wubetu.pdf

Report: wubetu pro
Page 1 of 40
Report was generated on Wednesday, Aug 3, 2022, 07:01 PM
wubetu pro
by fan melaku
General metrics
35,608 5,231 501 20 min 55 sec 40 min 14 sec
characters words sentences reading
time
speaking
time
Score Writing Issues
84
This text scores better than 84%
of all texts checked by Grammarly
203
Issues left Critical
203
Advanced
Unique Words 22%
Measures vocabulary diversity by calculating the
percentage of words used only once in your
document
unique words
Rare Words 39%
Measures depth of vocabulary by identifying words
that are not among the 5,000 most common English
words.
rare words

Report: wubetu pro
Page 2 of 40
Word Length 4.9
Measures average word length characters per word
Sentence Length 10.4
Measures average sentence length words per sentence

Report: wubetu pro
Page 3 of 40
wubetu pro
MIZAN TEPI UNIVERSITY
COLLEGE OF MEDICINE AND HEALTH SCIENCE
DEPARTMENT OF MIDWIFERY
PREVALENCE AND ASSOCIATED FACTORS OF NEONATAL SEPSIS AMONG
NEONATES IN NEONATAL INTENSIVE CARE UNIT AT MIZAN TEPI UNIVERSITY
TEACHING HOSPITAL, MIZAN AMAN, SOUTH WESTERN, ETHIOPIA, 2022.
Advisor; Mr. Tadele Y.(BSC, MSC)
Mr. Gossa F (BSC, MSC)
A RESEARCH PROPOSAL WAS SUBMITTED TO MIZAN TEPI UNVERSITY COLLEGE
OF MEDICINE AND HEALTH SCIENCES, DEPARTMENT OF MIDWIFERY IN
PARTIAL FULFILLMENT OF THE REQUIREMENT FOR THE DEGREE OF
BACHELOR OF SCIENCE IN MIDWIFERY, JULY, 2022.
By:
Wubetu Tadesse………………………….Hsr/255/11
Motuma Saketa………………………….Hsr/184/11
Mahider Kebede…………………………Hsr/334/11

Report: wubetu pro
Page 4 of 40
Ayelech Gurmu………………………….Hsr/338/9
MIZAN AMAN ETHIOPIA
JULY, 2022.
1
MIZAN TEPI UNIVERSITY
COLLEGE OF MEDICINE AND HEALTH SCIENCE
DEPARTMENT OF MIDWIFERY
PREVALENCE AND ASSOCIATED FACTORS OF NEONATAL SEPSIS AMONG
NEONATES IN NEONATAL INTENSIVE CARE UNIT AT MIZAN TEPI UNIVERSITY
TEACHING HOSPITAL, MIZAN AMAN, SOUTH WESTERN, ETHIOPIA, 2022.
A RESEARCH PROPOSAL WAS SUBMITTED TO MIZAN TEPI UNVERSITY COLLEGE
OF MEDICINE AND HEALTH SCIENCES, DEPARTMENT OF MIDWIFERY IN
PARTIAL FULFILLMENT OF THE REQUIREMENT FOR THE DEGREE OF
BACHELOR OF SCIENCE IN MIDWIFERY, JULY, 2022.
Advisor; sign Date
Mr. Tadele Y. (BSc, MSc). ------------------- -----------------
Mr. Gossa F. (BSc, MSc). ------------------- -----------------

Report: wubetu pro
Page 5 of 40
Investigators:
Wubetu Tadesse -------------------- ---------------
Motuma Saketa --------------------- ---------------
Mahider Kebede --------------------- ---------------
Ayelech Gurmu --------------------- ---------------
SUMMARY
Background: Neonatal sepsis is one of the major causes of neonatal morbidity
and mortality, especially in developing countries. Socio-demographic,
maternal, neonatal, and medical factors were associated with the risk of
infection. The clinical signs and symptoms of neonatal sepsis are nonspeci c
and the con rmation of the diagnosis is challenging and time-consuming.
Therefore, the diagnostic approach should depend upon the consideration of
risk factors.
Objective: This study will aim to assess the prevalence and associated factors
of neonatal sepsis at Mizan Tepi university teaching hospital.
Methodology: An institution-based cross-sectional study design will be
conducted at Mizan tepi university teaching hospital from June to October
2022.
Simple random sampling techniques will be used to select the study sample.
Data will be collected by using a pre-tested, standardized questionnaire with
an interview type of data collection.
Work plan and budget: The study will be conducted from June to October 2022
with a total budget of 1260 birr including personal allowance and method and
materials.

