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BMJ Open Is Committed to Open Peer Review. As Part of This Commitment We Make the Peer Review History of Every Article We Publish Publicly Available BMJ Open: first published as 10.1136/bmjopen-2020-041723 on 11 February 2021. Downloaded from BMJ Open is committed to open peer review. As part of this commitment we make the peer review history of every article we publish publicly available. When an article is published we post the peer reviewers’ comments and the authors’ responses online. We also post the versions of the paper that were used during peer review. These are the versions that the peer review comments apply to. The versions of the paper that follow are the versions that were submitted during the peer review process. They are not the versions of record or the final published versions. They should not be cited or distributed as the published version of this manuscript. BMJ Open is an open access journal and the full, final, typeset and author-corrected version of record of the manuscript is available on our site with no access controls, subscription charges or pay-per-view fees (http://bmjopen.bmj.com). If you have any questions on BMJ Open’s open peer review process please email [email protected] http://bmjopen.bmj.com/ on September 29, 2021 by guest. Protected copyright. BMJ Open BMJ Open: first published as 10.1136/bmjopen-2020-041723 on 11 February 2021. Downloaded from Incidence and factors associated with neonatal hypothermia in Northern Uganda: a community-based cohort study Journal: BMJ Open ManuscriptFor ID peerbmjopen-2020-041723 review only Article Type: Original research Date Submitted by the 16-Jun-2020 Author: Complete List of Authors: Mukunya, David ; University of Bergen Department of Medicine, Center for Intervention Science in Maternal and Child Health, Center for International Health; Sanyu Africa Research Institute Tumwine, James; Makerere University College of Health Sciences, Department of Paediatrics and Child Health Nankabirwa, Victoria; Makerere University College of Health Sciences, Department of Epidemiology and Biostatistics; Universitet i Bergen, Center for Intervention Science in Maternal and Child Health, Center for International Health Odongkara, Beatrice; Gulu University, Department of Paediatrics and Child Health Tongun, Justin; University of Juba, Department of Paediatrics and Child Health Arach, Agnes; Lira University, Department of Nursing and Midwifery http://bmjopen.bmj.com/ Tumuhamye, Josephine; Universitet i Bergen, Center for Intervention Science in Maternal and Child Health, Center for International Health Napyo, Agnes; Busitema University, Department of Public Health Zalwango, Vivian; Makerere University College of Health Sciences, Department of Paediatrics and Child Health Achora, Vicentina; Gulu University, Department of Obstetrics and Gynaecology Musaba, Milton; Busitema University, Department of Obstetrics and Gynaecology Ndeezi, Grace; Makerere University College of Health Sciences, on September 29, 2021 by guest. Protected copyright. Department of Paediatrics and Child Health Tylleskär, Thorkild; Universitetet i Bergen, Centre for International health Epidemiology < TROPICAL MEDICINE, PAEDIATRICS, Public health < Keywords: INFECTIOUS DISEASES For peer review only - http://bmjopen.bmj.com/site/about/guidelines.xhtml Page 1 of 24 BMJ Open 1 2 3 BMJ Open: first published as 10.1136/bmjopen-2020-041723 on 11 February 2021. Downloaded from 4 5 6 7 8 9 I, the Submitting Author has the right to grant and does grant on behalf of all authors of the Work (as defined 10 in the below author licence), an exclusive licence and/or a non-exclusive licence for contributions from authors 11 who are: i) UK Crown employees; ii) where BMJ has agreed a CC-BY licence shall apply, and/or iii) in accordance 12 with the terms applicable for US Federal Government officers or employees acting as part of their official 13 duties; on a worldwide, perpetual, irrevocable, royalty-free basis to BMJ Publishing Group Ltd (“BMJ”) its 14 licensees and where the relevant Journal is co-owned by BMJ to the co-owners of the Journal, to publish the 15 Work in this journal and any other BMJ products and to exploit all rights, as set out in our licence. 16 17 The Submitting Author accepts and understands that any supply made under these terms is made by BMJ to 18 the Submitting Author Forunless you peer are acting as review an employee on behalf only of your employer or a postgraduate 19 student of an affiliated institution which is paying any applicable article publishing charge (“APC”) for Open 20 Access articles. Where the Submitting Author wishes to make the Work available on an Open Access basis (and 21 intends to pay the relevant APC), the terms of reuse of such Open Access shall be governed by a Creative 22 Commons licence – details of these licences and which Creative Commons licence will apply to this Work are set 23 out in our licence referred to above. 