Determinants of neonatal mortality among hospitalised neonates with sepsis at Queen Elizabeth Central Hospital, Blantyre, Malawi: A mixed-methods study

Mangwiro, Lucky, Misyenje, Joseph, Iroh Tam, Pui-Ying ORCID: https://orcid.org/0000-0002-3682-8892, Kawaza, Kondwani and Nyondo Mipando, Alinane Linda (2024) 'Determinants of neonatal mortality among hospitalised neonates with sepsis at Queen Elizabeth Central Hospital, Blantyre, Malawi: A mixed-methods study'. PLOS Global Public Health, Vol 4, Issue 12, e0004059.

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Abstract

Neonatal sepsis-related deaths remain a significant health problem contributing to higher morbidity and mortality rates, particularly in low resource settings, such as Malawi. However, there is limited information to associate risk factors and health system factors with mortality. This study investigated the risk factors associated with mortality and explored health system factors contributing to deaths among neonates with sepsis at Queen Elizabeth Central Hospital (QECH), Blantyre, Malawi. This mixed-method study utilised a convergent parallel approach to describe the determinants of neonatal mortality among neonates with sepsis. We selected this design because it allowed the researchers to triangulate, support and enhance the internal and external validity of the results. We retrospectively reviewed 237 neonatal records using a simple random sampling technique for cross-sectional quantitative data. Exploratory qualitative data was collected using a semi-structured interview guide from 10 purposively selected healthcare workers directly involved in providing neonatal care through in-depth interviews. Quantitative data were analysed using univariate and multivariate logistic regression in Stata v.14; qualitative data were analysed manually using a thematic analysis approach. We found that gestation age (OR 0.76 (95% CI: 0.58, 0.99), p-value = 0.040) and number of days spent in the hospital (OR 0.64 (95% CI: 0.48, 0.85), p-value = 0.002) were the most predictive risk factors. The qualitative inquiry showed the maternal behavioural factors; reporting late to hospital, cultural and religious beliefs; maternal health related factors: prolonged labour, unnecessary vaginal examinations, premature rupturing of membranes; Neonatal factors: prematurity, meconium aspiration, home deliveries and lastly, health system factors included delay in treatment, referrals and blood culture results, limited resources contributed to documented clinical outcomes. Determinants of neonatal mortality were gestation age, number of days spent in the hospital, maternal behavioural and health related, neonatal and health system factors. Reducing mortality among neonates with sepsis will require a multi-sectoral approach.

Item Type:	Article
Subjects:	WS Pediatrics > By Age Groups > WS 420 Newborn infants. Neonatology WS Pediatrics > By Age Groups > WS 421 Diseases of newborn infants WY Nursing > WY 157.3 Maternal-child nursing. Neonatal nursing. Perinatal nursing
Faculty: Department:	Education
Digital Object Identifer (DOI):	https://doi.org/10.1371/journal.pgph.0004059
SWORD Depositor:	JISC Pubrouter
Depositing User:	JISC Pubrouter
Date Deposited:	13 Jan 2025 13:18
Last Modified:	13 Jan 2025 13:18
URI:	https://archive.lstmed.ac.uk/id/eprint/25856

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