Neonatal hypothermia in Northern Uganda: a community-based cross-sectional study
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Date
2021
Journal Title
Journal ISSN
Volume Title
Publisher
BMJ open
Abstract
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.
Description
Keywords
Neonatal hypothermia, Northern Uganda
Citation
Mukunya D, Tumwine JK, Nankabirwa V, et al. Neonatal hypothermia in Northern Uganda: a community-based cross-sectional study. BMJ Open 2021;11:e041723. doi:10.1136/ bmjopen-2020-041723