 31(9.2) 25 - 29 yrs. 76(25.5) 38(11.2) 30 -34 yrs. 18(5.3) 28(8.3) ≥ 35 yrs. 38(11.20 12(3.6) VDRL test result Reactive 17(5) 3(0.9) 2.62(0.75 , 9.18) 0.25(0.13 ,0. 48) 1 1.33(0.18 , 10.13) 0.31(0.11, 0.92) 1 Unknown 16(4.7) 30(8.9) Non-reactive 186(55) 86(25.4) History of UTIs Yes 10(3) 5(1.5) 1.01(0.34 , 3.03) 0.23(0.08 ,0.68) 1 6.26(1.16, 33.62) * 0.06(0.01 , 0.31) ** 1 Unknown 5(1.5) 11(3.3) Negative 204(60.4) 103(30.5) Birth weight <1500 g 24(7.1) 19(5.6) 0.57(0.29 , 1.14) 0.77(0.45 ,1.26) 1 0.76(0.18 , 3.19) 1.11(0.40 , 3.03) 1 1500 – 2499 g 87(25.7) 51(15.1) ≥ 2500 g 108(32) 49(14.5) foul smelling vaginal discharge Yes 9(2.7) 10(3) 0.47(0.18 , 1.18) 1 0.24(0.05 , 1.08) 1 No 210(62.1) 109(32.2) Neonatal age in days ≤ 7 days 163(48.2) 115(34) 0.10(0.04 , 0.29) 1 0 .05(0.01 ,0.21)** 1 >7 days 56(16.60 4(1.2) History of PROM Yes 73(21.6) 28(8.3) 1.62(0.98, 2.70) 1 1.82(0.706 , 4.69) 1 No 146(43.2) 91(26.9) Place of delivery Home 14(4.1) 14(4.1) 0.57(0.26 , 1.26) 1.43(0.85 ,2.39) 1 4.06(0.69 , 23.86) 3.05(1.19 , 7.79) * 1 Health center 70(20.7) 28(8.3) hospital 135(39.9) 77(22.8) *Significant at < 0.05 α – values, ** Significant at < 0.01 α-value . 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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-51669","acceptedTermsAndConditions":true,"allowDirectSubmit":true,"archivedVersions":[],"articleType":"Research","associatedPublications":[],"authors":[{"id":1195184,"identity":"a513b290-b71a-42ff-9ecd-a362d8947673","order_by":0,"name":"Zelalem Agnche","email":"","orcid":"","institution":"Dembia Primary Hospital","correspondingAuthor":false,"prefix":"","firstName":"Zelalem","middleName":"","lastName":"Agnche","suffix":""},{"id":1195185,"identity":"6e133dc6-bb77-45ad-b2e2-e1e131a75f8a","order_by":1,"name":"Hedja Yenus Yeshita","email":"","orcid":"","institution":"University of Gondar","correspondingAuthor":false,"prefix":"","firstName":"Hedja","middleName":"Yenus","lastName":"Yeshita","suffix":""},{"id":1195186,"identity":"8eebf1d8-ff45-4634-88c2-bfc3785d5410","order_by":2,"name":"Kedir Abdela Gonete","email":"data:image/png;base64,iVBORw0KGgoAAAANSUhEUgAAAZAAAAAyAQMAAABI0h/eAAAABlBMVEX///8AAABVwtN+AAAACXBIWXMAAA7EAAAOxAGVKw4bAAABCklEQVRIiWNgGAWjYJACCQaGA0AqsfHBhwobIIOx8QCRWpKbDWecSQNpaSBWS3qbNG/bYbAIXi3y7c0Pb/youRPNz57YJjmD7bzd2vbDQFtqbKJxaTE4c8zYsufYs9yZPQ+bLT7w3E7ediYRqOVYWm4DLi0SCWYSPGyHczfcSGy8OUPidrLZAaAWxobDOLXIz3/+TfLPv8O5+28kNkjzGJxLNjv/EL8Whhs8ZiBf526QSGyS5kk4YGd2g4AtBmdyiq1l+w7nzjjzEBjIB5ITzG4AbUnA4xf59uMbb775dji3vz394YOP/+zszc4DGR9qbHA7DB0kglUmEKscBOxJUTwKRsEoGAUjAwAA9i9yIx7WS8kAAAAASUVORK5CYII=","orcid":"https://orcid.org/0000-0001-9106-1615","institution":"University of Gondar","correspondingAuthor":true,"prefix":"","firstName":"Kedir","middleName":"Abdela","lastName":"Gonete","suffix":""}],"badges":[],"createdAt":"2020-07-31 10:37:59","currentVersionCode":1,"declarations":"","doi":"10.21203/rs.3.rs-51669/v1","doiUrl":"https://doi.org/10.21203/rs.3.rs-51669/v1","draftVersion":[],"editorialEvents":[],"editorialNote":"","failedWorkflow":false,"files":[{"id":1799216,"identity":"d5d8629b-cc14-4b13-93ff-49bf192b2c1e","added_by":"auto","created_at":"2020-08-05 15:35:06","extension":"jpg","order_by":1,"title":"Figure 1","display":"","copyAsset":false,"role":"figure","size":30124,"visible":true,"origin":"","legend":"Proportion of neonatal sepsis among neonates admitted in central Gondar zone primary hospitals, Northwest Ethiopia, 2019.","description":"","filename":"Figure1.JPG","url":"https://assets-eu.researchsquare.com/files/rs-51669/v1/Figure1.JPG"},{"id":13568518,"identity":"c33c623d-c178-45ca-8921-465202b099de","added_by":"auto","created_at":"2021-09-17 03:36:34","extension":"pdf","order_by":0,"title":"","display":"","copyAsset":false,"role":"manuscript-pdf","size":517725,"visible":true,"origin":"","legend":"","description":"","filename":"manuscript.pdf","url":"https://assets-eu.researchsquare.com/files/rs-51669/v1/d37c6100-5a55-4ca5-a094-75f0ebd81012.pdf"}],"financialInterests":"","formattedTitle":"\u003cp\u003eInstitutional Delivery Predisposes to Neonatal Sepsis and Its Associated Factors Among Neonates Admitted to Neonatal Intensive Care Units in Central Gondar Zone Primary Hospitals, Northwest Ethiopia, 2019.\u003c/p\u003e","fulltext":[{"header":"Background","content":"\u003cp\u003eNeonatal sepsis (NS) is defined as systemic inflammatory response syndrome in the presence of or as a result of suspected or proven infection in a neonate(1). Neonatal sepsis contributes substantially to neonatal morbidity and mortality and is an ongoing major global public health challenge (10). According to the World Health Organization (WHO), globally each year over 4 million neonates died within 28 days of birth (11). Infections are considered to be the leading cause of neonatal deaths (35%) followed by deaths resulted from preterm births (28%), intra-partum related complication (24%), and asphyxia (23%)(12) .\u003c/p\u003e\n\u003cp\u003eGlobally 7% of mortality in children under 5 years and 15% in neonates was related to sepsis and meningitis in 2016(13). Sepsis is the commonest cause of neonatal mortality and is probably responsible for 30-50% of the total neonatal deaths each year in developing countries (12). It is estimated that in 2012 about 6.9 million neonates were diagnosed with possible serious bacterial infection needing treatment and 2.6 million of these occurred in Sub Saharan Africa (2, 14).\u003c/p\u003e\n\u003cp\u003eIn Ethiopia; prematurity (37%), infection (28%), and asphyxia (24%) are the most common causes of death in neonates. Neonatal conditions which used to account for a quarter of under-five deaths in 2004 have recently increased to 43%. According to the current united nation estimate in Ethiopia, the neonatal deaths were reduced slowly by 48% in 2013 from the 1990 as compare to significant reduction rate of under-five mortality by 67%(15).\u003c/p\u003e\n\u003cp\u003eEthiopia demographic and health survey (EDHS, 2016) reported that neonatal mortality rate was 29/1000 live birth, which was reduced slowly from 39/1000 in 2005 and 37/1000 live births in 2011. Particularly Amhara region of the country was at the top in infant and neonatal mortality rates (NMRs). It was 67 and 47 per 1,000 live births, respectively (16).\u003c/p\u003e\n\u003cp\u003eNeonatal sepsis also has an economic impact resulted from increased medical costs, prolonged hospital stay and potentially poor long-term neurodevelopmental outcomes. Despite of this fact, the world is witnessing a steady decline in the number of neonatal deaths due to sepsis (17, 18).\u003c/p\u003e\n\u003cp\u003eMultiple factors including maternal, fetal and environmental factors have been associated with increased risk of infections in neonatal life(6).\u003c/p\u003e\n\u003cp\u003eEarly identification of the risk factors for neonatal sepsis would enable early clinical diagnosis and treatment aiming to reduce neonatal morbidity and mortality(2).Implementation of certain clinical strategies are also effective in reducing the incidence of neonatal sepsis(7) .\u003c/p\u003e\n\u003cp\u003eThe burden of neonatal sepsis and its complications can be averted and the target of Sustainable Development Goals for child survival can be achieved through expansion of clinical care for babies and mothers (13). Hence, there have been many advances in prevention, assessment and treatment of neonatal sepsis in the past few decades. However, the morbidity and mortality associated with sepsis remains high for susceptible neonates(8).\u003c/p\u003e\n\u003cp\u003eWorld Health Assembly resolution(WHA) makes a number of recommendations including prevention, diagnosis and treatment of sepsis in national health systems, training all health professionals on infection prevention and patient safety, promoting research, and others. Therefore, sepsis is considered as a good example of a cross-cutting approach for measurable reductions in neonatal mortality (13).\u003c/p\u003e\n\u003cp\u003eIn Ethiopia various efforts have been made to reduce neonatal morbidity and mortality. However, some studies conducted in referral hospitals of the country showed that neonatal morbidity and mortality related to neonatal sepsis is still high.(9).\u003c/p\u003e\n\u003cp\u003eDespite a considerable burden of neonatal sepsis in our setting, there were no studies conducted to assess proportion and associated factors of neonatal sepsis among neonates admitted in NICUs of recently established primary hospitals in Ethiopia. Therefore, this study was carried out to determine the proportion of neonatal sepsis and factors contributing to it among neonates in central Gondar Zone public primary hospitals of Amhara region in Ethiopia.\u003c/p\u003e"},{"header":"Methods","content":"\u003ch2\u003eStudy design, setting and period\u003c/h2\u003e\n\u003cp\u003eInstitutional based cross \u003cstrong\u003e\u0026ndash;\u003c/strong\u003esectional study was conducted in Amhara region at central Gondar zone public primary hospitals in Ethiopia from March to April, 2019. These hospitals were established recently in the last few years. They are providing preventive, promotive and curative health care services to the population in central Gondar zone of the region and serve as a referral centers for the local health centers in the area. These primary hospitals are found in five districts (Dembiya, Chilga, Wogera, Delgi, and East Belesa) in central Gondar zone of the region. They are 781, 780, 787, 832 and 867 km away from Addis Ababa, the capital city of Ethiopia towards the Northwest ,respectively. All hospitals have a total number of 341 health workers. The neonatal intensive care units of each hospital have five neonatal beds for neonatal admission and have three clinical staff (one physician and two clinical nurses) and one cleaner. More than three thousand neonates were admitted in these hospitals annually to get medical services.\u003c/p\u003e\n\u003cp\u003e\u003cstrong\u003eStudy population and sampling procedure \u003c/strong\u003e\u003c/p\u003e\n\u003cp\u003eAll neonates admitted to neonatal intensive care units in central Gondar Zone primary hospitals were included in the study. The sample size was determined by using single population proportion formula and the proportion was taken from the previous literature in Ethiopia. According to study conducted at Gondar University teaching hospital, the prevalence of neonatal sepsis was 69.7%(23). By considering 95% confidence interval (CI), 5% marginal error, and 5% non-response rate. Therefore the final minimum adequate sample size was 352.\u003c/p\u003e\n\u003cp\u003eThe study participants included 352 mother-neonate pairs who were admitted to NICUs during the study period and consented to participate in the study. The study enrolled neonates from birth to 28 days of age. Neonates with sepsis admitted for two or more time during the study period were considered to be excluded to avoid double count. However, there were no such cases in this study. The study populations were neonates admitted and treated in NICUs of central Gondar zone public primary hospitals in Ethiopia. According to the data obtained from these hospitals in 2018, the annual number of neonates admitted in neonatal intensive care units (NICUs) of these hospitals was estimated to be 3000 i.e. on the average 375 neonates were estimated to be admitted during the study period. Systematic random sampling technique was used to select study subjects during the study period. In this study neonatal sepsis is asserted when a medical diagnose of the neonate is stated as \u0026lsquo;neonatal sepsis\u0026rsquo; by the physician in the neonate\u0026rsquo;s medical record chart.\u003c/p\u003e\n\u003cp\u003e\u003cstrong\u003eData collection tool, measurements, and quality management \u003c/strong\u003e\u003c/p\u003e\n\u003cp\u003eThe tool was developed from different literatures to gather the desired information from the sample population. The questionnaire was initially prepared in English language and translated in to Amharic (local language) and again it was retranslated back to English language to check for any inconsistencies or distortions in the meaning of words and concepts. Two days training was given to five data collectors (clinical nurses, diploma) and two supervisors (BSc nurses) prior to the beginning of data collection. Data collectors collected the data from the mother or care giver of the neonates by using interviewer administered structured Amharic version questioner that contains detail questions comprising all the variables of the study. Admission diagnosis of neonates was taken from the diagnosis of physician in the unit.