Report: wubetu pro
Page 6 of 40
ACKNOWLEDGMENTS
We would like to acknowledge Mizan Tepi University, College of Medicine and
Health Sciences, and Department of Midwifery for assigning us to perform this
proposal.
Our heartfelt thanks go to our advisors Mr. Tadele and Gosa (BSC, MSC) for their
continuous help in equipping us with the necessary knowledge, information,
and encouragement and for helping us to prepare this proposal.
Abbreviation and acronyms
APGAR Activity, Pulse, Grimace, appearance, respiration
CI Con dence interval
CONS Coagulase-Negative Staphylococcus
MTUTH Mizan Tepi university teaching hospital
EDHS Ethiopia Demographic and Health Survey
EONS Early onset neonatal sepsis
E.COLI Escherichia coli
GBS Group B streptococcal sepsis
LONS Late-onset neonatal sepsis
MSAF Meconium stained amniotic uid
MDG Millennium development goal
NICU Neonatal intensive care unit
NMR Neonatal mortality rate
NS Neonatal sepsis
PROM Prolonged rupture of membrane
PSBI Possible severe bacterial infection
SDG Sustainable Development Goals
SPSS Statistical Package for Social science

Report: wubetu pro
Page 7 of 40
UTI Urinary tract infection
UN United Nation
WHO World health organization
Tables of content
SUMMARY II
ACKNOWLEDGMENTS III
Abbreviation and acronyms IV
CHAPTER ONE 1
1. INTRODUCTION 1
1.1. BACKGROUND 1
1.2. STATEMENT OF THE PROBLEM 3
1.3. SIGNIFICANT OF STUDY 5
CHAPTER TWO 6
2. LITERATURE REVIEW 6
2.1. Factors associated with neonatal sepsis 7
2.1.1. Socio-demographic Characteristics 7
2.1.2. Maternal risk factors 7
2.1.3. Neonatal risk factors 8
2.1.4. Medical risk factors 8
2.2. Organism causing neonatal sepsis 9
2.2.1. Developing and Developed countries 9
2.2.2. Justi cation 11
CHAPTER THREE 12
3. OBJECTIVE 12
3.1. General objective 12

Report: wubetu pro
Page 8 of 40
3.2. Speci c objective 12
CHAPTER FOUR 13
4. METHODS AND MATERIAL 13
4.1. Study area and period 13
4.2. Study design 14
4.3. Population 14
4.3.1. Source Population 14
4.3.2. Study population 14
4.4. Inclusion and Exclusion Criteria 14
4.4.1. Inclusion Criteria 14
4.4.2. Exclusion criteria 14
4.5. Sample Size Determination 14
4.6. Sampling Technique 15
4.7. Data collection procedure 15
4.8. Study variables 15
4.8.1. Dependent variables 15
4.8.2. Independent Variables 15
4.9. Data Quality Assurance 16
4.10. Data processing and Analysis 16
4.11. Oprational information 17
4.12. Ethical Consideration 17
4.13. Dissemination of results 17
CHAPTER FIVE 18
5. WORK PLAN 18
CHAPTER SIX 19

Report: wubetu pro
Page 9 of 40
6. Budget breakdown 19
REFERENCES 20
Page 7 of 28
CHAPTER ONE
INTRODUCTION
BACKGROUND
Sepsis is de ned as systemic in ammatory response syndrome resulting from
a suspected or proven infection (1), (2).
It is characterized by systemic manifestations which result from bacterial
invasion and multiplication in the bloodstream (3).
Neonatal sepsis (NS) is a serious blood bacterial infection in neonates at the
age equal to or less than 28 days of life which is manifested by systemic signs
and symptoms of infection (4).
The clinical presentation of neonatal sepsis is non-speci c and includes fever,
respiratory distress, lethargy, impaired or refusal of feeding, jaundice, absent
Moro re ex, hypothermia, convulsions, bleeding disorder, and bulging fontanel
(5).
Based on the onset of clinical sign and symptom, neonatal sepsis (NS) become
classi ed as early-onset infection (if the onset of the clinical feature presents
from birth to 7 days usually <72 hr) and late-onset infection (if it presents from
8 to 28days after birth (1), (6), (7).

Report: wubetu pro
Page 10 of 40
It is more helpful to differentiate between early and late-onset infections
according to per Partum pathogenesis because both have a different source of
infection, the onset of disease occurrence, mode of transmission,
management, and risk factors: (1), (7), (8) Which includes: socio-demographic,
maternal, neonatal and medical factors were associated with the development
of neonatal sepsis (9).
Blood culture is a de nitive diagnostic tool for neonatal sepsis. However, this
'gold standard testing method is time-consuming and may result in false
positive results as well as false negative results, which can be attributed to the
dif culties in discriminating a true CONS infection from sample contamination
(10).
In addition to this neonatal sepsis is diagnosed based on a combination of
clinical appearance and the use of positive septic screening parameters such
as TLC < 5000/mm, band to total polymorph nuclear cells ratio of >0.2, C-
reactive protein (CRP) >1mg/dl and micro ESR > 10 mm- rst hour (11). The
management of neonatal sepsis is with empirical antimicrobial therapy and
supportive care. Once the clinical diagnosis is known, the neonate becomes
critically ill. Due to this reason treatment should be started immediately after
obtaining samples for culture rather than waiting for the culture results (12).

