Factors associated with the admission of neonates within 72 hours of birth at Dedza and Mangochi District Hospitals, Malawi: A matched case-control study
Authors: Hajison Precious L , Dzikiti Loveness , Chimatiro Chancy , Thsotetsi Lumbani , Mbale Emmie , Makhumula Blessing , Mwanjera Godwin Evidence , Chinkonde Jacqueline Rose , Senbete Mesfin , Nwosisi Charles , Lufesi Norman 
Published: October 2023

Objective: To investigate the demographic characteristics, maternal, and perinatal factors associated with the hospitalization of neonates within 72 h of birth in the Dedza and Mangochi districts of Malawi.
Methods: This case-control study was conducted with one-to-one matching for age, location, and sex. Cases were sick neonates who were admitted in the Sick Intensive Neonatal Care Unit (SINCU) within 72 h of life, while controls were non-sick neonates delivered within two weeks of the birth dates of cases. Prenatal data were extracted from case files, while other maternal practices and demographic characteristics were obtained by interviewing primary care takers or legal guardians after obtaining consent. Descriptive analyses and logistic regression were used to identify factors associated with hospitalization of neonates within 72 h of birth.
Results: Application of tetracycline eye ointment (AOR: 0.41, 95% CI: 0.20–0.83, p = 0.013) applying chlorhexidine to the umbilical cord stump (AOR: 0.30, 95% CI: 0.10–0.86, p = 0.026), and stimulation resuscitation (AOR: 0.20, 95% CI: 0.05–0.78, p = 0.021) were associated with a reduced odd of hospitalization. An increased odds of hospitalization was significantly associated with low birth weight (AOR: 11.25, 95% CI: 4.59–27.53, p = 0.001), Apgar score <5 (AOR: 5.0, 95% CI: 2.14–11.7, p = 0.001), suctioning resuscitation (AOR: 2.83, 95% CI: 1.16–6.86, p = 0.022), and resuscitation using O2 (AOR: 4.24, 95% CI: 1.32–13.63, p = 0.015). Maternal factors associated with reduced odds of hospitalization included the mother testing positive for syphilis antenatally (AOR: 0.06, 95% CI: 0.02–0.76, p = 0.001) and the mother being married (AOR: 0.40, 95% CI: 0.17–0.97, p = 0.42). Maternal factors associated with an increased odds of hospitalization include premature rupture of membranes (AOR: 2.71, 95% CI: 1.24–5.95, p = 0.013) and presence of meconium stain during delivery (AOR: 3.01, 95% CI: 1.56–5.79, p = 0.001).
Conclusion: Neonatal factors significantly associated with neonate admission to the SINCU within 72 h of birth included application of eye ointment, use of chlorhexidine on the umbilical cord stump, low birth weight, Apgar score <5 at 1 min, suctioning resuscitation, and oxygen resuscitation. Maternal factors included, being married, testing positive for syphilis antenatally, premature rupture of membranes, and observing a meconium stain during delivery.
We recommend that stimulation be used as the core procedure for resuscitation, whereas suctioning should be used with caution and only when it is essential. Infection prevention measures should always be adhered to during all procedures on neonates. We recommend intensifying HIV and syphilis testing during the antenatal period to reduce neonatal infection.