\u003c/p\u003e\n\u003cp\u003eThe WHO IMNCI criteria were applied to assess babies for clinical sepsis. The IMNCI criteria uses the following clinical features to make a diagnosis of clinical neonatal sepsis: not feeding well, convulsions, drowsy or unconscious, movement only when stimulated or no movement at all, fast breathing (60 breaths per min), grunting severe chest in-drawing, raised temperature \u0026gt; 38 \u0026deg;C, hypothermia \u0026lt; 35.5 \u0026deg;C, central cyanosis or could be severe jaundice, severe abdominal distension or localizing signs of infection were diagnosed as having neonatal sepsis(35).\u0026nbsp;\u003c/p\u003e\n\u003cp\u003eA retrospective review of the history was taken to find out if the neonate had the symptoms suggestive of neonatal sepsis since birth. A conclusion of clinical neonatal sepsis was ascertained if the baby had any one of the symptoms of sepsis listed in the IMNCI criteria and admitted in NICUs. Medical documents from the health units attended were also used to get information on presentation of the patient to the health units and the treatment received\u003cstrong\u003e.\u003c/strong\u003e\u003c/p\u003e\n\u003cp\u003eData were checked for its completeness \u0026amp; accuracy during data collection. Close supervision of trained data collectors (five diploma nurses) was undertaken by the trained supervisors (two BSc nurses). The supervisor strictly supervised the data collection process and provided on-site advice and feedbacks to the data collectors on daily basis. Daily exchange of information between the principal investigator and supervisors was undertaken by telephone. The principal investigator had had regular onsite supervision of supervisors and data collectors on weekly basis.\u003c/p\u003e\n\u003ch2\u003e\u0026nbsp;Operational definitions\u003c/h2\u003e\n\u003cp\u003e\u003cstrong\u003eNeonatal sepsis\u003c/strong\u003e: Neonates presented with any one of the systemic manifestation of danger signs:- not feeding well, convulsions, drowsy or unconscious, movement only when stimulated or no movement at all, fast breathing (60 breaths per min), grunting severe chest in-drawing, raised temperature \u0026gt; 38 \u0026deg;C, hypothermia \u0026lt; 35.5 \u0026deg;C, central cyanosis or could be severe jaundice, severe abdominal distension or localizing signs of infection were diagnosed as having neonatal sepsis(35).\u0026nbsp;\u003c/p\u003e\n\u003cp\u003e\u003cstrong\u003eEarly onset of sepsis\u003c/strong\u003e: If sepsis is occurred from birth to 7 days of age.\u003c/p\u003e\n\u003cp\u003e\u003cstrong\u003eLate onset of sepsis\u003c/strong\u003e: If sepsis is occurred between 8 and 28 days of age(32)\u003c/p\u003e\n\u003ch2\u003eData management and analysis\u003c/h2\u003e\n\u003cp\u003eQuestionnaires were checked daily for completeness and accuracy. All data was double entered, cleaned, edited, coded and entered into EPI INFO version 7.0 and exported to SPSS version 20.0 for analysis by binary logistic regression model. Both bivariate and multivariable analysis was used to see the association of different variables. Categorical variables were summarized into percentages and proportions. The continuous variables were summarized into means, medians, standard deviation and ranges and the results were presented with tables and figures. The proportion of clinical neonatal sepsis was obtained by calculating the proportion of neonates with symptoms and signs of clinical neonatal sepsis out of the total number of neonates who were admitted in NICUs during the study period. Bivariate analysis was used to determine association between neonatal sepsis and various independent variables including maternal factors, neonatal factors, and service related factors. Continuous independent variables were categorized and associations established using Chi-squared tests. This was similarly done for categorical variables. Adjusted odds ratio with 95% confidence interval was used to measure the degree of association between variables. P-value of \u0026lt; 0.05 was considered as statistically significant during multivariable logistic regression.\u003c/p\u003e\n\u003cp\u003e\u003cstrong\u003eEthical consideration\u003c/strong\u003e\u003c/p\u003e\n\u003cp\u003eThe proposal was reviewed and approved by the institute review board (IRB) of University of Gondar Institute of Public Health College of Medicine and Health Science before the start of the study. Informed consent was also obtained from mothers. A neonate aged 0 to 28 days of age who met the selection criteria was enrolled in the study. A pretested interviewer administered questionnaire was used to obtain history, physical examination and evaluate factors associated with neonatal sepsis. These included maternal factors, neonatal factors and neonatal health care practices, and service related factors.\u003c/p\u003e"},{"header":"Results","content":"\u003ch2\u003eNeonatal characteristics\u003c/h2\u003e\n\u003cp\u003eA total of 338 mother-neonates pairs were included in five primary hospitals of central Gondar Zone making the response rate of 96%. The median age of neonates was 2 days with interquartile range of 4 days. Among all participants, more than half 200 (59.2%) were male neonates with male to female ratio 1.4:1. Nearly two-third of neonates were born at hospitals 212(62.7%). Similarly nearly two-third 218(64.5%) of neonates were term and the remaining one-third 120(35.5%) were preterm. Low birth weight was illustrated among 53.5% of neonates (Table1).\u0026nbsp;\u003c/p\u003e\n\u003ch2\u003eMothers socio-demographic and economic characteristics\u003c/h2\u003e\n\u003cp\u003eThe median age of mothers of the neonate was 26 years with an inter quartile range of 8 years and 4 months. Among the participants, one-third of neonates mother 114(33.7%) were in the age range of 25 to 29 years. More than half 195 (57.7%) of them were from rural areas (table 2).\u003c/p\u003e\n\u003ch2\u003e\u0026nbsp;Mothers medical and obstetric conditions\u003c/h2\u003e\n\u003cp\u003eIn this study more than half of the mothers 202(59.8%) were multiparous women. Majority of the mothers 314(92.9%) had at least one ANC follow-up at the time of pregnancy and 10 (3%) of them were positive with HIV AIDS. Among the positive mothers, majority 7(70%) were from urban areas. About one-third101 (29.9%) of them had history of PROM during the index pregnancy and nearly three-fourths 247(73.1%) of neonates were delivered by spontaneous vaginal delivery (table3).\u003c/p\u003e\n\u003ch2\u003eMedical procedures related to neonatal health care services\u003c/h2\u003e\n\u003cp\u003eNone of the neonates were on mechanical ventilation. About 2.7% of neonates had history of end tracheal intubation for resuscitation and 61(18%) were on oxygen therapy through intranasal oxygen catheter or face mask (table 4).\u003c/p\u003e\n\u003ch2\u003e\u0026nbsp;Proportion of neonatal sepsis and clinical characteristics of neonates\u003c/h2\u003e\n\u003cp\u003eTwo-thirds of the neonates158 (72.1%) were admitted within one week of age and the overall proportion of Neonatal sepsis was 64.8 %( 95% CI (59.2, 69.2). From these 158(72.1%) were early onset neonatal sepsis. Gross congenital malformation like neural tube defect, cleft palate and hydrocephalus were also found in 7(2.1%) of neonates (table 5 and figure 1).\u003c/p\u003e\n\u003ch2\u003e\u0026nbsp;Factors associated with neonatal sepsis\u003c/h2\u003e\n\u003cp\u003eAll the variables which fulfilled the chi-square assumption were fitted into bivariable and multivariable logistic regression. Residency, age of neonate, sex of neonate, place of birth, gestational age, birth weight, maternal age, maternal marital status, parity, ANC follow-up, duration of labor, history of UTI/STIs, history of PROM, history of foul smelling liquor, birth asphyxia, place of delivery and training of health works at NICUs fulfilled the variable screening criteria (p- value \u0026lt; 0.2) and entered into multivariable logistic regression analysis. Consequently, age of neonate, sex of neonates, maternal age, history of UTIs, frequency of PV examination, resuscitation at birth, and getting care from trained health workers were significantly associated with neonatal sepsis at multivariable with less than 0.05 p values.\u003c/p\u003e\n\u003cp\u003eAccordingly, sex of neonate showed significant association with the risk of onset of neonatal sepsis. The odds of having neonatal sepsis among male neonates were 3.7 times higher as compared to female neonates [AOR = 3.73; 95%CI(1.76 , 7.89)]\u003c/p\u003e\n\u003cp\u003eThis study showed that, neonates born to mothers who had UTIs during the index pregnancy had 6 times higher odds of developing sepsis as compared to those neonates born from mothers who did not have a UTIs during the index pregnancy [AOR =6.26; 95% CI[(1.16 , 33.62)]. Likewise, increased odds of neonatal sepsis was noted among mothers who have history of more than three PV examination during labor compared to mothers who had PV examination less than or equal to three [AOR = 6.06; 95% CI [(2.45, 14.99].\u003c/p\u003e\n\u003cp\u003eSimilarly, those neonates who were resuscitated at birth had 6 times higher odds of developing sepsis compared to those neonates who were not resuscitated [AOR = 6.110; 95% CI[(1.71,21.84)]. Nevertheless, the odds of neonatal sepsis decreased by 95% among neonates whose age is less than one week compared to those aged greater than a week [AOR = 0.05; 95% CI[(0.01, 0.21)].\u003c/p\u003e\n\u003cp\u003eMaternal age was significantly associated with neonatal sepsis. Neonates from older mother whose age is 30 \u0026ndash; 34 years were 81% less likely to develop neonatal sepsis when compared to neonates from mothers whose age is 35 years and older [AOR=0.19; 95%CI (0.05, 0.81].\u003c/p\u003e\n\u003cp\u003ePlace of delivery also has significant effect on neonatal sepsis. Neonates delivered in the health center were three times more likely to develop sepsis compared to those delivered at the hospital [AOR=3.05; 95% CI ((1.19, 7.79).\u003c/p\u003e\n\u003cp\u003eFinally neonates who get care by health workers who had no training on NICU/ IPPs were 2 times more likely to develop sepsis as compared to neonates who get care by trained health professionals. [AOR = 2.14; 95% CI [(1.04, 4.44)] (table 6).\u003c/p\u003e"},{"header":"Discussion","content":"\u003cp\u003eNeonatal sepsis contributes substantially to neonatal morbidity and mortality and is a major global public health challenge(10). In this study the overall proportion of neonatal sepsis was 64.8 %( 95% CI (59.2, 69.2).\u003c/p\u003e\n\u003cp\u003eThis finding is in line with a study conducted in Gondar (67.9 %,) (23). The possible reason for having similar results might be due to similarities of study population studied in the same area and the period in which the studies were conducted. This finding is, however, much higher than findings of studies from Uganda(11%)(14), India(32%)(6), Tanzania(31.4%)(2) and Nigeria(34%)(21). This difference might have been contributed by methodological difference and the difference in diagnostic modality to confirm neonatal sepsis. In contrast to the finding of these studies the prevalence of neonatal sepsis in Bishoftu (72.2%)(3) and Shashemene(77.9%) (9)were much higher than the current finding. This higher prevalence is likely due to the fact that these study sites are referral hospitals, most frequently receiving neonates with complications as well as complicated pregnancies. Furthermore, these differences could be due to difference in sample size, socio-demographic and economic status of study population and access to health facilities(9).\u003c/p\u003e\n\u003cp\u003eIn this study, neonates born from mothers who had a history of urinary tract infections (UTIs) during the index pregnancy were six times more likely to develop neonatal sepsis. This finding is in agreement with the findings of studies conducted previously in Mekelle(19) and Bishoftu(3) which revealed that maternal urinary tract and sexual infections was a significant factor for the development of neonatal sepsis. This finding may support the reason that maternal health problem is often associated with neonatal sepsis, especially if untreated during the third trimester pregnancy or labor. Hence, neonatal sepsis may result from the colonization of the birth canal by the infectious agent(3,24).\u003c/p\u003e\n\u003cp\u003eThis study also identified significant association between neonatal resuscitation and neonatal sepsis. The odds of developing neonatal sepsis among neonates who has history of neonatal resuscitation at birth were six times higher as compared to neonates who were not resuscitated. This finding was in agreement with studies from Bangladesh(24), Tanzania(2) and Ghana(25) which identified neonatal resuscitation at birth was a significant risk factor for neonatal sepsis. Resuscitation procedures at birth pose greater risk of neonatal sepsis. Many life- supporting procedures such as suctioning and endotracheal intubations can lead to transient and persistent bacteremia(24). Newborn infants are especially vulnerable to nosocomial infections because of their intrinsic susceptibility to infection as well as the performance of invasive procedures for neonatal resuscitation to which they are subjected (25). Studies from china, Korea and Ethiopia revealed that different medical procedures which are undertaken below the optimal level of asepsis (sterility or disinfection) for the management of neonatal health problems predispose the neonate to a great risk of neonatal sepsis(9,28,33) This might resulted from poor practices and non-adherence to guideline by health professionals during resuscitation that may predispose the neonate with a greater risk of developing sepsis(25).