Report: wubetu pro
Page 11 of 40
STATEMENT OF THE PROBLEM
Globally neonatal sepsis is one of the most signi cant causes of morbidity and
mortality among neonates during the neonatal period (0-28 days). Out of 5.9
million child deaths in 2015, almost 1 million occur in the rst day of life and

Report: wubetu pro
Page 12 of 40
close to 2 million occurs in the rst week of life. The main causes of neonatal
deaths were preterm birth complications (35 %), intrapartum-related
complications (24 %), and sepsis (15 %) (13).
According to the current United Nations estimate in 2015, neonatal death
reduced by 48% from the 1990 estimate to 28 per 1000 live births in 2013 while,
the under-5 mortality rate has declined to 67% (14).
The incidence of neonatal bacterial sepsis varies from 1 to 4 cases per 1,000
live births in developed countries, with great differences over time and
geographic location(1). Approximately four million global neonatal deaths occur
per year, of which about 98 % occur in developing countries especially in sub-
Saharan Africa (15), (16).
The risk of neonatal death becomes 6 times higher in developing countries
compared to that in developed countries (17). According to a 2011 UNICEF
report, neonatal deaths accounted for 52% of all under- ve child mortality in
South Asia, 53% in Latin America and the Caribbean, and 34% in sub-Saharan
Africa (18).
In Africa, and other developing countries, a small number of data were
available on risk factors associated with neonatal sepsis. Few evidence showed
that both maternal and neonatal factors play an important role in early-onset
sepsis, as they do in resource-rich countries (19), (20).
Despite Ethiopia's remarkable success in achieving the millennium
development goal (MDG 4) three years before, the reduction in neonatal

Report: wubetu pro
Page 13 of 40
mortality was comparatively low and at the end of the MDG era, the
international community was in agreement on a new framework the
sustainable development goals (SDGs) to reduce under- ve mortality to at
least as low as 25 per 1000 live birth by 2030 (21).
According to the 2016 EDHS report, the neonatal mortality rate (NMR) was
29/1000 live births, which shows a small signi cant reduction from the 2005
EDHS report of 39/1000 live births. Neonatal conditions which were causing
under- ve mortality in 2004 have recently increased to 43%. Out of these
conditions which cause under- ve mortality, neonatal sepsis accounts for 9%
(22).
Despite improvements in diagnosis and management of neonatal sepsis in
recent years, NS become a leading cause of admission and death in neonatal
units especially in developing countries due to different conditions that were
responsible for neonatal mortality (23).
Identi cation of the bacteria and treatment was often unsatisfactory due to the
non-speci c clinical presentation of sepsis and the lack of reliable diagnostic
tests. So the prevalence, etiology, risk factors, and outcome of this problem
need to be understood to diagnose and treat it early. But as the diagnosis of
sepsis became dif cult and time-consuming, the diagnostic approach should
necessarily by considering different associated risk factors of neonatal sepsis
(24).

Report: wubetu pro
Page 14 of 40
If there was a delay in diagnosis, there will be a delay in starting the treatment
which increases the mortality rate by 50 % (25).
To avoid this problem, knowledge about common risk factors of neonatal sepsis
in a given area becomes essential in guiding the local empirical choice of
antibiotics and preventing drug resistance (3).
SIGNIFICANCE OF THE STUDY
Neonatal sepsis is one of the most signi cant causes of morbidity and
mortality among neonates during the neonatal period (0-28 days).
The risk of neonatal death becomes 6 times higher in developing countries
compared to developed countries. There has been a limited study done about
the prevalence and associated factors of neonatal sepsis and no study

Report: wubetu pro
Page 15 of 40
available in the study area as far as my knowledge is concerned since neonatal
intensive care service was started two years back.
Therefore, the result of this study will help MTUTH to know the level of neonatal
sepsis and associated factors and the plan necessary.
Secondly, it will help to create awareness in the community because based on
the result nding, health professionals give health education to mothers about
different risk factors at the time of ANC follow up which helps them to be
screened and treated early.
Thirdly, it is hoped that this study result will provide insight to a health care
provider into the identi cation mechanism of common risk factors of neonatal
sepsis to overcome the challenge of early diagnosis and management.

