Neonatal Sepsis in Nigeria 2: Narrative Review of Epidemiology and Socioeconomic Factors

Epidemiology is the study of determinants and distribution of diseases occurring in human population and it revolves around the questions of who, where, when, what and how about a disease. This has been a special theme of focus of research work in the department of department of public and community of the university [1-4]. Thereby, this section focuses on the global distribution as well as trends of neonatal sepsis and compared with Nigeria. The incidence and prevalence of neonatal sepsis varies between the developed world and developing countries alike. It differs from one healthcare facility to another. Studies indicates that the prevalence rate is 3-10 times higher in preterm than in full-term neonates. Similarly, the incidence is higher in low birth weight than normal weight babies, and in males than in females. Other factors in association are levels of obstetric and nursery care available, the presence of determinant factors like sanitation, water supply, poor socioeconomic status, delivery at home or unhygienic environment [5]. Neonatal intensive care units which cater for high risk and extremely low birth weight babies had their survival longer, Also, the risk of repeated infections especially nosocomial infections was higher. According to the United Nations and WHO, the global burden of neonatal sepsis is quite difficult to ascertain due to paucity of reliable information. It is only estimated that annually.


c.
3 million newborn and 1.2 million children suffer from sepsis globally every year, and about 3/10 deaths are due to neonatal sepsis and are thought to be caused by resistant pathogens [6][7][8]. d.
One in ten deaths are associated with maternal sepsis with majority occurring in LMIC [6].

Years' Landmark Review
The United Nation Children's Fund (UNICEF) reports that levels are dropping both globally and in Nigeria [7]. Indeed, review of database show decline in neonatal mortality (Table 1).
Other research report corroborates that the infection rates have modestly decreased in NICU, although there remain problematic cases among hospitalized preterm children. For instance, in 2013, 7.6 million children less than five years old died due to infections including sepsis [8]. Thus, despite major advances in NICU services and increasing research, neonatal sepsis still constitutes a global public health issue [9][10][11][12]. In a study carried out in the medical unit in south eastern Mexico to assess the risk and prognostic factors for neonatal sepsis prevailing at the medical unit, through the use of historic cohort design to assess the association between a series of neonates and mothers in admission to hospital evaluation, found that, 514 of 11,790 (4.3%) newborns: 387 of these cases were early-onset sepsis (<72h) (75.3%) and 127, as late-onset (>72h) (24.7%). Epidemiological 'risk' factor was emphasized to include age of onset, APGAR Score, birth weight, and length of hospital stay [13]. Yet, another report emphasizes gender and geographical location as additional risk factors, especially in South Asia, Sub-Saharan Africa, and Latin America [14].

Africa/Sub-Saharan
Considering Nigeria being among the top 5 high-burden countries, a critical review of the decline in Nigeria's neonatal mortality was compare with the global trend. It is observed that the extent or level of global decline has been quite consistent, whereas that of Nigeria was much at a slower pace until 2018 and now seems to be declining at a better rate than global as at 2019 ( Figure   2). A study one the prevalence and risk factors of neonatal sepsis in Tanzania has report mortality rate of 69% [19], which is higher than that of Nigeria. Their findings underscored the importance of routine assessment and close monitoring of neonates as preventive measures. Also, together with the Nigerian trend, the observation is in line with a previous report that "on average, the pace of the decline across the sub-Saharan region has been too slow to meet up with the MDG 4 target" [20].

Conclusion
This review evaluated what is known about the behaviour of NICU healthcare workers and mothers of babies as determinants of neonatal sepsis. It is apparent to state that epidemiologically, neonatal sepsis is a serious public health and economic burden plaguing human race globally. Nigeria being the most populous country in Africa has one of the highest neonatal sepsis incident rates and third in the world (after India and China), which is responsible for about 30% of neonatal deaths. Effective prevention including regular periodic surveillance is imperative, and substantial achievements have been recorded over the past 10years.
However, more efforts are still required, especially at the primary care levels where data are lacking such as in Bayelsa State. Hence the justification of proposed study. It will enable health planners and policy makers to improve the standard of healthcare facilities for preventive management of neonatal sepsis including providing information that could advance maternal and child health services in Nigeria.