Factors Associated With Developing Ophthalmia Neonatorum in Harare City, 2013

Abstract

Introduction: Ophthalmia neonatorum is defined as any conjunctivitis with discharge from the eyes during the first 28 days of life. Ophthalmia neonatorum is preventable. Gonococcal ophthalmia, if untreated, may progress rapidly to corneal ulceration, perforation, corneal opacification, staphyloma formation and eventually blindness. Globally the prevalence of ophthalmia neonatorum has been on the decline. In Harare Province alone, the cases increased by a massive 65% from 1023 cases in 2010 to 1688 cases in 2011 although the total number of deliveries increased by only 8%. This study was conducted in order to determine the factors associated with developing ophthalmia neonatorum in Harare City. Materials and Methods: An unmatched 1:1 case-control study was conducted. A case was defined as any newly born baby with eye discharge in the first 28 days of life in Harare City while a control was any newly born baby in Harare City who did not develop eye discharge in the first 28 days of life. Pretested questionnaires were used to collect data and antenatal records were reviewed. 22 eye swabs were collected and analysed in the laboratory. Results: 77 cases and 75 controls were recruited into the study. Independent factors associated with developing ophthalmia neonatorum were being born to HIV positive mother AOR 0.35 (CI 0.13-0.92), having received Tetracycline Eye Ointment (TEO) prophylaxis at birth AOR 0.21 (CI 0.07-0.50) and being born of a planned pregnancy AOR 0.38 (CI 0.17-0.87). Only 43 (28%) study participants received TEO prophylaxis. On thirteen (62%) of the eye swabs collected the microorganism isolated was resistant to tetracycline. Sixteen (73%) of the isolated microorganisms were staphylococcus species, with 8 (50%) of the staphylococcus species being resistant to tetracycline. iv Conclusion: The huge increase in the cases of ophthalmia neonatorum was partly because the majority of health workers were not giving prophylaxis and treatment according to national guidelines, and partly due to widespread resistance to tetracycline. We recommended therefore that the Ministry of Health and Child Welfare in Zimbabwe consider replacing TEO with ciprofloxacin eye ointment for use as prophylaxis against ophthalmia neonatorum.