\u003c/p\u003e\n\u003cp\u003eFurthermore, in this study neonatal age was found to be significant factor for neonatal sepsis. Neonates whose age was less than or equal seven days were 95% less likely to develop neonatal sepsis compared with the age of neonates greater than seven days of age. This finding is in line with finding from a study in Ghana(25) and Shashemene (Ethiopia)(9) which revealed that the probability of to develop sepsis increased with increasing neonatal age. In fact nosocomial and community acquired neonatal infections occurs after 3 days of life. Consequently this will have an effect on the prevalence of late onset neonatal sepsis(36). This is also supported by the finding from this study which revealed that majority of neonates were delivered in the health institutions. This may in turn increased the possibility to develop neonatal sepsis after discharged from these institutions at late age.\u003c/p\u003e\n\u003cp\u003ePer-vaginal examination (PV) during labour and delivery was found to be significant factor for neonatal sepsis. Neonates from mothers who had history of PV examination greater than three were six times more likely to develop neonatal sepsis. This finding was in line with finding from study in Bangladesh in which neonates from mothers who have history of vaginal examination greater than three was found to be 2.5 times more likely to develop neonatal sepsis(24). Vaginal organisms can be introduced into the cervical canal even during sterile conditions. Hence, babies are at risk from ascending infection thought to be caused by vertical transmission from an infected mother. Therefore vaginal examination can increase the risk of harm for women and their babies(37). However, a study in Mekelle, Ethiopia reported that there was no significant association between PV examination and neonatal sepsis(19) This may also result from difference in study settings where the quality of obstetrical and neonatal health care services provided to mothers and neonates in primary hospitals differs to that of referral hospitals.\u003c/p\u003e\n\u003cp\u003eSex of neonate was significantly associated with neonatal sepsis. This study found that being male was 3.7 times more likely to develop neonatal sepsis as compared to their counterparts. This finding is in agreement with finding of a study in Australia. It reported that risk of neonatal sepsis was found increase three times more in male neonates as compared to female neonates(30). Male sex is associated with a higher risk of neurological, pulmonary, cardiovascular and infectious morbidities as well as overall mortality when compared to female infants of similar preterm gestation(29). Important differences in the immune response between male and female preterm neonates have also been noted (31). However, the etiology of sex-specific differences in disease remains relatively undetermined and is likely multifactorial, with genetic, immunological and hormonal influences playing key roles(30).\u003c/p\u003e\n\u003cp\u003ePlace of birth was found to be statistically significant with neonatal sepsis. Neonates delivered at the health center were three times more likely to develop sepsis as compared to neonates delivered at hospitals. This finding is in agreement with findings from studies in Nigeria(21) and Ethiopia(3,19). This might be due to the reason that neonates who were delivered at health center may be less likely to be screened based on a risk approach and treated with intra-partum antibiotic prophylaxis(38). Furthermore, difference in the level of knowledge about the maternal and neonatal health among health workers in hospitals and health centers and level of adherence of health workers to guidelines and protocols on IPPs to prevent infections in newborns might be the possible reason for this finding.\u0026nbsp;\u003c/p\u003e\n\u003cp\u003e\u0026nbsp;Maternal age was also significantly associated with neonatal sepsis. Neonates from mothers whose age was from 30 - 34 years were 81% less likely to develop neonatal sepsis as compared to those neonates from mothers older than 35 years. However, studies from Bangladesh(24) and Tanzania(2) showed that the attack rates of sepsis increased significantly among neonates born from mothers less than 20yrs of age. This difference may result from the high number of mothers less than 20 years of age in Bangladesh (67%), and Tanzania (17.7%) as compared to the current finding (13.6%) in Ethiopia. Sample size and methodological difference may also have its own impact for this difference.\u003c/p\u003e\n\u003cp\u003eTraining of health workers in NICUs in all matters related to neonatal health and infection prevention in particular was significantly associated with neonatal sepsis. Pathogenic agents can be transmitted by direct contact or indirectly via contaminated equipment, intravenous fluids, medications, blood products, or enteral feedings(36). Poor practices and non-adherence to guidelines by health professionals during resuscitation and other medical procedures may predispose the neonate with a greater risk of developing sepsis(25). This might not be different with the finding of current study.\u003c/p\u003e\n\u003cp\u003eResidence, ANC, parity, duration of labor, mode of delivery, foul smelling liquor, birth asphyxia, PROM, gestational age, and birth weight were not found to be predictors of neonatal sepsis in this study. This is in against the findings of studies on risk factors of neonatal sepsis in different parts of the world(3,9,19,21,24,25).\u003c/p\u003e"},{"header":"Conclusion","content":"\u003cp\u003eThe proportion of neonatal sepsis is high. Late neonatal age at onset of sepsis, being male sex, 30 -34 years of age of the mother, neonatal resuscitation at birth, history urinary tract infections during pregnancy, frequency of per-vaginal examinations greater than three times during labor and delivery, and place o delivery(health center)were identified risk factors for neonatal sepsis. Therefore; training of health workers, provision of health care services as per standards and monitoring and evaluation of obstetrical/neonatal cares during labor and delivery are mandatory.\u003c/p\u003e\n\u003ch1\u003eLimitations of the study\u003c/h1\u003e\n\u003cp\u003eSince the study was done on admitted neonates, these findings may lack generalizability to the entire population in the catchment area. Additionally, Clinical diagnosis of neonatal sepsis may overestimate the proportion of neonatal sepsis.\u003c/p\u003e"},{"header":"Abbreviations","content":"\u003cp\u003eANC: Antenatal Care, APGAR: Appearance, Pulse, Grimace, Activity and respiration, CNS: Central Nervous System, EDHS: Ethiopia Demographic and Health Service Survey, EONS: Early Onset Neonatal Sepsis, HEW: Health Extension Workers, HIV: Human Immune Deficiency Virus, LMICs: Low and Middle Income Countries, LONS: Late Onset Neonatal Sepsis, NICU: Neonatal Intensive Care Unit, NMR: Neonatal Mortality Rate, NS: Neonatal Sepsis, PMTCT: Prevention of Mother to Child Transmission, PROM: Premature Rupture of Membrane, PV: Per-vaginal Examination, STIs: Sexually Transmitted Infections, SVD: Spontaneous Vaginal Delivery, UTIs: Urinary Tract Infections, VDRL: Venereal Disease Research Laboratory, VLBW :Very Low Birth Weight, WHO: World Health Organization.\u003c/p\u003e"},{"header":"Declarations","content":"\u003ch2\u003eEthics approval and consent to participate\u003c/h2\u003e\n\u003cp\u003eEthical clearance was obtained from the Ethical Review Committee of the Institute of Public Health, the University of Gondar. An official permission letter was obtained central Gondar Zone. Written informed consent was obtained from study participants in their local language after explaining the purpose, potential risks and benefits of the study, along with the right to withdraw from the study at any time. The participants were also assured that the data was confidential.\u003c/p\u003e\n\u003ch2\u003eConsent for publication\u003c/h2\u003e\n\u003cp\u003e\u0026nbsp;Not applicable\u003c/p\u003e\n\u003ch2\u003eAvailability of data and material\u003c/h2\u003e\n\u003cp\u003eThe datasets used and/or analyzed during the current study are available from the corresponding author on reasonable request.\u003c/p\u003e\n\u003ch2\u003eCompeting interest\u003c/h2\u003e\n\u003cp\u003eWe the authors declare that there is no any competing interest\u003c/p\u003e\n\u003ch2\u003eFunding\u003c/h2\u003e\n\u003cp\u003eThe authors have declared that there was no funding.\u003c/p\u003e\n\u003ch2\u003eAuthors\u0026rsquo; contributions\u003c/h2\u003e\n\u003cp\u003eZA,wrote the proposal, involved in study design, analyzed the data, drafted paper. KAG, and HYY, approved the design, the proposal, involved in data analysis, revised subsequent drafts of the paper and reviewing of the manuscript. All authors read and approved the final manuscript.\u003c/p\u003e\n\u003cp\u003e\u003cstrong\u003eAuthors' detail\u003c/strong\u003e\u003c/p\u003e\n\u003col\u003e\n\u003cli\u003eAmhara Regional State, central Gondar zone ,West Dembia district ,kolladba primary Hospital\u003c/li\u003e\n\u003cli\u003eDepartment of Reproductive Health, Institute of Public Health, College of Medicine and Health sciences, University of Gondar, Gondar, Ethiopia\u003c/li\u003e\n\u003cli\u003eDepartment of Human Nutrition, Institute of Public Health, College of Medicine and Health sciences, University of Gondar, Gondar, Ethiopia\u003c/li\u003e\n\u003c/ol\u003e\n\u003ch2\u003eAcknowledgements\u003c/h2\u003e\n\u003cp\u003eThe authors would like to thank the study participants, data collectors, and the supervisor\u003c/p\u003e"},{"header":"References","content":"\u003col\u003e\n\u003cli\u003eGoldstein B, Giroir B RA. International pediatric sepsis consensus conference: Definitions for sepsis and organ dysfunction in pediatrics*. Pediatr Crit Care Med. 2005;6(1):2\u0026ndash;8.\u003c/li\u003e\n\u003cli\u003eJabiri A, Wella HL, Semiono A, Sariah A, Protas J. Prevalence and factors associated with neonatal sepsis among neonates in Temeke and Mwananyamala Hospitals in Dar es Salaam, Tanzania. Tanzan J Health Res. 2016;18(4):1\u0026ndash;7.\u003c/li\u003e\n\u003cli\u003eWoldu M, Lenjisa J, Tegegne G, Tesfaye G, Dinsa H, Guta M. Assessment of the incidence of neonatal sepsis, its risk factors, antimicrobials use and clinical outcomes in Bishoftu general hospital, neonatal intensive care unit, Debrezeit-Ethiopia. Int J Contemp Pediatr [Internet]. 2014;4(4):1. Available from: http://www.ijpediatrics.com/?mno=166126\u003c/li\u003e\n\u003cli\u003eHoogen AV, Gerards LJ, Verboon-Maciolek MA, Fleer A KT. Long-term trends in the epidemiology of neonatal sepsis and antibiotic susceptibility of causative agents. Pall Med Life Sci Neonatol 2009;9722\u0026ndash;8.\u003c/li\u003e\n\u003cli\u003eSimonsen KA, Anderson-Berry AL, Delair SF DH. Early-onset neonatal sepsis. Clin Microbiol Rev. 2014;27(1):21\u0026ndash;47.\u003c/li\u003e\n\u003cli\u003eGandhi S. , Ranjan K. , KP, Neelima R. , Neha S. MM. Incidence of neonatal sepsis in tertiary hospita: an overview. Int J Med Sci Public Heal. 2013;2(3):548\u0026ndash;52.\u003c/li\u003e\n\u003cli\u003eKim JK, Chang YS, Sung S, Ahn SY, Park WS. Trends in the incidence and associated factors of late-onset sepsis associated with improved survival in extremely preterm infants born at 23 \u0026ndash; 26 weeks \u0026rsquo; gestation : a retrospective study. BMC Pediatr. 2018;18(172):1\u0026ndash;9.\u003c/li\u003e\n\u003cli\u003eMaryniak K. Neonatal Sepsis: Assessment and Care. RN.com. 2015. p. 1\u0026ndash;51.\u003c/li\u003e\n\u003cli\u003eGetabelew A, Aman M, Fantaye E, Yeheyis T. Prevalence of Neonatal Sepsis and Associated Factors among Neonates in Neonatal Intensive Care Unit at Selected Governmental Hospitals in Shashemene Town, Oromia Regional State, Ethiopia, 2017. Int J Pediatr [Internet]. 2018;2018:1\u0026ndash;7. Available from: https://www.hindawi.com/journals/ijpedi/2018/7801272/\u003c/li\u003e\n\u003cli\u003eUNICEF. Committing to Child Survival : A Promise Renewed Progress Report. New York; 2014.\u003c/li\u003e\n\u003cli\u003eYamey G, Horv\u0026aacute;th H, Schmidt L, Myers J, Brindis CD. Reducing the global burden of Preterm Birth through knowledge transfer and exchange : a research agenda for engaging effectively with policymakers. Reprod Health [Internet]. 