Background Neonatal sepsis is a common cause of mortality and morbidity during the first 28 days of life, particularly in resource-limited settings. Of those infants who survive sepsis, there is a lack of clarity as to the likelihood of developmental difficulties in these children. This study aimed to understand the impact of probable neonatal sepsis on the development of 2-year-old children in Uganda.Methods We assessed 404 infants aged between 18 and 36 months using the WHO’s Global Scales for Early Development (GSED) Long Form (directly observed) and Short Form (parent report). This included 100 infants treated for probable neonatal sepsis and were part of a large community infection prevention trial (BabyGel). We then recruited 304 age-matched children from the same communities who took part in the parent trial but had no probable neonatal sepsis. We used linear regression and inverse probability of treatment weighting analyses to calculate measures of association and effect. We adjusted for the clustering effect, trial arm or other confounders.Results The mean age (SD) of children in our cohort was 23.3 months (4.4) in both groups. GSED development for age Z-scores were significantly lower for the children with a probable sepsis diagnosis compared with those without for both the GSED Short Form −0.22, 95% CI −0.47 to −0.04 and the GSED Long Form −0.33, 95% CI −0.60 to −0.05 when adjusted. An additional model adjusting for HIV exposure as a confounder (only available 373/404) provided similar results with adjusted mean GSED Short Form developmental age Z-scores difference of −0.29, 95% CI −0.53 to −0.04 and −0.33, 95% CI −0.59 to −0.07 for GSED Long Form.Conclusion Neonatal sepsis may be associated with poorer developmental outcomes in resource-limited settings such as Uganda. To ensure better outcomes for these children, it is vital to explore more effective strategies for follow-up, monitoring and early interventions in infants with probable neonatal sepsis.
BackgroundOmphalitis is a bacterial infection of the umbilicus and/or surrounding tissues, occurring primarily in the neonatal period. Whereas it is known to be a major route of localized and often systemic infection, studies describing incidence and risk factors remain scanty, especially in resource limited settings where the condition is thought to be common. We assessed the incidence and risk factors for omphalitis among neonates born to women who received a birth kit containing chlorhexidine for umbilical cord care after birth in Eastern Uganda.Trial registration for the parent studyThe BabyGel trial was registered in the Pan African Clinical Trial Registry -(PACTR202004705649428 Registered 1 April 2020, https://pactr.samrc.ac.za/).MethodsWe conducted a community-based cohort study between January 2021 and June 2023. This study was nested within the BabyGel trial. Our outcome of interest was clinical omphalitis, defined as purulent discharge from the umbilical cord stump within the first twenty-eight days of life as witnessed by a study midwife. Data were analyzed using Stata version 17.0. Bivariable and multivariable analyses were conducted using Cox proportional hazard regression models to estimate hazard ratios (HR) of selected exposures and time to omphalitis.ResultsA total of 2052 neonates were enrolled; half of which were female (51.1%). The incidence of omphalitis was 3.0% (62/2052; 95% confidence interval (CI): 1.9%, 4.4%). The incidence rate of omphalitis was 1.6 cases per 1000 person days (95% CI: 1.1, 2.3). Neonates born at home were twice as likely to develop omphalitis as those born in a health facility (adjusted hazards ratio (AHR) 1.99; 95% CI: 1.01, 3.9).ConclusionThe incidence of omphalitis among neonates in Eastern Uganda was low. Home births carried twice the risk for omphalitis. Use of chlorhexidine coupled with close follow-up of neonates in the community by health workers and community health workers might have reduced the risk of omphalitis.
