This was a hospital based cross-sectional study carried out at Muhimbili National Hospital neonatal unit. Both term and preterm neonates admitted with clinical diagnosis of neonatal septicaemia, presenting with any one of the following features were eligible; presence of fever (≥ 38.0°C) or hypothermia (≤ 36.5°C), convulsions, lethargy, inability to feed, hypoglycaemia, vomiting, bulging fontanels, respiratory distress, jaundice and signs of infection on the skin (pus spots) and umbilical pus discharge or hyperaemia. Sample size in this study was calculated using Epi info version 6 statistical package, and a prevalence of 16% from a study conducted previously at the same hospital by Bloomberg et al.
 was used with a target of recruiting about 300 participants. During the study period 1811 were admitted in the neonatal ward out of which 330 fulfilled inclusion criteria and were recruited.
Standardized questionnaires were used to obtain demographic and clinical information which included details of thorough physical examination. Weight was measured using SECA beam balance (CMS Weighing equipment, London, United Kingdom) to the nearest 100g. Two millilitres of venous blood was aseptically drawn from anterior cubital fossa of each neonate and inoculated into paediatric blood culture bottles. Pus swab were taken from the umbilical cord stump or skin pustules to determine the contribution of cord stump/skin infection to sepsis and correlate the two infections, pus swabs were transported in Stuart transport media.
Blood culture bottles were incubated at 37°C for 24 h after which aliquots were sub-cultured on solid agar plates; MacConkey, blood and chocolate agars for up 96 h before being regarded as no growth. Pus swabs were smeared on a glass slides for gram stain identification and were also inoculated on solid MacConkey agar at 37°C for 24 h. Colonies on solid agar plates were identified based on characteristic morphology, gram stain appearance and standard commercially prepared biochemical tests
Antimicrobial sensitivity testing was performed for antimicrobials which included first and second line antibiotics for treating neonatal sepsis at MNH; first line antibiotics are ampicillin, cloxacillin and gentamicin and second line is ceftriaxone. Ampicillin 10μg, cloxacillin 5μg gentamicin 10μg, amikacin 30μg, cefuroxime 30μg, and ceftriaxone 30μg sensitivity testing were performed by Kirby Bauer diffusion method using Mueller Hinton agar with incubation of 24 h at 37°C. Sensitivity was determined according to Clinical Laboratory Standard Institute standards
. Results were recorded as resistant, intermediate and sensitive, however, during data analysis intermediate were categorized as resistant.
Statistical Package for Social Sciences (SPSS) version 17 was used for data entering, cleaning and analysis. Chi square and Fischer’s exact test were used to determine association between categorical variables. Probability (p) value of <0.05 was considered statistically significant. This study was approved by MUHAS ethical committee and informed written consents were obtained from parents/guardian prior to recruitment. Results of laboratory tests were used in the participants’ management.