2016;13(26):1\u0026ndash;9. Available from: http://dx.doi.org/10.1186/s12978-016-0146-8\u003c/li\u003e\n\u003cli\u003eNighat A., Nasrul H. SK. Disease Burden of NICU at a Tertiary Care Hospital,Karachi,Pakistan. J DOW Univ Heal Sci. 2012;6(1):32\u0026ndash;5.\u003c/li\u003e\n\u003cli\u003eWHO. WHO Sepsis Technical Expert Meeting. 2018;1\u0026ndash;36. Available from: http://www.who.int/sepsis/en/\u003c/li\u003e\n\u003cli\u003eKayom VO, Mugalu J, Kakuru A, Kiguli S, Karamagi C. Burden and factors associated with clinical neonatal sepsis in urban Uganda: a community cohort study. BMC Pediatr. 2018;18(1):355.\u003c/li\u003e\n\u003cli\u003eFMOH(Ethiopia). Health Sector Transformation Plan (2015/16-2019/20). 2015.\u003c/li\u003e\n\u003cli\u003eCSA. Federal Democratic Republic of Ethiopia Demographic and Health Survey. Addis Ababa,Ethiopia; 2016.\u003c/li\u003e\n\u003cli\u003eLiang L, Kotadia N, English L, Kissoon N, Ansermino JM, Kabakyenga J, et al. Predictors of Mortality in Neonates and Infants Hospitalized With Sepsis or Serious Infections in Developing Countries: A Systematic Review. Front Pediatr [Internet]. 2018;6(October):1\u0026ndash;12. Available from: https://www.frontiersin.org/article/10.3389/fped.2018.00277/full\u003c/li\u003e\n\u003cli\u003eWHO and UNICEF. Every newborn: An action plan to end Preventable deaths: Executive summary. Geneva; 2014.\u003c/li\u003e\n\u003cli\u003eGebremedhin D, Berhe H, Gebrekirstos K. Risk factors for neonatal sepsis in public hospitals of Mekelle City, North Ethiopia, 2015: Unmatched case control study. PLoS One. 2016;11(5):1\u0026ndash;10.\u003c/li\u003e\n\u003cli\u003eDwiana O. WT. Risk Factors for Neonatal Sepsis in Pregnant Women with Premature Rupture of the Membrane. J Pregnancy. 2018;2018.\u003c/li\u003e\n\u003cli\u003eShobowale E. et.al. Aetiology and risk factors for neonatal sepsis at the Lagos University Teaching Hospital Idi-Araba, Lagos, Nigeria. South Afrca J child Heal. 2016;10(3):4\u0026ndash;7.\u003c/li\u003e\n\u003cli\u003eMeron A. Pattern ofadmission and outcome of neonates admitted to NICU at Tikur Anbesa specialized teaching hospital, Addis Abeba, Ethiopia. 感染症誌. 2017;91:399\u0026ndash;404.\u003c/li\u003e\n\u003cli\u003eDemisse AG, Alemu F, Gizaw MA, Tigabu Z. Patterns of admission and factors associated with neonatal mortality among neonates admitted to the neonatal intensive care unit of University of Gondar Hospital, Northwest Ethiopia. Pediatr Heal Med Ther [Internet]. 2017;Volume 8:57\u0026ndash;64. Available from: https://www.dovepress.com/patterns-of-admission-and-factors-associated-with-neonatal-mortality-a-peer-reviewed-article-PHMT\u003c/li\u003e\n\u003cli\u003eHasan S. MC. Predictive V alues of Risk Factors in Neonatal Sepsis. J Bangladesh Coll Physicians Surg. 2011;29(4):187\u0026ndash;95.\u003c/li\u003e\n\u003cli\u003eAdatara P, Afaya A, Salia SM, Afaya RA, Konlan KD, Agyabeng-fandoh E, et al. Risk Factors Associated with Neonatal Sepsis : A Case Study at a Specialist Hospital in Ghana. 2019;2019:0\u0026ndash;2.\u003c/li\u003e\n\u003cli\u003ePeter B. JSSEMF. Cesarean Delivery and Risk of Intestinal Bacterial Infection. J Infect Dis. 2010;201(6):898\u0026ndash;902.\u003c/li\u003e\n\u003cli\u003eHamid J. , Fayaz B. SA. Comparsion of late neonatel Ssepsis in reast fed and bottle fed infants amitted to Khyber Teaching Hospital, Peshawar, Pakistan. Pakistan J Heal Sci. 2017;01(01).\u003c/li\u003e\n\u003cli\u003eHwang J., Choi C., Chang Y., Choe Y., Park W., Shin S. et al. The efficacy of clinical strategies to reduce nosocomial sepsis in extremely low birth weight infants. J Korean Med Sci [Internet]. 2005;20:177\u0026ndash;81. Available from: http://dx.doi.org/10.1016/j.drudis.2016.09.013\u003c/li\u003e\n\u003cli\u003eAbdel-latif ME, Capital. Mortality and Adverse Neurologic Outcomes Are Greater in Preterm Male Infants.Australian Neonatal, Territory Care, Intensive Audit, Units. Am Acad Pediatr. 2012;129(1):124\u0026ndash;31.\u003c/li\u003e\n\u003cli\u003eDriscoll DNO, Mcgovern M, Greene CM, Molloy EJ. Gender disparities in preterm neonatal outcomes. Found Acta P\u0026aelig;diatrica. 2018;107(Acta P\u0026aelig;diatrica ISSN 0803-5253):1494\u0026ndash;9.\u003c/li\u003e\n\u003cli\u003eO\u0026rsquo;Driscoll DN, Greene CM ME. Immune function ? A missing link in the gender disparity in preterm neonatal outcomes . Expert Rev Clin Immunol. 2017;13:1061\u0026ndash;71.\u003c/li\u003e\n\u003cli\u003eTewabe T, Mohammed S, Tilahun Y, Melaku B, Fenta M, Dagnaw T, et al. Clinical outcome and risk factors of neonatal sepsis among neonates in Felege Hiwot referral Hospital, Bahir Dar, Amhara Regional State, North West Ethiopia 2016: A retrospective chart review. BMC Res Notes. 2017;10(1):1\u0026ndash;7.\u003c/li\u003e\n\u003cli\u003eWu IH, Tsai MH, Lai MY, Hsu LF, Chiang MC, Lien R, et al. Incidence, clinical features, and implications on outcomes of neonatal late-onset sepsis with concurrent infectious focus. BMC Infect Dis. 2017;17(1):1\u0026ndash;10.\u003c/li\u003e\n\u003cli\u003eChan GJ, Lee ACC, Baqui AH, Tan J, Black RE. Prevalence of early-onset neonatal infection among newborns of mothers with bacterial infection or colonization: A systematic review and meta-analysis. BMC Infect Dis. 2015;15(1):1\u0026ndash;16.\u003c/li\u003e\n\u003cli\u003eFMOH(Ethiopia). Neonatal Intensive Care Unit managment protocol. Addis ababa,Ethiopia; 2014.\u003c/li\u003e\n\u003cli\u003eNelson Textbook of Pediatrics 17th edition (May 2003): by Richard E., Md. Behrman (Editor), Robert M., Md. Kliegman (Editor), Hal B., Md. Jenson (Editor) By W B Saunders By OkDoKeY. 2003. 629-30 p.\u003c/li\u003e\n\u003cli\u003eLesley D. The vaginal examination during labour : Is it of benefit or harm ? New Zeal Coll Midwives J. 2010;42(May):21\u0026ndash;6.\u003c/li\u003e\n\u003cli\u003eEdmond K ZA. New Approaches to Preventing , Diagnosing , and Treating Neonatal Sepsis. 2010;7(3):1\u0026ndash;8.\u003c/li\u003e\n\u003c/ol\u003e"},{"header":"Tables","content":"\u003cp\u003eTable 1. Socio-demographic characteristics of neonates admitted to neonatal intensive care units (NICUs) of central Gondar zone primary hospitals, Northwest Ethiopia, 2019.\u003c/p\u003e\n\u003ctable border=\"1\"\u003e\n\u003ctbody\u003e\n\u003ctr\u003e\n\u003ctd colspan=\"2\" width=\"319\"\u003e\n\u003cp\u003e\u003cstrong\u003eVariables\u003c/strong\u003e\u003c/p\u003e\n\u003c/td\u003e\n\u003ctd width=\"143\"\u003e\n\u003cp\u003e\u003cstrong\u003eFrequency\u003c/strong\u003e\u003c/p\u003e\n\u003c/td\u003e\n\u003ctd width=\"141\"\u003e\n\u003cp\u003e\u003cstrong\u003ePercent\u003c/strong\u003e\u003c/p\u003e\n\u003c/td\u003e\n\u003c/tr\u003e\n\u003ctr\u003e\n\u003ctd rowspan=\"2\" width=\"154\"\u003e\n\u003cp\u003eAge\u003c/p\u003e\n\u003c/td\u003e\n\u003ctd width=\"165\"\u003e\n\u003cp\u003e0-7 days\u003c/p\u003e\n\u003c/td\u003e\n\u003ctd width=\"143\"\u003e\n\u003cp\u003e278\u003c/p\u003e\n\u003c/td\u003e\n\u003ctd width=\"141\"\u003e\n\u003cp\u003e82.2\u003c/p\u003e\n\u003c/td\u003e\n\u003c/tr\u003e\n\u003ctr\u003e\n\u003ctd width=\"165\"\u003e\n\u003cp\u003e8-28 days\u003c/p\u003e\n\u003c/td\u003e\n\u003ctd width=\"143\"\u003e\n\u003cp\u003e60\u003c/p\u003e\n\u003c/td\u003e\n\u003ctd width=\"141\"\u003e\n\u003cp\u003e17.8\u003c/p\u003e\n\u003c/td\u003e\n\u003c/tr\u003e\n\u003ctr\u003e\n\u003ctd rowspan=\"2\" width=\"154\"\u003e\n\u003cp\u003eSex\u003c/p\u003e\n\u003c/td\u003e\n\u003ctd width=\"165\"\u003e\n\u003cp\u003eMale\u003c/p\u003e\n\u003c/td\u003e\n\u003ctd width=\"143\"\u003e\n\u003cp\u003e200\u003c/p\u003e\n\u003c/td\u003e\n\u003ctd width=\"141\"\u003e\n\u003cp\u003e59.2\u003c/p\u003e\n\u003c/td\u003e\n\u003c/tr\u003e\n\u003ctr\u003e\n\u003ctd width=\"165\"\u003e\n\u003cp\u003eFemale\u003c/p\u003e\n\u003c/td\u003e\n\u003ctd width=\"143\"\u003e\n\u003cp\u003e138\u003c/p\u003e\n\u003c/td\u003e\n\u003ctd width=\"141\"\u003e\n\u003cp\u003e40.8\u003c/p\u003e\n\u003c/td\u003e\n\u003c/tr\u003e\n\u003ctr\u003e\n\u003ctd rowspan=\"3\" width=\"154\"\u003e\n\u003cp\u003ePlace of delivery\u003c/p\u003e\n\u003c/td\u003e\n\u003ctd width=\"165\"\u003e\n\u003cp\u003eHome\u003c/p\u003e\n\u003c/td\u003e\n\u003ctd width=\"143\"\u003e\n\u003cp\u003e28\u003c/p\u003e\n\u003c/td\u003e\n\u003ctd width=\"141\"\u003e\n\u003cp\u003e8.3\u003c/p\u003e\n\u003c/td\u003e\n\u003c/tr\u003e\n\u003ctr\u003e\n\u003ctd width=\"165\"\u003e\n\u003cp\u003eHealth centre\u003c/p\u003e\n\u003c/td\u003e\n\u003ctd width=\"143\"\u003e\n\u003cp\u003e98\u003c/p\u003e\n\u003c/td\u003e\n\u003ctd width=\"141\"\u003e\n\u003cp\u003e29\u003c/p\u003e\n\u003c/td\u003e\n\u003c/tr\u003e\n\u003ctr\u003e\n\u003ctd width=\"165\"\u003e\n\u003cp\u003eHospital\u003c/p\u003e\n\u003c/td\u003e\n\u003ctd width=\"143\"\u003e\n\u003cp\u003e212\u003c/p\u003e\n\u003c/td\u003e\n\u003ctd width=\"141\"\u003e\n\u003cp\u003e62.7\u003c/p\u003e\n\u003c/td\u003e\n\u003c/tr\u003e\n\u003ctr\u003e\n\u003ctd rowspan=\"2\" width=\"154\"\u003e\n\u003cp\u003eGestational age\u003c/p\u003e\n\u003c/td\u003e\n\u003ctd width=\"165\"\u003e\n\u003cp\u003e\u0026lt; 37 weeks\u003c/p\u003e\n\u003c/td\u003e\n\u003ctd width=\"143\"\u003e\n\u003cp\u003e120\u003c/p\u003e\n\u003c/td\u003e\n\u003ctd width=\"141\"\u003e\n\u003cp\u003e35.5\u003c/p\u003e\n\u003c/td\u003e\n\u003c/tr\u003e\n\u003ctr\u003e\n\u003ctd width=\"165\"\u003e\n\u003cp\u003e37 \u0026ndash; 42 weeks\u003c/p\u003e\n\u003c/td\u003e\n\u003ctd width=\"143\"\u003e\n\u003cp\u003e218\u003c/p\u003e\n\u003c/td\u003e\n\u003ctd width=\"141\"\u003e\n\u003cp\u003e64.5\u003c/p\u003e\n\u003c/td\u003e\n\u003c/tr\u003e\n\u003ctr\u003e\n\u003ctd rowspan=\"4\" width=\"154\"\u003e\n\u003cp\u003eBirth weight\u003c/p\u003e\n\u003c/td\u003e\n\u003ctd width=\"165\"\u003e\n\u003cp\u003e\u0026lt;1500 g\u003c/p\u003e\n\u003c/td\u003e\n\u003ctd width=\"143\"\u003e\n\u003cp\u003e43\u003c/p\u003e\n\u003c/td\u003e\n\u003ctd width=\"141\"\u003e\n\u003cp\u003e12.7\u003c/p\u003e\n\u003c/td\u003e\n\u003c/tr\u003e\n\u003ctr\u003e\n\u003ctd width=\"165\"\u003e\n\u003cp\u003e1500 \u0026ndash; 2499 g\u003c/p\u003e\n\u003c/td\u003e\n\u003ctd width=\"143\"\u003e\n\u003cp\u003e138\u003c/p\u003e\n\u003c/td\u003e\n\u003ctd width=\"141\"\u003e\n\u003cp\u003e40.8\u003c/p\u003e\n\u003c/td\u003e\n\u003c/tr\u003e\n\u003ctr\u003e\n\u003ctd width=\"165\"\u003e\n\u003cp\u003e2500 -3499 g\u003c/p\u003e\n\u003c/td\u003e\n\u003ctd width=\"143\"\u003e\n\u003cp\u003e137\u003c/p\u003e\n\u003c/td\u003e\n\u003ctd width=\"141\"\u003e\n\u003cp\u003e40.5\u003c/p\u003e\n\u003c/td\u003e\n\u003c/tr\u003e\n\u003ctr\u003e\n\u003ctd width=\"165\"\u003e\n\u003cp\u003e\u0026ge; 4000 g\u003c/p\u003e\n\u003c/td\u003e\n\u003ctd width=\"143\"\u003e\n\u003cp\u003e20\u003c/p\u003e\n\u003c/td\u003e\n\u003ctd width=\"141\"\u003e\n\u003cp\u003e5.9\u003c/p\u003e\n\u003c/td\u003e\n\u003c/tr\u003e\n\u003c/tbody\u003e\n\u003c/table\u003e\n\u003cp\u003e\u003cstrong\u003eTable \u003c/strong\u003e\u003cstrong\u003e2\u003c/strong\u003e\u003cstrong\u003e. \u003c/strong\u003eSocio-demographic and economic characteristics of mothers of neonates admitted to NICU in central Gondar zone primary hospitals, Northwest Ethiopia, 2019.\u003c/p\u003e\n\u003ctable border=\"1\" width=\"603\"\u003e\n\u003ctbody\u003e\n\u003ctr\u003e\n\u003ctd colspan=\"2\" width=\"413\"\u003e\n\u003cp\u003e\u003cstrong\u003eVariables\u003c/strong\u003e\u003c/p\u003e\n\u003c/td\u003e\n\u003ctd colspan=\"2\" width=\"94\"\u003e\n\u003cp\u003e\u003cstrong\u003eFrequency\u003c/strong\u003e\u003c/p\u003e\n\u003c/td\u003e\n\u003ctd width=\"95\"\u003e\n\u003cp\u003e\u003cstrong\u003ePercent\u003c/strong\u003e\u003c/p\u003e\n\u003c/td\u003e\n\u003c/tr\u003e\n\u003ctr\u003e\n\u003ctd rowspan=\"2\" width=\"224\"\u003e\n\u003cp\u003eResidence\u003c/p\u003e\n\u003c/td\u003e\n\u003ctd width=\"189\"\u003e\n\u003cp\u003eUrban\u003c/p\u003e\n\u003c/td\u003e\n\u003ctd colspan=\"2\" width=\"94\"\u003e\n\u003cp\u003e143\u003c/p\u003e\n\u003c/td\u003e\n\u003ctd width=\"95\"\u003e\n\u003cp\u003e42.3\u003c/p\u003e\n\u003c/td\u003e\n\u003c/tr\u003e\n\u003ctr\u003e\n\u003ctd width=\"189\"\u003e\n\u003cp\u003eRural\u003c/p\u003e\n\u003c/td\u003e\n\u003ctd colspan=\"2\" width=\"94\"\u003e\n\u003cp\u003e195\u003c/p\u003e\n\u003c/td\u003e\n\u003ctd width=\"95\"\u003e\n\u003cp\u003e57.7\u003c/p\u003e\n\u003c/td\u003e\n\u003c/tr\u003e\n\u003ctr\u003e\n\u003ctd rowspan=\"5\" width=\"224\"\u003e\n\u003cp\u003eMaternal age\u003c/p\u003e\n\u003c/td\u003e\n\u003ctd width=\"189\"\u003e\n\u003cp\u003e15 - 19 years\u003c/p\u003e\n\u003c/td\u003e\n\u003ctd colspan=\"2\" width=\"94\"\u003e\n\u003cp\u003e46\u003c/p\u003e\n\u003c/td\u003e\n\u003ctd width=\"95\"\u003e\n\u003cp\u003e13.6\u003c/p\u003e\n\u003c/td\u003e\n\u003c/tr\u003e\n\u003ctr\u003e\n\u003ctd width=\"189\"\u003e\n\u003cp\u003e20 \u0026ndash; 24 years\u003c/p\u003e\n\u003c/td\u003e\n\u003ctd colspan=\"2\" width=\"94\"\u003e\n\u003cp\u003e82\u003c/p\u003e\n\u003c/td\u003e\n\u003ctd width=\"95\"\u003e\n\u003cp\u003e24.3\u003c/p\u003e\n\u003c/td\u003e\n\u003c/tr\u003e\n\u003ctr\u003e\n\u003ctd width=\"189\"\u003e\n\u003cp\u003e25 \u0026ndash; 29 years\u003c/p\u003e\n\u003c/td\u003e\n\u003ctd