Report: wubetu pro
Page 16 of 40
CHAPTER TWO
LITERATURE REVIEW
Globally neonatal sepsis is one of the most signi cant causes of morbidity and
mortality among neonates during the neonatal period (0-28 days). Out of 5.9
million child deaths in 2015, almost 1 million occur in the rst day of life and
close to 2 million occurs in the rst week of life. The main causes of neonatal
deaths were preterm birth complications (35 %), intrapartum-related
complications (24 %), and sepsis (15 %) (13).
The incidence of neonatal bacterial sepsis varies from 1 to 4 cases per 1,000
live births in developed countries, with great differences over time and
geographic location (1). Approximately four million global neonatal deaths
occur per year, of which about 98 % occur in developing countries especially in
sub-Saharan Africa (15), (16).
According to the global health observatory data report of 2015, around a
4.5million (75%) of all under- ve mortality occurred in the rst year of life
which was the highest in Africa and accounts for 55/for 1000 live birth but, was
greater than ve times higher than that of European (10 per 1000live birth) (25).
In developing countries, neonatal mortality per 1000 live births from all causes
was about 34; most of these deaths occur in the rst week of life, mostly on the
rst day of life (26). The prevalence of neonatal sepsis was more common in
developing countries than that in developed countries. A study conducted in

Report: wubetu pro
Page 17 of 40
Japan indicated that the incidence of neonatal sepsis was 0 .74% and out of
these 0.13% was EONS (27).
Other studies also conducted in different areas revealed that similar ndings
like that of the study conducted in Egypt indicated, that the prevalence was
40.7% with a mortality rate of 51% and 42.9% for EONS and LONS, respectively
(28).
The study from Sudan showed the prevalence of NS was with 17.5with
mortality rate of 10. A study conducted in Black lion hospital showed that the
prevalence of neonatal sepsis is 44.7%.
Another study conducted in Bishoftu hospital shows among 306 neonates
included in the study 81.0% were EONS and 19% of them were LONS.
Factors associated with neonatal sepsis
Socio-demographic Characteristics
Socio-demographic characteristics such as maternal age, sex, and age of the
neonate were risk factors that contribute to the occurrence of neonatal sepsis.
For instance, male neonates were predominantly affected than females.
Preterm (<37 weeks) neonates have a 3- to 10-fold higher incidence of infection
than full-term (37-42 weeks) neonates (28).
There was a nding from Iraq that revealed that Out of the 50 septic neonates,
32 (64 %) were males versus 18(36%) were females resulting in an overall
female to male ratio of 1: 1.8 (28).
Neonatal sepsis de nition criteria were not the same for the term and preterm
neonates for whom the developmental stage in uence the abnormality

Report: wubetu pro
Page 18 of 40
associated with host immune response. Thus, a speci c agreement in
de nition was needed for both which is critical for the understanding of
observational studies, training for practitioners, and implementation of clinical
trials in neonates (2).
According to a study done in Bishoftu city to assess the incidence and risk
factors of NS, Among the total of 306 neonates (age 0-28 days) sampled 249
(81.4%) were aged less than or equal to 7 days and 169 (55.23%) of them were
male which indicates that the occurrence of sepsis was high in male neonates
and premature or preterm neonate (29). There was also another study done in
Indonesia showed similar reports (25).
Maternal risk factors
Neonatal infections became acquired from the mother through different routes
such as:-prenatally (during pregnancy) with or without the occurrence of
recognizable signs and symptoms of bacteremia through the placental
transmission to the fetus and infection which occurs immediately before or
during delivery by ascending transmission of micro-organisms to the fetus.
According to results of several studies conducted in different countries, the
main maternal risk factors for the occurrence of neonatal sepsis were: foul-
smelling liquor, meconium-stained amniotic uid, parity, history of urinary tract
infection (UTI/STI), maternal age, Chorioamintis, Genital tract colonization with
group B Streptococcus (GBS) and prolonged rupture of membrane (PROM) (8,
15), (24), (30).
Neonatal risk factors
Many neonatal risk factors were identi ed those play an important role in the
occurrence of neonatal sepsis such as male sex, preterm delivery, gestational
age, birth asphyxia, low birth weight <2.5kg, Agra score less than seven in the

Report: wubetu pro
Page 19 of 40
rst one minute, mechanical ventilation, and prolonged rupture of membranes
have signi ed Prolonged rupture of membranes have signi cant roles in early
and late-onset neonatal sepsis, as they do in resource-rich countries (8), (15),
(24), (26).
Studies conducted in different areas revealed that the occurrence of early-
onset neonatal sepsis was more frequent than that of late-onset neonatal
sepsis which was supported by the study conducted in Debrezeit hospital
showed that among 306 neonates included in the study,81.0% were EONS and
19% of them were LONS.
Medical risk factors
After delivery or in the postpartum period neonates could be acquired infection
from the surroundings (nosocomial infection), delivery room, or in the postnatal
room through the main pathways, namely the respiratory, gastrointestinal
tracts, and place of delivery.
According study conducted in Bishoftu hospital identi ed that a signi cant
number of neonates with 95% were born in a health center and developed
sepsis. This value was 4.2 times higher when compared to the neonates born at
home (28).
Usually, early-onset neonatal sepsis was related to maternal conditions and
late-onset was mostly related to the medical and surgical risk factors which
include invasive and non-invasive procedures (vascular catheters,
endotracheal tubes, or feeding tubes) needed for neonates who already have
the disease (29),(30).