Background The 2014 World Health Organization (WHO) guidelines on delayed umbilical cord clamping for improved maternal and infant health and nutritional outcomes strongly recommend a delay in umbilical cord clamping of 1–3 minutes after delivery. Delayed cord clamping (DCC) is known to provide an iron load that improves the infant’s iron status up to 6 months after birth. Despite the benefits associated with DCC, only a few countries have set policies regarding this practice. In Uganda, the practice of umbilical cord clamping has not been studied. The purpose of this study is to assess the practice of delayed cord clamping at birth among skilled birth attendants at three different levels of health care system in the Mbale district. Methods This was a descriptive cross-sectional study. A total of 379 births and their skilled birth attendants at Mbale Regional Referral, Namatala Health Centre IV, and Nakaloke Health Centre III were observed. Research assistants used a stopwatch to time the interval from the time the baby was delivered to the time the umbilical cord was clamped. We reported the timing of umbilical cord clamping overall and by skilled birth attendant groups (obstetricians, medical officers, interns, and midwives). Results Almost half (52%, 197/379) (95% CI: 25.7%-46.9%) of the newborns had their cords clamped after at least 60 seconds, a practice of delayed cord clamping (DCC). Approximately half (182/379; 48%) of the newborns had cords clamped before the 60 s (ICC), and approximately one quarter (26.1% (99/379)) of the newborns had their umbilical cords clamped before 30 seconds. The median (5th, 95th percentile) umbilical cord clamping time in seconds was 65 (8.35, 393.79), with variations within the practitioner subgroup. The midwives practised DCCs for 124 (22, 408.71) seconds, whereas the doctors practised ICCs for 22.35 (5.47, 80) seconds and the students practised 56.77 (11.82, 471.96) seconds. Doctors were more likely to clamp the umbilical cord immediately than were midwives and students (COR 33.1; 95% CI: 15.1--72.6). Conclusions The study revealed that only half of health providers practice delayed cord clamping in these delivery rooms. Doctors were more likely not to practice DCC than midwives and students were. This is the first study to guide the timing of umbilical cord clamping in facilities around the Mbale.
Abstract Background Globally, high systolic blood pressure accounts for 10.8 million deaths annually. The deaths are disproportionately higher among black people. The reasons for this disparity are poorly understood, but could include a high burden of perinatal insults such as birth asphyxia. Therefore, we aimed to assess the incidence of elevated blood pressure and to explore associated factors among children born to women with obstructed labour. Methods We followed up children born to women with obstructed labour aged 25 to 44 months at Mbale regional referral hospital that had participated in the sodium bicarbonate trial ( Trial registration number PACTR201805003364421) between October 2021 and April 2022. Our primary outcome was elevated blood pressure defined as blood pressure (either systolic or diastolic or both) ≥ the 90th percentile for age, height, and sex in the reference population based on the clinical practice guideline for screening and management of high blood pressure in children and adolescents. We used logistic regression to estimate odds ratios between selected exposures and elevated blood pressure. Results The incidence of elevated blood pressure was (39/140, 27.9%: 95% (CI: 20.6–36.1)). Participants aged three years and above had twice the odds of elevated blood pressure as those aged less than three years (Adjusted odds ratio (AOR) 2.46: 95% CI (1.01–5.97). Female participants had 2.81 times the odds of elevated blood pressure as their male counterparts (AOR 2.81 95% CI (1.16–6.82). Participants with reduced estimated glomerular filtration rate had 2.85 times the odds of having elevated blood pressure as those with normal estimated glomerular filtration rate (AOR 2.85 95% CI (1.00–8.13). We found no association between arterial cord lactate, stunting, wealth index, exclusive breastfeeding, food diversity and elevated blood pressure. Conclusion Our findings show a high incidence of elevated blood pressure among children. We encourage routine checking for elevated blood pressure in the pediatric population particularly those with known risk factors.
Abstract Background Over two million children and adolescents suffer from chronic kidney disease globally. Early childhood insults such as birth asphyxia could be risk factors for chronic kidney disease in later life. Our study aimed to assess renal function among children aged two to four years, born to women with obstructed labour. Methods We followed up 144 children aged two to four years, born to women with obstructed labor at Mbale regional referral hospital in Eastern Uganda. We used serum creatinine to calculate estimated glomerular filtration rate (eGFR) using the Schwartz formula. We defined decreased renal function as eGFR less than 90 ml/min/1.73m2. Results The mean age of the children was 2.8 years, standard deviation (SD) of 0.4 years. Majority of the children were male (96/144: 66.7%). The mean umbilical lactate level at birth among the study participants was 8.9 mmol/L with a standard deviation (SD) of 5.0. eGFR of the children ranged from 55 to 163 ml/min/1.73m2, mean 85.8 ± SD 15.9. Nearly one third of the children (45/144) had normal eGFR (> 90 ml/Min/1.73m2), two thirds (97/144) had a mild decrease of eGFR (60–89 ml/Min/1.73m2), and only two children had a moderate decrease of eGFR (< 60 ml/Min/1.73m2). Overall incidence of reduced eGFR was 68.8% [(99/144): 95% CI (60.6 to 75.9)]. Conclusion We observed a high incidence of reduced renal function among children born to women with obstructed labour. We recommend routine follow up of children born to women with obstructed labour and add our voices to those calling for improved intra-partum and peripartum care.