colspan=\"2\" width=\"94\"\u003e\n\u003cp\u003e114\u003c/p\u003e\n\u003c/td\u003e\n\u003ctd width=\"95\"\u003e\n\u003cp\u003e33.7\u003c/p\u003e\n\u003c/td\u003e\n\u003c/tr\u003e\n\u003ctr\u003e\n\u003ctd width=\"189\"\u003e\n\u003cp\u003e30 \u0026ndash; 34 years\u003c/p\u003e\n\u003c/td\u003e\n\u003ctd colspan=\"2\" width=\"94\"\u003e\n\u003cp\u003e46\u003c/p\u003e\n\u003c/td\u003e\n\u003ctd width=\"95\"\u003e\n\u003cp\u003e13.6\u003c/p\u003e\n\u003c/td\u003e\n\u003c/tr\u003e\n\u003ctr\u003e\n\u003ctd width=\"189\"\u003e\n\u003cp\u003e\u0026ge; 35 years\u003c/p\u003e\n\u003c/td\u003e\n\u003ctd colspan=\"2\" width=\"94\"\u003e\n\u003cp\u003e50\u003c/p\u003e\n\u003c/td\u003e\n\u003ctd width=\"95\"\u003e\n\u003cp\u003e14.8)\u003c/p\u003e\n\u003c/td\u003e\n\u003c/tr\u003e\n\u003ctr\u003e\n\u003ctd rowspan=\"2\" width=\"224\"\u003e\n\u003cp\u003eMarital status\u003c/p\u003e\n\u003c/td\u003e\n\u003ctd width=\"189\"\u003e\n\u003cp\u003eMarried\u003c/p\u003e\n\u003c/td\u003e\n\u003ctd colspan=\"2\" width=\"94\"\u003e\n\u003cp\u003e322\u003c/p\u003e\n\u003c/td\u003e\n\u003ctd width=\"95\"\u003e\n\u003cp\u003e95.3\u003c/p\u003e\n\u003c/td\u003e\n\u003c/tr\u003e\n\u003ctr\u003e\n\u003ctd width=\"189\"\u003e\n\u003cp\u003eUnmarried\u003c/p\u003e\n\u003c/td\u003e\n\u003ctd colspan=\"2\" width=\"94\"\u003e\n\u003cp\u003e16\u003c/p\u003e\n\u003c/td\u003e\n\u003ctd width=\"95\"\u003e\n\u003cp\u003e4.7\u003c/p\u003e\n\u003c/td\u003e\n\u003c/tr\u003e\n\u003ctr\u003e\n\u003ctd rowspan=\"5\" width=\"224\"\u003e\n\u003cp\u003eMaternal educational level\u003c/p\u003e\n\u003c/td\u003e\n\u003ctd width=\"189\"\u003e\n\u003cp\u003eUnable to read and write\u003c/p\u003e\n\u003c/td\u003e\n\u003ctd colspan=\"2\" width=\"94\"\u003e\n\u003cp\u003e136\u003c/p\u003e\n\u003c/td\u003e\n\u003ctd width=\"95\"\u003e\n\u003cp\u003e40.2\u003c/p\u003e\n\u003c/td\u003e\n\u003c/tr\u003e\n\u003ctr\u003e\n\u003ctd width=\"189\"\u003e\n\u003cp\u003eAble to read and write\u003c/p\u003e\n\u003c/td\u003e\n\u003ctd colspan=\"2\" width=\"94\"\u003e\n\u003cp\u003e87\u003c/p\u003e\n\u003c/td\u003e\n\u003ctd width=\"95\"\u003e\n\u003cp\u003e25.7\u003c/p\u003e\n\u003c/td\u003e\n\u003c/tr\u003e\n\u003ctr\u003e\n\u003ctd width=\"189\"\u003e\n\u003cp\u003ePrimary education\u003c/p\u003e\n\u003c/td\u003e\n\u003ctd colspan=\"2\" width=\"94\"\u003e\n\u003cp\u003e57\u003c/p\u003e\n\u003c/td\u003e\n\u003ctd width=\"95\"\u003e\n\u003cp\u003e16.9\u003c/p\u003e\n\u003c/td\u003e\n\u003c/tr\u003e\n\u003ctr\u003e\n\u003ctd width=\"189\"\u003e\n\u003cp\u003eSecondary education\u003c/p\u003e\n\u003c/td\u003e\n\u003ctd colspan=\"2\" width=\"94\"\u003e\n\u003cp\u003e45\u003c/p\u003e\n\u003c/td\u003e\n\u003ctd width=\"95\"\u003e\n\u003cp\u003e13.3\u003c/p\u003e\n\u003c/td\u003e\n\u003c/tr\u003e\n\u003ctr\u003e\n\u003ctd width=\"189\"\u003e\n\u003cp\u003eCertificate and above\u003c/p\u003e\n\u003c/td\u003e\n\u003ctd colspan=\"2\" width=\"94\"\u003e\n\u003cp\u003e13\u003c/p\u003e\n\u003c/td\u003e\n\u003ctd width=\"95\"\u003e\n\u003cp\u003e3.8\u003c/p\u003e\n\u003c/td\u003e\n\u003c/tr\u003e\n\u003ctr\u003e\n\u003ctd rowspan=\"4\" width=\"224\"\u003e\n\u003cp\u003eOccupation\u003c/p\u003e\n\u003c/td\u003e\n\u003ctd width=\"189\"\u003e\n\u003cp\u003eHousewife\u003c/p\u003e\n\u003c/td\u003e\n\u003ctd colspan=\"2\" width=\"94\"\u003e\n\u003cp\u003e256\u003c/p\u003e\n\u003c/td\u003e\n\u003ctd width=\"95\"\u003e\n\u003cp\u003e75.7\u003c/p\u003e\n\u003c/td\u003e\n\u003c/tr\u003e\n\u003ctr\u003e\n\u003ctd width=\"189\"\u003e\n\u003cp\u003eGovernment employee\u003c/p\u003e\n\u003c/td\u003e\n\u003ctd colspan=\"2\" width=\"94\"\u003e\n\u003cp\u003e45\u003c/p\u003e\n\u003c/td\u003e\n\u003ctd width=\"95\"\u003e\n\u003cp\u003e15.3\u003c/p\u003e\n\u003c/td\u003e\n\u003c/tr\u003e\n\u003ctr\u003e\n\u003ctd width=\"189\"\u003e\n\u003cp\u003eNGO(private)\u003c/p\u003e\n\u003c/td\u003e\n\u003ctd colspan=\"2\" width=\"94\"\u003e\n\u003cp\u003e14\u003c/p\u003e\n\u003c/td\u003e\n\u003ctd width=\"95\"\u003e\n\u003cp\u003e4.1\u003c/p\u003e\n\u003c/td\u003e\n\u003c/tr\u003e\n\u003ctr\u003e\n\u003ctd width=\"189\"\u003e\n\u003cp\u003e0thers*\u003c/p\u003e\n\u003c/td\u003e\n\u003ctd colspan=\"2\" width=\"94\"\u003e\n\u003cp\u003e23\u003c/p\u003e\n\u003c/td\u003e\n\u003ctd width=\"95\"\u003e\n\u003cp\u003e6.8\u003c/p\u003e\n\u003c/td\u003e\n\u003c/tr\u003e\n\u003ctr\u003e\n\u003ctd rowspan=\"4\" width=\"224\"\u003e\n\u003cp\u003eMonthly income\u003c/p\u003e\n\u003c/td\u003e\n\u003ctd width=\"189\"\u003e\n\u003cp\u003e\u0026lt; 900 birr\u003c/p\u003e\n\u003c/td\u003e\n\u003ctd colspan=\"2\" width=\"94\"\u003e\n\u003cp\u003e97\u003c/p\u003e\n\u003c/td\u003e\n\u003ctd width=\"95\"\u003e\n\u003cp\u003e28.7\u003c/p\u003e\n\u003c/td\u003e\n\u003c/tr\u003e\n\u003ctr\u003e\n\u003ctd width=\"189\"\u003e\n\u003cp\u003e900-1200 birr\u003c/p\u003e\n\u003c/td\u003e\n\u003ctd colspan=\"2\" width=\"94\"\u003e\n\u003cp\u003e78\u003c/p\u003e\n\u003c/td\u003e\n\u003ctd width=\"95\"\u003e\n\u003cp\u003e23.1\u003c/p\u003e\n\u003c/td\u003e\n\u003c/tr\u003e\n\u003ctr\u003e\n\u003ctd width=\"189\"\u003e\n\u003cp\u003e1201- 2050 birr\u003c/p\u003e\n\u003c/td\u003e\n\u003ctd colspan=\"2\" width=\"94\"\u003e\n\u003cp\u003e79\u003c/p\u003e\n\u003c/td\u003e\n\u003ctd width=\"95\"\u003e\n\u003cp\u003e23.4\u003c/p\u003e\n\u003c/td\u003e\n\u003c/tr\u003e\n\u003ctr\u003e\n\u003ctd width=\"189\"\u003e\n\u003cp\u003e\u0026gt; 2050 birr\u003c/p\u003e\n\u003c/td\u003e\n\u003ctd colspan=\"2\" width=\"94\"\u003e\n\u003cp\u003e84\u003c/p\u003e\n\u003c/td\u003e\n\u003ctd width=\"95\"\u003e\n\u003cp\u003e24.8\u003c/p\u003e\n\u003c/td\u003e\n\u003c/tr\u003e\n\u003ctr\u003e\n\u003ctd rowspan=\"2\" width=\"224\"\u003e\n\u003cp\u003eReligion\u003c/p\u003e\n\u003c/td\u003e\n\u003ctd width=\"189\"\u003e\n\u003cp\u003eOrthodox\u003c/p\u003e\n\u003c/td\u003e\n\u003ctd colspan=\"2\" width=\"94\"\u003e\n\u003cp\u003e330\u003c/p\u003e\n\u003c/td\u003e\n\u003ctd width=\"95\"\u003e\n\u003cp\u003e97.7\u003c/p\u003e\n\u003c/td\u003e\n\u003c/tr\u003e\n\u003ctr\u003e\n\u003ctd width=\"189\"\u003e\n\u003cp\u003eMuslim\u003c/p\u003e\n\u003c/td\u003e\n\u003ctd width=\"94\"\u003e\n\u003cp\u003e8\u003c/p\u003e\n\u003c/td\u003e\n\u003ctd colspan=\"2\" width=\"95\"\u003e\n\u003cp\u003e2.3\u003c/p\u003e\n\u003c/td\u003e\n\u003c/tr\u003e\n\u003c/tbody\u003e\n\u003c/table\u003e\n\u003cp\u003e*Merchant, daily labourer and house servant\u003c/p\u003e\n\u003cp\u003e\u003cstrong\u003eTable \u003c/strong\u003e\u003cstrong\u003e3\u003c/strong\u003e\u003cstrong\u003e. \u003c/strong\u003eMedical and obstetrical characteristics of mothers of neonates admitted to NICU in central Gondar zone primary hospitals, Northwest, Ethiopia, 2019.\u003c/p\u003e\n\u003ctable border=\"1\" width=\"612\"\u003e\n\u003ctbody\u003e\n\u003ctr\u003e\n\u003ctd colspan=\"2\" width=\"442\"\u003e\n\u003cp\u003e\u003cstrong\u003eVariables\u003c/strong\u003e\u003c/p\u003e\n\u003c/td\u003e\n\u003ctd width=\"85\"\u003e\n\u003cp\u003e\u003cstrong\u003eFrequency\u003c/strong\u003e\u003c/p\u003e\n\u003c/td\u003e\n\u003ctd width=\"85\"\u003e\n\u003cp\u003e\u003cstrong\u003ePercent\u003c/strong\u003e\u003c/p\u003e\n\u003c/td\u003e\n\u003c/tr\u003e\n\u003ctr\u003e\n\u003ctd rowspan=\"3\" width=\"234\"\u003e\n\u003cp\u003eparity\u003c/p\u003e\n\u003c/td\u003e\n\u003ctd width=\"208\"\u003e\n\u003cp\u003eI\u003c/p\u003e\n\u003c/td\u003e\n\u003ctd width=\"85\"\u003e\n\u003cp\u003e136\u003c/p\u003e\n\u003c/td\u003e\n\u003ctd width=\"85\"\u003e\n\u003cp\u003e40.2\u003c/p\u003e\n\u003c/td\u003e\n\u003c/tr\u003e\n\u003ctr\u003e\n\u003ctd width=\"208\"\u003e\n\u003cp\u003eII\u003c/p\u003e\n\u003c/td\u003e\n\u003ctd width=\"85\"\u003e\n\u003cp\u003e58\u003c/p\u003e\n\u003c/td\u003e\n\u003ctd width=\"85\"\u003e\n\u003cp\u003e17.2\u003c/p\u003e\n\u003c/td\u003e\n\u003c/tr\u003e\n\u003ctr\u003e\n\u003ctd width=\"208\"\u003e\n\u003cp\u003eIII and more\u003c/p\u003e\n\u003c/td\u003e\n\u003ctd width=\"85\"\u003e\n\u003cp\u003e144\u003c/p\u003e\n\u003c/td\u003e\n\u003ctd width=\"85\"\u003e\n\u003cp\u003e42.6\u003c/p\u003e\n\u003c/td\u003e\n\u003c/tr\u003e\n\u003ctr\u003e\n\u003ctd rowspan=\"2\" width=\"234\"\u003e\n\u003cp\u003eAntenatal care\u003c/p\u003e\n\u003c/td\u003e\n\u003ctd width=\"208\"\u003e\n\u003cp\u003eYes\u003c/p\u003e\n\u003c/td\u003e\n\u003ctd width=\"85\"\u003e\n\u003cp\u003e314\u003c/p\u003e\n\u003c/td\u003e\n\u003ctd width=\"85\"\u003e\n\u003cp\u003e92.9\u003c/p\u003e\n\u003c/td\u003e\n\u003c/tr\u003e\n\u003ctr\u003e\n\u003ctd width=\"208\"\u003e\n\u003cp\u003eNo\u003c/p\u003e\n\u003c/td\u003e\n\u003ctd width=\"85\"\u003e\n\u003cp\u003e24\u003c/p\u003e\n\u003c/td\u003e\n\u003ctd width=\"85\"\u003e\n\u003cp\u003e7.1\u003c/p\u003e\n\u003c/td\u003e\n\u003c/tr\u003e\n\u003ctr\u003e\n\u003ctd rowspan=\"3\" width=\"234\"\u003e\n\u003cp\u003eHIV test result\u003c/p\u003e\n\u003c/td\u003e\n\u003ctd width=\"208\"\u003e\n\u003cp\u003ePositive\u003c/p\u003e\n\u003c/td\u003e\n\u003ctd width=\"85\"\u003e\n\u003cp\u003e10\u003c/p\u003e\n\u003c/td\u003e\n\u003ctd width=\"85\"\u003e\n\u003cp\u003e3\u003c/p\u003e\n\u003c/td\u003e\n\u003c/tr\u003e\n\u003ctr\u003e\n\u003ctd width=\"208\"\u003e\n\u003cp\u003eUnknown\u003c/p\u003e\n\u003c/td\u003e\n\u003ctd width=\"85\"\u003e\n\u003cp\u003e311\u003c/p\u003e\n\u003c/td\u003e\n\u003ctd width=\"85\"\u003e\n\u003cp\u003e92\u003c/p\u003e\n\u003c/td\u003e\n\u003c/tr\u003e\n\u003ctr\u003e\n\u003ctd width=\"208\"\u003e\n\u003cp\u003eNegative\u003c/p\u003e\n\u003c/td\u003e\n\u003ctd width=\"85\"\u003e\n\u003cp\u003e17\u003c/p\u003e\n\u003c/td\u003e\n\u003ctd width=\"85\"\u003e\n\u003cp\u003e5\u003c/p\u003e\n\u003c/td\u003e\n\u003c/tr\u003e\n\u003ctr\u003e\n\u003ctd rowspan=\"3\" width=\"234\"\u003e\n\u003cp\u003eVDRL/RPR status\u003c/p\u003e\n\u003c/td\u003e\n\u003ctd width=\"208\"\u003e\n\u003cp\u003eReactive\u003c/p\u003e\n\u003c/td\u003e\n\u003ctd width=\"85\"\u003e\n\u003cp\u003e20\u003c/p\u003e\n\u003c/td\u003e\n\u003ctd width=\"85\"\u003e\n\u003cp\u003e5.9\u003c/p\u003e\n\u003c/td\u003e\n\u003c/tr\u003e\n\u003ctr\u003e\n\u003ctd width=\"208\"\u003e\n\u003cp\u003eNon-reactive\u003c/p\u003e\n\u003c/td\u003e\n\u003ctd width=\"85\"\u003e\n\u003cp\u003e272\u003c/p\u003e\n\u003c/td\u003e\n\u003ctd width=\"85\"\u003e\n\u003cp\u003e80.5\u003c/p\u003e\n\u003c/td\u003e\n\u003c/tr\u003e\n\u003ctr\u003e\n\u003ctd width=\"208\"\u003e\n\u003cp\u003eUnknown\u003c/p\u003e\n\u003c/td\u003e\n\u003ctd width=\"85\"\u003e\n\u003cp\u003e46\u003c/p\u003e\n\u003c/td\u003e\n\u003ctd width=\"85\"\u003e\n\u003cp\u003e13.6\u003c/p\u003e\n\u003c/td\u003e\n\u003c/tr\u003e\n\u003ctr\u003e\n\u003ctd rowspan=\"3\" width=\"234\"\u003e\n\u003cp\u003eMode of delivery\u003c/p\u003e\n\u003c/td\u003e\n\u003ctd width=\"208\"\u003e\n\u003cp\u003eSpontaneous vaginal delivery\u003c/p\u003e\n\u003c/td\u003e\n\u003ctd width=\"85\"\u003e\n\u003cp\u003e247\u003c/p\u003e\n\u003c/td\u003e\n\u003ctd width=\"85\"\u003e\n\u003cp\u003e73.1\u003c/p\u003e\n\u003c/td\u003e\n\u003c/tr\u003e\n\u003ctr\u003e\n\u003ctd width=\"208\"\u003e\n\u003cp\u003eCaesarean section\u003c/p\u003e\n\u003c/td\u003e\n\u003ctd width=\"85\"\u003e\n\u003cp\u003e38\u003c/p\u003e\n\u003c/td\u003e\n\u003ctd width=\"85\"\u003e\n\u003cp\u003e11.2\u003c/p\u003e\n\u003c/td\u003e\n\u003c/tr\u003e\n\u003ctr\u003e\n\u003ctd width=\"208\"\u003e\n\u003cp\u003eInstrumental\u003c/p\u003e\n\u003c/td\u003e\n\u003ctd width=\"85\"\u003e\n\u003cp\u003e53\u003c/p\u003e\n\u003c/td\u003e\n\u003ctd width=\"85\"\u003e\n\u003cp\u003e15.7\u003c/p\u003e\n\u003c/td\u003e\n\u003c/tr\u003e\n\u003ctr\u003e\n\u003ctd rowspan=\"4\" width=\"234\"\u003e\n\u003cp\u003eDuration of labor\u003c/p\u003e\n\u003c/td\u003e\n\u003ctd width=\"208\"\u003e\n\u003cp\u003e\u0026lt; 6 hours\u003c/p\u003e\n\u003c/td\u003e\n\u003ctd width=\"85\"\u003e\n\u003cp\u003e118\u003c/p\u003e\n\u003c/td\u003e\n\u003ctd width=\"85\"\u003e\n\u003cp\u003e34.9\u003c/p\u003e\n\u003c/td\u003e\n\u003c/tr\u003e\n\u003ctr\u003e\n\u003ctd width=\"208\"\u003e\n\u003cp\u003e6 -12 hours\u003c/p\u003e\n\u003c/td\u003e\n\u003ctd width=\"85\"\u003e\n\u003cp\u003e87\u003c/p\u003e\n\u003c/td\u003e\n\u003ctd width=\"85\"\u003e\n\u003cp\u003e25.7\u003c/p\u003e\n\u003c/td\u003e\n\u003c/tr\u003e\n\u003ctr\u003e\n\u003ctd width=\"208\"\u003e\n\u003cp\u003e12 \u0026ndash; 24 hours\u003c/p\u003e\n\u003c/td\u003e\n\u003ctd width=\"85\"\u003e\n\u003cp\u003e108\u003c/p\u003e\n\u003c/td\u003e\n\u003ctd width=\"85\"\u003e\n\u003cp\u003e32\u003c/p\u003e\n\u003c/td\u003e\n\u003c/tr\u003e\n\u003ctr\u003e\n\u003ctd width=\"208\"\u003e\n\u003cp\u003e˃ 24 hours\u003c/p\u003e\n\u003c/td\u003e\n\u003ctd width=\"85\"\u003e\n\u003cp\u003e25\u003c/p\u003e\n\u003c/td\u003e\n\u003ctd width=\"85\"\u003e\n\u003cp\u003e7.4\u003c/p\u003e\n\u003c/td\u003e\n\u003c/tr\u003e\n\u003ctr\u003e\n\u003ctd rowspan=\"2\" width=\"234\"\u003e\n\u003cp\u003eFrequency of PV* exam during labor\u003c/p\u003e\n\u003c/td\u003e\n\u003ctd width=\"208\"\u003e\n\u003cp\u003e\u0026le; 3 times\u003c/p\u003e\n\u003c/td\u003e\n\u003ctd width=\"85\"\u003e\n\u003cp\u003e143\u003c/p\u003e\n\u003c/td\u003e\n\u003ctd