Report: wubetu pro
Page 20 of 40
There were pieces of evidence that revealed that the risk of acquiring sepsis in
neonates born using Instrumental delivery has almost 6.2 times more common
than in children born via spontaneous vaginal delivery (28).
The organism causing neonatal sepsis
Developing and Developed countries
The common cause of neonatal sepsis became varies in both developed and
developing countries, and GBS was the leading cause of neonatal sepsis in
developed countries. But the load in developing countries was not as clear (30).
According to a review study conducted in a developing country, Approximately
about 1 million annual neonatal deaths occurs from severe invasive bacterial
infections, In which 99% of these deaths occur in developing countries. In this
review, the most commonly recognized pathogens were Staphylococcus aureus
(14.9%), Escherichia coli (12.2%), and Klebsiella species (11.6%).
Staphylococcus aureus and Streptococcus pneumonia were most common in
Africa, while Klebsiella was highly prevalent in South-East Asia (30).
Another study conducted in southern Mexico revealed that the commonest
bacteria identi ed were Coagulase-Negative Staphylococcus Group (CoNS) in
59 (67.8 %) patients; Klebsiella specious in 15 (17.2 %), and Candida spp. was
found in 13 (14.9 %) patients (8).
This nding agrees with the result of the study done in Gaza which identi es
the common causative bacteria were: coagulase-negative Staphylococcus

Report: wubetu pro
Page 21 of 40
(39%), Staphylococcus aureus (23%), Streptococcus spp. (12%), Enterobacter
cloacae and Pseudomonas species. (8%) and Escherichia coli and Klebsiella
pneumonia was (5%) (29).
Another study also conducted in Egypt to assess the causes of neonatal sepsis
revealed that among the total of 100 positive cases, 88% were identi ed as
bacterial and 12% were infections caused by yeast. Candida barbicans were
isolated from 11 cases 91.7% while only one case of Debaryomyceshansenii
was isolated representing 8.3% of the positive yeast identi ed (31).
MEDICAL FACTOR
Non-invasive procedures (any medical problem of the mother)
MATERNAL FACTOR
Maternal UTI, Place of delivery, PROM, Foul smell of liquor and MSAF, Duration
of labor, ANC, mode of delivery
NEONATAL SEPSIS
NEONATAL FACTORS

Report: wubetu pro
Page 22 of 40
LBW, Gestational Age, Birth asphyxia, APGAR score<7
SOCIO-DEMOGRAPHIC
Age of the neonate, Sex of the neonate, maternal age, parity
Justi cation
Neonatal sepsis is one of the most signi cant causes of morbidity and
mortality among neonates during the neonatal period and is also the leading
cause of morbidity and mortality in both developing and developed countries. It
is a life-threatening emergency and delays in diagnosis and treatment with
appropriate antibiotics may have overwhelming consequences.
Improving newborns and children's health is a national and global agenda that
comprises the third component of the sustainable development goals (SDG).
Improving the health of a newborn and reducing their mortality will play a great
role in the achievement of the SDG.
Despite the advancing healthcare system in Ethiopia, the admission of
neonates to the NICU with infection, most typically sepsis has increased. But,
there is no attention to that much.
Therefore, this study aims to assess the current prevalence of neonatal sepsis
and to identify factors affecting newborns in NICU at Mizan tepi University
Teaching Hospital
CHAPTER THREE
OBJECTIVE
General objective
To assess the prevalence and associated factors of neonatal sepsis among
neonates admitted to the neonatal intensive care unit at Mizan tepi university

Report: wubetu pro
Page 23 of 40
teaching hospital Southwest Ethiopia,2022.
Speci c objective
To determine the prevalence of neonatal sepsis among neonates admitted to
NICU at Mizan tepi university teaching hospital in southwest Ethiopia, 2022.
To assess the impact of neonatal sepsis among neonates admitted to NICU at
Mizan tepi university teaching hospital in southwest Ethiopia, 2022
CHAPTER FOUR
METHODS AND MATERIAL

