Neonatal bacterial infections in developing countries: strategies for prevention

Abstract

Neonatal infections account for the bulk of neonatal deaths in developing countries. Of these, most are related to tetanus, sepsis, diarrhoea and pneumonia. Whilst poor maternal health and inadequate antenatal care underlie these problems, the immediate predisposing factors to neonatal bacterial infections include low birth weight, perinatal asphyxia and lack of attention to asepsis. The contributory role of bacterial vaginosis and intrauterine infections in developing countries is uncertain and although vertical transmission of gram negative bacteria has been described, the relative contribution of Group B Streptococcus to early-onset neonatal sepsis is low. In addition, poor environmental sanitation and heavy microbial colonization are major risk factors for neonatal infections in both health care facilities and domiciliary circumstances. Of the preventive strategies for neonatal bacterial infections in developing countries, appropriate basic antenatal care, clean safe delivery, administration of colostrum, exclusive breast feeding, antenatal tetanus toxoid administration and cord care are the most cost-effective preventive strategies, but need strong maternal primary-care programmes for implementation. The important role of mother—baby cohorting needs to be especially stressed. Neonatal infections account for the bulk of neonatal deaths in developing countries. Of these, most are related to tetanus, sepsis, diarrhoea and pneumonia. Whilst poor maternal health and inadequate antenatal care underlie these problems, the immediate predisposing factors to neonatal bacterial infections include low birth weight, perinatal asphyxia and lack of attention to asepsis. The contributory role of bacterial vaginosis and intrauterine infections in developing countries is uncertain and although vertical transmission of gram negative bacteria has been described, the relative contribution of Group B Streptococcus to early-onset neonatal sepsis is low. In addition, poor environmental sanitation and heavy microbial colonization are major risk factors for neonatal infections in both health care facilities and domiciliary circumstances. Of the preventive strategies for neonatal bacterial infections in developing countries, appropriate basic antenatal care, clean safe delivery, administration of colostrum, exclusive breast feeding, antenatal tetanus toxoid administration and cord care are the most cost-effective preventive strategies, but need strong maternal primary-care programmes for implementation. The important role of mother—baby cohorting needs to be especially stressed.