Prevalence and predictors of neonatal sepsis in a cohort of Kenyan mothers in Nairobi

Background: Neonatal sepsis is one of the main causes of neonatal morbidity and mortality. The study aims to analyze the prevalence of neonatal sepsis and to identify the risk factors associated with neonatal sepsis in a hospital in Nairobi, Kenya, to improve early diagnosis and treatment. Methods: A retrospective cohort study was conducted in a statistically significant subset of neonates delivered in Ruaraka Uhai Neema Hospital in Nairobi, Kenya, between 1st October 2023 and 30th September 2024. Various predictive factors for neonatal sepsis have been collected and analyzed to determine their predictive value of neonatal sepsis. Results: The estimated prevalence of neonatal sepsis in the hospital during the analyzed period was 6.21%. The predictive factors can be distinguished in maternal and neonatal factors. The maternal factors strongly associated with sepsis were pre-eclampsia/eclampsia (p<0.001; OR 4.571) and premature rupture of membrane (PROM) (p<0.001; OR 4.591). The neonatal factors linked to sepsis were meconium-stained liquor (p=0.021), asphyxia (p<0.001; OR 12.783), and meconium aspiration (p=0.029). Due to the lack of access to blood cultures, the diagnosis of sepsis was based solely on clinical criteria, and it could not be confirmed by the microbiological laboratory. Conclusions: The study highlights significant maternal and neonatal predictive factors for neonatal sepsis which may aid in the early diagnosis. In LMIC, a risk factor approach, which consists of the analysis of individual risk factors and characteristics of both the mother and the newborn, can be effective in predicting early-onset neonatal sepsis. However, improvements in laboratory availability are necessary to improve diagnostic accuracy and improve quality of care.