Neonatal hypothermia in Northern Uganda: a community-based cross-sectional study.

Affiliation

Mukunya D(1)(2)(3), Tumwine JK(4), Nankabirwa V(2)(5)(6), Odongkara B(7), Tongun JB(8), Arach AA(9), Tumuhamye J(2)(5), Napyo A(9), Zalwango V(4), Achora V(10), Musaba MW(11), Ndeezi G(4), Tylleskär T(12).
Author information:
(1)Department of Research, Sanyu Africa Research Institute, Mbale, Uganda [Email]
(2)Department of Global Public Health and Primary Care, Centrefor Intervention Science in Maternal and Child Health
(CISMAC), Centre forInternational health, University of Bergen, Bergen, Norway.
(3)Department of Public Health, Busitema University Faculty of Health Sciences, Mbale, Uganda.
(4)Departmentof Paediatrics and Child Health, School of Medicine, Makerere University College of Health Sciences, Kampala, Uganda.
(5)Center for Intervention Science in Maternal and Child Health, Center for International Health, Universitet i Bergen, Bergen, Norway.
(6)Departmentof Epidemiology and Biostatistics, School of Public Health, Makerere University College of Health Sciences, Kampala, Uganda.
(7)Department of Paediatrics and Child Health, Gulu University, Gulu, Uganda.
(8)Department of Paediatrics and Child Health, Juba University, Juba, Uganda.
(9)Department of Nursing and Midwifery, Lira University, Lira, Uganda.
(10)Department of Obstetrics and Gynaecology, Gulu University, Gulu, Uganda.
(11)Department of Obstetrics and Gynaecology, Busitema University Faculty of Health Sciences, Mbale, Uganda.
(12)Centre for International health, Universitetet i Bergen, Bergen, Norway.

Abstract

OBJECTIVE: To determine the prevalence, predictors and case fatality risk of hypothermia among neonates in Lira district, Northern Uganda. SETTING: Three subcounties of Lira district in Northern Uganda. DESIGN: This was a community-based cross-sectional study nested in a cluster randomised controlled trial. PARTICIPANTS: Mother-baby pairs enrolled in a cluster randomised controlled trial. An axillary temperature was taken during a home visit using a lithium battery-operated digital thermometer. PRIMARY AND SECONDARY OUTCOMES: The primary outcome measure was the prevalence of hypothermia. Hypothermia was defined as mild if the axillary temperature was 36.0°C to <36.5°C, moderate if the temperature was 32.0°C to <36.0°C and severe hypothermia if the temperature was <32.0°C. The secondary outcome measure was the case fatality risk of neonatal hypothermia. Predictors of moderate to severe hypothermia were determined using a generalised estimating equation model for the Poisson family. RESULTS: We recruited 1330 neonates. The prevalence of hypothermia (<36.5°C) was 678/1330 (51.0%, 95% CI 46.9 to 55.1). Overall, 32% (429/1330), 95% CI 29.5 to 35.2 had mild hypothermia, whereas 18.7% (249/1330), 95% CI 15.8 to 22.0 had moderate hypothermia. None had severe hypothermia. At multivariable analysis, predictors of neonatal hypothermia included: home birth (adjusted prevalence ratio, aPR, 1.9, 95% CI 1.4 to 2.6); low birth weight (aPR 1.7, 95% CI 1.3 to 2.3) and delayed breastfeeding initiation (aPR 1.2, 95% CI 1.0 to 1.5). The case fatality risk ratio of hypothermic compared with normothermic neonates was 2.0 (95% CI 0.60 to 6.9). CONCLUSION: The prevalence of neonatal hypothermia was very high, demonstrating that communities in tropical climates should not ignore neonatal hypothermia. Interventions designed to address neonatal hypothermia should consider ways of reaching neonates born at home and those with low birth weight. The promotion of early breastfeeding initiation and skin-to-skin care could reduce the risk of neonatal hypothermia. TRIAL REGISTRATION NUMBER: ClinicalTrial.gov as NCT02605369.