Project – Assessment of knowledge and control practices of neonatal sepsis among Nurses working in Post – natal and neonatal intensive care of Lagos University Teaching Hospital Idi-araba Lagos.

CHAPTER ONE

INTRODUCTION

1.1 Background to the Study

Neonatal sepsis is one of the most significant challenges in neonatal health care, particularly in low- and middle-income countries (LMICs). It refers to a systemic infection occurring in newborns during the first 28 days of life and is characterized by clinical symptoms such as temperature instability, poor feeding, respiratory distress, and lethargy (WHO, 2024). Two distinct forms are recognized: early-onset sepsis (EOS), which typically manifests within the first 72 hours of life and is often linked to maternal or perinatal risk factors, and late-onset sepsis (LOS), which occurs after 72 hours and is usually associated with nosocomial or community-acquired infections (Kariniotaki et al., 2024). Despite advances in neonatal medicine, sepsis continues to account for substantial morbidity and mortality globally, underscoring its public health importance.

Globally, neonatal infections contribute to nearly 20% of all neonatal deaths, with an estimated 2.5 million newborns dying annually, many from preventable causes (Mu et al., 2025). Sepsis has been identified as a key driver of these deaths, particularly in regions with limited access to timely diagnosis and adequate treatment. Mortality from neonatal sepsis is often higher in LMICs compared to high-income countries, where better healthcare infrastructure and advanced laboratory facilities exist (Bech et al., 2022). The disparity reflects systemic challenges such as inadequate infection prevention practices, shortage of skilled personnel, and poor adherence to evidence-based protocols.

In Nigeria, neonatal mortality remains a pressing issue, with recent estimates suggesting about 33 deaths per 1,000 live births (Olorukooba et al., 2020). Among the leading causes of these deaths, sepsis consistently ranks alongside prematurity and birth asphyxia. Given Nigeria’s high birth rate, this burden translates into a significant absolute number of neonatal deaths annually. Lagos University Teaching Hospital (LUTH), Idi-Araba, serves as a critical referral centre for Lagos State and surrounding regions. It manages a large number of high-risk deliveries and neonatal admissions, making it a strategic location for studying neonatal sepsis and associated healthcare practices (LUTH, n.d.).

The neonatal unit at LUTH comprises both inborn and outborn units, including neonatal intensive care units (NICUs), where critically ill or premature infants receive specialized care. These facilities, while providing lifesaving interventions, are also environments where neonates may be exposed to healthcare-associated infections, particularly if infection prevention and control (IPC) protocols are suboptimal. Overcrowding, limited resources, and frequent invasive procedures increase the risk of nosocomial infections, including late-onset neonatal sepsis. Hence, the quality of nursing practices in these settings is crucial to neonatal survival (Shobowale et al., 2016).

Research conducted in Nigeria has documented numerous risk factors for neonatal sepsis. These include prolonged rupture of membranes, prolonged labour, prematurity, low birth weight, maternal fever during labour, and perinatal asphyxia (Uwe et al., 2022). These risk factors emphasize the need for vigilant monitoring during the perinatal period and the immediate postnatal phase. In many cases, timely interventions by healthcare workers, particularly nurses, could prevent progression to severe sepsis or septic shock. As the primary caregivers in neonatal wards, nurses are positioned to detect early warning signs and implement preventive measures.

A growing concern in Nigeria and globally is the rising trend of antimicrobial resistance (AMR) among pathogens causing neonatal sepsis. Studies from LUTH and other Nigerian tertiary hospitals have revealed high resistance rates to commonly used antibiotics such as ampicillin and gentamicin, which are often prescribed empirically (Uwe et al., 2022). This complicates treatment outcomes and places a premium on infection prevention practices. Since antimicrobial therapy is becoming less reliable, preventive strategies—including strict adherence to aseptic techniques, hand hygiene, and proper environmental cleaning—are indispensable.

Nurses play a central role in neonatal infection control. Their responsibilities include maintaining sterile environments, implementing evidence-based infection prevention practices, ensuring appropriate umbilical cord care, and educating mothers on hygienic practices. The effectiveness of these measures depends largely on nurses’ knowledge, training, and consistent practice. Studies have shown that inadequate knowledge and lapses in practice contribute significantly to high rates of healthcare-associated infections in neonatal units (Shobowale et al., 2016; WHO, 2024). Therefore, assessing the knowledge and control practices of nurses is vital to identifying gaps and designing targeted interventions.

