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British Journal of Healthcare and Medical Research - Vol. 11, No. 5

Publication Date: October 25, 2024

DOI:10.14738/bjhmr.115.17673.

Chiri, A. K., Heyi, S. K., Bidu, K. T., & Assegu, Y. B. (2024). Prevalence of Hypothermia and Associated Factors Among Neonates Visiting

Neonatal Intensive Care Unit, Asella Teaching and Referral Hospital, Asella, South East Ethiopia. British Journal of Healthcare and

Medical Research, Vol - 11(5). 139-151.

Services for Science and Education – United Kingdom

Prevalence of Hypothermia and Associated Factors Among

Neonates Visiting Neonatal Intensive Care Unit, Asella Teaching

and Referral Hospital, Asella, South East Ethiopia

Abdureshid Kedir Chiri

Department of Pediatrics and Child Health

Bule Hora University Hospital and Medical College;

Bule Hora, Oromia, Ethiopia

Sadat Kasim Heyi

Department of Emergency Preparedness and Response

World Health Organization (WHO), Addis Ababa,

Oromia, Ethiopia

Kassahun Tegegne Bidu

Department of Emergency Preparedness and Response,

World Health Organization (WHO), Addis Ababa,

Oromia, Ethiopia

Yirga Bieza Assegu

Department of Emergency Preparedness and Response,

World Health Organization (WHO), Addis Ababa,

Oromia, Ethiopia

ABSTRACT

Background: Hypothermia is the reduction in the body temperature (below 36.5°C).

It is a global problem but it showed a higher prevalence in developing countries

(>90%) and contributes to a substantial proportion of neonatal mortality.

Objective: To assess the prevalence and associated factors of neonatal hypothermia

among newborns admitted to the NICU of Asella Referral Hospital. Methods and

Materials: Institution-based retrospective cross-sectional study was conducted

from September to October 2022. The data was collected from mother and newborn

charts using a semi-structured questionnaire. Data were cleaned, coded, entered in

EPI-info version 7.2, and exported to Statistical Package for Social Sciences (SPSS)

version 25 for analysis. Bivariate and multivariate logistic regression and crude and

adjusted odds ratio with 95% confidence interval were computed. Variables that

had a significant association in multivariate logistic regression were taken as a

factor of neonatal hypothermia. Result: Of 189 neonates included in the study, 137

(72.4%) had neonatal hypothermia. Low birth weight (AOR=7.94; 95% CI: 27,

27.71), pre-term delivery (AOR=2.99; 95% CI: 1.73, 12.23), bathing the neonate

before 24 hours (AOR=5.12; 95% CI: 1.02, 25.68), not starting breastfeeding within

1 hour of birth (AOR=4.09; 95% CI: 1.27, 13.23), no skin-to-skin contact

immediately after birth (AOR=20.98; 95% CI: 1.69, 259.68), neonates who received

CPR (AOR=4.17, 95% CI: 1.15, 15.02), and neonates born in a room not having

radian heater (AOR=5.14; 95% CI: 2.03, 12.66) showed significant association with

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British Journal of Healthcare and Medical Research (BJHMR) Vol 11, Issue 05, October-2024

Services for Science and Education – United Kingdom

neonatal hypothermia. Conclusion: In this study, the proportion of hypothermia

was high. Therefore, special attention is needed for the thermal care of preterm

neonates, Low birth weight, and neonates receiving CPR. There should be strict

adherence to WHO recommendations like warm resuscitation, skin-to-skin contact,

breastfeeding within one hour, and delaying bathing of the neonate.

Keywords: Associated factors, Hypothermia, Neonate, Prevalence.

INTRODUCTION

Background

Globally, 2.5 million children died in the first months of life in 2017, which accounts for 47% of

all under-five child deaths [1]. Most neonatal deaths (99%) arise in low and middle-income

countries, and the leading causes of death include prematurity, birth asphyxia, infection, and

birth defects [2]. Although hypothermia is rarely a direct cause of death, it contributes to a

substantial proportion of neonatal mortality globally, mostly as comorbidity [3]. A high

prevalence of neonatal hypothermia has been reported in countries with the highest burden of

neonatal mortality [4]. Therefore, reducing the prevalence of neonatal hypothermia in low- resource communities has a significant contribution to reducing the global burden of neonatal

deaths [4, 5].