width=\"85\"\u003e\n\u003cp\u003e42.3\u003c/p\u003e\n\u003c/td\u003e\n\u003c/tr\u003e\n\u003ctr\u003e\n\u003ctd width=\"208\"\u003e\n\u003cp\u003e\u0026gt;3 times\u003c/p\u003e\n\u003c/td\u003e\n\u003ctd width=\"85\"\u003e\n\u003cp\u003e195\u003c/p\u003e\n\u003c/td\u003e\n\u003ctd width=\"85\"\u003e\n\u003cp\u003e57.7\u003c/p\u003e\n\u003c/td\u003e\n\u003c/tr\u003e\n\u003ctr\u003e\n\u003ctd rowspan=\"2\" width=\"234\"\u003e\n\u003cp\u003eHistory of foul smelling liquor\u003c/p\u003e\n\u003c/td\u003e\n\u003ctd width=\"208\"\u003e\n\u003cp\u003eYes\u003c/p\u003e\n\u003c/td\u003e\n\u003ctd width=\"85\"\u003e\n\u003cp\u003e19\u003c/p\u003e\n\u003c/td\u003e\n\u003ctd width=\"85\"\u003e\n\u003cp\u003e5.6\u003c/p\u003e\n\u003c/td\u003e\n\u003c/tr\u003e\n\u003ctr\u003e\n\u003ctd width=\"208\"\u003e\n\u003cp\u003eNo\u003c/p\u003e\n\u003c/td\u003e\n\u003ctd width=\"85\"\u003e\n\u003cp\u003e319\u003c/p\u003e\n\u003c/td\u003e\n\u003ctd width=\"85\"\u003e\n\u003cp\u003e94.4\u003c/p\u003e\n\u003c/td\u003e\n\u003c/tr\u003e\n\u003ctr\u003e\n\u003ctd rowspan=\"2\" width=\"234\"\u003e\n\u003cp\u003eHistory of PROM**\u003c/p\u003e\n\u003c/td\u003e\n\u003ctd width=\"208\"\u003e\n\u003cp\u003eYes\u003c/p\u003e\n\u003c/td\u003e\n\u003ctd width=\"85\"\u003e\n\u003cp\u003e101\u003c/p\u003e\n\u003c/td\u003e\n\u003ctd width=\"85\"\u003e\n\u003cp\u003e29.9\u003c/p\u003e\n\u003c/td\u003e\n\u003c/tr\u003e\n\u003ctr\u003e\n\u003ctd width=\"208\"\u003e\n\u003cp\u003eNo\u003c/p\u003e\n\u003c/td\u003e\n\u003ctd width=\"85\"\u003e\n\u003cp\u003e237\u003c/p\u003e\n\u003c/td\u003e\n\u003ctd width=\"85\"\u003e\n\u003cp\u003e70.1\u003c/p\u003e\n\u003c/td\u003e\n\u003c/tr\u003e\n\u003ctr\u003e\n\u003ctd rowspan=\"2\" width=\"234\"\u003e\n\u003cp\u003eHistory of high grade fever during pregnancy\u003c/p\u003e\n\u003c/td\u003e\n\u003ctd width=\"208\"\u003e\n\u003cp\u003eYes\u003c/p\u003e\n\u003c/td\u003e\n\u003ctd width=\"85\"\u003e\n\u003cp\u003e74\u003c/p\u003e\n\u003c/td\u003e\n\u003ctd width=\"85\"\u003e\n\u003cp\u003e21.9\u003c/p\u003e\n\u003c/td\u003e\n\u003c/tr\u003e\n\u003ctr\u003e\n\u003ctd width=\"208\"\u003e\n\u003cp\u003eNo\u003c/p\u003e\n\u003c/td\u003e\n\u003ctd width=\"85\"\u003e\n\u003cp\u003e264\u003c/p\u003e\n\u003c/td\u003e\n\u003ctd width=\"85\"\u003e\n\u003cp\u003e78.1\u003c/p\u003e\n\u003c/td\u003e\n\u003c/tr\u003e\n\u003c/tbody\u003e\n\u003c/table\u003e\n\u003cp\u003e\u0026nbsp;*Per-vaginal, **premature rupture of membrane\u003c/p\u003e\n\u003cp\u003e\u003cstrong\u003eTable \u003c/strong\u003e\u003cstrong\u003e4\u003c/strong\u003e\u003cstrong\u003e. \u003c/strong\u003eMedical procedures done for neonates who were admitted to NICU in central Gondar zone primary hospitals, Northwest Ethiopia, 2019\u003c/p\u003e\n\u003ctable border=\"1\"\u003e\n\u003ctbody\u003e\n\u003ctr\u003e\n\u003ctd colspan=\"2\" width=\"308\"\u003e\n\u003cp\u003e\u003cstrong\u003eVariables\u003c/strong\u003e\u003c/p\u003e\n\u003c/td\u003e\n\u003ctd width=\"154\"\u003e\n\u003cp\u003e\u003cstrong\u003eFrequency\u003c/strong\u003e\u003c/p\u003e\n\u003c/td\u003e\n\u003ctd width=\"154\"\u003e\n\u003cp\u003e\u003cstrong\u003ePercent\u003c/strong\u003e\u003c/p\u003e\n\u003c/td\u003e\n\u003c/tr\u003e\n\u003ctr\u003e\n\u003ctd width=\"253\"\u003e\n\u003cp\u003eMechanical ventilation\u003c/p\u003e\n\u003c/td\u003e\n\u003ctd width=\"55\"\u003e\n\u003cp\u003eNo\u003c/p\u003e\n\u003c/td\u003e\n\u003ctd width=\"154\"\u003e\n\u003cp\u003e338\u003c/p\u003e\n\u003c/td\u003e\n\u003ctd width=\"154\"\u003e\n\u003cp\u003e100\u003c/p\u003e\n\u003c/td\u003e\n\u003c/tr\u003e\n\u003ctr\u003e\n\u003ctd rowspan=\"2\" width=\"253\"\u003e\n\u003cp\u003eOxygen administration\u003c/p\u003e\n\u003c/td\u003e\n\u003ctd width=\"55\"\u003e\n\u003cp\u003eYes\u003c/p\u003e\n\u003c/td\u003e\n\u003ctd width=\"154\"\u003e\n\u003cp\u003e61\u003c/p\u003e\n\u003c/td\u003e\n\u003ctd width=\"154\"\u003e\n\u003cp\u003e18\u003c/p\u003e\n\u003c/td\u003e\n\u003c/tr\u003e\n\u003ctr\u003e\n\u003ctd width=\"55\"\u003e\n\u003cp\u003eNo\u003c/p\u003e\n\u003c/td\u003e\n\u003ctd width=\"154\"\u003e\n\u003cp\u003e277\u003c/p\u003e\n\u003c/td\u003e\n\u003ctd width=\"154\"\u003e\n\u003cp\u003e82\u003c/p\u003e\n\u003c/td\u003e\n\u003c/tr\u003e\n\u003ctr\u003e\n\u003ctd rowspan=\"2\" width=\"253\"\u003e\n\u003cp\u003eEndotracheal tube intubation\u003c/p\u003e\n\u003c/td\u003e\n\u003ctd width=\"55\"\u003e\n\u003cp\u003eYes\u003c/p\u003e\n\u003c/td\u003e\n\u003ctd width=\"154\"\u003e\n\u003cp\u003e9\u003c/p\u003e\n\u003c/td\u003e\n\u003ctd width=\"154\"\u003e\n\u003cp\u003e2.7\u003c/p\u003e\n\u003c/td\u003e\n\u003c/tr\u003e\n\u003ctr\u003e\n\u003ctd width=\"55\"\u003e\n\u003cp\u003eNo\u003c/p\u003e\n\u003c/td\u003e\n\u003ctd width=\"154\"\u003e\n\u003cp\u003e329\u003c/p\u003e\n\u003c/td\u003e\n\u003ctd width=\"154\"\u003e\n\u003cp\u003e97.3\u003c/p\u003e\n\u003c/td\u003e\n\u003c/tr\u003e\n\u003ctr\u003e\n\u003ctd rowspan=\"2\" width=\"253\"\u003e\n\u003cp\u003eNasogastric tube insertion\u003c/p\u003e\n\u003c/td\u003e\n\u003ctd width=\"55\"\u003e\n\u003cp\u003eYes\u003c/p\u003e\n\u003c/td\u003e\n\u003ctd width=\"154\"\u003e\n\u003cp\u003e21\u003c/p\u003e\n\u003c/td\u003e\n\u003ctd width=\"154\"\u003e\n\u003cp\u003e6.2\u003c/p\u003e\n\u003c/td\u003e\n\u003c/tr\u003e\n\u003ctr\u003e\n\u003ctd width=\"55\"\u003e\n\u003cp\u003eNo\u003c/p\u003e\n\u003c/td\u003e\n\u003ctd width=\"154\"\u003e\n\u003cp\u003e317\u003c/p\u003e\n\u003c/td\u003e\n\u003ctd width=\"154\"\u003e\n\u003cp\u003e93.8\u003c/p\u003e\n\u003c/td\u003e\n\u003c/tr\u003e\n\u003ctr\u003e\n\u003ctd rowspan=\"2\" width=\"253\"\u003e\n\u003cp\u003eCentral venous catheterization\u003c/p\u003e\n\u003c/td\u003e\n\u003ctd width=\"55\"\u003e\n\u003cp\u003eYes\u003c/p\u003e\n\u003c/td\u003e\n\u003ctd width=\"154\"\u003e\n\u003cp\u003e50\u003c/p\u003e\n\u003c/td\u003e\n\u003ctd width=\"154\"\u003e\n\u003cp\u003e14.8\u003c/p\u003e\n\u003c/td\u003e\n\u003c/tr\u003e\n\u003ctr\u003e\n\u003ctd width=\"55\"\u003e\n\u003cp\u003eNo\u003c/p\u003e\n\u003c/td\u003e\n\u003ctd width=\"154\"\u003e\n\u003cp\u003e288\u003c/p\u003e\n\u003c/td\u003e\n\u003ctd width=\"154\"\u003e\n\u003cp\u003e85.2\u003c/p\u003e\n\u003c/td\u003e\n\u003c/tr\u003e\n\u003c/tbody\u003e\n\u003c/table\u003e\n\u003cp\u003eTable 5. Clinical characteristics of neonates who were admitted to central Gondar zone primary hospitals, Northwest Ethiopia, 2019.\u003c/p\u003e\n\u003ctable border=\"1\"\u003e\n\u003ctbody\u003e\n\u003ctr\u003e\n\u003ctd colspan=\"2\" width=\"308\"\u003e\n\u003cp\u003e\u003cstrong\u003eVariables\u003c/strong\u003e\u003c/p\u003e\n\u003c/td\u003e\n\u003ctd width=\"154\"\u003e\n\u003cp\u003e\u003cstrong\u003eFrequency\u003c/strong\u003e\u003c/p\u003e\n\u003c/td\u003e\n\u003ctd width=\"154\"\u003e\n\u003cp\u003e\u003cstrong\u003ePercent\u003c/strong\u003e\u003c/p\u003e\n\u003c/td\u003e\n\u003c/tr\u003e\n\u003ctr\u003e\n\u003ctd rowspan=\"2\" width=\"253\"\u003e\n\u003cp\u003eBirth injury\u003c/p\u003e\n\u003c/td\u003e\n\u003ctd width=\"55\"\u003e\n\u003cp\u003eYes\u003c/p\u003e\n\u003c/td\u003e\n\u003ctd width=\"154\"\u003e\n\u003cp\u003e26\u003c/p\u003e\n\u003c/td\u003e\n\u003ctd width=\"154\"\u003e\n\u003cp\u003e7.7\u003c/p\u003e\n\u003c/td\u003e\n\u003c/tr\u003e\n\u003ctr\u003e\n\u003ctd width=\"55\"\u003e\n\u003cp\u003eNo\u003c/p\u003e\n\u003c/td\u003e\n\u003ctd width=\"154\"\u003e\n\u003cp\u003e312\u003c/p\u003e\n\u003c/td\u003e\n\u003ctd width=\"154\"\u003e\n\u003cp\u003e92.3\u003c/p\u003e\n\u003c/td\u003e\n\u003c/tr\u003e\n\u003ctr\u003e\n\u003ctd rowspan=\"2\" width=\"253\"\u003e\n\u003cp\u003eBirth asphyxia\u003c/p\u003e\n\u003c/td\u003e\n\u003ctd width=\"55\"\u003e\n\u003cp\u003eYes\u003c/p\u003e\n\u003c/td\u003e\n\u003ctd width=\"154\"\u003e\n\u003cp\u003e56\u003c/p\u003e\n\u003c/td\u003e\n\u003ctd width=\"154\"\u003e\n\u003cp\u003e16.6\u003c/p\u003e\n\u003c/td\u003e\n\u003c/tr\u003e\n\u003ctr\u003e\n\u003ctd width=\"55\"\u003e\n\u003cp\u003eNo\u003c/p\u003e\n\u003c/td\u003e\n\u003ctd width=\"154\"\u003e\n\u003cp\u003e282\u003c/p\u003e\n\u003c/td\u003e\n\u003ctd width=\"154\"\u003e\n\u003cp\u003e83.4\u003c/p\u003e\n\u003c/td\u003e\n\u003c/tr\u003e\n\u003ctr\u003e\n\u003ctd rowspan=\"2\" width=\"253\"\u003e\n\u003cp\u003eGross congenital malformation\u003c/p\u003e\n\u003c/td\u003e\n\u003ctd width=\"55\"\u003e\n\u003cp\u003eYes\u003c/p\u003e\n\u003c/td\u003e\n\u003ctd width=\"154\"\u003e\n\u003cp\u003e7\u003c/p\u003e\n\u003c/td\u003e\n\u003ctd width=\"154\"\u003e\n\u003cp\u003e2.1\u003c/p\u003e\n\u003c/td\u003e\n\u003c/tr\u003e\n\u003ctr\u003e\n\u003ctd width=\"55\"\u003e\n\u003cp\u003eNo\u003c/p\u003e\n\u003c/td\u003e\n\u003ctd width=\"154\"\u003e\n\u003cp\u003e331\u003c/p\u003e\n\u003c/td\u003e\n\u003ctd width=\"154\"\u003e\n\u003cp\u003e97.9\u003c/p\u003e\n\u003c/td\u003e\n\u003c/tr\u003e\n\u003ctr\u003e\n\u003ctd rowspan=\"2\" width=\"253\"\u003e\n\u003cp\u003eCry at birth\u003c/p\u003e\n\u003c/td\u003e\n\u003ctd width=\"55\"\u003e\n\u003cp\u003eYes\u003c/p\u003e\n\u003c/td\u003e\n\u003ctd width=\"154\"\u003e\n\u003cp\u003e271\u003c/p\u003e\n\u003c/td\u003e\n\u003ctd width=\"154\"\u003e\n\u003cp\u003e80.2\u003c/p\u003e\n\u003c/td\u003e\n\u003c/tr\u003e\n\u003ctr\u003e\n\u003ctd width=\"55\"\u003e\n\u003cp\u003eNo\u003c/p\u003e\n\u003c/td\u003e\n\u003ctd width=\"154\"\u003e\n\u003cp\u003e67\u003c/p\u003e\n\u003c/td\u003e\n\u003ctd width=\"154\"\u003e\n\u003cp\u003e19.8\u003c/p\u003e\n\u003c/td\u003e\n\u003c/tr\u003e\n\u003c/tbody\u003e\n\u003c/table\u003e\n\u003cp\u003eTable 6. Bivariable and multivariable analysis of factors associated with neonatal sepsis among neonates admitted at central gonad zone primary hospitals, Northwest Ethiopia, 2019.\u003c/p\u003e\n\u003ctable border=\"1\" width=\"738\"\u003e\n\u003ctbody\u003e\n\u003ctr\u003e\n\u003ctd rowspan=\"2\" width=\"114\"\u003e\n\u003cp\u003e\u003cstrong\u003eVariables\u003c/strong\u003e\u003c/p\u003e\n\u003c/td\u003e\n\u003ctd rowspan=\"2\" width=\"102\"\u003e\u0026nbsp;\u003c/td\u003e\n\u003ctd colspan=\"2\" width=\"207\"\u003e\n\u003cp\u003e\u003cstrong\u003eNeonatal sepsis N (%)\u003c/strong\u003e\u003c/p\u003e\n\u003c/td\u003e\n\u003ctd rowspan=\"2\" width=\"141\"\u003e\n\u003cp\u003e\u003cstrong\u003eCOR(95%CI)\u003c/strong\u003e\u003c/p\u003e\n\u003c/td\u003e\n\u003ctd rowspan=\"2\" width=\"174\"\u003e\n\u003cp\u003e\u003cstrong\u003eAOR(95%CI)\u003c/strong\u003e\u003c/p\u003e\n\u003c/td\u003e\n\u003c/tr\u003e\n\u003ctr\u003e\n\u003ctd width=\"131\"\u003e\n\u003cp\u003e\u003cstrong\u003eYes\u003c/strong\u003e\u003c/p\u003e\n\u003c/td\u003e\n\u003ctd width=\"76\"\u003e\n\u003cp\u003e\u003cstrong\u003eNo\u003c/strong\u003e\u003c/p\u003e\n\u003c/td\u003e\n\u003c/tr\u003e\n\u003ctr\u003e\n\u003ctd rowspan=\"2\" width=\"114\"\u003e\n\u003cp\u003eResidence\u003c/p\u003e\n\u003c/td\u003e\n\u003ctd width=\"102\"\u003e\n\u003cp\u003eUrban\u003c/p\u003e\n\u003c/td\u003e\n\u003ctd width=\"131\"\u003e\n\u003cp\u003e105(31.1)\u003c/p\u003e\n\u003c/td\u003e\n\u003ctd width=\"76\"\u003e\n\u003cp\u003e38(11.2)\u003c/p\u003e\n\u003c/td\u003e\n\u003ctd rowspan=\"2\" width=\"141\"\u003e\n\u003cp\u003e1\u003c/p\u003e\n\u003cp\u003e0.51(0.32, 0.81)\u003c/p\u003e\n\u003c/td\u003e\n\u003ctd rowspan=\"2\" width=\"174\"\u003e\n\u003cp\u003e1\u003c/p\u003e\n\u003cp\u003e0.75(0.34 ,1.66)\u003c/p\u003e\n\u003c/td\u003e\n\u003c/tr\u003e\n\u003ctr\u003e\n\u003ctd width=\"102\"\u003e\n\u003cp\u003eRural\u003c/p\u003e\n\u003c/td\u003e\n\u003ctd width=\"131\"\u003e\n\u003cp\u003e114(33.7)\u003c/p\u003e\n\u003c/td\u003e\n\u003ctd width=\"76\"\u003e\n\u003cp\u003e81(24)\u003c/p\u003e\n\u003c/td\u003e\n\u003c/tr\u003e\n\u003ctr\u003e\n\u003ctd rowspan=\"3\" width=\"114\"\u003e\n\u003cp\u003eParity\u003c/p\u003e\n\u003c/td\u003e\n\u003ctd width=\"102\"\u003e\n\u003cp\u003eI\u003c/p\u003e\n\u003c/td\u003e\n\u003ctd width=\"131\"\u003e\n\u003cp\u003e97(28.7)\u003c/p\u003e\n\u003c/td\u003e\n\u003ctd width=\"76\"\u003e\n\u003cp\u003e39(11.5)\u003c/p\u003e\n\u003c/td\u003e\n\u003ctd rowspan=\"3\" width=\"141\"\u003e\n\u003cp\u003e1.49(0.90,2.47)\u003c/p\u003e\n\u003cp\u003e0.74(0.398,1.370)\u003c/p\u003e\n\u003cp\u003e1\u003c/p\u003e\n\u003c/td\u003e\n\u003ctd rowspan=\"3\" width=\"174\"\u003e\n\u003cp\u003e1.21(0.41 ,3.62)\u003c/p\u003e\n\u003cp\u003e0.58(0.18 ,1.88)\u003c/p\u003e\n\u003cp\u003e1\u003c/p\u003e\n\u003c/td\u003e\n\u003c/tr\u003e\n\u003ctr\u003e\n\u003ctd width=\"102\"\u003e\n\u003cp\u003eII\u003c/p\u003e\n\u003c/td\u003e\n\u003ctd width=\"131\"\u003e\n\u003cp\u003e32(9.7)\u003c/p\u003e\n\u003c/td\u003e\n\u003ctd width=\"76\"\u003e\n\u003cp\u003e26(7.7)\u003c/p\u003e\n\u003c/td\u003e\n\u003c/tr\u003e\n\u003ctr\u003e\n\u003ctd width=\"102\"\u003e\n\u003cp\u003eIII\u003c/p\u003e\n\u003c/td\u003e\n\u003ctd width=\"131\"\u003e\n\u003cp\u003e90(26.6)\u003c/p\u003e\n\u003c/td\u003e\n\u003ctd width=\"76\"\u003e\n\u003cp\u003e54(16)\u003c/p\u003e\n\u003c/td\u003e\n\u003c/tr\u003e\n\u003ctr\u003e\n\u003ctd rowspan=\"4\" width=\"114\"\u003e\n\u003cp\u003eDuration of labor\u003c/p\u003e\n\u003c/td\u003e\n\u003ctd