Trends and Factors Associated with Neonatal Sepsis at Ruhengeri Referral Hospital, Rwanda

Research Article

Trends and Factors Associated with Neonatal Sepsis at Ruhengeri Referral Hospital, Rwanda

Nimukuze E1,2, Mukarwego B1, Bizimana GE1,3 and Rutayisire E1*

1Department of Public Health, Mount Kenya University, Rwanda

2Department of Laboratory, Ruli District Hospital, Rwanda Ministry of Health, Rwanda

3Jigsaw Consult/Refugee Education, UK

*Corresponding author: Erigene Rutayisire, Department of Public Health, Mount Kenya University, Kigali, Rwanda

Received: June 08, 2021; Accepted: July 07, 2021; Published: July 14, 2021


Neonatal sepsis is estimated to cause 26% of all neonatal mortality globally including Africa with 17% neonatal deaths. Early diagnosis and management can considerably decrease the risk of neonatal sepsis, and improve the outcome. This study aimed to determine trends and the risk factors associated with neonatal sepsis at Ruhengeri Referral Hospital from 2018 to 2019. A total of 1220 neonates’ medical files were reviewed. Data were recorded and analyzed by using SPSS. Logistic regression analysis was used to estimate factors associated with neonatal sepsis, 5% was considered as significance level. Results showed that the majority of neonates 57.4% were females, 53.9% of neonates had 0-7 days while 46.1% had more than 7 days of birth. The total cases of neonatal sepsis from January to December 2018 were found to be 207 with an average of 17 cases per month whereas there were 165 cases from January to December 2019 with an average of 14 cases per month. Research findings revealed that rupture of membranes (AOR=3.6; 95% CI: (1.34-4.76); p<0.001) and prolonged labour (AOR=1.5; 95% CI: (1.12-2.43); p<0.001) were associated with neonatal sepsis. Vaginal delivery and no history of urinary tract infection were protective factors to neonatal sepsis occurrence. The study also observed that the majority of the neonates had early onset of sepsis (<7 days). Hence, encouraging mothers to use antenatal care services might help identify the risk factors and possible interventions to reduce the risk factors of adverse birth outcomes including neonatal sepsis.

Keywords: Neonatal sepsis; Neonatal death; Ruhengeli referral hospital


Sepsis is a dysregulated host response to infection leading to lifethreatening organ dysfunction [1]. The Global Burden of Disease (GBD) estimated 1.3 million annual incident cases of neonatal sepsis and other infections (approximately 937 cases per 100 000 live births) and 203000 sepsis-attributable neonatal deaths [2,3].

Neonates are disproportionately affected in Low-Income and Middle-Income Countries (LMICs) with a high prevalence of infectious diseases and poor access to adequately equipped and staffed healthcare facilities [4,5]. In sub-Saharan Africa alone, an estimated 5.3-8.7 million disability-adjusted life-years have been lost in 2014 due to neonatal sepsis and consecutive long-term morbidity [6]. In sub-Saharan Africa neonatal sepsis is the main newborn killer where more than one third of neonatal deaths [7].

Neonatal sepsis is categorized based on the time of occurrence including early onset diseases (EOD) and late onset diseases (LOD). This differentiation has clinical fact: for instance, EOD is mostly caused by bacteria attracted before and during birth whereas LOD bacteria are attracted afterbirth from health facility or community [8]. Early onset of sepsis remains a common and big issue for neonate, especially intrapartum antimicrobial streptococcus (BGS) commonly found to be an etiological agent, but Escherichia viral or fungal etiology may also manifested at 7 days of life and must be differentiated from bacteria sepsis [9].

In Rwanda, there has been a significant decrease in under-five mortality, from 196 per 1000 live births in 2000 to 50 per 1000 live birth in 2015, making the country one of the dew in SSA to achieve the MDGs for child mortality. Again, the neonatal mortality rate significantly decreased from 41 per 1000 live births in 1990 to 17 per 1000 live births in 2016 [10]. The main cause of neonatal mortality in Rwanda are prematurity (41%), and neonatal sepsis (10%) [11]. The Rwanda Demographic Health Survey (RDHS 2014-2015) reported that newborn death was 20/1000 live birth [12].

To our knowledge no study have been conducted in Northern Province of Rwanda assessed the risk factors of neonatal sepsis. A report from Ruhengeri hospital showed that 2142 neonates admitted in neonatology in 2016 of them 514 (24%) were reported to have neonatal infections during hospitalization. Therefore, this research sought to assess the trends and factors associated with neonatal sepsis in Rwanda with special focus on Ruhengeri Referral Hospital.

Materials and Methods

Study design

This research was a descriptive hospital-based retrospective study. This study has used quantitative approach to determine the trends, and factors associated with neonatal sepsis among hospitalized neonates. This study was conducted among neonates hospitalized in neonatal unit at Ruhengeri Referral Hospital located in Northern Province, Musanze District of Rwanda. Ruhengeri referral hospital serves 413,470 people with 17 health centers. The hospital building comprises the pediatric department with 96 beds among them 36 beds and 11 incubators and 12 staffs among them 3 health care providers are on daily shift in neonatal unit.

Target population

The study targeted 1220 individuals composed with neonates and mothers found in neonatal unit from January 2018 to December 2019. All 1220 medical records (neonates’ files) from Neonatal units with inclusion criteria were checked during data collection period from January 1, 2018 to December 31, 2019.

A structured checklist was used to retrieve needed information from neonate’s medical files. Mainly, the checklist comprised the socio-demographic features, maternal and pregnancy- related factors and neonates-related factors.

Data analysis and ethical consideration

Data collected was analyzed by using SPSS after being coded, compiled and recorded. Descriptive statistics showing frequency distributions and percentage have been used to represent variables under study. Research findings are presented in tables and graphs. Multivariate analysis was used to determine statistical associations between the dependent and independent variables. A two tailed p-value of less than or equal to 0.05 at 95% confidence interval has been used in order to state the statistical significance.

This study was approved by Mount Kenya University Rwanda Ethical review board. The ethical approval was presented to the Ruhengeri Referral Hospital Administration to obtain permission to carry out the study according to the required rules and regulations of hospital administration. The hospital management’s team was informed that findings are to be used for academic purpose and confidentiality was ensured.


A total of 1220 clients’ files have been reviewed in line with the objectives and giving a response rate of 100%.

Socio-demographic characteristics of the mothers

As presented in table 1, a total of 1220 medical files equals to a total of 1220 mothers aged at least 18years old have been reviewed in the Neonatal Unit at Ruhengeri Referral Hospital. Findings revealed that 66.2% of mothers were aged between 18 and 35 years, 57.1% were in the second social category, 66.7% were coming from rural areas, most of the mothers (75.3%) had attended primary school, a big part of the mothers(76.0%) were married while the majority of the mothers (73.4%) of the mothers were unemployed.