Neonatal hypothermia is a progressive reduction in the axillary temperature of the newborn

(temperature < 36:5°C). It is categorized as mild hypothermia (36°C–36.4°C), moderate

hypothermia (32°C–35.9°C), and severe hypothermia (<32°C) [6]. Neonates are prone to rapid

heat loss and consequent hypothermia because of the large surface area-to-body mass ratio,

decreased subcutaneous fat, and immature skin, high body water content, poorly developed

metabolic mechanism, and altered skin blood flow [7]. Hypothermic neonates had a higher risk

of developing hypoglycemia, respiratory distress syndrome, jaundice, and metabolic acidosis

[8].

Although neonatal hypothermia is a global problem that occurs in neonates born both at

hospitals (32% - 85%) and homes (11% - 92%), it showed a higher prevalence in developing

countries (> 90%) [ 3,9].

Similarly, different studies conducted in Ethiopia showed that the prevalence of neonatal

hypothermia ranges from 53% - 69.8% [3, 10, 11]. Physiological, environmental, and behavioral

risk factors predispose newborn infants to neonatal hypothermia [4]. Thermal care is the major

component of the essential newborn care package included in the World Health Organization

(WHO) to be applied universally for all babies to decrease neonatal mortality [12].

In Ethiopia, the principle of skin-to-skin contact and initiating breastfeeding within the first

hour after birth was the common practice to prevent hypothermia, which is also recommended

by the WHO [13]. Besides this intervention, neonatal hypothermia is still high in Ethiopia [3, 10,

11]. As a result, identifying different factors that had an association with neonatal hypothermia

is valuable to design an appropriate intervention strategy to decrease neonatal hypothermia

and to improve the quality of newborn care. So, this study aimed to assess neonatal

hypothermia and associated factors among newborns admitted to the NICU of Asella Referral

and Teaching Hospital.

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141

Chiri, A. K., Heyi, S. K., Bidu, K. T., & Assegu, Y. B. (2024). Prevalence of Hypothermia and Associated Factors Among Neonates Visiting Neonatal

Intensive Care Unit, Asella Teaching and Referral Hospital, Asella, South East Ethiopia. British Journal of Healthcare and Medical Research, Vol -

11(5). 139-151.

URL: http://dx.doi.org/10.14738/bjhmr.115.17673.

Objective of the Research

To assess the prevalence of Neonatal hypothermia and associated factors among newborn

neonates admitted to NICU Asella Referral and Teaching Hospital

MATERIALS AND METHOD

Study Area and Period

The study was conducted in the Neonatal Intensive Care Unit (NICU) of Asella Referral and

Teaching Hospital Pediatric ward which is one of the federal referral hospitals located in Arsi

Zone, Oromia region, South East Ethiopia. The Pediatric and Child Health Department is one of

the major units of the hospital delivering services under four main sub-units which include:

Inpatient, NICU, and Outpatient units and follow-up clinics. NICU is one of the busiest wards of

the hospital with an annual average admission rate of 4000. The NICU renders service under a

critical newborn care unit, septic ward, kangaroo mother care (KMC), and mother side. The

study period was from September 1st to October 30th, 2022.

Study Design

A hospital-based retrospective cross-sectional study design was conducted in the NICU of Asella

Referral and Teaching Hospital.

Source and Study Population

All neonates with their mothers admitted in the NICU of Asella Referral Hospital were the

source populations and the study populations were randomly selected neonates with their

mothers admitted in the NICU of Asella Referral Hospital from September 1st to October 30th,

2022.

Exclusion Criteria

Neonates whose mothers were not present during the study period were excluded.

Sample Size Determination and Sampling Procedure

The sample size was determined using a single population proportion formula with the

assumption of 64% proportion of neonatal hypothermia taken from the study conducted in

Addis Ababa University, with a 95% confidence level and 5% margin of error [10].

n =

Z

2 P(1−P)

d2

n =

1.962

∗0.64(1−0.64)

0.052

= n =354 = 354

The initial sample size was calculated to be 354. The source population in the data collection

period was estimated to be 333, which is less than 10, 000. As a result, the following correction

formula was used to calculate the final sample size:

nf =

ni

1+ni/N

nf =

354

1+

354

333

=

354

2.06

= 171.8 = 172

Where nf is the final sample size, ni is the initial sample size, and N is the total estimated

neonatal admission during the data collection time.

By considering a 10% nonresponse rate of participants, the final sample size was 189.