Determinants of neonatal sepsis among neonates admitted to neonatal intensive care units in Ethiopian Hospitals: A systematic review and meta-analysis

Background: Sepsis is a fatal disease that occurs when the body reacts to infections by damaging its organs. Neonatal sepsis occurs in newborns less than 90 days. Several studies have identified risk factors for neonatal sepsis, but they are limited to a specific area and are inconclusive. Therefore, this study aims to determine the association between the mode of delivery, prolonged rupture of membrane, APGAR score, and neonatal sepsis in newborns who develop sepsis in Ethiopia. Methods: PubMed/Medline, Hinari, and Google Scholar, were systematically searched for eligible studies. Authors also conducted a grey literature search (e.g., Google and the digital library of Addis Ababa University). The Joanna Briggs Institute's (JBI) critical appraisal tools for case-control and cross-sectional studies were used to assess the quality of included articles. Both random and fixed-effect model was used to estimate the pooled odds ratio. The Cochrane Q-statistics and I 2 tests assessed heterogeneity between included studies. Publication bias was assessed using Begg’s and Egger’s tests. Results: A total of 130 articles were retrieved through primary search, and 15 studies comprising 4,895 study participants were included. In this study, cesarean section delivery [odds ratio (OR:1.36,95 CI:1.05-1.76)], prolonged rupture of membrane (OR:4.03,95CI:1.88-8.60), low first minute APGAR score (OR: 3.33, 95 CI:2.42-4.58) ,low fifth minute (OR:2.72, 95 CI:2.02-3.67) APGAR score and delayed initiation of breastfeeding (OR: 3.41, 95 CI:2.18-5.36) were found to have a positive association with neonatal sepsis. Conclusion: Mode of delivery, duration of rupture of membrane, APGAR score and time of initiation of breastfeeding have a role in the occurrence of neonatal sepsis. Adhering to standard infection prevention measures and minimizing factors that lead to cesarean delivery and premature rupture of membrane may help to reduce the occurrence of neonatal sepsis. In addition, following clean resuscitation procedures and early initiation of breastfeeding is important.