NECROTIZING ENTEROCOLITIS AND ITS ASSOCIATED FACTORS AMONG PRETERM NEONATES ADMITTED TO NEONATAL INTENSIVE CARE UNITS OF PUBLIC HOSPITALS OF HARAR TOWN AND DIRE DAWA CITY ADMINISTRATION, EASTERN ETHIOPIA

Abstract

Background: Necrotizing Enterocolitis is the most common multifactorial and devastating gastrointestinal medical/surgical emergency that primarily affects premature neonates. It has a much higher burden in developing countries, particularly Ethiopia. However, there are limited studies on the prevalence and associated factors of necrotizing enterocolitis in Ethiopia and no study in the study area. Objective: To assess the prevalence of Necrotizing Enterocolitis and associated factors among preterm neonates admitted to Neonatal intensive care unit of Public Hospitals of Harar Town and Dire Dawa City Administration from 1 June 2020 to 30 June 2023 which was collected from June 20 to 30, 2024. Methods: An institution-based cross-sectional study design was employed among 471 preterm neonates admitted to the neonatal intensive care unit of Hiwot Fana Specialized University Hospital and Dilchora referral hospital. The study participants were selected using a systematic random sampling technique. Data were collected by using a structured checklist from neonates’ card reviews. Data were collected by using a checklist through the Kobo tool and analyzed by using the SPSS-27 statistical package. Bi-variable and multivariable logistic regression analysis were carried out to distinguish the relationship between dependent and independent variables. The significance of statistical association was tested by a 95% confidence interval (CI) and p-value <0.005. Results: The prevalence of Necrotizing Enterocolitis among neonates was 90 (19.2%) [95% CI :(.158, .231)]. Having gestational age 28+1-32 week [P=0.007, AOR=2.78, 95% CI: (1.32, 5.86)], birth weight between 1000-1499 [AOR= 3.11, 95% CI:(1.65,5.87)], APGAR score 4-6 [AOR=7.62, 95% CI:(1.23,47.01), use of CPAP ventilation [AOR=3.00, 95% CI:(1.47,6.13)], neonates born from mothers with PROM [AOR=3.46, 95% CI:(1.12,8.688)], neonates born from mothers with prolonged labor [AOR= 2.09, 95% CI:(1.09, 4.00)], neonates born from mothers with chronic disease/hypertension [AOR= 2.52, 95% CI:(1.25, 5.05)] and who fed formula milk [AOR=5.92, 95% CI:( 1.22, 28.61)] were factors significantly associated with NEC. Conclusions and recommendations: In this study, nearly one-fifth of preterm neonates developed necrotizing enterocolitis (NEC) in the study area. Factors such as gestational age between 28+1-32, birth weight between 1000-1499, APGAR score between 4-6, neonates born from mothers with prolonged labor, neonates born from mothers with chronic disease/hypertension, use of CPAP ventilation, formula milk, and neonates born from mothers with PROM were independent predictors of necrotizing enterocolitis. Finally, I recommend that there is a need to strengthen NICUs with proper equipment and trained staff, along with promoting breastfeeding support programs is recommended. Local health authorities and policymakers should enhance maternal and neonatal care, while researchers are urged to explore NEC prevention strategies.