The burden of neonatal sepsis and its association with antenatal urinary tract infection and intra-partum fever among admitted neonates in Ethiopia: A systematic review and meta-analysis

BACKGROUND: More than one-third of the neonatal death in Ethiopia has been attributed to neonatal sepsis. However, there is no recent national evidence about the burden of neonatal sepsis and its association with antenatal urinary tract infection and intra-partum fever, which are commonly reported maternal morbidities in Ethiopia. Therefore, the aim of this systematic review and meta-analysis was to assess the pooled burden of neonatal sepsis and its association with antenatal urinary tract infection as well as intra-partum fever in the country. METHODS: Primary studies were accessed through Google scholar, HINARI, SCOPUS and PubMed databases. The methodological and evidence quality of the included studies were critically appraised by the modified Newcastle-Ottawa quality assessment tool scale adapted for observational studies. From eligible studies, two authors extracted author/year, study region, study design, sample size, reported prevalence of neonatal sepsis, antenatal urinary tract infection and intrapartum fever on an excel spreadsheet. During critical appraisal and data extraction, disagreements between the two authors were resolved by the involvement of a third author. The extracted data were then exported to stata version 14. Effect sizes were pooled using the random inverse varience-effects model due to significant heterogeneity between studies (I(2)= 99.2%). Subgroup analysis was performed for evidence of heterogeneity. Sensitivity analyses were performed. Absence of publication bias was declared from symmetry of funnel plot and Egger's test (p = 0.244). RESULTS: In this systematic review and meta-analysis, a total of 36,016 admitted neonates were included from 27 studies. Of these 27 studies, 23 employed cross-sectional design whereas 3 studies had case control type and only one study had cohort design. The prevalence of neonatal sepsis among admitted Ethiopian neonates at different regions of the country ranged from 11.7%–77.9%. However, the pooled prevalence of neonatal sepsis was 40.25% [95% CI: 34.00%, 46.50%; I(2) = 99.2%]. From regional subgroup analysis, the highest prevalence was observed in the Oromiya region. Neonates born to mothers who had antenatal urinary tract infection were at 3.55 times (95% CI: 2.04, 5.06) higher risk of developing neonatal sepsis as compared to those neonates born to mothers who didn't have antenatal urinary tract infection. Moreover, neonates born to mothers having intra-partum fever were 3.63 times (95% CI: 1.64, 5.62) more likely to develop neonatal sepsis as compared to those born to mothers who were nonfebrile during intrapartum. CONCLUSION: Neonatal sepsis has remained a problem of public health importance in Ethiopia. Both antenatal urinary tract infection and intra-partum fever were positively associated with neonatal sepsis. Therefore, preventing maternal urinary tract infection during pregnancy and optimizing the intra-partum care are recommended to mitigate the burden of neonatal sepsis in Ethiopia.