Report: wubetu pro
Page 24 of 40
Study area and period
An institutional-based cross-sectional study design will be conducted from
June to October 2022 at MizanTepi University Teaching Hospital of Bench Sheko
Zone, South West Ethiopia.
This zone is located 565 kilometers far from Addis Ababa (the capital city of
Ethiopia) and 855 kilometers far from Hawassa (the capital city of South
Nations Nationalities and Peoples Region). It is bordered Northwest by the
Sheka Zone and eastern part of the Gambela region and, East by the Kafa zone,
Southeast by the Western Omo zone.
MizanAman is the administrative center of the zone with a total population of
623 329, of these females 317,275(50.9%) and males 306,054(49.1%).
There is one Teaching Hospital, one primary hospital, 26 health centers, and
131 health posts under the catchment of Bench Sheko Zone. MizanTepi
University Teaching Hospital is one of these health institutions in the Bench
Sheko Zone.
It has wide service units like outpatient, inpatient, and emergency service
units. Some of the outpatient services are GYN outpatient, MCH outpatient,
ART outpatient, and regular outpatient where eligible clients for cervical cancer
screening services are attending.
Other inpatient services are Internal medicine, Pediatrics Surgery including
minor and major surgical procedures, Gynecological and Obstetrics surgery and
delivery services other services like laboratory and pharmacy, Radiology,
pathology and Psychiatry dental and ophthalmology, and so on.

Report: wubetu pro
Page 25 of 40
Study design
An institution-based cross-sectional study design will be conducted among
neonates admitted to NICU at MTUTH. From June to October 2022.
Population
Source Population
The study population for the study will be all neonates who were admitted to
NICU at MTUTH during the study period.
Study population
The study population for this study will be all neonates who were admitted to
NICU at MTUTH in the last four months preceding the study period.
Inclusion and Exclusion Criteria
Inclusion Criteria
All neonates admitted to the NICU in MTUTH during the study period will be
included.
Exclusion criteria
Neonates card with incomplete patient chart information.
Mothers who were referred from other health institutions.
Neonates card with congenital malformation.
Sample Size Determination
For Our study, the Calculation of sample size (n) was estimated using single
population formula; we calculated the sample size for the prevalence of
Neonatal Sepsis by taking the population proportion of 33.8% from the

Report: wubetu pro
Page 26 of 40
previous study conducted in the lolita zone, SNNPR, Ethiopia, (29). And at a
con dence interval of 95% and a margin of error of 5 %.
Z a/2= con dence interval at 95% level (1.96)
d =the degree of precision (margin of error) 5%
n = Za/2)2 p(1-p)
d2
n= sample size
𝑍𝛼⁄2=Z value of 95% con dence level =1.96 from the Z-table
P = proportion of formula feeding from previous study 33.8%= 0.338
d= marginal error=5%=0.05
By substituting the values into the formula:
n= (1.96)2 0.333(1-0.338)/ (0.05)2
n=3.8416× (0.338×0.662)/0.0025
n=343.82=344
Total study sample size by adding non-response rate 344+5*344/100 =361
Sampling Technique
A systematic random sampling technique will be used to select the sample
size. Every 2 intervals will be used until the required sample size will be
ful lled.
Data collection procedure
Data will be collected by using interview administered questions. The questions
were prepared in English and translated into Amharic while making the
interview. The questionnaire contains four parts which include: part one Socio-
demographic characteristics; part two maternal information, part three
neonatal information, and part four contains medical factors for neonatal

Report: wubetu pro
Page 27 of 40
sepsis. If there is incomplete maternal information on the neonatal card, the
maternal card will be traced by using the neonatal card number.
Study variables
Dependent variables
neonatal sepsis
Independent Variables
Socio-demographic characteristics
Address
Age of the neonate
Sex of the neonate
Maternal age
Maternal Risk Factors
Chorioamnionitis
Maternal Urinary Tract Infection
Place of delivery
Prolonged Rupture of Membrane
The foul smell of liquor and
Meconium Stained Amniotic Fluid
Duration of labor
Antenatal Care
Neonatal Risk Factors
Low Birth Weight
Gestational Age
Birth asphyxia
APGAR score<7
Medical Risk Factors(Invasive & Non-invasive procedures)
Mechanical ventilation

Report: wubetu pro
Page 28 of 40
Oxygen via a nasal catheter
Oxygen via mask
Data Quality Assurance
Data completeness will be checked, cleaned, and compiled by the investigator
on daily basis.
Data processing and Analysis
The data will be cleaned for inconsistencies and missing values and coded and
entered into SPSS (Statistical Package for Social science) version 20 for
analysis. Frequency, proportion means, and SD will be used. After assessing
the normality of the distribution of the data, a bivariate analysis will be used to
determine the association between different factors and the outcome variable.
Those variables which have a signi cant association at 5% signi cance will be
entered for further analysis to multivariate analysis. Finally, the result will be
presented in texts, pie charts, and tables.
Oprational de nition
Neonatal sepsis: neonate with sepsis within 0-28daysof life
Early onset neonatal sepsis: neonate with sepsis within 0-7 days
Late-onset neonatal sepsis: neonate with sepsis within 8-28 days
Low Birth Weight: weight of the child <2.5kg
Preterm Birth: live birth before 37 weeks of gestation
Neonate: Baby from birth until 28day of life
Neonatal period: The time from 0-28 days of life
Prolonged rupture of membrane: Rupture of amniotic membrane >=18 hour
Ethical Consideration

