A Prospective Study of Causes of Illness and Death in Preterm Infants in Ethiopia: The SIP Study Protocol
Creators: name: Muhe, Lulu M.
name: McClure, Elizabeth M.
name: Mekasha, Amha
name: Worku, Bogale
name: Worku, Alemayehu
name: Dimtse, Asrat
name: Gebreyesus, Goitom
name: Tigabu, Zemene
name: Abayneh, Mahlet
name: Workneh, Netsanet
name: Eshetu, Beza
name: Girma, Abayneh
name: Asefa, Mesfin
name: Portales, Ramon
name: Arayaselassie, Mahlet
name: Gebrehiwot, Yirgu
name: Bekele, Tiruzer
name: Bezabih, Mesele
name: Metaferia, Gesit
name: Gashaw, Mulatu
name: Abebe, Bewketu
name: Geleta, Alemu
name: Shehibo, Abdulkadir
name: Hailu, Yohanes
name: Berta, Hailu
name: Alemu, Addisu
name: Desta, Tigist
name: Hailu, Rahel
name: Patterson, Janna
name: Nigussie, Assaye K.
name: Goldenberg, Robert L.
Publisher: name: Columbia University
Year: 2018
Subjects: Reproductive health
Premature infants
Infants--Mortality
Death--Causes

description: Background
                With nearly 15 million annual preterm births globally, preterm birth is the most common cause of neonatal death. Forty to 60 % of neonatal deaths are directly or indirectly associated with preterm mortality. As countries aim to meet the Sustainable Development Goals to reduce neonatal mortality, significant reductions in preterm mortality are needed. This study aims to identify the common causes of preterm illness and their contribution to preterm mortality in low-resource settings. This article will describe the methods used to undertake the study.
              
              
                Methods
                This is a prospective, multi-centre, descriptive clinical study. Socio-demographic, obstetric, and maternal factors, and clinical and laboratory findings will be documented. The major causes of preterm mortality will be identified using clinical, laboratory, imaging, and autopsy methods and use the national Ethiopian guidelines on management of preterm infants including required investigations to reach final diagnoses. The study will document the clinical and management protocols followed in these settings. The approach consists of clinical examinations and monitoring, laboratory investigations, and determination of primary and contributory causes of mortality through both clinical means and by post-mortem examinations. An independent panel of experts will validate the primary and contributory causes of mortality.
                To obtain the estimated sample size of 5000 preterm births, the study will be undertaken in five hospitals in three regions of Ethiopia, which are geographically distributed across the country. All preterm infants who are either born or transferred to these hospitals will be eligible for the study. Three methods (last menstrual period, physical examination using the New Ballard Score, and ultrasound) will be used to determine gestational age.
                All clinical procedures will be conducted per hospital protocol and informed consent will be taken from parents or caretakers prior to their participation in the study as well as for autopsy if the infant dies.
              
              
                Discussion
                This study will determine the major causes of death and illness among hospitalized preterm infants in a low-resource setting. The result will inform policy makers and implementers of areas that can be prioritized in order to contribute to a significant reduction in neonatal mortality.