Trends in the incidence of possible severe bacterial infection and case fatality rates in rural communities in Sub-Saharan Africa, South Asia and Latin America, 2010-2013: a multicenter prospective cohort study.

Patricia L Hibberd,Nellie I Hansen,Archana B Patel,Edward A Liechty,Shivaprasad S Goudar,Marion Koso-Thomas,Pierre Buekens,Marie E Wang,Fernando Althabe,Fabian Esamai,Elizabeth M Mcclure,K Michael Hambidge,Waldemar A Carlo,Nancy F Krebs,Ana Garces,Omrana Pasha,Elwyn Chomba,Robert L Goldenberg,Richard J Derman

doi:10.1186/s12978-016-0177-1

Abstract

BackgroundPossible severe bacterial infections (pSBI) continue to be a leading cause of global neonatal mortality annually. With the recent publications of simplified antibiotic regimens for treatment of pSBI where referral is not possible, it is important to know how and where to target these regimens, but data on the incidence and outcomes of pSBI are limited.MethodsWe used data prospectively collected at 7 rural community-based sites in 6 low and middle income countries participating in the NICHD Global Network’s Maternal and Newborn Health Registry, between January 1, 2010 and December 31, 2013. Participants included pregnant women and their live born neonates followed for 6 weeks after delivery and assessed for maternal and infant outcomes.ResultsIn a cohort of 248,539 infants born alive between 2010 and 2013, 32,088 (13 %) neonates met symptomatic criteria for pSBI. The incidence of pSBI during the first 6 weeks of life varied 10 fold from 3 % (Zambia) to 36 % (Pakistan), and overall case fatality rates varied 8 fold from 5 % (Kenya) to 42 % (Zambia). Significant variations in incidence of pSBI during the study period, with proportions decreasing in 3 sites (Argentina, Kenya and Nagpur, India), remaining stable in 3 sites (Zambia, Guatemala, Belgaum, India) and increasing in 1 site (Pakistan), cannot be explained solely by changing rates of facility deliveries. Case fatality rates did not vary over time.ConclusionsIn a prospective population based registry with trained data collectors, there were wide variations in the incidence and case fatality of pSBI in rural communities and in trends over time. Regardless of these variations, the burden of pSBI is still high and strategies to implement timely diagnosis and treatment are still urgently needed to reduce neonatal mortality.Trial registrationThe study was registered at ClinicalTrials.gov (NCT01073475).

Highlights

Possible severe bacterial infections continue to be a leading cause of global neonatal mortality annually
The percent of infants who died ranged from 1.2 % in Argentina to 3.0 % in Pakistan (Table 3)
It is likely that these respiratory variables increased the proportion of our Possible severe bacterial infections (pSBI) cases that had respiratory distress due to preterm birth or birth asphyxia, both of which are difficult to distinguish from possible severe bacterial infection, in the first few days of life

Summary

Introduction

Possible severe bacterial infections (pSBI) continue to be a leading cause of global neonatal mortality annually. The recently published studies of simplified antibiotic regimens for treatment of neonatal pSBI provide a potential way to reduce part of the burden of neonatal mortality in settings where hospitalization is not accepted or available [3,4], but the impact of these new regimens and optimal ways to make them available globally is not clear, [5,6] because there is limited information on the incidence and case fatality rates of pSBI. There is an important need to confirm these estimates of neonatal pSBI incidence and case fatality rates using prospectively collected, population based data, in which the outcomes of all pregnancies are recorded and to evaluate recent trends over time, as facility births and survival of preterm infants increase

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Conclusion