Neonatal sepsis - a major killer to be tackled in communities
More than one-third of the estimated four million neonatal deaths around the world each year are caused by severe infections, and a quarter - around one million deaths - are due to neonatal sepsis/pneumonia alone.
The chances of survival are slim for newborns with a serious infection, whether hospitalized or in the community. The identification and treatment of newborns with infection is weak in many developing country settings, and because sick newborns present with non-specific signs and symptoms, diagnosing neonatal sepsis is difficult in even the most sophisticated settings.
Many factors contribute to the high number of neonatal deaths from infection. These include under-recognition of illness, delay in care seeking by the family, and lack of access to appropriately-trained health workers and high-quality services to manage the illness. Even if quality services are available, the cost of treatment is beyond the reach of many. It is particularly poignant that many neonatal deaths occur in the community, without the child ever having had contact with the health services they needed.
In January 2009 WHO's Department of Child and Adolescent Health and Development (CAH), in collaboration with Saving Newborn Lives, supported the publication of a special supplement to the Pediatric Infectious Disease Journal on serious bacterial infections among neonates and young infants.
The purpose of the supplement, which consists of an introduction followed by seven papers, was to evaluate available evidence on the burden of disease, etiology, antimicrobial resistance and potential options for managing neonatal sepsis in the community. The first three papers in the supplement highlight the findings of a comprehensive review of the literature on neonatal sepsis commissioned by CAH. This review found a serious lack of data -- both in terms of quality and quantity -- on newborn infections from community-based studies in developing countries. An encouraging finding of the review was the lower level of antimicrobial resistance to commonly used antibiotics which there seems to be in the community as compared with hospitals.
Another paper presents the findings of a review on approaches for managing neonatal sepsis in the community in low-resource countries which showed that, despite limitations, these approaches hold promise for reducing mortality.
Two more papers present data on the use of oral and injectable antibiotics for treating neonatal sepsis. They explore the advantages and disadvantages of various antibiotics and discuss some potential choices for simplified treatment regimens.
The final paper shows that the management of neonatal infections in community settings should be a priority, based on the Child and Nutrition Research Initiative (CHNRI) process.
What becomes clear overall in the special supplement is that, if we are to improve rates of child survival, it is no longer possible to overlook the importance of addressing neonatal deaths from infections. There is a clear need for investment in expanded surveillance activities and in more research on diagnosis, etiology, and treatment of neonatal sepsis at all levels of the health system, and especially at the community level. High-quality data are needed to make policy decisions that can help reduce neonatal mortality. National and international donors must be convinced to invest in research and improved health service delivery at country and global levels. The papers presented in the supplement are the basis for initiating this process.