width=\"102\"\u003e\n\u003cp\u003e\u0026lt; 6 hours\u003c/p\u003e\n\u003c/td\u003e\n\u003ctd width=\"131\"\u003e\n\u003cp\u003e82(24.3)\u003c/p\u003e\n\u003c/td\u003e\n\u003ctd width=\"76\"\u003e\n\u003cp\u003e36(10.7)\u003c/p\u003e\n\u003c/td\u003e\n\u003ctd rowspan=\"4\" width=\"141\"\u003e\n\u003cp\u003e1\u003c/p\u003e\n\u003cp\u003e0.39(0.22 , 0.69)\u003c/p\u003e\n\u003cp\u003e0,99(0.57 , 1.76)\u003c/p\u003e\n\u003cp\u003e2.31(0.74, 7.19)\u003c/p\u003e\n\u003c/td\u003e\n\u003ctd rowspan=\"4\" width=\"174\"\u003e\n\u003cp\u003e1\u003c/p\u003e\n\u003cp\u003e0.47(0.181,1.19)\u003c/p\u003e\n\u003cp\u003e0.66(0.25,1.77)\u003c/p\u003e\n\u003cp\u003e1.02(0.21,4.93)\u003c/p\u003e\n\u003c/td\u003e\n\u003c/tr\u003e\n\u003ctr\u003e\n\u003ctd width=\"102\"\u003e\n\u003cp\u003e6 \u0026ndash; 12 hours\u003c/p\u003e\n\u003c/td\u003e\n\u003ctd width=\"131\"\u003e\n\u003cp\u003e41(12.1)\u003c/p\u003e\n\u003c/td\u003e\n\u003ctd width=\"76\"\u003e\n\u003cp\u003e46(13.6)\u003c/p\u003e\n\u003c/td\u003e\n\u003c/tr\u003e\n\u003ctr\u003e\n\u003ctd width=\"102\"\u003e\n\u003cp\u003e12 -24 hours\u003c/p\u003e\n\u003c/td\u003e\n\u003ctd width=\"131\"\u003e\n\u003cp\u003e75(22.2)\u003c/p\u003e\n\u003c/td\u003e\n\u003ctd width=\"76\"\u003e\n\u003cp\u003e33(9.8)\u003c/p\u003e\n\u003c/td\u003e\n\u003c/tr\u003e\n\u003ctr\u003e\n\u003ctd width=\"102\"\u003e\n\u003cp\u003e\u0026gt;24 hours\u003c/p\u003e\n\u003c/td\u003e\n\u003ctd width=\"131\"\u003e\n\u003cp\u003e21(9.6)\u003c/p\u003e\n\u003c/td\u003e\n\u003ctd width=\"76\"\u003e\n\u003cp\u003e4(3.4)\u003c/p\u003e\n\u003c/td\u003e\n\u003c/tr\u003e\n\u003ctr\u003e\n\u003ctd rowspan=\"2\" width=\"114\"\u003e\n\u003cp\u003eFrequency of PV examination\u003c/p\u003e\n\u003c/td\u003e\n\u003ctd width=\"102\"\u003e\n\u003cp\u003e\u0026le; 3 times\u003c/p\u003e\n\u003c/td\u003e\n\u003ctd width=\"131\"\u003e\n\u003cp\u003e84(24.9)\u003c/p\u003e\n\u003c/td\u003e\n\u003ctd width=\"76\"\u003e\n\u003cp\u003e59(17.5)\u003c/p\u003e\n\u003c/td\u003e\n\u003ctd rowspan=\"2\" width=\"141\"\u003e\n\u003cp\u003e1\u003c/p\u003e\n\u003cp\u003e1.58((1.01, 2.48)\u003c/p\u003e\n\u003c/td\u003e\n\u003ctd rowspan=\"2\" width=\"174\"\u003e\n\u003cp\u003e1\u003c/p\u003e\n\u003cp\u003e6.06(2.45, 14.99)**\u003c/p\u003e\n\u003c/td\u003e\n\u003c/tr\u003e\n\u003ctr\u003e\n\u003ctd width=\"102\"\u003e\n\u003cp\u003e\u0026gt;3 times\u003c/p\u003e\n\u003c/td\u003e\n\u003ctd width=\"131\"\u003e\n\u003cp\u003e135(39.9)\u003c/p\u003e\n\u003c/td\u003e\n\u003ctd width=\"76\"\u003e\n\u003cp\u003e60(17.8\u003c/p\u003e\n\u003c/td\u003e\n\u003c/tr\u003e\n\u003ctr\u003e\n\u003ctd rowspan=\"2\" width=\"114\"\u003e\n\u003cp\u003eSex of neonate\u003c/p\u003e\n\u003c/td\u003e\n\u003ctd width=\"102\"\u003e\n\u003cp\u003eMale\u003c/p\u003e\n\u003c/td\u003e\n\u003ctd width=\"131\"\u003e\n\u003cp\u003e139(41.1)\u003c/p\u003e\n\u003c/td\u003e\n\u003ctd width=\"76\"\u003e\n\u003cp\u003e61(18)\u003c/p\u003e\n\u003c/td\u003e\n\u003ctd rowspan=\"2\" width=\"141\"\u003e\n\u003cp\u003e1.65(1.05 , 2.59)\u003c/p\u003e\n\u003cp\u003e1\u003c/p\u003e\n\u003c/td\u003e\n\u003ctd rowspan=\"2\" width=\"174\"\u003e\n\u003cp\u003e3.73(1.76, 7.89)**\u003c/p\u003e\n\u003cp\u003e1\u003c/p\u003e\n\u003c/td\u003e\n\u003c/tr\u003e\n\u003ctr\u003e\n\u003ctd width=\"102\"\u003e\n\u003cp\u003eFemale\u003c/p\u003e\n\u003c/td\u003e\n\u003ctd width=\"131\"\u003e\n\u003cp\u003e80(23.7)\u003c/p\u003e\n\u003c/td\u003e\n\u003ctd width=\"76\"\u003e\n\u003cp\u003e58(17.2)\u003c/p\u003e\n\u003c/td\u003e\n\u003c/tr\u003e\n\u003ctr\u003e\n\u003ctd rowspan=\"2\" width=\"114\"\u003e\n\u003cp\u003eGestational age\u003c/p\u003e\n\u003c/td\u003e\n\u003ctd width=\"102\"\u003e\n\u003cp\u003e\u0026lt; 37 weeks\u003c/p\u003e\n\u003c/td\u003e\n\u003ctd width=\"131\"\u003e\n\u003cp\u003e66(19.5)\u003c/p\u003e\n\u003c/td\u003e\n\u003ctd width=\"76\"\u003e\n\u003cp\u003e54(16)\u003c/p\u003e\n\u003c/td\u003e\n\u003ctd rowspan=\"2\" width=\"141\"\u003e\n\u003cp\u003e0.52(0.32, 0.82)\u003c/p\u003e\n\u003cp\u003e1\u003c/p\u003e\n\u003c/td\u003e\n\u003ctd rowspan=\"2\" width=\"174\"\u003e\n\u003cp\u003e0.98(0.35 , 2.78)\u003c/p\u003e\n\u003cp\u003e1\u003c/p\u003e\n\u003c/td\u003e\n\u003c/tr\u003e\n\u003ctr\u003e\n\u003ctd width=\"102\"\u003e\n\u003cp\u003e37 \u0026ndash; 42 weeks\u003c/p\u003e\n\u003c/td\u003e\n\u003ctd width=\"131\"\u003e\n\u003cp\u003e153(45.3)\u003c/p\u003e\n\u003c/td\u003e\n\u003ctd width=\"76\"\u003e\n\u003cp\u003e65(19.3)\u003c/p\u003e\n\u003c/td\u003e\n\u003c/tr\u003e\n\u003ctr\u003e\n\u003ctd rowspan=\"2\" width=\"114\"\u003e\n\u003cp\u003eHistory of birth asphyxia\u003c/p\u003e\n\u003c/td\u003e\n\u003ctd width=\"102\"\u003e\n\u003cp\u003eYes\u003c/p\u003e\n\u003c/td\u003e\n\u003ctd width=\"131\"\u003e\n\u003cp\u003e31(9.2)\u003c/p\u003e\n\u003c/td\u003e\n\u003ctd width=\"76\"\u003e\n\u003cp\u003e25(7.4)\u003c/p\u003e\n\u003c/td\u003e\n\u003ctd rowspan=\"2\" width=\"141\"\u003e\n\u003cp\u003e0.62(0.35 , 1.11)\u003c/p\u003e\n\u003cp\u003e1\u003c/p\u003e\n\u003c/td\u003e\n\u003ctd rowspan=\"2\" width=\"174\"\u003e\n\u003cp\u003e0.55(0.18 , 1.68)\u003c/p\u003e\n\u003cp\u003e1\u003c/p\u003e\n\u003c/td\u003e\n\u003c/tr\u003e\n\u003ctr\u003e\n\u003ctd width=\"102\"\u003e\n\u003cp\u003eNo\u003c/p\u003e\n\u003c/td\u003e\n\u003ctd width=\"131\"\u003e\n\u003cp\u003e188(55.6)\u003c/p\u003e\n\u003c/td\u003e\n\u003ctd width=\"76\"\u003e\n\u003cp\u003e94(27.8)\u003c/p\u003e\n\u003c/td\u003e\n\u003c/tr\u003e\n\u003ctr\u003e\n\u003ctd rowspan=\"2\" width=\"114\"\u003e\n\u003cp\u003eHistory of oxygen administration\u003c/p\u003e\n\u003c/td\u003e\n\u003ctd width=\"102\"\u003e\n\u003cp\u003eYes\u003c/p\u003e\n\u003c/td\u003e\n\u003ctd width=\"131\"\u003e\n\u003cp\u003e45(13.3)\u003c/p\u003e\n\u003c/td\u003e\n\u003ctd width=\"76\"\u003e\n\u003cp\u003e16(4.4)\u003c/p\u003e\n\u003c/td\u003e\n\u003ctd rowspan=\"2\" width=\"141\"\u003e\n\u003cp\u003e1.67(0.89 , 3.09)\u003c/p\u003e\n\u003cp\u003e1\u003c/p\u003e\n\u003c/td\u003e\n\u003ctd rowspan=\"2\" width=\"174\"\u003e\n\u003cp\u003e2.06(0.642, 6.59)\u003c/p\u003e\n\u003cp\u003e1\u003c/p\u003e\n\u003c/td\u003e\n\u003c/tr\u003e\n\u003ctr\u003e\n\u003ctd width=\"102\"\u003e\n\u003cp\u003eNo\u003c/p\u003e\n\u003c/td\u003e\n\u003ctd width=\"131\"\u003e\n\u003cp\u003e174(51.5)\u003c/p\u003e\n\u003c/td\u003e\n\u003ctd width=\"76\"\u003e\n\u003cp\u003e103(30.5)\u003c/p\u003e\n\u003c/td\u003e\n\u003c/tr\u003e\n\u003ctr\u003e\n\u003ctd rowspan=\"2\" width=\"114\"\u003e\n\u003cp\u003eHistory of NG tube insertion\u003c/p\u003e\n\u003c/td\u003e\n\u003ctd width=\"102\"\u003e\n\u003cp\u003eYes\u003c/p\u003e\n\u003c/td\u003e\n\u003ctd width=\"131\"\u003e\n\u003cp\u003e20(5.9)\u003c/p\u003e\n\u003c/td\u003e\n\u003ctd width=\"76\"\u003e\n\u003cp\u003e1(0.3)\u003c/p\u003e\n\u003c/td\u003e\n\u003ctd rowspan=\"2\" width=\"141\"\u003e\n\u003cp\u003e11.86(1.57,89.51)\u003c/p\u003e\n\u003cp\u003e1\u003c/p\u003e\n\u003c/td\u003e\n\u003ctd rowspan=\"2\" width=\"174\"\u003e\n\u003cp\u003e10.36(0.81 ,132.78)\u003c/p\u003e\n\u003cp\u003e1\u003c/p\u003e\n\u003c/td\u003e\n\u003c/tr\u003e\n\u003ctr\u003e\n\u003ctd width=\"102\"\u003e\n\u003cp\u003eNo\u003c/p\u003e\n\u003c/td\u003e\n\u003ctd width=\"131\"\u003e\n\u003cp\u003e199(58.9)\u003c/p\u003e\n\u003c/td\u003e\n\u003ctd width=\"76\"\u003e\n\u003cp\u003e118(34.9)\u003c/p\u003e\n\u003c/td\u003e\n\u003c/tr\u003e\n\u003ctr\u003e\n\u003ctd rowspan=\"2\" width=\"114\"\u003e\n\u003cp\u003eHistory IV catheterization\u003c/p\u003e\n\u003c/td\u003e\n\u003ctd width=\"102\"\u003e\n\u003cp\u003eYes\u003c/p\u003e\n\u003c/td\u003e\n\u003ctd width=\"131\"\u003e\n\u003cp\u003e42(12.4)\u003c/p\u003e\n\u003c/td\u003e\n\u003ctd width=\"76\"\u003e\n\u003cp\u003e8(2.4)\u003c/p\u003e\n\u003c/td\u003e\n\u003ctd rowspan=\"2\" width=\"141\"\u003e\n\u003cp\u003e3.29(1.49 , 7.27)\u003c/p\u003e\n\u003cp\u003e1\u003c/p\u003e\n\u003c/td\u003e\n\u003ctd rowspan=\"2\" width=\"174\"\u003e\n\u003cp\u003e2.81(0.89, 8.93)\u003c/p\u003e\n\u003cp\u003e1\u003c/p\u003e\n\u003c/td\u003e\n\u003c/tr\u003e\n\u003ctr\u003e\n\u003ctd width=\"102\"\u003e\n\u003cp\u003eNo\u003c/p\u003e\n\u003c/td\u003e\n\u003ctd width=\"131\"\u003e\n\u003cp\u003e177(52.4)\u003c/p\u003e\n\u003c/td\u003e\n\u003ctd width=\"76\"\u003e\n\u003cp\u003e111(32.8)\u003c/p\u003e\n\u003c/td\u003e\n\u003c/tr\u003e\n\u003ctr\u003e\n\u003ctd rowspan=\"2\" width=\"114\"\u003e\n\u003cp\u003eHistory of neonatal resuscitation\u003c/p\u003e\n\u003c/td\u003e\n\u003ctd width=\"102\"\u003e\n\u003cp\u003eYes\u003c/p\u003e\n\u003c/td\u003e\n\u003ctd width=\"131\"\u003e\n\u003cp\u003e37(10.9)\u003c/p\u003e\n\u003c/td\u003e\n\u003ctd width=\"76\"\u003e\n\u003cp\u003e12(3.6)\u003c/p\u003e\n\u003c/td\u003e\n\u003ctd rowspan=\"2\" width=\"141\"\u003e\n\u003cp\u003e1.81(0.91 , 3.63)\u003c/p\u003e\n\u003cp\u003e1\u003c/p\u003e\n\u003c/td\u003e\n\u003ctd rowspan=\"2\" width=\"174\"\u003e\n\u003cp\u003e6.11(1.71 , 21.84) *\u003c/p\u003e\n\u003cp\u003e1\u003c/p\u003e\n\u003c/td\u003e\n\u003c/tr\u003e\n\u003ctr\u003e\n\u003ctd width=\"102\"\u003e\n\u003cp\u003eNo\u003c/p\u003e\n\u003c/td\u003e\n\u003ctd width=\"131\"\u003e\n\u003cp\u003e182(53.8)\u003c/p\u003e\n\u003c/td\u003e\n\u003ctd width=\"76\"\u003e\n\u003cp\u003e107(31.7)\u003c/p\u003e\n\u003c/td\u003e\n\u003c/tr\u003e\n\u003ctr\u003e\n\u003ctd rowspan=\"2\" width=\"114\"\u003e\n\u003cp\u003eTraining of Health workers\u003c/p\u003e\n\u003c/td\u003e\n\u003ctd width=\"102\"\u003e\n\u003cp\u003eYes\u003c/p\u003e\n\u003c/td\u003e\n\u003ctd width=\"131\"\u003e\n\u003cp\u003e112(33.1)\u003c/p\u003e\n\u003c/td\u003e\n\u003ctd width=\"76\"\u003e\n\u003cp\u003e39(11.5)\u003c/p\u003e\n\u003c/td\u003e\n\u003ctd rowspan=\"2\" width=\"141\"\u003e\n\u003cp\u003e1\u003c/p\u003e\n\u003cp\u003e2.17(1.35 , 3.42)\u003c/p\u003e\n\u003c/td\u003e\n\u003ctd rowspan=\"2\" width=\"174\"\u003e\n\u003cp\u003e1\u003c/p\u003e\n\u003cp\u003e2.14(1.04 , 4.44)*\u003c/p\u003e\n\u003c/td\u003e\n\u003c/tr\u003e\n\u003ctr\u003e\n\u003ctd width=\"102\"\u003e\n\u003cp\u003eNo\u003c/p\u003e\n\u003c/td\u003e\n\u003ctd width=\"131\"\u003e\n\u003cp\u003e107(31.7)\u003c/p\u003e\n\u003c/td\u003e\n\u003ctd width=\"76\"\u003e\n\u003cp\u003e80(23.7)\u003c/p\u003e\n\u003c/td\u003e\n\u003c/tr\u003e\n\u003ctr\u003e\n\u003ctd rowspan=\"2\" width=\"114\"\u003e\n\u003cp\u003eMarital status\u003c/p\u003e\n\u003c/td\u003e\n\u003ctd width=\"102\"\u003e\n\u003cp\u003eMarried\u003c/p\u003e\n\u003c/td\u003e\n\u003ctd width=\"131\"\u003e\n\u003cp\u003e204(60.4)\u003c/p\u003e\n\u003c/td\u003e\n\u003ctd width=\"76\"\u003e\n\u003cp\u003e118(34.9)\u003c/p\u003e\n\u003c/td\u003e\n\u003ctd rowspan=\"2\" width=\"141\"\u003e\n\u003cp\u003e1\u003c/p\u003e\n\u003cp\u003e8.68(1.13 , 66.52)\u003c/p\u003e\n\u003c/td\u003e\n\u003ctd rowspan=\"2\" width=\"174\"\u003e\n\u003cp\u003e1\u003c/p\u003e\n\u003cp\u003e0.14(0.01 , 1.42)\u003c/p\u003e\n\u003c/td\u003e\n\u003c/tr\u003e\n\u003ctr\u003e\n\u003ctd width=\"102\"\u003e\n\u003cp\u003eNot married\u003c/p\u003e\n\u003c/td\u003e\n\u003ctd width=\"131\"\u003e\n\u003cp\u003e15(4.4)\u003c/p\u003e\n\u003c/td\u003e\n\u003ctd width=\"76\"\u003e\n\u003cp\u003e1(0.3)\u003c/p\u003e\n\u003c/td\u003e\n\u003c/tr\u003e\n\u003ctr\u003e\n\u003ctd rowspan=\"5\" width=\"114\"\u003e\n\u003cp\u003eMaternal age category\u003c/p\u003e\n\u003c/td\u003e\n\u003ctd width=\"102\"\u003e\n\u003cp\u003e15 -19 yrs.\u003c/p\u003e\n\u003c/td\u003e\n\u003ctd width=\"131\"\u003e\n\u003cp\u003e36(10.7)\u003c/p\u003e\n\u003c/td\u003e\n\u003ctd width=\"76\"\u003e\n\u003cp\u003e10(3)\u003c/p\u003e\n\u003c/td\u003e\n\u003ctd rowspan=\"5\" width=\"141\"\u003e\n\u003cp\u003e1.14(0.44 , 2.95)\u003c/p\u003e\n\u003cp\u003e0.52(0.24 , 1.14)\u003c/p\u003e\n\u003cp\u003e0.63(0.29, 1.35)\u003c/p\u003e\n\u003cp\u003e0.20(0.08, 0.49)\u003c/p\u003e\n\u003cp\u003e1\u003c/p\u003e\n\u003c/td\u003e\n\u003ctd rowspan=\"5\" width=\"174\"\u003e\n\u003cp\u003e0 .97(0.16 , 5.95)\u003c/p\u003e\n\u003cp\u003e0.32(0.07 , 1.57)\u003c/p\u003e\n\u003cp\u003e0.63(0.18 , 2.29)\u003c/p\u003e\n\u003cp\u003e0.19(0.05, 0.81)*\u003c/p\u003e\n\u003cp\u003e1\u003c/p\u003e\n\u003c/td\u003e\n\u003c/tr\u003e\n\u003ctr\u003e\n\u003ctd width=\"102\"\u003e\n\u003cp\u003e20 -24 yrs.\u003c/p\u003e\n\u003c/td\u003e\n\u003ctd width=\"131\"\u003e\n\u003cp\u003e51(15.1)\u003c/p\u003e\n\u003c/td\u003e\n\u003ctd width=\"76\"\u003e\n\u003cp\u003e31(9.2)\u003c/p\u003e\n\u003c/td\u003e\n\u003c/tr\u003e\n\u003ctr\u003e\n\u003ctd width=\"102\"\u003e\n\u003cp\u003e25 - 29 yrs.\u003c/p\u003e\n\u003c/td\u003e\n\u003ctd width=\"131\"\u003e\n\u003cp\u003e76(25.5)\u003c/p\u003e\n\u003c/td\u003e\n\u003ctd width=\"76\"\u003e\n\u003cp\u003e38(11.2)\u003c/p\u003e\n\u003c/td\u003e\n\u003c/tr\u003e\n\u003ctr\u003e\n\u003ctd width=\"102\"\u003e\n\u003cp\u003e30 -34 yrs.\u003c/p\u003e\n\u003c/td\u003e\n\u003ctd width=\"131\"\u003e\n\u003cp\u003e18(5.3)\u003c/p\u003e\n\u003c/td\u003e\n\u003ctd width=\"76\"\u003e\n\u003cp\u003e28(8.3)\u003c/p\u003e\n\u003c/td\u003e\n\u003c/tr\u003e\n\u003ctr\u003e\n\u003ctd width=\"102\"\u003e\n\u003cp\u003e\u0026ge; 35 yrs.