Given the high burden of neonatal sepsis in Nigeria, particularly in tertiary hospitals such as LUTH, evaluating nurses’ knowledge and practices is both timely and essential. By identifying strengths and weaknesses in current practice, hospital administrators and policymakers can implement tailored training, improve resource allocation, and update IPC guidelines. Ultimately, strengthening nursing practices in neonatal units will not only reduce the incidence of sepsis but also contribute significantly to achieving global health targets for reducing neonatal mortality (Mu et al., 2025; Bech et al., 2022).

1.2 Problem Statement

Neonatal sepsis remains a significant global health challenge, particularly in low- and middle-income countries where healthcare resources are limited. Despite improvements in neonatal care, sepsis continues to contribute substantially to neonatal morbidity and mortality in Nigeria (Bech et al., 2022). Although clinical guidelines and protocols for the prevention and management of neonatal sepsis exist, their effective implementation often faces barriers. These include delayed recognition of symptoms, inadequate laboratory support for prompt diagnosis, and poor adherence to recommended treatment regimens. Consequently, many newborns succumb to preventable complications of sepsis.

One of the central issues is that infection prevention and control (IPC) measures are inconsistently applied in many healthcare facilities. Practices such as hand hygiene, aseptic procedures during delivery and neonatal care, and appropriate cord care are sometimes poorly enforced due to high workload, limited resources, or inadequate staff training (WHO, 2024). Nurses, who are the frontline caregivers in both post-natal wards and neonatal intensive care units (NICUs), are critical actors in the prevention and early management of neonatal sepsis. However, gaps in knowledge and inconsistent practice compromise the effectiveness of infection control measures, thereby increasing the risk of healthcare-associated infections in neonates.

Evidence from Nigerian studies has revealed persistent knowledge-practice gaps among nurses regarding neonatal sepsis. For example, while many nurses may be aware of basic infection control principles, adherence to best practices is often suboptimal due to systemic constraints, lack of regular training, or attitudinal factors (Shobowale et al., 2016; Olorukooba et al., 2020). Moreover, challenges such as overcrowded wards, inadequate availability of personal protective equipment, and high patient-to-nurse ratios exacerbate the situation. This raises concerns about the extent to which neonatal sepsis can be effectively prevented and managed in tertiary hospitals, even with established guidelines.

At Lagos University Teaching Hospital (LUTH), Idi-Araba, neonatal caseloads are high, and the institution serves as a referral centre for Lagos State and beyond. This setting is particularly vulnerable to neonatal sepsis outbreaks given the volume of admissions and the proportion of high-risk newborns requiring intensive care. However, there is limited evidence on the current level of nurses’ knowledge and their adherence to infection prevention and sepsis control practices in these critical care units. Without such data, it is difficult for hospital administrators to evaluate the effectiveness of current strategies or to design interventions that address existing gaps.

Another dimension of the problem lies in the growing challenge of antimicrobial resistance (AMR). Pathogens commonly associated with neonatal sepsis in Nigeria are increasingly resistant to first-line antibiotics such as ampicillin and gentamicin (Uwe et al., 2022). This makes prevention strategies even more critical, as reliance on antibiotics alone is no longer sufficient. In this context, the role of nurses becomes even more pivotal since rigorous infection control remains the most reliable means of reducing neonatal sepsis incidence and associated mortality. Without adequate knowledge and effective practice among nurses, the control of neonatal sepsis in high-burden facilities like LUTH remains a daunting challenge.

Therefore, this study seeks to fill a critical knowledge gap by assessing the knowledge and control practices of nurses working in post-natal and NICU units at LUTH regarding neonatal sepsis. The findings will provide evidence to guide the development of targeted training, improve hospital infection control policies, and strengthen neonatal care practices. Ultimately, addressing these gaps will contribute to reducing preventable neonatal deaths and improving neonatal survival outcomes in Nigeria.

1.3 Research Objectives

1.3.1 General Objective

To assess the knowledge and control practices relating to neonatal sepsis among nurses working in post-natal and neonatal intensive care at Lagos University Teaching Hospital (LUTH), Idi-Araba, Lagos.

1.3.2 Specific Objectives

1. To determine the level of knowledge of nurses at LUTH regarding risk factors, signs and symptoms, prevention, and management of neonatal sepsis.
2. To describe infection prevention and control practices used by nurses in post-natal and neonatal intensive care units.
3. To identify associations between nurses’ demographic/professional characteristics (years of experience, level of training, in-service education) and their knowledge and practices.
4. To examine perceived barriers hindering effective prevention and control of neonatal sepsis.

