Risk Factors for Possible Serious Bacterial Infection in Young Infants in Central Rural India

Background: Possible serious bacterial infection (PBSI) is a major cause of neonatal mortality worldwide, responsible for an estimated 20% of neonatal deaths. Our objective was to study risk factors for PSBI in a rural population in Central India where facility deliveries have increased as a result of a government financial assistance program started in 2005, but are not universal.      

Methods: We studied pregnant women and their singleton live born infants with birth weight ≥ 1.5kg from 20 rural primary health centers around Nagpur, Central India, using data from the 2010-13 population-based Maternal and Newborn Health Registry supported by NICHD’s Global Network for Women’s and Children’s Health Research. PSBI was adapted from the WHO Young Infant Clinical Signs Study and defined as breathing or feeding problems, fever, hypothermia, convulsions, or umbilical cord infection in the first 42 days of life. Factors associated with PSBI were identified using Poisson regression with generalized estimating equations used to account for clustering by primary health center.

Results: Among the 37,378 infants studied, 2,042 (5.5%) had PSBI. Neonatal risk factors for PSBI included low birth weight (<2.5kg, RR 3.2, 95% CI 2.2-4.5) and male sex (RR 1.2, 95% CI 1.1-1.3). Maternal risk factors included age < 20 (RR 1.2, 95% CI 1.01-1.4), nulliparity (RR 1.1, 95% CI 1.01-1.2) and parity ≥ 3 (RR 1.3, 95% CI 1.1-1.6) compared to parity 1-2, and first antenatal care visit in the 2^nd/3^rd trimester (RR 1.5, 95% CI 1.1-2.0) compared to 1^st trimester. Peripartum factors associated with PSBI included delivery at home (RR 1.7, 95% CI 1.1-2.8) when compared to a government referral center, maternal antibiotics (RR 1.6, 95% CI 1.2-2.3) and lack of initiation of breastfeeding within 1 hour of birth (RR 4.0, 95% CI 2.7-5.9). Delivery by caesarean section (RR 0.5, 95% CI 0.3-0.6) was associated with a lower risk of PSBI. Maternal educational level, maternal anemia, and prolonged labor were not associated with PSBI.

Conclusion: In the era of increasing facility deliveries, low birth weight and lack of initiation of breastfeeding within 1 hour of birth were significant risk factors for PSBI. To decrease the risk of PSBI, facilities should develop strategies to promote timely initiation of breastfeeding.