24 25 Other than as permitted in any relevant BMJ Author’s Self Archiving Policies, I confirm this Work has not been 26 accepted for publication elsewhere, is not being considered for publication elsewhere and does not duplicate 27 material already published. I confirm all authors consent to publication of this Work and authorise the granting 28 of this licence. 29 30 31 32 33 34 35 36 37 http://bmjopen.bmj.com/ 38 39 40 41 42 43 44 45 on September 29, 2021 by guest. Protected copyright. 46 47 48 49 50 51 52 53 54 55 56 57 58 59 60 For peer review only - http://bmjopen.bmj.com/site/about/guidelines.xhtml BMJ Open Page 2 of 24 1 2 3 Original research BMJ Open: first published as 10.1136/bmjopen-2020-041723 on 11 February 2021. Downloaded from 4 5 6 Incidence and factors associated with neonatal hypothermia in Northern 7 Uganda: a community-based cohort study 8 9 David Mukunya1,3*, James K. Tumwine4, Victoria Nankabirwa2,5,6, Beatrice 10 Odongkara7, Justin B. Tongun8, Agnes A. Arach9, Josephine Tumuhamye3, Agnes 11 Napyo12, Vivian Zalwango4, Vicentina Achora10, Milton W. Musaba11, Grace 12 Ndeezi4, Thorkild Tylleskar6 13 14 15 1Sanyu Africa Research Institute, Mbale, Uganda 16 17 2Department of Epidemiology and Biostatistics, School of Public Health, Makerere 18 University CollegeFor of Health peer Sciences, review Kampala, Uganda only 19 20 3 21 Centre for Intervention Science in Maternal and Child Health (CISMAC), Centre for 22 International health, University of Bergen. 23 24 4Department of Paediatrics and Child Health, School of Medicine, Makerere 25 University College of Health Sciences, Kampala, Uganda 26 27 5Department of Epidemiology and Biostatistics, School of Public Health, Makerere 28 29 University College of Health Sciences, Kampala, Uganda 30 31 6Centre for Intervention Science and Maternal Child health (CISMAC), Centre for 32 International health, University of Bergen. 33 34 7Department of Paediatrics and Child Health, Gulu University 35 36 8Department of Paediatrics and Child Health, Juba University 37 http://bmjopen.bmj.com/ 38 39 9Department of Nursing and Midwifery, Lira University 40 41 10Department of Obstetrics and Gynaecology, Gulu University 42 43 11 44 Department of Obstetrics and Gynaecology, Busitema University Faculty of Health 45 Sciences on September 29, 2021 by guest. Protected copyright. 46 47 12Department of Public Health, Busitema University Faculty of Health Sciences 48 49 50 *Corresponding author 51 52 David Mukunya, P.O Box 2190, Mbale, Uganda 53 Email; [email protected], Mob; +256775152316 54 55 Key words: newborn care, neonatal care, kangaroo mother care 56 57 Word count: 2892 58 59 60 1 For peer review only - http://bmjopen.bmj.com/site/about/guidelines.xhtml Page 3 of 24 BMJ Open 1 2 3 Abstract BMJ Open: first published as 10.1136/bmjopen-2020-041723 on 11 February 2021. Downloaded from 4 5 6 7 Objective: To determine the incidence and risk factors for hypothermia among 8 neonates in Lira district, Northern Uganda. 9 10 Setting: Three sub counties of Lira district in Northern Uganda 11 12 Design: This was a community-based prospective cohort study nested in a cluster 13 14 randomized controlled trial. 15 Participants: Mother – baby pairs enrolled in a cluster randomised controlled trial, 16 designed to promote health facility births and newborn care practices, in Lira district, 17 Northern Uganda. An axillary temperature was taken during a home visit using a 18 lithium battery-operatedFor peerdigital thermometer review only 19 20 21 Primary and secondary outcomes: The primary outcome measure was the incidence 22 of hypothermia. The secondary outcome measures were socioeconomic, 23 environmental, birth and newborn related factors associated with moderate to severe 24 hypothermia determined using a generalized estimating equation model for the 25 Poisson family, with a log link, taking clustering into account, and assuming an 26 exchangeable correlation. 27 28 29 Results: We recruited 1527 participants. Of these, 1330 had a temperature taken 30 within the first 3 days of life. The incidence of hypothermia (temperature less than 31 36.5°C) was 678/1330 [51.0%: 95% CI (46.9-55.1)]. Of these, 32% (429/1330), 32 95%CI (29.5-35.2)] had mild hypothermia (temperature 36.0°C - <36.5°C), whereas 33 18.7% (249/1330), 95% CI (15.8-22.0) had moderate hypothermia (temperature 34 32.0°C - <36.0°C). None had severe hypothermia (temperature less than 32.0°C). At 35 multivariable analysis, the factors associated with neonatal hypothermia included: 36 home birth [Adjusted Risk Ratio, ARR, 1.9, 95% CI (1.4-2.6)]; low birth weight 37 http://bmjopen.bmj.com/ 38 [ARR 1.7, 95%CI (1.3-2.3)]; and delayed breastfeeding initiation [ARR 1.2, 95%CI 39 (1.0-1.5]. 40 41 Conclusion: The incidence of neonatal hypothermia was very high, demonstrating 42 that communities in tropical climates should not ignore neonatal hypothermia. 43 44 Interventions designed to address neonatal hypothermia should consider ways of 45 reaching newborns born at home, as those with low birth weight are at greater risk of on September 29, 2021 by guest.
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