1.4 Research Questions

The research questions are buttressed below:

1. What is the level of knowledge among nurses at LUTH about neonatal sepsis?
2. What infection prevention and control practices do nurses apply in post-natal and NICU settings to prevent neonatal sepsis?
3. How do nurses’ demographic and professional characteristics influence their knowledge and practices regarding neonatal sepsis?
4. What barriers do nurses perceive as hindering effective neonatal sepsis control?

1.5 Research Hypothesis

The study will test the following hypothesis:

H₀: There is no significant relationship between nurses’ level of knowledge and their infection prevention and control practices regarding neonatal sepsis.

H₁: There is a significant relationship between nurses’ level of knowledge and their infection prevention and control practices regarding neonatal sepsis.

1.6 Significance of the Study

The study is significant because it will provide much-needed baseline evidence on the knowledge and infection control practices of nurses regarding neonatal sepsis at Lagos University Teaching Hospital (LUTH). Neonatal sepsis remains a leading cause of morbidity and mortality in Nigeria, and data on the preparedness of healthcare workers, particularly nurses, to prevent and control this condition are limited (Bech et al., 2022). By assessing the level of knowledge and practice among nurses, this research will reveal existing strengths and gaps in clinical practice, which can serve as the foundation for quality improvement interventions.

Secondly, the findings will guide hospital management in designing effective training and capacity-building programs. Continuous professional education tailored to nurses in post-natal and neonatal intensive care units is essential for sustaining safe and evidence-based practices (WHO, 2024). Furthermore, the study can inform updates to existing infection prevention and control (IPC) protocols, ensuring they align with current realities and international best practices.

The study will also have broader implications for health policy. Policymakers at state and national levels often rely on data from tertiary hospitals like LUTH to design and implement neonatal health programs. By highlighting areas where nurse capacity is limited, the results will support informed decision-making that prioritizes neonatal health interventions aimed at reducing preventable neonatal deaths (Mu et al., 2025). This aligns with Nigeria’s commitments to Sustainable Development Goal (SDG) 3, which seeks to ensure healthy lives and promote well-being for all at all ages, particularly reducing neonatal mortality.

Academically, the research contributes to existing literature on neonatal sepsis and IPC practices in Nigeria. Previous studies have been conducted in other regions of the country but remain sparse in Lagos, despite its high patient load and diverse neonatal population (Shobowale et al., 2016; Olorukooba et al., 2020). This study will therefore enrich scholarly understanding of nurse-led neonatal care in high-demand urban tertiary hospitals. It will also provide reference material for future studies, fostering further research on neonatal health and professional practice.

Practically, the study will improve the quality of care delivered to neonates by strengthening the role of nurses in preventing and managing sepsis. Since nurses are the healthcare professionals with the most contact time with neonates, equipping them with the necessary skills and knowledge will directly translate into improved survival rates and reduced long-term complications. Improved IPC practices will also help in reducing antimicrobial resistance, a growing concern in Nigerian neonatal care units (Uwe et al., 2022).

Ultimately, this research will have long-term societal benefits. By improving neonatal survival, it contributes to reducing the emotional, financial, and social burden on families and the health system. Neonates who survive sepsis without major disabilities can grow into healthy, productive adults, thereby supporting Nigeria’s human capital development and economic growth. In this way, the study bridges clinical, policy, academic, and societal dimensions, making its significance both immediate and far-reaching.

1.7 Scope of the Study

This study focuses on nurses working in post-natal wards and NICUs at LUTH, Idi-Araba. It will assess their knowledge, practices, and perceived barriers at the time of data collection. It does not measure actual neonatal sepsis incidence, microbial profiles, or long-term outcomes. Findings will mainly be generalizable to similar tertiary hospitals in urban Nigeria.

1.8 Operational Definitions

• Neonatal sepsis: A systemic infection occurring in the first 28 days of life, often confirmed by blood culture but sometimes diagnosed clinically (WHO, 2024).
• NICU: Specialized hospital ward for critically ill or premature newborns.
• Post-natal ward: Hospital unit where mothers and newborns are monitored after delivery.
• Knowledge: Nurses’ understanding of risk factors, clinical features, prevention, and management of neonatal sepsis.
• Control practices: Nursing infection prevention and control measures aimed at reducing neonatal sepsis risk, e.g., hand hygiene, sterile techniques, cord care.

1.9 Organization of the Study

The work is structured into five chapters. Chapter One introduces the study. Chapter Two reviews related literature. Chapter Three outlines methodology. Chapter Four presents data and analysis, while Chapter Five provides discussion, conclusions, and recommendations.

Project – Assessment of knowledge and control practices of neonatal sepsis among Nurses working in Post – natal and neonatal intensive care of Lagos University Teaching Hospital Idi-araba Lagos.