\u003c/p\u003e\n\u003c/td\u003e\n\u003ctd width=\"131\"\u003e\n\u003cp\u003e38(11.20\u003c/p\u003e\n\u003c/td\u003e\n\u003ctd width=\"76\"\u003e\n\u003cp\u003e12(3.6)\u003c/p\u003e\n\u003c/td\u003e\n\u003c/tr\u003e\n\u003ctr\u003e\n\u003ctd rowspan=\"3\" width=\"114\"\u003e\n\u003cp\u003eVDRL test result\u003c/p\u003e\n\u003c/td\u003e\n\u003ctd width=\"102\"\u003e\n\u003cp\u003eReactive\u003c/p\u003e\n\u003c/td\u003e\n\u003ctd width=\"131\"\u003e\n\u003cp\u003e17(5)\u003c/p\u003e\n\u003c/td\u003e\n\u003ctd width=\"76\"\u003e\n\u003cp\u003e3(0.9)\u003c/p\u003e\n\u003c/td\u003e\n\u003ctd rowspan=\"3\" width=\"141\"\u003e\n\u003cp\u003e2.62(0.75 , 9.18)\u003c/p\u003e\n\u003cp\u003e0.25(0.13 ,0. 48)\u003c/p\u003e\n\u003cp\u003e1\u003c/p\u003e\n\u003c/td\u003e\n\u003ctd rowspan=\"3\" width=\"174\"\u003e\n\u003cp\u003e1.33(0.18 , 10.13)\u003c/p\u003e\n\u003cp\u003e0.31(0.11, 0.92)\u003c/p\u003e\n\u003cp\u003e1\u003c/p\u003e\n\u003c/td\u003e\n\u003c/tr\u003e\n\u003ctr\u003e\n\u003ctd width=\"102\"\u003e\n\u003cp\u003eUnknown\u003c/p\u003e\n\u003c/td\u003e\n\u003ctd width=\"131\"\u003e\n\u003cp\u003e16(4.7)\u003c/p\u003e\n\u003c/td\u003e\n\u003ctd width=\"76\"\u003e\n\u003cp\u003e30(8.9)\u003c/p\u003e\n\u003c/td\u003e\n\u003c/tr\u003e\n\u003ctr\u003e\n\u003ctd width=\"102\"\u003e\n\u003cp\u003eNon-reactive\u003c/p\u003e\n\u003c/td\u003e\n\u003ctd width=\"131\"\u003e\n\u003cp\u003e186(55)\u003c/p\u003e\n\u003c/td\u003e\n\u003ctd width=\"76\"\u003e\n\u003cp\u003e86(25.4)\u003c/p\u003e\n\u003c/td\u003e\n\u003c/tr\u003e\n\u003ctr\u003e\n\u003ctd rowspan=\"3\" width=\"114\"\u003e\n\u003cp\u003eHistory of UTIs\u003c/p\u003e\n\u003c/td\u003e\n\u003ctd width=\"102\"\u003e\n\u003cp\u003eYes\u003c/p\u003e\n\u003c/td\u003e\n\u003ctd width=\"131\"\u003e\n\u003cp\u003e10(3)\u003c/p\u003e\n\u003c/td\u003e\n\u003ctd width=\"76\"\u003e\n\u003cp\u003e5(1.5)\u003c/p\u003e\n\u003c/td\u003e\n\u003ctd rowspan=\"3\" width=\"141\"\u003e\n\u003cp\u003e1.01(0.34 , 3.03)\u003c/p\u003e\n\u003cp\u003e0.23(0.08 ,0.68)\u003c/p\u003e\n\u003cp\u003e1\u003c/p\u003e\n\u003c/td\u003e\n\u003ctd rowspan=\"3\" width=\"174\"\u003e\n\u003cp\u003e6.26(1.16, 33.62) *\u003c/p\u003e\n\u003cp\u003e0.06(0.01 , 0.31) **\u003c/p\u003e\n\u003cp\u003e1\u003c/p\u003e\n\u003c/td\u003e\n\u003c/tr\u003e\n\u003ctr\u003e\n\u003ctd width=\"102\"\u003e\n\u003cp\u003eUnknown\u003c/p\u003e\n\u003c/td\u003e\n\u003ctd width=\"131\"\u003e\n\u003cp\u003e5(1.5)\u003c/p\u003e\n\u003c/td\u003e\n\u003ctd width=\"76\"\u003e\n\u003cp\u003e11(3.3)\u003c/p\u003e\n\u003c/td\u003e\n\u003c/tr\u003e\n\u003ctr\u003e\n\u003ctd width=\"102\"\u003e\n\u003cp\u003eNegative\u003c/p\u003e\n\u003c/td\u003e\n\u003ctd width=\"131\"\u003e\n\u003cp\u003e204(60.4)\u003c/p\u003e\n\u003c/td\u003e\n\u003ctd width=\"76\"\u003e\n\u003cp\u003e103(30.5)\u003c/p\u003e\n\u003c/td\u003e\n\u003c/tr\u003e\n\u003ctr\u003e\n\u003ctd rowspan=\"3\" width=\"114\"\u003e\n\u003cp\u003eBirth weight\u003c/p\u003e\n\u003c/td\u003e\n\u003ctd width=\"102\"\u003e\n\u003cp\u003e\u0026lt;1500 g\u003c/p\u003e\n\u003c/td\u003e\n\u003ctd width=\"131\"\u003e\n\u003cp\u003e24(7.1)\u003c/p\u003e\n\u003c/td\u003e\n\u003ctd width=\"76\"\u003e\n\u003cp\u003e19(5.6)\u003c/p\u003e\n\u003c/td\u003e\n\u003ctd rowspan=\"3\" width=\"141\"\u003e\n\u003cp\u003e0.57(0.29 , 1.14)\u003c/p\u003e\n\u003cp\u003e0.77(0.45 ,1.26)\u003c/p\u003e\n\u003cp\u003e1\u003c/p\u003e\n\u003c/td\u003e\n\u003ctd rowspan=\"3\" width=\"174\"\u003e\n\u003cp\u003e0.76(0.18 , 3.19)\u003c/p\u003e\n\u003cp\u003e1.11(0.40 , 3.03)\u003c/p\u003e\n\u003cp\u003e1\u003c/p\u003e\n\u003c/td\u003e\n\u003c/tr\u003e\n\u003ctr\u003e\n\u003ctd width=\"102\"\u003e\n\u003cp\u003e1500 \u0026ndash; 2499 g\u003c/p\u003e\n\u003c/td\u003e\n\u003ctd width=\"131\"\u003e\n\u003cp\u003e87(25.7)\u003c/p\u003e\n\u003c/td\u003e\n\u003ctd width=\"76\"\u003e\n\u003cp\u003e51(15.1)\u003c/p\u003e\n\u003c/td\u003e\n\u003c/tr\u003e\n\u003ctr\u003e\n\u003ctd width=\"102\"\u003e\n\u003cp\u003e\u0026ge; 2500 g\u003c/p\u003e\n\u003c/td\u003e\n\u003ctd width=\"131\"\u003e\n\u003cp\u003e108(32)\u003c/p\u003e\n\u003c/td\u003e\n\u003ctd width=\"76\"\u003e\n\u003cp\u003e49(14.5)\u003c/p\u003e\n\u003c/td\u003e\n\u003c/tr\u003e\n\u003ctr\u003e\n\u003ctd rowspan=\"2\" width=\"114\"\u003e\n\u003cp\u003efoul smelling vaginal discharge\u003c/p\u003e\n\u003c/td\u003e\n\u003ctd width=\"102\"\u003e\n\u003cp\u003eYes\u003c/p\u003e\n\u003c/td\u003e\n\u003ctd width=\"131\"\u003e\n\u003cp\u003e9(2.7)\u003c/p\u003e\n\u003c/td\u003e\n\u003ctd width=\"76\"\u003e\n\u003cp\u003e10(3)\u003c/p\u003e\n\u003c/td\u003e\n\u003ctd rowspan=\"2\" width=\"141\"\u003e\n\u003cp\u003e0.47(0.18 , 1.18)\u003c/p\u003e\n\u003cp\u003e1\u003c/p\u003e\n\u003c/td\u003e\n\u003ctd rowspan=\"2\" width=\"174\"\u003e\n\u003cp\u003e0.24(0.05 , 1.08)\u003c/p\u003e\n\u003cp\u003e1\u003c/p\u003e\n\u003c/td\u003e\n\u003c/tr\u003e\n\u003ctr\u003e\n\u003ctd width=\"102\"\u003e\n\u003cp\u003eNo\u003c/p\u003e\n\u003c/td\u003e\n\u003ctd width=\"131\"\u003e\n\u003cp\u003e210(62.1)\u003c/p\u003e\n\u003c/td\u003e\n\u003ctd width=\"76\"\u003e\n\u003cp\u003e109(32.2)\u003c/p\u003e\n\u003c/td\u003e\n\u003c/tr\u003e\n\u003ctr\u003e\n\u003ctd rowspan=\"2\" width=\"114\"\u003e\n\u003cp\u003eNeonatal age in days\u003c/p\u003e\n\u003c/td\u003e\n\u003ctd width=\"102\"\u003e\n\u003cp\u003e\u0026le; 7 days\u003c/p\u003e\n\u003c/td\u003e\n\u003ctd width=\"131\"\u003e\n\u003cp\u003e163(48.2)\u003c/p\u003e\n\u003c/td\u003e\n\u003ctd width=\"76\"\u003e\n\u003cp\u003e115(34)\u003c/p\u003e\n\u003c/td\u003e\n\u003ctd rowspan=\"2\" width=\"141\"\u003e\n\u003cp\u003e0.10(0.04 , 0.29)\u003c/p\u003e\n\u003cp\u003e1\u003c/p\u003e\n\u003c/td\u003e\n\u003ctd rowspan=\"2\" width=\"174\"\u003e\n\u003cp\u003e0 .05(0.01 ,0.21)**\u003c/p\u003e\n\u003cp\u003e1\u003c/p\u003e\n\u003c/td\u003e\n\u003c/tr\u003e\n\u003ctr\u003e\n\u003ctd width=\"102\"\u003e\n\u003cp\u003e\u0026gt;7 days\u003c/p\u003e\n\u003c/td\u003e\n\u003ctd width=\"131\"\u003e\n\u003cp\u003e56(16.60\u003c/p\u003e\n\u003c/td\u003e\n\u003ctd width=\"76\"\u003e\n\u003cp\u003e4(1.2)\u003c/p\u003e\n\u003c/td\u003e\n\u003c/tr\u003e\n\u003ctr\u003e\n\u003ctd rowspan=\"2\" width=\"114\"\u003e\n\u003cp\u003eHistory of PROM\u003c/p\u003e\n\u003c/td\u003e\n\u003ctd width=\"102\"\u003e\n\u003cp\u003eYes\u003c/p\u003e\n\u003c/td\u003e\n\u003ctd width=\"131\"\u003e\n\u003cp\u003e73(21.6)\u003c/p\u003e\n\u003c/td\u003e\n\u003ctd width=\"76\"\u003e\n\u003cp\u003e28(8.3)\u003c/p\u003e\n\u003c/td\u003e\n\u003ctd rowspan=\"2\" width=\"141\"\u003e\n\u003cp\u003e1.62(0.98, 2.70)\u003c/p\u003e\n\u003cp\u003e1\u003c/p\u003e\n\u003c/td\u003e\n\u003ctd rowspan=\"2\" width=\"174\"\u003e\n\u003cp\u003e1.82(0.706 , 4.69)\u003c/p\u003e\n\u003cp\u003e1\u003c/p\u003e\n\u003c/td\u003e\n\u003c/tr\u003e\n\u003ctr\u003e\n\u003ctd width=\"102\"\u003e\n\u003cp\u003eNo\u003c/p\u003e\n\u003c/td\u003e\n\u003ctd width=\"131\"\u003e\n\u003cp\u003e146(43.2)\u003c/p\u003e\n\u003c/td\u003e\n\u003ctd width=\"76\"\u003e\n\u003cp\u003e91(26.9)\u003c/p\u003e\n\u003c/td\u003e\n\u003c/tr\u003e\n\u003ctr\u003e\n\u003ctd rowspan=\"3\" width=\"114\"\u003e\n\u003cp\u003ePlace of delivery\u003c/p\u003e\n\u003c/td\u003e\n\u003ctd width=\"102\"\u003e\n\u003cp\u003eHome\u003c/p\u003e\n\u003c/td\u003e\n\u003ctd width=\"131\"\u003e\n\u003cp\u003e14(4.1)\u003c/p\u003e\n\u003c/td\u003e\n\u003ctd width=\"76\"\u003e\n\u003cp\u003e14(4.1)\u003c/p\u003e\n\u003c/td\u003e\n\u003ctd rowspan=\"3\" width=\"141\"\u003e\n\u003cp\u003e0.57(0.26 , 1.26)\u003c/p\u003e\n\u003cp\u003e1.43(0.85 ,2.39)\u003c/p\u003e\n\u003cp\u003e1\u003c/p\u003e\n\u003c/td\u003e\n\u003ctd rowspan=\"3\" width=\"174\"\u003e\n\u003cp\u003e4.06(0.69 , 23.86)\u003c/p\u003e\n\u003cp\u003e3.05(1.19 , 7.79) *\u003c/p\u003e\n\u003cp\u003e1\u003c/p\u003e\n\u003c/td\u003e\n\u003c/tr\u003e\n\u003ctr\u003e\n\u003ctd width=\"102\"\u003e\n\u003cp\u003eHealth center\u003c/p\u003e\n\u003c/td\u003e\n\u003ctd width=\"131\"\u003e\n\u003cp\u003e70(20.7)\u003c/p\u003e\n\u003c/td\u003e\n\u003ctd width=\"76\"\u003e\n\u003cp\u003e28(8.3)\u003c/p\u003e\n\u003c/td\u003e\n\u003c/tr\u003e\n\u003ctr\u003e\n\u003ctd width=\"102\"\u003e\n\u003cp\u003ehospital\u003c/p\u003e\n\u003c/td\u003e\n\u003ctd width=\"131\"\u003e\n\u003cp\u003e135(39.9)\u003c/p\u003e\n\u003c/td\u003e\n\u003ctd width=\"76\"\u003e\n\u003cp\u003e77(22.8)\u003c/p\u003e\n\u003c/td\u003e\n\u003c/tr\u003e\n\u003c/tbody\u003e\n\u003c/table\u003e\n\u003cp\u003e*Significant at \u0026lt; 0.05 \u0026alpha; \u0026ndash; values, ** Significant at \u0026lt; 0.01 \u0026alpha;-value\u003cstrong\u003e.\u003c/strong\u003e\u003c/p\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":"Neonatal sepsis, risk factors, neonatal intensive care units","lastPublishedDoi":"10.21203/rs.3.rs-51669/v1","lastPublishedDoiUrl":"https://doi.org/10.21203/rs.3.rs-51669/v1","license":{"name":"CC BY 4.0","url":"https://creativecommons.org/licenses/by/4.0/"},"manuscriptAbstract":"\u003cp\u003e\u003cstrong\u003eBackground:\u003c/strong\u003e Neonatal sepsis contributes substantially to neonatal morbidity and mortality and is an ongoing major global public health challenge particularly in developing countries. Studies conducted on proportion and risk factors of neonatal sepsis in Ethiopia are from referral hospital which may not be generalized to primary health care units where a significant proportion of mothers give birth in these health facilities. This study sought to determine the proportion of clinical neonatal sepsis and associated factors in the study areas.\u003c/p\u003e\u003cp\u003e\u003cstrong\u003eMethods:\u003c/strong\u003e Institutional based cross-sectional study was conducted from March to April 2019, in Amhara regional state, central Gondar zone public primary hospitals in Ethiopia.\u0026nbsp;A\u0026nbsp;total\u0026nbsp;of 352\u0026nbsp;subjects (mother-neonate pairs ) were\u0026nbsp;selected\u0026nbsp;using systematic random sampling technique and\u0026nbsp;pre-tested\u0026nbsp;and\u0026nbsp;structured\u0026nbsp;questionnaires\u0026nbsp;were\u0026nbsp;used\u0026nbsp;to\u0026nbsp;collect\u0026nbsp;data.\u0026nbsp;Multivariable logistic regression analysis was fitted to identify factors associated with neonatal sepsis. Adjusted Odds Ratio (AOR) with the corresponding 95%\u0026nbsp;confidence\u0026nbsp;Interval\u0026nbsp;(CI)\u0026nbsp;was\u0026nbsp;used\u0026nbsp;to\u0026nbsp;show\u0026nbsp;the\u0026nbsp;strength\u0026nbsp;of\u0026nbsp;associations\u0026nbsp;and\u0026nbsp;variables\u0026nbsp;with\u0026nbsp;p-values of\u0026nbsp;\u0026lt;0.05\u0026nbsp;were considered as statistically significant.\u003c/p\u003e\u003cp\u003e\u003cstrong\u003eResults: \u003c/strong\u003eThe overall proportion of neonatal sepsis was 64.8 %( 95% CI (59.2, 69.2). Being male neonate(AOR=3.7; 95% CI(1.76,7.89)), history of urinary tract infections during the index pregnancy(AOR =6,26; 95% CI (1.16,33.62)), frequency of per-vaginal examination greater than three during labor and delivery(AOR=6.06; 95% CI((2.45,14.99)), neonatal resuscitation at birth (AOR=6.1; 95% CI (1.71,21.84)), place of delivery at the health center(AOR=3.05; 95% CI(1.19,7.79)),\u0026nbsp;lack of training of health workers on neonatal resuscitation and infection prevention practices (AOR=2.14; 95% CI (1.04,4.44)), late age of neonate at onset of illness(AOR=0.05; 95% CI(0.01, 0.21)) and maternal age of 30-34 years (AOR=0.19; 95% CI(.047, 0.81)) were significantly associated with\u0026nbsp;neonatal sepsis.\u003c/p\u003e\u003cp\u003e\u003cstrong\u003eConclusion:\u003c/strong\u003e The proportion of neonatal sepsis is high. Maternal, neonatal and health service related factors were identified for neonatal sepsis. Therefore; training of health workers, provision of health care services as per standards and monitoring and evaluation of obstetrical/neonatal cares during labor and delivery are mandatory.\u0026nbsp;\u003c/p\u003e","manuscriptTitle":"Institutional Delivery Predisposes to Neonatal Sepsis and Its Associated Factors Among Neonates Admitted to Neonatal Intensive Care Units in Central Gondar Zone Primary Hospitals, Northwest Ethiopia, 2019.","msid":"","msnumber":"","nonDraftVersions":[{"code":1,"date":"2020-08-05 15:35:05","doi":"10.21203/rs.3.rs-51669/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":"fae97651-1a6a-47de-9052-e4a5eb618492","owner":[],"postedDate":"August 5th, 2020","published":true,"recentEditorialEvents":[],"rejectedJournal":[],"revision":"","amendment":"","status":"posted","subjectAreas":[{"id":244555,"name":"Health Policy"}],"tags":[],"updatedAt":"2020-08-05T15:35:05+00:00","versionOfRecord":[],"versionCreatedAt":"2020-08-05 15:35:05","video":"","vorDoi":"","vorDoiUrl":"","workflowStages":[]},"version":"v1","identity":"rs-51669","journalConfig":"researchsquare"},"__N_SSP":true},"page":"/article/[identity]/[[...version]]","query":{"redirect":"/article/rs-51669","identity":"rs-51669","version":["v1"]},"buildId":"_2-kVJe1T_tPrBINL-cwx","isFallback":false,"isExperimentalCompile":false,"dynamicIds":[84888],"gssp":true,"scriptLoader":[]}