Report: wubetu pro
Page 29 of 40
Ethical clearance will be sought from the MTUTH department of midwifery
ethical review committee. After explaining the purpose and the possible bene t
of the study permission to gather data will be obtained from the head of the
neonatal intensive care unit. Con dentiality of information will be maintained.
Dissemination of results
The study nding will be submitted and presented to the department of
Midwifery College of health sciences, MizanTepi University.
It will also be disseminated to MTUTH. It will also be distributed to the bench
shiko health bureau and regional and federal health services to encourage
health professionals to teach about the risk factor for low birth weight and its
complication as well as to improve the health strategy to reduce the highest
neonatal mortality rate related to low birth weight.
CHAPTER FIVE
WORK PLAN
Table 1 work plan for a research project on the prevalence and associated
factors of neonatal sepsis among neonates in the neonatal intensive care unit
at Mizan tepi university teaching hospital, Mizan Aman, southwestern,
Ethiopia, 2022.
Activities
Responsible body
Time
June 2022

Report: wubetu pro
Page 30 of 40
July 2022
August 2022
September 2022
October 2022
Topic selection
PI
Proposal development
PI &advisor
Submission of Proposal
PI
Ethics clearance
PI

Report: wubetu pro
Page 31 of 40
Data collection
PI,SP &DC
Data analysis
PI
Report writing
PI
Final paper submission

Report: wubetu pro
Page 32 of 40
PI
Defending the report
PI
Final submission
PI
Monitoring
PI and supervisor

Report: wubetu pro
Page 33 of 40
PI – principal investigator SP – supervisor DC – data collectors
CHAPTER SIX
Budget breakdown
Table 2 budget breakdowns for a research project on the prevalence and
associated factors of neonatal sepsis among neonates in the neonatal
intensive care unit at Mizan tepi university teaching hospital, Mizan Aman,
southwestern, Ethiopia, 2022.
Category
Unit of measurement
Unit cost
Multiplying factors
Total price(birr)
Number
100
4x100
400
1. personal cost

Report: wubetu pro
Page 34 of 40
principal investigators
secretary
Number
60
4x60
240
Subtotal
640
2. transport cost
Trip
3
3x15
45
Paper
Packs
0.5
0.5x100
50
3. stationary and another cost

Report: wubetu pro
Page 35 of 40
Pen
Piece
10
3x10
30
Pencil
Piece
3
2x3
6

Report: wubetu pro
Page 36 of 40
Binder
Number
20
20x3
60
Calculator
Number
150
1x150
150
Eraser
Number
3
3x3
9
Marker
Number
20
10x3
60
Subtotal
365
4. Budget Summary

Report: wubetu pro
Page 37 of 40
4. Budget Summary
Personal cost
640
Transportation cost
45
Stationary and another cost
365
Contingency (20%)
210
Total
1260
REFERENCES
1. M.RMK. Nelson textbook of pediatrics, nineteenth edition ISBN international
edition. 2011.

Report: wubetu pro
Page 38 of 40
2. James L. Wynn M HRW M, Thomas P. Shanley, MD, Matthew J. Bizzarro, MD
LS, MD, and Richard Polin, MD. Time for a neonatal-speci c consensus
de nition for sepsis. Pediatric Care Med. 2014.
3. Amare Gebrehiwot WL F, BeyeneMoges, BelayAnagaw,
ChandrashekharUnakal AK. . Predictors of positive blood culture and death
among neonates with suspected neonatal sepsis in Gondar University Hospital,
Northwest Ethiopia. European Journal of Experimental Biology. 2012.
4. ElsadigYousif Mohamed SE HAG, Mohamed Ahmed A/GadirElimam ,Sawsan
M. Abdalla,, Khamis AA. Neonatal sepsis in a General SudaneseTeaching
Hospital, Sudan. IntJ Pharm Med Res 2015.
5. Omer SaeedMagzoub MAA Y. Clinical presentation of neonatal sepsis in the
pediatric ward at Khartoum North Teaching Hospital, Sudan. Basic Research
Journal of Medicine and Clinical Sciences. 2015.
6. Vergnano S ME KN, et al. Archives of disease in childhood. Neonatal
infections in England: the NeonINsurveillance network. 2011.
7. Stoll BJ HN SP ea. the burden of group B Streptococcal and E. coli disease
continues. . Early onset neonatal sepsis: 2011.
8. Yelda A Leal1 JÁ-N JRV, Ulises Rosado-Quiab, Nidia Diego-Rodríguez,,
Dávila-Velázquez EP-BaJ. Risk factors and prognosis for neonatal sepsis
insoutheastern Mexico: analysis of a four-yearhistoric cohort follow-up. Leal et
al BMC Pregnancy and Child birth 2012.
9. Mate Siakwa K D M, 4s, Semuatu, Mohamed. . Neonatal Sepsis in Rural
Ghana: A Case-Control Study of Risk Factors in a Birth Cohort. International
Journal of Research in Medical and Health Sciences 2014.
10. Meem M MJ MR, et al. Biomarkers for diagnosis of neonatal infections: A
systematic analysis of their potential as a point-of-care diagnostics. J Glob
Health. 2011.

