Neonatal hypothermia: prevalence and assessment of warm chain practices in Lira Regional Referral Hospital

Abstract

Background: Neonatal hypothermia remains a worldwide issue across all climates and all levels of income. Newborn hypothermia is associated with serious complications and should be avoided. In Uganda, the exact prevalence of hypothermia is not known and the warm chain practices are not well understood. Objective: To determine the prevalence and factors associated with neonatal hypothermia; and describe warm chain practices by midwives and mothers in Lira Regional Referral Hospital. Methods: A cross-sectional study conducted from January to February 2019 in Lira Regional Referral Hospital, Northern Uganda. Direct observations of 271 newborn were done in the maternity ward and theatre. The axillary temperature of neonates was measured at intervals of 10 minutes, 30 minutes, one hour and 2 hours after birth. Fourteen midwives were observed using a structured checklist. The multivariate binary logistic regression, with 95% confidence interval and p-value< 0.05 used to identify variables which had a significant association with neonatal hypothermia. ResultsAxillary temperatures taken at 10, 30, 60 minutes and 2 hours revealed 64.5%, 80.8%, 76.0% , and 49.1% of the newborns had hypothermia respectively. Hypothermia was associated with neonates who had low birth weight AOR=2.78; (95% CI: 1.01, 7.62), male neonates AOR= 1.69, (95% CI: 1.04, 3.33), not dried properly AOR = 3.06, (95% CI: 1.64, 5.72), no skin to skin contact AOR = 2.17, (95% CI: 1.15, 4.10) within 5 minutes after delivery, maternal body temperature < 36.5oC AOR= 2.70, (95% CI: 1.49, 4.76). Conclusions: The prevalence of neonatal hypothermia was high in the first two hours. Neonates who were more likely to have hypothermia were male, not dried properly, had low birth weight, no skin to skin contact and mothers’ low body temperature. Proper drying of the newborn and skin to skin contact can reduce the burden of neonatal hypothermia. Recommendations: There is need to train the midwives about proper drying of the newborn, keeping the mother warm and the importance of skin to skin contact in prevention of neonatal hypothermia