Report: wubetu pro
Page 39 of 40
11. ShuvekshaRawat KN DK, MathurPrashant. . A Review on Type, Etiological
Factors, De nition, Clinical Features, Diagnosis Management and Prevention of
Neonatal Sepsis. Journal of Scienti c and Innovative Research. 2013.
12. Martin's. MFA. Neonatal-Perinatal Medicine. 2006.
13. UNI-aGfCMEU. I. Levels and Trends in Child Mortality. Published in United
Nations Inter-agency Group for Child Mortality Estimation, Report 2015.
14. F. M. Health Sector Transformation Plan (HSTP). . (2008-2012n EFY)
Draft_V2. feb2015.
15. Stephanie J. Schrage D CLCl, MD, Elizabeth R. Zell, MStat,
LocadiahKuwanda, MSc,, Eckhart J. Buchmann M, Sithembiso C. Velaphi,
MD,Michelle J. Groome, MD,, Shabir A. Madhi M, PhD,and the PoPS Trial Team.
Risk Factors for Neonatal Sepsis and Prenatal Death among Infants Enrolled in
the Prevention of per natal Sepsis Trial, Soweto, South Africa. The Pediatric
Infectious Disease Journal 2.
16. Tumaini V Mhada FF MIMaAMNsaMNH, Dares Salaam, Tanzania. an
etiology, antimicrobial sensitivity pattern, and clinical outcome. Mhada et al
BMC Public Health 2012.
17. ZA. EK. New approaches to preventing, diagnosing, and treating neonatal
sepsis. PLoS Med
18. UNICEF.org/ les/UNICEF. Levelsandtrendsinchildmortality.
childmortalityforweb(http://apromisere. 2012.
19. Barros FC BZ BM, Hansen TN, Victora CG, Rubens CE. Global report on
preterm birth and stillbirth (3 of 7): evidence for the effectiveness of
interventions. . BMC Pregnancy Childbirth 2010.
20. Kayange N KE MD, et al. Predictors of positive blood culture and deaths
among neonates with suspected neonatal sepsis in a tertiary hospital,
Mwanza-Tanzania. BMC Pediatr. 2014.

Report: wubetu pro
Page 40 of 40
21. mortality WGHOGdoU-f.
22. EDHS. 2016.
23. FÖ. MS. Neonatal sepsis: a continuing disease burden. The Turkish Journal
of Pediatrics 2012.
24. Chiabi A DM ME, Nguefack S, Mbuagbaw L, Zafack J et al. Iran J Pediatr.
2011.
25. Muhammad Hayun EA DD D, DjauhariahMadjid. . The Risk Factors of Early
Onset Neonatal Sepsis. American Journal of Clinical and Experimental
Medicine 2015.
26. ANKARA. K. Prevalence and outcome in a tertiary neonatal unit in Sudan. .
Time Journals of Neonatal sepsis. 2014.
27. NHSAK. AB. The Bacterial Causes and the Risk Factors. International
Research Journal of Medical Sciences 2013.
28. NHSAK. AB. Neonatal Sepsis; the Bacterial Causes and the Risk Factors.
International Research Journal of Medical Sciences 2013.
29. MinyahilAlebachewWoldu MBG J, GobezieTemesgenTegegne, GurmuTesafye
and HundumaDinsa. Assessment of the Incidence of Neonatal Sepsis, its Risk
Factors, Antimicrobials Use and Clinical Outcomes in Bishoftu General
Hospital, Neonatal Intensive Care Unit, Debrezeit-Ethiopia. Woldu, et al,
PediatTherapeut 2014.
30. ANKARA. K. Prevalence and outcome in a tertiary neonatal unit in Sudan. .
Time Journals of Neonatal sepsis. 2014.
31. KliegmanM. RM. Nelson textbook of pediatrics, twentieth International
Edition.

wubetu.pdf

Recommended

Recommended

More Related Content

Similar to wubetu.pdf

Similar to wubetu.pdf (20)

Recently uploaded

Recently uploaded (20)

wubetu.pdf